United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

V.G., Appellant

and

U.S. POSTAL SERVICE, JAMES A. FARLEY 

POST OFFICE, New York, NY, Employer

__________________________________________

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Docket No. 19-0908

Issued: October 25, 2019

Appearances: Case Submitted on the Record

Thomas S. Harkins, Esq., for the appellant1

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 March 26, 2019 appellant, through counsel, filed a timely appeal from a February 12, 

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 bilateral shoulder 

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

FACTUAL HISTORY

On May 27, 2016 appellant, then a 45-year-old modified general clerk, filed an 

occupational disease claim (Form CA-2) alleging that she developed left shoulder derangement 

and impingement syndrome due to factors of her federal employment including reaching above 

her neck to answer the telephone.

3

 She identified April 21, 2016 as the date she first became aware 

of her condition, and May 2, 2016 as the date she first realized her condition was caused or 

aggravated by her employment.

In an undated statement, appellant indicated that on April 21, 2016 she reached for the 

telephone with her left arm and placed it next to her right ear and felt a sharp shooting pain from 

her shoulder to her left arm. 

Appellant was treated in the emergency room on April 21, 2016 by Dr. Rana Biary, an 

emergency medical specialist, for chronic left shoulder pain. Dr. Biary noted that appellant’s

history was significant for left shoulder rotator cuff tear and pinched nerve. She indicated that 

appellant’s left shoulder pain was similar to pain experienced in her prior injury. Dr. Biary 

performed a trigger point injection.

In a report and corresponding letter dated May 23, 2016, Dr. Igor Cohen, a Board-certified

neurologist, examined appellant and noted that on April 21, 2016 she was repeatedly answering

the phone using her left arm, twisting her left shoulder. Dr. Cohen noted moderate tenderness in 

the left rotator cuff, restricted range of motion with pain, positive impingement sign, and intact 

muscle strength in upper and lower extremities except at 4/5 in the left deltoid, biceps, triceps. He 

noted intact sensation to light touch and pinprick in all dermatomes except hypoesthesia in the left 

from C5-C6 dermatomes. Dr. Cohen reported a history of work-related injuries and findings 

consistent with left shoulder derangement and advised that appellant was totally disabled. He 

opined that within a reasonable degree of medical certainty that these conditions were causally 

related to the work duties performed since February 23, 2015 which included repetitive reaching 

above her shoulder with the left arm to answer phones with an already “damaged left shoulder.” 

Dr. Cohen indicated that such duties would have exacerbated her left shoulder injury resulting in 

left shoulder impingement and left shoulder derangement.

 

3 Appellant was working limited duty as a result of a previous employment-related left shoulder injury, accepted 

for a shoulder strain. That claim was assigned OWCP File No. xxxxxx113. Appellant underwent authorized left 

shoulder surgeries on April 22, 2005 and December 15, 2006. She returned to work in a part-time, limited-duty 

capacity, and OWCP paid her compensation for intermittent wage loss from April 17, 2015 through April 29, 2016. 

On May 25, 2017 OWCP administratively combined File No. xxxxxx113 with the present claim. File No. xxxxxx113 

is designated as the master file.
3

On a corresponding form report dated June 13, 2016 Dr. Cohen checked a box marked 

“yes” indicating that the employment incident that appellant described was the “competent medical 

cause” of her diagnosed conditions.

In a development letter dated July 29, 2016, OWCP advised appellant that the evidence of 

record was insufficient to establish that her diagnosed left shoulder conditions were causally 

related to her employment activities. It notified her of the type of additional evidence needed, 

including a detailed factual statement describing the activities that she believed contributed to her 

condition and a report from her attending physician addressing causal relationship between any 

diagnosed condition and factors of her federal employment. OWCP afforded appellant 30 days to 

submit the requested evidence.

OWCP subsequently received a form report dated July 11, 2016, wherein Dr. Cohen 

diagnosed other specific joint derangements of the left shoulder and noted that appellant remained 

disabled from work. 

A magnetic resonance imaging (MRI) scan of appellant’s left shoulder, dated August 17, 

2016, revealed a mild partial thickness supraspinatus tendon tear affecting the articular greater 

than bursal surfaces, minor subacromial spur formation, and minimal spurring of glenoid rim 

anteriorly with mild diffuse labral degeneration.

By decision dated September 2, 2016, OWCP denied appellant’s claim, finding that the 

medical evidence submitted did not establish that the claimed medical condition was causally 

related to the established work-related events. 

