United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

K.J., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Duluth, GA, Employer 

__________________________________________ 

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Docket No. 15-34 

Issued: June 15, 2015 

Appearances: Case Submitted on the Record

Lonnie Boylan, Esq., for the appellant 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

CHRISTOPHER J. GODFREY, Chief Judge 

COLLEEN DUFFY KIKO, Judge 

JAMES A. HAYNES, Alternate Judge 

JURISDICTION 

On October 6, 2014 appellant, through counsel, filed a timely appeal from merit decisions 

of the Office of Workers’ Compensation Programs (OWCP) dated April 18 and July 22, 2014. 

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 established an injury in the performance of duty on 

March 4, 2012, as alleged. 

On appeal appellant’s counsel contends that the medical evidence establishes that 

appellant’s injuries were causally related to the March 4, 2012 employment incident. 

 1

 5 U.S.C. § 8101 et seq. 
2

FACTUAL HISTORY 

On March 21, 2012 appellant’s supervisor filed a traumatic injury claim on behalf of 

appellant, who was then a 58-year-old mail processing clerk. Her supervisor noted that appellant 

alleged that on March 4, 2012 a coworker ran into her. The nature of injury was listed as “all 

other occupational illnesses not applicable chest.” In an authorization for treatment form (Form 

CA-16) dated March 6, 2012, appellant stated that another employee ran into her at work while 

he was running down the aisle across from a mail processing machine and that she was knocked 

to the floor. 

In support of her claim, appellant submitted medical records and notes from the Gwinnett 

Clinic dated March 6 through April 26, 2012. These include intake notes, notes from physical 

examinations that are largely illegible, and radiology orders. The record also contained work 

excuse notes signed by Dr. Meena Shah, a Board-certified family practitioner, dated March 12 

and 29, 2012, finding appellant totally disabled. There is also an attending physician’s report 

dated March 12, 2012 wherein an unidentified person at the Gwinnett Clinic found that appellant 

had chest and shoulder pain related to her employment. 

By decision dated May 14, 2012, OWCP denied appellant’s claim. It determined that the 

medical evidence failed to establish a diagnosed condition causally related to the employment 

incident. 

On June 12, 2012 appellant requested review of the written record by an OWCP hearing 

representative. 

In an April 17, 2012 note, Dr. Maurice Jove, a Board-certified orthopedic surgeon, noted 

that appellant complained of discomfort and pain in her left knee, a chronic ongoing problem. 

He noted that she was exquisitely tender and had pain with rotation, abduction, and forward 

flexion above the subacromial arch. Dr. Jove gave appellant an injection of Cortisone. He noted 

that x-rays of her shoulder demonstrated no bony or soft tissue abnormalities but some changes 

along the tuberosity. Dr. Jove noted that, with regard to her left knee, appellant has pain along 

the medial joint line which has been ongoing for many years. He noted that she appeared to have 

a meniscal tear, but x-rays did not demonstrate any significant pathology. 

Dr. Jove noted that, with regard to her right shoulder, appellant apparently passed out 

when she was hit by her coworker and fell to the floor. In an April 24, 2012 note, he reported 

that her knee continued to bother her. Dr. Jove noted that appellant’s magnetic resonance 

imaging (MRI) scan showed a large medial meniscal tear, patellofemoral arthritis, and some 

other changes that were significant. Dr. Jove recommended arthroscopy. 

In a May 1, 2012 report, Dr. Farhan Malik, a Board-certified family practitioner, noted 

that appellant had an exacerbation of left knee pain approximately six weeks ago. He listed his 

clinical impression as left knee medial meniscus tear. 

Dr. Jove noted, in a May 8, 2012 note, that appellant had no pain or complaints, that she 

felt much better, and that she would continue to improve with time. In a June 21, 2012 note, he 

found appellant doing very well with her ankle, but that she was also having problems with her 
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shoulder. Dr. Jove noted that all of this was related to appellant’s work injury. In a July 24, 

2012 report, he diagnosed pain and discomfort in her right shoulder that had not improved. 

