United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

S.M., Appellant

and

DEPARTMENT OF THE INTERIOR,

U.S. GEOLOGICAL SURVEY, Reston, VA, 

Employer

__________________________________________

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Docket No. 20-0241

Issued: August 25, 2020

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

CHRISTOPHER J. GODFREY, Deputy Chief Judge

JANICE B. ASKIN, Judge

PATRICIA H. FITZGERALD, Alternate Judge

JURISDICTION

On November 11, 2019 appellant filed a timely appeal from an October 2, 2019 merit 

decision of the Office of Workers’ Compensation Programs (OWCP).1 Pursuant to the Federal 

Employees’ Compensation Act2and 20 C.F.R. §§ 501.2(c) and 501.3, the Board has jurisdiction 

over the merits of this case.

 

1 Appellant timely requested oral argument before the Board. 20 C.F.R. § 501.5(b). By order dated August 20, 

2020, the Board exercised its discretion and denied the request, finding that the arguments on appeal could adequately 

be addressed based on the case record. Order Denying Request for Oral Argument, Docket No. 20-0241 (issued 

August 20, 2020). The Board’s Rules of Procedure provide that an appeal in which a request for oral argument is 

denied by the Board will proceed to a decision based on the case record and the pleadings submitted. 20 C.F.R. 

§ 501.5(b).

2 5 U.S.C. § 8101 et seq.
2

ISSUE

The issue is whether appellant has met her burden of proof to expand acceptance of the

claim to include additional right upper extremity conditions as causally related to her November 7, 

2016 employment injury.

FACTUAL HISTORY

On June 6, 2019 appellant, then a 59-year-old financial specialist, filed a traumatic injury 

claim (Form CA-1) alleging that on November 7, 2016, she cut her right knee and bruised her right 

hand when she tripped and fell while, landing on her right hand and knee due to a crevice on an 

asphalt path while in the performance of duty. 

In a June 12, 2019 development letter, OWCP advised appellant that the evidence of record 

was insufficient to establish her claim. It advised her of the type of factual and medical evidence 

needed and provided a questionnaire for her completion. OWCP afforded appellant 30 days to

submit the necessary evidence.

In a report dated November 7, 2016, a registered nurse diagnosed a knee abrasion. 

On June 8, 2019 Dr. Fuad Alykhan, a specialist in internal medicine, examined appellant 

for complaints of pain and swelling in the right palm related to repetitive work. He noted that she

told him she injured her right hand on November 7, 2016 when she tripped and fell on an asphalt 

path. On examination, Dr. Alykhan noted mild swelling, tenderness, and ecchymosis of the right 

hand. He diagnosed right hand pain, tingling, and swelling. Dr. Alykhan repeated these diagnoses 

in a discharge instruction sheet of even date. 

In a prescription note dated June 8, 2019, Dr. Alykhan referred appellant to physical 

therapy for a diagnosis of right hand swelling, overuse, and strain. In a work status form of even 

date, he diagnosed right hand pain and swelling and restricted appellant from performing repetitive 

motion. 

An x-ray of appellant’s right hand taken on June 10, 2019 demonstrated mild osteoarthritis, 

but no fracture or subluxation. An x-ray of his left hand of even date demonstrated mild 

osteoarthritis. 

On June 19, 2019 appellant replied to OWCP’s inquiries. She noted that after her fall on 

the pathway on November 7, 2016 her right hand was sore and bruised. Appellant submitted 

photographs of hand and knee injuries taken on the date of injury. She explained that she had not 

filed her traumatic injury claim until June 2019 because she had been experiencing worsening pain 

and swelling in her right hand when performing repetitive tasks at home and at work. Appellant 

also submitted e-mails dated November 8, 2016, in which she informed her supervisor that on 

November 7, 2016 she had tripped and had gone to the health unit because her knee was bleeding.

In a letter dated June 20, 2019, Dr. Alykhan noted that he had seen appellant on June 8, 

2019 for complaints of right hand pain and swelling. Appellant recalled a work-related injury on 

November 7, 2016 when she tripped and fell on an asphalt path. She was treated for right knee 

abrasion and noted that her hand had been bruised and sore with full range of movement, which 
3

resolved after one day. Appellant had no gross symptoms until about a year and a half before the 

date of Dr. Alykhan’s letter, when she began to develop symptoms of pain with use of her right 

hand at work and when cleaning at home. On physical examination of the right hand, Dr. Alykhan

observed minimal to mild swelling/edema to the base of her right thumb with full range of motion 

and no point tenderness, ecchymosis, erythema, soft tissue/bony crepitus, or bony deformity. He 

provisionally diagnosed right hand pain and swelling with a history of right hand injury after a fall, 

likely due to right thumb tenosynovitis and possible concomitant right hand arthritis. Dr. Alykhan 

opined that it was possible that her fall “may have been” the precipitating event to her current right 

hand symptoms, which were noted to recur when she performed repetitive movements at work or 

at home. 

