United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

C.C., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Urbana, IL, Employer

__________________________________________

)

)

)

)

)

)

)

)

Docket No. 19-1631

Issued: February 12, 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

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On July 29, 2019 appellant, through counsel, filed a timely appeal from a May 16, 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 that her bilateral 

hand/thumb condition is causally related to the accepted factors of her federal employment.

FACTUAL HISTORY

On March 14, 2017 appellant, then a 52-year-old carrier technician, filed an occupational 

disease claim (Form CA-2) for a bilateral hand/thumb condition that allegedly arose while in the 

performance of duty. She reported that repetitive motion of casing mail, carrying, grasping 

bundles of mail, and thumbing through each delivery caused pain. Appellant first became aware 

of her hand condition and first realized it was related to factors of her federal employment on 

February 12, 2017. She did not stop work.

In an April 4, 2017 attending physician’s report (Form CA-20), Dr. Scott Paluska, Boardcertified in family medicine and sports medicine, diagnosed osteoarthritis of first carpometacarpal

(CMC) joint, bilaterally. He noted that x-rays revealed severe CMC joint arthritis. Dr. Paluska 

attributed appellant’s condition to continuous use of her hands at work. He further noted that 

appellant could resume work as of March 9, 2017. In an April 4, 2017 duty status report (Form 

CA-17), Dr. Paluska similarly noted that appellant could return to work as of March 9, 2017 

without restrictions.

In a development letter dated May 12, 2017, OWCP advised appellant of the deficiencies 

in her claim. It requested that she submit a comprehensive narrative medical report containing a 

detailed description of findings and diagnoses, explaining how accepted work-related factors had 

caused or aggravated her medical condition. OWCP also provided a factual questionnaire for her 

completion regarding how she experienced her condition. It afforded appellant 30 days to respond. 

In response appellant submitted a handwritten narrative statement, dated May 18, 2017, 

detailing the development of her condition over the two-year period, her pain progressing with 

working to the point of hurting all the time. She stated that she had worked 8 to 10 hours each day 

for five to six days a week, casing and delivering mail.

By decision dated June 14, 2017, OWCP denied appellant’s claim, finding that she had not 

submitted sufficient medical evidence to establish causal relationship between the accepted workrelated factors and her medical condition. It concluded, therefore, that the requirements had not 

been met to establish an injury or condition causally related to the accepted factors of appellant’s 

employment.

Following the June 14, 2017 decision, OWCP received additional evidence including a 

March 9, 2017 x-ray report and April 20, 2017 progress notes from Dr. Paluska. The March 9, 

2017 x-ray revealed no evidence of recent fracture or dislocation and severe arthritis at the first 

CMC joint bilaterally. In progress notes dated April 20, 2017, Dr. Paluska listed arthritis as 

appellant’s past medical history. He indicated that appellant’s pain was onset in the past years. 

Dr. Paluska noted that he examined both hands and wrists of appellant for recheck after performing 

bilateral basilar joint injections on appellant at an earlier appointment on March 9, 2017. He 

observed mild prominence and mild basilar joint swelling. Dr. Paluska performed load and grind 
3

test and observed mildly positive result. He again diagnosed bilateral osteoarthritis of first CMC 

joint, noting that appellant had “moderate[-]to[-]severe degenerative changes which [were] likely 

exacerbated from her continuous use of her hands at work.” Dr. Paluska opined that appellant’s 

degenerative changes may cause long-term disability and dysfunction. He recommended thumb 

stabilizer splints and oral anti-inflammatories. 

On August 28, 2017 appellant requested reconsideration. In progress notes dated 

August 17, 2017, Dr. Paluska again diagnosed primary osteoarthritis of both first CMC joint and 

noted pain in both wrists. He related that appellant worked more than 20 years, spending several 

hours a day casing mail and then delivering mail for several hours, which included letters, 

packages, and bundles that might have been heavy. Dr. Paluska opined that appellant’s 

employment clearly contributed significantly to the onset of her present degenerative changes, 

which likely would persist.

By decision dated November 21, 2017, OWCP denied modification of its June 14, 2017 

decision.

On February 26, 2018 appellant again requested reconsideration. In accompanying 

statements, she discussed her workplace duties. Appellant further explained that she worked as a 

carrier technician since February 1996. Each day she repeatedly picked up and held a handful of 

letters, flats, and other large packages, in a bundle with her left hand while casing them. After she 

finished casing, appellant put the mail into trays for delivery. She also loaded all the letters and 

flats into her delivery vehicle. Appellant noted that she often held letters and flats in her left hand 

while her right hand did actual mail delivery. The delivery sequence was repeated for the duration 

of her workday until she finished her route. Appellant alleged that she continuously used her hands 

from the start of her workday until the end of it. She had been doing that more than 22 years. 

Appellant had also submitted photographs of her workstation, showing various stages of 

her workplace duties. The photographs documented casing letters, casing flats, filling trays, 

loading her vehicle, and delivering mail. Appellant also provided a February 19, 2018 letter from

Dr. Paluska who noted that he had reviewed appellant’s workplace photographs, as well as her 

description of her employment duties. He opined that appellant’s bilateral osteoarthritis of first 

CMC joint was aggravated and accelerated by continual repetitive motions and stretching of the 

hands and thumbs over the years working as a carrier technician. 

By decision dated May 16, 2018, OWCP denied modification of the November 21, 2017 

decision. 

On October 4, 2018 appellant, through counsel, again requested reconsideration. 

