United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

H.K., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Manorville, NY, Employer

__________________________________________

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Docket No. 23-0739

Issued: September 27, 2023

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

JANICE B. ASKIN, Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On April 28, 2023 appellant filed a timely appeal from an April 4, 2023 merit decision 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 right upper 

extremity condition causally related to the accepted October 17, 2022 employment incident.

FACTUAL HISTORY

On October 18, 2022 appellant, then a 52-year-old rural carrier associate, filed a traumatic 

injury claim (Form CA-1) alleging that on October 17, 2022 she sustained injuries to her right 

1

5 U.S.C. § 8101 et seq.
2

shoulder and upper arm delivering mail while in the performance of duty. She stopped work on 

October 18, 2022. 

In an October 18, 2022 note, Dr. Maria Vesey, a family medicine specialist, noted an 

October 17, 2022 date of injury and diagnosed bursitis of right shoulder. She replied “Yes” to the 

question of whether the incident was the probable medical cause of the injury. 

In an undated attending physician’s report, Part B of an authorization for examination 

and/or treatment (Form CA-16), Dr. Syed Maqsood, an osteopath and internal medicine specialist, 

reported that he examined appellant on October 18, 2022 for pain in right shoulder after repetitive 

motion of delivering packages and mail. He diagnosed subacromial bursitis of right shoulder and 

indicated with a checkmark “Yes” that the diagnosed condition was caused or aggravated by the 

described employment activity. In an October 21, 2022 duty status report (Form CA-17),

Dr. Maqsood noted a date of injury of October 17, 2022 and diagnosed subacromial bursitis of 

right shoulder. He opined that appellant was temporarily totally disabled. In an October 21, 2022 

note, Dr. Maqsood held her off work for three days for the diagnosed right shoulder bursitis. 

In an October 24, 2022 report, Dr. Rasel Rana, an osteopathic physician and Boardcertified orthopedic surgeon, noted the history of the October 17, 2022 work injury and her medical 

course. He noted examination findings and provided assessments of right shoulder conditions of 

calcific tendinitis, bursitis, impingement syndrome, and rotator cuff tear arthropathy. Dr. Rana 

opined that appellant was totally disabled. In separate notes dated October 24, 2022, he referred 

herto physical therapy and for a right shoulder magnetic resonance imaging (MRI) scan. Dr. Rana 

also opined that appellant was temporarily disabled for two months. 

Physical therapy reports were also received. 

An October 31, 2022 MRI scan of appellant’s right shoulder indicated prominent fullthickness tear involving the majority of supraspinatus insertion, mild-to-moderate infraspinatus 

tendinosis with shallow articular-sided tearing anteriorly, and moderate acromial joint arthrosis 

and mild subacromial/subdeltoid bursitis. 

In a November 14, 2022 report, Dr. Rana reviewed the MRI scan report and presented 

examination findings. He continued to provide right shoulder assessments of bursitis, calcific 

tendinitis, impingement syndrome, and rotator cuff tear arthropathy of right shoulder and opine 

that appellant was totally disabled. Dr. Rana recommended surgical treatment as she failed 

conservative care. 

In a December 17, 2022 attending physician’s report (Form CA-20), Dr. Rana opined, after

checking a box marked “Yes,”that the diagnosed rotator cuff tear, bursitis, impingement syndrome 

and calcific tendinitis of right shoulder were causally related to the October 17, 2022 work injury 

as carrying and delivering mail can cause shoulder issues. He further opined that appellant had

been totally disabled since October 24, 2022 pending surgery authorization and postoperation 

reevaluation. 

In a December 23, 2022 development letter, OWCP informed appellant of the deficiencies 

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

questionnaire for her completion. OWCP afforded appellant 30 days to respond. 
3

On January 5, 2023 appellant responded to OWCP’s development questionnaire, 

describing her history of injury and treatment. She reported that she had not sustained any other 

injury and had no history of prior right arm/shoulder pain. 

On January 5, 2023 OWCP received Dr. Rana’s November 16, 2022 addendum report. 

Dr. Rana opined that appellant’s history, physical examination and radiographic findings were 

compatible with shoulder injuries sustained after repetitive lifting, overhead reaching, etc. 

In a January 4, 2023 Form CA-20, Dr. Rana checked a box marked “Yes” and opined that 

the diagnoses of rotator cuff tear, bursitis, impingement syndrome and calcific tendinitis of right 

shoulder were causally related to the October 17, 2022 work injury as heavy lifting/carrying (such 

as in delivering mail/packages) could cause the shoulder issues. He continued to note that 

appellant has been totally disabled since October 24, 2022 pending surgery authorization and 

postoperation reevaluation. 

