United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

S.P., Appellant 

and 

DEPARTMENT OF VETERANS AFFAIRS, 

VETERANS ADMINISTRATION MEDICAL 

CENTER, Gainesville, FL, Employer 

__________________________________________ 

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Docket No. 14-1386 

Issued: November 25, 2014 

Appearances: Case Submitted on the Record

Richard A. Daniels, for the appellant 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

CHRISTOPHER J. GODFREY, Chief Judge 

PATRICIA HOWARD FITZGERALD, Judge 

MICHAEL E. GROOM, Alternate Judge 

JURISDICTION 

On June 2, 2014 appellant, through her representative, filed a timely appeal from a 

January 16, 2014 merit decision 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 sustained bilateral carpal tunnel syndrome or a right index 

trigger finger causally related to factors of her federal employment. 

 1

 5 U.S.C. § 8101 et seq. 
2

FACTUAL HISTORY 

On December 8, 2010 appellant, then a 56-year-old medical technologist, filed an 

occupational disease claim alleging that she sustained bilateral carpal tunnel syndrome and a 

right index trigger finger due to repetitive motion in the course of her federal employment. She 

became aware of her condition on April 1, 2004. Appellant did not stop work. 

On October 31, 2006 appellant underwent a right carpal tunnel release. On 

November 19, 2009 she underwent a left carpal tunnel release and release of the right index 

finger. 

By decision dated February 15, 2011, OWCP denied appellant’s claim. It found that she 

had not submitted sufficient medical evidence to establish a causal relationship between a 

diagnosed condition and the established work factors. 

On February 22, 2011 appellant requested a telephone hearing before an OWCP hearing 

representative. In a report dated May 10, 2011, Dr. Arthur M. Sharkey, a Board-certified 

orthopedic surgeon, related that she had a long history of carpal tunnel syndrome as a result of 

working for 30 years as a laboratory technician at the employing establishment. He diagnosed 

bilateral carpal tunnel syndrome and right index trigger finger with flexor tenosynovitis. 

Dr. Sharkey stated, “It is my unequivocal opinion that the causal relationship of her activities as 

a laboratory technologist which include repetitive pipefitting, repetitive removal of specimen 

tops and protracted computer use has a causal relationship to her diagnoses.” 

By decision dated August 18, 2011, an OWCP hearing representative set aside the 

February 15, 2011 decision. She found that the opinion of Dr. Sharkey was sufficient to warrant 

further development of the medical evidence and instructed OWCP to refer appellant for a 

second opinion examination. 

On August 9, 2012 OWCP referred appellant to Dr. Steven J. Lancaster, a Board-certified 

orthopedic surgeon, for a second opinion examination. It requested that he address whether the 

2006 and 2009 procedures to appellant’s wrists and right index finger were warranted and 

causally related to her employment. The accompanying statement of accepted facts described 

appellant’s work duties as a medical technologist beginning in 1992. OWCP also noted that she 

had a long history of preexisting or concurrent numbness and pain of the hands. 

In a report dated September 28, 2012, Dr. Lancaster discussed appellant’s history of 

surgeries for bilateral carpal tunnel syndrome and right index trigger finger. On examination, he 

found a negative Tinel’s sign and Phalen’s test bilaterally with no atrophy and no triggering of 

any digit. Dr. Lancaster diagnosed status post bilateral carpal tunnel releases and status post 

right index trigger finger release with residual tenosynovitis and pain. He attributed appellant’s 

current symptoms of trigger finger and some symptoms from the carpal tunnel releases to “scar 

tissue from the surgeries for the accepted condition of carpal tunnel syndrome and trigger 

finger.” Dr. Lancaster found that her current symptoms outweighed the objective findings. He 

stated that the prior surgeries were warranted to treat the accepted employment-related 

conditions of carpal tunnel syndrome and index trigger finger. 
3

On October 4, 2012 OWCP advised Dr. Lancaster that it had not accepted any condition 

as employment related. It requested that he clarify whether appellant’s work duties as a medical 

technologist caused or exacerbated her diagnosed conditions. 

In a supplemental report dated October 10, 2012, Dr. Lancaster found that appellant’s 

work duties did not cause or contribute to her carpal tunnel syndrome or trigger finger. He 

opined that pipefitting was not a “significant enough repetitive movement to cause a carpal 

tunnel syndrome. As such my opinion is that the claimant was going to develop her carpal 

tunnel syndrome independent of her activities as a medical technologist.” 

By decision dated November 2, 2012, OWCP denied appellant’s claim on the grounds 

that she did not establish that she sustained a medical condition due to the identified work 

factors. It found that Dr. Lancaster’s opinion represented the weight of the evidence and 

demonstrated that she did not have bilateral carpal tunnel syndrome or right trigger finger due to 

factors of her federal employment. 

On November 11, 2012 appellant, through her representative, requested an oral hearing. 

