United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

P.G., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Springfield, MA, Employer

__________________________________________

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Docket No. 18-0524

Issued: April 18, 2019

Appearances: Case Submitted on the Record

Shawn P. Allyn, Esq., for the appellant1

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 January 17, 2018 appellant, through counsel, filed a timely appeal from a November 29, 

2017 merit decision of the Office of Workers’ Compensation Programs (OWCP).2 Pursuant to the 

 

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 Appellant, through counsel, timely requested oral argument pursuant to 20 C.F.R. § 501.5(b). By order dated 

March 1, 2019, the Board exercised its discretion and denied the request, finding that the arguments on appeal could 

be adequately addressed in a decision based on a review of the case record. Order Denying Request for Oral Argument, 

Docket No. 18-0524 (issued March 1, 2019).
2

Federal Employees’ Compensation Act3(FECA) and 20 C.F.R. §§ 501.2(c) and 501.3, the Board 

has jurisdiction over the merits of this case.4

ISSUE

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

condition causally related to the accepted January 31, 2017 employment incident.

FACTUAL HISTORY

On February 1, 2017 appellant, then a 47-year-old mail handler, filed a traumatic injury 

claim (Form CA-1) alleging that on January 31, 2017 he injured his neck and right shoulder while 

operating a pallet jack while in the performance of duty. He indicated that when the pallet jack hit 

a groove in the floor, it pulled on his arm. Appellant stopped work on February 1, 2017.

Appellant was initially treated in urgent care. In an examination report dated February 1, 

2017, Suzanne F. Dabakis-Choquette, a nurse practitioner, related that appellant sustained an 

injury “last night” while operating a pallet jack and complained of right shoulder and neck pain. 

Examination of appellant’s right shoulder showed positive Hawkins and Neer signs and pain along 

the trapezius. A February 1, 2017 right shoulder x-ray showed no fracture or dislocation and 

normal acromioclavicular (AC) and glenohumeral joints. She diagnosed a shoulder strain and 

advised appellant to avoid heavy lifting. A February 2, 2017 work status note from the same urgent 

care facility indicated “[right] shoulder injury,” and advised that appellant could resume work on 

February 6, 2017 performing light duty, with a 10-pound lifting restriction. Appellant was to 

continue light duty through February 13, 2017.

In an examination report and duty status report (Form CA-17) dated February 13, 2017,

Dr. Talal Khan, a Board-certified internist, related that he had treated appellant for a right shoulder 

injury that occurred on January 31, 2017. He reported that appellant was driving a power jack and 

drove over a groove on the platform, which jolted his right shoulder. Dr. Khan reported that on 

clinical examination appellant’s pain “could be secondary to rotator cuff injury.” He diagnosed 

rotator cuff injury and checked a box indicating that appellant could not work. Dr. Khan referred 

appellant for a right shoulder magnetic resonance imaging (MRI) scan. 

A February 27, 2017 right shoulder MRI scan revealed AC joint degeneration, acromion 

anatomic morphology, rotator cuff tendinopathy, and intra-articular bicipital tendinopathy without 

full-thickness rotator cuff tear. 

 

3 5 U.S.C. § 8101 et seq.

4 The Board notes that following the November 29, 2017 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.
3

On February 28, 2017 Dr. Jennie V. Garver, a Board-certified orthopedic surgeon, 

diagnosed right rotator cuff tendinitis and referred appellant for physical therapy. Appellant began 

physical therapy on March 10, 2017, which OWCP authorized.

In a report dated March 24, 2017, Dr. Garver indicated that she had seen appellant on 

February 28, 2017 and that he was under her care for a right shoulder injury. She also indicated 

that she would evaluate appellant’s ability to return to work at his next appointment on 

April 4, 2017.

In a follow-up note dated April 4, 2017, Dr. Garver indicated that appellant’s status was 

essentially unchanged since his February 28, 2017 visit. She recommended that appellant remain 

off work for another six weeks while he continued with physical therapy. Dr. Garver also provided 

an April 4, 2017 duty status report (Form CA-17) with a diagnosis of right shoulder labral injury.

In an undated attending physician’s report (Form CA-20), Dr. Garver described a history 

of injury of “jarring injury” to the right shoulder on January 31, 2017. She diagnosed right 

shoulder labral injury. Dr. Garver checked a box marked “yes” indicating that appellant’s 

condition was caused or aggravated by the employment activity. She explained: “jarring injury 

caused labral injury.” Dr. Garver noted that appellant remained disabled from work. 

