United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

R.C., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE,

Peekskill, NY, Employer

__________________________________________

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Docket No. 23-0413

Issued: December 4, 2023

Appearances: Case Submitted on the Record

Thomas Harkins, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

PATRICIA H. FITZGERALD, Deputy Chief Judge

JANICE B. ASKIN, Judge

JURISDICTION

On February 6, 2023 appellant, through counsel, filed a timely appeal from an August 26,

2022 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 medical condition

causally related to the accepted December 28, 2020 employment incident.

FACTUAL HISTORY

On January 21, 2021 appellant, then a 56-year-old city carrier, filed a traumatic injury 

claim (Form CA-1) alleging that, on December 28, 2020, he sustained injuries to his left elbow 

and right ankle when his foot got caught under a forklift and he tripped and fell while in the 

performance of duty. He stopped work on September 9, 2021.

In a January 13, 2021 statement, appellant indicated that on December 28, 2020 his right 

foot became caught under a forklift, which caused him to fall and land on his left elbow. He related 

that he primarily injured his left elbow, but also wrenched his back and injured his left hip, right 

foot, and right ankle. Appellant further related that the veins in his left arm appeared more 

pronounced, and he experienced constant pain in the left elbow, which worsened with any type of 

lifting. 

In an attending physician’s report, Part B of an authorization for examination and/or 

treatment (Form CA-16), dated January 14, 2021, Dr. Ingrid Van Hollebeke, an osteopathic 

internal medicine physician, noted the history of appellant’s December 28, 2020 employment 

incident and diagnosed pain in the right ankle and left elbow. She checked a box marked “Yes”

indicating that his condition was caused by an employment activity. Dr. Van Hollebeke referred 

appellant to physical medicine and rehabilitation and released him to light-duty work with no 

lifting. 

In a medical report dated March 4, 2021, Dr. Amit Dholakia, a Board-certified physical 

medicine and rehabilitation specialist, noted that appellant related complaints of left forearm, left 

elbow, and right ankle pain, which he attributed to falling at work on December 28, 2020. He 

performed a physical examination, which revealed exquisite tenderness along the left medial 

epicondyle and a normal right ankle. Dr. Dholakia diagnosed right ankle pain and medial 

epicondylitis of the left elbow and noted that he “did not see anything wrong with [appellant’s]

right ankle at this point.” He administered a left medial epicondyle steroid injection and opined 

that he was unable to return to his date-of-injury position. 

In a duty status report (Form CA-17) of even date, Dr. Dholakia released appellant to work 

with restrictions of no lifting, pushing, or pulling greater than 15 pounds.

In a follow-up report dated April 19, 2021, Dr. Dholakia administered a second left medial 

epicondyle steroid injection, with ultrasound guidance. He diagnosed left medial epicondylitis. 

In a May 11, 2021 development letter, OWCP informed appellant of the deficiencies of his 

claim. It advised him of the type of factual and medical evidence necessary and provided a 

questionnaire for his completion. OWCP afforded appellant 30 days to respond.

OWCP thereafter received a May 14, 2021 Form CA-17, wherein Dr. Dholakia diagnosed 

left medial epicondylitis due to the December 28, 2020 injury. Dr. Dholakia released appellant to 
3

return to work with restrictions regarding climbing, kneeling, bending, squatting, pulling, pushing, 

simple grasping, fine manipulation, reaching above shoulder height, and driving a vehicle. 

In a May 19, 2021 narrative report, Dr. Van Hollebeke indicated that she had examined 

appellant on January 14, 2021 for the December 28, 2020 employment incident and observed that 

there was no visible injury to the right ankle. Regarding the left elbow, she noted that he related 

that he had developed some mild swelling and had constant pain and difficulty moving the left 

elbow. Dr. Van Hollebeke indicated that she obtained x-rays on January 14, 2021 of appellant’s 

right ankle, which were normal; and of the left elbow, which revealed a small epicondylar spur 

and insertional triceps enthesopathy. She opined that “the condition he is experiencing was caused 

by the injury which he sustained at work on the date reported to us.”

In a May 21, 2021 report, Dr. Ogheneochuko E. Metitiri, a Board-certified orthopedic 

surgeon (hand surgery), noted the history of the December 28, 2020 employment incident and 

appellant’s treatment, including the injections by Dr. Dholakia. He performed a physical 

examination of the left upper extremity, which revealed tenderness with palpation of the ulnar 

nerve immediately proximal to the cubital tunnel, medial elbow discomfort with elbow flexion, 

and minimal pain at the left elbow with resisted left wrist flexion. Dr. Metitiri reviewed the 

January 14, 2021 left elbow x-rays, which revealed no evidence of acute bony pathology or 

degenerative disease. He diagnosed left medial epicondylitis, numbness and tingling in the left 

arm, and paresthesia of skin, which he opined were “related to the workers’ compensation claim.”

Dr. Metitiri recommended magnetic resonance imaging (MRI) scan of the left elbow and an

electromyography and nerve conduction study (EMG/NCV) of the left upper extremity to evaluate 

possible cubital tunnel syndrome.

