United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

K.C., Appellant

and

U.S. POSTAL SERVICE, WATERTOWN POST 

OFFICE, Watertown, CT, Employer

__________________________________________

)

)

)

)

)

)

)

)

Docket No. 20-0899

Issued: December 1, 2020

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, Deputy Chief Judge

JANICE B. ASKIN, Judge

PATRICIA H. FITZGERALD, Alternate Judge

JURISDICTION

On March 18, 2020 appellant, through counsel, filed a timely appeal from a February 10, 

2020 merit decision of the Office of Workers’ Compensation Programs (OWCP). 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

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 bilateral carpal 

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

FACTUAL HISTORY

On May 4, 2019 appellant, then a 61-year-old mail carrier, filed an occupational disease 

claim (Form CA-2) alleging that she sustained bilateral carpal tunnel syndrome causally related to 

factors of her federal employment including repetitive twisting and turning of her wrists and hands. 

She indicated that she first became aware of her condition on March 24, 2015 and its relationship 

to her federal employment on February 4, 2016. Appellant did not stop work. 

Appellant explained in a narrative statement dated May 4, 2019 that she began to notice 

numbness of her bilateral hands and fingers as of March 24, 2015, which she attributed to carpal 

tunnel syndrome. She noted that duties of her federal employment included repetitive twisting and 

turning of her wrists and hands when sorting and delivering mail, carrying trays, and steering her 

mail truck. Appellant explained that she had performed these duties for 40 or more hours per 

week, for 17 years.

In a report dated May 19, 2015, Dr. Craig Rodner, a Board-certified orthopedic hand 

surgeon, followed up with appellant subsequent to electrodiagnostic testing, which demonstrated 

bilateral moderate median neuropathy of the wrists. On physical examination of the hands and 

wrists, he observed a positive Phalen’s test and full strength of the adductor pollicis brevis muscle. 

Dr. Rodner diagnosed carpal tunnel syndrome and discussed surgical options with appellant, 

which she deferred.

On February 4, 2016 Dr. Rodner examined appellant for bilateral carpal tunnel syndrome. 

Appellant associated her symptoms with duties of her federal employment for 14 years, noting that 

she had symptoms for the last 3 years. Dr. Rodner observed the same results on physical 

examination as in his report of May 19, 2015. He diagnosed bilateral carpal tunnel syndrome and 

recommended the use of splints.

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

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

needed, including a report containing a medical diagnosis and a comprehensive narrative report 

from a qualified physician explaining how factors of her federal employment caused, contributed 

to, or aggravated a diagnosed condition. OWCP afforded appellant 30 days to respond and submit 

additional evidence.

Appellant submitted a September 26, 2017 report by Antigona Ajro, an advanced practice 

registered nurse, for assessment of complaints of left shoulder pain. In a report dated October 6, 

2017, the nurse noted conditions including carpal tunnel syndrome and left shoulder pain.

By decision dated July 26, 2019, OWCP denied appellant’s occupational disease claim 

finding that the evidence of record was insufficient to establish that her diagnosed condition was 

causally related to the accepted factors of her federal employment.
3

On January 16, 2020 appellant, through counsel, requested reconsideration.

In support of the reconsideration requested counsel submitted an October 14, 2019 report

by Dr. Douglas C. Wisch, a Board-certified orthopedic hand surgeon, noted that he had examined 

appellant for complaints of a flare-up of her bilateral wrist condition. He reviewed the results of 

an electromyogram/nerve conduction velocity (EMG/NCV) study dated September 16, 2019, 

which demonstrated mild carpal tunnel syndrome. Physical examination of the right upper 

extremity demonstrated positive Tinel’s and Phalen’s tests and a mildly positive flexion test of the 

cubital tunnel, while examination of the left upper extremity demonstrated positive Tinel’s and 

Phalen’s tests with a positive flexion test of the cubital tunnel. Dr. Wisch diagnosed bilateral 

cubital tunnel syndrome and bilateral carpal tunnel syndrome. He noted that appellant was 

currently working under restrictions due to a left shoulder surgery. Dr. Wisch recommended use 

of splints.

