United States Department of Labor

Employees’ Compensation Appeals Board

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J.R., Appellant

and

SOCIAL SECURITY ADMINISTRATION,

Richmond, CA, Employer

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Docket No. 17-1781

Issued: January 16, 2018

Appearances: Case Submitted on the Record

Appellant, pro se

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 August 16, 2017 appellant filed a timely appeal from a June 29, 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 met his burden of proof to establish right carpal tunnel 

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

On appeal appellant contends that the medical opinion of Dr. Victor Dominguez, an 

attending Board-certified family practitioner, establishes that his right-sided carpal tunnel 

syndrome was caused by his federal employment.

 

1 5 U.S.C. § 8101 et seq.
2

FACTUAL HISTORY

On August 23, 2016 appellant, then a 50-year-old claims representative, filed an 

occupational disease claim (Form CA-2) alleging that he sustained carpal tunnel syndrome in his 

right hand to his elbow and shoulder caused or aggravated by typing 90 to 99 percent of the work 

day since he was first hired to work at the employing establishment. He first became aware of 

his condition on August 9, 2016 and realized its relationship to his federal employment on 

October 10, 2016. The employing establishment did not indicate whether appellant stopped 

work. 

OWCP received a diagnostic report dated September 12, 2016 from Dr. Albert E. 

Amorteguy, a neurologist, who evaluated the results of a nerve conduction velocity study. 

Dr. Amorteguy provided an impression of delayed right distal median latency indicating 

evidence of moderate carpal tunnel compression. He also provided an impression of ulnar 

conduction velocities within normal limits.

OWCP, by development letter dated September 27, 2016, advised appellant of the 

deficiencies of his claim and afforded him 30 days to submit medical evidence in support of his 

claim.

OWCP received an unsigned appointment itinerary which noted appellant’s occupational 

therapy appointments from October 17 to November 9, 2016.

OWCP also received encounter reports dated August 29 and September 19, 2016 from

Dr. Victor Dominguez, Board-certified in family practice, noted appellant’s right wrist, forearm, 

and fingers complaints, examined him, and assessed numbness of the right hand. In an 

October 24, 2016 encounter note, he advised that appellant’s right wrist carpal tunnel was likely 

exacerbated by repetitive right wrist motion, including typing. Dr. Dominguez recommended 

that appellant undergo a work ergonomic evaluation and be given voice recognition technology 

to avoid repetitive typing.

Dr. Amorteguy, in a diagnostic report dated September 12, 2016, reviewed the results of 

an electromyogram of the bilateral upper extremities and noted that they were normal with 

minimal movement artifact.

In an October 6, 2016 report, Jacqueline Razo noted that appellant had right wrist carpal 

tunnel syndrome that was managed by Dr. Dominguez. 

By decision dated November 28, 2016, OWCP denied appellant’s claim, finding that the 

medical evidence of record failed to establish a diagnosed condition causally related to his 

established employment factors. It found that Dr. Dominguez’s opinion on causal relationship 

was ambiguous and not rationalized.

On an appeal request form and letter dated December 13, 2016 and received by OWCP 

on December 21, 2016, appellant requested an oral hearing before an OWCP hearing 

representative.2 In his letter, appellant again attributed his right carpal tunnel condition to his 

 

2 A hearing was held on May 19, 2017.
3

long-term employment in the Federal Government, which involved repetitive typing 99 percent 

of the time in his job at the employing establishment. 

Appellant submitted a December 8, 2016 note from Dr. Dominguez who opined that 

appellant’s right wrist carpal tunnel condition was caused and exacerbated by repetitive right 

wrist motion including, typing. Dr. Dominguez reiterated his prior recommendations that 

appellant undergo a work ergonomic evaluation and be given voice recognition technology to 

avoid repetitive typing. In a May 22, 2017 letter, he indicated that he had reviewed appellant’s 

December 13, 2016 letter and noted that his workers’ compensation claim had been denied. 

Dr. Dominguez advised that appellant’s clerical work contributed to his right carpal tunnel 

condition which caused pain over his hand, fingers, and arm. Appellant also submitted unsigned 

orders for his physical and occupational therapy from November 23 to December 23, 2016. 

By decision dated June 29, 2017, an OWCP hearing representative affirmed the 

November 28, 2016 decision. He found that Dr. Dominguez’s May 22, 2017 report was 

insufficiently rationalized to establish causal relationship between appellant’s right wrist 

condition and his established employment factor. Additionally, the hearing representative noted 

that Dr. Dominguez’s field of expertise was in family medicine, rather than in a specialty 

focused on treatment of upper extremity conditions.

