United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

D.A., Appellant 

and 

DEPARTMENT OF VETERANS AFFAIRS, 

VETERANS ADMINISTRATION MEDICAL 

CENTER, Richmond, VA, Employer 

__________________________________________ 

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Docket No. 14-223 

Issued: May 6, 2014 

Appearances: Case Submitted on the Record

Appellant, pro se 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

ALEC J. KOROMILAS, Alternate Judge 

MICHAEL E. GROOM, Alternate Judge 

JAMES A. HAYNES, Alternate Judge 

JURISDICTION 

On November 12, 2013 appellant filed a timely appeal from June 25 and 

October 18, 2013 merit decisions of the Office of Workers’ Compensation Programs (OWCP) 

denying her occupational disease 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 established that she sustained right de Quervain’s 

tendinitis in the performance of duty. 

On appeal, appellant asserts that she sustained right de Quervain’s tendinitis in the 

performance of duty as early as 2005. OWCP denied several claims for the condition that she 

 1

 5 U.S.C. § 8101 et seq. 
2

had filed since 2005. Appellant contended that the medical record was sufficient to establish her 

claim. 

FACTUAL HISTORY 

On March 29, 2013 appellant, then a 43-year-old medical technician, filed an 

occupational disease claim (Form CA-2) alleging that she sustained de Quervain’s tendinitis of 

the right wrist on or before December 14, 2011 due to the repetitive motions in her duties as a 

phlebotomist. She did not stop work. 

In an April 8, 2013 letter, OWCP advised appellant of the evidence needed to establish 

her claim, including her statement of how the right wrist condition developed and the work tasks 

alleged to have caused or contributed to it. It also requested a statement from an attending 

physician explaining the medical reasons why the repetitive motions while drawing blood would 

cause de Quervain’s tendinitis. OWCP afforded appellant 30 days to submit such evidence. 

In response, appellant submitted an April 26, 2013 statement asserting that she was first 

diagnosed with right wrist tendinitis in 2005. She filed a traumatic injury claim on October 18, 

2007 for right shoulder, elbow and wrist injuries sustained when attacked by a patient and an 

August 23, 2012 occupational disease claim for tendinitis due to repetitive hand motions while 

drawing blood. Appellant sought treatment for her upper extremity conditions through 2012. 

She attributed her current right hand and wrist symptoms to continuous grasping and fine 

manipulation while drawing blood, as well as pushing and pulling laboratory carts. 

In a December 14, 2011 report, Dr. Robert S. Adelaar, a Board-certified orthopedic and 

hand surgeon, related appellant’s account of persistent right wrist symptoms. He diagnosed 

“de Quervain’s or a more proximal scissoring of the tendon sheath” and administered an 

injection. Appellant presented on March 19, 2012 with pain in the base of the right thumb, a 

positive Finkelstein’s tests and tenderness at the first dorsal compartment. Dr. Adelaar 

diagnosed de Quervain’s tenosynovitis and recommended surgery. In an August 13, 2012 report, 

he opined that appellant had a “work-related problem from repetitive use as a blood 

phlebotomist, where she uses her wrist a great deal and that irritates her first dorsal compartment. 

This problem started in 2007.” Dr. Adelaar noted on March 14, 2013 that appellant presented on 

December 14, 2011 with radial styloid tenosynovitis.2

 

By decision dated June 25, 2013, OWCP denied appellant’s claim on the grounds that 

fact of injury was not established. It found that she provided conflicting histories of injury, 

asserting that she developed tendinitis in 2005 and 2011 without explaining the role of the 2007 

traumatic injuries. OWCP noted that it denied a prior claim for tendinitis in 2008 under File No. 

xxxxxx490. 

 2

Appellant also submitted an unsigned March 23, 2005 prescription for a wrist splint, October 2007 work 

restrictions and employing establishment health clinic notes that do not bear a legible signature. As these forms 

were not signed by a physician, they are not considered medical evidence. See Merton J. Sills, 39 ECAB 

572 (1988). 
3

In a September 24, 2013 letter, appellant requested reconsideration. She asserted that her 

right wrist symptoms commenced in 2005. Appellant submitted an August 28, 2013 report from 

Dr. Adelaar noting that she was in a “rear-end collision the last few months and then she had 

pain in the whole left side and it also aggravated her right wrist.” Dr. Adelaar planned an 

endoscopic carpal tunnel release and prescribed a wrist splint.3

 

By decision dated October 18, 2013, OWCP denied modification on the grounds that 

appellant submitted insufficient evidence to establish fact of injury. It found that Dr. Adelaar’s 

August 28, 2013 report noted that appellant sustained a right wrist injury in a motor vehicle 

accident, adding to the conflicting history of injury. 

