United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

J.B., Appellant

and

DEPARTMENT OF VETERANS AFFAIRS, 

VETERANS AFFAIRS NORTH 

FLORIDA/SOUTH GEORGIA HEALTH CARE, 

OCALA WEST SPECIALTY CLINIC, 

Ocala, FL, Employer

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Docket No. 21-1169

Issued: May 12, 2022

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

PATRICIA H. FITZGERALD, Deputy Chief Judge

JANICE B. ASKIN, Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On July 22, 2021 appellant filed a timely appeal from a July 8, 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 met her burden of proof to establish a bilateral upper 

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

FACTUAL HISTORY

On June 25, 2020 appellant, then a 47-year-old medical clerk, filed an occupational disease 

claim (Form CA-2) alleging that she sustained right epicondylitis and carpal tunnel syndrome 

1

5 U.S.C. § 8101 et seq.
2

causally related to factors of her federal employment including repetitive typing, scheduling 

appointments, folding letters, stuffing envelopes, and writing messages. She noted that she first 

became aware of her condition on April 9, 2020 and realized its relation to her federal employment 

on May 19, 2020. Appellant did not stop work.2 

Appellant submitted November 8, 2019 and May 19 and June 10 and 24, 2020 reports from 

Matthew Ota, a physician assistant. Mr. Ota noted her complaints of bilateral hand pain, and right 

elbow pain. He related an assessment of right carpal tunnel syndrome. 

In a report dated May 27, 2020, Dr. Eduardo J. Cruz-Colon, a Board-certified physiatrist, 

related that appellant was seen for complaints of tingling and numbness to the right hand since 

April 2020. He noted that she had undergone carpal tunnel surgery in approximately 2013. 

Dr. Cruz-Colon reviewed the findings of a nerve conduction velocity/electromyogram 

(NCV/EMG) study, which he concluded was abnormal and revealed evidence of moderate right 

carpal tunnel syndrome. 

In a development letter dated June 29, 2020, OWCP informed appellant that the evidence 

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

needed and afforded her 30 days to respond. 

Appellant submitted an NCV/EMG study dated May 27, 2020, which indicated findings of

moderate right carpal tunnel syndrome affecting motor and sensory components. 

In notes dated July 14, 2020, Dr. Stephen Pyles, a Board-certified anesthesiologist, 

examined appellant for complaints of left-sided wrist pain and numbness. On physical 

examination of the extremities, he observed normal range of motion, movement, and reflexes. 

Dr. Pyles diagnosed status post left wrist carpal tunnel syndrome revision on February 27, 2019. 

By decision dated July 29, 2020, OWCP denied appellant’s occupational disease claim, 

finding that the evidence of record was insufficient to establish a diagnosed condition in 

connection with the accepted work-related factors. It concluded, therefore, that the requirements 

had not been met to establish an injury as defined by FECA. 

OWCP thereafter received surgical records relating that appellant underwent a 

percutaneous tenotomy of the right lateral elbow and a right carpal tunnel release on June 24, 2014. 

On February 27, 2019 appellant underwent a repair of a median nerve with application of a 

synthetic conduit and neuroplasty to treat a left-sided lesion to the carpal tunnel median nerve. 

In a report dated July 16, 2020, Dr. Nirav Gupta, a Board-certified orthopedic surgeon, 

examined appellant for complaints of bilateral elbow pain and epicondylitis. On physical 

examination of the right lateral elbow, he observed pain to palpation over the lateral aspect of the 

elbow to the lateral epicondyle and the radial tunnel, as well as minimal pain with resisted 

extension of the wrist and index finger. On examination of the right hand, Dr. Gupta observed a 

positive carpal compression test and noted that appellant’s left hand was worse than her right. He 

diagnosed radial tunnel syndrome of the right upper limb, carpal tunnel syndrome of the left upper 

2 On March 29, 2013appellant filed a traumatic injury claim (Form CA-1) alleging that she sustained inflammation 

of tissues and tendons of the right forearm, thumb and index finger, due to an assault by a coworker. OWCP assigned 

this claim OWCP File No. xxxxxx534 and accepted it for right wrist contusion. The current claim has been 

administratively combined by OWCP with OWCP File No. xxxxxx534, with the latter serving as the master file. 
3

limb, and right lateral epicondylitis. Dr. Gupta stated that it was safe to assume that duties of 

appellant’s work caused her right upper extremity’s pain, noting that she engaged in a heavy 

amount of typing. 

