United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

K.K., Appellant 

and 

DEPARTMENT OF VETERANS AFFAIRS, 

VETERANS HEALTH ADMINISTRATION, 

East Orange, NJ, Employer 

__________________________________________ 

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Docket No. 15-1037 

Issued: August 19, 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 

ALEC J. KOROMILAS, Alternate Judge 

JAMES A. HAYNES, Alternate Judge 

JURISDICTION 

On April 8, 2015 appellant filed a timely appeal from the March 13, 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 the claim. 

ISSUE 

The issue is whether appellant has met her burden of proof to establish a recurrence of 

disability as of December 3, 2014, causally related to her accepted December 12, 2011 

employment injury. 

 1

 5 U.S.C. § 8101 et seq. 
2

FACTUAL HISTORY 

On December 15, 2011 appellant, then a 47-year-old medical clerk, filed a claim for a 

traumatic injury alleging that on December 12, 2011 her chair slipped from underneath her and 

she injured her left thumb, wrist, and shoulder. OWCP accepted the claim for a left thumb 

sprain. Following the injury, appellant continued to work in a full-duty capacity. She stopped 

work on December 3, 2014. 

On December 4, 2014 appellant filed a claim for a recurrence of disability alleging an 

increase in disability and time loss from work. She stated that since December 15, 2011 she 

wore a left thumb spica and now wears a hand brace. Appellant alleged her condition had 

worsened after medical treatment. 

Evidence submitted in support of the claim included: December 4, 2014 x-ray reports of 

the hand and wrists, requests for medical treatment, and claims for compensation. 

In a December 3, 2014 report, Dr. Jason M. Cuellar, an orthopedic surgeon, noted that 

appellant injured her left thumb after a fall at work and, since then, has had left thumb pain. He 

noted that the electromyogram (EMG) performed in October showed mild left carpal tunnel 

syndrome in addition to mild cubital tunnel compression but no radiculopathy. Also an x-ray of 

her left hand two years prior showed some carpometacarpal (CMC) joint arthritis. Examination 

findings revealed positive Tinel’s sign over the left cubital tunnel, positive tunnel compression 

test, positive Phalen’s test, weak grip strength, and weak small finger abduction. Dr. Cuellar 

noted that appellant was scheduled for tentative left carpal tunnel release and CMC 

interpositional arthroplasty. In December 3, 2014 CA-17 and OWCP-5c form reports, he noted 

appellant’s history of the December 12, 2011 injury and diagnosed left thumb CMC joint 

osteoarthritis, carpal tunnel syndrome, and cubital tunnel syndrome. 

In a December 2, 2014 CA-20 medical form, Dr. Cuellar noted the history of the 2011 

injury and that there was evidence of concurrent or preexisting disease of carpal tunnel and 

cubital tunnel syndrome. He diagnosed left CMC joint arthritis, left carpal tunnel syndrome, and 

left cubital tunnel syndrome which he opined was caused or aggravated by the fall onto left 

thumb. Dr. Cuellar opined that appellant needed surgery and that she would be able to resume 

light-duty work two months after surgery. 

In a January 7, 2015 medical report, Dr. Abhishek Ganta2

 noted that appellant had a fall 

at work and injured the left thumb. Since then appellant had left thumb pain. Dr. Ganta noted 

results from the initial evaluation of December 3, 2014 and reported that appellant was scheduled 

for tentative left carpal tunnel release and CMC interpositional arthroplasty. 

In a January 22, 2015 letter, OWCP found the evidence received was insufficient to 

establish the recurrence claim. It requested that appellant submit additional factual and medical 

information, including bridging medical evidence to support causal relationship between the 

newly diagnosed conditions and her accepted injury. Appellant was provided 30 days to submit 

the requested information. 

