United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

C.W., Appellant

and

DEPARTMENT OF VETERANS AFFAIRS, 

NATIONAL CEMETERY ADMINISTRATION,

St. Louis, MO, Employer

__________________________________________

)

)

)

)

)

)

)

)

)

Docket No. 22-0009

Issued: March 7, 2022

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

PATRICIA H. FITZGERALD, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On October 3, 2021 appellant filed a timely appeal from a September 24, 2021 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.

ISSUE

The issue is whether appellant has met her burden of proof to establish a medical condition 

causally related to the accepted factors of her federal employment.

FACTUAL HISTORY

On May 6, 2020 appellant, then a 51-year-old program specialist, filed an occupational 

disease claim (Form CA-2) alleging that she developed trigger finger of her left middle finger due 

to factors of her federal employment. She explained that she was working at her computer and 

experienced left hand and left middle finger pain. Appellant noted that she first became aware of 

1

5 U.S.C. § 8101 et seq.
2

her condition on April 21, 2020 and realized its relation to her federal employment on 

May 5, 2020. She stopped work on May 6, 2020.

In a May 8, 2020 development letter, OWCP informed appellant that it had not received 

any evidence in support of her claim. It advised her of the type of factual and medical evidence 

necessary and provided a questionnaire for her completion. In a separate development letter of 

even date, OWCP requested that the employing establishment provide additional information 

regarding appellant’s alleged injury, including comments from a knowledgeable supervisor 

regarding the accuracy of her allegations and an explanation of any areas of disagreeme nt. It 

afforded both parties 30 days to submit the requested evidence.

OWCP thereafter received a May 5, 2020 after visit summary by Dr. Nwamaka Olutola 

Oluwato, a Board-certified family physician, who noted a diagnosis of left trigger finger and 

hypertension, and referred appellant for an orthopedic evaluation. In a separate note of even date,

Dr. Oluwato recommended that she remain out of work through May 8, 2020.

Dr. Audrey K. Tsao, a Board-certified orthopedic surgeon, in a note dated May 5, 2020, 

also diagnosed left middle trigger finger.

In a May 13, 2020 response to OWCP’s questionnaire, appellant indicated that she believed 

that typing on a computer and using a keyboard for eight to nine hours per day for the past 20 years 

had caused her symptoms. She noted that on April 21, 2020 she was working at her keyboard and 

started feeling pain in her left hand and left middle finger, which progressively worsened each day. 

Appellant related that she then woke up on May 5, 2020 and her left middle finger was stuck in 

the bent position, so she massaged it untilstraightened out.

In a May 15, 2020 response to OWCP’s development letter, the employing establishment 

noted that appellant used a keyboard for up to eight hours per day, which depended upon whether 

she had to attend conference calls.

OWCP also received a position description for a program specialist with the employing 

establishment.

By decision dated August 4, 2020, 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.

OWCP continued to receive evidence, including a July 24, 2020 after visit summary by 

Allison M. Parver, a physician assistant, who noted that appellant received an injection.

In a note dated September 4, 2020, Dr. Oluwato indicated that appellant had received 

medical treatment for a diagnosis of left middle trigger finger. She opined that this diagnosis can 

be caused by repetitive use, such as frequent typing or repeated finger and thumb use.

On September 12, 2020 appellant requested reconsideration of OWCP’s August 4, 2020 

decision.

By decision dated December 11, 2020, OWCP denied modification of its August 4, 2020

decision.
3

On January 25, 2021 appellant requested reconsideration of OWCP’s December 11, 2020 

decision. In support of her request, she submitted a January 13, 2021 note by Dr. Tsao, who 

diagnosed left middle trigger finger and opined that typing and keyboard work had aggravated her 

condition and irritated her trigger finger. The note further indicated that appellant had undergone 

two injections and may require surgery.

By decision dated September 24, 2021, OWCP denied modification of its December 11, 

2020 decision.

LEGAL PRECEDENT

An employee seeking benefits under FECA2 has the burden of proof to establish the 

essential elements of his or her claim, including 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,3that 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.5

To establish that an injury was sustained in the performance of duty in an occupational 

disease claim, an employee must submit the following: (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 employee. 6

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.7 A physician’s opinion on whether there is causal relationship 

between the diagnosed condition and the implicated employment factors must be based on a 

complete factual and medical background.8 Additionally, the physician’s opinion must be 

expressed in terms of a reasonable degree of medical certainty, and must be supported by medical 

2

Id.

