United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

D.C., Appellant 

and 

DEPARTMENT OF VETERANS AFFAIRS, 

VETERANS ADMINISTRATION MEDICAL 

CENTER, Washington, DC, Employer 

__________________________________________ 

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Docket No. 17-0680 

Issued: June 1, 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 

ALEC J. KOROMILAS, Alternate Judge 

VALERIE D. EVANS-HARRELL, Alternate Judge 

JURISDICTION 

On February 6, 2017 appellant, through counsel, filed a timely appeal from a 

December 27, 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. 

 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. 
2

ISSUE 

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

syndrome causally related to factors of her federal employment. 

FACTUAL HISTORY 

On November 6, 2015 appellant, then a 48-year-old food service worker, filed an 

occupational disease claim (Form CA-2) for left carpal tunnel syndrome.3

 She first became 

aware of her condition on February 12, 2013. However, it was not until July 14, 2015 that 

appellant realized the condition was employment related. On her Form CA-2, appellant omitted 

any description of the particular employment activity/activities she believed either caused or 

contributed to her left carpal tunnel syndrome. The employing establishment represented that 

appellant continued to work, albeit in a light-duty capacity. 

OWCP received September 1 and 14, 2015 records from the employing establishment’s 

occupational health unit where appellant was seen for left hand complaints and initially advised 

not to use her left hand until further evaluation and diagnosis. The occupational health unit 

records are unsigned. 

OWCP also received a September 8, 2015 “Disability Certificate” from Howard 

University’s Orthopedics and Rehabilitative Services.4 The document indicated that appellant 

had been a patient there since 2003. The certificate included the diagnoses of cervical and 

lumbar disc herniation, with neck and back pain, carpal tunnel syndrome, and trigger finger. 

Appellant had been totally incapacitated, but had sufficiently recovered such that she could 

perform light-duty work, effective September 14, 2015. Appellant’s work restrictions included a 

five-pound lifting limitation and she was advised to reduce the frequency of repetitive hand 

action/movements. 

In a December 14, 2015 claim development letter, OWCP informed appellant that the 

documentation received to date, both factual and medical evidence, was insufficient to establish 

entitlement to FECA benefits. It afforded appellant at least 30 days to submit a detailed factual 

statement regarding her implicated employment activities, as well as a narrative medical report 

that included, among other things, a specific diagnosis and a discussion regarding the etiology of 

any diagnosed conditions. 

In a January 6, 2016 narrative statement, appellant indicated that as of November 23, 

2015 she continuously engaged in repetitive motion(s) to complete her assigned duties, which 

included stacking supplies for the steam line, lifting and repositioning materials, preparing meats 

and vegetables for the deli, and lifting/repositioning metal food containers. Additional duties 

 3

 Appellant has an accepted occupational disease claim for right carpal tunnel syndrome, which arose on or about 

June 10, 2013 (OWCP File No. xxxxxx156). She was also injured in a July 7, 1998 work-related fall, which OWCP 

accepted for cervical and lumbar sprains, post-traumatic headache, and left forearm bruise/contusion (OWCP File 

No. xxxxxx966). Appellant initially filed the current left CTS claim as a recurrence (Form CA-2a) of her July 7, 

1998 employment injury. 

4

 The certificate bears no signature, signature stamp, or signature block. 
3

included stocking clear trays, labeling Grab-Go foods, sanitizing the coffee area, refilling coffee 

containers, and providing supplies for the coffee area. Appellant explained that continuous 

lifting and repositioning of equipment and supplies caused a lot of stress on both hands. She also 

indicated that she had been diagnosed with diabetes, but this condition was under control. 

OWCP received a May 13, 2015 left upper extremity electromyography and nerve 

conduction velocity (EMG/NCV) study, which revealed mild carpal tunnel syndrome with no 

evidence of axonapathy. 

OWCP also received another disability certificate from Howard University’s Orthopedics 

and Rehabilitative Services. This one, dated November 23, 2015, was electronically signed by 

Dr. Janaki Kalyanam, a Board-certified physiatrist. Dr. Kalyanam noted that appellant had been 

under her care since 2003. She also noted that appellant was recently evaluated in 2015 and 

diagnosed with bilateral carpal tunnel syndrome. Dr. Kalyanam reiterated the diagnosis of 

bilateral carpal tunnel syndrome, and recommended that appellant continue with occupational 

therapy, twice weekly. 