Following a preliminary review, on January 7, 2013, an OWCP hearing representative set aside 

the November 2, 2012 decision. She found that the record contained a conflict in medical 

opinion between Dr. Sharkey and Dr. Lancaster. 

By letter dated March 15, 2013, OWCP referred appellant to Dr. Raul B. Zelaya, a 

Board-certified orthopedic surgeon, for an impartial medical examination to determine whether 

she sustained carpal tunnel syndrome due to factors of her federal employment. It advised that a 

conflict arose between Dr. Sharkey and Dr. Lancaster regarding whether her condition arose 

from work factors beginning April 1, 2004. 

In a report dated April 18, 2013, Dr. Zelaya reviewed appellant’s history of upper 

extremity symptoms and the medical reports of record, including the results of 2005 

electrodiagnostic studies showing carpal tunnel syndrome. He noted that she underwent a right 

tunnel release in 2006 and a left carpal tunnel and right index finger release in 2009. Dr. Zelaya 

stated: 

“On March 2, 2010 [appellant] underwent an MRI [magnetic resonance imaging] 

[study] of the right hand that shows degenerative changes of the proximal phalanx 

of the right index finger in addition to tenosynovitis as well as tendinosis of the 

flexor synovial sheet that more likely than not was a contributing factor to her 

previous CTS [carpal tunnel syndrome], already released and currently 

asymptomatic.” 

Dr. Zelaya noted that appellant’s job duties included referral testing, preparing 

specimens, and capping and uncapping tubes. He stated that these actions did not put pressure 

on the carpal canal and noted that he had given her a test tube to cap and uncap during his 

examination.2

 On examination, Dr. Zelaya found normal two-point discrimination, a negative 

Tinel’s sign and Phalen’s test and a loss of sensation to light touch and pinwheel along the C4, 

 2

 Dr. Zelaya indicated that appellant’s hobby of bicycle riding did increase pressure on the carpal canal. 
4

C5, and C6 distribution, especially on the right side. He interpreted x-rays as showing 

discogenic disease at these levels which he indicated could be confused with symptoms of carpal 

tunnel syndrome. Dr. Zelaya diagnosed cervical radiculopathy with discogenic disease at C4, 

C5, and C6. He determined that appellant’s cervical radicular symptoms were unrelated to her 

employment. Dr. Zelaya opined that she did not currently have carpal tunnel syndrome. 

By decision dated May 3, 2013, OWCP denied appellant’s claim. It found that 

Dr. Zelaya’s opinion represented the weight of the evidence and established that she did not have 

a diagnosed condition due to factors of her federal employment. 

On May 10, 2013 appellant, through her representative, requested an oral hearing. On 

October 29, 2010 counsel requested a review of the written record in lieu of an oral hearing. 

In a report dated November 14, 2013, Dr. Sharkey discussed appellant’s history of 

surgery for carpal tunnel syndrome and right trigger finger. He opined that her repetitive work 

duties, including pipefitting, removing specimen tops and computer use caused her condition. 

Dr. Sharkey also diagnosed de Quervain’s syndrome and residual synovitis of the right index 

finger. 

By decision dated January 16, 2014, an OWCP hearing representative affirmed the 

May 3, 2013 decision. 

On appeal appellant’s representative asserts that electromyogram (EMG) testing 

demonstrates that she has carpal tunnel syndrome. He notes that Dr. Zelaya failed to discuss the 

July 13, 2010 EMG which confirmed the diagnosis of carpal tunnel syndrome and instead relied 

on less objective findings on clinical examination. Counsel maintains that Dr. Zelaya based his 

opinion on x-rays that were not provided to her attending physician and failed to provide 

sufficient rationale explaining why the diagnosed cervical condition was unrelated to 

employment. He contends that Dr. Zelaya’s opinion is insufficient to resolve the conflict in 

medical opinion. 

LEGAL PRECEDENT 

An employee seeking benefits under FECA3 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

 3

 5 U.S.C. § 8101 et seq. 

4 See Tracey P. Spillane, 54 ECAB 608 (2003); Elaine Pendleton, 40 ECAB 1143 (1989). 

5 See Ellen L. Noble, 55 ECAB 530 (2004). 
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;6

 (2) a 

factual statement identifying employment factors alleged to have caused or contributed to the 

presence or occurrence of the disease or condition;7 and (3) medical evidence establishing 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.8

Section 8123(a) provides that, if there is disagreement between the physician making the 

examination for the United States and the physician of the employee, the Secretary shall appoint 

a third physician who shall make an examination.9

 The implementing regulations state that, if a 

conflict exists between the medical opinion of the employee’s physician and the medical opinion 

of either a second opinion physician or an OWCP medical adviser, OWCP shall appoint a third 

physician to make an examination. This is called a referee examination and OWCP will select a 

physician who is qualified in the appropriate specialty and who has no prior connection with the 

case.10

When OWCP secures an opinion from an impartial medical specialist for the purpose of 

resolving a conflict in the medical evidence and the opinion from the specialist requires 

clarification or elaboration, it has the responsibility to secure a supplemental report from the 

specialist for the purpose of correcting a defect in the original report.11 When the impartial 

medical specialist’s statement of clarification or elaboration is not forthcoming or if the specialist 

is unable to clarify or elaborate on the original report or if the specialist’s supplemental report is 

also vague, speculative or lacks rationale, OWCP must submit the case record and a detailed 

statement of accepted facts to a second impartial specialist for a rationalized medical opinion on 

the issue in question.12 Unless this procedure is carried out by OWCP, the intent of section 

