United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

V.A., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Fredericksburg, VA, Employer

__________________________________________

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Docket No. 21-1023

Issued: March 6, 2023

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

PATRICIA H. FITZGERALD, Deputy Chief Judge

JANICE B. ASKIN, Judge

JAMES D. McGINLEY, Alternate Judge

JURISDICTION

On June 24, 2021 appellant filed a timely appeal from April 19 and June 9, 2021 merit 

decisions of the Office of Workers’ Compensation Programs (OWCP).1 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. 

1 Appellant submitted a timely request for oral argument before the Board. 20 C.F.R. § 501.5(b). Pursuant to the 

Board’s Rules of Procedure, oral argument may be held in the discretion of the Board. 20 C.F.R. § 501.5(a). In 

support of appellant’s oral argument request, it was asserted that oral argument should be granted because her right 

ulnar nerve condition was causally related to her work-related injury and the subsequent right ulnar surgery was 

medically necessary to address the effects of her work-related condition. The Board, in exercising its discretion, 

denies appellant’s request for oral argument because this matter requires an evaluation of the medical evidence 

presented. As such, the Board finds that the arguments on appeal can adequately be addressed in a decision based on 

a review of the case record. Oral argument in this appeal would further delay issuance of a Board decision and not 

serve a useful purpose. As such, the oral argument request is denied and this decision is based on the case record as 

submitted to the Board.

2

5 U.S.C. § 8101 et seq.
2

ISSUES

The issues are: (1) whether appellant has met her burden of proof to expand the acceptance 

of her claim to include a right ulnar nerve condition causally related to her accepted employment

injuries; and (2) whether OWCP properly denied authorization for right ulnar surgery at the elbow 

and wrist. 

FACTUAL HISTORY

This case has previously been before the Board on different issues.3 The facts of the case 

as presented in the prior Board order and decision are incorporated herein by reference. The 

relevant facts are as follows.

On April 1, 2011 appellant, then a 54-year-old letter carrier, filed an occupational disease 

claim (Form CA-2) alleging that her right hand conditions of carpal tunnel syndrome and trigger 

finger were caused or aggravated by the daily duties of lifting, pulling, sorting and handling of 

mail and heavy parcels in the performance of duty. She noted that she first became aware of her

conditions and realized their relation to her employment on January 3, 2011. OWCP accepted the 

claim for right hand tenosynovitis and right carpal tunnel syndrome.

4

 The record reflects that 

appellant underwent left de Quervain’s release on March 27, 2009; left carpal tunnel release and 

recurrent left de Quervain’s release on March 1, 2013; right carpal tunnel release and right middle 

finger trigger release on October 28, 2011; and right carpal tunnel release on June 26, 2019. 

OWCP paid her wage-loss compensation for all periods of disability. Appellant eventually 

returned to full-duty work, but stopped work again on November 19, 2012 and retired from the 

employing establishment in March 2013. OWCP paid herwage-loss compensation on the periodic 

rolls, effective June 30, 2013. 

On December 27, 2019 OWCP expanded the acceptance of the claim to include lesion of 

the left ulnar nerve; bilateral tenosynovitis of the hand and wrist; bilateral carpal tunnel syndrome; 

and bilateral radial styloid tenosynovitis. 

Appellant subsequently submitted additional evidence. In an October 30, 2019 report,

Dr. James R. Patterson, a Board-certified physiatrist opined that her electromyogram and nerve 

conduction velocity (EMG/NCV) study was consistent with residuals of right carpal tunnel 

syndrome with evidence of motor and sensory fiber involvement and some chronic denervation of 

the abductor pollicis brevis. Given appellant’s history of surgical decompression, he opined that 

postsurgical residuals had not fully resolved and recommended clinical correlation. Dr. Patterson 

also noted a mild entrapment of the right ulnar nerve at the cubital tunnel that was combined with 

a mild entrapment of the ulnar nerve at the Guyon’s canal involving sensory fibers. He opined 

3 Docket No. 13-1433 (issued December 13, 2013); Order Dismissing Appeal, Docket No. 14-519 (issued 

July 29, 2014). 

