United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

M.M., Appellant

and

DEPARTMENT OF VETERANS AFFAIRS, 

VETERANS ADMINISTRATION MEDICAL 

CENTER, Augusta, ME, Employer

__________________________________________

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Docket No. 16-1851

Issued: January 19, 2018

Appearances: Case Submitted on the Record

Bradley M. Lown, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

CHRISTOPHER J. GODFREY, Chief Judge

PATRICIA H. FITZGERALD, Deputy Chief Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On September 19, 2016 appellant, through counsel, filed a timely appeal from a July 20, 

2016 merit decision of the Office of Workers’ Compensation Programs (OWCP). Pursuant to 

the Federal Employees’ Compensation Act2(FECA) and 20 C.F.R. §§ 501.2(c) and 501.3, the 

Board has jurisdiction over the merits of this claim.

 

1

In all cases in which a representative has been authorized in a matter before the Board, no claim for a fee for 

legal or other service performed on appeal before the Board is valid unless approved by the Board. 20 C.F.R. 

§ 501.9(e). No contract for a stipulated fee or on a contingent fee basis will be approved by the Board. Id. An 

attorney or representative’s collection of a fee without the Board’s approval may constitute a misdemeanor, subject 

to fine or imprisonment for up to one year or both. Id.; see also 18 U.S.C. § 292. Demands for payment of fees to a 

representative, prior to approval by the Board, may be reported to appropriate authorities for investigation.

2 5 U.S.C. § 8101 et seq.
2

ISSUE

The issue is whether appellant met her burden of proof to establish an injury or medical 

condition causally related to the accepted factors of her federal employment.

FACTUAL HISTORY

On July 12, 2013 appellant, then a 56-year-old correspondence clerk, filed an 

occupational disease claim (Form CA-2) for cervical strain/myofascial pain, multilevel severe 

spondylosis, right shoulder impingement syndrome, and right carpal tunnel syndrome. OWCP 

assigned File No. xxxxxx412. Appellant attributed her claimed conditions to uploading medical 

files to patients’ computer charts. She indicated that she first became aware of her condition on 

June 10, 2013, and first realized that it was caused or aggravated by factors of her federal

employment on June 17, 2013. Appellant stopped work on July 10, 2013.

Under OWCP File No. xxxxxx459, OWCP had previously accepted cervical spondylosis, 

right shoulder impingement syndrome, and right carpal tunnel syndrome, which arose on or 

about August 2, 2010. It also accepted a September 28, 2011 recurrence of disability.3 Effective 

July 3, 2013, OWCP terminated appellant’s wage-loss compensation and medical benefits 

because her accepted conditions had resolved. It combined her two cervical and right upper 

extremity occupational disease claims, and designated OWCP File No. xxxxxx459 as the master 

file.

In a July 24, 2013 narrative statement in support of her current claim, appellant alleged a 

recurrence of her previously accepted conditions under OWCP File No. xxxxxx459. She also 

submitted a position description for correspondence clerk, a June 11, 2013 e-mail thread 

regarding a requested ergonomic evaluation, a June 20, 2013 memorandum pertaining to 

counseling for absence without leave (AWOL), and previously submitted medical evidence that 

had been referenced in OWCP’s July 3, 2013 decision terminating benefits.4

In an August 27, 2013 letter, OWCP advised appellant of the deficiencies in her claim 

and provided her 30 days to submit additional evidence. Specifically, appellant was asked to 

submit a comprehensive narrative medical report from her attending physician with an opinion as 

to how her employment activities caused, contributed to, or aggravated any diagnosed condition. 

In a June 24, 2013 medical report, Dr. Karyn L. Woelflein, a Board-certified physiatrist, 

indicated that in the second week after appellant returned to work, she was doing computer work 

uninterrupted eight hours daily with no other tasks. By the end of the week, she had burning 

pain in the left side of her neck. When appellant returned to work the next week, the pain 

worsened and she sought treatment at the emergency room. Dr. Woelflein indicated that 

appellant stayed off work, rested, and felt better at the time of her June 24, 2013 appointment. 

