United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

J.S., Appellant

and

DEPARTMENT OF THE TREASURY, 

INTERNAL REVENUE SERVICE, 

Holtsville, NY, Employer

__________________________________________

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Docket No. 18-0944

Issued: November 20, 2018

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

CHRISTOPHER J. GODFREY, Chief Judge

PATRICIA H. FITZGERALD, Deputy Chief Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On April 4, 2018 appellant, through counsel, filed a timely appeal from a February 27, 

2018 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 expand the acceptance of the 

claim to include the additional condition of osteoarthritis of the first carpometacarpal (CMC) joint 

of her right hand due to 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 and circumstances outlined in 

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

On November 7, 2013 appellant, a 56-year-old customer service representative, filed an 

occupational disease claim (Form CA-2) alleging that she developed a right hand injury that 

allegedly arose on or about October 25, 2013. She indicated that, during the course of an 8-hour 

workday, she spent 7.2 hours keyboarding and using a mouse, and at least 2 hours stapling and/or 

paper clipping documents. Appellant’s duties included such activities as handling 35 to 40 

telephone calls from taxpayers, processing tax returns, sending documents to central processing, 

and corresponding with taxpayers via letters. Initially, she did not submit any medical evidence 

with her claim.

In a November 27, 2013 development letter, OWCP requested a more detailed description 

of the employment duties appellant believed caused her right hand/wrist condition. It also advised 

her to submit appropriate medical evidence in support of her claim. 

OWCP subsequently received a November 20, 2013 narrative report and a November 27, 

2013 attending physician’s report (Form CA-20) from Dr. Warwick Green, a Board-certified 

orthopedic surgeon. In his November 20, 2013 report, Dr. Green noted that appellant reported a 

sudden onset of sharp pain in her right thumb, with swelling at the base of the thumb, occurring at 

work on October 25, 2013. He indicated that November 20, 2013 x-ray testing showed mild 

osteoarthritis of the first CMC joint of the right hand, and he provided a diagnosis of osteoarthritis 

and sprain/strain of the right hand. In his November 27, 2013 attending physician’s report,

Dr. Green again noted that appellant reported a sudden pain and swelling in her right thumb 

occurring at work on October 25, 2013. He diagnosed sprain/strain of the right thumb and 

osteoarthritis of the hand. Dr. Green checked a box marked “Yes” to denote that these conditions 

were employment related, and added the notation “Complaints represent exacerbation of 

preexisting conditions due to work.” He advised that appellant could return to work, but was 

unable to use her right hand. Dr. Green also submitted a duty status report (Form CA-17) that 

contained a diagnosis of osteoarthritis of the first CMC joint of the right hand. In December 23, 

2013 and January 22, 2014 reports, he further discussed appellant’s right thumb condition.

By decision dated February 4, 2014, OWCP denied appellant’s claim, finding that she 

failed to establish fact of injury as she had not submitted a detailed description of her work-related 

activities as requested by OWCP on November 27, 2013. It also found the medical evidence of 

record was insufficient to establish an employment-related diagnosis.

Appellant, through counsel, timely requested reconsideration on June 12, 2014. In support 

of the request, counsel submitted February 12 and April 23, 2014 reports from Dr. Sang H. Song, 

a Board-certified physiatrist. In the April 23, 2014 report, Dr. Song noted that it was his medical 

opinion that appellant’s right carpal tunnel syndrome condition was causally related to her

 

2 Docket No. 15-0089 (issued February 20, 2015).
3

repetitive work activities, including keyboarding (7 hours daily), operating a computer mouse (7 

hours daily), stapling (4.5 hours daily), and grasping paper clips (4.5 hours daily).

By decision dated June 18, 2014, OWCP denied appellant’s request for reconsideration of 

the merits of her claim pursuant to 5 U.S.C. § 8128(a), finding the submitted evidence to be 

immaterial.

On June 26, 2014 counsel again requested reconsideration. He submitted a June 23, 2014 

statement from appellant regarding her employment duties. Appellant indicated that she was a 

customer service worker whose duties consisted of reconciling taxpayers’ accounts via 

correspondence and/or telephone. During the course of an eight-hour workday, she was 

responsible for processing tax returns, sending documents to central processing, and corresponding 

with taxpayers via letters. Appellant was also responsible for stapling and/or paper clipping 

documents. She performed this activity at least two hours per day, as needed. Appellant also 

stated that she was responsible for documenting each telephone conversation with a taxpayer. On 

any given day, she documented between 35 and 40 calls. Both paper and telephone

communications were documented via computer. Appellant worked a 40-hour week, and each day 

she spent 7.2 hours keyboarding and using a mouse.

