United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

A.W., Appellant

and

DEPARTMENT OF VETERANS AFFAIRS, 

SHERIDAN VA MEDICAL CENTER, 

Sheridan, WY, Employer

__________________________________________

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Docket No. 22-0265

Issued: September 23, 2022

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

JANICE B. ASKIN, Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JAMES D. McGINLEY, Alternate Judge

JURISDICTION

On December 12, 2021 appellant filed a timely appeal from a November 15, 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 medical condition

causally related to the accepted employment factors. 

FACTUAL HISTORY

On January 12, 2021 appellant, then a 69-year-old social worker, filed an occupational 

disease claim (Form CA-2) alleging that she developed right carpal tunnel syndrome (CTS) due to 

1

5 U.S.C. § 8101 et seq.
2

factors of her federal employment including repetitive data entry on a laptop computer. She noted 

that she first became aware of her condition and realized its relationship to her federal employment 

on September 21, 2020. Appellant did not stop work.

In a development letter dated January 21, 2021, OWCP advised appellant of the 

deficiencies of her claim. It explained the type of additional evidence needed and provided a 

questionnaire for her completion. OWCP afforded appellant 30 days to respond.

On January 25, 2021 OWCP received a September 22, 2020 report by Dr. Brian Darnell, 

an osteopath Board-certified in family practice. Dr. Darnell noted appellant’s symptoms of right 

wrist pain with tingling in the third and fourth fingers, and that she had previously undergone 

surgery for right CTS. He also noted that appellant had sustained injuries to the right lower 

extremity, right shoulder, and left wrist when she fell in an airport in 2012, and had undergone

several orthopedic surgeries. On examination, Dr. Darnell found full range of right wrist motion. 

He diagnosed right CTS and prescribed a wrist brace.

On January 25, 2021 OWCP also received a November 9, 2020 report by Dr. Jennifer A. 

Rice, a Board-certified family practitioner, who observed full range of motion of the right wrist. 

Dr. Rice diagnosed right CTS and recommended that appellant continue to wear the wrist brace.

In a January 26, 2021 duty status report (Form CA-17), Dr. Darnell returned appellant to 

full-duty work, with keyboarding and fine manipulation up to eight hours a day.

In response, appellant submitted a January 26, 2021 statement noting that her assigned 

duties required keyboarding for several hours a day while updating documents and a handbook, 

and developing presentations and curricula. She noted that she had undergone right carpal tunnel 

surgery approximately 25 years previously. Appellant indicated that wearing a wrist brace helped 

to alleviate her symptoms.

By decision dated February 22, 2021, OWCP accepted that the identified employment 

factors were established. However, it denied appellant’s occupational disease claim for right CTS, 

finding that the medical evidence of record was insufficient to establish that the diagnosed 

condition was causally related to the established employment factors. OWCP concluded, 

therefore, that the requirements had not been met to establish an injury and/or a medical condition 

causally related to the accepted employment factors.

OWCP continued to receive medical evidence. From March 23 through August 13, 2021, 

appellant submitted a series of reports by Dr. Monica L. Morman, a Board-certified orthopedic 

surgeon specializing in surgery of the hand. In a February 12, 2021 report, Dr. Morman noted that 

appellant had undergone a right median nerve release approximately 25 years previously, and had 

injured her left shoulder in a December 22, 2020 fall while at work.

2

 On examination of the right 

wrist and hand, she observed restricted range of motion, a positive Tinel’s sign at the wrist, an 

equivocal Finkelstein’s maneuver, and some pain with resisted thumb extension. Dr. Morman 

obtained right wrist x-rays, which demonstrated generalized osteoporosis, mild narrowing of the 

2 On January 12, 2021 appellant filed a traumatic injury claim (Form CA-1) for a left shoulder injury sustained in 

a fall while teleworking on December 22, 2020. OWCP assigned OWCP File No. xxxxxx672.
3

radiocarpal and midcarpal joints, moderate degenerative change of the carpometacarpal (CMC) 

and interphalangeal (IP) joints of the right thumb, and moderate degenerative change of the 

scaphotrapezio-trapezoid (STT) joint in the right wrist. She diagnosed possible recurrent right 

CTS status-post mini-open carpal tunnel release 25 years previously. Dr. Morman opined that 

appellant had not injured her wrist in the December 22, 2020 fall. She prescribed physical therapy. 

In Form CA-17 reports dated March 5 and 25, 2021, Dr. Morman diagnosed osteoarthritis

of the right wrist. She returned appellant to full-duty work regarding the right wrist.

Dr. Morman indicated in a June 24, 2021 report that appellant had injured her right wrist 

in the December 2020 fall. She obtained x-rays of the right wrist, which demonstrated significant 

narrowing of the STT joint with degenerative changes in the CMC, metacarpophalangeal (MCP),

and IP joints of the right thumb, mild diffuse osteopenia, and mild radiocarpal and midcarpal joint 

space narrowing. A right STT intra-articular injection had not relieved appellant’s symptoms. On 

examination of the right hand and wrist, Dr. Morman observed a negative Finkelstein’s maneuver, 

tenderness of the CMC joint of the thumb and STT joint, positive axial grind test of the thumb, 

paresthesias of the second, third and fourth fingers with direct compression of the median nerve, 

and positive Tinel’s and Phalen’s signs. She diagnosed primary osteoarthritis of the right first 

CMC joint, STT joint arthritis of the right wrist, and right CTS.

On July 21, 2021 Dr. Morman performed trapezial resection of the right thumb and wrist 

with Arthrex internal brace thumb metacarpal suspensionplasty, right wrist partial trapezoid 

excision, and revision of right wrist open carpal tunnel release. 

