United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

J.H., Appellant

and

DEPARTMENT OF VETERANS AFFAIRS, 

VETERANS AFFAIRS PACIFIC ISLANDS 

HEALTH CARE SYSTEM, Honolulu, HI, 

Employer

__________________________________________

)

)

)

)

)

)

)

)

)

)

Docket No. 21-0876

Issued: October 22, 2021

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

JANICE B. ASKIN, Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On May 17, 2021 appellant filed a timely appeal from a May 10, 2021 merit 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

1

5 U.S.C. § 8101 et seq.

2 The Board notes that, following the May 10, 2021 decision, appellant submitted additional evidence to 

OWCP. 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 a diagnosed medical 

condition causally related to the accepted factors of her federal employment.

FACTUAL HISTORY

On March 17, 2021 appellant, then a 48-year-old support services administrator, filed a 

traumatic injury claim (Form CA-1) alleging that she sustained an injury on March 2, 2020 to her 

hands, neck, and shoulders while in the performance of duty. She asserted that she felt a burning 

sensation and pop in both hands when moving computers at work in March 2020, and that she 

developed cramping, pain, and numbness in her hands, as well as pain and burning sensation in 

her neck and shoulders. Appellant also implicated typing duties on March 16, 2021 as causing 

injury and described the claimed “nature of injury” as bilateral carpal tunnel syndrome, and strains 

of the hands, neck, and shoulders. She stopped work on or about the time she filed her claim. 

Appellant submitted a July 31, 2020 form completed by Dr. Troy Tada, an osteopath 

Board-certified in anesthesiology, as part of her request for work accommodation. Dr. Tada 

detailed appellant’s complaints, which included pain of the neck and shoulders, and severe upper 

extremities intermittent numbness, burning, and tingling from the neck to the fingers. He opined 

that appellant’s severe pain limited her functioning and required her to rest for 10 minutes at times. 

In a March 25, 2021 report, Susan G. Suer, a physician assistant, diagnosed bilateral carpal 

tunnel syndrome and adjustment disorder with mixed anxiety and depressed mood. 

In a March 29, 2021 development letter, OWCP informed appellant of the deficiencies of 

her claim. It advised her as to the type of additional factual and medical evidence required and 

provided a questionnaire for her completion. OWCP noted that appellant had described a condition 

that she claimed had developed over a period of more than a year and it later indicated that it was 

developing her claim as one for an occupational disease.3 OWCP afforded appellant 30 days to 

respond. 

In response, appellant asserted that the pain in her neck and hands had worsened over a 

period of time and made it hard to fully perform her work. She reported that she experienced 

increased pain and burning sensation in her neck and hands after typing at work for 8 to 10 hours. 

Appellant submitted an April 1, 2021 note from Renae Gibbs, a certified nursing assistant, 

who indicated that appellant could work four or five hours per day for four weeks commencing 

April 5, 2021. Ms. Gibbs also indicated that appellant should have 4 breaks of 15 minutes each 

per workday. 

3 The Board notes that a traumatic injury refers to injury caused by a specific event or incident or series of incidents 

occurring within a single workday or work shift whereas an occupational disease refers to an injury produced by 

employment over a period longer than a single workday or shift. 20 C.F.R. §§ 10.5(q), (ee); R.V., Docket No. 18-1037 

(issued March 26, 2019); Brady L. Fowler, 44 ECAB 343, 351 (1992).
3

In an April 8, 2021 work restriction profile form report, Dr. Clayton Everline, a Boardcertified internist, advised that appellant could perform full-time modified-duty work with 

restrictions, including intermittently lifting/carrying no more than 21 pounds. He diagnosed neck 

muscle and thoracic myofascial strains, muscle spasm, hyperalgesia, and somatic dysfunction of 

the thoracic, cervical, and lumbar regions. 

In an April 21, 2021 report, Dr. Frederick O’Brien, a Board-certified orthopedic surgeon, 

advised that appellant could return to work for four hours per day with a 15-minute break for every 

hour that she worked. He noted that she was given splints to help with her “condition.” In a duty 

status report (Form CA-17) of even date, Dr. O’Brien listed a “date of injury” of March 15, 2021 

and noted that appellant reported sustaining neck and back injuries due to moving computers for 

work purposes on March 2, 2020. He provided a diagnosis “due to injury” of carpal tunnel 

syndrome and indicated that she could work for four hours per day with restrictions. 

Appellant submitted reports from Rafael Salazar, a physical therapist, who described

therapy sessions held on April 6, 9, 15, 20, and 28, 2021. She also submitted an April 15, 2021 

report from Brittney Harrell, a physical therapist.

By decision dated May 10, 2021, OWCP accepted appellant’s claimed employment 

factors, including moving computers and typing. However, it denied her occupational disease 

claim as it found that the medical evidence was insufficient to establish that the medical conditions 

diagnosed were causally related to the accepted employment factors. 

LEGAL PRECEDENT

An employee seeking benefits under FECA4 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 filed with the applicable time 

limitation, that an injury was sustained while in the performance of duty, as alleged, and that any

disability or specific condition for which compensation is claimed is causally related to the 

employment injury.5 These are the essential elements of every compensation claim regardless of 

whether the claim is predicated upon a traumatic injury or an occupational disease. 6

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

disease claim, a claimant must submit the following: (1) a factual statement identifying 

employment factors alleged to have caused or contributed to the presence or occurrence o f the 

disease or condition; (2) medical evidence establishing the presence or existence of the disease or 

4

Supra note 1.

