United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

T.S., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Greenville, NC, Employer 

__________________________________________ 

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Docket No. 15-1954 

Issued: June 5, 2017 

Appearances: Case Submitted on the Record

Appellant, pro se 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

CHRISTOPHER J. GODFREY, Chief Judge 

COLLEEN DUFFY KIKO, Judge 

ALEC J. KOROMILAS, Alternate Judge 

JURISDICTION 

On September 25, 2015 appellant filed a timely appeal from an August 19, 2015 merit 

decision of the Office of Workers’ Compensation Programs (OWCP).1 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 the claim.3

ISSUE 

The issue is whether appellant established total disability for the period April 10 through 

July 13, 2013 due to her accepted left carpal tunnel syndrome. 

 1

 On her application for review (Form AB-1), appellant timely requested oral argument. By order dated 

October 7, 2016, the Board denied the request as her arguments on appeal could be adequately addressed in a 

decision based on a review of the case as submitted on the record. Order Denying Request for Oral Argument, 

Docket No. 15-1954 (issued October 7, 2016). 

2

 5 U.S.C. § 8101 et seq.

3

 The case record provided to the Board includes evidence received after OWCP issued its August 19, 2015 

decision. The Board is precluded from considering evidence that was not in the record at the time OWCP rendered 

its final decision. 20 C.F.R. § 501.2(c)(1). 
2

FACTUAL HISTORY 

On April 9, 2013 appellant then a 43-year-old rural letter carrier, filed a traumatic injury 

claim (Form CA-1) alleging that she had injured her left wrist “casing mail with [her] left hand.” 

She indicated that she bent her wrist trying to hold mail and could not hold the mail with her left 

hand. Appellant reportedly advised her supervisor that she could not do the job because her hand 

was hurting. OWCP assigned File No. xxxxxx310 to the April 9, 2013 left wrist/hand traumatic 

injury claim, which she filed on April 29, 2013. Appellant stopped work on April 9, 2013 and 

resumed work on July 15, 2013. 

In a May 7, 2013 statement, the employing establishment indicated that on April 9, 2013 

appellant had returned to work in a limited-duty capacity as a result of a September 12, 2011 

traumatic injury which had been accepted for right wrist sprain and right de Quervain’s 

tenosynovitis (OWCP File No. xxxxxx920).4 According to the employing establishment, 

appellant’s April 9, 2013 return to work lasted only a few minutes. Her limited-duty assignment 

reportedly required appellant to case one piece of mail at a time using only her left hand. The 

employing establishment indicated that before even attempting to case mail, appellant 

complained to a coworker that she was unable to do the limited-duty assignment. Once she 

began casing, appellant touched only three to four pieces of mail before she gathered her things 

and left the premises. She reportedly left without notifying management of her alleged April 9, 

2013 injury. 

The medical evidence submitted with appellant’s April 29, 2013 Form CA-1 included an 

April 26, 2013 follow-up treatment note and a narrative report from Dr. Christopher M. Barsanti, 

a Board-certified orthopedic surgeon.5 Dr. Barsanti noted having previously treated appellant for 

de Quervain’s and intersection syndrome of the right upper extremity. He further noted that 

appellant had already undergone two right upper extremity surgical procedures, but continued to 

have a significant amount of discomfort.6 Dr. Barsanti reported that appellant had an upcoming 

appointment with a plastic surgeon regarding the right upper extremity, and also had left upper 

extremity carpal tunnel syndrome.7

 He indicated that appellant “tried to get back to work doing 

her normal job and was having quite a bit of discomfort while at work.” Based upon appellant’s 

history, Dr. Barsanti advised that she would not be able to do repetitive-type work in the near 

future. 

OWCP also received April 30, 2013 treatment notes from Dr. Peter P. Ganpat, a family 

practitioner, who saw appellant for left wrist carpal tunnel syndrome. Appellant also underwent 

 4

 As discussed infra, the complete case record under OWCP File No. xxxxxx920 is not part of the combined 

record associated with the current claim, OWCP File No. xxxxxx861. 

5

 Dr. Barsanti is affiliated with Orthopaedics East & Sports Medicine Center. 

6

 Dr. Barsanti performed right wrist surgery on April 7 and October 18, 2012. Appellant had since developed scar 

tissue at the surgical site, which was causing her a significant amount of discomfort. 

