United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

O.Y., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Little Rock, AR, Employer

__________________________________________

)

)

)

)

)

)

)

)

Docket No. 17-0651

Issued: May 2, 2018

Appearances: Case Submitted on the Record

Appellant, pro se 

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

CHRISTOPHER J. GODFREY, Chief Judge

PATRICIA H. FITZGERALD, Deputy Chief Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On January 31, 2017 appellant filed a timely appeal from an August 16, 2016 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 diagnosed medical 

conditions causally related to the accepted December 12, 2015 employment incident. 

 

1 5 U.S.C. § 8101 et seq.

2 The record provided to the Board includes evidence received after OWCP issued its August 16, 2016 decision. 

The Board’s jurisdiction is limited to the evidence that was before OWCP at the time of its final decision. Therefore, 

the Board is precluded from considering this additional evidence for the first time on appeal. 20 C.F.R. § 501.2(c)(1).
2

FACTUAL HISTORY

On December 14, 2015 appellant, then a 57-year-old rural carrier, filed a traumatic injury 

claim (Form CA-1) alleging that she sustained a right wrist strain on December 12, 2015 when a 

mailbox fell from its post while in the performance of her duties. She did not stop work.

In a December 16, 2015 supplemental statement, appellant explained that a customer had 

a large mailbox designed to hold packages. As she placed a package inside and closed the lid, the 

mailbox fell off its post with her hand still on “it.” Appellant indicated that her shoulder started to 

hurt/burn, but she finished her route. 

In a December 14, 2015 work excuse note, Dr. J. Brad Tilley, a Board-certified family 

practitioner, excused appellant from work for the period December 14 to 21, 2015. 

OWCP received a December 14, 2015 work excuse note and a December 18, 2015 

attending physician’s report (Form CA-20) from a nurse practitioner. The nurse practitioner 

indicated that appellant was off work the week of December 14, 2015 due to right upper extremity 

injury and pain. 

A December 16, 2015 duty status report (Form CA-17) and an attending physician’s report 

signed by a physical therapist were also submitted. In the December 16, 2015 attending 

physician’s report, the physical therapist indicated that appellant was injured on December 12, 

2015 with no prior history of injury and provided a diagnosis of right shoulder strain and rightsided neck strain. By checking a box marked “yes,” the physical therapist indicated that the 

conditions found were caused or aggravated by employment activity. 

By development letter dated December 29, 2015, OWCP advised appellant that the 

evidence submitted was insufficient to establish her claim. It noted that the evidence signed by 

the nurse practitioner would not qualify as medical evidence under FECA unless it was 

countersigned by a physician. OWCP also noted that the evidence signed by a physical therapist 

was of no probative medical value as physical therapists are not considered physicians under 

FECA. It requested that appellant submit additional medical evidence to establish that she 

sustained a diagnosed medical condition causally related to the employment incident. Appellant 

was afforded 30 days to submit the additional information.

In response, OWCP received December 14, 2015 x-ray reports of the right wrist and right 

shoulder, from Dr. Rajesh Sethi, a diagnostic radiologist. Dr. Sethi found no acute fracture or 

dislocation of the right wrist or acute findings in the right shoulder. An impression of arthritis in 

the wrist, acromioclavicular (AC) joint arthritis and early glenohumeral joint arthritis were 

provided. 

OWCP also received a December 14, 2015 report from Dr. Tilley. Dr. Tilley related that 

appellant had right shoulder and wrist pain that occurred three days prior after a work-related 

injury. Appellant had reported that she was delivering mail and grabbed the lid to a mailbox, 

which fell off. As she held on to the mailbox lid, it pulled her shoulder and wrist back (extended). 

Dr. Tilley provided an assessment of shoulder pain and unspecified injury of shoulder and upper 
3

arm, unspecified arm, sequela. In a December 14, 2015 referral to physical therapy, he diagnosed 

right shoulder and upper extremity pain. 

In January 8 and 20, 2016 reports, Dr. Tilley noted that appellant was in physical therapy. 

He provided an assessment of unspecified injury of shoulder and upper arm, unspecified arm, 

sequela; muscle spasms of head and/or neck; and right shoulder pain. Dr. Tilley recommended 

that appellant continue physical therapy and work light duty with restrictions. In a January 25, 

2016 letter, he noted that appellant was initially seen on December 14, 2015 due to a work-related 

injury that occurred on December 12, 2015. Dr. Tilley indicated that she was referred to physical 

therapy and that he followed the physical therapist’s recommendation for light duty. He noted

changes in appellant’s light-duty status and her medical restrictions. 

