United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

M.D., Appellant

and

U.S. POSTAL SERVICE, SAN FRANCISCO 

AIR MAIL CENTER, San Francisco, CA, 

Employer

__________________________________________

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Docket No. 21-0349

Issued: July 1, 2021

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

PATRICIA H. FITZGERALD, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On January 4, 2021 appellant filed a timely appeal from a December 9, 2020 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.2

ISSUE

The issue is whether appellant has met her burden of proof to establish a right middle finger 

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

 

1 5 U.S.C. § 8101 et seq.

2 The Board notes that, following the December 9, 2020 decision, OWCP received additional evidence and 

appellant also submitted additional evidence on appeal. 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

FACTUAL HISTORY

On October 5, 2020 appellant, then, a 56-year-old parcel post distributor (machine), filed 

an occupational disease claim (Form CA-2) alleging that she developed right middle trigger finger 

due to factors of her federal employment, including repetitive motion. She asserted that she 

experienced pain in her right middle finger and when she closed her hand, her middle finger makes 

a clicking sound and locks, forcing her to use her left hand. Appellant noted that she first became 

aware of her condition and its relation to her federal employment on September 21, 2020. She did

not stop work.

In an October 16, 2020 development letter, OWCP informed appellant that the evidence 

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

evidence necessary to establish her claim and attached a factual questionnaire for her completion. 

In a separate development letter of even date, OWCP requested that the employing establishment 

provide additional information including comments from a knowledgeable supervisor and an 

explanation of appellant’s work activities. It afforded both parties 30 days to submit the necessary 

evidence.

In a September 21, 2020 report, Dr. Karl Lee, an internist, diagnosed right middle trigger 

finger. In a work status report of even date, he found that appellant was unable to work from

September 21 to October 6, 2020 due to pain in her right hand. In a separate work status report of 

even date, Dr. Douglas Thierer, Board-certified in occupational medicine, also diagnosed right 

middle trigger finger and provided work restrictions.

Appellant, in an October 9, 2020 statement, contended that her work activities contributed 

to her injury. She noted that her work duties consisted of repetitive keying, feeding mail to and 

clearing mail from machines, lifting, tying sacks, gripping bundles of mail to process, and sorting 

mail. Appellant explained that she performed these repetitive activities every day at the employing 

establishment for eight hours a day. She noted that she had no hobbies or activities outside work 

that were relevant to her working conditions and indicated that she only used her personal 

computer limited to checking e-mail and paying bills. Appellant asserted that she experienced 

pain in her middle finger, which would get stuck in a bent position and would only bend or 

straighten with a snap. She indicated that she was diagnosed with right middle trigger finger on 

September 21, 2020 and received a cortisone injection in her right palm. 

In an October 16, 2020 response to OWCP’s development questionnaire, the employing 

establishment concurred with appellant’s allegations and noted that appellant’s work duties 

consisted of keying, lifting, tying sacks, feeding mail to machines, clearing mail from machines, 

and sorting mail. 

In an October 21, 2020 doctor’s first report of occupational injury or illness, Dr. Thierer 

noted that appellant had been working at the employing establishment since February 13, 1988. 

Appellant reported that, when she made a fist, her right middle finger would lock and she could 

not extend at the proximal interphalangeal joint. Dr. Thierer summarized appellant’s job duties as 

requiring repetitive hand activities, including gripping, grasping, pushing, pulling, lifting, and 

keyboard use. He conducted a physical examination and diagnosed right middle trigger finger. 

Dr. Thierer also noted that appellant had pain related to repetitive pulling, pushing, lifting, and 

keyboard use. He provided work restrictions. 
3

In an October 26, 2020 response to OWCP’s development questionnaire, appellant again 

asserted that her repetitive work duties, including repetitive keying, feeding mail to machines, 

clearing mail from machines, lifting, tying sacks, gripping pouches/bundles of mail to process, and 

sorting mail daily, caused her injury. She reiterated that she performed these work duties every 

day at the employing establishment for eight hours per day. 

Dr. Thierer, in a November 3, 2020 report, indicated that he had conducted a physical 

examination, which demonstrated full range of motion except for slightly decreased range of 

motion in the right middle finger’s metacarpophalangeal joint and proximal interphalangeal joint 

with flexion and extension. He reviewed an October 21, 2020 x-ray of appellant’s right hand, 

which revealed no acute fracture or dislocation, but demonstrated ulnar styloid old tiny avulsion 

fracture and mild degenerative joint disease at right thumb joints. Dr. Thierer diagnosed right 

middle trigger finger and repetitive strain injury. He indicated that appellant could return to work 

with restrictions. 

In a November 17, 2020 report, Dr. Thierer reiterated his findings and diagnoses. 

In a November 24, 2020 report, Dr. David W. Zeltser, a vascular surgeon, noted that 

appellant previously received a corticosteroid injection. He diagnosed right middle trigger finger 

and noted that her condition was aggravated by repetitive motions. Dr. Zeltser indicated that 

appellant no longer experienced pain or clicking in her right middle finger. 

In a December 1, 2020 work status report, Dr. Thierer reiterated his diagnoses. 

