United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

M.G., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Bellmawr, NJ, Employer 

__________________________________________ 

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Docket No. 16-1791 

Issued: February 22, 2017 

Appearances: Case Submitted on the Record

Thomas R. Uliase, Esq., for the appellant1

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

CHRISTOPHER J. GODFREY, Chief Judge 

PATRICIA H. FITZGERALD, Deputy Chief Judge 

COLLEEN DUFFY KIKO, Judge 

JURISDICTION 

On September 7, 2016 appellant, through counsel, filed a timely appeal from a May 18, 

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 merit decision in this case. 

ISSUE 

The issue is whether appellant has met her burden of proof to establish an occupational 

disease causally related to factors of her federal employment. 

 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

FACTUAL HISTORY 

On January 4, 2015 appellant then a 53-year-old mail handler, filed an occupational 

disease claim (Form CA-2) alleging that she developed carpal tunnel syndrome as a result of 

performing repetitive duties required in her job. She first became aware of her condition on 

November 3, 2014 and realized that it was causally related to her employment on 

December 17, 2014. Appellant stopped work on January 9, 2015. 

In a statement dated January 9, 2015, appellant indicated that on December 15, 2014 she 

experienced severe pain and numbness in her left wrist while working on a flat sorter machine. 

She indicated that her hand pain continued daily until January 2, 2015 when it became 

unbearable and she sought treatment. 

Appellant was treated in an emergency room on January 2, 2015 by Dr. Russell Harris, 

Board-certified in emergency medicine, who diagnosed carpal tunnel syndrome and prescribed 

medication. She submitted a January 2, 2015 work excuse form, signed by an unidentified health 

care provider, who noted that appellant could return to work in two to three days. 

Appellant came under the treatment of Dr. John M. Bednar, a Board-certified orthopedist, 

for bilateral carpal tunnel syndrome. In duty status reports dated January 9 to 23, 2015, 

Dr. Bednar diagnosed bilateral carpal tunnel syndrome and noted that appellant could work with 

restrictions. In a January 23, 2015 attending physician’s report, he diagnosed median 

neuropathy, bilateral carpal tunnel syndrome, bilateral ulnar neuropathy, bilateral cubital tunnel 

syndrome, and degenerative arthritis of the carpometacarpal joint and left elbow. Dr. Bednar 

noted appellant’s symptoms were due to work activities. He checked a box marked “yes” that 

appellant’s condition was caused or aggravated by work activity indicating that her symptoms 

were secondary to hand use. Dr. Bednar returned her to work with restrictions. 

On February 9, 2015 OWCP advised appellant of the type of evidence needed to establish 

her claim, particularly a physician’s reasoned opinion addressing the relationship between her 

claimed condition and specific work factors. 

In a statement dated February 18, 2015, appellant asserted that her repetitive job duties as 

a mail handler caused her bilateral hand conditions. She indicated that she does not have any 

hobbies outside of work. Appellant noted her symptoms of wrist, hand, and thumb pain and 

numbness were worse at night. She reported having worked as a mail handler for 15 years lifting 

and pushing all-purpose containers, hampers and tubs with sacks of mail weighing up to 100 

pounds, for eight hours a day for five days a week. 

Appellant provided a January 9, 2015 report from Dr. Bednar who treated appellant for 

bilateral hand pain, numbness and tingling in the thumb, index, and long finger, and left elbow 

stiffness and pain. She had a history of diabetes. Appellant had full range of motion of the 

elbow, tenderness of the left medial epicondyle, and positive Tinel’s sign at the cubital and 

carpal tunnel. X-rays of both wrists revealed degenerative arthritis at the carpometacarpal joint 

of the thumb. An x-ray of the left elbow revealed mild degenerative change on the medial aspect 

of the elbow. Dr. Bednar diagnosed median neuropathy, bilateral carpal tunnel syndrome, 
3

bilateral ulnar neuropathy, bilateral cubital tunnel syndrome, and degenerative arthritis of the 

carpometacarpal joint, thumb, and left elbow. He returned appellant to light duty. 

