United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

S.O., Appellant

and

DEPARTMENT OF THE ARMY, U.S. 

MILITARY ACADEMY, West Point, NY, 

Employer

__________________________________________

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Docket No. 21-1050

Issued: January 21, 2022

Appearances: Case Submitted on the Record

Appellant, pro se

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 July 2, 2021 appellant filed a timely appeal from a June 7, 2021 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.

ISSUE

The issue is whether appellant has established carpal tunnel syndrome (CTS) and ulnar 

nerve palsy causally related to the accepted factors of her federal employment.

FACTUAL HISTORY

On March 1, 2021 appellant, then a 38-year-old chief cook, filed an occupational disease 

claim (Form CA-2) alleging that she developed CTS and ulnar nerve palsy due to factors of her

1

5 U.S.C. § 8101 et seq.
2

federal employment,2including repetitive use of her hands while preparing, plating, and serving 

large volumes of meals twice daily for 16 years. She reported worsening pain and numbness in 

her hands, as well as frequent difficulty maintaining her grip on items. Appellant reported that she 

first became aware of her condition on November 13, 2020 and of its relation to her federal 

employment on February 23, 2021.

On November 13, 2020 appellant underwent a computerized tomography (CT) scan of her 

right hand and wrist, which revealed mild polyarticular degenerative changes, intraosseous cystic 

changes throughout the carpal bones, predominantly in the capitate and hamate. A CT scan of 

appellant’s left hand and wrist, of even date, revealed mild polyarticular degenerative changes, 

most prominent in the first carpometacarpal (CMC) joint, an ossific fragment along the ulnar side 

of the first CMC joint, and intraosseous cystic changes throughout the carpal bones, predominantly 

in the capitate and hamate.

In a February 22, 2021 referral note, Gina Cuneo-Ramos, a nurse practitioner, recounted 

that appellant worked as a cook for the employing establishment and reported pain and swelling 

in both hands and wrists. Ms. Cuneo-Ramos diagnosed bilateral swelling and pain in joints of the 

hands.

In a March 4, 2021 work excuse note, Ms. Cuneo-Ramos advised that appellant should 

remain out of work from March 4 through 18, 2021 for medical reasons.

OWCP also received appellant’s Standard Form (SF)-50 and position description, which 

noted that appellant’s employment duties included various cooking and food preparation tasks 

such as peeling, chopping, grinding, paring, cutting, slicing, dicing, pureeing, dredging, flouring, 

and breading, as well as operating and cleaning kitchen equipment.

In a development letter dated March 23, 2021, OWCP advised appellant of the deficiencies 

of her claim. It requested a narrative medical report from her treating physician, which contained 

a detailed description of findings and diagnoses, explaining how her work activities caused, 

contributed to, or aggravated hermedical condition. OWCPafforded appellant 30 days to respond.

Appellant subsequently submitted a March 4, 2021 emergency room note signed by

Dr. Joseph Kaczmarek, a Board-certified physician specializing in emergency medicine, relating 

appellant’s work history and symptoms. She reported numbness and tingling in the thumb, index 

finger, and middle finger, as well as pain with use at home and at work. Dr. Kaczmarek diagnosed 

CTS.

On March 9, 2021 appellant underwent a nerve conduction velocity (NCV) study, which 

revealed abnormal findings.

2 The Board notes that, in her Application for Review (AB-1 Form), appellant reports she frequently worked shifts 

from 3:00 a.m. until 8:00 p.m. Appellant also recounts that she was sexually assaulted, ridiculed, and forced to work 

beyond her strength in her time working for the employing establishment. She notes that, as a result, she has developed 

not only CTS and ulnar nerve palsy, but also anxiety, depression, and post-traumatic stress disorder (PTSD). As these 

emotional conditions are not the subject of the current appeal and were not part of the record reviewed by OWCP, the 

Board will not address them on this appeal. See 20 C.F.R. § 501.2(c). 
3

In a March 16, 2021 note, Dr. Patel related that appellant experienced hand paresthesia in 

both hands. He diagnosed bilateral CTS. Appellant was scheduled for a surgery on 

March 25, 2021.

In an April 7, 2021 letter, Dr. Patel reported that appellant was “doing well following the 

surgical release of the left carpal tunnel and left thumb trigger finger.” He further noted that, given 

the work that appellant described, these conditions are “most likely” attributable to the repetitive 

work. In a note dated April 8, 2021, Dr. Patel advised that appellant should be excused from work 

until her reevaluation on April 21, 2021.

On April 19, 2021 OWCP received an unsigned attending physician’s report (Form CA20), affirmatively notinga history of preexisting injury, disease or physical impairment. Appellant

reported having surgery on March 25, 2021.

In an April 21, 2021 referral order, Dr. Patel referred appellant to occupational therapy for 

12 visits over six weeks. He again diagnosed of bilateral CTS and trigger finger of the left thumb.

