United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

U.M., Appellant

and

U.S. POSTAL SERVICE, NORTH TEXAS 

PROCESSING & DISTRIBUTION CENTER, 

Coppell, TX, Employer

__________________________________________

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Docket No. 23-0625

Issued: August 11, 2023

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

JANICE B. ASKIN, Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JAMES D. McGINLEY, Alternate Judge

JURISDICTION

On March 23, 2023 appellant filed a timely appeal from a December 6, 2022 merit 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.

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.

FACTUAL HISTORY

On December 21, 2021 appellant, then a 49-year-old mail handler, filed an occupational 

disease claim (Form CA-2) alleging that she sustained back, bilateral knee, bilateral shoulder, and 

1

5 U.S.C. § 8101 et seq.
2

bilateral foot conditions causally related to factors of her federal employment. She attributed her 

condition to repetitive and heavy work activities. Appellant indicated that she first became aware 

of the conditions and their relationship to factors of her federal employment on November 9, 2021. 

She did not stop work.

In a development letter dated January 12, 2022, OWCP advised appellant of the 

deficiencies in her claim and the factual and medical information needed to establish her 

occupational disease claim. It provided a questionnaire for her completion. In a separate letter of 

even date, OWCP requested that the employing establishment address the accuracy of appellant’s 

allegations and describe her work duties. It afforded both appellant and the employing 

establishment 30 days to respond.

Thereafter, OWCP received a December 13, 2021 magnetic resonance imaging (MRI) scan 

of appellant’s right shouldershowing supraspinatus and infraspinatus tendinosis without a discrete 

tear, tearing of the posterosuperior glenoid labrum with a paralabral ganglion cyst, and moderate 

subacromial/subdeltoid bursitis.

In a report dated November 9, 2021, Dr. Nara Pravat, an osteopath and Board-certified 

physiatrist, reviewed appellant’s complaints of pain in her low back, knees, feet, and shoulders. 

He discussed her work on a dumper machine and a jitney. Dr. Pravat noted that appellant’s duties 

included lifting heavy objects off rolling tables and into containers. On examination he found pain 

at L5-S1 and L4-5 over the intervertebral discs on palpation. Dr. Pravat diagnosed lumbar 

radiculopathy, lumbar spondylosis, lumbar disc displacement without myelopathy, bilateral 

primary osteoarthritis of the knee, an acquired valgus deformity of the knee, internal derangement 

of the knees bilaterally, bilateral plantar fasciitis, impingement syndrome of the bilateral shoulders, 

and subacromial bursitis of the bilateral shoulders. He advised that he was initiating an 

“occupational injury claim” and referred appellant for diagnostic testing. Dr. Pravat found that 

she could continue with her current work status.

On December 17, 2021 Dr. Pravat again described appellant’s symptoms of low back pain, 

bilateral knee pain worse on the left, bilateral feet pain, and bilateral shoulder pain. He noted that 

she had undergone diagnostic testing and diagnosed lumbar radiculopathy, lumbar spondylosis, 

lumbar disc displacement without myelopathy, bilateral lateral meniscus tears of the knee, bilateral 

unilateral primary osteoarthritis of the knees, bilateral Baker’s cysts of the knees, an acquired 

valgus deformity of the knee, bilateral superior glenoid labrum lesions of the shoulders, bilateral 

rotator cuff tendinopathy, subacromial bursitis of the shoulders, osteoarthritis of the left AC joint, 

and bilateral plantar fasciitis.

On January 14, 2022 Dr. Pravat listed similar findings and diagnoses. He opined that the 

diagnosed conditions were causally related to appellant’s repetitive work activities and noted that 

she had “no other predisposing factors for the injuries.” 

In a January 18, 2022 statement, appellant attributed her problems with her low back, 

knees, feet, and shoulders to repetitive work duties. She provided a detailed description of her 

work duties. 
3

By decision dated March 29, 2022, OWCP denied appellant’s occupational disease claim. 

It found that the evidence was insufficient to establish a medical condition causally related to the 

accepted employment factors.

On April 19, 2022 appellant requested reconsideration. In support of her request, she 

submitted an April 13, 2022 report from Dr. Pravat. Dr. Pravat discussed OWCP’s decision and 

asserted that he had explained how repetitive work activities caused biomechanical change to the 

shoulders that over time resulted in scarring, tears, and joint issues. He noted that appellant’s work 

duties required lifting heavy objects, bending and twisting at the waist and knees, and lifting, 

pushing, and pulling. Dr. Pravat opined that these repetitive work activities had caused, 

aggravated or accelerated the diagnosed conditions of lateral meniscus tears of the bilateral knees, 

primary osteoarthritis of the bilateral knees, Baker’s cysts of the knees, bilateral superior glenoid 

labrum lesions of the shoulders, tendinopathy of the bilateral rotator cuffs, bilateral subacromial 

bursitis, osteoarthritis of the left AC joint, an acquired valgus deformity of the bilateral knees, 

bilateral plantar fasciitis, and lumbar radiculopathy, spondylosis, and disc displacement without 

myelopathy. He indicated that appellant had severe degenerative conditions even though she was 

not yet 50 years old, had no history of trauma, and did not play sports. Dr. Pravat concluded that 

her employment duties “caused, aggravated, and/or accelerated degenerative or age[-]related 

changes that without her work activities would not have developed or would have developed many 

years later.”

