United States Department of Labor
Employees’ Compensation Appeals Board
__________________________________________
)
)
)
and
)
)
DEPARTMENT OF JUSTICE, FEDERAL
)
BUREAU OF PRISONS, Florence, CO, Employer )
__________________________________________ )
E.E., Appellant

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

Docket No. 20-1039
Issued: January 13, 2022

Case Submitted on the Record

ORDER REMANDING CASE
Before:
ALEC J. KOROMILAS, Chief Judge
JANICE B. ASKIN, Judge
PATRICIA H. FITZGERALD, Alternate Judge

On April 16, 2020 appellant filed a timely appeal from a February 24, 2020 merit decision
of the Office of Workers’ Compensation Programs (OWCP). The Clerk of the Appellate Boards
docketed the appeal as No. 20-1039.1
On July 22, 2019 appellant, then a 37-year-old corrections officer, filed a traumatic injury
claim (Form CA-1) alleging that on July 19, 2019 at 2:30 p.m., he suffered an allergic reaction
while in the performance of duty after drinking water from a water dispenser which had been
recently sanitized. He alleged that some of the disinfectant made contact with his lip, causing an
allergic reaction. In a July 22, 2019 narrative statement, appellant indicated that when he filled
his thermal drinking cup with ice and water from the dispenser in the health services department,
he noticed the smell of Oxivir antiseptic wipes in the air. While drinking his ice water from his
cup, he noticed a slight tingling sensation on his upper lip where it came in to contact with the cup.
When he refilled his cup approximately five minutes later from the same dispenser, he noticed that
his lip felt irritated after drinking. Appellant left his shift at approximately 3:00 p.m. When he
1

The Board notes that, following the February 24, 2020 decision, OWCP received additional evidence. However,
the Board’s Rules of Procedure provides: “The Board’s review of a case is limited to the evidence in the case
record that was before OWCP at the time of its final decision. Evidence not before OWCP will not be considered
by the Board for the first time on appeal.” 20 C.F.R. § 501.2(c)(1). Thus, the Board is precluded from reviewing
this additional evidence for the first time on appeal. Id.

arrived home, his lip was swollen. Appellant called his supervisor to inform him of the situation
and left for the emergency room. While en route to the emergency room, he called 911 at
approximately 3:45 p.m. as his tongue, mouth, and throat began to swell. Appellant indicated that
one of the active ingredients in the Oxivir antiseptics wipes, Dodocylbenzene sulfuric acid, had
caused him allergic reactions since he was a child.
Appellant submitted a safety data sheet for Oxivir TB, a photograph of his swollen lip, a
July 19, 2019 hospital after visit summary, a July 19, 2019 hospital emergency department
encounter, signed by Dr. Paul E. Numsen, an osteopath Board-certified in emergency medicine,
and a July 19, 2019 patient care report. In response to OWCP’s January 22, 2020 development
letter, which advised appellant of the deficiencies in the medical evidence and the type of medical
evidence needed to support his claim, appellant submitted a February 17, 2020 report from
Dr. Gary A. Mohr, a family medicine specialist.
By decision dated February 24, 2020, OWCP denied the claim, finding that “the medical
evidence of record does not demonstrate that the claimed medical condition is related to the
established work-related event(s)….” It also denied appellant’s claim “because the factual
component of the third basic element, Fact of Injury, has not been met.” The decision continued
that “the evidence does not support that the injury and/or event(s) occurred.”
The Board, having duly considered the matter, finds that this case is not in posture for
decision.2 FECA provides that OWCP shall determine and make findings of fact in making an
award for or against payment of compensation after considering the claim presented by the
employee and after completing such investigation as it considers necessary with respect to the
claim.3 The reasoning behind OWCP’s evaluation should be clear enough for the reader to
understand the precise defect of the claim and the kind of evidence which would overcome it. 4
In the February 24, 2020 decision, OWCP initially found that the medical evidence did not
demonstrate the claimed medical condition was related to the established work -related event(s).
However, it further found that the evidence did not support that the claimed event(s) occurred as
alleged. As these findings are conflicting, OWCP did not discharge its responsibility to set forth
findings of fact and a clear statement of reasons explaining the disposition so that appellant could
understand the basis for the decision, as well as the precise defe ct and the evidence needed to
overcome the denial of his traumatic injury claim. 5

2

See M.H., Docket No. 19-1187 (issued August 7, 2020); N.M., Docket No. 17-0262 (issued July 3, 2017).

3

5 U.S.C. § 8124(a)(2); 20 C.F.R. § 10.125.

4

Federal (FECA) Procedure Manual, Part 2 -- Claims, Disallowances, Chapter 2.1400.5(c) (February 2013). See
B.S., Docket No. 20-1008 (issued November 13, 2020); G.S., Docket No. 14-1933 (issued November 7, 2014).
5

N.D., Docket No. 20-0131 (issued September 11, 2020); J.S., Docket No. 18-0513 (issued March 1, 2019); R.M.,
Docket No. 19-0163 (issued July 17, 2019); K.J., Docket No. 14-1874 (issued February 26, 2015); J.J., Docket No.
11-1958 (issued June 27, 2012).

2

Accordingly, the Board will remand the case to OWCP to make appropriate findings
regarding appellant’s traumatic injury claim. Following this and other such development as
deemed necessary, OWCP shall issue a de novo decision.
IT IS HEREBY ORDERED THAT the February 24, 2020 decision of the Office of
Workers’ Compensation Programs is set aside and the case is remanded for further proceedings
consistent with this order of the Board.
Issued: January 13, 2022
Washington, DC

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

Janice B. Askin, Judge
Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Alternate Judge
Employees’ Compensation Appeals Board

3


United States Department of Labor
Employees’ Compensation Appeals Board
__________________________________________
H.C., Appellant
and
DEPARTMENT OF THE ARMY, ARMY CORP
OF ENGINEERS, Clewiston, FL, Employer
__________________________________________

)
)
)
)
)
)
)
)

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

Docket No. 13-477
Issued: April 17, 2013

Case Submitted on the Record

DECISION AND ORDER
Before:
COLLEEN DUFFY KIKO, Judge
PATRICIA HOWARD FITZGERALD, Judge
JAMES A. HAYNES, Alternate Judge

JURISDICTION
On December 26, 2012 appellant filed a timely appeal from a decision of the Office of
Workers’ Compensation Programs (OWCP) dated November 14, 2012. 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 sustained a right shoulder or cervical injury in the
performance of duty on August 25, 2009.
FACTUAL HISTORY
This is the third appeal before the Board. Appellant filed a claim for traumatic injury on
August 27, 2009, alleging that he sustained an injury to his right shoulder on August 25, 2009
while climbing a ladder in a boat basin. By decision dated December 7, 2009, OWCP denied the
1

5 U.S.C. § 8101 et seq.

claim, finding that he failed to submit medical evidence sufficient to establish that he sustained a
right shoulder or neck injury in the performance of duty on August 25, 2009. By decision dated
March 1, 2010, it denied his request for a hearing as untimely. By decision dated December 17,
2010, OWCP denied appellant’s request for reconsideration without a merit review, finding that
the request was untimely and that he had not established clear evidence of error. In an
October 5, 2011 decision,2 the Board set aside OWCP’s December 17, 2010 decision, finding that
OWCP erred in finding appellant’s reconsideration request untimely. The Board remanded the
case to OWCP to further review appellant’s December 17, 2010 reconsideration request in
accordance with its regulations and procedures.
On July 16, 2011 appellant requested reconsideration and submitted additional medical
evidence. By decision dated November 4, 2011, OWCP denied modification of the March 31,
2011 decision. In a decision dated July 2, 2012,3 the Board affirmed OWCP’s November 4, 2011
decision. The complete facts of this case are set forth in the Board’s July 2, 2012 decision and
are herein incorporated by reference.
By letter dated October 30, 2012, appellant, through his attorney, requested
reconsideration.
In a report dated October 9, 2012, received by OWCP on November 5, 2012,
Dr. James P. Weiner, Board-certified in orthopedic surgery, noted that appellant had related
complaints of left-sided neck pain and stiffness since the August 25, 2009 work incident. He
described the history of alleged injury and subsequent treatment and advised that, when he
initially saw appellant on February 16, 2010, he had neck and left shoulder pain radiating to the
upper trapezius and toward the shoulder. Dr. Weiner stated that appellant was not experiencing
any similar kind of pain prior to the August 25, 2009 work incident; he rated appellant’s current
pain at a six out of ten. He advised that on examination appellant had muscle spasm of the left
neck and upper trapezius area. Appellant underwent a magnetic resonance imaging (MRI) scan
in February 2010 which showed multilevel degenerative disc disease with multilevel foraminal
stenosis, neural foraminal stenosis and central stenosis at C5-6. His neck pain was treated with a
transcutaneous electrical nerve stimulator unit and, on February 15, 2012, cervical medial branch
blocks. Dr. Weiner last saw appellant on September 12, 2012, at which time he had complaints
of left-sided neck pain and lower back pain; the pain was continuous and stabbing, with a
tingling sensation in his hands and legs.
By decision dated November 14, 2012, OWCP denied modification of the prior decision.
LEGAL PRECEDENT
An employee seeking benefits under FECA4 has the burden of establishing that 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
2

Docket No. 11-716 (issued October 5, 2011).

