United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

A.M., Appellant

and

U.S. POSTAL SERVICE, NEWARK-BEAR

CARRIER ANNEX, Bear, DE, Employer

__________________________________________

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Docket No. 19-1970

Issued: May 6, 2020

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

JANICE B. ASKIN, Judge

PATRICIA H. FITZGERALD, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On September 26, 2019 appellant filed a timely appeal from an August 28, 2019 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.

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ISSUE

The issue is whether appellant has met her burden of proof to establish a medical condition 

causally related to the accepted July 10, 2019 employment incident.

 

1 5 U.S.C. § 8101 et seq.

2 The record provided to the Board includes evidence received after OWCP issued its August 28, 2019 decision.

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.
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FACTUAL HISTORY

On July 12, 2019 appellant, then a 28-year-old city carrier assistant, filed a traumatic injury 

claim (Form CA-1) alleging that on July 10, 2019 she sustained an injury to her upper chest muscle 

when she was moving a hard mail tray from the rear of her vehicle while in the performance of 

duty. She did not stop work. 

In a July 11, 2019 statement, appellant related that on July 10, 2019, while completing her 

route, she pulled her upper chest muscle in the process of moving a hard tray of flats from the rear 

outside of her vehicle to the loading tray in the front of the vehicle. She noted that the incident 

took place around 3:00 p.m. and when her supervisor arrived she declined medical attention at that 

time because of personal reasons.

A July 11, 2019 medical report from Christiana Care Hospital noted that appellant was in 

the emergency department for conditions, including chest wall pain. In a work excuse note of even 

date, Dr. Stephen J. Koczirka, Board-certified in emergency medicine, excused appellant from 

work for one day. 

A July 12, 2019 medical report from the Christiana Care Hospital noted that appellant had 

returned to the emergency department for musculoskeletal chest pain and vocal cord dysfunction. 

In a work excuse note of even date, Dr. Ashley Panicker, Board-certified in emergency medicine, 

excused appellant from work for one day.

In a July 15, 2019 authorization for examination and/or treatment (Form CA-16), the 

employing establishing authorized appellant to seek medical care at Horizon Family Practice. In 

Part B of the Form CA-16, attending physician’s report, of even date, Candice Reynolds, a nurse 

practitioner, reported that appellant experienced pulling in her chest and shortness of breath as a 

result of lifting mail at work. She diagnosed costochondritis and chest tenderness. Ms. Reynolds

checked a box marked “yes” indicating that the diagnosed conditions were caused or aggravated 

by the described employment activity. She opined that appellant was totally disabled from work 

from July 10 to August 6, 2019. In a duty status report (Form CA-17) of even date, Ms. Reynolds 

noted that appellant was unable to perform any duties and advised not to return to work. 

In a July 26, 2019 development letter, OWCP informed appellant of the deficiencies in her 

claim and afforded her 30 days to submit appropriate medical evidence. 

In a July 29, 2019 Form CA-17, Ms. Reynolds diagnosed chest wall tenderness and noted 

that appellant could return to work the next day with restrictions. 

In an August 8, 2019 medical report, Dr. Carol Alvarado noted that appellant had been a 

patient at Horizon Family Practice since June 10, 2019 and was first seen by Ms. Reynolds on 

July 15, 2019. She noted that appellant related to Ms. Reynolds that while lifting an unknown 

weight of boxes on July 10, 2019 she had sudden chest pain, as well as shortness of breath and

tingling in her arms. Dr. Alvarado noted that Ms. Reynolds diagnosed costochondritis and 

provided Motrin for pain and Atarax for anxiety. She indicated that appellant was then seen by 

her on August 2, 2019. Ms. Reynolds observed that appellant persisted with chest pain and dry 

cough. She noted that appellant was a nonsmoker and had no asthma. Dr. Alvarado stated that 
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appellant’s dry cough was treated as hyperactive airway disease with azithromycin, Flovent, and 

promethazine cough syrup. She further noted that blood work was ordered to rule out undiagnosed 

sickle cell disease, which results were still pending. Dr. Alvarado explained that appellant’s cough 

needed to be controlled since it was worsening her chest pain. 

By decision dated August 28, 2019, OWCP denied appellant’s traumatic injury claim 

finding that the medical evidence submitted was insufficient to establish causal relationship 

between her diagnosed condition and the accepted July 10, 2019 employment incident. 

LEGAL PRECEDENT

An employee seeking benefits under FECA3 has the burden of proof to establish the 

essential elements of his or her claim, including 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 of FECA,4that 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.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. Second component is whether the employment incident 

caused a personal injury and can be established only by medical evidence.7 

The medical evidence required to establish a causal relationship between a claimed specific 

condition and an employment incident is rationalized medical opinion evidence.8 The opinion of 

the physician must be based on a complete factual and medical background of the employee, must 

be one of reasonable medical certainty, and must be supported by medical rationale explaining the 

 

3 Supra note 1.

4 F.H., Docket No.18-0869 (issued January 29, 2020); J.P., Docket No. 19-0129 (issued April 26, 2019); Joe D. 

Cameron, 41 ECAB 153 (1989). 

