United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

M.C., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Merrifield, VA, Employer

__________________________________________

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Docket No. 22-0992

Issued: March 15, 2023

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, Deputy Chief Judge

JAMES D. McGINLEY, Alternate Judge

JURISDICTION

On June 15, 2022 appellant filed a timely appeal from March 18 and April 28, 2022 merit

decisions 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

ISSUE

The issue is whether appellant has met her burden of proof to establish a medical condition 

causally related to the accepted factors of her federal employment.

1

5 U.S.C. § 8101 et seq.

2 The Board notes that, following the April28, 2022 merit 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

FACTUAL HISTORY

On August 5, 2021 appellant, then a 38-year-old city carrier, filed an occupational disease 

claim (Form CA-2) alleging that she developed pain in her forearm, lateral epicondylitis, and bone 

spurs caused by Achilles tendinitis due to the factors of her federal employment. She related that 

she developed pain due to constant walking while delivering mail and the repetitive actions of 

opening mailboxes and lifting heavy boxes. Appellant noted that she first became aware of her 

conditions and realized their relation to her federal employment on May 26, 2021. She stopped 

work on July 22, 2021.

Along with her claim, appellant submitted a July 20, 2021 letter in which Dr. Stefan 

Coombs, an orthopedic surgeon, diagnosed lateral epicondylitis and recommended work 

restrictions. She also submitted an August 5, 2021 position description and undated salary 

information. 

In an August 5, 2021 development letter, OWCP informed appellant of the deficiencies of 

her claim. It advised her of the type of factual and medical evidence needed to establish her claim 

and provided a factual questionnaire for her completion. OWCP afforded appellant 30 days to 

submit the necessary evidence.

Thereafter, appellant submitted a May 26, 2021 visit note from an unidentified nurse 

practitioner indicating that appellant should remain off work until May 28, 2021. 

OWCP also received a July 16, 2021 physical therapy referral from Dr. Shelton McKenzie, 

a Board-certified orthopedic surgeon, and an unsigned letter of even date requesting that appellant 

be placed on light duty for three months and be permitted to attend physical therapy twice per 

week.

In an August 5, 2021 report, Dr. Robert Wilson, a Board-certified orthopedic surgeon, 

noted a diagnosis of right lateral epicondylitis. A duty status report (Form CA-17) and form report 

of even date signed by an unknown physician recommended work restrictions until

October 20, 2021. 

In an August 16, 2021 report, Dr. McKenzie diagnosed right insertional Achilles tendinitis 

and noted tenderness and swelling at the Achilles tendon. In a form report of even date, he

recommended work restrictions and held appellant off work until September 27, 2021.

An August 16, 2021 Form CA-17 from Dr. McKenzie noted tenderness of the Achilles 

tendon and reiterated a diagnosis of Achilles tendinitis. OWCP also received an undated 

appointment list.

By decision dated September 16, 2021, OWCP denied appellant’s claim, finding that she 

had not submitted sufficient evidence to establish that the claimed events occurred as alleged. 

Consequently, it found that she had not met the requirements to establish an injury as defined by 

FECA.

On October 14, 2021 appellant requested an oral hearing before a representative of

OWCP’s Branch of Hearings and Review, which was held on February 8, 2022. 
3

Appellant continued to submit evidence, including an undated letter asserting that her 

supervisor had stopped mail delivery to the apartment building where the outdated mailboxes were 

causing pain to her arm, and she further asserted that her supervisor tried to get the building’s 

management to fix the boxes. She also submitted a June 4, 2021 letter from the U.S. Postal Service 

informing the building’s property management that mail delivery would be suspended immediately

due to the unsafe condition of the mailboxes, as well as a June 6, 2021 undelivered mail report. 

In an October 8, 2021 letter, Dr. Rolanda Willacy, an orthopedic surgeon, noted that 

appellant had engaged in prolonged walking as a mail carrier and opined that it had exacerbated 

her medical conditions. She further noted that appellant’s right foot required therapy due to 

excessive walking and that her Achilles tenderness had caused a bone spur to grow. 

