United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

P.C., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Charlotte, NC, Employer 

__________________________________________ 

) 

) 

) 

) 

) 

) 

) 

) 

Docket No. 15-1382 

Issued: December 9, 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 

PATRICIA H. FITZGERALD, Deputy Chief Judge 

COLLEEN DUFFY KIKO, Judge 

JURISDICTION 

On June 9, 2015 appellant filed a timely appeal from a January 9, 2015 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 met her burden of proof to establish a left knee injury on 

May 27, 2014 while in the performance of duty. 

FACTUAL HISTORY 

On May 28, 2014 appellant, then a 43-year-old city carrier, filed a traumatic injury claim 

(Form CA-1) alleging that on May 27, 2014 she sustained a left knee injury while entering into 

her truck. She stated that when she got back in her truck, her left knee popped and it became 

 

 1 5 U.S.C. § 8101 et seq.
2

sore. By the next morning, it was difficult for appellant to move and she experienced pain when 

she put weight on her knee. 

In a May 28, 2014 narrative statement, appellant reiterated her prior description of the 

May 27, 2014 incident. She scheduled an evaluation of her left knee condition for 

May 29, 2014. 

A May 16, 2014 ambulatory work/school release form from Carolinas HealthCare 

System, containing an unknown signature, listed the date of injury as May 16, 2014. The form 

requested that appellant be excused that same day. 

In a May 29, 2014 note, Edward Hall, a supervisor, related that appellant failed to notify 

her supervisor on Tuesday night or Wednesday morning about her knee issues. Appellant 

worked the entire day and did not submit a leave slip until Wednesday after completing both of 

her runs. Mr. Hall noted that appellant had provided documentation regarding an injection she 

had received for arthritis in her knee and that she would need an injection every three months. 

On May 13, 2014 appellant submitted a leave slip to attend a knee appointment as appellant 

contended that she could not wait for her next appointment in June. She had submitted a Form 

3971 requesting sick leave on August 29, 2014 to receive an additional injection. Mr. Hall 

contended that her injury was not work related, but related to a prior injury for which she was 

receiving treatment. 

An undated Form CA-16, authorization for examination, signed by Mr. Hall, authorized 

appellant’s medical treatment related to the claimed May 27, 2014 injury. The description of 

injury was reported as a popped knee. 

In undated office visit work/school excuse reports, Dr. Gordon K.W. Lam, a Boardcertified internist, noted that appellant was evaluated in his office on May 29 and June 5, 2014 

and that, due to medical necessity, she should be excused from work through June 20, 2014. 

In an orthopedic visit note dated June 17, 2014, Dr. Brad A. Freidinger, a Board-certified 

orthopedic surgeon, provided a history that appellant was evaluated by Dr. Lam and noted her 

complaint of new left knee pain which she rated as 7 out of 10. Appellant reported an injury 

with a popping sensation that occurred about three weeks ago and an injury while getting out of 

her mail truck at work. Since then, she reported extreme difficulty with her knee. Appellant had 

swelling and an inability to twist and squat. She denied numbness or tingling. Dr. Freidinger 

provided a history of appellant’s medical treatment, family and social background. He listed 

examination findings and diagnosed subacute medial meniscus tear of the left knee. 

Dr. Freidinger recommended knee arthroscopy as appellant was rather symptomatic, was having 

difficulty with twisting and squatting, and did not demonstrate an effusion. He also diagnosed 

left knee degenerative joint disease. Dr. Freidinger advised that appellant had preexisting 

arthritis which would not be cured by the recommended procedure, but it would help improve 

her symptomatology significantly given her new onset of meniscal pain. 

In a June 17, 2014 work restriction report, he reiterated his diagnosis of left knee 

meniscus tear and surgery recommendation and advised that appellant would be unable to work 

during her four-to-six week postoperative recovery. In an orthopedic visit note dated July 10, 
3

2014, he indicated that appellant had presented for her first postoperative visit status post left 

knee arthroscopy. Appellant was doing well and denied any complaints of fevers or chills. She 

had no nausea or vomiting. Her pain was controlled. Dr. Freidinger provided normal physical 

examination findings. He diagnosed status post left arthroscopy, partial meniscectomy, and 

chondroplasty medial femora I condyle and trochlea. Dr. Freidinger advised that she could not 

work at that time and that she should continue with activity restrictions as discussed. 

A June 23, 2014 continuation of pay nurse report indicated that appellant stopped work 

on May 29, 2014 pending surgical repair of her left medial meniscus. Appellant’s anticipated 

return to work was August 18, 2014. 

