United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

P.G., Appellant

and

U.S. POSTAL SERVICE, MADISON POST 

OFFICE, Madison, TN, Employer

__________________________________________

)

)

)

)

)

)

)

)

Docket No. 19-1827

Issued: May 15, 2020

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

JANICE B. ASKIN, Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On August 29, 2019 appellant, through counsel, filed a timely appeal from a June 26, 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.

ISSUE

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

causally related to the accepted September 8, 2018 employment incident.

 

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

FACTUAL HISTORY

On September 8, 2018 appellant, then a 60-year-old clerk, filed a traumatic injury claim 

(Form CA-1) alleging that on that date she injured her left arm when a magazine binder wrapped 

around her feet and caused her to fall while in the performance of duty. On the reverse side of the 

claim form, the employing establishment indicated that she was injured in the performance of duty 

and stopped work on September 8, 2018. 

On September 17, 2018 Dr. Brent Frisbie, a Board-certified radiologist, indicated that an 

x-ray of appellant’s left elbow revealed no acute fracture, dislocation, or boney abnormality. 

A September 17, 2018 “referral order” from Dr. Clayton MacConnell, Board-certified in 

family medicine, diagnosed left elbow joint pain and referred appellant to an orthopedist. 

In a September 26, 2018 development letter, OWCP indicated that when appellant’s claim 

was received it appeared to be a minor injury that resulted in minimal or no lost time from work 

and, based on these criteria and because the employing establishment did not controvert 

continuation of pay or challenge the case, payment of a limited amount of medical expenses was 

administratively approved. It explained that it reopened the claim for consideration because it 

received indication that she did not return to work in a full-time capacity. OWCP related that 

additional evidence was required in support of appellant’s claim for benefits. It advised her of the 

type of medical evidence necessary to establish her claim. OWCP afforded appellant 30 days to 

submit the necessary evidence. 

A September 10, 2018 medical report by Dr. MacConnell indicated that appellant 

complained of pain upon moving her left elbow and shoulder and presented with her left arm in a 

sling. He noted that she fell on her flexed left elbow at work, and that medical records and imaging 

indicated that she sustained a left arm contusion and did not have any broken bones. 

Dr. MacConnell conducted a physical examination which revealed a reduced range of motion 

(ROM) and pain with movement in general and with abduction in particular in appellant’s left 

shoulder. He also found posterior tenderness, pain on palpation and extension, and a reduced ROM

in her left elbow. Dr. MacConnell diagnosed an unspecified elbow injury and left shoulder pain

and recommended specific shoulder exercises and advised that appellant stay off work and 

continue wearing the sling. 

September 17, 2018 medical records signed by Dr. MacConnell indicated that appellant 

continued to complain of left elbow pain. He conducted a physical examination which revealed 

an improved ROM in her left shoulder and swelling, tenderness over the olecranon process, pain 

on palpation, and a reduced ROM in her left elbow. Dr. MacConnell noted that appellant was 

unable to fully extend or flex her elbow without pain and that there was evidence of a resolving 

bruise in the posterior aspect of her elbow. He diagnosed left shoulder pain and advised that she

remain off work until cleared by an orthopedist. 

On October 3, 2018 the employing establishment executed an authorization for 

examination and/or treatment (Form CA-16) for appellant’s elbow and arm by Dr. MacConnell. 

By decision dated November 1, 2018, OWCP denied appellant’s traumatic injury claim, 

finding that the evidence of record was insufficient to establish a diagnosed condition in 
3

connection with her September 8, 2018 accepted employment incident. It concluded, therefore, 

that the requirements had not been met to establish an injury as defined by FECA. 

OWCP continued to receive medical evidence. September 8, 2018 emergency room notes 

signed by Dr. Heather Barnett, Board-certified in emergency medicine, indicated that appellant 

presented with left forearm pain. Dr. Barnett noted pain in appellant’s left elbow with ROM, and 

left wrist pain upon rotation. Appellant stated that she stumbled and fell on her left forearm and 

right hand, and she noted that she had no history of trauma to her left elbow. Her physical 

examination revealed left elbow and left dorsal tenderness and a full ROM of the left arm with 

stiffness. Dr. Barnett diagnosed a left forearm contusion. 

A September 8, 2018 x-ray of appellant’s left elbow interpreted by Dr. Stuart Caplan, a 

Board-certified radiologist, revealed no acute radiographic abnormalities. 

In an October 15, 2018 medical report, Dr. MacConnell indicated that appellant 

complained of pain along the ulnar side of her left elbow and of the inability to straighten her 

elbow. He conducted a physical examination, diagnosed an elbow injury, and indicated that she

should continue to work with restrictions. 

