United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

M.T., Appellant

and

U.S. POSTAL SERVICE, MORGAN 

PROCESSING & DISTRIBUTION CENTER, 

New York, NY, Employer

__________________________________________

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Docket No. 20-0184

Issued: June 24, 2022

Appearances: Case Submitted on the Record

Paul Kalker, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

PATRICIA H. FITZGERALD, Deputy Chief Judge

JAMES D. McGINLEY, Alternate Judge

JURISDICTION

On October 31, 2019 appellant, through counsel, filed a timely appeal from an October 10, 

2019 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 to consider 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 her burden of proof to establish a right upper 

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

FACTUAL HISTORY

This case has previously been before the Board.3 The facts and circumstances of the case 

as set forth in the Board’s prior order are incorporated herein by reference. The relevant facts are 

as follows.

On June 15, 2017 appellant, then a 71-year-old expeditor, filed an occupational disease 

claim (Form CA-2) alleging that she developed a right hand and wrist condition due to factors of 

her federal employment, including repetitive scanning, placement of placards, and unloading of 

pallets.4 She noted that she first became aware of her condition and its relation to her federal 

employment on May 11, 2017. Appellant stopped work on that date. 

On February 15 and March 28, 2017 Dr. Steven Lee, a Board-certified orthopedic surgeon, 

diagnosed TFCC sprain and degenerative joint disease of the right hand as a result of appellant’s

accepted March 16, 2016 traumatic injury under OWCP File No. xxxxxx059. He reported that she

felt the need to take approximately two days a week off work to recover from her symp toms. 

Dr. Lee advised appellant to avoid overuse, gripping, lifting, and carrying.

In notes dated May 9, 2017, Dr. Lee expanded his diagnoses to include right carpal tunnel 

syndrome (CTS) and cervical radiculopathy. He recommended a repeat electromyogram (EMG) 

and nerve conduction velocity studies and recounted that appellant believed that the benefits from 

physical therapy were negated when she returned to work. Dr. Lee found that she was totally 

disabled from work through June 20, 2017. He directed appellant to keep her wrist in a neutral 

position during the day, while sleeping, and to avoid leaning on her wrist, and push-up type 

3 Order Remanding Case, Docket No. 18-1131 (issued June12, 2019).

4 Appellant previously sustained employment injuries on April 23, 1992, October 1, 1996, January12, 1998, and 

April 22, 2015, which OWCP accepted for right trigger thumb, right de Quervain’s tenosynovitis, right shoulder 

sprain, aggravation of cervical radiculitis or brachial neuritis, andlumbar sprain/strain. She returned to light duty four 

hours a day on September 22, 2005. By decision dated February 27, 2006, OWCP reduced appellant’s wage-loss 

compensation based on her actual earnings in the light-duty position. Appellant returned to full-duty work on 

May 19, 2015. On March16, 2016 she filed a traumatic injury claim (Form CA-1) alleging on that date an elevator 

door hit her right hand and wrist while she was in the performance of duty. On May 4, 2016 OWCP accepted the 

claim, assigned OWCP File No. xxxxxx059, for right wrist triangular fibrocartilage complex (TFCC) tear. Appellant 

returned to light-duty work for eight hours a day on May 7, 2016. On June 24, 2016 OWCP authorized right wrist 

arthroscopy. Appellant stopped work on August 1, 2016, but declined surgery on November 16, 2016. On 

September 20, 2016 she filed a notice of recurrence (Form CA-2a) alleging that, beginning on August 10, 2016,she 

lost time from work due to her March 16, 2016 employment injury. On August 15, 2017 OWCP authorized right wrist 

arthroscopy TFCC tear repair or debridement, ulna shortening, endoscopic carpal tunnel release, and de Quervain’s 

surgical release. 
3

positions.

5

 On July 5, 2017 Dr. Lee noted that the EMG study was normal and that the appellant 

wished to continue with physical therapy rather than surgery.

In a July 27, 2017 development letter, OWCP informed appellant of the deficiencies of her 

claim. It advised her of the type of factual and medical evidence needed and provided a 

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

On August 10, 2017 appellant responded to OWCP’s development letter and reported that 

she had performed repetitive duties with her right hand during the 32 years she had worked at the 

employing establishment. She further noted that her March 16, 2016 right wrist injury was 

accepted by OWCP under OWCP File No. xxxxxx059 for right wrist TFCC tear when her wrist 

was struck by an elevator door, which resulted in her inability to work for more than 45 days.

