United States Department of Labor
Employees’ Compensation Appeals Board
__________________________________________
M.W., Appellant
and
DEPARTMENT OF THE AIR FORCE,
SPECIAL OPERATIONS COMMAND,
HURLBURT FIELD, FL, Employer
__________________________________________

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

Docket No. 19-1154
Issued: September 8, 2020

Case Submitted on the Record

DECISION AND ORDER
Before:
ALEC J. KOROMILAS, Chief Judge
CHRISTOPHER J. GODFREY, Deputy Chief Judge
JANICE B. ASKIN, Judge

JURISDICTION
On April 26, 2019 appellant filed a timely appeal from a March 6, 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

1
2

5 U.S.C. § 8101 et seq.

Together with his appeal request, appellant submitted a timely request for oral argument pursuant to 20 C.F.R.
§ 501.5(b). After exercising its discretion, by order dated July 21, 2020, the Board denied the request as appellant’s
arguments on appeal could be adequately addressed in a decision based on a review of the case as submitted on the
record. Order Denying Request for Oral Argument, Docket No. 19-1154 (issued July 21, 2020).

ISSUE
The issue is whether appellant has met his burden of proof to establish more than eight
percent monaural hearing loss of his right ear, for which he previously received schedule award
compensation.
FACTUAL HISTORY
On July 14, 2017 appellant, then a 62-year-old boiler plant equipment mechanic, filed an
occupational disease claim (Form CA-2) alleging that he sustained hearing loss and ringing in both
ears and periodic sharp pain in his right ear due to exposure to hazardous noise at work. He advised
that he first became aware of his condition on January 1, 2010 and first realized its relation to his
federal employment on June 1, 2010. Appellant did not stop work.
Appellant submitted a job description for the position of boiler plant equipment mechanic.
He also submitted audiograms, obtained by the employing establishment, which were dated
April 7, 2000, July 23 and 24, 2013, June 26 and July 1, 2014, and June 22, 2017. The audiograms
were not certified as accurate by a physician as defined under FECA and did not show ratable
hearing loss. In a July 1, 2014 report, Dr. Michael J. McBeth, a Board-certified family medicine
physician for the employing establishment, diagnosed asymmetrical sensorineural hearing loss.
In a July 21, 2017 development letter, OWCP requested that appellant submit additional
factual and medical evidence in support of his claim. It requested that he complete and return a
questionnaire about his work history and exposure to hazardous noise in the workplace. In a letter
of even date, OWCP also requested information from the employing establishment regarding
appellant’s work history and noise exposure. It afforded both parties 30 days to respond.
In response, appellant submitted a July 26, 2017 statement which indicated that he worked
as a boiler plant equipment mechanic for the employing establishment commencing
November 19, 1976. He advised that he had worked starting in May 1996 at Hurlburt Field in the
same job class. Appellant reported noise exposure from air conditioners (screw chillers), air
compressors, cooling and heating pumps, air handlers, exhaust fans, and chemical feeders for an
average of five hours per day. He asserted that, since January 2010, he had “failed” hearing tests
administered by the employing establishment and that, since approximately 2013, he experienced
ringing in both ears, as well as sharp pain in his right ear at least three times per week. In an
undated supplemental statement, appellant advised that earplugs had been made available to him
in the workplace. He also noted exposure to noise from F-22 jets when he was outside on the base
grounds. Appellant indicated that he had no hobbies which involve exposure to loud noises.
Appellant submitted March 12 and 20 and April 24, 2009 reports from Dr. Jason Boole, a
Board-certified otolaryngologist, who diagnosed sudden sensorineural hearing loss. In the
March 12, 2009 report, he noted, “The likely etiology is autoimmune given his history of
rheumatoid arthritis and possibly this could be a viral insult.” An April 6, 2009 magnetic resonance
imaging (MRI) scan contained an impression of normal internal auditory canals.
In an undated statement received by OWCP on September 14, 2017, appellant’s immediate
supervisor advised that he concurred with the description of work-related sources of noise

2

appellant provided in his July 26, 2017 statement. The supervisor noted that appellant was exposed
to these noises four to six hours per day. In a September 18, 2017 letter, an injury compensation
specialist indicated that the employing establishment was challenging appellant’s claim because
he failed to submit medical evidence relating a hearing loss condition to his federal employment.3
The employing establishment submitted copies of audiograms and other medical records
previously submitted by appellant.
On September 27, 2017 OWCP referred appellant and the case record, including a
statement of accepted facts (SOAF), for a second opinion examination to Dr. James McQueen, a
Board-certified otolaryngologist. It requested that Dr. McQueen perform otologic and audiologic
testing on appellant to evaluate his claimed hearing loss and its possible relation to federal
employment.
In an October 25, 2017 report, Dr. McQueen reported the results of his otologic and
audiologic evaluation, including the findings of an audiogram obtained on the same date. He
diagnosed bilateral sensorineural hearing loss and bilateral tinnitus, and he noted that appellant’s
hearing loss was due, in part or in whole, to noise exposure from his federal employment.
Dr. McQueen maintained that the high frequency notched hearing loss was consistent with noise
exposure. He confirmed the accuracy of the October 25, 2017 audiogram, noting that testing for
the right ear at the frequency levels of 500, 1,000, 2,000, and 3,000 Hertz (Hz) revealed decibel
(dB) losses of 20, 15, 50, and 35 respectively, and that testing for the left ear at the frequency
levels of 500, 1,000, 2,000, and 3,000 Hz revealed dB losses of 15, 15, 35, and 20 respectively.
On December 4, 2017 OWCP requested that Dr. Jeffrey M. Israel, a Board-certified
otolaryngologist serving as an OWCP district medical adviser (DMA), review the SOAF which
had been sent to the DMA which included the accepted conditions of bilateral sensorineural
hearing loss and tinnitus and Dr. McQueen’s October 25, 2017 findings and provide an opinion on
appellant’s hearing loss under the standards of the sixth edition of the American Medical
Association, Guides to the Evaluation of Permanent Impairment (A.M.A., Guides).4
On December 8, 2017 the DMA discussed the October 25, 2017 audiogram obtained by
Dr. McQueen, noting that its hearing loss patterns were suggestive of sensorineural hearing loss at
least in part due to work-related acoustic trauma from noise. He advised that appellant reached
maximum medical improvement (MMI) on October 25, 2017. The DMA then provided a
calculation of hearing loss, based on Dr. McQueen’s October 25, 2017 findings, by utilizing the
standards of the sixth edition of the A.M.A., Guides. Testing for the right ear at the frequency
levels of 500, 1,000, 2,000, and 3,000 Hz revealed dB losses of 20, 15, 50, and 35 respectively.
The DMA added these figures and divided the resultant figure of 120 dBs by 4 to yield an average
hearing loss of 30 dBs. This average loss when reduced by 25 dBs (25 dBs being discounted)
equals 5 which when multiplied by the established factor of 1.5 to equal, after rounding up the
resultant figure, an eight percent hearing loss in the right ear. Testing for the left ear at the
frequency levels of 500, 1,000, 2,000, and 3,000 Hz revealed dB losses of 15, 15, 35, and 20
3

The employing establishment also submitted an unsigned and undated form report containing further details
regarding appellant’s exposure to noise at work.
4

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

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respectively. The DMA added these figures and divided the resultant figure of 85 dBs by 4 to
yield an average hearing loss of 21.25 dBs. This average loss was then reduced by 25 dBs to equal
a value less than zero and therefore appellant had zero percent hearing loss of the left ear. To
compute the binaural hearing loss, the DMA multiplied the lesser loss in the left ear (zero percent)
by the established factor of 5, added the resultant figure to the 7.5 percent loss in the right ear, and
divided the sum by the established factor of 6 to calculate a 1.3 percent binaural hearing loss (1.25
percent rounded up to 1.3 percent). He indicated that a hearing aid was authorized for appellant.
On December 13, 2017 OWCP accepted that appellant sustained bilateral sensorineural
hearing loss and bilateral tinnitus.
On October 26, 2018 appellant filed a claim for a schedule award (Form CA-7) due to
hearing loss.
By decision dated March 6, 2019, OWCP granted appellant a schedule award for eight
percent monaural hearing loss of his right ear. The award ran for 4.16 weeks from October 25 to
November 23, 2017 and was based on the December 8, 2017 report of the DMA which evaluated
the October 25, 2017 examination findings of Dr. McQueen.
LEGAL PRECEDENT
The schedule award provision of FECA5 and its implementing regulation6 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, good administrative practice necessitates the
use of a single set of tables so that there may be uniform standards applicable to all claimants. As
of May 1, 2009, the sixth edition of the A.M.A., Guides is used to calculate schedule awards.7 The
Board has approved OWCP’s use of the A.M.A., Guides for the purpose of determining the
percentage loss of use of a member of the body for schedule losses purposes.8
OWCP evaluates industrial hearing loss in accordance with the standards contained in the
A.M.A., Guides.9 Using the frequencies of 500, 1,000, 2,000, and 3,000 Hz, the losses at each
frequency are added up and averaged.10 Then, the “fence” of 25 dBs is deducted because, as the
A.M.A., Guides points out, losses below 25 dBs result in no impairment in the ability to hear
5

5 U.S.C. § 8107.

6

20 C.F.R. § 10.404 (1999).

7
Federal (FECA) Procedure Manual, Part 2 -- Claims, Schedule Award and Permanent Disability Claims, Chapter
2.808.5a (March 2017); Federal (FECA) Procedure Manual, Part 3 -- Medical, Schedule Awards, Chapter 3.700,
Exhibit 1 (January 2010).
8

K.J., Docket No. 19-1492 (issued February 26, 2020); Isidoro Rivera, 12 ECAB 348 (1961).

9

A.M.A., Guides 250-51 (6th ed. 2009).

10

Id.

