United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

L.J., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Blairstown, NJ, Employer

__________________________________________

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Docket No. 17-1993

Issued: March 13, 2018

Appearances: Case Submitted on the Record

Michael D. Overman, 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 September 26, 2017 appellant, through counsel, filed a timely appeal from a June 29, 

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 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 after the June 29, 2017 decision. The Board’s 

jurisdiction is limited to evidence that was before OWCP at the time of its final decision. Therefore, the Board is 

precluded from reviewing this additional evidence for the first time on appeal. 20 C.F.R. § 501.2(c)(1).
2

ISSUE

The issue is whether appellant has established that her right elbow condition was causally 

related to her February 26, 2014 accepted employment injury. 

FACTUAL HISTORY

On March 18, 2014 appellant, then a 47-year-old supervisor in customer services, filed a 

traumatic injury claim (CA-1) alleging that on February 26, 2014 she sprained her right knee 

when she slipped on ground covered by snow and ice in the performance of her federal 

employment duties. In a supporting statement, she alleged that on February 26, 2014 she twisted 

her right knee and fell down, landing on the inside of her right knee, foot and on her right elbow. 

Appellant stopped work on March 11, 2014 and returned to work on March 17, 2014. The 

employing establishment controverted the claim.

In a March 13, 2014 report, Dr. Daniel A. Shaw, a Board-certified orthopedic surgeon,

noted that appellant reported discomfort following a work-related injury on February 26, 2014 

when she slipped on ice and reported injuring her right knee, foot, and elbow. He noted that she

has been trying to work in the meantime, but that her symptomatology persisted. Dr. Shaw

diagnosed right knee sprain with possible torn meniscus and right forefoot sprain. Appellant 

continued to submit reports by Dr. Shaw that discussed his treatment of her right knee.

By development letter dated May 27, 2014, OWCP informed appellant that additional 

factual and medical information was necessary to establish her claim. It afforded her 30 days to 

submit the necessary information. No additional information was received.

In a July 2, 2014 decision, OWCP denied appellant’s claim, finding that she had not 

established that she was in the performance of duty at the time of the alleged incident.

On July 16, 2014 appellant, through counsel, requested a hearing before an OWCP 

hearing representative. During the hearing held on November 25, 2014, appellant testified that 

she began working for the employing establishment on June 23, 2007, and that, on the date of 

injury, she was working on rural accounts. She stated that there was no place to get coffee on the 

premises, and that while going to get coffee on an authorized break at a store a few doors down, 

she slipped and fell on ice that was covered by a small amount of snow. Appellant indicated that 

she injured her right foot, knee, and elbow. She testified that she kept working after the injury, 

but that eventually she saw Dr. Shaw because her symptoms continued. Counsel contended that 

she was injured in the performance of duty.

By decision dated January 20, 2015, the hearing representative determined that appellant 

was in the performance of duty when she fell. However, he denied her claim as he determined 

that the medical evidence was insufficient to establish causal relationship between a diagnosed 

condition and the accepted fall on February 26, 2014.

On January 19, 2016 appellant, through counsel, requested reconsideration. In support 

thereof, he submitted report from Dr. Shaw dated January 15, 2016. Dr. Shaw noted that she

sought treatment on March 13, 2014 for an employment-related injury sustained on February 26, 
3

2014 when “she slipped on ice and banged her right knee, foot, and elbow on concrete.” 

Appellant told him that she had concerns regarding her right knee, right foot, and right elbow. 

At that time, Dr. Shaw diagnosed right knee sprain, significant symptomatic exacerbation of 

previously asymptomatic patellofemoral arthritis, and right forefoot sprain. He summarized the 

test results and appellant’s treatment on her right knee and right foot. Dr. Shaw opined that 

within a reasonable degree of medical probability she sustained a work-related injury on 

February 26, 2014 which resulted in injuries to her right knee, right foot and right elbow. He 

explained that appellant falling and landing on her right knee, foot, and elbow on concrete was 

consistent with injury to her right knee, right foot, and right elbow. Dr. Shaw noted that, as 

manifest on her December 22, 2015 follow-up, her post-traumatic right knee pathology persisted 

and had not healed. He further opined that appellant’s right foot injury was directly caused by 

the accident of February 26, 2014 and noted a diagnosis of mild sprain of the right foot great toe 

metatarsophalangeal joint.

