United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

T.B., Appellant

and

U.S. POSTAL SERVICE, FRANKLIN BRANCH, 

Franklin, WI, Employer

__________________________________________

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Docket No. 18-0461

Issued: October 2, 2018

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

PATRICIA H. FITZGERALD, Deputy Chief Judge

ALEC J. KOROMILAS, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On January 4, 2018 appellant, through counsel, filed a timely appeal from an October 26, 

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 to consider the merits of this case.

ISSUE

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

extremity conditions causally related to the accepted factors of her federal employment.

 

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

FACTUAL HISTORY

On July 8, 2016 appellant, then a 50-year-old rural carrier, filed an occupational disease 

claim (Form CA-2) alleging that she developed a right bicep/upper arm and elbow condition as 

the result of her repetitive work duties.3 She stated that she first became aware of her claimed

condition on July 5, 2016, and realized its relation to her federal employment on July 8, 2016. 

Appellant did not stop work. 

On July 8, 2016 appellant was seen by Dr. Rita E. Schulz, a Board-certified family 

practitioner, for complaints of right arm pain, which appellant attributed to her work duties. She

related that she first noticed her arm pain on July 5, 2016 and that her job entailed lots of repetitive 

activity. Shortly thereafter, appellant noticed that the pain radiated into her right shoulder. 

Physical examination findings included tenderness along the right elbow medial epicondyles up to 

the triceps and biceps muscles, right shoulder and scapular area tenderness, and decreased right 

shoulder range of motion. Dr. Schulz diagnosed right arm sprain and referred appellant to a 

chiropractor. On July 8, 2016 she reported that appellant was disabled from work as of that day. 

On July 15, 2016 Dr. Schult released appellant to return to desk work with restrictions. 

In a July 11, 2016 report, Dr. Michelle Jermier, a chiropractor, noted that appellant was 

seen for elbow pain. Appellant related striking her elbow while loading a truck at work and that 

the pain worsened as the day progressed. Examination findings were provided to include right 

lateral elbow edema and right elbow and forearm tenderness. Dr. Jermier diagnosed right elbow 

acute tendinosis/tendinitis.

On July 20, 2016 OWCP received an undated report from Dr. Jermier diagnosing right 

elbow acute tendinosis/tendinitis and right radial head subluxation. Dr. Jermier reported that 

appellant developed symptoms after hitting her right elbow while loading a truck on July 5, 2016. 

Examination findings were detailed. Dr. Jermier noted that anteroposterior (AP) and lateral elbow 

x-rays had essentially negative findings. 

By development letter dated July 26, 2016, OWCP informed appellant that the evidence of 

record was insufficient to support her claim. It advised her regarding the necessary medical and 

factual evidence needed to establish her claim. OWCP afforded appellant 30 days to submit the 

necessary evidence.

On August 10, 2016 Dr. Jermier listed dates of treatment and noted a date of injury of 

July 5, 2016, when appellant hit her right elbow loading a truck at work. Examination findings 

included right wrist positive Phalen’s, Finkelstein’s, and Tinel’s signs, right elbow positive valgus 

stress, extension, and flexion tests, and right shoulder positive Dawburns and Apleys Scratch tests. 

Dr. Jermier diagnosed right elbow lateral epicondylitis, right shoulder pain, other synovium and 

tendon specified disorders, and upper extremity segmental and somatic dysfunction. She opined 

 

3 OWCP assigned the present claim File No. xxxxxx000. Appellant also noted on her claim form that she bumped 

her elbow on a truck on July 2, 2016 while loading it. She then filed a separate claim for the July 2, 2016 injury, 

assigned OWCP File No. xxxxxx501, which OWCP denied on September 16, 2016. Appellant also subsequently filed 

other claims alleging injury to her right elbow/arm. On November 29, 2016 she filed a claim for a traumatic injury to 

her right arm on November 28, 2016, assigned OWCP File No. xxxxxx177. On December 23, 2016 appellant filed a 

claim for a traumatic injury to her right arm on December 22, 2016, assigned OWCP File No. xxxxxx871.
3

that the diagnosed conditions were caused by appellant’s repetitive work duties and bumping her 

elbow on July 5, 2016.

On August 26, 2016 OWCP received a July 27, 2016 report from Dr. Darin A. Maccoux, 

Board-certified in family and sports medicine. Dr. Maccoux diagnosed appellant’s condition as 

right elbow ulnar nerve contusion. He noted that she was disabled from work until August 18, 

2016 and that her symptoms should resolve within two to three months. 

By decision dated October 13, 2016, OWCP denied appellant’s claim, finding that the 

evidence of record was insufficient to establish the factual portion of her claim. 

In a letter dated October 24, 2016, counsel requested a telephonic hearing before an OWCP 

hearing representative. The hearing was held on April 25, 2017. 

In an operative report dated March 7, 2017, Dr. Rick F. Papandrea, a treating physician 

Board-certified in hand surgery, orthopedic surgery, and orthopedic sports medicine, performed 

right elbow cubital tunnel release, right percutaneous medial epicondyle flexor/pronator release, 

and right ECRB percutaneous release. Appellant’s diagnoses were listed as right lateral 

epicondylitis, right medial epicondylitis, and right cubital tunnel syndrome. 

By decision dated June 16, 2017, the hearing representative found that appellant had 

established the factual portion of her claim. However, the claim remained denied as appellant had 

not provided a rationalized medical opinion explaining how the diagnosed conditions were 

causally related to the accepted employment factors. Thus, appellant affirmed the October 13, 

2016 decision, as modified. 

On July 28, 2017 appellant, through counsel, requested reconsideration. 

