United States Department of Labor

Employees’ Compensation Appeals Board

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F.M., Appellant

and

DEPARTMENT OF JUSTICE, U.S. MARSHALS 

SERVICE, Fargo, ND, Employer

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Docket No. 16-1848

Issued: March 16, 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

ALEC J. KOROMILAS, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On September 19, 2016 appellant filed a timely appeal from the August 26, 2016 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. 

ISSUE

The issue is whether appellant met her burden of proof to establish a right upper extremity 

injury causally related to accepted factors of her federal employment.

FACTUAL HISTORY

On January 19, 2016 appellant, then a 58-year-old criminal program specialist, filed an 

occupational disease claim (Form CA-2) alleging that she developed achiness and discomfort in 

her right forearm and elbow while in in the performance of duty. She explained that she engaged 

 

1 5 U.S.C. § 8101 et seq.
2

in daily computer keying and entering. Appellant indicated that she first became aware of the 

injury and of its relation to her federal employment on October 1, 2015. She did not stop work. 

By development letters dated January 25, 2016, OWCP informed appellant and the 

employing establishment of the type of evidence needed to support her claim and afforded 

appellant 30 days to submit such evidence. It particularly requested that she have her physician 

provide an opinion, supported by a medical explanation, as to how work activities caused or 

aggravated her claimed condition.

In a February 3, 2016 narrative statement, appellant noted that on or about October 1, 2015, 

she started to notice unusual discomfort and achiness in her right forearm and elbow area. She 

indicated that, over time, it seemed to become relevant in that she had achiness, discomfort; pain, 

and “overall tiredness in [her] right arm.” Appellant explained that in late August 2015 to the 

present, she was covering more work as her coworker left for advanced training. She noted that 

the position could not be filled until she had successfully completed her training, and they were 

finally able to fill it. Appellant also indicated that it would be another three to six months before 

they had another person in the position to take back the additional duties that she had to undertake. 

She described her employment-related duties which were repetitive and included extra data and 

computer entries on a daily basis for at least six to eight hours a day, five days a week. Appellant 

explained that it was not until she started using her hand more repetitively that she started noticing 

the aggravation and achiness with pain and discomfort. She indicated that she believed the 

excessive use of her right forearm and elbow with the daily data entries contributed to her condition 

as well as overuse of the computer. Appellant denied having any other conditions. She noted that 

her outside activities included: attending sporting events; school activities; family and church 

functions; volunteering and charity work. Appellant denied engaging in any sports or physical 

activity, with the exception of walking on the treadmill and exercise bike riding at her place of 

employment. She also advised that she did not play any musical instruments or engage in any 

hobbies that involved nonwork-related computer usage. Furthermore, appellant noted her outside 

activities were sedentary.

In a February 11, 2106 statement, C.F., an administrative officer with the employing 

establishment, concurred with appellant’s statement that her condition was “likely attributable to 

repetitive motion related to the high volume of computer data entry she does on a daily basis.” 

She explained that appellant’s coworker left at the end of August 2015 and left a temporary 

vacancy with the administrative staff. Appellant explained that her duties were distributed 

amongst the staff and appellant’s additional duties were related to data entry and encompassed the 

majority of her workday. C.F. agreed that appellant was spending six to eight hours of her workday 

on the computer. She also advised that she was not aware that appellant was involved in any other 

outside activities that would have contributed to the orthopedic condition. C.F. noted that no 

changes were made to appellant’s workstation, but she was encouraged to take breaks and use fit 

time to step away from her desk during the day. She indicated that appellant’s first doctor visit 

was on December 29, 2015 and she had 15.5 hours of doctor visits. C.F. indicated that new 

computers were brought to the district in May 2015 and the change in the keyboard and mouse 

could have played a role in aggravating her arm. She related that the employing establishment was 

planning on purchasing a spit key board and a roller ball mouse. Additionally, the employing 

establishment would consider workstation adjustments, if advised by a physician. C.F. noted that 
3

the vacancy would be filled within the next few months and should alleviate some of the data entry 

duties performed by appellant. A copy of the position description was also provided.

OWCP received records from a physician assistant dating from December 29, 2015 to 

January 18, 2016. 

By decision dated April 13, 2016, OWCP denied appellant’s claim. It found that appellant 

did not submit any medical evidence containing a firm medical diagnosis in connection with the 

claimed work factors or events. OWCP explained that the evidence from the physician assistant 

could not be considered to be from a physician, unless counter-signed by a qualified physician.

On May 5, 2016 appellant requested reconsideration. She argued that her condition was 

caused or worsened by her work activities. Appellant indicated that her daily activities were 

always computer related and she had to take on extra work due to a staff shortage. She explained 

that the repetitive work on her computer and data entry performed over the eight-hour day caused 

her more aggravation and discomfort than normal. Appellant indicated that as time went on, it 

became apparent that the discomfort and aggravation would not go away with over-the-counter 

ibuprofen. She enclosed new medical evidence.

