United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

T.R., Appellant 

and 

DEPARTMENT OF VETERANS AFFAIRS, 

VETERANS HEALTH ADMINISTRATION 

MEDICAL CENTER, Gainesville, FL, Employer 

__________________________________________ 

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Docket No. 14-882 

Issued: March 11, 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 

COLLEEN DUFFY KIKO, Judge 

PATRICIA HOWARD FITZGERALD, Judge 

JURISDICTION 

On March 10, 2014 appellant filed a timely appeal from a January 21, 2014 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 in this case is whether appellant met her burden of proof to establish a 

traumatic injury in the performance of duty on September 23, 2011. 

FACTUAL HISTORY 

On September 26, 2011 appellant, then a 32-year-old nursing assistant, filed a traumatic 

injury claim (Form CA-1) alleging a right wrist sprain when transferring a patient from a 

 1

 5 U.S.C. § 8101 et seq. 
2

wheelchair to a bed with the help of another employee on September 23, 2011. A supervisor 

noted that appellant gave notice of this injury on the same date and that her injury occurred in the 

performance of duty. 

Appellant had a prior diagnosis of chronic extensor carpi ulnaris (ECU) tenosynovitis of 

the right wrist. In an operative report dated May 27, 2011, Dr. Rodger D. Powell, a Boardcertified orthopedic surgeon, described performing an ECU tenosynovectomy on her right wrist. 

The procedure was completed without complications. 

In a functional capacity evaluation dated September 1, 2011, a physical therapist 

evaluated appellant’s ability to tolerate work tasks involving her upper extremities. She wrote, 

“Results obtained indicate this client did not perform with determined consistent effort and 

demonstrated inappropriate pain behaviors. Results obtained should therefore be interpreted as a 

minimal level of function only and do not represent potentially true capabilities.” 

In progress notes dated September 26, 2011, Dr. John C. Charnas, Board-certified in 

preventative medicine, stated that appellant presented for a follow-up of her right wrist. He 

noted that she had surgery two months ago and returned to full duty on September 19, 2011. 

Dr. Charnas noted that appellant began noticing increasing pain in her right wrist on 

September 20, 2011, which progressed over the week without new injury or incident. He stated 

his impression of right wrist strain. 

On October 11, 2011 Dr. James B. Slattery, a Board-certified orthopedic surgeon, 

examined the results of nerve conduction studies to the right upper extremity. He stated that the 

findings were consistent with a very mild sensory carpal tunnel syndrome with no evidence of 

other peripheral neuropathy or radiculopathy. 

In a report dated October 24, 2011, Dr. Powell stated that appellant continued to have 

pain in her right wrist, but that it was minimal compared to what it was before surgery. He stated 

that his impression of very mild right carpal tunnel syndrome and mild persistence of extensor 

ECU tenosynovitis. Dr. Powell noted that he thought he had done everything he could do for 

appellant and did not know why she was having the problems she did. He suggested that OWCP 

obtain a second opinion. In a work capacity evaluation for musculoskeletal conditions of the 

same date, Dr. Powell stated that appellant was unable to perform her usual job and that 

maximum medical improvement had not been reached. 

In progress notes dated December 15, 2011, Dr. Charnas saw appellant for a follow-up 

and stated his impression of a right wrist strain. Appellant noted that her pain had been 

increasing. In a duty status report of the same date, Dr. Charnas stated that she could return to 

duty on December 16, 2011 with restrictions of no lifting over five pounds and that she should be 

off work on December 15, 2011. 

In a duty status report dated October 16, 2012, Dr. Powell stated that appellant had 

possible right carpal tunnel syndrome. He recommended that she could perform full-time regular 

work on October 24, 2012. 

Appellant submitted a duty status report dated November 5, 2012, which contained 

restrictions of no lifting over five pounds, no more than three hours a day of pulling/pushing, no 
3

more than five hours a day of fine manipulation, and no reaching above the shoulder. However, 

the physician’s signature on this report was illegible. 

On May 25, 2012 Dr. Charnas noted that appellant was working limited duty, and that her 

pain increased by the end of the day. He observed swelling remaining over the dorsum of the 

right wrist and recommended that she wear a splint and take medication for pain. In a duty status 

report of the same date, Dr. Charnas stated that appellant should be off work on May 25, 2012 

and could return to work the next day. 

