United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

N.H., Appellant

and

U.S. POSTAL SERVICE, KANSAS CITY 

PROCESSING & DISTRIBUTION 

CENTER/FACILITY, Kansas City, MO, 

Employer

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Docket No. 21-1133

Issued: February 25, 2022

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

JANICE B. ASKIN, Judge

PATRICIA H. FITZGERALD, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On July 20, 2021 appellant, through counsel, filed a timely appeal from a June 30, 2021 

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 to consider 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 a medical condition 

causally related to the accepted factors of her federal employment.

FACTUAL HISTORY

On November 9, 2020 appellant, then a 46-year-old mail handler technician, filed an 

occupational disease claim (Form CA-2) alleging that she developed right carpal tunnel syndrome 

(CTS) due to factors of her federal employment. OWCP assigned this claim File No. xxxxxx998.3 

Appellant noted that she first became aware of her condition on October 3, 2017 and realized its 

relationship to her federal employment on November 3, 2020. 

In a November 3, 2020 statement, appellant noted that she underwent an electromyogram/

nerve conduction velocity (EMG/NCV) study on October 3, 2020, which diagnosed right CTS due 

to repetitive motion of her right hand and wrist including gripping, lifting, pushing, and grasping 

equipment, tubs, and letter trays. Additionally, she noted that her thumb had been locking up.

OWCP, in a November 23, 2020 development letter, 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 and provided a questionnaire for her completion. In a separate development letter 

of even date, OWCP requested that the employing establishment provide a copy of appellant’s 

position description and physical requirements of her job. It afforded both parties 30 days to 

respond. No additional evidence was received from either party.

By decision dated December 28, 2020, OWCP denied appellant’s occupational disease 

claim, finding that the evidence of record was insufficient to establish the alleged factors of 

employment, therefore, the factual component of fact of injury had not been established. It

concluded, therefore, that she had not met the requirements to establish an injury as defined under 

FECA.

On January 6, 2021 appellant, through counsel, requested a telephonic hearing before a 

representative of OWCP’s Branch of Hearings and Review. 

OWCP subsequently received medical evidence by Dr. Prem Parmar, an attending Boardcertified orthopedic surgeon. In a letter dated May 3, 2017, Dr. Parmar noted a history of 

appellant’s April 22, 2017 employment injury and reported findings on physical examination. He 

provided an impression that she probably re-aggravated her previous work-related right shoulder 

injury.

3 The record indicates that appellant has prior claims. In OWCP File No. xxxxxx209, OWCP accepted herMay 29, 

2001 traumatic injury claim (Form CA-1) for right shoulder/upper arm/rotator cuff sprain. In a December 5, 2002 

decision, OWCP granted appellant a schedule award for eight percent permanent impairment of the right upper 

extremity. In OWCP File No. xxxxxx328 OWCP accepted her April22, 2017 traumatic injury claim for cervical 

strain at the right trapezius muscle. See infra note 4. 
3

In progress notes dated May 3, 2017 through February 3, 2021, Dr. Parmar discussed 

findings on physical examination of appellant’s shoulders and hands. In an October 14, 2020 

progress note, he provided an assessment that she was status quo with respect to her right and left 

shoulders. Dr. Parmar also assessed that appellant had right CTS based on an EMG/NCV study, 

his physical examination findings, and her complaints of discomfort radiating proximally and 

numbness and tingling in her hand. Further, he provided an assessment that she had right thumb 

A1 pulley pain. Dr. Parmar opined that appellant’s right CTS and right trigger thumb were caused 

by her repetitive work duties of gripping, grasping, pulling, and pushing that she performed over 

the past two decades.

In work status notes also dated May 3, 2017 through February 3, 2021, Dr. Parmar 

diagnosed right shoulder impingement. He advised that appellant could return to work with the 

temporary restrictions of no use of her right arm above the chest, and no lifting, pushing, or pulling 

more than 20 pounds.