OWCP also received a January 5, 2015 duty status report, a January 8, 2016 note and 

January 8, 2016 certification of health care provider under the Family and Medical Leave Act, and 

a January 20, 2016 letter, all signed by a nurse practitioner; as well as a January 21, 2016 physical 

therapy note.

By decision dated February 1, 2016, OWCP accepted that the December 12, 2015 incident 

occurred as alleged, but denied the claim, finding that the medical evidence of record failed to 

establish a diagnosed medical condition causally related to the accepted employment incident.

On February 4, 2016 appellant requested an oral hearing before an OWCP hearing 

representative, which was held telephonically on July 11, 2016. During the hearing, appellant 

testified regarding the December 12, 2015 employment incident.

OWCP received a February 4, 2016 statement from appellant further describing the 

December 12, 2015 employment incident; physical therapy reports from December 16, 2015 

through January 28, 2016 and reports signed by a nurse practitioner.

In a February 9, 2016 report, Dr. Tilley diagnosed muscle spasms of head and/or neck; 

unspecified injury of shoulder and upper arm, unspecified arm, sequela; and shoulder pain.

On February 16, 2016 OWCP received the December 16, 2015 attending physician’sreport 

initially signed by a physical therapist, countersigned by Dr. Tilley. This report diagnosed right 

shoulder and right neck strain. 

In a June 21, 2016 letter, Dr. Tilley noted that appellant returned to work full time. He

related that appellant’s unspecified shoulder and upper arm injury that was caused from the workrelated incident continued to cause her intermittent discomfort. Dr. Tilley opined that, but for the 

work-related incident, appellant would not have any pain to her right shoulder and right upper 

extremity.

By decision dated August 16, 2016, an OWCP hearing representative affirmed the 

February 1, 2016 decision.
4

LEGAL PRECEDENT

An employee seeking benefits under FECA3 has the burden of proof to establish the 

essential elements of his or her claim by the weight of the reliable, probative, and substantial 

evidence4including that he or she sustained an injury in the performance of duty and that any 

specific condition or disability from work for which he or she claims compensation is causally 

related to that employment injury.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.6 There 

are two components involved in establishing the 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.7 Second, the employee must submit probative medical 

evidence to establish that the employment incident caused a personal injury.8 An employee may 

establish that the employment incident occurred as alleged, but fail to show that his or her disability 

or condition relates to the employment incident.9

Whether an employee sustained an injury in the performance of duty requires the 

submission of rationalized medical opinion evidence.10 The opinion of the physician must be 

based on a complete factual and medical background of the employee, 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 employee.11 The weight of the medical evidence is determined by its reliability, its probative 

value, its convincing quality, the care of analysis manifested, and the medical rationale expressed 

in support of the physician’s opinion.12

 

3 Supra note 1.

4

J.P., 59 ECAB 178 (2007); Joseph M. Whelan, 20 ECAB 55, 58 (1968).

5 G.T., 59 ECAB 447 (2008); Elaine Pendleton, 40 ECAB 1143, 1145 (1989).

6 S.P., 59 ECAB 184 (2007); Alvin V. Gadd, 57 ECAB 172 (2005).

7 Bonnie A. Contreras, 57 ECAB 364 (2006); Edward C. Lawrence, 19 ECAB 442 (1968).

8 David Apgar, 57 ECAB 137 (2005); John J. Carlone, 41 ECAB 354 (1989).

9 T.H., 59 ECAB 388 (2008); see also Roma A. Mortenson-Kindschi, 57 ECAB 418 (2006).

10 See J.Z., 58 ECAB 529 (2007); Paul E. Thams, 56 ECAB 503 (2005).

11 I.J., 59 ECAB 408 (2008); Victor J. Woodhams, 41 ECAB 465 (2005).

12 James Mack, 43 ECAB 321 (1991).
5

ANALYSIS

The Board finds that appellant has not established diagnosed conditions causally related to 

the accepted December 12, 2015 employment incident. 

Appellant claimed that, on December 12, 2015, she sustained injuries to her right wrist and 

right shoulder when a large mailbox fell from its post with her hand still on it. OWCP accepted 

that the December 12, 2015 employment incident occurred as alleged, but denied her claim as the 

medical evidence of record failed to establish a diagnosed condition as a result of the accepted 

employment incident. 

