United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

E.W., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Cleveland, OH, Employer

__________________________________________

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Docket No. 19-1936

Issued: June 24, 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

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On September 20, 2019 appellant filed a timely appeal from an August 19, 2019 merit 

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.

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 February 13, 2019 appellant, then a 48-year-old mail handler, filed an occupational

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

factors of her federal employment, which included continuous and repetitive manual hand 

 

1 5 U.S.C. § 8101 et seq.
2

stamping of letters and mail. She noted that she first became aware of her claimed condition on 

February 7, 2019 and its relation to her federal employment on February 12, 2019. 

In February 12, 2019 emergency room notes, Dr. Joshua Burns, an emergency medicine 

specialist, noted that appellant presented with bilateral fingertip tingling and throbbing pain of the 

bilateral wrists that began five days prior. He indicated that she worked for the employing 

establishment and performed repetitive stamping duties, which she believed caused her condition. 

Dr. Burns examined appellant and found that she had intact and equal bilateral sensation across all 

dermatomes, no bilateral upper extremity skin abnormalities, no joint tenderness during 

palpitation, 5/5 strength across all joint levels, and a positive Phalen’s test, bilaterally. He

diagnosed bilateral carpal tunnel syndrome.

Dr. Burns noted, in a February 12, 2019 state workers’ compensation first report of an 

injury, that appellant engaged in hand stamping and canceling of letters on a belt and worked 

continuously with her fingers. He indicated that she experienced numbness on the left and right. 

In a February 12, 2019 state workers’ compensation physicians report of work ability, Dr. Burns 

noted that appellant had repetitive motion injury to both hands and released her to work on 

February 13, 2019 with restrictions.

Appellant, in a February 19, 2019 statement, described her repetitive duties utilizing a hand 

stamper.

In a development letter dated February 28, 2019, OWCP informed appellant that additional

factual and medical evidence was necessary to establish her claim. It advised her of the type of 

factual and medical evidence necessary and provided a questionnaire for her completion. OWCP 

afforded appellant 30 days to respond. 

In a March 12, 2019 progress note, Dr. Timothy Nice, a Board-certified orthopedic 

surgeon, noted that appellant had an acute onset of paresthesias in the index and middle finger and 

thumb of her right hand as well as the left nondominant hand. He noted that she worked as a hand 

stamper for two to four hours a day, four days a week, since 2013, that she was seen in the 

emergency room on February 12, 2019, and that she was told that she had bilateral carpal tunnel 

syndrome. Dr. Nice advised that “[w]e have never made that diagnosis in the past.” He opined 

that the type of work that appellant performed could cause carpal tunnel syndrome, in that she had 

a stamper and she stamped repetitively for two to four hours, four days a week. Dr. Nice found 

minimal changes in the thenar eminence of both hands, her light touch was intact, she did not have 

a positive Tinel’s, which he would have expected if she had acute carpal tunnel syndrome, and that 

it was “somewhat bizarre in presentation.” He indicated that he was unable to provide a diagnosis 

at that time. Dr. Nice advised that he did not object to appellant working and it was too early to 

proceed with electrical studies. He recommended that she continue to wear wrist splints at night

and use anti-inflammatories daily. Dr. Nice provided work restrictions on a duty status report 

(Form CA-17).

In a March 12, 2019 Form CA-17 report, Dr. Nice noted that his description of clinical 

findings was bilateral carpal tunnel syndrome, due to the use of both hands. He advised that 

appellant could return to work with restrictions. 
3

In a March 26, 2019 statement, appellant outlined her work duties and the development of 

her medical condition. She noted that she had worked in the position of a manual roller stamper 

for over three years. Appellant explained that she had to cancel thousands of pieces of mail by 

hand as parts for the manual roller were missing. She further explained that she had to manually 

push mail down the conveyor belt or place it in buckets to make room for her to work the mail on 

the belt. Appellant noted that some of the items were heavy to lift and over her 10-pound weight 

restriction. She indicated that the employing establishment was short staffed and there was no one 

to assist her. Appellant explained that she had no prior problems with her hands and her condition 

worsened with the repetitive and continuous hand stamping at work since 2013. She noted that 

she went to the emergency room on February 12, 2019 and was told that she had bilateral carpal 

tunnel syndrome. 

By decision dated April 9, 2019, OWCP denied appellant’s claim finding that the medical 

evidence was insufficient to establish causal relationship between the bilateral carpal tunnel 

syndrome and the accepted factors of federal employment.

On June 30, 2019 appellant requested reconsideration.

OWCP received a copy of Dr. Burn’s February 12, 2019 report and a copy of Dr. Nice’s 

March 12, 2019 report. 