4 OWCP assigned the present claim OWCP File No. xxxxxx292. Under OWCP File No. xxxxxx938, OWCP 

accepted appellant’s January29, 2009 occupational disease claim for the conditions of left carpal tunnel syndrome, 

left radial styloid tenosynovitis, and left wrist tendinitis. OWCP has administratively combined OWCP File Nos. 

xxxxxx938 and xxxxxx292, with the latterserving as the master file. 
3

that this could result in a double crush phenomenon for the ulnar nerve and recommended clinical 

correlation. 

In a July 27, 2020 report, Dr. Khader Muqtadir, a Board-certified orthopedic hand surgeon, 

reported examination findings. He diagnosed initial encounter of other closed intra -articular 

fracture of distal end of left radius, carpal tunnel syndrome of right wrist, and compression of left 

ulnar nerve at multiple levels. Dr. Muqtadir also indicated that appellant had right cubital 

tunnel/Guyon’s canal compression. He advised that repeat electrodiagnostic studies from 2019 

demonstrated median nerve residuals following right carpal tunnel release as well as mild 

compression of the ulnar nerve at both the cubital tunnel and Guyon canal. Dr. Muqtadir opined 

that if there were persistent or worsening symptoms, a right ulnar nerve decompression may be 

needed. 

In a September 14, 2020 letter, OWCP requested that Dr. Muqtadir provide a medical 

narrative, including a rationalized medical opinion on causal relationship between appellant’s 

January 3, 2011 employment injury and the diagnosed right ulnar nerve condition, if any. 

In an October 8, 2020 electrodiagnostic report, Dr. Patterson found that the EMG/NCV

studies were consistent with residuals of right carpal tunnel syndrome with slight worsening of the 

sensory latency from the October 30, 2019 diagnostic studies. He opined that he could not exclude 

that this could be postsurgical residuals as it could be some component of reentrapment secondary 

to scar. Dr. Patterson recommended clinical correlation. He also found moderate entrapment of 

the right ulnar nerve at the cubital tunnel and a mild entrapment of the ulnar nerve at Guyon’s 

canal. Dr. Patterson indicated that there was some mild worsening in comparison to the 

October 30, 2019 study and could result in a double crush phenomenon. He recommended clinical 

correlation. 

In an October 19, 2020 report, Dr. Muqtadir reviewed and interpreted the latest 

electrodiagnostic testing. He indicated that appellant had undergone multiple previous carpal 

tunnel releases, and that her residual symptoms may be mostly due to the ulnar nerve issues

because her symptoms were mostly ulnar in location and nature. Dr. Muqtadir noted that she may 

still have ongoing neurogenic symptoms with an ulnar nerve decompression and that she agreed 

to proceed with a cubital tunnel and Guyon canal release of the right upper extremity. 

In an October 29, 2020 report, Dr. Muqtadir noted that the October 30, 2019 EMG/NCV

studies revealed mild compression of the ulnar nerve at the cubital tunnel and Guyon ’s canal while 

the October 8, 2020 repeat EMG/NCV test revealed moderate right ulnar nerve compression at the 

cubital tunnel, and mild entrapment of right ulnar nerve at Guyon’s canal. He indicated that there 

was double crush phenomenon and some worsening since October 2019. Dr. Muqtadir opined that

“it was possible that the same inflammation that caused [appellant’s] carpal tunnels to be inflamed 

also resulted in ulnar nerve compressions. Besides that, I am not able to ascribe this to her 

work-related injury from 2011.” 

On November 10, 2020 OWCP referred appellant’s case along with a statement of accepted 

facts (SOAF) to Dr. Franklin M. Epstein, a Board-certified neurosurgeon serving as a district 

medical adviser (DMA). In a November 16, 2020 report, Dr. Epstein noted the accepted 

conditions and surgeries, and that she stopped working in November 2011. He noted that appellant
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had undergone four EMG studies in 2003, 2012, 2019 and recently on October 8, 2020. 

Dr. Epstein indicated that the 2012 EMG study, one year after the date of injury, reported no ulnar 

nerve entrapment. The 2019 EMG study, which was eight years after the date of injury and seven

years after appellant stopped working, first described evidence of ulnar nerve entrapment. The 

DMA opined that there was no rational medical reason to implicate the 2011 employment injury 

or the 2012 recurrence to the ulnar nerve abnormalities first demonstrated by the 2019 and 2020 

EMG studies, noting that such ulnar nerve pathology was not demonstrated by the 2003 EMG, 

eight years prior to the date of injury or by the 2012 EMG, one year after the date of injury. He 

additionally opined that the accepted right carpal tunnel syndrome and its authorized operative 

treatment could not be considered causally related to the new findings of ulnar nerve entrapment. 

