United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

K.F., Appellant

and

U.S. POSTAL SERVICE, PROCESSING & 

DISTRIBUTION CENTER, Lehigh Valley, PA, 

Employer

__________________________________________

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Docket No. 20-0308

Issued: October 14, 2020

Appearances: Case Submitted on the Record

Brian Odums, for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

CHRISTOPHER J. GODFREY, Deputy Chief Judge

JANICE B. ASKIN, Judge

JURISDICTION

On November 25, 2019 appellant, through her representative, filed a timely appeal from a 

June 27, 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.3

 

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 as 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.

3 The Board notes that appellant submitted additional evidence on appeal. 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.
2

ISSUE

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

causally related to the accepted November 2, 2018 employment incident.

FACTUAL HISTORY

On November 2, 2018 appellant, then a 31-year-old mail handler, filed a traumatic injury 

claim (Form CA-1) alleging that on that day she sprained her left wrist when lifting a tray of mail 

while in the performance of duty. On the reverse side of the claim form the employing 

establishment acknowledged that she was injured in the performance of duty, but controverted her 

claim alleging that she had a preexisting condition. Appellant stopped work on November 3, 2018. 

An after-visit summary dated November 2, 2018, by Dr. David Burmeister, an osteopath 

Board-certified in emergency medicine, diagnosed a ganglion cyst on the dorsum of the left wrist. 

In an accompanying work excuse note, a physician assistant noted that appellant could return to 

work on November 5, 2018.

In an undated attending physician’s report, Part B of a Form CA-16, a physician assistant 

diagnosed a ganglion cyst of the dorsum of the left wrist. Along with a notation of “overuse of 

wrist,” a box marked “Yes” was checked to indicate that the condition was caused or aggravated 

by the described employment activity.4 The physician assistant noted that appellant could resume 

light-duty work with restrictions on November 2, 2018.

In a November 14, 2018 development letter, OWCP informed appellant that the evidence 

of record was insufficient to establish her claim. It advised her of the type of factual and medical 

evidence needed and provided a questionnaire for her completion. OWCP afforded appellant 30 

days to submit the necessary evidence.

An after-visit summary, dated November 15, 2018, indicated that appellant saw Dr. Daniel 

Torres, a Board-certified orthopedic surgeon, for a left wrist sprain. In a November 15, 2018 form,

Dr. Torres ordered a magnetic resonance imaging (MRI) scan of appellant’s left wrist and 

diagnosed left wrist pain.

In a November 15, 2018 attending physician’s report (Form CA-20), Dr. Torres diagnosed 

left wrist sprain and possible ligament injuries. He checked a box marked “Yes” to indicate that 

the condition was caused or aggravated by an employment activity and noted that appellant was 

able to resume work with restrictions on November 15, 2018.

In a November 15, 2018 duty status report (Form CA-17), Dr. Torres diagnosed left wrist 

sprain and possible tears. He noted that appellant could return to work with restrictions on 

November 15, 2018.

On November 18, 2018 appellant accepted an offer of modified assignment to work a 

limited-duty position as a mail handler.

 

4 The Board notes that Part A, the first page of the Form CA-16, is not contained in the case record.
3

In a December 14, 2018 letter, the employing establishment controverted appellant’s claim 

noting that the medical evidence of record was insufficient to establish causal relationship.

By decision dated December 17, 2018, OWCP denied appellant’s traumatic injury claim 

finding that the factual evidence of record was insufficient to establish that the employment 

incident occurred as described. Specifically, it noted that, as she had failed to respond to its 

development questionnaire, there was insufficient evidence to establish the injury or event

occurred.

In a November 2, 2018 patient care report, appellant’s supervisor noted that she was sent 

to the hospital after lifting a heavy tray and feeling pain in her left wrist. In an accompanying 

witness statement, N.M., appellant’s coworker, indicated that appellant showed her wrist and 

stated that she felt left wrist pain after picking up a tray.

X-rays of appellant’s left wrist, dated November 15, 2018, revealed no acute fractures or 

dislocations, no signs of carpal instability, and no other degenerative changes.

In a November 15, 2018 progress report, Dr. Torres noted that appellant felt a pop in her 

left wrist after lifting a 40- to 50-pound tray. He reviewed x-rays of appellant’s left wrist and 

diagnosed left wrist pain and left wrist sprain. 

