S.R. and U.S. Postal Service, Indianapolis Post Office (Board decision, March 11, 2025)

ECAB final decision. The Board affirmed OWCP's denial of bilateral carpal tunnel syndrome attributed to accepted work factors. 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

An Indianapolis postal worker attributed bilateral carpal tunnel syndrome to her job duties. The Board found the medical evidence did not adequately establish a causal connection to the accepted work factors. It upheld the denial.

Decision snapshot

• Authority: Federal Employees' Compensation Act, 5 U.S.C. § 8101 et seq.
• Outcome: Bilateral carpal-tunnel claim denied.
• Key point: The record lacked a sufficient medical explanation linking the condition to work.

Full text (ECAB public release)

United States Department of Labor
Employees’ Compensation Appeals Board

________
)
S.R., Appellant
)
)
and ) Docket No. 25-0326
)
Issued: March 11, 2025
U.S. POSTAL SERVICE, POST OFFICE, )
Indianapolis, IN, Employer
)
__________ )

Appearances: Case Submitted on the Record
Alan J. Shapiro, 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 February 20, 2025 appellant, through counsel, filed a timely appeal from a January 31, 2025 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 to consider the merits of this case.

ISSUE

The issue is whether appellant has met her burden of proof to establish bilateral carpal tunnel syndrome causally related to the accepted factors of her 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 decisions are incorporated herein by reference. The relevant facts are as follows.

On January 13, 2021, appellant, then a 57-year-old sales, service, and distribution associate, filed an occupational disease claim (Form CA-2) alleging that she injured her upper extremities due to factors of her federal employment which required repetitive use of her arms and hands. She noted that she first became aware of her conditions and realized their relation to her federal employment on August 8, 2020. Appellant did not stop work.

In a development letter dated January 14, 2021, OWCP advised appellant of the type of factual and medical evidence needed to establish her claim and provided a questionnaire for her completion. By separate development letter of even date, it requested additional information from the employing establishment, including comments from a knowledgeable supervisor regarding her allegations. OWCP afforded both parties 30 days to respond.

In a January 12, 2021 form report, Jacqueline S. Cole, a nurse practitioner, noted a diagnosis of bilateral carpal tunnel syndrome and indicated that appellant could return to work on January 13, 2021.

OWCP received a report dated January 18, 2021 from Dr. Robert Falender, a Board- certified orthopedic surgeon, specializing in hand surgery. Dr. Falender related that appellant experienced numbness and tingling in both of her hands. He noted that she performed repetitive work which aggravated her condition and possibly caused it. Dr. Falender diagnosed bilateral hand numbness.

OWCP received a medical report dated January 21, 2021 from Dr. Vince Hume, a Board- certified physical medicine and rehabilitation specialist. Dr. Hume noted that appellant’s electrodiagnostic study revealed evidence of bilateral-moderate sensorimotor median mononeuropathy located at the carpal tunnel. He diagnosed bilateral hand numbness.

In a January 25, 2021 response to OWCP’s development questionnaire, appellant related that her job duties included pushing heavy containers, unloading trays of letters, carrying tubs and trays, unloading, scanning, and tossing packages into carts, delivering packages , and working the retail station.

In a report dated February 17, 2021, Dr. Casimir R. Starsiak, an osteopathic physician specializing in orthopedic surgery, diagnosed bilateral carpal tunnel syndrome and related that appellant experienced numbness and tingling in both hands. He also indicated that she wanted to proceed with right carpal tunnel release.

By decision dated February 24, 2021, OWCP accepted that the implicated employment factors occurred; however, it denied appellant’s claim as causal relationship had not been

3
Docket No. 24-0540 (issued August 2, 2024); Docket No. 22-0245 (issued July 18, 2022).

2 established between her diagnosed bilateral carpal tunnel syndrome and the accepted employment factors. It concluded, therefore, that the requirements had not been met to establish an injury as defined by FECA.

OWCP continued to receive medical reports. In a report dated January 21, 2021, Dr. Hume reviewed appellant’s nerve conduction velocity and electrodiagnostic studies and related that her right median motor nerves showed prolonged distal onset latency and reduced amplitude, her bilateral ulnar motor nerves showed decreased conduction velocity, and her bilateral median sensory nerves showed prolonged distal peak latency and decreased conduction velocity.

