United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

D.N., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Pinckneyville, IL, Employer

__________________________________________

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Docket No. 19-1312

Issued: February 14, 2020

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

JANICE B. ASKIN, Judge

ALEC J. KOROMILAS, Alternate Judge

JURISDICTION

On May 28, 2019 appellant, through counsel, filed a timely appeal from an April 19, 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 left carpal tunnel 

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

FACTUAL HISTORY

On June 5, 2018 appellant, then a 58-year-old rural carrier, filed an occupational disease 

claim (Form CA-2) alleging that she sustained injuries to her hands, wrists, and elbows while in 

the performance of duty. She attributed her bilateral upper extremity condition(s) to repetitive 

work factors, which included gripping, grasping, pushing, pulling, reaching, and lifting. Appellant 

identified February 28, 2018 as the date she first became aware of her condition. She did not stop 

work. 

Under OWCP File No. xxxxxx571, appellant has an accepted occupational disease claim 

for left forearm/elbow sprain, left ulnar nerve lesion, and left lateral epicondylitis, which arose on 

or about June 2, 2008.

3

In an April 23, 2018 work status note, Jeremy D. Palmer, a certified physician assistant, 

diagnosed left elbow lateral epicondylitis and requested authorization for left upper extremity 

electrodiagnostic testing for evaluation of cubital tunnel syndrome. He also provided work 

restrictions, which included no lifting in excess of three to five pounds and no repetitive 

pushing/pulling activities. 

In a July 13, 2018 development letter, OWCP informed appellant that the evidence of 

record was insufficient to establish her claim. It advised her of the type of factual information and 

medical evidence necessary to support her claim and provided a questionnaire for her completion. 

OWCP afforded appellant 30 days to submit the requested information. 

On August 10, 2018 appellant responded to OWCP’s development letter. In a narrative 

statement, she described in detail her employment duties, which included casing and sorting mail, 

pulling mail down and bundling and delivering it. Appellant indicated that her employment duties 

required repetitive gripping, reaching approximately 400 times a day, grasping and tying mail, 

driving, and pushing and pulling open mail boxes. She reported that she performed these motions

six days a week for approximately six to eight hours per day. 

In an April 23, 2018 report, Dr. John T. Davis, a Board-certified orthopedic surgeon, 

indicated that appellant worked as a rural mail carrier and that she sought treatment for complaints 

of left lateral elbow pain. He recounted that the pain began at work with repetitive activities over 

time and had progressively worsened in the past several months. Dr. Davis reported that 

appellant’s pain was aggravated with daily activities, including repetitive reaching and lifting at 

work. Examination of appellant’s bilateral upper extremities revealed tenderness focally over the 

lateral epicondyle, with pain reported on resisted wrist extension, long finger extension, resisted 

supination, and grip form elevation. Dr. Davis indicated that a left elbow x-ray revealed an ulnar 

 

3 Appellant’s previously accepted left upper extremity employment injury under OWCP File No. xxxxxx571 is not 

currently before the Board.
3

nerve lesion. He assessed left elbow pain, left elbow lateral epicondylitis, and left cubital tunnel 

syndrome. Dr. Davis opined that appellant’s current complaints were causally related to her 

repetitive work activity. 

In an April 26, 2018 report, Dr. Steven D. Young, a Board-certified orthopedic surgeon, 

related appellant’s complaints of left hand catching and pain, swelling, and numbness on the left 

side. He reported that appellant’s symptoms began four months prior and were nontraumatic. 

Dr. Young reviewed appellant’s history and noted that she was diabetic. Upon examination of 

appellant’s left hand, he observed a Dupuyten’s node on the long finger volar proximal 

interphalangeal (PIP) joint and triggering over the ring finger. Dr. Young diagnosed left hand pain 

and left ring finger triggering. 

