United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

S.S., Appellant

and

DEPARTMENT OF HOMELAND SECURITY, 

CUSTOMS & BORDER PROTECTION, 

St. Albans, VT, Employer

__________________________________________

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Docket No. 18-0950

Issued: October 23, 2018

Appearances: Case Submitted on the Record

Appellant, pro se

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 April 4, 2018 appellant filed a timely appeal from October 10, 2017 and January 23, 

2018 merit decisions 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.

ISSUE

The issue is whether appellant has met his burden of proof to establish a right shoulder

condition due to the accepted factors of his federal employment.

FACTUAL HISTORY

On June 9, 2017 appellant, then a 42-year-old supervisory customs and border protection 

officer, filed an occupational disease claim (Form CA-2) alleging that he sustained right shoulder 

 

1 5 U.S.C. § 8101 et seq.
2

pain due to engaging in a baton training demonstration on November 15, 2016 as well as engaging 

in training activities on later occasions.2 On June 26, 2017 he also filed a traumatic injury claim 

(Form CA-1) alleging that he sustained an injury at work on June 8, 2017. Appellant asserted that 

he began to feel right shoulder pain after pushing and lifting barricades that were flipped over and 

interlocked, and that he had sustained the employment-related conditions of right shoulder 

tendinitis and subacromial bursitis. He did not stop work. 

Appellant submitted an attending physician’s report (Form CA-20), dated July 20, 2017, 

from Dr. Jeff Haddock, an attending Board-certified family practitioner. Dr. Haddock listed the 

date of injury as June 8, 2017 and the history of injury as modest right shoulder pain for more than 

six months with escalation two months ago. He diagnosed overuse syndrome, right biceps 

tendinitis, and subacromial bursitis, and checked a box marked “Yes” to denote that the diagnosed 

conditions were related to appellant’s employment, adding the notation, “Minor injury exacerbated 

by repeated heavy use.” Dr. Haddock did not find any period of disability. 

In an August 18, 2017 attending physician’s report, Dr. Haddock listed the date of injury 

as June 8, 2017 and the history of injury as escalating right shoulder pain with use/overuse. He 

diagnosed right shoulder pain and checked a box marked “Yes” to denote that the diagnosed 

conditions were related to appellant’s employment, adding the notation, “Overuse/repetitive use 

injury.” Dr. Haddock again did not find any period of disability.3

In a September 8, 2017 development letter, OWCP requested that appellant submit

additional factual and medical evidence, including a physician’s opinion supported by a medical 

explanation of the causal relationship between the claimed condition and the implicated 

employment factor or factors. It requested that he complete and return an attached questionnaire 

which posed various questions regarding the employment factor or factors he believed had caused 

or aggravated his claimed condition. OWCP requested that appellant clarify whether he was

claiming a traumatic injury or occupational injury.4 It afforded him 30 days to submit the requested 

evidence. 

In his response, received on September 25, 2017, appellant asserted that he sustained an 

occupational condition of his right shoulder due to engaging in various work activities, including 

baton training, defensive tactics, control arrest techniques, and firearms training, as well as 

 

2 Appellant indicated that he noticed right shoulder soreness on November 15, 2016. He advised that he first

realized on June 2, 2017 that his claimed condition was caused or aggravated by his federal employment.

3 Appellant also submitted a physical therapy report produced on June 28, 2017 by Caitlin Thornton, an attending 

physical therapist. Ms. Thornton indicated that appellant reported first experiencing right shoulder pain in 

February 2017. 

4 OWCP informed appellant that a traumatic injury refers to injury caused by a specific event or incident or series of 

incidents occurring within a single workday or work shift whereas an occupational disease refers to an injury produced 

by employment over a period longer than a single workday or work shift. See 20 C.F.R. §§ 10.5(q), (ee); Brady L. 