7

 In his April 26, 2013 follow-up treatment notes, Dr. Barsanti indicated that “[appellant] told me she also has 

carpal tunnel in her left hand.” 
3

a follow-up visit on May 14, 2013 for left wrist pain, at which time Dr. Geniene N. Jones, a 

family practitioner, diagnosed, inter alia, bilateral carpal tunnel syndrome. 

In a May 28, 2013 medical absence form report, Dr. Barsanti diagnosed “left wrist pain,” 

and indicated “No work at this time.” He stated that the restrictions were necessary pending a 

magnetic resonance imaging (MRI) scan. Dr. Barsanti further advised that appellant should 

return for follow-up after obtaining the MRI scan. 

A May 29, 2013 left wrist MRI scan revealed no evidence of mass lesion or ganglion 

cyst. 

In a May 31, 2013 medical absence form report, Dr. Barsanti advised that appellant could 

not perform any work at that time due to her diagnosed “bilateral wrist” condition(s). The work 

restriction was to remain in effect for six weeks. 

On June 7, 2013 appellant advised OWCP that she wished to withdraw her April 29, 

2013 Form CA-1. She further indicated that she was filing a recurrence claim (Form CA-2a) 

under OWCP File No. xxxxxx920. Appellant alleged that the April 9, 2013 left wrist/hand 

injury was a consequence of her September 12, 2011 employment-related right hand injury. 

By letter dated June 10, 2013, OWCP granted appellant’s request to withdraw her alleged 

April 9, 2013 left wrist/hand traumatic injury under File No. xxxxxx310. 

On June 11, 2013 Dr. Brock J. Niceler, a family medicine and sports medicine specialist, 

examined appellant for complaints of bilateral wrist pain. With respect to her left upper 

extremity, Dr. Niceler noted that appellant had been using her left hand at work, and currently 

had left-hand pain. He indicated that appellant’s left wrist showed signs and symptoms 

consistent with carpal tunnel syndrome. Dr. Niceler ordered an electromyogram and nerve 

conduction velocity study (EMG/NCV) to confirm his preliminary diagnosis. He did not 

comment on appellant’s ability to work with respect to either her right or left upper extremity 

complaints. 

In a July 24, 2013 decision, OWCP denied appellant’s claim for recurrence and/or 

consequential left hand/wrist injury under OWCP File No. xxxxxx920. After requesting a 

hearing, by decision dated June 9, 2014, the Branch of Hearings and Review affirmed the denial, 

noting that the circumstances suggested a new occupational disease claim rather than a claim for 

recurrence of appellant’s September 12, 2011 right upper extremity injury. On April 21, 2014 

appellant filed the current occupational disease claim, File No. xxxxxx861, which OWCP later 

accepted on July 14, 2014 for left carpal tunnel syndrome, with an April 9, 2013 date of injury.8

 8

 Appellant also has an accepted occupational disease claim for right carpal tunnel syndrome (CTS), which arose 

on or about February 10, 2014 (OWCP File No. xxxxxx120). Under File No. xxxxxx120, OWCP paid wage-loss 

compensation for temporary total disability beginning April 5, 2014, and placed appellant on the periodic 

compensation rolls effective August 24, 2014. 
4

Appellant submitted a claim for compensation (Form CA-7) for the period April 10 

through July 13, 2013.9

On September 9, 2014 OWCP combined/doubled the case records with respect to File 

No. xxxxxx120 (right CTS), File No. xxxxxx310 (left wrist/hand traumatic injury -- withdrawn), 

and File No. xxxxxx861 (left CTS).10 It did not include the record associated with appellant’s 

September 12, 2011 injury (File No. xxxxxx920). 

The medical evidence relevant to the claimed period of wage-loss compensation 

beginning April 10, 2013 included the above-referenced evidence submitted under OWCP File 

No. xxxxxx310, as well as the following additional treatment notes and reports. 

In a May 28, 2013 report, Dr. Barsanti indicated that appellant had developed a problem 

with her left wrist, most likely a volar mass, but noted that x-rays showed no evidence of 

abnormality. He advised that he would schedule appellant for a left wrist MRI scan and would 

reevaluate her.11

In his May 31, 2013 treatment notes, Dr. Barsanti indicated that appellant was seen that 

day for follow-up and a recent diagnostic study showed no evidence of a left wrist mass. He 

noted that appellant was currently out of work and advised that he did not think she was “going 

to be able to go back and work in that capacity.” Dr. Barsanti planned to keep appellant out of 

work while undergoing home therapy, and have her follow-up in six weeks. 

