United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

C.J., Appellant

and

U.S. POSTAL SERVICE, RIDGEWAY POST 

OFFICE, Ridgeway, VA, Employer

__________________________________________

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Docket No. 22-0478

Issued: August 30, 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 February 7, 2022 appellant filed a timely appeal from a September 20, 2021 merit 

decision and an October 18, 2021 nonmerit 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.

ISSUES

The issues are: (1) whether appellant has met her burden of proof to establish a medical 

condition causally related to the accepted November 13, 2019 employment incident; and 

(2) whether OWCP properly denied appellant’s request for reconsideration of the merits of her 

claim, pursuant to 5 U.S.C. § 8128(a).

1

5 U.S.C. § 8101 et seq.
2

FACTUAL HISTORY

On January 10, 2020 appellant, then a 61-year-old rural carrier, filed a traumatic injury 

claim (Form CA-1) alleging that on November 13, 2019 she sustained a right shoulder injury when 

she stepped on a bag of mulch and fell while in the performance of duty.

In notes dated November 13 and December 2, 2019, and January 10, 2020, Dr. Jonathan 

Krome, a Board-certified orthopedic surgeon, recommended light duty. 

An unsigned report from a medical provider dated January 10, 2020 noted diagnoses of a 

tear of the right supraspinatus tendon, acute pain of the right shoulder, and numbness and tingling 

in the right hand.

In a development letter dated February 26, 2020, OWCP informed appellant that she had 

submitted insufficient factual and medical evidence to establish her claim. It advised her of the 

type of evidence needed and provided a questionnaire for her completion. OWCP afforded 

appellant 30 days to respond. 

In a report dated November 13, 2019, Dr. Krome noted that appellant had related that she 

had fallen and hurt her right shoulder on that date. He related an assessment of right shoulder 

injury and acute pain of the right shoulder. Dr. Krome also noted that appellant had left knee 

derangement, with pain for the last three weeks. 

In a report dated December 2, 2019, Dr. Krome diagnosed acute pain of the right shoulder, 

a tear of the right supraspinatus tendon, and left knee internal derangement. He noted his review 

of a magnetic resonance imaging (MRI) scan of appellant’s left knee, which demonstrated a 

possible small meniscus tear with fluid and a small cuff tear with no retraction. Dr. Krome stated 

that the age of these changes was unknown. He recommended physical therapy. In progress notes 

dated from January 10 through February 27, 2020, Dr. Krome diagnosed a tear of the right 

supraspinatus tendon and recommended continuation of physical therapy. 

In a duty status report (Form CA-17) dated February 27, 2020,Dr. Krome noted appellant’s 

history that on November 13, 2019 she stepped on a bag of mulch while delivering a parcel and 

fell, injuring her right shoulder. He diagnosed a tear of the right supraspinatus tendon and 

recommended work restrictions of no lifting with the right shoulder and sedentary work. 

By decision dated March 30, 2020, OWCP denied appellant’s claim, finding that the 

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

conditions and the accepted employment incident of November 13, 2019.

In a note dated March 20, 2020, Dr. Krome recommended light duty with sitting work only 

and no lifting with the right arm. 

On April 24, 2020 appellant requested an oral hearing before a representative of OWCP’s 

Branch of Hearings and Review. With her request she submitted a letter dated April 23, 2020 from

Dr. Krome, in which he stated that appellant’s right shoulder and left knee surgery had yet to be 

scheduled.
3

In a Form CA-17 dated May 20, 2020, Dr. Krome diagnosed a tear of the right 

supraspinatus tendon and advised that appellant could return to full-time regular work as of that 

date. 

In a report dated June 23, 2020, Dr. Robert Wainer, a Board-certified orthopedic surgeon, 

diagnosed a left knee chronic traumatic possible lateral meniscus tear with a Baker’s cyst and right 

knee chronic traumatic synovitis versus chondromalacia. He noted that appellant had sustained a 

fall and twisting injury at work in November 2019. Dr. Wainer administrated a series of injections. 

In a progress note dated July 14, 2020, Dr. Wainer followed up with appellant for her 

complaints of bilateral knee pain, left worse than right. He noted that an MRI scan of her left knee 

obtained on November 22, 2019 revealed no definite meniscal tearing with mild anterior cruciate 

ligament (ACL) strain and mild-to-moderate chondromalacia. Appellant stated that her right knee 

hurt and she had been favoring the left knee, which was hurt getting in and out of a mail truck 

many times over many years. Dr. Wainer diagnosed bilateral knee moderate primary localized 

osteoarthritis. 

In a progress note dated July 28, 2020, Dr. Wainerstated that he had administered a second 

injection to both knees on that date. He diagnosed bilateral knee moderate primary localized 

osteoarthritis.

An MRI scan of appellant’s left knee obtained on November 22, 2019 demonstrated 

suggestion of a mild strain of the ACL, osteoarthritis, a small knee joint effusion, and a small 

Baker’s cyst. An MRI scan of appellant’s right shoulder obtained on the same date demonstrated 

supraspinatus and infraspinatus tendinosis/strain and a 1.5 centimeter full-thickness tear of the 

supraspinatus tendon. 

