United States Department of Labor
Employees’ Compensation Appeals Board
__________________________________________
L.W., Appellant
and
U.S. POSTAL SERVICE, POST OFFICE,
San Diego, CA, Employer
__________________________________________

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Appearances:
Appellant, pro se
Office of Solicitor, for the Director

Docket No. 21-0136
Issued: March 28, 2022

Case Submitted on the Record

DECISION AND ORDER
Before:
ALEC J. KOROMILAS, Chief Judge
JANICE B. ASKIN, Judge
VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION
On November 2, 2020 appellant filed a timely appeal from an October 8, 2020 merit
decision of the Office of Workers’ Compensation Programs (OWCP). 1 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
On November 2, 2020 appellant also filed an appeal from a purported October 1, 2020 decision of OWCP.
However, the October 1, 2020 document is a proposed termination notice rather than a final decision of OWCP. The
only final adverse decision over which the Board may exercise jurisdiction is the October 8, 2020 merit decision. See
20 C.F.R. §§ 501.2(c) and 501.3.
2
3

5 U.S.C. § 8101 et seq.

The Board notes that, following the October 8, 2020 decision, appellant submitted additional evidence to OWCP
and on appeal to the Board. 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 f inal 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.

ISSUE
The issue is whether appellant has met her burden of proof to establish permanent
impairment of a scheduled member or function of the body, warranting a schedule award.
FACTUAL HISTORY
This case has previously been before the Board. 4 The facts and circumstances of the case
as set forth in the Board’s prior decision are incorporated herein by reference. The relevant facts
are as follows.
On April 24, 2013 appellant, then a 31-year-old automation clerk, filed a traumatic injury
claim (Form CA-1) alleging that on April 14, 2013 she sustained an injury to her neck and back
area when she engaged in reaching and lifting duties while in the performance of duty.5 She
stopped work on April 22, 2013. OWCP accepted that appellant sustained aggravation of
preexisting cervical spondylosis and paid appellant wage-loss compensation for disability from
work commencing April 22, 2013 on the supplemental rolls and commencing December 15, 2013
on the periodic rolls.
On January 15, 2015 appellant filed a claim for compensation (Form CA-7) for a schedule
award due to her accepted April 14, 2013 employment injury. In support of her claim, she
submitted an October 28, 2014 report in which Dr. Jonathan Nissanoff, a Board-certified
orthopedic surgeon, determined that she had a 30 percent “combined whole person impairment
rating.”
By decision dated March 11, 2015, OWCP denied appellant’s claim for a schedule award.
By decision dated October 22, 2015, OWCP denied modification of the March 11, 2015
decision. On April 7, 2016 appellant requested reconsideration and submitted additional evidence.
By decision dated April 14, 2016, OWCP denied her request for reconsideration of the merits of
her claim pursuant to 5 U.S.C. § 8128(a).

4

Docket No. 15-1437 (issued May 9, 2016).

5

Based on the description of injury, appellant’s claim was converted to an occupational disease claim (Form CA-2)
because the employment activities occurred over a period longer than one workday or shift. A traumatic injury refers
to injury caused by a specific event or incident or series of incidents occurring within a single workday or work shift,
whereas an occupational disease refers to an injury produced by employment over a period longer than a single workday
or shift. 20 C.F.R. §§ 10.5(q), (ee), respectively; R.V., Docket No. 18-1037 (issued March 26, 2019); Brady L. Fowler,
44 ECAB 343, 351 (1992).

2

Appellant also appealed to the Board and, by decision dated May 9, 2016, 6 the Board
affirmed the decision. 7
In a July 25, 2018 report, Dr. Kamshad Raiszadeh, a Board-certified orthopedic surgeon,
determined that appellant had zero percent permanent impairment of the upper extremities
stemming from the cervical spine. He noted that, although an electromyogram/nerve conduction
velocity (EMG/NCV) study suggested mild carpal tunnel syndrome and an ulnar condition, there
was no frank neurologic evidence of either condition upon which to rate a diagnosis-based
impairment. Dr. Raiszadeh referenced symptoms of pain in appellant’s wrists and found one
percent permanent impairment of each upper extremity due to the reported symptoms by utilizing
Table 15-2 (Wrist Regional Guide) on page 395 of the sixth edition of the American Medical
Association, Guides to the Evaluation of Permanent Impairment (A.M.A., Guides).8
In an October 22, 2018 report, Dr. David M. Kupfer, a Board-certified orthopedic surgeon,
indicated that appellant had a history of bilateral carpal tunnel syndrome and left ulnar neuropathy.
A February 15, 2019 EMG/NCV study found no sensory or motor findings emanating from the
cervical spine. The study revealed mild findings in the ulnar and median nerves.
On April 17, 2019 OWCP referred appellant’s medical record to Dr. Herbert White, a
Board-certified orthopedic surgeon serving as an OWCP district medical adviser (DMA). It
requested an opinion on permanent impairment utilizing The Guides Newsletter, Rating Spinal
Nerve Extremity Impairment Using the Sixth Edition (July/August 2009) (The Guides Newsletter),
which is a supplemental publication of the sixth edition of the A.M.A., Guides. In an April 22,
2019 report, Dr. White discussed the diagnostic testing of record and opined that there was no
evidence of compression of the cervical spine. He concluded that, under The Guides Newsletter,
there was no spinal nerve root abnormality that would result in a ratable upper extremity
impairment.
On May 7, 2019 OWCP referred appellant, along with a statement of accepted facts
(SOAF) and series of questions, for a second opinion examination and evaluation with Dr. Jon P.
Kelly, a Board-certified orthopedic surgeon. It requested an opinion on permanent impairment
utilizing The Guides Newsletter. In a July 17, 2019 report, Dr. Kelly discussed appellant’s factual
and medical history and reported the findings of the physical examination he conducted on that
date. He noted atypical and equivocal medical findings without regard to any true ulnar or carpal
tunnel condition. Dr. Kelly reported that appellant exhibited normal upper extremity sensory and
motor findings. 9 He indicated that she had subjective complaints of possible radicular symptoms
of the upper extremities, but advised that the diagnostic testing of record, including a magnetic
6

Supra note 4.

7

Appellant also appealed January 2 and 27 and June 8, 2015 merit decisions of OWCP, which the Board affirmed
in its May 9, 2016 decision, but the subject matters of these decisions are not currently before the Board.
8

A.M.A., Guides (6 th ed. 2009).

9

Dr. Kelly indicated that appellant had reached maximum medical improvement (MMI) by the date of his
examination.

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resonance imaging (MRI) scan of the cervical spine, did not demonstrate evidence of neural
impingement. Dr. Kelly determined that, therefore, appellant did not have a ratable permanent
impairment of the upper extremities under the sixth edition of the A.M.A., Guides and The Guides
Newsletter.
On August 28, 2019 OWCP again referred appellant’s case to Dr. White in his capacity as
a DMA. In a September 10, 2019 report, Dr. White found that she did not have a ratable permanent
impairment of the upper extremities. He expressed his agreement with the conclusions of
Dr. Kelly.
By decision dated September 16, 2019, OWCP denied appellant’s schedule award claim,
finding that she did not meet her burden of proof to establish permanent impairment of a scheduled
member or function of the body.
On October 14, 2019 appellant requested an oral hearing before a representative of
OWCP’s Branch of Hearings and Review. During the hearing, held on February 12, 2020, she
argued that she had permanent impairment of her upper extremities due to bilateral carpal tunnel
syndrome and a cubital tunnel condition.
Appellant submitted additional medical evidence, including September 19 and 30, 2019
reports from Dr. Kupfer who diagnosed cervical disc disorder with radiculopathy, history of
bilateral carpal tunnel syndrome, and left ulnar radiculopathy at the cubital tunnel with intermittent
ulnar nerve subluxation.
By decision dated April 28, 2020, OWCP’s hearing representative affirmed the
September 16, 2019 decision, finding that appellant failed to establish an upper extremity
impairment emanating from the cervical spine.
On July 10, 2020 appellant requested reconsideration of the April 28, 2020 decision.
Appellant submitted additional medical evidence, including May 19 and June 4, 2020
reports from Dr. Enass Rickards, a Board-certified orthopedic surgeon. In these reports,
Dr. Rickards diagnosed bilateral carpal tunnel syndrome and left ulnar nerve lesion. A June 1,
2020 EMG/NCV study showed a left ulnar neuropathy with conduction block between the elbow
and wrist.
On July 16, 2000 OWCP referred appellant, along with an updated SOAF and a series of
questions, for a second opinion examination and evaluation with Dr. William P. Curran, a Boardcertified orthopedic surgeon. It requested that he provide an opinion on whether she continued to
have residuals of her accepted April 22, 2013 employment injury.
In a September 1, 2020 report, Dr. Curran discussed appellant’s factual and medical history
and reported the findings of the physical examination he conducted on that date. He noted that the
cervical compression test he conducted was negative and that she did not exhibit spasms in her
cervical spine. The Phalen’s test was positive in both wrists. Dr. Curran diagnosed, inter alia,
cervical strain, and clinical and electrical evidence of left cubital tunnel syndrome. He opined that

