United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

C.J., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Riverton, UT, Employer

__________________________________________

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Docket No. 18-0298

Issued: October 3, 2018

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

CHRISTOPHER J. GODFREY, Chief Judge

ALEC J. KOROMILAS, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On November 27, 2017 appellant filed a timely appeal from a September 20, 2017 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 this case.

ISSUE

The issue is whether appellant has met her burden of proof to establish intermittent periods 

of total disability from September 7 through December 3, 2016 due to the accepted employment 

injury.

FACTUAL HISTORY

On September 2, 2016 appellant, then a 70-year-old rural carrier, filed an occupational 

disease claim (Form CA-2) alleging that she developed tendinitis in her wrist and thumb as a result 

 

1 5 U.S.C. § 8101 et seq.
2

of grasping letters and lifting trays at work. She first became aware of her condition and its 

relationship to her federal employment on July 15, 2016. 

A Family and Medical Leave Act (FMLA) certification of health care provider form dated 

September 20, 2016 and completed by Dr. Joyce A. Pritchard, an attending Board-certified family 

practitioner, was received. Dr. Pritchard diagnosed left radial styloid tenosynovitis that caused 

pain and weakness along the thumb with repetitive use or any significant weight. She also 

diagnosed severe tendinitis of the thumb. Dr. Pritchard checked a box marked “yes” indicating 

that appellant was unable to perform certain job functions due to the conditions. She advised that 

appellant was incapacitated on September 7 and 9, 2016 and from September 20 through 

October 16, 2016. 

OWCP, in an October 19, 2016 development letter, advised appellant of the deficiencies 

in her claim and requested that she submit additional medical and factual evidence. In a separate 

letter dated October 19, 2016, it requested that the employing establishment respond to her

allegations and provide information regarding her workplace exposure and medical evidence, if 

she had been treated at its medical facility. OWCP afforded appellant and the employing 

establishment 30 days to submit the requested information.

On October 31, 2016 the employing establishment responded that appellant’s statements 

were accurate and that she cased mail and lifted packages at work. It noted that training was 

provided to her to minimize the effects of her exposure. The employing establishment submitted 

an official description of a rural carrier position. 

An October 25, 2016 return to work form from Bryan Bernhardt, a certified physician 

assistant, indicated that appellant had a left wrist diagnosis and that she could return to work 

without restrictions on November 1, 2016.

On November 2, 2016 appellant responded to OWCP’s October 19, 2016 development 

letter. She described her work duties as including sorting and casing letters and flats and delivering 

mail. Appellant also provided a history of injury. In mid-July 2016 she began feeling pain and 

discomfort in her left hand while grasping and lifting mail. Appellant’s symptoms gradually 

worsened to include weakness, decreased strength, an inability to grasp with her hand and thumb, 

limited lifting ability, and pain when she attempted to perform her described work duties. She 

noted a history of her medical treatment, which included physical therapy and a cortisone shot. 

Appellant did not recall having any other similar condition.

Appellant submitted reports of intermittent dates from September 12 through 29, 2016 

from occupational therapists regarding the treatment of her diagnoses of left wrist tendinitis and 

de Quervain’s syndrome. She also submitted Disabilities of the Arm, Shoulder, and Hand (DASH) 

questionnaires dated September 12 and 19, 2016 from a physical therapy clinic which assessed her 

functional ability. 

Appellant further submitted an October 11, 2016 medical report by Mr. Bernhardt and 

reviewed by Dr. Steven B. Huish, an attending Board-certified orthopedic surgeon, but not signed, 

a September 20, 2016 progress note from Dr. Pritchard, and an October 25, 2016 report from
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Mr. Bernhardt, who diagnosed left wrist de Quervain’s tenosynovitis and opined that the diagnosed 

condition was causally related to her rural carrier duties. 

On December 2, 2016 OWCP accepted appellant’s claim for left radial styloid 

tenosynovitis (de Quervain). 

In a December 8, 2016 statement, appellant noted that she was out of work on 

November 25, 26, 29, and 30 and December 3, 2016 due to left wrist pain. She noted that her 

December 7, 2016 surgery was cancelled and that it would probably take place on 

December 12, 2016. 

Appellant submitted an October 11, 2016 return to work form from Mr. Bernhardt who 

reiterated his prior diagnosis of left wrist de Quervain’s tenosynovitis. Mr. Bernhardt advised that 

appellant could return to work the next day with restrictions. Appellant, in a handwritten note on 

the return to work form, related that the employing establishment would not provide light-duty

work until workers’ compensation had approved an injury. 

