United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

B.P., Appellant

and

U.S. POSTAL SERVICE, CLEVELAND 

PROCESSING & DISTRIBUTION CENTER, 

Cleveland, OH, Employer

__________________________________________

)

)

)

)

)

)

)

)

)

Docket No. 21-0872

Issued: December 8, 2021

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

PATRICIA H. FITZGERALD, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On May 21, 2021 appellant filed a timely appeal from a March 17, 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 March17, 2021 decision, appellant submitted additional evidence to OWCP. 

However, the Board’s Rules of Procedure provides: “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 April 30, 2020 employment incident.

FACTUAL HISTORY

On July 25, 2020 appellant, then a 50-year-old supervisor of distribution operations, filed 

a traumatic injury claim (Form CA-1) alleging that on April 30, 2020 she injured her feet, legs, 

hips, wrists, left shoulder, and back when pushing equipment, moving mail racks and lifting trays

while in the performance of duty. She did not immediately stop work.

In an undated statement, appellant indicated that her facility experienced an employee 

shortage and she would step in and move racks from one machine to another. On April 30, 2020 

she reported severe foot pain radiating upwards that affected her ability to walk.

Appellant was treated by Schirron Campbell, a physician assistant, on June 26, 2020 for 

low back pain radiating into her feet. Ms. Campbell reported that appellant underwent a left 

acetabulofemoral joint and left greater trochanteric bursa injection on June 19, 2020 with complete 

pain resolution. She diagnosed strain of the lumbar region, lumbar radiculopathy, and bilateral 

plantar fasciitis.

On August 11, 2020 appellant underwent a functional capacity evaluation thatrevealed she

could work in the sedentary physical demand category. It noted significant observational and 

evidence-based inconsistencies resulting in self-limiting behavior and submaximal effort.

In a report dated August 27, 2020, Dr. Timothy J. Nice, a Board-certified orthopedist, 

treated appellant noting that she worked at the employing establishment for over 20 years starting

out as a mail carrier and became a supervisor in 2014. He noted x-rays of the lumbar spine revealed 

increased lumbosacral angle, mild disc disease, mild foraminal disease, and facet disease and 

opined that carrying a mailbag “could” aggravate these conditions. Dr. Nice indicated that x-rays 

of the left hip revealed early degenerative changes. He noted findings of paresthesias in appellant’s 

feet and a negative neurologic examination in the upper and lower extremities. Dr. Nice further 

noted that appellant was diabetic with diabetic neuropathy. He noted weakly positive Tinel’s sign 

on the left and over the left ulnar nerve and recommended further diagnostic studies.

In a September 15, 2020 development letter, OWCP informed appellant of the deficiencies 

of her claim. It advised her of the type of factual and medical evidence required and provided a 

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

OWCP received additional evidence. Appellant was treated by Deborah Dicks, a nurse 

practitioner, on August 20, 2020 for depression and anxiety.

In duty status reports (Form CA-17) dated August 27, September 24, and October 21, 

2020, Dr. Nice noted clinical findings of left-side injury and responded, “Yes” that the diagnosis 

was due to injury. He noted that appellant could not return to work.
3

A magnetic resonance imaging (MRI) scan of the left hip dated September 9, 2020 

demonstrated mild post-stress changes involving the anterosuperior aspect of the left femoral head 

and mild left-sided greater trochanteric bursitis.

Appellant underwent an electromyogram (EMG) and nerve conduction velocity (NCV) 

study on September 10, 2020 that did not reveal distinctive evidence for lumbosacral motor 

radiculopathy. An EMG/NCV study of the upper extremities dated September 17, 2020 revealed 

bilateral median neuropathy, at or distal to the wrist, left ulnar mononeuropathy, at or distal to the 

elbow segment, and possible early neuropathy at the elbow.

Dr. Nice evaluated appellant on September 24, 2020 and indicated that she sustained an 

injury in April when she was pushing heavy equipment and experienced symptoms in her left groin 

and trochanter of the left hip. He opined that pushing equipment aggravated the underlying 

degenerative condition in her left hip and trochanteric bursitis. Dr. Nice noted that appellant had 

increased lumbosacral angle that predisposed her to facet symptoms in her back and when she 

carried a mailbag she became symptomatic. He further diagnosed bilateral pes planus and possible 

early stage of diabetic neuropathy in her feet. 

