United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

R.J., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Mechanicsville, NY, Employer 

__________________________________________ 

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Docket No. 15-88 

Issued: February 25, 2015 

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 

COLLEEN DUFFY KIKO, Judge 

PATRICIA HOWARD FITZGERALD, Judge 

JURISDICTION 

On October 15, 2014 appellant, through counsel, timely appealed an August 28, 2014 

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 the claim. 

ISSUE 

The issue is whether appellant sustained an injury in the performance of duty on or about 

May 1, 2012. 

FACTUAL HISTORY 

On May 15, 2013 appellant, then a 30-year-old rural carrier, filed an occupational disease 

claim (Form CA-2) for bilateral carpal tunnel syndrome (CTS), which allegedly arose on or 

about May 1, 2012. She attributed her condition to daily sorting, casing, and handling of mail. 

Appellant indicated that she performed these task six to nine hours per day, six days per week. 

 1

 5 U.S.C. §§ 8101-8193 (2006). 
2

She reported numbness, stiffness, and pain in her hands and wrists, which had progressively 

worsened since May 2012. Appellant’s left hand was more symptomatic than her right. 

In a May 22, 2013 attending physician’s report, CA-20 form, Dr. George Zanaros, a 

Board-certified orthopedic surgeon with a subspecialty in hand surgery, diagnosed bilateral CTS, 

which he attributed to employment-related repetitive activity and fine manipulation. He 

recommended surgery. 

In a May 31, 2013 development letter, OWCP advised appellant that the medical 

evidence was insufficient to establish that her bilateral CTS was caused or aggravated by her 

employment. It afforded her at least 30 days to submit additional medical evidence in support of 

her occupational disease claim. 

OWCP subsequently received the results of a November 5, 2012 electromyography and 

nerve conduction study (EMG/NCV), which revealed bilateral median nerve entrapment -- left 

more than right, consistent with CTS. 

Dr. Katherine J. Herdzik, a family practitioner, submitted a May 28, 2013 attending 

physician’s report, CA-20 form. She diagnosed bilateral CTS, which was noted to have been 

caused or aggravated by an employment activity. Dr. Herdzik explained that appellant was a 

carrier who sorted mail in the morning and delivered mail in the afternoon, and that her 

symptoms worsened with repetitive hand motions sorting mail. She further explained that 

appellant’s symptoms abated with time off from work. 

OWCP also received a June 11, 2013 CA-20 form from Dr. Justin M. Ferrara, a Boardcertified orthopedic surgeon. He diagnosed bilateral CTS. Dr. Ferrara noted that appellant 

advised that her condition “[c]ame on with duties of employment.” He checked the “Yes” box 

on the CA-20 form indicating that it was his belief that the diagnosed condition was caused or 

aggravated by an employment activity. Dr. Ferrara also provided a two-page narrative report 

dated June 11, 2013. He noted that appellant was a postal carrier who complained of numbness 

and tingling for the past year. Dr. Ferrara also noted that she “feels that her duties of 

employment ... have caused this and have made it worse.” Appellant denied any specific injury 

at work and stated that she had not missed any time from work because of her condition. She 

informed Dr. Ferrara that this was a workers’ compensation claim. Dr. Ferrara diagnosed 

bilateral CTS and recommended bilateral surgical releases to be performed separately. In the 

interim, he advised that appellant could continue working at her prior level of employment. 

In a decision dated August 23, 2013, OWCP denied appellant’s occupational disease 

claim because the medical evidence failed to establish a causal relationship between her rural 

carrier duties and her diagnosed bilateral CTS. 

Appellant timely requested reconsideration and submitted an October 2, 2013 report from 

Dr. Ferrara, who indicated that he had a long discussion with appellant regarding her symptoms 

and the employment activities that specifically brought on her symptoms. Dr. Ferrara noted that 

there was not any one specific event or injury that occurred. Appellant stated that activities 

which require repetitive motion and tasks involving the fingers, hand, and wrist caused her 

symptoms. These activities included collecting mail from around the office, unbinding bundled 
3

flats using scissors to cut plastic bands or wrap them while holding them in the left hand, 

grasping and cutting flats and inserting into cells in the mail case, holding bundles with the hand 

and the fingers, and having to grasp and insert raw letters into the cells of mail. In addition to 

holding bundles of mail, appellant reported having to place letters in curbside boxes, and hold 

bundles with the left arm and fingers, and grasping and inserting raw letters into cluster boxes, 

pulling mail from cells, pushing carts with a full day’s worth of mail to the truck, loading the 

truck, and on-street delivery including opening a mailbox with the right hand, grasping the mail 

with the left, and passing to the right hand to insert in the mailbox as well as cluster box delivery. 

