United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

W.W., Appellant 

and 

DEPARTMENT OF VETERANS AFFAIRS, 

VETERANS HEALTH ADMINISTRATION, 

Northport, NY, Employer 

__________________________________________ 

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Docket No. 14-1267 

Issued: September 26, 2014 

Appearances: Case Submitted on the Record

Appellant, pro se 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

CHRISTOPHER J. GODFREY, Chief Judge 

MICHAEL E. GROOM, Alternate Judge 

JAMES A. HAYNES, Alternate Judge 

JURISDICTION 

On May 13, 2014 appellant filed a timely appeal from a December 12, 2013 merit 

decision of the Office of Workers’ Compensation Programs (OWCP) denying his traumatic 

injury claim. 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 met his burden of proof to establish that he sustained a left 

wrist injury in the performance of duty on August 18, 2013. 

FACTUAL HISTORY 

On October 24, 2013 appellant, then a 47-year-old nursing assistant, filed a traumatic 

injury claim (Form CA-1) alleging that on August 18, 2013 he sustained a left wrist injury when 

 1

 5 U.S.C. § 8101 et seq.
2

he was covering a patient with a blanket and he was struck on the left wrist. He stopped work on 

October 21, 2013 and notified his supervisor on October 24, 2013. The employing establishment 

controverted the claim stating that appellant did not file his Form CA-1 within 30 days of the 

injury and failed to immediately notify his supervisor. Appellant’s supervisor indicated that, 

following the incident, appellant notified the workers’ compensation manager but refused 

medical treatment. 

In support of his claim, appellant submitted the October 18 and 28, 2013 return-to-work 

notes from a physician’s assistant at Amityville Family Practice. 

In an October 30, 2013 medical note, Dr. Brett M. Spain, an osteopath, diagnosed left 

wrist pain, carpal tunnel syndrome and de Quervain’s tenosynovitis. He noted that appellant was 

temporarily totally disabled due to left wrist pain. 

By letter dated November 8, 2013, OWCP informed appellant that the evidence of record 

was insufficient to establish his claim. Appellant was advised of the factual and medical 

evidence needed and asked to submit a narrative report from his physician within 30 days. 

In support of his claim, appellant submitted an August 19, 2013 emergency room triage 

note from Robert A. Milano, a registered nurse, who reported that appellant sought treatment for 

left wrist and arm pain after being struck by a patient. 

In an August 19, 2013 diagnostic report, Dr. Vijay Chandnani, a Board-certified 

diagnostic radiologist, advised that an x-ray of the left wrist revealed no acute fracture, 

dislocation or significant bony abnormality. 

In an August 19, 2013 report, Dr. Yelda Nouri, Board-certified in internal medicine, 

noted that appellant sought emergency treatment for complaints of left wrist pain after a patient 

struck him on the wrist the previous day. Upon physical examination and review of diagnostic 

testing, she diagnosed left wrist pain. 

In a December 2, 2013 note, Dr. Elena Stybel, an osteopath, reported that appellant’s left 

wrist was not fully healed, but that he could resume light-duty work. 

By decision dated December 12, 2013, OWCP denied appellant’s claim. It found that the 

medical evidence was insufficient to establish the causal relationship between the August 18, 

2013 incident at work and his left wrist complaints. 

LEGAL PRECEDENT 

An employee seeking benefits under FECA has the burden of establishing the essential 

elements of his or her claim, including the fact that the individual is an “employee of the United 

States” within the meaning of FECA; that the claim was filed within the applicable time 

limitation; that an injury was sustained while in the performance of duty as alleged and that any 

disability or specific condition for which compensation is claimed are causally related to the 
3

employment injury.2 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.3

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.4 The second 

component is whether the employment incident caused a personal injury and generally can be 

established only by medical evidence. 

To establish a causal relationship between the condition, as well as any attendant 

disability claimed and the employment event or incident, the employee must submit rationalized 

medical opinion evidence based on a complete factual and medical background, supporting such 

a causal relationship.5 The opinion of the physician must be based on a complete factual and 

medical background of the claimant, must be one of reasonable medical certainty and must be 

supported by medical rationale explaining the nature of the relationship between the diagnosed 

condition and the specific employment factors identified by the claimant. This medical opinion 

must include an accurate history of the employee’s employment injury and must explain how the 

condition is related to the injury. The weight of medical evidence is determined by its reliability, 

its probative value, its convincing quality, the care of analysis manifested and the medical 

rationale expressed in support of the physician’s opinion.6

ANALYSIS 

OWCP accepted that the August 18, 2013 incident occurred as alleged. The issue is 

whether appellant submitted sufficient medical evidence to establish that the employment 

incident caused a left wrist injury. The Board finds that he did not submit sufficient medical 

evidence to support that he sustained an injury causally related to the August 18, 2013 

employment incident.7 The medical evidence is deficient on two grounds: first, it fails to 

provide a firm medical diagnosis; and second, there is no narrative opinion on causal relationship 

addressing how appellant’s left wrist condition was caused or contributed to by the employment 

incident. 