In a June 28, 2013 report, Dr. Barsanti advised that he was going to attempt to return 

appellant to work on a limited-duty basis with a three- to five-pound lifting restriction with both 

hands. He opined that the overuse of appellant’s left hand due to the trouble she was having with 

her right hand “exacerbates problems with her left hand.” 

In a July 12, 2013 narrative report, Dr. Barsanti advised that he had been treating 

appellant for right hand pain, which stemmed from her tenosynovitis, radial styloid condition. 

He further noted that appellant called on April 9, 2013 and stated that her left wrist was hurting 

and she was unable to finish her day at work. Dr. Barsanti indicated that he provided appellant a 

medical absence note on April 9, 2013, which excused her from work until she could be further 

evaluated. He eventually saw appellant on April 26, 2013 for follow-up of her right hand 

condition, at which time she also reported having left wrist pain. Dr. Barsanti also noted there 

was documentation from February 2012 of left thumb complaints consistent with trigger 

thumb.12 He explained that the continued overuse of both hands, and specifically overuse of the 

 9

 The employing establishment previously represented that appellant returned to work on July 15, 2013 (Form 

CA-2). On the July 17, 2014 Form CA-7, the employing establishment verified that appellant was in leave without 

pay (LWOP) status from April 10 through July 13, 2013, for a total of 536 hours. 

10 OWCP designated File No. xxxxxx861 as the master file. 

11 Dr. Barsanti also noted that appellant had recently been advised against undergoing further right wrist surgery. 

12 On February 29, 2012 Dr. Barsanti saw appellant for follow-up with respect to her right upper extremity 

condition. He also noted at the time that appellant complained of trouble with her left thumb, and that she had signs 

and symptoms consistent with trigger thumb. Dr. Barsanti reported “he injected the left thumb today.” 
5

left hand that day (April 9, 2013) while having problems with the right hand exacerbated 

appellant’s problems with the left hand, causing her pain. 

Dr. Barsanti also provided separate treatment notes and a medical absence form report, 

both dated July 12, 2013. The follow-up treatment notes indicated that appellant seemed to be 

doing about the same, and that she continued to have intermittent trouble with the left hand 

where she had a trigger thumb and stenosing tenosynovitis. Dr. Barsanti noted that appellant 

previously responded to an injection of that thumb, and he planned to reinject her that same day. 

On physical examination, appellant’s left and right upper extremities were essentially 

unchanged. Dr. Barsanti felt that appellant’s use of her left upper extremity in trying to get back 

to work where she had limited use of her right upper extremity had gone on to more than likely 

precipitate the trigger thumb problem. He was hopeful that the left thumb injection would help 

resolve this problem. 

The July 12, 2013 medical absence form report included a diagnosis of “wrist pain,” and 

Dr. Barsanti noted that appellant could perform light duty with a lifting/carrying limit of three to 

five pounds, five hours per day. 

OWCP also received a July 24, 2013 report and treatment notes from Dr. Jason A. Foltz, 

a family practitioner.13 Dr. Foltz advised that appellant had left carpal tunnel syndrome which 

had been diagnosed on February 27, 2012. He also noted that appellant was currently being 

treated at another facility, Orthopaedics East, for right hand pain (radial styloid 

tenosynovitis/de Quervain’s, ICD-9 Code 727.04). Dr. Foltz reported that appellant stated she 

had called Orthopaedics East on April 9, 2013 complaining that her left wrist was hurting, and 

therefore, was unable to finish her day at work, and he noted that Orthopaedics East had 

provided a work note taking her out of work until she could be further evaluated. He believed 

that appellant’s work-related activities, which included turning wrists to get mail in cases, 

carrying heavy bundles of mail, and sorting mail, affected her previous conditions. Dr. Foltz 

reported that appellant demonstrated decreased strength in her wrists bilaterally with extension 

and flexion, and decreased grip strength in her wrists bilaterally with extension and flexion. 

Physical examination findings reflected decreased pincer strength in left wrist and findings 

consistent with a carpal tunnel diagnosis. Dr. Foltz advised that repetitive-type work does 

increase incidence of left wrist pain. He noted that appellant was using her left hand exclusively 

at work, resulting in left-hand pain. Dr. Foltz noted that continued overuse of the left hand 

would result in paresthesias and cramping in the palmar side. In conclusion, he advised that 

continued overuse of both hands, specifically overuse of appellant’s left hand while having 

problems with the right hand, exacerbated her left wrist problems and caused an increase in pain. 