All of these activities seemed to bring on and worsen appellant’s symptoms. 

Dr. Ferrara reiterated his diagnosis of bilateral CTS, and continued to recommend carpal 

tunnel releases. He concluded his October 2, 2013 report with the following statement: “I ... feel 

with a high degree of medical certainty that this [CTS] is causally related to [appellant’s] duties 

of employment which were outlined ... above.” 

By decision dated January 6, 2014, OWCP reviewed the merits of appellant’s claim, but 

denied modification of the August 23, 2013 initial denial. It found Dr. Ferrara’s October 2, 2013 

report insufficient to establish causal relationship. Although Dr. Ferrara indicated that 

appellant’s CTS was work related, he failed to provide an explanation as to how he arrived at this 

conclusion. 

On June 2, 2014 appellant’s counsel requested reconsideration. Counsel submitted a 

September 12, 2013 amended copy of Dr. Ferrara’s original June 11, 2013 treatment notes. He 

also resubmitted Dr. Ferrara’s October 2, 2013 report. 

The September 12, 2013 addendum reads in relevant part: 

“[It] was felt that this is a Workers’ Compensation issue as this syndrome 

developed and the symptoms developed through [appellant’s] duties of 

employment and she had not experienced them outside of her duties of 

employment. [Appellant] does a significant amount of repetitive motion in 

regards to use of the hands, and this does significantly exacerbate her symptoms. 

In my medical opinion with a high degree of medical certainty, I do feel that her 

[CTS] is work related....” 

OWCP again reviewed the merits of appellant’s claim, but denied modification in an 

August 28, 2014 decision. It found that Dr. Ferrara noted a temporal relationship between her 

symptoms and her employment duties, but did not otherwise provide a rationalized explanation 

of how her employment duties caused her bilateral CTS. 

LEGAL PRECEDENT 

A claimant seeking benefits under FECA has the burden of establishing the essential 

elements of her claim by the weight of the reliable, probative, and substantial evidence, including 
4

that an injury was sustained in the performance of duty as alleged and that any specific condition 

or disability claimed is causally related to the employment injury.2

To establish that an injury was sustained in the performance of duty, a claimant must 

submit: (1) medical evidence establishing the presence or existence of the disease or condition 

for which compensation is claimed; (2) a 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 diagnosed condition is causally related to the 

identified employment factors.3

ANALYSIS 

Appellant claims that her bilateral CTS is employment related. OWCP has denied her 

occupational disease claim on the basis that the medical evidence did not adequately establish a 

causal relationship between the diagnosed condition and her duties as a rural carrier. The earliest 

diagnostic evidence of appellant’s bilateral CTS appears to be the November 5, 2012 

EMG/NCV. However, the physician who interpreted the study did not address causal 

relationship. 

In his May 22, 2013 attending physician’s report, CA-20 form, Dr. Zanaros diagnosed 

bilateral CTS, which he attributed to employment-related repetitive activity and fine 

manipulation. He also noted that, when on vacation, appellant had no symptoms. Dr. Zanaros 

did not identify her as a rural carrier or otherwise exhibit any particular knowledge of her 

employment duties. A physician’s opinion must be based on a complete factual and medical 

background, and must be supported by medical rationale explaining the nature of the relationship 

between the diagnosed condition and appellant’s specific employment factors.4

In finding appellant’s bilateral CTS employment related, Dr. Herdzik noted that appellant 

“reports” her symptoms worsened with repetitive hand motions sorting mail. She also noted that 

appellant gets a bit of relief from symptoms with time off from work. In her May 28, 2013 

report, CA-20 form, Dr. Herdzik described appellant’s carrier duties as sorting in the morning 

and delivering in the afternoon. In this regard, she exhibited a very limited knowledge of 

appellant’s rural carrier duties, and she appears to have based her opinion solely on appellant’s 

 2

 20 C.F.R. § 10.115(e), (f) (2014); see Jacquelyn L. Oliver, 48 ECAB 232, 235-36 (1996). Causal relationship is 

a medical question, which generally requires rationalized medical opinion evidence to resolve the issue. See also 

Robert G. Morris, 48 ECAB 238 (1996). A physician’s opinion on whether there is a causal relationship between 

the diagnosed condition and the implicated employment factors must be based on a complete factual and medical 

background. Victor J. Woodhams, 41 ECAB 345, 352 (1989). Additionally, the physician’s opinion must be 

expressed in terms of a reasonable degree of medical certainty, and must be supported by medical rationale, 

explaining the nature of the relationship between the diagnosed condition and appellant’s specific employment 

factors. 

