United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

A.N., Appellant

and

DEPARTMENT OF VETERANS AFFAIRS, 

MARTINSBURG VETERANS 

ADMINISTRATION MEDICAL CENTER, 

Martinsburg, WV, Employer

__________________________________________

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Docket No. 19-1928

Issued: May 8, 2020

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

CHRISTOPHER J. GODFREY, Deputy Chief Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On September 17, 2019 appellant, through counsel, filed a timely appeal from a June 27, 

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 medical conditions 

causally related to the accepted factors of her federal employment.

FACTUAL HISTORY

On November 6, 2018 appellant, then a 36-year-old medical instrument technologist, filed 

an occupational disease claim (Form CA-2) alleging that she developed right carpal tunnel 

syndrome and right ulnar neuropathy due to factors of her federal employment. In a supplemental 

statement, she asserted that her conditions were caused by work-related activities including the 

continued repetitive motions associated with imaging, scanning, and ultrasound diagnostics. 

Appellant noted that she first became aware of her conditions and realized that they were caused 

or aggravated by factors of her federal employment on June 1, 2018. She did not stop work.

In a November 14, 2018 development letter, OWCP informed appellant that the evidence 

of record was insufficient to establish her claim. It advised her of the type of factual and medical 

evidence needed and provided a questionnaire for her completion. In a separate letter of even date, 

OWCP notified the employing establishment of appellant’s occupational disease claim and 

requested additional information from a knowledgeable supervisor. It afforded both parties 30 

days to submit the necessary evidence.

In an undated narrative statement, appellant responded to OWCP’s development 

questionnaire. She indicated that she began experiencing right wrist pain while scanning in 

June 2018. Appellant noted that she visited her primary care physician who recommended that 

she try wearing a splint while scanning. She indicated that after two months of splint use, there 

was no relief in pain. Appellant stated that she was referred to an orthopedic specialist who ordered 

an electromyography (EMG). She reported that the EMG revealed right carpal tunnel syndrome 

and left ulnar neuropathy and that the orthopedic specialist recommended surgical release of right 

carpal tunnel. Appellant noted that she did not participate in exercise activities at home and that 

she had never had an injury to her hand, arm, or wrist before. She indicated that she experienced 

numbness, tingling, pain, and limited grip strength from repetitive use of both hands in the course 

of her federal employment. 

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

evidence of record was insufficient to establish specific employment factors that she believed 

contributed to her conditions. It noted that she only provided vague and general information 

without supporting evidence or specific examples. OWCP concluded, therefore, that the 

requirements had not been met to establish an injury as defined by FECA.

On April 1, 2019 appellant requested reconsideration. OWCP continued to receive 

evidence. 

Appellant submitted literature regarding work-related musculoskeletal disorders in 

sonography.
3

In a July 31, 2018 report, Dr. Jeffrey Kellogg, a Board-certified family practitioner, noted 

that appellant was experiencing pain along the radial and ulnar aspects of her wrist/distal forearm. 

He diagnosed a strain of the right wrist and hand and recommended that appellant wear a wrist 

splint and avoid painful activity.

In a September 21, 2018 medical note, Dr. Kellogg indicated that appellant was 

experiencing right wrist pain as a result of her work as an ultra-sonographer. He noted that there 

was no obvious swelling or redness of the right wrist and diagnosed a strain of the right wrist and 

hand.

In an October 9, 2018 report, Dr. John W. Buschman, an osteopath specializing in 

orthopedic surgery, related that appellant was experiencing right wrist pain with numbness into 

her middle, ring, and small fingers. He noted that as an ultrasound technician, appellant sometimes 

had her wrist flexed or extended. Dr. Buschman reviewed x-ray scans of appellant’s right wrist 

and diagnosed right ulnar neuropathy.

In an October 30, 2018 report, Dr. Buschman noted that as an ultrasound technician, 

appellant was constantly using her right hand to run ultrasound probes. He reviewed EMGs,

performed a physical examination, and diagnosed right carpal tunnel syndrome and left ulnar 

neuropathy. Dr. Buschman recommended surgical release of appellant’s right carpal tunnel.

In a March 25, 2019 letter, Dr. Kellogg noted that he was appellant’s primary care 

physician and that he had previously opined that her right wrist pain was “certainly related to her 

work as an ultra-sonographer.” He also opined that appellant’s carpal tunnel syndrome was “a 

direct result of her work as an ultra-sonographer” and should be “covered” as an employmentrelated injury.

In an undated narrative statement, appellant explained that she worked as a registered 

diagnostic medical sonographer which required her to hold a transducer in her right hand and type 

with her left hand. She noted that she performed scanning activities for 40 plus hours a week. 

Appellant indicated that, while performing ultrasounds, she used repetitive motions and forceful 

or awkward movements of many body parts including her hand and wrist. She reported that she 

sustained pressure on her wrist for long durations because her department was chronically 

understaffed. Appellant related that many of her patients were morbidly obese which required her 

to use excessive pressure, force, and strain on her wrist to acquire optimal imaging. She alleged 

that her carpal tunnel syndrome was a result of constant scanning which involved flexion and 

extension of her hand and wrist to manipulate the ultrasound transducer. Appellant also noted that 

she frequently pushed and pulled her ultrasound machine and transported patients in wheel chairs, 

stretchers, and hospital beds. She indicated that this required flexion and extension of her wrist. 

