United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

S.P., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Bend, OR, Employer

__________________________________________

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Docket No. 19-0819

Issued: January 10, 2020

Appearances: Case Submitted on the Record

Howard L. Graham, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

PATRICIA H. FITZGERALD, Deputy Chief Judge

JANICE B. ASKIN, Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On March 4, 2019 appellant, through counsel, filed a timely appeal from a December 31, 

2018 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 left shoulder 

condition causally related to the accepted June 24, 2017 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 July 6, 2017 appellant, then a 59-year-old postal support employee, filed a traumatic 

injury claim (Form CA-1) alleging that on June 24, 2017 she injured her left shoulder while in the 

performance of duty. She related that she was moving three sets of hampers filled with mail that 

hit a pole, the force of which caused her arms and shoulders to thrust backwards. Appellant 

stopped work on June 26, 2017. The employing establishment indicated that she had reported a 

similar injury two weeks earlier. OWCP assigned OWCP File No. xxxxxx193 to the current claim.

Appellant had previously filed an occupational disease claim (Form CA-2) on June 20, 

2017 alleging that she sustained pain in her left shoulder, wrist, and hands causally related to 

factors of her federal employment. OWCP assigned OWCP File No. xxxxxx436 and denied the 

claim, finding that the medical evidence of record was insufficient to establish causal relationship 

between the accepted employment factors and the claimed condition.

In a report dated June 10, 2017, submitted under OWCP File No. xxxxxx436, Dr. Clayton 

Reinhardt, an osteopath, diagnosed left shoulder pain and wrist sprain. 

On June 26, 2017 Dr. Reinhardt evaluated appellant for left shoulder pain that had begun 

when she was pushing a cart that struck an object and abruptly stopped. He indicated that she had 

experienced a tearing sensation in the left shoulder at the time the incident occurred. Dr. Reinhardt 

diagnosed an unspecified sprain of the left shoulder joint. In a state workers’ compensation form 

of even date, he found that appellant could perform modified work duties.

The record contains the first page of an authorization for examination and/or treatment 

(Form CA-16) completed by the employing establishment on July 7, 2017, which indicated that 

appellant was authorized to seek medical treatment.

In progress reports dated June 30 and July 7, 2017, Dr. Reinhardt discussed appellant’s 

complaints of continued shoulder pain and diagnosed a sprain of the left shoulder joint. In return 

to work status forms of even dates, he provided work restrictions.

In a development letter dated July 19, 2017, OWCP advised appellant of the deficiencies 

of her claim. It requested that she submit additional factual and medical evidence, including a 

report from her physician explaining how the identified employment incident caused or aggravated 

a diagnosed medical condition. OWCP afforded appellant 30 days to respond.

Thereafter, OWCP received a June 10, 2017 magnetic resonance imaging (MRI) scan of 

appellant’s left shoulder showing osteopenia. 

By decision dated August 24, 2017, OWCP denied appellant’s traumatic injury claim. It 

found that the medical evidence of record was insufficient to establish a left shoulder condition 

causally related to the accepted June 24, 2017 employment incident. OWCP indicated that the 

medical evidence from OWCP File No. xxxxxx436 supported that she had a preexisting left 

shoulder strain.

OWCP subsequently received an August 21, 2017 note from Dr. Reinhardt, who noted that 

appellant had been off work beginning July 22, 2017. He diagnosed left shoulder joint sprain and 
3

sprain of the unspecified part of the wrist and hand. Dr. Reinhardt found that appellant could work 

modified duty, and referred her for an MRI scan.

In a report dated August 24, 2017, Dr. Robert Shannon, a Board-certified orthopedic 

surgeon, obtained a history of appellant experiencing left shoulder pain after she had pushed a cart 

into a pole at work jarring her shoulder. He noted that she “had immediate pain in the left shoulder 

and felt a tearing sensation in the shoulder.” Dr. Shannon indicated that appellant had experienced 

prior shoulder pain and had filed a claim “for what sounds like a repetitive use injury....” 

Appellant related that her left shoulder condition had significantly worsened after the June 24, 

2017 employment incident. Dr. Shannon diagnosed a rotator cuff tear of the left shoulder.

On August 30, 2017 appellant requested a review of the written record before a 

representative of OWCP’s Branch of Hearings and Review. 

In a report dated September 18, 2017, Dr. Aaron Hoblet, a Board-certified orthopedic 

surgeon, evaluated appellant for left wrist pain that had begun in April 2017. He noted that she 

repetitively lifted heavy trays at work. Dr. Hoblet indicated that appellant had sustained an

employment injury on July 24, 2017 when she “was pushing a heavy cart and it jammed against a 

pole causing an abrupt stop. The primary pain at that time was in her shoulder.” Dr. Hoblet 

diagnosed left first dorsal compartment tenosynovitis.