In an April 25, 2017 development letter, OWCP noted that when appellant’s claim was

first received it appeared to be a minor injury that resulted in minimal or no lost time from work 

and was therefore administratively approved for a payment of a limited amount of medical 

expenses. It reported that the medical evidence addressing his claim had not been formally 

considered and that additional factual and medical evidence was necessary to establish his claim. 

OWCP requested that appellant provide additional factual and medical evidence to establish his 

claim and provided a questionnaire for his completion. It afforded him 30 days to respond. 

OWCP subsequently received appellant’s completed questionnaire dated May 16, 2017. 

Appellant described that he was on dock 6 operating a pallet jack when the wheel of the pallet jack 

hit some grooves in the floor and made the handle move hard to the right, pulling his arm, and 

jerking his head and body.

OWCP also received additional physical therapy treatment records dated through 

May 11, 2017. 

By decision dated May 26, 2017, OWCP denied appellant’s traumatic injury claim. It 

accepted that the January 31, 2017 incident occurred as alleged and that there was a diagnosed

right shoulder condition. However, OWCP denied appellant’s claim finding insufficient medical 

evidence of record to establish that his right shoulder condition was causally related to the accepted 

January 31, 2017 employment incident.

Following the decision, OWCP received narrative reports by Dr. Garver dated April 4 and 

May 16, 2017. Dr. Garver noted appellant’s complaints of pain over the anterior and lateral 

aspects of his right shoulder. Upon physical examination of appellant’sright shoulder, he observed 

mild tenderness to palpation over the subacromial space. Neer and Hawkins tests were positive. 

Dr. Garver reported that appellant had a “jarring injury” to the right shoulder on January 31, 2017, 

which appeared to have resulted in a rotator cuff strain. 
4

On June 19, 2017 appellant, through counsel, requested a hearing before an OWCP hearing 

representative. 

Appellant submitted additional medical evidence. In a narrative reports dated June 13 

through July 31, 2017, Dr. Garver described that on January 31, 2017 appellant was at work when 

a “pallet jack he was driving hit an immovable object, resulting in a jarring injury to the shoulder.” 

She noted appellant’s complaints of right shoulder pain and diminished range of motion. 

Dr. Garver reported examination findings of mild tenderness over the subacromial space of 

appellant’s right shoulder and positive Neer and Hawkins tests. She indicated that a right shoulder 

MRI scan showed no evidence of rotator cuff tear, but there were concerns for strain and early 

capsulitis. In the July 31, 2017 report, Dr. Garver opined that appellant “sustained a jarring injury 

to the right shoulder on [January 31, 2017], resulting in a likely strain to the rotator cuff.” She 

also reported that appellant may have adhesive capsulitis and recommended that he return to 

physical therapy treatments. 

Dr. Garver also completed Form CA-20 and Form CA-17 reports dated June 13, 2017. She 

noted a January 31, 2017 date of injury and diagnosed right shoulder labral injury. Dr. Garver 

checked a box marked “yes” indicating that appellant’s condition was caused by his employment. 

She reported “jarring injury caused labral injury.”

In a narrative report dated September 12, 2017, Dr. Garver accurately described the 

January 31, 2017 employment injury. She reported dramatic improvement in appellant’s shoulder 

symptoms since his cortisone injection and returning to physical therapy treatments. Upon 

examination of appellant’s right shoulder, Dr. Garver observed no tenderness to palpation and 

improved range of motion. Speed and Neer tests were mildly positive. Dr. Garver again reported 

that appellant had a “jarring injury to the right shoulder at work on January 31, 2017 likely 

resulting in a strain to the rotator cuff.” She recommended that appellant return to part-time, 

limited duty for four hours per day beginning September 19, 2017. 

On September 19, 2017 appellant returned to work in a part-time, limited-duty capacity. 

A hearing was held on October 13, 2017. 

In a letter dated October 9, 2017, Dr. Garver related that appellant had been under her care 

since February 28, 2017. She described that, on January 31, 2017, appellant was steering a pallet 

jack at work when it struck something, resulting in a jarring injury to the right shoulder. Dr. Garver 

indicated that on initial evaluation of appellant’s right shoulder on February 28, 2017, she observed 

tenderness over the subacromial space and long head biceps tendon. Range of motion was mildly 

restricted. She opined: “I believe that the jarring injury to the shoulder likely caused a strain to 

the rotator cuff and/or biceps tendon with subsequent development of this inflammation.”

