United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

D.D., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Kearny, NJ, Employer 

__________________________________________ 

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Docket No. 14-1119 

Issued: September 9, 2014 

Appearances: Case Submitted on the Record

Thomas R. Uliase, Esq., for the appellant 

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 April 14, 2014 appellant, through her attorney, filed a timely appeal from an Office of 

Workers’ Compensation Programs (OWCP) decision dated November 4, 2013. Pursuant to the 

Federal Employees’ Compensation Act1

 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 or cervical radiculopathy 

conditions in the performance of duty. 

FACTUAL HISTORY 

Appellant, a 55-year-old mail clerk, filed a Form CA-2 claim for benefits on 

August 22, 2011. She alleged that she developed wrist, hand and forearm conditions causally 

 1

 5 U.S.C. § 8101 et seq. 
2

related to 35 years of repetitive activities at her usual job as a mail clerk. Appellant retired on 

March 2, 2012. 

Appellant submitted a statement, received by OWCP on November 14, 2011, in which 

she described her work duties which she alleges resulted in the development of her claimed 

conditions. She advised that through the years she had worked on numerous letter sorting 

machines, in addition to manually sorting mail; she alleged that during the course of her 35 years 

at the employing establishment the constant, repetitive activity involved with working these 

machines, in addition to manual sorting techniques, placed a strain on her tendons, ligaments, 

joints and muscles. Appellant indicated that she currently experienced pain in both wrists, severe 

at times tingling and numbness in her forearms and fingers and a weakened grip. 

In a report dated September 7, 2011, received by OWCP on October 24, 2011, Dr. Mark 

Filippone, a specialist in physical medicine and rehabilitation and appellant’s treating physician, 

advised that appellant had complaints of pain, numbness and tingling in both hands, in the 

cervical paraspinal area and in both shoulders; appellant believed that these symptoms were 

causally related to her employment. He indicated that based on his examination, appellant’s 

medical records, her September 7, 2011 statement and a colored print of her letter sorting 

machine that she had repetitive stress disorder of the upper extremities secondary to overuse 

from work. Dr. Filippone opined that these conditions were directly and solely the result of 

repetitive stress she experienced while working for the employing establishment. He also noted 

that he was attempting to rule out carpal tunnel syndrome; ulnar neuropathy; cervical double 

crush syndrome; cervical radiculopathy; brachioplexopathy; and lumbosacral derangement, 

radiculitis and radiculopathy. Dr. Filippone stated that he would obtain x-rays of both wrists, 

both hands and the cervical spine; he also advised that he seek authorization to perform 

electromyelogram (EMG) and nerve conduction (NCS) studies of the upper extremities. 

Dr. Filippone submitted a September 7, 2011 Form CA-20 on which he checked a box 

indicating that appellant’s conditions were caused or aggravated by her employment activities. 

On October 11, 2011 OWCP advised appellant that it required factual and medical 

evidence to determine whether she was eligible for compensation benefits. It asked appellant to 

submit a comprehensive report from her treating physician describing her symptoms and the 

medical reasons for her condition in addition to an opinion as to whether her claimed condition 

was causally related to her federal employment. OWCP requested that appellant submit this 

evidence within 30 days. 

Dr. Filippone subsequently submitted reports dated September 29 and October 20, 2011 

in which he stated findings on examination and essentially reiterated his previous findings and 

conclusions. In his October 20, 2012 report he opined that appellant’s neck, upper and lower 

extremity radicular and low back complaints were directly and solely the result of working for 

the employing establishment. 

By decision dated November 23, 2011, OWCP denied appellant’s claim. It accepted that 

appellant performed duties as a letter carrier but found that she failed to submit sufficient 

medical evidence to establish that her claimed conditions were causally related to her work 

duties. 
3

By letter dated December 6, 2011, appellant, through her attorney, requested an oral 

hearing. 

