United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

V.G., Appellant

and

U.S. POSTAL SERVICE, SEMINOLE 

PROCESSING & DISTRIBUTION CENTER, 

Orlando, FL, Employer

__________________________________________

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Docket No. 20-0982

Issued: June 17, 2021

Appearances: Case Submitted on the Record

Wayne Johnson, Esq., for the appellant1

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 April 4, 2020 appellant, through counsel, filed a timely appeal from an October 7, 2019 

merit decision of the Office of Workers’ Compensation Programs (OWCP).2 Pursuant to the 

 

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 The Board notes that appellant has another appeal pending before the Board under Docket No. 20-0455,

concerning July 1, 2019 OWCP decisions. That appeal is not addressed in this decision and will proceed under its 

own docket number. 
2

Federal Employees’ Compensation Act3(FECA) and 20 C.F.R. §§ 501.2(c) and 501.3, the Board 

has jurisdiction over the merits of this case.4

ISSUE

The issue is whether appellant has met her burden of proof to establish that the acceptance 

of her claim should be expanded to include right shoulder rotator cuff tear, right carpal tunnel 

syndrome, and right stenosis tenosynovitis sustained as a consequence of her accepted January 23, 

2011 employment injury.

FACTUAL HISTORY

On January 23, 2011 appellant, then a 46-year-old mail handler, filed a traumatic injury 

claim (Form CA-1) alleging that on that date she injured her left hand when she helped a coworker 

clear up a jam in the dolley maker while in the performance of duty. She did not stop work. OWCP 

accepted her claim for left hand sprain and subsequently expanded acceptance of her claim to 

include left carpal tunnel syndrome, left cubital tunnel syndrome, left trigger finger (long and little 

fingers), and other joint derangement of left shoulder and left arm. Appellant subsequently 

underwent various OWCP-authorized surgeries for her left upper extremity conditions.5 OWCP 

paid her wage-loss compensation, effective January 13, 2013.6

In a May 29, 2014 report, Dr. Richard M. Blecha, a Board-certified orthopedic surgeon,

discussed appellant’s history of her January 23, 2011 employment injury and also noted that 

appellant underwent surgery for her right rotator cuff in 2008. He recounted that appellant always 

believed that this condition was due to repetitive use of her shoulder on the job, but noticed that 

this past year she had used her right shoulder more as she received treatment for her left shoulder. 

Dr. Blecha indicated that appellant also complained of worsening right shoulder pain, numbness 

in the thumb, index, and long finger on the right hand identical to her previous left-sided carpal 

tunnel syndrome symptoms, and ongoing back and neck pain. Upon physical examination, he 

observed positive Tinel’s testing over the median nerve of the right wrist and right ulnar nerve.

Sensory testing of the right upper extremity was unremarkable except for decreased light touch in 

the right long and index fingers. Dr. Blecha diagnosed left shoulder internal derangement and 

rotator cuff syndrome, left shoulder impingement, post arthroscopic surgery, left wrist post

neurolysis median nerve of the left wrist, post neurolysis ulnar nerve and anterior transposition of 

the left elbow, status post tenolysis trigger fingers of the left little, ring, and long fingers, right 

 

3 5 U.S.C. § 8101 et seq.

4 The Board notes that, following the October 7, 2019 decision, appellant submitted additional evidence to OWCP. 

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

5 On July 1, 2011 appellant underwent OWCP-approved left carpal tunnel, left cubital tunnel, and left trigger finger 

release surgery. She stopped work, but returned to full-time limited duty on August 10, 2011. On January 10, 2013 

appellant underwent OWCP-authorized left shoulder arthroscopic surgery and stopped work again. 

6 Appellant retired from federal employment, effective May 1, 2014. She elected to receive Civil Service 

Retirement Benefits. 
3

ulnar dysfunction, C8-T1 entrapment of the right upper extremity, internal derangement and partial 

thickness tear of the right shoulder, right wrist carpal tunnel syndrome, and cervical and lumbar 

disc syndrome. 