Fowler, 44 ECAB 343, 351 (1992).
3

removing range barricades. He advised that he first noticed having right shoulder pain on 

November 15, 2016 after he had been engaged in firearms training for almost two weeks.5

Appellant submitted a June 15, 2017 authorization for examination and/or treatment form 

(Form CA-16), signed by the Assistant Director E.C. on June 9, 2017, in which Dr. Haddock listed 

the history of injury as progressive right anterior shoulder pain and diagnosed right biceps 

tendinitis and subacromial bursitis. Dr. Haddock checked a box marked “Yes” to denote that the 

diagnosed conditions were related to appellant’s employment, adding the notation, “repeated 

use/overuse injury.” He indicated that appellant was able to resume regular work on 

June 15, 2017.6

In an August 18, 2017 report, Dr. Haddock noted that appellant presented for follow-up 

“on his right shoulder overuse injury.” Appellant reported that he had “distant injuries, but doesn’t 

quite remember the exact nature of it.” Dr. Haddock advised that the apprehension test of 

appellant’s right shoulder was mildly positive and he diagnosed right shoulder pain, noting that 

there was some concern about instability of the right shoulder. 

In a September 15, 2017 attending physician’s report and a September 15, 2017 narrative 

report, Edwin Cowey, an attending physician assistant, noted appellant’s complaints of right 

shoulder pain and diagnosed right shoulder adhesive capsulitis. 

By decision dated October 10, 2017, OWCP denied appellant’s claim, finding that he had 

effectively claimed an occupational condition of his right shoulder because he had implicated 

federal employment factors occurring over the course of more than one workday/work shift. It 

accepted employment factors in the form of engaging in baton training, defensive tactics, control 

arrest techniques, and firearms training, as well as removing range barricades. OWCP further 

found, however, that appellant failed to submit rationalized medical evidence sufficient to establish 

a diagnosed condition causally related to the accepted employment factors. 

On December 22, 2017 appellant requested reconsideration of OWCP’s October 10, 2017 

decision. 

Appellant submitted the findings of September 15, 2017 right shoulder x-rays which 

contained an impression of mild acromioclavicular joint degenerative changes with no evidence 

of fracture or dislocation. 

In a November 7, 2017 report, Dr. Haddock advised that appellant returned for follow-up 

of “his right shoulder worker[s’] compensation injury.” He noted that it was clear that appellant’s 

right shoulder injury was an overuse injury, due to chronic use rather than a single event. 

Dr. Haddock noted, “There is no other reasonable explanation for [appellant’s] symptoms than the 

combination of repetitive use during his firearm and ‘less-lethal’ teaching sessions mixed with 

prolonged periods of computer use with suboptimal ergonomics.” He diagnosed right shoulder 

 

5 Appellant noticed increased right shoulder pain after engaging in firearms training on June 2, 2017 and handling 

barricades on June 8, 2017.

6

In a June 15, 2017 narrative report, Dr. Haddock reported physical examination findings and diagnosed right 

shoulder pain. It is noted that portions of the report are redacted out. 
4

adhesive capsulitis which he felt was almost certainly due to appellant’s earlier subacromial 

bursitis and biceps tendinitis. Dr. Haddock indicated, “These injuries, in turn, are almost certainly 

due to cumulative repetitive and poor ergonomics in the workplace.” He recommended that 

appellant undergo a magnetic resonance imaging (MRI) scan to confirm his diagnosis and rule out 

other pathologies such as labral tear or rotator cuff tear. 

In a November 7, 2017 attending physician’s report, Dr. Haddock listed the date of injury 

as June 8, 2017 and the history of injury as “escalating right shoulder pain with firearm/less lethal 

training, exacerbated by prolonged computer use.” He diagnosed right biceps tendinitis, 

subacromial bursitis, and adhesive capsulitis, and checked a box marked “Yes” to denote that the 

diagnosed conditions were related to appellant’s employment, adding the notation, “repetitive use 

injury from firearm/less lethal training, exacerbated by prolonged computer work/poor 

ergonomics.” Again, Dr. Haddock did not find any period of disability. 