On October 9, 2017 Dr. Reinhardt evaluated appellant for pain in her left shoulder, left 

wrist, and right hand. He advised that she related that her pain worsened when she performed 

lifting, pushing, and pulling while at work. Dr. Reinhardt diagnosed a sprain of the left and right 

wrist.3

In an October 9, 2017 letter, appellant requested that OWCP combine OWCP File Nos. 

xxxxxx436 and xxxxxx193. She advised that her claim began as a repetitive motion injury that 

had increased due to an equipment malfunction.

A physician assistant evaluated appellant on November 10, 2017 for left shoulder pain. 

By decision dated January 19, 2018, OWCP’s hearing representative affirmed the 

August 24, 2017 decision. 

In a January 24, 2018 progress report, Dr. Shannon indicated that appellant had a possible 

left rotator cuff tear as a result of a June 24, 2017 employment injury that had occurred when she 

pushed a cart. He diagnosed a left rotator cuff tear and questioned why he had not received 

authorization for an MRI scan. Dr. Shannon related, “I can say with a medical degree of certainty 

that [appellant’s] shoulder injury is due to her job duties and specifically to the event on 

June 24, 2017.” 

An April 4, 2018 MRI scan of the left shoulder revealed large “full-thickness tears of the 

supraspinatus and infraspinatus with muscular tendinous junction retraction....”

 

3

In a handwritten note on the form, appellant related that she had experienced left rather than right wrist pain.
4

In a report dated April 10, 2018, Dr. Shannon indicated that appellant had first injured her 

shoulder in June 2017. He diagnosed a large left shoulder rotator cuff tear.

On December 2, 2018 appellant, through counsel, requested reconsideration. Counsel 

contended that OWCP should have doubled her claims assigned OWCP File No. xxxxxx436 and 

OWCP File No. xxxxxx193. He asserted that the June 10, 2017 report under OWCP File No. 

xxxxxx193 attributed her shoulder pain to her work duties and that the medical evidence from

Dr. Reinhardt described her subsequent shoulder injury pushing a cart.

By decision dated December 31, 2018, OWCP denied modification of its January 19, 2018 

decision. It advised that it had reviewed the medical evidence from both OWCP File Nos. 

xxxxxx436 and xxxxxx193.4

LEGAL PRECEDENT

An employee seeking benefits under FECA5 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 filed within the applicable time 

limitation, that an injury was sustained while in the performance of duty as alleged; and that any 

disability or specific 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 on a traumatic injury or an occupational disease.7

In an occupational disease claim, appellant’s burden of proof requires submission of 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.8

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

relationship is rationalized medical opinion evidence. 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 claimant.9

 

4 The Board notes that OWCP ultimately combined File No. xxxxxx193 and File No. xxxxxx436, with the latter 

serving as the master file.

5 5 U.S.C. § 8101 et seq.

6 See R.B., Docket No. 18-1327 (issued December 31, 2018).

7 See Y.K., Docket No. 18-0806 (issued December 19, 2018).

8 T.H., Docket No. 18-1585 (issued March 22, 2019); Joe D. Cameron, 41 ECAB 153 (1989).

9 H.B., Docket No. 18-0781 (issued September 5, 2018).
5

In any case where a preexisting condition involving the same part of the body is present 

and the issue of causal relationship therefore involves aggravation, acceleration, or precipitation, 

the physician must provide a rationalized medical opinion that differentiates between the effects 

of the work-related injury or disease and the preexisting condition.10

ANALYSIS

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

condition causally related to the accepted June 24, 2017 employment incident.

On January 24, 2018 Dr. Shannon advised that appellant had possibly torn her left rotator 

cuff due to an employment injury on June 24, 2017 that had occurred while she was pushing a cart. 

He diagnosed a left rotator cuff tear. Dr. Shannon found that appellant’s shoulder injury was 

causally related to her work duties and the June 24, 2017 employment incident. His report, 

however, is of limited probative value as it does not contain any explanation of how the 

employment incident would physiologically cause the diagnosed condition.11 Medical opinions 

which contain no supporting rationale are of little probative value.12

In a report dated August 24, 2017, Dr. Shannon discussed appellant’s complaints of left 

shoulder pain after she jarred her shoulder when a cart she was pushing hit a pole. He noted that 

she had previously filed a claim for a repetitive use injury of the shoulder and that she related that 

her condition had worsened due to the June 24, 2017 employment injury. Dr. Shannon diagnosed 

a left rotator cuff tear. While he reviewed appellant’s history of injury and her complaints of 

worsening left shoulder pain, he failed to provide an opinion on causation. 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 on the issue of causal relationship.13 These reports, therefore, 

are insufficient to establish appellant’s claim.

