United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

S.D., Appellant

and

U.S. POSTAL SERVICE, SEATTLE 

PROCESSING & DISTRIBUTION CENTER, 

Tukwila, WA, Employer

__________________________________________

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Docket No. 22-1082

Issued: November 15, 2022

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

PATRICIA H. FITZGERALD, Deputy Chief Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JAMES D. McGINLEY, Alternate Judge

JURISDICTION

On July 8, 2022 appellant filed a timely appeal from March 28 and June 7, 2022 merit 

decisions 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 left shoulder 

condition causally related to the accepted June 17, 2021 employment incident.

FACTUAL HISTORY

On July 7, 2021 appellant, then a 56-year-old mail processing clerk, filed a traumatic injury 

claim (Form CA-1) alleging that on June 17, 2021 she experienced pain in her shoulder when 

1

5 U.S.C. § 8101 et seq.
2

sweeping mail into the top rack while in the performance of duty. On the reverse side of the claim 

form, appellant’s supervisor acknowledged that she was in the performance of duty at the time of 

the alleged incident.

On June 18, 2021 Dr. Anny Soon, a Board-certified internist, found that appellant should 

work light duty until July 2, 2021 due to an employment injury. She provided the date of injury 

as June 16, 2021.

In a June 30, 2021 form report, a physician assistant noted that appellant had loss of range 

of motion of the left shoulder and provided work restrictions.

In a statement dated July 2, 2021, H.C., a supervisor, related that appellant had informed 

her that she could not work due to an employment injury on June 18, 2021. She subsequently filed 

a claim on June 26, 2021 and began working in a modified position. Appellant advised that on 

June 30, 2021 she injured herself lifting the lid of a machine to clear a jam.

In a duty status report (Form CA-17) dated July 8, 2021, a physician diagnosed left 

shoulder strain and provided work restrictions.2

On July 9, 2021 appellant accepted a full-time, modified assignment at the employing 

establishment.

On July 21, 2021 Dr. Mark Lundquist, who specializes in occupational medicine, obtained 

a history of appellant experiencing a sharp pain in her shoulder radiating into the wrist sweeping 

mail into trays above her shoulder on June 17, 2021. He noted that her pain had increased on 

June 30, 2021 when she worked on a different machine. On examination, Dr. Lundquist found 

tenderness to palpation of the subdeltoid and posterior rotator cuff and lesser pain in the anterior 

humeral head. He diagnosed a left shoulder strain and “most likely also a subdeltoid bursitis.”

Dr. Lundquist advised that the mechanism of injury was “sweeping mail into trays” on 

June 17, 2021. He referred appellant for physical therapy and found that she could work modified 

duty.

Appellant submitted physical therapy notes dated from July 26, 2021.

In a July 27, 2021 progress report, Dr. Lundquist evaluated appellant for continued left 

shoulder pain that worsened with movement or sleeping. He noted the mechanism of injury as 

sweeping mail into trays and the date of onset as June 17, 2021. Dr. Lundquist diagnosed left 

shoulder strain. 

In progress reports dated August 3 and 17, 2021, Dr. Lundquist diagnosed left shoulder 

strain, probable rotator cuff tendinopathy, and possible subdeltoid bursitis. He provided the 

mechanism of injury as sweeping mail into trays and noted that appellant had experienced sudden 

pain in her shoulder. Dr. Lundquist found that she could work modified duty. In duty status 

reports (Form CA-17) dated August 3, 10, and 17, 2021, he provided work restrictions.

2 The name of the physician is not legible.
3

In a development letter dated September 9, 2021, OWCP informed appellant of the type of 

factual and medical evidence necessary to establish her claim and provided a questionnaire for her 

completion. It afforded her 30 days to provide the necessary evidence.

On August 24 and 31, 2021 Dr. Lundquist provided a recheck of appellant’s previouslydocumented left shoulder injury. He noted that her pain had improved, but worsened with 

movement and woke her up at night. Dr. Lundquist provided the same diagnoses and findings as 

in his prior reports. In a Form CA-17 of even date, he provided work restrictions.

