United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

S.W., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Milwaukee, WI, Employer

__________________________________________

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Docket No. 21-1105

Issued: December 17, 2021

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

JANICE B. ASKIN, Judge

PATRICIA H. FITZGERALD, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On July 13, 2021 appellant, through counsel, filed a timely appeal from a March 29, 2021

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 right wrist

condition causally related to the accepted August 8, 2020 employment incident.

FACTUAL HISTORY

On August 24, 2020 appellant, then a 63-year-old postal distributor, filed a traumatic injury 

claim (Form CA-1) alleging that on August 8, 2020 she felt a lump and severe pain on her right 

wrist when cutting strapping while in the performance of duty. She did not stop work.

In an August 24, 2020 development letter, OWCP informed appellant that it had received 

no evidence in support of her claim. It advised her of the factual and medical evidence necessary 

to establish her claim and also provided a questionnaire for completion. OWCP afforded appellant 

30 days to respond. No response was received.

By decision dated October 7, 2020, OWCP accepted that the August 8, 2020 employment 

incident occurred, as alleged. However, it denied appellant’s traumatic injury claim, finding that 

she had not submitted evidence containing a medical diagnosis in connection with the injury and/or 

events. OWCP, therefore, concluded that the requirements had not been met for establishing an 

injury as defined by FECA.

OWCP thereafter received a September 3, 2020 medical note by Dr. David Siverhus, a 

Board-certified orthopedic surgeon with added qualifications in hand surgery, who noted that 

appellant related a history of numbness and tingling in her right hand and a lump over the palmar 

radial aspect of the right wrist, which she attributed to repetitive forceful gripping and grasping 

activities at work over an extended period of time. Dr. Siverhus obtained x-rays, which were 

normal, and, on physical examination, he documented positive Tinel’s sign and a visible palpable 

mass over the palmar radial aspect of the right wrist. He noted an impression of right hand 

numbness and tingling and a right volar wrist mass consistent with a ganglion cyst. Dr. Siverhus

recommended that appellant undergo an electromyography/nerve conduction velocity 

(EMG/NCV) study and opined that her ganglion cyst and probable carpal tunnel were either caused 

or aggravated by her activities at work. A report of x-rays of the right wrist of even date was 

negative.

In a September 22, 2020 report, Dr. John Roffers, a specialist in electrodiagnostic 

medicine, indicated that appellant related a progressive history of numbness, tingling and pain in 

the right hand and wrist. He performed an EMG/NCV, which was consistent with right carpal 

tunnel syndrome.

In a medical note dated September 28, 2020, Dr. Siverhusreviewed appellant’s EMG/NCV 

results and noted her ongoing complaints of numbness and tingling. He examined her and noted 

that the ganglion cyst was asymptomatic, but that she wished to proceed with median nerve 

decompression surgery of the right hand to treat her carpal tunnel syndrome.

A separate narrative report of even date, Dr. Siverhus indicated that he had evaluated 

appellant on September 3 and 28, 2020 for complaints of pain, numbness and tingling in the right 
3

hand and wrist and a visible palpable mass over the palmar radial aspect of the wrist, which she 

attributed to repetitive gripping and grasping at work. He diagnosed carpal tunnel syndrome and 

a volar wrist ganglion cyst. Dr. Siverhus opined that these conditions were caused or substantially 

aggravated by her work activities. He noted that the medical literature was conflicting, but that it 

suggested that workplace forceful gripping and exertion were associated with an increased risk of 

carpal tunnel syndrome.

In a statement dated October 20, 2020, appellant indicated that she injured her right wrist 

on August 8, 2020 and that she also believed there was damage in the wrist due to repetitious use 

of the same muscles in the wrist.

On October 28, 2020 appellant, through counsel, requested a hearing before a 

representative of OWCP’s Branch of Hearings and Review, which was held on February 4, 2021.

By decision dated March 29, 2021, OWCP’s hearing representative affirmed the October 7, 

2020 decision.

LEGAL PRECEDENT

An employee 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 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 determine whether a federal employee has sustained a traumatic injury in the 

performance of duty, it first must be determined whether fact of injury has been established. There 

are two components involved in establishing fact of injury. The first component is that the 

employee must submit sufficient evidence to establish that he or she actually experienced the 

employment incident at the time and place, and in the manner alleged. The second component is 

whether the employment incident caused a personal injury and can be established only by medical 

evidence.7 

3

Id.

4 F.H., Docket No.18-0869 (issued January29, 2020); J.P., Docket No. 19-0129 (issued April26, 2019); JoeD. 

Cameron, 41 ECAB 153 (1989). 

5 L.C., Docket No. 19-1301 (issued January 29, 2020); J.H., Docket No. 18-1637 (issued January 29, 2020); 

James E.Chadden, Sr., 40 ECAB 312 (1988).

