United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

C.O., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE,

Pittsburgh, PA, Employer

__________________________________________

)

)

)

)

)

)

)

)

Docket No. 23-0678

Issued: September 28, 2023

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JAMES D. McGINLEY, Alternate Judge

JURISDICTION

On April 6, 2023 appellant filed a timely appeal from an October 27, 2022 merit decision

and a December 9, 2022 nonmerit decision of the Office of Workers’ Compensation Programs

(OWCP). Pursuant to the Federal Employees’ Compensation Act1(FECA) and 20 C.F.R.

§§ 501.2(c) and 501.3, the Board has jurisdiction over the merits of this case.

2

ISSUES

The issues are: (1) whether appellant has met her burden of proof to establish a diagnosed 

medical condition in connection with the accepted factors of her federal employment; and 

1

5 U.S.C. § 8101 et seq.

2 The Board notes that, following the December 9, 2022 decision, OWCP received additional evidence. 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

(2) whether OWCP properly denied her request for reconsideration of the merits of her claim,

pursuant to 5 U.S.C. § 8128(a).

FACTUAL HISTORY

On September 12, 2022 appellant, then a 60-year-old city delivery specialist, filed an 

occupational disease claim (Form CA-2) alleging that she developed a strain, pain, and 

inflammation in her left wrist and thumb that worsened while she was working due to factors of 

her federal employment, including fine manipulation and repetitive movement to sort mail, grasp 

and wrap bundles of mail, as well as turning doorknobs and using keys to enter locked buildings. 

She indicated that she first became aware of her condition on March 31, 2020, and realized its 

relation to her federal employment on August 31, 2022.3 Appellant did not stop work. 

In support of her claim, appellant submitted an undated statement relating that in 

March 2020 she began to experience pain and periodic inflammation in her left wrist and thumb. 

She indicated that, over the past two years, the pain increased significantly and was aggravated by 

her work duties, which included manipulation of letters and magazines, sorting, grasping, pulling, 

and bundling mail with rubber bands. Appellant explained that she performed these tasks for one 

and a half to five hours daily, five days per week. She performed additional tasks during her eighthour shift, five days per week, including grasping, manipulation of mail, unbundling, opening 

doors, and using keys to enter locked buildings, and noted that these tasks had become increasingly 

difficult. 

On August 31 2022 Dr. David Stone, a Board-certified physiatrist, referred appellant for a 

left wrist magnetic resonance imaging (MRI) scan and noted diagnoses of extensor carpi ulnaris 

tendinitis and a degenerative tear of the triangular fibrocartilage complex (TFCC). In a letter of 

even date, a healthcare provider with an illegible signature noted that appellant had a left wrist

TFCC injury with extensor capri ulnaris tendinopathy thatwas related to her work in the employing 

establishment. 

In a September 16, 2022 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 provided a factual questionnaire for her completion. In a development letter of even 

date, OWCP requested that the employing establishment provide additional information, including 

comments from a knowledgeable supervisor. It afforded both parties 30 days to submit the 

requested evidence. 

In an undated response to the development letter, an employing establishment supervisor,

R.A., related that appellant was a full-time mail carrier and cased mail for one to two hours daily, 

which involved fine manipulation with her hands and wrists while placing letters and flats into 

cases. Appellant’s duties also included carrying mail on a route which included, five to six hours 

of walking, climbing steps, one to two hours of driving, standing while casing, and reaching above 

and below eye level to place mail in a case. R.A. noted that in the past year appellant was on 

3

In OWCP File No. xxxxxx463, appellant had a previously accepted traumatic injury claim (Form CA-1) for a 

contusion of the lower back, contusion of the right hand, and contusion of the left forearm. The case has not been 

administratively combined by OWCP with the present file.
3

limited duty and was off work from January until June 2022 due to another injury not involving 

her wrists. He explained that she never brought to his attention nor complained about her wrists 

until she filed a Form CA-2, so the employing establishment was unable to take precautions for 

her wrists, and that her work area was indoors with a four-foot wide by six-foot high casing area. 

R.A. noted that appellant claimed that the casing and delivery of mail caused the development of 

her condition. 