In an October 17, 2018 report, Dr. Robert Landsberg, a Board-certified orthopedic 

surgeon, indicated that appellant presented with aching pain in her left shoulder and elbow. 

Appellant related that on September 8, 2018 while at work she fell on her left elbow and shoulder. 

She was taken to the emergency room where it was determined that she sustained left forearm and 

elbow bruising. Appellant stated that she originally found it uncomfortable to use her left upper 

extremity, including overhead activities, reaching, pushing, and pulling, and though her pain had 

slightly improved, she still struggled with these functions. She also stated that using her elbow 

exacerbated her pain and that she could not extend it fully. Appellant noted that she had no 

previous trauma to her left upper extremity. A physical examination revealed bilateral shoulder 

protraction with forward head posture, left elbow extension limited by five degrees with a 

semi-rigid endpoint at full extension, full flexion, supination, and pronation, soreness and 

apprehension through the entire left elbow arc, and tenderness over the medial epicondyle and 

olecranon fossa. Dr. Landsberg diagnosed left elbow pain, stiffness of the left elbow joint, and 

medial epicondylitis of the left elbow. He opined that appellant likely had a left shoulder resolving

strain and was concerned that her inability to fully extend her elbow was due to a loose chondral 

body. 

A November 7, 2018 medical report by Dr. Landsberg, reviewed appellant’s history of 

injury and indicated that she complained of continuing stiffness, pain, and dysfunction in her left 

elbow. He conducted a physical examination and diagnosed her with left elbow pain and stiffness. 

On November 12, 2018 appellant, through counsel, requested a telephonic hearing before 

an OWCP hearing representative. 

In a December 12, 2018 report, Dr. Landsberg reviewed appellant’s history of injury and 

noted that she continued to experience discomfort at the terminal ranges of extension of her left 

elbow and still was unable to fully extend her elbow. He conducted a physical examination and 

diagnosed left elbow pain and stiffness. 
4

A December 14, 2018 magnetic resonance imaging (MRI) scan of appellant’s left elbow 

interpreted by Dr. Jeffrey Huggett, a Board-certified radiologist, revealed a chronic appearing 

defect in the capitellar articular surface, likely reflecting an osteochondral abnormality. It 

additionally revealed associated radiocapitellar osteoarthritis with an elbow joint effusion and 

filling defects in the joint posteriorly favored to reflect loose bodies, though synovial 

thickening/synovitis were also in the differential. 

A January 18, 2019 medical report by Dr. Jason Haslam, Board-certified in orthopedic 

surgery, reviewed appellant’s history of injury and noted that she presented with episodic left 

elbow pain with certain movements, such as lifting, twisting, and pushing. He conducted a 

physical examination, reviewed her left elbow MRI scan, and diagnosed left elbow post-traumatic 

osteoarthritis. Dr. Haslam indicated that appellant’s chronic left elbow osteoarthritis was 

aggravated by her workplace fall. He further opined that her left elbow osteoarthritis was less than 

50 percent related to her work injury. 

On April 12, 2019 an OWCP hearing representative conducted an oral hearing. By 

decision dated June 26, 2019, the hearing representative modified the November 1, 2018 OWCP 

decision, finding that the evidence of record was sufficient to establish a medical diagnosis. 

However, OWCP’s hearing representative denied the claim as the evidence of record was 

insufficient to establish causal relationship between the diagnosed conditions and the accepted 

September 8, 2018 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 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 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 if an employee sustained a traumatic injury in the performance of duty, 

OWCP begins with an analysis of whether fact of injury has been established.7 Fact of injury 

consists of two components that must be considered in conjunction with one another. The first 

 

3

Id.

4

J.P., Docket No. 19-0129 (issued April 26, 2019); S.B., Docket No. 17-1779 (issued February 7, 2018); 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 R.R., Docket No. 19-0048 (issued April 25, 2019); L.M., Docket No. 13-1402 (issued February 7, 2014); 

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

7 E.M., Docket No. 18-1599 (issued March 7, 2019); T.H., 59 ECAB 388, 393-94 (2008).
5

component is whether the employee actually experienced the employment incident that allegedly 

occurred.8 The second component is whether the employment incident caused a personal injury.9 

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.10 

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 a medical 

condition causally related to the accepted September 8, 2018 employment incident. 

