United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

K.G., Appellant

and

DEPARTMENT OF VETERANS AFFAIRS,

St. Louis, MO, Employer

__________________________________________

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Docket No. 22-0712

Issued: September 9, 2022

Appearances: Case Submitted on the Record

Appellant, pro se,

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

PATRICIA H. FITZGERALD, Deputy Chief Judge

JANICE B. ASKIN, Judge

JURISDICTION

On April 7, 2022 appellant filed a timely appeal from a March 11, 2022 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.

ISSUE

The issue is whether appellant has met her burden of proof to establish an upper extremity 

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

FACTUAL HISTORY

On November 14, 2021 appellant, then a 55-year-old veterans claims examiner, filed an 

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

(CTS), radial tunnel syndrome, and cubital tunnel syndrome due to the factors of her federal 

1

5 U.S.C. § 8101 et seq.
2

employment. She noted that she first became aware of her condition on November 2, 20152 and 

realized its relation to her federal employment on January 27, 2021. On the reverse side of the 

claim form, the employing establishment indicated it would challenge the claim. Appellant did 

not stop work.

In an undated letter, appellant explained that she was diagnosed with CTS on or about 

December 2013 and submitted a doctor’s statement to her manager, R.J., who supplied an 

ergonomic keyboard, mouse, and chair. She related that she complied with her doctor’s

recommended treatment of injections and a wrist brace. The pain gradually worsened and she

noted that in 2021 she was diagnosed with radial tunnel and cubital tunnel syndrome. Appellant

underwent therapy and began taking breaks during the day, which her manager approved on the 

condition that she used leave. She explained that she was a veterans claims examiner when she 

submitted her medical statements and is now a veterans service representative, and both jobs 

involved repetitive actions including extensive typing and mouse usage. 

On November 16, 2021 the employing establishment controverted the claim, asserting that 

performance of duty and causal relationship had not been established.

In a November 18, 2021 development letter, OWCP informed appellant that the evidence 

submitted was insufficient to establish her claim. It advised her of the type of additional evidence 

needed and afforded her 30 days to respond. In a separate development letter of even date, OWCP 

informed the employing establishment that additional information was needed regarding 

appellant’s compensation claim. It specifically inquired whether the employing establishment 

disputed any aspect of the claim and requested a description of the repetitive hand and wrist tasks 

that appellant performed in the position. OWCP also requested a description of appellant’s work 

area, any precautions or mitigation measures taken, and a description of appellant’s official and 

actual duties.

Appellant submitted a November 2, 2015 letter from Dr. Harvey L. Mirly, a Boardcertified orthopedic hand surgeon, who examined her for bilateral hand pain and numbness. 

Dr. Mirly noted that she reported burning pain and numbness in both hands, wrists, and arms, but 

predominantly the right side. He diagnosed right CTS, after which he administered an injection to 

her right carpal tunnel. 

OWCP received a note from a May 19, 2016 encounter with Dr. Mirly, who examined 

appellant for recurrent symptoms of right CTS. Appellant reported burning pain and numbness in 

both hands, and Dr. Mirly administered a right carpal tunnel injection into her.

A visit note from an April 28, 2017 encounter with Dr. Mirly noted an impression of right 

CTS with no thenar atrophy or weakness. He administered an injection.

Appellant also submitted May 27, 2021 progress notes from an encounter with Dr. Vikas 

Dhawan, a Board-certified orthopedic hand surgeon, who observed mild swelling and thenar 

atrophy as well as thrombotic thrombocytopenic purpura over appellant’s flexor/pronator mass 

2

In a letter, appellant requested that the Board adjust her date of injury from December 10, 2013, the date she 

originally listed in her Form CA-2, to November 2, 2015.
3

and small nodules. He recommended cortisone injections to her mobile wad trigger points and a 

wrist splint.

Progress notes from a September 24, 2021 examination by Samantha Fisher, a physician 

assistant, reflect that appellant continued to experience numbness and tingling in her right hand. 

Ms. Fisher observed evidence of thenar atrophy and swelling and tenderness over the dorsal 

proximal forearm. Appellant reported that trigger point injections over the right dorsal forearm 

had helped with the pain, but on some days her hand did not function properly. Ms. Fisher 

reviewed imaging of the right wrist from June 16, 2021 and observed osteophyte formation at the 

first carpometacarpal joint.

