United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

P.A., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Cleveland, OH, Employer

__________________________________________

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Docket No. 18-0559

Issued: January 29, 2020

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

PATRICIA H. FITZGERALD, Deputy Chief Judge

ALEC J. KOROMILAS, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On January 23, 2018 appellant, through counsel, filed a timely appeal from a December 4, 

2017 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 right shoulder 

condition causally related to the accepted April 1, 2016 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 April 8, 2016 appellant, then a 51-year-old mail handler, filed a traumatic injury claim 

(Form CA-1) alleging that on April 1, 2016 she injured her right shoulder when lifting tubs of mail 

for two hours while in the performance of duty. The employing establishment provided her with 

modified work on April 8, 2016.

OWCP received an April 5, 2016 note from Stephanie M. Towers, a physician assistant, 

indicating that appellant was under his care for a medical problem.

In an April 7, 2016 work excuse, Dr. Jason A. Gennin, an osteopathic physician 

specializing in orthopedic surgery, noted that appellant could return to work with restrictions of 

no lifting over 10 pounds, and no overhead lifting. He also completed a duty status report (Form 

CA-17) in which he diagnosed osteoarthritis of the right shoulder and right shoulder muscle strain, 

and provided appellant’s work restrictions. Dr. Gennin saw appellant on April 21, 2016 and 

indicated that he could return to work without restrictions on April 23, 2016.

OWCP also received a May 3, 2016 note by Julie W. Brasfield, a certified physician 

assistant, who noted that appellant had been examined by Dr. Farrow for her right shoulder and 

could return to work on May 4, 2016. 

In a July 12, 2016 note, Dr. Lutul Farrow, an orthopedic surgeon, provided a work excuse 

and indicated that appellant had an expected return to work date of July 25, 2016. He completed 

a Form CA-17 on July 15, 2016 and advised that appellant had a right shoulder and elbow injury 

and indicated that appellant could not return to work.

Appellant stopped work on July 12, 2016. On July 25, 2016 he completed a claim for 

compensation (Form CA-7) for leave without pay from July 13 to 24, 2016.

Dr. Farrow indicated in a July 25, 2016 report that he was treating appellant for left elbow 

and right shoulder conditions. 

In a July 27, 2016 development letter, OWCP noted that the case was administratively 

closed without a formal review based upon the minor nature of the reported injury. However, upon

receipt of the wage-loss claim, it formally reopened the claim for adjudication. OWCP informed 

appellant of the type of factual and medical evidence needed to support her claim and afforded her 

30 days to submit the necessary evidence.

In a July 26, 2016 report, Dr. Farrow advised that appellant could return to work on 

August 1, 2016 with restrictions. In an August 10, 2016 attending physician’s report (Form CA20), Dr. Farrow diagnosed right shoulder tendinitis based on a magnetic resonance imaging (MRI)

scan. He replied “[not applicable] N/A” in response to whether he believed the condition was 

caused or aggravated by an employment activity. 

By decision dated September 9, 2016, OWCP denied appellant’s claim finding that the 

evidence of record was insufficient to establish causal relationship between the diagnosed right 

shoulder condition and the accepted employment incident.

On September 16, 2016 appellant, through counsel, requested a telephonic hearing before 

a representative of OWCP’s Branch of Hearings and Review.
3

OWCP subsequently received an August 18, 2016 report. Dr. Dominic King, a Boardcertified family practitioner, released appellant to unrestricted work. However, on October 31, 

2016, he provided work restrictions. 

OWCP also received a September 23, 2016 Form CA-17 duty status report from

Dr. Farrow. He indicated that appellant had a right shoulder muscle strain. Dr. Farrow checked 

the box marked “no” in response to whether the history of injury given to her by the employee 

corresponded to that shown in item number 5 which indicated that appellant sustained right 

shoulder muscle strain. He diagnosed tendinitis and pain and recommended a return to work on 

September 25, 2016 with restrictions. Dr. Farrow saw appellant on September 27, October 24 and 

25, 2016 and advised that she could work with restrictions.

In a November 2, 2016 report, Dr. Farrow completed another Form CA-17, indicating

appellant had a right shoulder muscle strain with a date of injury of April 1, 2016. He diagnosed 

right shoulder tendinitis and unspecified elbow tendinitis. Dr. Farrow also completed a separate 

narrative report and indicated that the incident or work activity that caused the incident was related 

to “repetitive overhead activities and actions.” He noted that subjective complaints included pain 

with internal rotation and overhead activities, as well as decreased flexion and abduction. 

