United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

D.W., Appellant

and

DEPARTMENT OF VETERANS AFFAIRS, 

PUGET SOUND HEALTH CARE SYSTEM, 

Seattle, WA, Employer

__________________________________________

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Docket No. 19-0968

Issued: October 9, 2019

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 April 4, 2019 appellant, through counsel, filed a timely appeal from a January 30, 2019 

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.

 

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

ISSUE

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

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

FACTUAL HISTORY

This case has previously been before the Board.3 The facts and circumstances as presented 

in the Board’s prior decision are incorporated herein by reference. The relevant facts are as 

follows.

On January 4, 2017 appellant, then a 38-year-old dental hygienist, filed an occupational 

disease claim (Form CA-2) alleging that she sustained carpal tunnel syndrome causally related to 

factors of her federal employment. She performed modified work duties effective January 4, 2017.

In a development letter dated January 18, 2017, OWCP advised appellant of the 

deficiencies of her claim and requested additional factual and medical evidence. It provided a 

questionnaire for her completion. OWCP afforded appellant 30 days to submit the necessary 

evidence. 

Thereafter, OWCP received a November 23, 2016 report from Dr. Wren V. McCallister, a 

Board-certified orthopedic surgeon. Dr. McCallister evaluated appellant for tingling and 

numbness in her hands bilaterally and noted that she intended to file a workers’ compensation 

claim. He indicated that an x-ray revealed cervical spondylosis. Dr. McCallister diagnosed 

numbness and tingling of the bilateral upper extremities that may “have elements of carpal tunnel 

syndrome, thoracic outlet [syndrome], and possible cervicalgia.”

A December 16, 2016 nerve conduction velocity study and electromyogram revealed right 

carpal tunnel syndrome with a moderate conduction delay, left carpal tunnel syndrome with a mild 

motor conduction delay and no evidence of right cervical radiculopathy or ulnar neuropathy. 

Appellant further submitted a December 23, 2016 report by Dr. Matthew C. Keifer, a 

Board-certified internist. Dr. Keifer reviewed her history of bilateral numbness, weakness, and 

tingling in her hands and forearms, worse on the left, for the past three months, and diagnosed 

carpal tunnel syndrome. He noted that appellant attributed her symptoms to her employment 

activities as a dental hygienist.

On January 4, 2017 Dr. Keifer again discussed appellant’s history of numbness, weakness, 

and tingling in both hands, worse on the left, for the past three months. He diagnosed carpal tunnel 

syndrome and provided work restrictions. Dr. Keifer advised that appellant believed that her 

symptoms were aggravated by her employment duties as a dental hygienist.

 

3 Docket No. 18-0509 (issued October 3, 2018).
3

In a statement dated January 11, 2017, appellant described the duties required of her 

position as a dental hygienist. She advised that prior to working for the employing establishment 

she had worked part time as a dental hygienist without problems.4

In a report dated January 26, 2017, Dr. McCallister evaluated appellant for continued 

complaints of upper extremity numbness. He reviewed the results of electrodiagnostic studies and 

found a positive Durkan’s compression test bilaterally on examination. Dr. McCallister diagnosed 

numbness and tingling of the right upper extremity suspected to be “secondary to a combination 

of carpal tunnel syndrome and likely, thoracic outlet syndrome.” He noted that appellant had 

significant delay on electrodiagnostic tests, but that her symptoms were not completely consistent 

with carpal tunnel syndrome. Dr. McCallister reviewed OWCP’s January 18, 2017 development 

letter and advised that he would defer an opinion on the cause of her condition to an independent 

examiner.

By decision dated April 3, 2017, OWCP denied appellant’s claim, finding that the medical 

evidence of record was insufficient to establish an injury or medical condition causally related to 

the accepted factors of her federal employment. 

On April 18, 2017 appellant requested an oral hearing before a representative of OWCP’s 

Branch of Hearings and Review. On October 2, 2017 OWCP scheduled a telephonic hearing for 

October 20, 2017 and also provided her with the time, telephone number, and required passcode. 

By decision dated October 31, 2017, OWCP determined that appellant had abandoned her 

request for a telephonic hearing before a representative of its Branch of Hearings and Review. It 

found that she had received written notice of the telephonic hearing 30 days prior to the scheduled 

hearing, but that she had failed to attend or contact the Branch of Hearings and Review either 

before or after the scheduled hearing to explain her absence.

