United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

S.V., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

San Juan, PR, Employer

__________________________________________

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Docket No. 22-1010

Issued: February 21, 2023

Appearances: Case Submitted on the Record

James D. Muirhead, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

PATRICIA H. FITZGERALD, Deputy Chief Judge

JANICE B. ASKIN, Judge

JAMES D. McGINLEY, Alternate Judge

JURISDICTION

On June 21, 2022 appellant, through counsel, filed a timely appeal from a March 14, 2022 

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.

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 wrist condition

causally related to her accepted September 8, 2020 employment incident. 

FACTUAL HISTORY

On September 30, 2020 appellant, then a 53-year-old mail handler assistant, filed a 

traumatic injury claim (Form CA-1) alleging that on September 8, 2020 she developed swollen 

right hand tendons and bilateral fingers when she felt a strong click on her right hand, and pain in 

both hands while managing a 70-pound bag full of parcels at the Automatic Parcel and Bundle

Sorter (APBS) machine in the performance of duty. 

A September 28, 2020 ultrasound of appellant’s right wrist indicated a thickened median 

nerve, possibly due to carpal tunnel syndrome and arthritis of the wrist.

In an October 12, 2020 report, Dr. Eric R. Javier, a physiatrist, diagnosed right wrist carpal 

tunnel syndrome and median nerve entrapment at the wrist. He provided temporary restrictions

for sedentary to light-duty positions. Dr. Javier advised, in a separate note dated October 12, 2020, 

that appellant could return to work October 26, 2020. 

OWCP also received an undated statement from appellant and an October 12, 2020 request 

for reasonable accommodation.

On November 23, 2020 Dr. Javier continued to provide light-duty restrictions. 

On December 7, 2020 OWCP received an October 8, 2020 letter, wherein the employing 

establishment controverted appellant’s claim. It contended that she was hired on August 1, 2020

and that she alleged that her injury occurred within weeks of her hire.

OWCP, in a development letter dated December 7, 2020, informed appellant of the 

deficiencies of her traumatic injury claim. It advised her of the type of factual and medical 

evidence necessary to establish her claim and afforded her 30 days to respond. 

In a December 9, 2020 response, appellant again described the September 8, 2020 incident 

and requested modified duty. 

OWCP also received a September 11, 2020 x-ray of appellant’s hands, which revealed

normal findings.

In a December 10, 2020 report, Dr. Javier indicated that appellant has been under his care 

since September 22, 2020 for a September 8, 2020 work-related injury when she felt a click on her 

right hand, and numbness and pain in both hands, while placing a 70-pound bag full of parcels 

onto a general post cart. He noted that her physical examination findings indicated positive 

bilateral Tinel’s and Phalen’s tests, decreased range of motion, and decreased sensation of the 

hands at the median nerve distribution. Dr. Javier diagnosed bilateral wrist tendinitis and bilateral 

carpal tunnel syndrome. He also noted that appellant was seen for a follow up on October 12, 

2020 following a sonogram, which noted thickening of the median nerve and mild arthritis. 
3

Dr. Javier opined that, based on medical literature’s definition of causation, her conditions were 

causally related to the September 9, 2020 work incident. He indicated that patients with chronic 

degenerative changes frequently develop exacerbations of pain, spasms, loss of motion and/or 

dysfunction and patients with hand and wrist problems who engage in repetitive vigorous heavy 

activities may develop swelling, pain and stiffness at the wrist and flexor tendons that causes 

median nerve entrapment (carpal tunnel syndrome). Dr. Javier, thus, opined that appellant suffered 

a repetitive injury and required work modification. 

By decision dated January 6, 2021, OWCP denied appellant’s claim. It found that the 

September 8, 2020 employment incident occurred as alleged, but that the medical evidence of 

record was insufficient to establish a medical condition causally related to the accepted 

employment incident.

On January 13, 2021 appellant requested a review of the written record by a representative 

of OWCP’s Branch of Hearings and Review. 

Appellant submitted a January 12, 2021

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report, wherein Dr. Javier indicated that appellant 

had worked at the APBS machine continuously for more than six days. Dr. Javier opined that,

based on scientific based medicine and the definition of causation from scientific literature,

appellant suffered a repetitive injury to her hands and wrists due to repetitive vigorous heavy 

activities, which caused swelling, pain and stiffness at the wrist and flexor tendons that caused 

median nerve entrapment (carpal tunnel syndrome). 

OWCP also received a copy of a January 13, 2021 electromyogram and nerve conduction 

velocity (EMG/NCV) testing. 

By decision dated February 26, 2021, OWCP’s hearing representative affirmed the 

January 6, 2021 decision. 

On December 27, 2021 appellant, through counsel, requested reconsideration. OWCP 

received a partial copy of an article entitled, “How Long Does it Take Somebody to Develop 

Carpal Tunnel?”

