United States Department of Labor

Employees’ Compensation Appeals Board

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J.W., Appellant

and

U.S. POSTAL SERVICE, PROCESSING & 

DISTRIBUTION CENTER, Jackson, MS, 

Employer

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Docket No. 18-0520

Issued: February 25, 2020

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

CHRISTOPHER J. GODFREY, Deputy Chief Judge

JANICE B. ASKIN, Judge

JURISDICTION

On January 17, 2018 appellant filed a timely appeal from a December 8, 2017 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 appellant submitted additional evidence with his appeal. 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 evidence for the first time 

on appeal. Id.
2

ISSUE

The issue is whether appellant has met his burden of proof to establish a left shoulder

condition causally related to the accepted factors of his federal employment.

FACTUAL HISTORY

On January 24, 2017 appellant, then a 50-year-old mail handler, filed an occupational 

disease claim (Form CA-2) alleging that he developed pain in his left elbow and shoulder due to 

factors of his federal employment, including pulling heavy wires filled with magazines, hooking 

up containers, and driving power equipment over a period of 14 years. He indicated that he first 

became aware of his condition on December 26, 2016 and first realized that it was caused or 

aggravated by his employment on January 20, 2017. Appellant did not stop work.

Appellant submitted a position description and an accident report dated January 30, 2017 

which indicated that he reported left elbow and shoulder pain due to repetitive motions that were

required to perform the duties of his federal employment.

In a development letter dated February 15, 2017, OWCP advised appellant of the factual 

and medical deficiencies of his claim. It informed him of the evidence necessary to establish his 

claim. OWCP afforded appellant 30 days to respond.

In response, appellant submitted a February 20, 2017 report from Regina Berry, a certified 

nurse practitioner, who noted the history of injury, performed a physical examination, and 

diagnosed left shoulder impingement and left elbow medial epicondylitis. Ms. Berry noted that 

appellant’s federal employment duties required a lot of repetitive movements. She opined that 

appellant was totally disabled for work until he was rechecked by a physician.

In reports dated February 28, 2017, Dr. J. Randall Ramsey, a Board-certified orthopedic 

surgeon, diagnosed pain in left shoulder, prescribed physical therapy, and advised that appellant 

would be totally disabled from work for two weeks. He found that appellant had pain at the 

acromioclavicular (AC) joint radiating up behind his ear with cross-body adduction and with 

O’Brien testing and Whipple’s testing. Appellant also had pain reaching behind his back. 

Dr. Ramsey administered a steroid injection in the AC joint and took him off work for two weeks. 

Appellant further submitted a narrative statement indicating that he had pain in his shoulder 

and elbows over the years, but recently the pain had intensified. He submitted photographic 

evidence of the mail bins and mail transport equipment he used in the performance of duty.

On March 9, 2017 the employing establishment controverted appellant’s claim arguing that 

he failed to establish fact of injury and causal relationship.

In a report dated March 21, 2017, Dr. Ramsey noted that appellant had severe pain upon 

impingement testing, pain and buckling on both Whipple’s and O’Brien testing, and pain without

buckling on supraspinatus isolation testing. Appellant reported aching in his left shoulder, even 

after the injection. Dr. Ramsey recommended a magnetic resonance imaging (MRI) scan to 

evaluate a superior labral injury versus rotator cuff injury. He advised that appellant would be 

disabled from work until he was rechecked in the clinic following the MRI scan.
3

By decision dated May 3, 2017, OWCP denied appellant’s claim finding that fact of injury 

had not been established.

On August 21, 2017 appellant requested reconsideration and submitted additional 

photographic evidence of the equipment he was required to use at work.

A June 7, 2017 operation report indicated that appellant had undergone a left shoulder 

arthroscopic acromioplasty, distal clavicle excision, extensive arthroscopic debridement, and 

removal of loose bodies. The surgery was performed by Dr. Ramsey.

On June 14, 2017 Dr. Ramsey saw appellant for a postsurgical follow-up and found 

significant bursitis and a partial tear of the rotator cuff. In his report, he opined that appellant’s 

duties of picking up large bags and doing repetitive lifting at work “can certainly cause or 

contribute” to the problem found in his shoulder at the time of surgery.

In reports dated May 18 and July 10 and 21, 2017, Dr. Ramsey noted that appellant 

continued to have pain trying to raise his left arm above shoulder level, but had full motion of his 

left shoulder and his surgical incisions had healed. It was noted that his pain had not improved 

despite anti-inflammatory medicines, injections, corticosteroids, activity modifications, and 

physical therapy.

By decision dated September 19, 2017, OWCP found that appellant had established fact of 

injury, but denied the claim finding that the medical evidence of record failed to establish a causal 

relationship between his left shoulder condition and accepted factors of his federal employment. 

On November 8, 2017 appellant filed a request for reconsideration.

Appellant later submitted an October 2, 2017 report from Dr. Ramsey who diagnosed 

bicipital tendinitis, bursitis of shoulder, primary osteoarthritis of shoulder, and incomplete rotator 

cuff tear or rupture, not specified as traumatic. Dr. Ramsey indicated that appellant had shown 

him pictures of the heavy metal bins that he had to push, pull, and lift during the course of his daily 

employment and opined that now that he had seen the type of work appellant performed he could 

say with “complete medical certainty” that this job had contributed to his shoulder issue if not 

directly caused it.

