United States Department of Labor

Employees’ Compensation Appeals Board

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P.L., Appellant

and

DEPARTMENT OF THE NAVY,

NAVAL AIR STATION, Pensacola, FL,

Employer

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Docket No. 20-0392

Issued: October 28, 2020

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

CHRISTOPHER J. GODFREY, Deputy Chief Judge

JANICE B. ASKIN, Judge

PATRICIA H. FITZGERALD, Alternate Judge

JURISDICTION

On December 9, 2019 appellant filed a timely appeal from a November 18, 2019 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

 

1 5 U.S.C. § 8101 et seq.

2 The Board notes that OWCP received additional evidence following the November 18, 2019 decision. 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

ISSUE

The issue is whether OWCP has abused its discretion by denying appellant’s request for 

authorization of carpal tunnel surgery.

FACTUAL HISTORY

On August 24, 1999 appellant, then a 49-year-old carpenter, filed a traumatic injury claim 

(Form CA-1) alleging that on August 20, 1999 he was lifting sheet rock and felt a sharp pain in 

his left elbow while in the performance of duty. He stopped work on August 20, 1999.

OWCP accepted the claim for lateral epicondylitis of the left arm and brachial neuritis or 

neuritis. Appellant underwent ulnar nerve transposition surgery on August 22, 2001. OWCP 

granted him a schedule award for 20 percent permanent impairment of the left arm. Appellant 

retired from federal employment effective September 30, 2002. 

In a February 27, 2019 report, Dr. Michael Gilmore, a Board-certified orthopedic surgeon,

noted that appellant was seen for a chief complaint of left elbow pain. He also noted that appellant 

had previously treated with another orthopedic specialist following his August 20, 1999 work 

injury. Dr. Gilmore reported appellant’s history of injury and medical treatment. He diagnosed 

left carpal tunnel syndrome, with an associated diagnosis of postoperative elbow cubital tunnel 

release. 

In an April 10, 2019 report, Dr. Gilmore noted appellant’s physical examination findings 

and diagnosed carpal tunnel syndrome on the left with thenar atrophy. He opined that appellant’s 

condition was “[m]ore likely than not related to overuse of digits from contributions of previous

work-related cubital tunnel release” and “repetitious gripping over the years with mainly the first 

three fingers instead of full grip ulnar numbness since 1999, despite two cubital tunnel releases.”

Dr. Gilmore also diagnosed medial epicondylitis on the left. He requested authorization for 

surgery to include left endoscopic carpal tunnel release on the left wrist. Dr. Gilmore also 

requested authorization for carpal tunnel surgery on May 7, 2019. 

In a May 6, 2019 development letter, OWCP advised appellant that the medical evidence 

of record was insufficient to authorize carpal tunnel surgery because the requested treatment did 

not appear to be medically necessary for and/or causally related to ahis accepted conditions. It 

requested a medical narrative from appellant’s physician describing how the newly diagnosed 

condition was caused or aggravated by the accepted employment injury. 

Appellant was seen again by Dr. Gilmore on May 15, 2019 due to pain from his left elbow 

up to his left shoulder. Dr. Gilmore noted that appellant was seen in follow up for medial 

epicondylitis of the left elbow, with flexor/pronator tendinosis partial tear. He treated appellant 

with a steroid injection for the medial epicondylitis. 

An August 16, 2019 electromyography (EMG) scan read by Dr. Stephen Slobodian, a 

physiatrist, revealed severe left median neuropathy at the wrist and mild-to-moderate ulnar nerve 

compression across the left elbow. 
3

In a September 11, 2019 report, Dr. Gilmore explained that appellant had carpal tunnel and 

cubital tunnel syndrome. He explained that carpal tunnel could occur with excess pressure on the 

nerve in the carpal tunnel in the wrist and that there were many factors that contributed to the 

development of carpal tunnel syndrome, such as heredity, overweight, overuse of the hand, and 

medical conditions such as diabetes and thyroid disease. Dr. Gilmore noted appellant’s surgical 

options and that appellant decided to proceed with the previously ordered left wrist surgery. 

