United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

B.P., Appellant

and

U.S. POSTAL SERVICE, TRENTON 

PROCESSING & DISTRIBUTION CENTER, 

Trenton, NJ, Employer

__________________________________________

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Docket No. 19-0777

Issued: October 8, 2019

Appearances: Case Submitted on the Record

James D. Muirhead, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

CHRISTOPHER J. GODFREY, Chief Judge

JANICE B. ASKIN, Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On February 25, 2019 appellant, through counsel, filed a timely appeal from a 

September 28, 2018 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 over the merits of this case.3

 

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.

3 The Board notes that appellant submitted additional evidence on appeal. 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.
2

ISSUE

The issue is whether appellant has met her burden of proof to establish a left elbow 

condition causally related to the accepted March 4, 2014 employment incident.

FACTUAL HISTORY

On March 12, 2014 appellant, then a 55-year-old mail processing clerk, filed a traumatic 

injury claim (Form CA-1) alleging that on March 4, 2014 she injured her left elbow when she hit 

it on a “pie rack” while in the performance of duty. She did not stop work. 

In a report dated March 13, 2014, Dr. Marcel Stern, a Board-certified internist, noted 

appellant’s date of injury as March 4, 2014, and reported the history of injury as “she lifted a tray 

of mail to the upper shelf” and “banged her left elbow on a metal rod.” He diagnosed status post 

contusion, sprain and strain of left elbow with lateral epicondylitis, and tendinitis. Dr. Stern 

provided work restrictions.

On March 24, 2014 the employing establishment issued an authorization for examination 

and medical treatment (Form CA-16).4

OWCP also received an attending physician’s report, Part-B of the Form CA-16, dated 

March 13, 2014, which noted that appellant had hit her left elbow on a metal tray. The other 

findings in the report and the physician’s signature are illegible. 

A series of duty status reports (Forms CA-17) were received dated from March 13 through 

August 26, 2014 which noted appellant’s history of injury as “lifting a tray of mail from a pie rack 

to top rack and hit left elbow.” Appellant’s work restrictions were provided. 

In a report dated March 25, 2014, Dr. Arvind Patel, a Board-certified internist, related 

appellant’s examination findings and diagnosed status post contusion and sprain and strain of left 

elbow with lateral epicondylitis. He noted that appellant could perform light-duty work with 

restrictions. 

In a series of reports dated April 2, April 16, May 14, and June 4, 2016, Dr. Stern noted 

appellant’s history of injury, and physical examination findings. He continued to diagnose 

persistent left elbow lateral epicondylitis, and provide work restrictions. 

In a series of reports dated June 24, July 15, August 5, August 26, and September 16, 2014,

Dr. Franklin Chen, a Board-certified orthopedic surgeon, reviewed appellant’s history of injury 

and physical examination findings. In his June 24, 2014 report, he noted that x-rays of appellant’s 

elbow revealed incidental calcification to medial and lateral elbow, and diagnosed left elbow 

epicondylitis. In his July 15, August 5, and August 26, 2014 reports, Dr. Chen noted that, based 

on a July 5, 2014 magnetic resonance imaging (MRI) scan, appellant displayed severe common 

extensor tendinitis with partial tearing of the deep fibers, and small joint, effusion. In each report,

he related that, based on appellant’s history of injury and examination findings, it was within 

 

4 The record reflects that the employing establishment issued additional Forms CA-16 authorizing medical 

treatment on June 24 and September 16, 2014. These forms are largely illegible.
3

medical probability that her current orthopedic complaints were causally related to her 

employment injury.

In a report dated March 16, 2016, Dr. David Weiss, an osteopath Board-certified in 

orthopedic surgery, performed a schedule award impairment evaluation of appellant’s left upper 

extremity and left lower extremity. Regarding the left elbow he diagnosed chronic lateral 

epicondylitis of the left elbow. Dr. Weiss opined that appellant’s employment-related injuries of 

July 22, 2005, September 26, 2010, February 10, 2013, March 28, 2013, and March 4, 2014 were 

the competent producing factors of her objective diagnoses. 

In a development letter dated July 26, 2017, OWCP advised appellant that when her claim 

was submitted it appeared to be a minor injury that necessitated minimal or no lost time from work 

and payment of a limited amount of medical expenses had been administratively approved. It 

explained that her claim was being reopened for consideration because she filed a claim for wage 

loss pursuant to a schedule award impairment rating. OWCP further informed appellant of the 

deficiencies of her claim, advised her of the type of factual and medical evidence needed, and 

provided a questionnaire for her completion. It afforded her 30 days to submit the necessary 

evidence. No response was received.