3

Docket No. 12-404 (issued July 2, 2012).

4

5 U.S.C. §§ 8101-8193.

2

time limitation period of FECA, that an injury was sustained in the performance of duty as alleged,
and that any disability and/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 upon a traumatic injury or an
occupational disease.6
To determine whether a federal employee has sustained a traumatic injury in the
performance of duty, it must first be determined whether a “fact of injury” has been established.
First, the employee must submit sufficient evidence to establish that he or she actually
experienced the employment incident at the time, place and in the manner alleged.7 Second, the
employee must submit sufficient evidence, generally only in the form of medical evidence, to
establish that the employment incident caused a personal injury.8 The medical evidence required
to establish causal relationship is usually rationalized medical evidence. Rationalized medical
opinion evidence is medical evidence which includes a physician’s rationalized opinion on the
issue of whether there is a 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
The Board has held that the mere fact that a condition manifests itself during a period of
employment does not raise an inference that there is a causal relationship between the two.10
An award of compensation may not be based on surmise, conjecture or speculation.
Neither the fact that appellant’s condition became apparent during a period of employment nor,
the belief that his condition was caused, precipitated or aggravated by his employment is
sufficient to establish causal relationship.11 Causal relationship must be established by
rationalized medical opinion evidence and appellant failed to submit such evidence.
ANALYSIS
OWCP accepted that appellant experienced right shoulder and neck pain while climbing a
ladder on August 25, 2009. The question of whether an employment incident caused a personal
injury can only be established by probative medical evidence.12 Appellant has not submitted
5
6

Joe D. Cameron, 41 ECAB 153 (1989); Elaine Pendleton, 40 ECAB 1143 (1989).
Victor J. Woodhams, 41 ECAB 345 (1989).

7

John J. Carlone, 41 ECAB 354 (1989).

8

Id. For a definition of the term “injury,” see 20 C.F.R. § 10.5(a)(14).

9

Id.

10

See Joe T. Williams, 44 ECAB 518, 521 (1993).

11

Id.

12

Carlone, supra note 7.

3

rationalized, probative medical evidence to establish that the August 25, 2009 employment
incident would have been competent to cause the claimed injury.
Following the Board’s July 2, 2012 review of the case, appellant submitted Dr. Weiner’s
October 9, 2012 report. Dr. Weiner stated that appellant was experiencing neck and left shoulder
pain and stiffness which radiated to the upper trapezius and left shoulder. He advised that
appellant did not have this type of pain prior to the August 25, 2009 work incident; he, however,
had related complaints of left-sided neck pain and stiffness since the August 25, 2009 work
incident. Dr. Weiner’s February 2010 MRI scan revealed multilevel degenerative disc disease
with multilevel foraminal stenosis, neural foraminal stenosis and central stenosis at C5-6. On
September 12, 2012 appellant complained of continuous and stabbing, left-sided neck pain and
lower back pain. Dr. Weiner’s report did not contain a probative, rationalized medical opinion
establishing that appellant’s claimed right shoulder and neck conditions were causally related to
the August 25, 2009 employment injury.
The weight of medical opinion evidence is determined by the opportunity for and
thoroughness of examination, the accuracy and completeness of physician’s knowledge of the
facts of the case, the medical history provided, the care of analysis manifested and the medical
rationale expressed in support of stated conclusions.13 While Dr. Weiner’s report contained a
diagnosis of the claimed conditions, he did not present a rationalized, probative medical opinion
attributing his alleged injury to the August 25, 2009 work incident. Accordingly, his opinion on
causal relationship is of limited probative value.14 Dr. Weiner stated in his October 9, 2012
report that appellant had experienced continued symptoms of neck and left shoulder pain since
his August 25, 2009 work injury, but he did not describe appellant’s accident in any detail or
explain how climbing a ladder in a boat basin would have been competent to cause an injury.
His opinion is of limited probative value for the further reason that it is generalized in nature and
equivocal in that he only noted summarily that appellant’s shoulder and neck conditions were
causally related to the August 25, 2009 work incident. Further, it is unclear if Dr. Weiner had an
accurate history of the August 25, 2009 incident as he repeatedly indicated in his report that
appellant was experiencing left shoulder injury as a result of the August 25, 2009 incident, but he
offered no specific details relating an accurate understanding of the incident.15
OWCP advised appellant of the evidence required to establish his claim; however,
appellant failed to submit such evidence. Appellant did not provide a medical opinion which
describes or explains the medical process through which climbing a ladder in a boat basin on
August 25, 2009 would have caused the claimed injury. Accordingly, he did not establish that he
sustained a right shoulder or neck injury in the performance of duty. OWCP properly denied
appellant’s claim for compensation.

13

See Anna C. Leanza, 48 ECAB 115 (1996).

14

William C. Thomas, 45 ECAB 591 (1994).

15

See Geraldine H. Johnson, 44 ECAB 745 (1993).

4

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 failed to establish that he sustained right shoulder or
cervical injuries in the performance of duty on August 25, 2009.
ORDER
IT IS HEREBY ORDERED THAT the November 14, 2012 decision16 of the Office of
Workers’ Compensation Programs be affirmed.
Issued: April 17, 2013
Washington, DC

Colleen Duffy Kiko, Judge
Employees’ Compensation Appeals Board

Patricia Howard Fitzgerald, Judge
Employees’ Compensation Appeals Board

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

16

The Board notes that OWCP erroneously stated in its November 14, 2012 decision that the issue was whether
the Board’s July 2, 2012 decision should be vacated and concluded that “modification of the July 2, 2012 decision is
denied.” Pursuant to 20 C.F.R. § 501.6(d) “the decisions and orders of the Board are final as to the subject matter
appealed, and such decisions and orders are not subject to review except by the Board.” The Board finds, however,
that any error is harmless. OWCP considered the medical evidence appellant submitted with his request for
reconsideration and found that it was not sufficient to modify its previous determinations that appellant did not meet
his burden to establish that he sustained a right shoulder or neck injury causally related to the August 25, 2009 work
incident.

5


United States Department of Labor
Employees’ Compensation Appeals Board
__________________________________________
D.V., Appellant
and
DEPARTMENT OF THE AIR FORCE, TRAVIS
AIR FORCE BASE, CA, Employer
__________________________________________

)
)
)
)
)
)
)
)

Appearances:
Gordon Reiselt, Esq., for the appellant
Office of Solicitor, for the Director

Docket No. 07-2123
Issued: September 8, 2008

Case Submitted on the Record

DECISION AND ORDER
Before:
DAVID S. GERSON, Judge
MICHAEL E. GROOM, Alternate Judge
JAMES A. HAYNES, Alternate Judge

JURISDICTION
On August 15, 2007 appellant filed a timely appeal from the Office of Workers’
Compensation Programs’ merit decision dated July 27, 2007. Pursuant to 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 had any employment-related disability on or after
April 4, 1993.
FACTUAL HISTORY
The case was before the Board on prior appeals. In a decision dated January 9, 2002, the
Board found that, although the Office had properly terminated compensation for wage-loss and
medical benefits as of April 4, 1993, appellant had submitted sufficient evidence to create a
conflict with respect to whether she continued to be entitled to compensation after
April 4, 1993.1 By order dated August 4, 2006, the Board remanded the case on the grounds that
1

Docket No. 00-1942 (issued January 9, 2002).

the referee physician, Dr. Britt Daniel, failed to provide an opinion on the issue presented.2 The
history of the case is provided in the Board’s prior decision and order and is incorporated herein
by reference.
In an April 20, 2007 letter to Dr. Daniel, the Office advised that he was not asked to give
a work capacity determination regarding the accepted employment injury. It sent Dr. Daniel a
work capacity evaluation (Form OWCP-5c). Dr. Daniel completed the form on April 25, 2007
and indicated that appellant could work with restrictions.
The Office then referred appellant for referee examination by Dr. Sandy Kimmel, an
osteopath Board-certified in neurology. Dr. Kimmel provided a history and results on
examination. She indicated that appellant had subjective complaints of sensory loss with no
atrophy or weakness. Dr. Kimmell completed an OWCP-5c indicating appellant could work four
hours per day.
By letter dated June 11, 2007, the Office requested that Dr. Kimmel discuss objective
findings and explain the limitation of four hours per day. In a report dated June 18, 2007,
Dr. Kimmel stated that she was unable to confirm whether the current findings were related to
the employment injury. She stated the basis for work limitations were appellant’s subjective
complaints of hand numbness and weakness, and repetitive activity seemed to exacerbate
symptoms. The Office again requested clarification in a June 26, 2007 letter, stating there was
no compensation for wage loss due to pain and prophylactic restrictions were not acceptable. In
a report dated June 29, 2007, Dr. Kimmel stated that the objective findings included a right
median sensory neuropathy, which was not seen on a previous nerve conduction velocity test.
She stated the work limitations were due to appellant’s multiple subjective complaints.
In a decision dated July 27, 2007, the Office found that the weight of the medical
evidence did not demonstrate disability for any period after April 4, 1993 in connection with the
right carpal tunnel syndrome. In reviewing the case, the Office claims examiner noted the
January 9, 2002 Board decision had remanded the case for evaluation by a referee, but “I am
unable to interpret this seemingly contrary conclusion as the Board has unequivocally stated that
the left carpal tunnel syndrome was not part of this claim and that there was no evidence of
temporary total disability after April 4, 1993, thereby affirming the prior decision.” The Office
stated that Dr. Kimmel concluded that appellant was capable of working full time.
LEGAL PRECEDENT
The Federal Employees’ Compensation Act provides that, if there is a disagreement
between the physician making the examination for the United States and the physician of the
employee, the Secretary shall appoint a third physician who shall make the examination.3 The
implementing regulation states that, if a conflict exists between the medical opinion of the
employee’s physician and the medical opinion of either a second opinion physician or an Office
medical adviser, the Office shall appoint a third physician to make an examination. This is
2

Docket No. 06-529 (issued August 4, 2006).