 2

 Dr. Ganta’s credentials are not of record. 
3

In response, OWCP received a February 15, 2015 written statement, requests for medical 

authorization, nerve conduction tests dated October 8, 2014, MRI scan reports dated May 8, 

2012, and x-ray reports dated December 13, 2011 and December 4, 2014. Treatment notes 

between the period May 2012 through February 12, 2015 noted the conditions of carpal tunnel 

syndrome, cubital tunnel syndrome, and left CMC arthritis and that surgery was indicated. 

In a January 11, 2013 report, Dr. Rama Rand, an internist, noted the history of the 

December 12, 2011 fall and provided an impression that appellant had stable left thumb pain 

after her fall onto outstretched hands one year ago. Examination was most consistent with left 

thumb flexor tendinitis but could not rule out less significant contribution from first CMC 

arthritis. A May 9, 2012 radiologic report noted mild degenerative change in the first CMC 

joint. 

By decision dated March 13, 2015, OWCP denied appellant’s claim for recurrence as she 

had not established that she had a return of disability or increased disability as a result of a 

consequential condition. It also noted that the evidence was insufficient to support expanding 

her claim to include additional conditions. 

LEGAL PRECEDENT 

FECA pays compensation for the disability of an employee resulting from personal injury 

sustained while in the performance of duty.3

 Disability means the incapacity, because of an 

employment injury, to earn the wages the employee was receiving at the time of injury. It may 

be partial or total.4

 

A recurrence of disability is defined as the inability to work after an employee has 

returned to work, caused by a spontaneous change in a medical condition which had resulted 

from a previous injury or illness without an intervening injury or new exposure to the work 

environment that caused the illness.5 The Board has held that whether a particular injury causes 

an employee to be disabled for work is a medical question that must be resolved by competent 

and probative medical evidence.6 The weight of medical opinion is determined on the report of a 

physician, who provides a complete and accurate factual and medical history, explains how the 

claimed disability is related to the employee’s work, and supports that conclusion with sound 

medical reasoning.7

 Where no such rationale is present, medical evidence is of diminished 

probative value.8

 

 3

 5 U.S.C. § 8102(a). 

4

 20 C.F.R. § 10.5(f). 

5 Id. at § 10.5(x). See S.F., 59 ECAB 525 (2008); Albert C. Brown, 52 ECAB 152 (2000); Terry R. Hedman, 38 

ECAB 222 (1986). 

6 See R.C., 59 ECAB 546 (2008); Carol A. Lyles, 57 ECAB 265 (2005); Donald E. Ewals, 51 ECAB 428 (2000). 

7 Sandra D. Pruitt, 57 ECAB 126 (2005). 

8 Michael Stockert, 39 ECAB 1186, 1187-88 (1988); see Ronald C. Hand, 49 ECAB 113 (1957). 
4

In order to establish that a claimant’s alleged recurrence of the condition was caused by 

the accepted injury, medical evidence of bridging symptoms between her present condition and 

the accepted injury must support the physician’s conclusion of a causal relationship.9 

For conditions not accepted by OWCP as being employment related, it is the employee’s 

burden to provide rationalized medical evidence sufficient to establish causal relation, not 

OWCP’s burden to disprove such relationship.10 

The general rule respecting consequential injuries is that, when the primary injury is 

shown to have arisen out of and in the course of employment, every natural occurrence that 

flows from the injury is deemed to arise out of the employment, unless it is the result of an 

independent intervening cause, which is attributable to the employee’s own intentional 

conduct.11 The subsequent injury is compensable if it is the direct and natural result of a 

compensable primary injury.12 With respect to consequential injuries, the Board has stated that, 

where an injury is sustained as a consequence of an impairment residual to an employment 

injury, the new or second injury, even though nonemployment related, is deemed, because of the 

chain of causation, to arise out of and in the course of employment and is compensable.13 A 

claimant bears the burden of proof to establish the claim for consequential injury.14

ANALYSIS

OWCP accepted appellant’s December 12, 2011 claim for a left thumb sprain. Appellant 

continued to work in a full-time, full-duty capacity until December 3, 2014 when she stopped 

work. She filed a recurrence claim alleging an increase of pain due to unaccepted conditions of 

carpal tunnel syndrome, cubital tunnel syndrome, and left CMC arthritis. OWCP denied the 

recurrence claim and also found the evidence was insufficient to support expanding appellant’s 

claim to include additional conditions. 