A July 25, 2013 EMG/NCV showed left greater than right bilateral median neuropathies 

at the wrist, which clinically correlated with moderate-to-severe carpal tunnel syndrome. 

By decision dated October 7, 2014, OWCP denied appellant’s claim for wage-loss 

compensation beginning April 10, 2013. It found that she failed to submit sufficient medical 

evidence to establish disability during the claimed period. OWCP also noted that a light/limitedduty assignment was available within appellant’s medical restrictions during the claimed period, 

 13 Alexis P. Goss, a certified physician assistant (PA-C), authored the report, which Dr. Foltz countersigned. 
6

and appellant had not provided evidence to support her claimed inability to perform the 

light/limited-duty assignment. 

Appellant timely requested an oral hearing, which was held on July 2, 2015. During the 

hearing she explained that for the claimed period -- April 10 through July 13, 2013 -- OWCP had 

paid her wage-loss compensation for partial disability under OWCP File No. xxxxxx920 (right 

de Quervain’s tenosynovitis), but that she was seeking compensation for the remaining hours 

under the current claim (OWCP File No. xxxxxx861) due to her inability to work with her left 

hand. 

OWCP also received additional medical evidence following its October 7, 2014 decision, 

which included reports and/or treatment notes from Dr. Barsanti dated August 15, October 6, 

2014, and July 3, 2015. 

In an August 15, 2014 report, Dr. Barsanti indicated that appellant complained of chronic 

pain and swelling in her left wrist and on April 9, 2013 she was no longer able to do left-handed 

work and was taken off work. He also noted that appellant had symptoms consistent with carpal 

tunnel syndrome, which included numbness and paresthesia in the median nerve distribution. 

Dr. Barsanti further indicated that appellant received several injections before returning to work 

on July 15, 2013 at which time she was not allowed to lift more than five pounds. He also noted 

August 27, 2013 EMG/NCV studies showed severe carpal tunnel syndrome. Dr. Barsanti 

diagnosed left carpal tunnel syndrome and trigger thumb. He explained that carpal tunnel 

syndrome was related to repetitive use of the hands on a continuous basis and noted that onehanded work was not an option. Dr. Barsanti also indicated that appellant was unable to work as 

a rural carrier and was unable to use her left hand, and as of February 11, 2014 she had been 

taken out of work indefinitely. 

In his October 6, 2014 follow-up treatment notes, Dr. Barsanti explained that appellant 

continued to have trouble with her trigger thumb on the left side, in addition to carpal tunnel 

symptoms on the left side. He reported that she had received two injections for her trigger 

thumb, but did not think another injection was needed. Dr. Barsanti advised that he had 

discussed the option of carpal tunnel release and noted the possibility that appellant could 

develop a keloid. He opined that her injuries were most likely job related “with overuse sort of 

syndrome.” 

On May 22, 2015 appellant underwent a left carpal tunnel release, which OWCP 

authorized.14

In a July 3, 2015 report, Dr. Barsanti essentially reiterated his previous findings and 

conclusions. He indicated that appellant was given a work excuse note for April 9, 2013. 

Dr. Barsanti further noted that she developed an inability to work with the left hand from 

April 10 through July 12, 2013 due to chronic pain as a result of left carpal tunnel syndrome. He 

reported that appellant was released to return to work with restrictions effective July 13, 2013. 

 14 Dr. Jacob R. Bosley, a Board-certified orthopedic surgeon, performed the May 22, 2015 left endoscopic carpal 

tunnel release. 
7

Effective July 7, 2015, appellant’s surgeon released her to full duty with no “left upper 

extremity” restrictions. 

