United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

H.H., Appellant 

and 

DEPARTMENT OF VETERANS AFFAIRS, 

VETERANS ADMINISTRATION MECIAL 

CENTER, Little Rock, AR, Employer 

__________________________________________ 

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Docket No. 15-0947 

Issued: August 5, 2015 

Appearances: Case Submitted on the Record

Appellant, pro se 

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 March 16, 2015 appellant filed a timely appeal from a March 5, 2015 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. 

ISSUE 

The issue is whether appellant has established that she sustained an aggravation of 

bilateral carpal tunnel syndrome, a cervical spine sprain, displacement of a cervical intervertebral 

disc, and a trigger finger in the performance of duty. 

 1

 5 U.S.C. § 8101 et seq. 
2

FACTUAL HISTORY 

On September 25, 2013 appellant, then a 57-year-old emergency room administrative 

assistant, filed an occupational disease claim (Form CA-2) alleging that on or before August 26, 

2013, she sustained an aggravation of previously accepted carpal tunnel syndrome, a cervical 

spine sprain, displacement of a cervical intervertebral disc, and a trigger finger in the 

performance of duty. OWCP accepted these conditions under four prior claims: File 

No. xxxxxx747, date of injury September 25, 2000, accepted for a sprain of the left radial 

collateral ligament affecting the elbow and forearm, left hand joint derangement, right radial 

styloid tenosynovitis, and right wrist and carpus enesopathy, resulting in a schedule award for a 

two percent impairment of the left upper extremity; File No. xxxxxx271, date of injury 

January 15, 2002, accepted for de Quervain’s tenosynovitis of the right upper extremity; File 

No. xxxxxx908,2 date of injury April 5, 2009, accepted for bilateral carpal tunnel syndrome, 

cervical strain, and a temporary aggravation of C5-6 and C6-7 disc herniations; File 

No. xxxxxx474, accepted January 26, 2011 for trigger finger deformity of the right long finger.3 

Appellant attributed these aggravations to being repeatedly forced to work outside of her medical 

restrictions, and repetitive upper extremity motions at work. She stopped work on August 26, 

2013 and did not return. Appellant filed claims for total disability compensation. 

In an October 23, 2013 letter, OWCP advised appellant of the additional evidence needed 

to establish her occupational disease claim, including a detailed description of the work factors 

alleged to have caused the claimed conditions and a statement from her physician explaining 

how and why those factors would cause those conditions. It afforded her 30 days to submit such 

evidence. 

Appellant’s supervisor provided a November 21, 2013 statement corroborating 

appellant’s description of her job duties.4 She noted that appellant’s position required computer 

data entry, answering the telephone, limited writing, and placing armbands on patients. 

Appellant checked in three to five patients an hour, and handled telephone calls between patients. 

The supervisor acknowledged that on approximately August 9, 2013, appellant advised her that 

she was unable to take prescribed breaks due to short staffing. She then stated to appellant “we 

don’t have enough staff,” but that she was still required to take prescribed breaks. The 

supervisor confirmed that appellant’s telephone headset was not at her workstation. 

 2

 In an October 17, 2013 file memorandum, OWCP noted that appellant did not request modification of a standing 

wage-earning capacity determination under File No. xxxxxx908, but instead filed a claim under File No. xxxxxx794 

for an occupational condition due to new occupational exposures. 

3

 In an October 30, 2013 file memorandum, OWCP noted that all of the conditions appellant listed on her claim 

form had been accepted in her prior claims. As appellant attributed these conditions to new work exposures, 

appellant filed a new claim for occupational disease on September 25, 2013. The previous claims are not presently 

before the Board. 

4

 The record contains a 1995 position description, modified on several occasions through April 1, 2002, for the 

administrative assistant job. The position required walking, occasional lifting, preparing reports, and extensive 

interpersonal contacts. 
3

The supervisor also provided May 13 and August 12, 2009 memoranda explaining that 

due to the accepted carpal tunnel syndrome and cervical strain, appellant was provided with an 

ergonomic chair, and an adjustable computer monitor. Appellant would also be given a 

telephone headset, footrest, adjustable keyboard tray, and a rearrangement of her desk to avoid 

reaching. On approximately August 9, 2013, she advised her supervisor that “her neck was 

hurting, because she was not taking her breaks like she was supposed to, due to personnel 

shortage. The supervisor informed [appellant], it did not matter if we were short, and she was 

required to take breaks.” Also, appellant’s headset was not in her work area although she was 

“required to use it when answering and talking on the telephone.” She was instructed to “take a 

15-minute break every hour from [her] workstation,” with no keyboarding or simple grasping. 

This change reduced appellant’s “fine manipulation and simple grasping” by a total two hours a 

day, in addition to other 15-minute breaks. Appellant acknowledged these duty modifications on 

August 14, 2009. 

By decision dated January 2, 2014, OWCP denied appellant’s claim, finding that 

appellant failed to establish causal relationship as she submitted no medical evidence. It found, 

however, that “the injury and/or event(s) occurred as described.” 

