United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

J.D., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Danville, VA, Employer

__________________________________________

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Docket No. 17-2016

Issued: April 16, 2018

Appearances: Case Submitted on the Record

Alan J. Shapiro, 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 28, 2017 appellant, through counsel, filed a timely appeal from a June 22, 

2017 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 case.

 

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 left shoulder and wrist 

conditions causally related to accepted factors of her federal employment.

FACTUAL HISTORY

This case has previously been before the Board.3 The facts set forth in the Board’s prior 

decision are incorporated herein by reference. The relevant facts are set forth below.

On April 16, 2015 appellant filed an occupational disease claim (Form CA-2) alleging that 

carrying a mail satchel on her left shoulder while at work on or before October 20, 2009 and from 

October through December 2013 caused left shoulder pain and left carpal tunnel syndrome. The 

employing establishment asserted that she had stopped work on December 13, 2013 and first 

reported the claimed condition to her supervisor on April 20, 2015.4

In a July 27, 2015 development letter, OWCP notified appellant of the additional evidence 

needed to establish her claim, including a detailed statement of the work factors alleged to have 

caused or contributed to the left upper extremity condition, and a report from her attending 

physician explaining how and why those tasks would have resulted in a left shoulder condition or 

left carpal tunnel syndrome. It afforded her 30 days to submit the requested evidence. 

By decision dated August 27, 2015, OWCP denied appellant’s occupational disease claim 

as she submitted insufficient factual evidence to substantiate any causative work factors. It also 

found that she had not submitted any medical evidence. 

In a September 4, 2015 letter, appellant, through counsel, requested a telephonic hearing 

before an OWCP hearing representative, which was held on March 30, 2016. During the hearing,

appellant asserted that carrying a mail satchel on her assigned walking route from October19 to 

December 13, 2013 aggravated her accepted left upper extremity condition and caused left carpal 

tunnel syndrome. She underwent left shoulder surgery and a left carpal tunnel release on 

August 12, 2014. 

Following the hearing, appellant submitted her April 7, 2016 statement in which she 

asserted that years of carrying a mail satchel at work injured her left shoulder, left hand, and the 

 

3 Order Remanding Case, Docket No. 16-1293 (issued August 26, 2016).

4 Appellant has a prior claim, assigned OWCP File No. xxxxxx076, wherein OWCP accepted that, on or before 

October 20, 2009, appellant, then a 38-year-old city carrier, sustained a left shoulder and upper arm sprain caused by 

carrying a satchel of mail on her left shoulder at work. Following that injury, appellant was off work. She returned 

to light-duty work in August 2010, delivering a mounted route. From October to December 14, 2013, appellant was 

assigned a modified walking route, which required her to carry a mail satchel. 

On January 24, 2014 appellant filed a claim for recurrence of disability (Form CA-2a) under OWCP File No. 

xxxxxx076. By decision dated May 1, 2014, under OWCP File No. xxxxxx076, OWCP denied the recurrence claim, 

finding that she did not establish a worsening of the accepted left upper extremity condition or a change in her lightduty position such that she was no longer medically capable of performing those duties. 
3

left side of her neck. Her symptoms were exacerbated by delivering a walking route from October 

to December 13, 2013. 

The employing establishment provided February 6 and March 12, 2014 e-mails which 

confirmed that appellant delivered a park and loop route from October 19 to December 11, 2013. 

Appellant applied for disability retirement on July 20, 2015. 

Appellant submitted medical evidence from Dr. William C. Andrews, Jr., an attending 

Board-certified orthopedic surgeon. In a January 13, 2011 report, Dr. Andrews diagnosed 

degenerative cervical disc disease and left subacromial bursitis. He opined that appellant’s left 

carpal tunnel syndrome preexisted the accepted left shoulder condition and was a “distinct problem 

from the other symptoms that occurred from the work injury.” Dr. Andrews obtained x-rays which 

demonstrated left acromioclavicular (AC) joint degeneration. 

In a February 7, 2011 report, Dr. Andrews opined that a small midline C6-7 herniation or 

protrusion demonstrated by January 30, 2011 magnetic resonance imaging (MRI) scan was of 

insufficient significance to cause appellant’s left shoulder pain. He administered a series of left 

subacromial injections.5In reports from March 31 to June 10, 2011, Dr. Andrews limited 

appellant to light-duty work with lifting up to 20 pounds and frequent lifting or carrying restricted 

to 10 pounds.6 He increased her lifting limitation to 25 pounds as of December 6, 2011. 

Dr. Andrews found in January 23 and March 12, 2012 reports, that appellant was unable 

to carry a mail satchel on her left shoulder. Appellant’s symptoms worsened as of a July 5, 2012 

examination as she “fell recently and caught herself with her left arm.” Dr. Andrews administered 

a left epicondylar injection on July 13, 2012. 

