United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

V.C., Appellant 

and 

DEPARTMENT OF VETERANS AFFAIRS, 

VETERANS HEALTH ADMINISTRATION, 

Hines, IL, Employer 

__________________________________________ 

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Docket No. 14-1124 

Issued: November 3, 2014 

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

CHRISTOPHER J. GODFREY, Chief Judge 

ALEC J. KOROMILAS, Alternate Judge 

JAMES A. HAYNES, Alternate Judge 

JURISDICTION 

On April 15, 2014 appellant, through counsel, filed a timely appeal from a March 24, 

2014 merit decision of the Office of Workers’ Compensation Programs (OWCP) denying her 

claim for compensation. Pursuant to the Federal Employees’ Compensation Act1

 (FECA) and 

20 C.F.R. §§ 501.2(c) and 501.3, the Board has jurisdiction over merits of this case. 

ISSUE 

The issue is whether appellant has met her burden of proof to establish that she sustained 

an injury or medical condition on October 17, 2012. 

FACTUAL HISTORY 

On November 1, 2012 appellant, then a 60-year-old dental assistant, filed an occupational 

disease claim indicating weakness of her right arm and hand every time she worked with a left-

 1

 5 U.S.C. § 8101 et seq. 
2

handed dentist. She explained that she was used to working with her right hand and she had to 

stand up and find the right position to place her suction if the dentist was working on the right 

side of the patient. Appellant first became aware of her condition and that it was caused or 

aggravated by her employment on October 17, 2012. No additional evidence was submitted. 

In a November 19, 2012 letter, OWCP advised appellant of the deficiencies in her claim 

and provided her the opportunity to submit additional evidence. Appellant was requested to 

submit within 30 days a response to the questionnaire regarding the factual aspects of her claim 

and a comprehensive medical report from a physician supported by a medical explanation as to 

how work factors caused or aggravated her condition. 

In response, OWCP received a December 13, 2002 claim for compensation and a 

December 12, 2012 request for physical therapy and work restrictions for appellant’s right arm 

from Dr. Keith L. Komnick, a Board-certified orthopedic surgeon. In a January 9, 2013 report, 

Dr. Paul Papierski, a Board-certified hand surgeon, indicated that appellant was off work from 

January 9 to 10, 2013 and may return to medium work January 10 to February 13, 2013. He also 

indicated that appellant had a follow-up appointment to schedule surgery. 

By decision dated January 29, 2013, OWCP denied the claim on the grounds that 

appellant had not established the medical component of fact of injury as the medical evidence 

submitted failed to contain a diagnosis in connection with the event or a well-rationalized 

opinion based on objective findings of whether and how any condition diagnosed was 

attributable to identified work activities. 

In a December 30, 2013 letter, appellant, through her attorney, requested reconsideration. 

Physical therapy notes dated January 9, 2013 to March 12, 2014 were submitted along with 

November 25 and a December 4, 2013 report from an occupational therapist and requests for 

authorization of hand therapy. 

In another January 9, 2013 report, Dr. Papierski provided a history of right wrist and 

forearm pain, much worse since October 2011. He noted that appellant has worked as a dental 

assistant for many years and works with patients as well as cleaning various kinds of equipment. 

Dr. Papierski opined that appellant had right de Quervain’s tenosynovitis most likely related to 

her job activities. Treatment options were discussed and appellant agreed to surgery. In a 

November 1, 2013 report, Dr. Papierski noted that appellant was previously scheduled for 

surgery but was apparently denied on the causation question from workers’ compensation. He 

continued to opine that appellant has right de Quervain’s tenosynovitis with failed conservative 

treatment. Appellant consented to surgical treatment. Dr. Papierski further diagnosed thumb 

arthritis and stated treatment would be discussed postoperatively. He also provided reports with 

work restrictions. On November 20, 2013 Dr. Papierski performed surgical release of right 

de Quervains. He provided postsurgical reports on appellant’s status, additionally diagnosing 

right middle trigger finger acquired. Dr. Papierski opined that she could resume work on 

December 2, 2013 with a splint. 
3

In a December 3, 2013 report, Dr. David Grosburg2

 noted that appellant’s right wrist 

became swollen on October 17, 2012, she was assisting with a spinal cord patient before that, 

and injured her wrist because of the position of the patient. He opined that appellant injured her 

wrist by work activity and diagnosed cellulitis. 

By decision dated March 24, 2014, OWCP modified its prior decision to reflect that the 

fact of injury had been established but denied the claim on the grounds that causal relationship 

had not been established. 

LEGAL PRECEDENT 

An employee seeking benefits under FECA has the burden of proof to establish the 

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

United States within the meaning 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 and/or specific condition for which compensation is claimed are causally related to the 

employment injury.3 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.4

 

To determine whether a federal employee has sustained a traumatic injury in the 

performance of duty, it must first be determined whether a fact of injury has been established. A 

fact of injury determination is based on two elements. 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. Second, the employee must submit sufficient evidence, 

generally only in the form of medical evidence, to establish that the employment incident caused 

a personal injury. An employee may establish that the employment incident occurred as alleged 

but fail to show that his or her condition relates to the employment incident.5 

Whether an employee sustained an injury in the performance of duty requires the 

submission of rationalized medical opinion evidence.6 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 factors identified by 

the employee.7

 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.8

 Neither the mere fact that a disease or condition 

 2

 Dr. Grosburg’s credentials are not of record. 