 

3 OWCP paid wage-loss compensation benefits for temporary total disability and placed appellant on the periodic 

compensation rolls, effective December 18, 2011. Appellant resumed full-time work effective June 3, 2013. 

4 By decisions dated December 11, 2013 and November 25, 2014, OWCP denied modification of the July 3, 2013 

termination of FECA benefits under File No. xxxxxx459.
3

Upon examination, appellant was tender in the left upper trapezius. She diagnosed left-sided 

neck strain. In a July 3, 2013 report, Dr. Woelflein indicated that appellant’s pain was generally 

worse. She indicated that even short periods of time working on the computer aggravated 

appellant’s left-sided neck pain. In an August 5, 2013 report, Dr. Woelflein indicated that 

appellant developed severe pain and stiffness in the left side of the neck when she was placed in 

a job which was repetitive in nature at the computer, which she believed involved scanning 

documents. 

In an August 15, 2013 Family and Medical Leave Act (FMLA) Certification of Health 

Care Provider for Employee’s Serious Health Condition, Dr. Woelflein noted that appellant was 

a correspondence clerk and her essential job functions include duties related to receipt, scanning, 

uploading, indexing, and destruction of health and administrative information for the file room, 

as well as numerous applications, long periods of computer work, bending, stretching, and 

carrying bulky files. She identified typing, data entry, and computer work as job functions that 

appellant was unable to perform and should be limited to 20 to 30 minutes per hour. 

Dr. Woelflein noted that appellant was placed in a job which required strenuous repetitive usage 

of her arms to scan documents into a computer and that she developed left-sided neck pain and 

stiffness. She diagnosed cervical muscle strain, left side and a tender and taunt left upper 

trapezius muscle. Dr. Woelflein noted that appellant had a preexisting neck problem and opined 

a significant aggravation occurred when she returned to work. She indicated that appellant 

recovered nicely with rest, gentle exercise, and medications and that she was ready to return to 

work with appropriate accommodations. 

In a September 4, 2013 progress note, Dr. Stephen D. Katz, an orthopedic surgeon, 

indicated that appellant was doing well with regard to pain in her right shoulder, until a few days 

ago, when she tried to push herself up out of a bathtub and had pain in her arm. He indicated 

that no other injury brought this on. Dr. Katz noted that appellant was off work because of neck 

issues. He opined, as far as the shoulder was concerned, she could return to work with no work 

over chest level with the right arm. 

In a September 19, 2013 visit summary, Dr. Elizabeth Rudenberg, an osteopath and 

family practitioner, diagnosed nonallopathic lesions of cervical region, a chronic problem which 

appeared to progress; degeneration of intervertebral disc, cervical spine; osteoarthrosis involving 

multiple sites; and nonallopathic lesions, thoracic region and upper extremities. She noted that 

appellant “returned to work in a production based job in June 17.” New x-rays showed 

multilevel spondylosis with foraminal stenosis. Appellant had a “short time off then went off 

work June 28.”

By decision dated October 11, 2013, OWCP denied appellant’s claim, finding that the 

medical evidence of record did not establish causal relationship between the claimed work 

factors and the conditions for which she was treated. Specifically, it found that the medical 

evidence did not contain sufficient rationale explaining how the repetitive uploading and 

indexing appellant performed for several days after returning to work on June 3, 2013 caused a 

neck sprain and significant aggravation to her preexisting neck problem. 

On October 28, 2013 OWCP received an undated form from appellant requesting

reconsideration and an October 23, 2013 letter from counsel. 
4

In a November 11, 2013 report, Dr. Woelflein opined that appellant’s work aggravated 

her preexisting work-related condition. She indicated that appellant has preexisting conditions 

that OWCP accepted and for which she was off work for approximately two years. 

Dr. Woelflein noted that she provided appellant restrictions which she felt would allow her to 

return successfully to work, but appellant was given a job not within those restrictions. 