By decision dated August 19, 2015, the hearing representative affirmed OWCP’s 

October 27, 2014 decision denying appellant’s claim for wage-loss compensation for the period 

April 10 through July 13, 2013. She noted appellant’s bilateral upper extremity claims, 

including her September 12, 2011 right upper extremity traumatic injury under claim number 

OWCP File No. xxxxxx920 (de Quervain’s tenosynovitis). The hearing representative also 

noted that appellant had filed an April 9, 2013 recurrence/consequential injury claim under 

OWCP File No. xxxxxx920, which OWCP had previously denied. As to the current 

occupational disease claim, which OWCP had accepted for left carpal tunnel syndrome (OWCP 

File No. xxxxxx861), the hearing representative found that appellant had not established 

disability for the claimed period because the medical evidence of record failed to establish why 

she was unable to perform her three-hour left-handed, limited-duty assignment on or after 

April 9, 2013. The hearing representative also noted that in several of his reports Dr. Barsanti 

noted complaints of left wrist pain, but the hearing representative indicated that “findings of pain 

alone” were not compensable. 

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, 

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.15

Disability means “the incapacity, because of an employment injury, to earn the wages the 

employee was receiving at the time of injury.”16 Disability may be partial or total.17 The 

question of whether an employee is disabled for work is an issue that must be resolved by 

competent medical evidence.18 The employee is responsible for providing sufficient medical 

evidence to justify payment of any compensation sought.19

 15 20 C.F.R. § 10.115(e), (f); see Jacquelyn L. Oliver, 48 ECAB 232, 235-36 (1996). Causal relationship is a 

medical question that 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 factor(s) 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 

factor(s). Id.

16 20 C.F.R. § 10.5(f). 

17 Id.

18 See R.C., 59 ECAB 546, 551 (2008). 

19 20 C.F.R. § 10.501(a). 
8

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

therapists, and social workers are not considered “physician[s]” as defined under FECA.20 

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

entitlement to FECA benefits.21

ANALYSIS 

OWCP accepted the current occupational disease claim, File No. xxxxxx861, for left 

carpal tunnel syndrome, with an April 9, 2013 date of injury. Appellant seeks wage-loss 

compensation for partial disability (three hours/day) for the period April 10 through 

July 13, 2013. According to the employing establishment, appellant returned to work on April 9, 

2013 in a part-time, limited-duty capacity. The employing establishment represented that the 

assignment required use of the left hand only, and had been designed to accommodate 

appellant’s right upper extremity limitations due de Quervain’s tenosynovitis, which OWCP 

accepted under File No. xxxxxx920. The record indicates that appellant reported for duty on 

April 9, 2013, but left soon after she had arrived. Appellant claimed that her employment-related 

left carpal tunnel syndrome precluded her from performing the part-time, left-hand-only 

assignment. The employing establishment indicated that before she even attempted to case mail, 

appellant complained to a coworker that she was unable to do the job, and once she began 

casing, appellant touched only three to four pieces of mail before she gathered her belongings 

and left the premises. As of July 15, 2013, appellant resumed work in a part-time (five 

hours/day), limited-duty capacity.22

For the claimed period April 10 through July 13, 2013, the Board finds that appellant did 

not met her burden of proof to establish that she was disabled for work due to her accepted left 

carpal tunnel syndrome. 

Dr. Barsanti reported that appellant called on April 9, 2013 and stated that her left wrist 

was hurting and she was unable to finish her day at work. He also indicated that appellant 

received a medical absence note on April 9, 2013 excusing her from work until she could be 

further evaluated. Dr. Barsanti did not examine appellant until more than two weeks later. As 

such, the record is devoid of any contemporaneous physical examination findings and/or 

diagnostic evidence that would support appellant’s claimed disability for the period April 10 

through April 25, 2013. The referenced April 9, 2013 medical absence note is not in the 

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

21 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). 

22 Dr. Barsanti’s July 12, 2013 medical absence form report noted that appellant could perform light duty with a 

lifting/carrying limit of three to five pounds, five hours per day. 
9

record.23 Appellant’s self-certification of her inability to work due to left hand/wrist complaints 

beginning April 9, 2013 will not suffice.24

When Dr. Barsanti eventually examined appellant on April 26, 2013, he noted that in 

addition to her right upper extremity condition, she also had left upper extremity carpal tunnel 

syndrome. Appellant reportedly told him that she had carpal tunnel in her left hand. 