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everyday speech under everyday conditions.11 The remaining amount is multiplied by a factor of
1.5 to arrive at the percentage of monaural hearing loss.12 The binaural loss is determined by
calculating the loss in each ear using the formula for monaural loss, the lesser loss is multiplied by
five, then added to the greater loss and the total is divided by six to arrive at the amount of the
binaural hearing loss.13 The Board has concurred in OWCP’s adoption of this standard for
evaluating hearing loss.14
Regarding tinnitus, the A.M.A., Guides provides that tinnitus is not a disease, but rather a
symptom that may be the result of disease or injury.15 The A.M.A., Guides notes that, if tinnitus
interferes with the activities of daily living, including sleep, reading (and other tasks requiring
concentration), enjoyment of quiet recreation, and emotional well-being, up to five percent may
be added to a measurable binaural hearing impairment.16
ANALYSIS
The Board finds that the case is not in posture for decision.
OWCP properly referred appellant to Dr. McQueen for a second opinion examination to
determine his entitlement to a schedule award for his hearing loss.17 Dr. McQueen’s October 25,
2017 report reviewed appellant’s audiogram findings and concluded that his bilateral hearing loss
and tinnitus were due to his workplace noise exposure.
On December 8, 2017 Dr. Israel, serving as OWCP’s DMA, reviewed the otologic and
audiologic testing performed on appellant by Dr. McQueen on October 25, 2017 and properly
applied OWCP’s standardized procedures to this evaluation. Testing for the right ear at the
frequency levels of 500, 1,000, 2,000, and 3,000 Hz revealed dB losses of 20, 15, 50, and 35
respectively. The DMA added these figures and divided the resultant figure of 120 dBs by 4 to
yield an average hearing loss of 30 dBs. This average loss when reduced by 25 dBs (25 dBs being
discounted as discussed above) equals 5 which when multiplied by the established factor of 1.5 to
equal, after rounding up the resultant figure, an eight percent hearing loss in the right ear. Testing
for the left ear at the frequency levels of 500, 1,000, 2,000, and 3,000 Hz revealed dB losses of 15,
15, 35, and 20 respectively. The DMA added these figures and divided the resultant figure of 85
11

Id.

12

Id.

13

Id.

14

M.F., Docket No. 16-1565 (issued March 15, 2017); Donald Stockstad, 53 ECAB 301 (2002); petition for recon.
granted (modifying prior decision), Docket No. 01-1570 (issued August 13, 2002).
15

See A.M.A., Guides 249.

16

Id. See also R.R., Docket No. 20-0245 (issued June 22, 2020); Robert E. Cullison, 55 ECAB 570 (2004).

17

See Federal (FECA) Procedure Manual, Part 2 -- Claims, Schedule Awards and Permanent Disability Claims,
Chapter 2.808.6d (March 2017) (regarding referral for a second opinion evaluation when an impairment rating from
an attending physician has not been provided).

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dBs by 4 to yield an average hearing loss of 21.25 dBs. This average loss was then reduced by 25
dBs (25 dBs being discounted as discussed above) to equal a value less than zero and therefore
appellant had zero percent hearing loss of the left ear.18
However, the Board finds that OWCP did not properly develop appellant’s degree of
impairment for his accepted bilateral tinnitus in that it made no determination on this matter. As
noted above, the A.M.A., Guides provides that, if tinnitus interferes with activities of daily living,
such as sleep, reading, enjoyment of quiet recreation, and emotional well-being, up to five percent
may be added to a measurable binaural hearing impairment.19
It is well established that proceedings under FECA are not adversarial in nature and OWCP
is not a disinterested arbiter.20 While the claimant has the burden of proof to establish entitlement
to compensation, OWCP shares responsibility in the development of the evidence and to see that
justice is done.21 Once OWCP undertook development of the evidence it had a duty to secure an
appropriate report addressing the relevant issues.22
OWCP did not obtain the appropriate documentation, such as a tinnitus handicap inventory
or similar survey, to evaluate appellant’s schedule award claim with respect to his accepted
bilateral tinnitus condition.23 Since it did not obtain the necessary evidence to properly determine
appellant’s entitlement to an award for his bilateral tinnitus (in conjunction with his schedule
award for hearing loss), the case will be remanded to OWCP to obtain the necessary documentation
and make a proper determination on this matter.24 Following this and any necessary further
development, OWCP shall issue a de novo decision on appellant’s claim for a schedule award.

18
To compute the binaural hearing loss, the DMA multiplied the lesser loss in the left ear (0 percent) by the
established factor of 5, added the resultant figure to the 7.5 percent loss in the right ear, and divided the sum by the
established factor of 6 to calculate a 1.3 percent binaural hearing loss (1.25 percent rounded up to 1.3 percent). While
section 8107(c)(13) provides separate calculations for loss of hearing in one ear and for loss of hearing in both, if
calculations based on the monaural hearing loss would result in greater compensation than calculations for binaural
loss, then the monaural hearing loss calculations should be used. FECA provides that a claimant is entitled to 52
weeks of compensation for 100 percent loss of hearing in one ear and 200 weeks’ compensation for 100 percent
hearing loss in both ears. Appellant’s rating is greater under the procedures used for calculating monaural hearing
loss and therefore OWCP properly granted a schedule award for monaural hearing loss. See supra note 13; 5 U.S.C.
§ 8107(c)(13)(B); Andrew P. Bell, Docket No. 06-0292 (issued April 6, 2006); Clarence L. Weeks, 38 ECAB 613
(1987) (quoting FECA Program Memorandum No. 181 (November 26, 1974)).
19

See supra note 16.

20

T.O., Docket No. 18-0659 (issued August 8, 2019).

21

T.O., id.; Donald R. Gervasi, 57 ECAB 281, 286 (2005); Jimmy A. Hammons, 51 ECAB 219 (1999).

22

T.O., id.; Peter C. Belkind, 56 ECAB 580 (2005); Ayanle A. Hashi, 56 ECAB 234 (2004).

23

See A.M.A., Guides 249.

24

J.E., Docket No. 19-1620 (issued March 9, 2020); D.L., Docket No. 19-0987 (issued October 23, 2019).

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CONCLUSION
The Board finds that the case is not in posture for decision.
ORDER
IT IS HEREBY ORDERED THAT the March 6, 2019 decision of the Office of Workers’
Compensation Programs is set aside, and the case is remanded to OWCP for proceedings consistent
with this decision of the Board.
Issued: September 8, 2020
Washington, DC

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

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

Janice B. Askin, Judge
Employees’ Compensation Appeals Board

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United States Department of Labor
Employees’ Compensation Appeals Board
__________________________________________
A.R., Appellant
and
U.S. POSTAL SERVICE, POST OFFICE,
Peekskill, NY, Employer
__________________________________________

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

Docket No. 19-0465
Issued: August 10, 2020

Case Submitted on the Record

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

JURISDICTION
On December 28, 2018 appellant, through counsel, filed a timely appeal from a
November 28, 2018 merit decision of the Office of Workers’ Compensation Programs (OWCP).2

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
The Board notes that counsel did not appeal from an October 31, 2018 decision which denied a wage-loss
compensation claim. Therefore, the Board will not exercise jurisdiction over that issue in the present appeal.

Pursuant to the Federal Employees’ Compensation Act3 (FECA) and 20 C.F.R. §§ 501.2(c)
and 501.3, the Board has jurisdiction over the merits of this case.4
ISSUE
The issue is whether appellant has met his burden of proof to expand the acceptance of his
claim to include additional left knee, left wrist, and left shoulder conditions causally related to the
accepted July 18, 2017 employment injury.
FACTUAL HISTORY
On July 20, 2017 appellant, then a 61-year-old city carrier assistant, filed a traumatic injury
claim (Form CA-1) alleging that on July 18, 2017 his left knee gave out and he fell, causing him
to hit his shoulder on the carrier case behind him. He stopped work that day.
In a July 18, 2017 handwritten statement, appellant indicated that at approximately 8:30
a.m. that day he was casing mail and, as he turned to stack an empty tray, his left knee gave out
causing him to fall and hit the carrier case with his left shoulder. He reported being in too much
pain to continue working, that he could not lift his left arm, and that his left knee was painful at
times.
T.T., a coworker, provided a statement dated July 18, 2017.
Appellant was treated in the emergency room on July 18, 2017 by Dr. Ping Wong, Boardcertified in emergency medicine. Dr. Wong reported a history that appellant’s left knee gave out
at work causing him to fall on his left shoulder. Findings on examination revealed mild left
trapezius tenderness, diffuse tenderness of the left shoulder and left knee, tenderness of the base
of the first metacarpal, mild swelling of the left knee, and tenderness of the medial joint line.
Dr. Wong diagnosed acute contusion of left shoulder, acute left knee sprain, and acute sprain of
the left wrist. He prescribed a wrist splint, wrapped appellant’s left knee with an ace bandage and
knee immobilizer, and placed his shoulder in a sling.
A July 18, 2017 left shoulder x-ray revealed degenerative changes of the acromioclavicular
(AC) joint with joint space narrowing and osteophyte formation and no acute bony abnormality.
A left knee x-ray of even date revealed joint space narrowing with associated osteophytes due to
osteoarthritis and no acute bony abnormality. A July 18, 2017 left wrist x-ray demonstrated no
bony abnormality.

3

5 U.S.C. § 8101 et seq.

4

The Board notes that following the November 28, 2018 decision, OWCP received additional evidence. However,
the Board’s Rules of Procedure provides: “The Board’s review of a case is limited to the evidence in the case record
that was before OWCP at the time of its final decision. Evidence not before OWCP will not be considered by the
Board for the first time on appeal.” 20 C.F.R. § 501.2(c)(1). Thus, the Board is precluded from reviewing this
additional evidence for the first time on appeal. Id.

