United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

J.T., Appellant

and

DEPARTMENT OF VETERANS AFFAIRS, 

HAMPTON VA MEDICAL CENTER, 

Hampton, VA, Employer

__________________________________________

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Docket No. 22-1308

Issued: May 25, 2023

Appearances: Case Submitted on the Record

Daniel M. Goodkin, Esq., for the appellant1

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 September 13, 2022 appellant, through counsel, filed a timely appeal from an April 1, 

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.

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 right carpal tunnel 

syndrome and bilateral cubital tunnel syndrome causally related to the accepted factors of her 

federal employment.

FACTUAL HISTORY

On October 30, 2020 appellant, then a 44-year-old nurse, filed an occupational disease 

claim (Form CA-2) alleging that she aggravated a preexisting work injury due to factors of her 

federal employment. She explained that she first realized that her condition was caused or 

aggravated by her federal employment on June 26, 2020. 

In an April 1, 2020 narrative statement, appellant explained that she injured her right wrist 

while caring for a morbidly obese patient who weighed over 500 pounds. She explained that the 

pain persisted and she was referred to Dr. Michael T. Davis, an orthopedic surgeon, and underwent

carpal tunnel surgery to her right wrist. Appellant also noted that she had undergone prior right

carpal tunnel surgery. She explained that she was currently working in a reasonable 

accommodation position as a care coordinator in home telehealth, her job was sedentary, and her 

duties included 75 percent typing daily and 25 percent communicating on the telephone. Appellant 

alleged that the extensive typing caused tremendous pain. She explained that she was required to 

work 8 hours per day; however, because of her limitations, she often worked 10 to 12 hours per 

day to complete her work. Appellant noted that she did not get a 30-minute break after 2 hours of 

typing, as ordered by Dr. Davis.

The employing establishment controverted the claim and noted that appellant was provided 

oral dictation software and a sit and stand desk for her wrist discomfort, however, appellant

indicated that she was not using the assigned software.

In an undated report received on January 13, 2021, Dr. Davis noted that he had been 

treating appellant for injuries to her right wrist. He noted that appellant had a preexisting history 

of right wrist injury for which she had undergone unsuccessful percutaneous fixation of a 

metacarpal fracture, partial wrist fusion, and later a carpal tunnel release. This happened prior to 

a right wrist employment injury which occurred as appellant was assisting with the care of a 500-

pound patient. Dr. Davis also noted that appellant then began duties which required repetitive 

wrist motion, her symptoms became markedly worse, requiring another surgery, the imposition of 

work restrictions, and the need for care. He opined, “[i]n my opinion [appellant’s] incident with 

the morbidly obese patient falling on her wrist and her repetitive motion activities have aggravated 

her right-sided wrist post-traumatic arthritis and carpal tunnel condition. Carpal tunnel syndrome 

is caused by abnormal pressure on the median nerve and aggravate s her underlying arthritic 

condition. Further, in my opinion, the repetitive motion [appellant] did caused repeated pressure 

on that nerve, worsening her condition.”

In a January 15, 2021 development letter, OWCP informed appellant that it had received 

insufficient evidence in support of her occupational disease claim. It advised her of the type of 

factual and medical evidence necessary to establish her claim and provided a questionnaire for her 

completion. OWCP noted that appellant’s traumatic injury claim was denied under OWCP File 
3

No. xxxxxx854.3 It explained that Dr. Davis did not provide any discussion of how the current 

occupational duties caused, aggravated, or accelerated her preexisting conditions. In a separate 

development letter on the same date, OWCP requested that the employing establishment provide 

additional information regarding appellant’s employment duties and comments from a 

knowledgeable supervisor regarding the accuracy of her statements. It afforded both parties 30 

days to respond.

OWCP received a copy of the September 25, 2018 reasonable accommodation 

reassignment of appellant from ER/acute care to home telehealth, nurse care coordinators.

