United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

E.B., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Atlanta, GA, Employer 

__________________________________________ 

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Docket No. 15-0924 

Issued: October 1, 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 

PATRICIA H. FITZGERALD, Deputy Chief Judge 

JAMES A. HAYNES, Alternate Judge 

JURISDICTION 

On March 23, 2015 appellant filed a timely appeal from a March 3, 2015 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.2

ISSUE 

The issue is whether appellant has met her burden of proof to establish that she sustained 

right carpal tunnel syndrome in the performance of duty. 

 1

 5 U.S.C. § 8101 et seq. 

2

 Appellant timely requested an oral argument setting forth many facts of her case, but no articulated basis for the 

oral argument. She did not timely respond to the Clerk of the Board’s request to provide a reason for the oral 

argument. By order issued August 14, 2015, the Board denied appellant’s request for oral argument, finding that the 

argument on appeal can be addressed adequately based on a review of the case record. Appellant did not appeal a 

second decision dated March 3, 2015, denying her claim for wage-loss compensation from August 4 to 

December 9, 2014. 
2

FACTUAL HISTORY 

On July 28, 2014 appellant, then a 29-year-old city carrier assistant, filed a traumatic 

injury claim (Form CA-1) alleging that on July 27, 2014 she sustained a right wrist sprain when 

pulling and releasing the emergency brake on her postal vehicle. After the incident, she received 

emergency room treatment.3

 Appellant did not stop work. She worked full-time modified duty 

through September 16, 2014, when the employing establishment reduced her schedule from eight 

hours to four hours a day. Appellant continued working light duty for four hours a day through 

December 12, 2014 and continuing. 

Appellant submitted medical evidence in support of her claim. 

Dr. Tarek A. Nessouli, an attending Board-certified orthopedic surgeon, followed 

appellant beginning on August 12, 2014. He opined that the July 27, 2014 incident caused right 

de Quervain’s tenosynovitis, based on a positive Finkelstein’s test and a negative Tinel’s sign. 

Dr. Nessouli prescribed a thumb spica brace and injected the tendon sheath. He released 

appellant to return to work with no use of the right hand. Dr. Nessouli noted that appellant’s 

presentation as of August 26, 2014 was more characteristic of right carpal tunnel syndrome, as 

she developed numbness in the fingertips and pain over the thenar eminence, as well as positive 

Tinel’s and Phalen’s signs. He extended light duty for 10 days. 

In a September 9, 2014 report, Dr. Nessouli noted that appellant attributed her right wrist 

pain to throwing mail. He restricted appellant to light duty for two weeks “because of the 

minimal Finkelstein test.” On September 23, 2014 Dr. Nessouli diagnosed right carpal tunnel 

syndrome noting that appellant performed repetitive motion in sorting mail. He recommended a 

de Quervain’s release and median nerve release. 

On December 3, 2014 OWCP accepted the claim for de Quervain’s tendinitis of the right 

wrist. It also advised appellant of the additional evidence needed to establish her claim for right 

carpal tunnel syndrome. This evidence would include a report from her attending physician 

explaining how and why the July 27, 2014 right wrist injury resulted in carpal tunnel syndrome. 

Appellant was given 30 days to submit such evidence. 

In response, appellant provided reports from Dr. Nessouli dated from November 11, 2014 

to January 13, 2015, which diagnosed improving de Quervain’s tenosynovitis based on an 

intermittently positive Finkelstein’s test. As of January 13, 2015, appellant had “no evidence of 

carpal tunnel.” 

By decision dated March 3, 2015, OWCP denied appellant’s claim for carpal tunnel 

syndrome, finding that fact of injury was not established. It found that the medical evidence was 

insufficient to establish a diagnosis of right-sided carpal tunnel syndrome. 

 3

 Appellant submitted July 27, 2014 hospital emergency department intake and discharge forms related to a wrist 

sprain. These forms do not contain a legible signature from a physician. Appellant also submitted an August 4, 

2014 form report that does not contain a legible signature. Dr. Benjamin Fernando, an attending internist, released 

appellant to modified work on August 11, 2014, with lifting limited to three pounds. 
3

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 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

The medical evidence required to establish causal relationship is generally 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 

OWCP accepted that appellant sustained right de Quervain’s tenosynovitis due to a 

July 27, 2014 work incident. Dr. Nessouli, an attending Board-certified orthopedic surgeon, 

opined that appellant also sustained right carpal tunnel syndrome. OWCP denied expansion of 

the claim to include carpal tunnel syndrome, finding that the medical evidence did not support 

that appellant sustained the condition. 

Dr. Nessouli initially diagnosed de Quervain’s tenosynovitis on August 12, 2014. 

However, he noted on August 26, 2014 that appellant’s presentation newly indicated carpal 

tunnel syndrome, as she developed paresthesias in the right hand, as well as positive Tinel’s and 

Phalen’s signs. Dr. Nessouli elaborated in September 9 and 23, 2014 reports that appellant 

believed that throwing mail and repetitive motion at work caused right carpal tunnel syndrome. 

However, he did not observe the condition from November 11, 2014 onward. Dr. Nessouli 

reported on January 13, 2015 that appellant no longer had any evidence of carpal tunnel 

syndrome. 

The Board finds that Dr. Nessouli’s opinion is insufficient to establish that appellant 

sustained carpal tunnel syndrome. Although he diagnosed the condition based on objective signs 

on August 26, 2014, Dr. Nessouli did not observe those indicators on subsequent examinations. 

He noted on January 13, 2015 that the condition was no longer present. Also, Dr. Nessouli did 

not explain how and why the July 27, 2014 incident would cause carpal tunnel syndrome. 

 4 Joe D. Cameron, 41 ECAB 153 (1989). 

5 See Irene St. John, 50 ECAB 521 (1999); Michael E. Smith, 50 ECAB 313 (1999). 

6 Solomon Polen, 51 ECAB 341 (2000). 
4

Dr. Nessouli did not offer an independent opinion or connect carpal tunnel syndrome to the 

accepted incident. 

OWCP advised appellant by letter dated December 3, 2014 of the necessity of providing 

her physician’s well-reasoned opinion explaining how and why work factors would cause right 

carpal tunnel syndrome. As appellant did not submit such evidence, it properly denied the claim. 

On appeal appellant argues that she remained debilitated due to her right wrist condition, 

could not tolerate pain medication, and required surgery as recommended by Dr. Nessouli. She 

asserted that Dr. Nessouli’s reports were sufficient to establish a diagnosis of carpal tunnel 

syndrome. As stated above, Dr. Nessouli’s opinion lacked the medical reasoning necessary to 

establish a firm diagnosis of carpal tunnel syndrome. The Board therefore finds that appellant 

has not met her burden of proof to establish a right carpal tunnel claim. Moreover, appellant’s 

pending claim is a traumatic injury claim. She has not pled an injury which is cumulative in 

nature. 

Appellant also alleged a pattern of harassment, retaliation, and wrongdoing by the 

employing establishment due to the accepted injury. The Board does not have jurisdiction over 

such actions of the employing establishment in the pending 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 that she 

sustained carpal tunnel syndrome in the performance of duty. 
5

ORDER 

IT IS HEREBY ORDERED THAT the decision of the Office of Workers’ 

Compensation Programs dated March 3, 2015 is affirmed. 

Issued: October 1, 2015 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 James A. Haynes, Alternate Judge 

 Employees’ Compensation Appeals Board