OWCP referred appellant to Dr. George M. Cole, an osteopath, for a second opinion 

evaluation. In a report dated June 7, 2022, Dr. Cole discussed appellant’s work duties and 

provided his review of the medical evidence of record, including the results of diagnostic testing. 

He diagnosed an aggravation of preexisting degenerative conditions in the bilateral shoulders, 

bilateral knees, and low back. Dr. Cole related that appellant had near normal findings on 

examination, including full range of motion of the shoulders and knees and no radicular findings 

of the lumbar spine. He found that her subjective complaints failed to correspond to the objective 

findings. Dr. Cole opined that appellant “may have sustained a temporary aggravation of the 

preexisting degenerative conditions in the shoulders, the low back, and the knees but those 

conditions have resolved with appropriate conservative care.” He attributed her lumbar pain to the 

“normal progression of life and due to the previous lumbar surgery.” Dr. Cole found that 

appellant’s work duties had not caused a permanent aggravation of preexisting degenerative 

bilateral shoulder, bilateral knee, or lumbar spine condition. He determined that her temporary 

employment-related aggravation had resolved and that she could perform full-time work without 

restrictions.

By decision dated July 6, 2022, OWCP denied modification of its March 29, 2022 decision.

On August 17, 2022 Dr. Jeffery Fritz, a Board-certified anesthesiologist, provided pain 

management.

On September 13, 2022 Dr. Fritz related that he was treating appellant for an employment 

injury to her shoulders, low back, knees, and feet. He reviewed her duties as a mail handler and 

opined that she had sustained an “occupational repetitive use injury.” Dr. Fritz described 

appellant’s history of joint pain while performing her various job duties over the years. He 

reviewed the results of imaging studies and diagnosed a left shoulder sprain, lesions of the superior 
4

glenoid labrum of the bilateral shoulders, other right shoulder lesions, an incomplete rotator cuff 

tear or rupture of the left shoulder, impingement syndrome of the right shoulder, lumbar 

radiculopathy, lumbar intervertebral disc displacement, unilateral post-traumatic osteoarthritis of 

the bilateral knees, a tear of the lateral meniscus of the bilateral knees, and plantar fascial 

fibromatosis. Dr. Fritz advised that appellant’s work duties had resulted in “overuse of her 

shoulders that causes a strain of the structures of the joint. This strain leads to inflammation and 

ultimately weakening of the structures of the shoulder that result in tearing of the labrum and 

tearing/damaging the tendons of the rotator cuff as in the case of [appellant].” Dr. Fritz further 

related that she had sustained tear of the glenoid labrum due to ongoing repetitive and overuse of 

the shoulder. He additionally asserted that appellant had sustained an overuse injury of the lumbar 

spine due to her work duties that had caused the inflammation of the joints, which weakened the 

lumbar structures and caused disc herniations at L3-4 and L4-5. Dr. Fritz further opined that 

appellant sustained an overuse injury to her knees and feet due to work duties that included 

extensive standing, walking on concrete floors, and repetitively going up and down stairs. He

related that performing repetitive work duties, including repetitive lifting, and standing on concrete 

floors, had caused swelling and inflammation of the joints of the lower extremities and plantar 

fascia of the foot, which resulted in cartilage and meniscal damage. 

In a statement dated September 26, 2022, appellant again described her work duties. 

On November 1, 2022 appellant requested reconsideration. 

By decision dated December 6, 2022, OWCP denied modification of its July 6, 2022 

decision. 

LEGAL PRECEDENT

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 filed within the applicable time limitation 

period of FECA,3that 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.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

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 

2

Id.

3

S.M., Docket No. 21-0937 (issued December 21, 2021); S.B., Docket No. 17-1779 (issued February 7, 2018); J.P., 

59 ECAB 178 (2007); Joe D. Cameron, 41 ECAB 153 (1989).

4

J.M., Docket No. 17-0284 (issued February 7, 2018); R.C., 59 ECAB 427 (2008); James E. Chadden, Sr., 40 

ECAB 312 (1988).

5 M.T., Docket No. 20-1814 (issued June 24, 2022); K.M., Docket No. 15-1660 (issued September 16, 2016); L.M., 

Docket No. 13-1402 (issued February 7, 2014); Delores C. Ellyett, 41 ECAB 992 (1990).
5

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.6

Causal relationship is a medical issue that requires rationalized medical opinion evidence

to resolve the issue.

