United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

B.Y., Appellant

and

U.S. POSTAL SERVICE, BENTON HARBOR 

POST OFFICE, Benton Harbor, MI, Employer

__________________________________________

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Docket No. 23-0950

Issued: November 28, 2023

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 June 30, 2023 appellant filed a timely appeal from a May 31, 2023 merit decision of 

the Office of Workers’ Compensation Programs (OWCP). Pursuant to the Federal Employees’

Compensation Act1 and 20 C.F.R. §§ 501.2(c) and 501.3, the Board has jurisdiction over the merits 

of this case.2

ISSUE

The issue is whether appellant has met her burden of proof to establish bilateral thumb 

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

1

5 U.S.C. § 8101 et seq.

2 The Board notes that, following the May 31, 2023 decision, OWCP received additional evidence. 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

FACTUAL HISTORY

On March 7, 2023 appellant, then a 59-year-old rural carrier, filed an occupational disease 

claim (Form CA-2) alleging that she developed bilateral trigger finger causally related to factors 

of her federal employment. She indicated that she first became aware of her condition on 

February 20, 2023, and its relationship to her federal employment on March 6, 2023. Appellant 

stopped work on February 21, 2023 and returned to work on March 9, 2023 without medical work 

restrictions.

In a report dated March 6, 2023, Dr. Michael Berry, an orthopedic hand surgery specialist, 

examined appellant for complaints of bilateral thumb triggering or clicking. On physical 

examination of the thumbs, he observed maximum tenderness over the palmar base of the thumb; 

localizing tenderness over the A-1 pulley; mild-to-moderate nodular changes palpable within the 

flexor tendon during active range of motion; and a discrete triggering on palpation. Dr. Berry

diagnosed bilateral thumb triggering.

In a development letter dated March 15, 2023, OWCP informed appellant that the evidence 

submitted was insufficient to establish her claim. It advised her of the type of factual and medical 

evidence needed. OWCP also provided appellant a questionnaire for completion regarding the 

factual elements of her claim. It afforded her 60 days to respond and submit additional evidence. 

In a report dated March 16, 2023,Dr. Berry noted that she indicated that her bilateral thumb 

triggering continued to be aggravated by her work. Observations on physical examination of the 

bilateral thumbs remained unchanged as in the report of March 6, 2023 with the additional 

observation that the range of motion of her interphalangeal joints was limited. Dr. Berry diagnosed 

bilateral thumb triggering.

On March 20, 2023 OWCP received a narrative statement from appellant wherein she 

indicated that she believed that her thumb conditions were caused by lifting of heavy packages, 

sorting, casing, and pulling mail. Appellant further described her routine work activities.

On April 17, 2023 OWCP issued an additional 30-day development letter to appellant 

requesting additional factual and medical evidence to substantiate her claim.

In an emergency department report dated February 20, 2023, Dr. Ashley Kowalkowski, an 

osteopath, stated that appellant had presented to the emergency department with right thumb pain 

on that date. She noted that appellant had experienced right thumb pain that was exacerbated on 

April 27, 2023 when appellant pulled a large package across her desk and felt a “pop” at the base 

of the right thumb. On physical examination, Dr. Kowalkowski observed tenderness to the base 

of the first metacarpal with difficulty flexing the interphalangeal joint. She diagnosed right thumb 

pain.

In a report dated April 3, 2023, Dr. Berry diagnosed bilateral trigger finger. On physical 

examination of the right thumb, the observations remained the same as on March 16, 2023, with 

the exception of a very stiff interphalangeal range of motion. On physical examination of the left 

thumb, the observations remained the same as on March 16, 2023 with the exception of moderate 

stiffness of the interphalangeal joint’s range of motion.
3

In a report dated May 18, 2023, Dr. Berry noted that appellant indicated that she 

experienced triggering and pain of the right thumb. On physical examination of the right thumb, 

he observed maximum tenderness over the palmar base of the thumb; localizing tenderness over 

the A-1 pulley; mild-to-moderate nodular changes palpable within the flexor tendon during active 

range of motion; and very limited interphalangeal joint range of motion. On physical examination 

of the left thumb, Dr. Berry observed the same symptoms, with the exception of a discrete 

triggering noted with palpation, and full interphalangeal joint range of motion. He diagnosed 

bilateral thumb triggering.

By decision dated May 31, 2023, OWCP denied appellant’s occupational disease claim, 

finding that the evidence of record was insufficient to establish that her diagnosed condition was 

causally related to 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 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, that 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.

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 

causally related to the identified employment factors.5

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.6 The opinion of the physician must be based on 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 incident.7

3

Supra note 1.

4 C.K., Docket No. 19-1549 (issued June 30, 2020); R.G., Docket No. 19-0233 (issued July 16, 2019); Elaine 

Pendleton, 40 ECAB 1143 (1989).

5 L.D., Docket No. 19-1301 (issued January29, 2020); S.C., Docket No. 18-1242 (issued March 13, 2019); Victor J. 

Woodhams, 41 ECAB 345, 352 (1989).

6

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

238 (1996).

7 D.J., Docket No. 19-1301 (issued January 29, 2020).
4

ANALYSIS

The Board finds that appellant has not met her burden of proof to establish bilateral thumb 

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

Appellant submitted reports from Dr. Berry dated from March 6 through May 18, 2023. In 

these reports, Dr. Berry provided findings on physical examination and diagnosed bilateral thumb 

triggering. However, he did not provide an opinion explaining the cause of appellant’s diagnosed 

condition. A medical opinion must explain how the implicated employment factors

physiologically caused, contributed to, or aggravated the specific diagnosed conditions.8 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. 9 As such, this 

report is insufficient to establish appellant’s claim.

In an emergency department report dated February 20, 2023, Dr. Kowalkowski diagnosed 

right thumb pain. Under FECA, the assessment of pain is not considered a diagnosis, as pain 

merely refers to a symptom of an underlying condition.10 As such, Dr. Kowalkowski’s report is 

insufficient to establish a firm diagnosis and thus insufficient to establish appellant’s claim.

As the medical evidence of record is insufficient to establish causal relationship between 

appellant’s bilateral thumb conditions and the accepted factors of her federal employment, the 

Board finds that she 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 bilateral thumb 

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

8 E.S., Docket No. 21-0341 (issued August 10, 2021); K.G., Docket No. 18-1598 (issued January 7, 2020).

9 D.C., Docket No. 19-1093 (issued June 25, 2020); see L.B., Docket No. 18-0533 (issued August27, 2018); D.K., 

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

10 M.V., Docket No. 18-0884 (issued December 28, 2018). The Board has consistently held that pain is a symptom, 

not a compensable medical diagnosis. See P.S., Docket No. 12-1601 (issued January 2, 2013); C.F., Docket No. 

08-1102 (issued October 10, 2008).
5

ORDER

IT IS HEREBY ORDERED THAT the May 31, 2023 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: November 28, 2023

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