United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

C.T., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

St. Louis, MO, Employer

__________________________________________

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Docket No. 22-0013

Issued: November 22, 2022

Appearances: Case Submitted on the Record

Shannon Bravo, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

JANICE B. ASKIN, Judge

JAMES D. McGINLEY, Alternate Judge

JURISDICTION

On October 4, 2021 appellant, through counsel, filed a timely appeal from an April 8, 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 to consider 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 April 8, 2021 decision, OWCP received additional evidence. 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 expand acceptance of her 

claim to include a consequential right shoulder condition causally related to the accepted June 14, 

2016 employment injuries.

FACTUAL HISTORY

On June 14, 2016 appellant, then a 38-year-old parcel post distribution machine clerk, filed 

a traumatic injury claim (Form CA-1) alleging that on that date she injured her left shoulder when 

tossing heavy bundles of standard mail while in the performance of duty. She returned to full-time 

limited-duty work on June 15, 2016. OWCP accepted the claim for left supraspinatus tendon tear, 

left shoulder sprain, left shoulder impingement syndrome, and left shoulder adhesive capsulitis.

On January 20, 2017 appellant underwent authorized left shoulder arthroscopy. She returned to 

light-duty work on February 3, 2017 and full-duty work on June 12, 2017.

On September 27, 2018 appellant filed a schedule award claim (Form CA-7). By decision 

dated July 30, 2019, OWCP granted appellant a schedule award for 12 percent permanent 

impairment of the left upper extremity.

In an undated letter received by OWCP on April 10, 2020, appellant asserted that she was 

experiencing right shoulder pain and attributed her pain to overuse of the right arm as her left arm 

was weak as a result of her accepted employment injuries.

In an April 13, 2020 development letter, OWCP requested that appellant submit additional 

factual and medical information in support of her claim for a consequential right shoulder 

condition, including a reasoned opinion from her physician explaining how a new condition 

resulted from, or was a consequence of, her accepted June 14, 2016 employment injury. It afforded

her 30 days to submit the requested information.

On April 22, 2020 the employing establishment contended that, beginning October 28, 

2017, appellant worked as a supervisor and that there were no duty requirements of this position 

which could cause a secondary right shoulder condition.

Appellant responded to OWCP’s development letter on June 6, 2020 and asserted that her 

left shoulder had not healed, that she had always relied more on her right arm, and that she reported 

her right arm condition on April 10, 2020. She alleged that her right arm symptoms began on 

April 7, 2020 and listed her duties at that time as restarting computers, looking for packages, and 

replacing ink cartridges. Appellant noted that her current supervisory duties required her to input 

data, use a long extended metal pole, ladders, hampers, rolling equipment, and platforms and to 

move printers and tables. In her previous supervisory position, she delivered mail to carriers, 

moved parcels, and loaded vehicles with packages which she then distributed to carriers. 

Appellant also provided photographs.

By decision dated July 8, 2020, OWCP modified its prior decision to include an increased 

payrate for schedule award purposes. By separate decision of even date, OWCP corrected

appellant’s pay rate for schedule award purposes and found she had 12 percent permanent 

impairment of the left upper extremity.
3

On July 2, 2020 Dr. Braden L. Dunbar, an osteopath, diagnosed right rotator cuff tear and 

opined that this condition “could be potentially caused from overuse at work.”

By decision dated July 15, 2020, OWCP denied expansion of appellant’s claim to include 

a consequential injury of the right shoulder.

In a May 28, 2020 note, Dr. Robert F. Greiner II, an osteopath, reported that appellant had 

developed right shoulder pain at work with no specific injury. He recounted that she attributed her 

right shoulder condition to lifting and overhead work. Dr. Greiner reviewed a right shoulder 

magnetic resonance imaging (MRI) scan and diagnosed traumatic incomplete tear of the 

supraspinatus tendon of the right rotator cuff and impingement syndrome of the right shoulder. He 

evaluated appellant’s left shoulder in notes dated April 8 and June 3, 2020.