In a February 17, 2016 decision, OWCP denied appellant’s claim, as the evidence of 

record failed to establish fact of injury. It explained that the medical evidence did not contain a 

diagnosis and also did not establish that the diagnosed condition was causally related to the 

accepted employment factors. 

Counsel timely requested an oral hearing before a representative of OWCP’s Branch of 

Hearings and Review, which was held on October 13, 2016. During the telephonic hearing, 

OWCP’s hearing representative noted that appellant’s accepted claims included a 1998 neck and 

low back injury, and right carpal tunnel syndrome, which arose in 2013. Appellant testified 

during the hearing and the record was kept open for at least 30 days post-hearing in order for 

appellant to submit additional medical evidence. 

OWCP subsequently received a November 3, 2016 report from Dr. Kalyanam, who 

diagnosed bilateral carpal tunnel syndrome, decreased activity tolerance, paresthesias in the left 

hand, and left wrist pain. Dr. Kalyanam noted that appellant had been a patient of hers since 

2003 due to a work injury sustained from a fall, and episodically for exacerbation or reinjury at 

work since 2013 for bilateral carpal tunnel syndrome, which was confirmed by electrodiagnostic 

studies. She asserted that appellant had reported symptom exacerbation with increased activity 

and repetitive movements. Appellant’s current hand complaints included pain, stiffness, weak 

grasp, difficulty opening jars, and numbness. 

By decision dated December 27, 2016, the hearing representative affirmed OWCP’s 

February 17, 2016 denial of appellant’s occupational disease claim, finding that appellant had 

not provided sufficient medical evidence of an employment-related condition to establish her 

claim. 

LEGAL PRECEDENT 

A claimant seeking benefits under FECA has the burden of proof to establish the essential 

elements of his or her claim by the weight of the reliable, probative, and substantial evidence, 
4

including that an injury was sustained in the performance of duty as alleged and that any specific 

condition or disability claimed is causally related to the employment injury.5

In an occupational disease claim, for a claimant to establish that an injury was sustained 

in the performance of duty he or she must submit: (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 

diagnosed condition is causally related to the identified employment factors.6 

To establish causal relationship between the condition, as well as any attendant disability 

claimed, and the employment event or incident, the employee must submit rationalized medical 

opinion evidence based on a complete factual and medical background supporting such causal 

relationship.7 The opinion of the physician 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. This 

medical opinion must include an accurate history of the employee’s employment injury and must 

explain how the condition is related to the injury. The weight of medical evidence is determined 

by its reliability, its probative value, its convincing quality, the care of analysis manifested, and 

the medical rationale expressed in support of the physician’s opinion.8

A medical report should bear the physician’s signature or signature stamp.9 OWCP may 

require an original signature on the report.10

Certain healthcare providers such as physician assistants, nurse practitioners, physical 

therapists, and social workers are not considered “physician[s]” as defined under FECA.11 

 5

 20 C.F.R. § 10.115(e), (f); see Jacquelyn L. Oliver, 48 ECAB 232, 235-36 (1996). Causal relationship is a 

medical question, which generally requires rationalized medical opinion evidence to resolve the issue. See 

Robert G. Morris, 48 ECAB 238 (1996). A physician’s opinion on whether there is a causal relationship between 

the diagnosed condition and the implicated employment factors must be based on a complete factual and medical 

background. Victor J. Woodhams, 41 ECAB 345, 352 (1989). Additionally, the physician’s opinion must be 

expressed in terms of a reasonable degree of medical certainty, and must be supported by medical rationale, 

explaining the nature of the relationship between the diagnosed condition and appellant’s specific employment 

factors. Id. 

6 Victor J. Woodhams, supra note 5. 

7 See C.F.R. § 10.110(a); John M. Tornello, 35 ECAB 234 (1983). 

8 James Mack, 43 ECAB 321 (1991). 

9

 20 C.F.R. § 10.331(a). 

10 Id.

11 5 U.S.C. § 8101(2); 20 C.F.R. § 10.5(t). 
5

Consequently, their medical findings and/or opinions will not suffice for purposes of establishing 

entitlement to FECA benefits.12

ANALYSIS 

Appellant claimed that her duties as a food service worker either caused or contributed to 

her diagnosed left carpal tunnel syndrome.13 The Board finds that appellant did not meet her 

burden of proof to establish that the implicated employment factors either caused or contributed 

to her diagnosed left carpal tunnel syndrome. 