OWCP also received diagnostic test reports. In an October 3, 2017 cervical spine magnetic 

resonance imaging (MRI) scan report, Dr. Jeffrey Herman, a Board-certified diagnostic 

radiologist, provided impressions of minimal annular disc bulging resulting in mild central canal 

stenosis and mild bilateral foraminal narrowing at C3-4; and mild broad-based posterior disc 

osteophyte formation and bilateral uncovertebral osteophyte formation resulting in moderate left 

foraminal narrowing, mild right foraminal narrowing, and mild central at C5-6.

Dr. Scott Sher, a Board-certified diagnostic radiologist, performed a right shoulder MRI 

scan arthrogram on October 20, 2017 and provided impressions of possible minimal supraspinatus 

tendinopathy without a tendon tear, no labral tear, and possible minimal subdeltoid/subacromial 

bursitis.

In an October 7, 2020 diagnostic test report, Dr. Kelly Own, a Board-certified physiatrist, 

indicated that an EMG/NCV study of appellant’s right upper extremity revealed moderate right 

median sensorimotor neuropathy across the wrist, and no electrodiagnostic evidence of cervical 

radiculopathy, brachial plexopathy, or peripheral neuropathy. 

During the telephonic hearing held on April 19, 2021, appellant again described the

repetitive work duties to which she attributed her claimed conditions. Additionally, she testified

that she had previously sustained a right shoulder injury in 2001 and a back injury in 2017. 

Appellant further testified that in the summer of 2020 she began treating with Dr. Parmar for her 

right-hand symptoms and that he diagnosed right CTS and right trigger thumb.

Following the hearing, OWCP received progress notes by Dr. Parma. In a March 17, 2017 

progress note, Dr. Parmar reported appellant’s complaints of intermittent bilateral shoulder issues 

and increasing right hand stiffness, numbness and tingling. He discussed examination findings, 

noting a positive compression test on the right and negative on the left. 

Dr. Parmar, in a June 9, 2021 progress note, related that appellant’s right lateral elbow 

complaints were a bigger concern than her bilateral shoulder complaints. He noted that she had 

been performing increased repetitive activities at work. Dr. Parmar also noted that appellant 
4

noticed pain in the right elbow. He provided an impression that she had right tennis elbow due to 

her repetitive work activities. 

By decision dated June 30, 2021, an OWCP hearing representative affirmed OWCP’s

December 28, 2020 decision, finding that the evidence of record was sufficient to establish the

alleged employment factors. The claim remained denied, however, as the medical evidence of 

record was insufficient to establish that appellant’s diagnosed medical conditions were causally 

related to the accepted employment factors.

4

LEGAL PRECEDENT

An employee seeking benefits under FECA5 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 period of FECA,6that 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.7 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.8

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 

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

diagnosed condition is causally related to the identified employment factors. 9

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.10 The opinion of the physician must be based on a complete factual 

4 The hearing representative also directed OWCP to administratively combine appellant’s prior claims for right 

shoulder and neck injuries under OWCP File Nos. xxxxxx209 and xxxxxx328 with the present claim, OWCP File No. 

xxxxxx998 in accordance with OWCP’s procedures. The Board notes that the electronic case record as transmitted 

to the Board indicates that OWCP administratively combined appellant’s claims under OWCP File Nos. xxxxxx209, 

xxxxxx328, and xxxxxx998 with OWCP File No. xxxxxx209 serving as the master file.

5

Supra note 2.

6

S.S., Docket No. 19-1815 (issued June 26, 2020); S.B.,Docket No. 17-1779 (issued February 7, 2018); JoeD. 

Cameron, 41 ECAB 153 (1989).

7 M.H., Docket No. 19-0930 (issued June 17, 2020); R.C., 59 ECAB 427 (2008); James E. Chadden, Sr., 40 ECAB 

312 (1988).

8

S.A.,Docket No. 19-1221 (issued June 9, 2020); L.M.,Docket No. 13-1402 (issued February 7, 2014); DeloresC. 

Ellyett, 41 ECAB 992 (1990).

9 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).