In a December 14, 2015 report, Dr. Tilley reported that appellant’s right shoulder and wrist 

pain occurred three days prior, following a work-related injury. He noted the history of injury and 

provided an assessment of shoulder pain and unspecified injury of shoulder and upper arm, 

unspecified arm, sequela. In a December 14, 2015 referral to physical therapy, Dr. Tilley

diagnosed right shoulder and upper extremity pain. In January 8 and 20, and February 9, 2016 

reports, he provided an assessment of unspecified injury of shoulder and upper arm, unspecified 

arm sequela; muscle spasms of head and/or neck; and right shoulder pain. Dr. Tilley’s assessment 

that appellant was experiencing pain in her right shoulder and upper extremity as well as muscle 

spasms of head and/or neck, without any explanation of the condition causing such pain or spasms, 

is a description of a symptom rather than a firm diagnosis of a compensable medical condition.13 

In his June 21, 2016 letter, he explained that the shoulder pain diagnosis was caused from the 

unspecified shoulder and upper arm injury from her work-related incident. However, Dr. Tilley

again failed to provide a medical diagnosis.

14

 It is not possible to establish the cause of a medical 

condition if the physician has not provided a diagnosis, but only notes pain.15 Because Dr. Tilley 

failed to provide medical diagnoses, his opinion is of diminished probative value. These reports,

which fail to provide diagnoses of appellant’s condition, are therefore insufficient to establish 

appellant’s claim. 

On January 9, 2016 Dr. Tilley countersigned the December 16, 2015 attending physician 

report previously signed by a physical therapist. As such, the December 16, 2015 report is 

probative medical evidence.16 This report noted that appellant was injured on December 12, 2015 

with no prior history of injury and diagnosed a right shoulder strain and right-sided neck strain. 

By checking a box marked “yes,” he indicated that the conditions found were caused or aggravated 

by appellant’s federal employment activity. The Board has held that when a physician’s opinion 

on causal relationship consists only of checking a box marked “yes” to a form question, without 

explanation or rationale, the opinion is of diminished probative value and is insufficient to establish 

 

13 The Board has consistently held that pain is a symptom, rather than a compensable medical diagnosis. C.F.,

Docket No. 08-1102 (issued October 10, 2008).

14 Id., K.W., Docket No. 12-1590 (issued December 18, 2012).

15 See M.P., Docket No. 17-1634 (issued November 24, 2017). 

16 L.B., Docket No. 13-1253 (issued September 18, 2013) (physical therapists do not qualify as physicians under 

FECA and, therefore, their medical reports do not qualify as probative medical evidence, unless such medical reports 

are countersigned by a physician).
6

a claim.17 Therefore while this report is sufficient to establish medical diagnoses, it is insufficient 

to establish causal relationship. 

The diagnostic reports from Dr. Sethi are also insufficient to discharge appellant’s burden 

of proof. The Board has previously explained that diagnostic testing is of limited probative value 

as it fails to provide a physician’s reasoned opinion on causal relationship between appellant’s 

work incident and the diagnosed conditions.18

Nurse practitioner notes and physical therapy reports were also submitted. As nurse 

practitioners and physical therapists are not considered physicians as defined under FECA,

19 these 

reports are insufficient to establish appellant’s claim.20

An award of compensation may not be based on surmise, conjecture, or speculation. 

Neither the fact that appellant’s condition became apparent during a period of employment nor the 

belief that her condition was caused, precipitated, or aggravated by her employment is sufficient 

to establish causal relationship. Causal relationship must be established by rationalized medical 

opinion evidence.21 Appellant failed to submit such evidence, and therefore failed to meet 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 established diagnosed conditions causally related to 

the accepted December 12, 2015 employment incident.

 

17 Sedi L. Graham, 57 ECAB 494 (2006); D.D., 57 ECAB 734 (2006).

18 M.S., Docket No. 17-1044 (issued February 2, 2018). 

19 A.C., Docket No. 08-1453 (issued November 18, 2008). Section 8101(2) of FECA provides as follows: 

(2) physician includes surgeons, podiatrists, dentists, clinical psychologists, optometrists, chiropractors, and 

osteopathic practitioners within the scope of their practice as defined by State law. The term physician includes 

chiropractors only to the extent that their reimbursable services are limited to treatment consisting of manual 

manipulation of the spine to correct a subluxation as demonstrated by x-ray to exist and subject to regulations by the 

secretary. See Merton J. Sills, 39 ECAB 572, 575 (1988). 5 U.S.C. § 8101(2); Sean O Connell, 56 ECAB 195 (2004) 

(nurse practitioners are not physicians under FECA); Jennifer L. Sharp, 48 ECAB 209 (1996) (physical therapists are 

not physicians under FECA).

20 Allen C. Hundley, 53 ECAB 551 (2002); Lyle E. Dayberry, 9 ECAB 369 (1998).

21 See Dennis M. Mascarenas, 49 ECAB 215 (1997). 
7

ORDER

IT IS HEREBY ORDERED THAT the August 16, 2016 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: May 2, 2018

Washington, DC

Christopher J. Godfrey, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board