T.N. and U.S. Postal Service, Fredericksburg Main Post Office (Board decision, April 11, 2025)

ECAB remand decision. The Board set aside OWCP's disability decisions and returned the claim for medical-adviser review; entitlement remains unresolved. A party may petition the Board for reconsideration within 30 days of issuance unless this order specifies another period, under 20 C.F.R. § 501.7(a). FECA compensation decisions are generally not subject to court review under 5 U.S.C. § 8128(b).

Plain-English summary

A postal worker sought wage-loss benefits beginning in August 2024 after an accepted injury. OWCP authorized a district medical adviser to review the evidence but issued its decision before obtaining the adviser's report. The Board returned the claim so the adviser could address the claimed disability period.

Decision snapshot

• Authority: Federal Employees' Compensation Act, 5 U.S.C. § 8101 et seq.
• Outcome: Disability decisions set aside; medical-adviser review ordered.
• Key point: OWCP needed to complete its authorized medical review before deciding the claim.

Full text (ECAB public release)

United States Department of Labor
Employees’ Compensation Appeals Board

________
)
T.N., Appellant
)
)
and ) Docket No. 25-0366
)
Issued: April 11, 2025
U.S. POSTAL SERVICE, FREDERICKSBURG )
MAIN POST OFFICE, Fredericksburg, VA, )
Employer
)
__________ )

Appearances: Case Submitted on the Record
Appellant, pro se
Office of Solicitor, for the Director

DECISION AND ORDER

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

JURISDICTION

On March 7, 2025 appellant filed a timely appeal from February 12 and March 7, 2025 merit decisions of the Office of Workers’ Compensation Programs (OWCP). Pursuant to the Federal Employees’ Compensation Act1 (FECA) and 20 C.F.R. §§ 501.2(c) and 501.3, the Board has jurisdiction over the merits of this case.

ISSUE

The issue is whether appellant has met her burden of proof to establish disability from work commencing August 24, 2024, causally related to her accepted March 10, 2015 employment injury.

1
5 U.S.C. § 8101 et seq.
FACTUAL HISTORY

This case has previously been before the Board on different issues. 2 The facts and circumstances set forth in the Board’s prior decisions are incorporated herein by reference. The relevant facts are as follows.

On March 19, 2015 appellant, then a 42-year-old rural carrier associate, filed a traumatic injury claim (Form CA-1) alleging that on March 10, 2015 she experienced pain in her right shoulder when finishing her route while in the performance of duty. The form indicated that she worked seven days a week “as directed.” OWCP accepted the claim for a closed fracture of the acromial end of the right clavicle. It subsequently expanded the acceptance of the claim to include an injury to the muscles/tendons of the right rotator cuff, a temporary aggravation of right shoulder bursitis, and a temporary aggravation of other specified arthropathies of the right shoulder. OWCP paid appellant wage-loss compensation on the supplemental rolls effective April 25, 2015, and on the periodic rolls effective March 6, 2016.

By decision dated December 22, 2020, OWCP terminated appellant’s wage-loss compensation and medical benefits effective that date. It found that medical evidence established that she had no disability causally related to her accepted March 10, 2015 employment injury. By decisions dated April 14, July 21, October 21, and December 15, 2021, and March 15, 2022, OWCP denied modification of its termination of appellant’s wage-loss compensation and medical benefits. By decision dated April 7, 2022, it denied her request for reconsideration of the merits of her claim, pursuant to 5 U.S.C. § 8128(a).

Appellant appealed to the Board. By decision dated September 14, 2022, the Board reversed OWCP’s termination of her wage-loss compensation as the medical evidence was insufficient to establish that she had no further employment-related disability or residuals. 3

By decision dated November 6, 2023, OWCP reduced appellant’s wage-loss compensation effective that date, finding that she had the capacity to earn wages of $512.00 per week as an administrative assistant, Department of Labor’s Dictionary of Occupational Titles (DOT) No. 219.362-010. By decision dated February 12, 2024, it denied modification of its November 6, 2023 decision. By decision dated February 21, 2024, OWCP denied appellant’s request for reconsideration of the merits of her claim, pursuant to 5 U.S.C. § 8128(a).