5 L.C., Docket No. 19-1301 (issued January 29, 2020); J.H., Docket No. 18-1637 (issued January 29, 2020); 

James E. Chadden, Sr., 40 ECAB 312 (1988).

6 P.A., Docket No. 18-0559 (issued January 29, 2020); K.M., Docket No. 15-1660 (issued September 16, 2016); 

Delores C. Ellyett, 41 ECAB 992 (1990).

7 T.H., Docket No. 19-0599 (issued January 28, 2020); K.L., Docket No. 18-1029 (issued January 9, 2019); John J. 

Carlone, 41 ECAB 354 (1989).

8 S.S., Docket No. 19-0688 (issued January 24, 2020); A.M., Docket No. 18-1748 (issued April 24, 2019); Robert G. 

Morris, 48 ECAB 238 (1996).
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nature of the relationship between the diagnosed condition and specific employment factors 

identified by the employee.9

ANALYSIS

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

condition causally related to the accepted July 10, 2019 employment incident. 

In an August 8, 2019 medical report, Dr. Alvarado noted that appellant reported

experiencing sudden chest pain, shortness of breath, and tingling in her arms while lifting unknown 

weight of boxes while working on July 10, 2019. She further noted that appellant was previously

diagnosed with costochondritis. Dr. Alvarado observed that appellant persisted with chest pain 

and dry cough and indicated that she was a nonsmoker and had no asthma. However, such 

generalized statements do not establish causal relationship because they merely repeat appellant’s 

allegations and are unsupported by adequate medical rationale explaining how the accepted 

July 10, 2019 employment incident actually caused a diagnosed medical condition.10 The Board 

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

contain medical rationale explaining how a given medical condition was related to an accepted 

employment incident.11 Without explaining how lifting of unspecified weight of mail caused or 

contributed to appellant’s injuries, Dr. Alvarado’s August 8, 2019 medical evidence is of limited 

probative value.12 Therefore, her medical report is insufficient to meet appellant’s burden of proof.

Appellant further submitted reports signed by Ms. Reynolds, a nurse practitioner. These 

medical reports do not constitute competent medical evidence because a nurse practitioner is not 

considered a “physician” as defined under FECA and is therefore not competent to provide medical 

opinions.13 Consequently, this evidence is also insufficient to establish appellant’s claim.

As none of the medical evidence appellant submitted constitutes rationalized medical 

evidence sufficient to establish causal relationship between the accepted July 10, 2019 

employment incident and her diagnosed costochondritis, the Board finds that appellant has not met 

her burden of proof.14

 

9 T.L., Docket No. 18-0778 (issued January 22, 2020); Y.S., Docket No. 18-0366 (issued January 22, 2020); Victor J. 

Woodhams, 41 ECAB 345, 352 (1989).

10 See U.B., Docket No. 18-0691 (issued March 12, 2020); J.B., Docket No. 18-1006 (issued May 3, 2019).

11 G.R., Docket No. 19-0940 (issued December 20, 2019); D.L., Docket No. 19-0900 (issued October 28, 2019).

12 See R.C., Docket No. 19-1770 (issued March 27, 2020); A.P., Docket No. 19-0224 (issued July 11, 2019).

13 Section 8101(2) of FECA provides that physician “includes surgeons, podiatrists, dentists, clinical psychologists, 

optometrists, chiropractors, and osteopathic practitioners within the scope of their practice as defined by State law.”

5 U.S.C. § 8101(2). See also C.S., Docket No. 19-1279 (issued December 30, 2019) (nurse practitioners are not 

considered physicians as defined under FECA). 

14 R.G., Docket No. 18-0792 (issued March 11, 2020).
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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 a medical 

condition causally related to the accepted July 10, 2019 employment incident.15

ORDER

IT IS HEREBY ORDERED THAT the August 28, 2019 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: May 6, 2020

Washington, DC

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Alternate Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board

 

15 The Board notes that the employing establishment issued a Form CA-16. A completed Form CA-16 authorization 

may constitute a contract for payment of medical expenses to a medical facility or physician, when properly executed. 

The form creates a contractual obligation, which does not involve the employee directly, to pay for the cost of the 

examination or treatment regardless of the action taken on the claim. See 20 C.F.R. § 10.300(c); J.G., Docket No. 

17-1062 (issued February 13, 2018); Tracy P. Spillane, 54 ECAB 608 (2003).