United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

A.M., Appellant

and

DEPARTMENT OF VETERANS AFFAIRS, 

AUDIE L. MURPHY MEMORIAL VETERANS 

HOSPITAL, San Antonio, TX, Employer

__________________________________________

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Docket No. 18-0562

Issued: January 23, 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

JANICE B. ASKIN, Judge

ALEC J. KOROMILAS, Alternate Judge

JURISDICTION

On January 23, 2018 appellant filed a timely appeal from an October 27, 2017 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 

 

1 5 U.S.C. § 8101 et seq.

2 The Board notes that, following the October 27, 2017 decision, OWCP received additional evidence. 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 that her breast 

cancer was causally related to the accepted factors of her federal employment. 

FACTUAL HISTORY

On April 4, 2017 appellant, then a 43-year-old sleep disorder technician, filed an 

occupational disease claim (Form CA-2) alleging that she developed right breast cancer due to 

working rotating day/night shifts in the performance of duty. On the reverse side of the claim 

form, the employing establishment indicated that she had stopped work on January 12, 2016 and 

returned to work on January 18, 2016. It noted that appellant no longer worked the night shift 

(8:00 p.m. to 8:00 a.m.), and was strictly on a tour of duty with daytime hours. 

In a report dated March 23, 2016, Dr. Amy S. Lang, a Board-certified internist, advised 

that appellant was under her care for breast cancer. She explained that appellant had worked as a 

sleep study technician for many years and had spent the last four to five years working both day 

and night shifts. Dr. Lang noted that “[t]here is evidence that rotating night shifts increases the 

risk of developing breast cancer” and referred to an attached study from the Journal of the National 

Cancer Institute. She recommended that appellant work regular shifts without rotating between 

days and nights. 

In an April 13, 2017 report, Dr. Judith L. Thompson, a Board-certified general surgeon, 

noted that appellant was diagnosed with breast cancer. She indicated that appellant was working 

rotating day and night shifts and that this was “now known to have several negative health 

outcomes, notably related to breast cancer.” Dr. Thompson advised that she was in agreement

with appellant’s medical oncologist that appellant work regular shifts without rotation. 

On May 23, 2017 OWCP received a supplemental statement from appellant. Appellant

explained that, when she was interviewed for her current position, she was informed that her

schedule would be: three, 12-hour shifts at night; every other Thursday; and a day shift for 8 hours. 

She explained that, after working the rotating shifts for a considerable amount of time, she and her 

coworkers expressed their concerns about working these shifts. Appellant noted that she and her 

coworkers suggested alternate schedule ideas to alleviate the rotation back and forth; however, 

nothing was changed. She explained that she had always worked nights and enjoyed the night 

shift, but switching back and forth was difficult. Furthermore, since working at the employing 

establishment, appellant had a number of health problems that she believed were medically linked 

to shift work. She noted that the International Agency for Research on Cancer of the World Health 

Organization labeled the working shift a “probable” carcinogen. 

By development letter dated May 25, 2017, OWCP informed appellant that additional 

factual and medical evidence was necessary to support her claim. It advised her of the type of

medical and factual evidence needed to establish her claim and provided a questionnaire for her 

completion. OWCP afforded appellant 30 days to submit the necessary evidence. 

On June 9, 2017 OWCP received a statement from M.W., a supervisor, who reported that 

appellant and the other technicians were informed that they would work a rotating schedule. She 
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also indicated that she was apprised of appellant’s condition in December 2015, and appellant was 

eventually switched to a day shift. 

OWCP received an article on diseases and shift work from a nurse training program and 

an article on shift work related to light at night and the risk of breast cancer. 

Additionally, OWCP received a January 29, 2016 operative report from Dr. Thompson, 

who performed appellant’s mastectomy, and a January 5, 2017 operative report from Dr. Alan J. 

White, a surgical oncologist, who performed laparoscopic robotic assisted bilateral salpingo 

oophorectomy. It also continued to receive diagnostic studies and pathology reports. 

In reports dated February 25, 2016 and February 14, 2017, Dr. Lang reiterated appellant’s 

cancer diagnosis and that she had undergone a right breast mastectomy. She indicated that 

appellant was a sleep technician who, after 20 years of working nights, spent the last four years on 

both day and night shifts, which “she believes may have contributed to her breast cancer 

diagnosis.” Dr. Lang advised that appellant was now working only day shifts. Furthermore, she 

noted that appellant’s family history included that her deceased maternal grandmother had breast 

cancer, and her deceased maternal grandfather had bladder cancer. Dr. Lang also added that 

appellant had quit smoking six years ago, previously smoking half a pack a day for 10 years. 

OWCP received a copy of appellant’s response to its development questionnaire. In a 

statement, appellant recounted the onset of her breast cancer. 

OWCP also received treatment notes from Dr. Regina Fearmonti, a Board-certified general 

and plastic surgeon, dating from August 19, 2016 to April 24, 2017, confirming that appellant had 

undergone breast reconstruction surgery. 

In an April 13, 2017 report, Dr. Thompson related that she has treated appellant for breast 

cancer. She related that it was her understanding that appellant was working rotating day and night 

shifts and that this was now known to have several negative health outcomes, notably related to 

breast cancer. Dr. Thompson concluded that she was in agreement with appellant’s oncologist that 

appellant work regular shifts, without rotation. 

By decision dated October 27, 2017, OWCP denied appellant’s claim, finding that the 

medical evidence of record was insufficient to establish that her condition was causally related to 

the accepted factors of her federal employment. 

