United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

A.M., Appellant

and

DEPARTMENT OF THE NAVY, NAVAL AIR 

STATION FLEET READINESS CENTER

SOUTHWEST, San Diego, CA, Employer

__________________________________________

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Docket No. 22-0313

Issued: August 16, 2022

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

JANICE B. ASKIN, Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On December 29, 2021 appellant, through counsel, filed a timely appeal from a 

December 8, 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 his burden of proof to establish a right upper 

extremity condition causally related to the accepted factors of his federal employment.

FACTUAL HISTORY

On December 12, 2018 appellant, then a 47-year-old nondestructive testing mechanic, filed 

an occupational disease claim (Form CA-2) alleging that his right carpal tunnel syndrome (CTS), 

right wrist pain, right shoulder joint derangement, and right hand trigger finger were aggravated 

by factors of his federal employment, including lifting heavy slippery parts during inspections. He 

noted that he first became aware of his condition on June 20, 2007 and realized its relationship to 

his federal employment on May 17, 2016. Appellant stopped work on January 20, 2017. On the 

reverse side of the form, the employing establishment noted that he had not reported an 

employment-related condition and that he had been removed from employment. 

A May 5, 2011 position description for nondestructive testing mechanic noted the physical 

requirements of the position. 

Accompanying appellant’s claim were medical records covering the period May 16, 2007 

through November 24, 2014 noting treatment for acid burns of the cervical nerve compression 

fracture, right shoulder pain, bilateral eye corneas, left side of chest wall work injury, back pain, 

right wrist sprain, and right carpal tunnel syndrome. 

Electromyogram and nerve conduction velocity (EMG/NCV) studies dated November 22, 

2016 documented right cervical radiculopathy or possible multiple upper extremity nerve 

involvement. 

In a September 10, 2018 report, Dr. Omar Ladas, an internist, diagnosed right carpal tunnel 

and right wrist and right shoulder pain. He noted that appellant related that his repetitive work 

duties of typing on a keyboard and lifting heavy, slippery objects contributed to his pain. Dr. Ladas

opined that it was reasonable to assume that the identified work activities aggravated the diagnosed 

conditions. 

In a November 28, 2018 narrative statement, appellant asserted that his carpal tunnel 

syndrome had been aggravated by repetitive lifting heavy slippery parts steeped in chemicals 

during inspection. Additionally, he asserted that his job aggravated his right shoulder and caused 

his right hand trigger finger. Appellant explained that he had undergone surgery for his trigger 

finger which resulted in damaged nerves and weakening of his hand. 

OWCP, in a January 2, 2019 development letter, informed appellant that the evidence of 

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

evidence needed and provided a questionnaire for his completion. In a separate development letter 

of even date, OWCP requested that the employing establishment provide a copy of appellant’s 

position description and physical requirements of his job. It afforded both parties 30 days to 

respond.
3

OWCP received appellant’s employing establishment health unit records covering the 

period August 13, 2006 to October 25, 2016. 

In e-mail correspondence dated February 4, 2019, an employing establishment supervisor, 

indicated that appellant’s position description did not involve excessive repetitive wrist and hand 

movement. In addition, she noted that when appellant was referred to occupational health for hand 

and wrist complaints, that the returned medical chit always indicated that he was fit for duty and 

was marked nonwork related for an occupational injury.

By decision dated March 12, 2019, OWCP denied appellant’s claim finding the evidence 

of record insufficient to establish that the alleged events occurred as alleged. It concluded, 

therefore, that the requirements had not been met to establish an injury as defined by FECA.

On April 10, 2019 appellant requested an oral hearing before a representative of OWCP’s

Branch of Hearings and Review. A telephonic hearing was held on August 14, 2019. At the 

hearing appellant described the job duties he claimed aggravated his preexistingright carpal tunnel 

syndrome and caused his right shoulder condition.

Dr. Ladas, in an August 20, 2019 report, noted that appellant was being seen at the 

Department of Veterans Affairs, VA San Diego Healthcare System for chronic radiculopathy, right 

shoulder hand, and wrist radiculopathy/pain, and trigger finger. On examination he reported 

significantly decreased grip strength and right index, middle, and ring finger numbness. Review 

of an October 31, 2013 x-ray demonstrated healed right distal clavicle fracture deformity.

Dr. Ladas noted that appellant had physical therapy for right shoulder/hand/arm pain and trigger 

finger in 2013/2014 and had trigger finger surgery in July 2017. Subsequent to the trigger finger 

surgery, appellant developed paresthesias of three fingers and right middle finger contracture. 