The DMA concurred with Dr. Muqtadir’s opinion that the right ulnar nerve entrapment was not 

causally related to the accepted work injury and, thus, opined that any ulnar nerve surgery should 

not be authorized. He further indicated his concurrence with Dr. Muqtadir that it may be 

reasonable to surgically reexplore the right-sided carpal tunnel and opined that OWCP should 

authorize that surgery. The DMA noted that a repeat carpal tunnel release may not prove availing 

given the intractability of appellant’s hand and wrist pain despite more than a decade of medical 

therapy and three surgical interventions. 

On November 11, 2020 appellant underwent a right cubital tunnel syndrome release and 

right wrist Guyon canal ulnar nerve decompression, performed by Dr. Muqtadir. 

By decision dated November 19, 2020, OWCP denied expansion of the acceptance of

appellant’s claim to include an additional diagnosis of right ulnar nerve. It found that the weight 

of the medical evidence rested with its DMA, who concurred with Dr. Muqtadir that herright ulnar 

nerve issue was not causally related to the accepted 2011 employment injury. 

On December 7, 2020 appellant requested an oral hearing before a representative of

OWCP’s Branch of Hearings and Review. A telephonic hearing was held on March 10, 2021. 

OWCP subsequently received a copy of the November 11, 2020 operative report for right elbow 

cubital tunnel release and right wrist Guyon canal decompression of the ulnar nerve;progress notes 

from Dr. Muqtadir; and a February 28, 2019 EMG/NCV study, which indicated evidence of a 

moderate right carpal tunnel syndrome (median nerve entrapment at wrist) and sensory peripheral 

neuropathy affecting bilateral upper extremities. 

By decision dated April 19, 2021, OWCP’s hearing representative affirmed the 

November 19, 2020 decision with regard to the expansion issue. However, based on the DMA’s 

opinion that it may be reasonable to surgically reexplore the right-sided carpal tunnel, the hearing 

representative remanded the case for further development with regard as to whether the 

November 11, 2020 surgery should be authorized. 

On May 10, 2021 OWCP referred the case record and a SOAF to Dr. Epstein, who again 

served as the DMA, to determine whether or not any additional conditions should be deemed 

employment related. 

In a May 11, 2021 report, Dr. Epstein noted that he had presented a detailed explanation 

rejecting causal relationship of the right ulnar entrapment neuropathies in his November 16, 2020 

report. He noted that on November 11, 2020 appellant had undergone decompressive surgery of 
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the right ulnar nerve at both the elbow and wrist and that she had indicated, in her March 25, 2021 

letter, that her conditions were the same or worse after the most recent surgery. Dr. Epstein opined 

that the additional medical evidence of record did not change his November 16, 2020 opinion. He 

indicated that the clinical and electrodiagnostic evidence of record do not support an employmentrelated occupational disease of the right ulnar nerve at either the wrist or the elbow. Dr. Epstein 

further indicated that appellant continued to have chronic bilateral upper limb pain despite four 

operative procedures on her upper extremities and 10 years of medical treatment. He opined that 

the most recent surgery on the right ulnar nerve should not be authorized as employment related. 

By decision dated June 9, 2021, OWCP denied expansion of the acceptance of the claim to 

include a right ulnar nerve condition and authorization for right ulnar surgery. It found that the 

medical evidence of record was insufficient to establish that the right ulnar surgery was medically 

necessary to address the effects of the January 3, 2011 employment-related injury. 