By decision dated October 26, 2020, OWCP denied appellant’s traumatic injury claim, 

finding that the medical evidence submitted was insufficient to establish causal relationship 

between her diagnosed conditions and the accepted April 30, 2020 employment incident.

OWCP received additional evidence. On May 8, 2018 appellant was treated by Dr. Stella 

Chiunda, a podiatrist, for left ankle pain. She reported a remote ankle sprain in the late 1990’s and 

an MRI scan revealed panos longus and brevis. Dr. Chiunda diagnosed sinus tarsitis secondary to 

abnormal pronation, history of peroneal tendon tear, and diabetes well controlled without pedal 

vasculopathy or neuropathy.

On April 24, 2019 Dr. Jianguo Cheng, a Board-certified anesthesiologist, evaluated 

appellant for low back and left leg pain that started five years prior, but worsened over the past 

year without any inciting event. Appellant noted radiating low back pain into the left groin with 

numbness in the left leg down the calf. He reported findings of tenderness to palpation at the left 

S1 joint and antalgic gait. Dr. Cheng diagnosed primary osteoarthritis of the left hip, trochanteric 

bursitis of the left hip, and radiculopathy of the lumbar region.

In a July 5, 2019 report, Dr. Deepak Agarwal, a Board-certified anesthesiologist,

performed left L4 diagnostic and therapeutic transforaminal epidural steroid injection. He 

diagnosed lumbar radiculopathy.

On October 2, 2019 Dr. Cheng treated appellant in follow up after her first transforaminal 

lumbar epidural steroid injection and appellant reported improvement for one month, but her 

symptoms gradually returned. He diagnosed radiculopathy of the lumbar region and recommended 

a second steroid injection. On May 27, 2020 Dr. Cheng evaluated appellant for left hip pain. 

Appellant noted persistent pain localizing to the left and right hip that radiates down the lateral leg 

to the left and right knee. Dr. Cheng diagnosed primary osteoarthritis of the left hip and greater 

trochanteric bursitis of the left hip and recommended a left acetabulofemoral joint injection and 

left greater trochanteric bursa injection.
4

On May 2, 2019 appellant was treated by Anthony Ciavarella, a physician assistant, for 

carpal tunnel syndrome. Mr. Ciavarella diagnosed bilateral carpal tunnel syndrome and 

recommended wrist splints and left carpal tunnel injection.

On January 28, 2020 Janel Frilling, a nurse practitioner, treated appellant for leg pain. She 

diagnosed lumbar radiculopathy and chronic pain of both knees. Ms. Frilling noted both 

conditions were chronic and recurring.

Dr. Nice treated appellant on October 22, 2020 and noted findings of mild bilateral median 

neuropathies in both upper extremities, severe left ulnar neuropathy with paresthesias into the 

small finger, positive Tinel’s sign at the elbow, and spondylitic changes in her low back. He noted 

appellant worked 24 years at the employing establishment. Dr. Nice recommended altered work 

activities and night splints. In a letter dated November 12, 2020, he summarized the findings in 

his reports dated August 27 and September 24, 2020. Dr. Nice indicated that appellant’s initial 

injury occurred in February 2019 when she was working as a supervisor that required prolonged 

walking and developed pain in her left upper leg. X-rays revealed mild degenerative changes in 

the left hip. Dr. Nice indicated that on April 30, 2020 appellant reported pushing and pulling 

equipment and experienced left groin pain. He treated her on June 19, 2020 and she reported pain 

over the trochanteric bursal area of her left hip. Dr. Nice noted tenderness over the greater 

trochanter of her left buttock that was aggravated by moving and twisting her left leg as well as 

the arthritic condition in the hip socket. He indicated that appellant did not need any further 

treatment for her left hip or bursitis. In Form CA-17 reports dated November 12, 2020 and 

January 14, 2021, Dr. Nice noted clinical findings of left-sided injury and responded “Yes” that 

the diagnosis was due to injury. He noted that appellant could not return to work.

An x-ray of the left shoulder dated November 24, 2020 revealed mild glenohumeral and 

acromioclavicular (AC) osteoarthritis.