3 C.S., Docket No. 08-1585 (issued March 3, 2009); Bonnie A. Contreras, 57 ECAB 364 (2006). 

4 S.P., 59 ECAB 184 (2007); Joe D. Cameron, 41 ECAB 153 (1989). 

5 See Shirley A. Temple, 48 ECAB 404, 407 (1997); John J. Carlone 41 ECAB 354, 356-57 (1989). 

6 See J.Z., 58 ECAB 529, 531 (2007); Paul E. Thams, 56 ECAB 503, 511 (2005). 

7 I.J., 59 ECAB 408, 415 (2008); Victor J. Woodhams, 41 ECAB 345, 352 (1989). 

8 James Mack, 43 ECAB 321, 329 (1991). 
4

manifests itself during a period of employment nor the belief that the disease or condition was 

caused or aggravated by employment factors or incidents is sufficient to establish causal 

relationship.9 

ANALYSIS 

OWCP denied appellant’s claim on the grounds there was insufficient medical evidence 

to establish that her diagnosed right hand conditions were caused or aggravated by either an 

incident with a spinal patient on October 17, 2012 or by her work activities of assisting a lefthanded dentist. The Board affirms the decision. 

Appellant alleged on her claim form that she experiences weakness of her right arm and 

hand every time she works with a left-handed dentist. She attributed her condition to positioning 

her suction when the left-handed dentist works on the patient’s left side of the mouth. Despite 

OWCP’s request for further factual information, appellant did not provide further detail of the 

duties she was required to perform and how often this occurred and if it only occurs while 

working with a left-handed dentist. While Dr. Papierski provided a history of right wrist and 

forearm pain, much worse since October 2011 and noted that appellant has worked as a dental 

assistant for many years and cleans various kinds of equipment, he does not appear to be aware 

of appellant’s complaints of experiencing right arm and hand pain every time she works with a 

left-handed dentist. Thus, while he opined that appellant had right de Quervain’s tenosynovitis 

most likely related to her general job activities, his opinion is not based on an accurate factual 

background and is equivocal in nature.10 Furthermore, Dr. Papierski’s report lacks adequate 

medical rationale as to how appellant’s work with a left-handed dentist or her work as a dental 

assistant could result in the diagnosed condition of right de Quervain’s tenosynovitis.11 Thus, 

Dr. Papierski’s reports are of little probative value in establishing appellant’s claim. 

Dr. Grosburg noted in his December 3, 2013 report that appellant’s right wrist became 

swollen on October 17, 2012 while assisting a spinal cord patient and diagnosed cellulitis. 

However, there is no statement from appellant with regard to that event and, even if accepted as 

factual, Dr. Grosburg provides no explanation in detail of how appellant’s condition 

physiologically resulted from appellant’s assistance of a spinal cord patient. 

 9 Dennis M. Mascarenas, 49 ECAB 215 (1997). 

10 D.F., Docket No. 09-1080 (issued December 7, 2009); Michael R. Shaffer, 55 ECAB 386 (2004). 

11 See I.J., supra note 6; Victor J. Woodhams, supra note 7. 
5

The physical therapy reports and reports from an occupational therapist are also 

insufficient to establish appellant’s claim. Physical therapists and occupational therapists are not 

a physician and a physical therapist’s or occupational therapist’s opinion regarding diagnosis or 

causal relationship is of no probative value.12 

The Board finds that the medical evidence does not establish that appellant sustained a 

medical condition causally related to her federal employment. An award of compensation may 

not be based on surmise, conjecture or speculation. Neither the fact that appellant’s condition 

became apparent during a period of employment nor the belief that her condition was caused, 

precipitated or aggravated by her employment, is sufficient to establish causal relationship.13 

Causal relationships must be established by rationalized medical opinion evidence. As noted, the 

medical evidence is insufficient to establish appellant’s claim. Consequently, OWCP properly 

found that appellant did not meet her burden of proof in establishing her claim. 

On appeal, appellant’s attorney argued that the decision is contrary to fact and law. As 

noted above, the medical evidence does not establish that appellant’s diagnosed conditions are 

causally related to the accepted October 17, 2012 event of assisting a spinal cord patient, 

working with a left handed dentist, or the dental assistance duties. Reports from appellant’s 

physicians failed to provide sufficient medical rationale based on a complete factual background 

explaining the reasons why her diagnosed conditions were caused or aggravated by particular 

employment duties. The need for such rationale is particularly important in view of the fact 

appellant provided a vague description of her work activities and how long and often she was 

required to perform them. 

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. 

 12 A medical report may not be considered as probative medical evidence if there is no indication that the person 

completing the report qualifies as physician as defined in 5 U.S.C. § 8101(2). Section 8101(2) of FECA provides as 

follows: (2) physician includes surgeons, podiatrists, dentists, clinical psychologists, optometrists, chiropractors and 

osteopathic practitioners within the scope of their practice as defined by State law. See Merton J. Sills, 39 ECAB 

572, 575 (1988). 

13 Supra note 9. 
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CONCLUSION 

The Board finds that appellant did not meet her burden of proof to establish that she 

sustained a medical condition causally related to her employment or the accepted October 17, 

2012 incident. 

ORDER 

IT IS HEREBY ORDERED THAT the March 24, 2014 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: November 3, 2014 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board 

 

 James A. Haynes, Alternate Judge 

 Employees’ Compensation Appeals Board