United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

A.M., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE,

Chippewa Falls, WI, Employer

__________________________________________

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Docket No. 19-1138

Issued: February 18, 2020

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

ALEC J. KOROMILAS, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On April 23, 2019 appellant filed a timely appeal from a March 18, 2019 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.2

ISSUE

The issue is whether appellant has met her burden of proof to establish cervical and left 

arm conditions causally related to the accepted factors of her federal employment.

 

1 5 U.S.C. § 8101 et seq.

2 The Board notes that following the March 18, 2019 decision 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

FACTUAL HISTORY

On February 27, 2017 appellant, then 66-year-old city carrier, filed an occupational disease 

claim (Form CA-2) alleging that she had developed swelling and pain in her left arm as well as a 

pull in her neck due to repetitive handing of mail on a daily basis while in the performance of duty. 

She noted that she first became aware of her conditions on February 22, 2015 and first attributed 

them to factors of her federal employment on April 12, 2015. Appellant did not stop work. 

In a March 15, 2017 development letter, OWCP advised appellant that the record did not 

contain evidence sufficient to establish her claim. It advised her of the type of factual and medical 

evidence needed and afforded her 30 days to submit the necessary evidence.

On April 18, 2016 Dr. Carol S. Carlson, a physician Board-certified in physical medicine 

and rehabilitation, examined appellant due to left-sided neck pain and left upper extremity pain 

aggravated by lifting and the repetitive use of her left arm. She noted that appellant’s pain began 

without any injury. Dr. Carlson reviewed appellant’s cervical spine magnetic resonance imaging 

(MRI) scan, noted a large disc protrusion at C5-6 compressing the spinal cord, and diagnosed 

cervical radiculopathy and cervical spondylosis without myelopathy. On April 21 and May 5 and 

19, 2016 appellant underwent cervical epidural steroid injections at C7-T1. On June 1, 2016

Dr. Carlson examined appellant due to left-sided neck pain aggravated by lifting. She diagnosed 

left-sided cervical radiculopathy with occasional left arm numbness and cervical spondylosis 

without myelopathy. Dr. Carlson also noted that appellant had residual lymphedema in the left 

arm after breast cancer treatment and lymph node resection.

By decision dated May 26, 2017, OWCP denied appellant’s occupational disease claim 

finding that she had not submitted medical evidence sufficient to establish causal relationship

between her diagnosed conditions and her accepted federal employment factors.

On June 26, 2017 appellant requested reconsideration. She provided a narrative statement 

describing her job duties including lifting heavy mail trays and parcels as well as opening and 

closing mailboxes, the mail truck doors, and dock doors. Appellant alleged that these activities 

caused or contributed to her cervical radiculopathy. She denied previous neck conditions and 

asserted that her left arm pain began on February 22, 2016 due to lifting heavy sacks and packages 

on her mail route. Appellant explained that, after injections, she was pain free until October 27, 

2016 when her neck and left arm pain recurred.

By decision dated July 3, 2017, OWCP denied appellant’s request for reconsideration of 

the merits of her claim. 

In a report dated August 2, 2017, Dr. Joseph T. Hebl, a physician specializing in 

occupational medicine, listed appellant’s employment duties including reaching, lifting, pushing, 

and pulling. He diagnosed cervical radiculopathy and cervical spondylosis and noted that she

reported that her work activities worsened her symptoms, especially turning her head or neck, 

reaching, and lifting mail. Dr. Hebl opined that appellant’s diagnoses were causally related to her 

job duties and that her work activities were a material contributing cause of the onset of her neck 

pain and radiculopathy. He provided work restrictions. 
3

On August 23, 2017 Dr. Hebl indicated that appellant began experiencing neck symptoms 

on February 22, 2016. He repeated her employment duties, medical history, diagnoses, and noted 

that she reported that her work activities worsened her symptoms. Dr. Hebl found that appellant

had an industrial injury to her neck with left upper extremity paresthesias and dysesthesias. He

opined that her diagnosed conditions were directly and causally related to her work duties. 