With regard to appellant’s right elbow, Dr. Shaw noted that her elbow was not prioritized 

until her most recent visit on December 22, 2015. He noted that at that time she did have 

significant tenderness at the medical aspect of the elbow associated with a stiffening sensation 

and a feeling of a “toothache in the elbow.” Appellant noted a jabbing/needle sensation 

aggravated by outstretch, reaching, or lifting, which had persisted since the time of the initial 

injury. Dr. Shaw noted that the right elbow examination demonstrated exquisite tenderness at 

the medial humeral epicondyle and mild soft tissue swelling. Radiographs of the right elbow 

showed a one centimeter void density superficial to the medial humeral epicondyle. Right elbow 

magnetic resonance imaging (MRI) scan was prescribed, but the results were not yet available, 

so a definitive right elbow diagnosis remained to be determined. Dr. Shaw continued to submit 

reports discussing his treatment of appellant’s right knee.

On April 15, 2016 OWCP vacated the decision of January 20, 2016 in part, noting that

Dr. Shaw provided a well-reasoned medical report explaining exactly how the fall of 

February 26, 2014 caused a right knee sprain and a great toe sprain. It therefore accepted 

appellant’s claim for sprain of the right knee and right great toe. However, OWCP determined 

that the evidence was insufficient to overturn the entire decision because Dr. Shaw had not 

provided a discussion or a diagnosis regarding the right elbow condition.

In a progress note from his December 22, 2015 report, Dr. Shaw noted that an x-ray of 

appellant’s right elbow revealed a one centimeter ovoid density superficial to the medial humeral 

epicondyle. No significant intra-articular degenerative changes were noted. Dr. Shaw diagnosed 

work-related injury of February 26, 2014; right elbow medial epicondylitis, post-traumatic with 

medial epicondylar ossific density, symptomatic; right knee arthritis, post-traumatic; and right 

knee patellofemoral arthritis, post-traumatic.

Dr. Shaw continued to provide treatment and reports with regard to appellant’s right 

knee. Further notes detailing physical therapy on the right knee were also submitted. 

In a September 23, 2016 report, Dr. Shaw noted that once appellant’s right knee 

symptomatology had diminished sufficiently, effective December 23, 2015 attention was able to 

be thoroughly focused on her right elbow symptomatology. He also noted that notes from 

Westfield Orthopedic Group indicated that she had scheduled appointments for evaluation of 
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right elbow symptomatology on August 29 and September 5, 2014, although she was not actually 

seen on those dates. Dr. Shaw noted that, when he saw appellant on December 22, 2015, she 

reported still being most severely affected by symptomatology not only in her right knee, but her 

right elbow. Appellant indicated that her right elbow pain had persisted since the time of the 

initial injury. 

On October 5, 2016 appellant requested reconsideration. In support thereof, she

submitted a February 27, 2016 MRI scan of the elbow report wherein Dr. Christina P. Annese, a 

Board-certified radiologist, found tendinosis of the common flexor tendon origin with 

questionable small focus of calcific tendinopathy and mild adjacent edema.

By decision dated June 29, 2017, OWCP denied modification of its April 15, 2016 

decision because appellant had not submitted a medical narrative from a treating physician which 

established causal relationship for the right elbow condition and also discussed the mechanism of 

injury. It noted that since the earliest medical report that addressed her right elbow condition 

was dated December 22, 2015, which was one year and two months after her injury, appellant’s

treating physician must provide a rationalized causal relationship explanation based on complete 

and accurate factual and medical history. OWCP further noted that the physician should also 

explore and consider nonwork-related factors or contributions when providing his explanation 

regarding causal relationship.

LEGAL PRECEDENT

An employee has the burden of proof to establish that any specific condition for which 

compensation is claimed is causally related to the employment injury.4 Causal relationship is a 

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

medical evidence.5 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.6 Neither the 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.7

ANALYSIS

Appellant alleged that she sustained injury to her right knee, foot, and elbow when she 

fell on ice in the performance of duty on February 26, 2014. OWCP accepted her claim for 

sprain of the right knee and right great toe. 

 

4 Kenneth R. Love, 50 ECAB 193 (1998). 

5

Jacqueline M. Nixon-Steward, 52 ECAB 140 (2000).

