United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

M.C., Appellant

and

DEPARTMENT OF VETERANS AFFAIRS, 

HAMPTON VA MEDICAL CENTER,

Hampton, VA, Employer

__________________________________________

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Docket No. 20-1266

Issued: September 13, 2022

Appearances: Case Submitted on the Record

Shannon Bravo, 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 June 11, 2020 appellant, through counsel, filed a timely appeal from a May 22, 2020 

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.

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

ISSUE

The issue is whether appellant has met his burden of proof to establish a right shoulder 

condition causally related to the accepted August 28, 2018 employment incident.

FACTUAL HISTORY

On September 27, 2018 appellant, then a 49-year-old maintenance mechanic, filed a 

traumatic injury claim (Form CA-1) alleging that on August 28, 2018 he sustained a right shoulder 

injury when he was repairing a weed trimmer while in the performance of duty. He explained that 

as he pulled the cord to start the engine, the recoil pulled and it “[f]elt like something ripped in the 

middle of my right shoulder.”

A March 18, 2019 magnetic resonance imaging (MRI) scan, reviewed by Dr. Bruce 

Sandow, a diagnostic radiologist, noted that appellant had an acute onset of pain in August 2018 

while pulling on a starter cord lawn mower. Dr. Sandow diagnosed a complete rotator cuff tear 

involving the anterior fibers of the infraspinatus tendon with retraction of tendon to level of 

acromion and moderate infraspinatus atrophy, tendinosis and or partial tears of supraspinatus and 

subscapularis tendons, small subacromial deltoid bursal effusion and small joint effusion, and 

moderate acromioclavicular (AC) joint degenerative changes. He compared the findings to an 

August 28, 2018 right shoulder x-ray, which revealed a complete tear of the anterior fibers of the 

infraspinatus tendon with retraction of the tendon to the level of the acromion. Dr. Sandow also 

noted tendinosis and or partial tears of the supraspinatus and subscapularis tendons, small 

subacromial subdeltoid bursal effusion and small joint effusion, and moderate AC joint 

degenerative changes.

In a report dated May 3, 2019, Dr. John McGee, a Board-certified orthopedic surgeon,

noted that appellant was seen for complaints of pain and weakness in his right shoulder, which he 

had experienced since the prior summer. He indicated that appellant injured his shoulder while 

pulling a starter on a small motor. Dr. McGee reviewed the MRI scan and diagnosed a right rotator 

cuff tear.

OWCP received reports of appellant’s emergency treatment dated August 29, 2018 and 

September 26, 2018, signed by a nurse practitioner. The reports indicated that appellant could 

continue working light duty with restrictions to the right shoulder.

In a development letter dated May 22, 2019, OWCP informed appellant that the evidence 

of record was insufficient to establish his claim. It advised him of the type of factual and medical 

evidence needed and provided a questionnaire for his completion. OWCP afforded appellant 30 

days to submit the necessary evidence.

In a January 24, 2019 report, Dr. McGee noted that appellant had right shoulder pain since 

August 2018. He indicated that appellant sustained an injury while trying to start a lawnmower.

Dr. McGee related that appellant was pulling on the lawnmower cord and had a sudden onset of 

sharp right shoulder pain. He noted that appellant had one previous injury to the shoulder “all on 

active duty.” Dr. McGee advised that at the time of the prior injury, appellant underwent physical 

therapy and his shoulder improved, but appellant still had some residual pain. He also noted that 
3

appellant denied pain radiating down to the arm, numbness, and tingling, and appellant denied 

having a previous dislocation. Dr. McGee diagnosed a possible right rotator cuff tear.

In a May 28, 2019 response to OWCP’s development questionnaire, appellant indicated 

that he had not sustained any subsequent injuries either on or off duty.

By decision dated June 26, 2019, OWCP denied appellant’s traumatic injury claim. It 

found that, while the August 28, 2018 employment incident occurred as alleged, the medical 

evidence of record was insufficient to establish causal relationship between appellant’s diagnosed 

right rotator cuff tear and the accepted employment incident.

On July 8, 2019 OWCP received a request for a review of the written record by a

representative of OWCP’s Branch of Hearings and Review.

In a September 6, 2019 report, Dr. McGee opined that appellant injured his right shoulder 

on the job in August 2018. He explained that appellant was pulling a lawn mower starter cord as 

part of his normal occupational activity when he experienced acute onset of sharp pain in his right 

shoulder. Dr. McGee related that further evaluation revealed this to be a full-thickness tear of 

appellant’s right rotator cuff. He opined “this injury occurred on the job, is directly related to his 

normal activities on the job, and subsequent treatment and injury is directly related to the injury 

which occurred on the job. I do not know how to more clearly state this fact.”