Dr. Hebl explained that appellant’s work activities were a material contributing cause to the onset 

of her neck pain and radiculopathy and that continued activities worsened these symptoms. He

found that she could return to work with restrictions.

On December 19, 2017 appellant requested reconsideration. She provided an additional 

narrative statement attributing her conditions to her daily job duties over a period of years. 

Appellant noted that she had experienced left arm lymphedema due to breast cancer treatment, but 

that her left arm condition was also aggravated by work activities.

On March 24, 2016 Dr. Mark Southard, a Board-certified diagnostic radiologist, reviewed 

appellant’s chest x-rays. Appellant also submitted notes dated February 23, March 24, and 

December 12, 2016 from Ellen N. Canopy, a physician assistant, who diagnosed postmastectomy 

lymphedema syndrome, lumbago, cervical radiculopathy, cellulitis, and chronic acquired 

lymphedema. On November 2, 2016 Stephanie A. Roth, a registered nurse, examined appellant 

due to lymphedema. 

On February 26, October 27, and November 22, 2016 Dr. Paul M. Ippel, a family 

practitioner, examined appellant due to left hand pain and diagnosed lymphedema and cellulitis in 

the left arm. On April 8, 2016 he found that she had pain in the left upper back just above the 

scapular spine that seemed to be radiating down in her left triceps. Appellant also reported that 

her neck felt stiff. Dr. Ippel diagnosed left arm pain and ruled out left cervical radiculopathy. He

noted that appellant’s upper back pain did not have anything to do with the bag that she carried to 

deliver mail.

On May 17, 2017 Dr. Carlson reported that appellant was experiencing right-sided neck 

upper extremity pain. She performed cervical epidural injections at C7-T1 on July 6, 27, and 

August 10, 2017. On August 30, 2017 Dr. Carlson reported that appellant was not experiencing 

any significant pain in her neck or left arm. She noted that appellant’s pain was only triggered by 

lifting the heavy back door on her mail truck or lifting packages weighing over 70 pounds.

By decision dated March 19, 2018, OWCP denied modification of the May 26, 2017 

decision. 

On April 19, 2018 appellant requested reconsideration. In a narrative statement, she again 

attributed her cervical condition to her federal employment duties.

On April 12, 2016 appellant underwent a cervical spine MRI scan which demonstrated a 

very significant large disc protrusion at C5-6 compressing against the spinal cord affecting both 

the right and left sides as well as a smaller disc protrusion at C4-5.

On September 20, 2017 Dr. Laura Isaacson, an osteopath Board-certified in family 

practice, examined appellant due to neck pain and found tenderness to palpation over the right 

cervical paraspinal muscles with moderate muscle spasm. She diagnosed dyspnea, and lipid 
4

disorders. In a March 2018 narrative report, Dr. Isaacson noted appellant’s history of cancer, 

chronic lymphedema, and recurrent cellulitis of the left arm with pain. She noted that appellant 

was experiencing an exacerbation of the lymphedema as a result of recent surgery on her right 

hand which required her to use her left arm and hand more frequently. 

In a report dated April 16, 2018, Dr. Isaacson related that, on February 22, 2016, while at 

work, appellant noticed significant left arm pain that quickly developed into lymphedema and 

cellulitis. She opined that repetitive motion and heavy lifting at work had exacerbated appellant’s 

lymphedema and had likely caused cervical radiculopathy. Dr. Isaacson noted that overuse of the 

left arm and hand had exacerbated appellant’s lymphedema and that appellant underwent right 

hand surgery which required her to use her left hand and arm more frequently with an exacerbation 

of the lymphedema. She implicated appellant’s work activities of lifting heavy mail trays, opening 

and closing her vehicle door, pushing and pulling the emergency brake, pulling dock doors, and 

pushing a heavy mail cart as contributing to her flares of lymphedema and arm pain. Dr. Isaacson

found that the recurrent lifting, pushing, and pulling of heavy mail parcels, and doors on a daily 

basis had caused increased left arm pain and lymphedema, which had progressed to cellulitis when 

it was difficult to control. She further found that appellant’s left arm and neck pain were also 

likely a result of the activities required for her job.

