United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

R.R., Appellant

and

U.S. POSTAL SERVICE, WEST MILWAUKEE 

POST OFFICE, Milwaukee, WI, Employer

__________________________________________

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Docket No. 22-1368

Issued: June 15, 2023

Appearances: Case Submitted on the Record

Aaron Aumiller, Esq., for the appellant1

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 September 28, 2022 appellant, through counsel, filed a timely appeal from a 

September 7, 2022 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 over the merits of this case.

ISSUE

The issue is whether appellant has met his burden of proof to establish bilateral carpal 

tunnel syndrome causally related to the accepted factors of his federal employment.

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

FACTUAL HISTORY

On January 25, 2021 appellant, then a 43-year-old mail carrier, filed an occupational 

disease claim (Form CA-2) alleging that he developed bilateral carpal tunnel syndrome due to 

factors of his federal employment including repetitive use of his wrists while delivering mail over 

19 years. He noted that he first became aware of his condition and realized its relation to his

federal employment on April 7, 2020. Appellant did not immediately stop work.

In a January 28, 2021 development letter, OWCP informed appellant of the deficiencies of 

his claim. It advised him of the type of factual and medical evidence necessary and provided a 

questionnaire for his completion. By separate development letter of even date, OWCP requested 

additional information from the employing establishment. It afforded both parties 30 days to 

respond.

On December 16, 2020 appellant was treated by Laura Tobon, a nurse practitioner, for a 

one-year history of bilateral hand paresthesia, pain, and numbness. He reported working as a mail 

carrier and noted his job required performing repetitive activities. Ms. Tobon diagnosed bilateral 

carpal tunnel syndrome.

On January 20, 2021 Dr. Peter K. Connelly, a Board-certified physiatrist, treated appellant 

for progressive bilateral upper extremity numbness, tingling, and pain. Appellant reported using 

wrist splints at work, which provided no relief in symptoms. Dr. Connelly reviewed an x-ray of 

the cervical spine dated December 16, 2020, which revealed early changes involving uncovertebral 

joints of the lower cervical segment. An x-ray of both hands of even date revealed no 

abnormalities. Dr. Connelly performed an electromyogram (EMG) and nerve conduction velocity 

(NCV) study, which revealed evidence of moderate-median mononeuropathy at the right wrist 

(moderate right carpal tunnel syndrome) and mild-to-moderate median mononeuropathy at the left 

wrist (mild-to-moderate left carpal tunnel syndrome).

Michael G. Ryan, a nurse practitioner, treated appellant on February 3, 2021, for bilateral 

hand, wrist, and forearm numbness and tingling. Appellant reported working as a letter carrier for

approximately 20 years. Findings on physical examination revealed reduced grip strength on the 

right and positive Phalen’s and Tinel’s sign at the wrists bilaterally. Mr. Ryan noted an abnormal 

EMG/NCV study and recommended right carpal tunnel release.

By decision dated March 1, 2021, OWCP denied appellant’s claim, finding that he had not 

established the implicated factors of employment as he had not responded to its January 28, 2021 

development questionnaire. It concluded that the requirements had therefore not been met to 

establish an injury as defined by FECA.

On March 29, 2021 appellant requested a review of the written record before a 

representative of OWCP’s Branch of Hearings and Review and submitted additional evidence.

A March 8, 2021 operative report by Dr. Kenneth Berg, a Board-certified orthopedist, 

revealed that he performed an open right carpal tunnel release on appellant and diagnosed right 

carpal tunnel syndrome.

On March 22, 2021 Dr. Daniel A. Ladwig, a Board-certified orthopedist, treated appellant 

status-post open right carpal tunnel release. Appellant reported the numbness and tingling in both 
3

hands resolved. He noted normal light-touch sensation across the index and long finger with intact 

motor function in the thumb. Dr. Ladwig returned appellant to work with a 10-pound lifting 

restriction. He noted that appellant continued to complain of numbness, tingling, and discomfort 

of the left wrist consistent with left carpal tunnel syndrome and recommended left carpal tunnel 

release. In an addendum report of even date, Dr. Ladwig indicated that appellant was employed 

as a letter carrier for over 20 years and experienced symptoms of bilateral carpal tunnel syndrome. 

