United States Department of Labor

Employees’ Compensation Appeals Board

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H.G., Appellant

and

DEPARTMENT OF THE NAVY, NAVAL AIR 

SYSTEMS COMMAND, FLEET READINESS 

CENTER SOUTHWEST, San Diego, CA,

Employer

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Docket No. 22-0587

Issued: August 24, 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

JANICE B. ASKIN, Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On March 10, 2022 appellant filed a timely appeal from an October 6, 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

1

5 U.S.C. § 8101 et seq.

2 The Board notes that, following the October 6, 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

ISSUE

The issue is whether appellant has met his burden of proof to establish a right upper 

extremity condition causally related to the accepted April 21, 2021 employment incident. 

FACTUAL HISTORY

On April 30, 2021 appellant, then a 58-year-old maintenance mechanic, filed a traumatic 

injury claim (Form CA-1) alleging that on April 21, 2021 he ruptured his right tricep when he lost 

balance working above ceiling level and fell while in the performance of duty. He explained that 

he attempted to grab a beam to prevent his fall, but was only able to grab the beam with three 

fingers. Appellant did not stop work. 

In a medical note dated April 30, 2021, Gina Kim, a registered nurse, noted a date of injury 

of April 21, 2021 and referred him for physical therapy. 

A form note dated April 28, 2021 from Dr. Sean Sheppard, a Board-certified orthopedist,

released appellant to work with modified duties, including no use of the right extremity. 

On April 30, 2021 Dr. Bryce Lokey, a Board-certified internist, performed a magnetic 

resonance imaging (MRI) scan of appellant’s arm, which demonstrated a high-grade partial tear of 

the lateral and long heads triceps tendon and a possible partial tear of a radial collateral ligament. 

In a medical report dated May 17, 2021, appellant was seen by Dr. Sheppard for an 

evaluation of his right arm. He related that appellant had been experiencing pain despite wearing 

a brace. Dr. Sheppard diagnosed a partial tear of the lateral and long head of the triceps tendon. 

In a medical note of even date, he restricted appellant to heavy or repetitive lifting of no greater 

than five pounds and no use or lifting of the right arm. 

In a medical report dated May 17, 2021, Dr. Benjamin Wheatley, a Board-certified 

orthopedic surgeon, related that on April 21, 2021 appellant felt a “pop” when he slipped and 

attempted to hold onto a beam with his right arm. He indicated that appellant developed swelling 

of the triceps as a result of the employment incident. In physical therapy notes of even date, an 

unidentifiable health care provider noted a diagnosis of spontaneous rupture of tendons in the 

upper arm. 

On May 25, 2021 the employing establishment indicated that appellant was unable to 

perform his modified duties due to the physicalrequirements of his official duties as a maintenance 

mechanic. As a result, it placed him in a continuation of pay status until June 5, 2021. 

In a development letter dated August 26, 2021, OWCP informed appellant of the 

deficiencies of his claim. It advised him of the type of factual and medical evidence necessary to 

establish his claim and provided a questionnaire for his completion. OWCP afforded appellant 30 

days to respond. 

OWCP received additional evidence. In a return to work note dated April 21, 2021,

Dr. Steven Portouw, a Board-certified emergency medicine physician, released appellant to work 

on April 23, 2021 with restrictions. 
3

On August 30, 2021 appellant responded to OWCP’s development questionnaire. He 

explained that on the date of injury, he was tasked to disassemble an air handler in an attic by using 

a ladder while carrying items in both hands. Appellant asserted that, as he was walking on a 

wooden joist to reach the attic, his right foot slid off and in order to prevent a fall, he managed to 

use three fingers to grab onto the beam, which caused his right arm to snap. He noted that he 

began to develop right arm pain following the employment incident. Appellant indicated that he 

did not have any previous injury or condition to his right arm or triceps. 

In a hospital note dated September 11, 2021, an unidentifiable health care provider 

diagnosed a partial tendon triceps tear and restricted appellant to no repetitive motion of the right 

elbow and no work with the right hand and wrist. 

By decision dated October 6, 2021, OWCP denied appellant’s traumatic injury claim, 

finding that the medical evidence of record was insufficient to establish that his diagnosed right 

upper extremity condition was causally related to the accepted April 21, 2021 employment 

incident

LEGAL PRECEDENT

A claimant seeking benefits under FECA3 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,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 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. There 

are two components involved in establishing fact of injury. The first component is that the 

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

employment incident at the time, place, and in the manner alleged. The second component is 

whether the employment incident caused a personal injury.7

3

Supra note 1.

4 F.H., Docket No.18-0869 (issued January 29, 2020); J.P., Docket No. 19-0129 (issued December 13, 2019); 

Joe D. Cameron, 41 ECAB 153 (1989). 

5 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).

6 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).

7 T.H., Docket No. 19-0599 (issued January 28, 2020); K.L., Docket No. 18-1029 (issued January 9, 2019); John J. 

Carlone, 41 ECAB 354 (1989).
4

The medical evidence required to establish causal relationship is rationalized medical 

opinion evidence.

8

 Rationalized medical opinion evidence is medical evidence which includes a 

physician’s rationalized opinion on the issue of whether there is a causal relationship between the 

claimant’s diagnosed condition and the implicated employment factors. 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 specific employment factors 

identified by the claimant.

9

ANALYSIS

The Board finds that appellant has not met his burden of proof to establish a right upper 

extremity condition causally related to the accepted April 21, 2021 employment incident. 

In medical reports dated May 17 and 18, 2021, Drs. Sheppard and Wheatley both diagnosed

a partial tear and division of the triceps tendon. However, neither physician provided an opinion 

explaining the cause of appellant’s diagnosed conditions. 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.10 These reports, therefore, are insufficient to 

establish appellant’s burden of proof. 

Appellant submitted an MRI scan report dated April 30, 2021 from Dr. Lokey. The Board 

has held that diagnostic tests, standing alone, lack probative value on the issue of causal 

relationship as they do not address the relationship between the accepted employment incident and 

a diagnosed condition.11 As such, Dr. Lokey’s report is insufficient to meet appellant’s burden of 

proof.

OWCP also received a series of notes providing work restrictions. As these notes did not 

address causal relationship they are of no probative value regarding the issue of causal 

relationship.12

OWCP received reports from unidentifiable providers. The Board has held that reports 

that are unsigned or bear an illegible signature lack proper identification and cannot be considered 

8

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).

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

Victor J. Woodhams, 41 ECAB 345, 352 (1989).

10 See M.G., Docket No. 21-0747 (issued October 15, 2021); L.B., Docket No. 18-0533 (issued August 27, 2018); 

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

11 D.C., Docket No. 19-1093 (issued June 25, 2020). 

12 See A.W., Docket No. 19-0327 (issued July 19, 2019); see also id.
5

probative medical evidence as the author cannot be identified as a physician. 13 Therefore, these 

reports are insufficient to establish appellant’s claim.

As there is no rationalized medical evidence explaining how the accepted April 21, 2021 

employment incident caused or aggravated appellant’s diagnosed right arm condition, the Board 

finds that he has not met his 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 his burden proof to establish a right arm

condition causally related to the accepted April 21, 2021 employment incident. 

ORDER

IT IS HEREBY ORDERED THAT the October 6, 2021 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: August 24, 2022

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

13 L.B., Docket No. 21-0353 (issued May 23, 2022); T.D., Docket No. 20-0835 (issued February 2, 2021)Merton J. 

Sills, 39 ECAB 572, 575 (1988).