Dr. Farrow provided examination findings of rotator cuff tendinopathy and advised that an 

October 2016 MRI scan revealed shoulder tendinitis and severe elbow tendinitis. He opined: “In 

my medical opinion, the facts of injury are the direct and proximate cause of the diagnosis that I 

cited above. This is based on reasonable medical probability. There may be other causes for this 

medical problem, but one of the causes is clearly the activities of work described [by] the patient 

and described above.”

Dr. Farrow continued to treat appellant and recommended restrictions for the shoulder.

The requested hearing was held on May 17, 2017. During the hearing, appellant testified 

that, on April 1, 2016, instead of rotating assignments hourly, she was forced to work in the same 

position, loading mail onto the belt for two hours. Appellant denied any prior history of right 

shoulder complaints and testified that she was seen by Dr. Farrow and diagnosed with bursitis. 

Counsel noted that appellant was not claiming that her osteoarthritis was work related. 

OWCP subsequently received an August 10, 2016 Form CA-20 attending physician’s

report from Dr. Farrow, noting a history of right shoulder and muscle strain. He checked the box 

marked “no” that there was no history of preexisting injury or disease. Dr. Farrow advised that an 

MRI scan of appellant’s right shoulder showed shoulder tendinitis. He replied “N/A” in response 

to whether he believed appellant’s condition was caused or aggravated by employment activity. 

By decision dated July 27, 2017, OWCP’s hearing representative affirmed the 

September 9, 2016 decision.

On September 22, 2017 appellant, through counsel, requested reconsideration and 

submitted additional medical evidence. In a September 19, 2017 report, Dr. Farrow noted that 

appellant was under his care for her right shoulder condition. He indicated that she first presented 

to his office for a visit on May 3, 2016 with a chief complaint of right shoulder pain, which she 

reported was caused by her work at the employing establishment. Dr. Farrow noted that appellant

indicated that the pain had been present for over a month and that she had pain with overhead 

activities as well as night pain. He explained that she was on limited duty at work in the weeks 
4

preceding the office visit. Dr. Farrow provided physical examination findings for the right 

shoulder. He also related appellant’s description of her injury at work which included that on 

April 1, 2016 she was loading tubs weighing between 10 pounds and 25 pounds consistent for two

hours. Additionally, appellant was sweeping which consisted of lifting and carrying tubs of mail 

to be placed in the appropriate containers. She also indicated that she was using a manual pallet 

jack to lift skids with Gaylord boxes filled with bulk mail (magazines, books, newspapers, etc.). 

Dr. Farrow opined that “certain[l]y” appellant’s shoulder condition was directly related to the 

series of events on April 1, 2016. He also provided a new report dated September 21, 2017, which 

was an exact copy of his previous report dated November 2, 2016. Dr. Farrow repeated his opinion 

that appellant’s activities at work caused the diagnosed conditions. 

By decision dated December 4, 2017, OWCP denied modification of the July 27, 2017 

decision.

LEGAL PRECEDENT

An employee seeking benefits under FECA 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 

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 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.6

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 

 

3 S.B., Docket No. 17-1779 (issued February 7, 2018); J.P., 59 ECAB 178 (2007); Joe D. Cameron, 41 ECAB 

153 (1989).

4

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 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

John J. Carlone, 41 ECAB 354 (1989); see 5 U.S.C. § 8101(5) (injury defined); 20 C.F.R. §§ 10.5(ee) and 10.5(q) 

(traumatic injury and occupational disease defined, respectively).
5

nature of the relationship between the diagnosed condition and the specific employment factors 

identified by the claimant.7

ANALYSIS

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

condition causally related to the accepted employment incident.

In support of her claim, appellant submitted a work excuse note and Form CA-17 dated

April 7, 2016, and treatment notes from Dr. Gennin dated April 21, 2016. Dr. King also provided 

treatment notes on August 18, 2016 releasing appellant to unrestricted work and on October 31, 

2016 prescribing work restrictions. However, these reports merely noted diagnoses and work 

restrictions and did not provide an opinion on causal relationship. 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.8

OWCP also received several reports from Dr. Farrow dated July 12, 25 and 26, 2016. 

Dr. Farrow initially indicated on July 12 and 25, 2016 that appellant had a right shoulder and elbow 

injury, and provided work restrictions. In his July 26, 2016 report, he reviewed appellant’s MRI 

scan and diagnosed right shoulder tendinitis. In response to a question as to whether appellant’s 

condition was caused or aggravated by an employment activity, Dr. Farrow replied “N/A.” 

However, none of these reports provided an opinion on the issue of causal relationship.9 As such, 

they are therefore insufficient to establish causal relationship.