On October 8, 2019 OWCP prepared a statement of accepted facts (SOAF) and referred it, 

together with the case record, to Dr. Todd Fellars, a Board-certified orthopedic surgeon serving as 

a district medical adviser (DMA), to determine the medical necessity of the requested surgery and 

whether the surgery was due to the accepted August 20, 1999 employment injury. The DMA, in 

an October 31, 2019 report, noted his review of the medical evidence of record. He noted that 

appellant underwent ulnar nerve transposition in August 2001, received a schedule award for 20 

percent upper extremity impairment for his left arm, and retired on disability on 

September 30, 2002. The DMA explained that given appellant’s EMG findings, surgical release 

of the carpal tunnel would be reasonable and necessary, but not due to the accepted employment 

injury claim. He noted that he had reviewed Dr. Gilmore’s September 11, 2019 report and 

disagreed with a finding that the need for surgery was due to the accepted employment injury as it 

had not contributed to his current carpal tunnel symptoms. The DMA explained that the proposed 

left carpal tunnel release was not causally related to the accepted medical conditions and that 

development of carpal tunnel, which was “typically idiopathic,” 17 years after appellant retired,

would not be work related. He concluded that if the SOAF was correct and appellant actually 

retired in 2002 “there would be no relation between [appellant’s] current carpal tunnel syndrome 

and his work activities.” 

By decision dated November 18, 2019, OWCP denied authorization for carpal tunnel 

surgery.

LEGAL PRECEDENT

Section 8103 of FECA provides that the United States shall furnish to an employee who is 

injured while in the performance of duty, the services, appliances, and supplies prescribed or 

recommended by a qualified physician, which OWCP considers likely to cure, give relief, reduce 

the degree, or the period of disability, or aid in lessening the amount of the monthly compensation.3 

In interpreting this section of FECA, the Board has recognized that OWCP has broad discretion in 

approving services provided under FECA.4 OWCP has the general objective of ensuring that an 

employee recovers from his or her injury to the fullest extent possible in the shortest amount of 

time. It therefore has broad administrative discretion in choosing means to achieve this goal. The 

only limitation on OWCP’s authority is that of reasonableness.5 

 

3 5 U.S.C. § 8103.

4 See D.M., Docket No. 17-1563 (issued January 15, 2019); J.B., Docket No. 11-1301 (issued March 22, 2012).

5

Id.
4

Abuse of discretion is generally shown through proof of manifest error, clearly 

unreasonable exercise of judgment, or actions taken which are contrary to both logic and probable 

deductions from established facts. It is not enough to merely show that the evidence could be 

construed so as to produce a contrary factual conclusion.6 

To be entitled to reimbursement of medical expenses, a claimant has the burden of proof 

to establish that the expenditures were incurred for treatment of the effects of an employmentrelated injury or condition. Proof of causal relationship in a case such as this must include 

supporting rationalized medical evidence.7 In order for a surgical procedure to be authorized, a 

claimant must submit evidence to show that the surgery is for a condition causally related to an 

employment injury and that it is medically warranted. Both of these criteria must be met in order 

for OWCP to authorize payment.8

ANALYSIS

The Board finds that OWCP has not abused its discretion by denying appellant’s request 

for authorization of carpal tunnel surgery.

Following appellant’s request for authorization of carpal tunnel surgery, OWCP sent a copy 

of the case record, and a SOAF to a DMA for an opinion as to whether the requested surgery was 

medically necessary and resulting from the accepted August 20, 1999 employment injury. The 

DMA reviewed the medical evidence of record and concluded that the proposed carpal tunnel 

surgery was neither warranted nor necessitated by any of appellant’s work-related conditions. He 

noted appellant’s history of injury and treatment, including that appellant underwent ulnar nerve 

transposition in August 2001, received a 20 percent upper extremity impairment for his left arm, 

and retired on disability on September 30, 2002. The DMA explained that the development of 

carpal tunnel is “typically idiopathic” and that development of the condition 17 years after 

appellant retired would not be work related. He concluded, therefore, that the requested surgery 

was not work related and was not medically necessary.

As the requested surgery was not determined to be medically necessary and resulting from 

the accepted August 20, 1999 employment injury, OWCP did not abuse its discretion by denying 

appellant’s requests for authorization for the surgery.

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.

 

6 E.L., Docket No. 17-1445 (issued December 18, 2018); L.W., 59 ECAB 471 (2008); P.P., 58 ECAB 673 (2007); 

Daniel J. Perea, 42 ECAB 214 (1990).

7 K.W., Docket No. 18-1523 (issued May 22, 2019).

8

Id.; see also R.C., 58 ECAB 238 (2006).
5

CONCLUSION

The Board finds that OWCP has not abused its discretion by denying appellant’s request 

for authorization for carpal tunnel surgery.

ORDER

IT IS HEREBY ORDERED THAT the November 18, 2019 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: October 28, 2020

Washington, DC

Christopher J. Godfrey, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Alternate Judge

Employees’ Compensation Appeals Board