Medical records signed by Dr. MacConnell indicated that appellant complained of left 

elbow pain. He noted that she fell on her flexed left elbow while at work. Dr. MacConnell

reviewed appellant’s previous medical records, conducted physical examinations, and diagnosed 

left shoulder pain and an elbow injury. The Board has held that a medical report is of no probative 

value if it does not provide a firm diagnosis of a particular medical condition.12 The Board has 

also explained that pain is a symptom and not a compensable medical diagnosis.13 Likewise the 

term injury does not constitute a firm diagnosis.14 Dr. MacConnell did not provide a specific 

diagnosis of a medical condition of the left shoulder or the left elbow.15 His reports are therefore 

insufficient to establish appellant’s claim. 

Dr. Barnett’s emergency room notes indicated that appellant presented with pain in her left 

forearm, left elbow, and left wrist. She noted that appellant stated that appellant stumbled and fell 

on her left forearm and right hand, and that she had no history of trauma to her left elbow. 

Dr. Barnett conducted a physical examination and diagnosed a left forearm contusion. While she

discussed the September 8, 2018 employment incident, she did not specifically address the cause 

 

8 L.T., Docket No. 18-1603 (issued February 21, 2019); Elaine Pendleton, 40 ECAB 1143 (1989).

9 B.M., Docket No. 17-0796 (issued July 5, 2018); John J. Carlone, 41 ECAB 354 (1989).

10 Dennis M. Mascarenas, 49 ECAB 215 (1997).

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

A.S., Docket No. 19-1955 (issued April 9, 2020).

12 See A.R., Docket No. 19-1560 (issued March 2, 2020). 

13 T.G., Docket No. 19-0904 (issued November 25, 2019). 

14 T.M., Docket No. 19-1283 (issued December 2, 2019). 

15 See T.H., Docket No. 19-1891 (issued April 3, 2020). 
6

of the diagnosed condition.16 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.17 Thus, 

these notes are insufficient to establish appellant’s claim.

Dr. Landsberg’s medical reports indicated that appellant complained of left shoulder pain 

and left elbow stiffness, pain, and dysfunction. He reviewed her medical records and noted that 

she fell on her left elbow and shoulder while at work. Dr. Landsberg conducted physical 

examinations and diagnosed left elbow pain, left elbow stiffness, and left elbow medial 

epicondylitis. He opined that appellant likely had a left shoulder resolving strain and was 

concerned that her inability to fully extend her elbow was due to a loose chondral body.

Dr. Landsberg failed to address the cause of her left elbow medial epicondylitis. As stated above, 

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.18 

Dr. Haslam reviewed appellant’s history of injury and noted that she presented with left 

elbow pain. He conducted a physical examination, reviewed her left elbow MRI scan, and 

diagnosed left elbow post-traumatic osteoarthritis. Dr. Haslam indicated that appellant’s diagnosis 

was a chronic problem that was aggravated by her workplace fall. He further opined that her left 

elbow osteoarthritis was less than 50 percent related to her work injury. An employee is not 

required to prove that occupational factors are the sole cause of appellant’s claimed condition.19 

If work-related exposures caused, aggravated, or accelerated her condition, appellant is entitled to 

compensation.20 While Dr. Haslam suggested that her left elbow osteoarthritis might have been 

partially work related, he failed to explain how her work injury aggravated her preexisting left 

elbow osteoarthritis. Without explaining physiologically how the accepted employment incident 

caused or contributed to the diagnosed condition, Dr. Haslam’s report is of limited probative 

value.21

OWCP also received x-rays and an MRI scan of appellant’s left elbow. The Board has 

held, however, that reports of diagnostic tests standing alone lack probative value as they do not 

provide an opinion on causal relationship between an employment incident and a diagnosed 

condition.22

 

16 See R.K., Docket No. 20-0049 (issued April 10, 2020); L.B., Docket No. 18-0533 (issued August 27, 2018).

17 Id. 

18 Supra note 15. 

19 See S.T., Docket No. 18-1119 (issued March 6, 2019); S.S., Docket No. 08-2386 (issued June 5, 2008). See also 

Willie J. Clements, 43 ECAB 244 (1991).

20 S.T., id.; see also Beth P. Chaput, 37 ECAB 158, 161 (1985).

21 See A.S., Docket No. 19-1955 (issued April 9, 2020). 

22 L.F., Docket No. 19-1905 (issued April 10, 2020). 
7

As appellant has not submitted rationalized medical evidence establishing causal 

relationship between a medical condition and the accepted September 8, 2018 employment 

incident, the Board finds that she has not met his burden of proof to establish her 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 a medical 

condition causally related to the accepted September 8, 2018 employment incident.

ORDER

IT IS HEREBY ORDERED THAT the June 26, 2019 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: May 15, 2020

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board

 

23 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).