United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

L.A., Appellant 

and 

DEFENSE HEALTH AGENCY, NATIONAL 

CAPITAL REGION MEDICAL 

DIRECTORATE, Bethesda, MD, Employer 

__________________________________________ 

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Docket No. 16-1352 

Issued: August 28, 2017 

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant1

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

PATRICIA H. FITZGERALD, Deputy Chief Judge 

COLLEEN DUFFY KIKO, Judge 

ALEC J. KOROMILAS, Alternate Judge 

JURISDICTION 

On June 14, 2016 appellant filed a timely appeal from an April 13, 2016 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

 In all cases in which a representative has been authorized in a matter before the Board, no claim for a fee for 

legal or other service performed on appeal before the Board is valid unless approved by the Board. 20 C.F.R. 

§ 501.9(e). No contract for a stipulated fee or on a contingent fee basis will be approved by the Board. Id. An 

attorney or representative’s collection of a fee without the Board’s approval may constitute a misdemeanor, subject 

to fine or imprisonment for up to one year or both. Id.; see also 18 U.S.C. § 292. Demands for payment of fees to a 

representative, prior to approval by the Board, may be reported to appropriate authorities for investigation. 

2

 5 U.S.C. § 8101 et seq. 

3

 The Board notes that appellant submitted additional evidence on appeal and to OWCP after the April 13, 2016 

decision was issued. The Board’s jurisdiction 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 left wrist and upper 

extremity conditions causally related to a July 21, 2015 employment incident. 

FACTUAL HISTORY 

On September 29, 2015 appellant, then a 46-year-old medical technologist, filed a 

traumatic injury claim (Form CA-1) for a left wrist injury that allegedly occurred in the 

performance of duty on July 21, 2015. She explained that she had been performing microscopic 

work and using a manual counter with her left hand when she experienced pain in her left wrist. 

In a July 30, 2015 narrative statement, appellant indicated that she had severe pain in her 

left wrist and cervical spine due to repetitive motion at work over the past two months. She 

noted that OWCP had previously accepted a cervical condition under File No. xxxxxx345 and 

she believed that her condition had been aggravated by constant use of a microscope while 

digitally counting cells, using a computer to enter results, constant standing, and bending her 

head down to assist doctors with bone marrow procedures. 

On July 21, 2015 Dr. Sharda Katyal, a Board-certified occupational medicine specialist, 

diagnosed neck pain and left wrist pain and asserted that appellant had sustained a work-related 

injury that day. He reported that appellant’s federal duties required working in the department of 

pathology in laboratory services, which included bone marrow duties and manual differential 

counts. Dr. Katyal found that appellant was developing symptoms in her left hand and forearm 

and noted that she also had a preexisting cervical condition that had been aggravated by her 

manual count of bone marrow. He described her duties as assisting physicians and prepping 

patients by holding them still during procedures, which put strain on her cervical spine. 

Dr. Katyal also reported that appellant was asked to perform manual differential counts that 

required repeatedly looking under a microscope and manually using her left hand which caused 

pain in her left wrist and forearm. 

In a July 22, 2015 referral form, Dr. Katyal reiterated that appellant had sustained an 

occupational injury and advised that she work under the following restrictions for the period 

July 21 through September 1, 2015: no use of left arm, no use of left hand, no fine manipulation, 

no lifting or carrying over 10 pounds, and no pulling or pushing over 10 pounds. Appellant also 

advised appellant to avoid bone marrow duties and manual differential counts. 

A July 23, 2015 electromyography (EMG) report was normal and showed no evidence of 

an entrapment neuropathy at the wrist or elbow bilaterally, nor was there evidence of a cervical 

radiculopathy, brachial plexopathy, or a generalized polyneuropathy. A September 3, 2015 

magnetic resonance imaging (MRI) scan of the left wrist revealed tendinosis and a tendon tear. 

In an August 20, 2015 report, Dr. Solomon Rojhani, a physiatrist, asserted that appellant 

presented with left wrist pain radiating to the left hand and lower arm. He opined that this was a 

chronic condition which had worsened in the past couple of months and was “aggravated by 

activity.” Dr. Rojhani also asserted that appellant had a chronic neck problem and diagnosed 

cervicalgia status post C5-7 fusion. 
3

In an August 27, 2015 report, Dr. Akhil Chhatre, a Board-certified physiatrist, stated that 

appellant was receiving treatment for her cervicalgia status post C5-7 fusion and left wrist 

tendinitis. He asserted that appellant had a history of cervical radicular pain that was treated 

with a C5-7 fusion and “continue[d] to have residual radicular pain that radiate[d] to her left 

arm.” Dr. Chhatre reported that appellant presented with left wrist pain on July 21, 2015. A 

clinical examination demonstrated a negative Tinel’s sign, an EMG showed no chronic nerve 

damage in her left upper extremity, and an x-ray of the left wrist revealed no fracture, 

dislocation, or soft tissue swelling. Dr. Chhatre reiterated his diagnosis of left wrist tendinitis 

and advised her to avoid certain activities in her job, which required repetitive motion, including 

manual differential counts and bone marrow duties. 

