United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

J.G., Appellant

and

SOCIAL SECURITY ADMINISTRATION, 

Santa Rosa, CA Employer

__________________________________________

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Docket No. 18-1484

Issued: June 14, 2019

Appearances: Case Submitted on the Record

Brett E. Blumstein, 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

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On July 30, 2018 appellant, through counsel, filed a timely appeal from a March 21, 2018 

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 that her right upper 

extremity conditions were causally related to the accepted factors of her federal employment.

FACTUAL HISTORY

On August 26, 2015 appellant, then a 51-year-old social insurance specialist/plans for 

achieving self-support (PASS)) specialist, filed an occupational disease claim (Form CA-2) 

alleging that on November 15, 2014 she first realized that her right carpal tunnel syndrome, thumb 

osteoarthritis, and de Quervain’s disease were due to her federal employment duties of repetitive 

typing, filing, and writing. She stopped work on March 24, 2015. The employing establishment 

noted that on June 17, 2015 appellant returned to full-duty work for six hours per day.

In support of her claim, appellant submitted a Certification of Health Care Provider for 

Employee’s Serious Medical Condition (Family and Medical Leave Act) signed by Dr. Kai-Uwe 

Mazur, a Board-certified hand and orthopedic surgeon, and a March 24, 2015 work status form 

releasing appellant to return to full-duty work on March 26, 2015.

In a development letter dated September 10, 2015, OWCP informed appellant that 

additional medical and factual evidence was necessary to establish her claim. It also provided her 

with a questionnaire for completion. OWCP afforded appellant 30 days to provide the requested 

information.

In response to OWCP’s request, appellant submitted a statement responding to the 

questions posed in the questionnaire.

By decision dated November 6, 2015, OWCP denied appellant’s claim, finding that she 

had not met her burden of proof to establish a diagnosed medical condition causally related to the

accepted employment factors. It concluded, therefore, that the requirements had not been met to 

establish an injury as defined by FECA.

On December 9, 2015 OWCP received appellant’s December 3, 2015 request for a 

telephonic hearing before an OWCP hearing representative, which was held on August 9, 2016.

In progress reports covering the period March 24 to October 20, 2015, Dr. Mazur noted 

physical examination findings and diagnoses of right thumb basilar joint arthritis, status post right 

carpal tunnel release and de Quervain’s release, and status post right volar radiocarpal 

ganglionectomy.

An August 20, 2015 magnetic resonance imaging (MRI) scan of appellant’s right wrist 

revealed tenosynovitis, positive ulnar variance with central thickening and likely triangular 

fibrocartilage perforation, and small bilobed ganglion cyst on the dorsum of the mid carpal joint 

deep to the extensor tendons. A right hand MRI scan of even date revealed mild thumb 

carpometacarpal joint osteoarthritis without significant edema and first compartment extensor 

tendinopathy, which did not appear to extend beyond the carpometacarpal joint into the extensor 

tendons.
3

Dr. Mazur, in a May 5, 2016 report, noted that appellant was seen for complaints of right 

thumb discomfort. Active problems were noted to include arthritis, right wrist ganglion, right hand 

primary osteoarthritis, radial styloid tenosynovitis/de Quervain’s, and right hand first 

carpometacarpal joint primary osteoarthritis. A physical examination revealed full finger range of 

motion, normal wrist range of motion, some tightness along the dorsal wrist with wrist volar 

flexion, and mildly painful Finkelstein’s test along the thumb dorsum metacarpophalangeal joint.

By decision dated October 24, 2016, OWCP’s hearing representative modified the 

November 6, 2015 decision, finding that the evidence of record was sufficient to establish a 

medical diagnosis. However, the claim remained denied as appellant had not met her burden of 

proof to establish causal relationship between the diagnosed medical conditions and the accepted 

employment factors.

On March 16, 2017 appellant, through counsel, requested reconsideration and submitted 

additional evidence.

