United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

E.W., Appellant

and

DEPARTMENT OF VETERANS AFFAIRS, 

SAN FRANCISCO VA MEDICAL CENTER, 

San Francisco, CA, Employer

__________________________________________

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Docket No. 20-0760

Issued: January 11, 2021

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 February 20, 2020 appellant, through counsel, filed a timely appeal from a January 17, 

2020 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 a bilateral

wrist condition causally related to the accepted factors of her federal employment.

FACTUAL HISTORY

On June 24, 2019 appellant, then a 59-year-old social worker, filed a traumatic injury claim 

(Form CA-1) alleging that on March 22, 2019 she injured both of her hands and developed carpal 

tunnel syndrome while in the performance of duty. She explained that during the past two months 

her workload increased, which required that she perform more typing, which then caused

numbness and pain in both of her hands. Appellant related that her pain and numbness worsened

when typing or sleeping, and that she awakened with numbness in her left thumb. On the reverse 

side of the claim form, the employing establishment indicated that appellant was injured in the 

performance of duty, but it controverted continuation of pay (COP) because appellant had not 

provided medical documentation when she filed her claim. It noted that appellant had been fitted 

for bilateral hand splints to wear to work, and that she also wore them when sleeping.

In a development letter dated June 1, 2019, OWCP informed appellant of the deficiencies 

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

claim and attached a questionnaire for her completion. OWCP afforded appellant 30 days to 

submit the requested evidence.

In a development letter dated June 1, 2019, OWCP informed the employing establishment 

that if appellant was treated at an agency medical facility for the alleged injury it must provide 

treatment notes. It additionally stated that, although the evidence of record was insufficient to 

make a decision regarding appellant’s alleged injury, the employing establishment should provide 

appellant with COP for up to 45 days.

May 2, 2019 progress notes by Dr. Tarini Anand, Board-certified in internal medicine, 

indicated that appellant complained of bilateral wrist pain along the thumb side of her wrists and 

numbness in both thumbs, which had increased gradually for the past two to three months and 

which had begun in her left hand. Appellant had related that her symptoms were exacerbated by 

repetitive movements like typing at work and noted the numbness woke her at night. Her physical 

examination revealed positive Phalen’s test with reproducible symptoms in the medial nerve 

distribution in both hands. Dr. Anand opined that appellant likely had a ganglion cyst in her right 

wrist and possibly superimposed de Quervain’s tenosynovitis on her right side, and he diagnosed 

bilateral carpal tunnel syndrome.

Appellant submitted occupational therapy notes from May 15 to July 22, 2019, and a 

July 12, 2019 report by a physical therapist.

By decision dated August 12, 2019, OWCP denied appellant’ claim, finding that the

evidence of record was insufficient to establish fact of injury. 

On August 26, 2019 appellant, through counsel, requested an oral hearing before a

representative of OWCP’s Branch of Hearings and Review. 
3

A May 23, 2019 employee health report containing an illegible signature indicated that 

appellant presented with bilateral hand pain and pain and numbness in her thumbs, with the left 

worse than the right. It listed her date of injury as March 22, 2019 and indicated that her symptoms 

worsened with typing, driving, gripping, and were relieved upon using splints. Appellant denied 

experiencing a specific traumatic incident or work exposure and indicated that she did not engage 

in repetitive hand motions or strenuous hand activity at home. She stated that she began to 

experience her symptoms when her work load and the amount of typing she had to do increased. 

The report indicated that appellant also experienced neck stiffness, finger weakness, and chronic 

fatigue for the past three to four months which had worsened in the past two weeks. Appellant’s 

past medical history included sciatica and narrowing at L4 and L5 in the lumbar spine and lower 

back and bilateral knee arthritis. A physical examination revealed normal results and the report

related that this was a possible occupational injury and less likely to be cervical radiculopathy or 

hand osteoarthritis. 

A hearing was held on December 2, 2019. Appellant testified that at work she handwrote

notes while she was with patients and then typed them up and placed them in charts. She noted 

that she spent half of her day typing and that she had worked in the same job since 2007. Appellant 

indicated that her condition did not happen over just one shift and related that she started to notice 

her symptoms in March 2019. She noted that while she believed that her carpel tunnel was work 

related, no doctor had related that to her. Appellant confirmed that she would like her claim to be 

processed as an occupational disease claim.

A January 6, 2020 letter from Dr. Norman Banks, Board-certified in physical medicine and 

rehabilitation, indicated that appellant had a complex medical history with various conditions that 

caused pain and impacted daily functions. He opined that regarding appellant’s carpel tunnel 

syndrome, it was probable that her symptoms were directly related to her job, which required

repetitive keyboarding and various other desk-related responsibilities. Dr. Banks indicated that he 

had counseled appellant on various pain management strategies and that she did not have any 

surgeries or injections. 