On July 1, 2021 appellant filed a notice of recurrence (Form CA-2a) of the need for medical 

treatment on June 30, 2021 causally related to her June 17, 2021 employment injury. She related 

that she was working with restrictions on that date when she used her left hand to open a machine 

and experienced pain in her shoulder and arm. Appellant provided a witness statement.

In a progress report dated September 14, 2021, Dr. Lundquist noted that appellant had 

sustained her injury on June 17, 2021, but had waited until after her symptoms increased after 

working a machine on June 30, 2021 to file a claim. He diagnosed a left shoulder strain. 

Dr. Lundquist indicated that appellant had given him a letter from OWCP for review.

In progress reports dated September 20 and 28, 2021, Dr. Lundquist found gradual 

improvement of left shoulder strain, probable rotator cuff tendinopathy, and possible subdeltoid 

bursitis. On September 28, 2021 he treated appellant with a steroid injection to the subacromial 

region of the left shoulder. Dr. Lundquist continued to provide CA-17 forms listing work 

restrictions. 

By decision dated October 13, 2021, OWCP denied appellant’s traumatic injury claim. It 

found that she had not established a medical condition causally related to the accepted June 17, 

2021 employment incident.

Thereafter, OWCP received a June 22, 2021 report from Dr. Brian D. Cameron, a Boardcertified orthopedic surgeon. Dr. Cameron described appellant’s complaints of left shoulder pain 

over the past six months. He noted that she had received chiropractic treatment for herleft shoulder 

in March and April. Dr. Cameron diagnosed adhesive capsulitis of the left shoulder. 

In a progress report dated October 5, 2021, Dr. Lundquist diagnosed left shoulder strain, 

subdeltoid bursitis, and adhesive capsulitis. He provided the mechanism of injury as sweeping 

mail into trays. In a CA-17 form of even date, Dr. Lundquist found that appellant could work with 

restrictions.

In an October 12, 2021 progress report, Dr. Lundquist advised that appellant had left 

shoulder strain, probable rotator cuff tendinopathy, and possible subdeltoid bursitis. He related, 

“Arguably, she may have some adhesive capsulitis as previously documented. If so, all that 

remains of her capsular movement patternis mildly limited external rotation.” Dr. Lundquist again 

noted that the mechanism of injury was sweeping mail into trays and provided work restrictions in 

an accompanying CA-17 form.

On October 28, 2021 appellant requested an oral hearing before a representative of 

OWCP’s Branch of Hearings and Review.
4

On November 2, 2021 Dr. Lundquist related that he had treated appellant since July 21, 

2021 for a “non-traumatic shoulder injury.” He indicated that she had described her job as 

involving some repetitiveness and intermittent mild-to-moderate shoulder joint loading 

performing overhead work. Dr. Lundquist found that it was reasonable on a more probable than 

not basis that appellant’s sudden onset of shoulder pain while performing this activity with her 

shoulder and arm in an awkward position had caused an acute injury such as a rotator cuff strain

due to the employment activity. He found that her short stature may have also contributed. 

Dr. Lundquist noted that appellant may have had some degeneration of the rotator cuff due to age 

but indicated it was previously asymptomatic. He found a repetitive and moderately stressful work 

increased the risk of degenerative rotator cuff symptoms and that if that had occurred it “would be 

considered to represent a work-related temporary exacerbation of preexisting disease.”

Dr. Lundquist opined that appellant should find a job that was less strenuous and repetitive to avoid 

a recurrence or reinjury.

A telephonic hearing was held on February 16, 2022.

On March 1, 2022 Dr. Bich-Khanh Nguyen, a Board-certified internist, advised that she 

had treated appellant in June 2021 for “acute left shoulder pain due to her job in the mail room.” 

She noted that appellant’s job required “repetitive overhead reaching and sweeping mail daily 

which injured her left shoulder.” 

By decision dated March 28, 2022, OWCP’s hearing representative affirmed the 

October 13, 2021 decision. He noted that the current case should be administratively combined 

with OWCP File No. xxxxxx589, which was created for a June 30, 2021 incident. 

In a report dated April 18, 2022, Dr. Cameron advised that he had incorrectly found that 

appellant had received previous left shoulder treatment. He noted that her prior treatment was for 

a 2016 right shoulder condition.