The new medical evidence was comprised of an April 22, 2016 report from Dr. Kevin 

Dahl, a Board-certified orthopedic surgeon.

2

 Dr. Dahl noted that appellant presented with 

complaints of right forearm pain which was present over the last several months and denied any 

particular injuries. He advised that her pain was localized over the medial versus lateral aspect of 

her right elbow joint and was worse with activity such as computer use and better with rest. 

Dr. Dahl also related that she had night time discomfort as well and took occasional ibuprofen with 

some relief in symptoms. He related that she had no numbness or tingling involving the right 

upper extremity digits and her pain was “more dull at rest and sharp with activity.” Dr. Dahl

examined appellant and diagnosed right elbow pain, right medial epicondylitis, and right elbow 

lateral epicondylitis. In the social history narrative, he indicated that appellant was a criminal 

specialist working with prisoner data filing. 

By decision dated August 26, 2016, OWCP modified the April 13, 2016 decision from a 

denial based on one of the five basic elements for FECA coverage to a denial based on another 

basic element. It explained that the claim remained denied based on causal relationship as she 

presented no medical evidence outlining the connection between the diagnosed condition and the 

accepted factors of her federal employment.

 

2 The report was originally from a physician assistant and was subsequently signed by Dr. Dahl on April 22, 2016. 
4

LEGAL PRECEDENT

A claimant seeking benefits under FECA 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.3

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.4 

Certain healthcare providers such as physician assistants, nurse practitioners, physical 

therapists, and social workers are not considered “physician[s]” as defined under FECA.5 

Consequently, their medical findings and/or opinions will not suffice for purposes of establishing 

entitlement to FECA benefits.6

ANALYSIS

Appellant alleged that she developed a right arm and elbow condition due to daily repetitive 

activities which included computer data entry as part of her work as a criminal program specialist. 

The employing establishment concurred with her statement and explained that she incurred 

additional repetitive duties while filling in for a coworker that left a position. OWCP properly 

found that the evidence of record supports that appellant engaged in repetitive data entry activities 

for six to eight hours per day as part of her criminal program specialist duties.

However, appellant submitted insufficient medical evidence to establish that her condition

was caused or aggravated by these activities or any other specific factors of her federal 

employment. 

 

3 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.

4 Victor J. Woodhams, id.

5 5 U.S.C. § 8101(2); 20 C.F.R. § 10.5(t).

6 K.W., 59 ECAB 271, 279 (2007); David P. Sawchuk, 57 ECAB 316, 320 n.11 (2006). A report from a physician 

assistant or certified nurse practitioner will not be considered medical evidence. Federal (FECA) Procedure 

Manual, Part 2 -- Claims, Causal Relationship, Chapter 2.805.3a (1) (January 2013).
5

In his April 22, 2016 report, Dr. Dahl diagnosed right elbow pain, right medial 

epicondylitis, and right elbow lateral epicondylitis. However, he did not indicate that appellant’s 

work activities as a criminal program specialist either caused or aggravated these conditions. 

Medical evidence that does not offer any opinion regarding the cause of an employee’s condition 

is of limited probative value on the issue of causal relationship.7 A mere conclusory opinion 

provided by a physician without the necessary rationale explaining how and why the incident or 

work factors were sufficient to result in the diagnosed medical condition is insufficient to meet a 

claimant’s burden of proof to establish a claim.8 Consequently, Dr. Dahl’s report is of limited 

probative value.

The Board notes that the record contains reports from physician assistants. However, they 

are not considered physicians as defined under FECA. Thus, the Board finds that their opinions 

on causal relationship do not constitute rationalized medical opinions and have no weight or 

probative value.9

The Board has held that the mere fact that a condition manifests itself during a period of 

employment does not raise an inference that there is a causal relationship between the two.10 

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.11 

As there is no reasoned medical evidence explaining how appellant’s employment duties 

caused or aggravated a medical condition involving her right arm and elbow, appellant has not met 

her burden of proof in establishing that she developed a medical condition causally related to 

accepted factors of her federal employment.

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 her burden of proof to establish a right upper 

extremity injury causally related to accepted factors of her federal employment.

 

7 S.E., Docket No. 08-2214 (issued May 6, 2009).

8

J.D., Docket No. 14-2061 (issued February 27, 2015).

9 5 U.S.C. § 8102(2) of FECA provides that 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. § 8101(2); 20 C.F.R. § 10.404; Roy L. Humphrey, 57 ECAB 238 (2005). See also D.B., Docket 

No. 17-0448 (issued October 12, 2017) wherein the Board held that reports from physician assistants are not 

considered medical evidence as these practitioners are not physicians under FECA.

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

11 Id.
6

ORDER

IT IS HEREBY ORDERED THAT the August 26, 2016 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: March 16, 2018

Washington, DC

Christopher J. Godfrey, Chief Judge

Employees’ Compensation Appeals Board

Alec J. Koromilas, Alternate Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board