United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

C.M., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE,

Erie, CO, Employer

__________________________________________

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Docket No. 19-0264

Issued: December 19, 2019

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

CHRISTOPHER J. GODFREY, Chief Judge

PATRICIA H. FITZGERALD, Deputy Chief Judge

JANICE B. ASKIN, Judge

JURISDICTION

On November 16, 2018 appellant filed a timely appeal from a November 1, 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 this case.

ISSUE

The issue is whether appellant has met her burden of proof to establish left carpal tunnel 

syndrome causally related to the accepted factors of her federal employment. 

FACTUAL HISTORY

On December 8, 2016 appellant, then a 49-year-old rural carrier, filed an occupational 

disease claim (Form CA-2) alleging a left upper extremity condition which she attributed to factors 

of her federal employment, including handling letters, trays of mail, and magazines. She also 

 

1 5 U.S.C. § 8101 et seq.
2

attributed her injury to pulling down mail with her right arm and holding it with her left arm. 

Appellant explained that she was compensating for her right-side surgeries. She identified 

January 1, 2008 as the date she first became aware of her condition and its relation to her federal

employment. OWCP assigned the above-noted claim OWCP File No. xxxxxx979.2

In a December 28, 2016 development letter, OWCP informed appellant that the evidence 

of record was insufficient to establish her left-upper extremity claim. It advised her of the type of 

factual information and medical evidence necessary and provided a questionnaire for her 

completion. By separate letter of even date, OWCP requested that the employing establishment 

comment on the accuracy of appellant’s statements and provide additional information regarding 

her employment duties. It afforded both parties 30 days to respond. 

Appellant responded to OWCP’s development letter in a completed questionnaire dated 

December 28, 2016. She explained that she had worked for the employing establishment for 111⁄2 

years. Appellant related that she cased letter mail and flats for approximately 4 to 6 hours per day, 

sorted packages for approximately 1 to 11⁄2 hours per day, and delivered mail on her route for 3 to 

31⁄2 hours per day. She reported that she recently had surgery on her right hand and shoulder and 

had been compensating with her left side. 

In a December 27, 2016 state workers’ compensation injury form, Dr. James Rafferty, 

Board-certified in occupational medicine, described a January 8, 2016 work injury and reported 

diagnoses of status post right shoulder surgery, right elbow medial epicondylitis, and left hand 

probable carpal tunnel syndrome. He also suspected basal joint osteoarthritis and mild 

de Quervain’s tenosynovitis. 

By decision dated February 2, 2017, OWCP denied appellant’s occupational disease claim

finding the medical evidence submitted was insufficient to establish a causal relationship between 

her condition(s) and the accepted factors of her federal employment.3

On February 13, 2017 appellant requested a review of the written record by a representative 

of OWCP’s Branch of Hearings and Review. 

In a February 9, 2017 duty status report (Form CA-17), an unknown provider with an 

illegible signature indicated that appellant’s history included overuse of left hand and noted 

diagnoses of right elbow tendinosis and probable left carpal tunnel syndrome. 

 

2 Under OWCP File No. xxxxxx680, appellant has an accepted occupational disease claim for right carpal tunnel 

syndrome, which arose on or about January 8, 2008. Under OWCP File No. xxxxxx052, she has an accepted traumatic 

injury claim for right shoulder impingement syndrome and right biceps tendon strain, which arose on January 8, 2016. 

Appellant underwent OWCP-authorized right upper extremity surgical procedures on April 12 and June 17, 2016. 

Following her latest surgery, she returned to work in a full-time and limited-duty capacity on November 21, 2016. 

OWCP also granted appellant schedule awards totaling 22 percent permanent impairment of the right upper extremity. 

The three above-noted right and left upper extremity claims have been combined, with OWCP File No. xxxxxx052 

designated as the master file. 

3 OWCP further explained that, if appellant was claiming a consequential injury related to her previously accepted 

right upper extremity conditions, then she should submit a written request under her prior claim(s) seeking to expand 

the accepted conditions. 
3

In an April 18, 2017 narrative report, Dr. Rafferty recounted appellant’s complaints of 

numbness/tingling of the left hand. He explained that in December 2016 she began to develop 

pain over the radial aspect of her left wrist, pain in her left basal joint, and numbness and tingling 

in her left hand. Dr. Rafferty related that appellant believed that her symptoms resulted from an 

“overuse of [appellant’s] left upper extremity” when she was having the greatest difficulty with 

her right upper extremity. He assessed probable basal joint arthritis and carpal tunnel syndrome. 

Dr. Rafferty recommended electrodiagnostic studies in order to provide a definitive diagnosis and 

reported that he could not address causation without a definitive diagnosis. 

Dr. Rafferty completed additional state workers’ compensation forms dated April 18 and 

May 9, 2017. He noted a date of injury of December 8, 2016 and reported that appellant believed 

that her medical condition resulted from her usual job duties. Dr. Rafferty diagnosed presumptive 

carpal tunnel syndrome of the left wrist/hand. 