By decision dated November 29, 2017, OWCP denied appellant’s claim finding that the 

evidence submitted was insufficient to establish that the alleged incident occurred as described, 

and that she had not submitted sufficient medical evidence to establish a diagnosed medical 

condition causally related to the alleged employment incident. It concluded, therefore, that the 

requirements had not been met to establish an injury as defined by FECA.

On December 5, 2017 appellant, through counsel, requested a telephonic hearing regarding 

OWCP’s November 29, 2017 decision. A hearing before an OWCP hearing representative was 

held on May 9, 2018. Appellant testified at the hearing that her left elbow injury occurred as she 

lifted a tray of mail to place it on a top rack, and she hit her left elbow on a connected rack. 

By decision dated July 9, 2018, OWCP’s hearing representative affirmed the 

November 29, 2017 decision finding that the evidence of record lacked a report from a physician 

containing a history of injury, a firm diagnosis, and a discussion, with rationale, of the relationship

between the two.

On July 18, 2018 appellant, through counsel, requested reconsideration of the July 9, 2018 

decision. She submitted additional medical evidence along with her request.

In an unsigned hospital report dated March 12, 2014, the treating physician indicated that 

appellant injured her left elbow on a metal cage while at work. In addition, it noted that she had 

elbow tenderness laterally and along the lateral epicondyle, no edema, no swelling, and full range 

of motion. Appellant was diagnosed with left elbow contusion.

By decision dated September 28, 2018, OWCP denied modification of the July 9, 2018 

decision as appellant had not met her burden of proof to establish that her diagnosed left elbow 

conditions were causally related to the accepted employment incident.
4

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

In order to determine whether a federal employee has sustained a traumatic injury in the 

performance of duty, OWCP must first determine whether fact of injury has been established. 9 

There are two components involved in establishing fact of injury. First, the employee must submit 

sufficient evidence to establish that he or she actually experienced the employment incident at the 

time, place, and in the manner alleged.10 Second, the employee must submit evidence, generally 

only in the form of probative medical evidence, to establish that the employment incident caused 

a personal injury.11

Causal relationship is a medical issue, and the medical evidence required to establish causal

relationship is rationalized medical evidence.12 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 factor(s) identified by the 

employee.13 The weight of the medical evidence is determined by its reliability, its probative 

value, its convincing quality, the care of analysis manifested, and the medical rationale expressed 

in support of the physician’s opinion.14

 

5

Supra note 2.

6 R.C., Docket No. 18-1146 (issued August 12, 2019); S.B.,Docket No. 17-1779 (issued February 7, 2018); J.P., 59 

ECAB 178 (2007); Joe D. Cameron, 41 ECAB 153 (1989).

7 L.E., Docket No. 19-0470 (issued August 12, 2019); 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 L.E., id.; K.M.,Docket No. 15-1660 (issued September 16, 2016); L.M., Docket No. 13-1402 (issued February 7, 

2014); DeloresC. Ellyett, 41 ECAB 992 (1990).

9 D.B., Docket No. 18-1348 (issued January 4, 2019); S.P., 59 ECAB 184 (2007).

10 R.C., supra note 6; D.S.,Docket No. 17-1422 (issued November 9, 2017); Bonnie A. Contreras, 57 ECAB 

364 (2006).

11 L.E., supra note 7; B.M.,Docket No. 17-0796 (issued July 5, 2018); David Apgar, 57 ECAB 137 (2005); John J. 

Carlone, 41ECAB 354 (1989).

12 M.K., Docket No. 19-0428 (issued July 15, 2019); L.D., Docket No. 17-1581 (issued January 23, 2018); 

JacquelineM. Nixon-Steward, 52 ECAB 140 (2000).

13 L.E., supra note 7; M.V.,Docket No. 18-0884 (issued December 28, 2018); I.J., 59 ECAB 408 (2008); Victor J. 

Woodhams, 41 ECAB 345 (1989).

14 R.C., supra note 6; James Mack, 43 ECAB 321 (1991).
5

ANALYSIS

The Board finds that appellant has not met her burden of proof to establish a left elbow 

condition causally related to the accepted March 4, 2014 employment incident.