In a note dated July 28, 2020, Dr. Cruz-Colon described administration of an ultrasoundguided right radial tunnel steroid injection for treatment of right elbow pain. 

On December 31, 2020 appellant requested reconsideration. 

In a report dated July 23, 2020, Dr. Gupta diagnosed a lesion of the right radial nerve, left 

carpal tunnel syndrome, and right lateral epicondylitis. He noted that he could not attribute 

appellant’s “conditions to [appellant’s]job at the 100 percent level,”and that “[t]hey can be related

and that is all I can say.”

In a report dated December 4, 2020, Dr. Donna Saatman, a Board-certified neurosurgeon, 

examined appellant for ongoing issues with carpal tunnel syndrome. She noted that appellant had 

ongoing issues since 2015 and had been diagnosed with right cubital tunnel syndrome. On physical 

examination of the upper extremities, Dr. Saatman observed a positive Tinel’s response over the 

right and left wrist and elbow, decreased grip strength bilaterally, and diminished sensory activity 

in the median and ulnar nerves. She diagnosed bilateral carpal tunnel syndrome and right cubital 

tunnel syndrome. Dr. Saatman noted that there was evidence of significant tendinosis at the elbow 

and wrist, which was likely related to appellant’s repetitive hand tasks associated with her

administrative work. She opined that appellant had a preexisting condition leaving her prone to 

carpal tunnel syndrome and persistent nerve injury, as well as aggravation of carpal tunnel 

syndrome by her occupation, which was at least in part related to the diagnosis of carpal tunnel 

syndrome prompting surgical intervention. 

By decision dated February 3, 2021, OWCP modified the prior decision, finding that 

appellant had submitted sufficient evidence to establish diagnoses of bilateral carpal tunnel 

syndrome and right cubital tunnel syndrome. However, appellant’s claim remained denied as she 

had not submitted sufficient rationalized medical evidence to establish that factors of her federal 

employment caused or aggravated her diagnosed conditions. 

In a report dated February 17, 2021, Dr. Gupta examined appellant for complaints of lefthand pain. He diagnosed right lateral epicondylitis, bilateral carpal tunnel syndrome, and cubital 

tunnel syndrome. Dr. Gupta opined that appellant’s ulnar nerve condition could have been work

related due to her work position. He noted that to what degree her cubital tunnel syndrome was 

work related was difficult for him to tell. 

On April 14, 2021 appellant requested reconsideration. 

By decision dated July 8, 2021, OWCP denied modification of its February 3, 2021 

decision. 
4

LEGAL PRECEDENT

An employee seeking benefits under FECA3 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 of FECA, 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 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.

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.5

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.6 The opinion of the physician must be based on a complete factual 

and medical background, 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 incident.7

ANALYSIS

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

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

In a report dated July 16, 2020, Dr. Gupta diagnosed radial tunnel syndrome of the right 

upper limb, carpal tunnel syndrome of the left upper limb, and right lateral epicondylitis. He stated 

that it was safe to assume that duties of appellant’s work caused her right upper extremity’s pain, 

noting that she engages in a heavy degree of typing. In a report dated December 4, 2020,

Dr. Saatman diagnosed bilateral carpal tunnel syndrome and right cubital tunnel syndrome. She 

noted that there was evidence of significant tendinosis at the elbow and wrist, which was likely 

related to appellant’s repetitive hand tasks associated with her administrative work. Dr. Saatman 

opined that appellant had a preexisting condition leaving her prone to carpal tunnel syndrome and 

persistent nerve injury, as well as aggravation of carpal tunnel syndrome by her occupation, which 

was at least in part related to the diagnosis of carpal tunnel syndrome prompting surgical 

3

Supra note 1.

