United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

B.L., Appellant

and

DEPARTMENT OF LABOR, OFFICE OF 

WORKERS’ COMPENSATION PROGRAMS, 

New York, NY, Employer

__________________________________________

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Docket No. 21-0500

Issued: December 10, 2021

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

JANICE B. ASKIN, Judge

PATRICIA H. FITZGERALD, Alternate Judge

JURISDICTION

On February 8, 2021 appellant filed a timely appeal from a January 22, 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.2

ISSUE

The issue is whether appellant has met her burden of proof to establish total disability from 

work for the period June 26 to September 2, 2018 causally related to the accepted May 11, 2018 

employment injury.

1

5 U.S.C. § 8101 et seq.

2 The Board notes that,following the January 22, 2021 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

FACTUAL HISTORY

This case has previously been before the Board on a different issue.

3

 The facts and 

circumstances as set forth in the Board’s prior order are incorporated herein by reference. The 

relevant facts are as follows.

On May 15, 2018 appellant, then a 31-year-old claims examiner, filed a traumatic injury 

claim (Form CA-1) alleging that on May 11, 2018 she sustained bilateral shoulder and back strains

when she attempted to open a heavy door with her left hand, while pushing a chair with her right 

hand. She stopped work on the date of injury. Appellant returned to work on June 27, 2018, 

stopped work again on June 29, 2018, and returned to work on September 4, 2018.4 After initial 

denial of the claim, by decision dated April 5, 2019, OWCP accepted the claim for bilateral 

shoulder and lumbar strains.

On March 3, 2020 appellant filed claims for wage-loss compensation (Form CA-7) alleging 

disability for the periods June 26 through July 25, 2018, and July 25 through September 2, 2018.

In a development letter dated March 10, 2020, OWCP advised appellant of the necessary 

medical evidence to support disability during the periods claimed. It afforded her 30 days to 

respond.

In a July 2, 2018 disability form report, Dr. Dante T. Lazo, a Board-certified internist,

noted that appellant had been seen that day for a May 11, 2018 injury and advisedshe was disabled 

from work for eight weeks due to bilateral shoulder and lower back pain and weakness.

An August 20, 2018 attending physician’s report, Part B of the Form CA-16,from Dr. Lazo 

indicated that appellant was totally disabled from work for the period May 11 through 

September 2, 2018. Dr. Lazo described how the May 11, 2018 injury occurred and diagnosed 

lumbar and shoulder strain. He checked a box marked “Yes” to the questions of whether there 

was a history or evidence of concurrent or preexisting injury and whether the condition had been 

aggravated by the employment activity. Dr. Lazo noted that appellant had been involved in a 

motor vehicle accident on April 6, 2018, during which she sustained shoulder and back injuries.

In a state workers’ compensation form report dated August 20, 2018, Dr. Lazo noted a 

May 11, 2018 injury date and described the employment incident. He diagnosed bilateral shoulder 

joint and lumbar sprains based upon physical findings of bilateral shoulder abnormal range of 

motion (ROM), shoulder weakness, and pain/tenderness in the lower back and shoulders. Dr. Lazo 

opined that appellant was disabled from work due to pain and weakness. 

By decision dated May 29, 2020, OWCP denied appellant’s claim for wage-loss 

compensation for the period June 26 through September 2, 2018, finding that the medical evidence 

of record was insufficient to establish disability from work during the claimed period causally 

related to her accepted May 11, 2018 employment injury. It noted the record also contained

3 Order Granting Remand, Docket No. 19-0240 (issued March 22, 2019).

4 The employing establishment issued an authorization for examination and/or treatment (Form CA-16) on 

May 21, 2018.
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evidence of preexisting conditions due to a nonemployment-related April 16, 2018 automobile 

accident, which was not addressed by the medical evidence submitted by appellant.

On July 1, 2020 appellant requested reconsideration. 

