United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

G.H., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Barre, VT, Employer

__________________________________________

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Docket No. 19-0767

Issued: August 23, 2019

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

PATRICIA H. FITZGERALD, Deputy Chief Judge

JANICE B. ASKIN, Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On February 25, 2019 appellant filed a timely appeal from a September 13, 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.

ISSUE

The issue is whether appellant has met her burden of proof to establish a left shoulder

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

FACTUAL HISTORY

On January 16, 2018 appellant, then a 43-year-old rural letter carrier, filed an occupational 

disease claim (Form CA-2) alleging that she sustained rotator cuff tendinitis in her left shoulder as 

a result of reaching for mail while in the performance of duty. She noted that she first became

 

1 5 U.S.C. § 8101 et seq.
2

aware of her condition on June 1, 2017 and first realized that her condition was caused or 

aggravated by factors of her federal employment on January 2, 2018. Appellant did not stop work.

In a development letter dated February 1, 2018, OWCP informed appellant that the 

evidence submitted was insufficient to establish her claim. It advised her of the type of medical 

and factual evidence needed, including a narrative report from her physician diagnosing a 

condition causally related to the identified employment duties and explaining how and why those 

activities would cause the diagnosed condition. OWCP afforded appellant 30 days to respond. 

On February 22, 2018 appellant submitted a February 21, 2018 statement wherein she

indicated that she spent approximately four to five hours per day reaching and pulling mail to the 

left and that these motions were the cause of her rotator cuff tendinitis. 

OWCP also received a progress note dated February 8, 2018 from Dr. Clea James, a Boardcertified family practitioner who reported that appellant presented with mild tenderness in her left 

upper trapezius/supraspinatus region and diagnosed tendinitis of the left rotator cuff. Dr. James

opined that appellant’s injury was likely a repetitive work-related injury.

By decision dated March 16, 2018, OWCP denied appellant’s claim, finding that the 

evidence submitted was insufficient to establish causal relationship between her diagnosed left 

shoulder condition and the accepted factors of her federal employment. 

In a report dated May 8, 2018, Dr. Robert Quinn, a Board-certified family practitioner, 

indicated that appellant was under his care for a work-related shoulder injury. He opined that her

injury was consistent with rotator cuff tendinitis and that the injury was caused by carrying and 

sorting mail at work. 

On July 19, 2018 appellant requested reconsideration of OWCP’s March 16, 2018 

decision.

By decision dated September 13, 2018, OWCP denied modification of its previous 

decision, again finding that the submitted evidence failed to establish causal relationship between 

appellant’s accepted work factors and the diagnosed left rotator cuff tendinitis. 

LEGAL PRECEDENT

An employee seeking benefits under FECA2 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,3that 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 

 

2

Id.

3 S.C., Docket No. 18-1242 (issued March 13, 2019); S.B., Docket No. 17-1779 (issued February 7, 2018); J.P., 59 

ECAB 178 (2007); Joe D. Cameron, 41 ECAB 153 (1989).
3

to the employment injury.4 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.5

To establish that an injury was sustained in the performance of duty in an occupational 

disease claim, a claimant must submit 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 

employment factors identified by the claimant were the proximate cause of the condition for which 

compensation is claimed or, stated differently, medical evidence establishing that the diagnosed 

condition is causally related to the employment factors identified by the claimant.6

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

relationship is rationalized medical opinion evidence.7 Rationalized medical opinion evidence is 

medical evidence which includes a physician’s rationalized opinion on the issue of whether there 

is causal relationship between the claimant’s diagnosed condition and the implicated employment 

factors. 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 claimant.8

ANALYSIS

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

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

In her progress note dated February 8, 2018, Dr. James diagnosed left rotator cuff tendinitis 

and concluded that appellant’s condition was “likely” a repetitive work-related injury. The Board 

has held that medical opinions which are speculative or equivocal in nature are of diminished 

probative value.9 The physician’s opinion must be expressed in terms of a reasonable degree of 

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

 

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

40 ECAB 312 (1988).

5 S.C., supra note 3; 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).

6 C.D., Docket No. 17-2011 (issued November 6, 2018); Jacquelyn L. Oliver, 48 ECAB 232, 235-36 (1996).

7 M.B., Docket No. 17-1999 (issued November 13, 2018).

8 M.L., Docket No. 18-1605 (issued February 26, 2019).

9 See S.E., Docket No. 08-2214 (issued May 6, 2009) (finding that opinions such as the condition is probably related, 

most likely related, or could be related are speculative and diminish the probative value of the medical opinion); 

Cecilia M. Corley, 56 ECAB 662, 669 (2005) (finding that medical opinions which are speculative or equivocal are 

of diminished probative value).
4

relationship between the diagnosed condition and appellant’s specific employment factor(s).10 

While Dr. James did opine that appellant’s condition was “likely” related to her work, she did not 

offer any medical rationale sufficient to explain how and why she believes appellant’s work 

activities could have resulted in or contributed to the diagnosed condition. For the foregoing 

reasons, her progress note is of diminished probative value and is insufficient to establish 

appellant’s claim.

In support of her request for reconsideration, appellant submitted Dr. Quinn’s physician’s 

note dated May 8, 2018. This note only provided a conclusory statement that appellant’s injury 

was “consistent with rotator cuff tendinitis that is attributable to her work at the post office.” The 

Board has held that a mere conclusion without the necessary rationale explaining how and why 

the physician believes that appellant’s work activities could result in the diagnosed condition is 

insufficient to meet appellant’s burden of proof.11 Without explaining how, physiologically, the 

employment incident caused or contributed to the diagnosed conditions, a conclusory statement 

on causal relationship is insufficiently rationalized and of limited probative value.12 As

Dr. Quinn’s note did not contain any medical rationale explaining how appellant’s accepted work 

factors caused or contributed to her diagnosed condition, it is insufficient to meet appellant’s 

burden of proof on the issue of causal relationship.13

As there is no rationalized medical evidence of record explaining how appellant’s accepted 

employment factors caused or aggravated her left rotator cuff tendinitis, 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(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 left shoulder 

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

 

10 M.V., Docket No. 18-0884 (issued December 28, 2018); Victor J. Woodhams, 41 ECAB 345, 352 (1989).

11 E.D., Docket No. 16-1854 (issued March 3, 2017).

12 S.N., Docket No. 18-1627 (issued May 15, 2019).

13 J.M., Docket No. 19-0359 (issued June 3, 2019).
5

ORDER

IT IS HEREBY ORDERED THAT the September 13, 2018 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: August 23, 2019

Washington, DC

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board