United States Department of Labor

Employees’ Compensation Appeals Board

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J.M., Appellant

and

DEFENSE COMMISSARY AGENCY, JOINT 

BASE LEWIS-McCHORD, WA, Employer

__________________________________________

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Docket No. 19-0300

Issued: July 5, 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

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On November 20, 2018 appellant filed a timely appeal from an October 29, 2018 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 has met her burden of proof to establish that her right elbow 

conditions were causally related to the accepted May 20, 2018 employment incident.

 

1 5 U.S.C. § 8101 et seq.
2

FACTUAL HISTORY

On June 8, 2018 appellant, then a 39-year-old sales store checker, filed a traumatic injury 

claim (Form CA-1) alleging that on May 20, 2018 she injured her right arm and hand due to 

continuously scanning groceries in the performance of duty.

In duty status reports (Form CA-17) dated June 5, 19, and 28, 2018, and an attending 

physician’s report (Form CA-20) dated June 5, 2018, Dr. Mark Mariani, a Board-certified family 

practitioner, diagnosed right elbow tendinitis and right lateral epicondylitis. He noted that 

appellant was injured, while scanning groceries, and that she was able to resume modified duty 

with restrictions. In his June 5, 2018 attending physician’s report, Dr. Mariani checked the box 

marked “yes” when asked whether he believed appellant’s conditions were caused or aggravated 

by her May 20, 2018 employment activities.

In reports dated June 5, 12, 19, and 28, 2018, Daniel L. Stamper, a physician assistant, also 

diagnosed right elbow lateral epicondylitis. In these reports, he noted that her mechanism of injury 

was scanning grocery items at work. In his June 5, 2018 report, Mr. Stamper referred appellant 

for physical therapy. In his June 28, 2018 report, he indicated that appellant’s condition was 

improving.

In support of her claim, appellant also submitted physical therapy notes dated June 6, 12, 

14, 19, 21, 26, and 28, and July 3 and 5, 2018.

In a development letter dated August 16, 2018, OWCP informed appellant that it initially, 

paid a limited amount of medical expenses in her claim as it appeared to be for a minor injury that 

resulted in minimal or no lost time from work. However, appellant’s claim was now being 

reopened. OWCP advised appellant that the evidence submitted was insufficient to establish her 

claim. It provided a factual questionnaire for her completion and requested medical evidence in 

support of her claim. OWCP afforded appellant 30 days to submit the necessary evidence.

In response, appellant resubmitted Mr. Stamper’s June 5, 12, 19, and 28, 2018 reports.

OWCP also received a Form CA-17 dated June 12, 2018, wherein Dr. Mariani diagnosed 

right elbow tendinitis and indicated that appellant was able to resume modified duty with 

restrictions. Appellant also resubmitted Dr. Mariani’s June 5, 2018 completed Form CA-20, as 

well as his June 28, 2018 Form CA-17.

Appellant completed the questionnaire on August 24, 2018 and related that on the date of 

injury she had worked her full shift without a break. She related that she could not grip without 

feeling numbness, pain, soreness, and tingling along her arm and hand.

By decision dated October 29, 2018, OWCP denied appellant’s traumatic injury claim,

finding that the evidence submitted was insufficient to establish that her medical conditions were

causally related to the accepted May 20, 2018 employment incident.
3

LEGAL PRECEDENT

An employee seeking benefits under FECA2 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,3that 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 the employment injury.4 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.5

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

OWCP begins with an analysis of whether fact of injury has been established. Generally, 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.6 The second component is whether the employment incident caused a personal 

injury.7

To establish causal relationship between the condition, as well as any attendant disability 

claimed and the employment event or incident, the employee must submit rationalized medical 

opinion evidence supporting such causal relationship.8 Causal relationship is a medical issue, and 

the medical evidence required to establish causal relationship is rationalized medical evidence.9 

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

employment factors identified by the employee.10 Neither the mere fact that a disease or condition 

manifests itself during a period of employment, nor the belief that the disease or condition was 

 

2

Id.

3 S.B., Docket No. 17-1779 (issued February 7, 2018); J.P., 59 ECAB 178 (2007); Joe D. Cameron, 41 ECAB 

153 (1989).

4

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

ECAB 312 (1988).

5 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).

6 Elaine Pendleton, 40 ECAB 1143 (1989).

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

8

J.L., Docket No. 18-0698 (issued November 5, 2018); I.J., 59 ECAB 408 (2008); Victor J. Woodhams, 41 ECAB 

465 (2005). 

9 L.D., Docket No. 17-1581 (issued January 23, 2018); Jacqueline M. Nixon-Steward, 52 ECAB 140 (2000).

10 L.D., id.; see also Leslie C. Moore, 52 ECAB 132 (2000); Gary L. Fowler, 45 ECAB 365 (1994). 
4

caused or aggravated by employment factors or incidents is sufficient to establish causal 

relationship.11

ANALYSIS

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

elbow conditions were causally related to the accepted May 20, 2018 employment incident.

Appellant submitted a number of form reports dated June 5 to 28, 2018 from Dr. Mariani. 

Dr. Mariani diagnosed right elbow tendinitis and right lateral epicondylitis, but he offered no 

opinion regarding causal relationship. 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.12 These reports are, therefore, insufficient to establish appellant’s 

claim. 

In his June 5, 2018 attending physician’s report, Dr. Mariani checked the box marked “yes”

when asked whether he believed appellant’s conditions were caused or aggravated by her 

employment activities. However, the Board has held that an opinion consisting only of a 

checkmark notation supporting causation, without supporting medical rationale, is of limited 

probative value and insufficient to establish causal relationship.13 This report is, therefore, also 

insufficient to establish appellant’s claim. 

OWCP also received a series of medical reports dated June 5, 12, 19, and 28, 2018 from

Mr. Stamper, a physician assistant, and a number of physical therapy reports. These reports do 

not constitute competent medical evidence because physician assistants and physical therapists are

not considered “physicians” as defined under FECA.14 Therefore, their reports will be considered 

medical evidence only if countersigned by a qualified physician.15 As these reports were not 

countersigned by a qualified physician, this evidence is insufficient to meet appellant’s burden of 

proof.16

 

11 T.H., Docket No. 18-1736 (issued March 13, 2019); Dennis M. Mascarenas, 49 ECAB 215 (1997). 

12 D.B., Docket No. 18-1359 (issued May 14, 2019); K.K., Docket No. 18-1209 (issued March 7, 2019).

13 J.R., Docket No. 18-1609 (issued March 7, 2019); see K.R., Docket No. 18-1388 (issued January 9, 2019).

14 G.S., Docket No. 18-1696 (issued March 26, 2019); see M.M., Docket No. 17-1641 (issued February 15, 2018); 

K.J., Docket No. 16-1805 (issued February 23, 2018); 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).

15 L.T., Docket No. 18-1603 (issued February 21, 2019) (a report from a physician assistant must be countersigned 

by a physician to be of probative medical value); P.G., Docket No. 18-0524 (issued April 18, 2019) (a report from a 

physical therapist must be countersigned by a physician to be of probative medical value). 

16 Id.
5

As appellant has not submitted rationalized medical evidence to establish that her right 

elbow conditions were causally related to the accepted May 20, 2018 employment incident, the 

Board finds that she has not met her burden of proof to establish her claim.

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 her right 

elbow conditions were causally related to the accepted May 20, 2018 employment incident.

ORDER

IT IS HEREBY ORDERED THAT the October 29, 2018 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: July 5, 2019

Washington, DC

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board