2

In an undated attending physician’s report (Form CA-20) received by OWCP on
August 25, 2017, Dr. Douglas J. Fauser, Board-certified in orthopedic surgery, recounted a history
of left knee, left shoulder, and left wrist injuries. He diagnosed contusion of the left wrist, left
knee meniscal tear, and possible left shoulder rotator cuff tear. Dr. Fauser checked a box marked
“Yes,” indicating that the diagnosed conditions were caused or aggravated by the described
employment incident. A date of injury was not recorded. An unsigned progress note from
Dr. Fauser’s office indicated that on July 18, 2017 appellant’s left knee buckled twice, he fell
twice, and hit his left shoulder, wrist, and thumb.
In correspondence dated August 8, 2017, L.W., a health and resources management
specialist at the employing establishment controverted the claim.
In a progress notes dated August 4, 2017, Laura Klein, a nurse practitioner in Dr. Fauser’s
office, noted the history of injury. She described examination findings of restricted range of
motion of the left shoulder with a positive impingement sign, and medial and lateral joint line
tenderness of the left knee. Ms. Klein indicated that a left wrist x-ray done that day demonstrated
carpometacarpal (CMC) degenerative changes, that a left shoulder x-ray demonstrated
acromioclavicular (AC) joint degenerative changes, and left knee x-rays revealed medial and
lateral degenerative changes and more significant patellofemoral compartment degenerative
changes. She noted that appellant continued to use a wrist splint, arm sling, and knee immobilizer.
On October 19 and November 30, 2017 Ms. Klein noted that appellant’s left wrist pain had
subsided, but that he still had complaints of left shoulder and left knee pain. She again described
examination findings.
By decision dated January 5, 2018, OWCP accepted a left shoulder contusion. By separate
January 5, 2018 decision, however, it denied appellant’s claim for left knee sprain, left wrist sprain,
and contusion of the left wrist finding that the medical evidence of record was insufficient to
establish that these conditions were causally related to the accepted July 18, 2017 employment
incident.
On January 31, 2018 appellant requested a review of the written record by OWCP’s Branch
of Hearings and Review. On March 21, 2018 appellant, through counsel, requested an oral hearing
before an OWCP hearing representative.
Subsequent to the January 5, 2018 decisions, appellant resubmitted treatment notes from
August 4 to November 30, 2017 described above. All of those notes had been countersigned by
Dr. Fauser.
In a statement dated January 25, 2018, appellant reiterated that he fell twice on
July 18, 2017. He indicated that his left arm pain was too great to continue to work, so he returned
to his station and reported his injury to his postmaster. Appellant wrote that he was then taken by
ambulance to the emergency department.
In a January 31, 2018 progress note, Dr. Fauser reported appellant’s complaints of left hand
and wrist pain, left shoulder weakness and pain, and left knee instability. He noted a positive left
shoulder impingement sign with restricted range of motion, and CMC grind and pain on left hand
3

examination. Dr. Fauser indicated that appellant was using a left knee immobilizer and described
knee examination findings of marked weakness, joint line tenderness, and quadriceps and
hamstring weakness. He noted that x-rays from “last year” revealed a possible chronic rotator cuff
tear and arthritis of the left hand CMC joint.
A February 5, 2018 magnetic resonance imaging (MRI) scan of the left knee demonstrated
a complex, horizontal oblique tear through the anterior horn and body of the lateral meniscus,
communicating with the inferior articular surface, a small oblique tear involving the posterior horn
of the medial meniscus, communicating with the inferior articular surface, lateral patellar facet and
lateral compartment chondromalacia, small joint effusion, and degenerative changes without
evidence of an intra-articular loose body.
In a progress note dated March 3, 2018, Dr. Fauser discussed the left knee MRI scan
findings, noting medial and lateral meniscal tears and advanced arthritis of the patellofemoral joint.
He described continued findings of left shoulder impingement with decreased range of motion,
and right CMC joint pain. Left knee examination included a positive McMurray’s sign with
patellofemoral crepitation, decreased range of motion, and joint line tenderness. Dr. Fauser
recommended left knee arthroscopic surgery.
An April 26, 2018 MRI scan of the left shoulder demonstrated rotator cuff tendinosis and
high-grade partial-thickness bursal surface tear versus focal non-retracted full-thickness tear of the
anterior fibers of the supraspinatus tendon of indeterminate age, severe arthrosis of the ACL joint,
mild osteoarthritis of the glenohumeral joint, and a suspected type I superior labral tear from
anterior to posterior (SLAP) lesion.
On May 9, 2018 Dr. Fauser reviewed the left shoulder MRI scan findings with appellant
and recommended rotator cuff reconstruction.
On May 25, 2018 appellant requested that his claim be expanded to include all injuries
sustained on July 18, 2017.
On June 7, 2018 appellant was treated in follow-up by Ms. Klein for left knee, left shoulder,
and left wrist/hand injuries. Ms. Klein indicated that they were awaiting approval for surgery of
the left shoulder and left knee.
By decision dated June 19, 2018, an OWCP hearing representative affirmed the January 5,
2018 decision. He found that the medical evidence of record was insufficient to establish causal
relationship between the additional claimed conditions and the accepted July 18, 2017 employment
injury because the physicians of record failed to provide a sufficiently reasoned opinion explaining
how the July 18, 2017 employment injury caused or contributed to additional conditions.
On August 30, 2018 appellant, through counsel, requested reconsideration. Counsel
submitted an August 8, 2018 report in which Dr. Fauser noted that on July 18, 2017 appellant
sustained a fall at work and injured his left knee, left shoulder, and left wrist. He advised that
appellant had no left knee instability or issues with his left shoulder prior to his workplace fall and
described the findings of the MRI scans. Dr. Fauser opined that the rotator cuff tear and tear of
4

the lateral and medial meniscus were directly related to the fall at work. He noted that appellant
had complete instability of his left lower extremity, he could not stand or sit for long periods, he
had significant restriction of his left arm, and he could not work. Dr. Fauser concluded that these
injuries were directly related to his fall at work.
A telephonic hearing was held on August 14, 2018. Appellant testified regarding his injury
and medical condition, maintaining that the medical evidence submitted supported his claim. He
stated that when he returned to work in July 2017, he was using a cane.
On September 4, 2018 appellant, through counsel, requested reconsideration of the
June 19, 2018 decision.
By decision dated November 28, 2018, OWCP denied modification of the June 19, 2018
decision.
LEGAL PRECEDENT
When 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.5
To establish causal relationship between a medical condition and any attendant disability
claimed and the accepted employment injury, the employee must submit rationalized medical
opinion evidence.6 The opinion of the physician must be based on a complete factual and medical
background of the claimant, must be one expressed in terms of f reasonable degree of medical
certainty, and must be supported by medical rationale explaining the nature of the relationship
between the diagnosed condition and the accepted employment injury.7
ANALYSIS
The Board finds that appellant has not met his burden of proof to expand the acceptance of
his claim to include additional left knee, left wrist, and left shoulder conditions causally related to
the accepted July 18, 2017 employment injury.
OWCP accepted that appellant sustained a contusion of the left shoulder due to a July 18,
2017 employment injury when his left knee gave out and he hit his left shoulder on a case. It
denied expansion of his claim to include additional left knee, left wrist, and left shoulder conditions
finding that the medical evidence of record was insufficient to meet his burden of proof to establish
that these additional claimed conditions were causally related to the accepted employment injury.

5

D.S., Docket No. 18-0353 (issued February 18, 2020); Jaja K. Asaramo, 55 ECAB 200 (2004).

6

A.T., Docket No. 19-1608 (issued April 21, 2020).

7

Id.

5

On July 18, 2017 appellant was treated in the emergency room by Dr. Wong who reported
a history that appellant’s left knee gave out at work causing him to fall. Dr. Wong noted positive
physical examination findings and diagnosed acute contusion of the left shoulder, acute left knee
sprain, and acute sprain of the left wrist. However, he did not provide a clear narrative as to the
issue of causal relationship. 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 on the issue of
causal relationship.8 The Board finds that Dr. Wong’s report is insufficient to establish that
appellant sustained additional conditions on July 18, 2017.9
On an undated attending physician’s report, Dr. Fauser diagnosed contusion of the left
wrist, left knee meniscus, and possible left shoulder rotator cuff tear. He checked a form box
marked “Yes” indicating that the diagnosed conditions were caused or aggravated by the described
employment activity. The Board has held that an opinion on causal relationship which consists
only of a physician checking a box marked “Yes” in response to a form report question regarding
whether the claimant’s condition or disability is related to the history given is of little probative
value.10 Dr. Fauser did not provide any rationale for his opinion. This report is, therefore, of
diminished probative value and insufficient to establish that additional conditions should be
accepted as employment related.11
In reports dated August 4, 2017 to May 9, 2018, Dr. Fauser noted the history of injury and
described examination findings. However, he did not provide an opinion regarding the cause of
any diagnosed condition in those reports. As noted, medical evidence that does not offer an
opinion regarding the cause of an employee’s condition is of no probative value on the issue of
causal relationship.12 It was not until August 8, 2018 that Dr. Fauser indicated that, as appellant
had no instability of the left knee or issues with his left shoulder prior to the July 18, 2017 fall, the
rotator cuff tear and tear of the lateral and medial menisci were directly related to the fall. The
Board has held that an opinion that a condition is causally related to an employment injury because
the employee was asymptomatic before the injury is insufficient, without supporting rationale, to
support a causal relationship.13 Moreover, Dr. Fauser did not discuss the significant degenerative
changes seen on both the left shoulder MRI scan and that of the left knee. While he provided an
affirmative opinion in his August 8, 2018 report that supported causal relationship, he did not
provide a pathophysiological explanation as to how the accepted incident either caused or

8

See R.T., Docket No. 19-1346 (issued December 4, 2019); Willie M. Miller, 53 ECAB 697 (2002).