In a January 30, 2021 response to OWCP’s development questionnaire, appellant described 

her employment activities, noting that she typed and manipulated the computer mouse for six to 

seven hours during an eight-hour shift, which caused tremendous pain and discomfort. She listed 

all of the steps involved in monitoring the patients, the mandatory reviews, and the training 

required for the home telehealth competencies. Appellant noted that her workday was scheduled 

to be 8:00 a.m. to 4:30 p.m., but she started earlier at 7:15 a.m. to get a “jump start” and often 

worked until between 6:00 p.m. and 9:00 p.m. She denied having any outside activities or hobbies

and explained that the initial injury to her hand/wrist occurred in 1998 while she was on active 

duty. Appellant noted that she fractured and dislocated her carpal and metacarpal, underwent 

surgery, hardware was placed to keep the bones together, and the pins were later removed. She 

also noted that she underwent a right-hand carpal boss removal and a carpal tunnel release in 1999, 

and she had a bone-on-bone fusion of her right index finger in 2000. Regarding the oral dictation 

software, appellant explained that it was futile because it picked up all the noises in the workspace, 

she tried coming in earlier when it was quiet, but she was not compensated for coming in earlier.

In a January 27, 2021 statement, the employing establishment noted that appellant was 

reassigned to be a home telehealth nurse in October 2018, and she did not provide patient care. It

also noted that she was provided with the dictation software. 

By decision dated April 14, 2021, 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.

On March 23, 2022 appellant, through counsel, requested reconsideration and submitted 

additional evidence.

In a December 17, 2021 report, Dr. Davis, noted that appellant was last seen on 

November 1, 2021, after a four-week history of numbness and tingling involving the bilateral 

fourth and fifth digits, right worse than left. He related that appellant primarily described

paresthesia involving the fourth and fifth digits, that her employment as a telehealth nurse entailed

multiple hours of keyboarding/typing, her symptoms worsened when her elbows were at a bent 

position at her desk for prolonged periods of time, her previous neutral wrist splints had not 

3 On December 1, 2016 appellant filed a traumatic injury cla im (Form CA-1) alleging that on November 28, 2016 

she injured her right wrist while turning a patient who weighed over 500 pounds. OWCP denied the claim as she had 

not established causal relationship between the diagnosed condition and the accepted employment incident. The Board 

affirmed the denial of the claim in Docket No. 18-0664 (issued August 12, 2019).
4

alleviated her symptoms. Dr. Davis noted that his examination revealed positive Tinel’s sign at 

the elbow bilaterally and positive Froment’s sign. He also noted that a June 9, 2021

electromyography (EMG) study revealed a normal study, mildly limited due to motion application

prior to testing, with no clear signs of focal right median or ulnar neuropathy, right brachial 

plexopathy, or right cervical motor radiculopathy. Dr. Davis diagnosed bilateral cubital tunnel 

syndrome, right worse than left. He related that appellant believed that her constant typing and 

arm positioning to fulfill her job role exacerbated her symptoms. Dr. Davis explained that, “There 

are plenty of literature sources supporting the fact, and it is commonly accepted, that the incidence 

of cubital tunnel syndrome is much higher in individuals who work for long periods with elbows 

bent or with pressure applied to the elbow region, i.e., typing, custodial work, or scanning items at 

a checkout. I do believe [appellant] in stating that her symptoms are exacerbated by her job role. 

I also believe that the dictation system could be a viable option for her and allow her to continue 

working in her current job role if she were in a quiet environment, such as her own office so that 

the dictation system would be more efficient. Otherwise, having to constantly correct her 

dictations as she is typing, results in her doubling the amount of keyboarding, and further 

exacerbating her condition.” Dr. Davis opined, “I do concur with the history provided by the 

patient, her clinical exam[ination] and objective testing that her current job role is more likely than 

not exacerbating her preexisting condition. I do believe her current job station can be optimized 

to provide her the opportunity to continue her employment without further worsening her 

symptoms.”

By decision dated April 1, 2022, OWCP denied modification of the April 14, 2021 

decision. 

LEGAL PRECEDENT

An employee seeking benefits under FECA4 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,5that 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.6 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.7

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 of the 

4

Supra note 2.

5

S.B., Docket No. 17-1779 (issued February 7, 2018); J.P., 59 ECAB 178 (2007); Joe D. Cameron, 41 ECAB 

153 (1989).

6 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).

7

See J.L., Docket No. 20-1662 (issued October 7, 2022); K.M., Docket No. 15-1660 (issued September 16, 2016); 

L.M., Docket No. 13-1402 (issued February 7, 2014); Delores C. Ellyett, 41 ECAB 992 (1990).
5

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.8

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.9 A physician’s opinion on whether there is causal relationship 

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

complete factual and medical background.10 Additionally, the physician’s opinion 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 appellant’s 

specific employment factor(s).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 the cased is not in posture for decision. 