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the June 1, 2020 EMG/NCV study of appellant’s upper extremities was negative for bilateral
carpal tunnel syndrome and he found no objective findings of the accepted condition of cervical
spondylosis. Dr. Curran noted that the most recent cervical MRI scan, dated March 8, 2019, was
entirely within normal limits. He found evidence of a left cubital tunnel syndrome, which caused
numbness, tingling, and weakness of digits four and five of the left hand , but indicated that this
was a nonindustrial condition. Dr. Curran advised that appellant had reached MMI.
By decision dated October 8, 2020, OWCP denied modification of the April 28, 2020
decision.
LEGAL PRECEDENT
The schedule award provisions of FECA 10 and its implementing regulations11 set forth the
number of weeks of compensation payable to employees sustaining permanent impairment from
loss, or loss of use, of scheduled members or functions of the body. However, FECA does not
specify the manner in which the percentage of loss shall be determined. For consistent results and
to ensure equal justice under the law to all claimants, OWCP has adopted the A.M.A., Guides as
the uniform standard applicable to all claimants. 12 As of May 1, 2009, the sixth edition of the
A.M.A., Guides is used to calculate schedule awards. 13
Neither FECA nor its implementing regulations provide for the payment of a schedule
award for the permanent loss of use of the back/spine or the body as a whole. 14 However, a
schedule award is permissible where the employment-related spinal condition affects the upper
and/or lower extremities. 15 The sixth edition of the A.M.A., Guides (2009) provides a specific
methodology for rating spinal nerve extremity impairment in The Guides Newsletter, which is a
supplemental publication of the sixth edition of the A.M.A., Guides. It was designed for situations
where a particular jurisdiction, such as FECA, mandated ratings for extremities and precluded
ratings for the spine. The FECA-approved methodology is premised on evidence of radiculopathy
affecting the upper and/or lower extremities. The appropriate tables for rating spinal nerve
extremity impairment are incorporated in the Federal (FECA) Procedure Manual. 16

10

5 U.S.C. § 8107.

11

20 C.F.R. § 10.404.

12

Id. See also T.T., Docket No. 18-1622 (issued May 14, 2019).

13

Federal (FECA) Procedure Manual, Part 2 -- Claims, Schedule Awards and Permanent Disability Claims, Chapter
2.808.5a (March 2017); id. at Chapter 3.700.2 and Exhibit 1 (January 2010).
14

5 U.S.C. § 8107(c); 20 C.F.R. § 10.404(a) and (b); see A.G., Docket No. 18-0815 (issued January 24, 2019);
Jay K. Tomokiyo, 51 ECAB 361, 367 (2000).
15

Supra note 13 at Chapter 2.808.5c(3) (March 2017).

16

Supra note 13 at Chapter 3.700, Exhibit 4 (January 2010).

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ANALYSIS
The Board finds that appellant has not met her burden of proof to establish permanent
impairment of a scheduled member or function of the body, warranting a schedule award.
In his July 17, 2019 report, Dr. Kelly discussed appellant’s factual and medical history and
reported the findings of the physical examination he conducted on that date. He noted atypical
and equivocal medical findings without regard to any true ulnar o r carpal tunnel condition.
Dr. Kelly reported that appellant exhibited normal upper extremity sensory and motor findings.
He indicated that she had subjective complaints of possible radicular symptoms of the upper
extremities, but advised that the diagnostic testing of record, including an MRI scan of the cervical
spine, did not demonstrate evidence of neural impingement. Dr. Kelly determined that, therefore,
appellant did not have a ratable permanent impairment of the upper extremities under the sixth
edition of the A.M.A., Guides. Moreover, Dr. White, a DMA, found in a September 10, 2019
report that she did not have a ratable permanent impairment of the upper extremities. Dr. White
expressed his agreement with the conclusions of Dr. Kelly.17
Appellant has not submitted probative medical evidence establishing ratable permanent
impairment of the upper extremities. The Board has held that an opinion on permanent impairment
is of little probative value if it is not derived in accordance with the standards adopted by OWCP
and approved by the Board as appropriate for evaluating schedule losses. 18
Appellant submitted a July 25, 2018 report from Dr. Raiszadeh who referenced symptoms
of pain in her wrists and found one percent permanent impairment of each upper extremity due to
the reported symptoms by utilizing Table 15-2 on page 395 of the sixth edition of the A.M.A.,
Guides.19 However, OWCP has not accepted an employment-related wrist condition. Moreover,
Dr. Raiszadeh’s report is of little probative value because he has not adequately explained how the
employment-related conditions resulted in a ratable impairment under the A.M.A., Guides.20 In
addition, he acknowledged in the same report that appellant had zero percent permanent
impairment of the upper extremities stemming from her cervical spine. Dr. Raiszadeh also noted
that, although an EMG/NCV study suggested mild carpal tunnel syndrome and an ulnar co ndition,
there was no frank neurologic evidence of either condition upon which to rate a diagnosis -based
impairment. The Board notes that neither of these conditions has been accepted by OWCP.
The Board finds that OWCP properly relied on the opinion of Dr. Kelly, an OWCP referral
physician, in denying appellant’s schedule award claim. Dr. Kelly’s comprehensive and well-

17
The Board notes that Dr. Curran, an OWCP referral physician, indicated in a September 1, 2020 report that he
found no objective findings of the accepted condition of cervical spondylosis. OWCP did not ask him to comment on
permanent impairment.
18

See N.A., Docket No. 19-0248 (issued May 17, 2019); James Kennedy, Jr., 40 ECAB 620, 626 (1989).

19

A.M.A., Guides (6 th ed. 2009).

20

See supra note 19.

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rationalized July 17, 2019 report constitutes the most recent assessment of her upper extremity
impairment and represents the weight of the medical evidence with respect to the matter.
Appellant may request a schedule award at any time based on evidence of a new exposure
or medical evidence showing progression of an employment-related condition resulting in
permanent impairment or increased impairment.
CONCLUSION
The Board finds that appellant has not met her burden of proof to establish permanent
impairment of a scheduled member or function of the body, warranting a schedule award.
ORDER
IT IS HEREBY ORDERED THAT the October 8, 2020 decision of the Office of
Workers’ Compensation Programs is affirmed.
Issued: March 28, 2022
Washington, DC

Alec J. Koromilas, Chief Judge
Employees’ Compensation Appeals Board

Janice B. Askin, Judge
Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge
Employees’ Compensation Appeals Board

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United States Department of Labor
Employees’ Compensation Appeals Board
__________________________________________
M.G., Appellant
and
DEPARTMENT OF HEALTH & HUMAN
SERVICES, Rockville, MD, Employer
__________________________________________

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Appearances:
Jeffrey P. Zeelander, Esq., for the appellant
Office of Solicitor, for the Director

Docket No. 10-1771
Issued: May 4, 2011

Case Submitted on the Record

DECISION AND ORDER
Before:
RICHARD J. DASCHBACH, Chief Judge
COLLEEN DUFFY KIKO, Judge
MICHAEL E. GROOM, Alternate Judge

JURISDICTION
On June 22, 2010 appellant, through his attorney, filed a timely appeal from a June 15,
2010 merit decision of the Office of Workers’ Compensation Programs. Pursuant to the Federal
Employees’ Compensation Act1 and 20 C.F.R. §§ 501.2(c) and 501.3, the Board has jurisdiction
over the merits of the schedule award decision.
ISSUE
The issue is whether appellant met her burden of proof to establish impairment greater
than the two percent previously awarded for her right lower extremity.
FACTUAL HISTORY
On June 23, 2008 appellant, then a 42-year-old management analyst, was injured when
her foot got caught in a chair runner and she twisted her right knee. The Office accepted the
claim for effusion of the right knee and authorized arthroscopic surgery which was performed on
1

5 U.S.C. §§ 8101-8193.

December 3, 2008. Appellant stopped work on June 23, 2008 and returned to full-time, regular
duty on July 7, 2008.
Appellant came under the treatment of Dr. Brett J. Hampton, a Board-certified orthopedic
surgeon, from June 24 to December 3, 2008, for the right knee twisting injury which occurred at
work. Dr. Hampton noted her history was significant for right knee arthroscopy in 2006. He
noted that plane, lateral and sunrise view x-rays revealed moderately severe tricompartmental
degenerative joint disease of the right knee. Dr. Hampton diagnosed right knee twisting injury
with contusion. A June 26, 2008 magnetic resonance imaging (MRI) scan of the right knee
revealed a large joint effusion with soft tissue swelling and degenerative joint disease which was
moderately severe. On December 3, 2008 Dr. Hampton performed right knee arthroscopy,
partial lateral meniscectomy, chondroplasty, chondral picking of the medial femoral condyle and
debridement of the medial synovial plica. He diagnosed grade 4 chondromalacia involving 50
percent of the femoral trochlea, multiple areas with unstable loose chondral flaps, multiple
marginal osteophytes and diffuse grade 3 chondromalacia involving entire lateral tibial plateau.
In reports dated December 11, 2008 and April 6, 2009, Dr. Hampton noted appellant was
progressing well postoperatively with some lateral knee pain and swelling. He diagnosed right
knee tricompartmental degenerative joint disease.
On November 4, 2009 appellant claimed a schedule award. She submitted an
October 20, 2009 report from Dr. Donald I. Saltzman, a Board-certified orthopedic surgeon, who
provided an impairment rating under the sixth edition of the American Medical Association,
Guides to the Evaluation of Permanent Impairment (A.M.A., Guides).2 Dr. Saltzman provided
examination findings for the right knee that included: full range of motion; no atrophy; good
strength; no medial or lateral knee instability; negative patellar grind; negative Lachman;
negative anterior and posterior drawer signs; no varus or valgus instability and some tenderness
in the medial femoral condylar area. He diagnosed right knee osteoarthritis, status post two
arthroscopic surgeries, chondromalacia of the patella and medial femoral condyle and status post
partial lateral meniscectomy. Dr. Saltzman noted appellant was at maximum medical
improvement. He advised that, in accordance with the sixth edition of the A.M.A., Guides, she
had zero percent impairment secondary to weakness, atrophy or instability on range of motion.
Using the Knee Regional Grid, appellant fell into two categories. For the partial meniscectomy,
she was a grade 2 which would yield two percent impairment of the right leg. Dr. Saltzman
further noted that appellant had underlying degenerative arthritis of the patellofemoral joint and
the tibiofemoral joint pursuant to the arthroscopic surgery and the patellofemoral changes were
described as full-thickness defect involving part of the patella but her symptomology would be
more in the moderate range or class 2. He noted that using various adjustment modifiers would
yield 14 percent impairment of the right leg combined with the 2 percent impairment for the
meniscectomy would yield a 16 percent right leg impairment.
In a May 7, 2010 report, Dr. Craig Uejo, Board-certified in occupational medicine and an
Office medical consultant, reviewed Dr. Saltzman’s report and opined that the objective findings
did not support his impairment rating. He noted that there were two possible diagnoses under the
Knee Regional Grid -- Lower Extremity Impairment, Table 16-3, page 509-11, of the A.M.A.,
2

