E.P. and Department of Homeland Security, Customs & Border Protection, Atlanta, GA (Board decision, December 1, 2014)

ECAB final decision. The Board affirmed OWCP’s December 13, 2013 denial of E.P.’s occupational disease claim. Under 20 C.F.R. § 501.6(d), this Board decision becomes final 30 days after issuance unless the Board fixed a different period in it. A party may petition the Board for reconsideration within 30 days unless this decision specifies another period, under 20 C.F.R. § 501.7(a).

Plain-English summary

E.P., an entry specialist, claimed that extensive typing at work caused or aggravated carpal tunnel syndrome in both wrists. OWCP accepted her typing duties and the diagnosis but found the medical evidence insufficient to link them. The Board affirmed. Her doctor's brief reports lacked a full, accurate history and did not explain how the typing caused or aggravated compression of the median nerve.

Decision snapshot

• Authority: Occupational disease causation under FECA.
• Outcome: December 13, 2013 claim denial affirmed.
• Key point: A general statement that repetitive computer work causes carpal tunnel syndrome did not explain causation in E.P.'s case.

Full text (ECAB public release)

United States Department of Labor
Employees’ Compensation Appeals Board

________
)
E.P., Appellant
)
)
and ) Docket No. 14-1027
) Issued: December 1, 2014
DEPARTMENT OF HOMELAND SECURITY,
)
CUSTOMS & BORDER PROTECTION,
)
Atlanta, GA, Employer
)
__________ )

Appearances: Case Submitted on the Record
Appellant, pro se
Office of Solicitor, for the Director

DECISION AND ORDER

Before:
COLLEEN DUFFY KIKO, Judge
PATRICIA HOWARD FITZGERALD, Judge
MICHAEL E. GROOM, Alternate Judge

JURISDICTION

On March 31, 2014 appellant filed a timely appeal from the December 13, 2013 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’s bilateral carpal tunnel syndrome is causally related to her federal employment.

FACTUAL HISTORY

On July 27, 2012 appellant, a 49-year-old entry specialist, filed an occupational disease claim alleging that her bilateral carpal tunnel syndrome was a result of her federal employment.

1
5 U.S.C. § 8101 et seq.
Specifically, she alleged that her hands would hurt every time she typed, and on several occasions her right wrist would lock up. Appellant stated that her fingers were tingling, her right thumb was numb, and her left thumb was a little numb. Her supervisor indicated that the information furnished by appellant was true to the best of his knowledge. Appellant explained that typing was a requirement of her job. She worked four days a week and in a 10-hour day, she typed on the computer eight and a half hours.

An electromyogram (EMG) and nerve conduction studies obtained on March 15, 2012 showed moderately severe right median neuropathy at the wrist, compatible with carpal tunnel syndrome; mild-to-moderate left median neuropathy at the wrist, compatible with carpal tunnel syndrome; and no evidence of a more proximal lesion, plexopathy or cervical radiculopathy.2

In a decision dated November 19, 2012, OWCP denied appellant’s occupational disease claim. It accepted that the employment activities occurred and that a medical condition had been diagnosed, but appellant did not provide sufficient medical evidence to establish causal relationship. OWCP explained: “You must present rationalized medical opinion evidence based upon a complete factual and medical background showing causal relationship.”

Dr. Pran N. Sood, an attending orthopedic surgeon, offered the following opinion on December 10, 2012:

“[Appellant] wanted me to clarify regarding her causal relationship of right carpal tunnel as well as left carpal tunnel neuropathy per EMGs and per her symptoms. I received her records and I know her pretty long time. Her work involves mostly computer and handling the computer-related work. This carpal tunnel is usually related to repetitive work of this nature. In my opinion, this is causally related to her profession.”

On March 14, 2013 an OWCP hearing representative reviewed the written record and affirmed the denial of appellant’s occupational disease claim. It was accepted as factual that appellant’s duties required typing eight and a half hours a day, four days a week. The hearing representative found, however, that Dr. Sood failed to provide an accurate history of appellant’s employment environment, failed to address causal relationship, and provided no medical rationale for his stated conclusion.

Appellant requested reconsideration contending that Dr. Sood supported causal relationship.

In a decision dated May 13, 2013, OWCP denied a merit review of appellant’s case. It explained that her claim was denied due to the lack of a rationalized medical opinion based on an accurate factual background.

2
The record indicates that appellant had a previous neck injury with surgery in 2000. OWCP File No. xxxxxx369. Under that claim, she received a schedule award for a 29 percent impairment of her right upper extremity.