4 C.K., Docket No. 19-1549 (issued June 30, 2020); R.G., Docket No. 19-0233 (issued July 16, 2019); Elaine 

Pendleton, 40 ECAB 1143 (1989).

5 L.D., Docket No. 19-1301 (issued January 29, 2020); S.C., Docket No. 18-1242 (issued March 13, 2019); Victor J. 

Woodhams, 41 ECAB 345, 352 (1989).

6

I.J., Docket No. 19-1343 (issued February 26, 2020); T.H., 59 ECAB 388 (2008); RobertG. Morris, 48 ECAB 

238 (1996).

7 D.J., Docket No. 19-1301 (issued January 29, 2020).
5

intervention. While in these reports, Drs. Gupta and Saatman provided an opinion as to the cause 

of appellant’s diagnosed upper extremity conditions, they did not support their opinion with 

medical rationale explaining how her work duties caused her claimed conditions. Without 

explaining how, physiologically, the specific movements involved in appellant’s job caused, 

contributed to, or aggravated the specific diagnosed conditions, their opinions in these reports are 

of limited probative value and insufficient to establish the claim.8

In a report dated July 23, 2020, Dr. Gupta diagnosed a lesion of the right radial nerve, left 

carpal tunnel syndrome, and right lateral epicondylitis. He noted that he could not attribute 

appellant’s “conditions to her job at the 100 percent level,” and that “[t]hey can be related and that 

is all I can say.” In a report dated February 17, 2021, Dr. Gupta diagnosed right lateral 

epicondylitis, bilateral carpal tunnel syndrome, and cubital tunnel syndrome. He opined that 

appellant’s ulnar nerve condition could have been work related due to her work position. 

Dr. Gupta noted that to what degree her cubital tunnel syndrome was work related was difficult 

for him to tell. The Board notes that, while the opinion of a physician supporting causal 

relationship need not be one of absolute medical certainty, it must not be speculative or equivocal. 

The opinion should be expressed in terms of a reasonable degree of medical certainty. 9 The Board 

thus finds that the February 17 and July 23, 2020 reports from Dr. Gupta were equivocal and as 

such are of limited probative value and insufficient to establish the claim.

Appellant submitted a February 28, 2019 hospital report, reports from Dr. Cruz-Colon 

dated May 27 and July 28, 2020, and a report from Dr. Pyles dated July 14, 2020, which did not 

contain opinions as to whether her diagnosed conditions were caused or aggravated by factors of 

her federal employment. 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 As such, these reports are insufficient to establish appellant’s claim.

Appellant submitted November 8, 2019 and May 19 and June 10 and 24, 2020, reports 

from a physician assistant. The Board has held that medical reports signed solely by a physician 

assistant, lack probative value, as they are not considered physicians as defined under FECA and,

therefore, are not competent to provide a medical opinion.11

8

See T.F., Docket No. 20-0260 (issued June 12, 2020); D.J., Docket No. 18-0694 (issued March 16, 2020); K.G.,

Docket No. 18-1598 (issued January 7, 2020); K.O., Docket No. 18-1422 (issued March 19, 2019).

9 P.W., Docket No. 20-0407 (issued July 17, 2020); Ricky S. Storms, 52 ECAB 349 (2001).

10 D.C., Docket No. 19-1093 (issued June 25, 2020); see L.B., Docket No. 18-0533 (issued August27, 2018); D.K., 

Docket No. 17-1549 (issued July 6, 2018).

11 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) (January 2013); L.T., Docket No. 19-0145 (issued June 3, 2019); T.H., Docket No. 

18-1736 (issued March 13, 2019); see DavidP. 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).
6

Lastly, appellant submitted an NCV/EMG study dated May 27, 2020. The Board has held 

that diagnostic test reports, standing alone, lack probative value as they do not provide an opinion 

on causal relationship between the claimed employment factors and a diagnosed condition. 12

As the record lacks rationalized medical evidence establishing causal relationship between 

appellant’s claimed conditions and 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 a bilateral upper 

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

ORDER

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

Compensation Programs is affirmed.

Issued: May 12, 2022

Washington, DC

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board

12 See T.H., id.