United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

D.S., Appellant

and

U.S. POSTAL SERVICE, PHILADELPHIA 

PROCESSING & DISTRIBUTION CENTER, 

Philadelphia, PA, Employer

__________________________________________

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Docket No. 21-1388

Issued: May 12, 2022

Appearances: Case Submitted on the Record

Michael D. Overman, 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 September 21, 2021 appellant, through counsel, filed a timely appeal from a March 31, 

2021 merit decision of the Office of Workers’ Compensation Programs (OWCP). Pursuant to the 

Federal Employees’ Compensation Act2 and 20 C.F.R. §§ 501.2(c) and 501.3, the Board has 

jurisdiction over the merits of this case.3

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.

3 The Board notes that, following the March 31, 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 bilateral carpal 

tunnel syndrome causally related to the accepted factors of her federal employment.

FACTUAL HISTORY

On December 13, 2019 appellant, then a 42-year-old mail handler, filed an occupational 

disease claim (Form CA-2) alleging that she sustained carpal tunnel syndrome causally related to 

factors of her federal employment including driving power equipment, which required constant

gripping of handles and twisting of the wrists. She noted that she first became aware of her 

condition on February 12, 2019 and realized its relation to her federal employment on 

March 12, 2019.4

An electromyogram/nerve conduction velocity (EMG/NCV) study of appellant’s upper 

extremities obtained on April 5, 2019 demonstrated bilateral median neuropathies localized to the 

segment at the wrist consistent with carpal tunnel syndrome, moderate on the right and mild on 

the left.

In reports dated April 5 and May 3, 2019, Dr. Christopher Reid, a neurologist, diagnosed

bilateral carpal tunnel syndrome, moderate on the right and mild on the left. 

By decision dated February 26, 2020, OWCP denied appellant’s occupational disease 

claim, finding that the evidence of record was insufficient to establish a firm diagnosis in 

connection with the claimed work factors. It concluded, therefore, that the requirements had not 

been met to establish an injury as defined by FECA.

On March 5, 2020 appellant, through counsel, requested an oral hearing before a 

representative of OWCP’s Branch of Hearings and Review. 

In a report dated February 6, 2020, Dr. William Ingram, II, a family practitioner, examined 

appellant and reviewed her history of injury. He noted that appellant had a right metatarsal fracture 

at work in 2013. On examination of her upper extremities, Dr. Ingram observed a positive Tinel’s 

test, a negative Guyon’s canal test, and a positive right scapholunate click with stress or 

provocation. He diagnosed work-related bilateral carpal tunnel syndrome, post-traumatic 

myofasciitis and sprain of the bilateral shoulders, and a ligament sprain of the right wrist.

Dr. Ingram opined that all of appellant’s symptoms were directly related to her work activities and 

usual duties as a mail handler, culminating on February 12, 2019. He explained that the 

abnormalities on her physical examination included Tinel’s testing, laxity of the ligaments, and 

decreased sensation and weakness, noting that these were signs of her neuropathic and orthopedic 

diagnoses.

An EMG/NCV study, dated March 2, 2020, demonstrated early median neuropathy at the 

wrist level, with clinical correlation suggested. 

4 Under OWCP File No. xxxxxx742, OWCP accepted that appellant sustained a right fracture of the metatarsal 

bones, closed dislocation of foot, and right shoulder sprain as a result of being struck from behind by an all-purpose 

container while in the performance of duty on March 4, 2014. 
3

Following a preliminary review, by decision dated May 21, 2020, an OWCP hearing

representative set aside the February 26, 2020 decision and remanded the case for further 

development, finding that OWCP’s denial of the claim was incorrect, as the medical evidence of 

record at that time provided a firm diagnosis of bilateral carpal tunnel syndrome. The hearing 

representative further found that Dr. Ingram’s February 6, 2020 report created an uncontroverted 

inference requiring further medical development by OWCP. On remand the hearing representative 

directed OWCP to prepare a statement of accepted facts (SOAF) and refer appellant for a second 

opinion examination regarding the medical connection between appellant’s diagnosed bilateral 

carpal tunnel syndrome and the accepted exposure in her federal employment.

On August 3, 2020 OWCP referred appellant, along with a SOAF, to Dr. Steven Valentino, 

a Board-certified orthopedic surgeon, for a second opinion examination. The SOAF noted that 

appellant had a previously accepted claim for right fracture of the metatarsal bones, closed 

dislocation of foot, and right sprain of the shoulder and upper arm. 