LEGAL PRECEDENT -- ISSUE 1

Where an employee claims that, a condition not accepted or approved by OWCP was due 

to an employment injury, he or she bears the burden of proof to establish that the condition is 

causally related to the employment injury.5

The medical evidence required to establish causal relationship between a specific 

condition, as well as any attendant disability claimed, and the employment injury, is rationalized 

medical opinion evidence.6 A physician’s opinion on whether there is a causal relationship 

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

complete factual and medical background.7 Additionally, the opinion of the physician 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 claimant.8

When an injury arises in the course of employment, every natural consequence that flows 

from that injury likewise arises out of the employment, unless it is the result of an independent 

intervening cause attributable to a claimant’s own intentional misconduct.9 The basic rule is that 

a subsequent injury, whether an aggravation of the original injury or a new and distinct injury, is 

5 T.B., Docket No. 20-0182 (issued April23, 2021); W.L., Docket No. 17-1965 (issued September 12, 2018); V.B., 

Docket No. 12-0599 (issued October 2, 2012); JajaK. Asaramo, 55 ECAB 200, 204 (2004).

6 C.W., Docket No. 21-0017 (issued December 28, 2021); T.B., id.; T.C., Docket No. 19-1043 (issued November 8, 

2019); M.W., 57 ECAB 710 (2006); JohnD. Jackson, 55 ECAB 465 (2004).

7 E.M., Docket No. 18-1599(issued March7, 2019); Robert G. Morris, 48 ECAB 238 (1996).

8 M.V., Docket No. 18-0884 (issued December 28, 2018);I.J., 59 ECAB 408 (2008);Victor J. Woodhams, 41 ECAB 

345 (1989).

9 T.B., supra note 5; C.W., Docket No. 18-1536 (issued June 24, 2019); C.R., Docket No. 18-1285 (issued 

February12, 2019); AlbertF. Ranieri, 55 ECAB 598 (2004); Clement Jay After Buffalo, 45 ECAB 707 (1994).
6

compensable if it is the direct and natural result of a compensable primary injury. 10 With respect 

to consequential injuries, the Board has held that, where an injury is sustained as a consequence 

of an impairment residual to an employment injury, the new or second injury, even though 

nonemployment related, is deemed, because of the chain of causation, to arise out of and in the 

course of employment and is compensable.11

ANALYSIS -- ISSUE 1 

The Board finds that appellant has not met her burden of proof to expand the acceptance 

of her claim to include a right ulnar nerve condition, causally related to her accepted employmentrelated injury.

In a July 27, 2020 report, Dr. Muqtadir indicated that appellant had right cubital tunnel and 

Gayon’s canal compression of the ulnar nerve and that a right ulnar nerve decompression may be 

needed. This was based on 2019 electrodiagnostic studies which demonstrated mild compression 

of the ulnar nerve at both the cubital tunnel and Guyon canal. Dr. Muqtadir, however, did not 

address the cause of appellant’s right ulnar nerve condition. 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.12

Following OWCP’s September 14, 2020 request for an opinion on causal relationship,

Dr. Muqtadir reviewed and interpreted the October 30, 2019 and the October 8, 2020 diagnostic 

testing. In his October 19 and 30, 2020 reports, he indicated that appellant had undergone multiple 

previous carpal tunnel releases and that the residual symptoms may be mostly due to the ulnar 

nerve issues as her symptoms were mostly ulnar in location and nature. Dr. Muqtadir indicated 

that there was double crush phenomenon with some worsening since October 2019. He noted that 

appellant agreed to proceed with an ulnar nerve decompression with a cubital tunnel and Guyon 

canal release of the right upper extremity. Dr. Muqtadir opined “it was possible that the same 

inflammation that caused [appellant’s] carpal tunnels to be inflamed also resulted in ulnar nerve 

compressions. Besides that, I am not able to ascribe this to her work-related injury from 2011.”

The Board has long held that medical opinions that are speculative or equivocal in character have 

little probative value.13 Dr. Muqtadir’s opinion is therefore of diminished probative value and

insufficient to establish appellant’s consequential claim.

The record also contains reports from Dr. Patterson, who found entrapment of the right 

ulnar nerve at the cubital tunnel and at the Guyon’s canal which he opined that could result in a 

double crush phenomenon for the ulnar nerve. He recommended clinical correlation. However, 

10 R.M., Docket No. 18-1621 (issued August 23, 2019);Debra L. Dilworth, 57 ECAB 516 (2006).

11 K.C., Docket No. 19-1251 (issued January 24, 2020); R.V., Docket No. 18-0552 (issued November 5, 2018);L.S., 

Docket No. 08-1270 (issued July 2, 2009).