OWCP continued to receive medical evidence. Dr. Lazo, in a May 21, 2018 narrative 

report, noted appellant’s history of injury on May 11, 2018. He related that appellant’s physical 

examination findings included: decreased lumbar and bilateral shoulder ROM; lumbar spasm, 

tenderness, and trigger points on palpation; negative straight leg raising; and 3/5 muscle strength, 

and he diagnosed shoulder joint, lower back and pelvis sprains. 

In a state workers’ compensation form report dated August 31, 2018, Dr. Lazo reiterated 

findings from his prior report. He released appellant to return to work on September 4, 2018. On 

August 31, 2018 Dr. Lazo also completed an attending physician’s report, Part B of the Form CA16, relating that appellant could return to work on September 4, 2018. 

By decision dated September 22, 2020, OWCP denied modification. It found the medical 

evidence submitted failed to discuss appellant’s injuries caused by the April 2018 motor vehicle 

accident and did not provide medical rationale explaining how the accepted May 11, 2018 work 

injury caused disability.

On October 21, 2020 appellant filed a request for reconsideration. 

In support of her request for reconsideration, appellant submitted disability notes

previously of record from Dr. Lazo and an additional note dated August 1, 2018. Dr. Lazo again 

diagnosed bilateral shoulder and lumbar sprains due to a May 11, 2018 accident. He reiterated 

that appellant would be disabled from work for an additional four weeks. 

In a November 25, 2020 note, Dr. Erie Augustin advised that appellant had reached 

maximum medical improvement and required no further medical treatment. He noted an April 6, 

2018 motor vehicle accident and May 11, 2018 work injury. Dr. Augustin diagnosed neck, 

bilateral shoulder, upper and lower back, and left knee injuries and noted that appellant underwent 

shoulder surgery on June 13, 2018.

By decision dated January 22, 2021, OWCP denied modification, finding that the record 

failed to contain an opinion based on an accurate medical and injury history explaining how her 

disability from work during the period claimed was causally related to the accepted May 11, 2018 

employment injury. 

LEGAL PRECEDENT

An employee seeking benefits under FECA5 has the burden of proof to establish the 

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

evidence.6 The term disability is defined as the incapacity, because of an employment injury, to 

5

Supra note 1.

6

See A.S., Docket No. 20-0406 (issued August 18, 2021); B.K.,Docket No. 18-0386 (issued September 14, 2018);

see also Amelia S. Jefferson, 57 ECAB 183 (2005); Nathaniel Milton, 37 ECAB 712 (1986).
4

earn the wages the employee was receiving at the time of the injury.7 For each period of disability 

claimed, the employee has the burden of proof to establish that he or she was disabled from work 

as a result of the accepted employment injury.8

Whether a particular injury causes an employee to become disabled from work, and the 

duration of that disability, are medical issues that must be proven by a preponderance of the 

reliable, probative, and substantial medical evidence.9 The medical evidence required to establish 

causal relationship between a claimed period of disability and an employment injury is rationalized 

medical opinion evidence. 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 claimed 

disability and the specific employment factors identified by the claimant.10

The Board will not require OWCP to pay compensation for disability in the absence of 

medical evidence directly addressing the specific dates of disability for which compensation is 

claimed. To do so would essentially allow an employee to self-certify his or her disability and 

entitlement to compensation.11

ANALYSIS

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

from work for the period June 26 to September 2, 2018 causally related to the accepted May 11, 

2018 employment injury.

Appellant was involved in an April 6, 2018 nonwork-related motor vehicle accident and

remained out of work until May 7, 2018. She alleged that she sustained a torn right shoulder 

rotator cuff from the motor vehicle accident and that she aggravated her condition during the

May 11, 2018 employment incident. On June 13, 2018 appellant underwent a right shoulder 

partial synovectomy arthroscopy, extensive debridement of right shoulder labral tear and rotator 

cuff tear subscapularis tendon, and right shoulder subacromial decompression with acromioplasty. 

She attempted to return to work on June 27, 2018? and stopped work again on June 29, 2018.