In a January 16, 2015 duty status report, Dr. Bednar diagnosed bilateral carpal tunnel 

syndrome and returned appellant to work full time with restrictions. Appellant submitted a 

February 3, 2015 work status report from Dr. Bednar which reflected a diagnosis of left carpal 

tunnel syndrome and triggering of the left index. Dr. Bednar continued appellant’s work 

restrictions. In February 6 and 20, 2015 attending physician’s reports, he noted appellant’s 

symptoms were secondary to work activities. Dr. Bednar again noted, by checking a box marked 

“yes” that appellant’s condition was caused or aggravated by work activity indicating that her 

symptoms were due to hand use. Dr. Bednar returned her to work with restrictions. In a work 

capacity evaluation dated February 6, 2015, he returned appellant to full-time light-duty work. 

In an April 6, 2015 decision, OWCP denied appellant’s claim, finding that she failed to 

establish that her claimed medical condition was related to the established work-related events. 

On April 14, 2015 appellant requested an oral hearing which was held on July 9, 2015. 

She also submitted records of previous medical treatment. This included an August 30, 2010, 

work status note from Dr. Victor Diaz, a Board-certified family practitioner advising that 

appellant could return to full duty. In notes dated May 25 and August 12, 2013, Dr. Diaz noted 

that appellant could return to work full duty in six months.3

 

In an April 22, 2015 report, Dr. Bednar treated appellant for bilateral hand pain, 

numbness and tingling in her thumb, index and long finger, and stiffness in her left elbow. 

Appellant reported her symptoms had been progressive since December 2014. Dr. Bednar noted 

that a January 16, 2015 electromyogram (EMG) revealed left median motor latency and mild 

slowing across the ulnar nerve at the elbow. Steroid injections into her left side carpal tunnel and 

left thumb and finger did not improve her condition. Dr. Bednar noted treating appellant on 

April 3, 2015 for bilateral wrist pain, swelling, and weakness. He diagnosed median neuropathy, 

bilateral carpal tunnel syndrome, bilateral ulnar neuropathy, bilateral cubital tunnel syndrome, 

degenerative arthritis of the carpometacarpal joint, thumb, and left elbow, and flexor 

tenosynovitis of the left thumb and left index finger. Dr. Bednar opined that the causality of the 

median and ulnar neuropathy and flexor tenosynovitis diagnoses was multifactorial. He noted 

that appellant’s diabetes did have some causal relation with regards to these diagnoses, but 

opined that appellant’s work history and work activities as a postal handler were responsible for 

material worsening of these diagnoses and the resultant impairment. Dr. Bednar noted that 

appellant was not receptive to surgery. He advised that surgery would not return appellant to 

normal status and the prognosis for return to pain free function was poor. Dr. Bednar advised his 

opinion was set forth within a reasonable degree of medical certainty. 

In a decision dated September 3, 2015, an OWCP hearing representative affirmed the 

April 6, 2015 decision. 

 3

 Dr. Diaz did not specify any condition for which appellant was treated. Appellant also submitted medical 

records from Dr. Annie M. Peter, a Board-certified internist, and Dr. Alan Askenase, a Board-certified cardiologist, 

from 2012 and 2013 who treated appellant for cardiac and other nonorthopedic conditions. On September 9, 2013 

Dr. Askenase returned appellant to full duty. 
4

On October 2, 2015 appellant requested reconsideration. She submitted a January 16, 

2015 EMG which revealed severe left subacute carpal tunnel syndrome and moderate right 

chronic carpal tunnel syndrome, and left chronic cubital tunnel syndrome. A May 22, 2015 

EMG revealed moderate left chronic carpal tunnel syndrome and early/mild right chronic carpal 

tunnel syndrome. 

Appellant was treated by Dr. Bruce Monoghan, a Board-certified orthopedist, on July 20, 

2015, for pain in both hands and arms which was present since November 2014. Appellant 

attributed her symptoms to pushing and pulling heavy equipment and repetitive lifting of mail 

and mail tubs. Findings included tenderness in the trapezius, deltoid, biceps muscle, and positive 

Tinel’s sign. X-rays of both elbows were unremarkable and x-rays of the wrists and thumb 

revealed basilar joint arthritis. Dr. Monoghan diagnosed bilateral carpal tunnel syndrome and 

ulnar neuropathy, left index finger and left thumb stenosing tenosynovitis, bilateral thumb 

carpometacarpal degenerative joint disease and possible fibromyalgia. He recommended carpal 

tunnel braces, diagnostic injections and continued limited duty. 