According to the job description, the work entailed looking left at a hard copy, right at the 

screen, doing typing and mouse work, and then repeating. Dr. Woelflein indicated that appellant 

should not be doing repetitive typing as she needed to look at the keyboard, which required 

stretching of the neck and the flexed forward position aggravated her symptoms. Doing this full

time led to increased pain and tenderness which was documented on physical examination. 

By decision dated January 24, 2014, OWCP denied appellant’s request for 

reconsideration. It found she did not “identify the grounds upon which reconsideration is being 

requested” and she did not provide new evidence or legal argument not previously considered.

On February 5 and December 15, 2014 OWCP received a January 30, 2014 letter from 

counsel requesting reconsideration. Included was a copy of a December 13, 2014, and 

December 10 and October 23, 2013 letters from counsel. In support of the reconsideration 

request appellant also included copies of e-mail correspondence to A.L., an employing 

establishment employee/labor relations specialist, concerning work restrictions.

In a November 11, 2013 letter, Dr. Woelflein responded to several questions posed by 

counsel. She indicated that appellant has right shoulder tendinitis (impingement), cervical 

spondylosis (aggravated by cervical strain), and mild right carpal tunnel syndrome. 

Dr. Woelflein opined that those conditions were caused by repetitive work as a medical clerk and 

advised that appellant could not work at that particular job or any other clerical job. She 

indicated that appellant was at maximum medical improvement and further medical treatment 

was based on symptomatic management. 

By decision dated February 12, 2016, OWCP denied modification of its October 11, 2013 

decision. It found that Dr. Woelflein failed to offer a well-rationalized opinion discussing how 

appellant’s preexisting conditions progressed beyond what might be expected from the natural 

progression of such conditions and how the new injury of June 10, 2013 aggravated her 

preexisting conditions. OWCP additionally noted that all of counsel’s letters were scanned under 

OWCP File No. xxxxxx459 as he had identified the date of injury as August 2, 2010. 

On July 5, 2016 appellant requested reconsideration.

In a June 16, 2016 report, Dr. Katz noted that appellant was originally seen in 

January 2012 after being followed by Dr. Woelflein for persistent shoulder and neck pain. He 

noted that x-rays at that time revealed mild AC joint arthritis, a type 2 acromion, but no 

glenohumeral arthritis. A magnetic resonance imaging scan did not show any evidence of a 

rotator cuff tear. Dr. Katz diagnosed impingement syndrome with some neck pain, which he 

opined may be related to some of her shoulder issues. He noted that appellant returned in 

April 2013 with pain radiating down her arm. Dr. Katz noted that she had been held out of work 

for neck issues, but the shoulder continued to have intermittent problems. He indicated that 

appellant’s last cortisone injection was in February 2016 and she had been doing fairly well since 
5

then. Dr. Katz opined that appellant’s repetitive work could be the cause of some of her shoulder 

issues, but within the limits given to her, she should have been fine. He noted that repetitive 

overhead reaching and gripping/grasping could cause irritation of the shoulder. 

In a June 27, 2016 report, Dr. Rudenberg reported that appellant had been under the care 

of the Richmond Area Health Center prior to 2007. She indicated that appellant had 

osteoarthritis, which normally progresses slowly with age unless additional external factors 

exacerbate the progression. Dr. Rudenberg reported that appellant experienced injuries in the 

workplace which would not normally occur without the impact of ergonomically challenging 

conditions. She reported that in 2013 appellant was reassigned to a position where she was 

required to perform clerical duties of typing, using a mouse, and uploading files. This required 

repetitive movements of flexing and extending her neck as well as movements at the wrist while 

typing and manipulating a mouse, which have been documented to contribute to carpal tunnel 

syndrome when ergonomics are not ideal. Dr. Rudenberg noted that overuse tendionopathy can 

be related to poor environmental conditions such as inadequate equipment, poor ergonomics, and 

substantial increases in training load without adequate time for the body to adjust. She opined 

that tendinopathy was a common result of repetitive movement and that this was a substantial 

basis for appellant’s medical complaints. Dr. Rudenberg indicated that less than a week after 

beginning a new position, appellant suffered an acute episode of torticollis which resulted in an 

emergency room visit. She opined that in appellant’s case, she performed work in both jobs 

which involved repetitive motions from a static position. In 2013, less than a week after starting 

the new position, appellant suffered an acute episode of torticollis. Dr. Rudenberg opined that 

appellant had shown good cause for her work assignments contributing to her disability on 

multiple occasions.

