United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

B.P., Appellant 

and 

DEPARTMENT OF VETERANS AFFAIRS, 

VETERANS ADMINISTRATION MEDICAL 

CENTER, East Orange, NJ, Employer 

__________________________________________ 

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Docket No. 15-233 

Issued: May 21, 2015 

Appearances: Case Submitted on the Record

Appellant, pro se 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

PATRICIA H. FITZGERALD, Deputy Chief Judge 

COLLEEN DUFFY KIKO, Judge 

ALEC J. KOROMILAS, Alternate Judge 

JURISDICTION 

On November 10, 2014 appellant filed a timely appeal from an October 2, 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 has established a traumatic injury in the performance of 

duty. 

 1

 5 U.S.C. § 8101 et seq. 
2

FACTUAL HISTORY 

On April 7, 2014 appellant, then a 52-year-old medical support assistant, filed a 

recurrence (Form CA-2a) on March 6, 2014, due to a November 3, 2013 work injury.2

 She 

alleged that she was walking through a tunnel at work when she began to experience left ankle 

pain. Appellant stopped work on March 7, 2014 and returned on April 21, 2014. 

In a March 6, 2014 disability status report, Dr. Thomas Cuomo, a Board-certified 

orthopedic surgeon, advised that appellant was disabled from work until April 17, 2014. On 

physical examination he found tenderness of the left ankle and a mild antalgic gait and diagnosed 

left foot contusion and left ankle sprain. 

In a March 6, 2014 report, Dr. Thomas Helbig, a Board-certified orthopedic surgeon, 

advised that appellant had injured her left ankle in a fall at the employing establishment. He 

noted that he began treating her in December and that recently she began to experience a 

worsening of left ankle pain without any new trauma. Dr. Helbig also advised that appellant 

should return to physical therapy. In a March 27, 2014 report, he advised that she was 

experiencing left knee and ankle pain that marginally improved following an injection. 

Appellant was diagnosed with internal derangement of the left knee and sprained left ankle. 

An April 21, 2014 report signed by a physician assistant advised that appellant was 

experiencing discomfort with knee range of motion, global tenderness to palpation and good 

ankle range of motion. Appellant was again diagnosed with internal derangement of the left 

knee and left ankle sprain. 

In a May 12, 2014 memorandum, OWCP advised that appellant’s claim was a new injury 

as opposed to a recurrence and would be developed as a new claim. 

By letter dated May 20, 2014, OWCP notified appellant of the deficiencies in her claim 

and advised her of the type of evidence needed to establish her claim. She was also notified that 

her claim was being developed as a new injury. 

In an April 21, 2014 disability status report, Dr. Helbig advised that appellant was able to 

return to work that day with restrictions including no excessive walking or heavy lifting. He 

diagnosed left ankle and knee strain. 

In a May 29, 2014 report, Dr. Helbig noted seeing appellant for left knee and ankle pain. 

Appellant related that her initial injury occurred on November 1, 2013, she returned to work in 

late December 2013, and she had a recurrence of her problem in early March with increased pain 

and swelling in her left ankle and leg up to her knee. Dr. Helbig advised that appellant was 

currently working despite pain. He diagnosed left ankle sprain, left knee sprain, and internal 

derangement of the left knee with possible medial meniscus tear. Dr. Helbig indicated that he 

would try to help appellant with her OWCP claim. 

 2

 Although appellant initially filed a recurrence claim, the claim was adjudicated as a traumatic injury claim. Her 

Form CA-2a lists November 3, 2013. However, other evidence of record indicates that her injury took place on 

November 1, 2013. 
3

In a June 2, 2014 statement, appellant advised that she originally injured herself on 

November 1, 2013 when she fell at the employing establishment. She noted that her current 

symptoms were a recurrence from that injury. Appellant requested that OWCP restore her leave 

used while she was disabled from work. She also submitted a June 3, 2014 response to an 

OWCP questionnaire. Appellant advised that she was on the employing establishment’s 

premises walking through a tunnel when she had an onset of ankle pain and leg swelling. 

By decision dated June 25, 2014, OWCP accepted the incident but denied appellant’s 

claim because the evidence was insufficient to establish a diagnosed condition in connection to 

the March 6, 2014 work incident. 

On July 3, 2014 appellant requested reconsideration. She submitted a June 12, 2014 

report from Dr. Helbig who advised that she had a previous November 1, 2013 work-related left 

ankle sprain. Dr. Helbig noted that appellant had full range of motion with tenderness over the 

medial joint line and left ankle tenderness over the anterior talofibular ligament with full motion 

in dorsiflexion and mild limitation in plantar flexion with pain. He diagnosed left ankle sprain 

and internal derangement of the left knee. Dr. Helbig opined that appellant’s condition was 

causally related to her November 1, 2013 injury. Appellant also submitted treatment reports 

previously of record. 

By decision dated October 2, 2014, OWCP affirmed the denial of appellant’s claim 

because the medical evidence was insufficient to establish that her condition was causally related 

to the March 6, 2014 work incident. 