He noted that EMG/NCV studies confirmed bilateral carpal tunnel syndrome and appellant was 

status-post right carpal tunnel release. Dr. Ladwig noted that appellant described various work 

activities performed over 20 years involving repetitive work activities and both light and moderate 

lifting activities. He indicated that it was well known that repetitive movement and lifting activities

“may” lead to the development or aggravation of carpal tunnel syndrome. Dr. Ladwig noted that 

appellant’s disease was confirmed by the medical records and clinical examination findings were 

consistent with carpal tunnel syndrome. He opined, to a reasonable degree of medical certainty,

that the work-related activities contributed and/or aggravated his condition resulting in bilateral 

carpal tunnel syndrome. 

By decision dated July 7, 2021, OWCP’s hearing representative affirmed OWCP’s 

March 1, 2021 decision.

In an undated statement, appellant responded to the development letter and described his 

work activities that attributed to his bilateral carpal tunnel syndrome. He noted that he cased mail 

daily for at least two hours, which required grabbing a bucket, placing the bucket on a countertop, 

unloading the mail onto the countertop, grabbing the mail and placing it into an appropriate slot,

and sorting parcels and placing them in order of the route. Appellant indicated that street delivery

required him to finger through the presorted letters and flats, break them down into blocks, grab 

parcels from his bag to deliver to houses, turn vehicle on and off multiple times, open and close 

vehicle doors multiple times, and open and close multiple mailboxes. He stated that these 

repetitive activities caused his bilateral carpal tunnel syndrome.

On October 7, 2021 Dr. Ladwignoted that appellant was diagnosed with moderate bilateral 

carpal tunnel syndrome and underwent right carpal tunnel release in January 2021. He reviewed 

a description of appellant’s work activities over the past 20 years, which involved repetitive work 

with light and moderate lifting. Dr. Ladwig advised that repetitive movement and lifting activities 

may lead to the development or aggravation of carpal tunnel syndrome. He noted EMG/NCV 

studies were consistent with carpal tunnel syndrome. Dr. Ladwig opined to a reasonable degree 

of medical certainty that the work-related activities contributed to and/or aggravated his condition 

resulting in clinical bilateral carpal tunnel syndrome.

On June 9, 2022 appellant, through counsel, requested reconsideration.

By decision dated September 7, 2022, OWCP modified the July 7, 2021 decision, finding 

that appellant had established the implicated employment factors and that the medical reports 

established a diagnosis of bilateral carpal tunnel syndrome. The claim remained denied, however, 

as the medical evidence of record was insufficient to establish causal relationship between a 

diagnosed medical condition and the accepted factors of his federal employment.
4

LEGAL PRECEDENT

A claimant seeking benefits under FECA3 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,4that 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.5 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.6

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

disease claim, a claimant must submit: (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 

casually related to the identified employment factors.

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.7 The opinion of the physician must be based upon a complete factual 

and medical background, 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.8

ANALYSIS

The Board finds that appellant has not met his burden of proof to establish bilateral carpal 

tunnel causally related to the accepted factors of his federal employment.

On January 20, 2021 Dr. Connelly treated appellant for progressive bilateral upper 

extremity numbness, tingling, and pain. He performed an EMG/NCV study, which revealed 

evidence of moderate right carpal tunnel syndrome and mild-to-moderate left carpal tunnel 

syndrome. Similarly, on March 8, 2021, Dr. Berg performed an open right carpal tunnel release,

and diagnosed right carpal tunnel syndrome. However, these physicians failed to provide an 

3

Id.

4 F.H., Docket No.18-0869 (issued January 29, 2020); J.P., Docket No. 19-0129 (issued December 13, 2019); 

Joe D. Cameron, 41 ECAB 153 (1989).

5 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).

6 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).

