United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

C.L., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

South Euclid, OH, Employer

__________________________________________

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Docket No. 18-1092

Issued: January 7, 2019

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

CHRISTOPHER J. GODFREY, Chief Judge

PATRICIA H. FITZGERALD, Deputy Chief Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On May 7, 2018 appellant, through counsel, filed a timely appeal from a March 23, 2018 

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 that her right wrist 

de Quervain’s tenosynovitis was causally related to the accepted September 27, 2017 employment 

incident.

FACTUAL HISTORY

On September 27, 2017 appellant, then a 35-year-old letter carrier, filed a traumatic injury 

claim (Form CA-1) alleging that, on that date, she developed burning in her right wrist, as well as 

cramping and swelling of her hand after delivering mail. She stopped work on that day.

In a September 27, 2017 authorization for examination and/or treatment (Form CA-16), 

received by OWCP on October 6, 2017, the employing establishment authorized treatment for 

appellant’s right wrist.

A September 27, 2017 duty status report (Form CA-17) diagnosed de Quervain’s 

tenosynovitis and noted an injury date of September 27, 2017.3 The report noted that appellant 

developed right wrist pain and burning and hand cramping while delivering mail and that she could 

not perform her usual employment duties. 

By development letter dated October 18, 2017, OWCP advised appellant that the evidence 

of record was insufficient to support her claim. It indicated that a physician’s opinion supported 

by a medical explanation as to how the reported work incident caused or aggravated the claimed 

injury was needed. OWCP afforded appellant 30 days to submit the requested information.

Dr. Timothy J. Nice, a treating Board-certified orthopedic surgeon, related in an

October 10, 2017 report that appellant was diagnosed with de Quervain’s tendinitis at an Urgent 

Care Center. Appellant attributed her right wrist pain to delivering and sorting mail. Physical

examination findings included positive Finkelstein and tenderness over the first dorsal right wrist 

compartment. In an October 10, 2017 Form CA-17, Dr. Nice diagnosed right wrist de Quervain’s 

tendinitis and noted an injury date of September 27, 2017. On October 30, 2017 Dr. Nice observed 

that appellant continued to have first dorsal compartment tendinitis. He placed her off work until 

the condition improved.

Appellant subsequently submitted physical therapy reports dated October 25, 26, and 31 

and November 2, 6, and 8, 2017. 

By decision dated November 27, 2017, OWCP denied appellant’s traumatic injury claim. 

It found that the September 27, 2017 incident occurred as alleged and a medical condition was 

diagnosed. However, OWCP found that the medical evidence of record was insufficient to 

establish an injury or condition causally related to the accepted September 27, 2017 employment

incident. 

 

3 The signature on the form is illegible. 
3

In a letter dated December 29, 2017, appellant requested reconsideration and submitted

additional evidence, including physical therapy reports. 

In a December 17, 2017 report, Dr. Nice noted the physical findings supported a diagnosis 

of de Quervain’s tendinitis based on appellant exhibiting the signs of this condition. He explained 

that this condition typically occurs from overuse or percussion on the wrist as found in a traumatic 

event and comes from sorting mail and putting mail into boxes. 

Dr. Nice, in progress notes dated December 28, 2017, reported that appellant continued to 

exhibit tenderness and weakly positive right wrist Finkelstein. Appellant related that she felt 

unable to handle mail.

By decision dated March 23, 2018, OWCP denied modification of its prior decision, 

finding that the medical evidence remained insufficient to establish causal relationship between 

the accepted September 27, 2017 work incident and the diagnosed right de Quervain’s tendinitis. 

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 filed within the applicable time 

limitation, that an injury5 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.6 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.7

To determine whether a federal employee has sustained a traumatic injury in the 

performance of duty it must first be determined whether fact of injury has been established.8 First, 

the employee must submit sufficient evidence to establish that he or she actually experienced the 

employment incident at the time, place, and in the manner alleged.9 Second, the employee must 

 

4 Supra note 2.

5 OWCP regulations define a traumatic injury as a condition of the body caused by a specific event or incident, or 

series of events or incidents, within a single workday or shift. Such condition must be caused by external force, 

including stress or strain, which is identifiable as to time and place of occurrence and member or function of the body 

affected. 20 C.F.R. § 10.5(ee).

6 N.C., Docket No. 17-0425 (issued June 21, 2018); C.S., Docket No. 08-1585 (issued March 3, 2009); Bonnie A. 

Contreras, 57 ECAB 364 (2006).

7 N.C., id.; S.P., 59 ECAB 184 (2007); Joe D. Cameron, 41 ECAB 153 (1989).

8 B.F., Docket No. 09-0060 (issued March 17, 2009); Bonnie A. Contreras, supra note 6.

9 S.F., Docket No. 18-0296 (issued July 26, 2018); D.B., 58 ECAB 464 (2007); David Apgar, 57 ECAB 137 (2005).
4

submit sufficient evidence, generally only in the form of medical evidence, to establish that the 

employment incident caused a personal injury.10

Rationalized medical opinion evidence is generally required to establish causal 

relationship. 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 factors identified by the claimant.11 This medical opinion must include an accurate 

history of the employee’s employment injury and must explain how the condition is related to the 

injury. The weight of medical evidence is determined by its reliability, its probative value, its 

convincing quality, the care of analysis manifested, and the medical rationale expressed in support 

of the physician’s opinion.12

ANALYSIS

The Board finds that appellant has not established that her right wrist de Quervain’s 

tenosynovitis was causally related to the accepted September 27, 2017 employment incident.