Dr. Patel provided appellant a work excuse note of even date.

By decision dated June 7, 2021, OWCP denied appellant’s occupational disease claim, 

finding that the evidence of record was insufficient to establish that her medical conditions were 

causally related to the accepted factors of her 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 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 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 

3

S.B., Docket No. 17-1779 (issued February 7, 2018); J.P., 59 ECAB 178 (2007); Joe D. Cameron, 41 ECAB 

153 (1989).

4

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 K.M., Docket No. 15-1660 (issued September 16, 2016); L.M., Docket No. 13-1402 (issued February 7, 2014);

DeloresC. Ellyett, 41 ECAB 992 (1990).
4

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 question that requires rationalized medical opinion 

evidence to resolve the issue.7 A physician’s opinion on whether there is a causal relationship 

between the diagnosed condition and the implicated employment factor(s) must be based on a 

complete factual and medical background.8 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 factor(s).9

ANALYSIS

The Board finds that appellant has not met her burden of proof to establish CTS and ulnar 

nerve palsy causally related to the accepted factors of her federal employment.

In his April 7, 2021 letter, Dr. Patel reported that appellant was “doing well following the 

surgical release of the left carpal tunnel and left thumb trigger finger.” He further noted that, given 

the work that appellant described, these conditions are “most likely” attributable to the repetitive 

work. While he provided an affirmative opinion suggestive of causal relationship, Dr. Patel did 

not offer medical rationale sufficient to explain how appellant’s employment duties resulted in or 

contributed to her diagnosed condition. Without identifying specific employment duties or 

explaining how they caused or aggravated appellant’s conditions, Dr. Patel’s letter is of limited 

probative value and is insufficient to meet appellant’s burden of proof.

10

In medical notes dated March 16 and April 21, 2021, Dr. Patel diagnosed CTS, ulnar nerve 

palsy, and trigger finger. Similarly, Dr. Kaczmarek’s March 4, 2021 emergency room note related 

appellant’s work history and symptoms and diagnosed CTS. However, neither Dr. Patel nor

Dr. Kaczmarek offered an opinion on causal relationship. 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.11 For these reasons, these reports are 

insufficient to meet appellant’s burden of proof.

Appellant submitted a February 22, 2021 referral note and March 4, 2021 work excusenote 

from Ms. Cuneo-Ramos, a nurse practitioner. The Board has held that medical reports signed 

6 R.G., Docket No. 19-0233 (issued July 16, 2019). See also Roy L. Humphrey, 57 ECAB 238, 241 (2005);Ruby I. 

Fish, 46 ECAB 276, 279 (1994);Victor J. Woodhams, 41 ECAB 345 (1989).

7 T.H., 59 ECAB 388, 393 (2008);Robert G. Morris, 48 ECAB 238 (1996).

8 M.V., Docket No. 18-0884 (issued December 28, 2018).

9

Id.; Victor J. Woodhams,supra note6.

10 See A.P., Docket No. 19-0224 (issued July 11, 2019).

11 S.J., Docket No. 19-0696 (issued August23, 2019); M.C., Docket No. 18-0951 (issued January 7, 2019); L.B., 

Docket No. 18-0533 (issued August27, 2018); D.K., Docket No. 17-1549 (issued July 6, 2018).
5

solely by a physician assistant, registered nurse, or medical assistant are of no probative value as 

such healthcare providers are not considered physicians as defined under FECA and are, therefore,

not competent to provide medical opinions.12 Consequently, their medical findings and/or 

opinions will not suffice for the purpose of establishing entitlement to FECA benefits.

The remaining medical evidence consisted of a November 13, 2020 CT scans of appellant’s 

hands and wrists and a March 9, 2021 NCV study. The Board has held, however, that diagnostic 

testing reports, standing alone, lack probative value on the issue of causal relationship as they do 

not address the relationship between the accepted employment factors and a diagnosed condition. 13 

For this reason, this evidence is also insufficient to meet appellant’s burden of proof.

As appellant has not submitted rationalized medical evidence establishing that her CTS 

and ulnar nerve palsy are causally related to the accepted factors of her federal employment, 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 CTS and ulnar 

nerve palsy causally related to the accepted factors of her federal employment.

12 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); 20 C.F.R. § 10.5(t). See also Federal (FECA) Procedure Manual, Part 2 -- Claims, Causal 

Relationship, Chapter 2.805.3a(1) (January2013); R.L., Docket No. 19-0440 (issued July 8, 2019) (nurse practitioners 

are not considered physicians under FECA); 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). 

13 W.M.,Docket No. 19-1853 (issued May 13, 2020); L.F., Docket No. 19-1905 (issued April10, 2020).
6

ORDER

IT IS HEREBY ORDERED THAT the June 7, 2021 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: January 21, 2022

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board