In a March 11, 2013 report, Dr. Andrews opined that appellant’s left-hand symptoms 

“stemmed directly from the shoulder” as she had no other injury to the left hand and had not been 

performing significant repetitive activities. He diagnosed left shoulder-hand syndrome. 

Dr. Andrews restricted appellant to light duty through October 13, 2013 with no carrying on the 

left shoulder. 

In January 8 and 15, 2014 reports, Dr. Andrews opined that appellant had sustained left 

shoulder impingement syndrome with AC joint arthritis and arthrosis, related to the accepted left 

upper extremity condition under OWCP File No. xxxxxx076. He held her off work. 

Dr. Andrews noted in a February 14, 2014 report that appellant’s left carpal tunnel 

syndrome “can be a result of repetitive use of the wrist made worse by [appellant’s] AC joint.”

 

5 A March 1, 2011 MRI scan of the left shoulder showed low-grade tendinosis with supraspinatus insertion with 

mild peritendinobursitis and mild AC joint arthropathy with a very subtle stress reaction within the distal clavicle. 

August 15, 2012 electromyography and nerve conduction velocity studies of the left upper extremity demonstrated 

moderate median neuropathy at the wrist. 

6 Appellant participated in physical therapy from 2011 through November 2014. 
4

On August 5, 2014 he performed a left distal clavicle excision and left carpal tunnel release. 

Dr. Andrews provided progress reports through November 6, 2014.7

In a December 11, 2015 report, Dr. Andrews noted that appellant was “still significantly 

limited in terms of range of motion [ROM] and strength.” He found that she was unable to perform 

any overhead activities, with lifting to shoulder level limited to 15 pounds. Dr. Andrews held 

appellant off work through April 28, 2016 due to left shoulder pain. 

By decision dated May 9, 2016, OWCP’s hearing representative affirmed the prior decision

as modified, finding that the medical evidence of record was insufficient to establish causal 

relationship. He accepted that appellant carried a mail satchel at work from October 19 to 

December 11, 2013. The hearing representative found, however, that Dr. Andrews provided 

insufficient rationale to support that carrying a mail satchel caused or aggravated the diagnosed 

left carpal tunnel syndrome and left shoulder impingement. Appellant, through counsel, 

subsequently appealed to the Board.

By order issued August 26, 2016,8the Board set aside OWCP’s May 9, 2016 decision and 

remanded the case for OWCP to administratively combine OWCP File Nos. xxxxxxx076 and

xxxxxx789. 

On September 7, 2016 OWCP combined the two claims, with OWCP File No. xxxxxx076

serving as the master file. Appellant submitted an October 15, 2015 impairment rating by

Dr. Joshua B. Macht, an attending Board-certified internist. Dr. Macht noted appellant’s assertion 

that “the constant pressure and weight of the [mailbag] caused injury to [appellant’s] left arm and 

shoulder.” He diagnosed postoperative status of the left wrist and shoulder.9 

By decision dated September 15, 2016, OWCP denied appellant’s claim as the medical 

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

factors and a left wrist or shoulder condition. It found that Dr. Andrews did not provide sufficient 

medical rationale to support that the established work factor of carrying a mail satchel caused or 

aggravated the diagnosed left shoulder and wrist conditions. 

In a September 26, 2016 letter, received by OWCP on September 27, 2016, appellant, 

through counsel, requested a hearing before an OWCP hearing representative. During the hearing, 

 

7 From July 24, 2015 to January 28, 2016, appellant was followed by Dr. Andrea Stutesman, a Board-certified 

physiatrist, for pain management. 

8 Supra note 3.

9 By decision dated June 2, 2016 under OWCP File No. xxxxxx076, OWCP issued a schedule award for 10 percent 

permanent impairment of the left upper extremity, based on Dr. Macht’s October 15, 2015 impairment rating as 

reviewed by an OWCP medical adviser. Following a telephonic hearing, an OWCP hearing representative affirmed 

the June 2, 2016 schedule award by decision dated May 3, 2017. Appellant then appealed to the Board. By decision 

and order issued December 15, 2017 under Docket No. 17-1470, the Board set aside the June 2, 2016 schedule award 

and remanded the claim for further development on whether a ROM or diagnosis-based impairment method should 

be utilized to determine the appropriate percentage of permanent impairment. 
5

held on April 26, 2017, appellant reiterated that carrying a mail satchel at work in late 2013 

exacerbated her left shoulder condition and caused the development of shoulder-hand syndrome. 

By decision dated June 22, 2017, OWCP’s hearing representative affirmed the 

September 15, 2016 decision. The hearing representative found that the medical evidence of 

record was insufficient to establish that carrying a mail satchel on her left shoulder and arm 

worsened appellant’s accepted left shoulder condition or caused new left upper extremity 

conditions to develop.

