United States Department of Labor

Employees’ Compensation Appeals Board

C.G., Appellant

and

DEPARTMENT OF VETERANS AFFAIRS, 

PORTLAND VA MEDICAL CENTER, 

Portland, OR, Employer

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Docket No. 23-0642

Issued: November 21, 2023

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

ORDER REMANDING CASE

Before:

PATRICIA H. FITZGERALD, Deputy Chief Judge

JANICE B. ASKIN, Judge

JAMES D. McGINLEY, Alternate Judge

On March 29, 2023 appellant filed a timely appeal from an October 19, 2022 merit decision 

of the Office of Workers’ Compensation Programs (OWCP). The Clerk of the Appellate Boards 

assigned the appeal Docket No. 23-0642.

On April 21, 2020 appellant, then a 53-year-old medical clerk, filed an occupational 

disease claim (Form CA-2) alleging that she developed a right wrist and thumb condition due to 

factors of her federal employment, resulting from work modifications necessitated by prior 

accepted right shoulder and right elbow injuries resulting in overuse of the right wrist and thumb. 

She noted that she first became aware of her condition on March 19, 2020 and realized its relation 

to her federal employment on April 20, 2020. Appellant did not stop work.

1

1 OWCP assigned the present claim OWCP File No. xxxxxx486. Appellant also has two prior traumatic injury 

claims (Form CA-1) for right upper extremity injuries. Under OWCP File No. xxxxxx186, OWCP accepted an 

August 26, 2014 right elbow injury, sustained when appellant lifted a heavy recycling bag while in the performance 

of duty, for right lateral epicondylitis, right ulnar nerve lesion, right radial nerve lesion, synovitis and tenosynovitis of

the right upper extremity, right medial epicondylitis, and enthesopathy of the right elbow. Under OWCP File No. 

xxxxxx326, it accepted a January 24, 2018 right shoulder injury, sustained when appellant caught a sliding container 

with her right hand, for right rotator cuff strain and adhesive capsulitis of the right shoulder. Appellant underwent 

OWCP-authorized right rotator cuff repair on September 13, 2018. 
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In a development letter dated May 1, 2020, OWCP informed appellant of the deficiencies 

of her claim. It advised her of the type of factual and medical evidence needed, and provided a 

questionnaire for her completion. OWCP afforded appellant 30 days to respond.

In May 12, 2020 response to OWCP’s development letter, appellant submitted a statement 

alleging that a modified computer keyboard and mouse issued to her as an accommodation for her 

accepted right elbow injury caused overuse of the fingers, thumb, and wrist. She also provided a 

September 26, 2019 report, wherein Dr. Eric W. Long, a Board-certified physiatrist, obtained 

electrodiagnostic test results for the right upper extremity demonstrating radial and ulnar nerve 

lesions in the proximal forearm.

By decision dated June 9, 2020, OWCP found that appellant had established the implicated 

employment factors, but denied her occupational disease claim, finding that the medical evidence 

of record was insufficient to establish a medical diagnosis under the present claim. It noted that

Dr. Long’s September 26, 2019 report addressed appellant’s accepted right elbow injury under a 

OWCP File No. xxxxxx186, but not the claimed right thumb and wrist condition under OWCP 

File No. xxxxxx486. OWCP concluded, therefore, that the requirements had not been met to 

establish an injury as defined by FECA.

On July 5, 2020 appellant requested a review of the written record by a representative of 

OWCP’s Branch of Hearings and Review. 

OWCP received a June 22, 2020 report by Dr. Paul M. Puziss, a Board-certified orthopedic 

surgeon. Dr. Puziss opined that “thousands of repetitive movements per day” while operating the 

rollerball mouse “led to tissue breakdown in the first dorsal compartment or thumb extensor 

tendinitis and had also caused overuse of the trapezium first metacarpal joint resulting in a 

synovitis and thus pain in that joint.” He explained that overuse syndrome involving a tendon 

caused inflammation of the tendon, leading to constriction of the tendon around the first dorsal 

compartment, resulting in additional friction and pain. Dr. Puziss also noted that overuse of the 

right trapezium first metacarpal joint caused “mechanical inflammation within the joint as it is 

overwhelmed by the number of strokes of a right dominant thumb.” He added that appellant had 

greater strain on her hands because of her occupational right shoulder and elbow conditions, 

worsened by working 10-hour days during the prior 18 months. 

By decision dated August 20, 2020, the hearing representative set aside the June 9, 2020 

decision and remanded the case for further medical development. The hearing representative 

directed OWCP to administratively combine the present claim with OWCP File Nos. xxxxxx326 

and xxxxxxx186, as they also pertained to the right upper extremity. 

OWCP continued to receive additional reports by Dr. Puziss. 