3

By decision dated September 24, 2014, OWCP modified its prior decision to find that fact 

of injury had been established, but denied appellant’s claim because the medical evidence of record 

was insufficient to establish causal relationship between her diagnosed right carpal tunnel 

syndrome and her described duties as a customer service representative.

4

On February 10, 2016 counsel, requested reconsideration of OWCP’s denial of appellant’s 

claim. He argued that her claim for occupational injury was established by an enclosed January 13, 

2016 report of Dr. Neil Allen, an attending Board-certified internist and neurologist.

In his January 13, 2016 report, Dr. Allen indicated that he had reviewed appellant’s 

medical records “in order to establish a causal relationship between the patient’s right hand injury 

and work-related trauma sustained prior to and on October 25, 2013.”

5

 He noted that appellant 

reported being required to engage in constant writing, typing, use of a mouse, stapling, and paperclipping documents for seven hours per day (eight-hour shift with a one-half hour break and two 

15-minute breaks). Dr. Allen discussed appellant’s reported right upper extremity conditions and 

summarized medical reports of Dr. Green and Dr. Song. He asserted that appellant’s right wrist 

injury was employment related and that her case should be accepted under the diagnosis of right 

carpal tunnel syndrome. Dr. Allen referenced several passages in the Merck Manual (14th edition) 

which described the symptoms, physical examination/diagnostic test findings, and causes of carpal 

 

3 Appellant had a half-hour lunch break and two 15-minute breaks each workday.

4 Appellant appealed OWCP’s September 24, 2014 decision to the Board and, by decision dated February 20, 2015, 

the Board affirmed the September 24, 2014 decision. Supra note 2.

5 Counsel later confirmed during a December 15, 2016 hearing before an OWCP hearing representative that

Dr. Allen, whose office was located in Chicago, IL, did not physically examine appellant. Rather, Dr. Allen based his 

report on a review of the case record and a telephone conversation with appellant.
4

tunnel syndrome, and he indicated that appellant’s symptoms, physical examination/diagnostic test 

findings, and work duties showed that she had employment-related right carpal tunnel syndrome

Dr. Allen further asserted that appellant’s claim should also be accepted for the diagnosis 

of osteoarthritis of the first CMC joint of the right hand. While acknowledging that this condition 

likely existed prior to appellant’s federal employment, he opined that the duties required by her 

position resulted in an aggravation of this condition. Dr. Allen noted that, per the Merck Manual

(14th edition), biomechanical stress might lead to chondrocyte damage and proteolytic enzyme 

release resulting in articular cartilage degeneration, and that osteoarthritis developed when 

cartilage repair did not keep pace with degeneration. He posited that appellant’s excessive typing, 

mouse usage, and writing caused degradation of the cartilage within her right CMC, resulting in

an aggravation of her osteoarthritic condition. Dr. Allen noted that the Merck Manual provides 

that onset of CMC osteoarthritis is gradual and localized to one or a few joints and that pain, 

generally the earliest symptom, was greatest after exercise. He opined that the exercise in 

appellant’s case was her work duties which affected the first CMC joint of her right hand.

Dr. Allen felt that appellant’s subjective complaints of right thumb pain/swelling and her objective

findings of tenderness over the right CMC joint with digit weakness mirrored the symptoms that 

the Merck Manual associated with CMC joint osteoarthritis. He opined that appellant’s work

duties of repetitive grasping, pinching, and typing for seven hours per day “precipitated the 

symptoms of an underlying osteoarthritis condition.”

By decision dated April 25, 2016, OWCP accepted appellant’s claim for right carpal tunnel 

syndrome. It based its determination on the January 13, 2016 opinion of Dr. Allen.

By separate decision dated April 25, 2016, OWCP denied appellant’s claim for 

osteoarthritis of the first CMC joint of her right hand. It found that the medical evidence of record, 

including Dr. Allen’s January 13, 2016 report, failed to establish that her right thumb condition 

was causally related to her accepted employment factors.

On May 9, 2016 counsel requested a hearing before a representative of OWCP’s Branch 

of Hearings and Review with respect to OWCP’s April 25, 2016 decision denying appellant’s 

claim for osteoarthritis of the first CMC joint of her right hand. During the hearing, held on 

December 15, 2016, counsel argued that Dr. Allen’s January 13, 2016 report established 

appellant’s claim for employment-related osteoarthritis of the first CMC joint of her right hand. 

