United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

J.R., Appellant

and

U.S. POSTAL SERVICE, AKELEY POST 

OFFICE, Akeley, MN, Employer

__________________________________________

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Docket No. 19-0812

Issued: September 29, 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

PATRICIA H. FITZGERALD, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On March 8, 2019 appellant filed a timely appeal from a February 26, 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.3

 

1 Appellant timely requested oral argument before the Board. 20 C.F.R. § 501.5(b). By order dated July 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. 19-0812 (issued 

July 20, 2020). 

2 5 U.S.C. § 8101 et seq.

3 The Board notes that, following the February 26, 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 his burden of proof to establish right carpal tunnel 

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

FACTUAL HISTORY

On January 11, 2019 appellant, then a 38-year-old rural carrier, filed an occupational 

disease claim (Form CA-2) alleging that he sustained right-sided CTS causally related to factors 

of his federal employment. He indicated that he first became aware of his condition and its 

relationship to his federal employment on November 21, 2018. Appellant did not stop work.

In a development letter dated January 22, 2019, OWCP informed appellant that the 

evidence of record was insufficient to establish his claim. It advised him of the type of factual and 

medical evidence needed and provided a questionnaire for his completion. The questionnaire 

requested that appellant describe in detail the employment duties which he believed contributed to 

his condition and requested that he provide a physician’s opinion, supported by medical rationale, 

as to how those duties caused or aggravated his medical condition. It afforded him 30 days to 

submit additional evidence and to respond to its inquiries.

On January 27, 2019 appellant completed the questionnaire. He explained that he had 

delivered mail for 12 years out of a right-sided vehicle window, and that he had used his dominant 

hand for sorting mail. Appellant alleged that these repetitive motions had aggravated an alreadyweak right arm and wrist. He indicated that he performed the described activities of sorting and 

delivering mail for 8 hours per day, 40 hours per week. Appellant noted that he had recently 

undergone a right elbow repair. Regarding the development of his condition, he indicated that he 

had noticed it intermittently for two years, and that the condition was aggravated by the volume of 

mail and delivery with the right hand. Appellant further noted that it had become a daily issue as 

of October 2018 with symptoms including numbness of the hand and pain of the wrist. He 

explained that steroid injections had allowed him to work through Christmas and that he required

surgery. 

In a supplemental statement dated January 11, 2019, received on February 4, 2019, 

appellant explained that, on October 2, 2018, he was seen for on-going pain in his wrist, which 

required splints and a steroid injection for the diagnosed CTS condition. He alleged that the CTS 

was due to repetitive motion in his federal employment. 

OWCP also received occupational therapy progress notes dated November 15, 2018, 

wherein Ashlee M. Lee, an occupational therapist, described decreased range of motion, strength, 

edema, and pain of the right upper extremity. Ms. Lee noted a diagnosis of right cubital tunnel 

syndrome and right CTS and a method of injury of overuse. She recommended a right long arm 

elbow splint and a right volar wrist splint with nerve glides. 

In progress notes dated November 17, 2018, Dr. Tibor T. Warganich, a Board-certified 

orthopedic surgeon, indicated that he had examined appellant for complaints of numbness and 

tingling in the median nerve distribution of the right upper extremity. He noted that appellant was 

right-hand dominant with no significant past medical history. Dr. Warganich indicated that 

appellant performed occasional heavy lifting and light construction work at home. He noted a 
3

history of right lateral epicondylitis status post-surgery two years prior. On physical examination 

of the right upper extremity, Dr. Warganich observed pink and perfused digits with no evidence 

of acute compressive neuropathy. He further observed a mild Tinel’s sign bilaterally, more on the 

right than the left, and negative compression, Phalen’s, and reverse Phalen’s tests bilaterally. Twopoint discrimination was less than six millimeters in the median and ulnar nerve distributions. 

Dr. Warganich noted no thenar or intrinsic atrophy and no Tinel’s sign at the cubital tunnels. He 

diagnosed mild intermittent right CTS. Dr. Warganich recommended use of a volar splint and 

administered a corticosteroid injection. He opined that he suspected appellant’s CTS was a chronic 

condition that may have been exacerbated by work. Dr. Warganich further observed that appellant 

did not have any high-vibration tools at work that could be linked the CTS. 

In progress notes dated January 5, 2019, Dr. Warganich examined appellant for increasing 

symptoms of right-sided CTS despite conservative treatment, along with bilateral medial 

epicondylitis. He told appellant that he likely had ongoing and chronic CTS exacerbated by work, 

but that he had not worked with high-vibration tools, which were the most widely accepted workrelated cause of CTS. On physical examination of the right upper extremity, Dr. Warganich

observed a positive compression test at 20 seconds in the right carpal tunnel, a mild Tinel’s sign 

for bilateral cubital tunnel syndrome, and two-point discrimination at six millimeters in the 

bilateral median and ulnar nerve distributions. He noted that an electromyogram (EMG) 

demonstrated mild right-sided CTS. Dr. Warganich diagnosed right-sided CTS and recommended 

surgery.

In a letter dated January 28, 2019, the employing establishment challenged appellant’s 

claim. It contended that based on a January 5, 2019 report by Dr. Warganich, appellant had not 

established causal relationship between work factors and his diagnosed right-sided CTS.

In an after visit summary from a physician with an illegible signature, dated January 22, 

2019, noted a diagnosis of CTS of the right upper limb and explained that the injury was incurred 

from repetitive motions of the wrist while delivering mail. The physician noted that appellant had 

undergone an injection and that surgery was scheduled to occur the following week. 

