On September 2, 2008 appellant, then a 49-year-old rural carrier, filed an occupational disease claim alleging that she sustained carpal tunnel syndrome due to years of repetitive motions with unnatural sitting and body positions.  She stopped work on September 10, 2008.  Appellant became aware of her condition and its relationship to her employment on September 1, 2007.  In an accompanying September 2, 2008 statement, she remarked that repetitive motions weakened her arm and shoulder to the extent that she was unable to case mail on the top shelf and lift her arm for prolonged periods.  Appellant asserted that her job duties subsequently aggravated her condition.

In a June 30, 2008 note from Dr. M. K. N, an orthopedic surgeon, appellant complained of right wrist pain and tingling.  On examination, appellant exhibited a positive Tinel’s sign and Phalen’s maneuver as well as right anterior shoulder tenderness to palpation.  Dr. N diagnosed right carpal tunnel syndrome.  He reiterated his findings in a July 22, 2008 follow-up report, adding that appellant demonstrated a positive carpal compression sign and an electromyogram (EMG) was consistent with the diagnosis.  In a September 8, 2008 duty status report, Dr. N listed her date of injury as October 2007 and discharged her to modified duty on September 3, 2008.  

Appellant specified in a November 3, 2008 statement that she worked 40 hours each week for the employing establishment for approximately 20 years.  Her job duties entailed repetitive movements such as casing letters, sorting parcels, loading mail tubs, sacks and trays into her postal vehicle, driving and distributing and retrieving mail with her right hand on the delivery route.  Appellant reiterated that her condition was due to these tasks.

In an October 27, 2008 report, Dr. N noted that appellant experienced right shoulder pain radiating to her hand about six months after she underwent a right shoulder arthroscopy with rotator cuff repair and subacromial decompression.  A physical examination and prior EMG study confirmed mild carpal tunnel syndrome.  Dr. N commented:

By decision dated January 9, 2009, OWCP denied appellant’s claim, finding the medical evidence insufficient to establish that her claimed condition was related to the accepted employment activity.

“There is certainly a distinct and unmistakable causal relationship between [appellant]’s work activities and duties for the [employing establishment] during her [21]-year career and the symptoms involving her right hand commencing 2 [to] 3 years ago which were eventually found to be carpal tunnel syndrome.  [Appellant] used both hands constantly and repetitively during her workday.  She was required to ‘put the mail together -- case the mail,’ lift and carry the mail (up to 70 pounds) and deliver the mail.  [Appellant] performed these activities for more than 20 years.  These activities are known to cause and worsen carpal tunnel syndrome.  The cumulative trauma of her work activities precipitated the injury to the right median nerve requiring neurolysis in March 2009.  Carpal tunnel syndrome is caused by pressure on the median nerve as it passes through the bony flexor compartment of the wrist.  The work activities described above ultimately resulted in injury to the median nerve.”

In an April 14, 2010 report, Dr. C noted treating appellant since December 4, 2007.  He advised that she was diagnosed with right carpal tunnel syndrome based on the results of median nerve compression, Tinel’s and Phalen’s testing and a 2008 EMG study.  Appellant underwent carpal tunnel surgery on March 15, 2009.  Dr. C noted that she work at the employing establishment for about 20 years where she lifted objects weighing 70-plus pounds engaged in repetitive movements, such as driving, casing and delivering mail.  He opined that heavy lifting and repetitive motions and constantly elevating her arm, for 20 years contributed to her condition.

An employee seeking benefits under FECA has the burden of establishing the essential elements of his or her claim, including the fact 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 period, that an injury was sustained in the performance of duty as alleged and that any disabilities and/or specific conditions for which compensation is claimed are causally related to the employment injury.  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.

Whether an employee actually sustained an injury in the performance of duty begins with an analysis of whether fact of injury has been established.  To establish fact of injury in an occupational disease claim, an employee 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.

                                                                                                         ANALYSIS 

In an October 27, 2008 report, after conducting a physical examination and reviewing a prior EMG study, Dr. N attributed appellant’s carpal tunnel syndrome to repetitive job activities, “especially [those] requiring elevation of the arm.”  An April 14, 2010 report from Dr. C specified that routine heavy lifting, driving, casing and delivering mail and elevating of her arm for around 20 years contributed to her condition.  Neither opinion, however, provided detailed medical rationale explaining the pathophysiological process by which appellant’s employment duties caused her injury. Dr. F's April 4, 2010 report reviewed Dr. N's earlier record, but the record establishes that he did not conduct any physical examination of appellant.  Moreover the Board notes that he is a Board-certified urologist, a field not generally affiliated with treatment of carpal tunnel.  Dr. F did not treat appellant or conduct a physical examination. The Board found that the reports of Drs. N, F and C are not sufficient to meet appellant’s burden of proof as they do not offer a sufficiently rationalized medical opinion based on a complete and accurate factual and medical background.