United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

R.J., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

San Francisco, CA, Employer 

__________________________________________ 

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Docket No. 15-1772 

Issued: October 7, 2016 

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 

VALERIE D. EVANS-HARRELL, Alternate Judge 

JURISDICTION 

On August 13, 20151 appellant filed a timely appeal from a February 18, 2015 merit 

decision of the Office of Workers’ Compensation Programs (OWCP). Pursuant to the Federal 

Employees’ Compensation Act2

 (FECA) and 20 C.F.R. §§ 501.2(c) and 501.3, the Board has 

jurisdiction over the merits of this case.3

 1

 On February 9, 2016 the Board issued an order dismissing the appeal finding that appellant’s appeal was 

untimely filed. Order Dismissing Appeal, Docket No. 15-1772 (issued February 9, 2016). Appellant subsequently 

submitted a U.S. Postal Service postmark confirming that the appeal was timely filed. In an order dated 

September 8, 2016, the Board granted appellant’s petition for reconsideration and reinstated the current appeal. 

Order Granting Petition for Reconsideration and Reinstating Appeal, Docket No. 15-1772 (issued 

September 8, 2016). 

2

 5 U.S.C. § 8101 et seq. 

3

 The Board notes that appellant submitted additional evidence to OWCP after the February 18, 2015 decision 

was issued. The Board’s jurisdiction, however, is limited to reviewing the evidence that was before OWCP at the 

time of its final decision. Therefore, the Board lacks jurisdiction to review this additional evidence. 20 C.F.R. 

§ 501.2(c)(1). 
2

ISSUE 

The issue is whether appellant met her burden of proof to establish bilateral carpal tunnel 

syndrome causally related to factors of her federal employment. 

On appeal, appellant contends that her treating physicians and physical therapist 

submitted supporting evidence to prove that her bilateral carpal tunnel syndrome was due to 

repetitive use of her hands and twisting and grasping mail in the performance of duty. 

FACTUAL HISTORY 

On November 22, 2013 appellant, a 48-year-old mail carrier, filed a recurrence claim 

(Form CA-2a), alleging a recurrence of total disability on November 13, 2013 due to repetitive 

motions with her arms and hands, including repetitively casing mail, lifting packages, trays of 

letters, and flats, and gripping and grasping letters and flats. OWCP had previously accepted 

bilateral/lateral epicondylitis under File No. xxxxxx511, with an August 13, 2008 date of injury. 

In reports dated October 29 and November 13, 2013, Dr. Douglas Thierer, a Boardcertified occupational medicine specialist, diagnosed bilateral carpal tunnel syndrome and 

bilateral lateral epicondylitis. He advised appellant to avoid repetitive and forceful gripping, 

grasping, and pinching activities, especially with her hands in awkward positions. Dr. Thierer 

recommended 5-minute breaks every 25 minutes from repetitive activities involving the hands in 

order to allow for stretching. 

In a December 27, 2013 letter, OWCP advised appellant that it had administratively 

created a new claim for an occupational disease because she indicated an injury or medical 

condition to her bilateral hands and arms on November 13, 2013 due to factors of her federal 

employment. It notified appellant of the deficiencies of her claim and afforded her 30 days to 

submit additional evidence and respond to its inquiries. 

In response, appellant submitted a January 8, 2014 narrative statement reiterating the 

factual history of her claim. 

By decision dated February 19, 2014, OWCP denied the claim because the medical 

evidence of record failed to establish a causal relationship between appellant’s conditions and 

factors of her federal employment. 

By letter dated October 20, 2014, received November 21, 2014, appellant requested 

reconsideration and submitted an occupational disease claim (Form CA-2) alleging bilateral hand 

and arm conditions as a result of repetitive grasping, gripping, and twisting in the performance of 

duty. She further submitted physical therapy reports dated November 11 through 

December 3, 2013. 

In reports dated June 5, 2012 through October 29, 2014, Dr. Thierer reiterated his 

diagnoses and opined that appellant’s symptoms had been present since 2008 and her conditions 

developed over time due to repetitive use of her hands, repetitive gripping, and repetitive 

grasping related to sorting, casing, and delivering mail. On October 29, 2014 he further opined 

that there was strong evidence that a causal relationship existed between a combination of risk 
3

factors (including repetition, force, and posture) and lateral epicondylitis and carpal tunnel 

syndrome. Dr. Thierer observed that appellant’s job included both repetitive and forceful 

activities and noted that she already had an accepted claim for bilateral lateral epicondylitis. He 

concluded that since appellant had already established a causal relationship between her job 

duties and her bilateral lateral epicondylitis condition, it followed that her bilateral carpal tunnel 

syndrome was also causally related to the same repetitive and forceful activities required by her 

job duties. 

In reports dated April 22 and 25, 2014, Dr. Leslie H. Kim, a Board-certified orthopedic 

surgeon, diagnosed chronic progressive left heel plantar fasciitis. On May 5, 2014 she diagnosed 

carpal tunnel syndrome and lateral epicondylitis and reported that appellant believed that her 

injury occurred gradually over time as her work was repetitive in nature due to lifting, pushing, 

and pulling. 

By decision dated February 18, 2015, OWCP denied modification of its prior decision. 

LEGAL PRECEDENT 

An employee seeking benefits under FECA has the burden of proof to establish 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 timely filed within the 

applicable time limitation period of FECA, and that an injury4 was sustained in the performance 

of duty. These are the essential elements of each 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 a claim for an 

occupational disease claim, an employee must submit the following: (1) a factual statement 

identifying employment factors alleged to have caused or contributed to the presence or 

occurrence of the disease or condition; (2) medical evidence establishing the presence or 

existence of the disease or condition for which compensation is claimed; and (3) medical 

evidence establishing that the diagnosed condition is causally related to the employment factors 

identified by the employee.6

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

establish causal relationship is rationalized medical evidence. 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 

 4

 OWCP regulations define an occupational disease or illness as a condition produced by the work environment 

over a period longer than a single workday or shift. 20 C.F.R. § 10.5(q). 

