United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

S.V., Appellant 

and 

DEPARTMENT OF VETERANS AFFAIRS, 

VETERANS ADMINISTRATION MEDICAL 

CENTER, Redding, CA, Employer 

__________________________________________ 

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Docket No. 15-0377 

Issued: September 10, 2015 

Appearances: Case Submitted on the Record 

Alan J. Shapiro, Esq., for the appellant 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

PATRICIA H. FITZGERALD, Deputy Chief Judge 

COLLEEN DUFFY KIKO, Judge 

ALEC J. KOROMILAS, Alternate Judge 

JURISDICTION 

On December 9, 2014 appellant, through counsel, filed a timely appeal from a 

November 12, 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 this case. 

ISSUE 

The issue is whether appellant has met his burden of proof to establish that his right 

thumb or left ring finger conditions were caused by factors of his federal employment. 

 1

 5 U.S.C. § 8101 et seq. 
2

FACTUAL HISTORY 

This case has previously been on appeal before the Board.2 In a June 10, 2013 decision, 

the Board affirmed the October 4, 2012 decision of OWCP, finding that appellant failed to meet 

his burden of proof to establish that his claimed right thumb and left ring finger conditions were 

caused by factors of his federal employment. The facts and history contained in the prior appeal 

are incorporated herein by reference. Relevant facts include that appellant was a gastrointestinal 

physician who filed an occupational disease claim, alleging that his repeated use of an endoscope 

contributed to injuries to his right thumb and left ring finger. OWCP informed him of the 

deficiencies in the medical evidence and what was needed to establish his claim in a letter dated 

August 10, 2012. 

Appellant submitted a March 29, 2013 report from Dr. Stephen Ferraro, a Board-certified 

orthopedic surgeon, who advised that appellant presented with left and right hand pain. 

Dr. Ferraro diagnosed pain in right limb. On April 10, 2013 he stated that appellant was being 

evaluated for a follow up on the right thumb and a new problem on the right elbow. Dr. Ferraro 

advised that appellant’s right trigger thumb was ok, his carpometacarpal (CMC) joint was better 

with an injection. Appellant also had tennis elbow and shoulder pain. Dr. Ferraro diagnosed 

right shoulder pain, right lateral epicondylitis, and right hand pain. 

In a June 10, 2013 statement, appellant indicated that the pain in his left hand began in 

2010 and he sought treatment from an orthopedic surgeon. He noted that, at that time, he began 

using thick bicycle gloves and wrist and elbow supports to reduce his injury. Appellant 

explained that he performed endoscopies for the whole day, three days a week, averaging 60-per 

month. He explained that, when he held the scope with the left hand, the shaft required a firm 

grip and that caused a lot of squeezing and continued pressure on his hand. Appellant noted that 

the equipment required that he use his left hand, fingers, and thumb to manipulate wheels and 

knobs on the scope to do multiple functions. He had to use his right hand to twist the scope to 

position, and advance the scope, as well as write notes in electronic medical records and use a 

mouse all day to go to different parts of the electronic chart. Appellant denied having any 

hobbies and also noted that he had tennis elbow pain in the past when he worked for a private 

employer, Kaiser. 

In a letter dated June 26, 2013, counsel requested reconsideration of the last OWCP merit 

decision dated June 10, 2013 and submitted new evidence. He referenced reports from 

Dr. Ferraro dated April 10 and June 17, 2013.3

 Counsel argued that Dr. Ferraro opined that 

appellant’s condition stemmed from overuse due to the thumb and wrist motion needed to use an 

endoscope. He argued that Dr. Ferraro provided a rationalized opinion on causal relationship or, 

in the alternative, was sufficient to require additional medical development. 

In the June 17, 2013 report, Dr. Ferraro, noted that appellant returned for routine follow 

up. He indicated that appellant’s previous work restrictions of 4.5 days of endoscopy procedures 

 2

 Docket No. 13-555 (issued June 10, 2013). 