9

Id.; see also Frank Luis Rembisz, 52 ECAB 147 (2000) (medical opinions based on an incomplete history or which
are speculative or equivocal in character have little probative value).
10
C.T., Docket No. 20-0020 (issued April 29, 2020); M.R., Docket No. 17-1388 (issued November 2, 2017);
Gary J. Watling, 52 ECAB 278 (2001).
11

Id.

12

Supra note 8.

13

J.F., Docket No. 19-1694 (issued March 18, 2020); Kimper Lee, 45 ECAB 565 (1994).

6

contributed to the additional diagnosed conditions.14 The Board has consistently held that
complete medical rationalization is particularly necessary when there are preexisting conditions
involving the same body part, as were shown on MRI scans in this case.15 Medical rationale
differentiating between the effects of the work-related injury and the preexisting condition in such
cases is required.16 For these reasons the Board finds that Dr. Fauser’s opinion is also insufficient
to meet appellant’s burden of proof.
Appellant also submitted a June 7, 2018 report from Ms. Klein, a nurse practitioner that
was not co-signed by Dr. Fauser. Medical reports signed solely by a nurse practitioner are of no
probative value, as a nurse practitioner is not considered a physician as defined under FECA and,
therefore, is not competent to provide a medical opinion.17
Likewise, regarding the x-rays and MRI scans, the Board has explained that diagnostic
tests standing alone lack probative value on the issue of causal relationship, as they do not address
whether the employment incident caused a diagnosed condition.18
As the medical evidence of record is insufficient to establish causal relationship, the Board
finds that appellant has not met his burden of proof to establish that his claim should be expanded
to accept additional conditions.19
On appeal counsel asserts that causation was obvious, as this was a blunt force trauma
injury, no further explanation was required, and that OWCP failed to give due deference to the
findings of the attending physician. As discussed, the medical evidence of record is insufficient
to meet appellant’s burden of proof.
Appellant may submit new evidence or argument with a written request for reconsideration
to OWCP within one year of this merit decision, pursuant to 5 U.S.C. § 8128(a) and 20 C.F.R.
§§ 10.605 through 10.607.

14
See K.W., Docket No. 19-1906 (issued April 1, 2020); Victor J. Woodhams, 41 ECAB 345 (1989); Federal
(FECA) Procedure Manual, Part 2 -- Claims, Causal Relationship, Chapter 2.805.3e (January 2013). See R.D., Docket
No. 18-1551 (issued March 1, 2019).
15

C.T., supra note 10.

16

Id.

17

K.P., Docket No. 18-0350 (issued February 11, 2020); Paul Foster, 56 ECAB 208 (2004) (where the Board found
that a nurse practitioner is not a “physician” pursuant to FECA); see 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).
18

M.A., Docket No. 19-1551 (issued April 30, 2020); N.B., Docket No. 19-0221 (issued July 15, 2019).

19

See A.T., supra note 6.

7

CONCLUSION
The Board finds that appellant has not met his burden of proof to expand the acceptance of
his claim to include additional left knee, left wrist, and left shoulder conditions causally related to
the accepted July 18, 2017 employment injury.
ORDER
IT IS HEREBY ORDERED THAT the November 28, 2018 decision of the Office of
Workers’ Compensation Programs is affirmed.
Issued: August 10, 2020
Washington, DC

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

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

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

8


United States Department of Labor
Employees’ Compensation Appeals Board
___________________________________________
)
)
)
and
)
)
DEPARTMENT OF INTERIOR, NATIONAL
)
PARK SERVICE, Madison, WI, Employer
)
___________________________________________ )
J.N., Appellant

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

Docket No. 07-1115
Issued: September 10, 2007

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 March 19, 2007 appellant filed a timely appeal from the Office of Workers’
Compensation Programs’ merit decision dated January 9, 2007 which denied his claim for a
recurrence of disability. 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 on appeal is whether appellant sustained a recurrence of a medical condition on
May 15, 2005 causally related to his 1995 employment injury.
FACTUAL HISTORY
On October 13, 1995 appellant, then a 42-year-old fire technician, filed a claim alleging
that, on August 17, 1995, he sustained injury to his left knee when he stepped between rocks

while pulling a hose. He did not stop work.1 The Office accepted appellant’s claim for a left
knee sprain.
On October 12, 2006 appellant filed a claim alleging that he sustained a recurrence of
disability on May 15, 2005. He alleged that he was seeking medical treatment only and that he
developed an abscess in his bottom left molar, which coincided with the original point of impact
and fracture of his jaw on June 5, 1995.
In an October 10, 2006 report, Dr. Mike Hagley, a dentist, noted that on January 5, 1995
appellant was seen for a blow to the mandible. He indicated that appellant related that “he had
been hit with a piece of wood in the jaw.” Appellant felt a “snapping” followed by pain and
swelling. Dr. Hagley conducted an examination and advised that it showed a “previously
nonexistent space between teeth numbers 27 and 28. The occlusion did not match between the
upper and lower dentition.” Dr. Hagley noted that x-rays showed three fractures of the mandible.
He indicated that they included a fracture through the right ascending ramus, one through the
body between 27 and 28; and one through the left angle. Dr. Hagley advised that appellant’s
teeth numbers 27 and 28 were mobile and that tooth number 5 had a fracture of the buccal cusp.
He referred appellant to an oral surgeon. Dr. Hagley noted that, on June 7, 2006, they discovered
that tooth number 19 had no bone around the roots of the tooth and once it was removed it
discovered that “the tooth had two vertical root fractures which obviously caused the rapid,
severe bone loss.” He indicated that this created a question as to whether the fracture could be a
sequel. Dr. Hagley opined that it was a “likely sequel to a severe blow to the mandible.” He
added that these “sorts of problems do not always manifest themselves immediately post
trauma.” Dr. Hagley determined that “it is possible that the blow to the mandible in 1995 may
have led to the failure of tooth number 19 in 2006, especially in the absence of any subsequent
injury to the area.”
By letter dated November 28, 2006, the Office advised appellant that it had received his
claim for a recurrence related to “teeth and jaw problems.” The Office indicated that appellant’s
claim under File No. 100451293 was originally accepted for a left knee injury of August 17,
1995 and there was no evidence documenting any dental condition from June or August 1995
until the receipt of Dr. Hagley’s report. Appellant was further advised that Dr. Hagley’s report
was “equivocal” and he must provide an “unequivocal opinion as to why current tooth/jaw
problems are believed to be attributable to the injury which occurred in 1995. He was allotted
30 days to submit the additional evidence.
In a letter dated December 15, 2006, appellant advised the Office that he had provided
the Office with the wrong file number originally and that it should have been File
No. 100445080. He explained that while working for the employing establishment he was struck
in the jaw by a falling tree, which resulted in a triple fracture of his mandible. Appellant noted
that his dentist believed that it was the cause of the fractured root and abscess which required
removal of his tooth.
By letter dated December 18, 2006, the Office advised appellant that he should file a new
recurrence claim under File No. 100445080 and send it to the Office. Appellant was further
1

The record reflects that appellant has a June 5, 1995 jaw injury under File No. 100445080.

2

advised that he had 30 days from November 28, 2006 to provide any further information under
the current File No. 100451293. No additional evidence was received.
In a decision dated January 9, 2007, the Office denied appellant’s recurrence claim. The
Office found that the factual and medical evidence did not establish that the claimed recurrence
resulted from the accepted work injury of a left knee problem under File No. 100451293. The
Office found that the medical evidence failed to show the relationship between his current jaw
condition and the original left knee injury.
LEGAL PRECEDENT
A claimant seeking compensation under the Federal Employees’ Compensation Act2 has
the burden of establishing the essential elements of his claim by the weight of the reliable,
probative and substantial evidence.3 In this case, appellant has the burden of establishing that he
sustained a recurrence of a medical condition causally related to his accepted occupational
disease. This burden includes the necessity of furnishing medical evidence from a physician
who, on the basis of a complete and accurate factual and medical history, concludes that the
condition is causally related to the accepted conditions and supports that conclusion with sound
medical rationale.4 Where medical rationale in support of the physician’s opinion is not present,
the medical evidence is of diminished probative value.5
Office regulations define a recurrence of medical condition as the documented need for
further medical treatment after release from treatment of the accepted condition when there is no
work stoppage. Continued treatment for the original condition is not considered a renewed need
for medical care, nor is examination without treatment.6 In order to establish that his claimed
recurrence of the condition was caused by the accepted injury, medical evidence of bridging
symptoms between his present condition and the accepted conditions must support the
physician’s conclusion of a causal relationship.7
ANALYSIS
The Office accepted that on August 17, 1995 appellant sustained a left knee sprain in the
performance of duty. He subsequently alleged that he sustained a recurrence of disability
commencing on May 15, 2005. The Office requested that appellant provide medical evidence
that would establish a causal relationship between his current conditions and his present
disability.
2

5 U.S.C. §§ 8101-8193.

3

Mary A. Ceglia, 55 ECAB 626 (2004).

4

See id.

5

Id.

6

20 C.F.R. § 10.5(y).

7

See supra note 3.