On September 12, 2017 Dr. Lee noted that appellant’s pain had worsened since her last 

visit. He again instructed her to avoid overuse, gripping, lifting, and carrying activities.

By decision dated September 26, 2017, OWCP denied appellant’s occupational disease 

claim, finding that the medical evidence of record was insufficient to establish causal relationship 

between her diagnosed conditions and the accepted factors of her federal employment.

On December 13, 2017 appellant, through counsel, requested reconsideration of the 

September 26, 2017 decision. 

Appellant submitted a report from Dr. Lee dated September 20, 2017 in which he described 

her history of traumatic injury on March 16, 2016 accepted for right wrist TFCC tear under OWCP 

File No. xxxxxx059 and her treatment history. Dr. Lee further noted that she had right wrist 

surgery in 2009 consisting of distal radius open reduction and internal fixation. He provided his 

findings on physical examination on September 12, 2017, including significant tenderness over 

the area of the TFCC, significant tenderness overlaying the right trigger thumb, and right middle 

finger with positive clicking and locking. Dr. Lee reported normal strength of the median radial 

and ulnar nerves with symmetric range of motion. He diagnosed large TFCC tear causing 

ulnar-sided wrist pain. Dr. Lee noted that, from January 4 through September 12, 2017, appellant 

had informed him that her right wrist pain had worsened and attributed this change in symptoms 

to her return to employment duties. Appellant asserted that she could not go back to work in her 

usual position using a scanner for over eight hours a day. Dr. Lee repeatedly informed appellant 

that surgery due to the March 16, 2016 traumatic injury under OWCP File No. xxxxxx059 was a 

possible option. He noted that her original diagnosis appeared to be related to her TFCC tear, and 

that she had developed ulnar impaction as well as basal joint arthritis and some right thumb 

triggering and potential nerve issues, as well as right middle finger triggering and de Quervain’s 

tenosynovitis. Dr. Lee concluded that, due to appellant’s persistent pain and tenderness, she was 

unable to perform her full duties without aggravating her condition further and opined that she was 

70 percent disabled.

5 On August 24, 2016 appellant underwent an EMG, which found no evidence of right CTS, Guyon’s canal 

syndrome or cervical radiculopathy.
4

By decision dated March 13, 2018, OWCP denied modification of its prior decision. 

On July 3, 2018 Dr. Lee released appellant to return to work with restrictions including no 

scanning more than three hours a day, no pulling tape, no lifting over five pounds, and no 

continuous repetitive movements of her bilateral wrist in addition to avoiding overuse, gripping, 

lifting, and carrying activities. In a September 10, 2018 note, he again advised her to avoid 

overuse, gripping, lifting, and carrying activities. Dr. Lee completed notes dated August 28 

through November 27, 2018 and January 29 through October 8, 2019 repeating his 

recommendations regarding avoidance of gripping, lifting, and carrying.

Appellant, through counsel, appealed the March 13, 2018 decision to the Board. By order 

dated May 14, 2018, the Board directed OWCP to administratively combine her claim files and

issue a de novo decision.

6

 Thereafter, OWCP administratively combined OWCP File Nos. 

xxxxxx059, xxxxxx967, xxxxxx971, and OWCP File No. xxxxxx549, with OWCP File No. 

xxxxxx059 serving as the master file.

By decision dated October 10, 2019, OWCP again denied modification.

LEGAL PRECEDENT

An employee seeking benefits under FECA7 has the burden of proof to establish the 

essential elements of his or her claim by the weight of the reliable, probative and substantial 

evidence, including the fact that the individual is an “employee of the United States” within the 

meaning of FECA and that the claim was timely filed within the applicable time limitation period 

of FECA, that an injury was sustained 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.8 These are the essential elements of every compensation claim regardless of whether the 

claim is predicated on a traumatic injury or an occupational disease. 9

OWCP’s regulations define an occupational disease as “a condition produced by the work 

environment over a period longer than a single workday or shift.”

10

 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 condition for which compensation is 

claimed; and (3) medical evidence establishing that the employment factors identified by the 

claimant were the proximate cause of the condition for which compensation is claimed or, stated 

6

Supra note 3.

7

Supra note 2.

8

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

ECAB 312 (1988).

9 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).