OWCP received a series of reports from Dr. Lazo in support of appellant’s claim, wherein

he indicated that appellant was totally disabled through September 2, 2018. However, Dr. Lazo

offered no rationalized medical opinion as to whether appellant’s accepted conditions were the 

cause of her disability. The Board has held that medical evidence that does not provide an opinion 

regarding whether a period of disability is due to an accepted employment condition is of no 

7

20 C.F.R. § 10.5(f); S.T.,Docket No. 18-0412 (issued October 22, 2018); Cheryl L. Decavitch, 50 ECAB 

397 (1999).

8

See A.S., supra note 6; D.G.,Docket No. 18-0597 (issued October 3, 2018);AmeliaS. Jefferson, supranote 6.

9 A.S., id.; AmeliaS. Jefferson, id.; WilliamA. Archer, 55 ECAB 674 (2004).

10 T.L., Docket No. 20-0978 (issued August 2, 2021); V.A.,Docket No. 19-1123 (issued October 29, 2019).

11 C.T., Docket No. 20-0786 (issued August 20, 2021); S.G., Docket No. 18-1076 (issued April 11, 2019);

WilliamA. Archer,supra note 9; Fereidoon Kharabi, 52 ECAB 291 (2001).
5

probative value and, thus, is insufficient to establish a claim. 12 Dr. Lazo also did not discuss 

appellant’s April 2018 motor vehicle accident and whether or not appellant continued to be 

disabled due to that injury. A discussion of appellant’s prior injury is necessary as appellant 

underwent surgical treatment including right shoulder partial synovectomy arthroscopy, extensive 

debridement of right shoulder labral tear and rotator cuff tear subscapularis tendon, and right 

shoulder subacromial decompression with acromioplasty on June 13, 2018 and Dr. Lazo did not 

address whether this procedure and any resulting disability were directly caused or aggravated by 

appellant’s May 11, 2018 employment injury. The need for a rationalized medical opinion was 

particularly important because appellant had preexisting shoulder conditions.13 Consequently,

Dr. Lazo’s reports are insufficient to establish that appellant was disabled from work during the 

period June 26 through September 2, 2018 due to her May 11, 2018 employment injury.14 

The remaining medical evidence fails to address the claimed periods of disability from 

June 26 through September 2, 2018 and, thus, lacks probative value and is insufficient to meet 

appellant’s burden of proof.15

As appellant has not submitted medical evidence sufficient to establish disability during 

the claimed period due to her accepted injury, the Board finds that she has not met her burden of 

proof.16

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 total disability 

from work for the period June 26 to September 2, 2018 causally related to the accepted May 11, 

2018 employment injury.

12 See S.D., Docket No. 20-1255 (issued February 3, 2021); L.L., Docket No. 19-1794 (issued October 2, 2020);

C.R., Docket No. 19-1427 (issuedJanuary3, 2020); L.B., Docket No. 18-0533 (issued August 27, 2018); D.K., Docket 

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

13 Federal (FECA) Procedure Manual, Part 2 --Claims, Causal Relationship, Chapter 2.805.3e (January 2013). See 

R.D., Docket No. 18-1551 (issued March 1, 2019).

14 Id.

15 K.R., Docket No. 20-0681(issued January 12, 2021); M.A., Docket No. 19-1119 (issued November 25, 2019).

16 K.A., Docket No. 17-1718 (issued February 12, 2018).
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ORDER

IT IS HEREBY ORDERED THAT the January 22, 2021 decision of the Office of 

Workers’ Compensation Programs is affirmed.17

Issued: December 10, 2021

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Alternate Judge

Employees’ Compensation Appeals Board

17 The Board notes that the employing establishment issued a Form CA-16, dated November 10, 2020. A completed 

Form CA-16 authorization may constitute a contract for payment of medical expenses to a medical facility or 

physician, when properly executed. The form creates a contractual obligation, which does not involve the employee 

directly, to pay for the cost of the examination or treatment regardless of the action taken on the claim. See 20 C.F.R. 

§ 10.300(c); V.S.,Docket No. 20-1034 (issued November 25, 2020); J.G.,Docket No. 17-1062 (issued February 13, 

2018); Tracy P. Spillane, 54 ECAB 608 (2003).