3

The Board notes that appellant informed the Office that he had filed the claim under the
wrong file number. He alleged that his claim was related to a June 5, 1995 employment injury
when he was struck in the jaw by a piece of wood and submitted evidence comprised of an
October 10, 2006 report from Dr. Hagley, who discussed a January 5, 1995 employment injury
where appellant was struck in the jaw. Dr. Hagley did not provide any opinion or rationale
attempting to relate appellant’s jaw and teeth problems to his left knee injury. Furthermore, he
did not appear to be aware of a left knee injury. Thus, appellant has not submitted any medical
reports indicating any need for continuing medical treatment attributable to the original
August 17, 1995 left knee employment injury.
It is appellant’s burden of proof to submit a physician’s rationalized opinion on the issue
of whether there is a causal relationship between his diagnosed condition and the implicated
employment factors.8 He did not do so in this case. Accordingly, the Board finds that appellant
has not met his burden of proof as he has not submitted a reasoned medical opinion explaining
why his recurrence of a medical condition beginning May 15, 2005 was caused or aggravated by
the August 17, 1995 employment injury. On appeal, appellant notes that submission of the
“correct file number.” The Board notes that its review is limited to review of final decision of
the Office. The Office advised appellant to file a new recurrence claim under the injury case file
associated with the injury to his jaws. This aspect of the case has not been adjudicated by the
Office.
CONCLUSION
The Board finds that appellant has not met his burden to establish that he sustained a
recurrence on May 15, 2005 that was causally related to his August 17, 1995 employment
injury.9

8

Calvin E. King, 51 ECAB 394 (2000).

9

On appeal, appellant indicated that he wished to appeal the denial based on the submission of the correct
File No. 100445080. However, the January 9, 2007 decision that appellant appealed is part of File No. 100451293.
The record for File No. 100445080 is not before the Board on the present appeal. Should appellant wish to pursue
any issue in File No. 100445080, he should contact the Office regarding how to proceed under File No. 100445080
for his jaw condition.

4

ORDER
IT IS HEREBY ORDERED THAT the January 9, 2007 decision of the Office of
Workers’ Compensation Programs is affirmed.
Issued: September 10, 2007
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

5


United States Department of Labor
Employees’ Compensation Appeals Board
__________________________________________
A.L., Appellant
and
U.S. POSTAL SERVICE, AIRPORT MAIL
FACILITY, San Francisco, CA, Employer
__________________________________________

)
)
)
)
)
)
)
)

Appearances:
Bob Williamson, for the appellant
Office of Solicitor, for the Director

Docket No. 12-867
Issued: October 4, 2012

Case Submitted on the Record

DECISION AND ORDER
Before:
COLLEEN DUFFY KIKO, Judge
ALEC J. KOROMILAS, Alternate Judge
JAMES A. HAYNES, Alternate Judge

JURISDICTION
On March 13, 2012 appellant, through her representative, filed a timely appeal from a
September 26, 2011 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 established a bilateral wrist condition as a
consequence of the accepted employment injuries.

1
2

5 U.S.C. § 8101 et seq.

The record also contains a December 1, 2011 wage-earning capacity final decision. The record indicates that
appellant requested a hearing as to the December 1, 2011 decision, received a final decision and filed an appeal
(Docket No. 12-1634). The wage-earning capacity determination will be reviewed under Docket No. 12-1634.

FACTUAL HISTORY
On April 4, 2007 appellant, then a 47-year-old clerk, filed a traumatic injury claim (Form
CA-1) alleging that she sustained injuries when she was hit in the back by a forklift while in the
performance of duty on April 3, 2007. OWCP accepted the claim for contusions to the chest
wall, left shoulder and upper arm and sprains to the lumbar spine, left shoulder and upper arm.
Appellant returned to a part-time light-duty position on May 2, 2007. She stopped working on
August 31, 2009 and began receiving compensation for temporary total disability.
OWCP referred appellant for a second opinion examination by Dr. Ramon Jimenez, a
Board-certified orthopedic surgeon. In a report dated April 23, 2010, Dr. Jimenez diagnosed
cervical and lumbar sprain and shoulder tendinitis. He opined that appellant continued to have
employment-related residuals and he completed a work capacity evaluation (OWCP-5c).
Appellant was referred for vocational rehabilitation services on May 18, 2010. A
vocational rehabilitation report dated January 3, 2011 indicated that she had begun training at a
vocational school as of November 22, 2010 and her studies included typing.
On February 19, 2011 appellant filed an occupational disease claim for compensation
(Form CA-2) alleging that she sustained injury to her neck, left arm and both wrists as a result of
repetitive keying on computers for two hours a day since November 22, 2010. By letter dated
March 10, 2011, OWCP stated that it was developing the claim as a consequential injury.
In a report dated March 31, 2011, Dr. Robert Harrison, a Board-certified internist, stated
that on February 13, 2011 appellant was seen with neck and bilateral hand pain, which was
worse with prolonged sitting and typing more than two hours. He stated that he limited her to
two hours of typing a day. Dr. Harrison stated that appellant provided him with photographs that
showed “the ergonomic setup of the training facility.” He stated that the chairs and workstations
were not adjustable with a lack of attention to good ergonomic design. Dr. Harrison diagnosed
cervical strain and bilateral wrist tendinitis. He stated that the ergonomic set up was inadequate
and it was likely appellant had developed two musculoskeletal disorders as a result of excessive
typing.
By decision dated April 14, 2011, OWCP denied the claim for compensation. It found
the medical evidence was insufficient to establish a consequential injury.
Appellant requested a hearing before an OWCP hearing representative, which was held
on August 4, 2011. In a report dated September 8, 2011, Dr. Harrison again noted that appellant
was seen on February 13, 2011 with wrist pain and was limited to two hours of typing. He
indicated that appellant continued to have bilateral wrist pain on April 14, May 12 and
July 11, 2011. Dr. Harrison stated that, based on his review of the ergonomic setup, it was likely
that she developed bilateral wrist tendinitis as a result of vocational rehabilitation activities.
By decision dated September 26, 2011, OWCP’s hearing representative found that a
cervical strain was employment related, noting that the second opinion physician, Dr. Jimenez
had confirmed causal relationship. As to the bilateral wrist tendinitis, the hearing representative
found the medical evidence was insufficient to establish the claim.

2

LEGAL PRECEDENT
The general rule respecting consequential injuries is that when the primary injury is
shown to have arisen out of and in the course of employment, every natural consequence that
flows from the injury is deemed to arise out of the employment, unless it is the result of an
independent intervening cause which is attributable to the employee’s own intentional conduct.3
The subsequent injury will be compensable if it is the direct and natural result of a compensable
primary injury.4
Causal relationship is a medical question that can generally be resolved only by
rationalized medical opinion evidence.5 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.6
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 medical rationale, explaining
the nature of the relationship between the diagnosed condition and the specific employment
factors.7
ANALYSIS
The Board notes that appellant filed a claim for a new injury in this case. OWCP stated
that it was developing the claim as a consequential injury. Although the claimed injury is not
based on a natural medical progression of an accepted condition, workers’ compensation law has
recognized that injuries resulting from directed vocational rehabilitation services may be
considered the direct and natural consequence of a primary injury.8 In this case, OWCP directed
appellant to undergo vocational rehabilitation activities and she has alleged an injury resulting
from performing these activities.9
The issue therefore is whether appellant has established a diagnosed condition causally
related to the identified activity. The record indicates that she did engage in typing activity from
November 22, 2010. To establish the claim, however, there must be a rationalized medical
opinion on causal relationship.
3

S.S., 59 ECAB 315 (2008).

4

Carlos A. Marrero, 50 ECAB 117, 120 (1998); 1 A. Larson, The Law of Workers’ Compensation
§ 10.01 (2006).
5

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

6

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

7

Id.

8

Supra note 4 at § 13.13 (2006); Firkus v. Alder Creek Lumber, 617 P.2d 620 (1980).

9

A claimant is required to maintain regular attendance at all approved vocational rehabilitation training. Federal
(FECA) Procedure Manual, Part 2 -- Claims, Vocational Rehabilitation Services, Chapter 2.813.8(b)
(February 2011). Noncooperation in vocational rehabilitation may result in reduction of compensation pursuant to 5
U.S.C. § 8113(b).

3

Dr. Harrison indicated in his March 31, 2011 report that appellant had reported bilateral
wrist pain commencing February 13, 2011. In his March 31 and September 8, 2011 reports, he
does not provide detailed results on examination, diagnostic tests or other detail with regards to
the diagnosis of wrist tendinitis. Dr. Harrison opined that the typing had likely caused the
diagnosed condition based on his review of photographs of the work setup, which he found to be
ergonomically inadequate. He does not explain specifically what those photographs revealed,
describe the mechanism of injury or otherwise explain why he felt that computer keying activity
in vocational rehabilitation from November 22, 2010 had caused the diagnosed condition.10
On appeal, appellant argued that the examining physician did provide a sufficient medical
opinion on the issue presented. For the reasons noted above, the Board finds the evidence of
record does not contain a rationalized medical opinion based on a complete and accurate
background with respect to the issue presented. The evidence is not sufficient to establish an
injury causally related to the vocational rehabilitation activity. 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 the evidence of record does not establish a bilateral wrist condition as a
consequence of the accepted employment injuries.

10

Cf. D.E. Docket No. 09-1013 (issued October 26, 2009) (where the physician discussed the ergonomic setup,
the location of appellant with respect to a monitor and keyboard and described how he believed the injury had
resulted).

4

ORDER
IT IS HEREBY ORDERED THAT the decision of the Office of Workers’
Compensation Programs dated September 26, 2011 is affirmed.
Issued: October 4, 2012
Washington, DC

Colleen Duffy Kiko, Judge
Employees’ Compensation Appeals Board

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

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

5


United States Department of Labor
Employees’ Compensation Appeals Board
__________________________________________
D.H., Appellant
and
U.S. POSTAL SERVICE, POST OFFICE,
East Hampton, NY, Employer
__________________________________________

)
)
)
)
)
)
)
)

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

Docket No. 18-0415
Issued: September 13, 2018

Case Submitted on the Record

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

JURISDICTION
On December 21, 2017 appellant, through counsel, filed a timely appeal from an August 2,
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 the claim.3

1
In all cases in which a representative has been authorized in a matter before the Board, no claim for a fee for legal
or other service performed on appeal before the Board is valid unless approved by the Board. 20 C.F.R. § 501.9(e).
No contract for a stipulated fee or on a contingent fee basis will be approved by the Board. Id. An attorney or
representative’s collection of a fee without the Board’s approval may constitute a misdemeanor, subject to fine or
imprisonment for up to one year or both. Id.; see also 18 U.S.C. § 292. Demands for payment of fees to a
representative, prior to approval by the Board, may be reported to appropriate authorities for investigation.
2
3

5 U.S.C. § 8101 et seq.

The record provided to the Board includes evidence received after OWCP issued its August 2, 2017 decision. The
Board’s jurisdiction is limited to the evidence that was before OWCP at the time of its final decision. Therefore, the
Board is precluded from reviewing this additional evidence for the first time on appeal. 20 C.F.R. § 501.2(c)(1).