In reports dated August 3 and 31, 2015, Dr. Monoghan noted positive Tinel’s sign in both 

hands and tenderness over the A1 pulley of her left thumb and index finger. He performed a 

steroid injection of both thumb and index fingers. Dr. Monoghan noted significant improvement 

in symptoms and range of motion after the injections. On September 23, 2015 he noted the 

injections afforded appellant some relief, but she still remained symptomatic in her index and 

middle fingers. Dr. Bednar noted limited range of motion over the A1 pulley and thumb with 

positive Tinel’s sign. Dr. Monoghan recommended endoscopic carpal tunnel release and A1 

pulley release of the thumb on the left hand and left A1 pulley release of the index finger with 

traction tenolysis of the deep and superficial flexor tendons. On October 29, 2015 appellant 

underwent left index finger A1 pulley release traction tenolysis, left thumb A1 pulley release and 

left endoscopic carpal tunnel release.4

 On November 9, 2015 Dr. Monoghan treated appellant in 

follow-up and reported experiencing significant discomfort and she was uncertain whether the 

numbness and tingling resolved. He recommended physical therapy. 

In a decision dated May 18, 2016, OWCP denied modification of the September 3, 2015 

decision. 

LEGAL PRECEDENT 

An employee seeking benefits under FECA has the burden of proof to establish the 

essential elements of his or her claim. When an employee claims that he or she sustained an 

injury in the performance of duty, the employee must submit sufficient evidence to establish that 

he experienced a specific event, incident or exposure occurring at the time, place, and in the 

manner alleged. Appellant must also establish that such event, incident or exposure caused an 

injury.5

 

 4

 The full October 29, 2011 operative report is not in the record. 

5 See Walter D. Morehead, 31 ECAB 188, 194 (1979) (occupational disease or illness); Max Haber, 19 ECAB 

243, 247 (1967) (traumatic injury). See generally John J. Carlone, 41 ECAB 354 (1989); Elaine Pendleton, 40 

ECAB 1143 (1989). 
5

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

an analysis of whether fact of injury has been established.6 To establish fact of injury in 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.7

The medical evidence required to establish causal relationship is generally rationalized 

medical opinion evidence. Rationalized medical opinion evidence is medical evidence which 

includes a physician’s rationalized opinion on the issue of whether there is a causal relationship 

between the claimant’s diagnosed condition and the implicated employment factors. The 

opinion of the physician must be based on a complete factual and medical background of the 

claimant, 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.8

ANALYSIS 

It is undisputed that appellant’s duties as a mail handler included lifting and pushing allpurpose containers, hampers and tubs with sacks of mail weighing up to 100 pounds. It is also 

undisputed that appellant was diagnosed with bilateral carpal tunnel syndrome and ulnar 

neuropathy, left index finger and left thumb stenosing tenosynovitis, and bilateral thumb 

carpometacarpal degenerative joint disease. However, appellant failed to submit sufficient 

medical evidence to establish that her diagnosed medical conditions are causally related to 

specific factors of her federal employment. 

In his April 22, 2015 report, Dr. Bednar noted appellant’s progressive symptoms since 

December 2014. He diagnosed median neuropathy, bilateral carpal tunnel syndrome, bilateral 

ulnar neuropathy, bilateral cubital tunnel syndrome, degenerative arthritis of the carpometacarpal 

joint, thumb, and left elbow, and flexor tenosynovitis of the left thumb and left index finger. 