A.M.A., Guides (6th ed. 2008).

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Guides. Dr. Uejo noted that page 499 of the A.M.A., Guides provides that, if more than one
diagnosis in a region can be used, the one that provides the most clinically accurate and causally
related impairment rating should be used. He noted that appellant was diagnosed with a partial
lateral meniscectomy and patellofemoral chondromalacia with a described full-thickness
articular cartilage defect. Dr. Saltzman noted that no specific joint space measurements were
provided from the patellofemoral joint and that there was no description of joint space narrowing
or full-thickness chondral defects. He noted that each diagnosis would be considered a class 1
rating due to the partial lateral meniscectomy and full-thickness chondral defect for the
patellofemoral joint. The class 1 rating range for a partial lateral meniscectomy was one to three
percent impairment and the patellofemoral full-thickness chondral defect under the arthritis
section was one to five percent impairment. Dr. Uejo opined that impairment under the arthritis
section yielded greater impairment and was appropriate.
The medical consultant noted that the most applicable rating for the chondromalacia
patella or patellofemoral arthritis was a class 1 severity, not a class 2 as noted by Dr. Saltzman
which he had based on her “symptomology.” Within the regional grids, the class of severity was
chosen based on the key facts outlined under each diagnostic class. In this case, a class 1 rating
definition for patellofemoral arthritis was “full-thickness articular cartilage defect … [or]
ununited osteochondral fracture.” Dr. Uejo noted that the more severe diagnostic classes for
patellofemoral arthritis require joint space narrowing with exact measurement values based on
radiographs which were not obtained by Dr. Saltzman. He noted that, using the section for
arthritis in Table 16-3, page 511 of the A.M.A., Guides, the diagnosis of full-thickness chondral
defect was a class 1 rating with a default score of three percent leg impairment. Dr. Uejo noted
that Section 16.3a, Adjustment Grid-Functional History and Table 16-6, Functional History
Adjustment -- Lower Extremities, page 516, appellant was a grade 1 modifier as her functional
history was consistent with a mild problem. He noted that Dr. Saltzman did not provide
significant detail regarding ongoing symptoms, including a limp or antalgic gait and prior
records did not document such a problem. Dr. Uejo noted that, under the Functional History
Adjustment Grid, without specific detail of gait problems the primary classification would be a
grade zero but, given the lack of information and giving the benefit of the doubt, a grade 1
modifier would be reasonable. He noted that, pursuant to the Adjustment Grid -- Physical
Examination, Table 16-7, appellant would be assigned a grade modifier of zero as the physical
examination was normal. Dr. Uejo noted that, under the Adjustment Grid -- Clinical Studies,
page 518, Table 16-8, Clinical Studies Adjustment -- Lower Extremities, page 519, appellant
was assigned a grade modifier of 1 as the clinical studies show degenerative knee changes. He
noted that the Diagnosis Class was one and, applying the net adjustment formula to the grade
modifiers yielded -1 which move the default grade C to B, for which two percent lower
extremity impairment is provided.
On June 15, 2010 appellant was granted a schedule award for two percent right leg
impairment. The period of the award was October 20 to November 29, 2009.

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LEGAL PRECEDENT
The schedule award provision of the Act3 and its implementing federal regulations4 set
forth the number of weeks of compensation payable to employees sustaining permanent
impairment from loss or loss of use, of scheduled members or functions of the body. However,
the Act does not specify the manner in which the percentage of loss shall be determined. For
consistent results and to ensure equal justice under the law for all claimants, the Office has
adopted the A.M.A., Guides as the uniform standard applicable to all claimants.5 For decisions
after February 1, 2001, the fifth edition of the A.M.A., Guides is used to calculate schedule
awards.6 For decisions issued after May 1, 2009, the sixth edition of the A.M.A., Guides will be
used.7
The sixth edition of the A.M.A., Guides provides a diagnosis-based method of evaluation
utilizing the World Health Organization’s International Classification of Functioning, Disability
and Health (ICF).8 Under the sixth edition, for lower extremity impairments, the evaluator
identifies the impairment class for the diagnosed condition (CDX), which is then adjusted by
grade modifiers based on functional history (GMFH), physical examination (GMPE) and clinical
studies (GMCS).9 The net adjustment formula is (GMFH - CDX) + (GMPE - CDX) + (GMCS CDX).10
Office procedures provide that, after obtaining all necessary medical evidence, the file
should be routed to the Office medical consultant for an opinion concerning the nature and
percentage of impairment in accordance with the A.M.A., Guides with the Office medical
consultant providing rationale for the percentage of impairment specified.11
ANALYSIS
The sixth edition of the A.M.A., Guides provides that lower extremity impairments be
classified by diagnosis which is then adjusted by grade modifiers according to the formula noted

3

5 U.S.C. § 8107.

4

20 C.F.R. § 10.404.

5

Id. at § 10.404(a).

6

Federal (FECA) Procedure Manual, Part 3 -- Medical, Schedule Awards, Chapter 3.700, Exhibit 4 (June 2003).

7

FECA Bulletin No. 09-03 (issued March 15, 2009).

8

Supra note 2 at 3, section 1.3, The International Classification of Functioning, Disability and Health (ICF): A
Contemporary Model of Disablement.
9

Id. at 494-531.

10

Id. at 521.

11

See Federal (FECA) Procedure Manual, Part 2 -- Claims, Schedule Awards and Permanent Disability Claims,
Chapter 2.808.6(d) (August 2002).

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above.12 Appellant’s accepted diagnosed conditions were effusion of the right knee joint and
partial lateral meniscectomy.
Appellant submitted an October 20, 2009 report from Dr. Saltzman who noted that she
sustained a 16 percent impairment of the right lower extremity under the A.M.A., Guides.
Dr. Saltzman opined that she was a grade 2 for the diagnosed partial meniscectomy and would be
entitled to two percent impairment of the lower extremity. He further noted that appellant was a
class 2 with “various modifiers” for a 14 percent impairment of the right lower extremity
pursuant to the A.M.A., Guides for the diagnoses of degenerative arthritis of the patellofemoral
joint and tibiofemoral joint described as a full-thickness defect. Dr. Saltzman combined the 2
percent impairment for the partial meniscectomy with the 14 percent impairment for the
patellofemoral arthritis for 16 percent impairment of the right leg. However, the Board notes
that it was unclear how Dr. Saltzman determined that appellant was a class 2 rating for
chondromalacia patella or patellofemoral arthritis pursuant to the A.M.A., Guides, as he failed to
note specific findings including measurements for joint space narrowing pursuant to radiographs,
rather, he merely noted class 2 was based on her “symptomology.”
Table 16-3, page 511 of the A.M.A., Guides provides that patellofemoral arthritis with a
full-thickness articular cartilage defect was a class 1 and that the more severe diagnostic classes
for patellofemoral arthritis for class 2 require joint space narrowing of one millimeter interval or
no cartilage interval pursuant to radiographs. In this instance, Dr. Saltzman did not provide these
x-ray findings to support his determination. Similarly, the A.M.A., Guides provide that, if more
than one diagnosis in a region can be used, the one that provides the most clinically accurate and
causally related impairment rating should be used and only one condition for each region can be
rated and the ratings for each diagnosis cannot be combined.13 Dr. Saltzman erroneously
combined the 2 percent impairment for the right lower extremity for the partial meniscectomy
with the 14 percent impairment for the patellofemoral arthritis for a 16 percent impairment of the
right lower extremity. He failed to provide a detailed narrative describing his evaluation to
explain how he applied grade modifiers for either of his diagnoses in accordance with the
A.M.A., Guides. The Board finds that Dr. Saltzman did not properly follow the A.M.A., Guides,
and an attending physician’s report is of little probative value where the A.M.A., Guides were
not properly followed.14
Dr. Uejo discussed the relevant tables under the sixth edition of the A.M.A., Guides. He
followed the assessment formula of the A.M.A., Guides and advised that, under the Knee
Regional Grid in Chapter 16, Table 16-3, there were two possible diagnoses that applied, a
partial lateral meniscectomy and patellofemoral chondromalacia with a described full-thickness
articular cartilage defect. Dr. Uejo explained why both diagnoses could not be combined under
the A.M.A., Guides, and opined that rating appellant’s patellofemoral chondromalacia of the
right knee under the section on arthritis in Table 16-3, for the diagnosis of full-thickness
12

Supra notes 9, 10.