ISSUE
The issue is whether appellant has established bilateral lower extremity conditions causally
related to the accepted June 27, 2015 employment incident.
FACTUAL HISTORY
On June 29, 2015 appellant, then a 53-year-old city carrier assistant, filed a traumatic injury
claim (Form CA-1) alleging that on June 27, 2015 at 5:00 p.m. she was exiting her vehicle in the
employing establishment parking lot and felt her right leg give way. She stumbled and caught
herself from falling. However, in the process of doing so, she pulled her right leg muscles and
strained her right knee and left ankle. Appellant stopped work on June 27, 2017. The employing
establishment controverted the claim.4
In a report dated June 22, 2015, Dr. Alexander Finger, a Board-certified orthopedic
surgeon, related that appellant had experienced right knee and hip pain after shoveling snow
approximately six months prior. Appellant also reported a month or two after that, she suffered a
fall and landed directly on her right knee. Since that time, she had continued pain. Dr. Finger
diagnosed right hip strain/sprain.
On July 1, 2015 Dr. Carl S. Goodman, an osteopath Board-certified in emergency
medicine, treated appellant at Brookhaven Memorial Hospital Medical Center. Appellant reported
that her injury occurred when she was exiting her vehicle and her leg muscles gave away, causing
her to twist her left ankle. She indicated that she fell due to leg weakness from arthritis. Appellant
also felt that something had popped in her back. She noted that she had previously hurt her leg in
the snow in January. Dr. Goodman noted that appellant’s July 1, 2015 x-ray of the left ankle and
venous left lower extremity ultrasound revealed negative findings. He opined that appellant’s
symptoms were consistent with Achilles tendinitis.
In a July 14, 2015 report, Dr. Finger noted that appellant had previously been seen for a
right hip strain. Dr. Finger indicated that she had been doing well until June 27, 2015, when she
had right leg pain, almost fell, and braced her fall with her left foot and ankle. An assessment of
right hip adductor strain and left Achilles strain was provided. He indicated that appellant could
not return to work, and he referred her to physical therapy. In a July 14, 2015 duty status report,
Form CA-17, Dr. Finger opined that appellant’s diagnoses of left ankle sprain and right hip sprain
were due to the June 27, 2015 incident when appellant’s right leg/knee gave out while appellant
was getting out of her work truck.
By August 5, 2015 development letter, OWCP advised appellant of the deficiencies in her
claim. Appellant was provided a questionnaire for her completion regarding the circumstances of
the injury. She was also asked to provide a narrative medical report from her physician which
contained a detailed description of findings and diagnoses, explaining how the claimed work

4
The employing establishment indicated that appellant worked for one hour after the alleged incident, but did not
report the injury until two days later. It also noted that she did not seek medical attention until July 1, 2015.

2

incident caused or aggravated a medical condition. OWCP afforded appellant 30 days to submit
the necessary evidence.
In response, OWCP received an August 11, 2015 statement and an undated statement
wherein appellant stated that, on February 21, 2015, she twisted her right leg while delivering mail
in the snow. She was advised by the Postmaster not to report the injury and she did not receive
any immediate medical treatment. Appellant indicated that she developed chronic muscular pain,
strain and weakness in her right leg, which caused her leg to give away several times. She indicated
that she believed that this was the cause of her right leg instability on June 27, 2015. Appellant
recounted that she also sought treatment at Peconic Bay Medical Center on June 17, 2015 for her
right knee and indicated that the x-rays showed she had arthritis in the right knee and right hip.
She was referred to Dr. Finger and initially saw him on June 22, 2015. Dr. Finger diagnosed her
with strain of the muscle, fascia, and tendon of the hip, prescribed physical therapy and medication
for the arthritis. Appellant stated that on June 27, 2015 her supervisor, A.H., and coworker, M.F.,
were no more than 10 feet away from her vehicle and had heard her scream when she hurt her leg
and ankle. She continued to work and finish her job despite the pain. The next day, she applied
ice to her left ankle and heat and ointment to her right knee and leg muscles.
On August 18, 2015 the employing establishment completed an authorization for
examination and/or treatment (Form CA-16), which was received by OWCP. It listed the date of
injury as June 27, 2015 and indicated a sprain/strain of right hip and thigh and left Achilles tendon
strain.
In the attending physician’s portion of the Form CA-16, Dr. Finger included a history of
injury that appellant had hurt herself stepping out of a mail truck. He diagnosed right hip and left
ankle sprain, and indicated by checking a box marked “yes” that the conditions were employment
related. Dr. Finger explained that appellant “felt pain in [right] hip and [left] ankle getting out of
mail truck.”
In August 19, 2015 duty status report and work capacity evaluation form, Dr. Finger held
appellant off work due to right ankle sprain/right hip sprain, which he opined was due to the
June 27, 2015 employment incident.
Follow-up reports, duty status reports, and attending physician’s reports from Dr. Finger
regarding appellant’s right hip strain and left Achilles tendinitis were received. On September 25,
2015 Dr. Finger advised that appellant was able to return to work without restrictions on
October 15, 2015. In an October 1, 2015 attending physician report (Form CA-20), he opined that
appellant’s right hip sprain and left ankle sprain were caused or aggravated by the June 27, 2015
work incident as appellant “felt pain at work stepping out of mail truck.”
By decision dated October 19, 2015, OWCP denied the claim as the evidence was
insufficient to establish that the injury occurred in the performance of duty and that the evidence
indicated that the injury was caused by a preexisting condition.
On October 26, 2015 appellant, through counsel, requested a telephonic hearing by an
OWCP hearing representative. A hearing was scheduled for June 13, 2016. On June 13, 2016
counsel requested a review of the written record.

3

OWCP received an October 15, 2015 magnetic resonance imaging (MRI) scan report of
appellant’s right knee which revealed a lateral meniscus tear; degeneration of medial
gastrocnemius and hamstrings with bursitis; no fracture; small joint effusion; and post-traumatic
scarring of the medial infrapatellar fat. A November 15, 2015 MRI scan of appellant’s right hip
revealed mild osteoarthritis, right hip; small reactive joint effusion; intrasubstance degeneration
and nondisplaced tearing, acetabular labrum. No fracture or avascular necrosis (AVN) was seen.
Degenerative change, lower lumbar spine, incompletely imagined, was noted.
By decision dated August 24, 2016, a representative from OWCP’s Branch of Hearings
and Review vacated the prior decision and remanded the case to OWCP for further factual
development. The hearing representative directed OWCP to obtain a statement from the
employing establishment as to whether the alleged injury occurred on its premises. OWCP was
also directed to obtain additional information from appellant as to why she did not work on
June 28, 2015, to respond to Dr. Goodman’s July 1, 2015 report that appellant fell due to weakness
from arthritis, and to explain why she did not file a claim for the February 21, 2015 injury.
In letters dated August 25, 2016, OWCP requested that appellant and the employing
establishment provide additional information as noted in its hearing representative’s decision.
On December 7, 2016 the Postmaster verified that the June 27, 2015 injury occurred on its
premises during the performance of duty. She also related that when appellant reported the
June 27, 2015 injury, she noted that she had a preexisting condition and was not sure where she
was hurt/injured. Appellant did not respond to OWCP’s August 25, 2016 letter.
By decision dated January 11, 2017, OWCP denied the claim as the factual component of
fact of injury had not been established.
On January 23, 2017 appellant, through counsel, requested a telephonic hearing before an
OWCP hearing representative.
A telephonic hearing was held on June 28, 2017. Counsel argued that fact of injury had
been established and the medical evidence established the claim. No new evidence was received.
By decision dated August 2, 2017, another OWCP hearing representative modified the
prior decision to reflect the factual component of fact of injury was in fact established. However,
she affirmed the denial of the claim as the medical evidence of record was insufficient to support
that the diagnosed conditions were causally related to the accepted June 27, 2015 employment
incident. OWCP’s hearing representative found that the medical evidence did not contain
sufficient rationale to explain how the June 27, 2015 employment incident caused or contributed
to the diagnosed conditions and failed to differentiate the diagnosed conditions from appellant’s
underlying conditions.

4

LEGAL PRECEDENT
An employee seeking benefits under FECA5 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
employment injury.6 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.7
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.8 The second component is whether the
employment incident caused a personal injury and generally can be established only by medical
evidence.9
The medical evidence required to establish causal relationship is generally rationalized
medical opinion evidence. 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.10
ANALYSIS
The Board finds that appellant has not established that her diagnosed bilateral lower
extremity conditions were causally related to the accepted June 27, 2015 employment incident.11
In his July 1, 2015 report, Dr. Goodman provided a history of appellant’s June 27, 2015
employment incident. He also noted that appellant had previously hurt her leg in the snow in
January and had weakness from arthritis. He noted that appellant felt herself falling from such
5

Supra note 2.

6

Joe D. Cameron, 41 ECAB 153 (1989).

7

See Irene St. John, 50 ECAB 521 (1999); Michael E. Smith, 50 ECAB 313 (1999).

8

Elaine Pendleton, 40 ECAB 1143, 1154 (1989).