In an August 31, 2018 letter, Dr. Paluska explained that he was writing in response to a 

request for further information concerning appellant’s three clinical encounters starting 

March 9, 2017. He noted that appellant was first seen on March 9, 2017 for complaints of right 

and left-sided thumb and hand pain. Dr. Paluska opined that she had moderate-to-severe 

degenerative changes, which were likely exacerbated from continuous use of her hands at work. 

Dr. Paluska noted a slight improvement in appellant’s condition during an April 20, 2017 

appointment, where she used a brace on the left hand and thumb. His diagnosis did not change 
4

despite observing significantly less tenderness over the basilar joints upon examination of the 

hands. Dr. Paluska further noted that appellant deferred surgery for time being. He related that 

he had told her during this appointment that her conditions were likely contributing and 

aggravating her symptoms and recommended that she modify her daily activities.

Dr. Paluska indicated that by the third and final appointment on August 17, 2017, appellant 

had some recurrent symptoms and had been using braces on the left hand and anti-inflammatories 

as needed. He noted that the examination on her hands again demonstrated prominence and 

tenderness over basilar joints bilaterally, and that her range of motion was limited. Dr. Paluska

also observed weakness of intrinsic muscles. He opined that appellant’s more than two decades 

of work as a carrier technician, with several hours a day casing mail and delivering letters, 

packages, and heavy bundles for several hours a day, likely contributed and significantly 

aggravated her symptoms.

In closing his August 31, 2018 letter, Dr. Paluska again opined, to a reasonable degree of 

medical certainty, that appellant’s pain and disability were related to permanent degenerative 

changes, which were clearly related to excessive repetitive use of her hands and fingers for which 

her work was a strong contributing factor.

By decision dated May 16, 2019, OWCP denied modification of the May 16, 2018 

decision, finding that the medical evidence failed to establish that appellant’s bilateral hand/thumb 

condition was causally related to the accepted employment factors. 

LEGAL PRECEDENT

An employee seeking benefits under FECA3has 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,4that 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.6

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

Id.

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

153 (1989). 

5

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

ECAB 312 (1988).

6 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).
5

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

causally related to the employment factors identified by the claimant.7 

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

relationship is rationalized medical opinion evidence.8 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.9

In any case where a preexisting condition involving the same part of the body is present 

and the issue of causal relationship therefore involves aggravation, acceleration, or precipitation, 

the physician must provide a rationalized medical opinion that differentiates between the effects 

of the work-related injury or disease and the preexisting condition.10

ANALYSIS

The Board finds the case not in posture for decision.

Proceedings under FECA are not adversarial in nature and OWCP is not a disinterested 

arbiter. The claimant has the burden of proof to establish entitlement to compensation; however, 

OWCP shares responsibility in the development of the evidence to see that justice is done.11

In an August 31, 2018 letter, Dr. Paluska related that appellant’s diagnosed condition was 

due to permanent degenerative changes, including loss of cartilage at the basilar joints of the 

bilateral hands with the wrist and hand bones transition. He opined to a reasonable degree of 

medical certainty that, while appellant’s work did not cause all of her present symptoms, her

excessive repetitive use of her hands and fingers as a carrier technician over two decades was a 

strong contributing cause to her permanent degenerative changes. The Board finds that, although

Dr. Paluska’s August 31, 2018 report is not sufficiently rationalized to meet appellant’s burden of 

proof to establish her claim, it is sufficient to require further development of the case by OWCP. 

It is unnecessary that the evidence of record in a case be so conclusive as to suggest causal 

connection beyond all possible doubt. Rather, the evidence required is only that which is necessary 

to convince the adjudicator that the conclusion drawn is rational, sound, and logical.12 

 

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

8 A.M., Docket No. 18-1748 (issued April 24, 2019); T.H., 59 ECAB 388, 393 (2008); Robert G. Morris, 48 ECAB 

238 (1996).

9 M.V., Docket No. 18-0884 (issued December 28, 2018); I.J., 59 ECAB 408 (2008); Victor J. Woodhams, 41 ECAB 

345, 352 (1989).

10 Federal (FECA) Procedure Manual, Part 2 -- Claims, Causal Relationship, Chapter 2.805.3e (January 2013);

N.C., Docket No. 19-1191 (issued December 19, 2019); Docket No. 18-1551 (issued March 1, 2019).

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

29 ECAB 820 (1978).

12 S.M., Docket No. 18-1195 (issued January 6, 2020); W.M., Docket No. 17-1244 (issued November 7, 2017);

E.M., Docket No. 11-1106 (issued December 28, 2011).
6

Dr. Paluska’s August 31, 2018 letter demonstrated a series of his medical observations that led to 

his conclusion on the causal relationship between appellant’s diagnosed condition and her accepted 

factors of employment. While not sufficiently rationalized, his conclusion is rational, sound, and 

logical based on the evidence submitted to OWCP, particularly given over 20 years of appellant’s 

working as a carrier technician which predominately required continual excessive use of her hands. 

Therefore, the Board finds that the case must be remanded to OWCP.

On remand, OWCP shall prepare a statement of accepted facts concerning appellant’s 

employment factors and refer the matter to an appropriate medical specialist to determine whether 

appellant’s accepted employment factors either caused or contributed to her bilateral hand/thumb 

condition. The appropriate medical specialist shall also consider the differences, if any, between 

the effects of appellant’s diagnosed condition and her preexisting condition.13 After this and other 

such further development deemed necessary, OWCP shall issue a de novo decision.

CONCLUSION

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

ORDER

IT IS HEREBY ORDERED THAT the May 16, 2019 decision of the Office of Workers’

Compensation Programs is set aside, and the case is remanded for further action consistent with 

this decision. 

Issued: February 12, 2020

Washington, DC

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board

 

13 See supra note 10.