Appellant asserted that she sometimes scanned twice the number of patients than the recommended 

safe number. She clarified that she believed pushing, pulling, gripping, pinching, scanning, 

flexing, extending, transporting, and typing motions of her hand and wrist caused her conditions.

In an April 25, 2019 narrative statement, appellant noted that she did not engage in any 

other nonwork activities that would cause her to injure or overuse her wrist.
4

By decision dated June 27, 2019, OWCP modified the January 9, 2019 decision finding 

that she had established specific employment factors. However, it further found that the claim 

remained denied as the medical evidence of record was insufficient to establish conditions were

caused or aggravated by the accepted employment factors.

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 period 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 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 identified employment factors.7

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.8 The opinion of the physician must be based on a complete factual 

and medical background of the claimant, 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.9

 

3

Id.

4 R.S., Docket No. 19-1774 (issued April 3, 2020); J.P., 59 ECAB 178 (2007); Joe D. Cameron, 41 ECAB 

153 (1989).

5 C.F., Docket No. 19-1748 (issued March 27, 2020); R.C., 59 ECAB 427 (2008); James E. Chadden, Sr., 40 ECAB 

312 (1988).

6 20 C.F.R. § 10.115; E.S., Docket No. 18-1580 (issued January 23, 2020); L.M., Docket No. 13-1402 (issued 

February 7, 2014); Delores C. Ellyett, 41 ECAB 992 (1990).

7 See T.L., Docket No. 18-0778 (issued January 22, 2020); Roy L. Humphrey, 57 ECAB 238, 241 (2005); Victor J. 

Woodhams, 41 ECAB 345, 352 (1989).

8 P.L., Docket No. 19-1750 (issued March 26, 2020); Jacqueline M. Nixon-Steward, 52 ECAB 140 (2000).

9 A.M., Docket No. 18-0562 (issued January 23, 2020); Leslie C. Moore, 52 ECAB 132 (2000).
5

ANALYSIS

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

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

In reports dated July 31 and September 21, 2018, Dr. Kellogg diagnosed a strain of the 

right wrist and hand, but failed to provide an opinion as to whether the sprain was causally related 

to the accepted factors of appellant’s federal employment. 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 on the issue of causal relationship.10 Accordingly, these medical notes are 

insufficient to establish appellant’s claim.

In a March 25, 2019 letter, Dr. Kellogg opined that appellant’s right wrist pain and carpal 

tunnel syndrome were a direct result of her work as an ultra-sonographer. Although he supported 

causal relationship, he did not offer medical rationale explaining the basis of his conclusory 

opinion regarding the causal relationship between appellant’s right hand and wrist conditions and 

the factors of her federal employment.11 The Board has held that a mere conclusion without the 

necessary rationale as to whether a period of disability is due to an accepted employment condition 

is insufficient to meet a claimant’s burden of proof.12 As such, this letter is of limited probative 

value.

In medical reports dated October 9 and 30, 2018, Dr. Buschman indicated that appellant

worked as an ultrasound technician which required her to sometimes flex and extend her wrist and 

constantly use her right hand to run ultrasound probes. He diagnosed right ulnar neuropathy, right 

carpal tunnel syndrome, and left ulnar neuropathy, but did not provide medical rationale regarding 

causal relationship. As Dr. Buschman failed to explain how the accepted employment factors 

physiologically caused or contributed to the diagnosed conditions, his reports are of limited 

probative value.13

Appellant also submitted a number of excerpts from publications. The Board has held that 

medical texts and excerpts from publications are of no evidentiary value in establishing the causal 

relationship between a claimed condition and an employee’s federal employment as such materials 

are of general application and are not determinative of whether the specific condition claimed is 

related to the particular employment factors alleged by the employee.14 This material has probative 

value only to the extent that it is interpreted and cited by a physician rendering an opinion on the 

 

10 C.F., supra note 5; L.B., Docket No. 18-0533 (issued August 27, 2018); D.K., Docket No. 17-1549 (issued 

July 6, 2018).

11 P.L., supra note 8.

12 A.T., Docket No. 19-0410 (issued August 13, 2019); E.L., Docket No. 17-1632 (issued January 3, 2018). 

13 M.M., Docket No. 19-1580 (issued February 19, 2020); K.G., Docket No. 18-1598 (issued January 7, 2020); A.B., 

Docket No. 16-1163 (issued September 8, 2017).

14 L.C., Docket No. 17-1811 (issued March 23, 2018); N.B., Docket No. 14-1702 (issued December 29, 2014); S.A.,

Docket No. 13-1551 (issued December 17, 2013); Gloria J. McPherson, 51 ECAB 441 (2000).
6

causal relationship between a condition and specified employment injury.15 As these publications 

were not interpreted and cited by appellant’s physicians in offering a rationalized medical opinion 

as to how appellant’s specific employment factors caused her diagnosed conditions, these 

publications are insufficient to establish causal relationship. 

As appellant has not submitted rationalized medical evidence explaining the causal 

relationship between her diagnosed medical conditions and the accepted factors of her federal 

employment, the Board finds that she has not met her burden of proof.

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 a medical

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

ORDER

IT IS HEREBY ORDERED THAT the June 27, 2019 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: May 8, 2020

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Christopher J. Godfrey, Deputy Chief Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board

 

15 L.C., id.; C.S., Docket No. 12-1169 (issued November 5, 2012); Harlan L. Soeten, 38 ECAB 566, 567 (1987).