On February 23, 2024 appellant appealed to the Board.

On May 6, 2024 appellant returned to work as a rural carrier associate. She did not have a set schedule.

By decision dated June 13, 2024, the Board found that OWCP had improperly reduced appellant’s wage-loss compensation, effective November 6, 2023, based on her capacity to earn

2
Docket No. 22-0721 (issued September 14, 2022); Docket No. 24-0370 (issued June 13, 2024).
3
Docket No. 22-0721 (issued September 14, 2022).

2 wages as an administrative clerk. 4 The Board determined that the medical evidence failed to clearly establish that she had the physical capacity to perform the duties of the position.

On July 23, 2024 the employing establishment advised that appellant had transferred to a facility in another state as a rural carrier associate and provided information regarding her pay rate. A notification of personnel action (PS Form 50) provided the effective date of the position as June 15, 2024. Appellant worked a variable schedule.

In a physical capacities evaluation form dated August 21, 2024, Dr. Ali R. Hashemi, a Board-certified orthopedic surgeon, found that appellant could perform sedentary work only.

On August 23, 2024 appellant resigned from the employing establishment, citing health reasons. In a letter to OWCP of even date, she noted that OWCP had not paid her compensation following the Board’s June 13, 2024 decision. Appellant related that on August 21, 2024 her physician had provided work restrictions which the employing establishment was unable to accommodate.

On September 10, 2024 appellant filed a claim for compensation (Form CA-7) for disability from work from August 24 to September 6, 2024.

In a development letter dated September 16, 2024, OWCP advised appellant of the deficiencies in her claim for disability compensation and requested that she submit a reasoned opinion from a physician supporting that she was unable to work during the claimed period due to the accepted employment injury. It afforded her 30 days to submit the requested information.

Subsequently, OWCP received an August 21, 2024 report from Dr. Hashemi, who evaluated appellant for possible right shoulder surgery. On examination he observed positive Neer and Hawkin’s maneuver of the right shoulder. Dr. Hashemi diagnosed adhesive bursitis of the right shoulder, an incomplete rotator cuff tear or rupture of the right shoulder, not specified as traumatic, arthritis of the right acromioclavicular (AC) joint, and cervical spine arthritis with nerve pain. He recommended right shoulder surgery.

Appellant continued to submit CA-7 forms requesting continuing wage-loss compensation due to disability from work.

In a follow-up report dated October 2, 2024, Dr. Hashemi discussed appellant’s continued right shoulder pain and difficulty with overhead activities. He diagnosed right shoulder adhesive bursitis and an incomplete rotator cuff tear or rupture. Dr. Hashemi again recommended surgery. In an October 2, 2024 physical capacities evaluation form, he determined that appellant could perform light-duty work lifting up to 10 pounds.

By decision dated October 22, 2024, OWCP denied appellant’s claim for disability compensation commencing August 24, 2024.

4
Docket No. 24-0370 (issued June 13, 2024).

3
In a report dated November 11, 2024, Dr. Hashemi provided the same diagnoses as in his August 21, 2024 report. He again recommended surgery and, in an accompanying form report, found that appellant was unable to work.

On November 12, 2024 appellant requested reconsideration. She related that her accepted condition had not been surgically repaired.

By decision dated November 14, 2024, OWCP denied modification of its October 22, 2024 decision. It advised appellant that she could file an occupational disease claim (Form CA-2) if she believed that new work factors contributed to her condition.

On November 26, 2024 the employing establishment provided that appellant had worked 105.61 hours from June 15 through August 25, 2024.

On February 10, 2025 appellant requested reconsideration.