LEGAL PRECEDENT

An employee seeking benefits under FECA3 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; that 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.4 These are the essential elements of each and every compensation claim 

regardless of whether the claim is predicated on a traumatic injury or an occupational disease.5

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.6

 

3 Supra note 1.

4 C.S., Docket No. 08-1585 (issued March 3, 2009); Elaine Pendleton, 40 ECAB 1143 (1989).

5 S.P., 59 ECAB 184 (2007); Victor J. Woodhams, 41 ECAB 345 (1989); Joe D. Cameron, 41 ECAB 153 (1989).

6

Id.
4

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 employee, must be one of reasonable certainty, and must be supported by 

medial rationale explaining the nature of the relationship between the diagnosed condition and 

the specific employment factors identified by the employee.7 

ANALYSIS

It is undisputed that appellant performed activities of repetitive typing as a claims 

representative. The Board finds, however, that the medical evidence of record is insufficient to 

establish right carpal tunnel syndrome caused or aggravated by the accepted work factor.

Dr. Dominguez, in his December 8, 2016 note and May 22, 2017 report, opined that 

appellant’s right wrist carpal tunnel condition was caused, exacerbated, and contributed to by 

typing and clerical duties at work which involved repetitive motions of the wrist. Although

Dr. Dominguez provided an opinion on causal relationship, the Board finds that he did not 

provide any medical rationale to support his opinion. The Board has found that a medical report 

is of limited probative value on the issue of causal relationship if it contains a conclusion 

regarding causal relationship which is unsupported by medical rationale.8 Dr. Dominguez did 

not adequately explain how the established repetitive work duty caused or aggravated appellant’s

right wrist condition. The Board finds that the lack of medical rationale significantly diminishes 

the probative value of his opinion.9 In his October 24, 2016 encounter note, Dr. Dominguez 

opined that appellant’s right wrist carpal tunnel condition was “likely” exacerbated by typing 

which involved repetitive motion of the wrist. This opinion is speculative in nature and therefore 

is of limited probative value to show causal relationship to the established employment factor. 

The Board has held that an opinion which is speculative in nature is of limited probative value 

regarding the issue of causal relationship.10 Other reports from Dr. Dominguez likewise did not 

offer any medical opinion addressing whether appellant’s right hand condition was caused or 

aggravated by the established employment factor. Medical evidence that does not offer any 

opinion regarding the cause of an employee’s condition is of limited probative value.11 

Similarly, Dr. Amorteguy’s diagnostic test results are of diminished probative value. He 

failed to offer an opinion on whether appellant’s diagnosed right wrist condition was caused or 

aggravated by the established employment factor.12 

 

7

I.J., 59 ECAB 408 (2008); Victor J. Woodhams, supra note 5.

8 T.M., Docket No. 08-075 (issued February 6, 2009); S.E., Docket No. 08-2214 (issued May 6, 2009).

9 Deborah L. Beatty, 54 ECAB 340 (2003) (where the Board found that in the absence of a medical report 

providing a diagnosed condition and a reasoned opinion on causal relationship with the employment incident, 

appellant did not meet her burden of proof).

10 See Kathy A. Kelley, 55 ECAB 206 (2004).

11 See C.B., Docket No. 09-2027 (issued May 12, 2010); J.F., Docket No. 09-1061 (issued November 17, 2009); 

A.D., 58 ECAB 149 (2006).

12 Id.
5

Appellant also submitted a report from Ms. Razo and an unsigned appointment itinerary 

and order for physical and occupational therapy. However, such evidence has no probative 

medical value on the issue of causal relationship as these reports were not signed by a 

physician.

13

 

The Board finds that appellant has failed to submit any rationalized, probative medical 

evidence sufficient to establish right carpal tunnel syndrome causally related to the established 

employment factor. Appellant, therefore, has not met his burden of proof. 

On appeal appellant contends that the medical opinion of Dr. Dominguez establishes that 

his right-sided carpal tunnel syndrome was caused by his federal employment. However, for the 

reasons noted above, Dr. Dominguez failed to explain with medical rationale how the established 

employment factor caused or aggravated appellant’s right wrist condition.

14

 Thus,

Dr. Dominguez’s opinion is insufficient to establish that appellant’s condition was caused by the 

established work factor.

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 his burden of proof to establish right 

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

 

13 See 5 U.S.C. § 8101(2); Merton J. Sills, 39 ECAB 572, 575 (1988).

14 Deborah L. Beatty, supra note 9.
6

ORDER

IT IS HEREBY ORDERED THAT the June 29, 2017 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: January 16, 2018

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