13

Id. at 499.

14

See Paul R. Evans, Jr., 44 ECAB 646 (1993); John Constantin, 39 ECAB 1090 (1988) (medical report not
explaining how the A.M.A., Guides are utilized is of little probative value).

5

chondral defect was most appropriate as it would yield the most impairment. He noted that
appellant had a class 1 diagnosis, with a default rating of three percent impairment, as no specific
joint space measurements were provided for the patellofemoral joint or for the full-thickness
chondral defects.15 Dr. Uejo also noted that she did not qualify for the more severe diagnostic
classes for patellofemoral arthritis because no findings of joint space narrowing with exact
measurements based on radiographs were provided.
After determining the impairment class and default grade, Dr. Uejo determined whether
there were any applicable grade adjustments for so-called nonkey factors or modifiers. These
include adjustments for GMFH, GMPE and GMCS. The grade modifiers are used in the net
adjustment formula to calculate a net adjustment.16 The final impairment grade is determined by
adjusting the grade up or down from the default value C by the calculated net adjustment.
Dr. Uejo identified two modifiers; one based on the GMFH and the other based on GMCS. For
the functional history, he assigned a grade modifier 1 based on a history of a mild problem.
Dr. Uejo noted that Dr. Saltzman did not provide significant detail regarding ongoing symptoms,
limp or antalgic gait but noted that, giving the benefit of the doubt, a grade 1 modifier was
reasonable.17 He further determined that appellant was not entitled to an additional impairment
for physical examination as the examination was normal. Dr. Uejo also found a grade 1 modifier
based on her clinical studies which showed degenerative changes in the right knee.18 Applying
the net adjustment formula resulted in a modifier of -1, which resulted in a grade adjustment
from C to B.19 The corresponding lower extremity impairment for a class 1, grade B fullthickness articular cartilage defect is two percent.20
The Board finds that Dr. Uejo properly applied the A.M.A., Guides to rate impairment to
appellant’s right knee. Dr. Uejo reviewed the medical evidence and fully explained how he
determined appellant’s rating and why the rating of Dr. Saltzman was not in conformance with
the A.M.A., Guides.
On appeal, counsel argued that the sixth edition of the A.M.A., Guides does not
adequately allow for the consideration of impairment based on all the conditions impairing
appellant’s lower extremity as dictated by Office procedure. The Board notes that the Office has
explicitly adopted the standards of the sixth edition of the A.M.A., Guides, effective May 1,
2009, for evaluating permanent impairment.21 As noted, Dr. Uejo clearly explained his rating
under the sixth edition of the A.M.A., Guides.
15

A.M.A., Guides at 511, Table 16-3.

16

Supra note 10.

17

Id. at 516, Table 16-6.

18

Id. at 519, Table 16-8.

19

Using the formula at page 521 of the A.M.A., Guides, (GMFH - CDX) + (GMPE - CDX) + (GMCS - CDX)
results in the following: (1-1) + (0-1) + (1-1) = -1.
20

Id. at 511, Table 16-3.

21

Supra note 7.

6

CONCLUSION
The Board finds that appellant has no more than two percent right lower extremity
impairment for which she received a schedule award.
ORDER
IT IS HEREBY ORDERED THAT the June 15, 2010 decision of the Office of
Workers’ Compensation Programs is affirmed.
Issued: May 4, 2011
Washington, DC

Richard J. Daschbach, Chief Judge
Employees’ Compensation Appeals Board

Colleen Duffy Kiko, Judge
Employees’ Compensation Appeals Board

Michael E. Groom, Alternate Judge
Employees’ Compensation Appeals Board

7


United States Department of Labor
Employees’ Compensation Appeals Board
__________________________________________
B.C., Appellant
and
U.S. POSTAL SERVICE, HARVEST POST
OFFICE, Harvest, AL, Employer
__________________________________________
Appearances:
Appellant, pro se
Office of Solicitor, for the Director

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Docket No. 21-0585
Issued: March 11, 2022

Case Submitted on the Record

ORDER REMANDING CASE
Before:
ALEC J. KOROMILAS, Chief Judge
PATRICIA H. FITZGERALD, Alternate Judge
VALERIE D. EVANS-HARRELL, Alternate Judge

On March 5, 2021 appellant filed a timely appeal from a November 13, 2020 merit decision
of the Office of Workers’ Compensation Programs (OWCP). The Clerk of the Appellate Boards
docketed the appeal as No. 21-0585.
On May 7, 2018 appellant, then a 58-year-old rural carrier, filed a traumatic injury claim
(Form CA-1) alleging that on May 4, 2018,1 at approximately 8:30 a.m., he strained his back when
picking up a delivery point sequence (DPS) tray while in the performance of duty. He stopped
work on the alleged date of injury. OWCP assigned the claim OWCP File No. xxxxxx463.2

1

Appellant indicated on his claim form that the injury occurred on May 5, 2018. In a June 11, 2018 letter, however,
appellant clarified that the correct date of injury was May 4, 2018. In a June 13, 2018 letter, the employing
establishment notified OWCP that the correct date of injury was May 4, 2018. In a June 19, 2018 letter, OWCP
notified appellant that his date of injury was changed to May 4, 2018.
2

The record reflects that appellant has a prior cla im for a February 4, 2009 traumatic injury, that was accepted for
lumbar sprain under OWCP File No. xxxxxx873. Appellant also has a prior claim for a June 7, 2011 traumatic injury
accepted for shoulder and upper arm sprains; abrasions/friction burn; contusion; face, neck, and scalp
abrasions/friction; neck sprain; lumbar sprain; and concussion under OWCP File No. xxxxxx378. Additionally, he
filed a Form CA-1 on September 29, 2017 alleging that he sustained a work-related back and neck injury on that date
under OWCP File No. xxxxxx574. Appellant subsequently filed a nother Form CA-1 alleging that on November 16,
2017 he strained his mid-back under OWCP File No. xxxxxx665.

By decision dated January 14, 2019, OWCP accepted that the May 4, 2018 incident
occurred as alleged, but denied appellant’s claim as the medical evidence of record was insufficient
to establish causal relationship between a diagnosed medical condition and the accepted
employment incident.
OWCP received additional medical evidence.
On September 21, 2019 appellant requested reconsideration.
By decision dated November 8, 2019, OWCP modified the January 14, 2019 decision to
find that appellant had not established the factual component of his claim.
On February 4, 2020 appellant requested reconsideration and submitted additional medical
evidence.
By decision dated March 23, 2020, OWCP denied modification.
On June 19, 2020 appellant requested reconsideration. By decision dated September 11,
2020, OWCP denied modification of the March 23, 2020 decision.
On October 1, 2020 appellant requested reconsideration and submitted additional evidence.
By decision dated November 13, 2020, OWCP denied modification.
The Board has duly considered the matter and concludes that this case is not in posture for
decision. OWCP’s procedures provide that cases should be administratively combined when
correct adjudication of the issues depends on frequent cross-referencing between files. 3 For
example, if a new injury case is reported for an employee who previously filed an injury claim for
a similar condition or the same part of the body, doubling is required. 4 In the present claim,
appellant alleged injuries to his back, shoulders, and neck. He has prior claims before OWCP
alleging neck, shoulder, and back injuries, including previously accepted claims under OWCP File
Nos. xxxxxx873 and xxxxxx378. However, OWCP has not administratively combined appellant’s
claims.
For a full and fair adjudication of appellant’s current claim, the case must be remanded to
OWCP to administratively combine the current case record with OWCP File Nos. xxxxxx873,
xxxxxx378, xxxxxx574, and xxxxxx665.5 Following this and other such further development as
OWCP deems necessary, it shall issue a de novo decision.

3

Federal (FECA) Procedure Manual, Part 2 -- Claims, File Maintenance and Management, Chapter 2.400.8(c)
(February 2000).
4

Id.; L.M., Docket No. 19-1490 (issued January 29, 2020); L.H., Docket No 18-1777 (issued July 2, 2019).

5

Id.