By decision dated June 15, 2021, OWCP denied the claim, finding that the medical 

evidence of record was insufficient to establish causal relationship between the diagnosed 

conditions and the accepted December 28, 2020 employment incident.

OWCP continued to receive evidence. In a June 3, 2021 medical report, Dr. Jeontaik J. 

Kwon, a Board-certified vascular surgeon, noted that appellant related left forearm pain and vein 

bulging following an accident at work. He performed an examination and diagnosed pain in the 

left arm. Dr. Kwon opined that there was no evidence of superficial vein thrombosis and that 

appellant’s condition was likely musculoskeletal rather than vascular in nature.

On June 3, 2022 appellant, through counsel, requested reconsideration of OWCP’s 

June 15, 2021 decision.

By decision dated August 26, 2022, OWCP denied modification of its June 15, 2021 

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 that the individual is an employee of the United 

3

Id.
4

States within the meaning of FECA, that the claim was timely filed within the applicable time 

limitation 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, 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 whether the 

employee has established 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.7 

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

condition and an employment incident is rationalized medical opinion evidence.8 A physician’s

opinion on whether there is causal relationship between the diagnosed condition and the implicated 

employment incident must be based on a complete factual and medical background.9 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 appellant’s specific employment incident.10

ANALYSIS

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

condition causally related to the accepted December 28, 2020 employment incident. 

In her January 14, 2021 form medical report, Dr. Van Hollebekediagnosed pain in the right 

ankle and left elbow and checked a box marked “Yes” indicating that appellant’s condition was 

caused by his federal employment. In her subsequent May 19, 2021 narrative report, she opined 

“the condition he is experiencing was caused by the injury which he sustained at work on the date 

reported to us,” but did not provide a medical diagnosis. In both reports, Dr. Hollebeke failed to 

4 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). 

5 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).

6 P.A., Docket No. 18-0559 (issued January 29, 2020); K.M., Docket No. 15-1660 (issued September 16, 2016); 

Delores C. Ellyett, 41 ECAB 992 (1990). 

7 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).

8

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).

9 C.F., Docket No. 18-0791 (issued February 26, 2019); Jacqueline M. Nixon-Steward, 52 ECAB 140 (2000).

10 Id.
5

explain with adequate rationale how the accepted employment incident either caused or 

contributed to appellant’s diagnosed conditions. The Board has held that a medical opinion should 

reflect a medically-sound and rationalized explanation by the physician of how the specific 

employment incident physiologically caused or aggravated the diagnosed conditions. 11 An 

opinion on causal relationship with an affirmative check mark, without more by the way of medical 

rationale, is insufficient to establish the claim.12 This evidence is therefore insufficient to establish 

the claim.

Dr. Metitiri, in his May 21, 2021 report, diagnosed left medial epicondylitis, numbness and 

tingling in the left arm, and paresthesia of skin, which he opined were “related to the workers’

compensation claim.” He did not, however, provide a rationalized explanation of how the accepted 

employment incident physiologically caused or aggravated the diagnosed conditions.13 Therefore,

Dr. Metitiri’s report is also of limited probative value and is insufficient to establish the claim.

Dr. Dholakia, in a May 14, 2021 Form CA-17, diagnosed left medial epicondylitis due to 

the December 28, 2020 injury and provided work restrictions. He did not, however, provide a 

rationalized explanation of how the accepted employment incident physiologically caused or 

aggravated the diagnosed condition.14 Therefore, Dr. Dholakia’s May 14, 2021 Form CA-17 is 

also insufficient to establish the claim.

In his March 4 and April 19, 2021 reports, Dr. Dholakia diagnosed right ankle pain and 

medial epicondylitis of the left elbow. He administered left medial epicondyle steroid injections

and opined that appellant was not able to return to his time-of-injury position due to his left elbow

condition. Dr. Kwon, in his June 3, 2021 medical report, diagnosed pain in the left arm and opined 

that there was no evidence of superficial vein thrombosis. These physicians did not, however, 

provide an opinion as to the cause of the diagnosed conditions. 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.15 This evidence is therefore also insufficient 

to establish the claim.

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

the diagnosed conditions and the accepted December 28, 2020 employment incident, the Board 

finds that appellant has not met his burden of proof. 

11 T.G., Docket No. 21-0175 (issued June 23, 2021); J.D., Docket No. 19-1953 (issued January 11, 2021); see K.W., 

Docket No. 19-1906 (issued April 1, 2020).

12 See C.S., Docket No. 18-1633 (issued December 30, 2019); D.S., Docket No. 17-1566 (issued 

December 31, 2018).

13 Supra note 11.

14 Id.

15 D.C., Docket No. 19-1093 (issued June25, 2020); see L.B., Docket No. 18-0533 (issued August 27, 2018); D.K., 

Docket No. 17-1549 (issued July 6, 2018).
6

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 medical

condition causally related to the accepted December 28, 2020 employment incident.

ORDER

IT IS HEREBY ORDERED THAT the August 26, 2022 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: December 4, 2023

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board