United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

M.G., Appellant

and

DEPARTMENT OF VETERANS AFFAIRS, 

NORTHPORT VA MEDICAL CENTER, 

Northport, NY, Employer

__________________________________________

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Docket No. 21-0898

Issued: November 3, 2021

Appearances: Case Submitted on the Record

Paul Kalker, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

JANICE B. ASKIN, Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On May 5, 2021 appellant, through counsel, filed a timely appeal from an April 2, 2021 

merit decision of the Office of Workers’ Compensation Programs (OWCP). Pursuant to the 

Federal Employees’ Compensation Act2(FECA) and 20 C.F.R. §§ 501.2(c) and 501.3, the Board 

has jurisdiction over the merits of this case.

 

1

In all cases in which a representative has been authorized in a matter before the Board, no claim for a fee for legal 

or other service performed on appeal before the Board is valid unless approved by the Board. 20 C.F.R. § 501.9(e). 

No contract for a stipulated fee or on a contingent fee basis will be approved by the Board. Id. An attorney or 

representative’s collection of a fee without the Board’s approval may constitute a misdemeanor, subject to fine or 

imprisonment for up to one year or both. Id.; see also 18 U.S.C. § 292. Demands for payment of fees to a 

representative, prior to approval by the Board, may be reported to appropriate authorities for investigation.

 

2

5 U.S.C. § 8101 et seq.
2

ISSUE

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

casually related to the accepted November 22, 2019 employment incident.

FACTUAL HISTORY

On November 27, 2019 appellant, then a 61-year-old registered nurse, filed a traumatic 

injury claim (Form CA-1) alleging that on November 22, 2019 she sustained injury to the left side 

of her neck and left upper extremity when she lowered an examination table and grabbed a handle 

in order to place the head of the table at 90 degrees, while in the performance of duty.3 She asserted 

that the handle was broken and did not spring up, thereby causing injury to her neck, left shoulder, 

and left arm. Appellant stopped work on November 25, 2019 and returned to work on 

November 27, 2019.

Appellant submitted a December 2, 2019 report from Dr. Paul R. Alongi, aBoard-certified 

orthopedic surgeon, who indicated that appellant explained that on November 22, 2019 she injured 

her neck and shoulder when she reached to adjust a bed at work and the bed did not move. She

presented with complaints of neck, left shoulder, and left arm pain, but did not report arm 

weakness. Dr. Alongi indicated that, upon physical examination, bilateral shoulder pain was 

elicited on motion, but not by impingement testing. He advised that December 2, 2019 cervical 

spine x-rays revealed loss of normal cervical lordosis and disc height. Dr. Alongi diagnosed 

cervicalgia, cervical radiculopathy, and left shoulder sprain, and recommended treatment with 

nonsteroidal anti-inflammatory medication, physical therapy, and home exercise.

OWCP also received a December 2, 2019 report from Robert Troiano, a physical therapist, 

who detailed his therapy session with appellant on that date.

In a January 16, 2020 development letter, OWCP notified appellant of the deficiencies of 

her claim. It advised her of the type of factual and medical evidence needed and provided a 

questionnaire for her completion. OWCP afforded appellant 30 days to submit the necessary 

evidence. 

In response, appellant submitted a November 29, 2019 report from Dr. Ioanis Siderias, a 

Board-certified emergency medicine specialist, who indicated that appellant reported a 

November 22, 2019 injury due to lifting an examination table at work. Dr. Siderias reported

physical examination findings and diagnosed left shoulder pain and “work[-]related injury.” He

indicated that appellant possibly had a left rotator cuff injury and noted that she had claimed that 

she was unable to work with the injury.

In a December 19, 2019 report, Dr. Alongi diagnosed cervicalgia, cervical radiculopathy, 

and left shoulder sprain and opined that appellant was 100 percent disabled from work. OWCP 

3 Under a separate claim, assigned OWCP File No. xxxxxx822, OWCP accepted that appellant sustained a strain 

of muscle, fascia, and tendon of the lower back on October 29, 2018. This separate claim, which has not been 

combined with the present claim, concerns a different body region than the present claim and is not the subject of this 

appeal.
3

also received a January 15, 2020 report in which he referenced an October 29, 2018 fall from a 

chair at work and diagnosed lumbar strain, herniated intervertebral disc, and lower back pain. On

January 16, 2020 Dr. Alongi provided the additional diagnosis of left shoulder impingement and 

again opined that appellant was 100 percent disabled from work. In a January 16, 2020 note, he

certified that physical therapy was medically necessary to treat appellant’s medical condition. 

