United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

C.M., Appellant

and

DEPARTMENT OF VETERAN AFFAIRS, 

VETERANS HEALTH ADMINISTRATION, 

CINCINNATI VA MEDICAL CENTER, 

Cincinnati, OH, Employer

__________________________________________

)

)

)

)

)

)

)

)

)

)

Docket No. 21-1245

Issued: March 11, 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

PATRICIA H. FITZGERALD, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On August 17, 2021 appellant, through counsel, filed a timely appeal from a June 21, 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.

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.
2

ISSUE

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

causally related to the accepted December 4, 2018 employment incident.

FACTUAL HISTORY

On November 3, 2020 appellant, then a 41-year-old nurse, filed a traumatic injury claim 

(Form CA-1) alleging that on December 4, 2018 she injured her right arm when she grabbed a 

patient who attempted to leave the premises while in the performance of duty. She explained that 

the patient became agitated, started to swing his cane at the staff, and attempted to leave the 

hospital. Appellant asserted that she grabbed him at the same time the police attempted to subdue 

him by placing him on the bed which jerked her arm to the left and pulled her down with the patient

onto the bed. She noted that she initially experienced immediate pain to her wrist and arm, which 

worsened with certain activities and continued days later. Appellant stopped work on 

December 7, 2018.

In a November 18, 2020 development letter, OWCP notified appellant of the deficiencies 

of her claim. It advised her of the type of factual and medical evidence needed and provided a 

factual questionnaire for her completion. OWCP afforded appellant 30 days to respond. No 

further evidence was submitted.

By decision dated December 21, 2020, OWCP denied appellant’s traumatic injury claim, 

finding that the evidence of record was insufficient to establish a medical diagnosis in connection 

with the accepted December 4, 2018 employment incident. It concluded, therefore, that the 

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

In a December 4, 2018 report, Dr. Jason T. Hildebrant, an internist, related that appellant 

was involved in a work-related altercation with a patient who was trying to leave the hospital. He 

summarized her account that the patient became agitated and aggressive, and that she tried to 

redirect him back to his bed while a coworker relieved him of his cane. Dr. Hildebrant noted that 

appellant was unsure whether she injured her arm from being hit by the cane or by the patient. 

Appellant reported having aching pain in her right forearm. Dr. Hildebrant conducted a physical 

examination and diagnosed right arm pain. 

A December 15, 2018 x-ray of the right wrist revealed no acute osseous injury. A right 

hand x-ray of even date demonstrated no fracture or dislocation. A right forearm x-ray of even 

date revealed mild degenerative changes. 

In an August 31, 2020 medical report, Dr. Glen A. McClung, a Board-certified orthopedic 

surgeon, noted that appellant presented with right shoulder pain after she fell on her right shoulder. 

He conducted a physical examination and diagnosed a possible right shoulder partial rotator cuff 

tear. 

In a November 18, 2020 medical report, Dr. McClung reported that appellant sustained a 

work-related injury of the right shoulder “back in December” when a patient grabbed and pulled 

her arm. He noted that she reinjured her right shoulder “in April.” Dr. McClung conducted a 
3

physical examination and diagnosed probable right shoulder distal clavicle osteolysis, right 

shoulder impingement, and a possible partial rotator cuff tear. 

A November 30, 2020 magnetic resonance imaging (MRI) scan of the right shoulder 

revealed moderate-to-severe supraspinatus and mild infraspinatus tendinosis without tear as well 

as mild acromioclavicular (AC) joint osteoarthritis with acromial morphology. 

In a December 2, 2020 medical report, Dr. McClung conducted a physical examination and 

diagnosed right shoulder impingement, AC arthrosis, and rotator cuff tendinitis. 

In a December 10, 2020 form report, Dr. McClung noted that appellant’s condition began 

in April 2020 and diagnosed right shoulder pain, rotator cuff tendonitis, impingement, and AC 

arthrosis. He advised that she was scheduled for right shoulder surgery on December 28, 2020. 

In a December 28, 2020 operative report, Dr. McClung noted that appellant underwent 

surgery, including right shoulder arthroscopies with subacrominal decompression, distal clavicle 

excision, and extensive debridement. He diagnosed right shoulder impingement, AC arthrosis, 

bursitis, and synovitis. 

In a letter dated January 12, 2021, appellant, through counsel, requested a telephonic 

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

held on April 19, 2021.