In an October 12, 2021 response to OWCP’s development questionnaire, appellant related 

that she had been a mail carrier since December 12, 2016 and that her job required her to walk for 

six to eight hours per day, at least five days a week. She noted that in October 2020, she changed 

postal stations and began delivering mail to a high-rise building where the mailboxes were very 

old and hard to access. Appellant reported that her arm would periodically hurt after completing 

delivery to this building, but she continued her duties because the pain was not constant. She 

recounted that in May 2021 her pain became an everyday occurrence and grew overwhelming, so 

she informed her supervisor and made an appointment with her doctor.

In an October 14, 2021 letter, Dr. Coombs noted that on July 20, 2021 appellant was 

diagnosed with lateral epicondylitis in her right arm and recommended work restrictions. He

further noted that she was placed on employment leave due to the constant lifting, pulling, and 

tugging on boxes that had caused injury to her right arm and elbow. 

In a letter dated January 11, 2022, Dr. Keli Doe, an orthopedic surgeon, noted that 

appellant was being treated by Dr. Wilson and had a diagnosis of right lateral epicondylitis 

radiating to her right wrist. He recommended work restrictions of lifting no more than five pounds 

and ongoing physical and occupational therapy.

By decision dated March 18, 2022, OWCP modified its September 16, 2021 decision to 

find that the evidence of record was sufficient to establish the implicated employment factors. The 

claim remained denied, however, because the medical evidence of record was insufficient to 

establish causal relationship between appellant’s diagnosed conditions and the accepted factors of 

her federal employment.

On April 26, 2021 appellant requested reconsideration of the March 18, 2022 decision and 

submitted additional evidence, including an April 14, 2022 note from Dr. Jared Nowell, an

orthopedic surgeon, indicating that she presented on March 2, 2022 for elbow pain and right radial 

tunnel syndrome. Dr. Nowell noted that her symptoms began in May 2021 after she began

delivering mail to an older apartment building where opening the mailboxes caused pain and 

swelling in her right forearm. He opined that the May 2021 incident caused appellant to develop 

persistent symptoms including radial tunnel syndrome in her right arm and that all previous 

treatments were related to that incident. 
4

By decision dated April 28, 2022, OWCP denied modification of its March 18, 2022 

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

disease claim, an employee 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 employment factors identified by the employee. 7

To establish causal relationship between the condition, as well as any attendant disability 

claimed and the employment event or incident, the employee must submit rationalized medical 

opinion evidence.8 The opinion of the physician must be based on a complete factual and medical 

background of the employee, must be expressed in terms of a reasonable degree of medical 

certainty, and must be supported by medical rationale explaining the nature of the relationship 

between the diagnosed condition and the specific employment factor(s) identified by the 

employee.9 The weight of the medical evidence is determined by its reliability, its probative value, 

3

Supra note 1.

4 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). 

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.D., Docket No. 20-0921 (issued November 12, 2020); M.S.,Docket No. 18-1554 (issued February 8, 2019). See 

also Roy L. Humphrey, 57 ECAB 238, 241 (2005); Ruby I. Fish, 46 ECAB 276, 279 (1994);Victor J. Woodhams, 41 

ECAB 345 (1989).

8

S.A., Docket No. 18-0399 (issued October 16, 2018);Robert G. Morris, 48 ECAB 238 (1996).

9 M.V., Docket No. 18-0884 (issued December 28, 2018); I.J., 59 ECAB 408 (2008); Victor J. Woodhams, 

supra note 7.
5

its convincing quality, the care of analysis manifested, and the medical rationale expressed in 

support of the physician’s opinion.10

ANALYSIS

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

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

In support of her claim, appellant submitted an April 14, 2022 note from Dr. Nowell noting

that her pain and swelling in the right forearm began in May 2021, after she began delivering mail 

at an older apartment building requiring her to repetitively open mailboxes. Dr. Nowell opined 

that the May 2021 incident caused her to develop persistent symptoms and radial tunnel syndrome 

in her right arm. The Board has held that medical evidence that merely states a conclusion but 

does not offer a rationalized medical explanation regarding the cause of an employee’s condition,

is of limited probative value on the issue of causal relationship.11 Moreover, an opinion that a 

condition is related to an employment incident because the employee was asymptomatic before 

the injury is insufficient, without adequate rationale, to establish causal relationship.

