United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

E.P., Appellant

and

U.S. POSTAL SERVICE, COLUMBUS 

PROCESSING & DISTRIBUTION CENTER, 

Columbus, OH, Employer

__________________________________________

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Docket No. 22-0606

Issued: March 23, 2023

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant1

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 16, 2022 appellant, through counsel, filed a timely appeal from a December 13, 

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.3

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.

3 The Board notes that, following the issuance of the December 13, 2021 decision, OWCP received additional 

evidence. However, the Board’s Rules of Procedureprovides: “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

ISSUE

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

causally related to the accepted October 20, 2018 employment incident.

FACTUAL HISTORY

On October 30, 2018 appellant, then a 71-year-old mail handler, filed a traumatic injury 

claim (Form CA-1) alleging that on October 20, 2018 she injured her left shoulder, hip, and knee 

when she lifted heavy trays, pulled skids, all-purpose containers (APC), and bulk mail center 

containers (BMC) while in the performance of duty. She noted that her left shoulder popped while 

lifting the heavy trays. Appellant stopped work on October 21, 2018.

OWCP subsequently received medical evidence. An October 21, 2018 letter cosigned by 

Gina A. Grosscup, a certified nurse practitioner, and Teresa Jordan, a registered nurse, indicated 

that appellant may return to work on October 24, 2018. In an after-visit summary of even date,

Ms. Grosscup and Ms. Jordan noted a diagnosis of joint inflammation.

In an October 29, 2018 return-to-work/school note, Dr. Pamela Dull, a Board-certified 

family practitioner, provided appellant’s work restrictions.

In an attending physician’s report (Form CA-20) and duty status report (Form CA-17) 

dated November 21, 2018 and January 2, 2019, respectively, Dr. Robert A. Martin, an attending

Board-certified orthopedic surgeon, noted a history that on October 20, 2018 appellant fell and 

injured her left shoulder and left hip. He diagnosed left shoulder bursitis and left hip osteoarthritis. 

In the Form CA-20 report, Dr. Martin checked a box marked “Yes” indicating that the diagnosed 

conditions were caused or aggravated by an employment activity. He also noted that appellant 

was totally disabled from October 21, 2018 through March 21, 2019 and that initially, she could 

return to work on January 3, 2019 and later return to work on March 21, 2019. In the Form CA-17 

report, Dr. Martin indicated that the diagnosed conditions were due to injury. In a January 2, 2019

narrative report, he noted that appellant presented for a follow-up evaluation of her left shoulder. 

Dr. Martin performed an injection which provided temporary relief, but appellant continued to 

have a sense of mechanical catching on the shoulder. He reported that a previous magnetic 

resonance imaging (MRI) scan showed a possible loose body in the subscapularis recess and no 

obvious rotator cuff pathology. Dr. Martin discussed possible left shoulder surgery. 

Dr. David J. Magee, a Board-certified diagnostic radiologist, in x-ray reports dated 

October 21, 2018, provided impressions of no acute osseous abnormality of the left knee, left 

shoulder, and left hip. He also provided an impression of mild osteoarthritic changes in the left 

hip.

On January 22, 2019 OWCP received appellant’s request for authorization forleft shoulder 

arthroscopic surgery. 

In a development letter dated January 28, 2019, OWCP informed appellant of the 

deficiencies of her claim and advised her of the factual and medical evidence necessary to establish 

her claim and provided a questionnaire for her completion. It allotted her 30 days to submit the 

requested evidence. 
3

OWCP subsequently received a November 5, 2018 report from Dr. Martin, who discussed 

findings on physical examination and reviewed diagnostic test results. Dr. Martin provided 

assessments of left shoulder rotator cuff tear and left hip possible occult fracture. In an undated 

Form CA-20 report, he reiterated appellant’s history of injury on October 20, 2018. Dr. Martin

also reiterated his prior diagnosis of left hip arthritis and, also diagnosed left shoulder rotator cuff 

tendinitis and possible loose body. He checked a box marked “Yes” indicating that the diagnosed 

conditions were caused or aggravated by an employment activity. Dr. Martin explained that 

appellant fell on her left shoulder, and had difficulty with overhead and reaching activities. He

noted that since her fall, she had left shoulder pain. Dr. Martin also noted that appellant was 

scheduled to undergo left shoulder arthroscopic debridement with rotator cuff repair on

February 21, 2019.