By decision dated July 20, 2016, OWCP denied modification of its prior decision. It 

found that the medical evidence of record did not provide a well-rationalized opinion relating her 

diagnosed condition to the accepted factors of her federal employment based on a complete and 

accurate history of her reported work factors.

LEGAL PRECEDENT

A claimant seeking benefits under FECA5 has the burden of proof to establish the 

essential elements of his or her claim by the weight of the reliable, probative, and substantial 

evidence, including that an injury was sustained in the performance of duty as alleged and that 

any specific condition or disability claimed is causally related to the employment injury.6

 

5 Supra note 2.

6 20 C.F.R. § 10.115(e), (f); see Jacquelyn L. Oliver, 48 ECAB 232, 235-36 (1996). Causal relationship is a 

medical question, which generally requires rationalized medical opinion evidence to resolve the issue. See 

Robert G. Morris, 48 ECAB 238 (1996). A physician’s opinion on whether there is a causal relationship between 

the diagnosed condition and the implicated employment factors must be based on a complete factual and medical 

background. Victor J. Woodhams, 41 ECAB 345, 352 (1989). Additionally, the physician’s opinion must be 

expressed in terms of a reasonable degree of medical certainty, and must be supported by medical rationale, 

explaining the nature of the relationship between the diagnosed condition and appellant’s specific employment 

factors. Id.
6

To establish that an injury was sustained in the performance of duty in an occupational 

disease claim, a claimant must submit: (1) medical evidence establishing the presence or 

existence of the disease or condition for which compensation is claimed; (2) a factual statement 

identifying employment factors alleged to have caused or contributed to the presence or 

occurrence of the disease or condition; and (3) medical evidence establishing that the diagnosed 

condition is causally related to the identified employment factors.7

The fact that a condition manifests itself during a period of employment is insufficient to 

establish causal relationship.8 Temporal relationship alone will not suffice.9 Entitlement to 

FECA benefits may not be based on surmise, conjecture, speculation, or on the employee’s own 

belief of causal relationship.10

In any case where a preexisting condition involving the same part of the body is present,

and the issue of causal relationship therefore involves aggravation, acceleration, or precipitation, 

the physician must provide a rationalized medical opinion that differentiates between the effects 

of the work-related injury or disease and the preexisting condition.11

ANALYSIS

Appellant alleged that she aggravated her preexisting conditions of cervical 

strain/myofascial pain, multilevel severe spondylosis, right shoulder impingement syndrome, and 

carpal tunnel syndrome as a result of repeatedly uploading medical files to patients’ computer 

charts in her new position as a correspondence clerk. The evidence supports that appellant 

engaged in clerical-type duties which involved repetitive typing, mouse moving, and uploading 

medical files to patients’ computer charts, but she submitted insufficient medical evidence to 

establish that her conditions were caused or aggravated by these work duties.

Appellant has a prior claim under File OWCP No. xxxxxx459 for the same conditions in

the present claim. Her wage-loss compensation and medical benefits were terminated on July 3, 

2013 for her accepted conditions. Appellant started her new assignment in the correspondence 

clerk position under the current claim on or about June 3, 2013. 

On appeal and before OWCP, counsel and appellant have argued that the current claim 

should be adjudicated as a recurrence of disability, rather than as a new occupational disease 

claim.12 Appellant, however, attributed her condition to her work duties as a correspondence 

 

7 Victor J. Woodhams, id.

8 20 C.F.R. § 10.115(e).