On September 28, 2015 Dr. Chhatre diagnosed cervicalgia, left wrist pain, left wrist 

tendinitis, and upper extremity tendon tear, left, sequela. 

On October 21, 2015 appellant, through counsel, requested authorization for surgery of 

her left wrist condition. 

In a November 9, 2015 letter, OWCP indicated that when appellant’s claim was received 

it appeared to be a minor injury that resulted in minimal or no lost time from work and, based on 

these criteria and because the employing establishment had not controverted continuation of pay 

or challenged the case, payment of a limited amount of medical expenses was administratively 

approved. It stated that it had reopened the claim for consideration because appellant requested 

authorization for surgery. OWCP requested additional evidence and afforded appellant 30 days 

to respond to its inquiries. 

In response, appellant submitted a November 13, 2015 narrative statement claiming that 

she had been experiencing discomfort while performing manual differential counts since the end 

of June 2015. On July 21, 2015 while performing manual cell differential counts, which she had 

been doing “nonstop since May,” she suddenly experienced excruciating pain, weakness, 

inability to grip anything, tenderness, warmth, burning, and stiffness in her left wrist and little 

finger, which stopped her from continuing counting cells. Appellant stated that a bone marrow 

procedure was also scheduled for that day and she went to a room to prepare a patient and had a 

lot of pain and difficulty while trying to move her left wrist. She also experienced sharp pain 

when entering data into the computer at work. Appellant stated that her left wrist tendon tear 

injury occurred on July 21, 2015 due to the repetitive motion tasks she had performed at work 

during the two and a half months prior. She also submitted a November 20, 2015 MRI scan of 

the cervical spine which showed a normal evaluation of the spinal cord and no significant canal 

or foraminal narrowing in the cervical spine. 

In progress reports dated October 22 through November 17, 2015, Dr. Chhatre reiterated 

his diagnoses. On December 3, 2015 he opined that appellant should remain off work until 

cleared by an orthopedic surgeon for the tendon tear in her left wrist. On December 8, 2015 

Dr. Chhatre reiterated his diagnoses and asserted that appellant had some minor discomfort in 

her left wrist for a couple of months prior to July 21, 2015. On the date of injury, appellant was 

performing manual cell differential counts with her left hand at work, using a digital cell counter. 

While she was doing this, she had her head on a microscope and was entering data into the 

computer while typing with her right hand. Appellant suddenly had an intolerable pain in her 
4

left hand that prevented her from continuing to count the cells. She stated that as the day 

progressed she could not even use her left hand, even to type on the computer. 

By decision dated December 22, 2015, OWCP denied the claim on the basis that the 

medical evidence failed to establish a causal relationship between appellant’s diagnosed 

conditions and the July 21, 2015 employment incident. 

On January 29, 2016 appellant, through counsel, requested reconsideration and submitted 

a January 14, 2015 report from Dr. Chhatre who opined that appellant incurred the diagnosed 

conditions of tendinitis and/or tendinosis of the left wrist and a left upper extremity tendon tear 

as a result of doing a microscopic cell count on July 21, 2015.4

 In a February 18, 2016 report, 

Dr. Chhatre advised that appellant should remain off work for three months until cleared by an 

orthopedic surgeon. 

By decision dated April 13, 2016, OWCP denied modification of its prior decision. 

LEGAL PRECEDENT 

An employee seeking benefits under FECA5 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, that an injury6

 was sustained in the performance of 

duty, as alleged, and that any disability or medical condition for which compensation is claimed 

is causally related to the employment injury.7

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. 

A fact of injury determination is based on two elements. First, the employee must submit 

sufficient evidence to establish that she actually experienced the employment incident at the 

time, place, and in the manner alleged. 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. An employee may establish that the employment incident occurred, as alleged, 

but fail to show that his or her condition relates to the employment incident.8

 4

 The report was most likely dated January 14, 2016; otherwise it would have been more than 6 months prior to 

the July 21, 2015 employment incident. 