A November 8, 2017 MRI scan of appellant’s right shoulder contained an impression of 

fluid undermining the anterior superior chondral labral junction favored as representing a sublabral 

foramen over an anterior superior labral tear, moderate acromioclavicular joint degenerative 

changes with subchondral cystic changes in the distal clavicle, and mild tendinosis of the 

supraspinatus and infraspinatus with cystic changes at the insertion of the infraspinatus. There 

was no discrete rotator cuff tearing.

In a November 17, 2017 attending physician’s report and a November 17, 2017 narrative 

report, Mr. Cowey diagnosed right shoulder adhesive capsulitis. 

By decision dated January 23, 2018, OWCP denied modification of its October 10, 2017 

decision. It determined that appellant failed to submit rationalized medical evidence sufficient to 

establish a diagnosed condition causally related to the accepted employment factors.

LEGAL PRECEDENT

An employee seeking benefits under FECA7 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 period of FECA, that the 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.8 To establish fact of injury, an employee must submit evidence 

sufficient to establish that he or she experienced a specific event, incident, or exposure occurring 

at the time, place, and in the manner alleged.9 An employee must also establish that such event, 

incident, or exposure caused an injury.10 These are the essential elements of each and every 

 

7 Supra note 1.

8 5 U.S.C. § 8101(1); B.B., 59 ECAB 234 (2007); Elaine Pendleton, 40 ECAB 1143 (1989).

9

J.C., Docket No. 16-0057 (issued February 10, 2016); E.A., 58 ECAB 677 (2007). 

10 Id.
5

compensation claim regardless of whether the claim is predicated upon a traumatic injury or an 

occupational disease.11

OWCP’s regulations define the term “[o]ccupational disease or illness” as a condition 

produced by the work environment over a period longer than a single workday or work shift.12 To 

establish that an injury was sustained in the performance of duty in an occupational disease claim, 

an employee must submit the following: (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 employment factors identified by the employee.13

The medical evidence required to establish causal relationship generally is rationalized 

medical opinion evidence.14 The opinion of the physician must be based on a complete factual 

and medical background of the employee, must be one of reasonable medical certainty, and must 

be supported by medical rationale explaining the nature of the relationship between the diagnosed 

condition and the established employment factors.15

ANALYSIS

The Board finds that appellant has not met his burden of proof to establish a right shoulder

condition due to factors of his federal employment. 

Appellant claimed an occupational condition of his right shoulder and OWCP accepted his 

claimed employment factors in the form of engaging in baton training, defensive tactics, control 

arrest techniques, and shooting drills, as well as removing range barricades. The Board finds, 

however, that he failed to submit rationalized medical evidence sufficient to establish a diagnosed 

condition causally related to the accepted employment factors.

Appellant submitted a June 15, 2017 authorization for examination and/or treatment form 

(Form CA-16) in which Dr. Haddock listed the history of injury as progressive right anterior 

shoulder pain and diagnosed right biceps tendinitis and subacromial bursitis. Dr. Haddock 

checked a box marked “Yes” to denote that the diagnosed conditions were related to appellant’s 

employment, adding the notation, “repeated use/overuse injury.” He indicated that appellant was 

able to resume regular work on June 15, 2017.

 

11 R.H., 59 ECAB 382 (2008); Ellen L. Noble, 55 ECAB 530 (2004).

12 20 C.F.R. § 10.5(q); see also Federal (FECA) Procedure Manual, Part 2 -- Claims, Initial Development of Claims, 

Chapter 2.800.2b (June 2011).

13 D.H., Docket No. 15-1876 (issued January 29, 2016); D.I., 59 ECAB 158 (2007); Victor J. Woodhams, 41 ECAB 

345 (1989).