3

5 U.S.C. § 8123(a).

2

called a referee examination and the Office will select a physician who is qualified in the
appropriate specialty and who has no prior connection with the case.4
ANALYSIS
The July 27, 2007 Office decision appears to have misunderstood the Board’s prior
decision and order in this case. In reviewing the Board’s January 9, 2002 decision, the Office
stated that the Board had found “no evidence of temporary total disability after April 4, 1993.”
The Board’s holding was that, although the Office had met its burden of proof to terminate
compensation in its March 26, 1993 decision, additional evidence submitted by appellant had
created a conflict as to whether appellant had established a continuing employment-related
disability after April 4, 1993.5 It appears the Office interpreted the Board’s decision as having
resolved the issue of disability after April 4, 1993 and therefore a remand to resolve the conflict
was found to be a “seemingly contrary conclusion.” The issue must be resolved by the referee
physician.
The Office again failed to secure medical evidence to resolve the issue. It is not
sufficient for the referee physician to discuss only appellant’s current disability. The physician
must address the issue of employment-related disability from April 4, 1993 to the present.
Dr. Kimmel was not asked to address the issue and therefore did not render a rationalized
opinion on the relevant issue. With respect to current disability, the Board notes that, while the
Office stated that Dr. Kimmel found appellant capable of working full time, her opinion on
employment-related disability is not clear from her reports. Dr. Kimmel stated that she was
unable to confirm whether the current findings were related to the employment injury, and did
not provide a rationalized medical opinion.
On remand the Office should submit a complete statement of accepted facts and relevant
medical records to a referee physician for an opinion that properly resolves the conflict in the
medical evidence. After such further development as the Office deems necessary, it should issue
an appropriate decision.
CONCLUSION
The conflict in the medical evidence as to an employment-related disability on or after
April 4, 1993 remains unresolved.

4

20 C.F.R. § 10.321 (1999).

5

Once the Office has met its burden of proof to terminate compensation, the burden shifts to appellant.
Talmadge Miller, 47 ECAB 673, 679 (1996); see also George Servetas, 43 ECAB 424 (1992).

3

ORDER
IT IS HEREBY ORDERED THAT the decision of the Office of Workers’
Compensation Programs dated July 27, 2007 is set aside and the case remanded for further action
consistent with this decision of the Board.
Issued: September 8, 2008
Washington, DC

David S. Gerson, Judge
Employees’ Compensation Appeals Board

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

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

4


United States Department of Labor
Employees’ Compensation Appeals Board
__________________________________________
C.M., Appellant
and
U.S. POSTAL SERVICE, POST OFFICE,
Twin Falls, ID, Employer
__________________________________________

)
)
)
)
)
)
)
)

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

Docket No. 19-1262
Issued: February 10, 2020

Case Submitted on the Record

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

JURISDICTION
On May 13, 2019 appellant filed a timely appeal from a March 13, 2019 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.2
ISSUE
The issue is whether appellant has met her burden of proof to establish a left shoulder
condition causally related to the accepted factors of her federal employment.

1
2

5 U.S.C. § 8101 et seq.

The Board notes that following OWCP’s March 13, 2019 decision, appellant submitted additional evidence.
However, the Board’s Rules of Procedure provides: “The Board’s review of a case is limited to the evidence in the
case record that was before OWCP at the time of its final decision. Evidence not before OWCP will not be considered
by the Board for the first time on appeal.” 20 C.F.R. § 501.2(c)(1). Thus, the Board is precluded from reviewing this
additional evidence for the first time on appeal. Id.

FACTUAL HISTORY
On June 8, 2018 appellant, then a 45-year-old rural carrier, filed an occupational disease
claim (Form CA-2) alleging that she injured her left shoulder while in the performance of duty.
She indicated that she first became aware of her condition and realized that it was caused or
aggravated by factors of her federal employment on June 8, 2018. Appellant explained that she
had been employed by the employing establishment for the past 20 years and that her shoulder had
been in pain for over a month as a result of delivering the mail. She did not stop work.
In an accompanying statement, appellant provided that her job required repetitive lifting,
pulling, carrying and casing of mail, as well as taking the mail down, driving and putting mail up
five days a week. She explained that she is required to lift 70 pounds and that her route is 30 miles
long with 1,033 customers. Appellant put up six to seven delivery point sequencing (DPS) trays
of mail per day and up to 21 DPS trays every Wednesday when delivering newspapers. She was
required to push and pull two carts of mail every day in order to load her long life vehicle (LLV),
which requires lifting multiple trays from her carts and stacking them into the LLV.
In a July 10, 2018 medical report, Dr. R. Tyler McKee, a Board-certified orthopedic
surgeon, examined appellant for her complaints of left shoulder pain. He reported that she
indicated that she injured her shoulder at work in June when she picked up a heavy mail tub while
reaching back in a twisting motion. Dr. McKee further reported pain radiating from her left
shoulder to her neck, as well as numbness in her left arm. Upon evaluation, he diagnosed appellant
with cervical radiculopathy, tendinitis of the left rotator cuff and biceps tendinitis of the left upper
extremity.
In a development letter dated August 3, 2018, OWCP advised appellant that it required
additional factual and medical evidence to establish her claim. It attached a questionnaire,
requesting that she provide a detailed description of the employment factors she believed
contributed to her left shoulder condition, including her required duties and the amount of time she
spent performing these duties. OWCP also requested that appellant’s attending physician provide
a comprehensive narrative medical report. It afforded appellant 30 days to submit the necessary
evidence.
In a separate development letter of even date, OWCP requested that the employing
establishment provide additional information regarding appellant’s occupational disease claim,
including comments from a knowledgeable supervisor regarding the accuracy of her statements,
and a copy of her position description and physical requirements of her position. It afforded the
employing establishment 30 days to submit the necessary evidence.
In response to OWCP’s questionnaire, appellant’s supervisor, A.P., agreed with her
statements concerning the description of the events leading up to her claim. A.P. related that
appellant was required to lift for six to eight hours per day, push and pull for two to four hours per
day and bend and stoop for another two to four hours per day. The supervisor further noted that
she was given safety stand ups on proper lifting techniques as precautions to minimize the effects
of her work duties. A.P. also attached a copy of her job description to the questionnaire response.

2

On August 16, 2018 appellant submitted a signed copy of OWCP’s questionnaire, but she
did not answer any of the questions posed by it.
In an August 29, 2018 medical report, Dr. McKee noted appellant’s continuing pain in her
left shoulder and ordered a magnetic resonance imaging (MRI) scan for further evaluation.
By decision dated September 24, 2018, OWCP denied appellant’s claim, finding that the
evidence submitted was insufficient to establish that her conditions were causally related to the
accepted factors of her federal employment.
Appellant submitted multiple physical therapy notes dated from July 10 to August 21, 2018
signed by various physical therapists and physical therapy assistants.
In an office visit note dated October 30, 2018, Dr. McKee indicated that appellant
continued to experience pain in her left shoulder and related that the pain had increased since her
last visit.
An x-ray of appellant’s left shoulder of even date revealed no fractures or dislocations.
In an October 31, 2018 medical report, Dr. McKee again noted appellant’s history of pain
in her left shoulder related to repetitive use at work in June 2018. He noted that appellant had
failed nonoperative management and stopped her physical therapy, activity modification and
steroid injections. Dr. McKee ordered an MRI scan of appellant’s left shoulder to confirm her
diagnosis and to help with surgical planning.
On December 11, 2018 appellant requested reconsideration of OWCP’s September 24,
2018 decision.
By decision dated March 13, 2019, OWCP denied modification of its prior decision.
LEGAL PRECEDENT
An employee seeking benefits under FECA3 has the burden of proof to establish the
essential elements of his or her claim, including 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,4 that 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

3

Supra note 1.

4
S.C., Docket No. 18-1242 (issued March 13, 2019); S.B., Docket No. 17-1779 (issued February 7, 2018); J.P., 59
ECAB 178 (2007); Joe D. Cameron, 41 ECAB 153 (1989).