By decision dated March 8, 2019, OWCP accepted that the October 20, 2018 employment 

incident occurred, as alleged, but denied appellant’s claim, finding that the medical evidence of 

record did not contain a rationalized medical opinion, based on an accurate factual background, 

relating her diagnosed conditions to the accepted employment incident. 

OWCP subsequently received hospital emergency room records dated October 21, 2018, 

which indicated that appellant was treated for left hip pain and osteoarthritis, and left knee and left 

shoulder pain.

In a March 21, 2019 report, Dr. Charles Manfresca, an attending osteopathic physician 

specializing in family practice, noted a history of injury that on October 20, 2018 appellant tried 

pushing a fully loaded APC, but instead she had to pull it. As appellant was pulling the cart with 

both hands and walking backwards a faulty wheel that jammed or became stuck caused the APC 

to abruptly stop. As a result, herfeet slipped out from under her and to prevent herself from falling 

backwards onto the floor she instinctively reached out and grabbed the cage on the cart. Although 

appellant did not fall, this maneuver caused her to twist and jerk her shoulder and trunk, resulting 

in sudden onset of pain in her left shoulder and right hip down to her right knee. She reported to 

the infirmary for treatment and returned to finish her work duties on that day. Dr. Manfresca 

reviewed medical records and discussed examination findings. He diagnosed left rotator cuff tear, 

strain of the muscle fascia tendon of the left hip, aggravation of left hip osteoarthritis, and strain

of the lumbar muscle fascia tendon. Dr. Manfresca opined that appellant suffered an acute rotator 

cuff injury and left hip strain as a result of the October 20, 2018 employment incident. He noted 

that she needed to use her body weight to help pull a heavy cart and when the wheel on the cart 

locked the load also locked. Dr. Manfresca further noted that while appellant’s body was leaning 

backwards and her weight and momentum moved in that direction, the force translated through 

her lower extremities and when her shoes lost grip with the floor her feet and lower extremities 

slipped out from under her in the opposite direction. Appellant’s instinctual reaction of grasping 

onto the cart to prevent falling to the floor caused all the force to be transmitted through her 

shoulder joint. Because she also twisted/torqued her body the force was transmitted unequally 

through the left side of her body which overstretched her left rotator cuff and caused it to tear. It 

also caused torquingforces through appellant’sleft hip which caused muscle strain. Dr. Manfresca

noted that he could not comment on the state of her arthritis because he did not perform the initial 

evaluation. He related, however, that appellant’s clinical presentation and examination were 

consistent with inflamed osteoarthritis of the left hip. As appellant had a previous injury to the 

area with a nearly complete resolution of symptoms, she was currently experiencing an 

exacerbation of her osteoarthritis either as a direct result of the employment incident or secondarily
4

related to the incident. Dr. Manfresca related that this was also true for appellant’s low back. 

Appellant currently demonstrated signs of lumbar strain. The torquing nature of her slip would 

translate forces through the soft tissues of the lumbar spine the same as they would for her hip. 

Dr. Manfresca maintained that if not directly related, then the strain pattern was secondary to 

walking, twisting, and bending repeatedly at work while favoring her injured hip. He indicated 

that contrary to the discrepancy in the statement of injury provided by appellant’s surgeon, she did 

not fall to the ground. Rather, appellant’s feet came out from under her and what is frequently the 

case, the act of grabbing on to something to prevent a fall, results in more severe soft tissue injurytearing muscles, tendons, or ligaments versus sustaining contusions from direct trauma.

Dr. Manfresca indicated that appellant was off work based on her surgeon’s recommendation.

In a physical therapy report and daily treatment notes datedMarch 29 and April 1, 2, and 4, 

2019, Dr. Ryan Cahall, an attending chiropractor, examined appellant and diagnosed left rotator 

cuff tear, strain of the muscle fascia tendon of the left hip, aggravation of left osteoarthritis, and 

strain of the lumbar muscle fascia tendon. 