Dr. Bednar opined that the diagnosed median and ulnar neuropathy and flexor tenosynovitis had 

multifactorial causality. Dr. Bednar opined within a reasonable degree of medical certainty that 

appellant’s diabetes had some effect on these diagnoses, but he opined that appellant’s work 

history and work activities as a postal handler were responsible for material worsening of these 

diagnoses and the resultant impairment. The Board finds that, although Dr. Bednar supported 

causal relationship, he did not provide medical rationale explaining the basis of his conclusory 

opinion regarding the causal relationship.9

 Dr. Bednar did not explain the process by which 

 6 S.P., 59 ECAB 184, 188 (2007). 

7 R.R., Docket No. 08-2010 (issued April 3, 2009); Roy L. Humphrey, 57 ECAB 238, 241 (2005). 

8 Solomon Polen, 51 ECAB 341 (2000). 

9 See T.M., Docket No. 08-975 (issued February 6, 2009) (a medical report is of limited probative value on the 

issue of causal relationship if it contains a conclusion regarding causal relationship which is unsupported by medical 

rationale). 
6

repetitively lifting and pushing all-purpose containers, hampers, and tubs with sacks of mail 

would cause or aggravate the diagnosed conditions. This report is thus insufficient to establish 

appellant’s claim. 

Attending physician reports from Dr. Bednar dated January 23 to February 20, 2015 

noted diagnoses and indicated that appellant’s symptoms were secondary to work activities. 

Dr. Bednar noted by checking a box marked “yes” that appellant’s condition was caused or 

aggravated by an employment duty and indicating that her symptoms were secondary to hand 

use. The Board has held that when a physician’s opinion on causal relationship consists only of 

checking “yes” to a form question, without explanation or rationale, that opinion is of diminished 

probative value and is insufficient to establish a claim.10 Other reports from Dr. Bednar are of 

limited probative value as they did not further address causal relationship. 

Reports from Dr. Monoghan dated July 20 to September 23, 2015 noted appellant’s 

treatment for pain in both hands and arms. Appellant attributed her symptoms to pushing and 

pulling heavy equipment and repetitive lifting of mail and mail tubs. He noted findings and 

diagnosed bilateral carpal tunnel syndrome and ulnar neuropathy, left index finger and left thumb 

stenosing tenosynovitis, bilateral thumb carpometacarpal degenerative joint disease and possible 

fibromyalgia. On October 29, 2015 Dr. Monoghan performed a left index finger A1 pulley 

release traction tenolysis, left thumb A1 pulley release and left endoscopic carpal tunnel release. 

Regarding causal relationship, he repeats the history of injury as reported by appellant without 

providing his own opinion regarding whether appellant’s condition was work related. To the 

extent that Dr. Monoghan is providing his own opinion, he failed to provide a rationalized 

opinion regarding the causal relationship between appellant’s diagnosed conditions and the 

factors of employment believed to have caused or contributed to such condition.11 Therefore, 

these reports are insufficient to meet appellant’s burden of proof. 

Other medical evidence of record is of limited probative value as it either predates the 

onset of appellant’s claimed condition or does not specifically address how the accepted work 

factors caused or aggravated the claimed condition.12 Consequently, the medical evidence of 

record is insufficient to establish appellant’s claim. 

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 his condition was caused, precipitated, or aggravated by his employment is 

sufficient to establish causal relationship. Causal relationship must be established by 

rationalized medical opinion evidence.13 Appellant failed to submit such evidence and OWCP 

therefore properly denied appellant’s claim for compensation. 

 10 D.D., 57 ECAB 734 (2006); Sedi L. Graham, 57 ECAB 494 (2006). 

11 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). 

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

13 See Dennis M. Mascarenas, 49 ECAB 215 (1997). 
7

On appeal appellant, through counsel, disagrees with OWCP’s decision denying her 

claim for compensation and noted that she submitted sufficient evidence to establish her claim. 

As noted above, the medical evidence does not establish that appellant’s diagnosed conditions 

are causally related to her employment. Reports from appellant’s physician’s failed to provide 

sufficient medical rationale explaining how appellant’s injuries are causally related to particular 

employment factors. 

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 did not meet her burden of proof to establish an 

occupational disease causally related to factors of her federal employment. 

ORDER 

IT IS HEREBY ORDERED THAT the May 18, 2016 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: February 22, 2017 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board