OWCP also received additional reports from Mr. Troiano and Christine Whiteman, another 

attending physical therapist, dated between December 2, 2019 and January 15, 2020. 

By decision dated February 18, 2020, OWCP accepted the occurrence of the employment 

incident in the form of appellant’s adjusting an examination table on November 22, 2019. 

However, it denied appellant’s traumatic injury claim, finding that appellant failed to submit 

sufficient medical evidence to establish an injury causally related to the accepted November 22, 

2019 employment incident. 

On January 4, 2021 appellant, through counsel, requested reconsideration of the 

February 18, 2020 decision.

Appellant submitted a January 6, 2020 report fromDr. William A. Healy, a Board-certified 

orthopedic surgeon, who indicated that appellant reported she was “status post a work[-]related 

injury on [November 22, 2019]” and complained of continuing left shoulder pain. Dr. Healy 

diagnosed rotator cuff arthropathy of the left shoulder. In a February 10, 2020 report, Dr. Alongi 

advised that appellant was unable to work from February 10, 2020 until further notice. 

In a June 1, 2020 report, Dr. Alongi indicated that appellant injured her neck and shoulder 

at work on November 22, 2019 when she felt a pull in the left side of her neck and left shoulder 

while pulling on a broken examination table. He described appellant’s symptoms when he 

examined her on December 2, 2019, including those relating to the neck and left shoulder, and 

noted that he had diagnosed her at that time with cervicalgia, cervical radiculopathy, and left 

shoulder sprain. Dr. Alongi further detailed appellant’s symptoms when he examined her on 

subsequent dates, including her neck and left shoulder symptoms on December 17, 2019, 

January 15, 16, and February 10, 2020. He indicated that appellant continued to have persistent 

neck, left shoulder, and low back pain. Dr. Alongi noted, “[s]he injured her lower back in a workrelated accident on October 29, 2018 and injured her neck and left shoulder in a work-related 

accident on November 22, 2019. It is my opinion, based upon reasonable medical probability, that 

there is a direct causal effect between the patient’s work-related accidents and her subsequent neck, 

left shoulder and back injuries.” Dr. Alongi advised that appellant required ongoing treatment in 

the form of physical therapy and pain management, and that she mightrequire surgery in the future. 

He opined that appellant was unable to return to work as a registered nurse and that her disability 

was permanent in nature.

In a June 30, 2020 report, Dr. Sara J. Johnson, a Board-certified rheumatologist, indicated 

that she had been treating appellant since 1998 for rheumatoid arthritis and that she had been 

diagnosed with seropositive erosive rheumatoid arthritis, cervical and lumbar spondylosis with 

radiculopathies, and left shoulder rotator cuff tear with permanent limitation of movement. She

advised that the recent rotator cuff rupture of the left shoulder had rendered appellant unable to lift 
4

her left arm greater than 50 degrees. Dr. Johnson opined that appellant was disabled from all 

employment due to her physical limitations, chronic pain, and fatigue.

A September 16, 2020 magnetic resonance imaging (MRI) scan of the left shoulder 

contained an impression of full-thickness tear of the anterior supraspinatus tendon with severe 

atrophy, interstitial tearing of the infraspinatus at the myotendinous junction with low-grade 

articular surface partial tearing and moderate atrophy, and Hill-Sachs deformity likely related to 

remote shoulder dislocation.

In a November 20, 2020 report, Dr. Alongi noted that appellant injured her neck and 

shoulder while at work on November 22, 2019 when she reached to adjust a bed and the bed did 

not move. He indicated that appellant’s symptoms from the injury persistedand that she underwent 

left shoulder surgery on November 4, 2020.4 Dr. Alongi diagnosed cervicalgia, cervical 

radiculopathy, left shoulder sprain, and left shoulder impingement, and found that appellant was 

100 percent disabled from work.

In a December 16, 2020 report, Dr. Timothy G. Reish, a Board-certified orthopedic 

surgeon, noted that he first examined appellant on September 8, 2020 at which time she reported 

that she had injured her left shoulder at work in November 2019 when she moved a broken 

examination table. He described the left shoulder symptoms elicited during the September 8, 2020 

physical examination and during follow-up visits on September 22 and October 8, 2020. Dr. Reish

advised that on November 4, 2020 appellant underwent left shoulder surgery, including 

arthroscopic supraspinatus tendon repair, subacromial decompression, distal clavicle excision, 

open subpectoralis biceps tenodesis, major synovectomy, debridement, and synovial biopsy. He

described post-surgery visits on November 17, December 8 and 15, 2020 and noted, “[appellant]

is a patient who suffered from a supraspinatus tendon tear as a result of an injury from work.”