He also acknowledged that Dr. Allen did not physically examine appellant and that his report was 

based on a review of the evidence in the case record and a telephone conversation with appellant. 

Appellant submitted additional evidence in support of her claim for employment-related 

osteoarthritis of the first CMC joint of her right hand. In a July 26, 2016 report, Dr. Bennett H. 

Brown, an attending Board-certified orthopedic surgeon, noted that appellant reported that her 

right hand/wrist condition was due to an unspecified injury at work on October 25, 2013, as well 

as due to the repetitive typing required by her job. Upon physical examination, he observed mild 

swelling of the first CMC joint of appellant’s right hand. In the portion of the report entitled 

“assessment,” Dr. Brown diagnosed right carpal tunnel syndrome, extensor tenosynovitis of the 

right wrist, and other secondary osteoarthritis of the first CMC joint of the right hand, and provided 

the notation, “According to the patient’s history and repetitive typing at work, her [osteoarthritis] 

and extensor tendinitis are causally related to her activities at work.” In the portion of the report 
5

entitled “plan,” he opined that appellant’s right carpal tunnel syndrome, thumb CMC osteoarthritis, 

and wrist tendinitis were directly due to repetitive use of her right hand at work, noting that 

appellant did an excessive amount of typing at work and had been performing her job for years.6

In reports dated December 20, 2016 and January 17, 2017, Dr. Brown diagnosed other 

secondary osteoarthritis of the first CMC joint of the right hand and several other right upper 

extremity conditions. He indicated that the osteoarthritis of the first CMC joint was causally 

related to appellant’s October 25, 2013 workers’ compensation injury and noted that the repetitive 

nature of appellant’s work “can cause the [osteoarthritis] of her wrist....”

By decision dated February 13, 2017, OWCP’s hearing representative affirmed the 

April 25, 2016 decision denying appellant’s claim for osteoarthritis of the first CMC joint of her 

right hand. He found that the medical reports of record, including Dr. Allen’s January 13, 2016

report and those of Dr. Brown, did not contain a rationalized medical opinion relating the 

osteoarthritis of the first CMC joint of appellant’s right hand to the accepted factors of her federal 

employment. The hearing representative found that Dr. Allen’s January 13, 2016 report was of 

limited probative value on this issue because he did not physically examine appellant. He indicated 

that, because the acceptance of appellant’s claim for right carpal tunnel syndrome was based on

Dr. Allen’s January 13, 2016 report, OWCP should undertake further review of its acceptance of 

appellant’s claim for that condition.

On October 6, 2017 counsel requested reconsideration of the February 13, 2017 decision. 

He indicated that he was submitting additional reports of Dr. Brown on behalf of appellant.

7

In February 28 and April 11, 2017 reports, Dr. Brown diagnosed other secondary 

osteoarthritis of the first CMC joint of the right hand and several other right upper extremity 

conditions. He indicated that the osteoarthritis of the first CMC joint was causally related to 

appellant’s “[workers’ compensation] injury on October 25, 2013]” and noted that the repetitive 

nature of appellant’s work “can cause the [osteoarthritis] of her wrist....”

By decision dated February 27, 2018, OWCP denied modification of its February 13, 2017 

decision. It found that the newly submitted medical evidence did not contain a rationalized medical 

opinion relating the osteoarthritis of the first CMC joint of appellant’s right hand to her work 

duties.

 

6 The Board notes that the present case only concerns appellant’s claim for osteoarthritis of the first CMC joint of 

her right hand. As noted, OWCP accepted appellant’s claim on April 25, 2016 for right carpal tunnel syndrome, and 

appellant has not claimed an additional employment-related right upper extremity condition other than right thumb 

osteoarthritis. After the issuance of OWCP’s April 25, 2016 decisions, appellant submitted a number of reports of

Dr. Brown and other providers, dated from mid-2016 to early-2017, which concerned her right carpal tunnel 

syndrome, right wrist tenosynovitis, and/or right epicondylitis conditions. The latter condition was first diagnosed on 

a regular basis in late-2016.

