R.R. and U.S. Postal Service, West Milwaukee Post Office (Board decision, February 10, 2025)

ECAB remand decision. The Board set aside OWCP’s denial and remanded for an impartial medical examination; claim entitlement remains unresolved. A party may petition the Board for reconsideration within 30 days of issuance unless this order specifies another period, under 20 C.F.R. § 501.7(a). FECA compensation decisions are generally not subject to court review under 5 U.S.C. § 8128(b).

Plain-English summary

A postal carrier claimed that repetitive mail handling caused bilateral carpal tunnel syndrome. His treating physician explained a work-related mechanism, while OWCP’s second opinion physician rejected a causal link. The Board found a conflict between the medical opinions. It directed OWCP to obtain an impartial examination and issue a new decision.

Decision snapshot

• Authority: Federal Employees' Compensation Act, 5 U.S.C. § 8101 et seq.
• Outcome: Carpal tunnel claim denial set aside; case remanded.
• Key point: Conflicting medical opinions required an impartial examination.

Full text (ECAB public release)

United States Department of Labor
Employees’ Compensation Appeals Board

________
)
R.R., Appellant
)
)
and ) Docket No. 25-0220
)
Issued: February 10, 2025
U.S. POSTAL SERVICE, WEST MILWAUKEE )
POST OFFICE, Milwaukee, WI, Employer )
__________ )

Appearances: Case Submitted on the Record
Aaron B. Aumiller, Esq., for the appellant1
Office of Solicitor, for the Director

DECISION AND ORDER

Before:
ALEC J. KOROMILAS, Chief Judge
PATRICIA H. FITZGERALD, Deputy Chief Judge VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On January 12, 2025, appellant, through counsel, filed a timely appeal from a July 24, 2024 merit decision of the Office of Workers’ Compensation Programs (OWCP). 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.

ISSUE

The issue is whether appellant has met his burden of proof to establish bilateral carpal tunnel syndrome causally related to the accepted factors of his federal employment.

1
In all cases in which a representative has been authorized in a matter before the Board, no claim for a fee for legal or other service performed on appeal before the Board is valid unless approved by the Board. 20 C.F.R. § 501.9(e). No contract for a stipulated fee or on a contingent fee basis will be approved by the Board. Id. An attorney or representative’s collection of a fee without the Board’s approval may constitute a misdemeanor, subject to fine or imprisonment for up to one year or both. Id.; see also 18 U.S.C. § 292. Demands for payment of fees to a representative, prior to approval by the Board, may be reported to appropriate authorities for investigation. 2 5 U.S.C. § 8101 et seq.
FACTUAL HISTORY

This case has previously been before the Board. 3 The facts and circumstances as set forth in the Board’s prior decision are incorporated herein by reference. The relevant facts are as follows.

On January 25, 2021, appellant, then a 43-year-old mail carrier, filed an occupational disease claim (Form CA-2) alleging that he developed bilateral carpal tunnel syndrome due to factors of his federal employment, including repetitive use of his wrists while delivering mail over a period of 19 years. He noted that he first became aware of his condition and realized its relation to his federal employment on April 7, 2020. Appellant did not immediately stop work.

On January 20, 2021, Dr. Peter K. Connelly, a Board-certified physiatrist, treated appellant for progressive bilateral upper extremity numbness, tingling, and pain. Appellant reported using wrist splints at work, which provided no relief in symptoms. He performed an electromyogram (EMG) and nerve conduction velocity (NCV) study, which revealed evidence of moderate -median mononeuropathy at the right wrist (moderate right carpal tunnel syndrome) and mild -to-moderate median mononeuropathy at the left wrist (mild-to-moderate left carpal tunnel syndrome).

By decision dated March 1, 2021, OWCP denied appellant’s claim, finding that he had not established the implicated factors of employment as he had not responded to its January 28, 2021 development questionnaire. It concluded that the requirements had therefore not been met to establish an injury as defined by FECA.

On March 29, 2021, appellant requested a review of the written record by a representative of OWCP’s Branch of Hearings and Review.

Appellant submitted a March 8, 2021 operative report by Dr. Kenneth Berg, a Board- certified orthopedist, which revealed that he performed an open right carpal tunnel release on appellant and diagnosed right carpal tunnel syndrome.

