United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

A.M., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE,

St. Louis, MO, Employer

__________________________________________

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Docket No. 23-0076

Issued: December 12, 2023

Appearances: Case Submitted on the Record

Daniel M. Goodkin, 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 October 21, 2022 appellant, through counsel, filed a timely appeal from an April 27,

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 an upper extremity

condition causally related to the accepted August 25, 2020 employment incident.

FACTUAL HISTORY

On August 25, 2020 appellant, then a 35-year-old general expeditor, filed a traumatic 

injury claim (Form CA-1) alleging that on August 25, 2020 she developed a traumatic injury in 

the palms of her hands due to building a box while in the performance of duty. She did not stop 

work.

In an undated letter, appellant related that she was treated in the emergency room and was 

provided with ice packs, wrist splints, and anti-inflammatory medication. She received

information on carpal tunnel syndrome (CTS) and was cleared to return to work on 

August 27, 2020. 

In an August 25, 2020 statement, appellant related that at approximately 2:20 a.m. that day, 

she experienced pain in her hands and forearms while setting up boxes and thereafter asked her 

supervisor for documentation to see a physician. After providing her supervisor with an account 

of the injury, the supervisor asserted that appellant’s injury was not job related.

In an August 25, 2020 statement, an employing establishment supervisor, T.J., noted that 

appellant approached her between 2:30 a.m. and 3:30 a.m. to report pain in her hand and request 

medical forms, but showed no signs of injury. She noted that appellant initially responded that her 

hands were just hurting when asked whether she hurt herself on the job. Appellant was advised 

that was not a work injury and asserted that she had pain in her hands as a result of assembling

boxes at work.

In a statement also dated August 25, 2020, T.W., an employing establishment supervisor, 

controverted the claim, noting that appellant had informed her direct supervisor that she was 

experiencing pain in her hands due to building boxes. T.W. subsequently spoke with appellant, 

who related that she felt pain when bending her wrist or moving her fingers, but she could not 

demonstrate how she injured herself while building boxes.

Encounter notes dated August 25, 2020 from Ashley Altman, a nurse practitioner, noted 

that appellant presented with complaints of bilateral wrist pain that began at 2:00 a.m. while 

assembling boxes at work. Appellant described the pain as shooting and originating at the volar 

aspect of her wrists, traveling up to her elbows, and reported having similar symptoms 

approximately five years ago that were never treated. Ms. Altman performed a physical 

examination and diagnosed bilateral wrist pain, acute radial nerve palsy, unspecified laterality, and 

ulnar nerve palsy. In a work status note of even date, she held appellant off work until 

August 27, 2020. 

In a February 3, 2021 development letter, OWCP informed appellant of the deficiencies of 

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

and afforded her 30 days to submit the necessary evidence.
3

Thereafter, appellant submitted a February 24, 2021 visit note wherein Dr. Raymond 

Leung, an internist, found that she had possible CTS and recommended that she undergo 

electrodiagnostic testing, schedule a follow up with her primary physician, and continue to wear 

braces. Dr. Leung also prescribed medication. 

By decision dated March 18, 2021, OWCP accepted that the August 25, 2020 employment 

incident occurred as alleged. However, it denied appellant’s claim, finding that the medical 

evidence of record was insufficient to establish a diagnosed medical condition in connection with 

the accepted employment incident. Consequently, OWCP found that appellant had not met the 

requirements to establish an injury as defined by FECA.

Appellant continued to submit evidence, includingadditional February 24, 2021 visit notes

from Dr. Leung, who related that she complained of pain in her hands and wrists from an 

August 25, 2020 work injury.

On February 24, 2022 appellant, through counsel, requested reconsideration of the 

March 18, 2021 decision and submitted additional evidence.

A July 12, 2019 report of electromyography and nerve conduction velocity (EMG/NCV) 

study revealed mild right-sided sensory demyelinating median neuropathy.