By decision dated May 30, 2017, an OWCP hearing representative affirmed the 

February 2, 2017 decision. She determined that Dr. Rafferty’s medical reports were insufficiently 

rationalized to explain how appellant’s work activities had caused or contributed to a new left 

hand/wrist occupational disease.4 

On September 7, 2017 appellant requested reconsideration. 

Appellant submitted a narrative statement dated July 27, 2017. She related that, after her 

three surgeries for her right upper extremity, she returned to modified-duty work on May 16, 2017 

using just her left side.5 Appellant described her various duties following her May 16, 2017 return 

to work. 

OWCP underwent a July 24, 2017 electromyography and nerve conduction velocity 

(EMG/NCV) study by Dr. Lynsee Hudson-Lang, a Board-certified neurologist, who reported

findings of moderate-to-severe left sensorimotor median neuropathy at the wrist and normal left 

ulnar nerve. She noted a diagnosis of left carpal tunnel syndrome. 

In a September 18, 2017 progress note, Dr. Patricia Hsu, a Board-certified orthopedic 

surgeon, noted diagnoses of left medial epicondylitis and left carpal tunnel syndrome. She 

recounted that appellant had worked for the employing establishment for the last 14 years. Dr. Hsu 

indicated that this past year appellant had multiple surgeries to her right upper extremity for workrelated injuries and that she resumed light duty in May 2017. She reported that appellant thinks 

that, in the process of trying to start working again, she overused her left side. Dr. Hsu related that 

appellant currently complained of numbness and tingling in her left hand and pain in the elbow. 

Upon examination of appellant’s left arm, she observed mild tenderness over the medial 

epicondyle. Phalen’s maneuver demonstrated tingling in the index and middle fingers. Tinel’s 

testing revealed tingling just to the volar central aspect of the wrist. Dr. Hsu diagnosed left carpal 

 

4 OWCP’s hearing representative similarly advised appellant that, if she was claiming a left arm consequential 

injury due to her accepted right upper extremity condition(s), she may file a claim for consequential injury under her 

previously accepted claim(s).

5 Appellant had recently undergone an April 20, 2017 OWCP-approved right elbow surgical procedure under 

OWCP File No. xxxxxx052.
4

tunnel syndrome and left medial epicondylitis. She completed a work restriction note, which 

released appellant to modified duty. 

By decision dated December 6, 2017, OWCP denied modification of the May 30, 2017 

decision. 

On September 14, 2018 appellant requested reconsideration. 

In a September 4, 2018 letter, Dr. Rafferty indicated that appellant was under his care for 

right-sided carpal tunnel syndrome from January 19 to June 23, 2016. He explained that on 

January 19, 2016 she reported that she had experienced numbness and tingling in her bilateral 

hands for many years, but she believed that her right-sided symptoms worsened after the January 8, 

2016 work-related injury. Dr. Rafferty also noted that appellant reported having undergone a left

carpal tunnel release on April 16, 2018. He opined that it was “medically probable” that she

developed carpal tunnel syndrome many years ago, possibly dating back to her hire date at the 

employing establishment. Dr. Rafferty reported: “If this is true, and if [appellant’s] job at that 

time involved repetitive motions and forceful exertions of her bilateral hands, then it is more likely 

true than not that her carpal tunnel syndrome is work related.” 

By decision dated November 1, 2018, OWCP denied modification of the December 6, 

2017 decision. 

LEGAL PRECEDENT

An employee seeking benefits under FECA6 has the burden of proof to establish the 

essential elements of his or her claim, including 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 of FECA,7that an injury was sustained in the performance of duty as alleged, and that 

any disability or medical condition for which compensation is claimed is causally related to the 

employment injury.8 These are the essential elements of each and every compensation claim, 

regardless of whether the claim is predicated upon a traumatic injury or an occupational disease.9

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

disease claim, a claimant 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 

 

6 Supra note 1.

7 S.B., Docket No. 17-1779 (issued February 7, 2018); J.P., 59 ECAB 178 (2007); Joe D. Cameron, 41 ECAB 

153 (1989). 

8

J.M., Docket No. 17-0284 (issued February 7, 2018); R.C., 59 ECAB 427 (2008); James E. Chadden, Sr., 40 

ECAB 312 (1988).

9 K.M., Docket No. 15-1660 (issued September 16, 2016); L.M., Docket No. 13-1402 (issued February 7, 2014); 

Delores C. Ellyett, 41 ECAB 992 (1990).
5

compensation is claimed; and (3) medical evidence establishing that the diagnosed condition is 

causally related to the employment factors identified by the claimant.10 

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

relationship is rationalized medical opinion evidence.11 The opinion of the physician must be 

based on a complete factual and medical background of the employee, 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 specific employment factors identified by the 

employee.12

In any case where a preexisting condition involving the same part of the body is present 

and the issue of causal relationship, therefore, involves aggravation, acceleration or precipitation, 

the physician must provide a rationalized medical opinion that differentiates between the effects 

of the work-related injury or disease and the preexisting condition.13

ANALYSIS

The Board finds that appellant has not met her burden of proof to establish left carpal tunnel 

syndrome causally related to the accepted factors of her federal employment. 