In an April 28, 2021 report, Dr. Javier opined that appellant suffered a work-related injury 

on September 8, 2020 while working at the APBS machines, and was diagnosed with bilateral 

wrist tendinitis, bilateral carpal tunnel syndrome and mild grade 1 degenerative arthritis. He 

indicated that her mild degenerative arthritis changes were not the cause of her carpal tunnel 

syndrome, and did not contribute to her symptoms. Dr. Javier again reiterated that medical and 

scientifically-based literature supported a conclusion that as appellant worked at the PBSM 

continuously for more than six days, she developed a cumulative trauma disorder that was known 

to most commonly affect muscle tendons and nerves. He noted that, while symptoms tend to 

develop over a period of weeks or months, multiple personal and work factors are involved in 

upper limb disorders and that carpal tunnel syndrome can be caused, in part or in whole, by adverse 

working conditions. Dr. Javier noted that appellant had several workplace risk factors at the time 

of her injury, including high repetition, high force and awkward wrist posture, and that her 

3 The report dated January 12, 2020 appears to be a typographical error as the injury occurred on September 8, 2020. 
4

threshold limit value for hand activity level and her strain index for the job was high. He noted 

that the combination of risk factors were strong evidence that demonstrated that the highest rates 

of carpal tunnel syndrome occur in occupations with high upper extremity physical demands. 

Dr. Javier, thus, concluded that using the medical and scientific definitions, along with the 

objective findings in the sonogram and EMG/NCV study, appellant’s carpal tunnel syndrome was 

causally related to her work. 

By decision dated March 14, 2022, OWCP denied modification of the February 26, 2021 

decision. 

LEGAL PRECEDENT

An employee seeking benefits under FECA4 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 timely filed within the applicable time 

limitation of FECA,5that an injury was sustained in the performance of duty, as alleged, and that 

any disability or medical condition for which compensation is claimed is causally related to the 

employment injury.6 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.7

To determine whether a federal employee has sustained a traumatic injury in the 

performance of duty, OWCP must first determine whether fact of injury has been established.8 

There are two components involved in establishing fact of injury. First, the employee must submit 

sufficient evidence to establish that he or she actually experienced the employment incident at the 

time, place, and in the manner alleged.9 Second, the employee must submit evidence, in the form 

of probative medical evidence, to establish that the employment incident caused a personal 

injury.10

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.11 A physician’s opinion on whether there is a causal relationship 

4 Supra note 2.

5 See J.K., Docket No. 20-0527 (issued May 24, 2022); J.C., Docket No. 20-0882 (issued June 23, 2021); S.B., 

Docket No. 17-1779 (issued February 7, 2018); J.P., 59 ECAB 178 (2007); Joe D. Cameron, 41 ECAB 153 (1989).

6

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

Chadden, Sr., 40 ECAB 312 (1988).

7 R.R., Docket No. 19-0048 (issued April 25, 2019); K.M., Docket No. 15-1660 (issued September 16, 2016); L.M., 

Docket No. 13-1402 (issued February 7, 2014); Delores C. Ellyett, 41 ECAB 992 (1990).

8 D.B., Docket No. 18-1348 (issued January 4, 2019); S.P., 59 ECAB 184 (2007).

9 D.S., Docket No. 17-1422 (issued November 9, 2017); Bonnie A. Contreras, 57 ECAB 364 (2006).

10 B.M., Docket No. 17-0796 (issued July 5, 2018); David Apgar, 57 ECAB 137 (2005); John J. Carlone, 41 ECAB 

354 (1989).

11 E.M., Docket No. 18-1599 (issued March 7, 2019); Robert G. Morris, 48 ECAB 238 (1996).
5

between the diagnosed condition and the employment injury must be based on a complete factual 

and medical background.12 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 employment injury.13

In a case in which 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 wrist condition 

causally related to her accepted September 8, 2020 employment injury. 

OWCP received several reports from Dr. Javier. In his October 12, 2020 report, Dr. Javier 

diagnosed right carpal tunnel syndrome. This report, however, is of no probative value because 

he failed to offer an opinion on causal relationship.15 Thus, this report is insufficient to meet 

appellant’s burden of proof.