In another report from a physician with an illegible signature, dated January 22, 2019, it 

was noted that appellant was examined for complaints of right wrist pain. The report described 

appellant’s history of injury as repetitive motions from using the wrist to deliver mail. On physical 

examination of the right wrist, the physician observed pain over the radial-carpal articulation and

diagnosed CTS of the right upper limb. The physician noted that appellant had surgery on 

January 30, 2019 for CTS. 

In an after visit summary dated February 19, 2019, Megan Askelson, a certified nurse

practitioner, indicated that appellant was on restricted work duty, due to right carpal tunnel 

syndrome. She also noted that appellant had sustained a right wrist injury from repetitive motions 

while delivering mail. In a report dated February 21, 2019, Ms. Askelson examined appellant for 

complaints of right wrist pain. She described appellant’s history of injury as repetitive motions 

from using the wrist to deliver mail. Appellant told Ms. Askelson that he was doing well after 

surgery and that his subjective symptoms had ceased to include numbness, but tingling, some 

weakness, some range of motion restriction, and minimal pain remained. On physical examination 

of the right wrist, Ms. Askelson observed limited range of motion and strength with scarring over 

the wrist extensor surface. She diagnosed CTS of the right upper limb, post carpal tunnel release.
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Ms. Askelson recommended work restrictions of occasional lifting of no more than five pounds 

with the right wrist.

By decision dated February 26, 2019, OWCP denied appellant’s claim finding that the 

medical evidence of record was insufficient to establish that his diagnosed condition was causally 

related to the accepted factors of his federal employment. 

LEGAL PRECEDENT

An employee seeking benefits under FECA4 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 timely filed within the applicable 

time limitation of FECA, that 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.5 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.

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 identified employment factors.6

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.7 The opinion of the physician must be based on a complete factual 

and medical background, 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 incident.8

ANALYSIS

The Board finds that appellant has not met his burden of proof to establish right CTS 

causally related to the accepted factors of his federal employment.

On November 17, 2018 Dr. Warganich diagnosed mild intermittent right CTS. He opined 

that he suspected appellant’s CTS was a chronic condition that may have been exacerbated by 

 

4 Supra note 2.

5 C.K., Docket No. 19-1549 (issued June 30, 2020); R.G., Docket No. 19-0233 (issued July 16, 2019); Elaine 

Pendleton, 40 ECAB 1143 (1989).

6 L.D., Docket No. 19-1301 (issued January 29, 2020); S.C., Docket No. 18-1242 (issued March 13, 2019); Victor J. 

Woodhams, 41 ECAB 345, 352 (1989).

7

I.J., Docket No. 19-1343 (issued February 26, 2020); T.H., 59 ECAB 388 (2008); Robert G. Morris, 48 ECAB 

238 (1996).

8 D.J., Docket No. 19-1301 (issued January 29, 2020).
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work. Dr. Warganich observed that appellant did not have any high-vibration tools at work that 

could be linked to the CTS. On January 5, 2019 he opined that appellant likely had ongoing and 

chronic CTS exacerbated by work, but again noted that appellant did not work with any highvibration tools, which were the most widely accepted work-related cause of CTS. The Board has 

found that, while the opinion of a physician supporting causal relationship need not be one of 

absolute medical certainty, it must not be speculative or equivocal. The opinion should be 

expressed in terms of a reasonable degree of medical certainty.9 Dr. Warganich’s opinions as to 

the cause of appellant’s right wrist CTS was not expressed in terms of a reasonable degree of 

medical certainty, instead referring to a suspicion that it was a chronic condition and that it may 

have been or likely was exacerbated by his work. The Board thus finds that the medical reports of

Dr. Warganich are not well rationalized and are of limited probative value on the issue of causal 

relationship.

Appellant submitted reports and notes from a physician with an illegible signature. The 

Board has held that a report bearing an illegible signature lacks proper identification and cannot 

be considered probative medical evidence.10 Thus, these reports remain of no probative value and 

are insufficient to establish appellant’s claim. 

Appellant also submitted treatment records from occupational therapists and from

Ms. Askelson, a nurse practitioner. However, these records do not constitute competent medical 

evidence because occupational therapists and nurse practitioners are not considered physicians as 

defined under FECA.11 As such, this evidence is of no probative value and is insufficient to meet 

appellant’s burden of proof.

As the medical evidence of record is insufficient to establish that appellant’s right CTS was 

causally related to the accepted employment factors, the Board finds that appellant has not met his

burden of proof to establish his claim.

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.

 

9 P.W., Docket No. 20-0407 (issued July 17, 2020); Ricky S. Storms, 52 ECAB 349 (2001).

10 C.N., Docket No. 16-1597 (issued August 10, 2017); see A.B., Docket No. 17-0545 (issued June 15, 2017); 

Merton J. Sills, 39 ECAB 572, 575 (1988).

11 5 U.S.C. § 8101(2) provides that a physician includes surgeons, podiatrists, dentists, clinical psychologists, 

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

See also 20 C.F.R. § 10.5(t); 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). E.B., Docket 

No. 19-1548 (issued July 14, 2020) and R.S., Docket No. 16-1303 (issued December 2, 2016) (an occupational 

therapist is not considered a physician under FECA); L.C., Docket No. 16-1717 (issued March 2, 2017) (a nurse 

practitioner is not considered a physician under FECA).
6

CONCLUSION

The Board finds that appellant has not met his burden of proof to establish right CTS 

causally related to the accepted factors of his federal employment.

ORDER

IT IS HEREBY ORDERED THAT the February 26, 2019 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: September 29, 2020

Washington, DC

Christopher J. Godfrey, Deputy Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Alternate Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board