On September 13, 2016 appellant requested a telephonic hearing before an OWCP hearing 

representative. Additional evidence was subsequently received.

Appellant underwent physical therapy treatments from January 6, 2015 to July 8, 2016. 

OWCP received a January 12, 2016 report from Dr. Danya E. Reich, a Board-certified 

family practitioner, noted in a handwritten report dated January 12, 2016 that she had treated 

appellant for severe neck pain likely due to her head and neck positioning while using the phone 

at work. Dr. Reich indicated that appellant needed a workplace evaluation for a new phone with 

headset or an alternative solution to correct her head positioning.

In reports dated March 21 and April 20, 2016, Dr. Cohen noted findings on examination of 

the left shoulder of moderate tenderness in the rotator cuff, restricted range of motion with pain, 

positive impingement test, and intact muscle strength in upper and lower extremities except 4/5 in 

the left deltoid, biceps, Dr. Cohen diagnosed history left shoulder derangement, left shoulder 

impingement syndrome, and status post left shoulder arthroscopies. He advised that appellant 

returned to a sedentary position on February 23, 2015 with occasional lifting up to five pounds, no 

reaching at the shoulder level or overhead, and no pushing or pulling heavy objects or operating 

heavy machinery. In a form report dated April 3, 2017, Dr. Cohen diagnosed other specific joint 

derangements of the shoulder and opined that appellant remained totally disabled from work. 
4

In a statement dated April 17, 2016, appellant’s coworker, B.C., indicated that on at least 

three occasions she relieved appellant from phone duties prior to the scheduled time due to her

pain and stiffness in her shoulder. 

A hearing was held on April 5, 2017. By decision dated May 18, 2017, OWCP’s hearing 

representative affirmed the September 2, 2016 decision.

On September 1, 2017 appellant, through a representative, requested reconsideration and 

submitted additional evidence. A left shoulder MRI scan dated July 10, 2017 revealed mild diffuse 

rotator cuff tendinosis, low-to-moderate grade elongated articular-sided tear within the anterior 

supraspinatus tendon without significant change, no full thickness rotator cuff tear, mild 

acromioclavicular (AC) joint impingement, and a superior labrum from anterior to posterior 

position (SLAP) tear which appeared to be new from the prior study. A right shoulder MRI scan 

revealed mild diffuse rotator cuff tendinosis, low grade curvilinear articular sided tear within the 

anterior supraspinatus tendon, mild degenerative changes at the AC joint, and moderate AC joint 

impingement.

On July 14, 2017 appellant was treated by Dr. Marc Levinson, a Board-certified physiatrist, 

for bilateral shoulder pain. She provided a history of injury consistent with using her shoulder to 

answer telephones at work. Dr. Levinson opined that this activity resulted in a new SLAP tear to 

the left shoulder. He further opined that as a result of favoring the left shoulder she developed 

tendinosis and a low grade tear in the right shoulder rotator cuff from overuse. Findings on 

examination of the left shoulder revealed well-healed arthroscopic scars, limited range of motion, 

strength was 4/5, anterior joint line tenderness, and positive Neer, Hawkins, and O’Brien signs. 

Examination of the right shoulder revealed strength of 4/5, and positive Neer and Hawkins signs.

Dr. Levinson diagnosed internal derangement of the left shoulder, right shoulder tendinitis, and 

rotator cuff tear arthropathy of the right shoulder. 

By decision dated November 30, 2017, OWCP denied modification of the May 18, 2017 

decision.

On November 23, 2018 appellant through counsel requested reconsideration and submitted 

additional evidence. 

In a July 30, 2018 report, Dr. Cohen noted his treatment of appellant’s shoulders. 

Appellant reported that her condition significantly worsened on April 21, 2016 when she 

accidentally twisted her left shoulder while repeatedly reaching for and answering phones at work. 

Dr. Cohen diagnosed left shoulder derangement, left shoulder SLAP tear, consequential right 

shoulder derangement, bilateral shoulder impingement, bilateral shoulder rotator cuff tendinitis , 

and status post left shoulder arthroscopy twice. He continued to note that she was totally disabled.