In a July 28, 2014 narrative report and a diagnosis update form report, Dr. Blecha requested 

to upgrade appellant’s accepted conditions to include right shoulder partial thickness rotator cuff 

tear, right wrist carpal tunnel syndrome, and right index finger stenosing tenosynovitis. He 

recounted that appellant was doing fairly well after her 2008 right shoulder surgery, but as she 

developed left shoulder problems her right shoulder became symptomatic again. Dr. Blecha 

reported: “it is felt that her current level of symptomatology is due to increased use of the right 

shoulder secondary to limited use of the left.” He also noted that over the last few years appellant 

had developed symptoms of right-sided carpal tunnel syndrome “felt to be compensatory because 

she was using the right hand more than the left when the left was symptomatic.” Dr. Blecha further 

indicated that appellant had developed triggering of the right index finger, which she stated was 

probably due to the fact that she was using the finger more because of some residual pain and 

soreness at the left hand. He provided examination findings and noted that previous diagnostic 

testing supported appellant’s conditions of right shoulder partial thickness tear of the rotator cuff, 

right wrist carpal tunnel syndrome, and right index finger stenosing tenosynovitis.

7

 Dr. Blecha

opined that all three of the problems were “felt to be compensatory resulting from overuse of the 

right upper extremity as she was troubled by symptoms of the accepted conditions present in the 

left upper extremity.”

Appellant also received medical treatment from Dr. Robert R. Reppy, an osteopath who 

specializes in family medicine. In reports dated September 29 and October 22, 2014, Dr. Reppy

reviewed appellant’s medical records and recounted her current complaints of neck pain and 

trigger finger deformity of her right index finger. He provided examination findings and diagnosed 

right shoulder partial thickness tear of the supraspinatus and infraspinatus tendon, bilateral rotator 

cuff syndrome, left wrist status postsurgical carpal tunnel and cubital tunnel syndrome release,

status post-surgical release of the trigger fingers of the left 3rd, 4th, and 5th fingers, left shoulder 

impingement syndrome, right ulnar neuropathy, entrapment of the C8-T1 nerve roots, left shoulder 

status postoperative arthroscopic surgery on the left shoulder and right shoulder internal 

derangement and impingement syndrome. In an October 22, 2014 report, Dr. Reppy opined that 

appellant’s right shoulder pain was consequential to the left-sided injury, due to the extra work 

stress put on that shoulder to compensate. 

In a November 26, 2014 follow-up evaluation report, Dr. Reppy recounted appellant’s 

complaints of right upper extremity pain in the hand, wrist, and elbow. He described the 

January 23, 2011 injury and noted that appellant had left hand surgery in July 2011. Dr. Reppy

reported that, by August, appellant began to have symptoms on the right arm because she was 

forced to utilize the right arm to compensate for the loss of use of the left arm from surgery. 

Regarding the right upper extremity symptoms that developed, he explained that, “first was the 

right trigger finger deformity after that appellant developed the right wrist pain from the carpal

tunnel and then lastly she developed the nerve entrapment syndrome of the elbow.” Dr. Reppy 

 

7 A May 28, 2013 right shoulder magnetic resonance imaging (MRI) scan report revealed acromiohumeral 

impingement and partial thickness tears of the supraspinatus and infraspinatus tendons. An April 14, 2014 bilateral 

upper extremity nerve conduction velocity (NCV) study demonstrated findings suggestive of mild carpal tunnel 

syndrome on the right and early or mild carpal tunnel syndrome on the left.
4

conducted an examination and diagnosed right upper extremity conditions of right shoulder rotator 

cuff tear, right wrist carpal tunnel syndrome, stenosing tenosynovitis, and right cubital tunnel 

syndrome involving the ulnar nerve. He continued to treat appellant for her right upper extremity 

symptoms and provided reports dated December 19, 2014 through March 20, 2015. 

In a February 13, 2015 letter, Dr. Reppy explained that, while the original injury focused 

on the left shoulder, appellant had to rely more upon the right upper extremity after the left shoulder 

surgery. He opined that “based on physical exam[ination], objective evidence, and my medical 

experience, her upper extremity diagnosis are, in fact, consequential injury to her original date of 

injury of 1/23/11 and should be compensable.” Dr. Reppy continued to treat appellant for her 

complaints of right upper extremity, cervical, and low back pain and provided reports dated 

April 24 through July 10, 2015. He requested that OWCP include appellant’s right shoulder and 

right upper extremity conditions to her list of accepted diagnoses. 

In reports dated April 14 and May 13, 2015, Dr. Samy Bishai, an orthopedic surgeon, 

recounted appellant’s complaints of problems with her right shoulder, elbow, wrist, and hand in 

very similar conditions to the ones on the left. Upon examination of her right shoulder, he observed 

tenderness overlying the anterior, lateral, and posterior aspects. Dr. Bishai diagnosed right upper 

extremity conditions of right shoulder joint internal derangement, right shoulder impingement 

syndrome, and partial thickness tear of the supraspinatus and infraspinatus tendons. He reported 

that appellant had a consequential injury to her right shoulder and right upper extremity as a result 

of the injuries to her left shoulder, elbow, and wrist. Dr. Bishai indicated that appellant “had to 

overuse the right upper extremity in order to be able to continue working.”