Additionally, Dr. Barsanti indicated that appellant “tried to get back to work doing her normal 

job and was having quite a bit of discomfort while at work.” He appears to have been 

misinformed about the type of work appellant was doing on April 9, 2013. The record does not 

support Dr. Barsanti’s representation that appellant tried to get back to work “doing her normal 

job.” His April 26, 2013 medical records made no mention of appellant having worked just a 

few minutes of her scheduled three-hour left-hand-only limited-duty assignment. Dr. Barsanti 

also failed to explain why he excused appellant from all work for the next two-month period. A 

physician’s opinion should be based on a complete factual and medical background, and should 

also include medical rationale supporting his/her conclusion(s).25

On April 30, 2013 Dr. Ganpat diagnosed left carpal tunnel syndrome, and on May 14, 

2013 Dr. Jones diagnosed bilateral carpal tunnel syndrome. However, neither physician 

indicated what, if any, work restrictions appellant had with respect to her left upper extremity. 

Accordingly, their respective reports are insufficient to establish entitlement to wage-loss 

compensation for the claimed period due to appellant’s accepted left carpal tunnel syndrome. 

On May 28, 2013 appellant returned for a follow-up visit with Dr. Barsanti. He 

continued to keep her off work pending the results of a left wrist MRI scan. Appellant’s May 29, 

2013 left wrist MRI scan revealed no evidence of mass lesion or ganglion cyst. When she 

returned to see Dr. Barsanti on May 31, 2013, he advised that appellant could not perform any 

work at the time due to her diagnosed “bilateral wrist” condition(s). Appellant was to remain off 

work for at least six weeks. However, Dr. Barsanti failed to explain or elaborate as to why 

appellant was unable to work given that her recent left upper extremity x-ray and MRI scan both 

revealed no abnormalities. In the absence of rationale to support his conclusion, Dr. Barsanti’s 

May 28 and 31, 2013 disability assessments are of limited probative value.26

Dr. Niceler examined appellant on June 11, 2013 and noted that she had been using her 

left hand at work, and currently had left-hand pain. Appellant’s left wrist showed signs and 

symptoms consistent with carpal tunnel syndrome. Dr. Niceler ordered an EMG/NCV to 

confirm his preliminary diagnosis. He did not specifically comment on appellant’s ability to 

work. Therefore, Dr. Niceler’s June 11, 2013 report is of limited probative value with respect to 

appellant’s entitlement to wage-loss compensation for the claimed period. 

 23 See supra notes 20 and 21. 

24 20 C.F.R. § 10.501(a); see R.C., supra note 18. 

25 See Victor J. Woodhams, supra note 15. 

26 Id.
10

In a June 28, 2013 follow-up report, Dr. Barsanti advised that he was going to try to 

return appellant to work on a limited-duty basis with a three- to five-pound lifting restriction 

with both hands. He thought that overuse of appellant’s left hand due to the trouble she was 

having with her right hand “exacerbates problems with her left hand.” Again, Dr. Barsanti 

offered no explanation of how appellant’s relatively brief work exposure on April 9, 2013 

constituted “overuse” that ostensibly exacerbated her left hand problems, thereby precluding her 

from all work for an approximate three-month period. It is apparent that Dr. Barsanti relied on 

an inaccurate and/or incomplete factual background, which undermines the probative value of 

his opinion.27 While Dr. Barsanti released appellant to return to work on June 28, 2013, she did 

not resume work for another 17 days. 

Dr. Barsanti reexamined appellant on July 12, 2013. On physical examination, 

appellant’s left and right upper extremities were essentially unchanged. Dr. Barsanti noted that 

appellant could work part-time (five hours/day), light duty with a lifting/carrying limit of three to 

five pounds. With respect to the claimed period of disability, he indicated that she called on 

April 9, 2013 and stated that her left wrist was hurting and she was unable to finish her day at 

work. Appellant received a medical absence note on April 9, 2013 that excused her from work 

until she could be evaluated, which occurred on April 26, 2013. When Dr. Barsanti examined 

her on April 26, 2013, appellant reported having left wrist pain. He also noted there was a prior 

history of left thumb complaints that dated back to February 2012. Dr. Barsanti explained that 

the continued overuse of both hands, and specifically overuse of the left hand that day (April 9, 

2013) while having problems with the right hand exacerbated appellant’s problems with the left 

hand, causing her pain. Dr. Barsanti’s repeated reference to left hand “overuse” on April 9, 2013 

is inconsistent with the evidence of record, which demonstrated that appellant worked only a few 

minutes casing mail with her left hand before curtailing what would have been a three-hour, 

limited-duty shift. The continued reliance upon an inaccurate factual background undermines 

Dr. Barsanti’s opinion.28

As noted, appellant returned to work as of July 15, 2013. However, Dr. Barsanti had 

released her to return to work on June 28, 2013. There is no apparent explanation for the more 

than two-week delay in resuming work. 

