United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

R.B., Appellant

and

DEPARTMENT OF THE AIR FORCE, 

AIR COMBAT COMMAND, 

NELLIS AIR FORCE BASE, NV, Employer

__________________________________________

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Docket No. 22-0561

Issued: November 10, 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

VALERIE D. EVANS-HARRELL, Alternate Judge

JAMES D. McGINLEY, Alternate Judge

JURISDICTION

On March 7, 2022, appellant filed a timely appeal from a December 13, 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.2

1

5 U.S.C. § 8101 et seq.

2 The Board notes that, following the December 13, 2021 decision, OWCP received additional evidence. 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 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

On November 2, 2021 appellant, then a 31-year-old unit program coordinator, filed an 

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

to factors of her federal employment. She noted that she first became aware of her condition and 

realized its relation to her federal employment on September 20, 2021. 

In an October 26, 2021 report, Dr. Ernesto Rubio, an internist, noted that appellant had 

experienced tingling in her hands, which she believed that was work related. 

On November 3, 2021 OWCP received appellant’s August 16, 2017 official position 

description, which described clerical duties including updating computer file systems. 

In a development letter dated November 5, 2021, OWCP informed appellant of the 

deficiencies of her claim. It advised her of the type of factual and medical evidence necessary and 

provided a questionnaire for her completion. In a separate development letter of even date, OWCP 

requested that the employing establishment provide comments from a knowledgeable supervisor 

regarding the accuracy of appellant’s allegations. It afforded both parties 30 days to respond. 

Appellant submitted additional evidence. In a November 2, 2021 statement, she alleged 

that she experienced an onset of sharp right wrist pain on September 20, 2021, with a “pins and 

needles” sensation radiating through the wrist, elbow, shoulder, and into the center of her neck. 

Appellant contended that keyboarding and using a mouse were physically stressful as her 

workstation did not have an ergonomically correct keyboard, mouse, desk, chair, or foot pedal. 

In statements dated November 2 and 11, 2021, appellant attributed the development of right 

carpal tunnel syndrome and right elbow, shoulder, and right-sided neck pain to using a computer 

keyboard and mouse for 40 hours a week. She noted that she had been diagnosed with 

de Quervain’s tenosynovitis of the right hand in 2015 while working at an employing 

establishment facility in Japan. That condition had resolved with treatment within months of the 

diagnosis. Appellant described nonoccupational activities involving repetitive upper extremity 

motion of working out at a gym once per week, swimming once per month, engaging in social 

media for 30 to 60 minutes per day, and volunteering at an arts organization one hour per month.

X-rays of the right wrist and shoulder taken on November 15, 2021 were within normal 

limits. A right elbow x-ray taken on even date demonstrated a bone fragment within the joint 

space adjacent to the olecranon process indicative of an avulsion fracture. 

In reports dated November 18, 2021, Dr. Hind Elsanousy, a family practitioner, diagnosed 

tendinitis of the right elbow and wrist, right carpal tunnel syndrome, and right shoulder 

bursitis/strain. She opined that these conditions had been caused by repetitive upper extremity 

motion while at work. Dr. Elsanousy prescribed medication, a right elbow brace, a right wrist 

splint, and ordered imaging studies. She recommended that appellant use an ergonomic keyboard 
3

and wrist support. Dr. Elsanousy also noted work restrictions through December 3, 2021 limiting

lifting to 10 pounds, no reaching above shoulder level, no carrying, and no pushing. 

On November 23, 2021 OWCP received November 15, 2021 reports by Keshavan

Kodandapani, a nurse practitioner. 

By decision dated December 13, 2021, 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.

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 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.4 These are the essential elements of every compensation claim 

regardless of whether the claim is predicated on a traumatic injury or an occupational disease. 5

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.”

6

 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 diagnosed condition is causally related to 

the employment factors identified by the claimant.7

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.8 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 

3

Supra note 1.

4

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

ECAB 312 (1988).

5 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).

6

20 C.F.R. §10.5(q).

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 April4, 2019); T.H., 59 ECAB 388 (2008).
4

between the diagnosed condition and specific employment activity or 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 right upper 

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

Dr. Rubio, in his November 2, 2021 report, noted that appellant believed that her bilateral 

hand tingling was work related, but did not offer an opinion as to whether her employment duties 

caused or aggravated any medical condition. 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.11 As 

such, Dr. Rubio’s report is insufficient to meet appellant’s burden of proof.

In her November 18, 2021 reports, Dr. Elsanousy diagnosed tendinitis of the right elbow 

and wrist, right carpal tunnel syndrome, and right shoulder bursitis/strain. She prescribed 

medication, wrist and elbow braces, and ordered imaging studies. While Dr. Elsanousy opined 

that appellant’s diagnosed conditions were related to repetitive upper extremity motion at work, 

she did not provide rationale explaining her conclusion. The Board has held that a report is of 

limited probative value regarding causal relationship if it does not contain medic al rationale 

explaining how a given medical condition/disability was related to employment factors. 12 As such, 

these reports are insufficient to establish appellant’s claim. 

OWCP also received November 15, 2021 reports by Mr. Kodandapani, a nurse 

practitioner. The Board has held that certain healthcare providers such as physician assistants and 

nurse practitioners are not considered physicians as defined under FECA. 13 Consequently, their 

9 M.T., Docket No. 20-0184 (issued June 24, 2022); M.V., Docket No. 18-0884 (issued December 28, 2018); I.J., 

59 ECAB 408 (2008); A.D., 58 ECAB 149 (2006).

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

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

12 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).

13 Section 8102(2) of FECA provides as follows: (2) 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. § 8102(2); 20 C.F.R. § 10.5(t). See Federal (FECA) Procedure Manual, Part 2 -- Claims,

Causal Relationship, Chapter 2.805.3a(1) (January 2013) 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); see also J.D., Docket No. 21-0164 (issued June 15, 2021) (nurse practitioners are not considered 

physicians as defined under FECA). 
5

medical findings and/or opinions will not suffice for purposes of establishing entitlement to FECA 

benefits. Thus, this evidence is of no probative value and is insufficient to establish appellant’s 

recurrence claim.

The remaining evidence of record consists of diagnostic study 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.14 Thus, this evidence is also insufficient to establish appellant’s claim.

As the medical evidence of record is insufficient to establish a right upper extremity 

condition causally related to factors of her federal employment, 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.

CONCLUSION

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.

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

IT IS HEREBY ORDERED THAT the December 13, 2021 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: November 10, 2022

Washington, DC

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board

James D. McGinley, Alternate Judge

Employees’ Compensation Appeals Board