In an April 28, 2021 statement, appellant related that she began working for the U.S. Postal 

Service in June 2011 and worked six to seven days per week, in 9- to 10-hour overnight shifts, 

sometimes longer. Until 2015, half of her shift was spent sorting letters in trays by turning each 

letter right side up. Appellant’s position involved fast-paced walking on concrete floors to retrieve 

mail containers, carrying them to elevators, sweeping mail from machines, overhead lifting, as 

well as placing, pushing, and pulling items and heavy equipment. After approximately one year, 

she began experiencing sharp pain through the center of her hands and wrists. By 2015, appellant 

transferred to a retail and distribution station where she worked 40- to 50-hour workweeks and 

was requested to work overtime. The position involved less strain on her hands and body and her 

pain became less frequent and intense, though it never ceased. After one year in her new position, 

appellant began to experience a different type of hand paindue to new repetitive motions, including 

sorting large and small packages into containers for each route. She asserted that her duties at the 

retail counter included accepting, lifting, and sorting packages over the counter, which wore on 

the condition of her hands and wrists/forearms. Appellant related that she would toss packages 

using a frisbee-style motion or a basketball-toss motion and would hand-carry heavier items to 

containers and trucks for transport. Each day she received pallets of packages for sorting and 

distribution, which doubled during the holiday season. 

Appellant explained that in April 2020 she was required to return to the warehouse/factory 

facility as an expediter and was responsible for printing, scanning, labeling, and radio/walkie-talkie 

use. Subsequently, she was removed from those duties and returned to work as a mail handler, 

which involved heavy lifting and repetitive motions, including assembling industrial-sized boxes 

by folding the bottoms so that the boxes would not collapse and then placing the boxes onto large, 

heavy plastic pallets. The pallets were stacked on top of one another, requiring appellant to lift

and place them onto the floor for loading. She performed this task repetitively for hours, filled the 
4

boxes with mail, and helped move the boxes with a hand jack. Additionally, appellant sorted and 

placed heavy bundles of magazines and mail weighing 5 to 10 pounds into the boxes.

In a January 6, 2022 report, Dr. Richard Howard, a Board-certified orthopedic surgeon, 

noted that appellant presented with complaints of bilateral hand pain, CTS, and trigger finger. He 

related that she was employed with the employing establishment as a clerk for nine years and

performed repetitive handling of mail and assembling boxes, which brought about her symptoms 

including the inability to bend her right thumb, which waslocked in extension. Dr. Howard further 

noted that appellant reported that in 2015 she began having problems with pain, occasional 

numbness, and tingling in the fingers in both hands, which she attributed to assembling boxes and 

retrieving cases of mail for long periods of time. He performed a physical examination and 

diagnosed bilateral CTS and right trigger thumb. Dr. Howard indicated that repetitive, gripintensive duties are known to be associated with development of CTS and trigger finger and opined 

that appellant’s duties were contributing causative factors in the development of her diagnosed 

conditions. He concluded that her work was a significant factor in the development of her 

conditions and noted that she did not have any major risk factors for CTS, other than being female 

and middle-aged. Dr. Howard related that she currently had limited use of her right thumb and

could resume full-time work without restrictions after she underwent trigger thumb release. 

In a February 16, 2022 note, Dr. Howard acknowledged receiving a copy of appellant’s 

July 12, 2019 NCV study, which was positive for mild right CTS. He related that the study did 

not have a significant impact on his prior opinion, but it did provide electrodiagnostic evidence of 

CTS in 2019, which had likely progressed when he examined appellant on January 6, 2022. 

Dr. Howard asserted that his opinion remained unchanged and that the 2019 study confirmed his 

previous impressions. 

By decision dated April 27, 2022, OWCP modified its March 18, 2021 decision to find that 

the evidence of record was sufficient to establish diagnoses of bilateral CTS and right thumb 

trigger finger in connection with the accepted August 25, 2020 employment incident. The claim 

remained denied, however, as the medical evidence of record was insufficient to establish causal 

relationship between appellant’s diagnosed conditions and the accepted August 25, 2020

employment incident.

LEGAL PRECEDENT

An employee seeking benefits under FECA3 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,4that 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 

3

Id.