In January 2, 2019 reports, Dr. Hebl listed appellant’s job duties of repetitive reaching, 

lifting, pushing, and pulling. He noted on February 22, 2016 while at work, she delivered several 

heavy packages and experienced severe pain, spasm, and tightness in the left side of her neck with 

radiation to her left upper back and down her left arm. Dr. Hebl also described appellant’s medical 

history and diagnosed cervical spondylosis and cervical radiculopathy. He noted that she reported 

that her work activities continued to worsen her cervical symptoms. Dr. Hebl noted that appellant 

had preexisting lymphedema from her cancer, but that her edema worsened significantly after work 

exposure. He further found that she had permanent aggravation of her preexisting post-cancer 

related left upper extremity lymphedema secondary to cervical radiculopathy as a result of a workrelated neck injury, repetitive work activities, and exacerbation of symptoms due to her right upper 

extremity surgery, resulting in use of the left upper extremity exclusively. Dr. Hebl opined that 

appellant’s work injury of February 22, 2016 was a material contributing cause to the onset of her 

neck pain and radiculopathy as well as worsening these conditions. He found that her left upper 

extremity paresthesias, dysesthesias, weakness, swelling, and pain, were permanently aggravated, 

accelerated, and worsened by her acute work injury of February 22, 2016. Dr. Hebl recommended 

that appellant work with restrictions.

On January 11, 2019 Dr. Thomas C. Jetzer, a physician Board-certified in occupational 

medicine serving as an OWCP second opinion physician, examined appellant due to right thumb 

osteoarthritis and left arm lymphedema and swelling. He noted her medical history and her work 

duties of repetitive casing and sorting mail. Dr. Jetzer opined that appellant’s lymphedema was 

due to her breast cancer surgeries and treatments. He noted that if her employment duties were 

causing lymphedema this condition would also occur in her right arm. Dr. Jetzer reported that 

lymphedema was a common and well-known complication of extensive breast cancer surgery 

which had been made worse by recurrent episodes of cellulitis. He found that appellant did not 

have a work-related condition.
5

In a January 15, 2019 report, Dr. Hebl addressed appellant’s right thumb condition.3 He

opined that her neck and left upper extremity conditions were continually being exacerbated by 

work activities. Dr. Hebl also noted that appellant reported increased pain and swelling in her left 

upper extremity as her work activities “seem[ed] to be flaring up [appellant’s] nonwork[-]related 

left upper extremity.” He reported that she was developing worsening of her left upper extremity 

pain, lymphedema, and inflammation secondary to overuse of her left upper extremity to 

compensation for her nonfunctioning right upper extremity. On physical examination, Dr. Hebl 

found bilateral posterior paracervical spasm and pain with extremes of range of motion of her neck 

in all planes, worse on the left. On February 26, 2019 he submitted an additional report focused 

on appellant’s accepted right thumb condition. Dr. Hebl repeated his findings and conclusions 

regarding her neck and left upper extremity conditions.

By decision dated March 18, 2019, OWCP denied modification of the March 19, 2018 

decision finding that appellant had not submitted medical evidence establishing that she had 

sustained a material worsening of her diagnosed conditions due to factors of her federal 

employment.

LEGAL PRECEDENT

An employee seeking benefits under FECA4 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 filed within the applicable time 

limitation, that an injury was sustained while in the performance of duty as alleged, and that any 

disability or specific 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 on a traumatic injury or an occupational disease.6

OWCP’s regulations define the term “occupational disease or illness” as a condition 

produced by the work environment over a period longer than a single workday or shift.”

7

 In an 

occupational disease claim, appellant’s burden of proof to requires submission of 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 

 

3 On January 3, 2018 appellant underwent right thumb surgery including trapeziectomy, ligament reconstruction, 

and tendon interposition. She underwent a second thumb surgery on June 1, 2018. 

4 Supra note 1.

5 E.B., Docket No. 17-0164 (issued June 14, 2018); Alvin V. Gadd, 57 ECAB 172 (2005); Bonnie A. Contreras, 57 

ECAB 364 (2006).