Dr. Farrow also treated appellant on August 10 and September 23, 2016. In the August 10, 

2016 report, he indicated that appellant had a right shoulder muscle strain. Dr. Farrow diagnosed 

right shoulder tendinitis and again replied “N/A” with regard to whether he believed the condition 

was caused or aggravated by an employment activity. In the September 23, 2016 report, he 

responded “no” in response to whether the history of injury given by the employee corresponded 

to the history of the alleged employment injury. Dr. Farrow continued to treat appellant on 

September 27, October 24 and 25, 2016. However, none of these reports offer an opinion on 

causal relationship and therefore are of no probative value.10

Dr. Farrow subsequently provided a November 2, 2016 report in which he indicated that 

appellant had a right shoulder muscle strain with a date of injury of April 1, 2016. He diagnosed 

right shoulder tendinitis. Dr. Farrow indicated that the incident or work activity that caused the 

incident was related to “repetitive overhead activities and actions.” He opined that the alleged 

incident of April 1, 2016 was the direct and proximate cause of the diagnosis provided based upon 

reasonable medical probability. He explained that there may be other causes for this medical 

problem, but one of the causes was clearly the activities of work. The Board has held that a medical 

 

7 A.W., Docket No. 19-0327 (issued July 19, 2019); I.J., 59 ECAB 408 (2008); Victor J. Woodhams, 45 ECAB 

345 (1989).

8 See J.H., Docket No. 19-0838 (issued October 1, 2019); S.G., Docket No. 19-0041 (issued May 2, 2019); L.B.,

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

9

Id.

10 Supra note 8.
6

opinion must provide an explanation of how the specific employment factors physiologically 

caused or aggravated the diagnosed conditions.11 As Dr. Farrow’s opinion regarding causal 

relationship was conclusory and unexplained, it is insufficient to meet appellant’s burden of proof 

to establish her claim.12

Dr. Farrow reported on September 19, 2017 that appellant was under his care for her right 

shoulder condition. He opined that “certain[l]y” appellant’s shoulder and elbow condition were 

directly related to the series of events on April 1, 2016. Dr. Farrow also provided a report dated 

September 21, 2017, which was verbatim of his previous report dated November 2, 2016. While

he provided additional details regarding appellant’s work activities on April 1, 2016, he did not 

explain how these work activities physiologically caused the diagnosed condition.

13

 As noted, 

without the requisite rationale, these reports are of limited probative value.14

Appellant also submitted notes dated April 5 and May 3, 2016 from physician assistants. 

Health care providers such as nurses, acupuncturists, physician assistants, and physical therapists 

are not physicians under FECA.15 Thus, their opinions on causal relationship do not constitute 

rationalized medical opinions and have no weight or probative value.16

OWCP also received diagnostic reports to include April 5, 2016 x-rays and a July 21, 2016 

MRI scan. The Board has held that diagnostic test reports lack probative value as they do not 

provide an opinion on causal relationship between the accepted employment factors and a 

diagnosed condition.17

As the medical evidence of record does not contain a rationalized opinion on causal 

relationship, the Board finds that appellant has not met her burden of proof. 

On appeal counsel argues that the treating physician explained causation. However, as 

explained above, the medical evidence of record does not explain, with medical rationale, how the 

April 1, 2016 work injury cause or aggravated a diagnosed condition. Appellant has, therefore,

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.

 

11 A.H., Docket No. 19-0270 (issued June 25, 2019); M.W., Docket No. 18-1624 (issued April 3, 2019).

12 Id.

13 Id.

14 Id.

15 5 U.S.C. § 8102(2) of FECA provides that the term physician includes surgeons, podiatrists, dentists, clinical 

psychologists, optometrists, chiropractors, and osteopathic practitioners within the scope of their practice as defined 

by State law. See also K.C., Docket No. 19-0834 (issued October 28, 2019) and E.T., Docket No. 17-0265 (issued 

May 25, 2018) (physician assistants are not considered physicians under FECA).

16 See A.A., Docket No. 19-0957 (issued October 22, 2019); Jane A. White, 34 ECAB 515, 518 (1983).

17 A.P., Docket No. 18-1690 (issued December 12, 2019); see R.M., Docket No. 18-0976 (issued January 3, 2019).
7

CONCLUSION

The Board finds that appellant did not meet her burden of proof to establish a right shoulder 

condition causally related to the accepted April 1, 2016 employment injury.

ORDER

IT IS HEREBY ORDERED THAT the December 4, 2017 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: January 29, 2020

Washington, DC

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Alec J. Koromilas, Alternate Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board