On December 14, 2011 Dr. Filippone administered EMG/NCS testing. Dr. Filippone 

opined that there was EMG and nerve conduction evidence of bilateral carpal tunnel syndrome 

based on EMG evidence of partial denervation in muscles innervated by the mid and lower right 

cervical dorsal rami and in the muscles innervated by the mid left cervical dorsal rami. He also 

stated that there was EMG evidence of a right C5-6 cervical radiculopathy. Dr. Filippone 

advised that all of these findings were directly and solely the result of work-related activities. 

By decision dated February 13, 2012, an OWCP hearing representative set aside the 

November 23, 2011 decision. She found that the medical evidence appellant submitted did not 

establish a causal relationship between her work and her claimed conditions2

 but was sufficient 

to require further development of the medical evidence. OWCP’s hearing representative 

remanded the case and referred appellant for a second opinion examination; and directed that a 

statement of accepted facts be prepared for review by the second opinion examiner. 

Appellant was referred for a second opinion examination with Dr. Kenneth Heist, Boardcertified in orthopedic surgery. In a report dated April 26, 2012, he reviewed the medical history 

and statement of accepted facts and discussed her exposure to repetitive activities at the 

employing establishment. Dr. Heist confirmed and agreed that Dr. Filippone’s December 14, 

2011 EMG/NCS of her upper extremities revealed bilateral carpal tunnel syndrome and C5-6 

cervical radiculopathy. He stated, however, that his examination of the cervical spine showed a 

normal lordotic curve; normal range of motion; a negative Spurling’s sign; negative Median, 

Tinel’s and Phalen’s signs bilaterally; no evidence of cervical radiculopathy, gross muscular 

weakness, atrophy, circulatory difficulty involving the cervical spine or upper extremities, 

paravertebral muscle guarding, bilateral carpal tunnel syndrome or peripheral neuropathy of the 

upper extremities. Dr. Heist further advised that grip strength was five out of five in the right 

and left wrists. He noted previous diagnoses by her treating physician of bilateral wrist sprains, 

bilateral carpal tunnel syndrome and right C5-6 cervical radiculopathy but stated that his 

objective findings at the time of examination were negative for carpal tunnel syndrome and 

cervical radiculopathy. Dr. Heist concluded based on his physical examination that appellant 

was capable of performing her duties as a mail processing clerk for the employing establishment. 

In an August 31, 2012 supplemental report, Dr. Heist again reiterated that his objective 

findings were negative for carpal tunnel syndrome as median and ulnar Tinel’s signs were 

negative bilaterally, and Phalen’s sign was negative bilaterally. Also as the spurling test was 

negative, appellant had no signs of cervical radiculopathy. Dr. Heist stated that appellant had no 

current disability and required no further treatment. He advised that based on his April 26, 2012 

examination he did not believe that the diagnoses of bilateral carpal tunnel syndrome and 

cervical radiculopathy C5-6 were causally related to her employment with the employing 

establishment and that she was capable of performing her duties as a mail processing clerk. 

 2

 The Board notes that appellant initially filed a claim based on bilateral hand, wrist and shoulder conditions, in 

addition to a cervical condition. The medical evidence presented focused on whether she had bilateral carpal tunnel 

syndrome and cervical radiculopathy. OWCP adjudicated the case on this basis. 
4

By decision dated October 24, 2012, OWCP found that Dr. Heist’s referral opinion 

represented the weight of medical evidence and that based on his opinion appellant’s claimed 

bilateral carpal tunnel and cervical radiculopathy conditions were not causally related to 

employment factors. 

By letter dated December 6, 2012, appellant, through her attorney, requested an oral 

hearing. 

By decision dated December 17, 2012, an OWCP hearing representative set aside the 

October 24, 2012 decision, finding that there was a conflict in medical opinion between 

Dr. Heist, the second opinion examiner, and Dr. Filippone, appellant’s treating physician 

regarding whether her claimed bilateral carpal tunnel and cervical radiculopathy conditions were 

causally related to employment factors. She remanded the case to the district office and 

instructed that appellant be referred for a referee medical examination to resolve the conflict in 

the medical evidence. 