5 See O.W., Docket No. 09-2110 (issued April 22, 2010); Ellen L. Noble, 55 ECAB 530 (2004). 

6 See D.R., Docket No. 09-1723 (issued May 20, 2010). See also Roy L. Humphrey, 57 ECAB 238, 241 (2005); 

Ruby I. Fish, 46 ECAB 276, 279 (1994); Victor J. Woodhams, 41 ECAB 345 (1989). 
4

of the relationship between the diagnosed condition and the specific employment factors 

identified by the employee.7

ANALYSIS 

The Board finds that appellant did not meet her burden of proof to establish her claim that 

federal employment factors caused or aggravated her bilateral carpal tunnel syndrome. 

Appellant identified the factors of employment that she believed caused the condition, including 

repetitive lifting, grasping, gripping, pinching, and twisting with her hands at work, which 

OWCP accepted as factual. However, in order to establish a claim for an employment-related 

injury, she must also submit rationalized medical evidence which explains how her medical 

condition was caused or aggravated by the implicated employment factors.8

In his reports, Dr. Thierer diagnosed bilateral carpal tunnel syndrome and bilateral lateral 

epicondylitis. He opined that appellant’s symptoms had been present since 2008 and her 

conditions developed over time due to repetitive use of her hands, repetitive gripping, and 

repetitive grasping related to sorting, casing, and delivering mail. Dr. Thierer further opined that 

there was strong evidence that a causal relationship existed between a combination of risk factors 

(including repetition, force, and posture) and lateral epicondylitis and carpal tunnel syndrome. 

He noted that appellant’s job included both repetitive and forceful activities and that she already 

had an accepted claim for bilateral lateral epicondylitis. Dr. Thierer concluded that since 

appellant had already established a causal relationship between her job duties and her bilateral 

lateral epicondylitis condition, it followed that her bilateral carpal tunnel syndrome was also 

causally related to the same repetitive and forceful activities required by her job duties. He 

failed, however, to provide a rationalized opinion explaining how factors of appellant’s federal 

employment, such as repetitive lifting, grasping, gripping, pinching, and twisting with her hands 

at work, caused or aggravated her bilateral carpal tunnel syndrome. Dr. Thierer noted that 

appellant’s condition occurred while she was at work, but such generalized observations do not 

establish causal relationship because they merely repeat appellant’s allegations and are 

unsupported by adequate medical rationale to explain how her physical activity at work actually 

caused or aggravated the diagnosed conditions.9

 The Board has held that the mere fact that 

appellant’s symptoms might arise during a period of employment or produce symptoms 

revelatory of an underlying condition does not establish a causal relationship between appellant’s 

condition and her employment factors.10 Dr. Thierer failed to provide a rationalized opinion 

explaining how factors of appellant’s federal employment, such as lifting, grasping, gripping, 

pinching, and twisting, caused or aggravated her bilateral carpal tunnel syndrome. Thus, the 

Board finds that Dr. Thierer’s reports are insufficiently rationalized to establish that appellant’s 

condition was caused or aggravated by factors of her federal employment. 

 7 See O.W., supra note 5. 

8 See A.C., Docket No. 08-1453 (issued November 18, 2008). 

9 See K.W., Docket No. 10-98 (issued September 10, 2010). 

10 See Richard B. Cissel, 32 ECAB 1910, 1917 (1981); William Nimitz, Jr., 30 ECAB 567, 570 (1979). 
5

In his May 5, 2014 report, Dr. Kim diagnosed carpal tunnel syndrome and lateral 

epicondylitis and reported that appellant believed that her injury occurred gradually over time as 

her work was repetitive in nature due to lifting, pushing, and pulling. As noted, the mere fact 

that appellant’s symptoms arise during a period of employment or produce symptoms revelatory 

of an underlying condition does not establish a causal relationship between appellant’s condition 

and her employment factors.11 Therefore, the Board finds that Dr. Kim’s report is insufficient to 

establish that appellant sustained an employment-related injury. 

In support of her claim, appellant submitted physical therapy reports dated November 11 

through December 3, 2013. These documents do not constitute competent medical evidence 

because a physical therapist is not considered a “physician” as defined under FECA.12 As such, 

this evidence is also insufficient to meet appellant’s burden of proof. 

On appeal, appellant contends that her treating physicians and physical therapist 

submitted supporting evidence to prove that her bilateral carpal tunnel syndrome was due to 

repetitive use of her hands and twisting and grasping mail in the performance of duty. Based on 

the findings and reasons stated above, the Board finds appellant’s arguments are not 

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

allegation that she sustained an injury causally related to the accepted employment factors, she 

failed to meet 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 bilateral 

carpal tunnel syndrome causally related to factors of her federal employment. 

 11 See id. 

12 5 U.S.C. § 8101(2) (this subsection defines a physician as surgeons, podiatrists, dentists, clinical psychologists, 

optometrists, chiropractors, and osteopathic practitioners within the scope of their practice as defined by State law); 

See David P. Sawchuk, 57 ECAB 316, 320 n.11 (2006) (lay individuals such as physician assistants, nurses, and 

physical therapists are not competent to render a medical opinion under FECA). 
6

ORDER 

IT IS HEREBY ORDERED THAT the February 18, 2015 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: October 7, 2016 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Valerie D. Evans-Harrell, Alternate Judge 

 Employees’ Compensation Appeals Board