United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

J.H., Appellant 

and 

SMITHSONIAN INSTITUTION, MUSEUM 

SUPPORT CENTER, Suitland, MD, Employer 

__________________________________________ 

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Docket No. 17-0248 

Issued: May 10, 2017 

Appearances: Case Submitted on the Record

Alan J. Shapiro, 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 November 14, 2016 appellant, through counsel, filed a timely appeal from a 

September 19, 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 the case. 

ISSUE 

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

disease claim due 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 February 13, 2015 appellant then a 58-year-old lead security guard, filed an 

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

result of typing on an elevated desk at work all day. She first became aware of her condition on 

September 29, 2014 and realized that it was causally related to her work on October 2, 2014. 

Appellant stopped work on January 16, 2015 and had carpal tunnel surgery. 

Appellant submitted a January 9, 2015 report from Dr. Sabine Balzora, a Board-certified 

internist, who diagnosed right trigger thumb, bilateral carpal tunnel syndrome, osteoarthritis of 

the knees, and joint pain. Dr. Balzora recommended use of a thumb splint for 12 to 22 hours per 

day and a cane to prevent falls due to knee pain. In another January 9, 2015 report, she noted 

being appellant’s primary care physician and advised that appellant had conditions involving the 

ligaments of her right thumb and carpal tunnel syndrome of her right hand and wrist. 

Dr. Balzora advised that, due to these acute medical conditions and upcoming surgery, appellant 

was unable to safely carry or operate her weapon for the next four weeks. In a verification of 

treatment form dated February 12, 2015, she noted that appellant was on acetaminophen-codeine 

for pain. 

Appellant submitted a verification of treatment form dated December 19, 2014, from 

Dr. Sidney G. Chetta, a Board-certified orthopedist, who noted that she was scheduled to have 

surgery on January 16, 2015 and would be unable to work for approximately three to four weeks 

to allow adequate recovery time. On January 30, 2015 Dr. Chetta saw her in follow-up after 

surgery. In a verification of treatment form dated January 30, 2015, he noted having treated 

appellant on January 16 and 30, 2015. Dr. Chetta indicated that she could return to office work 

on February 16, 2015, but was unable to carry a weapon for eight weeks. In an attending 

physician’s report (Form CA-20) dated February 13, 2015, he diagnosed carpal tunnel syndrome 

and right trigger thumb. Dr. Chetta noted that appellant had carpal tunnel release on January 16, 

2015 and was undergoing postoperative care. He advised that she was totally disabled from 

January 16 to February 16, 2015 and could return to work on February 17, 2015. In a Form CA16 dated February 13, 2015, Dr. Chetta diagnosed carpal tunnel syndrome and right trigger 

thumb. He noted that appellant had a right carpal tunnel release on January 16, 2015 and was 

undergoing postoperative care. Dr. Chetta noted that she was totally disabled from work during 

the period January 16 to February 16, 2015. In a verification of treatment form dated 

February 17, 2015, he indicated that appellant could return to work on February 23, 2015. 

By letter dated April 30, 2015, OWCP advised appellant of the type of evidence needed 

to establish her claim. It particularly requested that she submit additional information including 

a comprehensive medical report from her treating physician containing a reasoned explanation as 

to how the specific work factors had contributed to her claimed injury. 

Appellant provided a January 16, 2015 operative report from Dr. Chetta, who performed 

a carpal tunnel release of the right wrist and A1 pulley release of the right thumb. Dr. Chetta 

diagnosed carpal tunnel syndrome right wrist and trigger finger right thumb. In a progress note 

dated January 30, 2015, he indicated that appellant was status post right carpal tunnel release on 

January 16, 2015. Dr. Chetta indicated that the incision was clean and dry without drainage, the 

radial, medial, and ulnar motor strength was intact, and numbness and tingling in the medial 
3

distribution was resolving. In a February 10, 2015 duty status report, he diagnosed right carpal 

tunnel syndrome and indicated that appellant could return to work on May 1, 2015 subject to 

restrictions. In a treatment verification form dated April 30, 2015, Dr. Chetta treated her on 

February 17, 2015 and noted that she could resume light-duty work until May 13, 2015. 