In a second opinion report dated August 26, 2020, Dr. Valentino noted his examination of

appellant for evaluation of her bilateral carpal tunnel syndrome. He reviewed appellant’s history 

of injury, a SOAF, and the medical record. On physical examination he observed negative Allen’s, 

Wright’s, Roos, Phalen’s, reverse Phalen’s, ulnar stretch, and Tinel’s sign tests. Neurological 

examination demonstrated intact deep tendon reflexes with normal sensory examination. 

Dr. Valentino stated his impression of no evidence of a work-related injury. He explained that,

based on his evaluation, appellant’s symptoms were diffuse and not consistent with a specific 

diagnosis of bilateral carpal tunnel syndrome, and that as such, he could not relate any diagnosis 

related to the accepted factors of her federal employment.

In a report dated June 24, 2020, Dr. Ingram noted that he followed up with appellant for 

her upper extremity symptoms. On physical examination of the bilateral wrists, he observed 

positive Roos and bilateral Tinel’s tests. Dr. Ingram diagnosed rotator cuff tear, labral tear, 

brachial plexopathy, long head of the biceps tear, and overuse syndrome of the right upper 

extremity.

By de novo decision dated September 17, 2020, OWCP denied appellant’s occupational 

disease claim, based upon Dr. Valentino’s August 26, 2020 second opinion report. 

On September 23, 2020 appellant, through counsel, requested an oral hearing before a 

representative of OWCP’s Branch of Hearings and Review. 

In a report dated November 17, 2020, Dr. Ingram reviewed appellant’s history of injury for 

evaluation and treatment of pain and dysesthesias of the upper extremities. On physical 

examination of the upper extremities, he observed deep tendon reflexes of “1-2/4” on the right and 

“2/4” on the left. Dr. Ingram further observed a positive Tinel’s sign, a negative Guyon’s canal 

test, and positive right scapholunate click with stress or provocation. He diagnosed work-related 

carpal tunnel syndrome, post-traumatic myofasciitis and sprain of the bilateral shoulders, and a 

ligament sprain of the right wrist, to be ruled out as a tear. Dr. Ingram opined that all of appellant’s 

symptoms were directly related to her work activities and usual duties as a mail handler, 

culminating on February 12, 2019. He explained that the abnormalities on her physical 

examination included Tinel’s testing, laxity of the ligaments, and decreased sensation and 

weakness, noting that these were signs of her neuropathic and orthopedic diagnoses. Under the 

heading of additional discussion, Dr. Ingram further explained that appellant performed 
4

significantly physical and repetitive work, creating a cumulative trauma to her upper extremities 

involving the shoulder and bilateral wrists. In the course of performing these duties he continued, 

this activity led to trauma and inflammation in her upper extremities. Dr. Ingram noted that, in the 

performance of duty, appellant would operate a pallet jack, typically using the controls with one 

hand and the other to steer, and that this action required significant repetitive physical force. 

Appellant had performed this task for more than 10 years. Dr. Ingram further noted that EMG 

testing confirmed evidence of carpal tunnel syndrome. He opined within a reasonable degree of 

medical certainty that duties of appellant’s federal employment traumatized her wrists, leading to 

inflammation and compression of the median nerve at the wrist, which ultimately led to carpal 

tunnel syndrome in its full clinical manifestation. Dr. Ingram explained the clinical progression 

of carpal tunnel syndrome generally. He noted that his findings on physical examination differed 

from those of Dr. Valentino as Dr. Valentino did not give much weight to other physicians’

diagnoses or EMG testing.

A hearing was held on January 15, 2021. 

By decision dated March 31, 2021, a hearing representative affirmed the September 17,

2020 decision. 

LEGAL PRECEDENT

An employee seeking benefits under FECA5 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 timely filed within the applicable 

time limitation of FECA, that 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.

To establish that an injury was sustained in the performance of duty in an occupational 

disease claim, a claimant must submit: (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 identified employment factors.7

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.8 The opinion of the physician must be based on a complete factual 

and medical background, must be one of reasonable medical certainty, and must be supported by 

5

Supra note 2.

6 C.K., Docket No. 19-1549 (issued June 30, 2020); R.G., Docket No. 19-0233 (issued July 16, 2019); Elaine 

Pendleton, 40 ECAB 1143 (1989).

7 L.D., Docket No. 19-1301 (issued January 29, 2020); S.C., Docket No. 18-1242 (issued March13, 2019); Victor J. 

Woodhams, 41 ECAB 345, 352 (1989).

