United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

R.C., Appellant

and

DEPARTMENT OF VETERANS AFFAIRS, 

JESSE BROWN VA MEDICAL CENTER, 

Chicago, IL, Employer

__________________________________________

)

)

)

)

)

)

)

)

)

Docket No. 21-1226

Issued: January 20, 2022

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

PATRICIA H. FITZGERALD, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On August 6, 2021 appellant filed a timely appeal from a July 20, 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 February 12, 2021 employment incident.

FACTUAL HISTORY

On May 25, 2021 appellant, then a 35-year-old information technology manager, filed a 

traumatic injury claim (Form CA-1) alleging that on February 12, 2021 she sprained both of her 

1

5 U.S.C. § 8101 et seq.
2

elbows when unboxing and stacking monitors on a cart while in the performance of duty. She did 

not immediately stop work.

In a March 15, 2021 treatment note, Tiffany Pacocha, a nurse practitioner, returned 

appellant to light-duty work, with restrictions of no heavy lifting and avoiding repetitive 

movements of the arms.

On May 26, 2021 Dr. Emily M. Jones, a Board-certified internist, treated appellant for right 

elbow swelling and lateral epicondylitis of both elbows. She referred appellant for a magnetic 

resonance imaging (MRI) scan of the right elbow. In a separate note of even date, Dr. Jones 

referred appellant for physical therapy.

On June 2, 2021 the employing establishment challenged appellant’s claim, asserting that 

she had not established that she sustained an injury causally related to factors of her employment.

In a June 8, 2021 development letter, OWCP informed appellant of the deficiencies of her 

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

questionnaire for her completion. OWCP afforded appellant 30 days to respond.

In support of her claim, appellant submitted a report dated June 9, 2021 by Dr. Jones who 

noted evaluating appellant on May 26, 2021 for bilateral elbow pain that began when she was 

lifting heavy computer monitors at work in February 2021 and felt a strain in both elbows. 

Dr. Jones further reported that appellant’s pain persisted throughout the day and she sought 

medical treatment. She noted swelling in the proximal wrist extensor of unclear etiology. 

Dr. Jones diagnosed lateral epicondylitis of both elbows and recommended an MRI scan of the 

right elbow and physical therapy.

In an undated narrative statement, appellant reported experiencing an unrelated episodic 

seizure at work and was admitted to the hospital. She indicated that she accidentally “doubled up”

on her medication due to forgetfulness and experienced the seizure. Appellant was unsure if the 

seizure was related to her work. She noted that her arm injury occurred within weeks of the seizure 

incident. Appellant reported unboxing new monitors for deployment when she felt a sharp pain in 

both arms. She thought her elbow condition would resolve on its own, but the pain persisted and 

became more acute. Appellant reported taking sick leave to let her arm rest. Her elbows did not 

resolve and she sought treatment from an orthopedist who diagnosed lateral epicondylitis of both

arms. Appellant explained that the gap between the injury and medical diagnoses occurred because 

she thought her condition would resolve without treatment.

By decision dated July 20, 2021, OWCP denied appellant’s traumatic injury claim, finding 

that the medical evidence submitted was insufficient to establish causal relationship between her 

diagnosed conditions and the accepted February 12, 2021 employment incident.
3

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 of FECA, that the claim was timely filed within the applicable time 

limitation 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 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 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. First, 

the employee must submit sufficient evidence to establish that he or she actually experienced the 

employment incident at the time and place, and in the manner alleged. Second, the employee must 

submit sufficient evidence to establish that the employment incident caused a personal injury. 6

The medical evidence required to establish a causal relationship is rationalized medical 

opinion evidence.7 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 

specific employment incident identified by the employee.8

ANALYSIS

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

condition causally related to the accepted February 12, 2021 employment incident.

Dr. Jones treated appellant on May 26, 2021 for right elbow swelling and lateral 

epicondylitis of both elbows. However, she did not offer an opinion on causal relationship. The 

Board has held that medical evidence that does not offer an opinion regarding the cause of an 

2

Id.

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

Cameron, 41 ECAB 153 (1989).

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 T.J., Docket No. 19-0461 (issued August 11, 2020); K.L., Docket No. 18-1029 (issued January 9, 2019); John J. 

Carlone, 41 ECAB 354 (1989).

7

S.S.,Docket No. 19-0688 (issued January 24, 2020); A.M., Docket No. 18-1748 (issued April24, 2019); RobertG. 

Morris, 48 ECAB 238(1996).

8 T.L., Docket No. 18-0778 (issued January 22, 2020); Y.S., Docket No. 18-0366 (issued January 22, 2020); 

Victor J. Woodhams, 41 ECAB345, 352 (1989).
4

employee’s condition or disability is of no probative value on the issue of causal relationship.9 

Thus, the Board finds that this report is insufficient to meet appellant’s burden of proof.

Similarly, on June 9, 2021 Dr. Jones reported evaluating appellant on May 26, 2021 for 

bilateral elbow pain afterlifting heavy computer monitors at work in February. She noted swelling 

in the proximal wrist extensor of unclear etiology and diagnosed lateral epicondylitis of both 

elbows. Dr. Jones, however, did not offer an opinion on causal relationship. Therefore this report 

is of no probative value and is insufficient to establish appellant’s claim.10

Appellant submitted a report from a nurse practitioner. However, certain healthcare 

providers such as nurse practitioners11 are not considered “physician[s]” as defined under FECA.12 

Consequently, their medical findings and/or opinions will not suffice for purposes of establishing 

entitlement to FECA benefits.

13

As the record lacks rationalized medical evidence establishing causal relationship between 

a medical condition and the accepted February 12, 2021 employment incident, the Board finds that 

appellant 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 February 12, 2021 employment incident. 

9

See S.H., Docket No. 19-1128 (issued December 2, 2019); L.B.,Docket No. 18-0533 (issued August 27, 2018); 

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

10 Id.

11 S.J., Docket No. 17-0783, n.2 (issued April9, 2018) (nurse practitioners are not considered physicians under 

FECA).

12 Section 8101(2) of FECA 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.” 

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

Relationship, Chapter 2.805.3a(1) (January2013); R.L., Docket No. 19-0440 (issued July 8, 2019) (nurse practitioners 

are not considered physicians under FECA); 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).

13 Id.
5

ORDER

IT IS HEREBY ORDERED THAT the July 20, 2021 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: January 20, 2022

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Alternate Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board