In an August 19, 2013 medical report, Dr. Nouri reported that appellant sought 

emergency treatment for complaints of left wrist pain after a patient struck him on the wrist. 

Upon physical examination and review of diagnostic testing, she diagnosed left wrist pain. The 

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

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

4 Elaine Pendleton, supra note 2. 

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

6 James Mack, 43 ECAB 321 (1991). 

7 See Robert Broome, 55 ECAB 339 (2004).
4

Board finds that Dr. Nouri failed to provide a specific medical diagnosis of appellant’s left wrist 

injury. Dr. Nouri’s diagnosis of left wrist pain is a description of a symptom rather than a firm 

diagnosis of a compensable medical condition.8

 While she noted the August 18, 2013 incident, 

Dr. Nouri did not provide a firm medical diagnosis that caused his left wrist pain. Dr. Nouri’s 

report does not constitute probative medical evidence because she failed to provide a clear 

diagnosis and failed to adequately explain the cause of appellant’s left wrist condition.9

 

In an October 30, 2013 medical note, Dr. Spain diagnosed left wrist pain, carpal tunnel 

syndrome and de Quervain’s tenosynovitis. He found appellant temporarily totally disabled due 

to left wrist pain. The Board notes that Dr. Spain failed to provide a medical history, findings on 

physical examination, review of diagnostic testing or any details pertaining to the August 18, 

2013 employment incident. Without any mention of the August 18, 2013 employment incident, 

his diagnosis of left wrist pain, carpal tunnel syndrome and de Quervain’s tenosynovitis lacks 

any narrative addressing causal relationship to the incident accepted in this case. Dr. Spain’s 

report does not establish that appellant’s carpal tunnel syndrome and de Quervain’s tenosynovitis 

were caused by the August 18, 2013 incident at work. Appellant has failed to meet his burden of 

proof.10

The remaining medical evidence of record is also insufficient to establish appellant’s 

claim. Dr. Chandnani’s diagnostic report indicated no acute bone injury. Dr. Stybel’s 

December 2, 2013 note also failed to state a left wrist injury for which appellant was seeking 

treatment. The physician’s assistant and nursing notes are also of no probative value. A 

registered nurse, licensed practical nurse, physician’s assistant, or physical and occupational 

therapist, are not physicians as defined under FECA, and their opinions are of no probative 

value.11

The Board has held that the fact that a condition manifests itself during a period of 

employment does not raise an inference of causal relation.12 An award of compensation may not 

be based on surmise, conjecture, speculation or on the employee’s own belief of causal 

relation.13 To establish a firm medical diagnosis and causal relationship, appellant must submit a 

physician’s report that addresses the August 18, 2013 incident at work and how it caused a left 

wrist injury.14 

 8

 The Board has consistently held that pain is a symptom, rather than a compensable medical diagnosis. C.F., 

Docket No. 08-1102 (issued October 10, 2008). 

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

10 S.Y., Docket No. 11-1816 (issued March 16, 2012). 

11 5 U.S.C. § 8102(2) of FECA provides as follows: (2) physician includes surgeons, podiatrists, dentists, clinical 

psychologists, optometrists, chiropractors and osteopathic practitioners within the scope of their practice as defined 

by State law.

12 Daniel O. Vasquez, 57 ECAB 559 (2006). 

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

14 Supra note 3. 
5

In the instant case, appellant established that the August 18, 2013 incident occurred as 

alleged. He failed, however, to submit medical evidence expressing how his left wrist condition 

is causally related to the accepted August 18, 2013 employment incident. Appellant has failed to 

meet his burden of proof. 

Appellant may submit additional evidence, together with a written request for 

reconsideration, to OWCP within one year of the Board’s merit decision, pursuant to 5 U.S.C. 

§ 8128(a) and 20 C.F.R. §§ 10.605 and 10.607. 

CONCLUSION 

The Board finds that appellant did not meet his burden of proof to establish that he 

sustained a left wrist injury in the performance of duty on August 18, 2013. 

ORDER 

IT IS HEREBY ORDERED THAT the December 12, 2013 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: September 26, 2014 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Michael E. Groom, Alternate Judge 

 Employees’ Compensation Appeals Board 

 

 James A. Haynes, Alternate Judge 

 Employees’ Compensation Appeals Board