United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

D.S., Appellant

and

U.S. POSTAL SERVICE, NEW CITY POST 

OFFICE, New City, NY, Employer

__________________________________________

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Docket No. 19-1814

Issued: April 1, 2020

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

CHRISTOPHER J. GODFREY, Deputy Chief Judge

JANICE B. ASKIN, Judge

JURISDICTION

On August 28, 2019 appellant, through counsel, filed a timely appeal from a July 30, 2019 

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,following the July 30, 2019 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.
2

ISSUE

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

conditions causally related to the accepted factors of his federal employment.

FACTUAL HISTORY

On November 13, 2018 appellant, then a 54-year-old letter carrier, filed an occupational 

disease claim (Form CA-2) alleging that he had begun to experience persistent pain in the right 

shoulder that gradually worsened in severity due to factors of his federal employment, including 

repetitive lifting, pushing, grabbing, and loading. He indicated that he first became aware of the 

condition and attributed it to factors of his federal employment on August 15, 2018. Appellant 

stopped work on October 2, 2018. 

October 2, 2018 x-rays of appellant’s right shoulder revealed mild osteoarthritis. The xrays showed mild bony spurring at the glenohumeral and acromioclavicular joints. A partial

October 9, 2018 magnetic resonance imaging (MRI) scan report of his right shoulder revealed a 

rotator cuff tear with supraspinatus tendon retraction and subacromial/subdeltoid bursitis. It also 

showed evidence of long head biceps tendinitis. 

In a November 13, 2018 attending physician’s report (Form CA-20), Dr. James Giordano, 

an orthopedic surgeon, noted that appellant had been experiencing right shoulder pain for four

months while driving and delivering packages in his capacity as a letter carrier. He diagnosed 

right shoulder bicep tendinitis and a complete rotator cuff tear/rupture in the right shoulder. 

Dr. Giordano checked a box marked “Yes” to indicate that the diagnosed conditions were caused 

or aggravated by an employment activity. He added that appellant’s pain started on approximately 

August 15, 2018 while appellant was lifting heavy packages, working as a letter carrier. 

Dr. Giordano noted that appellant would be disabled from work for an indeterminate period of 

time as he required surgery. 

In a November 26, 2018 development letter, OWCP informed appellant that the evidence 

of record was insufficient to establish his claim. It advised him of the type of medical evidence 

needed, including a comprehensive narrative medical report from a qualified physician explaining 

how factors of his federal employment caused, contributed to, or aggravated his diagnosed medical 

conditions. OWCP afforded appellant 30 days to submit the necessary evidence. 

In an October 2, 2018 report, Dr. Giordano noted that appellant had been experiencing right 

shoulder pain for four months. He noted that appellant’s pain was worse with activity and that 

appellant also experienced pain while driving and carrying heavy packages. Dr. Giordano 

reviewed x-rays of appellant’s right shoulder and diagnosed rotator cuff syndrome of the right 

shoulder. 

An October 9, 2018 MRI scan of appellant’s right shoulder revealed a rotator cuff tear with 

supraspinatus tendon retraction and subacromial/subdeltoid bursitis. It also showed evidence for 

long head biceps tendinitis. 

In an October 12, 2018 report, Dr. Giordano reported that appellant was experiencing 

continued right shoulder pain while carrying heavy packages at work. He noted that appellant did 
3

not perform heavy lifting at home. Dr. Giordano responded “Yes” to a question as to whether 

appellant’s work activity was the “competent medical cause of [appellant’s] injury/illness.” He 

reviewed a right shoulder MRI scan and diagnosed a nontraumatic complete rotator cuff tear or 

rupture of the right shoulder. Dr. Giordano noted that appellant wished to pursue surgical 

management for his right shoulder condition. In a follow-up report dated October 19, 2018 report,

he again reviewed a right shoulder MRI scan and diagnosed a nontraumatic complete rotator cuff 

tear or rupture of the right shoulder and biceps tendinitis of the right shoulder. 

In a November 13, 2018 report, Dr. Giordano noted that appellant was still experiencing 

right shoulder pain and that he believed that it started on August 15, 2018. He again answered 

“Yes” to a question as to whether appellant’s work activity was the “competent medical cause of 

[appellant’s] injury/illness.” Dr. Giordano examined appellant and diagnosed biceps tendinitis of 

the right shoulder, a nontraumatic complete rotator cuff tear or rupture of the right shoulder, and 

rotator cuff syndrome of the right shoulder. He noted that appellant would undergo right shoulder 

arthroscopy with rotator cuff repair, subacromial decompression, partial acromioplasty, and 

possible biceps tenodesis open. In an accompanying Form CA-20 of even date, Dr. Giordano 

reiterated appellant’s diagnoses, noted that he worked as a mail carrier which required driving and 

lifting packages. He checked a box marked “yes” indicating that appellant’s diagnosed conditions 

were caused or aggravated by his employment activities. 