Appellant also submitted evidence from a nurse practitioner and physical therapy records. 

By decision dated June 26, 2015, OWCP accepted that appellant did engage in the noted 

employment factors, but denied the claim as the medical evidence of record failed to establish an 

injury or medical condition causally related to the accepted work factors. 

On June 21, 2016 appellant, through counsel, requested reconsideration. She submitted a 

June 9, 2016 report from Dr. Neil Allen, a Board-certified neurologist and internist. Dr. Allen 

did not examine appellant, but reviewed her medical records. He noted that she had reported 

being employed as an armed security guard which required typing on an elevated desk which 

forced flexion of her wrists, lifting up to 15 pounds and grasping, eight hours per day. Appellant 

noted that after two years in the job she noticed gradually worsening soreness on the inside of the 

right wrist, with grip strength weakness, and tingling in the palm of the hand. Dr. Chetta treated 

her, diagnosed carpal tunnel syndrome, and performed a carpal release on January 16, 2015. 

Appellant’s current symptoms were intermittent pain and difficulty making a closed fist. 

Dr. Allen opined that her right wrist injury was work related and her case should be accepted for 

right carpal tunnel syndrome. He advised that appellant denied any symptoms related to carpal 

tunnel syndrome before her work as a security guard for the employing establishment. 

In support of his causation opinion, Dr. Allen cited the Merck Manual which noted that 

the compression of the carpal tunnel produces paresthesia in the radial-palmar aspect of the hand 

plus pain in the wrist, in the palm, or sometimes proximal to the compression site in the forearm, 

and sensory deficit in the palmar aspect of the first three digits and/or weakness of thumb 

opposition. He noted that appellant’s symptoms were consistent with the Merck Manual. 

Dr. Allen noted that the Merck Manual described possible etiologies related to carpal tunnel 

syndrome and occupations that require repeated forceful wrist flexion, violent muscular activity 

or forcible overextension of a joint, and mechanical stress like typing in a biomechanically 

unsound setting. He indicated that in appellant’s case her elevated desk would produce 

repetitive, forceful wrist flexion. Dr. Allen also cited the A.M.A., Guides to the Evaluation of 

Disease and Injury Causation which indicated that occupations requiring repetitive hyperflexion 

and twisting of wrists increases the risk of carpal tunnel syndrome twofold. He noted other risk 

factors included manual handling, repetitive work, sustained forceful movement and repetitive 

work, force and duration of wrist flexion, and sustained forceful movement. Dr. Allen opined 

that for those reasons appellant’s work duties led to the development of carpal tunnel syndrome 

in the right wrist due to repetitive activity. 

In a decision dated September 19, 2016, OWCP denied modification of the decision 

dated June 26, 2015. 

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 an injury in the performance of 
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duty, the employee must submit sufficient evidence to establish that she experienced a specific 

event, incident, or exposure occurring at the time, place, and in the manner alleged. The 

employee must also establish that such event, incident, or exposure caused an injury.3 

To establish that an injury was sustained in the performance of duty in an occupational 

disease claim, a claimant must submit the following: (1) medical evidence establishing the 

presence or existence of the disease or condition for which compensation is claimed; (2) factual 

statement identifying employment factors alleged to have caused or contributed to the presence 

or occurrence of the disease or condition; and (3) medical evidence establishing that the 

employment factors identified by the claimant were the proximate cause of the condition for 

which compensation is claimed or, stated differently, medical evidence establishing that the 

diagnosed condition is causally related to the employment factors identified by the claimant. 

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.4

ANALYSIS 

It is undisputed that appellant’s work duties as a lead security guard involved typing on 

an elevated desk for prolonged periods of time, lifting up to 15 pounds, and grasping. However, 

the Board finds that she has submitted insufficient medical evidence to establish that her 

diagnosed conditions are causally related to specific employment factors. 