By decision dated October 9, 2019, OWCP’s hearing representative affirmed the June 26, 

2019 decision.

On February 5, 2020 appellant, through counsel, requested reconsideration.

OWCP received an August 28, 2018 treatment note from a physician assistant who 

indicated that appellant started a chainsaw that morning, pulled back hard on the string, and it did

not give, causing him to have a sharp pain in the right shoulder. The physician assistant diagnosed 

a right shoulder strain.

In an October 30, 2018 treatment note, Dr. Helina Amare, a Board-certified internist, noted

appellant was seen for right shoulder pain and limitation of movement since a sprain while trying 

to start a chainsaw at work on August 28, 2018.

On March 3, 2020 appellant, through counsel, requested reconsideration.

By decision dated April 23, 2020, OWCP denied modification of the October 9, 2019 

decision.

On May 18, 2020 appellant, through counsel, requested reconsideration.

In a May 18, 2020 attending physician’s report (Form CA-20), Dr. McGee noted that on 

August 28, 2018, appellant experienced a sharp pain in his right shoulder after pulling on a weed 

trimmer starter cord at his work station. He related that appellant had a preexisting combat injury 

to the right shoulder on August 18, 2011. Dr. McGee noted that an MRI scan revealed a fullthickness tear of the anterior supraspinatus tendon in the right shoulder (length of 1.1 centimeters 
4

and a tendon gap from 1 centimeter). He found subacromial bursitis, rotator cuff tendinitis, and 

impingement of complete tear of rotator. Dr. McGee marked the box “Yes” in response to whether 

he believed the condition(s) found were caused or aggravated by an employment activity. He 

noted that appellant injured his right shoulder “on the job August 2018, pulling a cord that 

jammed.”

Appellant provided a May 6, 2020 supplemental response to OWCP’s questionnaire. He 

described the injury at work on August 28, 2018. Appellant indicated that when he pulled on the 

starter cord, it did not recoil, he pulled his arm/shoulder, and he felt immediate pain and “a 

sensation like something had ripped in the middle of [his] right shoulder.” He noted his supervisor 

was there at the time of the injury, he denied any other injuries, and confirmed he did not sustain 

any other injuries between the time he reported the injury to his supervisor or the occupational 

clinic. In response to whether he had any similar injuries, appellant described his prior servicerelated injury to the right shoulder, which was diagnosed as a strain. He indicated that after 

undergoing physical therapy, he had no further treatment.

By decision dated May 22, 2020, OWCP denied modification of the April 23, 2020 

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 timely filed within the applicable 

time limitation period of FECA,4that 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.5 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.6

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

performance of duty, OWCP begins with an analysis of whether fact of injury has been established. 

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 

3

5 U.S.C. § 8101 et seq.

4

See V.S., Docket No. 20-1034 (issued November 25, 2020); M.O., Docket No. 19-1398 (issued August13, 2020); 

S.B., Docket No. 17-1779 (issued February 7, 2018); JoeD. Cameron, 41 ECAB 153 (1989).

5

J.R., Docket No. 20-0496 (issued August13, 2020); R.C., 59 ECAB 427 (2008); JamesE. Chadden, Sr., 40 ECAB 

312 (1988).

6 B.M., Docket No. 19-1341 (issued August 12, 2020); L.M., Docket No. 13-1402 (issued February 7, 2014); 

DeloresC. Ellyett, 41 ECAB 992 (1990).
5

allegedly occurred.7 The second component is whether the employment incident caused a personal 

injury.8

The medical evidence required to establish causal relationship between a claimed specific 

condition and an employment incident 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

ANALYSIS

The Board finds that appellant has not met his burden of proof to establish a right shoulder 

condition causally related to the accepted August 28, 2018 employment incident.

In support of his claim, appellant submitted reports from Dr. McGee. In a January 24, 2019 

report, Dr. McGee related that appellant sustained an injury while trying to start a lawnmower in 

August 2018. He diagnosed a “possible” right rotator cuff tear. In a May 3, 2019 report,

Dr. McGee reviewed the March 18, 2019 MRI scan, diagnosed a right rotator cuff tear, and related 

that appellant injured his shoulder while pulling a starter on a small motor. However, while

Dr. McGee related appellant’s history of injury, he did not offer his own opinion on causal 

relationship. As the Board has held, medical evidence 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.11 

These reports are therefore insufficient to establish appellant’s claim.