On December 9, 2020 OWCP referred appellant to Dr. Carolyn Yang, a Board-certified 

orthopedic surgeon, for a second opinion to determine if appellant’s right thumb and wrist 

conditions were causally related to the accepted employment factors. The November 23, 2020 

statement of accepted facts (SOAF) provided to Dr. Yang noted only the occupational right elbow 

conditions accepted under File No. xxxxxx186.

In a December 23, 2020 report, Dr. Yang opined that appellant’s right cubital and radial 

tunnel syndromes were not due to the accepted August 26, 2014 employment injury “on a more 

probable than not basis.” She also opined that appellant’s right thumb and wrist conditions were 
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not related to repetitive work duties “on a more-probable-than-not basis,” as it was “more likely”

that these conditions are idiopathic in nature due to her age over 46 years old, obesity, and female 

gender. 

On January 4, 2021 OWCP determined that a conflict of medical opinion existed between

Dr. Puziss, appellant’s treating physician, and Dr. Yang, the second opinion physician, regarding 

whether the claimed right thumb and wrist conditions were related to the accepted work factors. 

It referred her, along with the case record and November 23, 2020 SOAF, to Dr. Josef Eichinger, 

Board-certified in orthopedic surgery and sports medicine, for an impartial medical examination. 

OWCP continued to receive medical evidence from Dr. Puziss.

In a July 12, 2021 report, Dr. Eichinger, serving as the impartial medical examiner (IME),

reviewed the SOAF and medical record. On examination, he observed a subjectively diminished 

sensory exam in both upper extremities, well-healed incisions at the dorsoradial and medial aspects 

of the right elbow and over the shoulder, tenderness to palpation of the right anatomical snuffbox, 

no tenderness over the right first dorsal compartment, and a negative Finkelstein’s test “with only 

pain of the basilar joint on the right hand.” Dr. Eichinger diagnosed right basilar thumb CMC joint 

osteoarthritis “unrelated to work activities on a more-probable-than-not basis, to a reasonable 

degree of medical certainty.” He explained that CMC joint thumb osteoarthritis was associated 

with “non-occupational risk factors including age, BMI and gender,” unrelated to keyboard 

activities or highly repetitive work. 

By decision dated July 28, 2021, OWCP denied appellant’s occupational disease claim. It 

accorded the special weight of the medical evidence to Dr. Eichinger’s opinion as the IME. 

On July 21, 2022 appellant, through counsel, requested reconsideration and submitted 

additional medical evidence.

By decision dated October 19, 2022, OWCP denied modification of the July 28, 2021 

decision.2

The Board, having duly considered this matter, finds that this case is not in posture for 

decision.

Appellant has previously-accepted claims for right upper extremity conditions under 

OWCP File Nos. xxxxxx186 and xxxxxx326. The present claim, OWCP File No. xxxxxx486, 

also pertains to right upper extremity conditions. However, OWCP had not administratively 

combined the claims at the time it obtained the second opinion from Dr. Yang. 

OWCP’s procedures provide that cases should be administratively combined when correct 

adjudication of the issues depends on frequent cross-referencing between files.3 For example, if a 

2 The Board notes that OWCP had not administratively combined appellant’s claims for right upper extremity 

injuries as of the October 19, 2022 decision. 

3

See Federal (FECA) Procedure Manual, Part 2 --Claims, File Maintenance and Management,Chapter 2.400.8(c) 

(February 2000).
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new injury case is reported for an employee who previously filed an injury claim for a similar 

condition or the same part of the body, doubling is required. 4

Therefore, for a full and fair adjudication, the Board finds that this case must be remanded

to OWCP to administratively combine appellant’s claims under OWCP File Nos. xxxxxx186, 

xxxxxx326, and xxxxxx486 as they all concern the same region of the body. This will allow 

OWCP to consider all relevant claim files in adjudicating appellant’s claim.5 It shall then prepare 

an updated SOAF, noting all of appellant’s previously-accepted claims, and refer appellant to a 

new specialist in the appropriate field of medicine for a second opinion examination. Following 

this and other such further development as deemed necessary, OWCP shall issue a de novo

decision.

IT IS HEREBY ORDERED THAT the October 19, 2022 decision of the Office of 

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

consistent with this order of the Board.

Issued: November 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

4

Id.; Order Remanding Case,A.J.,Docket No. 21-1410 (issued May 10, 2022); R.H.,Docket No. 21-0575 (issued 

December 21, 2021); D.C.,Docket No. 19-0100 (issued June 3, 2019); N.M.,Docket No. 18-0833 (issued April18, 

2019); K.T., Docket No. 17-0432 (issued August 17, 2018).

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Id.;see also Order Remanding Case,Docket No. 22-0531 (issuedNovember 18, 2022); Order Remanding Case,

M.E., Docket No. 21-0094 (issued May 27, 2021); Order Remanding Case,L.M.,Docket No. 19-1490 (issued 

January 29, 2020); Order Remanding Case, L.H., Docket No. 18-1777 (issued July 2, 2019).