On June 3, 2015 appellant underwent a NCV study, which revealed an abnormal study of 

the upper extremities. The report noted evidence to suggest the presence of right C8-T1 

entrapment and the possibility of right median mononeuritis.

A June 27, 2015 right upper extremity MRI scan report revealed a full-thickness tear 

involving the supraspinatus tendon, partial tearing of the long head of the biceps tendon, and mild 

degenerative arthritis involving the acromioclavicular (AC) joint. 

In a July 13, 2015 letter, Dr. Reppy noted that office notes from 2013 reported that 

appellant had developed right shoulder and arm symptoms due to all the lifting and maneuvers that 

she performed with her upper extremities. He also pointed out that physicians, including 

Drs. Bishai and Blecha, had requested that appellant’s right shoulder and wrist conditions be added 

to her list of accepted conditions.

In an August 24, 2015 letter, OWCP informed appellant that it had received the request for 

expansion of her claim to include consequential right upper extremity conditions. It requested 

additional evidence in support of her claim for a consequential injury, including a physician’s 

rationalized medical opinion fully explaining how the current diagnosed conditions were related

to the accepted January 23, 2011 employment injury. OWCP afforded appellant 30 days to submit 

additional evidence.

Appellant continued to submit medical reports from Dr. Reppy dated August 21 through

October 23, 2015 regarding his medical treatment for her complaints of low back, bilateral 

shoulder, and neck pain. 
5

OWCP also received a September 20, 2015 letter by Dr. Reppy, who cited to Arnold 

Gustafson8and alleged that it was not necessary to prove a sufficient contribution of employment 

factors to a condition for the purpose of establishing causal relationship. Dr. Reppy noted 

diagnoses of status post right shoulder rotator cuff repair in 2008, right wrist carpal tunnel 

syndrome, stenosing tenosynovitis, right cubital tunnel syndrome with ulnar involvement, and 

bilateral supraspinatus and infraspinatus tears. He opined that appellant’s symptoms were directly 

related to her employment and that the conditions had not resolved. Dr. Reppy described the 

January 23, 2011 employment injury to her left upper extremity and explained that, because 

appellant had to rely more on her right arm during the postsurgical recovery period, she began to 

experience right arm symptoms by August of that year. He reported that appellant’s right shoulder 

preexisting injury was aggravated and became a consequential injury after appellant’s left arm 

became severely compromised by the hand surgery and subsequent recovery, which necessitated 

over-reliance on the other arm. 

By decision dated November 23, 2015, OWCP denied expansion of the acceptance of 

appellant’s claim to include a consequential injury. It found that the medical evidence of record 

did not demonstrate that weakness or impairment caused by her work-related injury or illness led 

to an aggravation of the original injury or to a new injury. 

On November 22, 2016 appellant, through counsel, requested reconsideration of the 

November 23, 2015 decision. 

Appellant continued to receive medical treatment from Dr. Reppy and submitted reports 

dated January 22, 2016 through January 13, 2017 regarding his treatment for her low back, neck, 

and bilateral shoulder pain. Dr. Reppy provided examination findings and noted right upper 

extremity diagnoses of supraspinatus and infraspinatus tears of both shoulders, right cubital tunnel 

syndrome, right wrist carpal tunnel syndrome, stenosing tenosynovitis, and status post right rotator 

cuff and clavicle surgery and repair in 2008.

OWCP also received additional diagnostic reports, including a May 14, 2016 right shoulder 

MRI scan report and an August 10, 2016 bilateral upper extremity NCV study report. 

Appellant submitted a February 1, 2017 report by Dr. Gary K. Arthur, a Board-certified 

psychiatrist and neurologist, who opined that appellant’s depression and anxiety were directly 

related to and caused by her physical disabilities and pain resulting from her January 23, 2011 

work injury.

By decision dated February 16, 2017, OWCP denied modification of the November 23, 

2015 decision. It found that the medical evidence of record was insufficient to establish that 

appellant’s diagnosed right shoulder and arm conditions were causally related or consequential to 

appellant’s accepted January 23, 2011 employment injury. 

On February 16, 2018 appellant, through counsel, requested reconsideration. 