In a March 21, 2019 Form CA-20 report, Dr. Manfresca noted a history of injury that on 

October 20, 2018 appellant slipped while pulling a heavily loaded APC. He restated his prior 

diagnoses of left rotator cuff tear, left hip strain, aggravation of left hip osteoarthritis, and lumbar 

strain. Dr. Manfresca checked a box marked “Yes” indicating that the diagnosed conditions were 

caused or aggravated by an employment activity. He noted that appellant caught herself after an 

APC stopped suddenly which caused her to lose her footing and she then tore her rotator cuff and 

strained her hip when she grabbed the cart to prevent herself from falling to the floor. 

Dr. Manfresca further noted that her period of total disability was uncertain.

On April 22, 2019 appellant requested a review of the written record by a representative of 

OWCP’s Branch of Hearings and Review regarding the March 8, 2019 decision. In support of her 

request, she submitted medical evidence. Appellant submitted daily treatment notes dated April 8

through May 2, 2019 from Dr. Cahall. 

Appellant also submitted an April 22, 2019 Form CA-20 report fromDr. Martin, who noted 

a history of injury that on October 21, 2018 appellant was lifting heavy trays when she lost her 

balance and slipped and grabbed a pallet jack to keep from falling onto the floor. Dr. Martin

diagnosed left shoulder bursitis and tendinitis. He checked a box marked “Yes” indicating that the 

diagnosed conditions were caused or aggravated by an employment activity. Dr. Martin noted that 

appellant was totally disabled for the period October 21, 2018 through June 10, 2019. He further 

noted that she had undergone left shoulder arthroscopic debridement and rotator cuff repair on 

February 21, 2019.

In an April 30, 2019 report, Dr. Manfresca reexamined appellant and reiterated his

diagnoses of left rotator cuff tear, strain of the muscle fascia tendon of the left hip, aggravation of 

left hip osteoarthritis, and strain of the lumbar muscle fascia tendon. He also restated his opinion 

that the diagnosed conditions were causally related to the October 20, 2018 employment incident.

On May 8, 2019 appellant withdrew her request for a review of the written record to pursue

reconsideration. 
5

On May 9, 2019 appellant requested reconsideration. In letters dated March 12 and May 8, 

2019, she reiterated the factual history of her claim explaining that she lifted overloaded trays and

on October 20, 2018 she pulled an overloaded BMC. 

Appellant also submitted additional medical evidence. In a November 14, 2018 left hip 

MRI scan report, Dr. Dave Pranav, a Board-certified diagnostic radiologist, provided an 

impression of moderate to advanced osteoarthritis in the left hip joint with prominent focal 

degenerative-type bone marrow edema with cystic change in the posteroinferior aspect of the left 

femoral head with lesser degree of degenerative subchondral bone marrow edema in the posterior 

left acetabulum. He noted that hip x-rays were not available for review at that time. Dr. Pranav 

also provided an impression of no evidence of acute fracture, avascular necrosis, or neoplastic 

change. Further, he provided an impression of osseus ankylosis of the left SI joint. In a left 

shoulder MRI scan report of even date, Dr. Pranav provided impressions of moderate 

supraspinatus tendinosis without tear, mild-to-moderate subscapularis tendinosis without tear, 

mild-to-moderate bursitis, and small glenohumeral joint effusion with a small six-millimeter focus 

of synovitis and/or intra-articular body in the subscapularis recess.

Dr. Martin, in a February 21, 2019 operative report, noted that he performed left shoulder 

arthroscopy with arthroscopic rotator cuff repair and intra-articular debridement labrum, and 

biceps tenotomy extensive. On March 9, 2019 he reported that appellant presented for a followup of evaluation of her rotator cuff repair. Dr. Martin noted that she was doing well, and her pain 

was well controlled. In a March 29, 2019 report, he noted that appellant still had pain issues and 

she had started physical therapy.

OWCP received additional daily treatment notes dated May 6 through June 19, 2019 from

Dr. Cahall. In a June 3, 2019 report, Dr. Cahall restated his prior diagnoses of left rotator cuff tear, 

strain of the muscle fascia tendon of the left hip, aggravation of left osteoarthritis, and strain of the 

lumbar muscle fascia tendon. 

Dr. Manfresca, in a June 4, 2019 report reiterated his prior left shoulder, left hip, and 

lumbar diagnoses. He noted that appellant had continued left shoulder, left bicep, left hip, and 

gluteus muscle groups symptomsrelated to her October 20, 2018 employment incident. Appellant

also continued to be off work.