On May 19, 2022 appellant, through a representative, requested reconsideration.

By decision dated June 7, 2022, OWCP denied modification of its March 28, 2022 

decision.

LEGAL PRECEDENT

An employee seeking benefits under FECA3 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 of FECA,4that 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 

3

Supra note 1.

4 C.B., Docket No. 21-1291 (issued April28, 2022); S.C., Docket No. 18-1242 (issued March 13, 2019); J.P., 59 

ECAB 178 (2007); Joe D. Cameron, 41 ECAB 153 (1989).
5

the employment injury.5 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. 6

To determine whether a federal employee has sustained a traumatic injury in the 

performance of duty, it first must be determined whether fact of injury has been established.7 Fact 

of injury consists of two components that must be considered in conjunction with one another. 

The first component is whether the employee actually experienced the employment incident that 

allegedly occurred at the time and place, and in the manner alleged.

8

 The second component is 

whether employment incident caused a personal injury.9 

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.10 A physician’s opinion on whether there is a causal relationship 

between the diagnosed condition and the accepted employment incident must be based on a 

complete factual and medical background.11 Additionally, the physician’s opinion must be 

expressed in terms of a reasonable degree of medical certainty, and must be supported by medical 

rationale, explaining the nature of the relationship between the diagnosed condition and the 

specific employment incident.12

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 17, 2021 employment incident.

In a report dated July 21, 2021, Dr. Lundquist described appellant’s history of left shoulder 

pain on June 17, 2021 extending to her wrist after sweeping mail into trays while performing 

overhead reaching. He noted that her pain increased on June 30, 2021 when she worked on another 

machine. Dr. Lundquist diagnosed a left shoulder strain and probable subdeltoid bursitis. He 

indicated that the mechanism of injury was appellant sweeping mail into trays on June 17, 2021.

Dr. Lundquist provided progress reports throughout 2021 in which he also diagnosed probable

5 L.C., Docket No. 19-1301 (issued January 29, 2020); T.H., Docket No. 18-1736 (issued March 13, 2019); R.C., 

59 ECAB 427 (2008).

6 P.A., Docket No. 18-0559 (issued January 29, 2020); T.E., Docket No. 18-1595 (issued March 13, 2019); 

DeloresC. Ellyett, 41 ECAB 992 (1990).

7 T.H., Docket No. 19-0599 (issued January 28, 2020); S.S., Docket No. 18-1488 (issued March 11, 2019); T.H., 59 

ECAB 388 (2008).

8

S.S., Docket No. 19-0688 (issued January 24, 2020); E.M., Docket No. 18-1599 (issued March 7, 2019); Bonnie A. 

Contreras, 57 ECAB 364 (2006).

9

Id.

10 S.K., Docket No. 22-0432 (issued June27, 2022); E.G., Docket No. 20-1184 (issued March 1, 2021); T.H., 59 

ECAB 388 (2008).

11 M.V., Docket No. 18-0884 (issued December 28, 2018).

12 B.C., Docket No. 20-0221 (issued July 10, 2020); Leslie C. Moore, 52 ECAB 132 (2000).
6

rotator cuff tendinopathy and, on October 5 and 12, 2021, adhesive capsulitis. He continued to 

provide the mechanism of injury as sweeping mail into trays. The Board has held, however, that 

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

medical rationale explaining how a given medical condition/disability was related to employment 

factors.13 Thus, this evidence is insufficient to meet appellant’s burden of proof.

On November 2, 2021 Dr. Lundquist related that he had treated appellant since July 21, 

2021 for a shoulder injury that was not traumatic in nature. He noted that her work duties required 

repetitive motion and intermittent shoulder joint loading while performing overhead work. 