By decision dated September 26, 2019, OWCP’s hearing representative affirmed OWCP’s 

March 12, 2019 decision as modified. He found appellant’s description of his job duties at the 

hearing sufficient to establish the employment factors. However, the hearing representative found 

the medical evidence insufficient to establish that the diagnosed conditions were caused or 

aggravated by the accepted employment factors. 

On May 6, 2020 counsel requested reconsideration. In support of his request, he submitted 

an April 13, 2020 report by Dr. Neil Allen, a Board-certified neurologist internist, who indicated 

that he had reviewed appellant’s medical records and that the patient was contacted for a statement.

Dr. Allen noted that appellant began working as a non-destructive testing mechanic in 2004. The 

duties of the position required lifting up to 60 pounds; pinching, grasping, and holding onto small, 

lubricated parts during inspections; repetitively reaching at, above, and below the chest level; and 

rotating, pulling, and pushing parts of various sizes for 8 to 10 hours per day, five to six days per 

week depending on overtime availability. In 2007 appellant noticed a worsening of hand and wrist 

pain, tingling in his right 2nd, 3rd, and 4th digits, and right shoulder pain with overhead reaching

and lifting. A review of an October 31, 2013 x-ray demonstrated right healed distal clavicle 

fracture deformity and a February 21, 2020 electromyograph/nerve conduction study (EMG/NCS) 

showed evidence of mild-to-moderate right and mild left wrist median neuropathy. Dr. Allen 

diagnosed right rotator cuff tendinitis and right carpal tunnel syndrome, which he attributed to 

appellant’s work duties. He reported that it was well documented that individuals who performed
4

repetitive lifting or overhead activities are at a greater risk of developing rotator cuff tendinitis. 

Dr. Allen explained that these activities stretch, strain and repeatedly breakdown the soft tissues 

of the shoulder leading to inflammation, which then led to pain, tenderness, and reduced mobility 

in appellant’s shoulder. He noted that appellant had been previously diagnosed with right carpal 

tunnel and had been asymptomatic for several years prior to his nondestructive testing mechanic 

job. Dr. Allen explained that a common etiology for carpal tunnel are jobs requiring “repeated 

forceful wrist flexion,” and violent or forceful overextension of a joint may result in mechanical 

neuritis and repeated small traumas resulting in median nerve injury. He concluded that 

appellant’s repetitive/prolonged inspection of small to large parts required by his position 

combined all of the noted insulting activities leading to compression and injury to the median 

nerve. 

By decision dated September 24, 2020, OWCP denied modification. 

On September 13, 2021 counsel requested reconsideration and submitted a September 1, 

2021 report from Dr. Allen. In the September 1, 2021 report, Dr. Allen addressed the deficiencies 

OWCP noted in the September 24, 2020 decision. He explained that he had reviewed the position 

description for the nondestructive-testing mechanic. Dr. Allen listed the duties in the position 

description and related that it would be impossible to perf orm these tasks without repetitive 

pinching and grasping of the hands as described by appellant. He opined that appellant’s repetitive 

hand and wrist activity resulted in mechanical stress of the joints, leading to inflammation and 

subsequent compression of the median nerve, which lead to the pain and numbess in his right writst 

and hand. Appellant’s February 21, 2020 EMG confirmed the diagnosis. Dr. Allen also noted that 

appellant had indicated that he lifted up to 60 pounds; however, if he lifted, pushed and pulled 

parts weighing up to 40 pounds, these activities would still expose appellant’s shoulder, wrist and 

hand to undue mechanical stress and wear. He then explained that while a 2007 medical report 

indicated that appellant had wrist and hand symptoms during his military service and while typing 

reports for school, these activities had ended by 2000, and after rest, appellant’s carpal tunnel and 

tendinitis resolved and remained asymptomatic until appellant’s employment as a nondestructivetesting mechanic.

By decision dated December 8, 2021, OWCP denied modification.

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,

4

that 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 

3

Id.

4 N.H., Docket No. 21-1113 (issued February 25, 2022); F.H., Docket No.18-0869 (issued January 29, 2020); J.P., 

Docket No. 19-0129 (issued April26, 2019); Joe D. Cameron, 41 ECAB 153 (1989).
5

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, an employee 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 employment factors identified by the employee.

7

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 the specific employment factors identified by the claimant.

10

 

In any case where 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.

11

ANALYSIS

The Board finds that this case is not in posture for decision.

In support of his reconsideration request, appellant submitted an April 13, 2020 report by

Dr. Allen who indicated that he had reviewed appellant’s medical records and that appellant had 

5 M.H., Docket No. 19-0930 (issued June 17, 2020); R.C., 59 ECAB 427 (2008); James E. Chadden, Sr., 40 ECAB 

312 (1988).

