United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

L.A., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

San Diego, CA, Employer

__________________________________________

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Docket No. 17-0842

Issued: May 16, 2018

Appearances: Case Submitted on the Record

Appellant, pro se

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 March 6, 2017 appellant filed a timely appeal from a September 9, 2016 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 bilateral upper 

extremity conditions causally related to the accepted factors of her federal employment. 

 

1 5 U.S.C. § 8101 et seq.
2

FACTUAL HISTORY

This case has previously been before the Board.2 The facts of the case as presented in the 

Board’s prior decision are incorporated herein by reference. The relevant facts are as follows. 

On October 24, 2013 appellant, then a 50-year-old rural carrier, filed an occupational 

disease claim (Form CA-2) alleging that she sustained bilateral medial epicondylitis while in the 

performance of her federal job duties. She stated that she first became aware of this condition on 

January 29, 2001, and first realized that it was caused or aggravated by factors of her federal

employment on September 11, 2013.3 The employing establishment controverted appellant’s 

claim, contending that medical documentation appellant had provided since December 2012 

precluded her from work due to a psychiatric condition. It explained that she had not provided 

any medical documentation concerning an epicondylitis condition until she was presented with a 

removal request to terminate her employment.

By decision dated December 11, 2013, OWCP denied the claim, finding that the evidence

of record was insufficient to establish fact of injury. Specifically, it found that appellant had not 

provided sufficient explanation regarding the nature, duration, and frequency of her alleged 

employment duties.

On December 23, 2013 counsel requested a telephonic hearing before an OWCP hearing 

representative, which was held on June 10, 2014. By decision dated July 21, 2014, OWCP’s

hearing representative modified the prior decision to accept fact of injury in appellant’s regular 

rural carrier duties since March 2009 and that she has not worked since April 2012. The hearing 

representative, however, affirmed the denial of appellant’s claim as appellant failed to establish 

an injury causally related to the established employment exposure from March 2009 through 

April 2012.

On August 19, 2014 appellant, through counsel, timely appealed to the Board. In a 

September 25, 2015 decision, the Board affirmed the July 21, 2014 OWCP decision, finding that 

appellant had not met her burden of proof to establish bilateral medial epicondylitis causally 

related to her rural carrier duties from March 2009 to April 2012. The Board noted appellant’s

prior claim under OWCP File No. xxxxxx245 for a January 29, 2001 traumatic injury, wherein 

she alleged that she strained both forearms. The Board found that there was no rationalized 

medical opinion evidence of record explaining how appellant’s bilateral medial epicondylitis 

condition was causally related to the employment exposure from March 2009 to April 2012.

 

2 Docket No. 14-1818 (issued September 25, 2015). 

3 Appellant has a prior claim under OWCP File No. xxxxxx245 for a traumatic injury on January 29, 2001 when 

she strained both forearms when lifting flats, and casing and boxing mail. The claim was allowed for payment of 

limited medical expenses without formal adjudication. The last medical documentation in that claim was dated 

August 6, 2002 for treatment of bilateral overuse tendinitis of the forearms. In January 2001 appellant was a parttime carrier, working as needed, with no regular workdays. In March 2009 she became a full-time rural carrier. 

Appellant stopped work on April 12, 2012 due to a nonwork-related knee condition. Although she was subsequently 

provided medical work restrictions concerning her knee condition, she did not return to work and in October 2012 

she became totally disabled due to a psychiatric condition. In November 2013 the employing establishment 

terminated appellant’s employment due to her being in a leave-without-pay status for more than 365 days.
3

On August 11, 2016 appellant requested reconsideration. In an August 1, 2016 narrative

statement, she noted a correction regarding her age, presented a list of her work history and 

income from 1996 to 2013 with the employing establishment, and discussed occurrences in her 

personal life which affected the medical reporting of her upper extremity conditions. Appellant

noted the physicians she saw for the overuse syndrome of her arms from January 2001 to 

August 2002. She described her employment duties as a part-time rural route carrier prior to 

2009 and alleged that she performed the same duties and repetitive upper extremities activities as 

a part-time rural route carrier, as she had in her full-time position after 2009. OWCP also 

received additional medical evidence. 

An April 2, 2012 report from a certified physician assistant noted that appellant had 

experienced a situation which she was anxious about, and which had affected her ability to work. 

The physician assistant diagnosed abdominal pain, right lower quadrant, gastroesophageal reflux 

disease, and anxiety state, unspecified.

A November 20, 2013 letter from the employing establishment indicated that appellant

would be separated from employment on November 30, 2013 as she was physically unable to 

meet the requirements of her position. 

In a June 1, 2015 electromyogram (EMG) and nerve conduction velocity (NCV) study 

report, Dr. John Ravitis, a neurologist, indicated that there was evidence of mild right and 

moderate left ulnar neuropathy at the elbows near the ulnar groove with axonal loss in the left 

arm. However, there was no sign of carpal tunnel syndrome, brachial plexopathy or cervical 

radiculopathy in the right upper limb.