By decision dated December 9, 2020, OWCP denied appellant’s occupational disease 

claim, finding that the medical evidence of record was insufficient to establish causal relationship 

between her diagnosed right middle finger condition and the accepted factors of her federal 

employment. 

LEGAL PRECEDENT

An employee seeking benefits under FECA3has 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

 

3 Supra note 1.

4

J.W., Docket No. 18-0678 (issued March 3, 2020); 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.S., Docket No.18-0657 (issued February 26, 2020); J.M., Docket No. 17-0284 (issued February 7, 2018); 

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

6 L.J., Docket No. 19-1343 (issued February 26, 2020); R.R., Docket No. 18-0914 (issued February 24, 2020); 

Delores C. Ellyett, 41 ECAB 992 (1990).
4

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 employment factors identified by the claimant.7 

Causal relationship is a medical issue, and the medical evidence required to establish causal 

relationship is rationalized medical opinion evidence.8 The opinion of the physician must be based 

on a complete factual and medical background of the employee, 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 specific employment factors identified by the employee.9

ANALYSIS

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

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

In his October 21, 2020 report, Dr. Thierer noted that appellant’s job required repetitive 

activities, including gripping, grasping, pushing, pulling, lifting, and keyboard use. He conducted 

a physical examination and diagnosed right middle trigger finger. Although he noted that appellant 

engaged in such activities as gripping and grasping at work, Dr. Thierer offered no opinion on the 

causal relationship of appellant’s job duties and the diagnosed right middle trigger finger. The 

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

not contain medical rationale explaining how an employment activity could have caused or 

aggravated a medical condition.10 As such, Dr. Thierer’s October 21, 2020 report is insufficient 

to establish appellant’s claim.

In a November 24, 2020 report, Dr. Zelster diagnosed right middle trigger finger and 

opined that appellant’s condition was aggravated by repetitive motions. However, he did not 

describe appellant’s work duties in detail or provide adequate medical rationale in support of his 

opinion that appellant’s job duties aggravated right middle trigger finger. As previously stated, a 

report is of limited probative value regarding causal relationship if it does not contain medical 

rationale explaining how an employment activity could have caused or aggravated a medical 

condition.11 Thus, Dr. Zelster’s report is also insufficient to establish causal relationship. 

In reports dated September 21, November 3 and 17, and December 1, 2020, Dr. Thierer 

conducted a physical examination, reviewed the October 21, 2020 x-ray of appellant’s hand, and 

 

7 S.C., Docket No. 18-1242 (issued March 13, 2019); R.H., 59 ECAB 382 (2008).

8 A.M., Docket No. 18-1748 (issued April 24, 2019); T.H., 59 ECAB 388, 393 (2008); Robert G. Morris, 48 ECAB 

238 (1996).

9 R.G., Docket No. 18-0792 (issued March 11, 2020); D.J., Docket No. 19-1301 (issued January 29, 2020); I.J., 59 

ECAB 408 (2008); Victor J. Woodhams, 41 ECAB 345, 352 (1989).

10 M.R., Docket No. 19-1954 (issued March 1, 2021); V.L., Docket No. 20-0884 (issued February 12, 2021).

11 Id.
5

diagnosed right middle trigger finger and repetitive strain injury. However, these reports are of no 

probative value because Dr. Thierer failed to provide an opinion as to whether appellant’s right 

middle trigger finger condition was related to the accepted employment factors. Similarly, in his 

September 21, 2020 report, Dr. Lee also failed to provide 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.12 Thus, these reports are

insufficient to establish appellant’s claim.

Dr. Lee, in his September 21, 2020 work status report, opined that appellant was unable to 

work due to pain in her right hand. The Board has consistently held that a diagnosis of “pain” does 

not constitute the basis for payment of compensation, as pain is a symptom not a specific 

diagnosis.13 Furthermore, the Board has held that a medical report lacking a firm diagnosis and a 

rationalized medical opinion regarding causal relationship is of no probative value.14 As Dr. Lee 

did not offer a valid medical diagnosis, his report is insufficient to establish causation.

Appellant has not submitted rationalized medical evidence establishing that her diagnosed 

right middle trigger finger condition is causally related to the accepted factors of her federal 

employment. Thus, the Board finds that she has not met her burden of proof to establish her claim. 

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 middle 

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

 

12 D.M., Docket No. 20-1347 (issued January 29, 2021); S.J., Docket No. 19-0696 (issued August 23, 2019); M.C., 

Docket No. 18-0951 (issued January 7, 2019).

13 T.S., Docket No. 20-0343 (issued July 15, 2020); D.H., Docket No. 19-0931 (issued October 2, 2019); R.R., 

Docket No. 18-1093 (issued December 18, 2018); A.C., Docket No. 16-1587 (issued December 27, 2016); Robert 

Broome, 55 ECAB 339 (2004).

14 J.P., Docket No. 20-0381 (issued July 28, 2020); R.L., Docket No. 20-0284 (issued June 30, 2020).
6

ORDER

IT IS HEREBY ORDERED THAT the December 9, 2020 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: July 1, 2021

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Alternate Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board