In support of her claim, appellant submitted a series of reports and workers’ compensation 

injury forms by Dr. Rafferty dated December 27, 2016 to September 4, 2018. Dr. Rafferty noted 

that she previously accepted injuries to her right upper extremity. In a September 4, 2018 letter, 

he indicated that appellant first complained of numbness and tingling in her bilateral upper 

extremities in January 2016. Dr. Rafferty further opined that it was “medically probable” that she

developed carpal tunnel syndrome many years ago. He explained that, if appellant’s job, at that 

time, involved repetitive motions and forceful exertions of her bilateral hands, then it is more likely 

true than not that her carpal tunnel syndrome was work related. The Board finds that Dr. Rafferty’s 

opinion that it was “medically probable” and “more likely than not” that appellant’s left carpal 

tunnel syndrome was related to her employment is speculative in nature, and therefore of 

diminished probative value on the issue of causal relationship.14 Dr. Rafferty did not definitively 

opine that her left carpal tunnel syndrome resulted from her work duties, but merely noted that “if”

appellant’s job involved repetitive motion, then it was likely that her medical condition was work 

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

appellant’s own belief that there is a causal relationship between her claimed condition and her

 

10 S.C., Docket No. 18-1242 (issued March 13, 2019); R.H., 59 ECAB 382 (2008).

11 A.M., Docket No. 18-1748 (issued April 24, 2019); T.H., 59 ECAB 388, 393 (2008); Robert G. Morris, 48 ECAB 

238 (1996).

12 M.V., Docket No. 18-0884 (issued December 28, 2018); I.J., 59 ECAB 408 (2008); Victor J. Woodhams, 41 

ECAB 345, 352 (1989).

13 Federal (FECA) Procedure Manual, Part 2 -- Claims, Causal Relationship, Chapter 2.805.3e (January 2013).

14 J.B., Docket No. 18-1751 (issued May 6, 2019); C.C., Docket No. 14-1667 (issued December 3, 2014); L.D., 

Docket No. 09-1503 (issued April 15, 2010); D.D., 57 ECAB 734, 738 (2006); Kathy A. Kelley, 55 ECAB 206 (2004).
6

employment.15 Dr. Rafferty’s reports, therefore, failed to establish that she sustained left carpal 

tunnel syndrome due to factors of her employment.

In a September 18, 2017 progress note, Dr. Hsu provided examination findings and 

diagnosed left medial epicondylitis and left carpal tunnel syndrome. She discussed appellant’s 

previous right upper extremity injuries and reported that appellant believed that she overused the 

left side when she returned to work following her surgeries. Dr. Hsu, however, did not provide an 

opinion on whether appellant’s left upper extremity conditions were work related, but merely 

communicated appellant’s belief that her condition resulted from her employment.16 Therefore,

Dr. Hsu’s opinion is insufficient to establish appellant’s occupational disease claim.

The July 24, 2017 EMG/NCV study is also insufficient to establish causal relationship as 

diagnostic tests do not provide an opinion on the cause of the diagnosed conditions and, therefore, 

lack probative value to establish causal relationship.17

Appellant submitted a February 9, 2017 Form CA-17 by an unknown provider with an 

illegible signature. The Board has previously held that unsigned reports or reports that bear 

illegible signatures cannot be considered as probative medical evidence because they lack proper 

identification.18 This report, therefore, is insufficient to establish appellant’s claim. 

On appeal appellant alleges that Dr. Rafferty submitted sufficient evidence to establish that 

her left carpal tunnel syndrome was causally related to her repetitive employment factors. As 

discussed, the medical evidence of record is insufficient to establish that her rural carrier 

employment duties caused or contributed to her left carpal tunnel syndrome. Because appellant 

has not submitted rationalized medical evidence to establish causal relationship, the Board finds 

that she has not met her burden of proof to establish her occupational disease claim.19

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 left carpal tunnel 

syndrome causally related to the accepted factors of her federal employment. 

 

15 B.M., Docket No. 17-1079 (issued June 4, 2018); Robert A. Boyle, 54 ECAB 381 (2003); Patricia J. Glenn, 53 

ECAB 159 (2000).

16 M.G., Docket No. 19-0918 (issued September 20, 2019); K.W., Docket No. 10-0098 (issued September 10, 2010).

17 See A.B., Docket No. 17-0301 (issued May 19, 2017).

18 G.N., Docket No. 19-0184 (issued May 29, 2019); Thomas L. Agee, 56 ECAB 465 (2005); Richard F. Williams, 

55 ECAB 343 (2004).

19 See M.C., Docket No. 19-0673 (issued September 6, 2019).
7

ORDER

IT IS HEREBY ORDERED THAT the November 1, 2018 merit decision of the Office 

of Workers’ Compensation Programs is affirmed.

Issued: December 19, 2019

Washington, DC

Christopher J. Godfrey, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board