United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

M.G., Appellant

and

U.S. POSTAL SERVICE, INTERNATIONAL 

SERVICE CENTER, Chicago, IL, Employer

__________________________________________

)

)

)

)

)

)

)

)

Docket No. 19-1199

Issued: December 19, 2019

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

PATRICIA H. FITZGERALD, Deputy Chief Judge

JANICE B. ASKIN, Judge

ALEC J. KOROMILAS, Alternate Judge

JURISDICTION

On May 9, 2019 appellant filed a timely appeal from a February 15, 2019 merit decision 

of the Office of Workers’ Compensation Programs (OWCP). Pursuant to the Federal Employees’

Compensation Act1(FECA) and 20 C.F.R. §§ 501.2(c) and 501.3, the Board has jurisdiction over 

the merits of this case.2

ISSUE

The issue is whether appellant has met his burden of proof to establish upper extremity 

conditions causally related to the accepted August 2, 2018 employment incident.

 

1 5 U.S.C. § 8101 et seq.

2 The Board notes that following the February 15, 2019 decision, OWCP received additional evidence. However, 

the Board’s Rules of Procedure provides: “The Board’s review of a case is limited to the evidence in the case record 

that was before OWCP at the time of its final decision. Evidence not before OWCP will not be considered by the 

Board for the first time on appeal.” 20 C.F.R. § 501.2(c)(1). Thus, the Board is precluded from reviewing this 

additional evidence for the first time on appeal. Id.
2

FACTUAL HISTORY

On August 3, 2018 appellant, then a 41-year-old mail processing clerk, filed a traumatic 

injury claim (Form CA-1) alleging that on August 2, 2018, he sustained an injury to his lower arms 

and symptoms of tingling when using an automated parcel and bundle sorter (APBS) machine

while in the performance of duty. On the reverse side of the claim form, a supervisor checked a 

box marked “yes” indicating that her knowledge of the facts about the claimed injury did not agree 

with statements of appellant or witnesses. She explained that appellant “was upset” and decided 

to file a claim. Appellant stopped work on August 3, 2018.

In a development letter dated August 20, 2018, OWCP informed appellant that he had not 

submitted sufficient factual or medical evidence to establish his claim. It advised him of the type 

of evidence needed and provided a questionnaire for his completion. OWCP afforded appellant 

30 days to respond.

On August 16, 2018 Dr. Gary A. Kronen, a Board-certified hand surgeon, examined 

appellant for complaints of neck, left elbow, and wrist pain. He noted that appellant had reported 

an injury approximately three weeks prior to the left upper extremity. Dr. Kronen reviewed x-rays 

of the left hand and wrist, which revealed no evidence of bone pathology, and a magnetic resonance 

imaging (MRI) scan of the cervical spine, which demonstrated significant disc bulging. On 

examination of the bilateral upper extremities, he noted tenderness at the biceps insertion and 

tenderness overlying the first dorsal compartment with a positive Finkelstein’s test. Dr. Kronen

diagnosed cervical disc disease, a left biceps tear, and left de Quervain’s tendinitis. He

administered a corticosteroid injection to the wrist and provided appellant a splint.

In a report dated August 20, 2018, Dr. Gurpal Pannu, who specializes in orthopedic 

surgery, noted that appellant presented with an approximate three-month history of discomfort in 

the bilateral upper extremities, worse in the left arm. Appellant stated that he worked as a clerk, 

which involved lifting his left arm to grab objects throughout the day, aggravating symptoms of 

his left upper extremity. An MRI scan demonstrated diffuse disc desiccation from C2 to C7 with 

mild bulging, and patent central canal and neural foramina at all levels with the exception of C5-

6, which had mild neural foraminal narrowing on the right and left secondary to hypertrophy and 

disc bulging. On examination of the bilateral upper extremities, Dr. Pannu noted full motor 

strength, intact sensation to light touch, a negative Hoffmann’s test, and 2+ brachioradialis and 

biceps reflexes. He recommended that appellant stay off work until further notice and undergo 

physical therapy treatment.

In a note dated August 20, 2018, Dr. Anton J. Fakhouri, a Board-certified orthopedic 

surgeon, prescribed physical therapy for a diagnosis of cervical radiculopathy.

In a medical excuse note dated August 16, 2018, Dr. Kronen stated that appellant was 

unable to work at that time due to pain management.