2

IT IS HEREBY ORDERED THAT the November 13, 2020 decision of the Office of
Workers’ Compensation Programs is set aside and this case is remanded for further proceedings
consistent with this order of the Board.
Issued: March 11, 2022
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

3


United States Department of Labor
Employees’ Compensation Appeals Board
__________________________________________
J.S., Appellant
and
U.S. POSTAL SERVICE, DOMINICK V.
DANIELS P & DC, Kearny, NJ, Employer
__________________________________________

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Appearances:
James D. Muirhead, Esq., for the appellant
Office of Solicitor, for the Director

Docket No. 10-1822
Issued: March 15, 2011

Case Submitted on the Record

DECISION AND ORDER
Before:
COLLEEN DUFFY KIKO, Judge
MICHAEL E. GROOM, Alternate Judge
JAMES A. HAYNES, Alternate Judge

JURISDICTION
On July 1, 2010 appellant filed a timely appeal from a June 3, 2010 schedule award
decision of the Office of Workers’ Compensation Programs. Pursuant to 20 C.F.R. §§ 501.2(c)
and 501.3, the Board has jurisdiction over the merits of the schedule award decision.
ISSUE
The issue is whether appellant met his burden of proof to establish more than a three
percent impairment of the left leg for which he received a schedule award.
On appeal, his attorney asserts that the fifth edition of the American Medical Association,
Guides to the Evaluation of Permanent Impairment (A.M.A., Guides) (hereinafter),1 should be
utilized rather than the sixth edition, because the date of maximum medical improvement was
September 8, 2008.

1

A.M.A., Guides (5th ed. 2001).

FACTUAL HISTORY
On November 25, 2006 appellant, then a 57-year-old maintenance mechanic, tore
cartilage in his left knee while climbing on and off a conveyor belt. He stopped work on
November 25, 2006 and returned to light duty on December 12, 2006. The Office accepted the
claim for a left meniscal tear.
On December 26, 2007 appellant filed a schedule award claim. He submitted an
unsigned report dated October 17, 2007 that rated a 30 percent left leg impairment.2
By decision dated January 16, 2008, the Office denied appellant’s claim for a schedule
award finding that he had not reached maximum medical improvement.
On February 11, 2008 Dr. Anthony L. Parks, a Board-certified orthopedic surgeon,
advised that appellant would be scheduled for left knee arthroscopic surgery. On March 5, 2008
he performed a left partial medial meniscectomy and chondroplasty. The Office accepted that
appellant sustained a recurrence of disability beginning that day.
In a September 8, 2008 report, Dr. Arthur Becan, an orthopedic surgeon, noted
appellant’s complaint of intermittent left knee pain, stiffness and episodes of instability and
locking. He provided findings on physical examination of mild effusion of the left knee,
tenderness in the peripatellar region and along the medial femoral and lateral femoral condyles
and the undersurface of the medial and lateral patellar facets. Pain was produced on compression
of the patellofemoral joint with no medial or lateral instability and negative Apley’s grind test,
drawer sign and posterior drop back. Appellant was unable to squat without left knee pain and
range of motion was diminished. Gastrocnemius and quadriceps muscle strength testing were
graded 3/5 on the left and circumferential measurements of the gastrocnemius was
34 centimeters (cm) on the right and 32 cm on the left with quadriceps measurements of 39 cm
on the right and 36 cm on the left. Dr. Becan diagnosed post-traumatic internal derangement of
the left knee with medial meniscus tear; post-traumatic chondromalacia to the left patella; status
post arthroscopy; and postoperative adhesions of the left knee. He advised that, under the fifth
edition of the A.M.A., Guides, Table 17-8, appellant had a left quadriceps motor deficit of
17 percent and a left gastrocnemius motor deficit of 25 percent, which combined to total
38 percent left lower extremity impairment. To this, appellant added a pain-related impairment
under Figure 18-1 of 3 percent, for a total 41 percent left leg impairment.
On October 9, 2009 Dr. Becan revised his impairment evaluation in accordance with the
sixth edition of the A.M.A., Guides.3 He advised that appellant had a total three percent
impairment of the left lower extremity. Dr. Becan explained that, under Table 16-3, Knee
Regional Grid, appellant had a Class 1 impairment for a left knee partial medial meniscectomy,
rated as a two percent impairment. He applied the modifiers for functional history (GMFH),
physical examination (GMPE) and clinical studies (GMCS) found in Tables 16-6, 16-7 and 16-8,
2

The report is on Regional Independent Medical Evaluations letterhead but does not include a physician’s
signature page.
3

A.M.A., Guides (6th ed. 2008).

2

finding a functional history modifier of one, a physical examination modifier of three and a
clinical studies modifier of two. Dr. Becan adjusted the impairment rating, concluding that
appellant had a three percent left lower extremity impairment under the sixth edition of the
A.M.A., Guides.
In a May 13, 2010 report, Dr. Henry J. Magliato, a Board-certified orthopedic surgeon
and Office medical adviser, reviewed the medical record including Dr. Becan’s October 2009
report. He advised that maximum medical improvement was reached on September 8, 2008, the
date of examination by Dr. Becan. Dr. Magliato advised that Dr. Becan properly applied the
sixth edition of the A.M.A., Guides to find three percent left lower extremity impairment.
By decision dated June 3, 2010, appellant was granted a schedule award for a three
percent impairment of the left lower extremity. The award was for a total of 8.84 weeks, from
September 8 to November 7, 2008.
LEGAL PRECEDENT
The schedule award provision of the Federal Employees’ Compensation Act4 and its
implementing federal regulations,5 set forth the number of weeks of compensation payable to
employees sustaining permanent impairment from loss or loss of use, of scheduled members or
functions of the body. However, the Act does not specify the manner in which the percentage of
loss shall be determined. For consistent results and to ensure equal justice under the law for all
claimants, the Office has adopted the A.M.A., Guides as the uniform standard applicable to all
claimants.6 For decisions after February 1, 2001, the fifth edition of the A.M.A., Guides is used
to calculate schedule awards.7 For decisions issued after May 1, 2009, the sixth edition will be
used.8
The sixth edition of the A.M.A., Guides provides a diagnosis-based method of evaluation
utilizing the World Health Organization’s International Classification of Functioning, Disability
and Health (ICF).9 Under the sixth edition, for lower extremity impairments the evaluator
identifies the impairment class for the diagnosed condition (CDX), which is then adjusted by
grade modifiers based on functional history (GMFH), physical examination (GMPE) and clinical
studies (GMCS).10 The net adjustment formula is (GMFH-CDX) + (GMPE - CDX) + (GMCS -

4

5 U.S.C. § 8107.

5

20 C.F.R. § 10.404.

6

Id. at § 10.404(a).

7

Fritz A. Klein, 53 ECAB 642 (2002).

8

FECA Bulletin No. 09-03 (issued March 15, 2009).

9

A.M.A., Guides, supra note 3 at 3, section 1.3, “The International Classification of Functioning, Disability and
Health (ICF): A Contemporary Model of Disablement.”
10

Id. at 494-531.

3

CDX).11 Under Chapter 2.3, evaluators are directed to provide reasons for their impairment
rating choices, including choices of diagnoses from regional grids and calculations of modifier
scores.12
Office procedures provide that, after obtaining all necessary medical evidence, the file
should be routed to the Office medical adviser for an opinion concerning the nature and
percentage of impairment in accordance with the A.M.A., Guides, with the medical adviser
providing rationale for the percentage of impairment specified.13
ANALYSIS
The Board finds that appellant has three percent impairment of the left leg due to his
November 25, 2006 injury.
Dr. Becan properly found that, in accordance with Table 16-3, Knee Regional Grid,14
appellant’s impairing diagnosis was a meniscal injury, status post partial medial meniscectomy,
which he rated as Class 1, equal to a two percent lower extremity impairment. He applied the
modifiers for functional history, physical examination and clinical studies found in Tables 16-6,
16-7 and 16-8.15 Dr. Becan rated a functional history modifier of one, a physical examination
modifier of three and a modifier of two for clinical studies. He applied the net adjustment
formula to rate three percent left leg impairment under the sixth edition of the A.M.A., Guides.16
Dr. Becan properly explained his calculations under the sixth edition of the A.M.A., Guides.
Dr. Magliato, the Office medical adviser, agreed with his analysis. There is no probative
medical evidence of record to establish that appellant had a greater impairment than the three
percent for which he received a schedule award.
Appellant argued on appeal that, since the date of maximum medical improvement was
September 8, 2008, the Office should have used the fifth edition of the A.M.A., Guides to rate
impairment. The edition the A.M.A., Guides to be applied is based on the date of the Office
decision, not the date of maximum medical improvement.17 For any Office schedule award

11

Id. at 521.

12

Id. at 23-28.

13

See Federal (FECA) Procedure Manual, Part 2 -- Claims, Schedule Awards and Permanent Disability Claims,
Chapter 2.808.6(d) (August 2002).
14

A.M.A., Guides, supra note 3 at 509.

15

Id. at 516-19.

16

Id. at 521.

17

The date of maximum medical improvement is the date the period covered by a schedule award commences.
Albert Valverde, 36 ECAB 233 (1984). The period of the award is determined by the compensation schedule found
at section 8107(c) of the Act. For complete loss of use of the leg, the maximum compensation is 288 weeks. Since
appellant’s impairment totaled three percent, he is entitled to three percent of 288 weeks or 8.64 weeks of
compensation, commencing September 8, 2008.