By decision dated February 12, 2025, OWCP denied modification of its November 14, 2024 decision.

Subsequently, appellant submitted progress reports from Dr. Hashemi dated March 27, May 22, August 21, October 2, and November 11, 2024, and January 29, 2025.

A February 7, 2025 magnetic resonance imaging (MRI) scan of appellant’s right shoulder demonstrated progression of a partial thickness tear at the supraspinatus and infraspinatus zones and new severe supraspinatus tendinopathy with a separate low-grade partial thickness bursal surface perforation, severe proximal biceps tendinopathy with partial tearing a the groove entrance, post-traumatic deformity of the distal clavicle with mild-to-moderate AC joint arthropathy, subacromial spur, moderate subacromial-subdeltoid bursitis, and adhesive capsulitis.

On February 20, 2025 OWCP requested that a district medical adviser (DMA) review the medical evidence and address whether it should approve Dr. Hashemi’s request for authorization for right shoulder surgery as medically necessary due to appellant’s accepted employment injury. It also requested that the DMA review and comment on Dr. Hashemi’s November 11, 2024 report and discuss any areas of disagreement. No DMA was consulted at that time.

On February 19, 2025 Dr. Hashemi provided positive findings on examination of the right shoulder and reviewed the results of a recent February 7, 2025 MRI scan. He diagnosed a complete tear of the right rotator cuff, unspecified whether traumatic and adhesive bursitis of the right shoulder. Dr. Hashemi noted that he had offered surgical management “given the worsening of the tear” and noted that appellant had increased pain and difficulty performing activities. He related, “I do believe this is all related to her workers[’] comp[ensation] accident.” Dr. Hashemi indicated that appellant was scheduled for surgery.

On February 21, 2025 appellant requested reconsideration. She advised that she required surgery due to her employment injury.

4
By decision dated March 7, 2025, OWCP denied modification of its February 12, 2025 decision.

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 that any disability or specific condition for which compensation is claimed is causally related to the employment injury. 6 For each period of disability, claimed, the employee has the burden of proof to establish that he or she was disabled from work as a result of the accepted employment injury. 7 Whether a particular injury causes an employee to become disabled from work, and the duration of that disability are medical issues, which must be proven by a preponderance of the reliable, probative, and substantial medical evidence.8

Under FECA, the term disability means the incapacity, because of an employment injury, to earn the wages that the employee was receiving at the time of injury. 9 Disability is, thus, not synonymous with physical impairment, which may or may not result in an incapacity to earn wages.10 An employee who has a physical impairment causally related to a federal employment injury, but who nevertheless has the capacity to earn the wages he or she was receiving at the time of injury, has no disability as that term is used in FECA. 11 When, however, the medical evidence establishes that the residuals or sequelae of an employment injury are such that, from a medical standpoint, they prevent the employee from continuing in his or her employment, he or she is entitled to compensation for loss of wages. 12

The medical evidence required to establish causal relationship between a claimed period of disability and an employment injury is rationalized medical opinion evidence. The opinion of the physician must be based on a complete factual and medical background of the claimant, must

5
Supra note 1.
6
A.R., Docket No. 20-0583 (issued May 21, 2021); S.W., Docket No. 18-1529 (issued April 19, 2019); Kathryn Haggerty, 45 ECAB 383 (1994). 7 E.B., Docket No. 22-1384 (issued January 24, 2024); C.B., Docket No. 20-0629 (issued May 26, 2021);
D.S., Docket No. 20-0638 (issued November 17, 2020); William A. Archer, 55 ECAB 674 (2004); Kathryn Haggerty, 45 ECAB 383 (1994); Elaine Pendleton, 40 ECAB 1143 (1989). 8 20 C.F.R. § 10.5(f); L.M., Docket No. 21-0063 (issued November 8, 2021); N.M., Docket No. 18-0939 (issued December 6, 2018). 9 20 C.F.R. § 10.5(f); see J.M., Docket No. 18-0763 (issued April 29, 2020); Bobbie F. Cowart, 55 ECAB 746 (2004).
10
D.W., Docket No. 20-1363 (issued September 14, 2021); L.W., Docket No. 17-1685 (issued October 9, 2018).
11
See M.W., Docket No. 20-0722 (issued April 26, 2021); D.G., Docket No. 18-0597 (issued October 3, 2018).
12
See D.R., Docket No. 18-0323 (issued October 2, 2018).