Dr. Jove noted that appellant’s knee had improved. In an August 2, 2012 report, he reviewed her 

MRI scan which demonstrated chronic impingement along the distal cuff and a spur which was 

indenting the cuff, causing cystic changes adjacent to it on the humeral head. Dr. Jove further 

noted that the biceps tendon and the labrum appeared to be torn. 

In an October 17, 2012 decision, an OWCP hearing representative noted that appellant 

had provided evidence of a medial meniscus tear and possible right shoulder rotator cuff tear. 

He noted that her knee problem had been long-standing. The hearing representative found that 

appellant had not established that her medical diagnoses were causally related to the employment 

incident. Accordingly, he affirmed the May 14, 2012 decision as modified. 

In a February 1, 2013 report, Dr. Shah clarified her diagnosis of pain as previously stated 

in the March 12, 2012 report. She stated that based upon her examination and the nature of 

appellant’s injuries, it was her professional determination that appellant’s injuries could have 

been sustained as a result of her being run over by or colliding with a coworker and falling to the 

floor. 

In a June 11, 2013 report, Dr. Jove noted that he had been taking care of appellant since 

April 17, 2012, that he last saw her on October 23, 2012, and that she had suffered from pain in 

her knee for many months. He summarized his treatment of appellant. Dr. Jove stated that on 

May 29, 2012 it was his understanding that her claim had been accepted relating to her chest and 

shoulder. This would consistent with appellant’s complaints when she was knocked down and 

fell, injuring her shoulder. Dr. Jove opined that the condition either occurred or was aggravated 

at the time of the fall. He stated that, although there were no MRI scan films prior to the fall, 

certainly the labral tear could have occurred at the time of the fall, as well as the fall could have 

been the beginning of impingement and rotator cuff aggravation. Dr. Jove opined that at this 

point appellant has limitation and instability related to her shoulder. He indicated that she had 

possibly suffered a permanent injury with the tear of the labrum and the biceps anchor, and that 

he would have to do an arthroscopic evaluation to see the extent of the injury. 

By decision dated September 20, 2013, OWCP denied modification of its October 17, 

2012 decision. 

On March 11, 2014 appellant, through counsel, filed a request for reconsideration. In 

support of the reconsideration request, appellant submitted a February 26, 2014 report wherein 

Dr. Jeff A. Traub, a Board-certified orthopedic surgeon, noted that she had sustained a fall on 

March 4, 2012 from falling to the ground after being run into by a coworker on March 4, 2012. 

Dr. Traub related that appellant had no prior problems with her knee or shoulder prior to this 

accident, but she was doing very well postarthroscopic partial medial meniscectomy and 

debridement on her knee. Dr. Traub noted that her only remaining complaint is her right 

shoulder. He noted that most of appellant’s pain in her shoulder appeared to be in the 

subacromial region. Dr. Traub opined that since appellant had no problem with her shoulder 

prior to the fall and that all of her issues occurred after the fall, he could say within a reasonable 

degree of medical certainty the fall was the cause of this condition. He recommended that 

appellant have a shoulder arthroscopy, decompression, and that he would evaluate the labrum at 
4

the time of the surgery. Dr. Traub concurred with Dr. Jove’s diagnosis. He also stated that he 

agreed that the causal relationship of this injury was sustained on March 4, 2012 during a fall 

when she was working at the employing establishment. 

By decision dated April 18, 2014, OWCP denied modification of the September 20, 2013 

decision. 

On June 9, 2014 appellant, through counsel, again requested reconsideration. In support 

thereof, appellant’s representative submitted the May 21, 2014 report wherein Dr. Dean S. 

Attaway, a Board-certified family practitioner, noted that appellant was injured when a coworker 

forcibly ran into her on March 4, 2012 causing her to fall unabated to the concrete workroom 

floor. He noted that as a direct result of her being unable to break her fall, she struck her left 

knee, chest, and right shoulder on the concrete work floor with the full force of her body. 

