United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

M.R., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Tampa, FL, Employer

__________________________________________

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Docket No. 22-0038

Issued: June 6, 2022

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant1

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 October 11, 2021 appellant, through counsel, filed a timely appeal from a September 8, 

2021 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 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.

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

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 decisions are incorporated herein by reference. The relevant facts 

are as follows.

On July 9, 2015 appellant, then a 50-year-old retired letter sorting machine (LSM)

operator, manual clerk, and automationoperator,filed an occupational disease claim (Form CA-2) 

alleging that she developed bilateral carpal tunnel syndrome due to factors of her federal 

employment. She noted that she first became aware of her claimed condition on July 25, 2013

and realized its relationship to her federal employment on April 15, 2015. On the reverse side of

the claim form a supervisor advised that appellant retired on disability effective March 26, 2001. 

The official reported that appellant first notified her supervisor about her claimed injury on 

August 11, 2015.

In a June 16, 2015 statement, appellant asserted that her claimed bilateral upper extremity 

condition developed over years of working at the employing establishment. She reported thatshe 

first began having problems with her hands on July 25, 2013, but was not conclusively diagnosed 

with bilateral carpal tunnel syndrome until April 15, 2015. Appellant advised that herwork duties 

as an LSM operator involved pushing/pulling heavy containers weighing approximately 600 

pounds,removingtraysfrom letter cages, droppingmail on a ledge, pulling mail down by reaching 

overhead, and bending down to place sleeves on mail trays. She also described her other work 

duties, which involved casing mail, moving containers, grasping handfuls of mail/magazines, 

bundling mail, filling mail trays, pushing/pulling cages, throwing bundles of magazines weighing 

15 to 25 pounds into bins, and picking up and throwing sacks weighing in excess of 120 pounds. 

Appellant reported thatshe worked for the employing establishment for approximately 13 years 

and asserted thatthe repetitive use of her hands, wrists, arms, and fingers causedher bilateral upper 

extremity condition to develop over time.

Appellant submitted a March 26, 2001 notification of personnel action (PS Form 50), 

which indicated that her last day in active pay status was March 15, 1999 after which she went on 

disability retirement. She also submitted the findings of an April 16, 2015 electromyogram and 

nerve conduction velocity (EMG/NCV) study of her upper extremities, which revealed abnormal 

findings of delayed peak latency readings involving both median nerves. The results were 

deemed to be suggestive of bilateral carpal tunnel syndrome.

In an August 17, 2015 development letter, OWCP informed appellant of the deficiencies 

of her claim. It advised her of the type of additional evidence needed and provided a questionnaire

for her completion. By separate development letter of even date, OWCP requested additional 

information from the employing establishment, including comments from a knowledgeable 

supervisor. It afforded both parties 30 days to respond. 

In response, the employing establishment submitted an August 27, 2015 statement in

which appellant’sformersupervisor provided a description of appellant’swork duties, which was

similar to that provided by appellant in her June 16, 2015 statement.

3 Docket No. 18-0164 (issued May 23, 2018); Docket No. 19-1954 (issued March 1, 2021).
3

By decision dated September 24, 2015, OWCP denied appellant’s claim, finding that it

was untimely filed. On October 13, 2015 appellant, through counsel, requested reconsideration 

and, by decision dated July 1, 2016, OWCP denied modification of its September 24, 2015 

decision. On June 23, 2017 appellant, through counsel, again requested reconsideration and, by

decision dated August 18, 2017, OWCP denied appellant’s request for reconsideration of the

merits of her claim pursuant to 5 U.S.C. § 8128(a). 

Appellant appealed to the Board and, by decision dated May 23, 2018,4the Board set aside 

the August 18, 2017 decision, finding that appellant had presented a new and relevant legal

argument on reconsideration. The Board remanded the case to OWCP for a merit review to be 

followed by the issuance of an appropriate decision.

By decision dated August 14, 2018, OWCP modified its prior decision, finding that

appellant had filed a timely occupational disease claim alleging a bilateral upper extremity injury

and had established employment factors in the form of the repetitive motion required by her

work duties. However, appellant’s claim remained denied because she failed to submit a

medical report relating a diagnosed condition to the accepted employment factors.

On July 29, 2019 appellant, through counsel, requested reconsideration of the August 14, 

2018 decision. She submitted a November 27, 2018 report from Dr. Robert R. Reppy, an 

osteopath Board-certified in family medicine, who noted that she reported sustaining bilateral 

carpal tunnel syndrome due to years of repetitive keying on a mailsorting machine, casing mail, 

and pushing/pulling heavy equipment while working for the employing establishment. Dr. Reppy

indicated that appellant had a positive Tinel’s sign and negative Phalen’s sign bilaterally, and 

diagnosed bilateral carpal tunnel syndrome.

