United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

V.R., Appellant

and

U.S. POSTAL SERVICE, LOS BANOS POST 

OFFICE, Los Banos, CA, Employer

__________________________________________

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Docket No. 23-0817

Issued: October 31, 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 May 5, 2023 appellant filed a timely appeal from a November 18, 2022 merit decision 

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 Pursuant to the Board’s Rules of Procedure, an appeal is considered filed when received by the Clerk of the 

Appellate Boards. 20 C.F.R. § 501.3(f). However, when the date of receipt would result in a loss of appeal rights, the 

appeal will be considered to have been filed as of the date of the U.S. Postal Service postmark or other carriers date 

markings. Id. at § 501.3(f)(1). The 180th day following OWCP’s November 18, 2022 decision was Wednesday, 

May 17, 2023. Because using May18, 2023, the date the appeal was received by the Clerk of the Appellate Boards, 

would result in the loss of appeal rights, the date of the postmark is considered the date of filing. The date of the U.S. 

Postal Service postmark is May 5, 2023, rendering the appeal timely filed. Id.

2

5 U.S.C. § 8101 et seq.
2

ISSUE

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

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

FACTUAL HISTORY

On May 19, 2021 appellant, then a 39-year-old rural carrier, filed an occupational disease 

claim (Form CA-2) alleging that she sustained bilateral carpal tunnel syndrome causally related to 

factors of her federal employment including repetitive reaching, twisting, bending, stretching, 

pushing, pulling, and turning the steering wheel of her postal vehicle. She indicated that she first 

became aware of her condition on February 1, 2019 and its relationship to her federal employment 

on April 14, 2021. Appellant did not stop work.

In a development letter dated May 25, 2021, OWCP informed appellant that the evidence 

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

needed, including a report containing a medical diagnosis and a comprehensive narrative report 

from a qualified physician explaining how factors of her federal employment caused, contributed 

to, or aggravated a diagnosed condition. OWCP afforded appellant 30 days to respond and submit 

additional evidence. 

By decision dated August 4, 2021, OWCP denied appellant’s occupational disease claim, 

finding that the evidence of record was insufficient to establish a diagnosed condition in connection 

with accepted factors of her federal employment. 

OWCP thereafter received medical evidence, including an April 3, 2019 electromyogram/

nerve conduction velocity (EMG/NCV) study, which indicated left moderate-to-several carpal 

tunnel syndrome and right moderate carpal tunnel syndrome. 

In a November 23, 2020 report, Dr. Abner Ward, a Board-certified hand surgeon, examined 

appellant for complaints of bilateral hand numbness and tingling. On physical examination of the 

bilateral hands, Dr. Ward observed a positive Tinel’s sign for carpal tunnel syndrome. He noted 

that an x-ray of the bilateral hands obtained on November 18, 2020 demonstrated no significant 

degenerative changes. Dr. Ward diagnosed bilateral carpal tunnel syndrome and recommended 

bilateral carpal tunnel release. 

On December 11, 2020 Dr. Ward recommended that appellant would not be able to work 

from December 10, 2020 through January 4, 2021.

On December 23, 2020 Dr. Ward followed up with appellant after a left carpal tunnel 

release on December 10, 2020. Appellant stated that her pain was well controlled. On physical 

examination, Dr. Ward observed local bruising at the region of the distal forearm fascia. He 

diagnosed left carpal tunnel syndrome. 

In a February 3, 2021 report, Dr. Ward related that, post-left carpal tunnel release, appellant 

did not have pain or tingling of the left hand. On physical examination, he observed a well-healed 

left palm incision site with trace residual swelling. Dr. Ward diagnosed left carpal tunnel 

syndrome.
3

On March 31, 2021 Dr. Ward related that appellant had begun to have problems with her 

right hand. On physical examination, he noted that a Tinel’s sign for carpal tunnel syndrome was 

not present in the right hand. Dr. Ward diagnosed bilateral carpal tunnel syndrome. He

recommended that appellant undergo right open carpal tunnel release after her left hand had fully 

healed. 

OWCP also received a series of reports from Juliette Tamagni, a physician assistant dated 

October 26, 2020 and April 27, 2021; Kheng Xiong, a physician assistant, dated November 9, 

2020; and Daniel Eustace, a physician assistant, dated November 12 and 29, 2020, which noted 

diagnoses of carpal tunnel syndrome. 

On October 7, 2021 appellant requested reconsideration. 

By decision dated January 4, 2022, OWCP reviewed the merits of appellant’s claim and 

found that she had submitted sufficient evidence to establish the diagnosis of bilateral carpal tunnel 

syndrome. However, it denied her claim on the basis that she had not submitted sufficient medical 

evidence to establish causal relationship between the diagnosed bilateral carpal tunnel syndrome

and the accepted factors of her federal employment. 