In a January 8, 2014 letter, appellant requested reconsideration. She alleged that the 

employing establishment did not modify her workstation, and forced her to perform continuous 

keyboarding and repetitive upper extremity tasks in violation of her work restrictions. Appellant 

asserted that she was forced to exceed her work limitations due to a staffing shortage. She 

contended that keyboarding, using a scanner, placing arm bands on patients, reaching, and 

“working at night” caused continuous finger, hand, arm, shoulder, and neck pain, aggravating the 

conditions accepted under her four prior claims. Appellant submitted additional evidence.5

A coworker submitted a November 4, 2011 statement noting that appellant was “willing 

to adjust her schedule when needed to accommodate coworkers and ensure coverage for the 

unit.” Another coworker asserted that appellant had no consistent assistance since the only other 

administrative assistant retired in 2009. The coworker alleged that, since appellant began 

working with her four days a week in 2008, appellant “appeared to be in pain” and expressed that 

she was in pain. Appellant did “not get the opportunity to take scheduled breaks because there 

[was] no one to relieve her.” The coworker also contended that appellant was not provided with 

an appropriate ergonomic chair and keyboard. 

In a December 23, 2013 report, Dr. William L. Rutledge, an attending Board-certified 

orthopedic surgeon, noted that appellant presented on August 26, 2013 with bilateral carpal 

tunnel syndrome, “[t]rigger finger, right long finger, and an acute exacerbation of cervicalgia. 

He noted her duties as an administrative support assistant in the employing establishment’s 

emergency department, checking in patients, “excessive keyboarding and use of the telephone,” 

with repetitive reaching aggravating chronic cervicalgia. Dr. Rutledge opined that the diagnosed 

exacerbations of a herniated cervical disc, as well as cervical paraspinal muscle spasms and 

shoulder spasms, were caused by excessive repetitive upper extremity motion and “working 

 5

 Appellant also submitted an October 11, 2013 report regarding a hospital admission to treat a diabetic 

complication. Dr. Supreet Sethi, an attending nephrologist, diagnosed diabetes mellitus, major depressive disorder, 

hypertension, and chronic back pain. 
4

outside of restrictions for many months.” He noted treating appellant’s carpal tunnel syndrome 

and cervical disc conditions for several years. Dr. Rutledge had permanently restricted simple 

grasping to no more than two hours a day intermittently, with reaching above the shoulder for no 

more than one-hour a day intermittently. He alleged that the employing establishment violated 

these restrictions by requiring appellant to keyboard several hours a day, reach above shoulder 

level, hold a telephone, and extensively use her hands and arms. Working outside of the 

restrictions has caused an acute exacerbation of chronic neck problems as well as [appellant’s] 

upper extremity pain and symptoms.” Dr. Rutledge held appellant off work through 

December 23, 2013. He administered trigger point injections and prescribed physical therapy. 

In March 27 and May 27, 2014 reports, Dr. Rutledge noted that appellant remained 

disabled for work due to her recuperation from a cervical fusion. Appellant continued to claim 

wage-loss compensation through June 1, 2014 

In a June 11, 2014 e-mail, the employing establishment noted that appellant’s job duties 

had not changed since she accepted a light-duty job offer on December 5, 2011. It 

acknowledged that according to October 15 and November 21, 2013 supervisory statements, 

appellant “did work outside of her restrictions.” 

By decision dated June 11, 2014, OWCP found that appellant had not established causal 

relationship. It also found that she did not establish as factual that she worked outside of her 

medical restrictions, keyboarded several hours a day, reached above shoulder level, or held a 

telephone. OWCP also noted that appellant failed to take breaks as instructed or use a telephone 

headset provided to her. It further found that Dr. Rutledge’s medical reports were insufficient to 

establish a causal relationship between the accepted work factors and the claimed conditions. 

In a June 30, 2014 letter, appellant requested reconsideration.6

 She submitted additional 

medical evidence. 

Dr. Rutledge provided two June 25, 2014 reports, opining that appellant’s bilateral carpal 

tunnel syndrome was caused by continuous, extensive keyboarding and repetitive upper 

extremity motion at work on or before August 26, 2013. These duties were noted to have also 

aggravated appellant’s long right finger triggering even after she underwent surgery for this 

condition. Dr. Rutledge also noted that she was made to work outside of her medical restrictions 

of fine manipulation and simple grasping for more than two hours a day. He submitted form 

reports through August 28, 2014 finding appellant totally disabled for work due to postsurgical 

status. 

By decision dated October 28, 2014, OWCP affirmed its June 11, 2014 decision, finding 

that causal relationship was not established. It found that Dr. Rutledge based his opinion on an 

inaccurate history, as he attributed appellant’s conditions to performing work outside her medical 

restrictions whereas this was not supported by the factual record. 