5 Supra note 1. 

6

 OWCP regulations define a traumatic injury as a condition of the body caused by a specific event or incident, or 

series of events or incidents, within a single workday or shift. Such condition must be caused by external force, 

including stress or strain, which is identifiable as to time and place of occurrence and member or function of the 

body affected. 20 C.F.R. § 10.5(ee). 

7 See T.H., 59 ECAB 388 (2008). 

8 Id.
5

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

establish causal relationship is rationalized medical opinion 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 of the relationship between the diagnosed condition and the specific employment factors 

identified by the employee.9

ANALYSIS 

OWCP has accepted that the employment incident of July 21, 2015 occurred at the time, 

place, and in the manner alleged. The issue is whether appellant’s left wrist and upper extremity 

conditions resulted from the July 21, 2015 employment incident. The Board finds that appellant 

failed to meet her burden of proof to establish causal relationship between the conditions for 

which compensation is claimed and the accepted employment incident. 

In his reports, Dr. Chhatre diagnosed left wrist tendinitis and upper extremity tendon tear, 

left, sequela. He opined that appellant incurred the diagnosed conditions as a result of doing a 

microscopic cell count on July 21, 2015. Dr. Chhatre asserted that on the date of injury appellant 

was performing manual cell differential counts with her left hand at work, using a digital cell 

counter. While she was doing this, appellant had her head on a microscope and was entering 

data into the computer while typing with her right hand when she suddenly felt an intolerable 

pain in her left hand. A clinical examination demonstrated a negative Tinel’s sign, an EMG 

showed no chronic nerve damage in her left upper extremity, and an x-ray of the left wrist 

revealed no fracture, dislocation, or soft tissue swelling. The Board finds that Dr. Chhatre failed 

to provide sufficient medical rationale as to how performing microscopic work and using a 

manual counter at work on July 21, 2015 caused or aggravated appellant’s left wrist and upper 

extremity conditions. Dr. Chhatre noted that appellant’s conditions occurred while she was at 

work, but such generalized statements do not establish causal relationship because they merely 

repeat appellant’s allegations and are unsupported by adequate medical rationale explaining how 

her physical activity at work actually caused or aggravated the diagnosed conditions.10 He did 

not otherwise sufficiently explain how diagnostic testing and examination findings led him to 

conclude that the July 21, 2015 incident at work caused or contributed to the diagnosed 

conditions. As such, the Board finds that the reports from Dr. Chhatre are insufficient to 

establish left wrist and upper extremity conditions causally related to the July 21, 2015 

employment incident. 

Dr. Rojhani diagnosed radiating left wrist pain and opined that appellant had a chronic 

condition which had worsened in the past couple of months and was “aggravated by activity.” 

Dr. Katyal diagnosed left wrist pain and asserted that appellant had sustained a work-related 

injury on July 21, 2015 as a result of her bone marrow duties and manual differential counts. 

The Board finds that Drs. Rojhani’s and Katyal’s diagnosis of left wrist pain is a description of a 

 9 Id.

10 See K.W., Docket No. 10-98 (issued September 10, 2010). 
6

symptom rather than a clear diagnosis of a medical condition.11 Moreover, appellant’s doctors 

did not provide sufficient medical rationale explaining how her left wrist pain was caused or 

aggravated by performing microscopic work and using a manual counter at work on 

July 21, 2015. For these reasons, the Board finds that the reports from Drs. Rojhani and Katyal 

are insufficient to establish that appellant sustained an employment-related injury. 

Other medical evidence of record, including diagnostic test reports, are of limited 

probative value as they do not specifically address whether appellant’s diagnosed conditions are 

causally related to the July 21, 2015 work incident.12

The Board finds that appellant failed to submit rationalized medical evidence sufficient to 

support her allegation or warrant further development that she sustained left wrist and upper 

extremity conditions causally related to the accepted July 21, 2015 employment incident. 

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 10.607.13

CONCLUSION 

The Board finds that appellant has not met her burden of proof to establish left wrist and 

upper extremity conditions causally related to the July 21, 2015 employment incident. 

 11 The Board has consistently held that pain is a symptom, rather than a compensable medical diagnosis. See P.S., 

Docket No. 12-1601 (issued January 2, 2013); C.F., Docket No. 08-1102 (issued October 10, 2008). 

12 See K.W., 59 ECAB 271 (2007); A.D., 58 ECAB 149 (2006); Linda I. Sprague, 48 ECAB 386 (1997) (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). 

13 The Board notes that appellant may separately file a new occupational disease claim or a claim for a recurrence 

under File No. xxxxxx345. 
7

ORDER 

IT IS HEREBY ORDERED THAT the April 13, 2016 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: August 28, 2017 

Washington, DC 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board