United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

N.G., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Jefferson, GA, Employer

__________________________________________

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Docket No. 19-0928

Issued: September 13, 2019

Appearances: Case Submitted on the Record

Alan J. Shapiro, 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 March 27, 2019 appellant, through counsel, filed a timely appeal from a January 24, 

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.

 

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.
2

ISSUE

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

injury causally related to the accepted October 26, 2017 employment incident.

FACTUAL HISTORY

On October 26, 2017 appellant, then a 52-year-old rural mail carrier, filed a traumatic 

injury claim (Form CA-1) alleging that she felt a sharp pulling sensation and pain in her right 

shoulder and armpit while turning a heavy package on its end in order to scan it while in the 

performance of duty. Appellant stopped work on October 26, 2017.3

Appellant submitted an authorization for examination and/or treatment form (Form CA16) completed on October 26, 2017 by Stephen Burton, a physician assistant, who listed the history 

of injury on that date as a “reinjury” following a February 2017 right shoulder surgery. Mr. Burton

checked a box marked “Yes” to indicate that appellant’s right shoulder condition was caused or 

aggravated by the “employment activity described.”

4

 He indicated that appellant was unable to 

work. In an October 26, 2017 disability note, Mr. Burton advised that appellant was unable to 

work for two weeks. Appellant also submitted medical evidence from a time prior to the 

October 26, 2017 employment incident. In an August 17, 2017 work status note, Dr. Bradley C. 

Register, a Board-certified orthopedic surgeon, indicated that appellant could return to her regular 

full-time work on September 5, 2017.

In a November 6, 2017 development letter, OWCP requested that appellant submit 

additional factual and medical evidence in support of her claim, including a physician’s opinion 

supported by a medical explanation as to how the alleged October 26, 2017 employment incident 

had caused or aggravated a medical condition. It afforded appellant 30 days to respond.

In response, appellant submitted a November 15, 2017 statement in which she provided 

further details of the alleged October 26, 2017 employment incident. She advised that in 

February 2017 she underwent right shoulder surgery and that she subsequently returned to her 

regular work. Appellant also submitted a November 9, 2017 work status note in which

Dr. Register advised that appellant could return to work on that date with restrictions including no 

lifting more than five pounds.

By decision dated December 11, 2017, OWCP denied appellant’s claim finding that she 

had not submitted evidence sufficient to establish the medical component of fact of injury. It also 

found that the medical evidence of record did not contain a diagnosis of appellant’s condition.

 

3 On the reverse of the Form CA-1 appellant’s immediate supervisor challenged the claim asserting that the case 

record did not contain a medical opinion explaining how the claimed injury was caused or aggravated by employment 

factors. In an October 27, 2017 letter, a health and resource management official also advised that the employing 

establishment was challenging the claim.

 

4 Mr. Burton provided a diagnosis code, which he identified as being derived from the tenth revision of the 

International Classification of Diseases (ICD-10), but the diagnosis code does not correspond to any established ICD10 code. The Form CA-16 makes reference to Dr. Charles L. Ogburn, III, a Board-certified orthopedic surgeon, but 

it is not counter-signed by him.
3

OWCP concluded, therefore, that the requirements had not been met to establish an injury as 

defined by FECA.

On May 14, 2018 appellant requested reconsideration of the December 11, 2017 decision. 

In an accompanying letter, she asserted that the package she turned on its end on October 26, 2017 

weighed between 50 and 70 pounds.5

Appellant submitted a February 23, 2017 report in which Dr. Register described the right 

shoulder surgery he performed on that date, including right shoulder arthroscopic rotator cuff 

repair with bovine and Achilles tendon augmentations, arthroscopic biceps tenodesis, subacromial 

compression, and distal clavicle excision.6

In a January 29, 2018 report, Dr. Register noted that appellant reported feeling a strain in 

her right shoulder while lifting a package (weighing 50 to 70 pounds) at work on October 26, 2017. 

