United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

M.M., Appellant

and

DEPARTMENT OF VETERANS AFFAIRS, 

CARL T. HAYDEN VA MEDICAL CENTER, 

Phoenix, AZ, Employer

__________________________________________

)

)

)

)

)

)

)

)

)

Docket No. 23-0855

Issued: November 13, 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

VALERIE D. EVANS-HARRELL, Alternate Judge

JAMES D. McGINLEY, Alternate Judge

JURISDICTION

On June 7, 2023 appellant filed a timely appeal from January 9 and April 11, 2023 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 to consider the merits of this case. 

1 The Board notes that, following the April 11, 2023 decision, OWCP received additional evidence. The Board’s 

Rules of Procedure 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

5 U.S.C. § 8101 et seq.
2

ISSUE

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

causally related to the accepted March 25, 2022 employment incident.

FACTUAL HISTORY

On November 23, 2022 appellant, then a 43-year-old recreation specialist, filed a traumatic 

injury claim (Form CA-1) alleging that on March 25, 2022 she sustained a laceration to her right 

hand and injuries to her left wrist and knee when she tripped over uneven pavement, landing on 

her hands and scraping her knee while moving while in the performance of duty. She did not stop 

work.

On November 22, 2022 appellant sought treatment from Dr. Ernest Lee, a family 

practitioner, due to her March 25, 2022 fall. Dr. Lee diagnosed right hand and elbow pain. He 

found that appellant could work without restrictions. Appellant also provided a form report from 

Minnerva E. Carroz, a nurse practitioner.

In a November 29, 2022 development letter, OWCP informed appellant of the deficiencies 

of her claim. It advised her of the type of factual and medical evidence needed to establish her 

claim, and provided a development questionnaire for completion. OWCP afforded appellant 30 

days to submit the necessary evidence.3

On November 29, 2022 Dr. Lee examined appellant for right wrist and elbow pain and 

noted her March 25, 2022 fall.

In a December 13, 2022 report, Dr. Rohan Kambeyanda, a general surgeon, recounted 

appellant’s fall at work in March 2022 and diagnosed bilateral carpal tunnel syndrome (CTS). He 

opined that she developed bilateral CTS symptoms after a traumatic fall. Marie Brewer, a nurse 

practitioner, also completed treatment notes on December 7, 2022.

On December 22, 2022 Dr. Lee noted the March 25, 2022 fall with a history of numbness 

and tingling in both hands. He diagnosed bilateral CTS and provided work restrictions.

By decision dated January 9, 2023, OWCP denied appellant’s traumatic injury claim, 

finding that the medical evidence of record was insufficient to establish causal relationship 

between her diagnosed condition(s) and the accepted March 25, 2022 employment incident. 

On January 19, 2023 appellant requested reconsideration. She provided a January 17, 2023 

note from Dr. Kambeyanda diagnosing bilateral CTS and trigger finger right ring finger.

Dr. Kambeyanda opined that appellant’s bilateral hand numbnesswas precipitated by a fall on both 

outstretched hands in March 2022 while at work. He recounted that her hand pain began after her 

fall. Dr. Kambeyanda further related that it was possible that the diagnosed trigger finger was a 

3

In a separate November 30, 2022 development letter, OWCP requested additional information from the employing 

establishment. It responded on December 2, 2022 and concurred that appellant was injured in its controlled parking 

lot.
3

sequela of her other hand injuries and that she continued to experience pain at the medial right 

elbow. He recommended surgery and provided work restrictions.

Dr. Ales Hlubocky, a Board-certified neurologist and clinical neurophysiologist, completed 

electromyogram and nerve conduction velocity (EMG/NCV) testing on January 10, 2023. He 

found severe right median neuropathy at the wrist or right carpal tunnel syndrome, but no evidence 

of left carpal tunnel syndrome nor right cervical radiculopathy.

By decision dated April 11, 2023, OWCP denied modification of its prior 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 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,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 determine whether a federal employee has sustained a traumatic injury in the 

performance of duty, it first must be determined whether fact of injury has been established. First, 

the employee must submit sufficient evidence to establish that he or she actually experienced the 

employment incident at the time and place, and in the manner alleged. Second, the employee must 

submit sufficient evidence to establish that the employment incident caused a personal injury. 8

The medical evidence required to establish causal relationship is rationalized medical 

opinion evidence.9 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 

4

Supra note 2.

5 F.H., Docket No. 18-0869 (issued January 29, 2020); J.P., Docket No. 19-0129 (issued April 26, 2019); JoeD. 

Cameron, 41 ECAB 153 (1989).

6 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).

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

Delores C. Ellyett, 41 ECAB 992 (1990).