4 F.H., Docket No.18-0869 (issued January 29, 2020); J.P., Docket No. 19-0129 (issued April26, 2019); JoeD. 

Cameron, 41 ECAB 153 (1989). 
5

employment injury.5 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.6

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. The first component is whether the 

employee actually experienced the employment incident at the time and place, and in the manner 

alleged. The second component is whether the employment incident caused an injury.7

The medical evidence required to establish causal relationship between a claimed specific 

condition and an employment incident is rationalized medical opinion evidence. 8 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 the specific employment incident 

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 medical 

condition causally related to the accepted August 25, 2020 employment incident.

In his January 6, 2022 report, Dr. Howard noted that appellant reported that her job duties 

required repetitive handling of mail and assembling boxes, which brought about her symptoms 

including the inability to bend her right thumb, which was locked in extension. He diagnosed 

bilateral CTS and right trigger thumb, and noted that repetitive, grip-intensive duties are known to 

be associated with development of CTS and trigger finger. Dr. Howard opined that appellant’s 

work duties were significant contributing causative factors in the development of her diagnosed 

conditions. In his February 16, 2022 note, he indicated that the July 12, 2019 EMG/NCV did not 

5 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).

6 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).

7 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).

8

S.S., Docket No. 19-0688 (issued January 24, 2020); A.M., Docket No. 18-1748 (issued April24, 2019); RobertG. 

Morris, 48 ECAB 238 (1996).

9 A.S., Docket No. 19-1955 (issued April 9, 2020); Leslie C. Moore, 52 ECAB 132 (2000).

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

R.D., Docket No. 18-1551 (issued March 1, 2019).
6

have a significant impact upon his previously stated opinions. Dr. Howard did not, however, 

provide a rationalized explanation of how the accepted August 25, 2020 employment incident 

caused or contributed to the diagnosed conditions. The Board has held that medical evidence 

which does not provide a rationalized explanation regarding causal relationship between the 

diagnosed condition and the specific employment incident is of limited probative value. 11 As such, 

this evidence is insufficient to establish the claim.

In his February 24, 2021 notes, Dr. Leung diagnosedCTS due to a work injury. However, 

he similarly failed to explain a pathophysiological process of how the accepted August 25, 2020

employment incident caused or contributed to the diagnosed condition.

12

 As such, this evidence 

is also insufficient to establish the claim.

Appellant also submitted August 25, 2020 encounter notes by Ms. Altman, a nurse 

practitioner. Certain healthcare providers such as physician assistants, nurse practitioners, and 

physical therapists are not considered qualified physicians as defined under FECA. 13 Their 

medical findings, reports and/or opinions, unless cosigned by a qualified physician, will not suffice 

for purposes of establishing entitlement to FECA benefits.14 As these reports were not cosigned 

by a physician, they are of no probative value and, thus, insufficient to establish appellant’s 

claim.15

The remaining evidence of record consisted of an EMG/NCV study dated July 12, 2019. 

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

causal relationship as they do not address whether the accepted employment injury caused any of 

the additional diagnosed conditions.16

As appellant has not submitted rationalized medical evidence to establish a medical 

condition causally related to the accepted August 25, 2020 employment incident, 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.

11 Id.

12 Id.

13 Section 8101(2) of FECA provides that 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. § 8101(2); 20 C.F.R. § 10.5(t). J.D.,Docket No. 21-0164 (issued June 15, 2021) (nurse practitioners are not 

physicians as defined under FECA; 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). 

14 See K.A., Docket No. 18-0999 (issued October 4, 2019); K.W., 59 ECAB 271, 279 (2007); DavidP. Sawchuk, 

id.

15 Id.

16 F.D., Docket No. 19-0932 (issued October 3, 2019); J.S., Docket No. 17-1039 (issued October 6, 2017).
7

CONCLUSION

The Board finds that appellant has not met her burden of proof to establish a medical 

condition causally related to the accepted August 25, 2020 employment incident. 

ORDER

IT IS HEREBY ORDERED THAT the April 27, 2022 decision of the Office of Workers’ 

Compensation Programs is affirmed.

Issued: December 12, 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