By letter dated June 23, 2014, OWCP notified appellant of the deficiencies of her claim 

and afforded her 30 days to submit additional medical evidence. It also requested that the 

employing establishment submit medical evidence, if appellant had been treated at its medical 

facility. 

In a July 28, 2014 decision, OWCP accepted that the May 27, 2014 incident occurred as 

alleged. However, it denied appellant’s claim because she had failed to provide a rationalized 

medical opinion explaining how the accepted employment incident caused or aggravated her 

medical condition. 

On August 19, 2014 appellant requested a review of the written record by an OWCP 

hearing representative. 

In a May 29, 2014 report, Dr. Lam noted that appellant had presented as an urgent 

evaluation for acute left knee pain and swelling following a May 27, 2014 employment incident. 

He noted that when she was last seen on May 16, 2014, x-rays noted mild osteoarthritic changes 

along her knees bilaterally. Appellant received Kenalog injections which were helpful. Dr. Lam 

reported examination findings and provided an impression of quiescent polymyalgia rheumatic, 

osteoarthritis of the knees, shoulders, and elbows, confirmed mild osteoarthritis of the bilateral 

knees, ongoing functional somatic and central pain syndrome, Vitamin D deficiency, acute left 

knee. He reported that the cause of appellant’s knee pain was uncertain. 

In a June 4, 2014 left lower extremity magnetic resonance imaging (MRI) scan report, 

Dr. Scott R. Kennedy, a Board-certified radiologist, dictated and verified an impression of 

medial meniscal tear as described with mild medial joint line edema, tri-compartmental 

osteoarthritis that was most evident in the medial and patellofemoral compartments, and small to 

moderate joint effusion with popliteal cyst. 

Dr. Freidinger reiterated his finding on July 10, 2014 that appellant was status post left 

knee arthroscopy. He advised that she was unable to work. In an August 19, 2014 report, 

Dr. Freidinger provided a history of the May 27, 2014 employment incident, referenced his 

June 17 and July 10, 2014 reports, and noted that appellant’s left knee arthroscopy was 

performed on June 30, 2014. Dr. Freidinger opined that her injury was work related. He 

recommended that appellant be transitioned to a work van. In a work restrictions form dated 

August 19, 2014, Dr. Freidinger again advised that appellant could return to work on 

September 15, 2014 with transition to a work van. In an October 7, 2014 medical information 
4

form and an undated medical restrictions assessment form, he listed appellant’s physical 

restrictions and advised that she could return to full-duty work three months postoperative. 

Dr. Freidinger noted that she had pain with prolonged walking, squatting, and kneeling which 

impacted her work life and life outside work. 

In a January 9, 2015 decision, an OWCP hearing representative affirmed the July 28, 

2014 decision. She found that the medical evidence was insufficient to establish a left knee 

injury causally related to the accepted May 27, 2014 employment incident. 

LEGAL PRECEDENT 

An employee seeking benefits under FECA2 has the burden of proof to establish the 

essential elements of his or her claim by the weight of the reliable, probative, and substantial 

evidence3

 including that he or she sustained an injury in the performance of duty and that any 

specific condition or disability for work for which he or she claims compensation is causally 

related to that employment injury.4

To determine whether a federal employee has sustained a traumatic injury in the 

performance of duty, it first must be determined whether fact of injury has been established.5 

There are two components involved in establishing the fact of injury. First, the employee must 

submit sufficient evidence to establish that she actually experienced the employment incident at 

the time, place and in the manner alleged.6 

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

generally can be established only by medical evidence.7 The evidence required to establish 

causal relationship is rationalized medical opinion evidence, based upon complete factual and 

medical background, showing a causal relationship between the claimed condition and the 

identified factors.8 The belief of the claimant that a condition was caused or aggravated by the 

employment is insufficient to establish a causal relationship.9

 

 2 5 U.S.C. §§ 8101-8193. 

 3 J.P., 59 ECAB 178 (2007); Joseph M. Whelan, 20 ECAB 55, 58 (1968). 

 4 G.T., 59 ECAB 447 (2008); Elaine Pendleton, 40 ECAB 1143, 1145 (1989). 

 5 S.P., 59 ECAB 184 (2007); Alvin V. Gadd, 57 ECAB 172 (2005). 

 6 Bonnie A. Contreras, 57 ECAB 364 (2006); Edward C. Lawrence, 19 ECAB 442 (1968). 

 7 John J. Carlone, 41 ECAB 354 (1989); see 5 U.S.C. § 8101(5) (injury defined); 20 C.F.R. §§ 10.5(ee), 10.5(q) 

(traumatic injury and occupational disease defined, respectively). 