6 P.S., Docket No. 17-0939 (issued June 15, 2018); Ellen L. Noble, 55 ECAB 530 (2004); Joe D. Cameron, 41 

ECAB 153 (1989).

7 20 C.F.R. § 10.5(ee).
6

evidence establishing that the diagnosed condition is causally related to the employment factors 

identified by the employee.8

Causal relationship is a medical question, which requires rationalized medical opinion 

evidence to resolve the issue.9 Aphysician’s opinion on whether there is causal relationship 

between the diagnosed condition and the implicated employment factors must be based upon a 

complete factual and medical background.10 Additionally, the physician’s opinion must be 

expressed in terms of a reasonable degree of medical certainly, and must be supported by medical 

rationale, explaining the nature of the relationship between the diagnosed condition and the 

claimant’s specific employment factors.11 The belief of a claimant that a condition was caused or 

aggravated by the employment is insufficient to establish causal relationship.

12

ANALYSIS

The Board finds that appellant has not met her burden of proof to establish cervical and left 

arm conditions causally related to the accepted factors of her federal employment.

Dr. Hebl provided reports dated August 2 and 23, 2017 as well as January 15 and 

February 26, 2019 in which he generally attributed appellant’s diagnosed cervical radiculopathy 

and cervical spondylosis to her job duties by direct causation. He did not explain, however, how 

her diagnosed conditions were causally related to the accepted factors of her employment.13 

Likewise, in a report dated January 2, 2019, Dr. Hebl found that appellant’s conditions of cervical 

radiculopathy and cervical spondylosis as well as left arm lymphedema were significantly 

worsened by work activities including delivering heavy packages. He described her work 

activities, but he did not explain how the accepted employment factors physiologically caused, 

contributed to, or aggravated appellant’s diagnosed conditions.14 While these reports offer an 

opinion on causal relationship, the reports are of limited probative value because of their 

conclusory nature.15 

OWCP also received several reports from Dr. Isaacson. In her initial reports dated 

September 20, 2017 and March 2018, Dr. Isaacson noted appellant’s diagnoses, but offered no 

opinion regarding causal relationship. Medical evidence that does not offer an opinion regarding 

 

8 C.H., Docket No. 19-0409 (issued August 5, 2019); L.E., Docket No. 18-1138 (issued February 1, 2019).

9 M.S., Docket No. 19-1001 (issued December 9, 2019); E.V., Docket No. 18-1617 (issued February 26, 2019).

10 Id.

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

12 E.V., supra note 9; Lourdes Harris, 45 ECAB 545, 547 (1994).

13 See M.S. Docket No. 19-1001 (issued December 9, 2019). 

14 S.H., Docket No. 19-0631 (issued September 5, 2019); M.S., Docket No. 19-0189 (issued May 14, 2019).

15 Id.
7

the cause of an employee’s condition is of no probative value on the issue of causal relationship.16 

In her April 16, 2018 report, Dr. Isaacson attributed an exacerbation of appellant’s left arm 

lymphedema to overuse of appellant’s left arm at work as well as her work duties of heavy lifting, 

pushing, and pulling. The Board has consistently held that medical rationale is particularly 

necessary when there are preexisting conditions involving the same body part17 and the Board has 

required medical rationale differentiating between the effects of the work-related injury and the 

preexisting condition in such cases.18 Dr. Isaacson provided no such medical rationale in support 

of her opinion regarding the aggravation of appellant’s underlying lymphedema and her report is 

therefore insufficient to establish appellant’s occupational disease claim.

Dr. Isaacson found that appellant’s cervical radiculopathy was “likely caused” by repetitive 

motion and heavy lifting at work. Entitlement to FECA benefits may not be based on surmise, 

conjecture, speculation, or on the employee’s own belief of a causal relationship.19 While the 

opinion supporting causal relationship does not have to reduce the cause or etiology of a disease 

or a condition to an absolute certainty, the opinion must be one of reasonable medical certainty 

and not speculative or equivocal in character.20 Because Dr. Isaacson’s opinion is speculative and 

equivocal in nature these opinions are insufficient to meet appellant’s burden of proof.21 

On June 1 and April 18, 2016 Dr. Carlson diagnosed cervical radiculopathy and cervical 

spondylosis without myelopathy aggravated by lifting and using appellant’s left arm. She noted 

on August 30, 2017 that appellant’s pain was triggered by lifting heavy doors or packages, but did 

not offer an opinion that these activities caused or contributed to appellant’s cervical conditions. 