8

I.J., Docket No. 19-1343 (issued February 26, 2020); T.H., 59 ECAB 388 (2008); RobertG. Morris, 48 ECAB 

238 (1996).
5

medical rationale explaining the nature of the relationship between the diagnosed condition and 

the specific employment incident.9

Section 8123(a) of FECA provides that, if there is disagreement between the physician 

making the examination for the United States and the physician of the employee, the Secretary 

shall appoint a third physician who shall make an examination.10 The implementing regulations 

state that, if a conflict exists between the medical opinion of the employee’s physician and the 

medical opinion of either a second opinion physician or a DMA, OWCP shall appoint a third 

physician to make an examination.11 When there exist opposing medical reports of virtually equal 

weight and rationale and the case is referred to an impartial medical specialist for the purpose of 

resolving the conflict, the opinion of such specialist, if sufficiently well rationalized and based 

upon a proper factual background, must be given special weight.12

ANALYSIS

The Board finds that this case is not in posture for decision.

OWCP referred appellant to Dr. Valentino for a second opinion evaluation and, in his 

August 26, 2020 report, Dr. Valentino opined that there was no evidence of a work-related injury. 

He explained that, based on his evaluation, appellant’s symptoms were diffuse and not consistent 

with a specific diagnosis of bilateral carpal tunnel syndrome. As such, he could not relate any 

diagnosis related to her accepted factors of federal employment.

In a report dated November 19, 2020, Dr. Ingram opined that all of appellant’s symptoms 

were directly related to her work activities and usual duties as a mail handler, culminating on 

February 12, 2019. He explained that the abnormalities on her physical examination included 

Tinel’s testing, laxity of the ligaments, and decreased sensation and weakness, noting that these 

were signs of her neuropathic and orthopedic diagnoses. Dr. Ingram further explained that 

appellant performed significantly physical and repetitive work, creating a cumulative trauma to 

her upper extremities involving the shoulder and bilateral wrists. Performing these duties led to 

trauma and inflammation in her upper extremities. Dr. Ingram noted that, in the performance of 

duty, appellant would operate a pallet jack, typically using the controls with one hand and the other

to steer, and that this action required significant repetitive physical force. Appellant had performed 

this task for more than 10 years. Dr. Ingram further noted that EMG testing confirmed evidence 

of carpal tunnel syndrome. He opined within a reasonable degree of medical certainty that duties 

of appellant’s federal employment traumatized her wrists, leading to inflammation and 

compression of the median nerve at the wrist, which ultimately led to carpal tunnel syndrome in 

its full clinical manifestation. Dr. Ingram explained the clinical progression of carpal tunnel 

syndrome generally. Responding directly to Dr. Valentino, he noted that their findings on physical 

9 D.J., Docket No. 19-1301 (issued January 29, 2020).

10 5 U.S.C. § 8123(a); see Y.A., 59 ECAB 701 (2008).

11 20 C.F.R. § 10.321.

12 K.S., Docket No. 19-0082 (issued July 29, 2019); V.G., 59 ECAB 635 (2008).
6

examination differed. Dr. Ingram noted that Dr. Valentino did not give much weight to other 

physicians’ diagnoses or EMG testing.

The Board finds that a conflict in medical opinion has been created between Dr. Ingram, 

appellant’s treating physician, and that of the second opinion physician regarding whether 

appellant sustained work-related carpal tunnel syndrome.13 Section 8123 of FECA provides that, 

if there is a disagreement between the physician making the examination for the United States and 

the employee’s physician, OWCP shall appoint a third physician who shall make an examination.14

As a conflict in medical opinion exists regarding whether appellant’s diagnosed carpal 

tunnel syndrome is causally related to the accepted employment factors, the case must be remanded 

to OWCP for creation of an updated SOAF and referral to a specialist in the appropriate field of 

medicine to obtain an impartial medical opinion regarding whether appellant sustained bilateral 

carpal tunnel syndrome causally related to the accepted factors of her federal employment.

Following this and any other further development as deemed necessary, OWCP shall issue a 

de novo decision.

CONCLUSION

The Board finds that this case is not in posture for decision.

13 See S.M., Docket No. 19-0397 (issued August 7, 2019).

14 Id.
7

ORDER

IT IS HEREBY ORDERED THAT the March 31, 2021 decision of the Office of 

Workers’ Compensation Programs is set aside and the case is remanded for further proceedings 

consistent with this decision of the Board.

Issued: May 12, 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