4

decision issued after May 1, 2009, the sixth edition of the A.M.A., Guides is to be used.18 The
schedule award decision in this case was dated June 2, 2010 and was properly based on the sixth
edition of the A.M.A., Guides.
CONCLUSION
The Board finds that appellant did not establish that he has greater than a three percent
impairment of the left lower extremity
ORDER
IT IS HEREBY ORDERED THAT the June 3, 2010 decision of the Office of Workers’
Compensation Programs is affirmed.
Issued: March 15, 2011
Washington, DC

Colleen Duffy Kiko, Judge
Employees’ Compensation Appeals Board

Michael E. Groom, Alternate Judge
Employees’ Compensation Appeals Board

James A. Haynes, Alternate Judge
Employees’ Compensation Appeals Board

18

Supra note 8; see W.D., 61 ECAB ____ (Docket No. 10-274, issued September 3, 2010).

5


United States Department of Labor
Employees’ Compensation Appeals Board
__________________________________________
A.C., Appellant
and
DEPARTMENT OF VETERANS AFFAIRS,
VETERANS HEALTH ADMINISTRATION,
Chicago, IL, Employer
__________________________________________

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Appearances:
Alan J. Shapiro, Esq., for the appellant1
Office of Solicitor, for the Director

Docket No. 17-1869
Issued: March 1, 2018

Case Submitted on the Record

DECISION AND ORDER
Before:
CHRISTOPHER J. GODFREY, Chief Judge
PATRICIA H. FITZGERALD, Deputy Chief Judge
VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION
On September 5, 2017 appellant, through counsel, filed a timely appeal from a June 16,
2017 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.
ISSUE
The issue is whether appellant met her burden of proof to establish a lumbar condition
causally related to the accepted June 23, 2016 employment incident.
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.

FACTUAL HISTORY
On July 20, 2016 appellant, then a 39-year-old practical nurse, filed a traumatic injury
claim (Form CA-1) alleging that, on June 23, 2016, she experienced a sharp pain in her back
while she was repositioning a patient on an air mattress. She stopped work intermittently
beginning on June 25, 2016. On the reverse side of the claim form, appellant’s supervisor
reported that the claimed incident occurred in the performance of duty as alleged.
In a July 7, 2016 note, Dr. Charles R. Schwartz, an internist and treating physician,
reported that appellant sustained a back injury and was excused from work until July 18, 2016.
In an August 10, 2016 note, he reported that appellant was off work until September 1, 2016.
By letter dated August 16, 2016, the employing establishment controverted the claim
arguing that appellant failed to establish causal relationship.
In an August 31, 2016 note, Dr. Daniel Dunham, Board-certified in internal medicine,
reported that appellant was restricted from returning to work.
Appellant submitted physical therapy notes dated September 7 through October 5, 2016
documenting treatment for her lower back condition.
By letter dated September 13, 2016, OWCP informed appellant that the evidence of
record was insufficient to establish her claim. Appellant was advised of the type of medical and
factual evidence needed and she was afforded 30 days to submit the necessary evidence. In a
September 6, 2016 note, Dr. Dunham diagnosed low back pain and sciatica, and reported that
appellant was to remain off work. In a September 21, 2016 note, he reported that appellant was
released to return to work on October 11, 2016.
OWCP also received a September 21, 2016 narrative statement in which appellant
explained that, on June 23, 2016, she and another coworker had to adjust a patient weighing over
450 pounds. Appellant noted that, in order to prevent the patient from falling out of bed, she had
to quickly lift the mattress under the patient and move it towards herself to reposition it. While
performing this maneuver, she immediately felt a sharp pain in her back. Appellant explained
that in July 2011 she initially experienced low back pain when pushing and pulling a heavy
medical cart at work for which she filed a Form CA-1 at the time. She also explained that her
alleged June 23 2016 employment incident resulted in a diagnosis of lumbar stenosis and that she
was unable to work as the employing establishment could not accommodate her restrictions.
In a September 22, 2016 diagnostic report, Dr. Miral Jhaveri, a Board-certified diagnostic
radiologist, reported that a magnetic resonance imaging (MRI) scan of appellant’s lumbar spine
revealed mild increase in the degenerative endplate changes at L5-S1 when compared with a
prior August 30, 2011 study. He noted L5-S1 asymmetric disc bulge to the left with central and
left paracentral disc extrusion causing narrowing of the left lateral recess with mild effacement of
the traversing left S1 nerve root which was less pronounced when compared with the August 30,
2011 study. Dr. Jhaveri also reported L4-5 small stable broad-based disc protrusion with no
spinal canal or foraminal stenosis.
In a September 28, 2016 attending physician’s report (Form CA-20), Dr. Dunham
reported that appellant was lifting a patient on June 23, 2016 when she experienced pain. He
2

noted a history of a preexisting 2011 injury based on a lumbar spine MRI scan which showed
disc disease. Dr. Dunham reported that appellant’s current MRI scan findings revealed L5-S1
disc disease. He checked the box marked “yes” when asked whether the condition was caused or
aggravated by the employment activity, noting that “lifting worsens back.”
By decision dated October 14, 2016, OWCP denied appellant’s claim, finding that the
evidence of record failed to establish that her diagnosed back condition was causally related to
the accepted June 23, 2016 employment incident.
On October 20, 2016 appellant, through counsel, requested a telephonic hearing before an
OWCP hearing representative. OWCP continued to receive additional evidence.
Physical therapy notes dated October 6 through 12, 2016 documented treatment for
appellant’s back condition.
In an October 11, 2016 medical note, Dr. Usama Ahmad, Board-certified in internal
medicine, reported that appellant was treated on September 29, 2016 by his partner, Dr. Dunham.
He reported that, per Dr. Dunham’s note, it was reasonable to provide appellant work restrictions
of no lifting, and no standing or bending for long periods of time. Dr. Ahmad requested these
restrictions be implemented for three weeks from the date of his letter.
In an October 13, 2016 narrative statement, appellant again described the alleged June 23,
2016 employment incident, noting that her back pain continued to worsen. She reported that she
had previously filed a Form CA-1 on July 8, 2011 for a work-related back injury under OWCP
File No. xxxxxx778.3
A hearing was held on April 25, 2017 where appellant testified in support of her claim.
Appellant reported that she previously incurred a herniated disc in 2011, but that she had not had
any trouble with her back since that date. On June 23, 2016 she was lifting a patient and
immediately began to experience back pain. Appellant alleged that this employment incident
caused an aggravation of her herniated disc at L4-5.
Following the hearing, appellant submitted a May 26, 2017 report from Dr. Diane P.
Ryan, Board-certified in internal medicine. Dr. Ryan noted that appellant had been a patient at
Rush University Internists (RUMC) for over 10 years and that she had been personally treating
appellant since April 2016. She reported that appellant had recurrent low back discomfort. A
2011 lumbosacral MRI scan revealed L5-S1 moderate left-sided spinal canal stenosis and
compression on left S1 traversing the nerve root for which appellant obtained conservative
treatment. Following a reported heavy lifting incident on June 23, 2016, appellant experienced
severe exacerbation of low back pain with variable left- and right-sided radicular leg pain. She
was initially assessed at RUMC on July 7, 2016 and experienced refractive symptoms despite
routine medical management. As such, appellant required further management with an
orthopedic spine surgeon/anesthetics. Dr. Ryan reported that appellant returned to work on
October 11, 2016 yet continued to experience residual low back pain/bilateral gluteal discomfort
3
The Board notes that the claim was handled administratively by OWCP, allowing payment of limited medical
expenses, with no formal adjudication of the claim. The record contains no further information pertaining to
appellant’s prior traumatic injury claim.

3

which limited her functional ability. She concluded that appellant’s condition had not resolved
to her preinjury baseline.
By decision dated June 16, 2017, OWCP’s hearing representative affirmed the
October 14, 2016 decision finding that the evidence of record failed to establish that appellant’s
diagnosed lumbar condition was causally related to the accepted June 23, 2016 employment
incident.
LEGAL PRECEDENT
An employee seeking benefits under FECA4 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 filed within the applicable time
limitation, that an injury was sustained while in the performance of duty as alleged, and that any
disability or specific condition for which compensation is claimed are 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 on a traumatic injury or an occupational disease.6
In order to determine whether an employee actually sustained an injury in the
performance of duty, OWCP begins with an analysis of whether fact of injury has been
established. Generally, fact of injury consists of two components which must be considered in
conjunction with one another. The first component to be established is that the employee
actually experienced the employment incident which is alleged to have occurred.7 The second
component is whether the employment incident caused a personal injury and generally can be
established only by medical evidence.
To establish causal relationship between the condition, as well as any attendant disability
claimed and the employment event or incident, the employee must submit rationalized medical
opinion evidence supporting such causal relationship.8 The opinion of the physician must be
based on a complete factual and medical background of the claimant, 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 the specific employment factors identified by
the claimant. This medical opinion must include an accurate history of the employee’s
employment injury and must explain how the condition is related to the injury. The weight of
medical evidence is determined by its reliability, its probative value, its convincing quality, the
care of analysis manifested, and the medical rationale expressed in support of the physician’s
opinion.9

4

Supra note 2.

5

Gary J. Watling, 52 ECAB 278 (2001); Elaine Pendleton, 40 ECAB 1143, 1154 (1989).

6

Michael E. Smith, 50 ECAB 313 (1999).

7

Elaine Pendleton, supra note 5.

8

See 20 C.F.R. § 10.110(a); John M. Tornello, 35 ECAB 234 (1983).

9

James Mack, 43 ECAB 321 (1991).

