United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

C.P., Appellant

and

SOCIAL SECURITY ADMINISTRATION, 

Richmond, CA, Employer

__________________________________________

)

)

)

)

)

)

)

)

Docket No. 21-0744

Issued: December 20, 2021

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

JANICE B. ASKIN, Judge

PATRICIA H. FITZGERALD, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On April 21, 2021 appellant filed a timely appeal from an April 12, 2021 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.

ISSUE

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

causally related to the accepted factors of her federal employment. 

FACTUAL HISTORY

On April 29, 2020 appellant, then a 41-year-old claims adjudicator, filed an occupational 

disease claim (Form CA-2) alleging that factors of her federal employment including typing, as 

well as ergonomic deficiencies with her work station caused neck, arm, and chest pain. She stated 

1

5 U.S.C. § 8101 et seq.
2

that she first became aware of her condition and that it was related to factors of her federal 

employment on April 27, 2020.

Appellant submitted treatment notes from Dr. Jerry M. Kenny, a chiropractor, dated from

December 21, 2017. In a note dated April 30, 2020, Dr. Kenny related that x-rays taken that day 

of appellant’s cervical spine revealed findings of degenerative disc disease at C5-C7, with loss of 

disc height, possible foramen stenosis at C5-C7 with loss of cervical curve. He also related that 

appellant’s x-ray, subjective complaints, and examination results indicated repetitive lower 

cervical compression due to possible computer ergonomics and repetitive looking down. In 

addition, Dr. Kenny noted that appellant’s right shoulder pain could possibly indicate a condition 

caused by repetitive computer use and improper ergonomics.

On May 5, 2020 Dr. Kenny completed a form report wherein he noted that repetitive work 

on a computer at home during COVID-19 increased appellant’s pain from her right shoulder to her 

fingers due to improper ergonomics. He related a diagnosis of right sciatica.

In a development letter dated May 15, 2020, OWCP advised appellant that additional 

evidence was necessary to establish her claim. It indicated the type of factual and medical evidence 

needed. OWCP noted that a chiropractor did not qualify as a physician under FECA unless a there 

was a diagnosed spinal subluxation based on x-ray evidence. It afforded appellant 30 days to 

submit the necessary evidence.

Appellant submitted an x-ray films dated May 21, 2020 of her collar bone and cervical 

spine.

OWCP received several notes from the chiropractor, Dr. Kenny which recommended that 

appellant be excused from work through July 28, 2020. In a May 5, 2020 note, Dr. Kenny’s

diagnoses included cervical subluxation based on x-rays.

By decision dated July 23, 2020, OWCP accepted that the employment factors occurred as 

alleged, but denied appellant’s claim finding that she had not established a diagnosed medical 

condition causally related to the accepted employment factors. It concluded, therefore, that the 

requirements had not been met to establish an injury as defined by FECA. 

Appellant submitted a report dated July 29, 2020 from Zachary Symmes, a physician 

assistant. Mr. Symmes related that appellant was seen for right-sided neck pain radiating down 

her right upper extremity since April 2020. He also stated that he believed appellant had cervical 

radiculopathy.

OWCP received an imaging report dated August 7, 2020 from Dr. Brad Piatt, a Boardcertified diagnostic radiologist. Dr. Piatt related that appellant experienced right upper extremity 

numbness and tingling. He found appellant had mild disc bulging at C5-C7, mild kyphosis, and a 

small lower cervical thoracic foraminal cyst.

OWCP received a note dated August 14, 2020 from Dr. Abid A. Qureshi, a Board-certified 

orthopedic surgeon. Dr. Qureshi noted appellant’s complaints of neck and arm pain that started in 

April. He noted that appellant’s August 7, 2020 MRI scan revealed visible mild-to-moderate 
3

spondylosis. Dr. Qureshi indicated that appellant’s lack of ergonomic equipment worsened her 

symptoms. 

