United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

K.B., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

St. Petersburg, FL, Employer

__________________________________________

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Docket No. 19-1243

Issued: February 21, 2020

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

JANICE B. ASKIN, Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On May 17, 2019 appellant filed a timely appeal from a March 14, 2019 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.2 

 

1 5 U.S.C. § 8101 et seq.

2 The Board notes that, following the March 14, 2019 decision, OWCP received additional evidence. However, the 

Board’s Rules of Procedure provides: “The Board’s review of a case is limited to the evidence in the case record that 

was before OWCP at the time of its final decision. Evidence not before OWCP will not be considered by the Board 

for the first time on appeal.” 20 C.F.R. § 501.2(c)(1). Thus, the Board is precluded from reviewing this additional 

evidence for the first time on appeal. Id.
2

ISSUE

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

tunnel syndrome (CTS) and bilateral shoulder tendinitis causally related to the accepted factors of 

her federal employment.

FACTUAL HISTORY

On August 11, 2015 appellant, then a 38-year-old mail handler, filed an occupational 

disease claim (Form CA-2) alleging that she developed bilateral CTS and bilateral shoulder 

tendinitis due to factors of her federal employment, including repetitive movements with her 

“hands, wrists, and bilateral upper extremities.” On the reverse side of the claim form, the 

employing establishment indicated that appellant was off work due to a prior claim under OWCP 

File No. xxxxxx810.

3

 

In an undated narrative statement, appellant explained that her federal employment duties 

required typing and computer use, bending and picking up papers and feeding them into a machine, 

carrying flyers and walking them to an office, and pushing and pulling carts. She indicated that 

she was experiencing neck, low back, and bilateral upper extremity pain, as well as tingling, 

numbness, and a burning sensation radiating into her wrists and hands as a result of her job duties. 

Appellant concluded that her collective injuries led to permanent cervical disc pathology and nerve 

impingement in her shoulders. 

In a letter dated August 21, 2015, the employing establishment confirmed that appellant’s

job duties required using a computer mouse, typing on a keyboard, and using a telephone, which 

included performing simple grasping, fine manipulation, and intermittent pushing and pulling. It 

explained that she had flexibility to get up and take breaks as needed during the workday, but she 

had not worked in this capacity since August 2014. 

In a report dated July 29, 2015, Dr. Joel Franck, a Board-certified neurosurgeon, detailed 

three separate injuries appellant alleged to have sustained and the treatment history following her 

initial injury in 2012. He diagnosed C6-7 post-traumatic herniated cervical disc with intractable 

cervical pain, headaches, and radiculopathy and noted planned surgical procedures to include a 

cervical discectomy at C6-7. 

In a development letter dated August 26, 2015, OWCP advised appellant of the deficiencies 

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

for her completion. OWCP afforded appellant 30 days to submit additional evidence and respond 

to its inquiries. 

 

3 Appellant has a prior accepted claim for a September 17, 2012 neck sprain and scalp contusion under OWCP File 

No. xxxxxx217. She also has a prior accepted claim for cervical intervertebral disc without myelopathy related to a 

February 19, 2013 work injury under OWCP File No. xxxxxx810. OWCP paid appellant wage-loss compensation for 

temporary total disability until September 4, 2013 when she returned to part-time, limited-duty work as a sales solution 

team member.
3

In response, appellant submitted a narrative statement dated September 2, 2015 reiterating

the factual history of her claim and asserting that various repetitive movements, while in the 

performance of duty, caused her claimed condition. She also submitted diagnostic studies,

including an August 13, 2015 nerve conduction study of the upper extremities that was suggestive 

of CTS on the right side and bilateral ulnar neuropathy, more pronounced in the right elbow. 

Magnetic resonance imaging (MRI) scans of the wrists dated September 3, 2015 demonstrated 

plus ulna configuration with a thinned fibrocartilage with signal in both wrists, supporting a tear.

A left hand MRI scan on the same date revealed fluid in the trapezium/first metacarpal junction 

and edema extending along the flexor pollicis longus tendon.

In a September 16, 2015 report, Dr. Kevin L. Scott, a Board-certified orthopedic surgeon, 

diagnosed bilateral radiculopathy of the upper extremities, bilateral CTS, right shoulder tendon 

and/or ligament tear, bilateral shoulder impingement, and depression and anxiety secondary to 

chronic pain and work-related injuries. He opined that, the evidence of record, his positive medical 

examination, and the confirmation of appellant’s orthopedic pathology by diagnostic studies were 

consistent with the mechanism of injury described by her. Therefore, Dr. Scott concluded that her 

repetitive work, overhead maneuvers, and continuous use of two computers and telephones in the 

workplace had caused tears in both of her hands/wrists and her bilateral CTS. 