On November 2, 2018 Dr. Levinson saw appellant in follow up for pain and limitation in 

both shoulders. Appellant reported that on April 21, 2016 she was reaching for the telephone at 

work and developed significant pain in the left shoulder radiating down her left arm. Her history 

was significant for a prior injury to her left shoulder which required surgery. Dr. Levinson noted 

findings on examination of the left shoulder revealed well-healed arthroscopic surgery scars, 

limited range of motion, strength of 3/5, anterior joint line tenderness, positive Neer, Hawkins, and 
5

O’Brien signs, and supraspinatus atrophy. He diagnosed internal derangement of the left shoulder

and midline rotator cuff tear of the right shoulder. Dr. Levinson noted that the left shoulder injury 

was causally related to appellant’s injury of April 21, 2016 and the right shoulder was 

consequential to the right shoulder injury. He opined that the continued overuse of the left shoulder 

resulted in damage to the cells of the tissues of the shoulder tendons.

By decision dated February 12, 2019, OWCP denied modification of the November 30, 

2017 decision. 

LEGAL PRECEDENT

An employee seeking benefits under FECA4 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 filed within the applicable time 

limitation; that an injury was sustained while in the performance of duty as alleged; and that any 

disability or specific 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 on a traumatic injury or an occupational disease. 6

In an occupational disease claim, appellant’s burden requires submission of 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 employment factors 

identified by the employee.7

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

relationship is rationalized medical evidence.8 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. 9 

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.10

 

4

Supra note 2.

5 M.S., Docket No. 18-1280 (issued March 12, 2019).

6

S.C., Docket No. 18-1242 (issued March 13, 2019).

7 P.D., Docket No. 17-1885 (issued September 17, 2018).

8 L.D., Docket No. 17-1581 (issued January 23, 2018); JacquelineM. Nixon-Steward, 52 ECAB 140 (2000).

9 L.D., id.; see also Leslie C. Moore, 52 ECAB 132 (2000); Gary L. Fowler, 45 ECAB 365 (1994).

10 T.H., Docket No. 18-1736 (issued March 13, 2019); Dennis M. Mascarenas, 49 ECAB 215 (1997).
6

In any case where a preexisting condition involving the same part of the body is present 

and the issue of causal relationship therefore involves aggravation, acceleration or precipitation, 

the physician must provide a rationalized medical opinion that differentiates between the effects 

of the work-related injury or disease and the preexisting condition.11

ANALYSIS

The Board finds that appellant has not met her burden of proof to establish bilateral 

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

In support of her claim, appellant submitted an emergency room note by Dr. Biary,

following treatment on April 21, 2016 for chronic left shoulder pain, who diagnosed rotator cuff 

tear and a pinched nerve. Dr. Biary explained that appellant had prior, similar shoulder pain due 

to a previous employment injury. She did not, however, provide an opinion as to the cause of the 

diagnosed conditions. 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.12 The report of Dr. Biary, therefore, is insufficient to establish appellant’s claim.

On May 23 and July 11, 2016 Dr. Cohen treated appellant for left shoulder pain.13 He 

noted appellant’s prior left shoulder surgeries as well the April 21, 2016 work incident in which 

she repeatedly used her left arm to reach and answer the phones. Dr. Cohen diagnosed history of 

work-related injuries and findings consistent with left shoulder derangement. Although he 

diagnosed left shoulder derangement, he did not specifically address the cause of the diagnosed 

condition. 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.14

On May 23, 2016 Dr. Cohen indicated that appellant was injured in 2004 and remained 

totally disabled until February 23, 2015 when she returned to a limited-duty position for six hours 

a day. He diagnosed left shoulder derangement and left shoulder impingement syndrome and 

opined within a reasonable degree of medical certainty that these conditions were caused by 

repetitive reaching above the shoulder with the left arm to answer phones from February 23, 2015 

to April 21, 2016. Although Dr. Cohen opined that the incident appellant described was the 

competent cause of her injury he did not provide a well-reasoned medical explanation with 

supporting objective findings as to how the claimed work-related activities directly caused or 

aggravated a medical condition. The Board has held that a report is of limited probative value 

 

11 Federal (FECA) Procedure Manual, Part 2 -- Claims, Causal Relationship, Chapter 2.805.3e (January 2013).

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

13 In reports dated March 21 and April20, 2016, Dr. Cohen diagnosed history left shoulder derangement, left 

shoulder impingement syndrome, and status post left shoulder arthroscopy twice. These reports have no relevance to 

the current issue of causal relationship as they predate the April 21, 2016 employment incident.