By decision dated December 8, 2017, OWCP denied modification of its prior decision.

LEGAL PRECEDENT

An employee seeking benefits under FECA3 has the burden of proof to establish the 

essential elements of his or her claim, including the fact 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 period of FECA,4that an injury was sustained in the performance of duty as alleged, 

 

3

Id.

4 S.D., Docket No. 19-1240 (issued December 11, 2019); J.P., 59 ECAB 178 (2007); Joe D. Cameron, 41 ECAB 

153 (1989).
4

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 establish that an injury was sustained in the performance of duty in an occupational 

disease claim, a claimant must submit the following: (1) a factual statement identifying 

employment factors alleged to have caused or contributed to the presence or occurrence of the 

disease or condition; (2) medical evidence establishing the presence or existence of the disease or 

condition for which compensation is claimed; and (3) medical evidence establishing that the 

diagnosed condition is causally related to the identified employment factors.7

Causal relationship is a medical issue, and the medical evidence required to establish causal 

relationship is rationalized medical evidence.8 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 the specific employment factors identified by the employee.9 

Neither the mere fact that a disease or condition manifests itself during a period of employment 

nor the belief that the disease or condition was caused or aggravated by employment factors or 

incidents is sufficient to establish causal relationship.10

ANALYSIS

The Board finds that appellant has not met his burden of proof to establish a left shoulder 

condition causally related to the accepted factors of his federal employment.

In support of his claim, appellant submitted a series of medical reports from Dr. Ramsey. 

In two reports Dr. Ramsey discussed the issue of causal relationship. On June 7, 2017 he opined 

that appellant’s duties of picking up large bags and doing repetitive lifting at work “can certainly 

cause or contribute” to the problem found in his shoulder at the time of surgery. In his October 2, 

2017 report, Dr. Ramsey diagnosed bicipital tendinitis, bursitis of shoulder, primary osteoarthritis 

of shoulder, and incomplete rotator cuff tear or rupture, not specified as traumatic. He indicated 

that he had viewed pictures of the heavy metal bins that appellant had to push, pull, and lift during 

the course of his daily employment and opined that now that he had seen the type of work appellant

performed, he could say with “complete medical certainty” that these duties had contributed to his 

shoulder issue if not directly caused it. While Dr. Ramsey provided generally supportive opinions 

 

5 A.S., Docket No. 19-0704 (issued September 11, 2019); R.C., 59 ECAB 427 (2008); James E. Chadden, Sr., 40 

ECAB 312 (1988).

6 20 C.F.R. § 10.115; M.C., Docket No. 18-1278 (issued March 7, 2019); L.M., Docket No. 13-1402 (issued 

February 7, 2014); Delores C. Ellyett, 41 ECAB 992 (1990).

7 See D.S., Docket No. 19-0925 (issued September 25, 2019); Victor J. Woodhams, 41 ECAB 345, 352 (1989).

8 E.V., Docket No. 18-1617 (issued February 26, 2019); A.M., Docket No. 18-0685 (issued October 26, 2018).

9 E.V., id.

10 B.J., Docket No. 19-0417 (issued July 11, 2019).
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on the issue of causal relationship, the Board finds that he failed to provide the necessary medical 

rationale to explain how the accepted employment duties had either caused or contributed to 

appellant’s 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 was related to the accepted employment factors.11 Thus, the Board finds that 

the reports from Dr. Ramsey are insufficient to establish that appellant sustained an employmentrelated injury.

In support of his claim, appellant also submitted evidence from a nurse practitioner. The 

February 20, 2017 nurse practitioner’s report does not constitute competent medical evidence 

because a nurse practitioner is not considered a “physician” as defined under FECA.12 

Consequently, the nurse’s medical findings and opinions will not suffice for establishing causal 

relationship.13 For these reasons, the note of the nurse practitioner is insufficient to establish

appellant’s burden of proof with respect to causal relationship.

As appellant has not submitted rationalized medical evidence to support his allegation that 

he sustained a left shoulder condition causally related to the accepted employment factors, he has 

not met his burden of proof to establish his claim.

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 of proof to establish a left shoulder 

condition causally related to the accepted factors of his federal employment.

 

11 D.L., Docket No. 19-0900 (issued October 28, 2019); Y.D., Docket No. 16-1896 (issued February 10, 2017);

C.M., Docket No. 14-0088 (issued April 18, 2014).

12 Section 8101(2) of FECA provides that medical opinions can only be given by a qualified physician. This section 

defines a physician as surgeons, podiatrists, dentists, clinical psychologists, optometrists, chiropractors, and 

osteopathic practitioners within the scope of their practice as defined by state law. H.K., Docket No. 19-0429 (issued 

September 18, 2019); K.W., 59 ECAB 271, 279 (2007); David P. Sawchuk, 57 ECAB 316, 320 n.11 (2006). A report 

from a physician assistant or certified nurse practitioner will be considered medical evidence if countersigned by a 

qualified physician. Federal (FECA) Procedure Manual, Part 2 -- Claims, Causal Relationship, Chapter 2.805.3a(1) 

(January 2013).

13 M.J., Docket No. 19-1287 (issued January 13, 2020).
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ORDER

IT IS HEREBY ORDERED THAT the December 8, 2017 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: February 25, 2020

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Christopher J. Godfrey, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board