9 See D.I., 59 ECAB 158, 162 (2007).

10 See M.H., Docket No. 16-0228 (issued June 8, 2016).

11 Federal (FECA) Procedure Manual, Part 2 -- Claims, Causal Relationship, Chapter 2.805.3e (January 2013).

12 A recurrence of disability means an inability to work after an employee has returned to work, caused by a 

spontaneous change in a medical condition which had resulted from a previous injury or illness without an 

intervening injury or new exposure to the work environment that caused the illness. 20 C.F.R. § 10.5(x).
7

clerk beginning June 3, 2013. She also submitted medical evidence which listed and related 

appellant’s medical conditions to her work duties as a correspondence clerk. Accordingly, the 

Board finds that OWCP properly adjudicated her claim as a new occupational disease claim.13

In support of her claim, appellant submitted a series of reports from Dr. Woelflein, who 

opined that appellant developed left-sided neck pain and weakness as a result of her job which 

she noted required strenuous repetitive usage of her arms to scan documents into a computer. 

Dr. Woelflein indicated that a significant aggravation of appellant’s preexisting cervical 

spondylosis occurred when she returned to work. In her reports, Dr. Woelflein noted the injury 

occurred in the second week after appellant returned to work when she did computer work eight 

hours a day with no other tasks. By the end of the week, appellant had burning pain in the left 

side of her neck. The neck pain worsened the following week and prompted a visit to the 

emergency room. Dr. Woelflein noted tenderness in the left upper trapezius on examination and 

diagnosed left-sided neck strain. 

In a July 3, 2013 report, Dr. Woelflein indicated that even short periods of time on the 

computer would aggravate appellant’s left-sided neck pain. In an FMLA form, she noted the 

essential job functions of appellant’s position and opined that typing, data entry, and computer 

work were job functions that appellant should be limited to performing 20 to 30 minutes each 

hour. Dr. Woelflein indicated that appellant’s job required strenuous repetitive usage of her arms 

to scan documents into a computer and she developed left-sided neck pain and stiffness. She 

indicated that appellant had a preexisting neck problem which was significantly aggravated when 

she returned to work. 

In her November 11, 2013 report, Dr. Woelflein indicated that appellant was out of work 

for approximately two years for conditions accepted by OWCP. She explained that when 

appellant returned to work, she was given a job not within her restrictions. Dr. Woelflein noted 

that the work entailed looking left at a hard copy, right at the screen, typing and mouse work then 

repeating. She indicated that appellant’s employment duties caused stretching of her neck, and 

the flexed forward position aggravated her symptoms causing increased pain and tenderness. On 

physical examination Dr. Woelflein noted that these employment duties had aggravated her 

preexisting work-related condition. 

However, Dr. Woelflein failed to provide a well-rationalized medical opinion which 

explained how the work factors caused or aggravated the diagnosed conditions. Other than 

noting appellant’s work duties required stretching her neck and being in a flexed forward 

position, Dr. Woelflein does not explain the mechanism by which repetitive typing, moving a

mouse, and uploading medical files to patients’ computer charts would cause or aggravate the 

diagnosed condition. A well-rationalized opinion is particularly warranted when there is a 

history of a preexisting condition.14 However, Dr. Woelflein failed to address why appellant’s 

complaints were not caused by her preexisting conditions.15 She did not provide adequate 

 

13 A.P., Docket No. 11-1802 (issued April 10, 2012).

14 T.M., Docket No. 08-975 (issued February 6, 2009); Michael S. Mina, 57 ECAB 379 (2006).

15 R.E., Docket No. 14-868 (issued September 24, 2014). 
8

bridging evidence to show a spontaneous worsening of the accepted conditions. Rather,

Dr. Woelflein generally opined that appellant’s conditions were caused by her return to work in a 

position which was outside her work restrictions.16 Medical conclusions unsupported by 

rationale are of little probative value.17 Though she generally supported that appellant’s 

conditions were caused by her return to work, Dr. Woelflein’s opinion on causal relationship was 

conclusory without any additional explanation as to how the conditions caused disability or 

became symptomatic. Thus, the reports of Dr. Woelflein are insufficient to meet appellant’s 

burden of proof. 

