United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

P.P., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Cleveland, OH, Employer 

__________________________________________ 

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Docket No. 17-0483 

Issued: June 13, 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 January 3, 2017 appellant, through counsel, filed a timely appeal from a December 6, 

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. 

ISSUE 

The issue is whether appellant met his burden of proof to establish that he developed 

bilateral arm and right wrist conditions causally related to factors of his 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 November 2, 2015 appellant, then a 52-year-old automobile mechanic, filed an 

occupational disease claim (Form CA-2) alleging that he developed tendinitis of the right arm, 

left arm, and right wrist as a result of his federal employment. He reported that his duties 

entailed heavy lifting, pushing, pulling, and a lot of repetitive motions while using his arms and 

hands. Appellant stopped work on July 23, 2015 and notified his supervisor on 

October 20, 2015. On the reverse side of the claim form, appellant’s supervisor reported that 

appellant was provided modified work as of October 16, 2015 based on his physician’s medical 

restrictions. 

In an accompanying narrative statement, appellant reported that he began feeling pain in 

his forearms on or around February 17, 2015 which progressively worsened and traveled to his 

right wrist, causing him to eventually seek medical treatment. He noted that his job duties 

entailed prying, pushing, pulling, and repetitive motions with his arms while using tools and 

lifting heavy objects. Appellant reported working two full-time jobs, as an automobile mechanic 

for the employing establishment performing repairs on light- to heavy-duty vehicles, and also as 

an automobile mechanic for AT&T performing repairs on light- and heavy-duty vehicles. 

In a November 3, 2015 statement, appellant’s supervisor reported that appellant stopped 

work on July 23, 2015 and returned to work on October 21, 2015. He further noted that he 

received appellant’s Form CA-2 on November 3, 2015, but that he had been complaining of his 

condition since February 2015. 

In a July 23, 2015 note, Dr. Keith Fuller, Board-certified in internal medicine, reported 

that appellant had been under his care and was incapacitated to work from July 22 through 

29, 2015. Appellant was released to work on July 30, 2015. 

By letters dated July 28 through October 9, 2015, Dr. Anne M. Rex, an osteopathic 

physician, reported that appellant was under her care and excused from work for the period 

July 22 through October 20, 2015. 

By letter dated October 16, 2015, Dr. Rex provided restrictions at a medium physical 

demand level with occasional lifting at 30 to 60 pounds. She noted no restrictions on fine and 

gross motor use of hands for repetitive tasks. 

By letter dated December 11, 2015, OWCP informed appellant that the evidence of 

record was insufficient to support his claim. It advised that appellant was advised of the medical 

and factual evidence needed and afforded him 30 days to submit the necessary evidence. 

Appellant did not respond and no further evidence was submitted. 

By decision dated February 2, 2016, OWCP denied appellant’s claim, finding that as the 

medical evidence of record failed to provide a firm medical diagnosis which could be reasonably 

attributed to the accepted federal employment duties fact of injury was not established. 

By letter dated February 8, 2016, appellant, through counsel, requested a telephone 

hearing before an OWCP hearing representative. 
3

A hearing was held on October 11, 2016 before an OWCP hearing representative. At the 

hearing, appellant testified that he had worked for 25 years on employing establishment vehicles 

including trucks and tractor trailers. He had also worked for AT&T for 15 years performing 

similar duties on vehicles including cars and medium duty trucks. Appellant reported 

experiencing pain in his arms around February 2015. He was subsequently diagnosed with 

tendinitis of both arms and the right wrist. Appellant stated that he did not sustain any injuries 

prior to February 2015 and did not engage in any hobbies or repetitive activities outside of work. 

He also noted that he had filed a separate claim with AT&T for his bilateral arm and right wrist 

conditions in October 2015. The record was held open for 30 days to allow appellant to submit 

further medical evidence. 

In support of his claim, appellant submitted an October 16, 2016 report from 

Dr. Freddie F. Fuentes, Board-certified in internal medicine. Dr. Fuentes reported that appellant 

was last treated on July 18, 2015 and was diagnosed with bilateral lateral epicondylitis and right 

wrist de Quervain’s tenosynovitis. Dr. Fuentes opined that appellant’s conditions were most 

likely due to his employment or work-related activities. He noted that appellant was a mechanic 

and had been doing a lot of pushing, hammering, lifting, and chiseling at work. Dr. Fuentes 

further noted that appellant often used a manual screwdriver and performed frequent twisting and 

movement of the bilateral hands and wrists. He concluded that appellant’s work-related 

activities could cause recurrent epicondylitis and tenosynovitis. 

By decision dated December 6, 2016, an OWCP hearing representative affirmed the 

February 2, 2016 decision, as modified, finding that the evidence of record established that the 

evidence supported that appellant performed the work activities, but failed to establish that his 

diagnosed conditions were causally related to his accepted federal employment duties. 