7

I.J., Docket No. 19-1343 (issued February 26, 2020); T.H., 59 ECAB 388 (2008); RobertG. Morris, 48 ECAB 

238 (1996).

8 D.C., Docket No. 19-1093 (issued June 25, 2020); see L.B., Docket No. 18-0533 (issued August 27, 2018); 

D.K., Docket No. 17-1549 (issued July 6, 2018).
5

opinion regarding the cause of appellant’s bilateral carpal tunnel syndrome.9 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.10 These reports are thus insufficient to establish causal 

relationship.

In reports dated March 22 and October 7, 2021,Dr. Ladwig noted that appellant was statuspost open right carpal tunnel release, and reported resolution of symptoms. In an addendum report,

he noted that appellant was employed as a letter carrier for over 20 years and experienced 

symptoms of bilateral carpal tunnel, which were confirmed by EMG/NCV studies. Appellant 

described repetitive work activities and both light and moderate lifting activities that he performed 

over a 20-year period. Dr. Ladwig advised that the medical records and clinical examination 

findings were consistent with carpal tunnel syndrome. He opined to a reasonable degree of medical 

certainty that the work-related activities contributed to and/or aggravated appellant’s condition 

resulting in bilateral carpal tunnel syndrome. Although these reports support causal relationship 

between appellant’s bilateral carpal tunnel syndrome and the accepted factors of his federal 

employment, Dr. Ladwigdid not provide rationale explaining his conclusions. Without explaining 

the mechanism of injury by which the repetitive movements involved in appellant’s employment 

duties caused or contributed to the diagnosis, his opinion is of limited probative value.11 Thus, 

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

Appellant submitted reports from nurse practitioners. However, certain healthcare 

providers such as nurse practitioners

12 are not considered “physician[s]” as defined under FECA.13

 

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

entitlement to FECA benefits.

14

 

Appellant also submitted x-rays and an EMG/NCV study. The Board has held that 

diagnostic studies, standing alone, lack probative value on the issue of causal relationship as they 

9 L.D., Docket No. 18-1468 (issued February 11, 2019).

10 See L.B., supra note 8; C.B., Docket No. 09-2027 (issued May 12, 2010); S.E., Docket No. 08-2214 (issued 

May 6, 2009).

11 Y.F., Docket No. 19-1576 (issued August 4, 2020); see A.P., Docket No. 19-0224 (issued July 11, 2019).

12 J.D., Docket No. 16-1752 (issued March1, 2017) (where the Board found that a nurse practitioner is not 

considered a physician under FECA, thus, her opinion is of no relevance to the issue of causal relationship).

13 Section 8102(2) of FECA provides as follows: (2) 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. § 8102(2); 20 C.F.R. § 10.5(t). See Federal (FECA) Procedure Manual, Part 2 -- Claims,

Causal Relationship, Chapter 2.805.3a(1) (January 2013); David P. 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 alsoB.D.,Docket No. 22-0503 (issued September 27, 2022 (nurse practitioners are not considered 

physicians as defined under FECA and their medical findings and/or opinions will not suffice for purposes of 

establishing entitlement to FECA benefits); L.S., Docket No. 19-1231 (issued March 30, 2021) (a nurse practitioner 

is not considered a physician as defined under FECA).

14 Id.
6

do not provide an opinion as to whether the employment incident caused any of the diagnosed 

conditions.15 This evidence is therefore insufficient to establish appellant’s claim.

As the medical evidence of record is insufficient to establish a medical condition causally 

related to the accepted factors of his federal employment, the Board finds that appellant has not 

met his 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 his burden of proof to establish bilateral carpal 

tunnel syndrome causally related to the accepted factors of his federal employment.

ORDER

IT IS HEREBY ORDERED THAT the September 7, 2022 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: June 15, 2023

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

15 See A.S., Docket No. 22-1227 (issued April6, 2023); J.L., Docket No. 20-1662 (issued October 7, 2022);see 

W.M., Docket No. 19-1853 (issued May 13, 2020); L.F., Docket No. 19-1905 (issued April 10, 2020).