In a March 22, 2021 report, Dr. Daniel A. Ladwig, a Board-certified orthopedist, noted his treatment of appellant status-post open right carpal tunnel release. He noted that appellant continued to complain of numbness, tingling, and discomfort of the left wrist consistent with left carpal tunnel syndrome and recommended left carpal tunnel release. In an addendum report of even date, Dr. Ladwig indicated that appellant was employed as a letter carrier for over 20 years and experienced symptoms of bilateral carpal tunnel syndrome. He noted that EMG/NCV studies confirmed bilateral carpal tunnel syndrome and that appellant was status-post right carpal tunnel release. Dr. Ladwig noted that appellant described various work activities performed over 20 years involving repetitive work activities and both light and moderate lifting activities. He indicated that it was well known that repetitive movement and lifting activities “may” lead to the development or aggravation of carpal tunnel syndrome. Dr. Ladwig opined, to a reasonable degree of medical certainty, that the work-related activities contributed and/or aggravated his condition resulting in bilateral carpal tunnel syndrome.

3
Docket No. 22-1368 (issued June 15, 2023).

2
By decision dated July 7, 2021, OWCP’s hearing representative affirmed OWCP’s March 1, 2021 decision.

In an undated statement, appellant responded to the development letter and described his work activities that attributed to his bilateral carpal tunnel syndrome. He noted that he cased mail daily for at least two hours, which required grabbing a bucket, placing the bucket on a c ountertop, unloading the mail onto the countertop, grabbing the mail and placing it into an appropriate slot, and sorting parcels and placing them in order of the route. Appellant indicated that street delivery required him to finger through the presorted letters and flats, break them down into blocks, grab parcels from his bag to deliver to houses, turn vehicle on and off multiple times, open and close vehicle doors multiple times, and open and close multiple mailboxes. He stated that these repetitive activities caused his bilateral carpal tunnel syndrome.

In an October 7, 2021 report, Dr. Ladwig noted that appellant was diagnosed with moderate bilateral carpal tunnel syndrome and underwent right carpal tunnel release in January 2021. He reviewed a description of appellant’s work activities over the past 20 years, which involved repetitive work with light and moderate lifting. Dr. Ladwig advised that repetitive movement and lifting activities may lead to the development or aggravation of carpal tunnel syndrome. He noted EMG/NCV studies were consistent with carpal tunnel syndrome. Dr. Ladwig opined to a reasonable degree of medical certainty that the work-related activities contributed to and/or aggravated his condition resulting in clinical bilateral carpal tunnel syndrome.

On June 9, 2022, appellant, through counsel, requested reconsideration.

By decision dated September 7, 2022, OWCP modified the July 7, 2021 decision, finding that appellant had established the implicated employment factors and that the medical reports established a diagnosis of bilateral carpal tunnel syndrome. The claim remained denied, however, as the medical evidence of record was insufficient to establish causal relationship between a diagnosed medical condition and the accepted factors of his federal employment.

Appellant appealed to the Board. By decision dated June 15, 2023, the Board affirmed the September 7, 2022 decision.4 The Board found that appellant did not meet his burden of proof to establish bilateral carpal tunnel syndrome causally related to the accepted factors of his federal employment.

On May 14, 2024, appellant, through counsel, requested reconsideration.

In support thereof, appellant submitted additional medical evidence. Dr. Karl Scheidt, a Board-certified orthopedic surgeon, treated appellant on February 18 and April 13, 2021, for bilateral hand and wrist pain. He noted positive Tinel’s sign at the right wrist and numbness and tingling in his thumb, index, and middle finger. Dr. Scheidt diagnosed bilateral carpal tunnel syndrome, right worse than left and recommended right carpal tunnel release. On April 13, 2021, he noted that appellant was status-post open carpal tunnel release on the right and reported significant improvement in symptoms. Dr. Scheidt diagnosed left carpal tunnel syndrome and

4
Id.

3 recommended a left carpal tunnel release. On April 26, 2021, he performed a left open carpal tunnel release and diagnosed left carpal tunnel syndrome.

On December 22, 2021, Dr. Ladwig treated appellant postoperatively after bilateral carpal tunnel releases and noted appellant was progressing well. On February 12, 2024, appellant reported marked improvement in his bilateral carpal tunnel symptoms.