In a December 5, 2016 return to work form, Dr. Huish advised that appellant could not 

return to work in any capacity from December 6, 2016 through January 4, 2017, a period of four 

weeks after her surgery. 

On December 9, 2016 appellant filed a claim for compensation (Form CA-7) for leave 

without pay (LWOP) for intermittent periods of disability from September 7 to December 9, 2016. 

In attached time analysis forms (Form CA-7a) dated December 13, 2016, she requested LWOP for 

304 hours.

In a December 16, 2016 statement, appellant indicated that on December 12, 2016 she 

returned to light-duty work at the employing establishment because her surgery did not take place 

and was rescheduled for December 19, 2016.

In a development letter dated December 22, 2016, OWCP advised appellant that the 

evidence submitted was insufficient to establish her claim for compensation for the period 

September 7 through December 9, 2016. It requested that she provide additional medical and 

factual evidence. OWCP noted that pain was a symptom and not a valid diagnosis. It further noted 

that a physician assistant was not considered a “physician” as defined by FECA. OWCP afforded 

appellant 30 days to submit the requested information. It sent a copy of its development letter to 

the employing establishment.

A November 22, 2016 report from Mr. Bernhardt was received in which he added an 

impression of continued left de Quervain’s syndrome despite conservative treatment and 

recommended a left first dorsal compartment release. He advised that appellant would need three 

to four weeks off work for recovery before returning to full duty. 

On December 28, 2016 the employing establishment responded to OWCP’s December 22, 

2016 development letter. It noted appellant’s work restrictions and explained that light-duty work 

was not provided to a rural carrier due to union contract provisions. Limited-duty work could be 

provided when a claim had been adjudicated by OWCP. The employing establishment noted that 

an October 25, 2016 medical document released appellant to return to full duty with no restrictions 
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as of November 1, 2016. It maintained that the medical documentation it had was vague as to why 

she sometimes worked and sometimes had not worked.

Appellant, on January 4, 2017, also responded to OWCP’s December 22, 2016 

development letter. She noted that she returned to light-duty work after the employing 

establishment postmaster mistakenly told her that he had to wait until OWCP accepted her claim

before she could do so. Appellant noted that she did not undergo surgery on December 19, 2016 

because OWCP had not authorized the surgery at that time.2

Appellant submitted an unsigned return to work form dated January 4, 2017, which 

indicated that she could not return to work in any capacity through February 1, 2017 and that 

surgery approval was still pending. The form listed her work restriction for a four-week duration.

An additional report dated September 19, 2016 from appellant’s occupational therapist 

addressed the treatment of her left wrist tenosynovitis and de Quervain’s syndrome. 

On February 16, 2017 OWCP authorized appellant’s left wrist surgery.

A further return to work form dated February 15, 2017 from Dr. Huish again indicated that 

appellant could not return to work in any capacity as of that day. He related that she was awaiting 

surgery approval.

In a March 14, 2017 return to work form, Mr. Bernhardt noted that appellant underwent 

left wrist surgery on March 6, 2017. He requested that she be excused from work from the date of 

surgery through March 31, 2017. Mr. Bernhardt reported that appellant could return to work with 

restrictions on March 31, 2017. 

By decision dated March 16, 2017, OWCP denied appellant’s claim for total disability 

compensation for the period September 7 to December 9, 2016. It found that the medical evidence 

of record failed to establish that she was disabled as a result of her accepted employment injury. 

In a letter and appeal request form received on June 30, 2017, appellant requested 

reconsideration of the March 16, 2017 decision. She contended that accompanying documents 

established that she was unable to perform her job and that the employing establishment failed to 

accommodate her with limited-duty work. Appellant provided a timeline of her medical treatment 

and time off work from September 7, 2016 through May 23, 2017.

Appellant submitted the employing establishment’s grievance guide regarding the 

withdrawal or failure to provide limited duty and additional medical evidence, which included 

progress notes from her occupational therapists who addressed the treatment of her left wrist 

tendinitis and de Quervain’s syndrome on September 12, 19, 23, and 29 and October 4, 2016. 

Appellant also submitted further DASH questionnaires dated September 19, 26, and 29, 

2016 from a physical therapy clinic and an operative note dated March 6, 2017 in which Dr. Huish 

 

2 The record indicates that OWCP initially authorized appellant’s request for left wrist surgery on 

December 20, 2016. 
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performed left first dorsal compartment release for her preoperative and postoperative diagnoses 

of left de Quervain’s syndrome. 