He advised that appellant reported that she was recovering well from her February 23, 2017 

surgery until her most recent injury on October 26, 2017. Dr. Register discussed his physical 

examinations of appellant between November 9, 2017 and January 12, 2018, noting that she had 

excellent range of motion in her right shoulder (with 4/5 strength upon external rotation), but also 

exhibited moderate tenderness in the right posterior shoulder/right paraspinal musculature. He 

noted that October 26, 2017 right shoulder x-rays showed evidence of prior surgery without 

evidence of complication or new bony injury. Dr. Register indicated, “It is my opinion that her 

work injury on [October 26, 2017] did cause a recurrence of these symptoms.” He maintained that 

appellant was doing very well following her February 23, 2017 surgery until she felt a right 

shoulder strain on October 26, 2017. Dr. Register indicated that she had been “having problems”

ever since that time.7

In an April 27, 2018 report, Dr. Register indicated that appellant had been performing fullduty work for approximately a month prior to her October 26, 2017 injury and was not 

experiencing any problems during this period. He indicated, “Therefore, I do believe that this new 

injury on October 26, 2017 lead [sic] to her new symptoms.”

By decision dated July 25, 2018, OWCP denied modification of its December 11, 2017 

decision, noting that appellant had not submitted evidence sufficient to establish the medical 

component of fact of injury.

On October 31, 2018 appellant, through counsel, requested reconsideration of the July 25, 

2018 decision.

Appellant submitted a September 21, 2018 report from Dr. Register who noted that a 

February 12, 2018 magnetic resonance imaging scan of the right shoulder showed a large articular 

 

 

5 The record contains a report of termination of disability and/or payment (Form CA-3) showing that appellant 

returned to work for the employing establishment on December 11, 2017.

6 There is no indication in the case record that this surgery was authorized by OWCP.

7

In a February 2, 2018 report, Dr. Register indicated that the injury appellant sustained on October 26, 2017 caused 

her “new right posterior shoulder symptoms.”
4

surface partial tear of the posterior supraspinatus/infraspinatus which was located more posterior 

to the repair location of the February 23, 2017 surgery. Dr. Register diagnosed unspecific rotator 

cuff tear or rupture of the right shoulder and noted that this condition “looks to be a new injury.” 

He advised that on July 12, 2018 he performed arthroscopic revision rotator cuff repair of the right 

shoulder with arthroscopic lysis of adhesions of the glenohumeral joint.8 Dr. Register indicated, 

“It is my opinion that this most recent surgery was necessitated by a tear to the posterior 

supraspinatus and the anterior infraspinatus, which she most likely sustained on [October 26, 2017] 

with a work injury.”

By decision dated January 24, 2019, OWCP affirmed its July 25, 2018 decision as modified 

to reflect that appellant’s claim was now denied because she had not submitted medical evidence 

sufficient to establish causal relationship between a diagnosed medical condition and the

October 26, 2017 employment incident.

LEGAL PRECEDENT

An employee seeking benefits under FECA 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,9that 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.10 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.11

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. 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.12 The second component is whether the employment incident caused a personal injury.13 

 

8 The case record does not contain a report of the July 12, 2018 surgery and there is no indication that the surgery 

was authorized by OWCP.

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

153 (1989).

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

ECAB 312 (1988).

11 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).

12 B.P., Docket No. 16-1549 (issued January 18, 2017); Elaine Pendleton, 40 ECAB 1143 (1989).

13 M.H., Docket No. 18-1737 (issued March 13, 2019); John J. Carlone, 41 ECAB 354 (1989). 
5

Rationalized medical opinion evidence is required to establish causal relationship. The 

opinion of the physician must be based on a complete factual and medical background, 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 incident.14 

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.15

ANALYSIS

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

injury causally related to the accepted October 26, 2017 employment incident.

Appellant submitted a January 29, 2018 report in which Dr. Register provided a brief 

description of the October 26, 2017 employment incident and advised that appellant was 

recovering well from her February 23, 2017 surgery until her most recent injury on

October 26, 2017. Dr. Register noted that, in late-2017 and early-2018, appellant exhibited 

various right shoulder symptoms upon examination, including 4/5 strength upon external rotation 

and moderate tenderness in the right posterior shoulder/right paraspinal musculature. He noted, 

“It is my opinion that her work injury on [October 26, 2017] did cause a recurrence of these 

symptoms.” In a February 2, 2018 report, Dr. Register indicated that the injury appellant sustained 

on October 26, 2017 caused her “new right posterior shoulder symptoms.” On April 27, 2018 he

advised that she had been performing full-duty work for approximately a month prior to her 

October 26, 2017 injury and was not experiencing any problems during this period. Dr. Register

posited that, therefore, appellant’s “new injury” on October 26, 2017 led to her “new symptoms.”