10 L.F., Docket No. 19-1905 (issued April10, 2020); Jacqueline M. Nixon-Steward, 52 ECAB 140 (2000).
5

and medical background of the claimant, 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 factors identified by the claimant. 11

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.12

ANALYSIS

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

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

In support of her claim, appellant submitted reports from Dr. Parmar, who indicated that 

he had treated appellant for her bilateral shoulders and hands, and right thumb and elbow 

conditions. In a March 17, 2017 progress note, Dr. Parmar reported examination findings, 

including a positive compression test on the right and negative on the left. In a progress note dated 

October 14, 2020, he reported findings on physical examination and reviewed EMG/NCV study

results and appellant’s employment duties, which consisted of gripping, grasping, pulling, and 

pushing over the past two decades. Dr. Parmar assessed right CTS and right trigger thumb. He

opined that appellant’s diagnosed conditions were caused by the accepted employment factors.

Dr. Parmar, in a June 9, 2021 progress note, provided an impression that appellant had right tennis 

elbow due to her repetitive work activities. While he provided an affirmative opinion on causal 

relationship, he did not offer medical rationale to explain why he believed appellant’s accepted

employment duties could have resulted in or contributed to her diagnosed conditions. The Board 

has held that a medical opinion must explain how the implicated employment factors 

physiologically caused, contributed to, or aggravated the specific diagnosed conditions.13 Without 

explaining how or why gripping, grasping, pulling, and pushing over the past two decades caused 

or aggravated appellant’s right wrist and thumb conditions, Dr. Parmar’s progress notes are of 

limited probative value and, thus, insufficient to establish appellant’s burden of proof.

14

Dr. Parmar noted in his May 3, 2017 letter that appellant “probably” re-aggravated her 

prior work-related right shoulder injury. This opinion is speculative in nature as he identified only 

a possible cause of the aggravation. The Board has held that medical opinions that are speculative 

11 A.S., Docket No. 19-1955 (issued April9, 2020);LeslieC. Moore, 52 ECAB 132 (2000).

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

J.D., Docket No. 20-0404 (issued July 22, 2020); K.G., Docket No. 18-1598 (issued January 7, 2020); M.S., Docket 

No. 19-0913 (issued November 25, 2019).

13 See R.P., Docket No. 20-0661 (issued April14, 2021); R.L., Docket No. 21-0397 (issued September 7, 2021); 

B.S.,Docket No. 20-0927(issued January29, 2021); A.P., Docket No. 19-0224 (issued July 11, 2019).

14 Id.
6

or equivocal are of diminished probative value.15 Thus, the Board finds that Dr. Parmar’s May 3, 

2017 letter is insufficient to meet appellant’s burden of proof.

Dr. Parmar’s remaining work status notes dated May 3, 2017 through February 3, 2021 

addressed appellant’s right shoulder impingement, work capacity, and restrictions, but failed to 

offer a medical opinion addressing whether the diagnosedcondition and resultant work restrictions 

were causally related to the accepted employment factors. 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.16 Therefore, the Board finds that this evidence is insufficient to establish 

appellant’s claim.

Appellant also submitted diagnostic test reports. However, diagnostic studies, standing 

alone, lack probative value on the issue of causal relationship as they do not address whether 

employment factors caused the diagnosed condition.17

As the record does not contain rationalized medical opinion evidence sufficient to establish 

causal relationship, 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.

CONCLUSION

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

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

15 See D.B., Docket No. 20-0775(issued July 28, 2021); R.P.,supra note 13. 

16 E.G., Docket No. 20-1191 (issued April5, 2021); K.G., Docket No. 20-0625 (issued November 6, 2020);L.B., 

Docket No. 18-0533 (issued August27, 2018); D.K., Docket No. 17-1549 (issued July 6, 2018).

17 C.A.,Docket No. 21-0601 (issued November 15, 2021); K.R., Docket No. 20-1103 (issued January 5, 2021); F.S., 

Docket No. 19-0205 (issued June 19, 2019); A.B.,Docket No. 17-0301 (issued May 19, 2017).
7

ORDER

IT IS HEREBY ORDERED THAT the June 30, 2021 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: February 25, 2022

Washington, DC

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Alternate Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board