Appellant continued to receive medical treatment from Dr. Reppy and submitted reports 

dated April 7 through September 15, 2017, regarding his treatment for her low back, neck, and 

 

8 41 ECAB 438 (1989).
6

bilateral shoulder pain. Dr. Reppy provided examination findings and diagnosed right upper 

extremity conditions of bilateral shoulder supraspinatus and infraspinatus tears, right carpal tunnel 

syndrome, right cubital tunnel syndrome, stenosing tenosynovitis, and right trigger finger.

In reports dated October 3 and December 12, 2017, Dr. Mark A. Seldes, a Board-certified 

family medicine specialist, recounted appellant’s complaints of continued pain in her left shoulder, 

elbow, and wrist despite prior surgeries. He indicated that appellant also had prior right shoulder, 

elbow, and wrist surgeries for carpal tunnel symptoms and requested that OWCP add the diagnoses 

of right carpal tunnel syndrome, right lesion of the ulnar nerve, and right shoulder rotator cuff tear 

as “consequential injuries.” Upon examination of appellant’s right shoulder, Dr. Seldes observed 

tenderness overlying the anterior, lateral, and posterior aspects of the right shoulder. Examination 

of appellant’s right elbow revealed slight tenderness over the medial aspect of the medial 

epicondyle as well as mild tenderness along the ulnar aspect of the forearm. Dr. Seldes also 

reported positive Tinel’s and Phalen’s testing on the right side. He diagnosed right upper extremity 

conditions of right ulnar nerve dysfunction, internal derangement of the right shoulder joint, right 

shoulder impingement syndrome, partial thickness tear of the supraspinatus and infraspinatus 

tendons of the right shoulder joint, and status postoperative release of carpal tunnel and cubital 

tunnel release. Dr. Seldes reported that appellant suffered from “consequential injuries to her right 

shoulder, elbow, wrist, and forearm secondary to the original injuries of her left shoulder, elbow, 

wrist, and forearm since the patient had overused and abuse her right upper extremity in doing 

most of the activities at work.” He continued to treat appellant for her bilateral upper extremity 

symptoms and submitted reports dated February 1 through May 1, 2018. 

In a February 7, 2018 report, Dr. Arthur again opined that appellant’s depression and 

anxiety were directly related to, and caused by, her physical disabilities and pain resulting from 

the January 23, 2011 employment injury. 

Appellant also began receiving medical treatment from Dr. Scott Gordon, a Board-certified 

orthopedic surgeon, for conditions of left elbow osteoarthritis and left thumb and index trigger 

finger conditions. He submitted reports and attending physician report forms (Form CA-20) dated 

January 9 through May 3, 2018. 

By decision dated July 9, 2018, OWCP denied modification of the February 16, 2017 

decision.

On July 9, 2019 appellant, through counsel, requested reconsideration. 

Appellant submitted reports dated August 1, 2018 through June 19, 2019 by Dr. Seldes. 

Dr. Seldes indicated that appellant’s left elbow continued to worsen and requested that OWCP add 

the conditions of left elbow osteoarthritis and left elbow lateral epicondylitis to her claim. 

A November 21, 2018 left elbow MRI scan revealed chronic osteoarthritis of the olecranon 

trochlea joint, lateral epicondylitis, and moderate osteoarthritis with prominent osteophytes.

OWCP also received reports and state workers’ compensation forms dated January 10 

through March 7, 2019 by Dr. Anup Patel, a Board-certified internist, who described the 

January 2011 left elbow and shoulder injury. Dr. Patel provided examination findings and 

diagnosed left elbow osteoarthritis and left elbow lateral epicondylitis. He recommended left 

elbow total replacement surgery.
7

In an April 17, 2019 report and state workers’ compensation form, Dr. George White, a 

Board-certified orthopedic surgeon, indicated that he treated appellant for severe degenerative 

arthritis of the left elbow. He reported examination findings of limited mobility and pain in the 

left elbow. Dr. White diagnosed left elbow primary osteoarthritis and left neuritis lesion of the 

ulnar nerve. He noted that appellant could work with restrictions. 

By decision dated October 7, 2019, OWCP denied modification of the July 9, 2018 

decision. 

