United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

N.R., Appellant

and

U.S. POSTAL SERVICE, PROCESSING & 

DISTRIBUTION CENTER, Louisville, KY, 

Employer

__________________________________________

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Docket No. 19-1366

Issued: December 6, 2019

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

CHRISTOPHER J. GODFREY, Chief Judge

PATRICIA H. FITZGERALD, Deputy Chief Judge

ALEC J. KOROMILAS, Alternate Judge

JURISDICTION

On June 8, 2019 appellant filed a timely appeal from a December 19, 2018 merit decision

of the Office of Workers’ Compensation Programs (OWCP). Pursuant to the Federal Employees’

Compensation Act1(FECA) and 20 C.F.R. §§ 501.2(c) and 501.3, the Board has jurisdiction over 

the merits of this case.2

 

1 5 U.S.C. § 8101 et seq.

2 The Board notes that, following the issuance of the December 19, 2018 merit 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 her burden of proof to establish a left elbow 

condition causally related to the accepted November 2, 2018 employment incident.

FACTUAL HISTORY

On November 5, 2018 appellant, then a 35-year-old mail processing clerk, filed a traumatic 

injury claim (Form CA-1) alleging that on November 2, 2018 she experienced soreness and 

tightness in her left elbow while in the performance of duty. It was noted on the form that the 

cause of her injury was unknown. On the reverse side of the claim form the employing 

establishment challenged the claim, contending that the cause of appellant’s claimed injury was 

unknown and she had not reported the injury for three days nor stopped work when she noticed 

the injury. 

In a November 5, 2018 narrative statement, appellant described the circumstances 

surrounding the claimed November 2, 2018 employment incident. She noted that after returning 

from lunch at 9:00 p.m. her left elbow began to “hurt and tighten up. Appellant further noted that 

as she continued to work through the night, her elbow stiffened and she could no longer move it. 

She related that she used her right arm to move packages throughout the rest of her shift. 

OWCP received an attending physician’s report (Form CA-20) and excuse from work note 

dated November 5, 2018 from Kristen Wheeler, a certified physician assistant. Ms. Wheeler 

diagnosed left elbow effusion and pain and opined that appellant’s conditions were caused or 

aggravated by moving boxes/mail at work on November 2, 2018. She advised that appellant could 

return to work on November 7, 2018, after being cleared by a physician.3

OWCP also received a properly executed authorization for examination and/or treatment 

form (Form CA-16) authorizing appellant’s medical treatment for her left elbow. 

In a development letter dated November 9, 2018, OWCP informed appellant of the 

deficiencies of her claim and requested additional medical evidence, including a well-rationalized 

medical report from a physician which provided an opinion as to how the alleged incident caused

or aggravated a diagnosed medical condition. It afforded her 30 days to submit the necessary 

evidence.

OWCP thereafter received a form report and a medical report, both dated November 6, 

2018, from Melissa Edds, a certified physician assistant. Ms. Edds diagnosed left lateral 

epicondylitis and released appellant to return to work with restrictions on November 7, 2018. 

OWCP also received hospital records, including a November 5, 2018 medical report from

Dr. James Chung, a Board-certified internist. Dr. Chung noted a history that appellant had worked 

at the employing establishment and that she had presented with left elbow pain with swelling down 

 

3 On November 7, 2018 the employing establishment offered appellant a full-time modified position which she 

accepted on that date. 
3

the left forearm into the hand which started the previous Friday. He discussed examination 

findings and diagnosed effusion of the left elbow joint and pain/swelling in the left elbow. 

In a November 15, 2018 left elbow x-ray report, Dr. Todd Blodgett, a Board-certified 

diagnostic radiologist, provided an impression of moderate-size joint effusion without a clear 

fracture. He recommended further evaluation by computerized tomography scan to determine 

whether appellant had an occult fracture. 

Dr. Thomas Loeb, a Board-certified orthopedic surgeon, noted in a November 21, 2018

report that appellant was last seen by Ms. Edds approximately two weeks prior and was diagnosed 

with left elbow lateral epicondylitis and was placed in a tennis elbow cuff. He reported findings 

on physical examination of the left elbow and also provided an assessment of lateral epicondylitis. 

Dr. Loeb recommended that appellant continue to wear the tennis elbow cuff. 

By decision dated December 19, 2018, OWCP accepted that the November 2, 2018 

employment incident occurred in the performance of duty as alleged. However, it denied 

appellant’s traumatic injury claim finding that the medical evidence of record was insufficient to 

establish that her medical condition was causally related to the accepted employment incident. 