LEGAL PRECEDENT

An employee seeking benefits under FECA10 has the burden of proof to establish the 

essential elements of his or her claim, including the fact that the individual is an employee of the 

United States within the meaning of FECA, that the claim was filed within the applicable time 

limitation, that an injury was sustained while in the performance of duty as alleged, and that any 

disability or specific condition for which compensation is claimed is causally related to the 

employment injury.11 These are the essential elements of each and every compensation claim 

regardless of whether the claim is predicated on a traumatic injury or an occupational disease.12

An occupational disease is defined as a condition produced by the work environment over 

a period longer than a single workday or shift.13 To establish that an injury was sustained in the 

performance of duty in an occupational disease claim, a claimant must submit the following: 

(1) medical evidence establishing the presence or existence of the disease or condition for which 

compensation is claimed; (2) 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 employment factors identified by the claimant were the proximate 

cause of the condition for which compensation is claimed or, stated differently, medical evidence 

establishing that the diagnosed condition is causally related to the employment factors identified 

by the claimant. 

The medical evidence required to establish causal relationship is generally rationalized 

medical opinion evidence. Rationalized medical opinion evidence is medical evidence which 

includes a physician’s rationalized opinion on the issue of whether there is causal relationship 

between the claimant’s diagnosed condition and the implicated employment factors. The opinion 

of the physician must be based on a complete factual and medical background of the claimant, 

must be one of reasonable medical certainty and must be supported by medical rationale explaining 

 

10 Supra note 2.

11 Joe D. Cameron, 41 ECAB 153 (1989).

12 See Irene St. John, 50 ECAB 521 (1999); Michael E. Smith, 50 ECAB 313 (1999).

13 20 C.F.R. § 10.5(q).
6

the nature of the relationship between the diagnosed condition and the specific employment factors 

identified by the claimant.14

ANALYSIS

The Board finds that appellant has not met her burden of proof to establish left shoulder

and wrist conditions causally related to factors of her federal employment.

In support of her occupational disease claim, appellant submitted reports from

Dr. Andrews, an attending Board-certified orthopedic surgeon. Dr. Andrews offered several 

explanations of the etiology of her left carpal tunnel syndrome and left shoulder impingement. On 

January 13, 2011 he opined that appellant’s left carpal tunnel syndrome preexisted her left shoulder 

condition and was distinct from the other sequelae of the accepted left shoulder injury. In a July 5, 

2012 report, Dr. Andrews noted that a recent fall had worsened her left shoulder and wrist 

symptoms. Yet, in a March 11, 2013 report, he opined that because appellant sustained no other 

left hand injury, her carpal tunnel syndrome “stemmed directly from the shoulder.” Additionally,

Dr. Andrews opined on February 14, 2014 that her left carpal tunnel syndrome “can be a result of 

repetitive use of the wrist” and exacerbated by AC joint involvement. He thus offered several 

conflicting etiologies of appellant’s left carpal tunnel syndrome and left shoulder condition. The 

equivocal nature of this opinion diminishes its probative quality.15 Dr. Andrews’ reports are 

therefore insufficient to meet appellant’s burden of proof to establish causal relationship between 

the accepted work factor of carrying a mail satchel and the onset of the claimed left shoulder and 

wrist conditions.

Dr. Macht, an attending Board-certified internist, repeated appellant’s assertion that the 

physical stresses of carrying a mail satchel on her left shoulder caused AC joint damage and left 

carpal tunnel syndrome. However, he did not provide his independent medical opinion to support 

this contention. Dr. Macht’s opinion is thus insufficient to meet appellant’s burden of proof.16

The Board notes that OWCP advised appellant, by a July 27, 2015 development letter, of 

the type of evidence needed to establish her claim, including a physician’s well-reasoned 

explanation of how the identified work factors would have caused or aggravated the claimed 

conditions. However, appellant has not submitted such evidence. Therefore, she has failed to 

meet her burden of proof to establish that she sustained left shoulder and wrist conditions causally 

related to factors of her federal employment. 

On appeal, counsel contends that the June 22, 2017 decision is contrary to fact and law. 

As set forth above, the medical evidence of record is insufficiently rationalized to meet appellant’s

burden of proof to establish causal relationship.

 

14 Solomon Polen, 51 ECAB 341 (2000).

15 Ricky S. Storms, 52 ECAB 349 (2001).

16 Deborah L. Beatty, 54 ECAB 340 (2003).
7

Appellant may submit new evidence or argument with 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 failed to meet her burden of proof to establish left shoulder 

and wrist conditions causally related to factors of her federal employment.

ORDER

IT IS HEREBY ORDERED THAT the decision of the Office of Workers’ Compensation 

Programs dated June 22, 2017 is affirmed.

Issued: April 16, 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