United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

A.B., Appellant

and

U.S. POSTAL SERVICE, PROCESSING & 

DISTRIBUTION CENTER, Cleveland, OH,

Employer

__________________________________________

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Docket No. 20-0971

Issued: January 26, 2021

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

JANICE B. ASKIN, Judge

PATRICIA H. FITZGERALD, Alternate Judge

JURISDICTION

On April 1, 2020 appellant, through counsel, filed a timely appeal from a February 26,

2020 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 right elbow, wrist, 

or hand condition causally related to the accepted May 15, 2019 employment incident.

FACTUAL HISTORY

On July 11, 2019 appellant, then a 22-year-old mail processing clerk, filed a traumatic 

injury claim (Form CA-1) alleging that on May 15, 2019 she injured her hands and developed 

carpal tunnel syndrome (CTS) in the right wrist and arm due to continuous grabbing and pulling 

mail while in the performance of duty.3

In a May 16, 2019 duty status report (Form CA-17), an unidentifiable healthcare provider 

provided work restrictions. In a May 20, 2019 work restrictions note, the same unidentifiable 

healthcare provider indicated that appellant could return to work with restrictions from May 17 to 

July 31, 2019.

In a June 30, 2019 statement, appellant indicated that she missed days from work due to 

appointments and pain in her hands. In a July 11, 2019 statement, she explained that she was 

working on May 15, 2019 when her hands cramped up and made it hard for her to continue 

working. The following day, appellant sought treatment with her physician, who suggested she 

might have arthritis. She indicated that she then notified her supervisor of her injury and was sent 

home. In a July 12, 2019 statement, appellant noted that she had a follow-up appointment on 

June 28, 2019 and received cortisone injections in her wrists on June 29, 2019. She asserted that 

the employing establishment notified her that no job was available for her current conditions. 

In a development letter dated July 16, 2019, OWCP informed appellant of the deficiencies 

in her claim. It advised her of the type of factual and medical evidence needed to establish her 

claim, asked that she clarify whether she was claiming a traumatic injury or an occupational 

disease, and provided a questionnaire for her completion. OWCP afforded appellant 30 days to 

submit the necessary evidence.

In a July 24, 2019 response to OWCP’s questionnaire, appellant asserted that her position 

as a mail processor clerk contributed to her current conditions. She noted that her shift typically 

began at 11:00 p.m. and ended between 6:00 a.m. and 6:30 a.m. Appellant described her work 

duties to include the constant motions of lifting and grabbing. She indicated that she typically

retrieved mail from up to 215 to 238 bins. Appellant asserted that on the day of her injury her ring 

and pinky fingers went numb at random moments, and her wrist was constantly in pain or aching 

when performing her usual daily activities. She acknowledged that she previously had a boxer’s 

fracture on the same hand in 2013, but it had resolved and she had no other problems before the 

alleged May 15, 2019 employment incident. Appellant also indicated that she had never been 

diagnosed with arthritis. She clarified that she was claiming a traumatic injury caused by the 

alleged May 15, 2019 employment incident, explaining that she experienced a sharp pain shooting 

from her wrist to elbow while lifting a tray. Appellant explained that she delayed filing her claim 

 

3 The claim form indicates that appellant stopped work, but the date is illegible. 
3

because she did not receive the proper paperwork from her supervisor. She indicated that she did 

not participate in any significant activities outside her job. 

In a July 30, 2019 medical report, Erik Johnson, a certified physician assistant, noted that 

appellant presented with right elbow, wrist, and hand injuries, which she sustained at work on 

May 16, 2019 between 12:00 a.m. and 1:00 a.m. when she lifted a heavy tray and pain shot from 

her wrist to her elbow. He conducted a physical examination and diagnosed right carpal tunnel 

syndrome and right cubital tunnel syndrome.

In an August 1, 2019 medical report, Mr. Johnson noted that appellant returned for a 

recheck of her right wrist. Appellant reported that her pain had increased since the last visit. 

Mr. Johnson reiterated his diagnoses. In an August 9, 2019 medical report, he noted his findings 

and diagnoses. 