6 Y.L., Docket No.. 21-1011(issued January 12, 2022); 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 Y.L., id.; P.L., Docket No. 19-1750 (issued March 26, 2020); R.G., Docket No. 19-0233 (issued July 16, 2019); 

DeloresC. Ellyett,id.

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

Robert G. Morris, 48 ECAB 238 (1996).

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

140 (2000).

10 See Y.L., id.; P.M., Docket No. 18-0287 (issued October 11, 2018); JohnW. Montoya, 54 ECAB 306 (2003).

11 Federal (FECA) Procedure Manual, Part 2 -- Claims, Causal Relationship, Chapter 2.805.3e (January 2013);

N.H., supra note 4; J.D., Docket No. 20-0404 (issued July22, 2020); K.G., Docket No. 18-1598 (issued January 7, 

2020); M.S., Docket No. 19-0913 (issued November 25, 2019).
6

been contacted for a statement. Dr. Allen reported that it was well documented that individuals 

who perform repetitive lifting or overhead activities are at a greater risk of developing rotator cuff 

tendinitis. He further explained that these activities stretch, strain and repeatedly breakdown the 

soft tissues of the shoulder leading to inflammation, and that these activities had led to pain, 

tenderness, and reduced mobility in appellant’s shoulder. Dr. Allen noted that appellant had been 

previously diagnosed with right carpal tunnel and had been asymptomatic for several years prior 

to his nondestructive-testing mechanic job. He explained that a common etiology for carpal tunnel 

were jobs that required repeated forceful wrist flexion, and violent or forceful overextension of a 

joint may result in mechanical neuritis and repeated small traumas resulting in median nerve injury. 

Dr. Allen explained that appellant’s repetitive/prolonged inspection of small to large parts required 

by his position combined all the noted insulting activities leading to compression and injury to the 

median nerve. He concluded that given appellant’s description of work duties and the clinical 

presentation documented by appellant’s treating physicians within the medical record of the case, 

caused appellant’s right rotator cuff tendinitis and aggravated his right carpal tunnel syndrome. 

In his November 1, 2021 report, Dr. Allen further addressed OWCP’s noted deficiencies 

in his prior report. He listed the duties in appellant’s position description and related that it would 

be impossible to perform these tasks without repetitive pinching and grasping of the hands. 

Dr. Allen opined that appellant’s repetitive hand and wrist activity resulted in mechanical stress of 

the joints, leading to inflammation and subsequent compression of the median nerve, which lead 

to the pain and numbess in his right wrist and hand, which was confirmed by apellant’s 

February 21, 2020 EMG. He also noted that appellant had indicated that he lifted up to 60 pounds, 

however if he lifted, pushed and pulled parts weighing up to 40 pounds, these activities would still 

expose appellant’s shoulder, wrist and hand to undue mechanical stress and wear. 

OWCP determined that Dr. Allen’s April 13, 2020 and September 1, 2021 reports were 

insufficient to establish causal relationship because theydid not include a well-rationalized opinion 

explaining how a diagnosed condition was related to the claimed exposures at work. Factors 

considered by OWCP in weighing medical reports include whether the opinion is based on a 

complete, accurate, and consistent history covering both the medical and factual aspects of the 

case; whether the opinion was well reasoned and well rationalized; whether the physician has the 

expertise and credentials to provide a medical opinion in this case; and whether the medical 

opinion was speculative or equivocal.

12

 The Board has long held that it is unnecessary that the 

evidence of record in a case be so conclusive as to suggest causal connection beyond all possible 

doubt. Rather, the evidence required is only that necessary to convince the adjudicator that the 

conclusion drawn is rational, sound, and logical.13

The Board finds that Dr. Allen provided an affirmative opinion on causal relationship.

Dr. Allen identified employment factors which appellant claimed caused his condition and 

explained how the identified employment factors, specifically the repetitive reachingat, above and 

below chest level physiologically caused the right rotator cuff tendinitis and the repetitive hand 

12 Federal (FECA) Procedure Manual, Part 2 -- Claims,Causal Relationship, Chapter 2.810.6a (September 2010);

see S.M., Docket No. 18-1195 (issued January 6, 2020).