The Board has held that 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.22 These reports, 

therefore, are insufficient to establish appellant’s claim.

Dr. Ippel examined appellant from February 26 through November 22, 2016 and negated 

causal relationship between her diagnosed conditions and her duty of carrying a mailbag.

Dr. Carlson attributed appellant’s left arm lymphedema to breast cancer treatment and lymph node 

resection rather than to her work duties. Dr. Jetzer also opined that appellant’s lymphedema was 

due to her breast cancer treatments and surgeries. He noted that lymphedema was a common and 

well-known complication of breast cancer surgery and found that she did not have a work-related 

 

16 A.P., Docket No. 19-1158 (issued October 29, 2019); L.B., Docket No. 18-0533 (issued August 27, 2018); D.K.,

Docket No. 17-1549 (issued July 6, 2018).

17 K.R., Docket No. 18-1388 (issued January 9, 2019).

18 A.J., Docket No. 18-1116 (issued January 23, 2019); M.F., Docket No. 17-1973 (issued December 31, 2018); 

J.B., Docket No. 17-1870 (issued April 11, 2018); E.D., Docket No. 16-1854 (issued March 3, 2017); P.O., Docket 

No. 14-1675 (issued December 3, 2015).

19 M.S., supra note 13; L.T., Docket No. 18-1603 (issued February 21, 2019).

20 M.S., id.; C.L., Docket No. 18-1379 (issued February 5, 2019).

21 C.H., Docket No. 19-0409 (issued August 5, 2019).

22 See L.B., supra note 16; D.K., supra note 16.
8

condition. The Board has held that a medical report that negates causal relationship between the 

accepted employment factors and the diagnosed conditions is of no probative value.23 Therefore,

these reports do no support appellant’s claim for cervical conditions or lymphedema caused or 

aggravated by her accepted employment activities.24

Appellant also submitted March 24, 2016 x-rays from Dr. Southard and an April 12, 2016 

MRI scan report in support of her claim for cervical and left upper extremity conditions. The 

Board has held, however, that diagnostic studies lack probative value as they do not address 

whether the accepted employment factors caused any of the diagnosed conditions.25 These reports 

are therefore also insufficient to establish appellant’s claim.

Appellant submitted reports from Ms. Canopy, a physician assistant, and Ms. Roth, a 

nurse. The Board has held that medical reports signed solely by a physician assistant or nurse are 

of no probative value as neither of these providers are considered physicians as defined under 

FECA.26 Therefore, these reports are also insufficient to establish the claim.

As appellant has not submitted rationalized medical evidence establishing that her cervical 

and left arm conditions are causally related to the accepted factors of her federal employment, 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 cervical and left 

arm conditions causally related to the accepted factors of her federal employment.

 

23 See T.W., Docket No. 19-0677 (issued August 16, 2019).

24 Id. 

25 R.Z., Docket No. 19-0408 (issued June 26, 2019); J.S., Docket No. 17-1039 (issued October 6, 2017).

26 See 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 medical opinions under FECA); 5 U.S.C. § 8101(2) (this subsection 

defines a physician as surgeons, podiatrists, dentists, clinical psychologists, optometrists, chiropractors, and 

osteopathic practitioners within the scope of their practice as defined by state law). N.C., Docket No. 19-0299 (issued 

June 24, 2019); M.W., Docket No. 18-1555 (issued May 20, 2019) (nurse’s reports are of no probative medical value 

as nurses are not considered physicians under FECA); T.K., Docket No. 19-0055 (issued May 2, 2019) (physician 

assistants are not considered physicians under FECA); B.B., Docket No. 09-1858 (issued April 16, 2010).
9

ORDER

IT IS HEREBY ORDERED THAT the March 18, 2019 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: February 18, 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