In a January 17, 2017 progress note, Dr. Mazur diagnosed right hand primary osteoarthritis 

of the first carpometacarpal joint and pain in the right wrist and finger(s). He noted appellant’s 

complaints, symptoms, and work activities. A physical examination revealed mildly painful 

Finkelstein’s test along the thumb metaphalangeal (MP) dorsum, normal wrist range of motion, 

full range of motion for her fingers, and some tightness along the dorsal wrist with volar flexion. 

Diagnoses included right thumb arthritis and flexor carpi radialis tendinosis, which Dr. Mazur 

attributed to cumulative trauma from her repetitive work duties and acceleration of natural 

degeneration.

By decision dated June 12, 2017, OWCP denied modification, finding that the record 

lacked probative medical evidence supporting causal relationship between the diagnosed 

conditions and the accepted employment factors.

On January 4, 2018 appellant, through counsel, requested reconsideration and submitted a 

December 17, 2017 report from Dr. John Ellis, a Board-certified family practitioner, in support of 

her request.

In a December 17, 2017 report, Dr. Ellis, based upon a review of medical records, 

diagnostic tests, and a physical examination, diagnosed right carpal tunnel syndrome, right 

de Quervain’s tenosynovitis, right thumb basilar joint arthritis, right thumb tenosynovitis of the 

first compartment extensor tendons, right hand triangular fibrocartilage perforation, right hand 

ganglion cyst dorsum of mid carpal joint deep to extensor tendons, right elbow cubital tunnel 

syndrome, right elbow medial epicondylitis, right shoulder traumatic arthritis, and right shoulder 

tendinitis, which he attributed to her employment. He noted that appellant worked for the 

employing establishment from 1989 to 1997 as a claims representative, then worked as a technical 

expert from 1997 to 2010, and from 2010 to 2016 worked as a PASS specialist. Dr. Ellis described 

her job duties over the years and different positions, which included taking and processing claims, 

maintaining records, determining eligibility, using the computer, filing, typing, and writing. Based 

on review of the medical records and examination of appellant, he opined that appellant’s work 

duties contributed to, aggravated, and/or caused the diagnosed conditions and disability noted in 

his report. Dr. Ellis explained that appellant’s repetitive work duties caused multiple repetitive 
4

right upper extremity muscle, tendon, and joint strains, particularly the right wrist and thumb,

tendinitis, and carpal tunnel syndrome. He explained that the right thumb and wrist inflammatory 

response caused tendon swelling leading to wrist median nerve impingement or carpal tunnel 

syndrome. As the wrist median nerve was impinged, it caused the right forearm extensor and 

flexor muscles to be taut, which in turn caused right elbow medial and lateral epicondylitis. 

Dr. Ellis further noted that the repetitive typing on a straight keyboard was an ulnar deviated or 

abnormal position, which led to internal wrist derangement. He explained that the right hand 

stresses caused the diagnosed right hand, elbow, and shoulder nerve impingement, ulnar wrist 

tendinitis, inflammatory right rotator cuff, and acromioclavicular joint tendons.

By decision dated March 21, 2018, OWCP denied modification finding that appellant had 

not met her burden of proof to establish her claim as the medical evidence of record was 

insufficiently rationalized to support causal relationship between the diagnosed right shoulder, 

elbow, wrist, and hand conditions to the accepted employment factors.

LEGAL PRECEDENT

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

essential elements of his or her claim by the weight of the reliable, probative, and substantial 

evidence, 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, that 

an injury was sustained 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.4 These 

are the essential elements of every compensation claim regardless of whether the claim is 

predicated on a traumatic injury or an occupational disease.5

OWCP’s regulations define an occupational disease as “a condition produced by the work 

environment over a period longer than a single workday or shift.”

6

 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) a 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.7

 

3

Id.

4 See E.B., Docket No. 17-0164 (issued June 14, 2018); Alvin V. Gadd, 57 ECAB 172 (2005).

5 See P.S., Docket No. 17-0939 (issued June 15, 2018); Ellen L. Noble, 55 ECAB 530 (2004).

6 20 C.F.R. § 10.5(ee).