In a January 16, 2023 duty status report (Form CA-17), Dr. Rana diagnosed right rotator

cuff tear due to the October 17, 2022 injury. He opined that appellant could resume part-time work 

for four hours per day. In a separate note, Dr. Rana referred her to physical therapy. 

By decision dated January 24, 2023, OWCP denied appellant’s traumatic injury claim, 

finding that the evidence of record was insufficient to establish that her medical condition was

causally related to the accepted October 17, 2022 employment incident. It concluded, therefore, 

that the requirements had not been met to establish an injury and/or medical condition.

OWCP subsequently received additional reports from Dr. Rana. In his January 16, 2023 

report, Dr. Rana indicated that appellant could return to part-time, light-duty work with restrictions 

on June 23, 2023. On February 6, 2023 he reported that she could return to full-duty work, with 

no restrictions as of February 7, 2023. In a February 17, 2023 report, Dr. Rana indicated that 

appellant presented to his office on October 24, 2022 and reported onset of her right shoulder 

symptoms on October 17, 2022 following work as a rural carrier. He presented examination 

findings and diagnosed right shoulder rotator cuff tear, right shoulder impingement syndrome, 

right shoulder subacromial and subdeltoid bursitis, right shoulder AC joint arthrosis, and right 

shoulder calcific tendinitis. Dr. Rana opined that appellant’s history, physical examination, and 

radiographic findings were compatible with work-related injury and that her right shoulder 

injuries/conditions were causally related and/or aggravated by the October 17, 2022 work injury.

He noted that she did not report a specific injury or trauma to her right shoulder and indicated that 

repetitive lifting can injure and damage rotator cuff tendon. 

On February 21, 2023 appellant requested reconsideration. 

By decision dated April 4, 2023, OWCP denied modification of its prior decision. 
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LEGAL PRECEDENT

An employee seeking benefits under FECA2 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,3that 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.4 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.5

To determine whether an 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 at the time and

place, and in the manner alleged.6 The second component is whether the employment incident 

caused a personal injury.7

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

condition and an employment incident is rationalized medical opinion evidence. 8 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 incident 

identified by the employee.9

In any case where a preexisting condition involving the same part of the body is present 

and the issue of causal relationship, therefore, involves aggravation, acceleration or precipitation, 

2

Id.

3

S.S., Docket No. 19-1815 (issued June26, 2020); S.B., Docket No. 17-1779 (issued February 7, 2018); JoeD. 

Cameron, 41 ECAB 153 (1989).

4 M.H., Docket No. 19-0930 (issued June 17, 2020); R.C., 59 ECAB 427 (2008); James E. Chadden, Sr., 40 ECAB 

312 (1988).

5

S.A., Docket No. 19-1221 (issued June9, 2020); L.M., Docket No. 13-1402 (issued February 7, 2014);DeloresC. 

Ellyett, 41 ECAB 992 (1990).

6 R.K., Docket No. 19-0904 (issued April 10, 2020); Elaine Pendleton, 40 ECAB 1143 (1989).

7 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).

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 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).
5

the physician must provide a rationalized medical opinion that differentiates between the effects 

of the work-related injury or disease and the preexisting condition.10

ANALYSIS

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

extremity condition causally related to the accepted October 17, 2022 employment incident.

Dr. Vesey and Dr. Maqsood reported an October 17, 2022 date of injury and diagnosed 

right shoulder bursitis. While both physicians indicated with a checkmark “Yes” that there was 

causal relationship, they did not explain how the right shoulder bursitis was physiologically related 

to the October 17, 2022 incident. Rather, they failed to explain the physiological process by which 

the October 17, 2022 work incident caused or aggravated the diagnosed conditions. Medical 

conclusions lacking rationale are of diminished probative value.11 As such, the reports from

Dr. Vesey and Dr. Maqsood fail to establish appellant’s claim.

Appellant submitted several reports from Dr. Rana. Dr. Rana noted the history of the 

October 17, 2022 work injury and provided assessments of right shoulder conditions of calcific 

tendinitis, bursitis, impingement syndrome, and rotator cuff tear arthropathy. In his reports of 

October 24 and November 14, 2022 and January 16 and February 6, 2023, he did not provide an 

opinion regarding causal relationship between the accepted employment incident and appellant’s 

diagnosed conditions. The Board has held that a report is of no probative value if it does not 

provide an opinion on causal relationship.12 As such, these reports from Dr. Rana are insufficient 

to establish appellant’s claim.