9

See Roy L. Humphrey, 57 ECAB 238, 241 (2005); see also P.W., Docket No. 10-2402 (issued August 5, 2011).

10

Solomon Polen, 51 ECAB 341 (2000).

11

See Robert Broome, 55 ECAB 339 (2004).

5

weakness while getting out of her work vehicle on June 27, 2015. Dr. Goodman diagnosed
Achilles tendinitis. However, Dr. Goodman’s opinion is not well rationalized. Dr. Goodman
failed to provide any medical explanation as to whether appellant’s current diagnosed condition
was caused or aggravated by the June 27, 2015 employment incident. Medical evidence that does
not offer an opinion regarding the cause of an employee’s condition is of limited probative value
on the issue of causal relationship.12 Thus, Dr. Goodman’s opinion is of limited probative value.13
Prior to the June 27, 2015 employment incident, Dr. Finger noted appellant’s diagnosis of
right hip strain/sprain in his June 22, 2015 report. In his July 14, 2015 report, he noted that
appellant was seen previously for a right hip strain and that she was doing well until June 27, 2015
when she had right leg pain and almost fell. He diagnosed right hip adductor stain and left Achilles
strain. Dr. Finger, however, also failed to provide any rationalized medical explanation as to how
appellant’s current diagnosed conditions were caused or aggravated by the June 27, 2015
employment incident. This is especially important since he related that appellant had preexisting
right hip conditions.14 Dr. Finger’s opinion is of limited probative value on the issue of causal
relationship as he did not offer an opinion regarding the cause of appellant’s condition.15
In duty status reports of July 14 and August 19, 2015, Dr. Finger opined that appellant’s
left ankle sprain was due to the June 27, 2015 employment incident. In an October 1, 2015
attending physician’s report, he also opined that appellant’s left ankle sprain was caused or
aggravated by the June 27, 2015 work incident as appellant “felt pain at work stepping out of mail
truck.” While he diagnosed a left ankle sprain, he did not explain how physiologically the
movements involved in the employment incident caused or contributed to the diagnosed
condition.16 Thus, these reports are of limited probative value.
In the attending physician’s report portion of the CA-16, Dr. Finger indicated by checking
a box marked “yes” that appellant’s diagnosed conditions of right hip and left ankle sprain were
causally related to the accepted June 27, 2015 employment incident. He explained that appellant
experienced pain to these areas when exiting the mail truck. Dr. Finger did not, provide rationale
explaining how the mechanism of exiting her mail truck physiologically caused any employmentrelated condition.17 Without such, his report is of limited probative value and insufficient to
establish appellant’s claim.

12

The opinion of a physician supporting causal relationship must rest on a complete factual and medical background
supported by affirmative evidence, address the specific factual and medical evidence of record, and provide medical
rationale explaining the relationship between the diagnosed condition and the established incident or factor of
employment. C.B., Docket No. 09-2027 (issued May 12, 2010); S.E., Docket No. 08-2214 (issued May 6, 2009).
13

P.O., Docket No. 14-1675 (issued December 3, 2015).

14

See M.D., Docket No. 17-0478 (issued July 5, 2018).

15

See supra note 12.

16

See V.J., Docket No. 17-0358 (issued July 24, 2018).

17

See id.

6

Appellant also submitted diagnostic reports. However the diagnostic reports are
insufficient to establish appellant’s claim as they fail to offer any opinion regarding causal
relationship.18
Accordingly, the Board finds that the medical evidence of record does not contain a wellrationalized medical opinion establishing that appellant’s diagnosed conditions were causally
related to the accepted June 27, 2015 employment incident. OWCP advised appellant of the type
of medical evidence necessary to establish her claim. Appellant failed to submit appropriate
medical documentation in response to OWCP’s request.19 As such, she has failed to meet her
burden of proof.
On appeal counsel contends that appellant had provided prima facie medical evidence
which showed causation. OWCP gave proper consideration to all evidence she submitted. As
previously noted causal relationship is a medical issue and the medical evidence generally required
to establish causal relationship is rationalized medical opinion evidence. Appellant has not
submitted sufficiently-rationalized medical evidence in this case and, therefore, has not met her
burden of proof.20
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 bilateral lower extremity conditions
causally related to the accepted June 27, 2015 employment incident.21

18

See W.S., Docket No. 17-1769 (issued July 26, 2018).

19
See D.B., Docket No. 16-1219 (issued November 8, 2016); see also T.H., Docket No. 15-0772 (issued
May 12, 2016).
20

The record contains a Form CA-16 which lists the date of injury as June 27, 2015 and which indicates a
sprain/strain of right hip and thigh and left Achilles tendon strain. The Board notes that where an employing
establishment properly executes a Form CA-16 which authorizes medical treatment as a result of an employee’s claim
for an employment-related injury, the Form CA-16 creates a contractual obligation, which does not involve the
employee directly, to pay for the cost of the examination or treatment regardless of the action taken on the claim. See
20 C.F.R. § 10.300(c); Tracy P. Spillane, 54 ECAB 608 (2003).
21

See R.C., Docket No. 17-0372 (issued May 3, 2018).

7

ORDER
IT IS HEREBY ORDERED THAT the August 2, 2017 decision of the Office of
Workers’ Compensation Programs is affirmed.
Issued: September 13, 2018
Washington, DC

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

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

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

8


United States Department of Labor
Employees’ Compensation Appeals Board
__________________________________________
B.P., Appellant
and
U.S. POSTAL SERVICE, TRENTON
PROCESSING & DISTRIBUTION CENTER,
Trenton, NJ, Employer
__________________________________________

)
)
)
)
)
)
)
)
)

Appearances:
James D. Muirhead, Esq., for the appellant1
Office of Solicitor, for the Director

Docket No. 19-0777
Issued: October 8, 2019

Case Submitted on the Record

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

JURISDICTION
On February 25, 2019 appellant, through counsel, filed a timely appeal from a
September 28, 2018 merit decision of the Office of Workers’ Compensation Programs (OWCP).
Pursuant to the Federal Employees’ Compensation Act2 (FECA) and 20 C.F.R. §§ 501.2(c) and
501.3, the Board has jurisdiction over the merits of this case. 3

1

In all cases in which a representative has been authorized in a matter before the Board, no claim for a fee for legal
or other service performed on appeal before the Board is valid unless approved by the Board. 20 C.F.R. § 501.9(e).
No contract for a stipulated fee or on a contingent fee basis will be approved by the Board. Id. An attorney or
representative’s collection of a fee without the Board’s approval may constitute a misdemeanor, subject to fine or
imprisonment for up to one year or both. Id.; see also 18 U.S.C. § 292. Demands for payment of fees to a
representative, prior to approval by the Board, may be reported to appropriate authorities for investigation.
2

5 U.S.C. § 8101 et seq.

3
The Board notes that appellant submitted additional evidence on appeal. 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.

ISSUE
The issue is whether appellant has met her burden of proof to establish a left elbow
condition causally related to the accepted March 4, 2014 employment incident.
FACTUAL HISTORY
On March 12, 2014 appellant, then a 55-year-old mail processing clerk, filed a traumatic
injury claim (Form CA-1) alleging that on March 4, 2014 she injured her left elbow when she hit
it on a “pie rack” while in the performance of duty. She did not stop work.
In a report dated March 13, 2014, Dr. Marcel Stern, a Board-certified internist, noted
appellant’s date of injury as March 4, 2014, and reported the history of injury as “she lifted a tray
of mail to the upper shelf” and “banged her left elbow on a metal rod.” He diagnosed status post
contusion, sprain and strain of left elbow with lateral epicondylitis, and tendinitis. Dr. Stern
provided work restrictions.
On March 24, 2014 the employing establishment issued an authorization for examination
and medical treatment (Form CA-16).4
OWCP also received an attending physician’s report, Part-B of the Form CA-16, dated
March 13, 2014, which noted that appellant had hit her left elbow on a metal tray. The other
findings in the report and the physician’s signature are illegible.
A series of duty status reports (Forms CA-17) were received dated from March 13 through
August 26, 2014 which noted appellant’s history of injury as “lifting a tray of mail from a pie rack
to top rack and hit left elbow.” Appellant’s work restrictions were provided.
In a report dated March 25, 2014, Dr. Arvind Patel, a Board-certified internist, related
appellant’s examination findings and diagnosed status post contusion and sprain and strain of left
elbow with lateral epicondylitis. He noted that appellant could perform light-duty work with
restrictions.
In a series of reports dated April 2, April 16, May 14, and June 4, 2016, Dr. Stern noted
appellant’s history of injury, and physical examination findings. He continued to diagnose
persistent left elbow lateral epicondylitis, and provide work restrictions.
In a series of reports dated June 24, July 15, August 5, August 26, and September 16, 2014,
Dr. Franklin Chen, a Board-certified orthopedic surgeon, reviewed appellant’s history of injury
and physical examination findings. In his June 24, 2014 report, he noted that x-rays of appellant’s
elbow revealed incidental calcification to medial and lateral elbow, and diagnosed left elbow
epicondylitis. In his July 15, August 5, and August 26, 2014 reports, Dr. Chen noted that, based
on a July 5, 2014 magnetic resonance imaging (MRI) scan, appellant displayed severe common
extensor tendinitis with partial tearing of the deep fibers, and small joint, effusion. In each report,
he related that, based on appellant’s history of injury and examination findings, it was within

4

The record reflects that the employing establishment issued additional Forms CA -16 authorizing medical
treatment on June 24 and September 16, 2014. These forms are largely illegible.

