United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

D.W., Appellant

and

DEPARTMENT OF VETERANS AFFAIRS, 

VETERANS HEALTH ADMINISTRATION, 

Columbia, SC, Employer

__________________________________________

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Docket No. 18-0876

Issued: March 10, 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

JANICE B. ASKIN, Judge

PATRICIA H. FITZGERALD, Alternate Judge

JURISDICTION

On March 9, 2018 appellant filed a timely appeal from a February 1, 2018 merit decision 

and a February 22, 2018 nonmerit decision of the Office of Workers’ Compensation Programs 

(OWCP). Pursuant to the Federal Employees’ Compensation Act1(FECA) and 20 C.F.R. 

§§ 501.2(c) and 501.3, the Board has jurisdiction over the merits of this case.2

ISSUES

The issues are: (1) whether appellant has met her burden of proof to establish right carpal 

tunnel syndrome and acquired trigger finger of the right thumb causally related to the accepted 

 

1 5 U.S.C. § 8101 et seq. 

2 The Board notes that, following the February 22, 2018 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

factors of her federal employment; and (2) whether OWCP properly denied appellant’s request for 

reconsideration of the merits of her claim pursuant to 5 U.S.C. § 8128(a).

FACTUAL HISTORY

On December 13, 2017 appellant, then a 51-year-old pharmacy technician, filed an 

occupational disease claim (Form CA-2) alleging that she sustained bilateral carpal tunnel 

syndrome and acquired trigger finger of the right thumb due to factors of her federal employment, 

including performing the physical demands required or associated with her employment. She

indicated that she first became aware of her condition and first realized it was caused or aggravated 

by her federal employment on June 16, 2017. Appellant stopped work on August 23, 2017 and 

returned to work on November 13, 2017.

In a December 18, 2017 development letter, OWCP advised appellant of the deficiencies 

of her claim. It requested that she submit additional factual and medical evidence and provided a 

questionnaire for her completion. OWCP afforded appellant 30 days to submit the necessary

evidence.

In response, appellant submitted a position description, a written confirmation of request 

for accommodation dated December 27, 2017, and an “Employee Limitations on Reassignment 

Options” form dated January 16, 2018 requesting a different type of position for which she was 

qualified.

Appellant also submitted occupational therapy reports in support of her claims dated 

October 2, 6, 13, 16, 20, and 31 and November 9 and 10, 2017.

In a July 12, 2017 report, Dr. Michael Ugino, a Board-certified orthopedic surgeon, 

diagnosed acquired trigger finger of the right thumb and left hand pain. He obtained a history of 

appellant experiencing triggering of the right thumb as well as bilateral hand numbness and 

tingling over the prior few months. Dr. Ugino indicated that her hands showed no arthritic changes 

to the carpometacarpal (CMC), metacarpophalangeal (MCP), and interphalangeal (IP) joints. 

Appellant otherwise had full range of motion (ROM) of the IP joints and there was no thenar 

eminence atrophy. Tinel’s testing was positive over the carpal canals and Phalen’s testing was 

positive after 30 seconds of volar flexion of the wrists. Sensibility testing showed diminished 

sensation in the median nerve distribution of the hands. Vascular Allen’s testing was normal. 

There was triggering over the A1 pulley of the right thumb.

An August 3, 2017 electromyography and nerve conduction velocity (EMG/NCV) study 

revealed mild-moderate bilateral median neuropathy at the wrist consistent with carpal tunnel 

syndrome.

In an August 7, 2017 report, Dr. Ugino reviewed the results of electrodiagnostic testing. 

He diagnosed right carpal tunnel syndrome and recommended a right carpal tunnel release.

On August 24, 2017 Dr. Ugino performed a right carpal tunnel release and a right trigger 

thumb release.
3

In work excuse notes dated September 1 and 15 and October 6 and 20, 2017, Dr. Ugino 

advised that appellant was not capable of returning to work.

On September 15, 2017 Dr. Ugino saw appellant for a follow-up evaluation and noted that 

she was approximately three weeks postsurgery. He confirmed his diagnosis of right carpal tunnel 

syndrome and found that the incision site was well healed.

In an October 6, 2017 report, Dr. Ugino noted the diagnoses previously made and indicated 

that appellant was undergoing occupational therapy.

On October 20, 2017 Dr. Ugino indicated that appellant still had numbness in all her 

fingers that went up her arm to her neck and reported a lot of pain in her thumb, especially in her 

thumb web space.

In a November 10, 2017 report, Dr. Ugino again diagnosed right carpal tunnel syndrome 

and right trigger thumb and found that appellant could resume limited-duty employment on 

November 13, 2017.

In work excuse notes dated November 10 and December 8, 2017 and January 8, 2018,

Dr. Ugino released appellant to return to work with restrictions.

