United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

C.G., Appellant

and

U.S. POSTAL SERVICE, LONG BEACH MAIN 

POST OFFICE, Long Beach, NY, Employer

__________________________________________

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Docket No. 22-1270

Issued: December 20, 2023

Appearances: Case Submitted on the Record

Bruce H. Didriksen, for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

JANICE B. ASKIN, Judge

JAMES D. McGINLEY, Alternate Judge

JURISDICTION

On August 31, 2022 appellant filed a timely appeal from a July 7, 2022 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.

ISSUE

The issue is whether appellant has met her burden of proof to establish a right elbow

condition causally related to the accepted May 22, 2019 employment incident.

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

FACTUAL HISTORY

On May 22, 2019 appellant, then a 45-year-old letter carrier, filed a traumatic injury claim 

(Form CA-1) alleging that on that date she injured her right elbow when lifting a bundle of flat 

postage and placing it into her carrier case while in the performance of duty. She noted that,

thereafter, she developed pain in her right elbow. Appellant stopped work that day.

In a May 22, 2019 duty status report (Form CA-17), Dr. Joshua Hourizadeh, an osteopath

Board-certified in family practice, recounted that appellant had injured herself lifting a bundle 

from a mail hamper while at work. In form report of even date, he diagnosed an elbow strain and 

recommended work restrictions.

In a May 22, 2019 authorization for examination and/or treatment (Form CA-16) the 

employing establishment authorized appellant to seek medical treatment. In Part B of the Form 

CA-16, attending physician’s report, of even date, Dr. Hourizadeh diagnosed elbow strain.

Dr. Arthur Pallotta, a Board-certified orthopedic surgeon completed a Form CA-17 dated 

May 24, 2019 providing a date of injury of May 22, 2019 and described appellant’s mechanism of 

injury as lifting a bundle from a mail hamper causing right elbow pain. 

In a May 30, 2019 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 questionnaire for her completion. OWCP afforded appellant 30 days to submit the 

necessary evidence.

Dr. Pallotta completed a report on May 24, 2019, recounting that appellant had lifted a 

bundle of newspapers on May 22, 2019 and injured her right elbow and forearm. He diagnosed 

lateral epicondylitis of the right elbow and a right forearm strain. Dr. Pallotta opined that the 

incident described by appellant was the competent medical cause of the injury, that her complaints 

were consistent with the injury, and that her history of injury was consistent with his observations. 

In a form report of even date, he diagnosed a right forearm strain and found appellant totally 

disabled from work through June 6, 2019. 

In a June 7, 2019 treatment note, Dr. Pallotta again diagnosed sprain/strain of the right 

elbow and repeated his opinion that the May 22, 2019 incident was the competent medical cause 

of the injury. He further diagnosed lateral epicondylitis of the right elbow and found that as her 

pain started immediately after her injury at work, this condition was related to the May 22, 2019 

employment incident rather than her preexisting shoulder injury.

In a June 22, 2019 response to OWCP’s development questionnaire, appellant related that 

on May 22, 2019 she was moving 5 to 10 pound bundles of flats from the mail hamper to her 

carrier case. She indicated thatshe felt a pulsatingand throbbing pain in her right elbow, extending 

into her forearm. Appellant noted that she informed her supervisor and sought medical care, and 

that her condition prevented her from completing daily tasks. She asserted that, prior to May 22, 

2019, she has never had pain in her right elbow or forearm.

By decision dated July 5, 2019, OWCP accepted that the May 22, 2019 employment 

incident occurred as alleged. However, it denied appellant’s traumatic injury claim, finding that 
3

the evidence of record was insufficient to establish a right elbow condition causally related to the 

accepted May 22, 2019 employment incident.

Appellant continued to submit evidence, including a June 28, 2019 visit note and Form 

CA-17 from Dr. Pallotta, reiterating his diagnoses and noting that the prognosis for recovery was 

uncertain. In a work status note of even date, Dr. Pallotta continued to opine that she was disabled 

from work. 

In a July 26, 2019 work status note, Dr. Pallotta opined that appellant was totally disabled 

from work through August 2, 2019 and provided light-duty work restrictions.

On August 2, 2019 appellant requested an oral hearing before a representative of OWCP’s 

Branch of Hearings and Review, which took place on October 22, 2019.

OWCP received additional evidence, including a May 22, 2019 report from

Dr. Hourizadeh, noting that he examined appellant that day and she related being injured while 

lifting newspapers. Dr. Hourizadeh diagnosed a work-related injury of right elbow strain. He 

explained that an elbow strain occurs when you overstretch or tear the ligaments around your 

elbow and that ligaments are the tough tissues that connect one bone to another. Dr Hourizadeh 

also completed an August 16, 2019 form report.