In a September 13, 2022 challenge letter, the employing establishment controverted the 

claim, asserting that appellant’s medical documentation lacked a detailed statement from her 

physician with diagnostic findings establishing that the injury was a result of her employment 

duties. 

In a September 29, 2022 statement, appellant explained that, as a letter carrier, her duties 

included manipulation of magazines and letters, sorting, grasping, pulling, bundling and 

unbundling mail with rubber bands, and turning keys in locks for eight hours per day, five days 

per week. Her outside hobbies included gardening and she first noticed the condition on

approximately March 31, 2020 and experienced pain and inflammation in both wrists and thumbs 

after completing daily tasks. Appellant indicated that she had arthritis in other parts of her body,

but was never diagnosed with arthritis in her wrists, and she broke a wrist in May 2022 and wore 

a cast for six weeks. She noted that while her original claim was for her left wrist, both her left 

and right wrists were affected in the same manner. 

In a statement dated September 30, 2022, appellant noted that she experienced 

inflammation and pain that increased over time due to her work duties, and she was diagnosed on 

August 31, 2022 with extensor carpi ulnaris tendinitis and a degenerative tear of the fibrocartilage 

complex of the left wrist, supported by documents she provided. She explained that she 

experienced the same inflammation and pain in her right wrist, had been a Pittsburg City letter 

carrier for 23 years, and performed her work duties daily for eight hours per day, five days per 

week, sometimes longer. Appellant indicated that the relationship between her diagnosis and her 

federal employment included her duties of manipulating letters and magazines, sorting, grasping, 

pulling, bundling and unbundling large groups of mail with rubber bands, and frequently turning 

keys to open and close doors and mailboxes. She asserted that the repetitive motion and strain on 

her thumb and wrist caused her pain and inflammation to increase to extreme levels over time. 

Appellant also related that the note signed by Dr. Stone, which was found by OWCPto be illegible, 

displayed his name beneath his signature and stated that the diagnosed condition was directly 

caused by her job duties, and the other documents that she submitted were signed by a physician. 

In an October 24, 2022 note, Dr. Stone noted that he treated appellant on August 31, 2022 

for bilateral wrist pain, left greater than right, of two years’ duration. He indicated thatshe reported

pain in the carpometacarpal joint and ulnar side of her wrist and that her symptoms were worse 

when writing and turning a door key. Dr. Stone related that appellant had a history of cervical 

spinal stenosis, which she felt might be contributing to her symptoms, and that she worked in a 

post office and engaged in repetitive activity that aggravated her symptoms. He explained that she

had a prior history of wrist fracture which was treated with casting, and that prior x-rays indicated

degenerative joint disease (DJD) of the thumb carpometacarpal joint. Dr. Stone diagnosed a TFCC 

injury related to appellant’s prior fall, carpometacarpal joint DJD, and extensor carpi ulnaris 

tendinopathy. He noted that her duties included sorting, grasping, and bundling of mail, which 
4

had the potential to create an overuse injury such as extensor carpi ulnaris tendinopathy, and that 

her TFCC injury could potentially be related to overuse, though it was possibly related to her prior

fall and fracture, which would explain why her symptoms persisted despite the healing of her 

fracture. Dr. Stone opined thatthe persistent use of appellant’sthumbto grip, hold, and manipulate

mail was likely the cause of her arthritis in the carpometacarpal joint of the thumb, and that DJD 

of the thumb naturally worsens over time. He also indicated that a TFCC injury can result in DJD

of the wrist, depending on where the tear is located, and that extensor carpi ulnaris tendinopathy 

is considered an overuse injury. 

By decision dated October 27, 2022, OWCP accepted that the employment factors 

occurred, as alleged. However, it denied appellant’s occupational disease claim, finding that she 

had not submitted evidence containing a medical diagnosis in connection with the accepted factors 

of her federal employment. Consequently, OWCP found that the requirements had not been met 

to establish an injury as defined by FECA.

On December 8, 2022 appellant requested reconsideration of the October 27, 2022 decision

and submitted additional evidence, including a November 30, 2022 MRI scan report of her left 

wrist which noted an impression of ulnar impaction syndrome with an extensive macerated fullthickness TFCC tear, full-thickness tears through the membranous segments of the scapholunate 

and lunotriquetral ligaments, severe thumb carpometacarpal joint osteoarthritis, and tendinopathy 

and low-grade partial tearing to the extensor carpi ulnaris with subluxation from the ulnar groove 

due to subs heath tear. 