In a September 6, 2019 report, Dr. McGee related that appellant was pulling a lawn mower 

starter cord when he experienced acute onset of sharp pain in his right shoulder. He opined “this 

injury occurred on the job, is directly related to his normal activities on the job, and subsequent 

treatment and injury is directly related to the injury which occurred on the job. I do not know how 

to more clearly state this fact.” The Board has held that an opinion which is conclusory and fails 

7 T.J., Docket No. 19-0461 (issued August11, 2020); Elaine Pendleton, 40 ECAB 1143 (1989).

8 D.M., Docket No. 20-0386 (issued August10, 2020); JohnJ. 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 N.D., Docket No. 20-0091 (issued January 12, 2021); 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).

11 See L.B., Docket No. 18-0533 (issued August 27, 2018); D.K.,Docket No. 17-1549 (issued July 6, 2018). 
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to provide a rationalized explanation as to how the work injury caused the diagnosed condition is 

of limited probative value.

12

 This report is therefore insufficient to establish appellant’s claim. 

In a May 18, 2020 Form CA-20, Dr. McGee related that appellant injured hisright shoulder 

“on the job August 2018, pulling a cord that jammed.” He noted that an MRI scan revealed a fullthickness tear of the anterior supraspinatus tendon in the right shoulder, subacromial bursitis, 

rotator cuff tendinitis, and impingement of complete tear of rotator. Dr. McGee checked the box

marked “Yes” in response to whether he believed the condition(s) found were caused or aggravated 

by an employment activity. However, the Board has held that an opinion on causal relationship 

which consists of a physician checking a box in response to a form question, without supporting 

medical rationale explaining how the employment activity caused the diagnosed condition, is of 

limited probative value.

13

In an October 30, 2018 treatment note, Dr. Amare related that appellant was seen for right 

shoulder pain and limitation of movement when trying to start a chainsaw at work on 

August 28, 2018. She did not offer her own opinion on 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. 14 As such, the treatment note 

from Dr. Amare is insufficient to meet appellant’s burden of proof.

The remaining evidence of record consists of the March 18, 2019 MRI scan, August 29 

and September 26, 2018 notes from a nurse practitioner, and an August 28, 2018 note from a 

physician assistant. The Board has held that diagnostic studies, standing alone, lack probative 

value and are insufficient to establish the claim.15 In addition, certain healthcare providers such 

as physician assistants and nurse practitioners are not considered physicians as defined under 

FECA.16 Their medical findings, reports and/or opinions, unless cosigned by a qualified physician, 

12 See E.M., Docket No. 20-0738 (issued June22, 2022); E.M.,Docket No. 18-0454 (issued February 20, 2020);see 

also J.J.,Docket No. 15-1329 (issued December 18, 2015).

13 See O.N., Docket No. 20-0902 (issued May 21, 2021); A.R., Docket No. 19-0465 (issued August 10, 2020); C.T., 

Docket No. 20-0020 (issued April29, 2020); M.R., Docket No. 17-1388 (issued November 2, 2017); Gary J. Watling, 

52 ECAB 278 (2001).

14 Supra note 12; see also S.H., Docket No. 22-0391 (issued June 29, 2022).

15 See B.R., Docket No. 21-1109 (issued December 28, 2021); J.K., Docket No. 20-0591 (issued August12, 2020);

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

16 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 Federal (FECA) Procedure Manual, Part 2 -- Claims, Causal 

Relationship, Chapter 2.805.3a(1) (January 2013); A.Z., Docket No. 21-1355 (issued May 19, 2022) (nurse 

practitioners are not physicians under FECA); 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).
7

will not suffice for purposes of establishing entitlement to FECA benefits. 17 Consequently, this 

evidence is also insufficient to meet appellant’s burden of proof.

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

finds that appellant has not met his burden of proof.

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

to OWCP within one year of this merit decision, pursuant to 5 U.S.C. § 8128(a) and 20 C.F.R. 

§§ 10.605 through 10.607.

CONCLUSION

The Board finds that appellant has not met his burden of proof to establish a right shoulder 

condition causally related to the accepted August 28, 2018 employment incident.

ORDER

IT IS HEREBY ORDERED THAT the May 22, 2020 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: September 13, 2022

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

17 Id.