In a January 28, 2019 report, Dr. Reppy provided findings for bilateral grip and pinch 

strength and diagnosed bilateral carpal tunnelsyndrome. In a March 13, 2019 report, he opined

that a February 6, 2019 EMG/NCV study revealed abnormal findings, including decreased

amplitude signal of the right ulnar nerve and reduced conduction velocity of the left median nerve.

Dr. Reppy again diagnosed bilateral carpal tunnel syndrome.

In a July 11, 2019 report, Dr.Reppy noted that, in July 2015,appellantfiled an occupational 

disease claim, alleging that years of repetitive motion keying on an LSM, casing mail, and 

pushing/pulling heavy equipment had damaged her wrists and hands. He discussed appellant’s 

upper extremity symptoms and indicated that she had no prior history of similar symptoms. 

Dr. Reppy noted, “The patient’s injury was caused by her workplace while she was in

performance of her duties at the [employing establishment], Tampa.” He indicated that the

repetitive nature of appellant’s lifting, keying, and sorting tasks at work caused the damage to her

median nerves over time. Dr. Reppy maintained that these tasks were a common and wellunderstood cause of carpal tunnel syndrome, noting that the medical literature was replete with

similar cases. He referenced a medical journal abstract, which described carpal tunnel syndrome 

as arising from compression of the median nerve where it passed through the carpal tunnel in the 

wrist and as being characterized by sensory and, less commonly, motor symptoms and signs in the 

peripheral distribution of the median nerve. Dr. Reppy indicated that the medical literature

concluded that there was evidence of positive association of carpal tunnel syndrome with work

4 Docket No. 18-0164 (issued May 23, 2018).
4

entailing highly repetitive or forceful movement of the hands. He noted, “Repetitive gripping is

precisely the action required of appellant in her employment as [an LSM] operator, and she did it

for years.” Dr. Reppy further advised that carpaltunnelsyndrome was comprised of sensory and 

motor features in the median nerve distribution of the hand, including delayed nerve conduction 

and gradual onset of numbness/tingling and pain in that distribution. He indicated, “This exactly 

matches the symptomatology reported by this patient.”

By decision dated August 27, 2019, OWCP affirmed its August 14, 2018 decision as 

modified to reflect that appellant had submitted medical evidence addressing causal relationship 

to the claimed condition, but that it was insufficient to establish a bilateral upper extremity 

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

Appellant appealedto the Board and, by decision dated March 1, 2021,5theBoard affirmed 

OWCP’s August 27, 2019 decision.

On June 15 2021 appellant, through counsel, requested reconsideration.

Appellant submitted an April 29, 2021 report in which Dr. Reppy indicated that, in

July 2015, she alleged that years of repetitive motion keying on an LSM, casing mail, and

pushing/pulling heavy equipment had damaged her wrists and hands. Dr. Reppy advised that 

appellant reported pain in her wrists and hands as well as loss of grip strength and noted thatshe 

had no prior history of similar symptoms. He maintained that appellant’s upper extremity 

condition “was caused by her workplace” while she was in performance of her duties. Dr. Reppy

opined that the repetitive nature of appellant’s lifting, keying, and sorting tasks at work caused the

damage to her median nerves over time. He discussed medical literature, which explained that

there was evidence of positive association of carpal tunnel syndrome with work entailing highly

repetitive/forcefulmovement of the hands and repetitive gripping. Dr. Reppy noted that repetitive

gripping was the action required of appellant in her employment as an LSM operator for years. 

He indicated that conditions that decreased the carpal tunnel’s size, or swelled the structures in

the tunnel, served to compress the median nerve against the transverse ligament bounding the

tunnel’s roof. Dr. Reppy maintained that such circumstances could arise traumatically, as was

the case for appellant. He advised that carpal tunnel syndrome was caused by extreme

flexion/extension of the wrist, which increased the pressure in the carpal tunnel sufficiently to

impair blood perfusion of the median nerve. Dr. Reppy found that the same mechanism applied

in appellant’s case. He indicated that his opinion was “based on my medical experience, objective

evidence, and my examination of the patient.”

Appellant submitted a report of May 3, 2021 EMG/NCV testing of her upper extremities. 

She also submitted photographs of her former workplace and further descriptions of her work 

duties.

By decision dated September 8, 2021, OWCP denied modification of its prior decision, 

finding that appellant did not submit sufficient medical evidence to establish a bilateral upper

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

5 Docket No. 19-1954 (issued March 1, 2021).
5

LEGAL PRECEDENT

An employee seeking benefits under FECA6 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 filed within the applicable time 

limitation, that 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.7 These are the essential elements of every compensation claim regardless of 

whether the claim is predicated upon a traumatic injury or an occupational disease. 8

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 o f 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 employmentfactors.9

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.10 A physician’s opinion on whether there is causal relationship 

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

complete factual and medical background.11 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).12

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.