In the letter dated January 2, 2020, Dr. Wisch opined that appellant’s current symptoms of 

numbness and tingling were consistent with carpal tunnel syndrome and cubital tunnel syndrome 

and that these conditions were related to her work as a mail handler. He explained that her 

diagnosed conditions were related to her job, as she had been a mail handler for 17 years, which 

involved significant repetitive elbow and wrist motion in sorting mail and other duties of the 

position.

By decision dated February 10, 2020, OWCP denied modification of its July 26, 2019 

decision.

LEGAL PRECEDENT

An employee seeking benefits under FECA3 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.4 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 

 

3 Supra note 2.

4 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).
4

compensation is claimed; and (3) medical evidence establishing that the diagnosed condition is 

causally related to the identified employment factors.5

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.6 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.7

ANALYSIS

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

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

On May 19, 2015 and February 4, 2016 Dr. Rodner examined appellant and diagnosed 

carpal tunnel syndrome. In an October 14, 2019 report, Dr. Wisch reviewed the results of an 

EMG/NCV study dated September 16, 2019, which demonstrated mild carpal tunnel syndrome. 

Dr. Wisch diagnosed bilateral cubital tunnel syndrome and bilateral carpal tunnel syndrome. 

These reports addressed her claimed bilateral carpal tunnel syndrome, but did not offer a medical 

opinion addressing whether the diagnosed conditions were causally related to the accepted 

employment factors. Medical evidence that does not offer an opinion regarding the cause of an 

employee’s condition is of no probative value on the issue of causal relationship.8 These reports 

of Dr. Rodner and Dr. Wisch are therefore insufficient to establish appellant’s claim.

In support of her claim, appellant also submitted a letter from Dr. Wisch dated 

January 2, 2020. Dr. Wisch opined that her symptoms of numbness and tingling were consistent 

with carpal tunnel syndrome and cubital tunnel syndrome and that these conditions were related 

to her work as a mail handler. He explained within a reasonable degree of medical certainty that 

appellant’s diagnosed conditions were related to her job, as she had been a mail handler for 17

years, which involved significant repetitive elbow and wrist motion in sorting mail and other duties 

of the position. While Dr. Wisch supported causal relationship, he did not provide medical 

rationale explaining how her work duties caused her claimed condition. Without explaining how, 

physiologically, the specific movements involved in appellant’s job caused, contributed to, or 

 

5 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).

6

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

238 (1996).

7 D.J., Docket No. 19-1301 (issued January 29, 2020).

8 A.P., Docket No. 18-1690 (issued December 12, 2019); L.B., Docket No. 18-0533 (issued August 27, 2018); D.K., 

Docket No. 17-1549 (issued July 6, 2018).
5

aggravated the specific diagnosed conditions, his opinion is of limited probative value and 

insufficient to establish the claim.

9

Appellant also submitted reports signed by Ms. Ajro, a nurse practitioner, dated 

September 26 and December 6, 2017. The Board has held that medical reports signed solely by a 

nurse practitioner are of no probative value, as nurse practitioners are not considered physicians

as defined under FECA and therefore are not competent to provide a medical opinion.10 Thus, 

these reports are of no probative value and are insufficient to establish appellant’s claim.

As the record lacks rationalized medical evidence establishing causal relationship between 

appellant’s claimed carpal tunnel syndrome and the accepted factors of her federal employment, 

the Board finds that appellant has not met her burden of proof to establish her 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.

CONCLUSION

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

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

 

9 See T.F., Docket No. 20-0260 (issued June 12, 2020); D.J., Docket No. 18-0694 (issued March 16, 2020); K.G., 

Docket No. 18-1598 (issued January 7, 2020); K.O., Docket No. 18-1422 (issued March 19, 2019).

10 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). See also C.C.

Docket No. 20-0950 (issued October 29, 2020) (nurse practitioners are not considered physicians under FECA).
6

ORDER

IT IS HEREBY ORDERED THAT the February 10, 2020 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: December 1, 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