14 Supra note 12.
7

regarding causal relationship if it does not contain medical rationale explaining how a given 

medical condition/disability was related to employment factors.15 

On July 30, 2018 Dr. Cohen treated appellant and noted her history of injury and 

preexisting left shoulder condition from her prior claim. He diagnosed left shoulder derangement, 

left shoulder SLAP tear, consequential right shoulder derangement, bilateral shoulder 

impingement, bilateral shoulder rotator cuff tendinitis, and status post left shoulder arthroscopy 

twice. Dr. Cohen did not provide an opinion as to the cause of the diagnosed conditions, thus this 

report is of no probative value and is insufficient to establish appellant’s claim.16

Appellant also submitted a series of form reports dated May 23 and July 11, 2016 and 

April 3, 2017, in which Dr. Cohen noted a date of injury of April 21, 2016 and diagnosed other 

specific joint derangements of the shoulder. Dr. Cohen advised that appellant was totally disabled 

from work. He checked a box marked “yes” indicating that the diagnosed conditions were caused 

by her workplace duties. The Board has held, however, that when a physician’s opinion on causal 

relationship consists only of checking “yes” to a form question, without explanation or rationale, 

that opinion has little probative value and is insufficient to establish a claim.17

Appellant underwent MRI scans of the left and right shoulders. The Board has held that 

reports of diagnostic tests lack probative value as they do not provide an opinion on causal 

relationship between appellant’s employment duties and a diagnosed condition.18

Appellant submitted various reports from a physical therapist19 dated from January 6, 2015 

to July 8, 2016. These reports are insufficient to satisfy appellant’s burden of proof as physical 

therapists are not considered physicians as defined under FECA and their reports are of no 

probative value.

20

In a handwritten note dated January 12, 2016, Dr. Reich opined that appellant’s neck pain 

is “likely” due to her head/neck position of phone at work. However, this report is speculative. 

The Board has held that medical opinions that are speculative or equivocal in character are of 

diminished probative value.

21

 Therefore, this report is insufficient to meet appellant’s burden of 

proof.

 

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

16 Supra note 12.

17 See M.O., Docket No. 18-1056 (issued November 6, 2018); DeborahL. Beatty, 54 ECAB 3234 (2003).

18 See J.M.,Docket No. 17-1688 (issued December 13, 2018).

19 T.H., Docket No. 18-1736 (issued March 13, 2019).

20 5 U.S.C. § 8101(2); 20 C.F.R. § 10.5(t); K.W., 59 ECAB 271, 279 (2007); David P. Sawchuk, 57 ECAB 316, 320 

n.11 (2006). 

21 D.D., 57 ECAB 734 (2006).
8

In July 14, 2017 and November 2, 2018 reports, Dr. Levinson noted appellant’s history of 

injuries to her left shoulder and her current complaints due to employment duties from reaching 

above her shoulder and twisting to answer a telephone. He initially diagnosed internal 

derangement of the left shoulder, right shoulder tendinitis, and rotator cuff tear arthropathy of the 

right shoulder and later diagnosed internal derangement of the left shoulder, midline rotator cuff 

tear of the right shoulder and opined that left shoulder injury was causally related to appellant’s 

injury of April 21, 2016. Dr. Levinson concluded that the continued overuse of appellant’s left 

shoulder resulted in damage to the cells of the tissues of the shoulder tendons. The Board finds 

that, although Dr. Levinson supported causal relationship, he did not provide medical rationale 

explaining his conclusory opinion regarding causal relationship between appellant’s left shoulder 

tear, or a consequential right shoulder condition, and the accepted factors of employment.22 Such 

rationale is particularly necessary as appellant had preexisting shoulder conditions and he failed to 

differentiate between the symptoms of the preexisting condition and the effects of the current 

conditions. Therefore, this report is also insufficient to meet appellant’s burden of proof. 

On appeal counsel asserts that appellant submitted sufficient evidence to establish that she 

developed a left shoulder condition causally related to repetitively reaching for a telephone at 

work. As discussed, however, the medical evidence of record is insufficient to establish causal 

relationship between her diagnosed conditions and the accepted employment factors. As appellant 

has not submitted rationalized medical evidence, the Board finds that she has not met her burden 

of proof to establish her occupational disease claim.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 her burden of proof to establish bilateral 

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

 

22 See T.M., Docket No. 08-0975 (issued February 6, 2009).

23 P.D., supra note 7.
9

ORDER

IT IS HEREBY ORDERED THAT the February 12, 2019 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: October 25, 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