The evidence of record does not establish that appellant either had a return or increase of 

disability due to her accepted left thumb strain work injury of December 12, 2011. There is no 

medical evidence in the record to support that the accepted thumb sprain is still active or that any 

of the additional conditions of carpal tunnel syndrome, CMC arthritis or cubital tunnel syndrome 

are medically connected to the accepted work injury of December 12, 2011. While the medical 

reports detail appellant’s work history and note additional conditions of left carpal tunnel 

syndrome, CMC arthritis, and cubital tunnel syndrome, they fail to provide an opinion on the 

 9 Mary A. Ceglia, 55 ECAB 626 (2004). 

10 G.A., Docket No. 09-2153 (issued June 10, 2010); Jaja K. Asaramo, 55 ECAB 200 (2004); Alice J. Tysinger, 

51 ECAB 638 (2000). 

11 Albert F. Ranieri, 55 ECAB 598 (2004). 

12 Id.; Carlos A. Marrero, 50 ECAB 117 (1998); A. Larson, The Law of Workers’ Compensation § 10.01 (2005). 

13 Kathy A. Kelley, 55 ECAB 206 (2004); see also C.S., Docket No. 11-1875 (issued August 27, 2012). 

14 S.P., Docket No. 14-900 (issued August 8, 2014). 
5

causal relationship of such conditions or provide any medical rationale explaining how such 

conditions are medically connected to the accepted work injury of December 12, 2011. 

In his December 2, 2014 CA-20 medical form, Dr. Cuellar noted there was evidence of 

concurrent or preexisting carpal tunnel and cubital tunnel syndrome. While he opined that the 

conditions of left CMC joint arthritis, left carpal tunnel syndrome, and left cubital tunnel 

syndrome were caused or aggravated by the fall onto left thumb, he provided no medical 

rationale to support his opinion on causal relationship. The Board has found that medical 

conclusions unsupported by rationale are of little probative value.15 The fact that appellant now 

experiences additional conditions to her left wrist does not necessarily mean that it was related to 

her accepted condition. Finally, the Board notes that there is no evidence of any bridging 

symptoms linking appellant’s conditions of carpal tunnel syndrome, cubital tunnel syndrome, 

and CMC arthritis to the accepted condition of left thumb sprain.16

While Dr. Rand opined in his January 11, 2013 report that appellant’s examination was 

most consistent with left thumb flexor tendinitis, he noted that the less significant contribution 

from first CMC arthritis could not be ruled out. He also failed to address causal relationship. 

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.17 Thus, Dr. Rand’s opinion is 

insufficient to establish appellant’s claim. 

Accordingly, the Board finds that appellant has not met her burden of proof in this case 

as she has not submitted a sufficiently reasoned medical opinion explaining why her recurrence 

of disability beginning December 3, 2014 was caused or aggravated by the December 12, 2011 

injury. Appellant also has not submitted medical evidence sufficient to establish that the 

additional conditions diagnosed were a consequence of the December 12, 2011 employment 

injury. 

Appellant contends on appeal that her injury worsened and that she is considering 

surgery. However, as discussed above, none of the medical evidence supports her claim for 

recurrence or her request to expand the 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 failed to meet her burden of proof to establish a recurrence 

of disability as of December 3, 2014, causally related to her December 12, 2011 employment 

injury. 

 15 M.P., Docket No. 14-1289 (issued September 26, 2014). 

16 L.M., Docket No. 13-855 (issued September 12, 2013). 

17 Jaja K. Asaramo, supra note 10. 
6

ORDER 

IT IS HEREBY ORDERED THAT the Office of Workers’ Compensation Programs’ 

decision dated March 13, 2015 is affirmed. 

Issued: August 19, 2015 

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