By decision dated June 21, 2021, the hearing representative affirmed, as modified, the 

December 21, 2020 decision, finding that the medical evidence submitted was sufficient to 

establish a diagnosed medical condition. The claim remained denied, however, as the medical 

evidence of record was insufficient to establish causal relationship between appellant’s diagnosed 

conditions and the accepted December 4, 2018 employment incident.

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 

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).
4

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 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.7 

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

condition and an employment incident is 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 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 employee.9

ANALYSIS

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

condition causally related to the accepted December 4, 2018 employment incident.

In his November 18 2020 medical report, Dr. McClung noted that appellant sustained a 

work-related injury of the right shoulder “back in December” when a patient grabbed and pulled 

her arm. He also indicated that she reinjured her right shoulder “in April.” Dr. McClung diagnosed 

right shoulder distal clavicle osteolysis, right shoulder impingement, and a possible partial rotator 

cuff tear. While his report is generally supportive of causal relationship, he did not offer any 

explanation or medical rationale as to how appellant could have developed the diagnosed right 

shoulder conditions due to the accepted December 4, 2018 employment incident. The Board has 

held that a report is of limited probative value regarding causal relationship if it does not contain 

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).

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).
5

medical rationale explaining how a given medical condition is related to the accepted employment 

incident.10 For these reasons, this report is insufficient to establish the claim.

In his reports dated December 2, 10, and 28, 2020, Dr. McClung provided multiple 

diagnoses related to appellant’s right shoulder and arm. However, he did not provide an opinion 

on causal relationship. 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.11 Thus, these reports are 

also insufficient to establish appellant’s claim.

In an August 31, 2020 medical report, Dr. McClung noted that appellant fell on her right 

shoulder and diagnosed a possible right shoulder partial rotator cuff tear. However, he failed to 

provide a firm diagnosis in connection with the accepted December 4, 2018 employment incident. 

The Board has long held that a medical report lacking a firm diagnosis and a rationalized medical 

opinion regarding causal relationship is of no probative value.12 Thus, this report is insufficient to 

establish appellant’s claim. 

Dr. Hildebrant, in his December 4, 2018 medical report, indicated that appellant was 

involved in a work-related altercation with a patient who was trying to leave the hospital while 

threatening staff members with his cane. He diagnosed right arm pain. However, the Board has 

held that pain is a description of a symptom, not a clear diagnosis of a medical condition. 13 A 

medical report lacking a firm diagnosis is of no probative value.14 This report is, therefore, 

insufficient to establish a diagnosed medical condition causally related to the accepted 

employment incident.

The remaining medical evidence includes radiographic studies. The Board has held, 

however, that diagnostic studies, standing alone, lack probative value and are, therefore, 

insufficient to establish the claim.15

10 B.H., Docket No. 20-077 (issued October 21, 2020); see S.Y., Docket No. 20-0470 (issued July 15, 2020); T.J., 

Docket No. 19-1339 (issued March 4, 2020); Y.D., Docket No. 16-1896 (issued February 10, 2017) (finding that a 

report is of limited probative value regarding causal relationship if it does not contain medical rationale describing the 

relation between work factors and a diagnosed condition/disability).

11 L.T., Docket No. 20-0582 (issued November 15, 2021); A.C., Docket No. 21-0087 (issued November 9, 2021); 

D.B., Docket No. 19-0514 (issued January 27, 2020); L.B., Docket No. 18-0533 (issued August 27, 2018); D.K., 

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

12 W.G., Docket No. 20-0439 (issued July 13, 2020); R.L., Docket No. 20-0284 (issued June30, 2020); P.C., Docket 

No. 18-0167 (issued May 7, 2019).

13 C.S., Docket No. 20-1354 (issued January 29, 2021); D.R., Docket No. 18-1408 (issued March 1, 2019); D.A., 

Docket No. 18-0783 (issued November 8, 2018).

14 C.S., id.; J.P., Docket No. 20-0381 (issued July 28, 2020); R.L., Docket No. 20-0284 (issued June 30, 2020).

15 J.E., Docket No. 21-0956 (issued November 23, 2021); J.K., Docket No. 20-0591 (issued August12, 2020); J.P., 

Docket No. 19-0129 (issued December 13, 2019).
6

As the medical evidence of record is insufficient to establish that appellant’s diagnosed 

right arm condition is causally related to the accepted December 4, 2018 employment incident, the 

Board finds that appellant 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 December 4, 2018 employment incident.

ORDER

IT IS HEREBY ORDERED THAT the June 21, 2021 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: March 11, 2022

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Alternate Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board