Dr. Reish indicated that appellant clearly suffered from rheumatoid arthritis, a chronic 

degenerative condition, but did not complain of shoulder pain prior to “the accident” and continued 

to suffer from pain from a rotator cuff tear after her injury. He noted, “[t]here is clearly causality 

between her rotator cuff tear and the accident that required surgical intervention and would 

certainly require more physical therapy going forward.”

By decision dated April 2, 2021, OWCP denied modification of its February 18, 2020 

decision.

LEGAL PRECEDENT

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

essential elements of his or her claim, including that 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 

4 The Board notes that the case record does not contain a report of left shoulder surgery.

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).
5

compensation claim, regardless of whether the claim is predicated upon a traumatic injury or an 

occupational disease.6

To determine if an employee has sustained a traumatic injury in the performance of duty, 

OWCP begins with an analysis of whether fact of injury has been established. Fact of injury 

consists of two components that must be considered in conjunction with one another. The first 

component is whether the employee actually experienced the employment incident that allegedly 

occurred.7 The second component is whether the employment incident caused a personal injury.8 

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.

9

 A physician’s opinion on whether there is causal relationship 

between the diagnosed condition and the accepted medical employment incident must be based on 

a complete factual and medical background. Additionally, the physician’s option 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 the specific 

employment incident.

10

ANALYSIS

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

condition casually related to the accepted November 22, 2019 employment incident.

Appellant submitted a June 1, 2020 report from Dr. Alongi who indicated that appellant 

injured her neck and left shoulder at work on November 22, 2019 due to pulling on a broken 

examination table. Dr. Alongi described appellant’s symptoms when he examined her on various 

dates and indicated that appellant continued to have persistent neck, left shoulder, and low back 

pain. He noted, “[s]he injured her lower back in a work-related accident on October 29, 2018 and 

injured her neck and left shoulder in a work-related accident on November 22, 2019. It is my 

opinion based upon reasonable medical probability that there is a direct causal effect between the 

patient’s work-related accidents and her subsequent neck, left shoulder and back injuries.” In a 

November 20, 2020 report, Dr. Alongi indicated that appellant injured her neck and left shoulder 

while at work on November 22, 2019 and noted that appellant’s symptoms from the injury 

persisted. He diagnosed cervicalgia, cervical radiculopathy, left shoulder sprain, and left shoulder 

impingement. 

The Board finds, however, that these reports are of limited probative value regarding 

appellant’s claim for a November 22, 2019 traumatic injury claim as Dr. Alongi did not provide 

6 K.M., Docket No. 15-1660 (issued September 16, 2016); L.M., Docket No. 13-1402 (issued February 7, 2014); 

DeloresC. Ellyett, 41 ECAB 992 (1990).

7 B.P., Docket No. 16-1549 (issued January 18, 2017); Elaine Pendleton, 40 ECAB 1143 (1989).

8 M.H., Docket No. 18-1737 (issued March 13, 2019); John J. Carlone, 41 ECAB 354 (1989). 

9 L.S., Docket No. 19-1769 (issued July 10, 2020); Jacqueline M. Nixon-Steward, 52 ECAB 140 (2000). 

10 B.C., Docket No. 20-0221 (issued July 10, 2020); Leslie C. Moore, 52 ECAB 132 (2000).
6

medical rationale in support of his opinion on causal relationship. Dr. Alongi did not describe the 

November 22, 2019 injury in detail or explain how it would have been competent to cause the 

diagnosed conditions. The Board has held that a report is of limited probative value regarding 

causal relationship if it does not contain medical rationale explaining how a given medical 

condition has an employment-related cause.11 Therefore, these reports are insufficient to establish 

appellant’s traumatic injury claim. 

In a December 16, 2020 report, Dr. Reish noted that appellant reported that she had injured 

her left shoulder at work in November 2019 when she moved a broken examination table. He 

described the left shoulder symptoms elicited during several physical examinations and discussed 

her November 4, 2020 left shoulder surgery. Dr. Reish noted, “[appellant] is a patient who 

suffered from a supraspinatus tendon tear as a result of an injury from work.” He indicated that 

appellant clearly suffered from rheumatoid arthritis, a chronic degenerative condition, but advised 

that she did not complain of shoulder pain prior to “the accident” and continued to suffer from pain 

from a rotator cuff tear after her injury. Dr. Reish noted, “[t]here is clearly causality between her 

rotator cuff tear and the accident that required surgical intervention and would certainly require 

more physical therapy going forward.” The Board finds, however, that this report also is of limited 

probative value regarding appellant’s claim for a November 22, 2019 traumatic injury claim as

Dr. Reish did not provide adequate medical rationale in support of his opinion on causal 

relationship. As noted above, a report is of limited probative value regarding causal relationship

if it does not contain medical rationale explaining how a given medical condition has an 

employment-related cause.12 Therefore, this report is insufficient to establish appellant’s traumatic 

injury claim.