LEGAL PRECEDENT

When an employee claims that a condition not accepted or approved by OWCP was due to 

an employment injury, he or she bears the burden of proof to establish that the condition is causally 

related to the employment injury.9

The claimant bears the burden of proof to establish a claim for a consequential injury.10 As 

part of this burden, he or she must present rationalized medical opinion evidence, based on a 

complete factual and medical background, establishing causal relationship.11 Additionally, the 

opinion of the physician must be expressed in terms of a reasonable degree of medical certainty, 

and must be supported by medical rationale, explaining the nature of the relationship between the 

diagnosed condition and the specific employment factor(s) or employment injury.12

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

relationship is rationalized medical evidence.13 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.14

In discussing the range of compensable consequences, once the primary injury is causally 

connected with the employment, the question is whether compensability should be extended to a 

subsequent injury or aggravation related in some way to the primary injury.15 The basic rule is 

that, a subsequent injury, whether an aggravation of the original injury or a new and distinct injury, 

is compensable if it is the direct and natural result of a compensable primary injury.16 When an 

 

9

J.R., Docket No. 20-0292 (issued June 26, 2020); W.L., Docket No. 17-1965 (issued September 12, 2018); V.B., 

Docket No. 12-0599 (issued October 2, 2012); Jaja K. Asaramo, 55 ECAB 200, 204 (2004).

10 V.K., Docket No. 19-0422 (issued June 10, 2020); A.H., Docket No. 18-1632 (issued June 1, 2020); I.S., Docket 

No. 19-1461 (issued April 30, 2020).

11 E.M., Docket No. 18-1599 (issued March 7, 2019); Robert G. Morris, 48 ECAB 238 (1996). 

12 M.V., Docket No. 18-0884 (issued December 28, 2018); I.J., 59 ECAB 408 (2008); Victor J. Woodhams, 41 

ECAB 345 (1989).

13 G.R., Docket No. 18-0735 (issued November 15, 2018).

14 Id. 

15 K.S., Docket No. 17-1583 (issued May 10, 2018).

16 Id. 
8

injury arises in the course of employment, every natural consequence that flows from that injury 

likewise arises out of the employment, unless it is the result of an independent intervening cause 

attributable to the claimant’s own conduct.17

ANALYSIS

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

acceptance of her claim should be expanded to include right shoulder rotator cuff tear, right carpal 

tunnel syndrome, and right stenosis tenosynovitis sustained as a consequence of her accepted 

January 23, 2011 employment injury.

In support of her request for a consequential injury, appellant submitted reports by

Dr. Blecha dated May 29 and July 28, 2014. In his initial May 29, 2014 report, he accurately 

described the January 23, 2011 employment injury and noted that appellant complained of 

worsening right shoulder pain, numbness in the thumb, index, and long finger on the right hand 

identical to her previous left-sided carpal tunnel syndrome symptoms. Dr. Blecha indicated 

appellant’s right shoulder symptoms increased this past year due to “increased use of the right 

shoulder secondary to limited use of the left.” He reported that appellant’s right-sided elbow, 

wrist, and trigger finger conditions had developed because she was using the right hand more than 

the left while the left was symptomatic. Dr. Blecha requested that appellant’s claim be upgraded 

to include right shoulder partial thickness tear of the rotator cuff, right wrist carpal tunnel 

syndrome, and right index finger stenosing tenosynovitis. He opined that all three of the problems 

were “felt to be compensatory resulting from overuse of the right upper extremity as she was 

troubled by symptoms of the accepted conditions present in the left upper extremity.” 

The Board finds that, although Dr. Blecha opined that appellant’s right shoulder, right 

wrist, right hand, and right trigger finger conditions were a consequence of her accepted 

January 23, 2011 employment injury, his opinion is of limited probative value in establishing a 

consequential employment injury because he did not provide adequate medical rationale in support 

of his opinion. Dr. Blecha did not describe the medical process through which appellant’s right 

upper extremity symptoms were related to the accepted January 23, 2011 employment injury.18 

He did not provide specific detail as to how appellant actually compensated for her left arm injury 

at work or describe the medical process of how increased use of her right upper extremity resulted 

in her diagnosed right shoulder, wrist, and hand conditions.19 These reports, therefore, are 

insufficient to establish appellant’s claim. 

Likewise, in reports dated April 14 and May 13, 2015, Dr. Bishai also opined that appellant 

had consequential right shoulder and hand injuries due to overuse of the right upper extremity in 

order to continue working. In reports dated October 3 and December 12, 2017, Dr. Seldes further 

 

17 A.M., Docket No. 18-0685 (issued October 26, 2018); Mary Poller, 55 ECAB 483, 487 (2004).

18 See L.D., Docket No. 20-0894 (issued January 26, 2021); see also L.B., Docket No. 19-1907 (issued 

August 14, 2020). 