By decision dated February 1, 2018, OWCP denied appellant’s occupational disease claim 

finding that the medical evidence of record failed to establish a causal relationship between her 

right carpal tunnel syndrome and acquired trigger finger of the right thumb and the accepted factors 

of her federal employment.

On February 15, 2018 appellant requested reconsideration and resubmitted a position 

description, as well as the August 3, 2017 EMG/NCV studies. She also submitted an undated, 

unsigned “Employee Limitations on Reassignment Options” form.

Appellant further submitted a January 11, 2018 e-mail message indicating that her work 

restrictions could not be accommodated by the employing establishment and an October 20, 2013 

notification of personnel action (SF-50) indicating that she had received a promotion.

In a February 7, 2018 report, Dr. Ugino discussed appellant’s complaints of pain in the 

hands bilaterally and trigger finger of the right thumb, and noted that she related that her condition 

was aggravated by excessive repetitive pulling, pushing, and twisting at work, working in awkward 

or stationary positions for extended hours, and extreme temperatures. He noted that appellant had 

worked in her current position for nine years and attributed her bilateral hand pain to the physical 

requirements of her position. Dr. Ugino diagnosed mild-moderate right carpal tunnel syndrome 

and mild left carpal tunnel syndrome. He opined that appellant had developed bilateral carpal 

tunnel syndrome with right trigger thumb due to her employment duties as an oncology pharmacy 

technician. Dr. Ugino explained that appellant was exposed to risk factors likely to result in carpal 

tunnel syndrome, including repetitive movements, awkward positioning, remaining stationary for 

extended periods, compression from grasping, and working in cold temperatures. He related, 

“These risk factors, either alone or in combination, can subject workers’ shoulders, arms, hands, 

wrists, backs, and legs to thousands of repetitive twisting, forceful, or flexing motions during a 

typical workday.”
4

By decision dated February 22, 2018, OWCP denied appellant’s request for 

reconsideration of the merits of her claim under 5 U.S.C. § 8128(a).

LEGAL PRECEDENT -- ISSUE 1

A claimant seeking benefits under FECA3 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 filed within the applicable time limitation period 

of FECA,4that an injury 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.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, an employee must submit the following: (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 employee.7

Causal relationship is a medical question, which requires rationalized medical opinion 

evidence to resolve the issue.8 A physician’s opinion on whether there is a causal relationship 

between the diagnosed condition and the implicated employment factors must be based on a 

complete factual and medical background.9 Additionally, the physician’s opinion must be 

expressed in terms of a reasonable degree of medical certainty and must be supported by medical 

rationale, explaining the nature of the relationship between the diagnosed condition and appellant’s 

specific employment factors.10

 

3 Supra note 1.

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).

7 See L.C., Docket No. 19-1301 (issued January 29, 2020); D.R., Docket No. 09-1723 (issued May 20, 2010). See 

also Roy L. Humphrey, 57 ECAB 238, 241 (2005); Ruby I. Fish, 46 ECAB 276, 279 (1994); Victor J. Woodhams, 41 

ECAB 345 (1989).

8 See A.L., Docket No. 19-1122 (issued January 7, 2020); Robert G. Morris, 48 ECAB 238 (1996). 

9 M.V., Docket No. 18-0884 (issued December 28, 2018); Victor J. Woodhams, supra note 7.

10 Id.
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ANALYSIS -- ISSUE 1

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

tunnel syndrome and acquired trigger finger of the right thumb causally related to the accepted 

factors of her federal employment.

In support of her claim, appellant submitted reports dated July 12, 2017 to January 8, 2018 

from Dr. Ugino. In these reports, however, Dr. Ugino failed to address the cause of the diagnosed 

conditions. The Board has held that medical evidence that does not offer an opinion regarding the 

cause of an employee’s condition is of no probative value and insufficient to establish the claim.

11

The August 3, 2017 EMG/NCV studies of record revealed mild-moderate bilateral median 

neuropathy at the wrist, as seen in carpal tunnel syndrome. The Board has held, however, that 

diagnostic studies lack probative value on the issue of causal relationship as they do not provide 

an opinion as to whether the accepted employment factors caused appellant’s diagnosed 

condition.12

Appellant also submitted occupational therapy reports dated October 2 through 

November 10, 2017 in support of her claim. These documents do not constitute competent medical 

evidence because an occupational therapist is not considered a “physician” as defined under 

FECA. Consequently, their medical findings and/or opinions will not suffice for purposes of 

establishing entitlement to compensation benefits.13

As appellant has not submitted rationalized medical evidence sufficient to establish a 

medical condition causally related to the accepted factors of her federal employment, the Board 

finds that she has not met her burden of proof to establish her claim.

LEGAL PRECEDENT -- ISSUE 2

Section 8128(a) of FECA does not entitle a claimant to review of an OWCP decision as a 

matter of right.14 OWCP has discretionary authority in this regard and has imposed certain 

 

11 A.P., Docket No. 18-1690 (issued December 12, 2019).

12 L.C., Docket No. 19-1301 (issued January 29, 2020).

13 See 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); 5 U.S.C. § 8101(2) (this 

subsection defines a physician as surgeons, podiatrists, dentists, clinical psychologists, optometrists, chiropractors, 

and osteopathic practitioners within the scope of their practice as defined by state law).