In a May 30, 2018 report, Dr. Davis related that appellant was treated for complaints of 

numbness and tingling in the ulnar digits of her left hand. He reviewed appellant’s history and 

conducted an examination. Dr. Davis noted positive Tinel’s sign and pain with hyperflexion of 

the elbow into the ulnar digits. He assessed left elbow ulnar neuritis and improving left elbow 

lateral epicondylitis. 

A June 7, 2018 electromyography and nerve conduction velocity (EMG/NCV) study 

revealed moderate left median neuropathy at the wrist and mild left ulnar neuropathy at the elbow. 

In a June 7, 2018 report, Dr. Young reported appellant’s complaints of left hand numbness 

and tingling and left ring finger triggering. Upon examination of appellant’s left hand, he observed 

positive Phalen’s and median nerve compression tests. Dr. Young diagnosed left ring trigger 

finger, left carpal tunnel syndrome, left cubital tunnel syndrome, and Dupuytren’s fibromatosis.

In a July 5, 2018 report, Dr. Young indicated that appellant had persistent symptoms of 

triggering of the left ring finger and left whole hand numbness and tingling that did not improve

with conservative care. He reviewed appellant’s history and noted that she was diabetic. Upon 

examination of appellant’s left hand, Dr. Young observed triggering and tenderness in the area of 

the A1 pulley, numbness and tingling of the whole left hand, and tenderness at the medial elbow. 

Dr. Young discussed the results of the EMG/NCV study and assessed left carpal tunnel syndrome, 

left cubital tunnel syndrome, and left ring trigger finger.

By decision dated August 16, 2018, OWCP accepted appellant’s employment duties as a 

rural carrier and diagnoses for left elbow lateral epicondylitis, left carpal tunnel syndrome, left 

cubital tunnel syndrome, and left ring trigger finger. However, it denied her claim finding 

insufficient medical evidence to establish causal relationship.

On August 29, 2018 appellant, through counsel, requested a telephonic hearing before an 

OWCP hearing representative. The hearing was held on January 15, 2019. Appellant clarified 

that she was not requesting acceptance of her claim for her left ring trigger finger or left hand 

nodules as her doctor had informed her that those conditions were due to her diabetes. She also 

related that, although she received medical treatment for her previously accepted left arm 

conditions in 2008, the pain and symptoms never went away.

By decision dated February 25, 2019, an OWCP hearing representative affirmed the 

August 16, 2018 decision. 
4

On March 22, 2019 appellant, through counsel, requested reconsideration. 

Appellant submitted a February 24, 2019 letter by Dr. Young. Dr. Young indicated that he 

had been treating appellant for diagnosed left ring trigger finger, left carpal tunnel syndrome, and 

left cubital tunnel syndrome. He also reported that appellant worked as a mail carrier for the past 

21 years and that her employment duties required driving, working in a rural setting, and lifting 

up to 70 pounds. Dr. Young opined that driving, lifting heavy loads, and the repetitive nature of 

these activities over a prolonged period of time, such as 21 years, was “most certainly a 

contributing factor” to her symptoms. He explained that these activities contributed to the 

“thickening of the transverse carpal ligament, which diminishes room for the median nerve at the 

carpal tunnel.” Dr. Young indicated that these activities also contributed to the development of 

cubital tunnel syndrome. He further noted that appellant’s diabetic condition did not negate the 

impact that her work situation had on the development of her left carpal tunnel, left cubital, and 

left ring trigger finger conditions. 

By decision dated April 19, 2019, OWCP denied modification of the February 25, 2019 

decision. 

LEGAL PRECEDENT

An employee seeking benefits under FECA4 has the burden of proof to establish the 

essential elements of his or her claim, including 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 of FECA,5that an injury was sustained in the performance of duty as alleged, and that 

any disability or medical condition for which compensation is claimed is causally related to the 

employment injury.6 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.7

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

disease claim, a claimant must submit: (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 claimant.8 

 

4 Supra note 2.

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

153 (1989). 

6

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

ECAB 312 (1988).

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

Delores C. Ellyett, 41 ECAB 992 (1990).