In an August 2, 2018 statement, appellant indicated that he was told that day by a supervisor 

to work on an APBS machine. He responded that he had used the machine the previous day, and 

stated that he would work in another area. The supervisor told him that he had to work on the 

APBS machine. Appellant proceeded to use the machine and scanned pieces of mail until his arms 
3

began to feel tight, after which he stopped immediately. He stated that he felt his arms had been 

overworked the past year from constantly keying mail.

In an undated attending physician’s report received on September 20, 2018, Dr. Pannu 

diagnosed cervical radiculopathy. He checked a box marked “yes” indicating that he believed 

appellant’s condition was caused or aggravated by employment activity, explaining that appellant 

was unable to carry, push, or pull. Dr. Pannu noted that appellant was not advised to return to 

work.

By decision dated October 1, 2018, OWCP denied appellant’s claim, finding that he had 

not submitted sufficient evidence to meet his burden of proof to establish causal relationship 

between his diagnosed conditions and the accepted August 2, 2018 employment incident.

In a report dated September 14, 2018, Dr. Pannu noted that appellant attributed his left 

upper extremity conditions to reaching many times with his left arm to grab objects at work, which 

caused irritation. On examination, he observed full strength of the bilateral upper extremities, 

intact sensation to light touch, and no upper motor neuron signs. Dr. Pannu recommended that 

appellant complete physical therapy and return in six to eight weeks. In an accompanying work 

status update of the same date, he recommended that appellant return to modified duty on 

September 24, 2018 with restrictions of no overhead work, use of tools/equipment, or use of 

vibrating tool, and occasional lifting, carrying, pulling, and pushing of 5 to 10 pounds. Dr. Pannu

also recommended that appellant be allowed 15-minute breaks every 3 hours. 

Appellant submitted notes signed by physical therapists dated August 31 through 

October 12, 2018. 

On November 9, 2018 appellant requested reconsideration. 

OWCP received progress notes dated August 2 through 10, 2018, containing illegible 

signatures and partially illegible content, detailing appellant’s continued treatment for a left arm 

condition.

By decision dated February 15, 2019, OWCP denied modification of the prior decision. 

LEGAL PRECEDENT

An employee seeking benefits under FECA 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 timely filed within the applicable 

time limitation of FECA, that an injury was sustained in the performance of duty as alleged, and 

that any disability or medical condition for which compensation is claimed is causally related to 
4

the employment injury.3 These are the essential elements of each and every compensation claim, 

regardless of whether the claim is predicated upon a traumatic injury or an occupational disease.4

To determine if an employee sustained a traumatic injury in the performance of duty, 

OWCP begins with an analysis of whether fact of injury has been established. Fact of injury 

consists of two components that must be considered in conjunction with one another. The first 

component is whether the employee actually experienced the employment incident that allegedly 

occurred.5 The second component is whether the employment incident caused a personal injury.6

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue. A physician’s opinion on whether there is causal relationship 

between the diagnosed condition and the implicated employment incident must be based on a 

complete factual and medical background. Additionally, the physician’s opinion must be 

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

rationale that explains the nature of the relationship between the diagnosed condition and 

appellant’s employment incident.7

ANALYSIS

The Board finds that appellant has not met his burden of proof to establish upper extremity 

conditions causally related to the accepted August 2, 2018 employment incident.

In an undated attending physician’s report received on September 20, 2018, Dr. Pannu 

diagnosed cervical radiculopathy and checked a box marked “yes” indicating that he believed 

appellant’s conditions were caused or aggravated by employment activity, explaining that 

appellant was unable to carry, push, or pull. The Board has held that a report that addresses causal 

relationship with a checkmark, without medical rationale explaining how the employment incident 

caused or aggravated the diagnosed condition, is of diminished probative value and insufficient to 

establish causal relationship.8 Dr. Pannu did not provide rationale for his opinion, but rather listed 

physical restrictions related to appellant’s diagnosed condition. As such, the attending physician’s 

report of Dr. Pannu is insufficient to satisfy appellant’s burden of proof with respect to causal 

relationship.

On August 16, 2018 Dr. Kronen noted that appellant reported an injury approximately 

three weeks prior to the left upper extremity. He examined appellant, and diagnosed cervical disc 

 

3

J.M., Docket No. 17-0284 (issued February 7, 2018); R.C., 59 ECAB 427 (2008); James E. Chadden, Sr., 40 

ECAB 312 (1988).

4 K.M., Docket No. 15-1660 (issued September 16, 2016); L.M., Docket No. 13-1402 (issued February 7, 2014); 

Delores C. Ellyett, 41 ECAB 992 (1990).

