United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

J.D., Appellant

and

U.S. POSTAL SERVICE, MURPHY ROAD 

CARRIER ANNEX, Hartford, CT, Employer

__________________________________________

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Docket No. 22-0935

Issued: December 16, 2022

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

PATRICIA H. FITZGERALD, Deputy Chief Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JAMES D. McGINLEY, Alternate Judge

JURISDICTION

On June 3, 2022 appellant filed a timely appeal from January 18 and May 18, 2022 merit 

decisions 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.

ISSUE

The issue is whether appellant has met her burden of proof to establish a right upper 

extremity condition causally related to the accepted December 4, 2021 employment incident.

FACTUAL HISTORY

On December 10, 2021 appellant, then a 56-year-old mail handler, filed a traumatic injury 

claim (Form CA-1) alleging that on December 4, 2021 she injured her right thumb, wrist, 

1

5 U.S.C. § 8101 et seq.
2

scapholunate ligament, and forearm when a pallet skid she was putting away fell and struck these 

areas while in the performance of duty. She stopped work on December 4, 2021.

Appellant submitted duty status reports (Form CA-17) dated December 7 and 8, 2021 by

Dr. S. Paul Winkel, Board-certified in internal and occupational medicine. Dr. Winkel diagnosed 

right scapholunate diastasis and right hand, wrist, and elbow pain status-post December 4, 2021 

trauma. On both reports, he returned appellant to full-time modified-duty work, effective 

December 9, 2021.

In a development letter dated December 20, 2021, OWCP informed appellant that the 

evidence of record was insufficient to establish her claim. It advised her of the type of factual and 

medical evidence needed. OWCP afforded appellant 30 days to respond.

In response, appellant submitted a December 4, 2021 x-ray of the right hand that

demonstrated mild degenerative changes of the first carpometacarpal joint, with no acute traumatic 

findings.

In a December 16, 2021 Form CA-17, Dr. Winkel noted increasing right elbow, forearm 

and wrist pain. He diagnosed right scapholunate diastasis and maintained appellant on modifiedduty work.

On January 4, 2022 OWCP received December 4, 2022 emergency department notes 

signed by Stephanie Nesdale, a registered nurse, Jessica Joseph, a registered nurse, and Misti C. 

Talati, a certified physician assistant, and a December 16, 2022 report by Adam Kovalski, a 

certified physician assistant.

In reports dated January 6, 2022, Dr. Allen R. Berkowitz, a Board-certified orthopedic 

surgeon specializing in hand surgery, recounted appellant’s December 4, 2021 employment 

incident where a plastic pallet slipped as she was lifting it and struck the radial aspect of the right 

hand, wrist, and distal forearm. On examination of the right upper extremity, he observed mild 

instability in the scapholunate joint, tenderness along the course of the ulnar nerve at the elbow, 

mild tenderness and shoulder deformity at the carpometacarpal joint of the thumb, positive 

Phalen’s and median nerve compression tests at the wrist, a positive Tinel’s sign over the ulnar 

nerve at the elbow, and a positive elbow flexion test. Dr. Berkowitz obtained x-rays of the right 

wrist and thumb, which demonstrated widening at the scapholunate interval, an increased 

scapholunate angle with a mild dorsal intercalated segment instability (DISI) deformity of the 

lunate, and mild osteophytic degenerative changes. X-rays of the right elbow were within normal 

limits. Dr. Berkowitz diagnosed right carpal tunnel syndrome, right ulnar neuropathy at the elbow, 

and carpometacarpal joint arthritis of the right thumb. He also suspected that the December 4, 

2021 employment incident with the pallet “precipitated the symptoms of nerve compression,” but 

that the x-ray findings regarding the scapholunate joint of the right wrist were “most likely 

preexisting” based on appellant’s age and objective clinical findings. Dr. Berkowitz recommended 

continued use of a right wrist splint for carpal tunnel syndrome and prescribed an elbow sleeve for 

right ulnar neuropathy. He returned appellant to light-duty work, effective January 7, 2022, with 

minimal repetitive activities with the right upper extremity and no lifting.
3

By decision dated January 18, 2022, OWCP denied appellant’s traumatic injury claim. It

accepted that the December 4, 2021 employment incident occurred, as alleged, but denied the 

claim, finding that the medical evidence of record was insufficient to establish causal relationship 

between the accepted employment incident and her diagnosed right upper extremity conditions.

On February 17, 2022 appellant requested reconsideration. Accompanying her request, 

she submitted duplicate copies of the December 4, 2021 nurses’ notes.

Appellant also submitted a copy of Dr. Berkowitz’ January 6, 2022 report with an 

addendum opining that within a reasonable degree of medical certainty, the diagnosed right carpal 

tunnel syndrome, ulnar neuropathy of the right elbow, and carpometacarpal joint arthritis of the 

right thumb were “causally related to her injury lifting a pallet to place it on top of 13 stacked 

pallets at work on December 4, 2021.”