The Board finds that these reports have limited probative value with respect to appellant’s 

claim that she sustained a right shoulder injury due to the October 26, 2017 employment incident.16 

Dr. Register did not describe the October 26, 2017 employment incident in any notable detail or 

explain the mechanism through which the incident could have caused or aggravated a diagnosed 

medical condition. In these reports, he described various right shoulder symptoms that appellant 

reported after October 26, 2017, but he did not diagnose a specific medical condition. The Board 

has held that a report is of limited probative value regarding causal relationship if it does not

contain medical rationale explaining how an employment activity could have caused or aggravated 

a medical condition.17 As noted, Dr. Register indicated that appellant was recovering well from her 

February 23, 2017 surgery and only developed multiple right shoulder symptoms after the

October 26, 2017 incident. However, the Board has held that the fact that a condition manifests itself 

or worsens during a period of employment or that work activities produce symptoms revelatory of 

an underlying condition does not raise an inference of causal relationship between a claimed 

 

14 S.S., Docket No. 18-1488 (issued March 11, 2019). 

15 J.L., Docket No. 18-1804 (issued April 12, 2019).

16 The Board notes that OWCP accepted that on October 26, 2017 appellant felt pain in her right shoulder region 

while turning a package (weighing 50 to 70 pounds) on its end.

17 See Y.D., Docket No. 16-1896 (issued February 10, 2017).
6

condition and employment factors.18 For these reasons, Dr. Register’s January 29, February 2, and 

April 27, 2018 reports are insufficient to establish appellant’s claim.

In a September 21, 2018 report, Dr. Register did, in fact, provide a diagnosis which he 

related to the October 26, 2017 employment incident, i.e., unspecific rotator cuff tear or rupture of 

the right shoulder as demonstrated by diagnostic testing.

19

 He advised that on July 12, 2018 he 

performed a revision rotator cuff repair of the right shoulder and indicated that this surgery was 

necessitated by the tear/rupture which appellant “most likely sustained” at work on 

October 26, 2017. The Board has long held that medical opinions that are speculative or equivocal 

in character have little probative value.20 Moreover, Dr. Register did not provide further 

explanation of how the October 26, 2017 employment incident caused or contributed to such a 

condition. His September 21, 2018 report contains a conclusory opinion without the necessary 

rationale explaining how and why the employment incident was sufficient to result in the diagnosed 

right shoulder tear/rupture. The Board has held that such an opinion is insufficient to meet a 

claimant’s burden of proof to establish a claim.21 

As the record does not contain a well-rationalized opinion establishing causal relationship 

between appellant’s claimed medical condition and her accepted October 26, 2017 employment

incident, the Board finds that she has not met her burden of proof.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 that she 

sustained a right shoulder injury causally related to the accepted October 26, 2017 employment 

incident.

 

 

18 J.S., Docket No. 18-0944 (issued November 20, 2018).

19 Dr. Register noted that this tear/rupture was located more posterior to the repair location of the February 23, 2017 

surgery and indicated that the condition “looks to be a new injury.”

20 Z.B., Docket No. 17-1336 (issued January 10, 2019); T.M., Docket No. 08-0975 (issued February 6, 2009).

 

21 J.D., Docket No. 14-2061 (issued February 27, 2015).

22 The case record contains an October 26, 2017 authorization for examination and/or treatment form (Form CA16) and an October 26, 2017 disability note completed by Mr. Burton, a physician assistant. However, under FECA, 

the report of a nonphysician, including a physician assistant, does not constitute probative medical evidence. R.S., 

Docket No. 16-1303 (issued December 2, 2016). The Board further notes that, where an employing establishment 

properly executes a Form CA-16 authorizing medical treatment related to a claim for a work injury, the form creates 

a contractual obligation, which does not involve the employee directly, to pay for the cost of the examination/treatment 

regardless of the action taken on the claim. See Tracy P. Spillane, 54 ECAB 608 (2003). The period for which 

treatment is authorized by a Form CA-16 is limited to 60 days from the date of issuance, unless terminated earlier by 

OWCP. See 20 C.F.R. § 10.300(c).
7

ORDER

IT IS HEREBY ORDERED THAT the January 24, 2019 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: September 13, 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