Appellant submitted a November 29, 2019 report from Dr. Siderias who indicated that 

appellant reported a November 22, 2019 injury due to lifting an examination table at work. 

Dr. Siderias diagnosed left shoulder pain and “work[-]related injury.” He indicated that appellant 

possibly had a left rotator cuff injury. While Dr. Siderias indicated that appellant sustained an 

employment injury he did not clearly identify the nature of the injury and his report is of limited 

probative value on the underlying issue of the case because he did not provide medical rationale 

explaining how a given specific medical condition has an employment-related cause.13 Therefore, 

this report is insufficient to establish appellant’s traumatic injury claim.

Appellant submitted a December 2, 2019 report from Dr. Alongi in which he diagnosed 

cervicalgia, cervical radiculopathy, and left shoulder sprain, and recommended treatment with 

nonsteroidal anti-inflammatory medication, physical therapy, and home exercise. In reports dated 

December 19, 2019 and January 16, 2020, Dr. Alongi provided similar diagnoses and, in reports 

dated December 2, 2019 and January 16, 2020, he certified that physical therapy was medically 

necessary to treat appellant’s medical condition. In a February 10, 2020 report, Dr. Alongi advised 

that appellant was unable to work from February 10, 2020 until further notice. In a January 6, 

2020 report, Dr. Healy diagnosed rotator cuff arthropathy of the left shoulder. In a January 21, 

 

11 See T.T., Docket No. 18-1054 (issued April8, 2020); Y.D., Docket No. 16-1896 (issued February 10, 2017).

 

12 See id.

13 Id.
7

2020 form report, Dr. Siderias listed the services he provided to appellant on November 29, 2019. 

On June 30, 2020 Dr. Johnson indicated that appellant had been diagnosed with seropositive 

erosive rheumatoid arthritis, cervical and lumbar spondylosis with radiculopathies, and left 

shoulder rotator cuff tear with permanent limitation of movement. These reports describe 

appellant’s cervical and shoulder conditions, but are of no probative value regarding her traumatic 

injury claim as they do not contain an opinion on causal relationship. 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.

14

 Given their lack of an opinion on causal 

relationship, these reports are insufficient to establish appellant’s traumatic injury claim. 

Appellant submitted reports of attending physical therapists, Mr. Troiano and

Ms. Whiteman, dated between December 2019 and January 2020. However, certain healthcare 

providers such as physician assistants, nurses, nurse practitioners, physical therapists, and social 

workers are not considered “physician[s]” as defined under FECA.15 Consequently, their medical 

findings and/or opinions will not suffice for purposes of establishing entitlement to FECA benefits. 

Appellant also submitted the findings of diagnostic testing, including a September 16, 2020 MRI 

scan. However, such evidence is of no probative value on the underlying issue of the case. The 

Board has held that diagnostic studies lack probative value on causal relationship as they do not 

address whether employment factors caused the diagnosed condition.16 Therefore, this evidence 

is insufficient to establish appellant’s claim.

On appeal counsel argues that appellant submitted sufficient medical evidence to establish 

an injury due to the accepted November 22, 2019 employment incident. However, the Board has 

explained that appellant failed to submit probative medical evidence establishing such a workrelated injury.

As appellant has not submitted rationalized medical evidence establishing causal relationship 

between her diagnosed conditions and the accepted factors of her federal employment, 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.

 

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

15 Section 8101(2) provides that under FECA the term physician includes surgeons, podiatrists, dentists, clinical 

psychologists, optometrists, chiropractors, and osteopathic practitioners within the scope of their practice as defined 

by State law. 5 U.S.C. § 8101(2); 20 C.F.R. § 10.5(t). See Federal (FECA) Procedure Manual, Part 2 -- Claims, 

Causal Relationship, Chapter 2.805.3a(1) (January 2013); DavidP. 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); see also S.T., Docket No. 17-0913 (issued June 23, 2017) (physical therapists are not considered 

physicians under FECA); R.S., Docket No. 16-1303 (issued December 2, 2016) (physician assistants and physical 

therapists are not considered physicians under FECA).

16 C.S., Docket No. 19-1279 (issued December 30, 2019).
8

CONCLUSION

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

condition casually related to the accepted November 22, 2019 employment incident.

ORDER

IT IS HEREBY ORDERED THAT the April 2, 2021 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: November 3, 2021

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board