LEGAL PRECEDENT

An employee seeking benefits under FECA3 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 

 

3 Supra note 1. 
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time limitation of FECA,4that 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.5 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.6

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

disease claim, a claimant must submit: (1) a factual statement identifying employment factors 

alleged to have caused or contributed to the presence or occurrence of a 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 diagnosed condition is 

causally related to the identified employment factors.7

The medical evidence required to establish causal relationship is rationalized medical 

opinion evidence. A physician’s opinion on whether there is causal relationship between the 

diagnosed condition and the implicated employment factor(s) must be based on a complete factual 

and medical background. Additionally, 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 relationship between the diagnosed condition and appellant’s specific 

employment factor(s).8

ANALYSIS

The Board finds that appellant has not met her burden of proof to establish that her breast 

cancer was causally related to the accepted factors of her federal employment. 

The relevant evidence includes a report dated March 23, 2016 from Dr. Lang, who advised 

that appellant was under her care for breast cancer. Dr. Lang explained that appellant had worked 

as a sleep study technician for many years and spent the last four to five years working both day 

and night shifts. She noted that “[t]here is evidence that rotating night shifts increases the risk of 

developing breast cancer” and referred to an attached study from the Journal of the National Cancer 

Institute. The Board has held, however, that newspaper clippings, medical texts, and excerpts from 

publications are of no evidentiary value in establishing the causal relationship between a claimed 

condition and an employee’s federal employment. Such materials are of general application and 

are not determinative of whether the specific condition claimed is related to the particular 

 

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

153 (1989).

5

J.M., Docket No. 17-0284 (issued February 7, 2018); R.C., 59 ECAB 427 (2008); James E. Chadden, Sr., 40 

ECAB 312 (1988).

6 D.K., Docket No. 19-1034 (issued November 4, 2019); L.M., Docket No. 13-1402 (issued February 7, 2014);

Delores C. Ellyett, 41 ECAB 992 (1990).

7 C.M., Docket No. 18-1516 (issued May 8, 2019); Beverly A. Spencer, 55 ECAB 501 (2004).

8 A.P., Docket No. 19-1158 (issued October 29, 2019); see J.R., Docket No. 17-1781 (issued January 16, 2018);

I.J., 59 ECAB 408 (2008).
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employment factors alleged by the employee.9 Without explaining how, physiologically, these 

employment duties caused or contributed to the diagnosed condition, Dr. Lang’s opinion on causal 

relationship is of limited probative value.10

Likewise, in progress notes dated February 25, 2016 and February 14, 2017, Dr. Lang

advised that appellant was a sleep technician who, after 20 years of working nights, spent the last 

4 years on both day and night shifts, which “she believes may have contributed to her breast cancer 

diagnosis.” However, she merely repeated appellant’s opinion regarding the cause of appellant’s

condition and did not provide her own opinion on causal relationship.11 These progress notes are 

therefore insufficient to establish causal relationship. 

In an April 13, 2017 report, Dr. Thompson noted that appellant was working rotating day 

and night shifts and that this was “now known to have several negative health outcomes, notably 

related to breast cancer.” She agreed that appellant should work regular shifts without rotation. 

However, Dr. Thompson did not provide rationale explaining how appellant’s specific work 

schedule of rotating shifts caused or aggravated the diagnosed condition.12 Thus, this report is also 

insufficient to establish causal relationship. 

OWCP also received reports documenting appellant’s surgical procedures. However, these 

reports provide no opinion regarding the cause of her breast cancer. 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.13 

Similarly, OWCP received diagnostic reports; however, the Board has held that diagnostic 

studies lack probative value as they do not provide an opinion on causal relationship.14

Appellant also submitted a series of articles regarding breast cancer. As explained above, 

the Board has held that newspaper clippings, medical texts, and excerpts from publications are of 

no evidentiary value in establishing the causal relationship between a claimed condition and an 

employee’s federal employment. Such materials are of general application and are not 

 

9 See A.G., Docket No. 18-0281 (issued July 12, 2018); R.O., Docket No. 08-1133 (issued October 8, 2008); 

William C. Bush, 40 ECAB 1064, 1075 (1989) (excerpts from publications lack probative value in resolving medical 

questions unless a physician shows the applicability of the general medical principles discussed in the articles to the 

specific factual situation in a case). 

10 M.M., Docket No. 19-0061 (issued November 21, 2019); see L.M., Docket No. 14-0973 (issued August 25, 2014); 

R.G., Docket No. 14-0113 (issued April 25, 2014); K.M., Docket No. 13-1459 (issued December 5, 2013); A.J., 

Docket No. 12-0548 (issued November 16, 2012). 

11 C.N., Docket No. 14-1805 (issued December 8, 2014). 

12 Supra note 8. 

13 M.W., Docket No. 18-1624 (issued April 3, 2019); S.B., Docket No. 18-1296 (issued January 24, 2019).

14 See I.C., Docket No. 19-0804 (issued August 23, 2019).
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determinative of whether the specific condition claimed is related to the particular employment 

factors alleged by the employee.15 

As appellant has not submitted rationalized medical evidence sufficient to establish causal 

relationship between her breast cancer and the accepted factors of her federal employment, the 

Board finds that she has not met her burden of proof.16

Appellant may submit additional evidence, together with a written request for 

reconsideration, to OWCP within one year of the Board’s 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 that her breast 

cancer was causally related to the accepted factors of her federal employment. 

ORDER

IT IS HEREBY ORDERED THAT the October 27, 2017 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: January 23, 2020

Washington, DC

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Alec J. Koromilas, Alternate Judge

Employees’ Compensation Appeals Board

 

15 William C. Bush, 40 ECAB 1064, 1075 (1989). 

16 Supra note 8.