In an April 23, 2019 addendum, Dr. Nice noted that appellant continued to have symptoms 

over the median nerve distribution, a bilateral positive Tinel’s, less reactive at the elbows, but 

suggestive on the left side. He indicated that appellant continued to work. Dr. Nice recommended 

electromyography and nerve conduction velocity (EMG/NCV) studies. 

Appellant’s June 24, 2019 EMG/NCV studies noted bilateral median neuropathies 

consistent with a clinical diagnosis of bilateral carpal tunnel syndrome. 

By decision dated August 19, 2019, OWCP denied modification of the April 9, 2019 

decision.

LEGAL PRECEDENT

A claimant seeking benefits under FECA2 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,3that 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 

 

2

Id.

3 G.H., Docket No. 19-0715 (issued March 19, 2010); S.B., Docket No. 17-1779 (issued February 7, 2018); J.P., 

59 ECAB 178 (2007); Joe D. Cameron, 41 ECAB 153 (1989).
4

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.5

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, which requires rationalized medical opinion 

evidence to resolve the issue.7 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.8 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.9

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.

In reports dated February 12, 2019, Dr. Burns noted appellant’s physical examination 

findings and her work duties which included hand stamping and canceling of letters on a conveyor 

belt and working continuously with her fingers. He indicated that she had repetitive motion injury 

to both hands and diagnosed bilateral carpal tunnel syndrome. Dr. Burns released appellant to 

work on February 13, 2019, with restrictions. The Board finds that, although Dr. Burns opined 

that she had sustained a repetitive motion injury, he did not provide medical rationale explaining 

the basis of his conclusory opinion. The Board has held that a medical report is of limited probative 

value on the issue of causal relationship if it contains a conclusion regarding causal relationship 

which is unsupported by medical rationale.10 Dr. Burns did not sufficiently explain the process by 

 

4

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

ECAB 312 (1988).

5 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).

6 L.C., Docket No. 19-1301 (issued January 29, 2020); Victor J. Woodhams, 41 ECAB 345, 352 (1989).

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

8 M.V., Docket No. 18-0884 (issued December 28, 2018); Victor J. Woodhams, supra note 6.

9

Id.

10 D.L., Docket No. 19-0900 (issued October 28, 2019); Y.D., Docket No. 16-1896 (issued February 10, 2017); 

C.M., Docket No. 14-0088 (issued April 18, 2014); T.M., Docket No. 08-0975 (issued February 6, 2009).
5

which performing repetitive hand movements would cause or aggravate the diagnosed 

conditions.11 His reports were therefore insufficient to establish appellant’s claim. 

In March 12, 2019 progress notes, Dr. Nice noted appellant’s duties at work and her 

emergency room diagnosis of bilateral carpal tunnel syndrome. He opined that the type of work 

that she does could cause carpal tunnel syndrome, in that she had a stamper and she stamped

repetitively for two to four hours, four days a week. While Dr. Nice opined that appellant’s work 

could cause carpal tunnel syndrome, the Board notes that his opinion on causation was speculative. 

While the opinion supporting causal relationship does not have to reduce the cause or etiology of 

a disease or a condition to an absolute certainty, the opinion must be one of reasonable medical 

certainty and not speculative or equivocal in character.12 As such, the Board finds that this report 

from Dr. Nice is of limited probative value.13

In a March 12, 2019 Form CA-17 report, Dr. Nice provided clinical findings of bilateral 

carpal tunnel syndrome, due to the use of both hands. However, he did not opine that appellant’s 

accepted factors of employment caused her diagnosed conditions. Medical evidence that does not 

offer an opinion regarding the cause of a diagnosed condition is of no probative value on the issue 

of causal relationship.

14

In an April 23, 2019 addendum, Dr. Nice merely noted that appellant had symptoms, but 

did not provide an opinion regarding causal relationship. This report was therefore insufficient to 

establish her claim.15

OWCP also received June 24, 2019 EMG/NCV studies. However, the Board has 

previously explained that diagnostic studies, standing alone, lack probative value on the issue of 

causal relationship, as they do not provide an opinion as to whether the accepted employment 

factors caused the diagnosed condition.

16

 As such, the June 24, 2010 diagnostic reports lack 

probative value and are insufficient to establish appellant’s claim.

As appellant has not submitted rationalized medical evidence to establish causal 

relationship between her bilateral carpal tunnel syndrome and the accepted factors of her federal 

employment, she has not met her burden of proof to establish her claim.17

 

11 J.W., Docket No. 18-0678 (issued March 3, 2020). 

12 See A.S., Docket No. 19-1955 (issued April 9, 2020); C.H., Docket No 19-0409 (issued August 5, 2019).

13 Id.

14 Id.

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

16 M.L., Docket No. 18-0153 (issued January 22, 2020).

17 Id.
6

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.

ORDER

IT IS HEREBY ORDERED THAT the August 19, 2019 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: June 24, 2020

Washington, DC

Christopher J. Godfrey, 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