LEGAL PRECEDENT 

An employee seeking compensation under FECA has the burden of establishing the 

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

evidence,3 including that he or she is an “employee” within the meaning of FECA and that he or 

she filed his or her claim within the applicable time limitation.4

 The employee must also 

establish that he sustained an injury in the performance of duty as alleged and that his disability 

for work, if any, was causally related to the employment injury.5

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. 

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

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

the time, place, and in the manner alleged. Second, the employee must submit medical evidence 

to establish that the employment incident caused a personal injury.6

 3

 J.P., 59 ECAB 178 (2007); Joseph M. Whelan, 20 ECAB 55, 57 (1968). 

4 R.C., 59 ECAB 427 (2008). 

5 Id.; Elaine Pendleton, 40 ECAB 1143, 1145 (1989). 

6

 T.H., 59 ECAB 388 (2008). 
4

Rationalized medical opinion evidence is generally required to establish causal 

relationship. The opinion of the physician must be based on 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 identified by the claimant.7

ANALYSIS 

On March 6, 2014 appellant alleged that she began to experience left ankle pain while 

walking through a tunnel at work. OWCP developed the present matter as a new injury claim. 

The evidence supports that the claimed incident occurred; therefore, the Board finds that the first 

component of fact of injury is established. However, the medical evidence is insufficient to 

establish that the employment incident on March 6, 2014 caused appellant’s left ankle injury. 

In his March 6, 2014 report, Dr. Helbig advised that appellant injured her left ankle in a 

fall at the employing establishment. He noted that he began treating appellant in December 2013 

and that recently she began to experience a worsening of left ankle pain without any new trauma. 

This report is insufficient to establish causal relationship because Dr. Helbig did not address 

whether a March 6, 2014 work incident caused appellant’s diagnosed condition. Instead, 

appellant reported no new trauma. Dr. Helbig did not otherwise reference the walking incident 

at work on March 6, 2014. In a May 29, 2014 report, he diagnosed left ankle sprain, left knee 

sprain, and internal derangement of the left knee. Dr. Helbig related that the initial injury 

occurred on November 1, 2013 and appellant sustained a recurrence of symptoms in March 2014 

with increased pain and swelling in her left ankle and leg up to her knee. He stated that he would 

try to help her with her claim. While Dr. Helbig indicates that appellant’s condition is 

employment related, it is unclear if he relates her condition to the November 1, 2013 injury, 

which is not presently before the Board, or to the March 6, 2014 incident. Furthermore, he did 

not offer any explanation as to how the March 6, 2014 incident caused or aggravated an injury. 

In his June 12, 2014 report, Dr. Helbig offered diagnoses and advised that appellant had a 

prior November 1, 2013 work-related left ankle sprain. He opined that appellant’s condition was 

causally related to her November 1, 2013 injury. This report is insufficient to establish 

appellant’s claim because it does not identify the March 6, 2014 incident as a cause of a 

diagnosed condition. In his March 27, 2014 report, Dr. Helbig advised that appellant was 

experiencing left knee and ankle pain that marginally improved following an injection. 

Appellant was diagnosed with internal derangement of the left knee and sprained left ankle. This 

report did not provide an opinion on causal relationship; therefore, it is insufficient to discharge 

appellant’s burden of proof. The Board has held that medical opinions which do not state an 

opinion on causal relationship are of little probative value.8

 Other reports submitted by 

Dr. Helbig are also insufficient to establish causal relationship because they do not address 

causal relationship.9

 

 7 I.J., 59 ECAB 408 (2008); Victor J. Woodhams, 41 ECAB 345 (1989). 

8 Jaja K. Asaramo, 55 ECAB 200 (2004). 

9 Id.
5

Likewise, Dr. Cuomo’s March 6, 2014 report is not sufficient to discharge appellant’s 

burden of proof because it does not address how the March 6, 2014 work incident caused or 

aggravated a diagnosed condition. Appellant also submitted evidence from a physician’s 

assistant. However, this is not considered probative medical evidence as physician assistants are 

not considered physicians as defined under FECA.10 Thus, records from physician assistants are 

insufficient to establish the claim. 

Consequently, appellant has submitted insufficient medical evidence to establish her 

claim. Causal relationship is a medical question that must be established by probative medical 

opinion from a physician.11 The physician must accurately describe appellant’s work duties and 

medically explain the pathophysiological process by which these duties would have caused or 

aggravated her condition.12 Because appellant has not provided such medical opinion evidence 

in this case, she has failed to meet her burden of proof. 

Appellant may submit new evidence or argument as part of a formal 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 a traumatic injury on 

March 6, 2014. 

 10 Under FECA, a “physician” includes surgeons, podiatrists, dentists, clinical psychologists, optometrists, 

chiropractors, and osteopathic practitioners within the scope of their practice as defined by State law. 5 U.S.C. 

§ 8101(2). See Charley V.B. Harley, 2 ECAB 208, 211 (1949) (where the Board held that medical opinion, in 

general, can only be given by a qualified physician). 

11 Y.J., Docket No. 08-1167 (issued October 7, 2008). 

12 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). 
6

ORDER 

IT IS HEREBY ORDERED THAT the October 2, 2014 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: May 21, 2015 

Washington, DC 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board