By decision dated June 26, 2019, OWCP denied modification of the March 8, 2019 

decision, finding that the medical evidence submitted was insufficient to establish that appellant’s 

diagnosed medical conditions were causally related to the accepted employment incident.

OWCP continued to receive daily treatment notes dated June 25 through November 13, 

2019 and reports dated August 13 and October 16, 2019 from Dr. Cahall in which he restated his 

diagnoses left shoulder, left hip, and lumbar conditions. 

OWCP also received additional reports dated July 9 and August 6, 2019 from

Dr. Manfresca in which he continued to diagnose left rotator cuff tear, strain of the muscle fascia 

tendon of the left hip, aggravation of left hip osteoarthritis, and strain of the lumbar muscle fascia 

tendon. Dr. Manfresca also continued to opine that appellant had lingering symptoms of her 

diagnosed conditions related to the October 20, 2018 employment incident. He disagreed with 

OWCP’s finding that appellant’s conditions were not employment related, noting that he had 

corrected appellant’s history of injury to reflect that she slipped rather than fell to the ground. 
6

In a July 8, 2019 report, Dr. Martin provided an assessment of status post rotator cuff tear 

with persistent pain. He performed an injection into the left shoulder subacromial space to provide 

relief.

On September 3, 2019 appellant requested reconsideration of the June 26, 2019 decision 

and submitted additional medical evidence. In narrative reports dated August 14, September 9, 

October 14, and November 16, 2019and Form CA-17 reports dated October 14 and November 18, 

2019, Dr. Manfresca reiterated his prior left shoulder, left hip, and lumbar diagnoses, and opinion 

on causal relationship. 

By decision dated November 19, 2019, OWCP denied modification of the June 26, 2019 

decision.

OWCP subsequently received additional daily treatment notes dated November 19, 2019 

through February 24, 2020 and a December 30, 2019 narrative progress report from Dr. Cahall. 

Additional reports dated December 18, 2019 and January 20, 2020 from Dr. Manfresca 

restated his prior left shoulder, left hip, and lumbar diagnoses, and opinion on causal relationship 

were also received.

Dr. Martin, in reports dated November 6 and December 18, 2019, discussed findings on 

physical examination. He provided assessments of status post left shoulder rotator cuff repair and 

possible injection to relieve appellant’s left hip pain.

In a November 22, 2019 left shoulder MRI scan report, Dr. David Berns, a Board-certified 

diagnostic radiologist, provided an impression of downward tilting of the acromioclavicular joint 

that would be consistent with the clinical diagnosis of impingement syndrome. He also provided 

an impression of no evidence of rotator cuff tear. Dr. Berns found evidence of prior surgery with 

metallic artifact noted in the humeral head in the greater tuberosity.

On March 9, 2020 appellant requested reconsideration of the November 19, 2019 decision

and submitted additional medical evidence. In a February 18, 2020 report, Dr. Manfresca 

continued to disagree with the finding that appellant’s diagnosed conditions were not employment 

related, again noting that he had corrected her history of injury and that his opinion on causal 

relationship was based on his examination findings and review of medical records. He noted that 

on October 20, 2018 appellant was transporting a fully loaded APC, but when she was unable to 

push the cart she instead pulled it. As appellant was pulling the cart with both hands and walking 

backwards there was a faulty wheel that jammed casing the cart to abruptly stop. As a result, her

feet slipped out from under her and to prevent herself from falling backwards and hitting her head 

on the floor she instinctively reached out and grabbed the cage on the cart. This maneuver 

prevented appellant from falling all the way to the floor, but it caused her to twist jerking her 

shoulder and trunk resulting in sudden onset of pain in her left shoulder and right hip down to her 

right knee. The force of all her body weight falling was transmitted through her shoulder resulting 

in a sudden, forceful abduction and torquing of the shoulder, stretching, or lengthening tendons 

that were unprepared to do so which overstretched and tore the left rotator cuff. Dr. Manfresca 

related that this was a classic mechanism of such an injury. He again opined that the accepted 

employment incident was the direct and proximal cause to appellant’s injury. Dr. Manfresca also 

attributed her left rotator cuff tear to accumulating chronic stress on the tendons and soft tissue 

structures from repetitive lifting to and above shoulder height, pushing and pulling APC carts for 
7