By decision dated October 5, 2015, OWCP denied the claim because the medical evidence 

of record was insufficient to establish a causal relationship between appellant’s diagnosed 

conditions and the accepted factors of her federal employment. 

On November 2, 2015 appellant requested an oral hearing before an OWCP hearing 

representative. 

Appellant continued to submit additional evidence. In a September 2, 2015 report, Dr. Sara 

Vizcay, a Board-certified family practitioner, reiterated Dr. Scott’s diagnoses and ruled out right 

shoulder tendon and/or ligament tear. Dr. Vizcay opined that based on her review of all of 

appellant’s statements, medical record evaluations, all correspondence available to her, and her 

physical examination, appellant’s statement of the events that occurred during and after her workrelated injuries of July 29, 2015 were true and consistent with her report of the facts and medical 

findings. She concurred with Dr. Scott that, even though appellant had returned to work on 

September 4, 20134in a light-duty capacity, her repetitive work, overhead maneuvers, and 

continuous use of two computers and telephones caused her bilateral shoulder and bilateral CTS 

pathology. 

Appellant submitted a right hand MRI scan dated September 3, 2015 in support of her 

request. The scan demonstrated plus ulna configuration with a thinned renal fibrocartilage with 

signal supporting a tear in the right hand. 

In a December 1, 2015 medical report from Dr. Vizcay, she again noted appellant’s 

complaints of severe pain in her neck and right shoulder, as well as complaints of numbness and 

 

4 The Board notes that Dr. Vizcay initially indicated that appellant’s return to work date was September 4, 2015. 

Dr. Vizcay later correctly indicated, as quoted by Dr. Franck, that appellant’s return to work date was 

September 4, 2013. The Board considers the initially referenced return to work date to be a typographical error.
4

tingling in appellant’s upper extremities. She was observed to be in acute distress and on physical 

examination she had tenderness and reduced range of motion in both shoulders, more severe on 

the right. Dr. Vizcay reiterated her concurrence with Drs. Franck and Scott’s opinion that 

repetitive movements at work, including overhead maneuvers and use of a computer and 

telephone, caused appellant’s shoulder conditions and bilateral CTS. 

In a progress note dated May 11, 2015, Dr. Jay Parekh, a Board-certified anesthesiologist 

and pain management specialist, reported administering cervical branch blocks to treat appellant’s 

conditions. 

On May 18, 2015 Dr. Parekh noted that appellant had 50 percent relief following the 

cervical branch blocks, but continued with pain. He performed a cervical medial branch 

radiofrequency ablation and indicated that she reported improvement in her pain. 

In a follow-up note dated February 12, 2016, Dr. Parekh noted that appellant had good 

relief from the cervical ablation, but the pain in her neck and shoulder gradually returned. 

On October 4, 2016 appellant, through counsel, requested reconsideration of the October 5, 

2015 decision. In support of this request, appellant submitted a September 22, 2016 medical report 

from Dr. Theodore Vlahos, a Board-certified orthopedic surgeon, who detailed her treatment 

history, and diagnostic and examination findings. Dr. Vlahos administered a right shoulder steroid 

injection to treat appellant’s ongoing pain, which he attributed to work-related activity on or 

around July 29, 2015. 

By decision dated December 23, 2016, OWCP denied modification of its prior decision. 

On February 13, 2017 appellant, through her representative, requested reconsideration of 

OWCP’s December 23, 2016 decision. In an attached report from Dr. Vlahos dated February 7, 

2017, he diagnosed chronic neck pain with disc herniations at C4-5 and C6-7 with displacement 

and radiculitis and found subjective evidence of right CTS, right cubital tunnel syndrome, and 

bilateral shoulder impingement syndrome. He opined that appellant’s CTS and shoulder 

impingement were the result of work-related activities that occurred in July 2014. Dr. Vlahos 

asserted that repetitive overhead lifting as she described was clearly associated as a mechanism 

causing impingement of the shoulders as the elevation of the arm caused approximation of the 

supraspinatus tendon against the acromion and acromial arch, thus leading to direct impingement. 