14 F.S., Docket No. 15-1052 (issued July 17, 2015); Tomas Martinez, 54 ECAB 623 (2003).

15 P.K., Docket No. 08-2551 (issued June 2, 2009); John W. Montoya, 54 ECAB 306 (2003).
6

The Board finds that this report is of limited probative value with respect to appellant’s 

claim for an occupational right shoulder injury caused by his work duties. The Board has held that 

when a physician’s opinion on causal relationship consists only checked a box marked “Yes” to a 

form question, without more by the way of medical rationale, that opinion has little probative value 

and is insufficient to establish causal relationship. Appellant’s burden of proof includes the necessity 

of furnishing an affirmative opinion from a physician who supports his or her conclusion with sound 

medical reasoning.16 Dr. Haddock did not provide any description of appellant’s work duties, nor 

did he provide medical rationale explaining how the diagnosed conditions could have been caused 

or aggravated by specific employment factors. As he did no more than check a box marked “Yes”

to a form question, Dr. Haddock’s opinion on causal relationship is of little probative value and is 

insufficient to discharge appellant’s burden of proof.17

Dr. Haddock’s July 20 and August 18, 2017 attending physician’s reports have limited 

probative value on appellant’s occupational claim for similar reasons. In the July 20, 2017 report, 

he listed the date of injury as June 8, 2017 and the history of injury as modest right shoulder pain 

for more than six months with escalation two months ago. Dr. Haddock diagnosed overuse 

syndrome, right biceps tendinitis, and subacromial bursitis, and checked a box marked “Yes” to 

denote that the diagnosed conditions were related to appellant’s employment, adding the notation, 

“Minor injury exacerbated by repeated heavy use.” In the August 18, 2017 report, he listed the 

date of injury as June 8, 2017 and the history of injury as escalating right shoulder pain with 

use/overuse. Dr. Haddock diagnosed right shoulder pain and checked a box marked “Yes” to 

denote that the diagnosed conditions were related to appellant’s employment, adding the notation, 

“Overuse/repetitive use injury.” However, he again failed to provide medical rationale in support 

of his opinion on causal relationship which was only effectuated by box checks.

18

 While he 

generally referred to “overuse” of appellant’s right shoulder, Dr. Haddock did not provide any 

description of appellant’s specific work duties or explain how they could have caused or 

aggravated the diagnosed conditions.

In a November 7, 2017 report, Dr. Haddock opined that appellant’s right shoulder 

condition was due to chronic use rather than a single event and noted, “There is no other reasonable 

explanation for [appellant’s] symptoms than the combination of repetitive use during his firearm 

and ‘less-lethal’ teaching sessions mixed with prolonged periods of computer use with suboptimal 

ergonomics.” He diagnosed right shoulder adhesive capsulitis which he felt was almost certainly 

due to appellant’s earlier subacromial bursitis and biceps tendinitis. Dr. Haddock indicated, 

 

16 Lillian M. Jones, 34 ECAB 379, 381 (1982).

17 Where an employing establishment properly executes a Form CA-16 authorizing medical treatment related to a 

claim for a work injury, the form creates a contractual obligation, which does not involve the employee directly, to 

pay for the cost of the examination/treatment regardless of the action taken on the claim. See Tracy P. Spillane, 54 

ECAB 608 (2003). The period for which treatment is authorized by a Form CA-16 is limited to 60 days from the date 

of issuance, unless terminated earlier by OWCP. See 20 C.F.R. § 10.300(c). 