hours a day over a 14-year period, and her age. Further, he attributed appellant’s left hip diagnosis 

to her history of injury, maintaining that a slip and loss of balance while pulling a heavily loaded 

cart caused a sudden jerk and torquing over a loaded joint resulting in translatory stress across the 

hip joint which was already arthritic in nature. This increased friction led to an increase in 

inflammation, which was evidence by sudden onset of pain and subsequent worsening over the 

next 24 hours to a severe level associated with difficulty ambulating and necessitating an 

emergency room visit. Dr. Manfresca maintained that appellant’s history, symptomology, and 

clinical evaluation supported with a high degree of medical certainty that employment incident

was the direct and proximate cause of the aggravation of her hip osteoarthritis.

OWCP also received a March 2, 2020 report and daily treatment notes dated March 2, 3, 

and 10, 2020 from Dr. Cahall.

By decision dated April 2, 2020, OWCP denied modification of the November 19, 2019 

decision.

On June 24, 2020 appellant requested reconsideration and submitted statements dated 

March 12, May 8, and June 1, 2020 which reiterated the factual history of her claim. She also 

submitted an additional report dated April 2, 2020 from Dr. Manfresca who disagreed with 

OWCP’s April 2 2020 decision, reiterating that her diagnosed conditions were causally related to 

the October 20, 2018 employment incident.

By decision dated September 22, 2020, OWCP denied modification of the April 2, 2020

decision.

OWCP continued to receive reports dated February 22, March 24, May 5, June 23, July 26, 

and August 25, 2021 from Dr. Manfresca. It also received daily treatment notes and reports dated 

March 8 through August 18, 2021 from Dr. Cahall.

Dr. Berns, in a February 26, 2021 left shoulder MRI scan report, provided impressions of 

evidence of rotator cuff surgery and increasing fluid signal around the anchorsin the humeral head.

In an August 3, 2021 letter, Dr. Jeremy Mathis, an osteopathic Board-certified orthopedic 

surgeon, related a history of the October 20, 2018 employment incident, indicating that appellant 

slipped while pulling heavy equipment. He reported findings on physical examination, reviewed 

diagnostic test results, and provided an impression of left shoulder pain.

In an August 25, 2021 letter, Dr. Mark Gittins, an osteopathic physician Board-certified in

orthopedic surgery, noted that appellant sustained work-related injuries in 2006 and 2018. He 

reported findings on physical examination and reviewed diagnostic test results. Dr. Gittins 

provided impressions of left hip pain, left hip sprain and strain, and left hip primary osteoarthritis. 

On September 22, 2021 appellant requested reconsideration of the September 22, 2020 

decision.

OWCP continued to receive reports dated September 27, October 27, and December 1, 

2021 from Dr. Manfresca and a report and daily treatment notes dated September 8 through 

November 17, 2021 from Dr. Cahall. 
8

By decision dated December 13, 2021, OWCP denied modification of the September 22, 

2020 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 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.8

The medical evidence required to establish causal relationship is rationalized medical 

opinion evidence.9 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.10

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); 

DeloresC. 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

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).

10 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).
9

ANALYSIS

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

condition causally related to the accepted October 20, 2018 employment incident.

In support of her claim, appellant submitted a series of reports dated March 21, 2019 

through December 1, 2021 from Dr. Manfresca. Dr. Manfresca initially provided a history of 

injury that appellant slipped and fell on October 20, 2018 while pushing a heavily loaded APC and 

subsequently reported a history that she slipped on the date of injury. He diagnosed left rotator 

cuff tear, strain of the muscle fascia tendon of the left hip, aggravation of left hip osteoarthritis, 

and strain of the lumbar muscle fascia tendon. In his narrative reports, Dr. Manfresca opined that 

appellant’s diagnosed conditions were causally related to the October 20, 2018 incident. In his 

CA-20 form reports, he checked a box marked “Yes” in response to a question as to whether the 

conditions were caused or aggravated by an employment activity. In his CA-17 form reports, 

Dr. Manfresca indicated that appellant’s diagnosed conditions were due to injury. While these 

reports generally support causal relationship, the Board finds that this evidence is of limited 

probative value as it provided an inaccurate history of injury. Moreover, the Board notes that

Dr. Manfresca did not provide a rationalized medical opinion explaining how the accepted incident

of lifting trays and pulling an APC physiologically caused appellant’s diagnosed conditions. When 

a physician’s opinion on causal relationship consists only of checking a box marked “Yes” in 

response to a form question, without explanation or rationale, that opinion has limited probative 

value and is insufficient to establish a claim.11 Additionally, Dr. Manfresca did not provide 

adequate medical rationale relating the diagnosed medical conditions to the accepted October 20, 

2018 employment incident in his Form CA-17 reports and narrative reports.