In a March 3, 2022 report, Dr. Berkowitz noted that appellant underwent an 

electrodiagnostic study on February 28, 2022, which demonstrated mild right carpal tunnel 

syndrome, but no evidence of ulnar neuropathy at the right elbow. He explained that most of 

appellant’s symptoms were related to right carpal tunnel syndrome, with pain and numbness in the 

right hand and nocturnal symptoms. On examination of the right upper extremity, Dr. Berkowitz 

observed tenderness along the course of the ulnar nerve at the elbow without subluxation of the 

ulnar nerve, mild instability at the scapholunate joint, mild tenderness and shoulder deformity at 

the carpometacarpal joint of the thumb, and positive Tinel’s and median nerve compression tests 

at the wrist. He diagnosed right carpal tunnel syndrome. Dr. Berkowitz noted work restrictions 

and administered an intra-articular injection into the right carpal tunnel.

Appellant submitted photographs of her right hand and wrist. She explained, in an 

accompanying note, that the photographs were taken on December 4, 2021, the date of the claimed 

injury.

In a March 31, 2022 report, Dr. Berkowitz noted that the March 3, 2022 intra-articular 

injection into the right carpal tunnel had relieved appellant’s right hand and wrist pain. However, 

appellant continued to have pain migrating into the right forearm, upper arm, and shoulder, and 

nocturnal right wrist symptoms. On examination of the right upper extremity, Dr. Berkowitz 

observed positive Phalen’s, Tinel’s, and median nerve compression tests at the right wrist. He 

maintained work restrictions for light-duty work and scheduled appellant for endoscopic/possible 

open right carpal tunnel release.

On April 1, 2022 OWCP received appellant’s March 31, 2022 statement contending that 

the December 4, 2021 photographs were medical evidence that the December 4, 2021 employment 

incident had caused right carpal tunnel syndrome, ulnar neuropathy at the right elbow, and 

carpometacarpal joint arthritis of the right thumb. Appellant noted that she had been scheduled 

for carpal tunnel release on April 11, 2022. She also provided preoperative scheduling and 

instruction documents.

In a May 9, 2022 work slip, Dr. Berkowitz noted light-duty work restrictions for the right 

upper extremity and that appellant should use a right wrist splint while at work.
4

By decision dated May 18, 2022, OWCP denied modification of the January 18, 2022

decision.

LEGAL PRECEDENT

An employee seeking benefits under FECA2 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,3that 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.4 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.5

To determine if an employee sustained a traumatic injury in the performance of duty, 

OWCP begins with an analysis of whether fact of injury has been established. 6 Fact of injury 

consists of two components that must be considered in conjunction with one another. The first 

component is whether the employee actually experienced the employment incident that allegedly 

occurred at the time and place, and in the manner alleged.7 The second component is whether the 

employment incident caused a personal injury.8

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.9 A physician’s opinion on whether there is causal relationship 

between the diagnosed condition and the implicated employment incident must be based on a 

complete factual and medical background.10 Additionally, the physician’s opinion must be 

expressed in terms of a reasonable degree of medical certainty, and must be supported by medical 

 

2

20 C.F.R. § 10.607(a).

 

3 Federal (FECA) Procedure Manual, Part 2 --Claims, Reconsiderations, Chapter 2.1602.4b (September 2020).

 

4 G.G., Docket No. 18-1072 (issued January 7, 2019); E.R., Docket No. 09-0599 (issued June 3, 2009); Leon D. 

Faidley, Jr., 41 ECAB 104 (1989).

 

5

See 20 C.F.R. § 10.607(b); M.H., Docket No. 18-0623 (issued October 4, 2018); Charles J. Prudencio, 41 ECAB 

499, 501-02 (1990).

 

6 L.C., Docket No. 18-1407 (issued February 14, 2019); M.L., Docket No. 09-0956 (issued April15, 2010). See 

also 20 C.F.R. § 10.607(b); supra note 3 at Chapter 2.1602.5 (September 2020).

 

7

J.W., Docket No. 18-0703 (issued November 14, 2018); Robert G. Burns, 57 ECAB 657 (2006).

 

8

J.S., Docket No. 16-1240 (issued December 1, 2016); supra note 3 at Chapter 2.1602.5a (September 2020).

 

9

20 C.F.R. § 10.607(a); see J.W., supra note 7; Alberta Dukes, 56 ECAB 247 (2005).

 

10 Supra note 3 at Chapter 2.1602.4 (February 2016); VelettaC. Coleman, 48 ECAB 367, 370 (1997).
5

rationale, explaining the nature of the relationship between the diagnosed condition and appellant’s 

specific employment factor(s).11

ANALYSIS

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

extremity condition causally related to the accepted December 4, 2021 employment incident.

Dr. Winkel, in CA-17 forms dated from December 7 through 16, 2021, diagnosed right 

scapholunate diastasis. However, Dr. Winkel did not provide any opinion on causal relationship.

The Board has held that medical evidence that does not offer an opinion regarding the cause of an 

employee’s condition is of no probative value on the issue of causal relationship.12 Thus, this 

evidence is insufficient to establish causal relationship.