6 P.A., Docket No. 18-0559 (issued January 29, 2020); K.M., Docket No. 15-1660 (issued September 16, 2016); 

DeloresC.Ellyett, 41 ECAB 992 (1990).

7 T.H., Docket No. 19-0599 (issued January 28, 2020); K.L., Docket No. 18-1029 (issued January 9, 2019); John J. 

Carlone, 41 ECAB 354 (1989).
4

The medical evidence required to establish causal relationship between a claimed specific 

condition and an employment incident is rationalized medical opinion evidence.8 A physician’s

opinion on whether there is causal relationship between the diagnosed condition and the implicated 

employment incident 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 incident.10

ANALYSIS

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

condition causally related to the accepted August 8, 2020 employment incident.

In his September 3, 2020 medical note, Dr. Siverhus noted that appellant related a history 

of forceful repetitive gripping and grasping with the right hand. He diagnosed right hand numbness 

and tingling and a ganglion cyst, and he opined that the conditions were caused or aggravated at 

work. In his September 28, 2020 narrative report, Dr. Siverhus diagnosed appellant with carpal 

tunnel syndrome and a volar wrist ganglion and opined that these conditions were caused or 

substantially aggravated by her work activities. He explained that medical literature suggested 

that workplace forceful gripping and exertion was associated with an increased risk of carpal tunnel 

syndrome. However, Dr. Siverhus failed to explain, with adequate rationale, how the accepted 

employment incident either caused or contributed to appellant’s right wrist condition. The Board 

has held that a medical opinion should reflect a correct history and offer a medically-sound and 

rationalized explanation by the physician of how the specific employment incident physiologically 

caused or aggravated the diagnosed conditions.11 In addition, the Board has held that reliance on 

medical literature has little probative value in resolving medical questions unless a physician 

shows the applicability of the general medical principles discussed in the articles to the specific 

factual situation at issue in the case.12 Dr. Siverhus did not identify any specific article, and he did 

not explain how the accepted employment incident of August 8, 2020 actually physiologically 

caused any diagnosed condition or how any medical literature supported causal relationship in this 

matter.

13

 The Board, therefore, finds that his opinions on causation in the September 3, 2020

medical note and the September 28, 2020 narrative reportfailed to provide a sufficient explanation 

8

S.S., Docket No. 19-0688 (issued January 24, 2020); A.M., Docket No. 18-1748 (issued April24, 2019); RobertG. 

Morris, 48 ECAB 238 (1996).

9 C.F., Docket No. 18-0791 (issued February 26, 2019); Jacqueline M. Nixon-Steward, 52 ECAB 140 (2000).

10 Id.

11 T.G., Docket No. 21-0175 (issued June 23, 2021); J.D., Docket No. 19-1953 (issued January 11, 2021); see K.W., 

Docket No. 19-1906 (issued April1, 2020).

12 S.J., Docket No. 20-0896 (issued January 11, 2021); R.G., Docket No. 18-0917 (issued March 9, 2020); T.S., 

Docket No. 18-1518 (issued April17, 2019); K.U., Docket No. 15-1771 (issued August 26, 2016); Roger D. Payne, 

55 ECAB 535 (2004).

13 S.J., id.; A.H., Docket No. 19-0270 (issued June 25, 2019); M.W., Docket No. 18-1624 (issued April3, 2019).
5

as to how the August 8, 2020 employment incident would have aggravated or accelerated 

appellant’s diagnosed right wrist conditions.

In his September 28, 2020 medical note, Dr. Siverhus diagnosed right carpal tunnel 

syndrome and an asymptomatic volar wrist ganglion cyst. However, the note does not contain an 

opinion on causation. 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.14 Therefore, Dr. Siverhus’ September 28, 2020 medical note is also insufficient to 

establish appellant’s claim.

The remaining evidence of record consists of reports of x-rays and an EMG/NCV study of 

the right wrist. The Board has held that diagnostic reports, standing alone, lack probative value 

on the issue of causal relationship as they do not provide an opinion as to whether the accepted 

employment incident caused a diagnosed condition.15 Consequently, these diagnostic reports are 

also insufficient to establish appellant’s claim.

As appellant has not submitted rationalized medical evidence to establish a right wrist 

condition causally related to the accepted August 8, 2020 employment incident, 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 right wrist

condition causally related to the accepted August 8, 2020 employment incident.

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

15 W.L., Docket No. 20-1589 (issued August26, 2021); A.P., Docket No. 18-1690 (issued December 12, 2019).
6

ORDER

IT IS HEREBY ORDERED THAT the March 29, 2021 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: December 17, 2021

Washington, DC

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Alternate Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board