Appellant appealed to the Board. By decision dated October 3, 2018, the Board set aside 

the October 31, 2017 OWCP decision.

5

 The Board found that OWCP had improperly determined 

that appellant abandoned her request for a telephonic hearing as it failed to provide her with 30 

days written notice of the time of the scheduled telephonic hearing. The Board remanded the case 

for OWCP to schedule another hearing.

On remand OWCP’s Branch of Hearings and Review held a telephonic hearing on 

November 16, 2018. During the hearing, appellant described her employment duties. OWCP’s 

hearing representative advised her to submit evidence addressing the relationship between her 

condition and employment factors.

By decision dated January 30, 2019, OWCP’s hearing representative affirmed the April 3, 

2017 decision. 

 

4 On February 3, 2017 the employing establishment advised that appellant’s statement was accurate. 

5

See supra note 3.
4

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 filed within the applicable time 

limitation period of FECA,6that 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.7 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.8

In an occupational disease claim, appellant’s burden requires submission of the following: 

(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.9

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

relationship 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. 10

ANALYSIS

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

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

In a report dated November 23, 2016, Dr. McCallister described appellant’s symptoms of 

bilaterally tingling and numbness of the hands. He noted that she intended to pursue obtaining 

workers’ compensation benefits. Dr. McCallister reviewed an x-ray finding cervical spondylosis. 

He diagnosed elements of carpal tunnel syndrome, thoracic outlet syndrome, and possible 

cervicalgia. While Dr. McCallister provided a diagnosis, he failed to offer an opinion on causal 

 

6

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

153 (1989).

7

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

ECAB 312 (1988).

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

DeloresC. Ellyett, 41 ECAB 992 (1990).

9 R.M., Docket No. 18-0976 (issued January 3, 2019); P.D., Docket No. 17-1885 (issued September 17, 2018).

10 H.B., Docket No. 18-0781 (issued September 5, 2018).
5

relationship. Medical evidence that does not offer an opinion regarding the cause of an employee’s 

condition is of no probative value on the issue of causal relationship.11

On December 27, 2016 and January 4, 2017 Dr. Keifer discussed appellant’s three-month 

history of tingling, numbness, and weakness of the hands. He diagnosed carpal tunnel syndrome

and noted that she believed that her work as a dental hygienist contributed to her condition. 

Dr. Keifer did not, however, render an independent finding relative to causation. A physician’s 

report is of little probative value when it is based on a claimant’s belief rather than a physician’s 

independent judgment.12 Without providing an independent opinion explaining how 

physiologically the accepted employment factors caused or contributed to the diagnosed condition,

Dr. Keifer’s opinion is of limited probative value.13

In a January 26, 2017 report, Dr. McCallister attributed appellant’s upper extremity 

numbness and tingling to a combination of carpal tunnel syndrome and possible thoracic outlet 

syndrome. He advised that electrodiagnostic studies showed a significant delay. Dr. McCallister 

deferred a finding on the cause of the diagnosed condition to another examiner. As he declined to 

address causation, his opinion is of no probative value on the issue.14

As the evidence of record does not include rationalized medical evidence sufficient to 

establish causal relationship, the Board finds that appellant has not met her burden of proof.

On appeal counsel argues that OWCP failed to adjudicate the claim in accordance with the 

proper standard of causation and failed to give due deference to the findings of the attending 

physician. As discussed, however, appellant has not provided rationalized medical evidence 

sufficient to establish that she sustained carpal tunnel syndrome causally related to factors of her 

federal employment.15 She has, therefore, not met her burden of proof to establish a claim for 

compensation.

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 bilateral carpal 

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

 

11 S.C.,Docket No. 18-1242 (issued March 13, 2019); L.B., Docket No. 18-0533 (issued August 27, 2018).

12 T.S., Docket No. 18-1501 (issued March 4, 2019).

13 A.B., Docket No. 18-0577 (issued October 10, 2018).

14 See supra note 11.

15 See N.C., Docket No. 19-0299 (issued June 24, 2019).
6

ORDER

IT IS HEREBY ORDERED THAT the January 30, 2019 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: October 9, 2019

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