Dr. Berkowitz, in reports dated January 6, 2022, recounted appellant’s December 4, 2021 

employment incident where a plastic pallet slipped and fell as she was lifting it onto a stack of 

pallets, striking the radial aspect of the right hand, wrist, and distal forearm. He diagnosed right 

wrist pain, right ulnar neuropathy at the elbow, and right carpal tunnel syndrome. In an addendum 

to his January 6, 2022 report, Dr. Berkowitz opined that within a reasonable degree of medical 

certainty, the diagnosed right carpal tunnel syndrome, ulnar neuropathy of the right elbow, and 

carpometacarpal joint arthritis of the right thumb were causally related to the December 4, 2021 

employment incident. He also suspected that the December 4, 2021 employment incident with the 

pallet precipitated the symptoms of nerve compression but that the x-rays findings regarding the 

right scapholunate joint were “most likely” preexisting based on appellant’s age and objective 

clinical findings. The Board finds that Dr. Berkowitz’ reports are speculative in nature as he 

expressed his support for causal relationship in an equivocal manner. 13 The Board has long held 

that medical opinions that are speculative or equivocal in character have little probative value. 14 

In his additional reports through May 9, 2022, Dr. Berkowitz did not address causal 

relationship. As these reports do not provide a rationalized medical opinion explaining the 

physiologic mechanisms whereby the accepted December 4, 2021 employment incident would 

cause a medical condition, they are, therefore, insufficient to establish an injury causally related to 

the accepted employment incident.15

OWCP also received December 4, 2022 reports by Ms. Nesdale, a registered nurse,

Ms. Joseph, a registered nurse, Ms. Talati, a certified physician assistant, and a December 16, 2002 

 

11 20 C.F.R. § 10.607(b); R.C., Docket No. 22-0426 (issued July 22, 2022); see Debra McDavid, 57 ECAB 

149 (2005).

12 See L.B., Docket No. 18-0533 (issued August 27, 2018); D.K., Docket No. 17-1549 (issued July 6, 2018).

13 See L.L., Docket No. 21-0981 (issued July 1, 2022); see also L.B., Docket No. 18-0533 (issued August27, 2018); 

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

14 See L.L., id.; see also C.A., Docket No. 21-0601 (issued November 15, 2021); J.P., Docket No. 19-0216 (issued 

December 13, 2019); T.M., Docket No. 08-0975 (issued February 6, 2009).

 

15 See supra note 12.
6

report by Mr. Kovalski, a certified physician assistant. The Board has held that medical reports 

signed solely by a nurse16 or physician assistant17 are of no probative value as they are not

considered physicians under FECA and are not competent to provide a medical opinion. 18

Therefore, these reports are insufficient to meet appellant’s burden of proof.19 

OWCP also received photographs of appellant’s right hand and wrist, appellant’s note 

indicating the photographs had been taken on December 4, 2021, and preoperative informational 

documents. As noted above, the issue of causal relationship is medical in nature, 20 and must be 

resolved by probative medical evidence.21 The photographs, note, and preoperative forms do not 

constitute medical evidence as they were not signed or reviewed by a physician. 22 They are, 

therefore, insufficient to meet appellant’s burden of proof.

The record also contains imaging studies. The Board has held, however, that diagnostic

studies, standing alone, lack probative value on the issue of causal relationship as they do not 

provide an opinion on causal relationship between an employment incident and a diagnosed 

condition.23 

As the medical evidence of record is insufficient to establish a right upper extremity 

condition causally related to the accepted December 4, 2021 employment incident, the Board finds 

that appellant 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.

16 Section 8101(2) of FECA 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 supra note 3 at Chapter 2.805.3a(1); P.S., Docket No. 17-0598 (issued 

June 23, 2017) (registered nurses are not considered physicians as defined under FECA); DavidP. 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 A.C., Docket No. 20-1510 (issued April23, 2021) (physician 

assistants are not physicians as defined by FECA).

17 Id., M.M., Docket No. 17-1641 (issued February 15, 2018).

18 See supra note 16.

19 David P. Sawchuk, supra note 16.

20 J.W., supra note 7.

 

21 R.C., supra note 11; see Debra McDavid, supra note 11.

22 Merton J. Sills, 39 ECAB 572, 575 (1988). See also N.V., Docket No. 20-0781 (issued November 18, 2020); 

C.T., Docket No. 19-0058 (issued June14, 2019); Susan M. Biles, 40 ECAB 420 (1989) (where the Board held that 

the statement of a layperson is not competent evidence on the issue of causal relationship).

 

23 N.B., Docket No. 20-0794 (issued July 29, 2022); C.F., Docket No. 19-1748 (issued March 27, 2020); L.B., 

supra note 13; D.K., Docket No. 17-1549 (issued July 6, 2018).
7

CONCLUSION

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

extremity condition causally related to the accepted December 4, 2021 employment incident.

ORDER

IT IS HEREBY ORDERED THAT the January 18 and May 18, 2022 decisions of the 

Office of Workers’ Compensation Programs are affirmed.

Issued: December 16, 2022

Washington, DC

Patricia H. Fitzgerald, Deputy 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