In a report dated September 18, 2017, Dr. Hoblet indicated that appellant had sustained 

shoulder pain due to an employment injury on July 24, 2017 when she was pushing a cart, struck 

a pole, and stopped suddenly. He diagnosed left first dorsal compartment tenosynovitis. However,

Dr. Hoblet did not relate the diagnosed condition of tenosynovitis to the June 24, 2017 

employment incident. As he failed to offer an opinion on causal relationship between the 

diagnosed condition and the June 24, 2017 employment incident, his report is of no probative 

value.14

On June 26, 2017 Dr. Reinhardt noted that appellant had experienced pain in her left 

shoulder when a cart she was pushing stopped suddenly after it struck an object. He diagnosed an 

unspecified sprain of the left shoulder joint. In reports dated June 30, July 7, August 21, and 

 

10 Federal (FECA) Procedure Manual, Part 2 -- Claims, Causal Relationship, Chapter 2.805.3e (January 2013).

11 D.J., Docket No. 17-0364 (issued April 13, 2018).

12 Id.

13 See L.B., Docket No. 18-0533 (issued August 27, 2018); D.K., Docket No. 17-1549 (issued July 6, 2018).

14 Id.
6

October 9, 2017, Dr. Reinhardt diagnosed a sprain of the left shoulder joint. He did not, however, 

relate the diagnosed left shoulder joint sprain to the accepted employment incident. As discussed, 

medical evidence that does not offer an opinion regarding the cause of an employee’s condition is 

of no probative value on the issue of causal relationship.15

On April 10, 2018 Dr. Shannon related that appellant had initially injured her shoulder in 

June 2017 and diagnosed a large left shoulder rotator cuff tear. Again, however, he failed to 

address causation and thus his report is of no probative value and insufficient to meet her burden 

of proof.16

On November 10, 2017 a physician assistant evaluated appellant for left shoulder pain. 

Physician assistants, however, are not considered physicians as defined under FECA and are 

incompetent to render a medical opinion. Therefore, this report is also of no probative value.17

MRI scans of her left shoulder dated June 10, 2017 and April 4, 2018 were also received. 

Diagnostic studies, however, lack probative value on the issue of causal relationship as they do not 

address whether the employment incident caused any of the diagnosed conditions.18

As the medical evidence of record does not contain a rationalized opinion on causal 

relationship between appellant’s diagnosed condition and the accepted June 24, 2017 employment 

incident, the Board finds that she has not met her burden of proof.

On appeal counsel asserts that OWCP disregarded the findings of appellant’s attending 

physicians and failed to consider all of the medical evidence. As discussed, however, appellant

has the burden of proof to submit rationalized medical evidence establishing an injury causally 

related to the accepted June 24, 2017 employment incident.19 She failed to submit such evidence 

and thus has not met her burden of proof.20 Counsel further argues on appeal that appellant’s 

claims assigned OWCP File No. xxxxxx193 and OWCP File No. xxxxxx436 should be 

administratively combined. However, in reaching its December 31, 2018 decision, OWCP 

reviewed the relevant medical evidence found in both claims. Additionally, appellant’s claims 

have now been administratively combined.

 

15 Supra note 12.

16 Id.

17 5 U.S.C. § 8101(2) provides that a physician includes surgeons, podiatrists, dentists, clinical psychologists, 

optometrists, chiropractors, and osteopathic practitioners within the scope of their practice as defined by state law. 

See id. at § 8102(2); 20 C.F.R. § 10.5(t); T.W., Docket No. 19-0677 (issued August 16, 2019). Lay individuals such 

as physician assistants, nurses, and physical therapists are not competent to render a medical opinion under FECA. 

A.A., Docket No. 19-0957 (issued October 22, 2019).

18 See C.D., Docket No. 17-2011 (issued November 6, 2018).

19 See D.T., Docket No. 17-1734 (issued January 18, 2018).

20 See D.S., Docket No. 18-0061 (issued May 29, 2018).
7

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 10.607.21

CONCLUSION

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

condition causally related to the accepted June 24, 2017 employment incident.

ORDER

IT IS HEREBY ORDERED THAT the December 31, 2018 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: January 10, 2020

Washington, DC

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board

 

21 The Board notes that the employing establishment issued a Form CA-16. A properly completed CA-16 form 

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. See 20 C.F.R. § 10.300(c); 

M.C., Docket No. 18-0951, n.20 (issued January 7, 2019); Tracy P. Spillane, 54 ECAB 608 (2003).