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ANALYSIS
OWCP accepted that the June 23, 2016 employment incident occurred as alleged. The
issue is whether appellant has met her burden of proof to establish that the accepted employment
incident caused her diagnosed lumbar condition.
The Board finds that appellant has not submitted sufficient medical evidence to establish
that her current diagnosed lumbar condition was causally related to the accepted June 23, 2016
employment incident.10
In a September 28, 2016 Form CA-20, Dr. Dunham reported that appellant was lifting a
patient on June 23, 2016 when she experienced pain. He noted preexisting disc disease from a
2011 injury, with current MRI scan findings of L5-S1 disc disease. Although Dr. Dunham
answered “yes” on a form report when asked if the diagnosis was a result of the employment
incident, the Board has held that a report that addresses causal relationship with a checkmark,
without medical rationale explaining how the work condition caused the alleged injury, is of
diminished probative value and is insufficient to establish causal relationship.11 He failed to
provide a sufficient explanation as to the mechanism of injury pertaining to appellant’s traumatic
injury claim, namely, how lifting a heavy patient would cause or aggravate appellant’s L5-S1
disc disease.12 Dr. Dunham’s statement that “lifting worsens back” is vague and generalized and
is found to be without sufficient detail pertaining to the cause of her injury.13 Without explaining
how, physiologically, the movements involved in the June 23, 2016 employment incident caused
or contributed to the diagnosed lumbar injury, his opinion is of limited probative value and is
insufficient to meet appellant’s burden of proof.14
In a May 26, 2017 medical note, Dr. Ryan reported that appellant had recurrent low back
discomfort, explaining that appellant was a patient with RUMC for over 10 years and that she
had personally been treating her since April 2016. She noted a 2011 lumbosacral MRI scan
which revealed L5-S1 moderate left-sided spinal canal stenosis and compression on left S1
traversing the nerve root for which she obtained conservative treatment. Following a reported
heavy lifting injury on June 23, 2016, appellant experienced a severe exacerbation of low back
pain with variable left- and right-sided radicular leg pain, causing her to seek treatment with
RUMC on July 7, 2016.
The Board notes that appellant alleged a lower back injury having occurred on June 23,
2016 when she was lifting a patient. While the record reflects a preexisting 2011 lumbar injury,
appellant testified that she had no issues with her back until the June 23, 2016 employment
incident. The Board notes that Dr. Ryan reported that she began treating appellant in April 2016,
approximately two months prior to the alleged employment injury. It is unclear whether
10

See Robert Broome, 55 ECAB 339 (2004).

11

See Calvin E. King, Jr., 51 ECAB 394 (2000); see also Frederick E. Howard, Jr., 41 ECAB 843 (1990).

12

S.W., Docket 08-2538 (issued May 21, 2009).

13

See R.G., Docket No. 17-1536 (issued December 5, 2017).

14

John W. Montoya, 54 ECAB 306 (2003).

5

Dr. Ryan was treating appellant for her back in April 2016 given that she reported no complaints
until she lifted a patient at work on June 23, 2016. A physician’s opinion must be based on a
complete factual and medical background of the claimant.15 As Dr. Ryan did not explain why
she treated appellant in April 2016, this raises doubts pertaining to an alleged lumbar injury
having occurred on June 23, 2016. Appellant’s medical treatment predates the employment
incident.
The Board further notes that Dr. Ryan failed to provide a firm medical diagnosis which
could be attributed to the June 23, 2016 employment incident. Rather, Dr. Ryan merely repeated
findings pertaining to the 2011 lumbosacral MRI scan with no discussion of appellant’s current
diagnosis or opinion on the cause of her injury. She did not address why appellant’s complaints
were not caused by her preexisting degenerative condition, nor did she discuss whether her
preexisting injury had progressed beyond what might be expected from the natural progression
of that condition.16 A well-rationalized opinion is particularly warranted when there is a history
of preexisting condition.17 As Dr. Ryan failed to provide a clear diagnosis and opinion regarding
causal relationship, her report is of limited probative value.18
The remaining medical evidence of record is also insufficient to establish appellant’s
claim. Dr. Schwartz’s, Dr. Dunham’s, and Dr. Ahmad’s medical notes dated July 7 through
October 11, 2016 excused appellant from work due to back pain, but did not provide a firm
medical diagnosis or opinion on the cause of her injuries. The Board has consistently held that
pain is a symptom, rather than a compensable medical diagnosis.19
Dr. Jhaveri’s September 22, 2016 report interpreted diagnostic studies pertaining to the
lumbar spine. The Board has held that diagnostic studies are of limited probative value as they
do not address whether the employment incident caused any of the diagnosed conditions.20
The physical therapy notes dated September 7 through October 12, 2016 are also
insufficient to establish appellant’s claim as they were not signed by a physician. As registered
nurses, physical therapists, and physician assistants, are not considered physicians as defined
under FECA, their opinions are of no probative value.21
There is no requirement that federal employment be the only cause of appellant’s injury.
If work-related exposures caused, aggravated, or accelerated appellant’s condition, she is entitled
15

Supra note 9.

16

R.E., Docket No. 14-0868 (issued September 24, 2014).

17

T.M., Docket No. 08-0975 (issued February 6, 2009); Michael S. Mina, 57 ECAB 379 (2006).

18

Ceferino L. Gonzales, 32 ECAB 1591 (1981).

19

T.G., Docket No. 13-0076 (issued March 22, 2013).

20

See R.S., Docket No. 17-1139 (issued November 16, 2017).

21
5 U.S.C. § 8102(2) of FECA provides as follows: (2) ‘physician includes surgeons, podiatrists, dentists,
clinical psychologists, optometrists, chiropractors, and osteopathic practitioners within the scope of their practice as
defined by State law. See also Roy L. Humphrey, 57 ECAB 238 (2005). See T.S., Docket No. 17-0779 (issued
December 11, 2017) (a physical therapist’s report is of no probative value regarding the issue of causal relationship).

6

to compensation.22 However, an award of compensation may not be based on surmise,
conjecture, speculation, or on the employee’s own belief of causal relationship.23 Herein, the
record lacks rationalized medical evidence establishing causal relationship between the accepted
June 23, 2016 employment incident and appellant’s lumbar condition. Thus, appellant has failed
to meet her burden of proof.
Appellant may submit additional evidence, together with a written request for
reconsideration, to OWCP within one year of the Board’s merit decision, pursuant to 5 U.S.C.
§ 8128(a) and 20 C.F.R. §§ 10.605 and 10.607.
CONCLUSION
The Board finds that appellant has not met her burden of proof to establish a lumbar
condition causally related to the accepted June 23, 2016 employment incident.
ORDER
IT IS HEREBY ORDERED THAT the Office of Workers’ Compensation Programs’
decision dated June 16, 2017 is affirmed.
Issued: March 1, 2018
Washington, DC

Christopher J. Godfrey, Chief Judge
Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge
Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge
Employees’ Compensation Appeals Board

22

See Beth P. Chaput, 37 ECAB 158, 161 (1985); S.S., Docket No. 08-2386 (issued June 5, 2008).

23

D.D., 57 ECAB 734 (2006).

7


United States Department of Labor
Employees’ Compensation Appeals Board
_________________________________________
B.W., Appellant
and
U.S. POSTAL SERVICE, POST OFFICE,
Los Angeles, CA, Employer
__________________________________________

)
)
)
)
)
)
)
)

Appearances:
Alan J. Shapiro, Esq., for the appellant1
Office of Solicitor, for the Director

Docket No. 17-1979
Issued: December 18, 2018

Case Submitted on the Record

DECISION AND ORDER
Before:
CHRISTOPHER J. GODFREY, Chief Judge
PATRICIA H. FITZGERALD, Deputy Chief Judge
ALEC J. KOROMILAS, Alternate Judge

JURISDICTION
On September 25, 2017 appellant, through counsel, filed a timely appeal from a July 19,
2017 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.

ISSUE
The issue is whether appellant has met her burden of proof to establish a diagnosed medical
condition causally related to the accepted factors of her federal employment.
FACTUAL HISTORY
On August 25, 2016 appellant, then a 54-year-old customer care agent, filed an
occupational disease claim (Form CA-2) alleging that she sustained a finger condition of both
hands while in the performance of duty.3 She advised that she was waiting for the doctor to
confirm her diagnosis. Appellant indicated that she first became aware of her claimed condition
and realized its relationship to her employment on June 23, 2016. She stopped work on
June 23, 2016.
In an August 5, 2016 statement, appellant indicated that she began working at the
employing establishment in March 2013 at a call center as a customer care representative. She
noted that she was informed that the job required light typing, which was not the case because
there was significant typing involved. Appellant noted that she worked 10 hours a day, four days
a week. She explained that, due to her pain, her hours were reduced to four hours a day, four days
a week. Appellant explained that the typing she was required to do daily started causing pain in
her fingers, “like locking in the joints.” She advised that the pain was in the fingers of both hands
and it was aggravated over time while she worked at the call center.
OWCP received a July 5, 2016 letter from the employing establishment regarding
appellant’s position and duties as a customer care agent. Appellant’s duties required her to engage
in seated work 8 hours per day, with intermittent standing and walking 2 hours per day, and
intermittent climbing and kneeling of 15 minutes. The physical requirements indicated that
appellant could sit in an office chair with a supportive back or stand at a workstation as needed for
comfort and occasionally grasp a mouse. Appellant was also required to use a computer mouse,
interchangeable to the right or left side as needed for comfort and occasionally use fine
manipulation or a single finger when using a keyboard. It was noted that the call agent workstation
included chairs that were ergonomically designed and adjustable. Further, it included that
appellant used a computer keyboard and mouse intermittently for approximately 24 minutes per
hour or a maximum of 3.2 hours per 8-hour shift during conversations with customers. It was
noted that “no continuous computer mouse movement is involved.” Additionally, a headset was
provided to answer calls and there was no use of a telephone handset to grip or grasp. The position
also included intermittent handling of sheets of paper and an erasable board for taking notes during
conversations with customers.
By development letter dated September 30, 2016, OWCP informed appellant of the type
of evidence needed to support her claim, including a narrative medical report from her attending
physician. It particularly requested that appellant complete a questionnaire and describe the
3

Appellant began working for the employing establishment on June 1984 as a letter carrier. She has a prior
occupational disease claim with a September 14, 2007 date of injury, accepted by OWCP for bilateral carpal tunnel
syndrome, neck sprain, and left shoulder impingement syndrome. That claim was assigned OWCP File No.
xxxxxx959. In March of 2013, appellant was offered light-duty work as a customer care assistant.