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 and/or specific condition for which compensation is claimed are causally related to the 

employment injury.4

 These are the essential elements of each and every compensation claim 

regardless of whether the claim is predicated on a traumatic injury or an occupational disease.5

An occupational disease is defined as a condition produced by the work environment 

over a period longer than a single workday or shift.6

 To establish that an injury was sustained in 

the performance of duty in an occupational disease claim, a claimant must submit the following: 

(1) medical evidence establishing the presence or existence of the disease or condition for which 

compensation is claimed; (2) factual statement identifying employment factors alleged to have 

caused or contributed to the presence or occurrence of the disease or condition; and (3) medical 

evidence establishing that the employment factors identified by the claimant were the proximate 

cause of the condition for which compensation is claimed or, stated differently, medical evidence 

establishing that the diagnosed condition is causally related to the employment factors identified 

by the claimant. 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 a 

causal relationship between the claimant’s diagnosed condition and the implicated employment 

factors. The opinion of the physician must be based on a complete factual and medical 

background of the claimant, must be one of reasonable medial certainty and must be supported 

 3

 Appellant also submitted a September 12, 2013 letter from a nurse practitioner which was not signed by a 

physician. As this letter was not signed by a physician, it is not considered medical evidence. See Merton J. 

Sills, id. 

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

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

6

 20 C.F.R. § 10.5(q). 
4

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

and the specific employment factors identified by the claimant.7

ANALYSIS 

Appellant claimed that she sustained tendinitis of the right wrist due to work factors but 

offered divergent histories of injury. In her March 29, 2013 claim form, she stated that she 

sustained de Quervain’s tendinitis on or before December 14, 2011 due to repetitive hand motion 

at work. Appellant explained that on April 26, 2013 her right wrist condition actually started in 

2005 and that she sustained right arm injuries on October 18, 2007 when attacked by a patient. 

She noted that she previously claimed right wrist tendinitis in 2008. In a September 24, 2013 

letter, appellant contended that her right wrist symptoms began in 2005 and continued unchanged 

to the present. These conflicting histories of injury do not provide a clear date or mechanism of 

onset. 

The Board finds that appellant has not established her claim due to the conflicting 

evidence regarding the history of the claimed right wrist condition.8

 OWCP advised appellant by 

April 8, 2013 letter of the evidence needed to establish fact of injury, including a history of how 

the right wrist condition developed. Appellant did not submit such evidence. Therefore, 

OWCP’s June 25 and October 18, 2013 decisions were proper under the law and circumstances 

of this case. 

As the threshold issue of fact of employment incidents or conditions giving rise to the 

injury is not established, it is premature to address the medical evidence.9

 The Board notes, 

however, that Dr. Adelaar, an attending Board-certified orthopedic surgeon, did not provide a 

complete history of injury or a clear diagnosis due to work factors. Dr. Adelaar diagnosed right 

wrist tendinitis, de Quervain’s tenosynovitis, radial styloid tenosynovitis and carpal tunnel 

syndrome. He attributed appellant’s condition to repetitive wrist motions at work irritating the 

first dorsal compartment beginning in 2007. Dr. Adelaar also opined that a 2013 motor vehicle 

accident aggravated her right wrist condition. He did not mention the 2007 traumatic injuries. 

On appeal, appellant asserts that she sustained right de Quervain’s tendinitis in the 

performance of duty as early as 2005. As noted, the conflicting histories of injury create 

significant doubt as to the cause of the right wrist condition. 

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. 

 7 Solomon Polen, 51 ECAB 341 (2000). 

8 A.D., Docket No. 09-1185 (issued January 27, 2010). See also Caroline Thomas, 51 ECAB 451 (2000). 

9 See Bonnie A. Contreras, 57 ECAB 364 (2006) (where a claimant did not establish an employment incident 

alleged to have caused an injury, it was not necessary to consider any medical evidence). 
5

CONCLUSION 

The Board finds that appellant did not establish that she sustained right de Quervain’s 

tendinitis in the performance of duty. 

ORDER 

IT IS HEREBY ORDERED THAT the decisions of the Office of Workers’ 

Compensation Programs dated October 18 and June 25, 2013 are affirmed.

Issued: May 6, 2014 

Washington, DC 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board 

 

 Michael E. Groom, Alternate Judge 

 Employees’ Compensation Appeals Board 

 

 James A. Haynes, Alternate Judge 

 Employees’ Compensation Appeals Board