On November 15, 2021, appellant, through counsel, requested reconsideration of OWCP’s February 24, 2021 decision and submitted a report dated September 3, 2021 from Dr. Jeffery Bollenbacher, an osteopath Board-certified in orthopedic surgery. Dr. Bollenbacher related that appellant complained of bilateral wrist pain and right elbow pain. He related her diagnoses as bilateral carpal tunnel syndrome, right greater then left, medial epicondylitis of the right elbow, lateral epicondylitis of the right elbow, ulnar nerve entrapment noted on the right elbow, and cubital tunnel syndrome. Dr. Bollenbacher opined that appellant’s injury was consistent with her occupation and caused by long-term overuse of her right elbow and wrists.

By decision dated November 18, 2021, OWCP denied modification of its February 24, 2021 decision.

Appellant appealed to the Board. The Board, by decision dated July 18, 2022, affirmed OWCP’s November 18, 2021 decision.4

On April 4, 2023, appellant, through counsel, requested reconsideration. In support thereof, she submitted a November 1, 2021 report from a provider with an illegible signature diagnosing right carpal tunnel syndrome, and right cubital tunnel syndrome. In a November 16, 2021 operative report, Dr. Bollenbacher performed an unauthorized right wrist carpal tunnel release, right elbow cubital tunnel release, and modified Nischl procedure of medial epicondyle. Appellant provided physical therapy notes beginning November 23, 2021. She also resubmitted her January 21, 2021 electrodiagnostic study

Dr. Bollenbacher indicated that appellant required physical therapy and could only use her left hand. He examined appellant on December 21, 2022 and recounted her symptoms of continued wrist and elbow pain. Dr. Bollenbacher described appellant’s work activities of sorting mail and lifting packages. He provided additional diagnoses following the November 16, 2021 surgery of flexor carpi ulnar tenodesis of the right wrist, and right elbow lateral epicondylitis. On February 11, 2022 Dr. Bollenbacher determined that appellant could return to full-duty work with no restrictions. In a February 15, 2023 note, he related that she worked at the employing establishment and that due to cumulative trauma with repetitive motion she had developed carpal and cubital tunnel syndromes.

4
Docket No. 22-0245 (issued July 18, 2022).

3
By decision dated October 6, 2023, OWCP denied modification of its November 18, 2021 decision.

On March 25, 2024, appellant, through counsel, requested reconsideration of the October 6, 2023 decision. In support of this request, she provided a February 6, 2024 report from Dr. Bollenbacher who diagnosed right elbow cubital tunnel and epicondylitis of the right elbow, and bilateral carpal tunnel syndrome with resulting surgeries. He opined that these conditions were consistent with an occupational injury due to long-term overuse. Dr. Bollenbacher related that appellant was employed as a postal worker, moving multiple packages and weights with both her arms for many years.

By decision dated March 27, 2024, OWCP denied modification of the October 6, 2023 decision.

Appellant appealed to the Board. The Board, by decision dated August 2, 2024, affirmed OWCP’s March 27, 2024 decision.5

On January 30, 2025 appellant, through counsel, requested reconsideration. In support thereof, she provided a January 14, 2025 report from Dr. Bollenbacher. Dr. Bollenbacher diagnosed right elbow cubital tunnel and epicondylitis of the right elbow and bilateral carpal tunnel syndrome and provided her surgical history. He related that carpal tunnel syndrome was the compression of the median nerve as it traversed through the carpal tunnel in the wrist and that cubital tunnel syndrome was the compression of the ulnar nerve as it traversed through the cubital tunnel in the elbow. Dr. Bollenbacher further noted that epicondylitis was inflammation of the epicondyles of the elbow. He explained that compression occurred when inflammation was present in the tunnels and that an electromyogram (EMG) could be used to confirm the diagnoses. Dr. Bollenbacher opined that inflammation of these areas could be induced with long term overuse and repetitive motions, such as pushing, pulling, and lifting. He described appellant’s repetitive job duties of sorting, lifting, pushing, and pulling parcels of various weights and quantity and concluded that the diagnoses of right elbow cubital tunnel, right elbow epicondylitis and bilateral carpal tunnel syndrome were consistent with her occupation due to long-term overuse and repetitive motions including pushing, pulling, and lifting.

