United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

R.K., Appellant 

and 

DEPARTMENT OF VETERANS AFFAIRS, 

NORTHPORT VETERANS 

ADMINISTRATION, Northport, NY, Employer 

__________________________________________ 

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Docket No. 14-1830 

Issued: February 3, 2015 

Appearances: Case Submitted on the Record

Appellant, pro se 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

CHRISTOPHER J. GODFREY, Chief Judge 

ALEC J. KOROMILAS, Alternate Judge 

JAMES A. HAYNES, Alternate Judge 

JURISDICTION 

On August 18, 2014 appellant filed a timely appeal from a July 31, 2014 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 established that he sustained an injury in the performance 

of duty on October 3, 2011, as alleged. 

FACTUAL HISTORY 

On October 6, 2011 appellant, then a 58-year-old maintenance worker, filed a traumatic 

injury claim alleging that on October 3, 2011, while lifting, he injured his left knee. 

 1

 5 U.S.C. § 8101 et seq. 
2

In support of his claim, appellant submitted an October 25, 2011 physical therapy report 

cosigned by Dr. Izhar Haque, an orthopedic surgeon, noting that appellant complained of severe 

left knee pain and that he received education with regard to breathing exercises and a home 

exercise program. In an October 27, 2011 progress note, Dr. Haque stated that appellant had all 

indications for a left total knee replacement due to advanced osteoarthritis and needed to meet 

the implant surgeon to plan for the date of definitive surgery. In an October 27, 2011 attachment 

to a general medical and surgery authorization request form, he stated that appellant had 

progressing pain and decreased quality of life related to advanced osteoarthritis in his left knee. 

Dr. Haque noted that appellant had failed to improve with conservative management and was 

scheduled for a left total knee arthroplasty on December 6, 2011. The record also contains notes 

signed by Dr. Haque’s physician’s assistant as well as an October 3, 2011 work capacity 

evaluation with an illegible signature. 

In response to OWCP’s November 16, 2011 letter asking appellant to submit further 

evidence, appellant submitted a radiology report dated October 3, 2011, containing an illegible 

signature, wherein an unidentified person noted in clinical history that appellant was lifting a bag 

over his head to throw into a larger bin when his left knee buckled and went out from under him 

and he landed on both knees. The radiographic report was interpreted as showing degenerative 

arthritis with no obvious acute fracture or dislocation. In an October 4, 2011 radiology report 

containing no signature, an unidentified person noted degenerative arthrosis most advanced at 

the patellofemoral articulation. 

In an October 6, 2011 progress note, Dr. Jeffrey Goldstein, an orthopedic surgeon, noted 

that appellant’s left knee evinced pain and swelling, but no specific loose body type symptoms. 

 By decision dated January 23, 2012, OWCP denied appellant’s claim. It determined that 

he had not established fact of injury as he failed to provide evidence to support that the event 

occurred as he alleged and did not provide medical evidence containing a definitive medical 

diagnosis in connection with the injury or events. 

 In a June 7, 2012 report, a nurse for the employing establishment noted that several 

weeks ago appellant had a left total knee replacement using his health insurance and veteran 

status. She further noted that appellant had injured his knee twice in recent years, once on 

June 24, 2008, which was accepted for a left knee sprain, and once on October 3, 2011, which 

was denied for left knee sprain. 

 On August 6, 2012 appellant requested reconsideration. He submitted progress notes 

from the employing establishment dated from August 16, 2011 through August 28, 2012, which 

included operative notes and follow up notes by physicians, nurse practitioners, and physical 

therapists. These notes indicate that on February 6, 2012 appellant underwent a left knee total 

knee arthroplasty and was discharged on February 21, 2012. However, due to insufficient 

progress on range of motion, appellant underwent a left knee manipulation under anesthesia on 

March 22, 2012. 

 By decision dated July 31, 2014, OWCP found that the factual component of appellant’s 

claim was established but that he had not provided medical evidence sufficient to connect his 

claimed conditions to the employment incident of October 3, 2011. 
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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 

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 an employment incident occurred as alleged on October 3, 2011. 