In a May 13, 2024 report, Dr. Joshua Macht, a Board-certified internist, diagnosed bilateral carpal tunnel syndrome. He described appellant’s work duties noting that he would case mail daily for at least two hours, grab buckets, unload mail, grab mail and place in the appropriate slot, sort parcels, finger through presorted letters and flats, grab parcels from his bag to deliver, open and close his vehicle door multiple times, and open and close mailboxes. Dr. Macht opined that the repetitive duties exacerbated his symptoms and resulted in the progression of his condition. He related that EMG/NCV studies confirmed the diagnosis of moderate right carpal tunnel syndrome and mild-to-moderate left carpal tunnel syndrome, noting that this “is not surprising as a right[- ]handed individual performing more of the daily tasks and handling more of the weight with his dominant right hand.” Dr. Macht indicated that appellant underwent surgical treatment with bilateral open carpal tunnel release and experienced significant improvement in h is condition. He noted that appellant repetitively engaged the wrist and hand musculature to grab and sort mail, lift, carry, and deliver mail, and open and closed mailboxes and car doors. Dr. Macht advised that the repetitive use activities resulted in swelling and inflammation of the involved musculature, which caused inflammation and irritation of the median nerve in the carpal tunnel. He noted that over time the repetitive inflammation and swelling led to scarring and narrowing of the carpal tunnel space causing further irritation and compression of the median nerve. Dr. Macht opined that based on a reasonable degree of medical certainty appellant developed bilateral carpal tunnel syndrome directly related to repetitive work duties as a mail carrier.

On June 17, 2024, OWCP referred appellant, along with a medical record, a statement of accepted facts (SOAF), and a series of questions, to Dr. Mysore Shivaram, a Board-certified orthopedic surgeon, for a second opinion evaluation to determine whether appellant sustained a diagnosed medical condition causally related to the accepted factors of his federal employment.

In a July 8, 2024 report, Dr. Shivaram noted appellant’s medical history included bilateral carpal tunnel syndrome. Physical examination of appellant’s hands revealed well-healed, nontender scars from prior carpal tunnel release, no tenderness along the scar, negative Tinel’s and Phalen’s tests, no evidence of ulnar nerve neuropathy, normal reflexes of both upper extremities, and intact sensory and motor examination. Dr. Shivaram diagnosed status post bilateral carpal tunnel release with satisfactory outcome following surgery. He indicated that work activities of a mail carrier were low demand activities and were not an etiological factor for the development of bilateral carpal tunnel syndrome. Dr. Shivaram noted that appellant had no symptoms of carpal tunnel syndrome and opined that his complaints of intermittent numbness in the ulnar nerve distribution were unrelated to carpal tunnel syndrome.

By decision dated July 24, 2024, OWCP denied modification of the June 15, 2023 decision.

4
LEGAL PRECEDENT

A claimant seeking benefits under FECA 5 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,6 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. 7 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. 8

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.

Causal relationship is a medical question that requires rationalized medical opinion evidence to resolve the issue. 9 The opinion of the physician must be based upon 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 factors. 10

Section 8123(a) of FECA provides that, if there is a disagreement between the physician making the examination for the United States and the physician of an employee, the Secretary shall appoint a third physician (known as a referee physician or impartial medical examiner (IME) ) who shall make an examination. 11 This is called a referee examination and OWCP will select a physician who is qualified in the appropriate specialty and who has no prior connection with the

5
Id.
6
F.H., Docket No.18-0869 (issued January 29, 2020); J.P., Docket No. 19-0129 (issued December 13, 2019);
Joe D. Cameron, 41 ECAB 153 (1989).
7
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). 8 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). 9 I.J., Docket No. 19-1343 (issued February 26, 2020); T.H., 59 ECAB 388 (2008); Robert G. Morris, 48 ECAB 238 (1996). 10 D.C., Docket No. 19-1093 (issued June 25, 2020); see L.B., Docket No. 18-0533 (issued August 27, 2018);
D.K., Docket No. 17-1549 (issued July 6, 2018).
11
5 U.S.C. § 8123(a); M.W., Docket No. 19-1347 (issued December 5, 2019); C.T., Docket No. 19-0508 (issued September 5, 2019); R.S., Docket No. 10-1704 (issued May 13, 2011); S.T., Docket No. 08-1675 (issued May 4, 2009).