Appellant identified the factors of her federal employment that she believed caused her 

left hand/wrist condition, which included stacking supplies, lifting and repositioning materials, 

preparing meats and vegetables for the deli, stocking clear trays, labeling Grab-Go foods, 

sanitizing the coffee area, refilling coffee containers, and providing supplies for the coffee area. 

She explained that continuous lifting and repositioning of equipment and supplies caused a lot of 

stress on both of her hands. However, in order to establish that she sustained an employmentrelated injury, appellant must submit rationalized medical evidence, which explains how her 

medical condition was caused or aggravated by the implicated employment factors.14

The May 13, 2015 left upper extremity EMG/NCV study confirmed the diagnosis of mild 

carpal tunnel syndrome; however, the electrodiagnostic study did not address the etiology of 

appellant’s left hand/wrist condition. As such, the evidence is not probative on the issue of 

causal relationship.15

With respect to the September 1 and 14, 2015 employing establishment occupational 

health unit records, the Board notes that these were unsigned and did not specifically address the 

cause of appellant’s left hand/wrist complaints. Also, the September 8, 2015 disability slip from 

Howard University’s Orthopedics and Rehabilitative Services is similarly unsigned, and the 

author did not specifically address the cause of appellant’s diagnosed conditions, which included 

carpal tunnel syndrome. Consequently, the above-noted evidence is insufficient to satisfy 

appellant’s burden of proof with respect to causal relationship.16

Dr. Kalyanam found on November 23, 2015 that electrodiagnostic testing of the left 

upper extremity revealed mild carpal tunnel syndrome with no evidence of axonapathy. She 

 12 K.W., 59 ECAB 271, 279 (2007); David P. Sawchuk, 57 ECAB 316, 320 n.11 (2006). A report from a 

physician assistant or certified nurse practitioner will be considered medical evidence if countersigned by a qualified 

physician. Federal (FECA) Procedure Manual, Part 2 -- Claims, Causal Relationship, Chapter 2.805.3a(1) 

(January 2013). 

13 Appellant’s personal belief that employment activities either caused or contributed to her condition is 

insufficient, by itself, to establish causal relationship. 20 C.F.R. § 10.115(e); Phillip L. Barnes, 55 ECAB 426, 

440 (2004). 

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

15 See T.C., Docket No. 16-1652 (issued May 9, 2017); G.G., Docket No. 16-0907 (issued March 20, 2017). 

16 See supra notes 7-10. 
6

indicated that appellant had been under her care since 2003 due to a work injury sustained from a 

fall and episodically for exacerbation or reinjury at work since 2013 for her diagnosis of bilateral 

carpal tunnel syndrome. On November 3, 2016 Dr. Kalyanam diagnosed carpal tunnel syndrome 

of the left wrist and paresthesias in the left hand. She asserted that appellant had reported 

symptomatic exacerbation with increased activity and repetitive movements, including pain, 

stiffness, weak grasp, difficulty opening jars, and numbness. However, Dr. Kalyanam failed to 

provide a rationalized opinion explaining how factors of appellant’s federal employment, such as 

repetitive motions required to stack supplies, lift and reposition materials, prepare meats and 

vegetables, stock trays, label Grab-Go foods, sanitize coffee areas, and refill coffee containers at 

work, caused or aggravated her left carpal tunnel syndrome. She noted that appellant’s condition 

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 condition.17 As such, the Board finds that Dr. Kalyanam’s reports are insufficient to 

establish that appellant’s condition was either caused or aggravated by factors of her federal 

employment. 

As appellant has not submitted rationalized medical evidence to support her allegation 

that she sustained an injury causally related to her duties as a food service worker, she failed to 

meet her burden of proof. 

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 left carpal 

tunnel syndrome causally related to factors of her federal employment. 

 17 See K.W., Docket No. 10-98 (issued September 10, 2010). 
7

ORDER 

IT IS HEREBY ORDERED THAT the December 27, 2016 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: June 1, 2017 

Washington, DC 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board 

 

 Valerie D. Evans-Harrell, Alternate Judge 

 Employees’ Compensation Appeals Board