13 D.M., Docket No. 20-0551 (issued July 21, 2021); W.M.,Docket No. 17-1244 (issued November 7, 2017); E.M.,

Docket No. 11-1106 (issued December 28, 2011); Kenneth J. Deerman, 34 ECAB 641, 645 (1983).
7

pinching and grasping aggravated appellant’s preexisting right carpal tunnel syndrome. He 

provided a pathophysiological explanation as to how the accepted employment factors were 

sufficient to cause the diagnosed conditions. The Board finds that Dr. Allen’s opinion while 

insufficiently rationalized to meet appellant’s burden of proof, is sufficient, given the absence of 

any opposing medical evidence, to require further development of the record.

14

 

Proceedings under FECA are not adversarial in nature, nor is OWCP a disinterested arbiter. 

While it is appellant’s burden of proof to establish the claim, OWCP shares responsibility in the 

development of the evidence.

15

 It has the obligation to see that justice is done.

16

 The Board will 

therefore remand the case to OWCP for further development of the medical evidence. On remand 

OWCP shall refer appellant, a statement of accepted facts, and the medical evidence of record to 

a physician in the appropriate field of medicine for a rationalized opinion as to whether appellant’s 

diagnosed right shoulder conditions are causally related to the accepted factors of his federal 

employment. If the physician opines that the diagnosed condition is not causally related to the 

accepted employment factors, he or she must explain with rationale how or why their opinion 

differs from that of Dr. Allen. Following this and any other further development as deemed 

necessary, OWCP shall issue a de novo decision on his claim.

CONCLUSION

The Board finds that this case is not in posture for a decision.

14 R.A., Docket No. 19-0650 (issued January 15, 2020); B.M., Docket No. 18-0448 (issued January 2, 2020);E.G., 

Docket No. 19-1296 (issued December 18, 2019).

15 Id.

16 Id.
8

ORDER

IT IS HEREBY ORDERED THAT December 8, 2021 decision of the Office of Workers’

Compensation Programs is set aside and the case is remanded for further proceedings consistent 

with this decision of the Board.

Issued: August 16, 2022

Washington, DC

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board

Alec J. Koromilas, Chief Judge, dissenting,

The majority opinion finds that, although the April 13, 2020 and September 1, 2021 

medical reports of Dr. Neil Allen were insufficient to meet appellant’s burden of proof to establish 

their claim, it was sufficient to require the Office of Workers’ Compensation Programs to further 

develop the medical evidence with regard to expansion. I disagree.1

While considered a treating physician, Dr. Allen never saw in person nor physically 

examined appellant. He premised his opinion solely on what he characterized as “medical records 

that he had reviewed” and that the “patient was contacted for a statement.”

1

See D.R., Docket No. 20-1104 (issued January 29, 2021); S.B., Docket No. 19-1778 (issued October 23, 2020); 

S.J., Docket No. 19-1029 (issued October 22, 2020); M.O., Docket No. 19-0278 (issued February 19, 2020); J.H., 

Docket No. 18-1637(issued January 29, 2020); C.C., Docket No. 18-1453 (issued January 28, 2020); K.P., Docket 

No.18-0056 (issued January 27, 2020); K.P., Docket No.18-0056 (issued January 27, 2020).
9

The Federal Employees’ Compensation Act Procedural Manual sets out parameters for the 

weighing of medical evidence.2 It describes a comprehensive report as one which reflects that all 

testing and analysis necessary to support the physician’s final conclusions were performed.

I believe certain basic medical examination parameters must be met. Dr. Allen espoused 

an opinion on causal relationship without the benefit of direct physical examination or 

observations. He based his findings on EMG/NCS studies and-rays without reference to any 

previous treating physicians. This is the type of injury that lends itself to an examination for the 

purposes of diagnosis and causation, where the physician is able at a minimum to see the patient, 

question and receive a first-hand account of the injury and compare same. This remains critical 

even when the only issue is causation. For example, visualizing the locus of injury is informative 

to the examining treating physician relative to issues of atrophy, dislocation, contusion, and, 

congenital malformation which could possibly cause the same symptoms along with other factors 

that may relate to the finding of causal relationship. I do not agree that words of causation in the 

ordinary course alone can be separated from some type of examination of appellant by appellant’s 

physician.

If Dr. Allen was able to view, speak with and examine appellant, I would be inclined to 

perhaps be satisfied with his knowledge and understanding along with his pathophysiological 

explanation and agree with the majority that his opinion would be sufficient to remand for OWCP 

to further develop the medical evidence. However, the majority finding in my view, without the 

benefit of a conversation coupled with a visualized examination effectively shifts the burden of 

proof to OWCP to disprove the claim based on a medical report that is of questionable probative 

value.

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

2 Federal (FECA) Procedure Manual, Part 2 -- Claims, Causal Relationship, Chapter 2.810.6(a)(4) 

(September 2010).