The oral hearing before a representative of OWCP’s Branch of Hearings and Review was 

held on August 6, 2020. 

Following the oral hearing, OWCP received additional evidence. An MRI scan of the left 

knee obtained on November 22, 2019 demonstrated suggestion of a mild strain of the ACL, 

osteoarthritis, small knee joint effusion, and a small Baker’s cyst. An MRI scan of the right 

shoulder obtained on the same date demonstrated supraspinatus an infraspinatus tendinosis/strain 

and a full-thickness tear of the supraspinatus tendon. 

By decision dated October 20, 2020, a hearing representative affirmed OWCP’s March 30, 

2020 decision. The hearing representative found that appellant had not established that her

diagnosed shoulder or knee conditions were causally related to the November 13, 2019 

employment incident. 

On June 17, 2021 appellant requested reconsideration of the decision of October 20, 2020.

In a letter dated January 15, 2021, Dr. Wainer stated that appellant tripped and fell at work 

on November 13, 2019. He explained that she had a traumatic injury to her right shoulder that 

occurred from the impact of the fall, with her full body weight on her right shoulder. Dr. Wainer 

opined that this injury was caused by the fall and caused a tear of appellant’s right shoulder rotator 

cuff, requiring surgery on September 9, 2020. He noted that an MRI scan obtained prior to surgery 
4

was consistent with the rotator cuff tear, which was secondary to her fall on November 13, 2019. 

Dr. Wainer further noted that due to her injury, appellant underwent arthroscopic surgery and 

rotator cuff repair on September 9, 2020.

By decision dated September 20, 2021, OWCP denied modification of its decision of 

October 20, 2020. 

On September 21, 2021 appellant requested reconsideration of OWCP’s September 20, 

2021 decision. In support of her request, she resubmitted the January 15, 2021 letter from

Dr. Wainer. Appellant also submitted a surgical report dated September 9, 2020. This report 

related that Dr. Wainer performed right shoulder partial labrum and partial rotator cuff tear 

debridement and subacromial decompression of appellant’s right shoulder.

By decision dated October 18, 2021, OWCP denied appellant’s request for reconsideration 

of the merits of her claim.

LEGAL PRECEDENT -- ISSUE 1

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. 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.6 

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.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).
5

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

condition and an employment incident 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.

8

ANALYSIS -- ISSUE 1

The Board finds that this case is not in posture for decision. 

In a letter dated January 15, 2021, Dr. Wainer stated that appellant tripped and fell at work 

on November 13, 2019. He explained that she had a traumatic injury to her right shoulder that 

occurred from the impact of the fall, with her full body weight on her right shoulder. Dr. Wainer 

opined that this injury was caused by the fall and caused a tear of her right shoulder rotator cuff, 

requiring surgery on September 9, 2020. He noted that an MRI scan obtained prior to surgery was 

consistent with the rotator cuff tear, which was secondary to her fall on November 13, 2019. 

Dr. Wainer further noted that due to her injury, she underwent arthroscopic surgery and rotator 

cuff repair on September 9, 2020.

The Board finds that the January 15, 2021 letter from Dr. Wainer is sufficient to require 

further development of the medical evidence. His report provided a pathophysiological 

explanation as to how appellant’s fall on November 13, 2019 caused her diagnosed rotator cuff 

tear. There is no evidence of record contradicting Dr. Wainer’s opinion on causation. The medical 

evidence of record from him provided a rational and logical opinion and is, therefore, sufficient to 

require further development of appellant’s claim.9

It is well established that proceedings under FECA are not adversarial in nature and, while 

appellant has the burden of proof to establish entitlement to compensation, OWCP shares 

responsibility in the development of the evidence.10 It has an obligation to see that justice is done.11

On remand OWCP shall refer appellant to a specialist in the appropriate field of medicine, 

along with the case record and a statement of accepted facts. Its referral physician shall provide a 

well-rationalized opinion as to whether appellant has a diagnosed condition causally related to or 

aggravated by the accepted factors of her federal employment. If the physician opines that the 

diagnosed condition is not causally related, he or she must explain with rationale how or why the 

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 ECAB 345, 352 (1989).

9 D.S., Docket No. 17-1359 (issued May 3, 2019); WilliamJ. Cantrell, 34 ECAB 1223 (1983).

10 Id. See also A.P., Docket No. 17-0813 (issued January3, 2018); Jimmy A. Hammons, 51 ECAB 219, 223 (1999).

11 S.M., Docket No. 19-1634 (issued August 25, 2020); see B.C., Docket No. 15-1853 (issued January 19, 2016); 

John J. Carlone, supranote 6.
6

opinion differs from that of Dr. Wainer. After such further development of the case record as 

OWCP deems necessary, it shall issue a de novo decision.

12

CONCLUSION

The Board finds that this case is not in posture for decision.

ORDER

IT IS HEREBY ORDERED THAT the September 20 and October 18, 2021 decisions of 

the Office of Workers’ Compensation Programs are set aside and the case is remanded for further 

proceedings consistent with this decision of the Board.

Issued: August 30, 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

12 In light of the Board’s disposition of Issue 1, Issue 2 is rendered moot.