12 See J.M., Docket No. 19-1926 (issued March 19, 2021);L.D., Docket No. 20-0894 (issued January 26, 2021).

13 See M.K., Docket No. 21-0520 (issued August23, 2021); T.M., Docket No. 08-975 (issued February 6, 2009).
7

as Dr. Patterson failed to address causation, his reports are of no probative value and are 

insufficient to establish the consequential claim.14

OWCP also received copies of diagnostic studies. The Board has held, however, that 

diagnostic tests, standing alone, lack probative value as they do not provide a physician’s opinion 

on whether there is a causal relationship between appellant’s accepted employment 

incident/exposure and a diagnosed condition.15 

In November 16, 2020 and May 11, 2021 reports, Dr. Epstein, the DMA, noted the history 

of injury and his review of the SOAF and the medical record. He also noted that appellant 

continued to have chronic bilateral upper limb pain despite four operative procedures on her upper 

extremities and 10 years of medical treatment. Dr. Epstein concurred with Dr. Muqtadir’s opinion 

that there was no causal relationship between the right ulnar nerve condition and her employment 

injury or condition. He explained, in his November 16, 2020 report, that appellant’s right ulnar 

nerve abnormalities were demonstrated by the 2019 and 2020 EMG studies, but not in the 2003 

EMG, eight years prior to the date of injury or by the 2012 EMG, one year after the date of injury. 

In Dr. Epstein’s May 11, 2021 report, which included a review of appellant’s November 11, 2020 

right ulnar nerve decompression surgery at the elbow and wrist, he indicated that the clinical and 

electrodiagnostic evidence of record did not support an employment-related occupational disease 

of the right ulnar nerve at either the wrist or the elbow. He further opined that the most recent 

surgery on the right ulnar nerve should not be authorized as employment related. Dr. Epstein 

provided a detailed report reviewing the medical record. It was based on a proper factual history 

and provided findings and medical reasoning supporting his conclusions and provided a 

rationalized medical opinion as to why appellant’s claim should not be expanded to include the 

additional conditions. Dr. Epstein’s report is therefore sufficient to carry the weight of the medical 

evidence.

As the medical evidence of record is insufficient to establish that appellant sustained right 

ulnar nerve conditions causally related to the accepted employment injury, the Board finds that 

she has not met her burden of proof. 

LEGAL PRECEDENT -- ISSUE 2

Section 8103(a) of FECA16 provides that the United States shall furnish to an employee 

who is injured while in the performance of duty, the services, appliances, and supplies prescribed 

by or recommended by a qualified physician, which OWCP considers likely to cure, give relief, 

reduce the degree or the period of disability, or aid in lessening the amount of the monthly 

14 T.S., Docket No. 19-0717 (issued May 22, 2020); J.H., Docket No. 19-0838 (issued October 1, 2019); L.B., 

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

15 See P.A., Docket No. 18-0559 (issued January 29, 2020); A.P.,Docket No. 18-1690 (issued December 12, 2019); 

R.M., Docket No. 18-0976 (issued January 3, 2019). 

16 Supra note 2 at § 8103(a).
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compensation.17 While OWCP is obligated to pay for treatment of employment-related conditions, 

the employee has the burden of proof to establish that the expenditure is incurred for treatment of 

the effects of an employment-related injury or condition.18

Section 10.310(a) of OWCP’s implementing regulations provide that an employee is 

entitled to receive all medical services, appliances, or supplies which a qualified physician 

prescribes or recommends and which OWCP considers necessary to treat the work-related injury.19

In interpreting section 8103 of FECA, the Board has recognized that OWCP has broad 

discretion in approving services provided, with the only limitation on OWCP’s authority being 

that of reasonableness.20 OWCP has the general objective of ensuring that an employee recovers 

from his or her injury to the fullest extent possible, in the shortest amount of time. It therefore has 

broad administrative discretion in choosing means to achieve this goal.21

Abuse of discretion is shown through proof of manifest error, clearly unreasonable exercise 

of judgment, or actions taken which are contrary to both logic and probable deductions from 

established facts. It is not enough to merely show that the evidence could be construed so as to 

produce a contrary factual conclusion.22

ANALYSIS -- ISSUE 2

The Board finds that OWCP properly denied authorization for right ulnar surgery at the 

elbow and wrist. 