By decision dated January 17, 2020, OWCP’s hearing representative converted appellant’s 

claim to a claim for occupational disease and found that appellant had established fact of injury, 

however, she affirmed the denial of appellant’s claim finding that the evidence of record was 

insufficient to establish that her diagnosed bilateral wrist conditions were causally related to the

accepted factors of federal employment.

LEGAL PRECEDENT

An employee seeking benefits under FECA 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,3that 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 

 

3 R.M., Docket No. 20-0342 (issued July 30, 2020); S.B., Docket No. 17-1779 (issued February 7, 2018); J.P., 59 

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

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.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 issue, and the medical evidence required to establish causal 

relationship is rationalized medical opinion evidence.7 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.8 

In a case in which 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.9

ANALYSIS

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

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

In support of her claim, appellant submitted May 2, 2019 progress notes by Dr. Anand who 

noted that appellant complained of bilateral wrist pain along the thumb side of the wrist and 

numbness in both thumbs, which she indicated had been worsening gradually for the past two to 

three months. Dr. Anand opined that appellant likely had a ganglion cyst in her right wrist and 

possibly superimposed de Quervain’s tenosynovitis on her right side and diagnosed bilateral carpal 

 

4 V.P., Docket No. 20-0415 (issued July 30, 2020); 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 S.A., Docket No. 20-0458 (issued July 23, 2020); 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 See B.H., Docket No. 18-1693 (issued July 20, 2020); S.C., Docket No. 18-1242 (issued March 13, 2019); Victor J. 

Woodhams, 41 ECAB 345, 352 (1989).

7 L.S., Docket No. 19-1769 (issued July 10, 2020); A.M., Docket No. 18-1748 (issued April 24, 2019); T.H., 59 

ECAB 388 (2008).

8 B.C., Docket No. 20-0221 (issued July 10, 2020); M.V., Docket No. 18-0884 (issued December 28, 2018); I.J., 59 

ECAB 408 (2008).

9 R.C., Docket No. 19-0376 (issued July 15, 2019); Federal (FECA) Procedure Manual, Part 2 -- Claims, Causal 

Relationship, Chapter 2.805.3e (January 2013)
5

tunnel syndrome. Dr. Anand did not offer an opinion regarding the cause of appellant’s diagnosed 

bilateral carpal tunnel syndrome. 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 This report, therefore, is insufficient to establish appellant’s claim. 

The May 23, 2019 employee health report contained an illegible signature and indicated 

that appellant presented with bilateral hand pain and pain and numbness in her thumbs, with the 

left worse than the right, noting it was a possible occupational injury. The Board has held, 

however, that reports that are unsigned or bear an illegible signature lack proper identification and 

cannot be considered probative medical evidence as the author cannot be identified as a 

physician.11 Therefore, this report is also insufficient to establish the claim. 

Dr. Banks’ January 26, 2020 letter indicated that appellant had a complex medical history 

with various conditions that caused pain and impacted daily functions. He opined that regarding 

appellant’s carpel tunnel syndrome, it was probable that her symptoms were directly related to her 

job, which required repetitive keyboarding and various other desk-related responsibilities. While

Dr. Banks opined that there was a direct causal relationship between her employment and her 

various conditions, he failed to provide medical rationale explaining how or why they were related.

The Board has held that a report is of limited probative value regarding causal relationship if it 

does not contain medical rationale explaining how a given medical condition was related to 

employment factors.12 Additionally, the Board has held that medical opinions that suggest that a 

condition was likely or possibly caused by work activities are speculative or equivocal in character 

and have limited probative value.13 Thus, Dr. Banks’ letter is insufficient to establish appellant’s 

claim. 

Appellant additionally submitted occupational and physical therapy notes. The Board has 

held that treatment notes signed by physical therapists and occupational therapists are not 

considered probative medical evidence as those providers are not considered physicians under 

FECA.14

 

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

11 M.A., Docket No. 19-1551 (issued April 30, 2020).

12 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).

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

14 Section 8101(2) of FECA provides that physician includes surgeons, podiatrists, dentists, clinical psychologists, 

optometrists, chiropractors, and osteopathic practitioners within the scope of their practice as defined by State law. 

5 U.S.C. § 8101(2). 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 C.D., Docket No. 

20-0858 (issued November 30, 2020); R.L., Docket No. 19-0440 (issued July 8, 2019) (physical therapists are not 

considered physicians under FECA; R.S., Docket No. 16-1303 (issued December 2, 2016) (occupational therapists are 

not considered physicians under FECA).
6

As appellant has not submitted rationalized medical evidence establishing a bilateral wrist 

condition causally related to 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 bilateral wrist 

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

ORDER

IT IS HEREBY ORDERED THAT the January 17, 2019 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: January 11, 2021

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