3

 Counsel also referred to a separate traumatic injury claim under File No. xxxxxx824, which was denied by 

OWCP on May 31, 2013. File No. xxxxxx824 is not presently before the Board. 
3

every 9 workdays, just started within the past few days, and he continued with bilateral thumb 

pain. Dr. Ferraro indicated that the left ring trigger finger was not much of an issue, and 

appellant had more pain on the right palmer thumb near the metacarpal phalangeal (MCP) joint. 

He advised that the right thumb flexor tendon sheath steroid injection did seem to help, although 

appellant still had wrist pain. Dr. Ferraro related that appellant was still performing endoscopies 

with a wrist brace on, and still had pain doing it, especially with a large volume of cases. He 

examined appellant and noted no right wrist swelling or other abnormality. Palpation found mild 

tenderness at the radial side of the wrist, volar wrist joint, and ulnar side of the wrist. Range of 

motion of the wrist was normal. Regarding the right fingers and thumb, Dr. Ferraro found that, 

the cascade of the fingers was normal, there was no tenderness on palpation and range of motion 

of all the fingers was normal. He diagnosed pain in limb (bilateral wrists, thumb CMC, and right 

thumb MCP) and trigger finger (acquired) (left ring). Dr. Ferraro opined that appellant had 

ongoing work-related thumb and wrist problems, including flexor tendinitis, and thumb CMC 

joint irritability. He explained that appellant’s occupation as an endoscopist placed him at 

increased risk for right hand problems, and was well documented in the medical literature. 

Dr. Ferraro referred to a study in the publication Endoscopy which contained a survey revealing 

19 percent thumb pain, 32 percent carpal tunnel, and/or hand pain. He opined that it appeared to 

“a clear case of overuse due to the particular thumb and wrist motion required in the use of an 

endoscope.” Dr. Ferraro explained that, with rest and proper activity modification, the condition 

could be controlled. He noted that injections into the thumb provided relief. Dr. Ferraro advised 

that appellant’s condition improved significantly when he was not performing endoscopies. He 

recommended continued work restrictions. On July 17, 2013 Dr. Ferraro saw appellant for 

follow up and repeated his diagnoses. 

By decision dated September 23, 2013, OWCP denied modification of its prior decision. 

On August 22, 2014 appellant, through counsel, requested reconsideration and submitted 

new evidence. In a report dated December 2, 2013, Dr. Michael Mikulecky, a Board-certified 

orthopedic surgeon, noted that appellant had a history of ankle pain, pain in the left hand at the 

base of the ring finger, and pain in the right thumb. He advised that Dr. Ferraro was treating 

appellant for triggering of the left ring finger and right thumb for CMC joint pain, which 

appeared secondary to his line of work. Dr. Mikulecky related that appellant was a 

gastrointestinal (GI) physician and performed thousands of GI scopes. He related that appellant 

explained that every time the employing establishment bought new equipment, it was very hard 

to break in. Appellant related that he had to use more force with his fingers and thumbs to 

manipulate the GI device and he had difficulty working because of the pain. Dr. Mikulecky 

explained that he recently performed surgery on another GI physician, who had a distal radius 

fracture after a fall and the muscles of his forearm and hand were quite hypertrophied, especially 

the flexor pollicis longus because of the multiple GI scopes he performed over the years. He 

opined that his pollicis longus was double the size of that which he would see in a patient who 

did not have this type of occupation. Dr. Mikulecky diagnosed tripper finger and unspecified 

arthropathy of the hand. He did not recommend surgery; and advised that appellant use a brace 

as needed and try to limit his activity level at work. 

By decision dated November 12, 2014, OWCP denied modification of its prior decision. 
4

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 FECA, that the claim was timely filed within the applicable time 

limitation period of FECA, that an injury was sustained 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 upon a traumatic injury or an occupational disease.5

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) 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 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, generally, is 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 

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.6

ANALYSIS 

As a gastrointerologist, appellant performed employment activities requiring use of his 

hands. His duties allegedly included performing endoscopies three days a week and averaging 

60 a month. Appellant described how the endoscopies were performed and explained how he 

used both hands in manipulating the equipment and writing notes. The Board finds that the first 

component of fact of injury regarding the alleged employment factors is established. However, 

the record contains insufficient medical evidence to establish that the claimed conditions were 

causally related to work factors. The medical evidence submitted by appellant is insufficiently 

rationalized to establish that his bilateral hand conditions were caused or aggravated by 

endoscopic activities at work. 