He further opined that repetitive typing, keyboarding, and other repetitive activities such as using 

a computer mouse had been associated with increased frequency of CTS and were noted as a 

common predisposing activity for CTS, which appellant had clinically on the right and was 

documented with the nerve conduction velocity (NCV) study. 

By decision dated April 7, 2017, OWCP denied modification of its prior decision. 

On February 14, 2018 appellant, through her representative, requested reconsideration of 

the April 7, 2017 decision. 

In a January 11, 2018 report, Dr. Mark A. Seldes, a Board-certified family practitioner, 

diagnosed bilateral shoulder impingement, bilateral elbow lateral epicondylitis, bilateral CTS, and 

cervical radiculopathy of the bilateral upper extremities, related to a separate case. He opined that 
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appellant’s federal duties of repetitive movement, heavy lifting, and constant pulling and pushing 

over many years aggravated the prior injuries to her shoulders, elbows, wrists, and hands. 

Dr. Seldes noted that, even when she returned to work in a limited-duty capacity, she was moving 

materials above her shoulders, stuffing materials into envelopes, working on the computer, and 

using a mouse and opined that these activities aggravated her CTS. 

A January 31, 2018 MRI scan of the cervical spine revealed posterior disc bulges at C4-5, 

C5-6, and C6-7, with minimal indentation of the ventral thecal sac. 

In a February 20, 2018 medical report, Dr. Robert Nucci, a Board-certified orthopedic 

surgeon, indicated that he was seeing appellant for a work-related injury that occurred on 

February 19, 2013. He detailed her treatment history and examination findings, and attached the 

results of an August 21, 2017 electromyography (EMG) and NCV study revealing probable 

right-sided cervical radiculopathy 

Appellant submitted additional reports from Dr. Nucci dated July 19 and August 9, 2018 

noting continued complaints of neck pain radiating into her shoulder and arm. 

On January 23, 2019 OWCP referred appellant to Dr. Patrick Horan, a Board-certified 

orthopedic surgeon, for a second opinion evaluation to determine the nature and extent of her 

employment-related conditions. 

In his February 27, 2019 report, Dr. Horan noted that the only objective finding on 

examination was appellant’s loss of full flexion and abduction of the shoulders. He found that the 

NCV studies were borderline positive and recommended readministering the test with a 

neurologist to get a definitive diagnosis on radiculopathy or the possibility of CTS because in 

reviewing the tests there was minimal difference in the median nerve, although it read as suggestive 

of CTS. Dr. Horan noted that the objective findings of the MRI scans of the shoulders were 

normal. Appellant had some arthritis in the acromioclavicular joint and some tendinosis in the 

supraspinatus, which he did not find consistent with her injury. Dr. Horan opined that she had a 

radicular pain pattern that radiated down her small finger, but her NCV tests were borderline and 

could not be identified as CTS. He further found no elbow pathology and concluded that the MRI

scans of the shoulder were consistent with normal wear and tear and that she did not have a specific 

mechanism of injury for shoulder impingement, with the exception that she was previously 

working at shoulder level. Dr. Horan concluded that appellant’s subjective complaints greatly 

outweighed her objective findings and that her work restrictions were related to her diagnosis of 

cervical radiculopathy. 

By decision dated March 14, 2019, OWCP denied modification of its prior decision. 

LEGAL PRECEDENT

An employee seeking benefits under FECA5 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 

 

5

Id.
6

meaning of FECA, that the claim was timely filed within the applicable time limitation period of 

FECA, 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.6 These are the essential elements of every compensation claim regardless of whether the 

claim is predicated on a traumatic injury or an occupational disease.

7

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

disease claim, an employee must submit 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.8

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.9 A physician’s opinion on whether there is causal relationship 

between the diagnosed condition and the implicated employment factor(s) must be based on a 

complete factual and medical background.10 Additionally, the physician’s opinion must be 

expressed in terms of a reasonable degree of medical certainty, and must be supported by medical 

rationale explaining the nature of the relationship between the diagnosed condition and appellant’s 

specific employment factor(s).11

ANALYSIS

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

and bilateral shoulder tendinitis causally related to the accepted factors of her federal employment.