7 A number of the submitted reports had previously been submitted to OWCP. Several reports were newly 

submitted, but only discussed appellant’s bilateral knee condition in 2015 and 2016.
6

LEGAL PRECEDENT

An employee seeking benefits under FECA 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 timely filed within the applicable 

time limitation period of FECA, that an injury was sustained in the performance of duty as alleged, 

and that any specific condition or disability for which compensation is claimed is causally related 

to the employment injury.8

The medical evidence required to establish causal relationship between a claimed specific 

condition or period of disability and an employment injury is rationalized medical opinion 

evidence. 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.9

The Board has held that where the medical evidence supports an aggravation or 

acceleration of an underlying condition precipitated by working conditions or injuries, such 

disability is compensable.10 However, the normal progression of untreated disease cannot be found 

to constitute an “aggravation” of a condition merely because the performance of normal work 

duties reveals the underlying condition.11

Where an employee claims that a condition not accepted or approved by OWCP was due 

to an employment injury, he/she bears the burden of proof to establish that the condition is causally 

related to the employment injury.12

ANALYSIS

The Board finds that appellant has not met her burden of proof to expand the acceptance 

of the claim to include the additional condition of osteoarthritis of the first CMC joint of her right 

hand due to factors of her federal employment.

On November 7, 2013 appellant filed an occupational disease claim for a right hand/wrist 

injury that allegedly arose on or about October 25, 2013. She attributed her condition to working 

on a computer and other repetitive hand/wrist/arm motions. In an April 25, 2016 decision, OWCP 

initially denied appellant’s claim for osteoarthritis of the first CMC joint of her right hand because 

she failed to submit sufficient medical evidence to establish her claim. On February 13, 2017 and 

 

8

J.F., Docket No. 09-1061 (issued November 17, 2009). See also J.T., Docket No. 17-0578 (issued 

December 6, 2017.

9 See E.J., Docket No. 09-1481 (issued February 19, 2010).

10 C.H., Docket No. 17-0488 (issued September 12, 2017).

11 Id.

12 Jaja K. Asaramo, 55 ECAB 200, 204 (2004).
7

February 27, 2018 OWCP also found that appellant failed to establish employment-related 

osteoarthritis of the first CMC joint of her right hand.

Appellant submitted a November 27, 2013 attending physician’s report from Dr. Green 

who noted that appellant reported a sudden pain and swelling in her right thumb occurring at work 

on October 25, 2013. Dr. Green diagnosed sprain/strain of the right thumb and osteoarthritis of 

the hand. He checked a box marked “Yes” to denote that these conditions were employment 

related, and added the notation “Complaints represent exacerbation of preexisting conditions due 

to work.”

The Board finds that this report fails to establish appellant’s claim for osteoarthritis of the 

first CMC joint of her right hand because Dr. Green has not provided adequate medical rationale 

in support of his opinion on causal relationship. The Board has held that when a physician’s opinion 

on causal relationship consists only of checking “Yes” to a form question, without more by the way 

of medical rationale, that opinion has little probative value and is insufficient to establish causal 

relationship. Appellant’s burden includes the necessity of furnishing an affirmative opinion from a 

physician who supports his or her conclusion with sound medical reasoning.13 Dr. Green did not 

describe appellant’s work duties in any detail or explain how they would have been competent to 

cause or aggravate the osteoarthritis of the first CMC joint of her right hand.14 As Dr. Green did no 

more than check “Yes” to a form question, his opinion on causal relationship is of little probative 

value and is insufficient to discharge appellant’s burden of proof.

In a January 13, 2016 report, Dr. Allen asserted that appellant’s claim should also be 

accepted for the diagnosis of osteoarthritis of the first CMC joint of the right hand. While 

acknowledging that this condition likely existed prior to appellant’s federal employment, he opined 

that the duties required by her position resulted in an aggravation of this condition. Dr. Allen noted 

that, per the Merck Manual (14th edition), biomechanical stress might lead to chondrocyte damage 

and proteolytic enzyme release resulting in articular cartilage degeneration, and that osteoarthritis 

developed when cartilage repair did not keep pace with degeneration. He posited that appellant’s 

excessive typing, mouse usage, and writing caused degradation of the cartilage within her right 

CMC, resulting in an aggravation of her osteoarthritic condition. Dr. Allen felt that appellant’s 

subjective complaints of right thumb pain/swelling and her objective findings of tenderness over 

the right CMC joint with digit weakness mirrored those symptoms that the Merck Manual 

associated with CMC joint osteoarthritis. He opined that appellant’s work duties of repetitive 

grasping, pinching and typing for seven hours per day “precipitated the symptoms of an underlying 

osteoarthritis condition.”