Mr. Bernhardt, in a May 23, 2017 report, indicated that appellant was doing well following 

her March 6, 2017 surgery, although she had lingering swelling and flare-ups of pain in the CMC 

joint of her left thumb. He completed FMLA paperwork indicating that she could have flare-ups 

of arthritis and overuse twice a month. 

By decision dated September 18, 2017, OWCP vacated its March 15, 2017 decision, 

finding that the evidence of record was sufficient to establish that appellant was totally disabled 

from work from September 7 through December 9, 2016 due to her accepted employment injury. 

However, in a September 20, 2017 cover letter, it advised her that the attached September 20, 2017 

decision superseded its September 18, 2017 decision, which had vacated its March 15, 2017 

decision. OWCP found that the medical evidence of record was sufficient to establish that 

appellant was totally disabled from work from September 23 through 30, 2016 and October 4 

through 27, 2016, on October 29 and November 22, 2016, and from December 7 through 9, 2016

due to her accepted employment injury. It further found, however, that the medical evidence of 

record was insufficient to establish that she was totally disabled from work on September 7 and 9

and November 12 and 16, 2016, from November 25 through 30, 2016, and on December 3, 2016

due to her accepted work injury. Accordingly, OWCP vacated in part, modified in part, and 

affirmed in part its March 15, 2017 decision.

LEGAL PRECEDENT

An employee seeking benefits under FECA3 has the burden of proof to establish the 

essential elements of his or her claim, including that any disability or specific condition for which 

compensation is claimed is causally related to the employment injury.4 The term disability is 

defined as the incapacity because of an employment injury to earn the wages the employee was 

receiving at the time of the injury.5

Whether a particular injury causes an employee to be disabled from employment and the 

duration of that disability are medical issues which must be proved by a preponderance of the 

reliable, probative, and substantial medical evidence.6 Findings on examination are generally 

needed to support a physician’s opinion that an employee is disabled for work. 

The Board will not require OWCP to pay compensation for disability in the absence of any 

medical evidence addressing the specific dates of disability for which compensation is claimed. 

 

3 Supra note 1. 

4 Kathryn Haggerty, 45 ECAB 383 (1994); Elaine Pendleton, 40 ECAB 1143 (1989).

5 20 C.F.R. § 10.5(f); see e.g., Cheryl L. Decavitch, 50 ECAB 397 (1999).

6 Amelia S. Jefferson, 57 ECAB 183 (2005); William A. Archer, 55 ECAB 674 (2004).
6

To do so would essentially allow an employee to self-certify his or her disability and entitlement 

to compensation.7

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

relationship is rationalized medical evidence.8 Rationalized medical evidence is medical evidence 

which includes a physician’s detailed medical 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.9 Neither the 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.10

ANALYSIS

The Board finds that appellant has failed to establish that she was totally disabled from 

work during intermittent periods from September 7 through December 3, 2016 due to the accepted 

employment injury.

OWCP accepted appellant’s claim for left radial styloid tenosynovitis (de Quervain’s 

syndrome). Appellant stopped work on September 7, 2016 and claimed that she sustained total 

disability between that day and intermittently until December 9, 2016 due to her accepted 

employment injury.11 By decision dated September 20, 2017, OWCP found that the medical 

evidence of record was sufficient to establish a causal relationship between her claimed total 

disability from September 23 through 30, 2016 and October 4 through 27, 2016, on October 29 

and November 22, 2016, and from December 7 through 9, 2016 and the accepted employment 

injury. It found, however, that the medical evidence of record was insufficient to establish a causal 

relationship between appellant’s claimed total disability on September 7 and 9 and November 12 

and 16, 2016, from November 25 through 30, 2016, and on December 3, 2016 and the accepted 

work injury. 

Appellant has the burden of proof to establish by the weight of the substantial, reliable, and 

probative evidence, a causal relationship between her claimed disability for that period and the 

 

7 Amelia S. Jefferson, id.

8

Jacqueline M. Nixon-Steward, 52 ECAB 140 (2000).

9 Leslie C. Moore, 52 ECAB 132 (2000).

10 Dennis M. Mascarenas, 49 ECAB 215 (1997).

11 Appellant returned to limited-duty work on December 12, 2016 while awaiting surgery approval. 
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accepted conditions.12 The Board finds that she has failed to submit sufficient medical evidence 

to establish employment-related disability for the period claimed due to her accepted injury.13

Appellant submitted a September 20, 2016 FMLA certification of health care provider 

form from Dr. Pritchard. The Board finds that the opinion of Dr. Pritchard is not well rationalized. 

