United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

S.P., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Federal Way, WA, Employer

__________________________________________

)

)

)

)

)

)

)

)

Docket No. 23-0327

Issued: August 8, 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

JAMES D. McGINLEY, Alternate Judge

JURISDICTION

On January 3, 2023 appellant filed a timely appeal from a July 14, 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.2

ISSUE

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

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

1

5 U.S.C. § 8101 et seq.

2 The Board notes that, following the July 14, 2022 decision and on appeal, appellant submitted new evidence. 

However, the Board’s Rules of Procedures 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 April 11, 2022 appellant, then a 59-year-old city delivery specialist, filed an 

occupational disease claim (Form CA-2) alleging that she sustained severe tendinitis in both hands 

due to factors of her federal employment including fingering, delivering mail, and handling 

packages. She indicated that she first became aware of the injury on February 2, 2022 and its 

relation to her work on April 4, 2022. Appellant did not stop work.

An April 7, 2022 x-ray of appellant’s right hand read by Dr. Ranjiv Kumar Saini, a Boardcertified radiologist, revealed no evidence of acute fracture, dislocation, or osseous lesion, normal 

carpal and metacarpal bone alignment, and preserved joint spaces. Dr. Saini concluded that the 

right hand was normal. An x-ray of appellant’s left hand revealed an old fracture involving the 

third metacarpal, no acute fracture. 

An April 7, 2022 report from a nurse practitioner noted that appellant presented with left 

and right hand index finger pain which she had been experiencing for the past month. Appellant 

believed that her pain was due to repetitive motions required by her work duties. The nurse 

practitioner diagnosed tendinitis of index finger of left hand and right hand and acquired trigger 

finger of left index finger. 

OWCP received April 7, 2022 duty status report (Form CA-17) from Dr. Todd Bouchard, 

a family medicine specialist, which noted that appellant had over-use of both index fingers and 

developed pain, swelling, limited range of motion of the fingers, and a trigger finger with left index 

finger. Dr. Bouchard provided light-duty restrictions. 

In an April 12, 2022 report, Dr. Bouchard noted that appellant presented for follow up of 

her left hand index finger as she had no improvement. He noted that she had not been working

and that she had an old third finger injury. Dr. Bouchard examined appellant and diagnosed 

tendinitis of finger of left hand, acquired trigger finger of left index finger, and tendinitis of finger 

of right hand. He opined that the injury was sustained on April 5, 2022 and was “most likely”

caused by repetitive grasping.

By development letter dated April 22, 2022, OWCP informed appellant that additional 

medical evidence was necessary to establish her claim. It advised her of the type of medical and 

factual evidence necessary to establish the claim and provided a questionnaire for her completion. 

OWCP afforded appellant 30 days to submit the necessary information.

In reports dated April 9 and 28, May 13, and June 7, 2022, Dr. Bouchard diagnosed 

acquired trigger finger of left index finger, tendinitis of finger of left hand, and tendinitis of finger 

of right hand. He opined that the injury was sustained on April 5, 2022 and was “most likely”

caused by repetitive grasping. 

OWCP also received April 7, 9, 12, and 28, May 13, and June 7, 2022 (Form CA-17’s)

from Dr. Bouchard wherein he described palpable triggering of left index finger and noted

“repetitive use” in response to how the injury occurred. Dr. Bouchard also recommended a return 

to work on April 13, 2022 with restrictions related to simple grasping and fine manipulation.
3

In a June 18, 2022 statement, appellant indicated that she began noticing shooting/stabbing 

pains in her hands that made it hard to grasp and hold mail and packages, which was required for 

her job as a letter carrier. She explained that she continued to work until on or about April 6, 2022,

when she could hardly hold anything due to extreme hand pain. Appellant explained that she 

sought treatment on April 7, 2022 and was diagnosed with tendinitis in her hands, with the left 

worse than the right. She noted that she had performed her duties for 16 years, and that her 

physician determined that her hand conditions were caused by her job. 

By decision dated July 14, 2022, OWCP denied appellant’s occupational disease claim. It 

accepted her employment factors, but found that the medical evidence of record was insufficient 

to establish that her diagnosed medical conditions were causally related to the accepted 

employment factors.

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 period of FECA,4 and 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.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, 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 employment factors identified by the claimant.7

3

Supra note 1.

4

See K.W., Docket No. 21-0839 (issued January 31, 2023); S.C.,Docket No. 18-1242 (issued March 13, 2019);

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

153 (1989).

5 T.H., Docket No. 18-1736 (issued March 13, 2019); J.M., Docket No. 17-0284 (issued February 7, 2018);R.C., 59 

ECAB 427 (2008); James E. Chadden, Sr., 40 ECAB 312 (1988).