10 20 C.F.R. §10.5(q).
5

differently, medical evidence establishing that the diagnosed condition is causally related to the 

employment factors identified by the claimant.11 

The evidence required to establish causal relationship is rationalized medical opinion 

evidence, based upon a complete factual and medical background, showing a causal relationship 

between the claimed condition and identified factors.12 The opinion of the physician must be based 

on a complete factual and medical background of the claim, 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 specific employment activity or factors identified by the 

claimant.13

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.14

ANALYSIS

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

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

In reports dated August 10 to September 20, 2016, Dr. Lee noted appellant’s continued 

complaints of ongoing right wrist tenderness and pain and diagnosed CTS, and sprain of the right 

TFCC. While he provided medical diagnoses, he did not offer a specific opinion as to whether her

employment duties caused or aggravated her additional right wrist conditions.15 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.16 As such, these reports are insufficient to meet appellant’s 

burden of proof. In notes dated February 15 to September 12, 2017, Dr. Lee related that 

appellant’s preexisting right wrist condition was aggravated by her work activity, as she had 

difficulty performing her job duties using only her nondominant left upper extremity. He 

additionally diagnosed degenerative joint disease of the right hand and provided work restrictions. 

However, Dr. Lee did not provide an opinion on causal relationship between appellant’s diagnosed 

conditions and the accepted employment factors.

17

 As such, this evidence is of no probative value 

and is insufficient to establish the claim. 

11 S.C., Docket No. 18-1242 (issued March 13, 2019); R.H., 59 ECAB 382 (2008).

12 A.M., Docket No. 18-1748 (issued April4, 2019); T.H., 59 ECAB 388 (2008).

13 M.V., Docket No. 18-0884 (issued December 28, 2018); I.J., 59 ECAB 408 (2008); A.D., 58 ECAB 149 (2006).

14 L.B., Docket No. 20-0462 (issued August 18, 2020).

15 L.G., Docket No. 20-0433 (issued August 6, 2020).

16 L.B., Docket No. 18-0533 (issued August 27, 2018); D.K., Docket No. 17-1549 (issued July 6, 2018).

17 Id.
6

In his September 20, 2017 report, Dr. Lee discussed appellant’s previous traumatic injury 

of TFCC tear and diagnose ulnar impaction, basal joint arthritis, some right thumb triggering and 

potential nerve issues, right middle finger triggering and de Quervain’s tenosynovitis. He found 

that she was unable to perform her full duties without aggravating her underlying con ditions. 

While Dr. Lee opined that appellant’s diagnosed conditions were work-related, he did not provide 

rationale explaining his conclusion. The Board has held that a report is of limited probative value 

regarding causal relationship if it does not contain medical rationale explaining how a given 

medical condition/disability was related to employment factors.18 

In notes dated October 2 through December 5, 2017 and January 8 and February 14, 2018,

Dr. Lee repeated his findings, diagnoses, and continued recommendation for surgery. He did not 

provide a medical opinion that the diagnosed conditions were causally related to appellant’s 

accepted employment factors.

19

 Therefore, this evidence is insufficient to meet her burden of 

proof. 

In notes dated July 3 through November 27, 2018 and January 29 through October 8, 2019,

Dr. Lee provided medical diagnoses and restrictions on her work duties, but did not provide a

medical opinion on causal relationship between appellant’s diagnosed conditions and the accepted 

employment factors.

20

 Accordingly, his reports are of no probative value and are insufficient to 

meet appellant’s burden of proof to establish her occupational disease claim.

The remaining evidence of record consists of diagnostic testing reports. The Board has 

held, however, that diagnostic studies, standing alone, lack probative value on the issue of causal 

relationship as they do not address whether the accepted employment factors caused the diagnosed 

conditions.21

As appellant has not submitted sufficient rationalized medical evidence to establish causal 

relationship, the Board finds that she has not met her burden of proof to establish her occupational 

disease 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.

18 See Y.D., Docket No. 16-1896 (issued February 10, 2017) (finding that a report is of limited probative value 

regarding causal relationship if it does not contain medical rationale describing the relation between work factors and 

a diagnosed condition/disability).

19 Id.

20 Id.

21 R.S., Docket No. 19-1774 (issued April3, 2020); J.P., Docket No. 19-0216 (issued December 13, 2019).
7

CONCLUSION

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

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

ORDER

IT IS HEREBY ORDERED THAT the October 10, 2019 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: June 24, 2022

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

James D. McGinley, Alternate Judge

Employees’ Compensation Appeals Board