On November 16, 2020 appellant, through counsel, requested reconsideration of the 

July 15, 2020 decision. She submitted a September 2, 2020 report from Dr. Kimberly M. Davies, 

an internist, detailing treatment of her left shoulder. Dr. Davies noted on May 11, 2020 that 

appellant sought care due to bilateral shoulder pain and that her right shoulder MRI scan 

demonstrated tearing of the supraspinatus tendon. She noted that she “was unable to do a full 

examination of the R shoulder due to the extensive tearing demonstrated on the MRI.” Dr. Davies

went on to opine that “[i]t is my clinical estimation that the injury of the R shoulder is related to 

overcompensation of the R side due to tearing and injury on the L side, thus work related.”

Appellant also submitted a May 15, 2020 right shoulder MRI scan and a November 5, 2020 

cervical spine MRI scan. She resubmitted Dr. Greiner’s notes dated April 8 through June 3, 2020.

In a note dated October 20, 2020, Dr. Daniel C. Farrell, a Board-certified orthopedic 

surgeon, examined appellant due to left shoulder pain and diagnosed tendinopathy of the left 

biceps, impingement syndrome left shoulder, and left cervical radiculopathy.

By decision dated January 26, 2021, OWCP denied modification of its prior decision. It 

did not mention or discuss Dr. Davies’ September 2, 2020 report.

On March 1, 2021 appellant, through counsel, requested reconsideration. She contended 

that OWCP failed to consider Dr. Davies’ September 2, 2020 report.

By decision dated April 8, 2021, OWCP denied modification of its prior decisions. It found 

that Dr. Davies’reportwas insufficient to meet appellant’s burden of proof as she failed to provide 

sufficient medical history and rationale explaining how overuse resulted in the diagnosed right 

shoulder conditions.
4

LEGAL PRECEDENT

Where an employee claims that a condition not accepted or approved by OWCP was due 

to an employment injury, he or she bears the burden of proof to establish that the condition is 

causally related to the employment injury.4

The claimant bears the burden of proof to establish a claim for a consequential injury.5 As 

part of this burden, he or she must present rationalized medical opinion evidence, based on a 

complete factual and medical background, establishing causal relationship.6 The opinion of the 

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

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

accepted employment injury.7

When an injury arises in the course of employment, every natural consequence that flows 

from that injury likewise arises out of the employment, unless it is the result of an independent 

intervening cause attributable to a claimant’s own intentional misconduct.8 Thus, a subsequent 

injury, be it an aggravation of the original injury or a new and distinct injury, is compensable if it 

is the direct and natural consequence of a compensable primary injury.9

ANALYSIS

The Board finds that appellant has not met her burden of proof to establish an expansion 

of her claim to include a right shoulder condition as a consequence of, or causally related to, the 

accepted June 14, 2016 employment injuries.

In a September 2, 2020 report, Dr. Davies recounted appellant’s medical history and noted 

her right shoulder injury was due to overcompensation of the right side as a result of her accepted 

left shoulder conditions. She did not, however, explain physiologically how the accepted 

employment injuries resulted in the diagnosed right shoulder condition. The Board has held that 

medical evidence that states a conclusion, but does not offer a rationalized medical explanation 

4

See C.M., Docket No. 20-1384 (issued October 6, 2021); R.R.,Docket No. 19-0086 (issued February 10, 2021); 

K.T., Docket No. 19-1718 (issued April7, 2020); JajaK. Asaramo, 55 ECAB 200 (2004).

5

S.S., Docket No. 21-1140 (issued June 29, 2022); V.K.,Docket No. 19-0422 (issued June10, 2020); A.H., Docket 

No. 18-1632 (issued June 1, 2020); I.S., Docket No. 19-1461 (issued April30, 2020).