5 Elaine Pendleton, 40 ECAB 1143 (1989).

6 M.H., Docket No. 18-1737 (issued March 13, 2019); John J. Carlone, 41 ECAB 354 (1989).

7 S.S., Docket No. 18-1488 (issued March 11, 2019).

8 See S.G., Docket No. 18-0209 (issued October 4, 2018); R.A., Docket No. 17-1472 (issued December 6, 2017); 

Sedi L. Graham, 57 ECAB 494 (2006); Deborah L. Beatty, 54 ECAB 340 (2003).
5

disease, a left biceps tear, and left de Quervain’s tendinitis. On August 20, 2018 Dr. Pannu noted 

that appellant presented with an approximate three-month history of discomfort in the bilateral 

upper extremities, worse in the left arm, and that he worked as a clerk, which involved lifting his 

left arm to grab objects throughout the day, aggravating symptoms of his left upper extremity 

condition. In a report dated September 14, 2018, he noted that appellant attributed his left upper 

extremity conditions to reaching many times with his left arm to grab objects at work, which 

caused irritation. The Board has held that medical evidence that does not offer an opinion 

regarding the cause of an employee’s condition is of no probative value on the issue of causal 

relationship.9 Drs. Kronen and Pannu did not provide an opinion on causal relationship, but rather 

repeated the history of injury as related to them by appellant. Such generalized statements do not 

establish causal relationship because they merely repeat appellant’s allegations and are 

unsupported by adequate medical rationale explaining how the incident of August 2, 2018 actually 

caused the diagnosed conditions.10

In a medical excuse note dated August 16, 2018, Dr. Kronen stated that appellant was 

unable to work at that time. In a note dated August 20, 2018, Dr. Fakhouri prescribed physical 

therapy treatment for a diagnosis of cervical radiculopathy. In a work status update of 

September 14, 2018, Dr. Pannu recommended that appellant return to modified-duty work on 

September 24, 2018 with restrictions. As noted above, medical evidence that does not offer an 

opinion regarding the cause of an employee’s condition is of no probative value on the issue of 

causal relationship.

11

 These documents, which do not contain opinions on causal relationship 

between appellant’s upper extremity conditions and the incident of August 2, 2018, are therefore 

insufficient to establish appellant’s claim.

OWCP received progress notes dated August 2 through 10, 2018 with illegible signatures. 

Reports that are unsigned or that bear illegible signatures cannot be considered as probative 

medical evidence because they lack proper identification.12 

OWCP also received notes signed by physical therapists dated from August 31 through 

October 12, 2018. The Board has held that medical reports signed solely by a physical therapist 

are of no probative value, as a physical therapist is not considered a physician as defined under 

FECA, and therefore, is not competent to provide a medical opinion.13 Consequently, the notes

signed by physical therapists are of no probative value in establishing appellant’s claim.

 

9 See L.B., Docket No. 18-0533 (issued August 27, 2018); D.K., Docket No. 17-1549 (issued July 6, 2018).

10 See J.B., Docket No. 18-1006 (issued May 3, 2019); K.W., 59 ECAB 271, 279 (2007).

11 Supra note 9.

12 T.C., Docket No. 18-1351 (issued May 9, 2019); Thomas L. Agee, 56 ECAB 465 (2005); Richard F. Williams, 

55 ECAB 343 (2004).

13 L.T., Docket No. 19-0145 (issued June 3, 2019); T.H., Docket No. 18-1736 (issued March 13, 2019); see David P. 

Sawchuk, 57 ECAB 316, 320 n.11 (2006) (lay individuals such as physician assistants, nurses and physical therapists 

are not competent to render a medical opinion under FECA); 5 U.S.C. § 8101(2) (this subsection defines a physician 

as surgeons, podiatrists, dentists, clinical psychologists, optometrists, chiropractors, and osteopathic practitioners 

within the scope of their practice as defined by state law). See also M.O., Docket No. 18-0229 (issued September 23, 

2019) (physical therapists are not considered physicians under FECA).
6

As such, the record lacks rationalized medical evidence establishing a causal relationship 

between the accepted August 2, 2018 employment incident and appellant’s diagnosed upper 

extremity conditions. Thus, the Board finds that appellant has not met his burden of proof.

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 has not met his burden of proof to establish upper extremity 

conditions causally related to the accepted August 2, 2018 employment incident.

ORDER

IT IS HEREBY ORDERED THAT the February 15, 2019 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: December 19, 2019

Washington, DC

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Alec J. Koromilas, Alternate Judge

Employees’ Compensation Appeals Board