19 Medical evidence that states a condition but does not offer any rationalized medical explanation regarding the 

cause of an employee’s condition is of limited probative value on the issue of causal relationship. D.H., Docket No. 

17-1913 (issued December 13, 2018); J.F., Docket No. 09-1061 (issued November 17, 2009); A.D., 58 ECAB 149 

(2006)
9

reported that appellant suffered from “consequential injuries to her right shoulder, elbow, wrist, 

and forearm secondary to the original injuries of her left shoulder, elbow, wrist, and forearm.” 

While Drs. Bishai and Seldes provide an affirmative opinion that supported causal relationship, 

neither physician offered a rationalized medical explanation to support his opinion.20 

Similarly, in reports and letters dated October 22, 2014 through September 20, 2015,

Dr. Reppy provided examination findings and diagnosed right upper extremity conditions of right 

shoulder partial thickness tear of the supraspinatus and infraspinatus tendon, right ulnar 

neuropathy, and right shoulder internal derangement and impingement syndrome. He indicated 

that appellant had right shoulder surgery in 2008, but her current right shoulder pain worsened due 

to the extra work stress put on that shoulder to compensate for her left hand injury. Dr. Reppy 

explained that, after appellant’s July 2011 left hand surgery, she had to use her right arm to 

compensate for the loss of use of her left arm. He reported that appellant’s right shoulder 

preexisting injury was aggravated and became a consequential injury after appellant’s left arm 

became severely compromised by the hand surgery and subsequent recovery. 

The Board finds that Dr. Reppy’s opinion regarding a consequential injury is of little 

probative value because he did not provide adequate medical rationale in support of his opinion. 

Dr. Reppy did not explain how physiologically appellant’s use of her right arm at work caused her 

right shoulder, wrist, and hand conditions.21 Such rationale is particularly necessary as appellant 

had a preexisting right shoulder condition.22 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.23 Thus, Dr. Reppy’s reports are insufficient to establish appellant’s claim.

The additional medical reports, including diagnostic reports and Drs. Arthur, Patel, and 

White’s reports, are also of no probative value in establishing appellant’s right upper extremity 

conditions as a consequence of the accepted January 23, 2011 employment injury since none of 

these reports provide an opinion that appellant sustained consequential right shoulder, wrist, or 

hand conditions.24 The Board has held that medical evidence that does not offer an opinion 

regarding the cause of an employee’s condition or disability is of no probative value on the issue 

 

20 T.T., Docket No. 19-0319 (issued October 26, 2020); C.W., Docket No. 19-1747 (issued September 2, 2020).

21 See C.H., Docket No. 20-0228 (issued October 7, 2020); see also D.J., Docket No 16-0663 (issued 

October 20, 2016).

22 V.G., Docket No. 19-0908 (issued October 25, 2019). 

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

K.G., Docket No. 18-1598 (issued January 7, 2020); M.S., Docket No. 19-0913 (issued November 25, 2019).

24 See T.T., Docket No. 20-0687 (issued December 11, 2020); see also L.B., Docket No. 18-0533 (issued 

August 27, 2018).
10

of causal relationship.25 These reports, therefore, are insufficient to establish appellant’s 

consequential injury claim.

On appeal counsel argues that all the medical evidence demonstrated that appellant 

suffered an injury due to having to compensate for her accepted conditions. As explained above, 

appellant submitted insufficient medical evidence to establish causal relationship between her right 

shoulder rotator cuff tear, right carpal tunnel syndrome, and right stenosis tenosynovitis conditions

and the accepted January 23, 2011 employment injury. 

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

acceptance of her claim should be expanded to include right shoulder rotator cuff tear, right carpal 

tunnel syndrome, and right stenosis tenosynovitis sustained as a consequence of the January 23, 

2011 employment injury.

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 the 

acceptance of her claim should be expanded to include right shoulder rotator cuff tear, right carpal 

tunnel syndrome, and right stenosis tenosynovitis sustained as a consequence of her accepted 

January 23, 2011 employment injury.26

 

25 See E.R., Docket No. 20-0880 (issued December 2, 2020); L.B., id.; D.K., Docket No. 17-1549 (issued 

July 6, 2018).

26 Should appellant wish to expand her claim to include emotional conditions, she may submit a request to OWCP.
11

ORDER

IT IS HEREBY ORDERED THAT the October 7, 2019 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: June 17, 2021

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