The Board preliminarily notes that it is unnecessary to consider the evidence appellant 

submitted prior to the issuance of OWCP’s August 27, 2019 decision, which was considered by 

the Board in its March 1, 2021 decision, which affirmed OWCP’s denial of appellant’s claim. 

6

Supra note 2.

7 E.S., Docket No. 18-1580 (issued January 23, 2020); M.E., Docket No. 18-1135 (issued January 4, 2019); C.S., 

Docket No. 08-1585 (issued March 3, 2009); Bonnie A. Contreras, 57 ECAB 364 (2006).

8 E.S., id.; S.P., 59 ECAB 184 (2007); Joe D. Cameron, 41 ECAB 153 (1989); Elaine Pendleton, 40 ECAB 

1143 (1989).

9 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).

10 W.M., Docket No. 14-1853 (issued May 13, 2020); T.H., 59 ECAB 388, 393 (2008); RobertG. Morris, 48 ECAB 

238 (1996).

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

12 Id.; Victor J. Woodhams, supra note 9.
6

Findings made in prior Board decisions are res judicata and cannot be considered absent further 

merit review by OWCP under section 8128 of FECA.13

Appellant submitted an April 29, 2021 report in which Dr. Reppy indicated that, in

July 2015, appellant alleged that years of repetitive motion keying on an LSM, casing mail, and

pushing/pulling heavy equipment had damaged her wrists and hands. Dr. Reppy maintained 

that appellant’s upper extremity condition “was caused by her workplace” while she was in the 

performance of her duties. He opined that the repetitive nature of appellant’s lifting, keying, and

sorting tasks at work caused the damage to her median nerves over time. Dr. Reppy discussed

medical literature, which explained that there was evidence of positive association of carpal

tunnel syndrome with work entailing highly repetitive/forceful movement of the hands and

repetitive gripping. He noted that repetitive gripping was the action required of appellant in her

employment as an LSM operator for years. Dr. Reppy indicated that conditions that decreased

the carpal tunnel’s size, or swelled the structures in the tunnel, served to compress the median

nerve against the transverse ligament bounding the tunnel’s roof. He maintained that such

circumstances could arise traumatically, as was the case for appellant. Dr. Reppy advised that

carpaltunnelsyndrome was caused by extreme flexion/extension of the wrist, which increased the

pressure in the carpal tunnel sufficiently to impair blood perfusion of the median nerve. He

found that the same mechanism applied in appellant’s case.

The Board finds that Dr. Reppy’s April 29, 2021 report is of limited probative value with 

respect to appellant’s claim for an employment-related upper extremity condition. Dr. Reppy did 

not describe appellant’s work duties in detail or provide adequate medical rationale in support of 

his opinion that appellant’s work duties caused bilateral carpal tunnel syndrome. Although he 

noted that appellant engaged in such activities as grasping and lifting mail, Dr. Reppy did not

provide sufficient detail regarding the frequency she performed such duties over the years she

worked for the employing establishment. He referenced medical literature of general

application regarding carpal tunnel syndrome, but he did not adequately describe the medical

mechanism for an upper extremity injury in appellant’s specific case. The Board has held that a

report is of limited probative value regarding causal relationship if it does not contain medical

rationale explaining how an employment activity could have caused or aggravated a medical 

condition.14 Therefore, Dr. Reppy’s April 29, 2021 report is insufficient to establish appellant’s 

claim.

Appellant also submitted the findings of May 3, 2021 EMG/NCV testing of her upper 

extremities. However, diagnostic studies lack probative value on causal relationship as they do 

not address whether employment factors caused the diagnosed condition. 15

13 C.M., Docket No. 19-1211 (issued August5, 2020); C.D., Docket No. 19-1973 (issued May 21, 2020); M.D.,

Docket No. 20-0007 (issued May 13, 2020); ClintonE. Anthony, Jr., 49 ECAB 476 (1998).

14 Y.D., Docket No. 16-1896 (issued February 10, 2017).

15 C.S., Docket No. 19-1279 (issued December 30, 2019). Appellant also submitted photographs of her former 

workplace and further descriptions of her work duties. However, this evidence is not relevant as the underlying issue 

in this case is medical in nature.
7

As appellant has not submitted rationalized medical evidence establishing causal

relationship between her diagnosed conditions and the accepted factors of her federal

employment, the Board finds thatshe 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 bilateral

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

ORDER

IT IS HEREBY ORDERED THAT the September 8, 2021 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: June 6, 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