3

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) a factual statement identifying
employment factors alleged to have caused or contributed to the presence or occurrence of the
disease or condition; (2) medical evidence establishing the presence or existence of the disease or
condition for which compensation is claimed; and (3) medical evidence establishing that the
diagnosed condition is causally related to the employment factors identified by the claimant.7
Causal relationship is a medical issue, and the medical evidence required to establish causal
relationship is rationalized medical evidence.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 employee.9
Neither the mere fact that a disease or condition manifests itself during a period of employment
nor the belief that the disease or condition was caused or aggravated by employment factors or
incidents is sufficient to establish causal relationship.10
ANALYSIS
The Board finds that appellant has not met her burden of proof to establish a left shoulder
condition causally related to the accepted factors of her federal employment.
Appellant submitted Dr. McKee’s July 10, August 29, and October 31, 2018 medical
reports in which he diagnosed cervical radiculopathy, tendinitis of the left rotator cuff and biceps
tendinitis of the left upper extremity as a result of the repetitive motions she engaged in at work.
Although his opinion generally supported causal relationship between the accepted employment
factors and appellant’s diagnosed conditions, Dr. McKee did not provide sufficient rationale
explaining this conclusion. Without explaining how the repetitive movements involved in
appellant’s employment duties caused or contributed to her injuries, his opinion is of limited
probative value.11 Further, Dr. McKee’s conclusions are largely based on appellant’s opinion as

5
S.C., id.; J.M., Docket No. 17-0284 (issued February 7, 2018); R.C., 59 ECAB 427 (2008); James E. Chadden, Sr.,
40 ECAB 312 (1988).
6

S.C., id.; K.M., Docket No. 15-1660 (issued September 16, 2016); L.M., Docket No. 13-1402 (issued February 7,
2014); Delores C. Ellyett, 41 ECAB 992 (1990).
7

C.D., Docket No. 17-2011 (issued November 6, 2018); Jacquelyn L. Oliver, 48 ECAB 232, 235-36 (1996).

8

E.V., Docket No. 18-1617 (issued February 26, 2019); A.M., Docket No. 18-0685 (issued October 26, 2018).

9

E.V., id.

10

B.J., Docket No. 19-0417 (issued July 11, 2019).

11

See A.P., Docket No. 19-0224 (issued July 11, 2019).

4

to what caused her injuries, rather than by his independent analysis of the cause of her conditions.12
A mere conclusion without the necessary rationale explaining how and why the physician believes
that a claimant’s accepted incident resulted in the diagnosed condition is insufficient to meet
appellant’s burden of proof.13 Accordingly, the Board finds that these medical reports are of little
probative value on the issue of causal relationship.
Appellant submitted multiple physical therapy notes dated from July 10 to August 21, 2018
providing updates on her progress through therapy sessions. Certain healthcare providers such as
physician assistants, nurse practitioners, physical therapists, and social workers are not considered
physicians as defined under FEFA.14 Consequently, their medical findings and/or opinions will
not suffice for purposes of establishing entitlement to FECA benefits.15
Additionally, appellant submitted the results of an October 30, 2018 x-ray, which revealed
no positive findings. The Board has held that diagnostic studies lack probative value as they do
not address whether an employment incident caused the diagnosed condition.16
As there is no rationalized medical evidence of record explaining how appellant’s
employment duties caused or aggravated her conditions, appellant has not met her burden of proof
to establish that her conditions are causally related to the accepted factors of her federal
employment.
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 left shoulder
condition causally related to the accepted factors of her federal employment.

12

See D.L., Docket No. 15-0866 (issued November 23, 2015); J.S., Docket No. 14-0818 (issued August 7, 2014).

13

See Y.T., Docket No. 17-1559 (issued March 20, 2018).

14

5 U.S.C. § 8101(2); 20 C.F.R. § 10.5(t).

15

See M.F., Docket No. 17-1973 (issued December 31, 2018); K.W., 59 ECAB 271, 279 (2007); David P. Sawchuk,
57 ECAB 316, 320 n.11 (2006). Federal (FECA) Procedure Manual, Part 2 -- Claims, Causal Relationship, Chapter
2.805.3a(1) (January 2013).
16

F.S., Docket No. 19-0205 (issued June 19, 2019); T.J., Docket No. 18-1500 (issued May 1, 2019).

5

ORDER
IT IS HEREBY ORDERED THAT the March 13, 2019 decision of the Office of
Workers’ Compensation Programs is affirmed.
Issued: February 10, 2020
Washington, DC

Janice B. Askin, Judge
Employees’ Compensation Appeals Board

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

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

6


United States Department of Labor
Employees’ Compensation Appeals Board
__________________________________________
M.C., Appellant
and
U.S. POSTAL SERVICE, VEHICLE
MAINTENANCE FACILITY, Baltimore, MD,
Employer
__________________________________________

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Docket No. 15-1706
Issued: October 22, 2015

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

Case Submitted on the Record

DECISION AND ORDER
Before:
ALEC J. KOROMILAS, Alternate Judge
JAMES A. HAYNES, Alternate Judge
VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION
On August 11, 2015 appellant timely appealed the June 11, 2015 nonmerit decision of the
Office of Workers’ Compensation Programs (OWCP). As more than 180 days elapsed from the
last merit decision of April 11, 2014 to the filing of the current appeal, pursuant to the Federal
Employees’ Compensation Act1 (FECA) and 20 C.F.R. §§ 501.2(c) and 501.3, the Board lacks
jurisdiction over the merits of this claim.2
ISSUE
The issue is whether OWCP properly declined to reopen appellant’s case for merit review
under 5 U.S.C. § 8128(a).

1
2

5 U.S.C. § 8101 et seq.

Appellant provided additional evidence on appeal that was not part of the record when OWCP issued its
June 11, 2015 decision. The Board is precluded from considering evidence that was not in the case record at the
time OWCP rendered its final decision. 20 C.F.R. § 501.2(c)(1) (2014).

FACTUAL HISTORY
On January 8, 2014 appellant, then a 60-year-old general clerk, filed an occupational
disease claim (Form CA-2) for a work-related right upper extremity injury that she allegedly
sustained on or about December 23, 2013. She indicated that her employment duties included
computer data input. Ninety percent of her time was reportedly spent doing data entry and filing.
Appellant also indicated that she had already been diagnosed with bilateral carpal tunnel
syndrome (CTS), and lately she experienced shocking nerve pain and swelling in her right
forearm, elbow, and shoulder. Additionally, she noted three prior claims that OWCP accepted
for injuries involving her neck and upper extremities.
OWCP received a December 23, 2013 bilateral upper extremity nerve conduction study
(NCS), as well as a similarly dated medical report from Dr. Margit L. Bleecker, a Board-certified
neurologist. In her narrative report, Dr. Bleecker diagnosed right neurogenic thoracic outlet
syndrome (TOS), which she explained was supported by examination findings (positive Adson’s
maneuver) and electrodiagnostic studies.3 She noted that appellant worked for the employing
establishment since 1986, and her duties as a general clerk involved frequent filing.4
Dr. Bleecker further noted that appellant frequently had to reach above shoulder height for filing,
and also the file drawers were extremely tight and required a lot of force to pull open. She
explained that these were risk factors for right thoracic outlet syndrome, which diagnosis had
been demonstrated on appellant’s physical examination and her nerve conduction studies.
Dr. Bleecker further explained that constant flexion and extension with filing put stress on the
ulnar nerve in the cubital tunnel, which diagnosis was also demonstrated both by examination
and nerve conduction studies.
OWCP incorporated various documents from one of appellant’s other claim files
(xxxxxx451). The evidence included: (1) a March 4, 2013 Form CA-2 for bilateral CTS with a
December 5, 2012 date of injury; (2) narrative reports from Dr. Bleecker dated September 10,
November 14, and December 19, 2013; (3) a February 28, 2014 statement of accepted facts
(SOAF); (4) a March 23, 2014 report from the district medical adviser (DMA) regarding
entitlement to a schedule award; and (5) OWCP’s April 4, 2014 schedule award for a combined
16 percent bilateral upper extremity impairment i.e., 10 percent LUE impairment and 6 percent
RUE impairment.
The above-noted reports from Dr. Bleecker pertained to appellant’s December 5, 2012
injury. Dr. Bleecker diagnosed neck sprain, left shoulder sprain, bilateral CTS, and left brachial
plexus lesions/TOS. She found an 18.1 bilateral upper extremity impairment.
The February 28, 2014 SOAF indicated that claim number xxxxxx451 had been accepted
for sprain of the left shoulder and upper left arm (ICD-9 840.9), sprain of the neck (ICD-9
847.0), bilateral CTS (ICD-9 354.0), and left brachial plexus (ICD-9 353.0).
3

Dr. Bleecker reported that the NCS results revealed right ulnar neuropathy at the elbow, which supported the
clinical presentation of right cubital tunnel syndrome. She also noted that a right brachial plexus lesion involving
the lower roots supported a positive examination for right thoracic outlet syndrome.
4

Appellant’s duties also included extensive keyboarding and use of a mouse. Dr. Bleecker explained that
constant flexion and extension of the elbow and reaching above shoulder height had proved to be difficult for
appellant.