Dr. Foltz, a family practitioner, examined appellant on July 24, 2013, after she had 

already returned to work. He advised that appellant had left carpal tunnel syndrome, which was 

diagnosed on February 27, 2012. Dr. Foltz also noted appellant’s treatment at Orthopaedics East 

for her right hand (radial styloid tenosynovitis/de Quervain’s), and her recent left wrist/hand 

complaints beginning April 9, 2013. He described appellant’s work-related activities, which 

included turning wrists to get mail in cases, carrying heavy bundles of mail, and sorting mail, 

affected the previously listed conditions. Dr. Foltz advised that repetitive-type work increased 

the incidence of left wrist pain. He further advised that appellant was noted to be using her left 

hand exclusively at work resulting in left-hand pain. Dr. Foltz noted that continued overuse of 

the left hand would result in paresthesias and cramping in the palmar side. In conclusion, he 

advised that continued overuse of both hands, specifically overuse of appellant’s left hand while 

 27 Id. 

28 Id.
11

having problems with the right hand, exacerbated her left wrist problems and caused an increase 

in pain. 

Dr. Foltz did not specifically address whether appellant’s left carpal tunnel syndrome 

disabled her from all work during the claimed period April 10 through July 13, 2013. As such, 

his opinion is not particularly probative with respect to the issue on appeal. Moreover, like 

Dr. Barsanti, Dr. Foltz’s reference to “overuse” strongly suggests that he was unaware of the 

very brief and limited activity appellant engaged in before she stopped work on April 9, 2013. 

In an August 15, 2014 report, Dr. Barsanti indicated that appellant complained of chronic 

pain and swelling in her left wrist and on April 9, 2013 she was no longer able to do left-handed 

work and was taken off work. He also noted that appellant had symptoms consistent with carpal 

tunnel syndrome, which included numbness and paresthesia in the median nerve distribution. 

Dr. Barsanti further indicated that appellant received several injections before returning to work 

on July 15, 2013, at which time she was not allowed to lift more than five pounds. He diagnosed 

left carpal tunnel syndrome and trigger thumb. Dr. Barsanti explained that carpal tunnel 

syndrome was related to repetitive use of the hands on a continuous basis and noted that onehanded work was not an option. He also indicated that appellant was unable to work as a rural 

carrier and was unable to use her left hand, and as of February 11, 2014 she had been taken out 

of work indefinitely. 

In a July 3, 2015 report, Dr. Barsanti reiterated his previous findings and conclusions. He 

noted that appellant developed an inability to work with the left hand from April 10 through 

July 12, 2013 due to chronic pain as a result of left carpal tunnel syndrome. Dr. Barsanti 

reported that appellant was released to return to work with restrictions effective July 13, 2013. 

In his August 15, 2014 and July 3, 2015 reports, Dr. Barsanti indicated that appellant was 

unable to work with her left hand for the period April 10 through July 13, 2013. As previously 

indicated, Dr. Barsanti did not examine appellant until April 26, 2013, and has not provided any 

evidence, apart from appellant’s own representations, that she was disabled for work dating back 

to her April 9, 2013 work stoppage. Moreover, Dr. Barsanti initially released appellant to return 

to work on June 28, 2013, which contradicts his more recent statement that she was disabled 

through July 13, 2013. With respect to appellant’s disability during the interim period April 26 

through June 28, 2013, Dr. Barsanti has not provided an explanation for why her left carpal 

tunnel syndrome precluded all work, and particularly why one-handed work was no longer an 

option. A physician’s opinion that lacks adequate rationale is insufficient to establish entitlement 

to FECA benefits.29

Based on the foregoing analysis, the Board finds that the medical evidence of record fails 

to establish that appellant was disabled during the claimed period due to her accepted left carpal 

tunnel syndrome. Accordingly, she is not entitled to an additional three hours of compensation 

per day for the period April 10 through July 13, 2013. 

 29 Id.
12

CONCLUSION 

The Board finds that for the period April 10 through July 13, 2013, appellant failed to 

establish entitlement to wage-loss compensation for partial disability due to her accepted left 

carpal tunnel syndrome. 

ORDER 

IT IS HEREBY ORDERED THAT the August 19, 2015 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: June 5, 2017 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board