2

medical probability that her current orthopedic complaints were causally related to her
employment injury.
In a report dated March 16, 2016, Dr. David Weiss, an osteopath Board-certified in
orthopedic surgery, performed a schedule award impairment evaluation of appellant’s left upper
extremity and left lower extremity. Regarding the left elbow he diagnosed chronic lateral
epicondylitis of the left elbow. Dr. Weiss opined that appellant’s employment-related injuries of
July 22, 2005, September 26, 2010, February 10, 2013, March 28, 2013, and March 4, 2014 were
the competent producing factors of her objective diagnoses.
In a development letter dated July 26, 2017, OWCP advised appellant that when her claim
was submitted it appeared to be a minor injury that necessitated minimal or no lost time from work
and payment of a limited amount of medical expenses had been administratively approved. It
explained that her claim was being reopened for consideration because she filed a claim for wage
loss pursuant to a schedule award impairment rating. OWCP further informed appellant of the
deficiencies of her claim, advised her of the type of factual and medical evidence needed, and
provided a questionnaire for her completion. It afforded her 30 days to submit the necessary
evidence. No response was received.
By decision dated November 29, 2017, OWCP denied appellant’s claim finding that the
evidence submitted was insufficient to establish that the alleged incident occurred as described,
and that she had not submitted sufficient medical evidence to establish a diagnosed medical
condition causally related to the alleged employment incident. It concluded, therefore, that the
requirements had not been met to establish an injury as defined by FECA.
On December 5, 2017 appellant, through counsel, requested a telephonic hearing regarding
OWCP’s November 29, 2017 decision. A hearing before an OWCP hearing representative was
held on May 9, 2018. Appellant testified at the hearing that her left elbow injury occurred as she
lifted a tray of mail to place it on a top rack, and she hit her left elbow on a connected rack.
By decision dated July 9, 2018, OWCP’s hearing representative affirmed the
November 29, 2017 decision finding that the evidence of record lacked a report from a physician
containing a history of injury, a firm diagnosis, and a discussion, with rationale, of the relationship
between the two.
On July 18, 2018 appellant, through counsel, requested reconsideration of the July 9, 2018
decision. She submitted additional medical evidence along with her request.
In an unsigned hospital report dated March 12, 2014, the treating physician indicated that
appellant injured her left elbow on a metal cage while at work. In addition, it noted that she had
elbow tenderness laterally and along the lateral epicondyle, no edema, no swelling, and full range
of motion. Appellant was diagnosed with left elbow contusion.
By decision dated September 28, 2018, OWCP denied modification of the July 9, 2018
decision as appellant had not met her burden of proof to establish that her diagnosed left elbow
conditions were causally related to the accepted employment incident.

3

LEGAL PRECEDENT
An employee seeking benefits under FECA 5 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 of FECA,6 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 to
the employment injury.7 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. 8
In order to determine whether a federal employee has sustained a traumatic injury in the
performance of duty, OWCP must first determine whether fact of injury has been established. 9
There are two components involved in establishing fact of injury. 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. 10 Second, the employee must submit evidence, generally
only in the form of probative medical evidence, to establish that the employment incident caused
a personal injury.11
Causal relationship is a medical issue, and the medical evidence required to establish causal
relationship is rationalized medical evidence. 12 The opinion of the physician must be based on a
complete factual and medical background of the employee, must be one of reasonable medical
certainty, and must be supported by medical rationale explaining the nature of the relationship
between the diagnosed condition and the specific employment factor(s) identified by the
employee.13 The weight of the 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.14
5

Supra note 2.

6

R.C., Docket No. 18-1146 (issued August 12, 2019); S.B., Docket No. 17-1779 (issued February 7, 2018); J.P., 59
ECAB 178 (2007); Joe D. Cameron, 41 ECAB 153 (1989).
7

L.E., Docket No. 19-0470 (issued August 12, 2019); J.M., Docket No. 17-0284 (issued February 7, 2018); R.C.,
59 ECAB 427 (2008); James E. Chadden, Sr., 40 ECAB 312 (1988).
8

L.E., 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).
9

D.B., Docket No. 18-1348 (issued January 4, 2019); S.P., 59 ECAB 184 (2007).

10

R.C., supra note 6; D.S., Docket No. 17-1422 (issued November 9, 2017); Bonnie A. Contreras, 57 ECAB
364 (2006).
11

L.E., supra note 7; B.M., Docket No. 17-0796 (issued July 5, 2018); David Apgar, 57 ECAB 137 (2005); John J.
Carlone, 41 ECAB 354 (1989).
12
M.K., Docket No. 19-0428 (issued July 15, 2019); L.D., Docket No. 17-1581 (issued January 23, 2018);
Jacqueline M. Nixon-Steward, 52 ECAB 140 (2000).
13

L.E., supra note 7; M.V., Docket No. 18-0884 (issued December 28, 2018); I.J., 59 ECAB 408 (2008); Victor J.
Woodhams, 41 ECAB 345 (1989).
14

R.C., supra note 6; James Mack, 43 ECAB 321 (1991).

4

ANALYSIS
The Board finds that appellant has not met her burden of proof to establish a left elbow
condition causally related to the accepted March 4, 2014 employment incident.
Appellant submitted a series of reports from Dr. Stern who noted appellant’s history of
injury, and diagnosed persistent left elbow lateral epicondylitis status post contusion, sprain and
strain of left elbow with lateral epicondylitis, and tendinitis. Dr. Stern did not, however, address
the issue of causal relationship. Medical evidence that does not offer an opinion regarding the
cause of an employee’s condition is of no probative value regarding the issue of causal
relationship.15
Similarly, Dr. Patel provided diagnoses of appellant’s left elbow condition and noted work
restrictions, but offered no opinion causally relating the diagnoses to the March 4, 2014
employment incident. As such his report is insufficient to establish appellant’s claim.16
OWCP also received a series of reports from Dr. Chen who noted that x-rays revealed
incidental calcification of appellant’s medial and lateral elbow, and diagnosed left elbow
epicondylitis. In Dr. Chen’s July 15, August 5, and 26, 2014 reports, he noted that, based on a
July 5, 2014 magnetic resonance imaging (MRI) scan, appellant displayed severe common
extensor tendinitis with partial tearing of the deep fibers, small joint effusion. In each report, he
related that, based on the patient’s history and examination, it was within medical probability that
her current orthopedic complaints were causally related to her employment injury. Although
Dr. Chen’s reports contain an affirmative opinion on causal relationship, the Board finds that they
do not contain sufficient medical rationale explaining how the mechanism of injury caused or
contributed to appellant’s left elbow conditions. The Board has found that medical evidence that
states a conclusion, but does not offer any rationalized medical explanation regarding the cause of
an employee’s condition is of limited probative value on the issue of causal relationship. 17 Because
Dr. Chen did not provide a reasoned opinion explaining how, physiologically, the March 4, 2014
employment incident caused or contributed to appellant’s left elbow condition, his reports are
insufficient to establish her claim.
Appellant also submitted a report from Dr. Weiss, who diagnosed inter alia chronic lateral
epicondylitis to the left elbow. Dr. Weiss opined that the employment-related injuries of July 22,
2005, September 26, 2010, February 10, March 28, 2013, and March 4, 2014 were the competent
producing factors of her objective diagnoses. As previously discussed, the Board has found that
medical evidence that provides a conclusion, but does not offer a rationalized medical explanation
regarding the cause of an employee’s condition is of limited probative value on the issue of causal
relationship.18
Because Dr. Weiss’ report did not provide sufficient rationalized medical

15

D.H., Docket No. 17-1913 (issued December 13, 2018); L.B., Docket No. 18-0533 (issued August 27, 2018);
Linda I. Sprague, 48 ECAB 386 (1997).
16

Id.

17

R.C., supra note 6; J.F., Docket No. 09-1061 (issued November 17, 2009); A.D., 58 ECAB 149 (2006).

18

Id.

5

explanation explaining how the March 4 2014 employment incident was sufficient to have caused
appellant’s diagnosed left elbow condition, his report is of limited probative value. 19
OWCP also received an unsigned hospital report, which noted that appellant injured her
left elbow on a metal cage while at work, that she had elbow tenderness laterally and along the
lateral epicondyle, no edema, no swelling, full range of motion, and a diagnosis of left elbow
contusion at that time. Reports that are unsigned or that bear illegible signatures cannot be
considered as probative medical evidence because they lack proper identification. 20 Thus, this
report is insufficient to meet appellant’s burden of proof.
In order to obtain benefits under FECA an employee has the burden of proof to establish
the essential elements of his or her claim by the weight of the reliable, probative, and substantial
evidence.21 Because appellant has failed to provide such evidence demonstrating that her
diagnosed left elbow condition was causally related to the accepted March 4, 2014 employment
incident, she has not met her burden of proof to establish her traumatic injury claim. 22
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 elbow
condition causally related to the accepted March 4, 2014 employment incident.

19

The duty status reports which accompany the physicians’ medical reports in the record are of no probative value
as they do not contain an opinion on the issue of causation. See supra note 16.
20

T.C., Docket No. 18-1351 (issued May 9, 2019); Thomas L. Agee, 56 ECAB 465 (2005); Richard F. Williams, 55
ECAB 343 (2004).
21

Supra note 7.

22

The Board notes that the employing establishment issued an authorization for examination and/or treatment
(Form CA-16). A completed Form CA-16 authorization may constitute a contract for payment of medical expenses
to a medical facility or physician, when properly executed. The form creates a contractual obligation, which does not
involve the employee directly, to pay for the cost of the examination or treatment regardless of the act ion taken on the
claim. See 20 C.F.R. § 10.300(c); J.G., Docket No. 17-1062 (issued February 13, 2018); Tracy P. Spillane, 54 ECAB
608 (2003).

6

ORDER
IT IS HEREBY ORDERED THAT the September 28, 2018 decision of the Office of
Workers’ Compensation Programs is affirmed.
Issued: October 8, 2019
Washington, DC

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

Janice B. Askin, Judge
Employees’ Compensation Appeals Board

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

7