In a June 24, 2015 report, Dr. Mohammad Ali Farkhondehpour, an internist, noted that 

appellant reported forearm swelling/pain with numbness and tingling radiating to the whole hand 

in 2000, which she attributed to her job as a postal worker, which required repetitive work with 

her hands. The neuropathy persisted and she tried physical therapy without significant benefit. 

In May 2015, appellant’s symptoms worsened. Physical therapy again offered little relief. 

Dr. Farkhondehpour noted that the May 2015 EMG study indicated bilateral ulnar neuropathy 

and ulnar nerve entrapment (cubital tunnel syndrome). 

In a June 29, 2015 report, Dr. Reid Allen Abrams, a Board-certified orthopedic surgeon, 

noted that appellant had a provisional diagnosis of ulnar neuropathy after June 1, 2015 

electrodiagnostic studies were performed. He indicated that her history started about 2001 when 

she was diagnosed with bilateral overuse syndrome after working at the employing 

establishment. Since 2013, appellant developed hand tingling and weakness. Dr. Abrams stated 

that appellant was a difficult historian. He also noted that she had a nonanatomical physical 

examination. Dr. Abrams indicated that there was no compressive neuropathy that would elicit 

appellant’s symptoms. However, he indicated that she may have atypical carpal tunnel 

syndrome with negative electrodiagnostic studies associated with cubital tunnel syndrome. 

Dr. Abrams recommended and provided appellant with a carpal tunnel injection.

In a June 4, 2016 report, Dr. Christopher T. Behr, a Board-certified orthopedic surgeon,

reported that appellant had been employed by the employing establishment in several different 

capacities. He noted that from 2009 through 2012 she had worked as a rural route carrier driver 
4

and described her duties. Dr. Behr also noted that she stopped working on April 11, 2012 due to 

a nonindustrial knee injury and was separated from her employment in November 2013. He

noted appellant’s history of illness, as reported by appellant, and provided examination findings. 

Dr. Behr noted that there was tenderness over the medial epicondyle and positive Tinel’s sign 

bilaterally over the cubital tunnels. He opined that, although appellant had reported that her 

symptoms and medical treatment began after she had stopped working for the employing 

establishment, her current bilateral upper extremity symptoms arose, in part, out of and in the 

course of her employment. Dr. Behr indicated that the description of a rural carrier required 

extensive repetitive activities of bilateral upper extremities. Also, appellant had objective 

evidence of bilateral cubital tunnel syndrome, condition whereby the ulnar nerve at the elbow 

becomes compressed as a result of repetitive activities and, in the vast majority of cases, was not 

due to a single incident or a single activity. Dr. Behr stated that there was nothing in her 

personal life that would explain this condition absent her employment. Further, had appellant

not worked for the employing establishment, she would not have bilateral cubital tunnel 

syndrome. Dr. Behr further stated that appellant has had unfortunate occurrences in her personal 

life, which caused the delay in the medical reporting of her medical condition.

By decision dated September 9, 2016, OWCP denied modification.

4

 It found that the 

medical evidence submitted was insufficient to establish right upper extremity conditions

causally related to the accepted factors of her federal employment.

5

LEGAL PRECEDENT

An employee seeking benefits under FECA6 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 filed within the applicable time 

limitation, that an injury was sustained while in the performance of duty as alleged and that any 

disability and/or specific condition for which compensation is claimed are causally related to the 

employment injury. These are the essential elements of each and every compensation claim 

regardless of whether the claim is predicated on a traumatic injury or an occupational disease. 

Whether an employee actually sustained an injury in the performance of duty begins with 

an analysis of whether fact of injury has been established. To establish an occupational disease 

claim, an employee must submit: (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. 

 

4 The September 9, 2016 decision notes that OWCP denied modification of the Board’s September 25, 2015 

decision. OWCP is not authorized to review Board decisions. Although the September 25, 2015 decision was the 

last merit decision, the July 21, 2014 decision is the appropriate subject of possible modification by OWCP. See 

20 C.F.R. § 501.6(d).

5 The September 9, 2016 decision did not specifically limit the accepted period of employment as 2009 to 2012. 

6 Supra note 1.
5

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

causal relationship is rationalized medical opinion evidence. Rationalized medical opinion 

evidence is generally required to establish causal relationship. The opinion of the physician must 

be based on a complete factual and medical background, 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.

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. Neither the mere fact that a disease or condition manifests 

itself during a period of employment, nor the belief that the disease or condition was caused or 

aggravated by employment factors or incidents, is sufficient to establish causal relationship. 

ANALYSIS

The Board finds that appellant has failed to submit the necessary rationalized medical 

opinion evidence sufficient to establish that her diagnosed upper extremity conditions were 

caused or aggravated by factors of her federal employment duties.