OWCP referred appellant to Dr. Robert I. Dennis, Board-certified in orthopedic surgery, 

for a referee medical examination. In a March 14, 2013 report, he opined that none of 

appellant’s claimed conditions were causally related to employment factors. Dr. Dennis 

reviewed diagnostic tests and found that cervical and lumbar MRI scans showed some mild 

degenerative changes but no disc herniations; X-rays of the wrists showed a small degree of 

arthritis; bony structures of the carpal and metacarpal bones were quite normal; and X-rays of the 

cervical spine were normal. Dr. Dennis stated that his examinations for carpal tunnel syndrome 

and cervical radiculopathy were negative. He indicated that she had normal pinch, normal grip 

strength, normal sensation and no evidence of clinical objective findings for carpal tunnel 

syndrome or radiculopathy. He asserted that her physical examination was very conclusive in 

regard to the normal exam of the upper extremities. Dr. Dennis related that appellant denied ever 

having a problem with her neck or with pain radiating from the shoulder to the hand; her only 

problem entailed pain radiating from the top of the forearm toward the wrist. 

Dr. Dennis found no clinical objective pathology that would support a diagnosis of 

repetitive activities producing carpal tunnel or radiculopathy, particularly with her benign history 

regarding neck activities at work. He advised that there were no repetitive issues or problems 

with her neck and no definitive relationship between appellant’s diffuse complaints of arm pain 

and hand pain to her work activities. Dr. Dennis noted that Dr. Filippone’s December 14, 2011 

EMG tests showed appellant had bilateral carpal tunnel syndrome and cervical radiculopathy at 

C5-6; he opined, however, that these findings were in such contrast with his clinical findings and 

appellant’s medical history that they should be discarded. He stated appellant’s work duties 

entailed repetitive activities but asserted that based on the manner in which she presented her 

symptoms her claimed cervical radiculopathy was not caused by those activities, as she had no 

neck complaints and no findings of cervical radiculopathy on examination. 

With regard to her bilateral wrist complaints, Dr. Dennis opined that her work activities 

could have produced strains to the wrist and crowding of the carpal tunnel; he found that they did 

not, however, because she would have had a more demonstrative history of pain and paresthesias 

and would have shown some clinical findings at that time. He further opined that the fact that 

her complaints of pain did not subside after a year of rest indicated that her work activities were 
5

not the cause of her discomforts or else she would have shown some improvement during this 

period. 

By decision dated April 15, 2013, OWCP denied appellant’s claim, finding that she failed 

to submit sufficient medical evidence to establish that her claimed bilateral carpal tunnel and 

cervical radiculopathy conditions were causally related to her work duties. It was found that 

Dr. Dennis’ impartial opinion represented the weight of the medical evidence. 

On April 19, 2013, appellant’s attorney requested an oral hearing, which was held on 

August 23, 2013. 

In an April 18, 2013 report, received by OWCP on May 15, 2013, Dr. Filippone advised 

that he reexamined appellant on March 12, 2013, at which time he stated that her medical history 

and his review of her systems were unchanged. He stated that there was interval or intercurrent 

history of trauma or injury and that she continued with her previous symptoms and complaints of 

pain, including bilateral hand pain, numbness, tingling and weakness. Dr. Filippone advised that 

she still experienced clicking in her neck and low back; she had persistent pain, guarding and 

spasm in the cervical and lumbar paraspinals, with bilaterally positive Tinel’s and Phalen’s sign 

and Finkelstein maneuver. He did not present an opinion as to whether these findings were 

attributable to employment factors. 

By decision dated November 4, 2013, an OWCP hearing representative affirmed the 

April 15, 2013 decision. 