7 Roy L. Humphrey, 57 ECAB 238 (2005).
5

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

relationship is rationalized medical evidence.8 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 employee.9 

Neither the mere 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 this case is not in posture for a decision.

The record reflects that appellant’s employment activities consist of repetitive typing, 

writing, taking and processing claims, and filing. Therefore, the issue is whether she has submitted 

sufficient medical evidence to establish that the factors of her federal employment caused or 

aggravated the diagnosed medical conditions.

In a December 17, 2017 report, Dr. Ellis noted that appellant worked in various positions 

for the employing establishment with her latest job as a PASS specialist and he explained the duties 

she performed with each position. He opined that appellant’s work duties caused and aggravated 

her right upper extremity conditions including carpal tunnel syndrome, right wrist and thumb 

tendinitis, and right upper extremity joint, muscle, and tendon strains. In particular, Dr. Ellis

explained that the act of typing on a straight keyboard caused her right forearm flexor and extensor 

muscle to become taught, which led to right elbow medial and lateral epicondylitis. He also 

explained that appellant’s right thumb and wrist inflammatory response caused tendon swelling,

which caused carpal tunnel syndrome or wrist median nerve impingement. Dr. Ellis related that 

stress from repetitive typing in an abnormal position on a straight keyboard caused internal wrist 

derangement. This stress from the repetitive work duties resulted in right hand, elbow, and 

shoulder nerve impingement, ulnar wrist tendinitis, inflammatory right rotator cuff and 

acromioclavicular joint tendons. 

The Board finds that, while Dr. Ellis’ December 17, 2017 report is not fully rationalized, 

he explained the physiological process by which appellant’s accepted factors of her federal 

employment caused her diagnosed right upper extremity conditions. Although the medical report 

is insufficient to meet appellant’s burden of proof to establish her claim, it raises an uncontroverted 

inference between the diagnosed conditions and the accepted work factors, sufficient to require 

OWCP to further develop the claim.11

 

8 L.D., Docket No. 17-1581 (issued January 23, 2018); Jacqueline M. Nixon-Steward, 52 ECAB 140 (2000).

9 L.D., id.; see also Leslie C. Moore, 52 ECAB 132 (2000); Gary L. Fowler, 45 ECAB 365 (1994).

10 T.H., Docket No. 18-1736 (issued March 13, 2019); Dennis M. Mascarenas, 49 ECAB 215 (1997).

11 See D.V., Docket No. 17-1590 (issued December 12, 2018); E.J., Docket No. 09-1481 (issued February 19, 

2010); John J. Carlone, 41 ECAB 354 (1989); Horace Langhorne, 29 ECAB 820 (1978).
6

Proceedings under FECA are not adversarial in nature, nor is OWCP a disinterested arbiter. 

While it is appellant’s burden of proof to establish the claim, OWCP shares responsibility in the 

development of the evidence. It has the obligation to see that justice is done.12 The Board will, 

therefore, remand the case to OWCP for further development. On remand OWCP should prepare 

a statement of accepted facts and obtain a rationalized opinion from an appropriate Board-certified 

physician as to whether appellant’s right shoulder, elbow, hand, and wrist conditions are causally 

related to the accepted factors of her federal employment. Following this and any other further 

development as deemed necessary, OWCP shall issue a de novo decision on appellant’s claim.

CONCLUSION

The Board finds that this case is not in posture for a decision.

ORDER

IT IS HEREBY ORDERED THAT that the March 21, 2018 decision of the Office of 

Workers’ Compensation Programs is set aside and the case is remanded for further action 

consistent with this decision of the Board.

Issued: June 14, 2019

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

 

12 D.V., id.; D.G., Docket No. 15-0702 (issued August 27, 2015); Donald R. Gervasi, 57 ECAB 281, 286 (2005); 

William J. Cantrell, 34 ECAB 1233, 1237 (1983).