The Board first notes that Dr. Allen did not personally conduct a physical examination of 

appellant. Rather, Dr. Allen based his report on a review of the case record and a telephone 

conversation with appellant. The Board has indicated that the absence of a physical examination by 

a physician may affect the weight to be a given medical report, but does not necessarily render it 

 

13 Lillian M. Jones, 34 ECAB 379, 381 (1982).

14 The Board notes that appellant reported experiencing right thumb and other symptoms while using the computer 

at work on October 23, 2013, but she also implicated other repetitive right hand/wrist work over an extended period 

as contributing to her claimed condition.
8

incompetent as medical evidence.15 However, a physician’s report still must contain adequate 

medical rationale to establish causal relationship between employment factors and a given claimed 

condition.16 The Board has held that a report is of limited probative value regarding causal 

relationship if it does not contain medical rationale explaining how an employment activity could 

have caused or aggravated a medical condition.17

The Board finds that Dr. Allen’s January 13, 2016 report is of limited probative value on 

the relevant issue of this case because he failed to provide adequate medical rationale in support 

of his opinion that appellant sustained employment-related osteoarthritis of the first CMC joint of 

her right hand. In his January 13, 2016 report, Dr. Allen made general references to the Merck 

Manual about how activities such as typing can cause CMC osteoarthritis, but he did not 

adequately explain how appellant’s specific work duties could have caused or aggravated her own 

right thumb osteoarthritis condition. He highlighted appellant’s reporting of right thumb 

symptoms while performing such duties as typing and stapling, but the Board has held that the fact 

that a condition manifests itself or worsens during a period of employment18 or that work activities 

produce symptoms revelatory of an underlying condition19 does not raise an inference of causal 

relationship between a claimed condition and employment factors. While Dr. Allen provided some 

discussion of appellant’s work duties, he did not provide sufficient explanation of how these specific 

duties could have caused or aggravated the diagnosed right thumb condition. Related to the fact that 

he did not physically examine appellant, he did not adequately detail findings on physical 

examination which supported his opinion on causal relationship. Dr. Allen opined that appellant’s 

right thumb condition was preexisting, but he did not explain why appellant’s right thumb problems 

were not solely due to the natural progression of the underlying condition.

In a July 26, 2016 report, Dr. Brown noted that appellant reported that her right hand/wrist 

condition was due to an unspecified injury at work on October 25, 2013, as well as due to the 

repetitive typing required by her job. He diagnosed other secondary osteoarthritis of the first CMC 

joint of the right hand and several other right upper extremity conditions, and he indicated that, 

according to appellant’s history and repetitive typing at work, her osteoarthritis was causally 

related to her activities at work. Dr. Brown also noted that appellant’s right thumb CMC 

osteoarthritis was directly due to repetitive use of her right hand at work, noting that appellant did 

an excessive amount of typing at work and had been performing her job for years. In reports dated 

December 20, 2016, January 17, February 28, and April 11, 2017, he diagnosed other secondary 

osteoarthritis of the first CMC joint of the right hand and several other right upper extremity 

conditions. Dr. Brown indicated that the osteoarthritis of the first CMC joint was causally related 

to appellant’s October 25, 2013 workers’ compensation injury and noted that the repetitive nature 

of appellant’s work “can cause the [osteoarthritis] of her wrist....”

 

15 See M.M., Docket No. 17-0438 (issued March 13, 2018). See also Melvina Jackson, 38 ECAB 443 (1987).

16 See Y.D., Docket No. 16-1896 (issued February 10, 2017).

17 Id.

18 William Nimitz, Jr., 30 ECAB 567, 570 (1979).

19 Richard B. Cissel, 32 ECAB 1910, 1917 (1981).
9

The Board finds that these reports are insufficient to establish appellant’s claim for 

osteoarthritis of the first CMC joint of her right hand because Dr. Brown has not provided adequate 

medical rationale in support of his opinion on causal relationship. Dr. Brown did not describe the 

implicated employment factors in any significant detail or explain how they could have caused or 

aggravated osteoarthritis of the first CMC joint of appellant’s right hand. He did not adequately 

detail findings on physical examination and diagnostic testing which supported his opinion on 

causal relationship. As noted, the Board has held that a report is of limited probative value 

regarding causal relationship if it does not contain medical rationale explaining how an 

employment activity could have caused or aggravated a medical condition.20

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 expand the acceptance 

of the claim to include the additional condition of osteoarthritis of the first CMC joint of her right 

hand due to factors of her federal employment.

 

20 See supra note 17.
10

ORDER

IT IS HEREBY ORDERED THAT the February 27, 2018 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: November 20, 2018

Washington, DC

Christopher J. Godfrey, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board