In a December 5, 2018 progress report, Dr. Torres noted that appellant was experiencing 

continued left wrist pain. He reviewed appellant’s left-wrist MRI scan and diagnosed left wrist 

tendinitis. Dr. Torres administered a steroid injection to appellant’s left extensor carpi ulnaris

(ECU). 

A December 13, 2018 MRI scan report of appellant’s left wrist revealed no significant 

abnormalities.

On January 4, 2019 appellant requested a telephonic hearing before a representative of 

OWCP’s Branch of Hearings and Review. 

In a January 16, 2019 progress report, Dr. Torres noted that appellant was experiencing 

some left wrist pain relief following a steroid injection to the left ECU. He diagnosed left wrist 

tendinitis and administered another left ECU steroid injection. 

In a March 6, 2019 progress report, Dr. Torres indicated that appellant’s left wrist pain was 

not improving despite conservative management including steroid injections, splinting, physical 

therapy, and nonsteroidal anti-inflammatory drugs. He examined her and diagnosed left wrist 

tendinitis and ganglion cyst of the volar aspect of the left wrist. Dr. Torres noted that appellant 

wanted to pursue surgical intervention and advised that she should undergo left wrist ECU 

tenosynovectomy and volar ganglion cyst excision.

In a March 14, 2019 letter, Dr. Torres indicated that appellant would be having surgery on 

her left wrist on March 19, 2019 to control her left wrist pain that began while she was lifting a 

tray. He opined that she had a torn ligament and that surgery was medically necessary.

A hearing was held on May 8, 2019. Appellant testified that she injured her left wrist while 

lifting a heavy tray on a high-speed trace order. The hearing representative advised appellant to 

submit medical evidence containing a physician’s opinion explaining how her diagnosed 
4

conditions were causally related to the employment incident. He held the case record open for 30 

days for the submission of additional evidence. OWCP did not receive additional evidence.

By decision dated June 27, 2019, OWCP’s hearing representative modified the 

December 17, 2018 decision, finding that appellant had established that the employment incident 

occurred as alleged, but affirmed the denial of the claim, finding that the medical evidence of 

record was insufficient to establish a causal relationship between appellant’s diagnosed conditions 

and the accepted November 2, 2018 employment incident.

LEGAL PRECEDENT

An employee seeking benefits under FECA5 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,6that 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.7 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.8

To determine if an employee has sustained a traumatic injury in the performance of duty, 

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

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

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

occurred.9 The second component is whether the employment incident caused a personal injury.10

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.11 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 incident identified by the claimant.12

 

5 Supra note 2.

6 G.L., Docket No. 18-1057 (issued April 14, 2020); J.P., 59 ECAB 178 (2007); Joe D. Cameron, 41 ECAB 

153 (1989).

7 M.G., Docket No. 18-1616 (issued April 9, 2020); R.C., 59 ECAB 427 (2008); James E. Chadden, Sr., 40 ECAB 

312 (1988).

8 20 C.F.R. § 10.115; A.S., Docket No. 19-1955 (issued April 9, 2020); L.M., Docket No. 13-1402 (issued 

February 7, 2014); Delores C. Ellyett, 41 ECAB 992 (1990).

9 R.K., Docket No. 19-0904 (issued April 10, 2020); Elaine Pendleton, 40 ECAB 1143 (1989).

10 Y.D., Docket No. 19-1200 (issued April 6, 2020); John J. Carlone, 41 ECAB 354 (1989).

11 L.F., Docket No. 19-1905 (issued April 10, 2020); Jacqueline M. Nixon-Steward, 52 ECAB 140 (2000).

12 A.S., Docket No. 19-1955 (issued April 9, 2020); Leslie C. Moore, 52 ECAB 132 (2000).
5

ANALYSIS

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

condition causally related to the accepted November 2, 2018 employment incident.

OWCP received an after-visit summary from Dr. Burmeister, dated November 2, 2018. 