Appellant submitted a series of reports from her attending physician, Dr. Nice. In a 

December 17, 2017 report, Dr. Nice explained that her physical findings supported the diagnosis 

of de Quervain’s tendinitis in that typically de Quervain’s syndrome occurs due to percussion or 

overuse of the wrist as found in a traumatic event such as sorting mail and placing mail into boxes. 

The Board has long held that a mere conclusion, without the necessary medical rationale 

explaining how and why the physician believes that a claimant’s accepted exposure could result 

in a diagnosed condition, is insufficient to meet the claimant s burden of proof.13 Dr. Nice offered 

no rationalized medical explanation as to how, appellant’s delivering mail on September 27, 2017 

would have caused her diagnosed condition. Without explaining how, physiologically, the 

movements involved in the employment incident caused or contributed de Quervain’s 

tenosynovitis, Dr. Nice’s opinion is of limited probative value. 

In his other previous reports, Dr. Nice diagnosed de Quervain’s tendinitis, provided 

examination findings, and noted an injury date of September 27, 2017. He however, offered no 

opinion as to whether the diagnosed condition was causally related to the accepted employment 

incident of September 27, 2017. Medical evidence that does not offer an opinion regarding the 

 

10 A.D., Docket No. 17-1855 (issued February 26, 2018); C.B., Docket No. 08-1583 (issued December 9, 2008); 

D.G., 59 ECAB 734 (2008); Bonnie A. Contreras, supra note 6.

11 A.D., id.; I.J., 59 ECAB 408 (2008); Victor J. Woodhams, 41 ECAB 345 (1989).

12 S.H., Docket No. 17-1660 (issued March 27, 2018); James Mack, 43 ECAB 321 (1991).

13 See D.A., Docket No. 18-0525 (issued November 2, 2018); A.B., Docket No. 16-0864 (issued November 16, 

2016); Beverly A. Spencer, 55 ECAB 501 (2004).
5

cause of an employee s condition is of no probative value on the issue of causal relationship.14 For 

the reasons set forth above, Dr. Nice’s reports are insufficient to establish appellant’s claim.

The record also contains a September 27, 2017 Form CA-17 with an illegible signature 

diagnosing de Quervain’s tenosynovitis and that appellant developed hand cramping and right 

wrist pain while delivering mail on September 27, 2017. The Board has held that a report that 

bears an illegible signature cannot be considered probative medical evidence because it lacks 

proper identification.15 Thus, this report is of no probative value.16 

Appellant also submitted evidence from physical therapists. These documents do not 

constitute competent medical evidence because physical therapists are not considered “physicians”

as defined under FECA.17 As such, this evidence is of no probative and is insufficient to meet 

appellant’s burden of proof.18

On appeal counsel alleges that OWCP’s decision was wrong as causation was established. 

As discussed above, the record contains no medical evidence explaining how the diagnosed 

condition had been caused or aggravated by the accepted September 27, 2017 employment 

incident.

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 10.607.19

 

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

Noble, 55 ECAB 530 (2004).

15 See S.W., Docket No. 18-0721 (issued November 6, 2018); R.M., 59 ECAB 690 (2008); D.D., 57 ECAB 734 

(2006); Richard J. Charot, 43 ECAB 357 (1991).

16 Id.

17 5 U.S.C. § 8101(2); N.C., Docket No. 17-0425 (issued June 21, 2018); Jennifer L. Sharp, 48 ECAB 209 (1996) 

(physical therapists). See also Gloria J. McPherson, 51 ECAB 441 (2000); Charley V.B. Harley, 2 ECAB 208, 211 

(1949) (a medical issue such as causal relationship can only be resolved through the submission of probative medical 

evidence from a physician).

18 C.N., Docket No. 17-1321 (issued January 16, 2018); A.C., Docket No. 08-1453 (issued November 18, 2008) 

(records from a physical therapist do not constitute competent medical opinion in support of causal relation, as physical 

therapists are not considered physicians as defined under FECA).

19 The record contains a Form CA-16 signed by the employing establishment official on September 27, 2017. When 

the employing establishment properly executes a CA-16 form which authorizes medical treatment as a result of an 

employee’s claim for an employment-related injury, the CA-16 form creates a contractual obligation, which does not 

involve the employee directly, to pay for the cost of the examination or treatment regardless of the action taken on the 

claim. The period for which treatment is authorized by CA-16 form is limited to 60 days from the date of issuance, 

unless terminated earlier by OWCP. See 20 C.F.R. § 10.300(c); Tracy P. Spillane, 54 ECAB 608 (2003). The record 

is silent as to whether OWCP paid for the cost of appellant’s examination or treatment for the period noted on the 

form.
6

CONCLUSION

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

wrist de Quervain’s tenosynovitis was causally related to the accepted September 27, 2017 

employment incident.

ORDER

IT IS HEREBY ORDERED THAT the March 23, 2018 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: January 7, 2019

Washington, DC

Christopher J. Godfrey, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board