In a June 17, 2013 report, Dr. Ferraro provided findings which were essentially normal 

and diagnosed pain in the wrists and thumbs as well as acquired left ring trigger finger. He 

 4 Joe D. Cameron, 41 ECAB 153 (1989); Elaine Pendleton, 40 ECAB 1143, 1145 (1989). 

5 Victor J. Woodhams, 41 ECAB 345 (1989). 

6 Id. 
5

opined that appellant had ongoing work-related thumb and wrist problems, including flexor 

tendinitis, and thumb CMC joint irritability. Dr. Ferraro explained that appellant’s occupation as 

an endoscopist placed him at increased risk for right hand problems, and such risk was 

documented in medical literature. He referred to a study in the publication Endoscopy. 

Dr. Ferraro opined that it appeared to “a clear case of overuse due to the particular thumb and 

wrist motion required in the use of an endoscope.” However, the Board has held that newspaper 

clippings, medical texts, and excerpts from publications are of no evidentiary value in 

establishing the causal relationship between a claimed condition and an employee’s federal 

employment. Such materials are of general application and are not determinative as to whether 

the specific condition claimed is related to the particular employment factors alleged by the 

employee.7

 Dr. Ferraro did not specifically explain how the study applied to appellant’s 

particular situation. Appellant submitted March 29 and April 10, 2013 reports from Dr. Ferraro 

who treated appellant and offered diagnoses. However, the Board notes that these reports do not 

address whether any factors of his employment caused a diagnosed condition.8

 Consequently, 

the Board finds the reports from Dr. Ferraro are insufficient to establish appellant’s claim. 

In a report dated December 2, 2013, Dr. Mikulecky noted that appellant had a history of 

pain in the left hand at the base of the ring finger, and pain in the right thumb. He advised that 

Dr. Ferraro was treating appellant for triggering of the left ring finger and right thumb for CMC 

joint pain, which appeared secondary to his line of work. Dr. Mikulecky explained that appellant 

performed thousands of GI scopes in his job. Appellant related that when the employing 

establishment bought new equipment, it was very hard to break in. Dr. Mikulecky noted that 

appellant indicated that he had to use more force with his fingers and thumbs to manipulate the 

GI device and he had difficulty working because of the pain. While he diagnosed trigger finger 

and unspecified arthropathy of the hand and recommended a limit on his activity at work, he did 

not provide a rationalized opinion on causal relationship. Dr. Mikulecky did not explain how 

appellant’s specific work activities caused or contributed to his diagnosed condition. Noting 

operative findings with regard to another patient does not explain how the specific findings apply 

to appellant’s particular situation. 

Appellant presented no other current medical evidence discussing how work factors 

caused or contributed to a diagnosed medical condition. 

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

employment does not raise an inference that there is a causal relationship between the two.9

 

Causal relationship must be substantiated by reasoned medical opinion evidence, which is 

appellant’s responsibility to submit. 

 7 William C. Bush, 40 ECAB 1064, 1075 (1989). 

8 Linda I. Sprague, 48 ECAB 386 (1997) (medical evidence that does not offer any opinion regarding the cause of 

an employee’s condition is of diminished probative value on the issue of causal relationship). 

9 See Joe T. Williams, 44 ECAB 518, 521 (1993). 
6

As there is no rationalized medical evidence explaining how appellant’s claimed hand 

conditions were caused or aggravated by employment factors, appellant has not met his burden 

of proof in establishing his claim. 

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

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. 

CONCLUSION 

The Board finds that appellant has not met his burden of proof to establish that his right 

thumb or left ring finger conditions were caused by factors of his federal employment. 

ORDER 

IT IS HEREBY ORDERED THAT the November 12, 2014 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: September 10, 2015 

Washington, DC 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board