8 S.C., Docket No. 18-1242 (issued March 13, 2019); R.H., 59 ECAB 382 (2008).
5

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

relationship is rationalized medical opinion evidence.9 The opinion of the physician must be based 

on a complete factual and medical background of the employee, 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 specific employment factors identified by the employee.10

ANALYSIS

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

Appellant submitted reports and letters by Dr. Young dated April 26, 2018 to 

February 24, 2019. In his initial report, Dr. Young related appellant’s complaints of left hand 

catching, pain, swelling, and numbness. In reports dated June 7 and July 5, 2018, he noted 

examination findings of positive Phalen’s and median nerve compression tests and tenderness in 

appellant’s left ring finger. Dr. Young diagnosed left ring trigger finger, left carpal tunnel 

syndrome, and left cubital tunnel syndrome. In a February 24, 2019 letter, he noted that appellant 

worked as a mail carrier and that her employment duties required driving and lifting up to 70 

pounds. Dr. Young opined that the repetitive nature of these activities over a prolonged period of 

time contributed to the development of appellant’s symptoms. He explained that these activities 

contributed to the “thickening of the transverse carpal ligament, which diminishes room for the 

median nerve at the carpal tunnel.” Dr. Young reported that these activities also contributed to the 

development of cubital tunnel syndrome.

The Board finds that Dr. Young provided an affirmative opinion on causal relationship, 

which describes appellant’s repetitive employment duties, findings upon examination, and 

explained the mechanism of injury of how the accepted factors of employment contributed to the 

development of her left cubital and carpal tunnel syndromes.11 Dr. Young also noted that although 

appellant had a preexisting diabetic condition, her work activities still contributed to the worsening 

of her left upper extremity conditions. His opinion is also supported by Dr. Davis, who opined in 

an April 23, 2019 report that appellant’s conditions were causally related to her repetitive reaching 

and lifting at work. The Board finds that, although Dr. Young’s and Dr. Davis’ opinions were not 

sufficiently rationalized to meet appellant’s burden of proof to establish her claim, they are

sufficient to require further development of the case by OWCP.12 

 

9 A.M., Docket No. 18-1748 (issued April 24, 2019); 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); I.J., 59 ECAB 408 (2008); Victor J. Woodhams, 41 

ECAB 345, 352 (1989).

11 See C.M., Docket No. 18-1516 (issued May 8, 2019). 

12 C.M., Docket No. 17-1977 (issued January 29, 2019); see also John J. Carlone, 41 ECAB 354 (1989); Horace 

Langhorne, 29 ECAB 820 (1978).
6

It is well established that proceedings under FECA are not adversarial in nature, and while 

appellant has the burden to establish entitlement to compensation, OWCP shares responsibility in 

the development of the evidence.13 OWCP has an obligation to see that justice is done.14

Therefore, the Board finds that the case shall be remanded to OWCP. On remand, OWCP 

shall prepare a statement of accepted facts concerning appellant’s working conditions and refer the 

matter to an appropriate medical specialist, consistent with OWCP’s procedures, to determine 

whether appellant’s employment duties caused or aggravated her left upper extremity conditions. 

Following this, and any other further development as deemed necessary, OWCP shall issue a de 

novo decision.

CONCLUSION

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

 

13 See e.g., M.G., Docket No. 18-1310 (issued April 16, 2019); Walter A. Fundinger, Jr., 37 ECAB 200, 204 (1985); 

Michael Gallo, 29 ECAB 159, 161 (1978); William N. Saathoff, 8 ECAB 769, 770-71; Dorothy L. Sidwell, 36 ECAB

699, 707 (1985).

14 See A.J., Docket No. 18-0905 (issued December 10, 2018); William J. Cantrell, 34 ECAB 1233, 1237 (1983); 

Gertrude E. Evans, 26 ECAB 195 (1974).
7

ORDER

IT IS HEREBY ORDERED THAT the April 19, 2019 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: February 14, 2020

Washington, DC

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Alec J. Koromilas, Alternate Judge

Employees’ Compensation Appeals Board