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

defined by FECA. 

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,4that an injury wassustained 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.5 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.6

To determine whether a federal employee has sustained a traumatic injury in the

performance of duty, it first must be determined whether fact of injury has been established. 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. The second component is whether the employment incident

caused a personal injury.7

 

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

153 (1989).

5

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

ECAB 312 (1988).

6 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).

7 M.H., Docket No. 18-1737 (issued March 13, 2019); John J. Carlone, 41 ECAB 354 (1989). 
4

The evidence required to establish causal relationship is rationalized medical opinion

evidence. 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 factors identified by the claimant.8 The belief of the claimant that a condition was

caused or aggravated by the employment is insufficient to establish causal relationship.9

ANALYSIS

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

condition causally related to the accepted November 2, 2018 employment incident.

In a report dated November 5, 2018, Dr. Chung noted appellant’s history of injury, 

discussed examination findings, and diagnosed effusion of the left elbow joint and pain/swelling 

in the left elbow. However, he did not offer a rationalized medical opinion indicating that her left 

elbow conditions were causally related to the November 2, 2018 employment incident. 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.10 This report, therefore, is 

insufficient to establish appellant’s claim.

Similarly, Dr. Loeb in his November 21, 2018 report diagnosed left elbow lateral 

epicondylitis, but he did not provide an opinion addressing causal relationship. His report is 

therefore of no probative value on causal relationship.11 

Appellant also submitted Dr. Blodgett’s November 15, 2018 left elbow x-ray report in 

support of her claim. The Board has held that diagnostic studies lack probative value as they do 

not address whether the employment incident caused a diagnosed condition.12 Such reports are 

therefore insufficient to establish appellant’s claim. 

The reports from Ms. Wheeler and Ms. Edds, physician assistants, have no probative 

medical value on the issue of causal relationship as physician assistants are not considered 

physicians as defined under FECA.13 Consequently, the medical findings and/or opinions of a 

 

8

I.J., 59 ECAB 408 (2008); Victor J. Woodhams, 45 ECAB 345(1989).

9 See M.J., Docket No. 17-0725 (issued May 17, 2018); see also Lee R. Haywood, 48 ECAB 145 (1996); Kathryn

Haggerty, 45 ECAB 383, 389 (1994).

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

11 Id.

12 B.C., Docket No. 18-1735 (issued April 23, 2019); J.S., Docket No. 17-1039 (issued October 6, 2017).

13 5 U.S.C. § 8101(2). See also B.K., Docket No. 19-0829 (issued September 25, 2019); T.C., Docket No. 19-0227 

(issued July 11, 2019); K.W., 59 ECAB 271, 279 (2007); David P. Sawchuk, 57 ECAB 316, 320 n.11 (2006) (Under 

FECA the term physician includes surgeons, podiatrists, dentists, clinical psychologists, optometrists, chiropractors, 

and osteopathic practitioners within the scope of their practice as defined by the applicable state law). Federal (FECA) 

Procedure Manual, Part 2 -- Claims, Causal Relationship, Chapter 2.805.3a(1) (January 2013).
5

physician assistant are of no probative value for purposes of establishing entitlement to 

compensation benefits.14

As there is no well-reasoned medical opinion establishing appellant’s claim for 

compensation the Board finds that she has not met her burden of proof.15

On appeal appellant contends that Dr. Loeb’s reports establish her claim for a work-related 

left elbow condition because he would not have completed the workers’ compensation 

documentation if he did not believe her condition was work related. However, as explained above,

Dr. Loeb did not provide an opinion on causal relationship supported by medical rationale, 

explaining the nature of the relationship between the diagnosed condition and accepted 

November 2, 2018 employment incident. Without a rationalized medical report submitted by 

appellant, she has not met her burden of proof to establish her 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 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 November 2, 2018 employment incident.16

 

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

15 D.N., Docket No. 19-0070 (issued May 10, 2019); R.B., Docket No. 18-1327 (issued December 31, 2018).

16 The record contains a Form CA-16 signed by an employing establishment official. When the employing 

establishment properly executes a Form CA-16 which authorizes medical treatment as a result of an employee’s claim 

for an employment-related injury, the Form CA-16 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. C.W., 

Docket No. 17-1293 (issued February 12, 2018); 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).
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ORDER

IT IS HEREBY ORDERED THAT the December 19, 2018 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: December 6, 2019

Washington, DC

Christopher J. Godfrey, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Alec J. Koromilas, Alternate Judge

Employees’ Compensation Appeals Board