In November 28 and December 21, 2018 work excuse notes, Dr. Giordano confirmed that 

appellant was seen for medical appointments on both dates. 

In a January 21, 2019 report, Dr. Giordano noted that appellant was experiencing continued 

right shoulder pain that he believed was caused by the activities of lifting and driving at work. He 

answered “Yes” to a question regarding causal relationship. Dr. Giordano noted appellant’s 

diagnoses and indicated that appellant wanted to pursue surgery as soon as he obtained approval. 4 

By decision dated February 14, 2019, OWCP denied appellant’s claim finding that the 

medical evidence of record was insufficient to establish a causal relationship between his right 

shoulder conditions and the accepted factors of his federal employment. 

On February 21, 2019 appellant, through counsel, requested a telephonic hearing before an 

OWCP hearing representative. 

In a February 14, 2019 operative note, received by OWCP on May 20, 2019, Dr. Giordano 

noted that appellant underwent right shoulder arthroscopy with subacromial decompression and 

partial acromioplasty, right shoulder arthroscopy with rotator cuff repair, right shoulder open 

biceps tenodesis, and right shoulder arthroscopy with synovectomy. He listed postoperative 

diagnoses of right shoulder subacromial impingement, right shoulder rotator cuff tear, right 

shoulder biceps tear, right shoulder extensive synovitis, and right shoulder degenerative anterior 

labral fraying. 

In a February 26, 2019 letter, Dr. Giordano noted that he had been treating appellant for 

right shoulder biceps tendinitis and rotator cuff tear since October 2, 2018. He indicated that 

 

4

In an accompanying prescription, Dr. Giordano prescribed a right shoulder abduction sling and a cryocuff 

machine. 
4

appellant’s condition started on approximately August 15, 2018 as a nontraumatic injury and had 

progressed since that time. Dr. Giordano opined that the nature and duties of appellant’s job as a 

mail carrier, along with the motions of repetitive stress, led to the work-related injury. He found 

that the “causal relationship of the injury [was] directly correlated with [appellant’s] job duties.” 

In a March 9, 2019 report, Dr. Giordano indicated that he saw appellant for a postoperative 

visit on February 26, 2019. He noted that appellant was doing well following his right shoulder 

operations. Dr. Giordano reported that appellant was in a sling and was unable to work at that 

time. 

In a March 26, 2019 report, Dr. Giordano diagnosed biceps tendinitis of the right shoulder, 

a nontraumatic complete rotator cuff tear or rupture of the right shoulder, and rotator cuff syndrome 

of the right shoulder. In a letter of even date, he noted appellant’s diagnoses and opined that 

appellant’s condition “seem[ed] to be exasperated while performing [appellant’s] duties at work 

of lifting packages and also driving.” Dr. Giordano again opined that appellant’s injury was 

causally related to his job duties, which he again noted included “repetitive stress.” 

A telephonic hearing was held on June 7, 2019. Appellant described his continued 

problems with his right shoulder. The record was held open for 30 days for the submission of 

additional evidence. 

In a June 19, 2019 statement, appellant noted that his job duties had increased following 

the employing establishment’s contract with Amazon in November 2013. He indicated that the 

daily amount of packages increased by 15 to 30 packages for each route. Appellant also indicated 

that he received heavier packages which required more use of the arm and shoulder. He stated that 

holiday parcels increased immensely which required significant overtime from Thanksgiving 

through the New Year. 

By decision dated July 30, 2019, OWCP’s hearing representative affirmed the February 14, 

2019 decision finding that the medical evidence of record was insufficient to establish a causal 

relationship between appellant’s right shoulder conditions and the accepted factors of his federal 

employment.

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 period 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 

 

5

Supra note 2.

6 E.W., Docket No. 19-1393 (issued January 29, 2020); J.P., 59 ECAB 178 (2007); Joe D. Cameron, 41 ECAB 

153 (1989).
5

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 establish that an injury was sustained in the performance of duty in an occupational 

disease claim, a claimant must submit the following: (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 identified employment factors.9

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.10 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 claimant.11 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 caused or aggravated by employment factors or incidents, is sufficient to 

establish causal relationship.12

ANALYSIS

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

conditions causally related to the accepted factors of his federal employment.

In support of his claim, appellant submitted a series of medical reports from Dr. Giordano. 