LEGAL PRECEDENT 

An employee seeking benefits under FECA3

 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 or specific condition for which compensation is claimed is causally related to the 

employment injury.4

 These are the essential elements of every compensation claim regardless of 

whether the claim is predicated on a traumatic injury or an occupational disease.5

In order to determine whether an employee actually sustained an injury in the 

performance of duty, OWCP begins with an analysis of whether fact of injury has been 

established. Generally, fact of injury consists of two components which must be considered in 

conjunction with one another. The first component to be established is that the employee 

actually experienced the employment incident which is alleged to have occurred.6 The second 3 Supra note 2. 

4 Gary J. Watling, 52 ECAB 278 (2001); Elaine Pendleton, 40 ECAB 1143, 1154 (1989). 

5 Michael E. Smith, 50 ECAB 313 (1999). 

6 Elaine Pendleton, supra note 4. 
4

component is whether the employment incident caused a personal injury and generally can be 

established only by medical evidence. 

To establish that an injury was sustained in the performance of duty in a claim for 

occupational disease, 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 

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 a causal 

relationship.8 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.9

ANALYSIS 

OWCP accepted that appellant engaged in repetitive activities in his federal employment 

as an automobile mechanic. It denied his claim, however, as the evidence of record failed to 

establish causal relationship between those activities and his diagnosed bilateral arm and right 

wrist conditions. The Board finds that the medical evidence of record is insufficient to establish 

that appellant developed bilateral lateral epicondylitis and right wrist de Quervain’s 

tenosynovitis causally related to factors of his federal employment as an automobile mechanic. 

In an October 16, 2016 medical report, Dr. Fuentes diagnosed bilateral lateral 

epicondylitis and right wrist de Quervain’s tenosynovitis which he opined was most likely due to 

appellant’s employment or work-related activities. He did not provide a history of injury which 

distinguished between appellant’s work-related activities as an automobile mechanic for the 

employing establishment as appellant has reported that he also works for AT&T performing 

similar duties. The opinion of the physician must be based on a complete factual and medical 

background of the claimant.10 Moreover, his opinion on causation is highly speculative as he 

notes that appellant’s work-related activities can cause recurrent epicondylitis and tenosynovitis 

 7 See Roy L. Humphrey, 57 ECAB 238, 241 (2005); Ruby I. Fish, 46 ECAB 276, 279 (1994). 

8 See 20 C.F.R. § 10.110(a); John M. Tornello, 35 ECAB 234 (1983). 

9 James Mack, 43 ECAB 321 (1991). 

10 See Genetra F. Gardner, Docket No. 98-2233 (issued December 22, 1999). Appellant’s physician did not 

distinguish between appellant’s federal and private employment in assigning causal relationship. 
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without a firm conclusion that these duties did in fact cause or aggravate his injury.11 To be of 

probative value, a physician’s opinion on causal relationship should be one of reasonable 

medical certainty.12 Dr. Fuentes failed to provide a fully detailed report as he made no mention 

of appellant’s medical history, findings on physical examination, or review of diagnostic testing. 

He reported that appellant’s employment as a mechanic entailed pushing, hammering, lifting, 

chiseling, use of a manual screwdriver, and often involved twisting and movement of the 

bilateral hands and wrists. Dr. Fuentes’ statement on causation failed to provide a sufficient 

explanation as to the mechanism of injury pertaining to this occupational disease claim as alleged 

by appellant, namely, how repetitive pushing, pulling, twisting, and lifting would cause or 

aggravate his bilateral lateral epicondylitis and right wrist de Quervain’s tenosynovitis.13 

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

occupational disease claim. The medical notes from Dr. Rex and Dr. Fuller merely excuse 

appellant from work and failed to state any diagnosis or cause of injury. The Board has held that 

medical evidence that does not offer any opinion regarding the cause of an employee’s condition 

is of limited probative value.14 

An award of compensation may not be based on surmise, conjecture, speculation, or on 

the employee’s own belief of causal relation.15 Appellant’s honest belief that his occupational 

employment duties caused his medical injury is not in question, but that belief, however 

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

relationship. In the instant case, the record lacks rationalized medical evidence establishing a 

causal relationship between appellant’s federal employment duties as an automobile mechanic 

and his diagnosed bilateral lateral epicondylitis and right wrist de Quervain’s tenosynovitis. 

Thus, appellant has failed to meet his burden of proof. 

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 and 10.607. 

CONCLUSION 

The Board finds that appellant has not met his burden of proof to establish that he 

developed bilateral arm and right wrist conditions causally related to factors of his federal 

employment. 

 11 See Michael R. Shaffer, 55 ECAB 339 (2004). 

12 See Beverly R. Jones, 55 ECAB 411 (2004). 

13 S.W., Docket 08-2538 (issued May 21, 2009). 

14 S.E., Docket No. 08-2214 (issued May 6, 2009); C.B., Docket No. 09-2027 (issued May 12, 2010).

15 D.D., 57 ECAB 734 (2006). 
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ORDER 

IT IS HEREBY ORDERED THAT the December 6, 2016 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: June 13, 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