United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

B.S., Appellant

and

DEPARTMENT OF THE NAVY, NAVAL 

FACILITIES ENGINEERING COMMAND, 

Great Lakes, IL, Employer

__________________________________________

)

)

)

)

)

)

)

)

)

Docket No. 22-0102

Issued: May 19, 2022

Appearances: Case Submitted on the Record

Alan J. Shapiro, 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 October 29, 2021 appellant, through counsel, filed a timely appeal from a 

September 14, 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.3

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.

3 The Board notes that, following the September 14, 2021 decision, OWCP received additional evidence. 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 her burden of proof to establish a medical condition

causally related to the accepted February 27, 2019 employment incident.

FACTUAL HISTORY

This case has previously been before the Board.4 The facts and circumstances as set forth 

in the Board’s prior decision are incorporated herein by reference. The relevant facts are as 

follows.

On March 5, 2019 appellant, then a 52-year-old painter, filed a traumatic injury claim 

(Form CA-1) alleging that on February 27, 2019 she sustained injuries to her head, right hip, right 

knee, and right shoulder when she slipped and fell on ice while in the performance of duty.

By decision dated June 25, 2019, OWCP denied appellant’s claim, finding that the medical 

evidence of record was insufficient to establish causal relationship between a diagnosed medical 

condition and the accepted employment incident of February 27, 2019. It concluded, therefore, 

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

On July 16, 2019 appellant requested an oral hearing before a representative of OWCP’s 

Branch of Hearings and Review. The hearing was held on November 12, 2019. The hearing 

representative held the case record open for 30 days for the submission of additional evidence. No 

additional evidence was received. 

By decision dated January 21, 2020, the hearing representative affirmed OWCP’s June 25, 

2019 decision with modification, accepting that appellant had submitted sufficient medical 

evidence to establish the presence or existence of the condition for which compensation was 

claimed, and that she was within the performance of duty, but affirming denial of the claim on the 

basis that appellant had not submitted sufficient medical evidence to establish a causal relationship 

between the accepted February 27, 2019 employment incident and her diagnosed condition. 

On March 18, 2020 appellant, through counsel, filed a timely appeal from OWCP’s 

January 21, 2020 decision to the Board.

By decision dated June 15, 2021, the Board affirmed OWCP’s January 21, 2020 decision, 

finding that appellant had not met her burden of proof to establish that her diagnosed medical 

condition was causally related to the accepted February 27, 2019 employment incident. 

On August 31, 2021 appellant, through counsel, requested reconsideration. With the 

request, appellant submitted an August 9, 2021 report from Dr. Navjot Kohli, a Board-certified 

orthopedic surgeon. Dr. Kohli examined appellant for a follow-up regarding her right shoulder 

condition. On physical examination of the shoulder, he observed abduction to 90 degrees, internal 

rotation to her lumbar spine, weakness with abduction and external rotation, positive Neer and 

Hawkins tests, and good cervical range of motion. Dr. Kohli diagnosed right shoulder rotator cuff 

arthropathy. He explained that according to his interview with appellant and records, it appeared 

that appellant did not have any complaints of shoulder pain prior to the incident of February 27, 

4 Docket No. 20-0895 (issued June15, 2021).
3

2019 and that a magnetic resonance imaging (MRI) scan had demonstrated a full-thickness rotator 

cuff tear. Dr. Kohli opined that the fall exacerbated her pain and the condition in her shoulder 

necessitating surgery. He explained that falling on an outstretched hand was a known mechanism 

to cause rotator cuff injury and appellant had denied symptoms prior to the fall. Dr. Kohli opined 

that in all medical probability, the accepted employment incident of February 27, 2019 caused a 

permanent exacerbation of a preexisting condition.

By decision dated September 14, 2021, OWCP denied modification of the June 15, 2021 

decision. 

LEGAL PRECEDENT

An employee seeking benefits under FECA5 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,6that 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.7 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.8

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 and place, and in the manner alleged. The second component is 

whether the employment incident caused a personal injury and can be established only by medical 

evidence.9 

The medical evidence required to establish a causal relationship between a claimed specific 

condition and an employment incident is rationalized medical opinion evidence. 10 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 

5

Supra note 2.

6 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). 

7 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).

8 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).

9 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).

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

Robert G. Morris, 48 ECAB 238 (1996).
4

nature of the relationship between the diagnosed condition and specific employment factors 

identified by the employee.11

In a case where a preexisting condition involving the same part of the body is present and 

the issue of causal relationship therefore involves aggravation, acceleration, or precipitation, the 

physician must provide a rationalized medical opinion that differentiates between the effects of the 

work-related injury or disease and the preexisting condition.12

ANALYSIS

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

condition causally related to the accepted February 27, 2019 employment incident.

Preliminary, the Board notes that it is unnecessary for the Board to consider the evidence 

submitted prior to its June 15, 2021 decision, because the Board considered that evidence in its 

decision, finding that it was insufficient to establish her claim. Findings made in prior Board 

decisions are res judicata absent any further review by OWCP under section 8128 of FECA.13

On reconsideration, appellant submitted an August 9, 2021 report from Dr. Kohli. 

Dr. Kohli explained that according to his interview with appellant and records, it appeared th at 

appellant did not have any complaints of shoulder pain prior to the incident of February 27, 2019 

and that an MRI scan had demonstrated a full-thickness rotator cuff tear. He opined that the fall 

exacerbated her pain and the condition in her shoulder necessitating surgery. Dr. Kohl explained 

that falling on an outstretched hand was a known mechanism to cause rotator cuff injury and 

appellant had denied symptoms prior to the fall. He opined that in all medical probability, the 

accepted employment incident of February 27, 2019 caused a permanent exacerbation of a 

preexisting condition. In this report, Dr. Kohli did not support his medical opinion with sufficient 

rationale differentiating appellant’s preexisting condition from the condition claimed as work

related. The Board has explained that such rationale is especially important in a case involving a 

preexisting condition.

14

 Dr. Kohli’s opinion regarding causal relationship is conclusory. The 

Board has held that a medical opinion is of limited value if it is conclusory in nature.15 While

Dr. Kohli noted appellant’s outstretched hand during the fall as the mechanism of injury, a medical 

opinion must explain how the implicated employment incident physiologically caused, contributed 

11 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).

12 Federal (FECA) Procedure Manual, Part 2 --Claims, Causal Relationship,Chapter 2.805.3e (January 2013);see 

also L.S.,Docket No. 18-0518(issued February 19, 2020).

13 See K.V., Docket No. 21-0008 (issued November 15, 2021); B.R., Docket No. 17-0294 (issued May 11, 2018); 

Clinton E. Anthony, Jr., 49 ECAB 476 (1998).

14 Supra note 12. 

15 O.N., Docket No. 20-0902 (issued May 21, 2021); C.M., Docket No. 19-0360 (issued February 25, 2020).
5

to, or aggravated the specific diagnosed condition.16 Without this explanation, Dr. Kohli’s 

August 9, 2021 report is insufficient to establish appellant’s claim.

17

As appellant has not submitted rationalized medical evidence establishing a medical 

condition causally related to the accepted employment incident of February 27, 2019, 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 February 27, 2019 employment incident.

ORDER

IT IS HEREBY ORDERED THAT the September 14, 2021 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: May 19, 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

16 S.C., Docket No. 20-0492 (issued May 6, 2021); R.S., Docket No. 19-1774 (issued April3, 2020).

17 Y.J., Docket No. 08-1167 (issued October 7, 2008); A.D., 58 ECAB 149, 155-56 (2006); D’Wayne Avila, 57 

ECAB 642, 649 (2006).