In a note dated December 10, 2020, Dr. Nice reported appellant’s continued loss of internal 

and external rotation of the left hip. He diagnosed degenerative joint disease in the left hip. On 

January 14, 2021 Dr. Nice indicated that appellant had multiple injuries in the 24 years that she 

worked for the employing establishment. He reported that in August 1996 she was carrying mail 

and fell off a porch and ruptured peroneal tendons of the left ankle; in 2005, while working as a 

clerk, she was hit in the head and sustained a head and neck injury; in 2009 she was struck in the 

left buttock and hip with a mail container and developed left hip arthritis; and also in 2009 while 

delivering mail she slipped and fell twisting her right ankle. Dr. Nice began treating appellant in 

2020 after she was pushing and pulling carts of mail and felt severe pain and popping sensation in 

her left groin. He opined that appellant aggravated a preexisting degenerative changes in the left 

hip. Dr. Nice noted an EMG/NCV study confirmed ulnar neuropathy and bilateral carpal tunnel 

syndrome that he opined was common among employing establishment employees who have 

worked long term as clerks, mail carriers, and handlers. He noted that as a supervisor, appellant 

was required to stand on concrete and do a lot of walking and he recommended more sedentary 

work.

On January 21, 2021 appellant, through counsel, requested reconsideration.

In a February 25, 2021 report, Dr. Nice sought to correct and clarify statements made in 

his January 14, 2021 report. He noted that in 2009 appellant sustained three injuries. Dr. Nice 

noted that appellant was struck in the left buttock by a nutting truck and fell to the ground injuring 
5

her left leg. In August 2009 appellanttripped on carpeting descending stairs and sprained her right 

ankle. In December 2009 while working as a carrier delivering mail she slipped on ice and fell 

onto her back and buttock. Dr. Nice noted that since the last injury appellant experienced 

worsening symptoms in the left hip despite conservative care and was diagnosed with early 

degenerative arthritis. Appellant underwent left lateral hip and left groin injections with only 

temporary relief in symptoms. X-rays confirmed that she had arthritic changes in her left hip, loss 

of internal and external rotation, and degenerative changes. Dr. Nice recommended guarded 

activities, pain medicine, anti-inflammatories, and a cane. He concluded that appellant had a 

progression of left hip pain commencing with the injury in December 2009.

By decision dated March 17, 2021, OWCP denied modification of the October 26, 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. First, 

the employee must submit sufficient evidence to establish that he or she actually experienced the 

employment incident at the time, place, and in the manner alleged. Second, the employee must 

submit sufficient evidence to establish that the employment incident caused a personal injury. 8

The medical evidence required to establish a 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 

4

Supra note 2.

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.J., Docket No. 19-0461 (issued August 11, 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).
6

by medical rationale explaining the nature of the relationship between the diagnosed condition and 

specific employment incident identified by the employee.10

ANALYSIS

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

condition causally related to the accepted April 30, 2020 employment incident.

Dr. Nice treated appellant on August 27, 2020 for mild disc disease, mild foraminal 

disease, facet disease, and early degenerative changes and opined that carrying a mailbag could 

aggravate this condition. The Board has held that medical opinions that suggest that a condition 

“could” be caused by work activities are speculative or equivocal in character and have limited 

probative value.11 Accordingly, this report is insufficient to establish causal relationship.

On September 24 and November 12, 2020 Dr. Nice evaluated appellant for symptoms in 

her left groin and trochanter of the left hip and buttock after a work injury on April 30, 2020 when 

she was pushing and pulling equipment. He opined that appellant’s underlying degenerative 

condition in her left hip and trochanteric bursitis was aggravated by moving and twisting her left 

leg. Similarly, on January 14, 2021, Dr. Nice indicated that appellant sustained multiple injuries 

in the 24 years of working at the employing establishment to the left ankle, head, neck, left buttock, 

hip, and right ankle and opined that the 2020 incident pushing and pulling carts of mail aggravated 

the preexisting conditions. The Board has held that the mere fact that symptoms arise during a 

period of employment or produce symptoms revelatory of an underlying condition does not 

establish a causal relationship between a diagnosed condition and employment factors. 12 As such, 

these medical notes by Dr. Nice that do not offer a rationalized medical opinion explaining causal 

relationship and are insufficient to establish appellant’s claim.