18 See supra note 16. In a June 15, 2017 narrative report, Dr. Haddock diagnosed right shoulder pain and, in an 

August 18, 2017 narrative report, he also diagnosed right shoulder pain, noting that there was some concern about 

instability of the right shoulder. These reports contain no opinion on the cause of the diagnosed conditions and 

therefore have no probative value on the underlying issue of this case. The Board has held that medical evidence which 

does not offer an opinion regarding the cause of an employee’s condition is of no probative value on the issue of causal 

relationship. See Charles H. Tomaszewski, 39 ECAB 461 (1988).
7

“These injuries, in turn, are almost certainly due to cumulative repetitive and poor ergonomics in 

the workplace.” While he generally mentioned accepted employment factors, including firearms

and less lethal forms of training, he did not provide any detailed discussion of the frequency with 

which appellant performed work tasks or describe the medical process through which they would 

have been responsible for the diagnosed right shoulder conditions. In addition, Dr. Haddock did 

not provide any substantive discussion of objective findings on physical examination and

diagnostic testing, or explain how they supported his opinion on causal relationship. Given this 

lack of medical rationale, his report is of limited probative value with respect to appellant’s claim 

for an occupational right shoulder condition. The Board has held that a report is of limited 

probative value regarding causal relationship if it does not contain medical rationale explaining 

how an employment activity could have caused or aggravated a medical condition.19

A November 7, 2017 attending physician’s report of Dr. Haddock contains similar 

deficiencies. Dr. Haddock listed the date of injury as June 8, 2017 and the history of injury as 

“escalating right shoulder pain with firearm/less lethal training, exacerbated by prolonged 

computer use.” He diagnosed right biceps tendinitis, subacromial bursitis, and adhesive capsulitis, 

and checked a box marked “Yes” to denote that the diagnosed conditions were related to 

appellant’s employment, adding the notation, “repetitive use injury from firearm/less lethal 

training, exacerbated by prolonged computer work/poor ergonomics.” However, Dr. Haddock

again failed to provide any detailed discussion of the frequency with which appellant performed 

work tasks that have been accepted as employment factors or to provide medical rationale 

explaining how the diagnosed right shoulder condition was related to such accepted factors.20

Appellant also submitted a June 28, 2017 report produced by Ms. Thornton, an attending 

physical therapist, and September 15 and November 17, 2017 reports of Mr. Cowey, an attending 

physician assistant. However, these reports are of no probative value on establishing appellant’s 

occupational condition claim because, under FECA, the report of a nonphysician, including a 

physical therapist or physician assistant, does not constitute probative medical evidence.21 

 

19 See Y.D., Docket No. 16-1896 (issued February 10, 2017). The Board further notes that Dr. Haddock’s 

November 7, 2017 report is of limited probative value for the further reason that it is not based on a complete and 

accurate factual history. Dr. Haddock asserted that appellant’s condition was partially related to factors that have not 

been accepted as employment factors, including extensive computer use and a nonergonomic work setting. See E.R., 

Docket No. 15-1046 (issued November 12, 2015) (finding that an opinion on a given medical question is of limited 

probative value if it is not based on a complete and accurate factual and medical history).

20 See D.R., Docket No. 16-0528 (issued August 24, 2016) (finding that a report is of limited probative value 

regarding causal relationship if it does not contain medical rationale explaining the relationship between a given 

employment activity and a diagnosed medical condition).

21 The term physician includes surgeons, podiatrists, dentists, clinical psychologists, optometrists, chiropractors, 

and osteopathic practitioners within the scope of their practice as defined by State law. 5 U.S.C. § 8102(2); Sean 

O’Connell, 56 ECAB 195 (2004) (physician assistants are not considered physicians under FECA); Jennifer L. Sharp, 

48 ECAB 209 (1996) (physical therapists are not considered physicians under FECA). See also Gloria J. McPherson, 

51 ECAB 441 (2000); Charley V.B. Harley, 2 ECAB 208, 211 (1949) (a medical issue such as causal relationship can 

only be resolved through the submission of probative medical evidence from a physician).
8

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 a right shoulder

condition due to factors of his federal employment.

ORDER

IT IS HEREBY ORDERED THAT the January 23, 2018 and October 10, 2017 decisions

of the Office of Workers’ Compensation Programs are affirmed.

Issued: October 23, 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