 8 Lourdes Harris, 45 ECAB 545 (1994); see Walter D. Morehead, 31 ECAB 188 (1979). 

 9 Kathryn Haggerty, 45 ECAB 383, 389 (1994). 
5

ANALYSIS 

The Board finds that appellant has not met her burden of proof to establish a traumatic 

injury caused by the accepted May 27, 2014 employment incident. Appellant failed to submit 

sufficient medical evidence to establish that the accepted employment incident caused a left knee 

injury. 

Appellant submitted medical reports from Dr. Freidinger, an attending physician. In his 

August 19, 2014 report, Dr. Freidinger opined that appellant’s left knee medial meniscus tear 

was causally related to the May 27, 2014 employment incident. He recommended that she be 

transitioned to a work van. Although Dr. Freidinger opined that appellant’s condition was 

related to the accepted employment incident, he did not provide any medical rationale to support 

his conclusion. Medical evidence that states a conclusion but does not offer any rationalized 

medical explanation regarding the cause of an employee’s condition is of limited probative value 

on the issue of causal relationship.10

Dr. Freidinger’s remaining reports are also insufficient to establish causal relationship. 

Within these additional reports, he did not provide an opinion stating that the accepted May 27, 

2014 employment incident caused or contributed to appellant’s diagnosed left knee conditions, 

resultant surgery, disability status, and work restrictions. The Board has found that medical 

evidence that does not offer any opinion regarding the cause of an employee’s condition is of 

limited probative value on the issue of causal relationship.11

Dr. Lam’s May 29, 2014 report provided a history of the May 27, 2014 employment 

incident. He listed findings on examination and provided an impression of quiescent 

polymyalgia rheumatic, osteoarthritis of the knees, shoulders, and elbows, confirmed mild 

osteoarthritis of the bilateral knees, ongoing functional somatic and central pain syndrome, acute 

left knee injury. Dr. Lam noted, however, that the cause of her knee pain was uncertain. As he 

did not opine that the accepted May 27, 2014 employment incident caused or contributed to 

appellant’s left knee conditions, the Board finds that his report is insufficient to establish her 

claim. 

Dr. Lam’s remaining reports are likewise insufficient to establish causal relationship. He 

found that appellant was disabled for work from May 29 to June 20, 2014 due to medical 

necessity, but failed to provide any medical opinion stating that the accepted employment 

incident caused or contributed to her disability.12 

Similarly, Dr. Kennedy’s June 4, 2014 left lower extremity MRI scan report lacks a 

medical opinion on causal relationship.13

 10 J.F., Docket No. 09-1061 (issued November 17, 2009); A.D., 58 ECAB 149 (2006). 

11 R.E., Docket No. 10-679 (issued November 16, 2010); K.W., 59 ECAB 271 (2007). 

12 Id. 

13 Id.
6

The May 16, 2014 note from Carolinas HealthCare System which contained an unknown 

signature is insufficient to establish appellant’s claim. A report that is unsigned or bears an 

illegible signature lacks proper identification as a physician cannot be considered probative 

medical evidence.14

Therefore, the Board finds that there is insufficient medical evidence to establish that 

appellant sustained a left knee injury causally related to the accepted May 27, 2014 employment 

incident. 

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. 

The Board also notes that the employing establishment issued a Form CA-16 authorizing 

medical treatment.15 The Board has held that when the employing establishment properly 

executes a Form CA-16 which authorizes medical treatment as a result of an employee’s claim 

for an employment-related injury, the Form CA-16 creates a contractual obligation, which does 

not involve the employee directly, to pay for the cost of the examination or treatment regardless 

of the action taken on the claim. The period for which treatment is authorized by a Form CA-16 

is limited to 60 days from the date of issuance, unless terminated earlier by OWCP.16 Although 

OWCP denied appellant’s claim for an injury, it did not address whether she would be entitled to 

reimbursement of medical expenses pursuant to the Form CA-16. Upon return of the case 

record, OWCP should further develop this issue.17

CONCLUSION 

The Board finds that appellant has failed to meet her burden of proof to establish a left 

knee injury on May 27, 2014 while in the performance of duty. 

 14 Thomas L. Agee, 56 ECAB 465 (2005); Richard F. Williams, 55 ECAB 343 (2004). 

15 20 C.F.R. § 10.300 provides that, when an employee sustains a work-related traumatic injury requiring medical 

treatment, the employing establishment should issue a CA-16 form. 

16 See 20 C.F.R. § 10.300(c); Tracy P. Spillane, 54 ECAB 608 (2003). 

17 See P.B., Docket No. 14-837 (issued August 12, 2014). 
7

ORDER 

IT IS HEREBY ORDERED THAT the January 9, 2015 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: December 9, 2015 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board