Progress notes from an October 14, 2021 follow up with Ms. Fisher relate that appellant 

continued to have pain and numbness in her forearm. Ms. Fisher noted swelling and tenderness in 

appellant’s forearm with evidence of thenar atrophy. She administered trigger point injections in 

appellant’s right forearm.

In a November 26, 2021 response to OWCP’s development questionnaire, R.T., appellant’s 

supervisor, related that she recalled appellant mentioning in 2016 that she had an ergonomic 

keyboard, but did not recall whether she had informed her of having CTS in 2016. R.T. noted that 

appellant was a senior veteran claims examiner responsible for responding to inquiries, and is 

currently a veteran service representative with a tour of duty of 7:00 a.m. to 4:30 p.m. She also 

noted that appellant was a work-at-home employee with a signed telework agreement attesting that 

her home workstation complied with the telework agreement requirements. R.T. indicated that

she was informed by her supervisor on September 20, 2021 that appellant was approved to take an 

extra 15-minute break, in addition to her 30-minute lunch and two standard 15-minute breaks. She 

further attached a position description enumerating the duties and responsibilities for a veterans 

service representative, which included preparing statements of the case, preparing correspondence, 

monitoring claims using electronic systems, and utilizing electronic data processing systems for 

inputting data, among others. The description noted that the position involved sedentary work in 

office conditions.

In a December 14, 2021 response to OWCP’s development questionnaire, appellant related 

that she was initially incorrect as to the date of her first diagnosis, but was relying on memory. 

She asserted that she informed her coachof her condition, who informed her manager. Appellant’s

doctor had recommended an ergonomic chair, mouse, mouse pad, and keyboard, which her 

employer provided. She explained that she worked from home and her position involved 

continuous typing. Appellant asserted that, in 2020, she awoke with severe pain in her upper right 

arm and observed a large lump in her arm. She did not recall anything that could have aggravated 

her arm other than the typing at work, so she sought out a hand specialist and underwent nerve 

conduction testing. Shortly thereafter, appellant’s department closed and she was reassigned to 

the Veterans Service Center and, thus, she was unable to schedule surgery due to the recent job 

change and demands of training. She related that she continued therapy, injections, and wore a 

splint. Appellant’s manager approved additional breaks, but only on the condition that she used

her own leave. 

By decision dated January 24, 2022, OWCP denied appellant’s claim, finding that she had 

not submitted sufficient evidence to establish that the claimed events occurred as alleged. 
4

Consequently, it found that she had not met the requirements to establish an injury as defined by 

FECA.

On February 2, 2022 appellant requested reconsideration. In a letter accompanying her 

request, she explained that as a veterans service representative she types all day, every day, and 

she had typed every day in her previous job as a veterans claims examiner. Appellant asserted that 

she had been typing every day in both of her positions for over 12 years, and this repetitive action 

caused bilateral CTS, predominantly in the right. She contended that the condition worsened and 

she developed radial tunnel and weak muscles in her right arm, requiring surgery. 

Appellant continued to submit evidence, including an undated article describing the 

symptoms of radial and cubital tunnel syndrome. 

In a February 10, 2022 report, Dr. Dhawan noted that appellant was being treated for right 

CTS and opined that her condition was “most likely” caused by the repetitive motion of typing in

her daily activities required for work. 

By decision dated March 11, 2022, OWCP modified its January 24, 2022 decision to find

that the medical evidence of record was sufficient to establish fact of injury. The claim remained 

denied, however, because the medical evidence of record was insufficient to establish causal 

relationship between appellant’s diagnosed conditions and the accepted factors of her federal 

employment.

LEGAL PRECEDENT

An employee 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, 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 

3

Supra note 1.

4 F.H., Docket No.18-0869 (issued January29, 2020); J.P., Docket No. 19-0129 (issued April26, 2019); JoeD. 

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); 

DeloresC.Ellyett, 41 ECAB 992 (1990).
5

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. 7

To establish causal relationship between the condition, as well as any attendant disability 

claimed and the employment event or incident, the employee must submit rationalized medical 

opinion evidence.8 The opinion of the physician must be based on a complete factual and medical 

background of the employee, 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 the specific employment factor(s) identified by the 

employee.

9

 The weight of the medical evidence is determined by its reliability, its probative value, 

its convincing quality, the care of analysis manifested, and the medical rationale expressed in 

support of the physician’s opinion.