The remaining reports from Dr. Woelflein, such as her November 11, 2013 letter, are also 

insufficient to establish appellant’s claim. In this letter, she indicated that appellant has right 

shoulder tendinitis (impingement), cervical spondylosis (aggravated by cervical strain), and mild 

right carpal tunnel syndrome, which she opined were caused by repetitive work as a medical 

clerk. However, it is unclear whether Dr. Woelflein was referring to appellant’s original injury 

in OWCP File No. xxxxxx459 or the current claim. Further, she failed to explain how the 

employment activities caused, contributed to, or aggravated any diagnosed condition. This letter 

is insufficiently rationalized and is of limited probative value with regard to causal relationship. 

Other medical evidence from Dr. Woelflein does not offer an opinion on causal relationship. 

Therefore these reports are of limited probative value.18

In a September 19, 2013 visit summary, Dr. Rudenberg noted that appellant returned to 

work in a “production based job in June 17.” She noted that new x-rays showed multilevel 

spondylosis with foraminal stenosis and diagnosed several conditions, some of which she noted 

were a chronic problem which appeared to progress. However, as Dr. Rudenberg does not offer 

an opinion on causal relationship, this report is of limited probative value.19

In her June 27, 2016 report, Dr. Rudenberg indicated that appellant performed work 

involving repetitive motions from a static position and, in less than a week after beginning the 

new position, she suffered an acute episode of torticollis which resulted in emergency room 

treatment. She opined that this showed good cause for appellant’s work assignments 

contributing to her disabling condition. Dr. Rudenberg discussed the additional external factors 

which had exacerbated the progression of the diagnosed osteoarthritis. She also discussed that 

poor environmental and ergonomic conditions, along with repetitive movements can cause carpal 

tunnel syndrome and overuse tendinopathy. Dr. Rudenberg concluded that this was a substantial 

basis for appellant’s medical complaints. However, she failed to identify the specific external 

factors that caused appellant’s exacerbation and progression of her diagnosed osteoarthritis, nor 

did she discuss the mechanics of how those external factors would have exacerbated her 

condition. Dr. Rudenberg has not explained the extent to which the normal progress of this 

degenerative condition has been altered as a result of those factors. A well-rationalized opinion 

 

16 J.H., Docket No. 14-775 (issued July 14, 2014).

17 Willa M. Frazier, 55 ECAB 379 (2004); Jimmy H. Duckett, 52 ECAB 332 (2001). 

18 Linda I. Sprague, 48 ECAB 386 (1997) (medical evidence that does not offer any opinion regarding the cause 

of an employee’s condition is of diminished probative value on the issue of causal relationship).

19 Id. 
9

is particularly warranted when there is a history of a preexisting condition.20 Dr. Rudenberg also 

discussed that poor environmental and ergonomic conditions and repetitive movements can 

cause carpal tunnel syndrome and overuse tendionopathy and opined that this was a substantial 

basis for appellant’s medical complaints. However, she failed to demonstrate how the 

ergonomics of appellant’s situation was not ideal and failed to provide any objective evidence to 

support that appellant’s preexisting carpal tunnel condition had been altered as a result of those 

factors. Dr. Rudenberg also has not provided any medical explanation as to how the flexing and 

extending of the neck would have resulted in an injury to appellant’s forearm and wrist. There is 

no indication that she had any knowledge of appellant’s work duties or the length of time 

performed. No medical rationale has been provided to support her conclusion that repetitive 

motions appear to be a substantial basis for appellant’s medical complaints of tendinopathy. 