OWCP properly referred appellant to Dr. Horan for a second opinion evaluation to 

determine the nature and extent of her bilateral CTS and bilateral shoulder conditions. In his 

February 27, 2019 second opinion report, Dr. Horan found that her NCV tests were borderline and 

could not be read to positively diagnose CTS. He also noted that appellant had no elbow 

pathology, her shoulder MRI scans were consistent with normal wear and tear and she did not have 

a specific mechanism of injury for shoulder impingement, with the exception that she was working 

at shoulder level previously. Dr. Horan noted that her subjective complaints greatly outweighed 

 

6 K.V., Docket No. 18-0947 (issued March 4, 2019); M.E., Docket No. 18-1135 (issued January 4, 2019); Kathryn 

Haggerty, 45 ECAB 383, 388 (1994).

7 K.V. and M.E., id.; Elaine Pendleton, 40 ECAB 1143 (1989).

8 R.G., Docket No. 19-0233 (issued July 16, 2019). See also Roy L. Humphrey, 57 ECAB 238, 241 (2005); Ruby I. 

Fish, 46 ECAB 276, 279 (1994); Victor J. Woodhams, 41 ECAB 345 (1989).

9 T.H., 59 ECAB 388, 393 (2008); Robert G. Morris, 48 ECAB 238 (1996).

10 M.V., Docket No. 18-0884 (issued December 28, 2018).

11 Id.; Victor J. Woodhams, supra note 8.
7

her objective findings and concluded that her work restrictions were related to her diagnosis of 

cervical radiculopathy, not her claimed conditions of bilateral CTS and shoulder tendinitis.

The Board finds that Dr. Horan’s report represents the weight of the medical evidence. The 

Board finds that he had full knowledge of the relevant facts and evaluated the course of appellant’s 

condition. Dr. Horan is a specialist in the appropriate field. His opinion is based on proper factual 

and medical history and his report contained a detailed summary of this history. Dr. Horan 

addressed the medical records to formulate his own examination findings to reach a reasoned 

conclusion regarding appellant’s conditions.12 He found no basis on which to establish a causal 

relationship between her bilateral CTS and bilateral shoulder conditions and her repetitive duties

at work. Dr. Horan’s opinion as set forth in his February 27, 2019 report is found to be probative 

evidence and reliable. 

The Board notes that, while the reports from Drs. Scott, Vizcay, Vlahos, and Seldes 

provided diagnoses and are generally supportive of causal relationship, they are insufficient to 

establish the claimed bilateral CTS and shoulder condition is causally related to appellant’s

employment duties. They failed to identify the specific employment factors alleged by her and 

did not provide a pathophysiological explanation as to how those activities either caused or 

contributed to her diagnosed condition.13 Moreover, the Board has held that 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 a causal relationship.14 For these reasons, the Board finds that the reports from 

appellant’s physicians are insufficient to meet appellant’s burden of proof or create a conflict, as 

they do not provide adequate physiological explanation regarding the cause of her diagnosed 

conditions.

Appellant was also followed by Drs. Franck, Parekh, and Nucci for her previously accepted 

cervical injuries. As these physicians failed to address causal relationship related to her claimed

CTS and shoulder tendinitis conditions, their reports are of no probative value and are insufficient 

to meet her burden of proof.15

Appellant further submitted various diagnostic studies in support of her claim. The Board 

has held that diagnostic studies lack probative value as they do not provide an opinion on causal 

relationship between the employment incident and her diagnosed conditions.16 These reports are 

therefore also insufficient to establish appellant’s claim.

 

12 See R.C., Docket No. 14-1964 (issued January 22, 2015); Michael S. Mina, 57 ECAB 379 (2006) (the opportunity 

for and thoroughness of examination, the accuracy and completeness of the physician’s knowledge of the facts and 

medical history, the care of analysis manifested, and the medical rationale expressed in support of the physician’s 

opinion are facts which determine the weight to be given to each individual report).

13 Supra note 9.

14 See J.L., Docket No. 18-1804 (issued April 12, 2019).

15 See L.B., Docket No. 18-0533 (issued August 27, 2018); D.K., Docket No. 17-1549 (issued July 6, 2018).

16 See I.C., Docket No. 19-0804 (issued August 23, 2019).
8

As appellant has not submitted any rationalized medical evidence to support her claim that 

she sustained bilateral CTS or bilateral shoulder tendinitis causally related to the accepted 

employment factors, she has failed to meet her burden of proof.

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 CTS

and bilateral shoulder tendinitis causally related to the accepted factors of her federal employment.

ORDER

IT IS HEREBY ORDERED THAT the March 14, 2019 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: February 21, 2020

Washington, DC

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board