In a July 7, 2017 report, Dr. Papandrea diagnosed right cubital tunnel syndrome or right 

elbow lateral epicondylitis and ulnar neuropathy. He noted that appellant stated that she developed 

medial and lateral elbow pain after hitting her elbow. Physical examination findings were 

provided. Dr. Papandrea attributed the diagnosed condition to the hitting of her elbow due to the 

lack of symptoms prior to the injury. In support of this conclusion, he explained that the direct 

trauma aggravated a preexisting condition causing it to become symptomatic. 

By decision dated October 26, 2017, OWCP denied modification of its prior decision. It 

found the evidence submitted by appellant was insufficient to establish causal relationship between 

the diagnosed medical conditions and the accepted factors of appellant’s federal employment. 

LEGAL PRECEDENT

An employee seeking benefits under FECA4 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 and/or specific condition for which compensation is claimed are causally related to the 

 

4 Supra note 3. 
4

employment injury.5 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.6

To establish that an injury was sustained in the performance of duty in a claim for 

occupational disease, an employee must submit: (1) a factual statement identifying employment 

factors alleged to have caused or contributed to the presence or occurrence of the disease or 

condition; (2) medical evidence establishing the presence or existence of the disease or condition 

for which compensation is claimed; and (3) medical evidence establishing that the diagnosed 

condition is causally related to the employment factors identified by the employee.7 

Causal relationship is a medical issue and the medical evidence generally required to 

establish causal relationship is rationalized medical opinion evidence.8 Rationalized medical 

opinion evidence is medical evidence which includes a physician’s rationalized opinion on 

whether there is causal relationship between the employee’s diagnosed condition and the 

compensable employment factors.9 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 specific employment factors identified by the employee.10 

ANALYSIS

The Board finds that appellant has not met her burden of proof to establish that the accepted 

factors of her federal employment caused or aggravated her diagnosed medical conditions. 

Dr. Schulz diagnosed right arm sprain in a July 8, 2016 report. In the work certificates 

dated July 8 and 15, 2016, she noted appellant’s ability to work status. Dr. Maccoux diagnosed a

right elbow ulnar nerve contusion in a July 27, 2016 report. However these physicians did not 

provide an opinion regarding the cause of appellant’s diagnosed conditions.

11

 The Board has held 

that 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.12

 

5 C.S., Docket No. 08-1585 (issued March 3, 2009); Bonnie A. Contreras, 57 ECAB 364 (2006).

6 S.P., 59 ECAB 184 (2007); Joe D. Cameron, 41 ECAB 153 (1989).

7 D.U., Docket No. 10-0144 (issued July 27, 2010); R.H., 59 ECAB 382 (2008); Roy L. Humphrey, 57 ECAB 238 

(2005); Donald W. Wenzel, 56 ECAB 390 (2005).

8 Y.J., Docket No. 08-1167 (issued October 7, 2008); A.D., 58 ECAB 149 (2006); D’Wayne Avila, 57 ECAB 

642 (2006).

9

J.J., Docket No. 09-27 (issued February 10, 2009); Michael S. Mina, 57 ECAB 379 (2006).

10 I.J., 59 ECAB 408 (2008); Victor J. Woodhams, 41 ECAB 345, 352 (1989).

11 D.H., Docket No. 11-1739 (issued April 18, 2012).

12 See C.B., Docket No. 09-2027 (issued May 12, 2010); S.E., Docket No. 08-2214 (issued May 6, 2009); Jaja K. 

Asaramo, 55 ECAB 200 (2004).
5

Dr. Papandrea’s July 7, 2017 report did not attribute appellant’s diagnosed conditions to 

her repetitive work duties over a period longer than a single shift. Rather he attributed her 

diagnoses to a prior traumatic incident when appellant allegedly struck her elbow.13 As appellant’s 

claim is for an occupational disease, and as Dr. Papandrea’s opinion on causal relationship related 

her diagnoses to a single traumatic incident, his July 7, 2017 report is of diminished probative 

value on the issue of causal relationship. His report was not based on an accurate factual 

background. Medical opinions based on an incomplete or inaccurate history are of 

diminished probative value.14 

Appellant also submitted reports from Dr. Jermier, a chiropractor. However, her reports 

are of no probative value because she did not diagnose a subluxation of the spine based upon x-ray

evidence, and, therefore, she is not considered a “physician” under FECA.

15

On appeal counsel contends that the report from Dr. Papandrea established causal 

relationship. As explained above, appellant has not provided rationalized medical evidence 

sufficient to establish causal relationship between the accepted employment factors and the 

diagnosed conditions. The Board thus finds that she failed to meet her 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 her burden of proof to establish that right upper 

extremity conditions were causally related to the accepted factors of her employment.

 

13 OWCP’s regulations define a traumatic injury as a condition of the body caused by a specific event or incident, 

or series of events or incidents, within a single workday or shift. 20 C.F.R. § 10.5(ee). The regulations define an 

occupational disease or illness as a condition produced by the work environment over a period longer than a single 

workday or shift. 20 C.F.R. § 10.5(q).

14 L.G., Docket No. 09-1692 (issued August 11, 2010).

15 A.O., Docket No. 08-580 (issued January 28, 2009). Under section 8101(2) of FECA, the term physician includes 

chiropractors only to the extent that their reimbursable services are limited to treatment consisting of manual 

manipulation of the spine to correct a subluxation as demonstrated by x-ray to exist and subject to regulation by the 

Secretary. 5 U.S.C. § 8101(2); see D.S., Docket No. 09-860 (issued November 2, 2009).
6

ORDER

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

Programs dated October 26, 2017 is affirmed.

Issued: October 2, 2018

Washington, DC

Patricia H. Fitzgerald, Deputy 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