The November 28 and December 21, 2018 work excuse notes from Dr. Giordano, and the 

February 20, 2019 surgical note from him did not offer 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.13 

In other reports dated from October 12, 2018 through January 21, 2019, Dr. Giordano 

provided multiple diagnoses related to appellant’s right shoulder condition and responded “Yes”

to questions as to whether appellant’s work activity was the medical cause of his diagnosed 

conditions. He offered no other opinion on causal relationship in these reports. The Board has 

 

7 L.C., Docket No. 19-1301 (issued January 29, 2020); R.C., 59 ECAB 427 (2008); James E. Chadden, Sr., 40 

ECAB 312 (1988).

8

20 C.F.R. § 10.115; E.S., Docket No. 18-1580 (issued January 23, 2020); L.M., Docket No. 13-1402 (issued 

February 7, 2014); DeloresC. Ellyett, 41 ECAB 992 (1990).

9

See T.L., Docket No. 18-0778 (issued January 22, 2020); Roy L. Humphrey, 57 ECAB 238, 241 (2005); Victor J. 

Woodhams, 41 ECAB 345, 352 (1989).

10 J.F., Docket No. 18-0492 (issued January 16, 2020); Jacqueline M. Nixon-Steward, 52 ECAB 140 (2000).

11 A.M., Docket No. 18-0562 (issued January 23, 2020); Leslie C. Moore, 52 ECAB 132 (2000).

12 E.W., supra note 6; Gary L. Fowler, 45 ECAB 365 (1994).

13 A.M., supra note 11.
6

held that when a physician’s opinion on causal relationship consists only of answering “yes” to a 

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

insufficient to establish a claim.14

In a February 26, 2019 letter, Dr. Giordano noted that appellant’s job duties, along with 

the motions of repetitive stress, led to his work-related injury. He opined that the “causal 

relationship of the injury [was] directly correlated with [appellant’s] job duties.” The Board has 

held that a medical opinion is of limited value if it is conclusory in nature.15 A medical opinion 

must explain how the implicated employment factors physiologically caused, contributed to, or 

aggravated the specific diagnosed conditions.16 While Dr. Giordano supported causal relationship, 

he did not provide medical rationale explaining the basis of his conclusory opinion regarding the 

causal relationship between appellant’s right shoulder conditions and the accepted factors of his 

federal employment.17 As such, his letter is insufficient to meet appellant’s burden of proof.18

In a March 26, 2019 letter, Dr. Giordano reiterated his opinion that appellant’s right 

shoulder conditions were causally related to his job duties. He added that appellant’s condition 

“seem[ed] to be exasperated while performing his duties at work of lifting packages and also 

driving.” As noted, a medical opinion must explain how the implicated employment factors 

physiologically caused, contributed to, or aggravated the specific diagnosed conditions. 19 

Additionally, the Board has held that a medical opinion supporting causal relationship must be one 

of reasonable medical certainty and not speculative or equivocal in character.20 Since

Dr. Giordano’s letter is equivocal in nature and lacks the proper medical rationale explaining 

causal relationship, it is of limited probative value.21

Appellant submitted multiple diagnostic studies. The Board has held, however, that 

diagnostic studies lack probative value on the issue of causal relationship as they do not address 

whether the implicated employment factors caused the diagnosed conditions.22 Accordingly, these 

diagnostic studies are insufficient to establish appellant’s claim.

As appellant has not submitted rationalized medical evidence explaining the causal 

relationship between his diagnosed right shoulder conditions and the accepted factors of his federal 

employment, the Board finds that he has not met his burden of proof.

 

14 J.S., Docket No. 18-0657 (issued February 26, 2020); Deborah L. Beatty, 54 ECAB 3234 (2003).

15 C.M., Docket No. 19-0360 (issued February 25, 2020).

16 Id.

17 Id.

18 L.J., Docket No. 19-1343 (February 26, 2020).

19 C.M., supra note 15.

20 A.M., Docket No. 19-1138 (issued February 18, 2020).

21 Id.

22 J.S., supra note 14; L.J., supra note 18.
7

On appeal counsel argues that OWCP called for a biomechanical explanation of injury 

which is beyond medical causation or pathophysiological explanation. The Board finds that 

OWCP correctly determined that the medical evidence of record was insufficient to establish 

causal relationship as the medical evidence did not explain how the accepted factors of appellant’s 

federal employment physiologically caused, contributed to, or aggravated his diagnosed 

conditions.23

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 that his right 

shoulder conditions were causally related to the accepted factors of his federal employment.

ORDER

IT IS HEREBY ORDERED THAT the July 30, 2019 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: April 1, 2020

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Christopher J. Godfrey, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

 

23 Id.