Dr. Garver discussed the medical treatment she provided. She further explained: “While rotator 

cuff inflammation can occur without injury, the onset of the patient’s symptoms correlates 

temporally with the jarring injury sustained at work on [January 31, 2017], and I believe with a 

reasonable degree of medical certainty that the patient’s right shoulder complaints are the result of 

that injury.”
5

Dr. Garver provided another narrative report dated October 16, 2017. She described the 

claimed January 31, 2017 employment injury and provided examination findings similar to her 

September 12, 2017 evaluation. Dr. Garver again noted that appellant had a “jarring injury to the 

shoulder at work on [January 31, 2017], resulting in a strain of the rotator cuff.” She recommended 

that appellant increase his work hours to six hours per day. 

In an October 19, 2017 letter, counsel requested that OWCP review five color photographs 

that were enclosed. 

By decision dated November 29, 2017, an OWCP hearing representative affirmed the 

May 26, 2017 decision. 

LEGAL PRECEDENT

An employee seeking benefits under FECA5 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,6that 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.7 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.8

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.9 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.10 The second component is whether the employment incident caused a 

personal injury.11 

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.12 A physician’s opinion on whether there is causal relationship 

 

5 Supra note 3.

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

153 (1989). 

7

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

ECAB 312 (1988).

8 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).

9 D.B., Docket No. 18-1348 (issued January 4, 2019); T.H., 59 ECAB 388, 393-94 (2008).

10 D.S., Docket No. 17-1422 (issued November 9, 2017); Elaine Pendleton, 40 ECAB 1143 (1989).

11 B.M., Docket No. 17-0796 (issued July 5, 2018); John J. Carlone, 41 ECAB 354 (1989).

12 T.H., supra note 9; Robert G. Morris, 48 ECAB 238 (1996).
6

between the diagnosed condition and the implicated employment factor(s) must be based on a 

complete factual and medical background.13 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 factor(s).14

In any case where a preexisting condition involving the same part of the body is present 

and the issue of causal relationship therefore involves aggravation, acceleration or precipitation, 

the physician must provide a rationalized medical opinion that differentiates between the effects 

of the work-related injury or disease and the preexisting condition.15

ANALYSIS

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

condition causally related to the accepted January 31, 2017 employment incident.

Appellant submitted several narrative reports, CA-20 and CA-17 forms, and letters by

Dr. Garver dated February 28 to October 16, 2017. In an April 4, 2017 narrative report, Dr. Garver

described that on January 31, 2017 appellant injured his right shoulder when the pallet jack he was 

driving hit something. She provided examination findings of observed mild tenderness to 

palpation over the right shoulder subacromial space and positive Neer and Hawkin’s signs. In

reports dated July 13 to September 12, 2017, Dr. Garver opined that appellant sustained a “jarring 

injury” to the right shoulder, which “likely resulted” in a rotator cuff strain. She also noted that 

appellant “may have adhesive capsulitis.” The Board finds that Dr. Garver’s determination of a 

“likely” rotator cuff strain and her opinion that he “may have” adhesive capsulitis is speculative 

and equivocal and does not constitute a definitive diagnosis.16 Likewise, Dr. Garver’s opinion in 

his February 13, 2017 note and Form CA-17 that appellant’s right shoulder pain “could be 

secondary” to a rotator cuff injury is speculative and equivocal.17 An award of compensation may 

not be based on surmise, conjecture, or speculation.18 Thus, the Board finds that these medical 

reports are insufficient to establish appellant’s claim.

Dr. Garver’s assessment regarding causal relationship is similarly equivocal. In an 

October 9, 2017 letter, she opined: “I believe that the jarring injury to the shoulder likely caused 

a strain to the rotator cuff and/or biceps tendon.” Dr. Garver did not definitively opine that the 

“jarring injury” to appellant’s right shoulder on January 31, 2017 caused or contributed to 

appellant’s current right shoulder condition. The Board has found that a physician’s opinion must 

 

13 M.V., Docket No. 18-0884 (issued December 28, 2018).

14 Id.

15 Federal (FECA) Procedure Manual, Part 2 -- Claims, Causal Relationship, Chapter 2.805.3e (January 2013).

16 Ricky S. Storms, 52 ECAB 349, 352 (2001).

17 Findings of pain or discomfort alone do not satisfy the medical aspect of the fact of injury medical determination. 

Supra note 15 at Chapter 2.803.4a(6) (August 2012).