Appellant submitted a series of reports from Dr. Stern who noted appellant’s history of 

injury, and diagnosed persistent left elbow lateral epicondylitis status post contusion, sprain and 

strain of left elbow with lateral epicondylitis, and tendinitis. Dr. Stern did not, however, address 

the issue of causal relationship. Medical evidence that does not offer an opinion regarding the 

cause of an employee’s condition is of no probative value regarding the issue of causal 

relationship.15

Similarly, Dr. Patel provided diagnoses of appellant’s left elbow condition and noted work 

restrictions, but offered no opinion causally relating the diagnoses to the March 4, 2014 

employment incident. As such his report is insufficient to establish appellant’s claim.16

OWCP also received a series of reports from Dr. Chen who noted that x-rays revealed 

incidental calcification of appellant’s medial and lateral elbow, and diagnosed left elbow 

epicondylitis. In Dr. Chen’s July 15, August 5, and 26, 2014 reports, he noted that, based on a 

July 5, 2014 magnetic resonance imaging (MRI) scan, appellant displayed severe common 

extensor tendinitis with partial tearing of the deep fibers, small joint effusion. In each report, he

related that, based on the patient’s history and examination, it was within medical probability that 

her current orthopedic complaints were causally related to her employment injury. Although

Dr. Chen’s reports contain an affirmative opinion on causal relationship, the Board finds that they

do not contain sufficient medical rationale explaining how the mechanism of injury caused or 

contributed to appellant’s left elbow conditions. The Board has found that medical evidence that 

states a conclusion, 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.17 Because

Dr. Chen did not provide a reasoned opinion explaining how, physiologically, the March 4, 2014

employment incident caused or contributed to appellant’s left elbow condition, his reports are 

insufficient to establish her claim.

Appellant also submitted a report from Dr. Weiss, who diagnosed inter alia chronic lateral 

epicondylitis to the left elbow. Dr. Weiss opined that the employment-related injuries of July 22, 

2005, September 26, 2010, February 10, March 28, 2013, and March 4, 2014 were the competent 

producing factors of her objective diagnoses. As previously discussed, the Board has found that 

medical evidence that provides a conclusion, but does not offer a rationalized medical explanation 

regarding the cause of an employee’s condition is of limited probative value on the issue of causal 

relationship.18 Because Dr. Weiss’ report did not provide sufficient rationalized medical 

 

15 D.H., Docket No. 17-1913 (issued December 13, 2018); L.B., Docket No. 18-0533 (issued August 27, 2018);

Linda I. Sprague, 48 ECAB 386 (1997).

16 Id. 

17 R.C., supra note 6; J.F.,Docket No. 09-1061 (issued November 17, 2009); A.D., 58 ECAB 149 (2006).

18 Id.
6

explanation explaining how the March 4 2014 employment incident was sufficient to have caused 

appellant’s diagnosed left elbow condition, his report is of limited probative value.19

OWCP also received an unsigned hospital report, which noted that appellant injured her 

left elbow on a metal cage while at work, that she had elbow tenderness laterally and along the 

lateral epicondyle, no edema, no swelling, full range of motion, and a diagnosis of left elbow 

contusion at that time. Reports that are unsigned or that bear illegible signatures cannot be 

considered as probative medical evidence because they lack proper identification.20 Thus, this 

report is insufficient to meet appellant’s burden of proof.

In order to obtain benefits under FECA an employee 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.21 Because appellant has failed to provide such evidence demonstrating that her 

diagnosed left elbow condition was causally related to the accepted March 4, 2014 employment 

incident, she has not met her burden of proof to establish her traumatic injury claim.22

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 left elbow 

condition causally related to the accepted March 4, 2014 employment incident.

 

19 The duty status reports which accompany the physicians’medical reports in the record are of no probative value 

as they do not contain an opinion on the issue of causation. See supranote 16.

20 T.C., Docket No. 18-1351 (issued May 9, 2019); Thomas L. Agee, 56 ECAB 465 (2005); RichardF. Williams, 55 

ECAB 343 (2004).

21 Supra note 7.

22 The Board notes that the employing establishment issued an authorization for examination and/or treatment 

(Form CA-16). A completed Form CA-16 authorization may constitute a contract for payment of medical expenses 

to a medical facility or physician, when properly executed. The form creates a contractual obligation, which does not 

involve the employee directly, to pay for the cost of the examination or treatment regardless of the action taken on the 

claim. See 20 C.F.R. § 10.300(c); J.G., Docket No. 17-1062 (issued February 13, 2018); Tracy P. Spillane, 54 ECAB 

608 (2003).
7

ORDER

IT IS HEREBY ORDERED THAT the September 28, 2018 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: October 8, 2019

Washington, DC

Christopher J. Godfrey, Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board