By letter dated August 13, 2013, OWCP informed appellant of the evidence needed to 

support her claim. It advised her that the claim had been reopened because she may be entitled 

to compensation for wage loss. OWCP noted that Dr. Charnas had stated in his September 26, 

2011 report that appellant’s pain had increased over the course of a week without new injury or 

incident. It afforded appellant 30 days to submit additional evidence. No response was received. 

By decision dated September 16, 2013, OWCP denied appellant’s claim for 

compensation. It found that she had not established that her condition of wrist strain was caused 

or aggravated by an incident on September 23, 2011. OWCP accepted that appellant was a 

federal civilian employee who filed a timely claim; that the incident occurred; that a medical 

condition had been diagnosed; and that she was within the performance of duty. 

By letter received on December 19, 2013, appellant requested reconsideration of her 

claim. She also submitted several time analysis forms claiming wage loss and an authorization 

request for orthopedic surgery. 

In a duty status report dated September 19, 2011, a person with an illegible signature 

stated that appellant could return to work on that date at full duty. 

In progress notes dated November 1, 2012, Dr. Marissa Olegario-Nebel examined the 

results of several electromyographic studies of appellant’s right hand and wrist.2

 She stated an 

impression of findings consistent mild carpal tunnel syndrome and mild right demyelinating 

ulnar nerve focal neuropathy. 

By letter dated January 3, 2014, OWCP informed appellant that her claim for 

compensation for the period January 12 through June 19, 2013 could not be processed because 

the forms were incomplete. 

By decision dated January 21, 2014, OWCP reviewed the merits of appellant’s claim and 

denied modification of the decision dated January 19, 2013. It noted that she had not submitted 

any opinion from a physician explaining how the claimed injury of September 23, 2011 caused 

or aggravated her diagnosed conditions. 

 2

 Dr. Olegario-Nebel’s Board certification could not be confirmed with the American Board of Medical 

Specialties or the American Osteopathic Association. 
4

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

To determine whether a federal employee has sustained a traumatic injury in the 

performance of duty it must first be determined whether a fact of injury has been established.6

 

First, the employee must submit sufficient evidence to establish that he or she actually 

experienced the employment incident at the time, place, and in the manner alleged.7

 Second, the 

employee must submit sufficient evidence, generally only in the form of medical evidence, to 

establish that the employment incident caused a personal injury.8

The claimant has the burden of establishing by the weight of reliable, probative, and 

substantial evidence that the condition for which compensation is sought is causally related to a 

specific employment incident or to specific conditions of employment.9

 An award of 

compensation may not be based on appellant’s belief of causal relationship. Neither the mere 

fact that a disease or condition manifests itself during a period of employment nor the belief that 

the disease or condition was caused or aggravated by employment factors or incidents is 

sufficient to establish a causal relationship.10

Causal relationship is a medical issue and the medical evidence generally required to 

establish causal relationship is rationalized medical opinion evidence.11 Rationalized medical 

opinion evidence is medical evidence which includes a physician’s rationalized opinion on 

whether there is a causal relationship between the employee’s diagnosed condition and 

 3 Supra note 1. 

4 C.S., Docket No. 08-1585 (issued March 3, 2009); Bonnie A. Contreras, 57 ECAB 364, 366 (2006). 

5 S.P., 59 ECAB 184, 188 (2007); Joe D. Cameron, 41 ECAB 153, 157 (1989). 

6 B.F., Docket No. 09-60 (issued March 17, 2009); Bonnie A. Contreras, supra note 4. 

7 D.B., 58 ECAB 464, 466 (2007); David Apgar, 57 ECAB 137, 140 (2005). 

8 C.B., Docket No. 08-1583 (issued December 9, 2008); D.G., 59 ECAB 734, 737 (2008); Bonnie A. Contreras, 

supra note 4. 