5 be one of reasonable medical certainty, and must be supported by medical rationale explaining the nature of the relationship between the claimed disability and the accepted employment injury. 13

The Board will not require OWCP to pay compensation for disability in the absence of medical evidence directly addressing the specific dates of disability for which compensation is claimed. To do so would essentially allow an employee to self -certify his or her disability and entitlement to compensation. 14

ANALYSIS

The Board finds that this case is not in posture for decision.

In support of her claim, appellant submitted progress reports dated August through October 2024 report from Dr. Hashemi, who diagnosed adhesive bursitis of the right shoulder, an incomplete rotator cuff tear or rupture of the right shoulder, arthritis of the right AC joint, and cervical spine arthritis with nerve pain. He recommended right shoulder surgery and provided work restrictions. On November 11, 20224 Dr. Hashemi again recommended surgery and determined that appellant was unable to work.

On February 20, 2025 OWCP referred the case record to a DMA to review the medical evidence and discuss whether it should authorize right shoulder surgery as causally related to the accepted employment injury. It further requested that the DMA review and comment on Dr. Hashemi’s November 11, 2024 report and provide any areas of disagreement. However, OWCP issued its March 7, 2025 decision denying appellant’s disability claim without first procuring a DMA’s report.

The Board notes that proceedings under FECA are not adversarial in nature and OWCP is not a disinterested arbiter. While the claimant has the burden of proof to establish entitlement to compensation, OWCP shares responsibility in the development of the ev idence to see that justice is done.15 Once it undertakes development of the record, it has an obligation to do a complete job in procuring medical evidence that will resolve the relevant issues in the case. 16 While OWCP began to develop the evidence by referring the record to the DMA for an opinion on surgical authorization and Dr. Hashemi’s November 11, 2024 report, it failed to complete its obligation to

13
D.S., Docket No. 23-0414 (issued December 4, 2023); Y.S., Docket No. 19-1572 (issued March 12, 2020).
14
A.G., Docket No. 21-0756 (issued October 18, 2021); J.B., Docket No. 19-0715 (issued September 12, 2019);
Fereidoon Kharabi, 52 ECAB 291, 293 (2001).
15
S.R., Docket No. 24-0880 (issued October 31, 2024); K.B., Docket No. 23-0272 (issued October 26, 2023); see E.W., Docket No. 17-0707 (issued September 18, 2017).
16
See S.M., Docket No. 22-1209 (issued February 27, 2024); B.B., Docket No. 18-1321 (issued April 5, 2019).

6 secure the report prior to issuing its March 7, 2025 decision.17 Therefore, OWCP failed to resolve the issue in the case. 18

On remand OWCP shall refer the case record to a DMA for review and comment regarding whether appellant was disabled from work commencing August 24, 2024 causally related to her accepted March 10, 2015 employment injury. Following this, and other such further development as deemed necessary, OWCP shall issue a de novo decision.

CONCLUSION

The Board finds that this case is not in posture for decision.

ORDER

IT IS HEREBY ORDERED THAT the February 12 and March 7, 2025 decisions of the Office of Workers’ Compensation Programs are set aside and the case is remanded for further proceedings consistent with this decision of the Board.

Issued: April 11, 2025
Washington, DC

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

Janice B. Askin, Judge
Employees’ Compensation Appeals Board

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

17
S.R. supra note 15; K.B., supra note 15.
18
Id.

7