8 T.J., Docket No. 19-0461 (issued August 11, 2020); K.L.,Docket No. 18-1029 (issued January 9, 2019); John J. 

Carlone, 41 ECAB 354 (1989).

9

S.S., Docket No. 19-0688 (issued January 24, 2020); A.M.,Docket No. 18-1748 (issued April 24, 2019); RobertG. 

Morris, 48 ECAB 238 (1996).
4

by medical rationale explaining the nature of the relationship between the diagnosed condition and 

specific employment incident identified by the employee. 10

ANALYSIS

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

condition causally related to the accepted March 25, 2022 employment incident.

In reports dated December 13, 2022 and January 17, 2023, Dr. Kambeyanda opined that 

appellant’s accepted March 25, 2022 employment incident caused her bilateral carpal tunnel 

syndrome. While he opined that her bilateral carpal tunnel syndrome was work related, he failed 

to provide medical rationale explaining the basis of his opinion. The Board has held that an opinion 

that does not explain, physiologically, how the specific employment incident or employment 

factors caused or aggravated the diagnosed condition, is of limited probative value on the issue of 

causal relationship.

11

 Therefore, this evidence is insufficient to establish the claim.

On December 22, 2022 Dr. Lee noted the March 25, 2022 fall with a history of numbness 

and tingling in both hands and diagnosed bilateral carpal tunnel syndrome. However, he did not 

offer an opinion as to whether appellant’s diagnosed condition was causally related to the accepted 

employment incident on March 25, 2022. 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 Accordingly, thisreportisinsufficient to establish appellant’s claim.

On November 22 and 29, 2022 Dr. Lee completed treatment notes diagnosing right 

hand/wrist and elbow pain. The Board has consistently held that pain is a symptom and not a 

compensable medical diagnosis.13 A medical report lacking a firm diagnosis is of no probative 

value.14 Accordingly, these reports are insufficient to satisfy appellant’s burden of proof.15

Appellant also submitted notes from nurse practitioners. However, certain healthcare 

providers such as physician assistants, nurse practitioners, physical therapists, and social workers 

are not considered “physician[s]” as defined under FECA and their reports do not constitute 

10 T.L., Docket No. 18-0778 (issued January 22, 2020); Y.S., Docket No. 18-0366 (issued January 22, 2020); 

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

11 Id.

12 S.C., Docket No. 22-1317 (issued May 18, 2023); S.P., Docket No. 22-0711 (issued March 13, 2023); L.B.,

Docket No. 19-1907 (issued August 14, 2020); L.B.,Docket No. 18-0533 (issued August 27, 2018); D.K.,Docket No. 

17-1549 (issued July 6, 2018).

13 L.S., Docket No. 22-1238 (issued May 19, 2023); J.P.,Docket No. 20-0381 (issued July 28, 2020); S.L.,Docket 

No. 19-1536 (issued June 26, 2020); D.Y.,Docket No. 20-0112 (issued June 25, 2020), Deborah L. Beatty, 54 ECAB 

340 (2003).

14 L.S., id.; R.L., Docket No. 20-0284 (issued June 30, 2020).

15 L.S., id.; R.H., Docket No. 21-1382 (issued March 7, 2022); S.E., Docket No. 21-0666 (issued 

December 28, 2021).
5

competent medical evidence.16 These reports are therefore of no probative value and are 

insufficient to establish appellant’s claim.

Appellant also submitted diagnostic studies of her bilateral upper extremities, including 

January 10, 2023 EMG/NCV testing. However, diagnostic studies, standing alone, lack probative 

value on causal relationship as they do not address whether employment factors caused the 

diagnosed condition.17

As the medical evidence of record is insufficient to establish a medical condition causally 

related to the accepted March 25, 2022 employment incident, 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 March 25, 2022 employment incident.

16 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 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 B.D., Docket No. 22-0503 (issued September 27, 2022) (nurse practitioners are not considered physicians as 

defined under FECA and their medical findings and/or opinions will not suffice for purposes of establishing 

entitlement to FECA benefits); L.S., Docket No. 19-1231 (issued March 30, 2021) (a nurse practitioner is not 

considered a physician as defined under FECA).

17 S.P., Docket No. 22-0944 (issued May 5, 2023); C.S., Docket No. 19-1279 (issued December 30, 2019).
6

ORDER

IT IS HEREBY ORDERED THAT the January 9 and April 11, 2023 decisions of the 

Office of Workers’ Compensation Programs are affirmed.

Issued: November 13, 2023

Washington, DC

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board

James D. McGinley, Alternate Judge

Employees’ Compensation Appeals Board