9 Roma A. Mortenson-Kindschi, 57 ECAB 418, 428 n.37 (2006); Katherine J. Friday, 47 ECAB 591, 594 (1996). 

10 P.K., Docket No. 08-2551 (issued June 2, 2009); Dennis M. Mascarenas, 49 ECAB 215, 218 (1997). 

11 Y.J., Docket No. 08-1167 (issued October 7, 2008); A.D., 58 ECAB 149, 155-56 (2006); D’Wayne Avila, 57 

ECAB 642, 649 (2006). 
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compensable employment factors.12 The opinion of the physician must be based on a complete 

factual and medical background of the employee, 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 employee.13

ANALYSIS 

OWCP found that the September 23, 2011 incident involving transferring a patient from a 

wheelchair to a bed occurred as alleged. The Board affirms this fact of injury and it also finds 

that the medical evidence submitted by appellant is insufficient to establish that this incident 

caused a medical condition. 

On September 26, 2011 Dr. Charnas stated that appellant presented for a follow-up on her 

right wrist. He noted that she had surgery two months prior and had returned to full duty on 

September 19, 2011. Dr. Charnas noted that appellant began noticing increasing pain in her right 

wrist on September 20, 2011, which progressed over the week without new injury or incident. 

As his report positively states that appellant’s symptoms progressed over the course of the week 

of September 20, 2011 without new injury or incident, his report does not offer an explanation of 

how the claimed work event caused or aggravated appellant’s claimed condition. Rather, 

Dr. Charnas’ report is supportive of the opposite proposition, that appellant’s condition was not 

caused or aggravated by the claimed work event, as it progressed without new injury or incident. 

Medical evidence submitted to support a claim for compensation should reflect a correct history 

and the physician should offer a medically sound explanation of how the claimed work event 

caused or aggravated the claimed condition.14 Lacking such an explanation, this report is not 

sufficient to establish a causal relationship between the event of September 23, 2011 and 

appellant’s diagnosed conditions. 

In a report dated May 27, 2011, Dr. Powell described performing an ECU 

tenosynovectomy on appellant’s right wrist. The procedure was completed without 

complications. On October 24, 2011 Dr. Powell stated that appellant continued to have pain in 

her right wrist, but that it was minimal compared to what it was before surgery. He stated that 

his impression of very mild right carpal tunnel syndrome and mild persistence of ECU 

tenosynovitis. On October 11, 2011 Dr. James B. Slattery, a Board-certified orthopedic surgeon, 

examined the results of nerve conduction studies to the right upper extremity. Dr. Powell noted 

that he thought he had done everything he could do and suggested a second opinion. In progress 

notes dated December 15, 2011, Dr. Charnas saw appellant for a follow-up and stated his 

impression of a right wrist strain. On May 25, 2012 he noted that she was working limited duty, 

and that her pain increased by the end of the day. Dr. Charnas observed swelling remaining over 

the dorsum of the right wrist and recommended that appellant wear a splint and take medication 

for pain. In a duty status report dated October 16, 2012, Dr. Powell stated that she had possible 

right carpal tunnel syndrome. He recommended that appellant could perform full-time regular 

 12 J.J., Docket No. 09-27 (issued February 10, 2009); Michael S. Mina, 57 ECAB 379, 384 (2006). 

13 I.J., 59 ECAB 408, 415 (2008); Victor J. Woodhams, 41 ECAB 345, 352 (1989). 

14 D.D., Docket No. 13-1517 (issued April 14, 2014). 
6

work on October 24, 2012. In progress notes dated November 1, 2012, Dr. Olegario-Nebel 

examined the results of several electromyographic studies of appellant’s right hand and wrist. 

These reports do not provide a clear statement of opinion as to the causation of 

appellant’s condition. Instead, they merely report on her surgery and her condition of mild right 

carpal tunnel syndrome, without offering a history of injury related to an event on September 23, 

2011 or an opinion on causal relationship. The Board has held that medical evidence that does 

not offer any opinion regarding the cause of an employee’s condition is of limited probative 

value on the issue of causal relationship.15 Hence, these reports are not sufficient to establish 

appellant’s claim. 

As appellant has not submitted any rationalized medical evidence to support her 

allegation that she sustained an injury causally related to a September 23, 2011 employment 

incident, she has not met her burden of proof to establish a claim. 

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. 

CONCLUSION 

The Board finds that appellant has not met her burden of proof to establish a traumatic 

injury in the performance of duty on September 23, 2011. 

 15 See C.B., Docket No. 09-2027 (issued May 12, 2010); S.E., Docket No. 08-2214 (issued May 6, 2009). 
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ORDER 

IT IS HEREBY ORDERED THAT the January 21, 2014 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: March 11, 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