10

ANALYSIS

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

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

In support of her claim, appellant submitted a February 10, 2022 letter from Dr. Dhawan 

indicating that he treated appellant for right CTS and that her condition was “most likely” caused 

by the repetitive motion of typing in her daily activities required for work. The Board finds that 

his opinion that appellant’s employment diagnosed conditions were “most likely” caused by the 

accepted factors of her federal employment is speculative in nature. 11 Medical opinions that are 

speculative or equivocal in character are of diminished probative value.12 Accordingly,

Dr. Dhawan’s opinion is insufficient to establish expansion of appellant’s claim.13

Appellant also submitted a November 2, 2015 letter from Dr. Mirly, noting a diagnosis of 

right CTS and that she received a right carpal tunnel injection. Likewise, notesfrom May 19, 2016 

and April 28, 2017 from Dr. Mirly also noted that she received additional injections. However, 

these reports did not address causal relationship. The Board has held that medical evidence which 

7 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).

8

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

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

supra note 7.

10 D.R., Docket No. 19-0954 (issued October 25, 2019); James Mack, 43 ECAB 321 (1991).

11 See P.D., Docket No. 18-1461 (issued July 2, 2019);E.B., Docket No. 18-1060 (issued November 1, 

2018); LeonardJ. O’Keefe, 14 ECAB 42 (1962).

12 D.B., Docket No. 18-1359 (issued May 14, 2019); Ricky S. Storms, 52 ECAB 349 (2001) (while the opinion of a 

physician supporting causal relationship need not be one of absolute medical certainty, the opinion must not be 

speculative or equivocal. The opinion should be expressed in terms of a reasonable degree of medical certainty).

13 See S.S., Docket No. 21-0837 (issued November 23, 2021).
6

does not offer an opinion regarding the cause of an employee’s condition is of no probative value 

on the issue of causal relationship. As such, these reports are insufficient to establish appellant’s 

claim.14

Similarly, progress notes from a May 27, 2021 encounter with Dr. Dhawan noted mild 

swelling and thenar atrophy as well as thrombotic thrombocytopenic purpura over appellant’s 

flexor/pronator mass and over small nodules but did not offer an opinion on causal relationship. 

As noted above, evidence that does not address causal relationship is of no probative value. Thus,

Dr. Dhawan’s May 27, 2021 notes are also insufficient to establish appellant’s claim.15

Appellant also submitted an undated article describing the symptoms of radial and cubital 

tunnel syndrome. The Board has long held, however, that excerpts from publications have little 

probative value in resolving medical questions unless a physician establishes the applicability of 

the general medical principle discussed in the article to the specific factual situation in the case.16

The remaining medical evidence consists of progress notes dated September 24 and

October 14, 2021 from Ms. Fisher. However, healthcare providers such as physician assistants, 

nurses, nurse practitioners, physical therapists, and social workers are not considered 

“physician[s]” as defined under FECA.17 Consequently, their medical findings or opinions will 

not suffice for purposes of establishing entitlement to FECA benefits.18

As appellant has not submitted rationalized medical evidence sufficient to establish that 

her diagnosed medical conditions were caused or aggravated by the accepted factors of her federal 

employment, the Board finds that she has not met her burden of proof.19

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.

14 See D.Y., Docket No. 20-0112 (issued June 25, 2020); L.B., Docket No. 18-0533 (issued August 27, 2018); D.K., 

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

15 Id.

16 T.S., Docket No. 18-1518 (issued April17, 2019); W.C. (R.C.), Docket No. 18-0531 (issued November 1, 2018);

K.U., Docket No. 15-1771 (issued August26, 2016); Roger D. Payne, 55 ECAB 535 (2004).

17 5 U.S.C. § 8101(2); 20 C.F.R. § 10.5(t).

18 Section 8101(2) of FECA provides that medical opinions can only be given by a qualified physician. This section 

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. H.K., Docket No. 19-0429 (issued 

September 18, 2019); K.W., 59 ECAB 271, 279 (2007); David P. Sawchuk, 57 ECAB 316, 320 n.11 (2006); see also 

S.L., Docket No. 19-0603 (issued January 28, 2020) (a nurse is not considered a physician as defined under FECA).

19 See T.J., Docket No. 19-1339 (issued March 4, 2020); F.D., Docket No. 19-0932 (issued October 3, 2019);

D.N., Docket No. 19-0070 (issued May 10, 2019);R.B., Docket No. 18-1327 (issued December 31, 2018).
7

CONCLUSION

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

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

ORDER

IT IS HEREBY ORDERED THAT the March 11, 2022 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: September 9, 2022

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board