In an August 16, 2019 medical report, Maureen Doolan, a certified physician assistant, 

noted that appellant had throbbing and achy pain in her right wrist and had been wearing a wrist 

brace. She diagnosed right carpal tunnel syndrome and right cubital tunnel syndrome. 

By decision dated August 26, 2019, OWCP denied appellant’s traumatic injury claim, 

finding that she had not established causal relationship between her diagnosed conditions and the 

accepted May 15, 2019 employment incident.

OWCP subsequently received additional evidence. In a June 24, 2019 medical report,

Dr. Scott Ciaccia, an orthopedic hand surgeon, noted that appellant presented for evaluation of her 

bilateral upper extremities. Appellant indicated that she experienced numbness and tingling in the

hands, right worse than left. She denied any discrete injury, noting that she felt that her activities 

at work made her more symptomatic. Dr. Ciaccia indicated that appellant’s work required 

performing repetitive activities. He also indicated that she previously had a closed fracture and 

experienced ongoing hand pain. Dr. Ciaccia diagnosed bilateral carpal tunnel syndrome and 

cubital tunnel syndrome.

In a July 25, 2019 medical report, Dr. Ciaccia indicated that appellant received a steroid 

injection in both hands, but noted that her pain, numbness, and tingling continued in her right hand. 

He again diagnosed bilateral carpal tunnel syndrome and noted that appellant had swelling in her 

right third metacarpophalangeal (MCP) joint in the absence of a discrete injury. Dr. Ciaccia also 

noted that appellant experienced numbness and tingling in the ulnar nerve consistent with mild 

cubital tunnel syndrome. 

In an August 2, 2019 letter, an unidentifiable healthcare provider noted that appellant was 

diagnosed with carpal tunnel syndrome, which worsened with repetitive motions. 

Ms. Doolan, in medical reports dated from August 5 to September 3, 2019, noted that 

repetitive motions made appellant’s pain worse and reiterated her diagnoses. 

In a November 25, 2019 medical report, Dr. Dominic Haynesworth, an emergency 

medicine specialist, noted that appellant injured herself while lifting a tray of mail. He indicated 

that appellant was working with restrictions. Dr. Haynesworth conducted a physical examination 

and diagnosed unspecified right elbow and right wrist sprains. He opined, within a reasonable 
4

degree of medical certainty, that the diagnosed conditions were causally related to the initial 

May 15, 2019 employment incident. In a Form CA-17 of even date, Dr. Haynesworth provided 

work restrictions.

On December 9, 2019 appellant requested reconsideration.

In a December 24, 2019 medical report, Sarah Williams, a certified nurse practitioner

(CNP), conducted a physical examination and diagnosed unspecified right elbow and right wrist 

sprains.

In a January 21, 2020 medical report, Jennifer Miller, a CNP, also diagnosed unspecified 

right elbow and right wrist sprains.

By decision dated February 26, 2020, OWCP denied modification of the August 26, 2019 

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, it first must be determined whether fact of injury has been established. 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. Second component is whether the employment incident 

caused a personal injury and can be established only by medical evidence.8 

 

4 Supra note 2.

5 F.H., Docket No.18-0869 (issued January 29, 2020); J.P., Docket No. 19-0129 (issued April 26, 2019); Joe D. 

Cameron, 41 ECAB 153 (1989). 

6 L.C., Docket No. 19-1301 (issued January 29, 2020); J.H., Docket No. 18-1637 (issued January 29, 2020); 

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

7 P.A., Docket No. 18-0559 (issued January 29, 2020); K.M., Docket No. 15-1660 (issued September 16, 2016); 

Delores C. Ellyett, 41 ECAB 992 (1990).

8 T.H., Docket No. 19-0599 (issued January 28, 2020); K.L., Docket No. 18-1029 (issued January 9, 2019); John J. 

Carlone, 41 ECAB 354 (1989).
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The medical evidence required to establish causal relationship between a claimed specific 

condition and an employment incident is rationalized medical opinion evidence.9 The opinion of 

the physician must be based on a complete factual and medical background of the employee, 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 factors 

identified by the employee.10

ANALYSIS

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

wrist, or hand condition causally related to the accepted May 15, 2019 employment incident.