2
 Appellant again requested reconsideration. She submitted an October 28, 2013 report from Dr. Sood, who noted that when he saw appellant on April 12, 2013,3 she had been complaining of bilateral wrist pain. Appellant stated that she typed a great deal at work. On examination, Tinel’s and Phalen’s signs were positive, and she was diagnosed with carpal tunnel syndrome. Dr. Sood stated: “The cause of this condition, in my opinion, is peripheral nerve compression which may be exacerbated by the repetitive work, which my patient has done for 17 years with …, such as, typing, writing, carrying filing to the central file room, etc. which involves excessive use of her wrist.”

In a decision dated December 13, 2013, OWCP reviewed the merits of appellant’s case and denied modification of its prior decision. It noted that Dr. Sood had expressed the same opinion on December 10, 2012, which was previously considered. OWCP noted that Dr. Sood provided a partial or inaccurate history; as the record established that appellant had worked light duty since February 19, 1996.4 The work history she provided to Dr. Sood was not accurate.

LEGAL PRECEDENT

FECA provides compensation for the disability of an employee resulting from personal injury sustained while in the performance of duty.5 An employee seeking benefits under FECA has the burden of proof to establish the essential elements of his or her claim. When an employee claims that he or she sustained an injury in the performance of duty, he or she must submit sufficient evidence to establish that he or she experienced a specific event, incident or exposure occurring at the time, place and in the manner alleged. He or she must also establish that such event, incident or exposure caused an injury.6

Causal relationship is a medical issue,7 and the medical evidence generally required to establish causal relationship is rationalized medical opinion evidence. The opinion of the physician must be based on a complete factual and medical background of the claimant,8 must be one of reasonable medical certainty,9 and must be supported by medical rationale explaining the nature of the relationship between the diagnosed condition and the established incident or factor of employment.10

3
The Board notes that Dr. Sood saw appellant on April 12, 2012 and reviewed her EMG and nerve conduction studies. Dr. Sood also reviewed a magnetic resonance imaging scan of the cervical spine. 4 A Form CA-1032 dated May 5, 2006 indicated that appellant had worked light duty from February 19, 1996 to present.
5
5 U.S.C. § 8102(a).
6
John J. Carlone, 41 ECAB 354 (1989).
7
Mary J. Briggs, 37 ECAB 578 (1986).
8
William Nimitz, Jr., 30 ECAB 567, 570 (1979).
9
See Morris Scanlon, 11 ECAB 384, 385 (1960).
10
See William E. Enright, 31 ECAB 426, 430 (1980).

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 ANALYSIS

Appellant alleged that typing was a requirement of her job and that she typed eight and a half hours a day, four days a week. In its November 19, 2012 decision, OWCP found that she established her occupational exposure as an entry specialist. On March 14, 2013 OWCP’s hearing representative noted that appellant’s duties required typing eight and a half hours a day, four days a week. The question is whether the accepted work factors caused or aggravated her diagnosed bilateral carpal tunnel syndrome.

Dr. Sood, appellant’s orthopedic surgeon, has not provided a clear opinion that appellant’s bilateral carpal tunnel syndrome was causally related to the repetitive nature of her work. He provided brief notes to the record addressing her claim in a paragraph or two. Dr. Sood did not provide a full or accurate factual or medical background of her claim. He noted that her work involved mostly computer and handling the computer-related work, including typing, writing, carrying, filing to the central file room. Dr. Sood stated that generally this involved excessive use of her wrist.

Dr. Sood’s opinion, however lacks medical rationale. He did not discuss the nature of appellant’s carpal tunnel syndrome or explain, from a neurological or biomechanical point of view, how appellant’s typing at work, which OWCP accepts as an established factor of employment, caused or aggravated a peripheral nerve compression of the median nerve. Dr. Sood failed to offer a sound medical explanation of how typing eight and a half hours a day, four days a week, caused or aggravated the diagnosed carpal tunnel syndrome to a reasonable medical certainty.

Medical conclusions unsupported by rationale are of little probative value.11 Accordingly, the Board finds that appellant has not met her burden to establish the critical element of causal relationship. The medical opinion evidence of record lacks sufficient medical rationale to discharge appellant’s burden of proof. The Board will therefore affirm OWCP’s December 13, 2013 decision.

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 to establish that her bilateral carpal tunnel syndrome is causally related to her federal employment.

11
Ceferino L. Gonzales, 32 ECAB 1591 (1981); George Randolph Taylor, 6 ECAB 968 (1954).

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 ORDER

IT IS HEREBY ORDERED THAT the December 13, 2013 decision of the Office of Workers’ Compensation Programs is affirmed.

Issued: December 1, 2014
Washington, DC

Colleen Duffy Kiko, Judge
Employees’ Compensation Appeals Board

Patricia Howard Fitzgerald, Judge
Employees’ Compensation Appeals Board

Michael E. Groom, Alternate Judge
Employees’ Compensation Appeals Board

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