In a note dated July 8, 2019, Dr. Subir S. Jossan, a Board-certified hand surgeon, noted that 

appellant had suffered a ground level fall and contusion to her right thumb and hand two and a half 

years prior. Appellant stated that she had experienced hand pain at that time, which persisted, and 

which increased in the right thumb with strenuous activity including pinching and gripping 

activities. On physical examination of the right hand and wrist, Dr. Jossan observed tenderness 

over the carpometacarpal (CMC) joint with a positive grind test, mild tenderness over the 

scaphotrapeziotrapezoidal (STT) joint with full wrist motion, and slight pain with resisted wrist 

flexion over the flexor carpi radialis (FCR) tendon. He diagnosed post-traumatic arthritis of the 

right thumb and wrist. 

On July 17, 2019 OWCP accepted the claim for right knee abrasion.

Appellant subsequently submitted a revised version of Dr. Jossan’s July 8, 2019 note. 

Dr. Jossan diagnosed post-traumatic arthritis of the right thumb and wrist. He opined that it was 

a work-related condition resulting from appellant’s injury of November 7, 2016. Dr. Jossan

recommended a permanent restriction of no repetitive motion of the right hand/wrist, including no 

data entry work. 

In a development letter dated August 21, 2019, OWCP advised appellant of the type of 

evidence required to support that the acceptance of her claim should be expanded, including

submission of a rationalized medical report explaining how the diagnosed condition(s) was work

related, bridging medical documentation from 2016 through 2019, and answers to its inquiries. It 

afforded her at least 30 days to submit the necessary evidence. 

In a letter dated August 28, 2019, Dr. Jossan noted that he had seen and treated appellant 

for conditions of her right thumb and wrist. He opined that, based on her history, physical 

examination, and diagnostic studies that her post-traumatic osteoarthritis of the right thumb and 

wrist were a direct result of the work injury dated November 7, 2016. Dr. Jossan explained that 

this injury caused cartilage damage that had been gradually progressing since that time, and that 

post-traumatic arthritis was a chronic, slow-developing condition.

Appellant responded to OWCP’s inquiries in a September 5, 2019 letter. She stated that 

she had noticed that the November 7, 2016 report signed by a nurse did not include reference to a 

hand injury. Appellant noted that she had photos of her knee and hand from her date of injury and 

that the hand injury should have been noted as well. She observed that she first experienced 

symptoms of right hand swelling and pain in May 2018 when she moved from one residence to 
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another and thoroughly cleaned the residences in a short time period. Appellant stated that her 

right hand swelled from the repetitive motion of wiping down cabinets, scrubbing bathrooms, 

mopping, and vacuuming within a short time frame. She further noted that her normal duties at 

work had not included repetitive motion, but that when she was occasionally asked to process 

invoices, which involved data entry, her right hand would swell and hurt from the repetitive 

motion.

By decision dated October 2, 2019, OWCP denied appellant’s request to expand the 

acceptance of her claim to include right thumb and wrist osteoarthritis causally related to the 

November 7, 2016 employment injury. 

LEGAL PRECEDENT

When an employee claims that a condition not accepted or approved by OWCP was due to 

an employment injury, he or she bears the burden of proof to establish that the condition is causally 

related to the employment injury.3

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.4 A physician’s opinion on whether there is causal relationship 

between the diagnosed condition and an accepted injury must be based on a complete factual and 

medical background.5 Additionally, the physician’s opinion must be expressed in terms of a 

reasonable degree of medical certainty and must be supported by medical rationale which, explains 

the nature of the relationship between the diagnosed condition and the accepted employment 

injury.6

ANALYSIS

The Board finds that appellant has not met her burden of proof to expand the acceptance 

of her claim to include additional right upper extremity conditions as causally related to the 

accepted November 7, 2016 employment injury.

In a report dated June 8, 2019, Dr. Alykhan diagnosed right hand pain, tingling, and 

swelling. He repeated these diagnoses in a discharge instruction sheet of even date. On the same 

date, Dr. Alykhan referred appellant to physical therapy for a diagnosis of right hand swelling, 

overuse, and strain. In a work status form of even date, he diagnosed right hand pain and swelling. 

Dr. Alykhan did not, however, provide an opinion as to the cause of the additional conditions. The 

Board has held that medical evidence offering no opinion regarding the cause of an employee’s 

 

3 A.A., Docket No. 19-1165 (issued December 16, 2019); M.B., Docket No. 19-0485 (issued August 22, 2019); R.J.,

Docket No. 17-1365 (issued May 8, 2019); Jaja K. Asaramo, 55 ECAB 200 (2004).