In his December 10, 2020 and January 12, 2021 reports, Dr. Javier indicated that appellant 

was working at the APBS machine continuously for more than six days and, based on scientific 

and medical literature, she suffered a repetitive injury. He explained that her hands and wrists 

were engaged in repetitive vigorous heavy activities, which caused her symptoms of swelling, 

pain, and stiffness at the wrist and flexor tendons, which, in turn, caused median nerve entrapment 

(carpal tunnel syndrome). The Board has held that reliance on medical literature has little 

probative value in resolving medical questions unless a physician shows the applicability of the 

general medical principles discussed in the articles to the specific factual situation at issue in the 

case.16 While Dr. Javier noted the repetition of appellant’s activities on September 8, 2020 and 

that she engaged in such activity for six days, he did not explain how the accepted employment 

incident of September 8, 2020 physiologically caused any diagnosed condition or how any medical 

literature supported causal relationship in this matter other than noting she was engaged in 

12 F.A., Docket No. 20-1652 (issued May 21, 2021); M.V., Docket No. 18-0884 (issued December 28, 2018);

Victor J. Woodhams, 41 ECAB 345, 352 (1989).

13 Id.

14 See G.D., Docket No. 20-0966 (issued July 21, 2022); R.C., Docket No. 19-0376 (issued July 15, 2019); Federal 

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

15 D.C., Docket No. 19-1093 (issued June 25, 2020); see L.B., Docket No. 18-0533 (issued August 27, 2018); D.K., 

Docket No. 17-1549 (issued July 6, 2018) (medical evidence that does not offer an opinion regarding the cause of an 

employee’s condition is of no probative value on the issue of causal relationship).

16 S.J., Docket No. 20-0896 (issued January 11, 2021); R.G., Docket No. 18-0917 (issued March 9, 2020); T.S., 

Docket No. 18-1518 (issued April 17, 2019); K.U., Docket No. 15-1771 (issued August 26, 2016); Roger D. Payne, 

55 ECAB 535 (2004).
6

repetitive activities, a factor of her employment.

17

 The Board, therefore, finds that the 

December 10, 2020 and January 12, 2021 reports are of diminished probative value and 

insufficient to establish the claim. 

In his April 28, 2021 report, Dr. Javier denied that appellant had any medical condition or 

nonoccupational risk factors that contributed to her symptoms. He also denied that her mild 

degenerative arthritis changes contributed to or caused her symptoms or carpal tunnel syndrome. 

Based on medical literature, Dr. Javier opined that appellant developed a cumulative trauma 

disorder by working at the APBS continuously for more than six days. He noted carpal tunnel 

syndrome may be caused, in part or in whole, by adverse working conditions, and that appellant 

had several workplace risk factors (high repetition, high force and awkward wrist posture). 

Dr. Javier, thus, opined that using the definition the causes of upper-limb cumulative trauma 

disorders from the medical literature, the combination of appellant’s risk factors and the objective 

findings in the sonogram and EMG/NCV study, appellant’s carpal tunnel syndrome was causally 

related to her work. The Board notes that Dr. Javier again failed to explain how the accepted 

employment incident of September 8, 2020 physiologically caused any diagnosed condition or 

how any medical literature supported causal relationship in this matter.18 Consequently. his report 

is insufficient to establish appellant’s traumatic injury claim.

Appellant also submitted diagnostic tests including EMG, x-ray, and sonogram studies. 

The Board has held that diagnostic studies, standing alone, lack probative value on the issue of 

causal relationship, as they do not provide an opinion as to whether the employment incident 

caused any of the diagnosed conditions.19

Appellant also submitted an article regarding carpal tunnel syndrome. The Board has held, 

however, that newspaper clippings, medical texts, and excerpts from publications are of no 

evidentiary value in establishing the causal relationship between a claimed condition and an 

employee’s federal employment. Such materials are of general application, and are not 

determinative of whether the specific condition claimed is related to the particular employment 

factors alleged by the employee.20

As the medical evidence of record is insufficient to establish a wrist condition causally 

related to the accepted September 8, 2020 employment incident, the Board finds that she has not 

met her burden of proof.

17 See S.W., Docket No. 21-1105 (issued December 17, 2021); S.J., id.; A.H., Docket No. 19-0270 (issued June 25, 

2019); M.W., Docket No. 18-1624 (issued April 3, 2019).

18 See S.W., id.

19 See L.B., Docket No. 21-0353 (issued May 23, 2022); K.C., Docket No. 20-1325 (issued May 5, 2021); C.B., 

Docket No. 20-0464 (issued July 21, 2020).

20 See A.M., Docket No. 18-0562 (issued January 23, 2020); A.G., Docket No. 18-0281 (issued July 12, 2018); R.O.,

Docket No. 08-1133 (issued October 8, 2008); William C. Bush, 40 ECAB 1064, 1075 (1989) (excerpts from 

publications lack probative value in resolving medical questions unless a physician shows the applicability of the 

general medical principles discussed in the articles to the specific factual situation in a case).
7

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 wrist condition 

causally related to her accepted September 8, 2020 employment incident. 

ORDER

IT IS HEREBY ORDERED THAT the March 14, 2022 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: February 21, 2023

Washington, DC

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

James D. McGinley, Alternate Judge

Employees’ Compensation Appeals Board