6 T.E., Docket No. 18-1595 (issued March 13, 2019); 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).

7

S.C., supra note 4; R.H., 59 ECAB 382 (2008).
4

Causal relationship is a medical issue, and the medical evidence required to establish causal 

relationship is 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 one of reasonable medical 

certainty, and must be supported by medical rationale explaining the nature of the relationship 

between the diagnosed condition and specific employment factors identified by the employee. 9

In a case in which 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.10

ANALYSIS

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

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

In support of her claim, appellant submitteda series of reports dated April 9 to June 7, 2022 

from Dr. Bouchard, who diagnosed tendinitis of finger of left hand, acquired trigger finger of left 

index finger, and tendinitis of finger of right hand. Dr. Bouchard opined that her finger conditions 

were “most likely” caused by repetitive grasping. The Board has held that medical opinions that 

are speculative or equivocal are of diminished probative value. 11 While Dr. Bouchard provided 

an “affirmative” opinion on causal relationship, he did not offer medical rationale sufficient to 

explain how the accepted employment factors caused or contributed to the diagnosed conditions. 

The Board has held that a medical opinion should offer a medically sound and rationalized 

explanation of how the specific employment factors physiologically caused or aggravated the 

diagnosed conditions.12 Medical evidence which does not explain the nature of the relationship 

between the diagnosed conditions and the specific employment factors, is insufficient to meet the 

claimant’s burden of proof.13 The need for medical rationale is particularly important since

Dr. Bouchard noted that appellant had a prior finger injury.14 In any case where a preexisting 

condition involving the same part of the body is present and the issue of causal relationship, 

8 A.M., Docket No. 18-1748 (issued April24, 2019); T.H., 59 ECAB 388, 393 (2008); Robert G. Morris, 48 ECAB 

238 (1996).

9 R.G., Docket No. 18-0792 (issued March 11, 2020); D.J.,Docket No. 19-1301 (issued January 29, 2020); I.J., 59 

ECAB 408 (2008); Victor J. Woodhams, 41 ECAB 345, 352 (1989).

10 Federal (FECA) Procedure Manual, Part 2 --Claims, Causal Relationship, Chapter 2.805.3e (January 2013). See 

C.W., Docket No. 20-1582 (issued December 22, 2022); C.F., Docket No. 20-0222 (issued December 21, 2020).

11 Id. at Chapter 2.810.5(c)(3); D.S., Docket No. 20-0384 (issued October 8, 2020); H.A., Docket No. 18-1455 

(issued August 23, 2019).

12 See T.L., Docket No. 23-0073 (issued January 9, 2023);see V.D., Docket No. 20-0884 (issued February 12, 

2021); Y.D., Docket No. 16-1896 (issued February 10, 2017).

13 See M.G., Docket No. 22-1119 (issued November 15, 2022);L.B., Docket No. 18-0533 (issued August 27, 2018);

A.P., Docket No. 19-0224 (issued July 11, 2019); D.K., Docket No. 17-1549 (issued July 6, 2018).

14 See R.B., Docket No. 19-1527 (issued July 20, 2020); R.S., Docket No. 19-1774 (issued April 3, 2020).
5

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.

15

 Therefore, the Board finds that these reports from

Dr. Bouchard are insufficient to meet appellant’s burden of proof.

The Board received duty status reports(Form CA-17) dated April 7, 9, 12, and 28, May 13, 

and June 7, 2022 from Dr. Bouchard. These reports simply indicate repetitive use in response to 

how the injury occurred and fail to provide a rationalized medical opinion explaining how 

repetitive motion caused the diagnosed condition.16 Thus, these reports have no probative value 

and are insufficient to establish the claim.

The record contains an April 7, 2022 report from a nurse practitioner who noted that 

appellant related that her conditions were caused by repetitive activities are work. However, 

certain healthcare providers such as physician assistants, nurse practitioners, and physical 

therapists are not considered physicians as defined under FECA.17 Consequently, their reports will 

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

OWCP also received April 7, 2022 x-rays of the right and left hands. However, the Board 

has held that diagnostic reports, standing alone, lack probative value on the issue of causal 

relationship, as they do not provide an opinion as to whether the accepted employment factors

caused a diagnosed condition.19 Consequently, the diagnostic reports are insufficient to establish 

appellant’s claim.

As appellant has not submitted rationalized medical evidence establishing causal 

relationship between her diagnosed medical conditions and the accepted employment factors, the 

Board finds that she has not met her burden of proof to establish her claim.

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.

15 See S.T., Docket No. 22-1025 (issued January 3, 2023);see L.B.,Docket No. 18-0533 (issued August 27, 2018);

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

16 Supra note 13. 

17 Section 8101(2) 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 supra note 10 at Chapter 2.805.3a(1) (September 2020); 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). See also M.M., Docket No. 20-1649 (issued January 4, 

2023) (physician assistants are not considered physicians as defined by FECA); A.F., Docket No. 22-1221 (issued 

December 8, 2022) (physical therapists are not considered physicians as defined by FECA).

18 See M.C., Docket No. 19-1074 (issued June 12, 2020) (nurse practitioners are not considered physicians under 

FECA).

19 W.L., Docket No. 20-1589 (issued August26, 2021); A.P., Docket No. 18-1690 (issued December 12, 2019).
6

CONCLUSION

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

her bilateral hand conditions are causally related to the accepted factors of her federal employment 

duties.

ORDER

IT IS HEREBY ORDERED THAT the July 14, 2022 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: August 8, 2023

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

James D. McGinley, Alternate Judge

Employees’ Compensation Appeals Board