2

In his March 23, 2014 report, Dr. Arnold T. Berman, a Board-certified orthopedic
surgeon and DMA, questioned Dr. Bleecker’s February 11, 2012 bilateral upper extremity
impairment rating, which was based in part on a diagnosis of TOS.5 The DMA indicated that
TOS was not an accepted condition, and further noted that there was no clinical evidence to
support the diagnosis. Additionally, he indicated that he would not recommend adding TOS to
the list of accepted conditions. Whereas Dr. Bleecker reportedly found a combined 18 percent
bilateral upper extremity impairment, the DMA found only 16 percent.
The April 4, 2014 schedule award under claim number xxxxxx451 was based on the
DMA’s March 23, 2014 impairment rating.
In a decision dated April 11, 2014, OWCP denied appellant’s claim for right thoracic
outlet syndrome. The senior claims examiner found that Dr. Bleecker’s December 23, 2013
narrative report was insufficient to establish that appellant’s condition was causally related to the
accepted work conditions. OWCP further noted that thoracic outlet syndrome had already been
rejected under appellant’s prior claim (xxxxxx451), and that the current claim was just an
attempt to add a medical condition that had already been reviewed and ruled out by OWCP in its
April 4, 2014 schedule award decision. The senior claims examiner quoted at length from the
DMA’s March 23, 2014 narrative report, including his statement that TOS was not an accepted
condition, and his recommendation that TOS not be added to the list of accepted conditions
under claim number xxxxxx451.
On March 9, 2015 appellant requested reconsideration. In a letter dated March 25 and
April 7, 2015, appellant noted, inter alia, that her prior claim (xxxxxx451) had been accepted for
left thoracic outlet syndrome, contrary to what both the DMA and the senior claims examiner
indicated. According to appellant, the May 24, 2013 acceptance letter she received from OWCP
included left thoracic outlet syndrome as an accepted condition under claim number xxxxxx451.
Appellant further noted that brachial plexus lesions and thoracic outlet syndrome share the same
ICD-9 Code, “353.0.”
By decision dated June 11, 2015, OWCP denied appellant’s request for reconsideration.
It explained that appellant had not submitted any new medical evidence with her request.
LEGAL PRECEDENT
Section 8128(a) of FECA does not entitle a claimant to review of an OWCP decision as a
matter of right.6 OWCP has discretionary authority in this regard and has imposed certain
limitations in exercising its authority.7 One such limitation is that the application for
reconsideration must be received by OWCP within one year of the date of the decision for which

5

The current record does not include a copy of the referenced February 11, 2012 impairment rating from
Dr. Bleecker.
6

This section provides in pertinent part: “[t]he Secretary of Labor may review an award for or against payment
of compensation at any time on his own motion or on application.” 5 U.S.C. § 8128(a).
7

20 C.F.R. § 10.607.

3

review is sought.8 A timely application for reconsideration, including all supporting documents,
must set forth arguments and contain evidence that either: (i) shows that OWCP erroneously
applied or interpreted a specific point of law; (ii) advances a relevant legal argument not
previously considered by OWCP; or (iii) constitutes relevant and pertinent new evidence not
previously considered by OWCP.9 When a timely application for reconsideration does not meet
at least one of the above-noted requirements, OWCP will deny the request for reconsideration
without reopening the case for a review on the merits.10
ANALYSIS
The Board finds that the case is not in posture for decision. OWCP referenced claim
number xxxxxx451 in both the April 11, 2014 merit decision and the June 11, 2015 nonmerit
decision. However, the complete record associated with claim number xxxxxx451 is not
currently available for review by the Board. Although OWCP included some information from
claim number xxxxxx451 in the current record (xxxxxx032), it did not double/combine the
respective case files associated with appellant’s two latest upper extremity claims.11
Appellant argued that OWCP’s May 24, 2013 acceptance letter identified left thoracic
outlet syndrome as one of several accepted conditions under claim number xxxxxx451.
However, the claims acceptance letter was not among the various documents OWCP included in
the current record. The February 28, 2014 SOAF lists “left brachial plexus” (ICD-9 353.0) as
one of four conditions accepted under claim number xxxxxx451.12 Appellant correctly noted
that the ICD-9 code for brachial plexus lesions includes thoracic outlet syndrome. The Board
notes that the June 11, 2015 nonmerit decision did not specifically address appellant’s argument
that the DMA and senior claims examiner were both incorrect regarding acceptance of thoracic
outlet syndrome under claim number xxxxxx451.
Decisions on claims are based on the written record, which may include forms, reports,
letters, and other evidence of various types such as photographs, videotapes or drawings.13
8

Id. at § 10.607(a). The one-year period begins on the date of the original decision, and an application for
reconsideration must be received by OWCP within one year of OWCP’s decision for which review is sought for
merit decisions issued on or after August 29, 2011. Federal (FECA) Procedure Manual, Part 2 -- Claims,
Reconsiderations, Chapter 2.1602.4 (October 2011). Timeliness is determined by the document receipt date of the
request for reconsideration as indicated by the “received date” in the Integrated Federal Employees’ Compensation
System (iFECS). Id. at Chapter 2.1602.4b.
9

20 C.F.R. § 10.606(b)(3).

10

Id. at §§ 10.607(b), 10.608(b).

11

See Federal (FECA) Procedure Manual, Part 2 -- Claims, File Maintenance and Management, Chapter 2.400.8c
(February 2000). (Cases should be doubled when correct adjudication of the issues depends on frequent crossreference between files).
12

The accepted conditions identified in a SOAF do not always mirror the conditions described in a formal
acceptance letter. This is particularly true when the SOAF reflects information obtained directly from iFECS
(ICD-9) “Accepted Conditions,” rather than from a review of OWCP’s acceptance letter and/or subsequent
correspondence expanding the list of accepted conditions.
13

Federal (FECA) Procedure Manual, Part 2 -- Claims, Initial Development of Claims, Chapter 2.800.5a
(June 2011).

4

Evidence may not be incorporated by reference, nor may evidence from another claimant’s case
file be used.14 Evidence contained in another of the claimant’s case files may be used, but a copy
of that evidence should be placed into the case file being adjudicated.15 All evidence that forms
the basis of a decision must be in that claimant’s case record.16
Because the record lacks sufficient evidence for the Board to render an informed
decision, the case shall be remanded to OWCP for further development. After OWCP has
developed the record consistent with the above-noted directive, it shall issue an appropriate
decision regarding appellant’s request for reconsideration.
CONCLUSION
The case is not in posture for decision.
ORDER
IT IS HEREBY ORDERED THAT the June 11, 2015 decision of the Office of
Workers’ Compensation Programs is set aside, and the case is remanded for further action
consistent with this decision.
Issued: October 22, 2015
Washington, DC

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

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

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

14

Id.

15

Id.

16

Id.

5


United States Department of Labor
Employees’ Compensation Appeals Board
__________________________________________
T.F., Appellant
and
DEPARTMENT OF THE NAVY, BUREAU OF
MEDICINE & SURGERY STATIONS,
Patuxent River, MD, Employer
__________________________________________

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

Docket No. 17-0645
Issued: August 15, 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 February 1, 2017 appellant, through counsel, filed a timely appeal from a December 15,
2016 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 the 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 that her claim should
be expanded to include additional conditions, of left hip strain and sciatica, as causally related to
her March 6, 2015 employment injury.
FACTUAL HISTORY
On March 12, 2015 appellant, then a 50-year-old financial technician, filed a traumatic
injury claim (Form CA-1) alleging that, on March 6, 2015, she injured and twisted her back,
shoulder, and knee while trying to grab a door to prevent from falling. She indicated that she was
the last person to leave her work and when she stepped back to lock the door, she slipped on ice
that had not been removed from behind the door. Appellant did not initially stop work.
In a March 9, 2015 treatment note, Dr. Charles Brenner, a Board-certified orthopedic
surgeon, indicated that appellant slipped on ice and jerked her shoulder. He advised that she had
pain, “mostly in the [left] shoulder to mid back and down into [left] buttocks and leg and gross
abnormality and swelling.” Dr. Brenner indicated that her left shoulder range of motion was
decreased due to pain. He diagnosed back pain, shoulder pain, and “palps.”
In a March 18, 2015 report, Dr. John Byrne, a Board-certified orthopedic surgeon, noted
that appellant presented with a complaint of shoulder pain. He advised that this occurred after a
fall at work on the ice. Dr. Byrne indicated that appellant slipped and her left leg, back, and neck
twisted as she attempted to support herself. He advised that she presented with neck, low back,
left shoulder, left knee pain, and left second toe numbness. Dr. Byrne also found that appellant
had pain radiating down the left leg, but no bowel or bladder symptoms. He reviewed her prior
history, which included that she had an L4-5 disc bulge and facet hypertrophy and bilateral
foraminal stenosis at L4-5 as noted by a September 23, 2011 magnetic resonance imaging (MRI)
scan. Dr. Byrne diagnosed pain in the shoulder, sprain/strain of the left knee and leg not otherwise
specified, strain of the left shoulder and upper arm, pain in the joint and foot, and sprain of the hip
and thigh.
In a May 19, 2015 attending physician’s report, Dr. Patricia Bray, Board-certified in
occupational medicine, noted that appellant slipped on stairs at work that were not cleared of snow
and ice. She advised that as appellant slipped, she twisted to reach the railing with her left hand
and caught herself and did not fall, but felt a pop in her back, left knee, and shoulder. Dr. Bray
indicated that she had a history of an Achilles rupture and repair in 2011 and a right rotator cuff
repair in 2012. She diagnosed L5 radiculopathy and sensory, acute trapezius strain and acute left
knee sprain. Dr. Bray indicated that appellant was unable to assess sensory and motor function.
She checked the box marked “yes” in response to whether she believed the condition was caused
or aggravated by an employment activity.
On June 18, 2015 OWCP accepted the claim for sprain of the shoulder and upper arm,
unspecified on the left, sprain of unspecified sites of the knee and leg on the left, along with sprain
of the back, lumbar region.