4 E.M., Docket No. 18-1599 (issued March 7, 2019); Robert G. Morris, 48 ECAB 238 (1996).

5 M.V., Docket No. 18-0884 (issued December 28, 2018); Victor J. Woodhams, 41 ECAB 345, 352 (1989).

6

Id.
5

condition is of no probative value on the issue of causal relationship.7 As Dr. Alykhan did not 

offer an opinion regarding the cause of appellant’s diagnosed conditions, these documents are of 

no probative value on the issue of causal relationship.8

In a letter dated June 20, 2019, Dr. Alykhan opined that it was possible that her fall “may 

have been” the precipitating event to her right hand symptoms. The Board has held that medical 

opinions that suggest that a condition was “likely” or “possibly” caused by work activities are 

speculative or equivocal in character and have limited probative value.9 Thus, Dr. Alykhan’s letter 

of June 20, 2019 is insufficient to establish appellant’s claim.

Appellant also submitted a July 8, 2019 note and a revised note of even date from

Dr. Jossan. Dr. Jossan diagnosed post-traumatic arthritis of the right thumb and wrist and opined 

that it was a work-related condition resulting from her injury of November 7, 2016. The Board 

has held that a mere conclusion without the necessary rationale as to whether a condition is due to 

an accepted employment incident is insufficient to meet a claimant’s burden of proof.10 Because

Dr. Jossan did not provide rationale to support his opinion in his July 8, 2019 note, it is insufficient 

to meet appellant’s burden of proof.

OWCP also received a report dated August 28, 2019 from Dr. Jossan in which he opined 

that based on her history, physical examination, and diagnostic studies, appellant’s post-traumatic 

osteoarthritis of the right thumb and wrist were a direct result of the work injury on

November 7, 2016. Dr. Jossan explained that this injury caused cartilage damage that had been 

gradually progressing, and that post-traumatic arthritis was a chronic, slow-developing condition. 

However, his report is insufficiently rationalized as he failed to address the pathophysiological

mechanism by which the accepted employment incident caused, aggravated, or accelerated 

appellant’s diagnosed osteoarthritis of the right thumb and wrist.11 Dr. Jossan failed to provide a 

sufficiently rationalized explanation of why appellant’s osteoarthritis of the right thumb and wrist 

was work related, given that appellant also had osteoarthritis of the left hand as demonstrated by 

x-ray on June 10, 2019. As such, his August 28, 2019 report is of limited probative value and is 

insufficient to meet appellant’s burden of proof.12

Appellant submitted diagnostic reports dated June 10, 2019, demonstrating bilateral mild 

osteoarthritis of the hands. The Board has held that diagnostic tests, standing alone, lack probative 

 

7 See R.G., Docket No. 18-0792 (issued March 11, 2020); L.B., Docket No. 18-0533 (issued August 27, 2018); 

D.K., Docket No. 17-1549 (issued July 6, 2018). 

8 R.Z., Docket No. 19-0408 (issued June 26 2019); P.S., Docket No. 18-1222 (issued January 8, 2019).

9

J.W., Docket No. 18-0678 (issued March 3, 2020).

10 A.T., Docket No. 19-0410 (issued August 13, 2019); E.L., Docket No. 17-1632 (issued January 3, 2018).

11 See A.P., Docket No. 19-0224 (issued July 11, 2019).

12 Id.
6

value as they do not provide an opinion on causal relationship between the traumatic incident and 

the diagnosed conditions.13 These reports are therefore insufficient to establish the claim.

Appellant submitted a November 7, 2016 report signed by a registered nurse. Certain 

healthcare providers, such as nurses, are not considered “physician[s]” as defined under FECA.14 

Consequently, their medical findings and/or opinions will not suffice for purposes of establishing 

entitlement to FECA benefits.15 Moreover, this report did not reference any right hand condition.

The Board finds that appellant has not submitted sufficient medical evidence to establish 

causal relationship between the accepted November 7, 2016 employment injury and the claimed 

osteoarthritis of the right thumb and wrist. As such, appellant has not met her burden of proof to 

expand the acceptance of her claim.16

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 expand the acceptance 

of her claim to include additional right upper extremity conditions as causally related to her 

November 7, 2016 employment injury.

 

13 See J.M., Docket No. 17-1688 (issued December 13, 2018).

14 5 U.S.C. § 8101(2); 20 C.F.R. § 10.5(t).

15 Section 8101(2) of FECA provides that physician “includes surgeons, podiatrists, dentists, clinical psychologists, 

optometrists, chiropractors, and osteopathic practitioners within the scope of their practice as defined by State law.”

5 U.S.C. § 8101(2). See also Federal (FECA) Procedure Manual, Part 2 -- Claims, Causal Relationship, Chapter 

2.805.3a(1) (January 2013); David P. Sawchuk, 57 ECAB 316, 320 n.11 (2006) (lay individuals such as physician 

assistants, nurses, and physical therapists are not competent to render a medical opinion under FECA); R.L., Docket 

No. 19-0440 (issued July 8, 2019) (nurse practitioners and physical therapists are not considered physicians under 

FECA); K.W., 59 ECAB 271, 279 (2007).

16 See O.M., Docket No. 18-1055 (issued April 15, 2020).
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ORDER

IT IS HEREBY ORDERED THAT the October 2, 2019 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: August 25, 2020

Washington, DC

Christopher J. Godfrey, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Alternate Judge

Employees’ Compensation Appeals Board