Appellant submitted a June 9, 2016 report from Dr. Allen, who had not examined her, but 

had reviewed her medical records. Dr. Allen generally noted appellant’s job duties, her medical 

history, and reported symptoms. He advised that her reported symptoms and work factors were 

consistent with the Merck Manual’s description of possible etiologies for carpal tunnel 

syndrome. Dr. Allen also referenced the A.M.A., Guides to the Evaluation of Disease and Injury 

Causation, as supporting that appellant’s condition was contributed to by work duties that 

involved repetitive activity. He opined that her right wrist injury was work related and her case 

should be accepted for right carpal tunnel syndrome. Although Dr. Allen supported causal 

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

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

and her work duties.5

 He did not explain how or why typing on an elevated desk would have 

 3 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). 

4 Solomon Polen, 51 ECAB 341 (2000). 

5 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). 
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caused or aggravated the diagnosed conditions. Instead Dr. Allen cited medical literature. The 

Board has held that excerpts from publications have little probative value in resolving medical 

questions unless a physician shows the applicability of the general medical principles discussed 

in the articles to the specific factual situation in a case.6

 Here, Dr. Allen provided little medical 

rationale to explain how the medical journals applied to appellant’s particular situation. He also 

noted that appellant denied carpal tunnel symptoms prior to her employment for the employing 

establishment. The Board, however, has held that an opinion that a condition is causally related 

to an employment injury because the employee was asymptomatic before the injury is 

insufficient, without supporting rationale, to support a causal relationship.7 Therefore, the report 

of Dr. Allen is insufficient to meet appellant’s burden of proof.8

Appellant submitted reports and treatment notes from Dr. Chetta. Dr. Chetta noted 

appellant’s status, findings, diagnoses, and recommended treatment. However, these reports are 

insufficient to establish the claim as he did not provide a history of injury9 or specifically address 

whether appellant’s employment activities had caused or aggravated a diagnosed medical 

condition.10 Likewise, reports from Dr. Balzora on January 9, 2015, who noted treating 

appellant, are also insufficient to establish the claim as she did not address whether appellant’s 

employment activities had caused or aggravated a diagnosed medical condition.11 

The record also contains evidence from a nurse practitioner and a physical therapist. The 

Board has held that treatment notes signed by nurse practitioners or physical therapists are not 

considered medical evidence as these providers are not considered physicians under FECA.12 

The remainder of the medical evidence does not provide an opinion on the causal 

relationship between appellant’s job and her diagnosed carpal tunnel syndrome. For this reason, 

this evidence is not sufficient to meet appellant’s burden of proof.13 

 6 Roger G. Payne, 55 ECAB 535 (2004). 

7 Kimper Lee, 45 ECAB 565 (1994). 

8 See L.D., Docket No. 09-1503 (issued April 15, 2010) (the fact that a condition manifests itself during a period 

of employment does not raise an inference that there is a causal relationship between the two). 

9 Frank Luis Rembisz, 52 ECAB 147 (2000) (medical opinions based on an incomplete history or which are 

speculative or equivocal in character have little probative value). 

10 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). 

11 See id. 

12 See David P. Sawchuk, 57 ECAB 316 (2006) (lay individuals such as physicians assistants, nurses, and 

physical therapists are not competent to render a medical opinion under the 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). See also Paul Foster, 56 

ECAB 208 (2004). 

13 See supra note 10. 
6

The employing establishment issued appellant a Form CA-16 authorizing medical 

treatment. The Board has held that where an employing establishment properly executes a Form 

CA-16, which authorizes medical treatment as a result of an employee’s claim for an 

employment-related injury, it creates a contractual obligation, which does not involve the 

employee directly, to pay the cost of the examination or treatment regardless of the action taken 

on the claim.14 Although OWCP denied appellant’s claim for an injury, it did not address 

whether she would be entitled to reimbursement of medical expenses pursuant to the Form 

CA-16. Upon return of the case record, OWCP should further address this matter. 

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 establish an 

occupational disease claim due to factors of her employment. 

ORDER 

IT IS HEREBY ORDERED THAT the September 19, 2016 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: May 10, 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 

 14 See D.M., Docket No. 13-535 (issued June 6, 2013). See also 20 C.F.R. §§ 10.300, 10.304.