In a November 16, 2020 report, Dr. Epstein noted the accepted conditions and surgeries, 

and that appellant stopped work in November 2011. He also noted that she had undergone four 

EMG studies in 2003, 2012, 2019, and recently on October 8, 2020. Dr. Epstein indicated that the 

2012 EMG study, one year after the date of injury, reported no ulnar nerve entrapment. The 2019 

EMG study, which was eight years after the date of injury, and seven years after appellant stopped 

working, first described evidence of ulnar nerve entrapment. The DMA opined that there was no 

rational medical reason to implicate the 2011 employment injury or the 2012 recurrence to the 

ulnar nerve abnormalities first demonstrated by the 2019 and 2020 EMG studies, noting that such 

ulnar nerve pathology was not demonstrated by the 2003 EMG, eight years prior to the date of 

17 Id.; see D.S., Docket No. 18-0353 (issued May 18, 2020); L.D., 59 ECAB 648 (2008); Thomas W. Stevens, 50 

ECAB 288 (1999).

18 M.P., Docket No. 19-1557 (issued February 24, 2020); M.B., 58 ECAB 588 (2007).

19 20 C.F.R. § 10.310(a); see D.W., Docket No. 19-0402 (issued November 13, 2019).

20 B.I., Docket No. 18-0988 (issued March 13, 2020);see also Daniel J. Perea, 42 ECAB 214, 221 (1990) (holding 

that abuse of discretion by OWCP is generally shown through proof of manifest error, clearly unreasonable exercise 

of judgment, or administrative actions which are contrary to both logic, and probable deductions from established 

facts).

21 E.F., Docket No. 20-1680 (issued November 10, 2021); D.S., supra note 17.

22 Id.; P.L., Docket No. 18-0260 (issued April14, 2020);L.W., 59 ECAB 471 (2008).
9

injury or by the 2012 EMG, one year after the date of injury. He additionally opined that the 

accepted right carpal tunnel syndrome, and its authorized operative treatment, could not be 

considered causally related to the new findings of ulnar nerve entrapment. The DMA concurred 

with Dr. Muqtadir’s opinion that the right ulnar nerve entrapment was not causally related to the 

accepted work injury and, thus, opined that any ulnar nerve surgery should not be authorized. He 

further indicated his concurrence with Dr. Muqtadir that it may be reasonable to surgically 

reexplore the right-sided carpal tunnel and opined that OWCP should authorize that surgery. The 

DMA noted that a repeat carpal tunnel release may not prove availing given the intractability of 

appellant’s hand and wrist pain, despite more than a decade of medical therapy and three surgical 

interventions. 

In a May 11, 2021 report, Dr. Epstein, noted that on November 11, 2020 appellant had 

undergone decompressive surgery of the right ulnar nerve at both the elbow and wrist, and that she 

had indicated, in her March 25, 2021 letter, that her conditions were the same or worse after the 

most recent surgery. He opined that the additional medical evidence of record did not change his 

November 16, 2020 opinion. Dr. Epstein indicated that the clinical and electrodiagnostic evidence 

of record does not support an employment-related occupational disease of the right ulnar nerve at 

either the wrist or the elbow. He further indicated that appellant continued to have chronic bilateral 

upper limb pain despite four operative procedures on her upper extremities and 10 years of medical 

treatment. Dr. Epstein opined that the most recent surgery on the right ulnar nerve should not be 

authorized as employment related. 

As the medical evidence of record fails to support that the requested November 11, 2020 

decompressive surgery of the right ulnar nerve at both the elbow and wrist surgery is medically 

necessary and causally related to the accepted employment injury, the Board finds that OWCP did 

not abuse its discretion by denying authorization.23 

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 expand the acceptance 

of her claim to include a right ulnar nerve condition, causally related to her accepted employment

injury. The Board further finds that OWCP properly denied authorization for right ulnar surgery

at the elbow and wrist. 

23 D.S., supra note 17. 
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ORDER

IT IS HEREBY ORDERED THAT the June 9 and April 19, 2021 decisions of the Office 

of Workers’ Compensation Programs are affirmed. 

Issued: March 6, 2023

Washington, DC

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

James D. McGinley, Alternate Judge

Employees’ Compensation Appeals Board