12

 The Board notes 

that OWCP accepted that appellant lifted heavy trays and pulled a APC. In a February 18, 2020 

report, Dr. Manfresca continued to disagree with the finding that appellant’s diagnosed conditions 

were not employment related and he noted that he had corrected her history of injury to reflect that 

on October 20, 2018 she was transporting a fully loaded APC, but when she was unable to push 

the cart she instead pulled it and slipped while performing this maneuver. He opined that 

appellant’s slip physiologically caused the diagnosed conditions. The Board has previously 

explained that medical reports which contain an incorrect history of injury are of limited probative 

value.13 Therefore, for these reasons, Dr. Manfresca’s reports are insufficient to establish 

appellant’s claim.

Appellant also submitted a series of reports dated November 21, 2018 through 

December 18, 2019 from Dr. Martin. In his reports, Dr. Martin also noted a history that on 

October 20, 2018 appellant fell at work. He diagnosed left shoulder bursitis and left hip 

osteoarthritis. In his Form CA-20 reports, Dr. Martin checked a box marked “Yes” in response to 

11 See J.K., Docket No. 20-0527 (issued May 24, 2022); J.K., Docket No. 20-0590 (issued July 17, 2020); J.A., 

Docket No. 17-1936 (issued August13, 2018); DonaldW. Long, 41 ECAB 142 (1989); LillianM. Jones, 34 ECAB 

379, 381 (1982).

12 B.P., Docket No. 21-0872 (issued December 8, 2021); L.S., Docket No. 20-0570 (issued December 15, 2020);

E.H., Docket No. 19-1352 (issued December 18, 2019); E.C., Docket No. 17-1645 (issued June 11, 2018).

13 D.W., Docket No. 22-0109(issued May17, 2022); M.G., Docket No. 18-1616 (issued April9, 2020); see J.M., 

Docket No. 17-1002 (issued August22, 2017) (a medical opinion must reflect a correct history and offer a medically 

sound explanation by the physician of how the specific employment incident physiologically caused or aggravated the 

diagnosed conditions).
10

a question as to whether the conditions were caused or aggravated by an employment activity. 

While these reports generally support causal relationship, the Board finds that this evidence is of 

limited probative value as it provided an inaccurate history of injury. As noted, OWCP accepted 

that appellant lifted heavy trays. Further, as noted, the Board has previously explained that medical 

reports which contain an incorrect history of injury are of limited probative value.14 Additionally, 

the Board notes that Dr. Martin did not offer a rationalized medical opinion explaining how the 

accepted incident physiologically caused appellant’s diagnosed conditions. As noted, when a 

physician’s opinion on causal relationship consists only of checking a box marked “Yes” in 

response to a form question, without explanation or rationale, that opinion has limited probative 

value and is insufficient to establish a claim.15 Moreover, in his Form CA-17 reports and narrative 

reports, he did not provide sufficient medical rationale relating the diagnosed medical conditions 

to the accepted October 20, 2018 employment incident and, thus, these reports are of diminished 

probative value.

16

 Dr. Martin’s remaining reports addressed appellant’s left shoulder condition 

and surgical treatment, but did not provide an opinion addressing 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 on the issue of causal relationship.17 For these reasons, the 

Board finds that Dr. Martin’s reports are insufficient to establish appellant’s claim.

Dr. Gittins’ August 25, 2021 report provided impressions of left hip pain, left hip sprain 

and strain, and left hip primary osteoarthritis, but also did offer an opinion addressing whether 

appellant’s diagnosed conditions were causally related to the October 20, 2018 employment injury. 

As noted above, 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.

18

The x-ray report of Dr. Magee and MRI scan reports of Dr. Pranav and Dr. Berns were 

submitted. The Board has held that diagnostic studies, standing alone, are of limited probative 

value as they do not address whether the employment incident caused any of the diagnosed 

conditions.19 Thus, these reports are insufficient to establish appellant’s claim.