The Board previously found that appellant had performed full-time rural carrier duties 

from March 2009 through April 2012, but had failed to establish that her bilateral medial 

epicondylitis condition was causally related to the factors of her federal employment. Findings 

made in prior Board decisions are res judicata absent any further review by OWCP under section 

8128 of FECA. The Board will, therefore, not review the evidence addressed in the prior appeal.

In his June 23, 2015 report, Dr. Farkhondehpour noted appellant’s history of her upper 

extremity symptoms and that her symptoms worsened in May 2015. While he stated that the 

May 2015 electromyelogram study indicated bilateral ulnar neuropathy and ulnar nerve 

entrapment (cubital tunnel syndrome), he did not address the cause of the diagnosed conditions. 

Medical evidence which does not offer any opinion regarding the cause of an employee’s 

condition is of limited probative value on the issue of causal relationship.7 Similarly, in his 

June 29, 2015 report, Dr. Abrams indicated that appellant may have atypical carpal tunnel 

syndrome with negative electrodiagnostic studies associated with cubital tunnel syndrome. His

report lacks probative value as it provides a speculative medical diagnosis and lacks an opinion 

on causal relationship.8 

In his June 4, 2016 report, Dr. Behr noted appellant’s work history at the employing 

establishment, which he indicated required extensive repetitive activities of bilateral upper 

extremities. He stated that, although appellant had reported that her symptoms and medical 

treatment began after she had stopped working for the employing establishment, it was his 

medical opinion that her current bilateral upper extremity symptoms arose, in part, out of and in 

the course of her employment. The reason for his opinion was that she had objective evidence of 

bilateral cubital tunnel syndrome, which he explained was a condition which occurred as a result 

of repetitive activities. Also, there was nothing in her personal life that would explain this 

 

7 A.D., 58 ECAB 149 (2006).

8

Id.
6

condition and had she not worked for the employing establishment, she would not have bilateral 

cubital tunnel syndrome. Thus, Dr. Behr concluded that her work duties caused the bilateral 

cubital tunnel syndrome. 

The Board finds that, although Dr. Behr supported causal relationship, he did not provide 

medical rationale explaining the basis of his opinion regarding causal relationship between 

appellant’s bilateral cubital tunnel condition and the factors of her federal employment. For 

example, Dr. Behr did not explain how appellant’s work duties would have caused or aggravated

the diagnosed condition, and why such condition would have worsened after she stopped work.9 

A mere conclusory opinion provided by a physician without the necessary rationale explaining 

how and why the incident or work factors were sufficient to result in the diagnosed medical 

condition is insufficient to meet a claimant’s burden of proof to establish a claim.10 An award of 

compensation may not be based on surmise, conjecture or speculation. Neither the fact that 

appellant’s condition became apparent during a period of employment, nor the belief that her 

condition was caused, precipitated or aggravated by her employment, is sufficient to establish 

causal relationship. Causal relationship must be established by rationalized medical opinion 

evidence.11 Therefore, this report is insufficient to meet appellant’s burden of proof.

The remaining medical evidence of record is also insufficient to establish appellant’s 

claim. Dr. Ravitis’ June 1, 2015 EMG/NCV study report only interpreted imaging studies 

related to the shoulders and provided no opinion on the cause of appellant’s claimed employment 

injury.12 Without any mention of the repetitive employment duties and any discussion of causal

relationship, his report is of limited probative value.13

The July 2, 2012 report by a physician assistant is also insufficient to establish her claim. 

Reports from physician assistants do not constitute competent medical evidence because 

physician assistants are not considered physicians as defined under FECA.14

As appellant failed to submit rationalized medical opinion evidence sufficient to establish 

her claim, the Board finds that she has not met her burden of proof.

On appeal, appellant argues that she has permanent damage to both arms, which started 

with her employment at the employing establishment and was initially documented under File 

 

9 Franklin D. Haislah, 52 ECAB 457 (2001) (medical reports not containing rationale on causal relationship are 

entitled to little probative value); Jimmie H. Duckett, 52 ECAB 332 (2001).

10 J.D., Docket No. 14-2061 (issued February 27, 2015).

11 See Dennis M. Mascarenas, 49 ECAB 215 (1997).

12 D.H., Docket No. 11-1739 (issued April 18, 2012).

13 S.Y., Docket No. 11-1816 (issued March 16, 2012).

14 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); 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); Sean O Connell, 56 ECAB 

195 (2004) (physician assistants).
7

No. xxxxxx245. Her honest belief that her occupational employment duties caused her medical 

injury, however sincerely held, does not constitute the medical evidence necessary to establish 

causal relationship.15

Appellant may submit additional evidence, together with a written request for 

reconsideration, to OWCP within one year of the Board’s 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 upper 

extremity conditions causally related to the accepted factors of her federal employment. 

ORDER

IT IS HEREBY ORDERED THAT the September 9, 2016 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: May 16, 2018

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

 

15 See B.H., Docket No. 16-1553 (issued March 27, 2017).