On August 17, 2021 appellant requested reconsideration. In a September 1, 2021 

statement, she noted that her right carpal tunnel symptoms had resolved following a median nerve 

release in 1993 but recurred after she began work at the employing establishment in August 2019. 

Appellant attributed the claimed right CTS to repetitive hand and wrist movements while 

keyboarding intake assessments, chart notes, case management notes, safety plans, risk 

evaluations, treatment plans, and updates. After the COVID-19 pandemic began, her duties 

expanded to include additional typing tasks while developing curricula, revising a handbook, and 

editing documents.

Appellant submitted additional medical evidence. 

In a January 11, 2021 report, Dr. Rice noted that appellant had experienced some 

symptomatic improvement when wearing the right wrist brace but that her symptoms had recently 

increased. Appellant underwent a right wrist STT joint injection on January 12, 2021.

An electromyogram and nerve conduction velocity (EMG/NCV) study of the right upper 

extremity performed on March 4, 2021 demonstrated no active neuropathy or radiculopathy.

In a March 25, 2021 report, Dr. Morman noted the gradual onset of right wrist pain in 

September 2020, unrelated to the December 22, 2020 fall. On examination of the right wrist, she 

found tenderness to palpation along the volar aspect of the STT joint with mild tenderness at the 

CMC joint of the thumb. Dr. Morman diagnosed primary osteoarthritis of the right wrist.

On April 9, 2021 appellant underwent an intra-articular injection of the right STT joint.
4

In reports dated August 5, 2021, Dr. Morman noted treating appellant for “work-related 

right thumb CMC joint derangement for which she underwent surgical intervention on 

July 21, 2021.” She opined that appellant could no longer safely perform cardiopulmonary 

resuscitation (CPR) training or similar physical activities due to her left upper extremity issues and

recent right-hand surgery. Dr. Morman limited fine manipulation and keyboarding to four hours 

per day.

Appellant also submitted telework request forms, and physical therapy treatment notes 

dated from April 8 through September 3, 2021.

By decision dated November 15, 2021, OWCP denied modification of the prior decision. 

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 filed within the applicable time limitation 

period of FECA,4that an injury was sustained while in the performance of duty as alleged, and 

that any disability or specific 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

In an occupational disease claim, appellant’s burden of proof requires submission of 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

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 claimant, must be one of reasonable medical 

3

Supra note 1.

 

4

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.M., Docket No. 17-0284 (issued February 7, 2018); R.C., 59 ECAB 427 (2008); James E. Chadden, Sr., 40

ECAB 312 (1988).

 

6 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).

 

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 April24, 2019); T.H., 59 ECAB 388 (2008).
5

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.9

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.10

ANALYSIS

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

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

In reports dated September 22, 2020 and January 26, 2021, Dr. Darnell diagnosed right 

carpal tunnel syndrome with a prior history of the condition and surgical release . Dr. Rice, in 

reports dated November 9, 2020 and January 11, 2021, diagnosed right carpal tunnel syndrome 

with STT joint pain. Neither physician, however, addressed causal relationship. The Board has 

held that medical reports lacking an opinion on causal relationship are of no probative value. 11 

Therefore, this evidence is insufficient to establish appellant’s burden of proof.

Dr. Morman, in reports dated from February 12 through August 5, 2021, provided clinical 

findings and noted the results of imaging and diagnostic studies. She diagnosed recurrent right 

CTS with prior surgical release, osteoarthritis of the right wrist and first CMC joint, and STT joint 

arthritis of the right wrist. On July 21, 2021 Dr. Morman performed trapezial resection of the right 

thumb and wrist with thumb metacarpal suspensionplasty, right wrist partial trapezoid excision, 

and revision of right carpal tunnel release.

Dr. Morman noted on February 12 and March 25, 2021 that appellant had not injured her 

right wrist in a December 22, 2020 fall, as her symptoms had progressed gradually commencing 

in September 2020. Dr. Morman, however, indicated in a June 24, 2021 report that appellant had 

injured her right wrist in the December 22, 2020 fall. The equivocal nature of her opinion 

diminishes its probative value.12 Therefore, these reports are insufficient to establish appellant’s 

burden of proof. 

OWCP also received an EMG/NCV study of the right wrist. The Board has held that 

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

 

9 E.B., Docket No. 22-0149 (issued April26, 2022); M.V., Docket No. 18-0884 (issued December 28, 2018); I.J., 

59 ECAB 408 (2008).

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

N.H., Docket No. 21-1133 (issued February 25, 2022); J.D., Docket No. 20-0404 (issued July 22, 2020); K.G., Docket 

No. 18-1598 (issued January 7, 2020); M.S., Docket No. 19-0913 (issued November 25, 2019).

 

11 E.B., supra note 9; L.B., Docket No. 18-0533 (issued August 27, 2018); D.K., Docket No. 17-1549 (issued 

July 6, 2018).

12 P.T., Docket No. 21-0110 (issued December 8, 2021); see M.K., Docket No. 21-0520 (issued August 23, 2021).
6

do not provide an opinion as to whether the accepted employment factors caused a diagnosed 

condition.13 Consequently, this diagnostic report is also insufficient to establish appellant’s claim.

As the record does not contain rationalized medical opinion evidence sufficient to establish 

causal relationship, the Board finds that appellant has not met her burden of proof. 

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 medical 

condition causally related to the accepted employment factors. 

ORDER

IT IS HEREBY ORDERED THAT the November 15, 2021 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: September 23, 2022

Washington, DC

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board

James D. McGinley, Alternate Judge

Employees’ Compensation Appeals Board

13 E.B., supra note 9; S.W., Docket No. 21-1105 (issued December 17, 2021); W.L., Docket No. 20-1589 (issued 

August 26, 2021); A.P., Docket No. 18-1690 (issued December 12, 2019).