LEGAL PRECEDENT 

An employee seeking benefits under FECA3 has the burden of establishing that 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 the Act, that the claim was timely filed within the 

applicable time limitation period of the Act, 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 

 3

 5 U.S.C. §§ 8101-8193. 

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

5 Victor J. Woodhams, 41 ECAB 345 (1989). 
6

diagnosed condition is causally related to the employment factors identified by the claimant. 

The medical evidence required to establish causal relationship is usually rationalized medical 

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

Appellant has the burden of establishing by the weight of the substantial, reliable and 

probative evidence, a causal relationship between her claimed bilateral wrist, hand, shoulder and 

neck condition and her federal employment. This burden includes providing medical evidence 

from a physician who concludes that the condition is causally related to employment factors and 

supports that conclusion with sound medical reasoning.7

Section 8123(a) provides that, if there is a 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.8

 It is well established that, when a 

case is referred to an impartial medical specialist for the purpose of resolving a conflict, the 

opinion of such specialist, if sufficiently well rationalized and based on a proper factual and 

medical background, must be given special weight.9

ANALYSIS 

OWCP properly determined that a conflict existed in the medical opinion evidence 

between appellant’s treating physician, Dr. Filippone, and the OWCP second opinion physician, 

Dr. Heist, as to whether appellant had bilateral carpal tunnel syndrome or cervical radiculopathy 

causally related to factors of her federal employment. Appellant was therefore properly referred 

to Dr. Dennis for an impartial medical evaluation. 

On appeal, appellant’s attorney argues that Dr. Dennis’ impartial medical report was not 

sufficiently rationalized and presented inaccurate conclusions regarding the work relatedness of 

appellant’s claimed bilateral carpal tunnel and cervical radiculopathy conditions. He argues that 

Dr. Dennis’ opinion is deficient because although he noted that EMG testing showed bilateral 

carpal tunnel syndrome and right C5-6 cervical radiculopathy on December 2011, he did not 

discuss the significance of these tests and indicated, contrary to the results of this EMG test, that 

appellant did not have carpal tunnel syndrome or cervical radiculopathy. Counsel asserts that 

this opinion conflicts with the opinions of Dr. Filippone and Dr. Heist and that Dr. Dennis gave 

insufficient reasons for “discarding” the EMG test results. He further argues that Dr. Dennis did 

 6 Id.

7 See Nicolea Bruso, 33 ECAB 1138, 1140 (1982). 

8 Regina T. Pellecchia, 53 ECAB 155 (2001). 

9 Jacqueline Brasch (Ronald Brasch), 52 ECAB 252 (2001). 
7

not describe what neurologic testing he performed in finding that appellant did not have carpal 

tunnel syndrome or cervical radiculopathy and in finding the nerves of the brachial plexus and 

ulnar distributions were normal. Counsel asserts that, absent an explanation as to why the EMG 

tests had to be “discarded,” Dr. Dennis’ report is not well reasoned and did not merit the special 

weight of a referee medical examiner. 

The Board does not accept counsel’s contentions. In his March 14, 2013 report 

Dr. Dennis acknowledged that Dr. Filippone’s December 14, 2011 EMG tests indicated bilateral 

carpal tunnel syndrome and cervical radiculopathy at C5-6 but discounted these findings because 

they were outweighed by his clinical findings and appellant’s medical history, which provided 

insufficient evidence that she had sustained these conditions. He stated that appellant engaged in 

repetitive work activities but advised that, based on the manner in which she presented her 

symptoms on examination, her claimed cervical radiculopathy and bilateral carpal tunnel 

syndrome were not caused by those activities. Dr. Dennis opined that her work activities could 

have produced strains to both wrists and crowding of the carpal tunnel but found that this did not 

occur given the lack of pain, paresthesias and clinical findings manifested in her medical history. 

He opined that the fact that appellant’s complaints of pain did not subside after a year of rest 

showed that her work activities were not the cause of her discomforts; otherwise they would 

have shown some improvement during this period. 