In Form CA-17 reports dated August 27, September 24, October 21, November 12, 2020 

and January 14, 2021, Dr. Nice noted clinical findings of left-sided injury and responded “Yes”

that the diagnosis was due to injury. However, as he did not provide adequate medical rationale 

relating a diagnosed medical condition to the accepted April 30, 2020 employment incident, these 

reports are of diminished probative value and, therefore, are insufficient to establish appellant’s 

claim.13

On May 27, 2020 Dr. Cheng evaluated appellant for left hip pain and diagnosed primary 

osteoarthritis of the left hip and greater trochanteric bursitis of the left hip. In a report dated 

October 22, 2020, he treated appellant for mild bilateral median neuropathies in both upper 

extremities, severe left ulnar neuropathy with paresthesias into the small finger, and spondylitic 

changes in her low back. Similarly, on December 10, 2020, Dr. Nice reported appellant’s 

continued loss of internal and external rotation of the left hip and diagnosed degenerative joint 

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).

11 J.W., Docket No. 18-0678 (issued March 3, 2020).

12 A.S., Docket No. 19-1955 (issued April9, 2020).

13 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).
7

disease in the left hip. Likewise, in a February 25, 2021 report, Dr. Nice noted that since 2009

appellant experienced worsening symptoms in the left hip and was diagnosed with early 

degenerative arthritis of the left hip, loss of internal and external rotation, and degenerative 

changes. However, he did not specifically relate the diagnosed conditions to the accepted April 30, 

2020 employment incident. The Board has held that medical evidence that does not offer an 

opinion regarding the cause of a diagnosed condition or disability is of no probative value on the 

issue of causal relationship.14 Therefore, the Board finds that these reports are insufficient to 

establish appellant’s burden of proof.

Other reports from Dr. Chiunda dated May 8, 2018, Dr. Cheng dated April 24, October 2, 

2019, and Dr. Agarwal dated July 5, 2019 are of no value in establishing the claimed conditions 

since they predate the time of the claimed condition of April 30, 2020. The Board has held that

medical evidence which predates the date of a traumatic injury has no probative value on the issue 

of causal relationship of a current medical condition.15

In support of her claim, appellant submitted reports from a nurse practitioner and physician 

assistants. However, certain healthcare providers such as nurse practitioners, 16 and physician 

assistants17 are not considered “physician[s]” as defined under FECA.18 Consequently, their 

medical findings and/or opinions will not suffice for purposes of establishing entitlement to FECA 

benefits.

19

Appellant submitted multiple diagnostic testing reports. The Board has held that diagnostic 

studies, standing alone, lack probative value as they do not address whether the employment 

incident caused any of the diagnosed conditions.20 

As the record lacks rationalized medical evidence establishing causal relationship between 

appellant’s diagnosed medical conditions and the accepted April 30, 2020 employment incident, 

the Board finds that appellant has not met her burden of proof.

14 See L.B., Docket No. 18-0533 (issued August 27, 2018); D.K.,Docket No. 17-1549 (issued July 6, 2018).

15 C.W., Docket No. 19-1555 (issued February 24, 2020); P.C.,Docket No. 18-0167 (issued May 7, 2019).

16 S.J., Docket No. 17-0783, n.2 (issued April9, 2018) (nurse practitioners are not considered physicians under 

FECA).

17 C.P., Docket No. 19-1716 (issued March 11, 2020) (a physician assistant is not a physician as defined under 

FECA). 

18 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);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 R.L., Docket No. 19-0440 (issued July 8, 2019) (physical therapists); T.J., Docket No. 19-1339 

(issued March 4, 2020) (nurse practitioner).

19 Id.

20 J.P., Docket No. 19-0216 (issued December 13, 2019); A.B., Docket No. 17-0301 (issued May 19, 2017).
8

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 met not her burden of proof to establish a medical 

condition causally related to the accepted April 30, 2020 employment incident. 

ORDER

IT IS HEREBY ORDERED THAT the March 17, 2021 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: December 8, 2021

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Alternate Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board