Dr. Attaway opined that, based on his 32 years of medical experience, physical examination, 

testing and observation, review of the relevant medical documents provided by Drs. Jove, Malik, 

and Traub, and the radiographic interpretations of objective diagnostic tests, it was his 

unequivocal opinion that given the absence of other causal factors, it was within a reasonable 

degree of medical certainty that the diagnoses of left knee medial meniscal tear, right shoulder 

rotator cuff tear, right shoulder superior labrum tear at the biceps anchor, and right shoulder 

impingement conditions were a natural and continuing sequence which would not have 

manifested itself to the present disabling stage if not precipitated by the factors of her 

employment on March 4, 2012. He emphasized that he was not aware of any previous medical 

history or medical treatment prior to March 4, 2012. Dr. Attaway concurred with Drs. Jove and 

Malik as to the medical necessity of the left knee medial meniscectomy and partial debridement 

of her patellofemoral chondral defects, and that the conditions were a direct result of the 

March 4, 2012 traumatic fall. He also agreed with Dr. Traub’s assessment that it was medically 

reasonable and necessary that appellant should have a right shoulder arthroscopy, 

decompression, and evaluation of the labrum at the time of the procedure. Dr. Attaway opined 

that appellant was temporarily totally disabled beginning March 4, 2012, but that he had no 

doubt after treatment appellant would be able to return to gainful employment with the 

employing establishment. 

By decision dated July 22, 2014, OWCP denied modification of the April 18, 2014 

decision. 

LEGAL PRECEDENT 

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 of FECA, that an injury was sustained in the performance of duty as alleged, 

and that any disability and/or specific condition for which compensation is claimed are causally 

related to the employment injury. These are the essential elements of each and every 
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compensation claim regardless of whether the claim is predicated upon a traumatic injury or an 

occupational disease.2 

In order to determine whether an employee actually sustained an injury in the 

performance of duty, OWCP begins with an analysis of whether fact of injury has been 

established. Generally, fact of injury consists of two components, which must be considered in 

conjunction with one another. The first component to be established is that the employee 

actually experienced the employment incident or exposure, which is alleged to have occurred.3 

In order to meet his or her burden of proof to establish the fact that he or she sustained an injury 

in the performance of duty, an employee must submit sufficient evidence to establish that he or 

she actually experienced the employment injury or exposure at the time, place, and in the manner 

alleged.4

 The second component is whether the employment incident caused a personal injury 

and generally can be established only by medical evidence.5

The medical evidence required to establish causal relationship is usually rationalized 

medical evidence. Rationalized medical opinion evidence is medical evidence which includes a 

physician’s rationalized opinion on the issue of whether there is a causal relationship between the 

claimant’s diagnosed condition and the implicated employment factors. The opinion of the 

physician must be based on a complete factual and medical background of the claimant, 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 

identified by the claimant.6

ANALYSIS 

OWCP accepted that on March 4, 2012 appellant fell to the floor when another employee 

accidentally ran into her. However, it denied her claim because she failed to establish a 

diagnosed medical condition causally related to this incident. 

The Board finds that the medical evidence does not establish that appellant suffered 

injuries causally related to the accepted employment incident. Initially, the Board notes that the 

incident occurred on March 4, 2012; however, in his April 17, 2012 report, Dr. Jove noted that 

appellant’s left knee had been bothering her for many, many months. Therefore, Dr. Jove likely 

believed that appellant’s knee problem preexisted her employment incident. In his June 11, 2013 

report, he determined that appellant’s shoulder condition either recurred or was aggravated at the 

time of the fall, and that the labral tear could have occurred at the time of the fall, as well as it 

could have been the cause of impingement and rotator cuff aggravation. Dr. Jove, however, 