Dr. Lundquist found that it was reasonable on a more probable than not basis that appellant’s

sudden onset of shoulder pain while performing this activity had caused an acute injury such as a 

rotator cuff strain. He found that her short stature may have also contributed. Dr. Lundquist noted 

that appellant may have had some degeneration of the rotator cuff due to age, but indicated it was 

previously asymptomatic. He opined that repetitive and moderately stressful work dutiesincreased 

the risk of degenerative rotator cuff symptoms and that if that had occurred it “would be considered 

to represent a work-related temporary exacerbation of preexisting disease.” Dr. Lundquist opined 

that appellant should find a job that was less strenuous and repetitive to avoid a recurrence or

reinjury. As noted above, the Board has held that a report is of limited probative value regarding 

causal relationship if it does not contain sufficient medical rationale explaining how a given 

medical condition/disability was related to employment factors.14 

In a March 1, 2022 report, Dr. Nguyen discussed her treatment of appellant in June 2021 

for left shoulder pain as a result of her job working in the mail room. She noted that appellant’s 

position required repetitive overhead reaching and sweeping mail each day, which had injured her 

left shoulder. As noted above, the Board has held that a report is of limited probative value 

regarding causal relationship if it does not contain sufficient medical rationale explaining how a 

given medical condition/disability was related to employment factors.15 Thus, this report is 

insufficient to establish appellant’s claim.

On June 18, 2021 Dr. Anny advised that appellant should perform light duty as the result 

of an employment injury. She did not, however, provide an opinion on causal relationship. The 

Board has long held that a medical report which does not offer an opinion regarding the cause of 

an employee’s condition is of no probative value on the issue of causal relationship.

16

 Therefore, 

this medical evidence is insufficient to establish appellant’s traumatic injury claim.

13 See Y.D., Docket No. 16-1896 (issued February 10, 2017) (finding that a report is of limited probative value 

regarding causal relationship if it does not contain medical rationale describing the relation between work factors and 

a diagnosed condition/disability).

14 Id.

15 Id.

16 See R.P., Docket No. 22-0621 (issued July 20, 2022); S.S., Docket No. 21-0837 (issued November 23, 2021); 

L.D., Docket No. 20-0894 (issued January 26, 2021); L.B., Docket No. 18-0533 (issued August 27, 2018);

D.K., Docket No. 17-1549 (issued July 6, 2018); Charles H. Tomaszewski, 39 ECAB 461 (1988).
7

In a report dated June 22, 2021, Dr. Cameron evaluated appellant for left shoulder pain and 

noted that she had previously received chiropractic treatment for the left shoulder. He diagnosed 

left shoulder adhesive capsulitis. On April 18, 2022 Dr. Cameron clarified that appellant’s prior 

shoulder treatment was for the right rather than left shoulder. He did not, however, address 

whether the diagnosed condition of adhesive capsulitis was causally related to the accepted 

employment incident. 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 Therefore, Dr. Cameron’s reports are insufficient to establish appellant’s claim.

The record contains CA-17 forms dated July through October 2021 providing work 

restrictions. However, these Form CA-17 reports do not contain an opinion as to whether the 

accepted employment injury caused a diagnosed condition, and thus are of no probative value on 

the issue of causal relationship.

18

OWCP also received reports from a physical therapist and a physician assistant. However, 

physician assistants and physical therapists are not considered physicians as defined under 

FECA.19 Consequently, this evidence is of no probative value and insufficient to establish the 

claim. 

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

left shoulder condition and the accepted employment incident, the Board finds that appellant has 

not met her burden of proof. 

Appellant may submit new evidence or argument with a written request for reconsideration 

to OWCP within one year of this merit decision, pursuant to 5 U.S.C. § 8128 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 left shoulder 

condition causally related to the accepted June 17, 2021 employment incident.

17 Id. 

18 Id. See also D.S., Docket No. 20-0377 (issued November 9, 2020); D.O., Docket No. 20-0307 (issued 

June 26, 2020).

19 Section 8101(2) of FECA provides that the term 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 Federal (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 P.D., Docket No. 21-0920 (issued January 12, 2022) (a physical therapist is not a physician 

under FECA); R.K., Docket No. 20-0049 (issued April10, 2020) (a physician assistant is not considered a physician 

as defined under FECA).
8

ORDER

IT IS HEREBY ORDERED THAT the March 28 and June 7, 2022 decisions of the 

Office of Workers’ Compensation Programs are affirmed.

Issued: November 15, 2022

Washington, DC

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board

James D. McGinley, Alternate Judge

Employees’ Compensation Appeals Board