3 F.H., Docket No. 18-0869 (issued January 29, 2020); J.P., Docket No. 19-0129 (issued April26, 2019); JoeD. 

Cameron, 41 ECAB 153 (1989). 

4 L.C., Docket No. 19-1301 (issued January 29, 2020); J.H., Docket No. 18-1637 (issued January 29, 2020); 

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

5 P.A., Docket No. 18-0559 (issued January 29, 2020); K.M., Docket No. 15-1660 (issued September 16, 2016); 

DeloresC.Ellyett, 41 ECAB 992 (1990).

6 R.G., Docket No. 19-0233 (issued July 16, 2019). See also Roy L. Humphrey, 57 ECAB 238, 241 (2005); Ruby I. 

Fish, 46 ECAB 276, 279 (1994); Victor J. Woodhams, 41 ECAB 345 (1989).

7 A.K., Docket No. 21-0278 (issued July 12, 2021); T.H., 59 ECAB 388, 393 (2008); Robert G. Morris, 48 ECAB 

238 (1996).

8 M.V., Docket No. 18-0884 (issued December 28, 2018).
4

rationale explaining the nature of the relationship between the diagnosed condition and appellant’s 

specific employment factors.9

ANALYSIS

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

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

In a January 13, 2021 medical note, Dr. Tsao diagnosed left middle trigger finger and 

opined that typing and keyboard work had aggravated appellant’s condition and irritated her trigger 

finger. Similarly, Dr. Oluwato, in her note dated September 4, 2020, opined that trigger finger can 

be caused by repetitive use such as frequent typing or repeated finger and thumb use. While these 

reports supported causal relationship, they did not a pathophysiological explanation of how the 

accepted factors of federal employment were competent to cause the diagnosed condition . The 

Board has held that a report is of limited probative value regarding causal relationship if it does 

not contain medical rationale explaining how a given medical condition was related to accepted 

employment factors.10 Consequently, the January 13, 2021 note by Dr. Tsao and September 4, 

2020 note by Dr. Oluwato are insufficient to meet appellant’s burden of proof to establish her 

claim.

In separate treatment notes dated May 5, 2020, Drs. Oluwato and Tsao diagnosed left 

middle trigger finger, but did not provide an opinion on causation. 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.11 Therefore, these notes are also insufficient 

to establish appellant’s claim.

The remaining evidence of record consists of a July 24, 2020 after visit summary by

Ms. Parver, a physician assistant. Certain healthcare providers such as physician assistants, 

physical therapists, nurse practitioners, and social workers are not considered “physician[s]” as 

defined under FECA.12 Consequently, their medical findings and/or opinions will not suffice for 

9

Id.; Victor Woodhams, supra note 6.

10 J.W., Docket No. 18-0678 (issued March 3, 2020); G.R., Docket No. 19-0940 (issued December 20, 2019); D.L., 

Docket No. 19-0900 (issued October 28, 2019); see also V.T., Docket No. 18-0881 (issued November 19, 2018); Y.D., 

Docket No. 16-1896 (issued February 10, 2017); T.M., Docket No. 08-975 (issued February 6, 2009); S.E., Docket 

No. 08-2214 (issued May 6, 2009).

11 See L.B., Docket No. 18-0533 (issued August 27, 2018); D.K., Docket No. 17-1549 (issued July 6, 2018).

12 Section 8101(2) provides that under FECA the term physician includes surgeons, podiatrists, dentists, clinical 

psychologists, optometrists, chiropractors, and osteopathic practitioners within the scope of their practice as defined 

by the applicable state law. 5 U.S.C. § 8101(2); 20 C.F.R. § 10.5(t). See 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); see also R.L., Docket No. 19-0440 (issued July 8, 2019) (nurse practitioners and physical 

therapists are not considered physicians under FECA).
5

purposes of establishing entitlement to FECA benefits. As such, this evidence is insufficient to 

establish appellant’s claim.13

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

appellant’s diagnosed medical conditions and the accepted factors of her federal employment, the 

Board finds that appellant 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 a medical 

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

ORDER

IT IS HEREBY ORDERED THAT the September 24, 2021 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: March 7, 2022

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Alternate Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board

13 D.P., Docket No. 19-1295 (issued March 16, 2020); G.S., Docket No. 18-1696 (issued March 26, 2019); see 

M.M., Docket No. 17-1641 (issued February 15, 2018); K.J., Docket No. 16-1805 (issued February 23, 2018); 

David P. Sawchuk, id.