3 Victor J. Woodhams, id. 

4 Id. 
5

representation regarding the cause of her symptoms. The May 28, 2013 CA-20 form does not 

constitute a rationalized medical opinion on causal relationship.5 

Dr. Ferrara’s June 11, 2013 CA-20 form did not include an explanation regarding causal 

relationship. He merely checked the “Yes” box (No. 8) indicating that it was his opinion that the 

condition found was caused or aggravated by an employment activity. The Board has 

consistently held that merely placing a checkmark in the “Yes” box on a questionnaire form 

(8) will not suffice for purposes of establishing causal relationship.6 Dr. Ferrara’s initial June 11, 

2013 treatment notes also failed to include an explanation regarding causal relationship. At the 

time, he noted that appellant denied any specific injury at work. Dr. Ferrara also reported that 

she “feels that [appellant’s] duties of employment ... have caused this and have made it worse.” 

He did not express an opinion independent of appellant’s personal belief that her condition was 

employment related. 

In his September 12, 2013 addendum, Dr. Ferrara stated that he felt appellant’s bilateral 

CTS was a workers’ compensation issue because her symptoms and condition developed through 

her employment, and she had not experienced them outside of her employment. He described 

her job as involving a significant amount of repetitive motion in regards to use of the hands. At 

the time, Dr. Ferrara did not exhibit a thorough understanding of appellant’s rural carrier duties. 

Furthermore, he merely described a temporal relationship between her work and the onset/ 

abatement of her bilateral hand and wrist symptoms. The fact that a condition manifests itself 

during a period of employment is not sufficient to establish causal relationship.7 A mere 

temporal relationship between the employment activity and the reported symptoms will not 

suffice.8

Dr. Ferrara’s latest report, dated October 2, 2013, incorporated appellant’s detailed 

account of her “repetitive motion and tasks,” such as collecting mail, unbinding flats, holding 

bundles of mail, and placing letters in curbside boxes. He noted that all of the reported activities 

seemed to bring on and worsen her symptoms. Dr. Ferrara concluded that appellant’s CTS was 

causally related to her described employment duties. Although he was aware of her various 

duties as a rural carrier, he failed to explain how these reported activities caused or contributed to 

her bilateral CTS. As previously indicated, it is not enough to merely conclude that a condition 

is employment related. A physician’s opinion must be supported by medical rationale explaining 

the nature of the relationship between the diagnosed condition and appellant’s specific 

employment factors.9

 5 Id.

6 See D.D., 57 ECAB 734, 739 (2006); Deborah L. Beatty, 54 ECAB 340, 341 (2003). 

7

 20 C.F.R. § 10.115(e). 

8 See D.I., 59 ECAB 158, 162 (2007). The fact that a condition manifests itself during a period of employment 

does not raise an inference of causal relationship. 

9 Victor J. Woodhams, supra note 2. 
6

The above-noted medical evidence is insufficient to establish a causal relationship 

between appellant’s rural carrier duties and her bilateral CTS. Moreover, her belief that factors 

of employment caused or aggravated her condition is insufficient, by itself, to establish causal 

relationship.10 Accordingly, the Board finds that appellant failed to establish that her bilateral 

upper extremity condition is employment related. 

Appellant may submit new evidence or argument with a written request for 

reconsideration to OWCP within one year of this merit decision.11

CONCLUSION 

Appellant failed to prove that she sustained an injury in the performance of duty on or 

about May 1, 2012. 

ORDER 

IT IS HEREBY ORDERED THAT the August 28, 2014 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: February 25, 2015 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 Patricia Howard Fitzgerald, Judge 

 Employees’ Compensation Appeals Board 

 10 20 C.F.R. § 10.115(e); Phillip L. Barnes, 55 ECAB 426, 440 (2004). 

11 5 U.S.C. § 8128(a); 20 C.F.R. §§ 10.605-10.607.