On July 26, 2019 Dr. Pallotta diagnosed right forearm strain and lateral epicondylitis of the 

right elbow. He related that her lateral epicondylitis “can be explained by lifting once.” He noted 

that it did not appear to be related to her previous shoulder injury.

In an August 23, 2019 visit note, Dr. Pallotta reiterated his prior diagnoses and indicated

that appellant’s condition was unrelated to her shoulder condition, and that a single episode of 

lifting “could lead to her forearm and elbow diagnosis.”

In notes dated September 20 and October 8, 2019, Dr. Pallotta opined that her right lateral 

epicondylitis and forearm strain were caused by her repetitively lifting bundles of papers at work 

on May 22, 2019 and that the injury was not related to her previous shoulder injury. 

In a November 11, 2019 note, Samantha Bravo, a physician assistant, reiterated

Dr. Pallotta’s findings and diagnoses. 

On December 9, 2019 Dr. Pallotta opined that appellant sustained the conditions of right 

lateral epicondylitis and forearm strain while lifting a bundle of papers at work on May 22, 2019.

By decision dated December 19, 2019, the hearing representative affirmed OWCP’s July 5, 

2019 decision.

3

On December 18, 2020 appellant, through her representative, requested reconsideration of 

the December 19, 2019 decision and submitted additional evidence. 

3 Following OWCP’s hearing representative’s December 19, 2019 decision, OWCP received medical records dated 

May 30, 2019 from Jonathan Simhaee regarding a male patient which are inappropriately associated with this case 

record.
4

In a November 15, 2020 report, Dr. Pallotta reviewed his previous medical records noting 

that appellant had related that on May 22, 2019 she was lifting a bundle of papers at work when 

she injured her right elbow and forearm, resulting in pain. He diagnosed a right forearm strain and 

lateral epicondylitis of the right elbow, and opined that the May 22, 2019 injury was causally 

related to the work incident and unrelated to her previous shoulder injury. Dr. Pallotta explained 

that the act of lifting and gripping bundles weighing 5 to 10 pounds activates the wrist extensor 

muscles, which originate from the lateral epicondyle. He related that whether there was a onetime or repetitive activation these movements “can lead” to micro trauma of the extensor carpi 

radialis brevis tendon, which “can lead” to the diagnosis of lateral epicondylitis.

By decision dated July 7, 2022, OWCP denied modification of its prior decision.

LEGAL PRECEDENT

An employee seeking benefits under FECA4 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,5that 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.6 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.7

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 whether he or 

she actually experienced the employment incident at the time, 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.8

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.9 The opinion of the physician must be based on a complete factual 

and medical background, 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 

4

Id.

5 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). 

6 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).

7 P.A., Docket No. 18-0559 (issued January 29, 2020); K.M., Docket No. 15-1660 (issued September 16, 2016); 

Delores C. Ellyett, 41 ECAB 992 (1990).

8 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).

9 T.H., 59 ECAB 388, 393-94 (2008); Robert G. Morris, 48 ECAB 238 (1996).
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the specific employment incident.10 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. 11

ANALYSIS

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

condition causally related to the accepted May 22, 2019 employment incident.

The Form CA-16 report dated May 22, 2019 from Dr. Hourizadeh, addressed appellant’s 

right elbow strain, but did not offer an opinion on causal relationship. Medical reports lacking an 

opinion regarding causal relationship are insufficient to establish a claim.12 Thus, the Board finds 

that this report is insufficient to establish appellant’s claim.

Drs. Hourizadeh and Pallotta completed reports dated May 22 through December 9, 2019

which diagnosed right elbow strain and lateral epicondylitis of the right elbow. The physicians 

described the May 22, 2019 employment incident and opined that the diagnosed conditions were 

due to this injury. However, neither physician offered a rationalized medical opinion explaining 

how the mechanism by which the accepted May 22, 2019 employment incident would have 

resulted in her diagnosed left elbow 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/disability was related to employment factors. 13

In a separate May 22, 2019 report, Dr. Hourizadeh diagnosed right elbow strain, described 

the lifting incident of even date, and opined that the diagnosed condition was work related. He 

explained that an elbow strain occurs when you overstretch or tear the ligaments around your 

elbow and that ligaments are the tough tissues that connect one bone to another. However, he did 

not explain how lifting a bundle of newspapers, the accepted May 22, 2019 employment incident, 

resulted in the diagnosed condition. Dr. Hourizadeh did not offer a rationalized medical opinion 

explaining that the accepted May 22, 2019 employment incident would have resulted in appellant’s 

diagnosed right elbow conditions. The Board has held that a medical opinion should offer a 

medically-sound explanation of how the specific employment incident physiologically caused the 

diagnosed condition.14 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 

10 S.S., Docket No. 18-1488 (issued March 11, 2019); M.V., Docket No. 18-0884 (issued December 28, 2018); 

Victor J. Woodhams, 41 ECAB 345, 352 (1989).