5 E.S., Docket No. 18-1580 (issued January 23, 2020); M.E., Docket No. 18-1135 (issued January 4, 2019); C.S., 

Docket No. 08-1585 (issued March 3, 2009); Bonnie A. Contreras, 57 ECAB 364 (2006).

6 E.S., id.; S.P., 59 ECAB 184 (2007); Joe D. Cameron, 41 ECAB 153 (1989); Elaine Pendleton, 40 ECAB 

1143 (1989).
4

condition for which compensation is claimed; and (3) medical evidence establishing that the

diagnosed condition is causally related to the identified employmentfactors.7

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.8 A physician’s opinion on whether there is causal relationship 

between the diagnosed condition and the implicated employment factor(s) must be based on a 

complete factual and medical background.9 Additionally, the physician’s opinion must be

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

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

specific employment factor(s).10

ANALYSIS

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

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

Appellant submitted a July 31, 2020 form report from Dr. Tada who opined that she

reported severe pain limited her functioning and required her to rest for 10 minutes at times. The 

Board finds that this report is of no probative value regarding her occupational disease claim 

because he did not provide an opinion regarding causal relationship between her diagnosed 

conditions and the accepted employment factors. The Board has held that medical evidence that 

does not offer an opinion regarding the cause of an employee’s condition or disability is of no 

probative value on the issue of causal relationship.11 Therefore, this report is insufficient to 

establish appellant’s occupational disease claim.

In an April 8, 2021 form report, Dr. Everline indicated that appellant could perform fulltime modified-duty work with restrictions, including intermittently lifting/carrying no more than 

21 pounds. He diagnosed neck muscle and thoracic myofascial strains, muscle spasm, 

hyperalgesia, and somatic dysfunction of the thoracic, cervical, and lumbar regions. In an 

April 21, 2021 report, Dr. O’Brien advised that appellant could return to work for 4 hours per day 

with a 15-minute break for every hour that she worked. He noted that she was given splints to 

help with her “condition.” However, these reports are of no probative value regarding appellant’s 

occupational disease claim because neither Dr. Everline nor Dr. O’Brien provided an opinion on 

the cause of a diagnosed medical condition. As stated above, the Board has held that medical

evidence that does notoffer an opinion regardingthe cause of an employee’s condition or disability

7 R.G., Docket No. 19-0233 (issued July 16, 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).

8 W.M., Docket No. 14-1853 (issuedMay13, 2020); T.H., 59 ECAB 388, 393 (2008); Robert G. Morris, 48 ECAB 

238 (1996).

9 M.V., Docket No. 18-0884 (issued December 28, 2018).

10 Id.; Victor J. Woodhams, supra note 7.

11 T.H., Docket No. 18-0704 (issued September 6, 2018). See also L.B., Docket No. 18-0533 (issued August 27, 

2018); D.K., Docket No. 17-1549 (issued July 6, 2018); Charles H. Tomaszewski, 39 ECAB 461 (1988).
5

is of no probative value on the issue of causal relationship.

12

 Therefore, these reports are

insufficient to establish appellant’s occupational disease claim.

In an April 21, 2021 Form CA-17, Dr. O’Brien listed a “date of injury” of March 15, 2021, 

noting that appellant reported sustaining neck and back injuries due to moving computers for work 

purposes on March 2, 2020 and diagnosed “due to injury” of carpal tunnel syndrome with 

restrictions that she could work for four hours per day. Although he referenced her work duties, 

he failed to provide a rationalized medical opinion relating the diagnosed upper extremity 

condition to the noted employment factors. The Board has held that a report is of limited probative 

value regarding causal relationship if it does not contain medical rationale explaining how an 

employment activity could have caused or aggravated a medical condition.13 Therefore, this report 

is insufficient to establish appellant’s claim.

Appellant submitted a March 25, 2021 report from Ms. Suer, a physician assistant, and an 

April 1, 2021 note from Ms. Gibbs, a certified nursing assistant. She also submitted reports from

Mr. Salazar, an occupational therapist, dated April 6, 9, 15, 20, and 28, 2021, and an April 15, 2021 

report from Ms. Harrell, a physical therapist. However, certain healthcare providers such 

as physician assistants, nurses, nurse practitioners, physical/occupational therapists, nursing 

assistants, and social workers are not considered “physician[s]” as defined under FECA.14 

Consequently, their medical findings and/or opinions will not suffice for purposes of establishing 

entitlement to FECA benefits.

As appellant has not submitted rationalized medical evidence establishing that her diagnosed 

medical conditions were causally related to the accepted factors of her federal employment, the 

Board finds that she has not met her burden of proof to establish her claim.

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.

CONCLUSION

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

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

12 Id.

13 See Y.D., Docket No. 16-1896 (issued February 10, 2017).

14 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); seeFederal (FECA) Procedure Manual, Part 2 --Claims, Causal Relationship, 

Chapter 2.805.3a(1) (January 2013); 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 R.L., Docket No. 19-0440 (issued July 8, 2019) (nurse practitioners and physical therapists are not considered 

physicians under FECA).
6

ORDER

IT IS HEREBY ORDERED THAT the May 10, 2021 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: October 22, 2021

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board