On September 1, 2020 appellant requested reconsideration and resubmitted evidence 

previously of record.

By decision dated September 4, 2020, OWCP denied modification of its July 23, 2019 

decision, finding that appellant had not established fact of injury.

On September 15, 2020 appellant requested reconsideration and submitted a July 29, 2020

report wherein Mr. Symmes, a physician assistant, noted appellant’s history of computer work for 

17 years and her current complaints. He listed appellant’s diagnoses as cervical C6-7 

radiculopathy and cervicalgia. Mr. Symmes noted that appellant’s condition “came about” from 

her stationary desk job.

By decision dated January 19, 2021, OWCP denied appellant’s request for reconsideration. 

On March 11, 2021 appellant again requested reconsideration.

In support of her reconsideration request, appellant submitted an undated treatment plan 

fromDr. Qureshi. Dr. Qureshi diagnosed cervical radiculopathy and stated that she has an element 

of tennis elbow. He concluded that “her symptoms were 100 percent work related.”

Appellant submitted a medical report dated February 25, 2021 from Mr. Symmes. 

Mr. Symmes related that appellant’s diagnoses were neck pain and cervical radiculopathy and that 

they were “100 percent work related” due to the poor ergonomics of her home office.

By decision dated April 12, 2021, OWCP modified its September 4, 2020 decision,finding 

that a diagnosis had been established, but affirmed the denial of the claim as the medical evidence 

of record was insufficient to establish causal relationship.

LEGAL PRECEDENT

An employee seeking benefits under FECA2 has the burden of proof to establish the 

essential elements of his or her claim, including that the individual is an employee of the United 

States within the meaning 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 

2

Id.

3 F.H., Docket No. 18-0869 (issued January 29, 2020); J.P., Docket No. 19-0129 (issued April26, 2019); Joe D. 

Cameron, 41 ECAB 153 (1989).
4

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

disease claim, a claimant must submit 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 evidence establishing that the 

diagnosed condition is causally related to the identified employment factors. 6

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.7 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 factors identified by the claimant. 8 Neither the mere fact 

that a disease or condition manifests itself during a period of employment, nor the belief that the 

disease or condition was caused or aggravated by employment factors, is sufficient to establish 

causal relationship.9

ANALYSIS

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

condition causally related to the accepted factors of her federal employment. 

Appellant submitted an undated treatment plan from Dr. Qureshi which listed appellant’s 

diagnosis of cervical radiculopathy and stated that her symptoms were 100 percent work related. 

OWCP also received a note dated August 14, 2020 from Dr. Qureshi related that appellant’s 

August 7, 2020 MRI scan revealed mild-to-moderate spondylosis, and that appellant’s lack of 

ergonomic equipment worsened her symptoms. While Dr. Qureshi provided an opinion on the 

causal relationship in both of these reports, he did not offer any rationale to explain how the 

accepted employment factors would have caused appellant’s diagnosed condition.10 The Board 

4 L.C., Docket No. 19-1301 (issued January 29, 2020); J.H., Docket No. 18-1637 (issued January 29, 2020); 

James E. Chadden, Sr., 40 ECAB 312 (1988).

5 P.A., Docket No. 18-0559 (issued January 29, 2020); K.M., Docket No. 15-1660 (issued September 16, 2016); 

DeloresC. Ellyett, 41 ECAB 992 (1990).

6

See T.L., Docket No. 18-0778 (issued January 22, 2020); RoyL. Humphrey, 57 ECAB 238, 241 (2005); Victor J. 

Woodhams, 41 ECAB 345, 352 (1989).

7

J.F., Docket No. 18-0492 (issued January 16, 2020); Jacqueline M. Nixon-Steward, 52 ECAB 140 (2000).