18 Robert A. Boyle, 54 ECAB 381 (2003); Patricia J. Glenn, 53 ECAB 159 (2001).
7

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 a 

claimant’s employment.19 

In an October 16, 2017 report, Dr. Garver again provided an accurate history of the 

January 31, 2017 work incident and findings on examination. She noted that appellant had a 

“jarring injury to the shoulder at work on [January 31, 2017], resulting in a strain of the rotator 

cuff.” Dr. Garver, however, did not explain how appellant’s diagnosed rotator cuff condition was 

causally related to the accepted employment incident. Medical evidence that states a condition,

but does not offer any rationalized medical explanation regarding the cause of an employee’s 

condition is of limited probative value on the issue of causal relationship.20 The need for 

rationalized medical opinion evidence is particularly important in this case because a February 27, 

2017 right shoulder MRI scan showed AC degenerative joint disease.21 Dr. Garver did not provide 

a discussion of the underlying degenerative condition or provide medical rationale explaining how 

appellant’s current right shoulder condition resulted from the January 31, 2017 employment 

incident and not the underlying degenerative condition.22 

Dr. Garver also provided Form CA-17 reports which did not provide an opinion on 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.23 

Appellant also submitted Form CA-20 reports dated April 4 to June 13, 2017 where she checked 

a box marked “yes” indicating that appellant’s condition had been caused or aggravated by the 

employment activity. She notated: “jarring injury caused labral injury.” The Board has held that 

when a physician’s opinion on causal relationship consists only of responding “yes” to a form 

question, without explanation or rationale, that opinion is of diminished probative value and is 

insufficient to establish a claim.24 

The remaining medical evidence of record also fails to establish appellant’s claim. The 

diagnostic examination reports, including the February 1, 2017 right shoulder x-ray examination 

and February 27, 2017 right shoulder MRI scan do not contain an opinion on the causal 

relationship between appellant’s diagnosed right shoulder conditions and the accepted January 31, 

2017 employment incident and therefore lack probative value.

25

 In addition, the February 1, 2017 

 

19 M.V., supra note 13.

20 D.H., Docket No. 17-1913 (issued December 13, 2018); J.F., Docket No. 09-1061 (issued November 17, 2009); 

A.D., 58 ECAB 149 (2006).

21 See supra note 15.

22 W.S., Docket No. 17-1769 (issued July 26, 2018); S.W., Docket No. 08-2538 (issued May 21, 2009).

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

24 M.E., Docket No. 18-0330 (issued September 14, 2018); D.D., 57 ECAB 734, 738 (2006); Deborah L. Beatty, 

54 ECAB 340 (2003). 

25 The Board has held that reports of diagnostic tests lack probative value as they fail to provide an opinion on the 

causal relationship between appellant’s employment duties and the diagnosed conditions. See M.S., Docket No. 18-

1280 (issued March 12, 2019); A.B., Docket No. 17-0301 (issued May 19, 2017).
8

urgent care treatment records are of no probative value because a nurse practitioner is not 

considered a “physician” as defined under FECA.26 The physical therapy treatment records are

similarly insufficient to establish entitlement to FECA benefits.27

On appeal counsel contends that OWCP did not reference the photographs of the work

place conditions that caused appellant’s injury. The Board notes, however, that the January 31, 

2017 employment incident has been accepted and is therefore not in dispute. The issue is whether 

the accepted January 31, 2017 employment incident caused or contributed to appellant’s right 

shoulder condition. Counsel argues that there is no medical evidence in the record to contradict

Dr. Garver’s opinion on causal relationship. For the reasons explained above, however,

Dr. Garver’s medical reports are insufficient to establish that appellant’s right shoulder condition 

was causally related to the accepted incident. Causal relationship is a medical issue and the 

medical evidence generally required to establish causal relationship is rationalized medical opinion 

evidence.28 Because appellant has failed to provide such evidence, he has not met his burden of 

proof to establish his traumatic injury 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 his burden of proof to establish a right shoulder 

condition causally related to the accepted January 31, 2017 employment incident.

 

26 5 U.S.C. § 8101(2); 20 C.F.R. § 10.5(t). K.W., 59 ECAB 271, 279 (2007); David P. Sawchuk, 57 ECAB 316, 

320 n.11 (2006). A report from a nurse practitioner or physical therapist will be considered medical evidence if 

countersigned by a qualified physician. Supra note 15 at Chapter 2.805.3a(1).

27 Id.

28 I.R., Docket No. 09-1229 (issued February 24, 2010); D.I., 59 ECAB 158 (2007).
9

ORDER

IT IS HEREBY ORDERED THAT the November 29, 2017 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: April 18, 2019

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