6 F.A., Docket No. 20-1652 (issued May 21, 2021); E.M., Docket No. 18-1599 (issued March 7, 2019); Victor J. 

Woodhams, 41 ECAB 345 (1989).

7 M.M.,Docket No. 20-1557 (issued November 3, 2021); M.V.,Docket No. 18-0884 (issued December 28, 2018).

8

See S.M., Docket No. 19-0397 (issued August 7, 2019); Mary Poller, 55 ECAB 483, 487 (2004).

9 A.T., Docket No. 18-1717 (issued May 10, 2019); Susanne W. Underwood (RandallL. Underwood), 53 ECAB 

139 (2001).
5

regarding the cause of an employee’s condition is of limited probative value on the issue of causal 

relationship.10 Thus, Dr. Davies’ opinion is insufficient to meet appellant’s burden of proof.

On July 2, 2020 Dr. Dunbar diagnosed right rotator cuff tear and opined that this condition 

was potentially caused by overuse at work. The Board finds that his opinion that appellant’s right 

shoulder condition “could be potentially caused from overuse at work” is speculative in nature.11 

Medical opinions that are speculative or equivocal in character are of diminished probative value. 12 

Accordingly, Dr. Dunbar’s opinion is insufficient to establish appellant’s claim.

13

Dr. Greiner completed notes on May 28, 2020 and recounted that appellant attributed her 

right shoulder condition to lifting and overhead work. 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 medical evidence from Dr. Greiner is insufficient to establish 

that appellant’s claim should be expanded to include the requested additional conditions.

Appellant also submitted a May 15, 2020 right shoulder MRI scan and a November 5, 2020 

cervical spine MRI scan. The Board has held, however, that diagnostic studies, standing alone, 

lack probative value as they do not provide an opinion on causal relationship between an 

employment injury, and a diagnosed condition.15

Appellant has not submitted rationalized medical evidence establishing that she sustained 

additional conditions causally related to, or as a consequence of, her accepted June 14, 2016

employment injury and, therefore, has not met her burden of proof. 16

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.

10 See R.B., Docket No. 22-0173 (issued July 26, 2022); A.P., Docket No. 20-1668 (issued March2, 2022); D.S.,

Docket No. 21-0673 (issued October 10, 2021) P.J., Docket No. 18-1738 (issued May 17, 2019); D.H., Docket No. 

17-1913 (issued December 13, 2018).

11 See P.D., Docket No. 18-1461 (issued July 2, 2019); E.B., Docket No. 18-1060 (issued November 1, 2018); 

LeonardJ. O’Keefe, 14 ECAB 42 (1962).

12 S.S., supra note 5; D.B., Docket No. 18-1359 (issued May 14, 2019); Ricky S. Storms, 52 ECAB 349 (2001) 

(while the opinion of a physician supporting causal relationship need not be one of absolute medical certainty, the 

opinion must not be speculative or equivocal. The opinion should be expressed in terms of a reasonable degree of 

medical certainty).

13 See S.S., Docket No. 21-0837 (issued November 23, 2021).

14 See T.L., Docket No. 21-0224 (issued February 22, 2022); J.H., Docket No. 19-0838 (issued October 1, 2019); 

S.G., Docket No. 19-0041 (issued May 2, 2019); L.B., Docket No. 18-0533 (issued August 27, 2018); D.K., Docket 

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

15 S.S., supra note 5; M.E.,Docket No. 18-0940 (issued June 11, 2019); V.J., Docket No. 17-0358 (issued July 24, 

2018); JohnW. Montoya, 54 ECAB 306 (2003).

16 A.P., supra note 10; G.M.,Docket No. 19-0933 (issued October 1, 2019).
6

CONCLUSION

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

should expand her claim to include a consequential right shoulder condition as causally related to 

the accepted June 14, 2016 employment injuries.

ORDER

IT IS HEREBY ORDERED THAT the April 8, 2021 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: November 22, 2022

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

James D. McGinley, Alternate Judge

Employees’ Compensation Appeals Board