By decision dated January 31, 2025, OWCP denied modification.

LEGAL PRECEDENT

An employee seeking benefits under FECA 6 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, 7 that an injury was sustained in the performance of duty as alleged, and that

5
Docket No. 24-0540 (issued August 2, 2024).
6
Supra note 2.
7
F.H., Docket No.18-0869 (issued January 29, 2020); J.P., Docket No. 19-0129 (issued April 26, 2019); Joe D. Cameron, 41 ECAB 153 (1989).

4 any disability or medical condition for which compensation is claimed is causally related to the employment injury. 8 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.9

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 employee. 10

Causal relationship is a medical question that requires rationalized medical opinion evidence to resolve the issue. 11 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. 12

ANALYSIS

The Board finds that appellant has not met her burden of proof to establish bilateral carpal tunnel syndrome causally related to the accepted factors of her federal employment.

Preliminarily, the Board notes that it is unnecessary to consider the evidence appellant submitted prior to the issuance of the March 27, 2024 decision because the Board considered that evidence in its August 2, 2022 decision. Findings made in prior Board decisions are res judicata absent any further review by OWCP under section 8128 of FECA. 13

Dr. Bollenbacher in a January 14, 2025 report, related that carpal tunnel syndrome was the compression of the median nerve as it run through the carpal tunnel in the wrist, that cubital tunnel syndrome was the compression of the ulnar nerve as it ran through the cubital tunnel in the elbow, and that epicondylitis was inflammation of the epicondyles of the elbow. He described appellant’s job duties of repetitive motions including sorting, lifting, pushing, and pulling parcels of various weights and quantity and concluded that the diagnoses of right elbow 8 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). 9 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). 10 P.L., Docket No. 19-1750 (issued March 26, 2020); R.G., Docket No. 19-0233 (issued July 16, 2019); L.M., Docket No. 13-1402 (issued February 7, 2014); Delores C. Ellyett, id. 11 I.J., Docket No. 19-1343 (issued February 26, 2020); T.H., 59 ECAB 388 (2008); Robert G. Morris, 48 ECAB 238 (1996).
12
D.C., Docket No. 19-1093 (issued June 25, 2020); see L.B., Docket No. 18-0533 (issued August 27, 2018).
13
G.W., Docket No. 22-0301 (issued July 25, 2022); M.D., Docket No. 19-0510 (issued August 6, 2019);
Clinton E. Anthony, Jr., 49 ECAB 476, 479 (1988).

5 cubital tunnel, right elbow epicondylitis and bilateral carpal tunnel syndrome were consistent with her occupation due to these activities. Dr. Bollenbacher, however, did not offer a rationalized medical explanation to support his conclusory opinion. He did not explain the pathophysiological process through which repetitive motion or moving multiple packages and weights with both her arms at the employing establishment would cause inflammation resulting in epicondylitis of the right elbow and carpal and cubital tunnel syndromes.14 The Board has held that medical evidence should offer a medically-sound and rationalized explanation by the physician of how employment duties physiologically caused or aggravated the diagnosed conditions. 15 Therefore, this evidence is insufficient to establish the claim.

As the medical evidence of record is insufficient to establish bilateral carpal tunnel syndrome causally related to the accepted employment factors, 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 bilateral carpal tunnel syndrome causally related to the accepted factors of her federal employment.

14
See R.B., id.; S.B., Docket No. 24-0064 (issued February 28, 2024); S.C., Docket No. 21-0929 (issued April 28, 2023); J.D., Docket No. 19-1953 (issued January 11, 2021); M.W., Docket No. 14-1664 (issued December 5, 2014). 15 See S.B., id.; T.L., Docket No. 23-0073 (issued January 9, 2023); V.D., Docket No. 20-0884 (issued February 12, 2021); Y.D., Docket No. 16-1896 (issued February 10, 2017).

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ORDER

IT IS HEREBY ORDERED THAT the January 31, 2025 decision of the Office of Workers’ Compensation Programs is affirmed.

Issued: March 11, 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

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