 6

 Appellant filed continuing claims for compensation through October 19, 2014. 
5

In a January 9, 2015 letter, appellant requested reconsideration. She provided an 

October 25, 2014 statement asserting that Dr. Rutledge’s opinion was sufficient to establish 

causal relationship. Appellant submitted additional medical evidence.7

Dr. Bernard Crowell, an attending Board-certified orthopedic surgeon, noted on 

December 26, 2013 that appellant had a long history of radicular neck pain with radiculopathy 

into the left upper extremity. A December 23, 2013 magnetic resonance imaging (MRI) scan 

showed a C5-6 disc herniation with central and neuroforaminal stenosis, and multilevel lumbar 

arthropathy and neuroforaminal stenosis. Dr. Crowell recommended a C5-6 fusion. 

In a February 13, 2014 report, Dr. Rutledge found appellant totally disabled for work 

since late August 2013 due to an aggravation of cervical disc disease with severe cervical 

spondylosis. Appellant underwent cervical fusion on January 13, 2014 by Dr. Bernard Crowell, 

who was then evaluating her for left shoulder pain. She also had continuing bilateral carpal 

tunnel syndrome and a right long trigger finger. 

By decision dated March 5, 2015, OWCP affirmed its prior decisions, finding that 

appellant failed to meet her burden of proof in establishing causal relationship. It found that 

Dr. Rutledge continued to base his opinion on appellant’s inaccurate account of being made to 

work outside her medical restrictions. Dr. Rutledge’s reports were therefore insufficient to 

establish that accepted work factors caused or aggravated the claimed medical conditions. 

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.8

 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.9

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

over a period longer than a single workday or shift.10 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 

 7

 Appellant also submitted duplicate copies of evidence previously of record. She claimed compensation for total 

disability through February 22, 2015 

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

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

10 20 C.F.R. § 10.5(q). 
6

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 by medical rationale 

explaining the nature of the relationship between the diagnosed condition and the specific 

employment factors identified by the claimant.11

ANALYSIS 

Appellant asserted that exposure to work factors on or before August 26, 2013 caused or 

aggravated previously accepted cervical spine and upper extremity conditions. She contended 

that in August 2013, a staffing shortage forced her to work beyond her medical limitations, 

causing the claimed aggravations. OWCP denied the claim on March 5, 2015, finding that 

although certain clerical work factors were established as factual, appellant had not substantiated 

that she had worked outside her prescribed restrictions. It therefore found that the opinion of 

Dr. Rutledge, an attending Board-certified orthopedic surgeon, was based on an inaccurate 

history. The Board, however, finds that the factual evidence supports appellant’s contentions. 

Appellant’s supervisor provided May 13 and August 12, 2009 memoranda and a 

November 21, 2013 statement corroborating that on approximately August 9, 2013, appellant 

advised that she was unable to take prescribed breaks due to short staffing. She confirmed that 

the emergency department did not have sufficient staff, and that an ergonomic telephone headset 

was not available at appellant’s workstation. Also, a coworker asserted that, since she began 

working with appellant four days a week in 2008, appellant could not take scheduled breaks as 

there was “no one to relieve her” due to a staffing shortage. Additionally, in a June 11, 2014 

e-mail, the employing establishment acknowledged that appellant’s supervisor’s statements 

established that she “did work outside of her restrictions.” The Board finds that these 

uncontroverted statements are of sufficient probative quality to warrant additional development 

by OWCP. 

Appellant also provided medical evidence addressing her assertions that working outside 

of her medical restrictions aggravated her neck and arm conditions. Dr. Rutledge explained on 

December 23, 2013 and June 25, 2014 that constant, repetitive upper extremity motions 

aggravated the accepted cervical spine and upper extremity conditions. He noted that OWCP 

accepted repetitive motion as a causative factor. 

On appeal, appellant contends that Dr. Rutledge’s reports are of sufficient probative 

quality to establish that work factors on or before August 26, 2013 aggravated the claimed 

conditions. As stated above, the case will be remanded for additional development. 

 11 Solomon Polen, 51 ECAB 341 (2000). 
7

Proceedings under FECA are not adversarial in nature and OWCP is not a disinterested 

arbiter. While the claimant has the burden to establish entitlement to compensation, OWCP 

shares responsibility in the development of the evidence. It has the obligation to see that justice 

is done.12 Therefore, the case will be remanded to OWCP for additional development of the 

factual and medical record. OWCP shall request that the employing establishment provide 

additional information regarding the short staffing acknowledged by the supervisor and its 

impact on appellant’s work duties. It shall then request that Dr. Rutledge, or an appropriate 

medical specialist, explain if the established work factors caused or aggravated the claimed 

conditions. Following this and any other development deemed necessary, OWCP shall issue an 

appropriate decision in the case. 

CONCLUSION 

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

ORDER 

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

Compensation Programs dated March 5, 2015 is set aside, and the case remanded for additional 

development consistent with this decision. 

Issued: August 5, 2015 

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 

 12 Jimmy A. Hammons, 51 ECAB 219 (1999); Marco A. Padilla, 51 ECAB 202 (1999); John W. Butler, 39 ECAB 

852 (1988).