14 This section provides in pertinent part: “[t]he Secretary of Labor may review an award for or against payment 

of compensation at any time on his own motion or on application.” 5 U.S.C. § 8128(a).
6

limitations in exercising its authority.15 One such limitation is that the request for reconsideration 

must be received by OWCP within one year of the date of the decision for which review is sought.16 

A timely request for reconsideration, including all supporting documents, must set forth 

arguments and contain evidence that either: (i) shows that OWCP erroneously applied or 

interpreted a specific point of law; (ii) advances a relevant legal argument not previously 

considered by OWCP; or (iii) constitutes relevant and pertinent new evidence not previously 

considered by OWCP.17 When a timely request for reconsideration does not meet at least one of 

the above-noted requirements, OWCP will deny the request for reconsideration without reopening

the case for a review on the merits.18

ANALYSIS -- ISSUE 2

The Board finds that OWCP improperly denied appellant’s request for reconsideration of 

the merits of her claim pursuant to 5 U.S.C. § 8128(a).

On reconsideration appellant submitted a February 7, 2018 report wherein Dr. Ugino 

discussed appellant’s complaints of pain in the hands bilaterally and trigger finger of the right 

thumb. He noted that appellant related that her condition was aggravated by excessive repetitive 

pulling, pushing, and twisting at work, working in awkward or stationary positions for extended 

hours, and extreme temperatures. Dr. Ugino discussed appellant’s work history and diagnosed 

mild-moderate right carpal tunnel syndrome and mild left carpal tunnel syndrome. He opined that 

appellant had developed bilateral carpal tunnel syndrome with right trigger thumb due to her 

employment duties as an oncology pharmacy technician. Dr. Ugino explained that appellant was 

exposed to risk factors likely to result in carpal tunnel syndrome, including repetitive movements, 

awkward positioning, remaining stationary for extended periods, compression from grasping, and 

working in cold temperatures. He concluded that “These risk factors, either alone or in 

combination, can subject workers’ shoulders, arms, hands, wrists, backs, and legs to thousands of 

repetitive twisting, forceful, or flexing motions during a typical workday.”

Dr. Ugino’s February 7, 2018 report directly addressed the basis upon which OWCP denied 

appellant’s claim as it provided additional explanation as to the cause of the diagnosed conditions 

and discussed the relationship to appellant’s federal employment.19 The Board, thus, finds that 

OWCP improperly refused to reopen appellant’s case for further review of the merits, as the 

evidence she submitted, in support of her reconsideration request, is relevant and pertinent new 

 

15 20 C.F.R. § 10.607.

16 Id. at § 10.607(a). For merit decisions issued on or after August 29, 2011, a request for reconsideration must be 

“received” by OWCP within one year of OWCP’s decision for which review is sought. Federal (FECA) Procedure 

Manual, Part 2 -- Claims, Reconsiderations, Chapter 2.1602.4 (February 2016). Timeliness is determined by the 

document receipt date of the request for reconsideration as indicated by the “received date” in the Integrated Federal 

Employees’ Compensation System (iFECS). Id. at Chapter 2.1602.4b.

17 20 C.F.R. § 10.606(b)(3); P.M., Docket No. 19-1253 (issued January 23, 2020).

18 Id. at § 10.608(a), (b).

19 M.C., Docket No. 17-1983 (issued August 17, 2018).
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evidence not previously considered.20 Reopening a claim for merit review does not require a 

claimant to submit all evidence that may be necessary to discharge his or her burden of proof.21

As appellant has submitted relevant and pertinent new evidence not previously considered 

by OWCP, she is entitled to a review of the merits of her claim under section 10.606(b)(3) of 

OWCP’s regulations.22 The case will be remanded to OWCP to conduct a merit review of the 

claim. Following this and such other development as deemed necessary, it shall issue an 

appropriate merit decision.

CONCLUSION

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

tunnel syndrome and acquired trigger finger of the right thumb causally related to the accepted 

factors of her federal employment. The Board further finds that OWCP improperly denied 

appellant’s request for reconsideration of the merits of her claim.

 

20 20 C.F.R. § 10.606(b)(3); P.M., Docket No. 19-1253 (issued January 23, 2020).

21 R.T., Docket No. 18-1263 (issued February 7, 2019); K.S., Docket No. 18-1022 (issued October 24, 2018).

22 Id.
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ORDER

IT IS HEREBY ORDERED THAT the February 1, 2018 decision of the Office of 

Workers’ Compensation Programs is affirmed and the February 22, 2018 decision is set aside and 

the case is remanded to OWCP for further proceedings consistent with this decision of the Board.

Issued: March 10, 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