On August 26, 2022 appellant again requested reconsideration. With her request she 

submitted a February 12, 2019 report from Dr. Karthikeya Devireddy, an internal medicine 

specialist. Dr. Devireddy examined appellant for complaints of pain and numbness of the bilateral 

arms. On physical examination of the extremities, he observed normal tone, motor strength, and 

movement without tenderness. Dr. Devireddy diagnosed peripheral nerve disease and referred 

appellant for an EMG/NCV study. 

Appellant resubmitted the April 3, 2019 EMG/NCV study, indicating left moderate-tosevere carpal tunnel syndrome and right moderate carpal tunnel syndrome. 

In an April 18, 2019 report, Dr. Devireddy reviewed the results of the EMG/NCV study. 

He diagnosed peripheral nerve disease. On October 25, 2020 Dr. Devireddy examined appellant 

for pain, tingling, and periods of numbness of the bilateral arms. On physical examination of the 

extremities, he observed normal tone, motor strength, and movement, further noting bilateral wrist 

tenderness with radiation. Dr. Devireddy diagnosed carpal tunnel syndrome. On October 28, 2020

he diagnosed left carpal tunnel syndrome and peripheral nerve disease. Dr. Devireddy referred 

appellant for hand surgery. In a report dated November 9, 2020, he again followed up with her for 

carpal tunnel syndrome. On physical examination, Dr. Devireddy observed tingling and numbness 

radiating proximally, positive Tinel’s and Phalen’s tests, and full range of motion of the bilateral 

wrists and hands. He diagnosed bilateral carpal tunnel syndrome. On November 17, 2020

Dr. Devireddy diagnosed left carpal tunnel syndrome and peripheral nerve disease, again referring 

appellant for hand surgery.

In a report dated May 6, 2022, Dr. Ward noted appellant’s right hand experienced 

numbness and that it was a work-related injury. Appellant underwent left carpal tunnel release on 

December 10, 2020. On physical examination, Dr. Ward observed a positive Tinel’s sign for carpal 

tunnel syndrome. He diagnosed bilateral carpal tunnel syndrome. Dr. Ward recommended 

physical therapy. 
4

By decision dated November 18, 2022, OWCP denied modification of its January 4, 2022 

decision. 

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

ANALYSIS

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

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

In support of her claim, appellant submitted a May 6, 2022 report from Dr. Ward. Dr. Ward

noted that her right hand experienced numbness and that it was a work -related injury. He

diagnosed bilateral carpal tunnel syndrome. Dr. Ward’s statement that appellant’s condition was 

work-related was conclusory, and he did not provide medical rationale explaining how her work 

duties caused her claimed condition. Without explaining physiologically how the specific 

3

Id.

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).
5

movements involved in appellant’s job caused, contributed to, or aggravated the specific diagnosed 

conditions, his opinion is of limited probative value and insufficient to establish the claim. 8

Appellant submitted further reports from Drs. Ward and Devireddy dated from 

February 12, 2019 through March 31, 2021, which diagnosed bilateral carpal tunnel syndrome. 

These reports did not contain an opinion as to the cause of her bilateral carpal tunnel syndrome. 

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 This evidence is therefore insufficient 

to establish appellant’s claim.

Appellant also submitted multiple documents from physician assistants. The Board has 

held that certain healthcare providers such as physician assistants, are not considered physicians 

as defined under FECA.10 Consequently, their medical findings and/or opinions will not suffice 

for purposes of establishing entitlement to FECA benefits.

The record also contains diagnostic studies. The Board has held that diagnostic studies, 

standing alone, lack probative value on the issue of causal relationship, as they do not provide an 

opinion as to whether the employment incident caused any of the diagnosed conditions. 11 

Accordingly, these diagnostic studies are insufficient to establish appellant’s claim.

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

appellant’s claimed carpal tunnel syndrome 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 carpal 

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

8

See T.F., Docket No. 20-0260 (issued June 12, 2020); D.J., Docket No. 18-0694 (issued March 16, 2020); K.G., 

Docket No. 18-1598 (issued January 7, 2020); K.O., Docket No. 18-1422 (issued March 19, 2019).

9 A.P., Docket No. 18-1690 (issued December 12, 2019); L.B., Docket No. 18-0533 (issued August27, 2018); D.K., 

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

10 Section 8101(2) of FECA provides that 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. § 8101(2); 20 C.F.R. § 10.5(t). See also Federal (FECA) Procedure Manual, Part 2 -- Claims, Causal 

Relationship, Chapter 2.805.3a(1) (January 2013);DavidP. 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); C.P., Docket No. 19-1716 (issued March 11, 2020) (physician assistants are not considered physicians as 

defined under FECA).

11 See K.C., Docket No. 20-1325 (issued May 5, 2021); C.B., Docket No. 20-0464 (issued July 21, 2020).
6

ORDER

IT IS HEREBY ORDERED THAT the November 18, 2022 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: October 31, 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