2

duration and frequency of typing she performed.4 It afforded her 30 days to submit the requested
evidence. No evidence was submitted.
By letter dated September 30, 2016, OWCP requested that the employing establishment
also provide details regarding the position. Both appellant and the employing establishment were
afforded 30 days to respond.
In a September 1, 2016 response from the employing establishment, which was received
on October 6, 2016, N.V., a supervisor of the customer care center, provided additional
information and controverted the claim. She noted that appellant’s job duties were congruent with
her physical restrictions. N.V. explained that the customer care agent duties were specifically
made in strict compliance with appellant’s medical work restrictions. She noted that appellant was
currently working four hours per day in accordance with permanent restrictions provided under
OWCP File No. xxxxxx959.
In a September 22, 2016 report, Dr. Christopher P. DeCarlo, specializing in sports
medicine, noted that appellant worked for the employing establishment since 1984 with a period
of contested termination from November 2003 to May 2006. He explained that appellant was a
letter carrier until she was sent home in March 2012, without available work within her restrictions.
Dr. DeCarlo indicated that appellant returned to work as a customer care agent in March 2013. He
explained her duties as a customer care agent and her restrictions since June 17, 2016, which he
advised included being restricted from all fine manipulation (including keyboarding) and he noted
she had been sent home without available work since June 23, 2016. Dr. DeCarlo continued to
describe appellant’s history work and her history of injury.
Dr. DeCarlo noted that appellant’s complaints included tingling and numbness in all fingers
of both hands with constant deep aches in her knuckles and tightness and locking in all of her
fingers and thumbs. He noted that x-rays of the bilateral fingers and hands were unremarkable.
Dr. DeCarlo examined appellant and diagnosed “possible early onset osteoarthritis of bilateral
fingers with finger strain” on the right and left. He opined that it “appears that [appellant], since
she was doing repetitive-type work, especially keyboarding and mouse use and writing for a
number of years, seems to be developing an early onset of osteoarthritis due to these repetitive
activities throughout the years working for the [employing establishment].” Dr. DeCarlo
recommended that appellant return to modified duty with limitations of intermittent lifting of 15
pounds, sitting and standing four hours a day; walking three to four hours a day; climbing, bending,
stooping, twisting, and pushing and pulling three hours a day; simple grasping two hours a day;
and no keyboarding or fine manipulation. He completed duty status reports on September 22 and
October 28, 2016 with the above-noted restrictions.
By decision dated November 15, 2016, OWCP denied appellant’s claim. It found that the
evidence submitted was insufficient to establish that the injury and/or event(s) occurred as alleged.

4

OWCP also noted that no medical evidence was received after it requested that appellant provide a diagnosis of
the condition(s) resulting from her injury and a physician’s opinion with supporting explanation as to how her injury
resulted in the condition(s).

3

On November 21, 2106 appellant, through counsel, requested a telephonic hearing, which
was held on June 9, 2017. During the hearing, appellant described her position and explained that
she began working four hours per day in 2015. She indicated that she did keyboarding work for
about three and a half out of four hours. Appellant denied that her workstation was ergonomic and
indicated that she had new symptoms commencing in 2016 in most of her fingers on both hands.
She also denied nonwork repetitive activities. Appellant clarified that her work hours were
reduced to four hours per day, four days per week in 2015 due to her carpal tunnel symptoms,
which were accepted as part of a prior claim. She explained that, in 2016, she increased to working
eight hours a day on December 31, 2016, and reduced to working four hours on June 2, 2017.
Dr. DeCarlo continued to submit duty status reports.
In an October 28, 2016 progress report, Dr. DeCarlo noted that appellant returned for
complaints of continued stiffness and tightness in the fingers of both hands. He found tenderness
to palpation in all fingers and the thumbs on both hands at the proximal interphalangeal joints with
increased pain with flexion and extension of the joints. Dr. DeCarlo diagnosed “possible early
onset osteoarthritis of bilateral fingers with finger strain.” He advised that appellant’s modified
duties remained the same.
By decision dated July 19, 2017, OWCP modified the November 15, 2016 decision. It
accepted that appellant used a keyboard and/or mouse intermittently for less than 30 minutes of
each hour in the performance of duty. However, the claim remained denied because the medical
evidence of record was insufficient to establish a firm diagnosis of a medical condition, causally
related to the accepted work factors.
LEGAL PRECEDENT
An employee seeking benefits under FECA 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 FECA, that the claim was timely filed within the applicable time limitation
period of FECA, that an injury was sustained in the performance of duty as alleged, and that any
disability or specific 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 establish that an injury was sustained in the performance of duty in an occupational
disease claim, a claimant must submit the following: (1) medical evidence establishing the presence
or existence of the disease or condition for which compensation is claimed; (2) a factual statement
identifying employment factors alleged to have caused or contributed to the presence or occurrence
of the disease or condition; and (3) medical evidence establishing that the employment factors
identified by the claimant were the proximate cause of the condition for which compensation is

5

Joe D. Cameron, 41 ECAB 153 (1989); Elaine Pendleton, 40 ECAB 1143, 1145 (1989).

6

Victor J. Woodhams, 41 ECAB 345 (1989).

4

claimed or, stated differently, medical evidence establishing that the diagnosed condition is causally
related to the employment factors identified by the claimant.7
The medical evidence required to establish causal relationship is rationalized medical
opinion evidence.8 Rationalized medical opinion evidence is medical evidence which includes a
physician’s rationalized opinion on the issue of whether there is causal relationship between the
claimant’s diagnosed condition and the implicated employment factors. The opinion of the physician
must be based on a complete factual and medical background of the claimant, 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 the specific employment factors identified by
the claimant.9
ANALYSIS
The Board finds that appellant has not met her burden of proof to establish an injury
causally related to the accepted factors of her federal employment.
In its July 19, 2017 decision, OWCP accepted as factual that appellant used a keyboard
and/or mouse intermittently for less than 30 minutes of each hour while in the performance of duty
as a part of her customer care duties. However, it further found that she submitted insufficient
medical evidence to establish a medical condition caused or aggravated by these activities.
In support of her claim, appellant submitted reports from Dr. DeCarlo. In a September 22,
2016 report which Dr. DeCarlo noted appellant’s history, included that she returned to work as a
customer care agent in March 2013. He explained her duties as a customer care agent and her
restrictions, which he advised included being restricted from all fine manipulation on June 17,
2016 (including keyboarding) and noted that she was sent home without available work since
June 23, 2016. Dr. DeCarlo diagnosed “possible” early onset osteoarthritis of bilateral fingers
with finger strain on the right and left. He opined that appellant seemed to him to be developing
an early onset of osteoarthritis due to repetitive work activities using a keyboard and mouse. The
Board notes that Dr. DeCarlo diagnosed only a “possible” condition and therefore offered a
speculative opinion. The Board has long held that medical opinions that are speculative or
equivocal in character have little probative value.10
In an October 28, 2016 form report, Dr. DeCarlo gave examination findings and diagnosed
possible early onset osteoarthritis of her bilateral fingers with finger strain. He also provided
continued work restrictions. Dr. DeCarlo offered no opinion in this report as to the cause of
appellant’s bilateral hand and finger 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

7

Id.

8

See Robert G. Morris, 48 ECAB 238 (1996).

9

Supra note 6.

10

T.M., Docket No. 08-0975 (issued February 6, 2009).

5

on the issue of causal relationship.11 Therefore, this report is insufficient to establish appellant’s
claim.
On appeal counsel argues that appellant submitted “excellent medical reports showing
causation” and that the claim should have been accepted based upon this medical evidence of
record. However, as found herein, the medical evidence of record was insufficient to establish that
appellant sustained an employment-related injury.
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 an injury
causally related to the accepted factors of her federal employment.
ORDER
IT IS HEREBY ORDERED THAT the July 19, 2017 decision of the Office of Workers’
Compensation Programs is affirmed.
Issued: December 18, 2018
Washington, DC

Christopher J. Godfrey, Chief Judge
Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge
Employees’ Compensation Appeals Board

Alec J. Koromilas, Alternate Judge
Employees’ Compensation Appeals Board

11

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

6