2

In a January 13, 2016 report, Dr. Byrne, noted that appellant was seen for follow up of her
shoulder. He also opined, “[i]n addition hip and sciatica discomfort is bothered by this as well.
[Appellant’s] biggest issue is sleeping is difficult because of the mattress.” Dr. Byrne examined
appellant’s hips and determined that she had normal range of motion and no crepitus. He noted
that there was no tenderness to palpation and no pain on the right hip, but there was pain on the
left. Dr. Byrne diagnosed impingement syndrome of the shoulder. He indicated that in addition,
appellant had a “nevus for both the hip and the shoulder, especially with the significant pain down
the leg and hip consistent with a sciatica and trochanteric bursitis from this work-related injury.”
Dr. Byrne recommended a new mattress for better contour and fit for her body sleeping to get
better sleep and to improve the sciatic pain.
Dr. Byrne provided an addendum dated February 24, 2016 in which he explained that
appellant had “pain in the hip completely associated with the low back injury which was from the
work-related injury.” In a March 23, 2016 certificate of disability, he noted that she could return
to light-duty work with restrictions to include: working for four to eight hours a day, as tolerated
with symptoms due to sciatica and shoulder symptoms.
In an April 1, 2016 report, Dr. Byrne explained that appellant was at work on April 1, 2016
when she slipped on ice which had not been cleared. He advised that she injured her neck, low
back, left shoulder, left knee, left second toe, and left hip. Dr. Byrne explained that appellant
related that she had pain radiating down her left leg. He indicated that it was “an oversight on our
part” as appellant’s left hip is also a part of her slipping on the ice on March 6, 2015 despite the
failure to mention it in his initial report. Dr. Byrne explained that appellant had a partial tear of
the rotator cuff from straining her shoulder when she slipped. He indicated that appellant would
try occupational therapy to her shoulder and physical therapy to her hip and knees. Dr. Byrne
diagnosed sprain/strain knee, pain in the foot, sprain in the hip/thigh and sprain/strain of the
shoulder. He advised that appellant returned to light-duty work on April 21, 2015 with restrictions
of no lifting over five pounds, no standing or sitting more than one hour without breaks, no
climbing or kneeling, and she could only work four or five hours a day. Dr. Byrne noted that a
lumbar spine MRI scan was ordered due to the significant pain and weakness that appellant
endured down her leg. He advised that physical therapy had not helped. Dr. Byrne determined
that the MRI scan did not reveal any nerve impingement. He explained that she was to continue
physical therapy and if there was no improvement to her shoulder, she was to consider surgery.
Dr. Byrne noted that he discussed surgery with appellant and also ordered a left hip MRI scan. He
advised that it revealed no pathology so it was presumed muscular. Dr. Byrne noted that she was
to continue physical therapy for the hip.
Dr. Byrne indicated that appellant underwent surgery to the shoulder on September 30,
2015 and returned on October 2, 2015 for her postoperative visit. He recommended continued
physical therapy and exercise. Dr. Byrne also noted that appellant’s hip and sciatica continued to
bother her. He argued that the delay in her treatment was due to the insurance company not
authorizing treatment. Dr. Byrne noted that appellant had not received physical therapy to her hip
since October 2015. He opined that she had a sciatica and left side issue from the injury and was
recovering from the left shoulder injury and surgery. Dr. Byrne recommended limited duties from
four to eight hours as tolerated and ultimately get rehabilitation approved.

3

In an April 20, 2016 report, Dr. Byrne noted that appellant indicated that she was in a
follow up for her left hip and shoulder. He noted that her past medical history included: sciatica;
shoulder pain, impingement syndrome of the shoulder; chronic pain syndrome; pain in the joint
and foot; sprain of the hip and thigh; knee strain; seizure disorder with pituitary adenoma surgery
removed in 1994 and afterwards temporal lobe damage; lumbar spondylosis; rupture of the
Achilles tendon; cervical sprain; lumbar stenosis with neurogenic claudication; lumbar
radiculopathy; syncope and collapse; pain of the knee, strain of upper arm; morbid obesity;
diabetes mellitus; borderline; anemia; sprain of the lumbar region. Dr. Byrne noted that
appellant’s past surgical history also included: arthroscopy of the right shoulder; left lumbar
epidural injections; Achilles tendon repair on the left in 2011; shoulder arthroscopy on the right in
2012 and the left on September 30, 2015. He indicated that appellant’s current work status was
light duty and no heavy lifting/sedentary. Dr. Byrne assessed a sprain of the hip and thigh. He
explained that there were significant issues that were not addressed and were waiting approval or
rehabilitation. Dr. Byrne recommended that appellant return to regular-duty work.
In a separate attending physician’s report also dated April 20, 2016, Dr. Byrne noted
appellant’s history of injury and indicated that she injured her left shoulder, knee, hip, and back.
He checked the box marked “no” in response to whether there was any history or evidence of
concurrent or preexisting injury or disease of physical impairment. Dr. Byrne noted that his
findings were “postop and injuries needing rehab[ilitation].” He diagnosed shoulder pain, sprain
of the hip, sciatica, and another condition which was illegible. Dr. Byrne checked the box marked
“yes” in response to whether he believed the condition was caused or aggravated by appellant’s
employment activity. He advised that he was awaiting rehabilitation approval for physical therapy.
Dr. Byrne recommended a return to work on December 16, 2015. In a disability certificate dated
April 20, 2016, he recommended that appellant could return to full-duty work on April 18, 2016
with no restrictions.
In a memorandum of telephone call dated May 20, 2016, appellant called to request that
her claim be expanded to include the additional conditions of hip strain and sciatica.
By letter dated May 20, 2016, OWCP requested that appellant provide additional evidence
to support her request to expand her claim to include hip strain and sciatica. It requested that
appellant provide a report from her treating physician with medical rationale, objective findings,
and an explanation as to how and why the hip sprain and sciatica were causally related to the
original injury. OWCP requested that she submit such evidence within 30 days.
In a May 23, 2016 report, Dr. Byrne again noted appellant’s history of injury. He noted
that the sciatica she is experiencing is coming from her low back, radiating into her left hip, and
down her leg. Dr. Byrne explained that the MRI scan for the left hip did not show any pathology
so it was “presumed muscular.” He recommended that she resume physical therapy to her hip.
Dr. Byrne advised that her hip and sciatica continued to bother her, and opined that “[o]nce again
the sciatica is related to the fall she sustained on March 6, 2015 when she slipped on ice and injured
her back and left hip. The sciatic pain runs down her left leg including her left hip.” Dr. Byrne
reiterated that “[appellant] has a sciatica issue and left side issue from the injury and of course
recovering from the left shoulder injury and surgery. [Appellant] [will] continue doing the limited
time scale from four to eight hours which she can tolerate and ultimately get the rehabilitation
approved if possible. At this point with her diagnosis: including the sciatic nerve, the hip strain,

4

shoulder and knee these are significant issues that had not been addressed and we are waiting
approval for rehabilitation unit produced.”
In a July 1, 2016 report, Dr. Byrne noted that appellant was seen for follow up of the left
shoulder. Additionally, he noted that she was seen for follow up of her hip and shoulder and was
awaiting authorization for treatment. Dr. Byrne examined appellant and determined that the right
and left hip had normal range of motion and no crepitus. He diagnosed impingement syndrome of
the shoulder and sprain of the hip and thigh.
By decision dated August 4, 2016, OWCP denied appellant’s request to expand her claim
to include the additional conditions of hip strain and sciatica. It found that the evidence of record
did not demonstrate that the claimed medical conditions were causally related to the accepted
March 6, 2015 employment injury. OWCP also noted that Dr. Byrne had released appellant to
regular duty on April 18, 2016.
On October 3, 2016 appellant requested reconsideration of the August 4, 2016 denial of
the expansion of her claim. She provided a detailed statement of her basis for requesting
reconsideration including citation to evidence already of record. In support of her request,
appellant resubmitted the March 18, 2015 MRI scan order by Dr. Byrne.
OWCP also received a March 16, 2015 attending physician’s report, which was signed by
a nurse and an August 25, 2016 report from a nurse.
On October 11, 2016 appellant’s representative noted that appellant requested
reconsideration. He noted that the decision had two dates August 3 and 4, 2016 and wondered if
it was reasonable to reissue the decision.
By decision dated December 15, 2016, OWCP found that the evidence of record was
insufficient to modify the August 4, 2016 decision. It found that the record did not contain a wellreasoned medical opinion from a qualified physician to support a relationship between the initial
injury and the additional conditions, including left hip strain and sciatica.
LEGAL PRECEDENT
An employee seeking benefits under FECA3 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 is causally related to the

3

Supra note 1.

5

employment injury.4 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.5
Where an employee claims that a condition not accepted or approved by OWCP was due
to an employment injury, he or she bears the burden of proof to establish that the condition is
causally related to the employment injury.6 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 based on a complete factual and medical
background, supporting such a causal relationship.7
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.8 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
ANALYSIS
The Board finds that appellant has not met her burden of proof to establish that her claim
should be expanded to include additional conditions, including left hip strain and sciatica, as
causally related to her March 6, 2015 employment injury.
The Board initially notes that the record contains a March 18, 2015 MRI scan read by
Dr. Byrne, which revealed a sprain of the hip and thigh. However, this report is of limited
probative value as it is a diagnostic test report and does not specifically address how a hip or thigh
sprain is causally related to the original employment injury.10 Diagnostic studies are of limited
probative value as they do not address whether the employment incident caused any of the
diagnosed conditions.11 OWCP also received a March 16, 2015 attending physician’s report,
which was signed by a nurse and an August 25, 2016 report from a nurse. The Board has long

4

Alvin V. Gadd, 57 ECAB 172 (2005); Anthony P. Silva, 55 ECAB 179 (2003).