By decision dated December 9, 2022, OWCP denied appellant’s request for 

reconsideration of the merits of her claim, pursuant to 5 U.S.C. § 8128(a).

LEGAL PRECEDENT -- ISSUE 1

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

4

Supra note 1.

5 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). 

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).
5

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

disease claim, an employee must submit the following: (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 employment factors identified by the employee. 8

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.

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 the specific employment factor(s) identified by the employee.10

ANALYSIS -- ISSUE 1

The Board finds that appellant has established a diagnosed medical condition in connection 

with the accepted factors of her federal employment.

In an October 24, 2022 note, Dr. Stone noted that he treated appellant on August 31, 2022 

for bilateral wrist pain, left greater than right. He indicated that she had a prior history of wrist 

fracture and that x-rays demonstrated evidence of DJD of the thumb carpometacarpal joint. 

Dr. Stone diagnosed a TFCC injury related to appellant’s prior fall, carpometacarpal joint DJD, 

and extensor carpi ulnaris tendinopathy. He explained that her employment duties included

sorting, grasping, and bundling of mail, which had the potential to create an overuse injury such 

as extensor carpi ulnaris tendinopathy, and that the TFCC injury could potentially be related to 

overuse, though it was possibly related to her previous fall and fracture. Dr. Stone opined that the 

persistent use of appellant’s thumb to grip, hold, and manipulate mail was likely the cause of her 

arthritis in the carpometacarpal joint of the thumb and noted that DJD in the thumb becomes worse 

over time. He also indicated that a TFCC injury can result in DJD of the wrist, depending on 

where the tear is located, and that extensor carpi ulnaris tendinopathy is considered an overuse 

injury. 

In light of the foregoing diagnoses by appellant’s attending physician, the Board thus finds 

that the evidence of record establishes diagnoses in connection with the accepted factors of her 

federal employment. The Board further finds, however, that the case is not in posture for decision 

with regard to whether any or all of the diagnosed medical conditions are causally related to the 

accepted employment factors.

8 T.D., Docket No. 20-0921 (issued November 12, 2020); M.S.,Docket No. 18-1554 (issued February 8, 2019). See 

also Roy L. Humphrey, 57 ECAB 238, 241 (2005); Ruby I. Fish, 46 ECAB 276, 279 (1994);Victor J. Woodhams, 41 

ECAB 345 (1989).

9

S.A., Docket No. 18-0399 (issued October 16, 2018); Robert G. Morris, 48 ECAB 238 (1996).

10 M.V., Docket No. 18-0884 (issued December 28, 2018); I.J., 59 ECAB 408 (2008); Victor J. Woodhams, supra

note 8.
6

As the medical evidence of record establishes diagnosed medical conditions, the case must 

be remanded for consideration of the medical evidence with regard to the issue of causal 

relationship.11 Following this and other such further development as deemed necessary, OWCP 

shall issue a de novo decision addressing whether appellant has met her burden of proof to establish 

an injury causally related to the accepted factors of her federal employment.12

CONCLUSION

The Board finds that appellant has met her burden of proof to establish diagnosed medical 

conditions in connection with the accepted factors of her federal employment. The Board further 

finds, however, that the case is not in posture for decision with regard to whether the diagnosed 

medical conditions are causally related to the accepted factors of her federal employment.

ORDER

IT IS HEREBY ORDERED THAT the October 27, 2022 decision of the Office of 

Workers’Compensation Programs is reversed in part and set aside in part, and the case is remanded 

for further proceedings consistent with this decision of the Board. The December 9, 2022 decision 

of the Office of Workers’ Compensation Programs is set aside as moot.

Issued: September 28, 2023

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board

James D. McGinley, Alternate Judge

Employees’ Compensation Appeals Board

11 See R.C., Docket No. 22-1099 (issued December 28, 2022); F.D., Docket No. 21-1045 (issued 

December 22, 2021).

12 In view of the Board’s disposition of Issue 1, Issue 2 is rendered moot.