While this summary listed a diagnosis of ganglion cyst of the dorsum of the left wrist, it did not 

provide a history of appellant’s employment incident or a rationalized medical explanation as to 

how this incident would have caused the diagnosed conditions. The Board has held that a medical 

opinion should reflect a correct history and offer a medically-sound explanation by the physician 

regarding how the specific employment incident caused or aggravated the diagnosed conditions.13 

As such, this summary is insufficient to establish her claim.

Appellant submitted a series of progress reports from Dr. Torres dated November 15, 2018 

through March 6, 2019. Dr. Torres diagnosed left wrist pain, left wrist sprain, left wrist tendinitis, 

and a ganglion cyst of the volar aspect of the left wrist. While he noted appellant’s history of 

injury in his November 15, 2018 report, he failed to provide his own opinion regarding causal 

relationship in his reports. The Board has held that medical evidence that does not include an 

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

causal relationship.14 As such, these reports from Dr. Torres are also insufficient to establish 

appellant’s claim.

Appellant also submitted November 15, 2018 Form CA-20 and Form CA-17 reports from

Dr. Torres. In these reports, Dr. Torres diagnosed left wrist sprain, possible ligament injuries, and 

possible wrist tears. He checked a box marked “Yes” to indicate that the conditions were caused 

or aggravated by appellant lifting a heavy tray. However, the Board has held that when a 

physician’s opinion on causal relationship consists only of checking “Yes” to a form question, 

without explanation or medical rationale, that opinion is of diminished probative value.15 

Accordingly, these reports are insufficient to establish appellant’s claim.

In a March 14, 2019 letter, Dr. Torres indicated that appellant would be undergoing surgical 

intervention for a torn ligament. While he opined that the surgery was necessary, he did not offer 

a rationalized medical opinion on how appellant’s diagnosed conditions were causally related to 

the accepted employment incident. As noted above, Dr. Torres’ opinion is of no probative value 

on the issue of causal relationship and is insufficient to establish appellant’s claim.16

 

13 B.M., Docket No. 19-1341 (issued August 12, 2020); T.M., Docket No. 19-1283 (issued December 2, 2019); 

T.G., Docket No. 17-1840 (issued December 20, 2018); see J.M., Docket No. 17-1002 (issued August 22, 2017). 

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

15 W.M., Docket No. 19-1853 (issued May 13, 2020).

16 Supra note 12.
6

Appellant submitted Part B of an undated Form CA-16 report from a physician assistant. 

The Board has held that medical reports signed solely by physician assistants are of no probative 

value as such healthcare providers are not considered physicians as defined under FECA.17

The record also contains x-rays and MRI scans of appellant’s left wrist. The Board has 

held, however, that diagnostic tests standing alone lack probative value on the issue of causal 

relationship as they do not provide an opinion on whether there is a relationship between an 

employment incident and a diagnosed condition.18

On appeal appellant references newly submitted evidence from Dr. Torres that was not in 

the case record that was before OWCP at the time of its final decision. Accordingly, the Board is 

precluded from reviewing this additional evidence for the first time on appeal.19

As appellant has not submitted rationalized medical evidence explaining the causal 

relationship between her diagnosed left wrist conditions and the accepted November 2, 2018 

employment incident, the Board finds that she has not met her burden of proof.

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 wrist 

condition causally related to the accepted November 2, 2018 employment incident.20

 

17 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 David P. Sawchuk, 57 ECAB 316, 320 n.11 (2006) (lay individuals such as physician 

assistants, nurses, and physical therapists are not competent to render a medical opinion under FECA); R.J., Docket 

No. 19-0179 (issued May 26, 2020) (physician assistants are not considered physicians under FECA).

18 L.F., supra note 10.

19 Supra note 3.

20 The Board further notes that, with respect to the undated Form CA-16 signed by a physician assistant, a properly 

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. The period 

for which treatment is authorized by a Form CA-16 is limited to 60 days from the date of issuance, unless terminated 

earlier by OWCP. 20 C.F.R. § 10.300(c); P.R., Docket No. 18-0737 (issued November 2, 2018); N.M., Docket No. 

17-1655 (issued January 24, 2018); Tracy P. Spillane, 54 ECAB 608 (2003).
7

ORDER

IT IS HEREBY ORDERED THAT the June 27, 2019 of the Office of Workers’

Compensation Programs is affirmed.

Issued: October 14, 2020

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Christopher J. Godfrey, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board