5

See Elizabeth H. Kramm (Leonard O. Kramm), 57 ECAB 117 (2005); Ellen L. Noble, 55 ECAB 530 (2004).

6

See V.B., Docket No. 12-0599 (issued October 2, 2012); Jaja K. Asaramo, 55 ECAB 200 (2004).

7

See M.W., 57 ECAB 710 (2006); John D. Jackson, 55 ECAB 465 (2004).

8

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

9

See H.H., Docket No. 16-0897 (issued September 21, 2016); James Mack, 43 ECAB 321 (1991).

10

Jaja K. Asaramo, 55 ECAB 200 (2004) (medical evidence that does not offer any opinion regarding the cause of
an employee’s condition is of diminished probative value on the issue of causal relationship).
11

See R.S., Docket No. 17-1139 (issued November 16, 2017); G.M., Docket No. 14-2057 (issued May 12, 2015).

6

held that nurses are not considered physicians under FECA and are therefore not competent to
render a medical opinion.12
The Board finds that the initial treatment records contemporaneous with the work injury
do not offer any opinion regarding the hip strain and sciatica. For example, Dr. Brenner began
treating appellant on March 9, 2015. He determined that she had pain, “mostly in the [left]
shoulder to mid back and down into [left] butt and leg and gross abnormality and swelling.”
Dr. Brenner diagnosed back pain, shoulder pain, and “palps.” He did not diagnose a hip strain or
sciatica. Likewise, Dr. Bray saw appellant on May 19, 2015. She explained that as appellant
slipped, she twisted to reach the railing with her left hand and caught herself and did not fall, but
felt a pop in her back, left knee and shoulder. Dr. Bray noted appellant’s prior surgeries which
included an Achilles rupture and repair in 2011 and a right rotator cuff repair in 2012. She
diagnosed L5 radiculopathy and sensory, acute trapezius strain and acute left knee sprain.
However, Dr. Bray did not diagnose either a hip strain or sciatica. The lack of contemporaneous
medical evidence casts doubt on the claim for additional medical conditions.13
Appellant contacted OWCP on May 20, 2016 and requested that her claim be expanded to
include the conditions of hip strain and sciatica. The remaining relevant evidence includes several
reports from Dr. Byrne. The Board finds that the reports of Dr. Byrne are insufficient to establish
her claim for the acceptance of additional medical conditions.
In his initial report dated March 18, 2015, Dr. Byrne noted that appellant presented with a
complaint of shoulder pain. He advised that this occurred after a fall at work on the ice. Dr. Byrne
also noted that appellant presented with neck, low back, left shoulder, left knee pain, and left
second toe numbness. He also found that she had pain radiating down the left leg, but had no
bowel or bladder symptoms. Dr. Byrne reviewed appellant’s prior medical history, which included
that she had an L4-5 disc bulge and facet hypertrophy and bilateral foraminal stenosis at L4-5 on
a September 23, 2011 MRI scan. He diagnosed: pain in the shoulder; sprain/strain of the left knee
and leg not otherwise specified; strain of the left shoulder and upper arm, pain in the joint and foot,
and sprain of the hip and thigh. While he noted a sprain in the hip or thigh, Dr. Byrne did not
provide any findings to support this diagnosis.14 His March 18, 2015 report also does not address
the cause of the diagnosed conditions.15
In his January 13, 2016 report and addendum dated February 24, 2016, Dr. Byrne noted
that appellant was seen for follow up of her shoulder. While he also noted hip and sciatica
discomfort, upon examination, Dr. Byrne determined that she had normal range of motion and no
12

See M.M., Docket No. 17-1641 (issued February 15, 2018); K.J., Docket No. 16-1805 (issued February 23,
2018); 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); 5 U.S.C. § 8101(2) (this subsection
defines a physician as surgeons, podiatrists, dentists, clinical psychologists, optometrists, chiropractors, and
osteopathic practitioners within the scope of their practice as defined by state law).
13

See Constance G. Patterson, 42 ECAB 206 (1989).

14

Supra note 10.

15

Id.

7

crepitus or pain in the left hip. He diagnosed impingement syndrome of the shoulder and explained
that in addition, she had a “nevus for both the hip and the shoulder, especially with the significant
pain down the leg and hip consistent with a sciatica and trochanteric bursitis from this work-related
injury.” These reports are of limited probative value regarding causal relationship, however, as
they do not contain medical rationale explaining how the claimed conditions are related to the
accepted employment injury.16
In his April 1, 2016 report, Dr. Byrne explained that appellant injured her neck, low back,
left shoulder, left knee, left second toe, and left hip. He explained that appellant related that she
had pain radiating down her left leg and her hip, which was not mentioned in the initial visit on
March 18, 2015. Dr. Byrne opined that “[h]er left hip is also a part of her slipping on the ice on
March 6, 2015” and his failure to document her condition was an oversight. While he advised that
her hip and sciatica continued to bother her, there is no explanation relating how this occurred as
a result of the March 6, 2015 incident. The need for rationale is further heightened by the initial
failure to document the condition and because the medical history of preexisting conditions such
as the L4-5 disc bulge dating back to September 23, 2011 and her facet hypertrophy and bilateral
foraminal stenosis. The Board finds that the April 1, 2016 report is of limited probative value as
it does not address how the March 6, 2015 work incident caused a hip strain or sciatica.17
Dr. Byrne’s April 20, 2016 reports are also of diminished probative value. He noted that
appellant indicated that she was in a follow up for her left hip and shoulder. Dr. Byrne noted her
prior medical history included: sciatica; lumbar spondylosis; lumbar stenosis with neurogenic
claudication; lumbar radiculopathy; syncope and collapse; pain of the knee, strain of upper arm;
morbid obesity; diabetes mellitus; borderline; anemia; sprain of the lumbar region. He diagnosed
sprain of the hip and thigh. In a separate attending physician’s report, Dr. Byrne noted that
appellant slipped on a snow covered icy step leaving work. He indicated that she hurt her left
shoulder, knee, hip and back. Dr. Byrne checked the box “no” in response to whether there was
any history or evidence of concurrent or preexisting injury or disease of physical impairment.
However, this was inaccurate, as appellant has a history of many conditions as noted above. It is
well established that medical reports must be based on a complete and accurate factual and medical
background, and medical opinions based on an incomplete or inaccurate history are of little
probative value.18 Dr. Byrne also diagnosed shoulder pain, sprain of the hip, sciatica and another
condition which was illegible. He checked the box marked “yes” in response to whether he
believed the conditions were caused or aggravated by an employment activity. However, this was
insufficient to establish that appellant’s claim should be expanded to include a left hip strain or
sciatica as the Board has held that the checking of a box “yes” in a form report, without additional
explanation or rationale, is insufficient to establish causal relationship.19 Dr. Byrne provided no

16
See Y.D., Docket No. 16-1896 (issued February 10, 2017) (finding that a report is of limited probative value
regarding causal relationship if it does not contain medical rationale describing the relation between work factors and
a diagnosed condition/disability).
17

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

18

Douglas M. McQuaid, 52 ECAB 382 (2001).

19

Calvin E. King, 51 ECAB 394 (2000); Linda Thompson, 51 ECAB 694 (2000).

8

reasoned opinion on causal relationship. Such rationale is particularly important given appellant’s
history of preexisting back conditions.20
In a May 23, 2016 report, Dr. Byrne noted appellant’s history of injury and advised that
she injured her neck, low back, left shoulder, left knee, left second toe and left hip. He noted that
she had pain radiating down her left leg. Dr. Byrne repeated his explanation regarding her hip.
He indicated that the left hip “was also a part of her slipping on the ice on 6 March 2015. The
sciatica [appellant] is experiencing is coming from her low back, radiating into her left hip and
down her leg.” Dr. Byrne also noted that the MRI scan for the left hip did not show any pathology
so it was “presumed muscular.” The Board has held that medical opinions which are speculative
or equivocal in character have little probative value.21 Dr. Byrne also indicated that her hip and
sciatica continued to bother her, and opined that “[o]nce again the sciatica is related to the fall she
sustained on March 6, 2015 when she slipped on ice and injured her back and left hip. The sciatic
pain runs down her left leg including her left hip.” Dr. Byrne reiterated that “she has a sciatica
issue and left side issue from the injury….” Again, he did not explain how the slipping injury
caused appellant’s hip strain or sciatica condition. The Board notes that, with respect to an opinion
on aggravation or exacerbation, the opinion must differentiate between the effects of the workrelated injury and the preexisting conditions.22 Dr. Byrne did not explain how the March 6, 2015
incident affected her numerous underlying conditions. Additionally, his report was speculative
and thus his report is insufficient to meet appellant’s burden of proof.
In a July 1, 2016 report, Dr. Byrne diagnosed impingement syndrome of the shoulder and
sprain of the hip and thigh. However, without further explanation as to how he arrived at these
diagnoses, this report is of limited probative value.
For these reasons, appellant has not established that her left hip strain and sciatica are
causally related to her March 6, 2015 employment 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 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 that her claim
should be expanded to include additional conditions, including left hip strain and sciatica, as
causally related to the accepted March 6, 2015 employment injury.