11 T.M., Docket No. 22-0220 (issued July 29, 2022); J.L., Docket No. 18-1804 (issued April 12, 2019).

12 See E.K., Docket 22-1130 (issued December 30, 2022); L.K., Docket No. 21-1155 (issued March 23, 2022); T.S.,

Docket No. 20-1229 (issued August6, 2021); J.M.,Docket No. 19-1169 (issued February 7, 2020); A.L.,Docket No.

19-0285 (issued September 24, 2019); L.B.,Docket No. 18-0533 (issued August 27, 2018); D.K.,Docket No. 17-1549 

(issued July 6, 2018).

13 Id.; see also P.B., Docket No. 23-0449 (issued July 28, 2023); H.D., Docket No. 22-0419 (issued 

February 22, 2023).

14 T.W., Docket No. 20-0767 (issued January 13, 2021); H.A., Docket No. 18-1466 (issued August 23, 2019).
6

condition was related to the employment incident.15 For these reasons, this report is insufficient 

to establish appellant’s claim.

In his November 15, 2020 report, Dr. Pallotta conducted a physical examination and 

diagnosed a right forearm strain and lateral epicondylitis of the right elbow. He opined that the 

diagnosed conditions were caused by the accepted May 22, 2019 employment incident involving 

the lifting of a bundle of papers. Dr. Pallotta explained that the act of lifting and gripping bundles 

weighing 5 to 10 pounds activates the wrist extensor muscles, which originate from the lateral 

epicondyle, and that this activation “can lead” to micro trauma of the extensor carpi radialis brevis 

tendon, which can lead to lateral epicondylitis. While he explained that activation “can lead” to 

micro trauma which could lead to lateral epicondylitis, his opinion is speculative in nature. The 

Board has held that medical opinions that are speculative or equivocal are of diminished probative 

value.16 Therefore, this evidence is insufficient to establish the claim. 

The remaining evidence consists of medical evidence signed by a physician assistant.

However, the Board has held that certain healthcare providers, such as physician assistants, are not 

considered physician[s] as defined under FECA.17 Consequently, their medical findings and/or 

opinions will not suffice for purposes of establishing entitlement to FECA benefits.18

As the medical evidence of record is insufficient to establish causal relationship between 

the diagnosed condition(s) and the accepted employment exposure, 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 right elbow 

condition causally related to the accepted May 22, 2019 employment incident.

15 R.V. Docket No. 21-0976 (issued July 18, 2023); S.O.,Docket No. 21-0332 (issued September 24, 2021); G.L.,

Docket No. 18-1057 (issued April 14, 2020).

16 See L.B., Docket No. 23-0099 (issued July 26, 2023); C.C.,Docket No. 22-0609 (issued October 25, 2022); H.A.,

Docket No. 18-1455 (issued August23, 2019); RickyS. Storms, 52 ECAB 349 (2001) (while the opinion of a physician 

supporting causal relationship need not be one of absolute medical certainty, the opinion must not be speculative or 

equivocal. The opinion should be expressed in terms of a reasonable degree of medical certainty).

17 Section 8101(2) of FECA provides that physician includes 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). SeeFederal (FECA) Procedure Manual, Part 2 --Claims, Causal Relationship, 

Chapter 2.805.3a(1) (January 2013); 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 S.S., Docket No. 21-1140 (issued June 29, 2022) (physician assistants are not considered physicians under FECA 

and are not competent to provide medical opinions); GeorgeH. Clark, 56 ECAB 162 (2004) (physician assistants are 

not considered physicians under FECA).

18 Id.
7

ORDER

IT IS HEREBY ORDERED THAT the July 7, 2022 decision of the Office of Workers’

Compensation Programs is affirmed.

19

 

Issued: December 20, 2023

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

James D. McGinley, Alternate Judge

Employees’ Compensation Appeals Board

19 The case record contains a Form CA-16 signed by appellant’s supervisor on May 22, 2019. A properly completed 

Form CA-16 authorization may constitute a contract for payment of medical expenses to a medical facility or 

physician, when properly executed. The form creates a contractual obligation, which does not involve the employee 

directly, to pay for the cost of the examination or treatment regardless of the action taken on the claim. The period 

for which treatment is authorized by a Form CA-16 is limited to 60 days from the date of issuance, unless terminated 

earlier by OWCP. 20 C.F.R. § 10.300(c); D.L., Docket No. 23-0356 (issued July 27, 2022); P.R.,Docket No. 18-0737 

(issued November 2, 2018); N.M., Docket No. 17-1655 (issued January 24, 2018); Tracy P. Spillane, 54 ECAB 

608 (2003).