8 A.M., Docket No. 18-0562 (issued January 23, 2020); LeslieC. Moore, 52 ECAB 132 (2000).

9 E.W., Docket No. 19-1393 (issued January 29, 2020); Gary L. Fowler, 45 ECAB 365 (1994).

10 T.W., Docket No. 20-0767 (issued January 13, 2021); see H.A.,Docket No. 18-1466 (issued August 23, 2019); 

L.R., Docket No. 16-0736 (issued September 2, 2016).
5

has held that a report is conclusory and of limited probative value regarding causal relationship if 

it does not contain medical rationale explaining how a given medical condition was related to 

employment factors.

11

 A medical opinion should offer a medically-sound explanation of how 

specific employment factors physiologically caused the diagnosed condition.12 As Dr. Qureshi 

did not provide a rationalized medical opinion explaining how the factors of appellant’s 

employment physiologically caused her diagnosed cervical conditions, his reports were 

insufficient to establish causal relationship. 

OWCP received medical evidence from Dr. Kenny, a chiropractor. Under FECA, a 

chiropractor is considered a physician only to the extent that the reimbursable services are limited 

to treatment consisting of manual manipulation of the spine to correct a subluxation as 

demonstrated by x-ray to exist.13 In his treatment notes dated December 21, 2017 through 

April 30, 2020, he did not diagnose a subluxation and is, therefore, not considered a physician with 

regard to those treatment notes. In a May 5, 2020 note, he diagnosed cervical subluxation based 

on x-rays. The Board thus finds that Dr. Kenny is a physician for purposes of FECA with regard 

to his May 5, 2020 note and form report. However, as Dr. Kenny did not provide an opinion on 

causal relationship, this evidence is of no probative value.14

OWCP received reports from Mr. Symmes, a physician assistant. Certain healthcare 

providers such as physician assistants, nurse practitioners, and physical therapists are not 

considered physicians as defined under FECA.15 Consequently, Ms. Symmes’ reports are 

insufficient to establish the claim.

Appellant submitted an imaging report dated August 7, 2020 from Dr. Piatt. OWCP also 

received x-ray films of her collar bone and cervical spine. The Board has held that diagnostic 

tests, standing alone, lack probative value on the issue of causal relationship as they do no t address 

11 See D.W., Docket No. 18-1139 (issued May 21, 2019)Y.D., Docket No. 16-1896 (issued February 10, 2017).

12 Id.; See also H.T., Docket No. 20-1238 (issued July 12, 2021).

13 FECA provides that the term “physician” includes surgeons, podiatrists, dentists, clinical psychologists, 

optometrists, chiropractors, and osteopathic practitioners with 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 regulation by the Secretary. 5 U.S.C. §8101(2). See also T.T., Docket No. 18-0838 (issued September 19, 2019); 

P.R., Docket No 14-1007 (issued August 13, 2014); Thomas W. Stevens, 50 ECAB 288 (1999); GeorgeE. Williams, 

44 ECAB 530 (1993); Merton J. Sills, 39 ECAB 572, 575 (1988).

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

15 5 U.S.C. § 8101(2) 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,” 

20 C.F.R. § 10.5(t). See Federal (FECA) Procedure Manual, Part 2 -- Claims, Causal Relationship, Chapter 

2.805.3a(1) (January 2013); see also M.F., Docket No. 19-1573 (issued March 16, 2020); N.B., Docket No. 19-0221 

(issued July 15, 2019); 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).
6

the relationship between the accepted employment factors and a diagnosed condition.16 For this 

reason, this evidence is insufficient to meet appellant’s burden of proof.

As the medical evidence of record is insufficient to establish causal relationship between 

appellant’s diagnosed medical conditions and 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 a medical 

condition causally related to the accepted factors of her federal employment.

ORDER

IT IS HEREBY ORDERED THAT the April 12, 2021 decision of the Workers’

Compensation Programs is affirmed. 

Issued: December 20, 2021

Washington, DC

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Alternate Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board

16 See W.M.,Docket No. 19-1853 (issued May 13, 2020); L.F.,Docket No. 19-1905 (issued April10, 2020).