5 case.12 When there exists opposing medical reports of virtually equal weight and rationale and the case is referred to an impartial medical specialist for the purpose of resolving the conflict, the opinion of such specialist, if sufficiently well rationalized and b ased upon a proper factual background, must be given special weight. 13

ANALYSIS

The Board finds that this case is not in posture for decision.

Initially, the Board notes that it is unnecessary to consider the evidence appellant submitted prior to the issuance of OWCP’s September 7, 2022 decision, which was considered by the Board in its June 15, 2023 decision. Findings made in prior Board decisions are res judicata absent further merit review by OWCP under section 8128 of FECA. 14

On May 13, 2024, Dr. Macht, appellant’s treating physician, diagnosed bilateral carpal tunnel syndrome. He noted that appellant’s duties as a mail carrier included casing mail daily for at least two hours, grabbing buckets, unloading mail, grabbing mail and placing in the appropriate slot, sorting parcels, fingering through presorted letters and flats, grab bing parcels from his bag to deliver, opening and closing his vehicle door multiple times during the day, and open ing and closing mailboxes. Dr. Macht related that EMG/NCV studies confirmed the diagnosis of moderate right carpal tunnel syndrome and mild-to-moderate left carpal tunnel syndrome, noting that this “is not surprising as a right[-]handed individual performing more of the daily tasks and handling more of the weight with his dominant right hand.” He advised that the repetitive use activities resulted in swelling and inflammation of the involved musculature, which caused inflammation and irritation of the median nerve in the carpal tunnel. Dr. Macht noted that over time the repetitive inflammation and swelling lead to scarring and narrowing of the carpal tunnel space causing further irritation and compression of the median nerve. He opined that based on a reasonable degree of medical certainty appellant developed bilateral carpal tunnel syndrome directly related to performing repetitive work duties as a mail carrier.

By contrast, Dr. Shivaram, the second opinion physician, opined in his July 8, 2024 report that appellant had no disabling residuals of any condition associated with h is current claim. He diagnosed status-post bilateral carpal tunnel release with satisfactory outcome following surgery. Dr. Shivaram opined that based on a review of the medical records, appellant’s work activities as a city mail carrier were low demand and not the etiological factor for development of bilateral carpal tunnel syndrome. He noted that no longer had symptoms referred to carpal tunnel syndrome and his complaints of intermittent numbness in the ulnar nerve distribution were unrelated to carpal tunnel syndrome.

Dr. Macht provided a rationalized description of how the accepted work factors caused or contributed to the diagnosed conditions. Dr. Shivaram, however, opined that there was no causal

12
20 C.F.R. § 10.321.
13
M.W., supra note 11; C.T., supra note 11; Darlene R. Kennedy, 57 ECAB 414 (2006); Gloria J. Godfrey, 52 ECAB 486 (2001); James P. Roberts, 31 ECAB 1010 (1980). 14 C.M., Docket No. 19-1211 (issued August 5, 2020); Clinton E. Anthony, Jr., 49 ECAB 476, 479 (1998).

6 relationship between the identified employment factors and appellant’s bilateral carpal tunnel syndrome. The Board, therefore, finds that a conflict in medical opinion exists regarding whether he developed bilateral carpal tunnel syndrome causally related to the accepted factors of federal employment.

OWCP’s regulations provide that, if a conflict exists between the medical opinion of the employee’s treating physicians and the medical opinion of a second-opinion physician or an OWCP medical adviser, OWCP shall appoint a third physician to make an examination. 15 The Board will, thus, remand the case to OWCP for referral to an IME regarding whether appellant has met his burden of proof to establish that he developed bilateral carpal tunnel syndrome due to accepted factors of his federal employment. 16 Following this and other such further development be deemed necessary, OWCP shall issue a de novo decision.

CONCLUSION

The Board finds that this case is not in posture for decision.

15
5 U.S.C. § 8123(a); M.W., supra note 11.
16
Id.

7
ORDER

IT IS HEREBY ORDERED THAT the July 24, 2024 decision of the Office of Workers’ Compensation Programs is set aside and the case is remanded for further proceedings consistent with this decision of the Board.

Issued: February 10, 2025
Washington, DC

Alec J. Koromilas, Chief Judge
Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge Employees’ Compensation Appeals Board

8