In a November 25, 2019 medical report, Dr. Haynesworth diagnosed unspecified right 

elbow and right wrist sprains and opined, to a reasonable degree of medical certainty, that they

were causally related to the initial May 15, 2019 employment incident. The Board finds that,

although he supported causal relationship, he did not provide medical rationale explaining the basis 

of his conclusory opinion. The Board has held that a medical report is of limited probative value 

on the issue of causal relationship if it contains a conclusion regarding causal relationship which 

is unsupported by medical rationale.11 Therefore, Dr. Haynesworth’s November 25, 2019 report 

is insufficient to establish appellant’s claim.

In medical reports dated June 24 and July 25, 2019, Dr. Ciaccia diagnosed bilateral carpal 

tunnel syndrome and cubital tunnel syndrome. These reports, however, do not address whether 

appellant’s diagnosed conditions were caused or aggravated by the May 15, 2019 employment 

incident. Likewise, Dr. Haynesworth, in his November 25, 2019 Form CA-17, provided work 

restrictions, but did not provide an opinion on the cause of appellant’s conditions. The Board has 

held that medical evidence that does not include an opinion regarding the cause of an employee’s 

condition is of no probative value on the issue of causal relationship.12 As such, these reports are 

also insufficient to establish appellant’s claim.

The record also contains reports from certified physician assistants and nurse practitioners. 

Certain healthcare providers such as physician assistants, nurse practitioners, and physical 

 

9 S.S., Docket No. 19-0688 (issued January 24, 2020); A.M., Docket No. 18-1748 (issued April 24, 2019); Robert G. 

Morris, 48 ECAB 238 (1996).

10 T.L., Docket No. 18-0778 (issued January 22, 2020); Y.S., Docket No. 18-0366 (issued January 22, 2020); 

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

11 J.W., Docket No. 18-0678 (issued March 3, 2020); L.B., Docket No. 18-0533 (issued August 27, 2018); D.K., 

Docket No. 17-1549 (issued July 6, 2018).

12 See D.M., Docket No. 19-1968 (issued August 28, 2020); L.B., id.; D.K., id.
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therapists are not considered physicians as defined under FECA.13 Consequently, these reports 

will not suffice for purposes of establishing entitlement to FECA benefits.14

Finally, appellant also submitted a May 16, 2019 Form CA-17, a May 20, 2019 work 

restrictions note, and an August 2, 2019 letter. However, these documents contained illegible 

signatures from an unidentifiable healthcare providers. The Board has held that reports that bear 

illegible signatures cannot be considered probative medical evidence because they lack proper 

identification that the author is a physician.15 Accordingly, these documents are also insufficient 

to satisfy appellant’s burden of proof to establish her claim. 

As the medical evidence of record does not include a rationalized opinion explaining how 

the accepted May 15, 2019 employment incident caused appellant’s diagnosed conditions, the 

Board finds that she 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 right a right

elbow, wrist, or hand condition causally related to the accepted May 15, 2019 employment 

incident.

 

13 Section 8101(2) of FECA provides that medical opinions can only be given by a qualified physician. This section 

defines a physician as 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. § 8101(2); 20 C.F.R. 

§ 10.5(t). See M.M., Docket No. 20-0019 (issued May 6, 2020); K.W., 59 ECAB 271, 279 (2007); David P. 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 C.P., Docket No. 19-1716 (issued March 11, 2020) 

(physician assistants are not considered physicians as defined under FECA); S.L., Docket No. 19-0603 (issued 

January 28, 2020) (nurse practitioners are not considered physicians as defined under FECA).

14 Id.

15 J.P., Docket No. 19-0197 (issued June 21, 2019).
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ORDER

IT IS HEREBY ORDERED THAT the February 26, 2020 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: January 26, 2021

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Alternate Judge

Employees’ Compensation Appeals Board