 2 Jussara L. Arcanjo, 55 ECAB 281, 283 (2004). 

3 See Elaine Pendleton, 40 ECAB 1143 (1989). 

4 Linda S. Jackson, 49 ECAB 486 (1998). 

5 John J. Carlone, 41 ECAB 354 (1989); Horace Langhorne, 29 ECAB 820 (1978). 

6 Judith A. Peot, 46 ECAB 1036 (1995); Ruby I. Fish, 46 ECAB 276 (1994). 
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provides no medical rationale to support this opinion. Medical evidence that does not provide 

rationale for the opinion offered is of little probative value.7

In her February 1, 2013 report, Dr. Shah tried to clarify her diagnosis of pain in the 

March 12, 2012 report. She indicated that, based upon that examination and the nature of 

appellant’s injuries, it was her professional opinion that appellant’s injuries could have been 

sustained as a result of her being run over or colliding with a coworker and falling to the floor. 

The Board has consistently held that a diagnosis of pain is a description of a symptom rather than 

a compensable medical diagnosis.8 Dr. Shah does provide a medical diagnosis beyond 

appellant’s “injuries.” Finally, his opinion is equivocal because she stated that appellant’s 

injuries “could have been sustained” as a result of the employment incident. An equivocal 

opinion has little or no evidentiary value.9

Dr. Traub’s opinion indicates that he believed the condition was causally related to the 

employment incident because appellant did not have the condition prior to the fall, but did have 

the condition thereafter. The Board has found that an opinion finding causal relationship 

because the employee was asymptomatic before the injury, but symptomatic after the injury is 

insufficient, without more to establish causal relationship.10 However, this is not an acceptable 

medical reason without more in the way of medical rationale explaining the nexus between the 

mechanism of the injury and the diagnosed condition. 

Dr. Attaway opined that appellant’s shoulder and knee condition were causally related to 

the accepted employment incident. However, his report is dated two years after the accepted 

incident. He appears to have based his conclusions on those reports of appellant’s other 

physicians. Dr. Attaway stated that he examined appellant, but there are no examination findings 

and no medical rationale supporting his conclusion. Without these elements, a medical opinion 

is deficient and cannot support causal relationship.11

Causal relationship must be based on rationalized medical opinion evidence.12 A 

physician must accurately describe appellant’s work duties and medically explain the process by 

which these duties caused or aggravated his condition.13 Because appellant did not submit a 

 7 Id. 

8 D.H., Docket No. 14-1852 (issued January 27, 2015). 

9 Philip J. Deroo, 39 ECAB 1294 (1988) (although the medical opinion of a physician supporting causal 

relationship does not have to reduce the cause or etiology of a disease or condition to an absolute medical certainty, 

neither can such opinion be speculative or equivocal); Jennifer Beville, 33 ECAB 1370 (1982) (statement of a 

Board-certified internist that the employee’s complaints could have been related to her work injury was speculative 

and of limited probative value). 

10 John F. Glynn, 53 ECAB 562, 567 (2002). 

11 Gary L. Fowler, 45 ECAB 365 (1994). 

12 M.E., Docket No. 14-1064 (issued September 29, 2014). 

13 Solomon Polen, 51 ECAB 341 (2000) (rationalized medical evidence must relate specific employment factors 

identified by the claimant to the claimant’s condition, with stated reasons by a physician). See also G.G., Docket No 

15-234 (issued April 9, 2015). 
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sufficiently rationalized medical opinion supporting that her injuries were causally related to the 

accepted March 4, 2012 employment incident, she did not meet her burden of proof to establish 

an employment-related traumatic injury. 

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 did not establish that she sustained an injury in the 

performance of duty on March 4, 2012, as alleged. 

ORDER 

IT IS HEREBY ORDERED THAT the decisions of the Office of Workers’ 

Compensation Programs dated July 22 and April 18, 2014 are affirmed. 

Issued: June 15, 2015 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 James A. Haynes, Alternate Judge 

 Employees’ Compensation Appeals Board