6 Leslie C. Moore, 52 ECAB 132 (2000); Gary L. Fowler, 45 ECAB 365 (1994). 

7 Dennis M. Mascarenas, 49 ECAB 215 (1997). 
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The Board finds that appellant has not met her burden of proof to establish that her right

elbow condition was caused or aggravated by the accepted February 26, 2014 employment 

injury. 

In a progress note dated December 22, 2015, Dr. Shaw diagnosed additional conditions 

causally related to the February 26, 2014 employment injury: right elbow medial epicondylitis, 

post-traumatic with medial epicondylar ossific density, symptomatic; post-traumatic right knee

osteoarthritis; and post-traumatic patellofemoral arthritis. In a September 23, 2006 report, he

noted that initially the attention was focused on appellant’s right knee, but that effective 

December 23, 2015 attention was able to now be focused on her right elbow symptomatology. 

Dr. Shaw noted that when he saw her on December 22, 2015, she reported still being affected by 

symptomatology not only in her right knee, but also in her right elbow.

The reports from Dr. Shaw are insufficient to establish appellant’s claim for right elbow 

injury as they do not contain a rationalized medical opinion explaining how her diagnosed right 

elbow conditions were causally related to the February 26, 2014 employment injury. When

Dr. Shaw first saw her with regard to the February 26, 2014 employment injury on March 13, 

2014, he noted that in addition to complaining of pain in her right knee and foot, she also 

complained of right elbow pain. Dr. Shaw made no medical diagnosis with regard to appellant’s 

right elbow at that time and did not discuss any injury to her right elbow until his report of 

December 22, 2015, at which time he concluded that she had symptomatic right elbow medial 

epicondylitis, post-traumatic, with medial epicondyle ossific density. In his January 15, 2016 

note, he explained that priority prior to that time was given to dealing with her right knee

condition, but that now her right elbow was having significant symptoms. Dr. Shaw noted that 

appellant hit her elbow when she fell, that she had persistent symptoms in her elbow since the 

employment injury, and that she had scheduled appointments to follow up with regard to her 

elbow, but that these appointments did not occur. 

The Board finds that Dr. Shaw’s opinion is not well rationalized. There is no evidence of 

any problem with appellant’s right elbow in between Dr. Shaw’s March 13, 2014 report and his 

December 22, 2015 report. Dr. Shaw’s reports, with the above brief exceptions, only discuss her

right knee and right foot. The fact that appellant scheduled an appointment with regard to her 

right elbow, but that the appointment did not take place is of no importance to determining 

whether she had a right elbow injury causally related to her accepted employment injury. 

Although Dr. Shaw suggested that her right elbow conditions were causally related to the 

accepted employment injury, he did not provide adequate medical rationale explaining the basis 

of his opinion regarding causal relationship.8 He did not discuss the February 26, 2014 

employment injury in any detail or explain the medical process through which it could have been 

responsible for the diagnosed right elbow conditions.9 The Board has held that medical evidence 

which does not offer a clear opinion explaining the physiological cause of an employee’s 

 

8

J.S., Docket No. 14-0818 (issued August 7, 2014). 

9 See R.B., Docket No. 16-1700 (issued September 25, 2017).
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condition is of limited probative value on the issue of causal relationship.

10

 Dr. Shaw’s reports 

were therefore insufficient to establish causal relationship. 

The Board notes that the diagnostic study by Dr. Annese was also insufficient to meet 

appellant’s burden of proof as she does not address whether the February 26, 2014 work injury

caused the 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 

To establish causal relationship, a claimant must submit a physician’s report in which the 

physician reviews the employment injury identified as causing the claimed condition and, taking 

this injury into consideration as well as findings upon examination, explains with medical 

rationale how the employment injury caused or aggravated the diagnosed condition.13 The Board 

finds that appellant submitted insufficient rationalized medical evidence supporting causal 

relationship between the accepted February 26, 2014 employment injury and her right elbow 

condition.

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 established that her right elbow condition was 

causally related to her February 26, 2014 employment injury.

 

10 Id. 

11 G.M., Docket No. 14-2057 (issued May 12, 2015).

12 See T.N., Docket No. 17-0773 (issued October 2, 2017).

13 M.R., Docket No. 17-1154 (issued January 10, 2018). 
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ORDER

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

Compensation Programs dated June 29, 2017 is affirmed.

Issued: March 13, 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