Dr. Rudenberg also reasoned that, because appellant suffered an acute episode of 

torticollis less than a week after starting a new position, there was good cause to opined that her 

work duties contributed to appellant’s condition. However, neither the fact that the condition 

became apparent during a period of employment nor the belief that the condition was caused or 

aggravated by employment factors or incidents is sufficient to establish causal relationship.21 

Causal relationship must be substantiated by reasoned medical opinion evidence, which is 

appellant’s responsibility to submit. For the above reasons, the Board finds that Dr. Rudenberg’s 

reports are insufficiently rationalized and is of limited probative value with regard to causal 

relationship. 

In a June 16, 2016 report, Dr. Katz noted that appellant was diagnosed with AC joint 

arthritis and impingement syndrome in 2012. He indicated that appellant returned to him in 

April 2013 with complaint of pain radiating down her arm. Dr. Katz opined that appellant’s 

repetitive work could be the cause of some of her shoulder issues and indicated that repetitive 

overhead reaching and gripping/grasping could cause irritation of the shoulder. His opinion 

lacks a clear diagnosis related to appellant’s claimed 2013 injury. Furthermore, Dr. Katz’s

opinion is speculative in nature as he expresses no knowledge of the amount of time appellant 

spent performing the repetitive activities listed and provides no explanation as to the mechanics 

of how those work duties would have resulted in an injury or irritation to appellant’s shoulder.22 

Thus, this report is insufficient to meet appellant’s burden of proof.

The remaining medical evidence of record is also insufficient to establish appellant’s 

claim. Dr. Katz’s September 4, 2013 progress note has no bearing on appellant’s claim as the 

physician discussed a history of appellant experiencing pain in her right shoulder a few days ago, 

when she tried to push herself up out of a bathtub. He indicated that no other injury brought this 

on and found that she could return to work with no work over chest level with the right arm. 

 

20 See supra note 14.

21 See Joe T. Williams, 44 ECAB 518, 521 (1993).

22 Frank Luis Rembisz, 52 ECAB 147 (2000) (medical opinions based on an incomplete history or which are 

speculative or equivocal in character have little probative value).
10

The diagnostic reports of record are also insufficient to establish appellant’s claim as the 

physicians interpreted diagnostic imaging studies and provided no opinion on the cause of 

appellant’s injury.23

As the medical evidence of record does not contain rationale explaining how appellant’s 

employment duties caused or aggravated a medical condition involving her neck or shoulder, 

appellant has not met her burden of proof to establish a medical condition causally related to 

factors of her federal employment. As noted, causal relationship is a medical question that must 

be established by probative medical opinion from a physician.24 The physician must accurately 

describe appellant’s work duties and medically explain the pathophysiological process by which 

these duties would have caused or aggravated her condition.25 The need for medical reasoning or 

rationale is particularly important given the fact that medical evidence of record indicates that 

appellant had preexisting conditions.26

On appeal counsel argues that OWCP should accept the claim given the absence of any 

contradictory medical evidence. For the reasons discussed above, the medical reports are 

insufficient to meet appellant’s burden of proof as they are not sufficiently rationalized. 

Appellant may submit new evidence or argument as part of a written request for 

reconsideration to OWCP within one year of this merit decision, pursuant to 5 U.S.C. § 8128(a) 

and 20 C.F.R. §§ 10.605 through 10.607.

CONCLUSION

The Board finds that appellant has not met her burden of proof to establish an injury or 

medical condition causally related to the accepted factors of her federal employment.

 

23 J.P., Docket No. 14-87 (issued March 14, 2014). 

24 I.J., 59 ECAB 408 (2008); Victor J. Woodhams, supra note 6.

25 Solomon Polen, 51 ECAB 341 (2000) (rationalized medical evidence must relate specific employment factors 

identified by the claimant to the claimant’s condition, with stated reasons by a physician). See also S.T., Docket No. 

11-237 (issued September 9, 2011).

26 T.M., supra note 14.
11

ORDER

IT IS HEREBY ORDERED THAT the July 20, 2016 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: January 19, 2018

Washington, DC

Christopher J. Godfrey, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board