7

 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 con dition and 

the specific employment factors.8

Section 8123(a) of FECA provides, in pertinent part, that if there is disagreement between 

the physician making the examination for the United States and the physician of the employee, the 

Secretary shall appoint a third physician (known as a referee physician or impartial medical 

specialist) who shall make an examination.9 This is called a referee examination, and OWCP will 

select a physician who is qualified in the appropriate specialty and who has no prior connection 

with the case.10

ANALYSIS

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

In a report dated April 13, 2022, Dr. Pravat described appellant’s work duties, including 

repetitive bending at the waist and knees and lifting, pushing, and pulling heavy objects. He opined 

that her repetitive work duties had caused, aggravated, or accelerated the diagnosed conditions of 

lateral meniscus tears of the bilateral knees, primary osteoarthritis of the bilateral knees, Baker’s 

cysts of the bilateral knees, bilateral superior glenoid labrum lesions of the shoulders, tendinopathy 

of the bilateral rotator cuffs, bilateral subacromial bursitis, osteoarthritis of the left AC joint, an 

acquired valgus deformity of the bilateral knees, bilateral plantar fasciitis, and lumbar 

radiculopathy, spondylosis, and disc displacement without myelopathy. Dr. Pravat further 

asserted that repetitive lifting caused biomechanical shoulder changes resulting in inflammation

and microtrauma which over time caused tearing, scarring, and cartilage changes.

On September 13, 2022 Dr. Fritz diagnosed a left shoulder sprain, lesions of the superior 

glenoid labrum of the bilateral shoulders, other right shoulder lesions, an incomple te rotator cuff 

tear or rupture of the left shoulder, impingement syndrome of the right shoulder, lumbar 

6

S.C., Docket No. 18-1242 (issued March 13, 2019); R.H., 59 ECAB 382 (2008).

7

J.L., Docket No. 21-1373 (issued March 27, 2023); K.R., Docket No. 21-0822 (issued June 28, 2022); A.M., 

Docket No. 18-1748 (issued April 24, 2019); T.H., 59 ECAB 388 (2008).

8 G.S., Docket No. 22-0036 (issued June 29, 2022); M.V., Docket No. 18-0884 (issued December 28, 2018); I.J., 

59 ECAB 408 (2008).

9

5 U.S.C. § 8123(a); see D.B.,Docket No. 20-1142 (issued December 31, 2020); S.T.,Docket No. 08-1675 (issued 

May 4, 2009); M.S., 58 ECAB 328 (2007).

10 20 C.F.R. § 10.321; C.W., Docket No. 20-1582 (issued December 22, 2022); R.C., 58 ECAB 238 (2006).
6

radiculopathy, lumbar intervertebral disc displacement, unilateral post-traumatic osteoarthritis of 

the bilateral knees, a tear of the lateral meniscus of the bilateral knees, and plantar fascial 

fibromatosis. He attributed the diagnosed conditions to appellant’s work duties. Dr. Fritz opined 

that repetitive work duties had caused overuse injuries and inflammation leading to structural 

damage. 

OWCP referred appellant to Dr. Cole for a second opinion examination. In a report dated 

June 7, 2022, Dr. Cole opined that appellant had sustained a temporary aggravation of preexisting 

degenerative conditions in the bilateral shoulders, bilateral knees, and low back due to her work 

duties. He noted that she had postsurgical changes at L5-S1. Dr. Cole found that the evidence 

failed to support an employment-related permanent aggravation of any preexisting degenerative 

shoulder, low back, or knee condition. He opined that appellant’s temporary aggravation of 

preexisting degenerative bilateral shoulder, knee, and low back conditions had resolved and that 

she could work full time without restrictions. 

The Board finds that a conflict exists between Dr. Pravat and Dr. Fritz, appellant’s 

physicians, and Dr. Cole, who provided a second opinion examination, regarding whether 

appellant sustained an aggravation of a medical condition causally related to the accepted factors 

of her federal employment. As noted above, if there is a disagreement between an employee’s 

physician and an OWCP referral physician, OWCP will appoint an impartial medical specialist 

who shall make an examination.11 Consequently, the case must be referred to an impartial medical 

specialist for resolution of the conflict in medical opinion evidence in accordance with 5 U.S.C. 

§ 8123(a).

On remand OWCP shall refer appellant, along with the case file and an updated SOAF, to 

a specialist in an appropriate field of medicine for an impartial medical examination to determine 

appellant’s conditions causally related to the accepted employment factors. Following this and 

other such further development as OWCP deems necessary, it shall issue a de novo decision.

CONCLUSION

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

11 Supra note 9.
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ORDER

IT IS HEREBY ORDERED THAT the December 6, 2022 decision of the Office of 

Workers’ Compensation Programs is set aside, and the case is remanded for further proceedings 

consistent with this decision of the Board.

Issued: August 11, 2023

Washington, DC

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board

James D. McGinley, Alternate Judge

Employees’ Compensation Appeals Board