However, the Board finds that appellant has not met his burden of proof to establish a causal 

relationship between his left knee injury and surgeries and the accepted employment incident of 

October 3, 2011. 

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

3 See Federal (FECA) Procedure Manual, Part 2 -- Claims, Fact of Injury, Chapter 2.803(2)(a) (June 1995). 

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). 
4

Appellant has submitted evidence that establishes that he had degenerative arthritis in his 

left knee and underwent surgery including a total knee arthoplasty on February 6, 2012. 

However, there is no medical evidence to establish that his surgery or the medical condition in 

his left knee was causally related to the accepted employment incident of October 3, 2011. The 

Board notes that appellant submitted evidence that either contains an illegible signature or no 

signature and thus the author cannot be identified as a physician. The Board has held that 

incomplete medical reports, containing no signature or illegible signatures, do not constitute 

probative medical evidence.7

 Appellant also submitted notes by physical therapists, nurse 

practitioners, and physician’s assistants. The Board has held that treatment notes signed by a 

nurse, physical therapist, or a physician’s assistant are not considered medical evidence as these 

providers are not physicians under FECA.8

 

The remaining progress notes or reports signed by physicians do not address the issue of 

causal relationship. In this regard, none of the radiologic evidence of record addresses the issue 

of causal relationship. Dr. Haque noted that appellant had advanced osteoarthritis in his left 

knee, that this resulted in a decreased quality of life, that conservative treatment had not been 

successful, and that he had been scheduled for a total left knee arthroplasty. However, he does 

not address the cause of appellant’s osteoarthritis. Dr. Goldstein noted that appellant’s left knee 

evidenced pain and swelling, but did not discuss appellant’s employment or any causal 

relationship. 

In order to establish his claim, appellant must submit a rationalized medical opinion 

addressing the causal relationship between his left knee condition and the October 3, 2011 

employment incident. An award of compensation may not be based on surmise, conjecture, or 

speculation. Neither the fact that appellant’s claimed condition became apparent during a period 

of employment nor is his belief that the condition was caused by his employment sufficient to 

establish causal relationship.9

 

The Board finds that appellant has not submitted sufficient medical evidence to establish 

his claim. As noted, causal relationship is a medical question that must be established by a 

probative medical opinion from a physician.10 The physician must accurately describe 

appellant’s work duties and medically explain the pathophysiological process by which this 

incident would have caused or aggravated his condition.11 The Board finds that there is no 

rationalized medical opinion in the record discussing the October 3, 2011 incident and explaining 

 7 See R.M., 59 ECAB 690, 693 (2008); Merton J. Sills, 39 ECAB 572, 575 (1988). 

8 See David P. Sawchuk, 57 ECAB 316 (2006) (lay individuals such as physician’s assistants, nurses and physical 

therapists are not competent to render a medical opinion under FECA); 5 U.S.C. § 8101(2) (this subsection defines a 

physician as surgeons, podiatrists, dentists, clinical psychologists, optometrists, chiropractors, and osteopathic 

practitioners within the scope of their practice as defined by State law). 

9 D.I., 59 ECAB 158 (2007); Ruth R. Price, 16 ECAB 688, 691 (1965). 

10 W.P., Docket No. 14-1076 (issued September 18, 2014). 

11 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 S.T., Docket 

No. 11-237 (issued September 9, 2011). 
5

how appellant’s left knee condition and subsequent surgery are related to this accepted incident. 

Because appellant has not provided such medical opinion evidence in this case, he has failed to 

meet his 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 failed to establish that he sustained an injury in the 

performance of duty on October 3, 2011, as alleged. 

ORDER 

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

Compensation Programs dated July 31, 2014 is affirmed. 

Issued: February 3, 2015 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board 

 

 James A. Haynes, Alternate Judge 

 Employees’ Compensation Appeals Board