In a November 16, 2022 addendum report, and in reports dated December 17, 2022 and

January 4 and February 17, 2023, Dr. Rana opined that carrying/delivering mail and repetitive 

lifting “can cause” or “could cause” the shoulder conditions. He noted, in his February 17, 2023 

report, that appellant did not report a specific injury or trauma to her right shoulder and indicated 

that repetitive lifting can injure and damage rotator cuff tendon. However, Dr. Rana did not 

explain which diagnoses related to the October 17, 2022 work incident and which were preexisting 

conditions. A rationalized medical opinion is especially necessary in light of appellant’s 

preexisting condition of calcific tendinitis.13 Dr. Rana provided only a conclusory opinion 

regarding causal relationship and failed to explain the physiological process by which the 

October 17, 2022 work incident caused or aggravated the diagnosed conditions. Medical 

10 Federal (FECA) Procedure Manual, Part 2 -- Claims, Causal Relationship, Chapter 2.805.3e 

(January2013); M.B., Docket No. 20-1275 (issued January 29, 2021); R.D., Docket No. 18-1551 (issued 

March 1, 2019).

11 See H.L., Docket N. 22-1058 (issued January 18, 2023);F.C.,Docket No. 19-1267 (issued December 20, 2019);

T.A., Docket No. 18-0431 (issued November 7, 2018).

12 See G.D., Docket No. 20-0966 (issued July 21, 2022);A.H.,Docket No. 18-1632 (issued June 1, 

2020); L.B., Docket No. 18-0533 (issued August 27, 2018); D.K., Docket No. 17-1549 (issued July 6, 2018).

13 See H.L., supra note 11; J.H.,Docket No. 19-0838 (issued October 1, 2019);D.M.,Docket No. 19-0389 (issued 

July 16, 2019).
6

conclusions lacking rationale are of diminished probative value.14 As such, Dr. Rana’s additional 

reports are insufficient to establish appellant’s claim.

Appellant also submitted an October 31, 2022 right shoulder MRI scan report which 

diagnosed several right shoulder conditions. The Board has held that diagnostic tests, standing 

alone, lack probative value on the issue of causal relationship as they do not address the 

relationship between the accepted employment factors and a diagnosed condition. 15 For this 

reason, the MRI scan report is insufficient to meet appellant’s burden of proof.

OWCP also received reports from a physical therapist. Certain healthcare providers such 

as physical therapists, nurses, physician assistants, and social workers are not considered 

physicians as defined under FECA. Consequently, their medical findings and/or opinions will not 

suffice for purposes of establishing entitlement to FECA benefits. 16

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

diagnosed condition and the accepted October 17, 2022 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(a) 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 right upper 

extremity condition causally related to the accepted October 17, 2022 employment incident.17

14 See F.C., Docket No. 19-1267 (issued December 20, 2019); T.A., Docket No. 18-0431 (issued 

November 7, 2018).

15 See L.S., Docket No. 22-0023 (issued March 1, 2023); W.M., Docket No. 19-1853 (issued May 13, 2020);L.F., 

Docket No. 19-1905 (issued April 10, 2020).

16 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 supra note 10 at Chapter 2.805.3a(1) (January2013);

David P. 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 T.S.,Docket No. 20-1229 (issued 

August 6, 2021); F.H., Docket No. 18-0160 (issued August 23, 2019) (physical therapists are not considered 

physicians as defined under FECA); J.L.,Docket No. 17-1207 (issued December 8, 2017) (physical therapists are not 

considered physicians under FECA).

17 The Board notes that the employing establishment executed a Form CA-16. A completed Form CA-16

authorization may constitute a contract for payment of medical expenses to a medical facility or physician, when 

properly executed. The form creates a contractual obligation, which does not involve the employee directly, to pay 

for the cost of the examination or treatment regardless of the action taken on the claim. See 20 C.F.R. 

§ 10.300(c); S.G., Docket No. 23-0552 (issued August 28, 2023); J.G., Docket No. 17-1062 (issued February 13, 

2018); Tracy P. Spillane, 54 ECAB 608 (2003).
7

ORDER

IT IS HEREBY ORDERED THAT the April 4, 2023 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: September 27, 2023

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