20

See P.H., Docket No. 16-0654 (issued July 21, 2016); S.R., Docket No. 16-0657 (issued July 13, 2016).

21

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

22
Federal (FECA) Procedure Manual, Part 2 -- Claims, Causal Relationship, Chapter 2.805.3(e) (January 2013);
see also J.R., Docket No. 16-0327 (issued July 6, 2016).

9

ORDER
IT IS HEREBY ORDERED THAT the December 15, 2016 decision of the Office of
Workers’ Compensation Programs is affirmed.
Issued: August 15, 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

10


United States Department of Labor
Employees’ Compensation Appeals Board
__________________________________________
D.R., Appellant
and
DEPARTMENT OF THE INTERIOR,
BUREAU OF RECLAMATION,
Truth or Consequences, NM, Employer
__________________________________________

)
)
)
)
)
)
)
)
)

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

Docket No. 15-379
Issued: April 17, 2015

Case Submitted on the Record

DECISION AND ORDER
Before:
CHRISTOPHER J. GODFREY, Chief Judge
ALEC J. KOROMILAS, Alternate Judge
JAMES A. HAYNES, Alternate Judge

JURISDICTION
On December 9, 2014 appellant, through counsel, filed a timely appeal from a
September 17, 2014 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 established a knee condition causally related to factors
of his federal employment.
FACTUAL HISTORY
On September 8, 2013 appellant, then a 61-year-old heavy duty repairman, filed an
occupational disease claim (Form CA-2) alleging that he sustained injury to his knees as a result
1

5 U.S.C. § 8101 et seq.

of his federal employment. He identified climbing, walking, crawling, kneeling, and standing as
the employment factors contributing to his condition. Appellant stated that his federal
employment caused his left knee to hurt and then after July 8, 2010 his right knee began to have
problems and had progressively worsened.
Appellant had two prior claims involving his knees. He filed a traumatic injury claim
(Form CA-1) for a left knee injury on February 16, 2005, and this claim was accepted for left
knee internal derangement. Under this claim file appellant received wage-loss compensation.
The record indicated that he returned to full-time, light-duty work as of January 13, 2014. In
addition, appellant had filed a traumatic injury claim on May 21, 2013 for a right knee injury on
July 8, 2010.2 He alleged that his right knee popped as he descended stairs. By decision dated
August 5, 2013, OWCP denied the claim on the grounds the medical evidence was insufficient to
establish causal relationship between a diagnosed condition and the employment incident.
In a letter dated August 12, 2013, appellant stated that his work involved climbing on and
under equipment, and most of his work was in the field. He noted that parts and tools were
heavy, and he engaged in pushing, pulling, lifting, kneeling, and squatting while at work.
Appellant stated that he had a left knee replacement surgery in 2012, but his right knee continued
to get worse and needed surgery.
With respect to medical evidence, appellant submitted a report dated May 25, 2012 from
Dr. David Mansfield, a Board-certified orthopedic surgeon, who provided a history of a right
knee injury on July 8, 2010, when appellant felt a pop in his knee when going down some stairs.
He stated that since that injury appellant had pain and swelling in the knee. Dr. Mansfield noted
that appellant’s job required getting down on his knees and climbing ladders and appellant was
having difficulty right now with these duties. He provided results on examination and diagnosed
osteoarthrosis and internal knee derangement.
In a report dated June 5, 2012, Dr. Mansfield stated that appellant’s right knee showed a
significant amount of degenerative changes. He further stated, “I do not think that his job causes
the dis[c] degenerative condition. I certainly think that the fall he has taken at work due to his
compensable injury has extremely exacerbated and accelerated this condition.” By report dated
July 3, 2012, Dr. Mansfield stated that appellant had questions about whether his right knee was
affected by the left knee. He stated that the trouble appellant was having with the left knee,
including degeneration, medial meniscus tear, arthritis and varus deformity, can sometimes put
pressure on the right knee. Dr. Mansfield further stated, “Certainly, he is predisposed because of
that [left knee] condition to have early degenerative changes in the right knee due to that
problem.”
In a July 2, 2013 report, Dr. Mansfield stated that appellant had hurt his right knee on
July 8, 2010, and since that time had significant pain in the knee. He stated that there was no
doubt appellant had previous degeneration in the knee, but the July 8, 2010 injury had
exacerbated his condition. According to Dr. Mansfield, he had explained to appellant “that his

2

The record in that claim contained a CA-1 for a claimed injury on July 8, 2010 that was signed by appellant on
July 13, 2010.

2

knee was at risk and when he was working he injured it. [Appellant] now has a knee that is
probably going to need a knee replacement.”
By decision dated December 16, 2013, OWCP denied the claim for compensation. It
found the medical evidence was insufficient to establish the claim.
Appellant requested a hearing before an OWCP hearing representative, which was held
on July 9, 2014. The hearing representative noted that there was some confusion as to what
appellant was claiming in the current claim. Appellant’s counsel discussed appellant’s right knee
and referenced the July 2, 2013 report from Dr. Mansfield.
By decision dated September 17, 2014, the hearing representative affirmed the
December 16, 2013 OWCP decision. The hearing representative found the medical evidence
was insufficient to establish the claim.
LEGAL PRECEDENT
A claimant seeking benefits under FECA3 has the burden of establishing the essential
elements of his or her claim by the weight of the reliable, probative, and substantial evidence,
including that an injury was sustained in the performance of duty as alleged and that any specific
condition or disability claimed is causally related to the employment injury.4
To establish that an injury was sustained in the performance of duty, a claimant must
submit: a factual statement identifying employment factors alleged to have caused or
contributed to the presence or occurrence of the disease or condition; medical evidence
establishing the presence or existence of the disease or condition for which compensation is
claimed; and medical evidence establishing that the diagnosed condition is causally related to the
employment factors identified by the claimant.5
Causal relationship is a medical question that can generally be resolved only by
rationalized medical opinion evidence.6 A physician’s opinion on the issue of whether there is a
causal relationship between the claimant’s diagnosed condition and the implicated employment
factors must be based on a complete factual and medical background of the claimant.7
Additionally, in order to be considered rationalized, the opinion must be expressed in terms of a
reasonable degree of medical certainty, and must be supported by sound medical rationale,
explaining the nature of the relationship between the diagnosed condition and appellant’s
specific employment factors.8
3

5 U.S.C. §§ 8101-8193.

4

20 C.F.R. § 10.115(e), (f) (2005); see Jacquelyn L. Oliver, 48 ECAB 232, 235-36 (1996).

5

Ruby I. Fish, 46 ECAB 276, 279 (1994).

6

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

7

Victor J. Woodhams, 41 ECAB 345, 352 (1989).

8

Id.

3

ANALYSIS
In the present case, appellant filed an occupational claim9 identifying a number of
employment factors as contributing to a knee condition. On the claim form he identified
climbing, walking, crawling, kneeling, and standing. In a narrative statement, appellant also
mentioned lifting, pushing, and pulling. OWCP does not contest that he engaged in such
activities in his federal employment as a heavy duty repairman.
It must be noted that appellant had filed prior claims with respect to the knees. As to the
right knee, he has a claim for a traumatic injury on July 8, 2010. The Board notes, however, that
the issue of whether appellant sustained an employment injury on July 8, 2010 is not before the
Board on this appeal.
Moreover, the issue of whether appellant may have sustained a consequential right knee
injury from an accepted left knee injury is not before the Board. Appellant has a claim for a left
knee injury on February 16, 2005.
The issue in the present case is whether the medical evidence is sufficient to establish
causal relationship between a diagnosed condition and the identified employment factors.
Although appellant referred to the left knee on the claim form, he did not submit medical
evidence on causal relationship between a diagnosed left knee condition and the identified
employment factors.
As to the right knee, the medical evidence is also insufficient to establish the claim.
Dr. Mansfield briefly noted in his May 25, 2012 report that appellant’s job duties included
kneeling and climbing. However, he did not relate any specific diagnosed right knee condition
to performing those duties. Dr. Mansfield referred only to a July 8, 2010 injury, and indicated
that appellant was having difficulty performing such job duties. The July 3, 2013 report is
similarly deficient with respect to the issue in this case. Dr. Mansfield opined that appellant had
exacerbated a preexisting degenerative condition on July 8, 2010. He did not provide a complete
medical history, or discuss the identified employment factors. Dr. Mansfield did not provide an
opinion, supported by sound medical rationale, on causal relationship between a diagnosed right
knee condition and the specific identified employment factors.
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 established a causal relationship between his right
knee condition and factors of his federal employment.

9

An occupational disease or illness is a condition produced by the work environment over a period longer than a
single workday or shift. 20 C.F.R. § 10.5(q).

4

ORDER
IT IS HEREBY ORDERED THAT the decision of the Office of Workers’
Compensation Programs dated September 17, 2014 is affirmed.
Issued: April 17, 2015
Washington, DC

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

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

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

5