Dr. Dull’s October 29, 2018 report noted appellant’s left shoulder, hip, and knee pain. The 

Board has held that pain is a symptom and not a compensable medical diagnosis. 20 For this reason,

Dr. Dull’s report is insufficient to establish appellant’s claim. Her remaining return to work/school 

note of even date set forth appellant’s work restrictions without a firm diagnosis. The Board has 

held that without a valid medical diagnosis of a current medical condition linked to the accepted 

14 Supra note 11.

15 Supra note 12.

16 Supra note 13.

17 J.H., Docket No. 20-1414 (issued April5, 2022); S.W., Docket No. 19-1579 (issued October 9, 2020); L.B., 

Docket No. 18-0533 (issued August27, 2018); D.K., Docket No. 17-1549 (issued July 6, 2018).

18 Id.

19 J.G., Docket No. 21-1334 (issued May 18, 2022); J.P.,Docket No. 19-0216 (issued December 13, 2019); A.B.,

Docket No. 17-0301 (issued May 19, 2017).

20 See B.T., Docket No. 22-0022 (issued May 23, 2022); S.L., Docket No. 19-1536 (issued June 26, 2020); D.Y., 

Docket No. 20-0112 (issued June 25, 2020).
11

employment incident, the medical component of fact of injury cannot be met.21 Thus, this note is 

insufficient to establish the medical component of fact of injury.

Dr. Mathis’ August 3, 2021 report also provided an impression of left shoulder pain. As 

noted, the Board has held that pain is a symptom and not a compensable medical diagnosis.22 Thus,

Dr. Mathis’ report is insufficient to establish appellant’s claim.

Appellant submitted physical therapy reports and daily treatment notes dated March 29, 

2019 through November 17, 2021 fromDr. Cahall, a chiropractor. However, a chiropractoris only 

considered a physician for purposes of FECA if he or she diagnoses subluxation based upon x-ray 

evidence.23 Dr. Cahall did not diagnose subluxation as demonstrated by x-ray to exist. Therefore, 

these reports and treatment notes are of no probative value and are insufficient to establish 

appellant’s claim. 

The record also contains reports signed by a certified nurse practitioner and a registered 

nurse. Certain healthcare providers such as physician assistants, nurse practitioners, and physical 

therapists are not considered qualified physicians as defined under FECA. 24 Their medical 

findings, reports and/or opinions, unless cosigned by a qualified physician, will not suffice for 

purposes of establishing entitlement to FECA benefits.25

As appellant has not submitted rationalized medical evidence to establish a medical 

condition causally related to the accepted October 20, 2018 employment incident, the Board finds 

that she 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.

21 L.T., Docket No. 20-0582 (issued November 15, 2021); K.B., Docket No. 16-0122 (issued April19, 2016); D.N., 

Docket No. 15-0987 (issued August3, 2015).

22 Supra note 20.

23 Section 8101(2) of FECA provides that the term “physician” includes chiropractors only to the extent that their 

reimbursable services are limited to treatment consisting of manual manipulation of the spine to correct a subluxation

as demonstrated by x-ray to exist and subject to regulations by the Secretary. 5 U.S.C. § 8101(2); K.W., Docket No. 

20-0230 (issued May 21, 2021); J.D., Docket No. 19-1953 (issued January 11, 2021); George E. Williams, 44 ECAB 

530 (1993).

24 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). See also Federal (FECA) Procedure Manual, Part 2 -- Claims, Causal 

Relationship, Chapter 2.805.3a(1) (January 2013); J.D., Docket No. 21-0164 (issued June 15, 2021) (nurse 

practitioners are not physicians as defined under FECA); C.G.,Docket No. 20-0957 (issued January 27, 2021); P.S., 

Docket No. 17-0598 (issued June 23, 2017) (registered nurses are not considered physicians as defined under FECA); 

David P. 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).

25 J.D., id.; K.A., Docket No. 18-0999 (issued October 4, 2019); K.W., 59 ECAB 271, 279 (2007); DavidP. 

Sawchuk,id.
12

CONCLUSION

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

condition causally related to the accepted October 20, 2018 employment incident.

ORDER

IT IS HEREBY ORDERED THAT the December 13, 2021 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: March 23, 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