8123(a) will be circumvented and the impartial medical examiner’s report is insufficient to 

resolve the conflict in medical evidence.13

 6 See Michael R. Shaffer, 55 ECAB 386 (2004). 

7 See Marlon Vera, 54 ECAB 834 (2003); Roger Williams, 52 ECAB 468 (2001). 

8 See Beverly A. Spencer, 55 ECAB 501 (2004). 

9

 5 U.S.C. § 8123(a). 

10 20 C.F.R. § 10.321. 

11 Federal (FECA) Procedure Manual, Part 2 -- Claims, Developing and Evaluating Medical Evidence, Chapter 

2.810.11(d)(2) (September 2010). 

12 See D.T., Docket No. 14-332 (issued May 14, 2014); Talmadge Miller, 47 ECAB 673 (1996); see also Federal 

(FECA) Procedure Manual, Part 2 -- Claims, Developing and Evaluating Medical Evidence, Chapter 2.810.11(e) 

(September 2010). 

13 See D.T., id. 
6

ANALYSIS 

Appellant attributed her wrist and trigger finger conditions to repetitive work as a 

medical technologist. OWCP accepted the occurrence of the claimed employment factors. The 

issue, therefore, is whether the medical evidence establishes a causal relationship between the 

claimed conditions and the identified employment factors. 

OWCP found that a conflict arose between Dr. Sharkey, an attending physician, who 

found that appellant sustained bilateral carpal tunnel syndrome and right index trigger finger due 

to her employment duties; and Dr. Lancaster, an OWCP referral physician, who found that her 

work duties did not cause her carpal tunnel syndrome and trigger finger. It referred her to 

Dr. Zelaya, a Board-certified orthopedic surgeon, for an impartial medical examination. 

When a case is referred to an impartial medical examiner for the purpose of resolving a 

conflict, the opinion of such specialist, if sufficiently well rationalized and based on a prior 

factual and medical background, must be given special weight.14 The Board finds, however, that 

Dr. Zelaya’s opinion is insufficient to resolve the conflict in medical opinion as he did not 

adequately address the causation issue. In a report dated April 18, 2013, Dr. Zelaya described 

appellant’s work duties, noting that the laboratory procedures that she performed did not increase 

the pressure on her carpal canal. On examination, he found a negative Tinel’s sign and Phalen’s 

test but reduced sensation to touch and pinwheel in the C4, C5 and C6 distribution. Dr. Zelaya 

diagnosed cervical radiculopathy and discogenic disease at C4, C5 and C6 unrelated to 

employment. He determined that appellant did not currently have carpal tunnel syndrome. 

Dr. Zelaya, however, discussed only her current condition and its relationship to her federal 

employment. He noted that a March 2, 2010 MRI scan study showed degenerative changes of 

the right index finger and tenosynovitis and tendinosis of the flexor synovial sheet. Dr. Zelaya 

found that these conditions most likely contributed to appellant’s previous bilateral carpal tunnel 

syndrome that was no longer symptomatic and had been treated with releases. He did not 

adequately address whether appellant’s history of bilateral carpal tunnel syndrome and right 

index trigger finger and resulting surgeries were due to factors of her federal employment. 

Consequently, Dr. Zelaya’s opinion is insufficient to resolve the conflict in medical opinion. 

When OWCP secures an opinion from an impartial medical specialist for the purpose of 

resolving a conflict in the medical evidence and the opinion from the specialist requires 

clarification or elaboration, it has the responsibility to secure a supplemental report from the 

specialist for the purpose of correcting a defect in the original report.15 On remand, OWCP 

should ask Dr. Zelaya to clarify whether appellant sustained bilateral carpal tunnel syndrome or 

right index trigger finger as a result of her work duties. Following such further development as 

deemed necessary, OWCP should issue a de novo decision on her claim. 

CONCLUSION 

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

 14 L.W., 59 ECAB 471 (2008). 

15 See K.C., Docket No. 14-791 (issued August 8, 2014); Guiseppe Aversa, 55 ECAB 164 (2003). 
7

ORDER 

IT IS HEREBY ORDERED THAT the January 16, 2014 decision of the Office of 

Workers’ Compensation Programs is set aside and the case is remanded for further proceedings 

consistent with this opinion of the Board. 

Issued: November 25, 2014 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Patricia Howard Fitzgerald, Judge 

 Employees’ Compensation Appeals Board 

 

 Michael E. Groom, Alternate Judge 

 Employees’ Compensation Appeals Board