She diagnosed left radial styloid tenosynovitis that caused pain and weakness along the thumb 

with repetitive use or any significant weight and severe tendinitis of the thumb. Dr. Pritchard

checked a box marked “yes” indicating that appellant’s incapacity to perform certain job duties on

September 7 and 9, 2016 and from September 20 through October 16, 2016 was due to the 

conditions for which compensation was claimed. The Board has held that a report that addresses 

causal relationship with a checkmark on a form report, without medical rationale explaining how 

the conclusion was reached, is of diminished probative value and insufficient to establish causal 

relationship.14 As Dr. Pritchard did not explain why appellant was disabled during the dates in 

question, and the causal relationship between appellant’s disability and the accepted employment 

injury, her form report is insufficient to meet appellant’s burden of proof. 

Appellant also submitted Dr. Huish’s December 5, 2016 and February 15, 2017 return to 

work formsin which he advised that she could not return to work in any capacity from December 6, 

2016 through January 4, 2017, and as of February 15, 2017, respectively. While Dr. Huish 

addressed her total disability from work, he did not directly address the specific dates in question.15 

Likewise, he did not address the specific dates in question in his March 6, 2017 operative note.16 

Thus, the Board finds that Dr. Huish’s form reports and operative note are insufficient to meet

appellant’s burden of proof.

The reports and DASH questionnaires from Mr. Bernhardt, a certified physician assistant, 

and appellant’s occupational therapists, have no probative medical value. Neither a physician 

assistant nor an occupational therapist is considered a physician as defined under FECA and, 

therefore, their opinions are of no probative medical value.

17

 

The January 4, 2017 unsigned return to work form indicated that appellant could not work 

through February 1, 2017. The Board has held that unsigned reports and reports that bear illegible 

 

12 Amelia S. Jefferson, supra note 6.

13 Alfredo Rodriguez, 47 ECAB 437 (1996).

14 See Elmer C. Campbell, Docket No. 94-1267 (issued March 5, 1996).

15 M.C., Docket No. 12-1895 (issued April 18, 2013); M.F., Docket No. 08-1927 (issued April 16, 2009).

16 Id.

17 5 U.S.C. § 8101(2) provides that a physician includes surgeons, podiatrists, dentists, clinical psychologists, 

optometrists, chiropractors, and osteopathic practitioners within the scope of their practice as defined by state law. 

See Sean O Connell, 56 ECAB 195 (2004) (physician assistant); and E.R., Docket No. 16-1634 (issued May 25, 2017) 

(occupational therapist); Charley V.B. Harley, 2 ECAB 208, 211 (1949) (a medical issue such as causal relationship 

can only be resolved through the submission of probative medical evidence from a physician).

5 U.S.C. § 8101(2); 20 C.F.R. § 10.5(t).
8

signatures cannot be considered probative medical evidence because they lack proper 

identification.18 Thus, this form report is of no probative value.

As noted, appellant must submit reasoned medical evidence directly addressing the specific 

dates of disability for work for which she claims compensation.19 She did not provide medical 

evidence containing a rationalized opinion supporting that she could not work during intermittent 

periods from September 7 through December 3, 2016 due to her accepted condition, and thus did 

not meet her burden of proof.

On appeal, appellant expresses her dissatisfaction with an examination performed by her 

physician assistant and a nurse who had difficulty obtaining authorization for her left wrist surgery. 

She contends that her disability from work was due to work stress and an incomplete surgery. The 

Board finds these arguments without merit. For the reasons stated above, the Board finds that the 

weight of the medical evidence of record does not establish that appellant was totally disabled 

from work during intermittent periods from September 7 through December 3, 2016 due to her 

accepted employment injury.

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 failed to meet her burden of proof to establish 

intermittent periods of total disability from September 7 through December 3, 2016 due to the 

accepted July 15, 2016 employment injury.

 

18 See R.M., 59 ECAB 690 (2008); D.D., 57 ECAB 734 (2006); Richard J. Charot, 43 ECAB 357 (1991).

19 See K.A., Docket No. 16-0592 (issued October 26, 2016).
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ORDER

IT IS HEREBY ORDERED THAT the September 20, 2017 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: October 3, 2018

Washington, DC

Christopher J. Godfrey, 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