Dr. Dennis found no clinical objective pathology to support a diagnosis of repetitive 

activities producing carpal tunnel or cervical radiculopathy. He advised that cervical and lumbar 

MRI scans of the cervical and lumbar spine showed some mild degenerative changes but no disc 

herniations, that X-rays of the wrists showed a small degree of arthritis, that bony structures of 

the carpal and metacarpal bones and x-rays of the cervical spine were normal. Dr. Dennis 

asserted that his examination for carpal tunnel syndrome and cervical radiculopathy was 

negative. He advised that appellant had no repetitive issues or problems with her neck and that 

there was no definitive connection between her diffuse complaints of arm pain and hand pain and 

her work activities. Dr. Dennis concluded that appellant’s bilateral wrist, hand, shoulder and 

neck conditions were essentially due to arthritis, not causally related to her work activities. 

OWCP relied on Dr. Dennis’ opinion in its April 15, 2013 decision, finding that appellant had 

not established that she had bilateral carpal tunnel and cervical radiculopathy conditions causally 

related to her employment. 

The Board finds that Dr. Dennis’ impartial opinion finds that appellant does not have 

carpal tunnel syndrome or cervical radiculopathy causally related to her employment. 

Dr. Dennis’ opinion is sufficiently probative, rationalized, and based upon a proper factual 

background. Therefore, OWCP properly accorded Dr. Dennis’ opinion the special weight of an 

impartial medical examiner.10 The Board therefore finds that Dr. Dennis’ opinion constituted the 

weight of medical opinion and supports the OWCP’s April 15, 2013 decision finding that 

appellant did not sustain bilateral carpal tunnel and cervical radiculopathy conditions in the 

performance of duty. 

 10 Gary R. Seiber, 46 ECAB 215 (1994). 
8

Appellant subsequently requested an oral hearing and submitted the April 18, 2013 report 

from Dr. Filippone. This report merely reiterates his previous findings and conclusions. 

Dr. Filippone stated that appellant’s medical history and his review of her symptoms were 

unchanged. He advised that she continued with her previous symptoms and complaints of pain, 

including bilateral hand pain, numbness, tingling and weakness, in addition to persistent pain, 

guarding and spasm in the cervical and lumbar paraspinals. His report, however, did not contain 

an opinion as to whether these findings were attributable to employment factors. Dr. Filippone’s 

report merely restates one side of the conflict in medical evidence which was resolved by 

Dr. Dennis’ opinion. He did not provide a sufficiently reasoned and factually supported opinion 

that would vitiate OWCP’s April 15, 2013 determination that appellant’s claimed bilateral carpal 

tunnel and cervical radiculopathy conditions were not causally related to her employment.11 

Thus the Board will affirm the OWCP hearing representative’s November 5, 2013 decision. 

An award of compensation may not be based on surmise, conjecture or speculation. 

Neither the fact that appellant’s condition became apparent during a period of employment nor 

the belief that her condition was caused, precipitated or aggravated by her employment is 

sufficient to establish causal relationship.12 Causal relationship must be established by 

rationalized medical opinion evidence and appellant failed to submit such evidence. 

Appellant has not met her burden of proof in establishing that her claimed bilateral carpal 

tunnel and cervical radiculopathy conditions were causally related to her employment. For this 

reason, she has not discharged her burden of proof to establish her claim that these conditions 

were sustained in the performance of duty. 

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 failed to meet her burden of proof to establish that she 

sustained bilateral carpal tunnel and cervical radiculopathy conditions in the performance of 

duty. 

 11 Furthermore, the form report from Dr. Filippone which supports causal relationship with a check mark is 

insufficient to establish the claim, as the Board has held that without further explanation or rationale, a checked box 

is not sufficient to establish causation. Debra S. King, 44 ECAB 203 (1992); Salvatore Dante Roscello, 31 ECAB 

247 (1979). 

12 See Seiber, supra.
9

ORDER 

IT IS HEREBY ORDERED THAT the November 4, 2013 decision of the Office of 

Workers’ Compensation Programs’ be affirmed. 

Issued: September 9, 2014 

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