12

 

Similarly, appellant submitted an October 8, 2021 letter in which Dr. Willacy opined that 

excessive walking as a mail carrier had exacerbated her conditions and caused Achilles tenderness 

and a bone spur. As noted above, the Board has held that a medical opinion without adequate 

rationale is insufficient to establish causal relationship.

13

 This report is therefore insufficient to 

establish causal relationship. 

Appellant also submitted a July 20 and October 14, 2021 letter from Dr. Coombs noting a 

diagnosis of lateral epicondylitis and providing work restrictions. Dr. McKenzie, in his July 16, 

2021 physical therapy referral and August 16, 2021 Form CA-17, diagnosed Achilles tendinitis

and provided work restrictions. Dr. Wilson, in his August 5, 2021 report, diagnosed right lateral 

epicondylitis and referred appellant to occupational therapy on August 9, 2021. Dr. Doe, in her 

January 11, 2022 report, noted a diagnosis of right lateral epicondylitis and provided work 

restrictions. However, none of this evidence included an opinion on causal relationship. The 

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

employee’s condition is of no probative value on the issue of causal relationship. As such, these 

reports from Drs. Coombs, McKenzie, Wilson, and Doe are also insufficient to establish 

appellant’s claim.14

10 D.R., Docket No. 19-0954 (issued October 25, 2019); James Mack, 43 ECAB 321 (1991).

11 M.E., Docket No. 18-0940 (issued June 11, 2019).

12 See S.D., Docket No. 20-1255 (issued February 3, 2021); F.H., Docket No. 18-1238 (issued January 18, 2019);

J.R., Docket No. 18-0206 (issued October 15, 2018).

13 Supra note 11.

14 See D.Y., Docket No. 20-0112 (issued June 25, 2020); L.B., Docket No. 18-0533 (issued August 27, 2018); D.K., 

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

The remaining medical evidence of record consists of a May 26, 2021 note from an 

unidentified nurse practitioner and an August 5, 2021 Form CA-17 from an unidentifiable 

physician. Certain healthcare providers such as physician assistants, nurses, nurse practitioners, 

physical therapists, and social workers are not considered “physician[s]”as defined under FECA.15 

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

entitlement to FECA benefits.

16

 Moreover, the Board has held that reports that are unsigned or 

bear an illegible signature lack proper identification and cannot be considered probative medical 

evidence as the author cannot be identified as a physician.17

As the medical evidence of record is insufficient to establish a medical condition causally 

related to the accepted employment factors, the Board finds that appellant has not met her burden 

of proof.18

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 factors of her federal employment.

15 5 U.S.C. § 8101(2); 20 C.F.R. § 10.5(t).

16 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. 5 U.S.C. § 8101(2); 20 C.F.R. 

§ 10.5(t). See Federal (FECA) Procedure Manual, Part 2 -- Claims, Causal Relationship, Chapter 2.805.3a(1) 

(January2013); H.K., Docket No. 19-0429 (issued September 18, 2019); K.W., 59 ECAB 271, 279 (2007); DavidP. 

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); see also J.D.,Docket No. 21-0164 (issued June 15, 2021) 

(nurse practitioners are not physicians as defined under FECA).

17 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).

18 See T.J., Docket No. 19-1339 (issued March 4, 2020); F.D., Docket No. 19-0932 (issued October 3, 2019); 

D.N., Docket No. 19-0070 (issued May 10, 2019); R.B., Docket No. 18-1327 (issued December 31, 2018).
7

ORDER

IT IS HEREBY ORDERED THAT the March 18 and April 28, 2022 decisions of the 

Office of Workers’ Compensation Programs are affirmed. 

Issued: March 15, 2023

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

James D. McGinley, Alternate Judge

Employees’ Compensation Appeals Board