Appellant submitted two reports from Dr. Davis. In an undated report received on 

January 13, 2021, Dr. Davis explained that appellant had a preexisting wrist injury, which required 

unsuccessful percutaneous fixation of metacarpal fractures, leading to partial wrist fusion and later 

a carpal tunnel release. He also noted that she had a subsequent work incident while assisting a 

morbidly obese patient, and that she then performed typing and duties requiring repetitive motion 

as a reasonable accommodation assignment. Dr. Davis opined, “[i]n my opinion [appellant’s] 

incident with the morbidly obese patient falling on her wrist and her repetitive motion activities 

have aggravated her right sided wrist post-traumatic arthritis and carpal tunnel condition. Carpal 

tunnel syndrome is caused by abnormal pressure on the median nerve and aggravates her 

underlying arthritic condition. Further, in my opinion, the repetitive motion she did caused 

repeated pressure on that nerve, worsening her condition.” In a December 17, 2021 report,

Dr. Davis diagnosed bilateral cubital tunnel syndrome, right worse than left. He opined, appellant 

primarily described paresthesia involving the fourth and fifth digits, that her employment as a 

telehealth nurse entailed multiple hours of keyboarding/typing, her symptoms worsened when her 

elbows were at a bent position at her desk for prolonged periods of time, Dr. Davis also noted that 

it was commonly accepted, that the incidence of cubital tunnel syndrome was much higher in 

8 R.G., supra note 6. See also Roy L. Humphrey, 57 ECAB 238, 241 (2005); RubyI. Fish, 46 ECAB 276, 279 

(1994); Victor J. Woodhams, 41 ECAB 345 (1989).

9 T.H., 59 ECAB 388, 393 (2008); Robert G. Morris, 48 ECAB 238 (1996).

10 M.V., Docket No. 18-0884 (issued December 28, 2018).

11 Id.; Victor J. Woodhams, supra note 8.

12 Federal (FECA) Procedure Manual, Part 2 --Claims, Causal Relationship, Chapter 2.805.3e (January2013). See 

R.D., Docket No. 18-1551 (issued March 1, 2019).
6

individuals who worked for long periods with elbows bent or with pressure applied to the elbow 

region, i.e., typing, custodial work, or scanning items at a checkout.

Dr. Davisidentified employment factors which appellant claimed caused her condition and 

explained how the identified employment factors, specifically the repetitive typing and motion 

activities physiologically caused her right carpal tunnel syndrome and appellant’s work with her 

elbow bent caused her bilateral cubital tunnel syndrome. He provided a pathophysiological 

explanation as to how the accepted employment factors were sufficient to cause the diagnosed 

conditions. The Board finds that Dr. Davis’s opinion, while insufficiently rationalized to meet 

appellant’s burden of proof, is sufficient to require further development of the record.13

Proceedings under FECA are not adversarial in nature, nor is OWCP a disinterested arbiter.

While it is appellant’s burden of proof to establish the claim, OWCP shares responsibility in the 

development of the evidence.14 It has the obligation to see that justice is done.15

The Board shall therefore remand the case to OWCP for further development of the medical 

evidence. On remand, OWCP shall refer appellant, along with a statement of accepted facts and 

the medical record to a physician in the appropriate field of medicine for a rationalized opinion 

regarding whether appellant’s diagnosed right shoulder conditions are causally related to the 

accepted factors of her federal employment. If the physician opines that the diagnosed condition 

is not causally related to the accepted employment factors, he or she must explain with rationale 

how or why their opinion differs from that of Dr. Davis. OWCP, for full and fair adjudication, 

shall also administratively combine the present claim with OWCP File No. xxxxxx854. Following 

this and other such further development as deemed necessary, OWCP shall issue a de novo

decision.

CONCLUSION

The Board finds that this case is not in posture for decision.

13 R.A.,Docket No. 19-0650 (issued January 15, 2020); B.M.,Docket No. 18-0448 (issued January 2, 2020);

E.G., Docket No. 19-1296 (issued December 18, 2019).

14 Id.

15 Id.
7

ORDER

IT IS HEREBY ORDERED THAT the April 1, 2022 decision of the Office of Workers’

Compensation Programs is set aside and this case is remanded for further proceedings consistent 

with this decision of the Board.

Issued: May 25, 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