United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

A.J., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Madison, WI, Employer 

__________________________________________ 

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Docket No. 15-1438 

Issued: October 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 

COLLEEN DUFFY KIKO, Judge 

JAMES A. HAYNES, Alternate Judge 

JURISDICTION 

On June 22, 2015 appellant filed a timely appeal from an April 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.2

ISSUE 

The issue is whether appellant met her burden of proof to establish a right knee condition 

causally related to the July 25, 2014 employment incident. 

 1

 5 U.S.C. § 8101 et seq.

2

 The Board notes that appellant submitted additional evidence following the April 9, 2015 decision. Since the 

Board’s jurisdiction is limited to evidence that was before OWCP at the time it issued its final decision, the Board 

may not consider this evidence for the first time on appeal. See 20 C.F.R. § 501.2(c); Sandra D. Pruitt, 57 ECAB 

126 (2005). Appellant may submit that evidence to OWCP along with a request for reconsideration, pursuant to 

5 U.S.C. § 8128(a) and 20 C.F.R. § 10.606(b)(2). 
2

FACTUAL HISTORY 

On August 15, 2014 appellant, then a 52-year-old mail carrier, filed a traumatic injury 

claim alleging that on July 25, 2014 she injured her right knee when she fell at work. She stated 

that she was walking when her knee suddenly gave out. Appellant stopped work on August 8, 

2014 and returned on August 12, 2014.3

 

In an April 8, 2013 x-ray of the right knee, Dr. Jason W. Stephenson, a Board-certified 

diagnostic radiologist, noted that appellant complained of right knee pain. The examination 

revealed no acute fracture or subluxation. Dr. Stephenson opined that appellant had mild 

patellofemoral joint and medial compartment osteophyte formation without joint space 

narrowing. 

On April 8, 2013 appellant was also examined by Dr. Timothy P. Vanderbilt, a Boardcertified orthopedic surgeon. Dr. Vanderbilt related her complaints of persistent left knee and 

right knee pain. He discussed appellant’s medical treatment in 2011 and reported that she was 

doing well until she began to work 12-hour days, which exacerbated her pain. Dr. Vanderbilt 

related that, because her right knee was the “good” knee, she felt that she may have been over 

doing it and putting more stress on the right knee in order to protect the left knee. Upon 

examination of the bilateral lower extremities, he observed no joint swelling and full range of 

motion. Dr. Vanderbilt reported tenderness to palpation at the right knee lateral joint and left 

knee medial joint line. He explained that x-rays showed early arthritic changes, but no severe 

osteoarthritis. Dr. Vanderbilt noted that appellant had early arthritic changes, with overuse 

secondary to her job as a mail carrier and being on her feet for 12 hours a day, 6 days a week. 

He recommended that she work with restrictions until June 8, 2013 to allow her to strengthen her 

legs. 

In a January 3, 2014 work restriction letter, Marcia Bolles, a physician assistant, noted 

that appellant worked for the employing establishment as a mail carrier. She reported that 

appellant could return to work on January 3, 2014 with restrictions of no working more than 8 

hours per day and standing or walking no longer than 3 hours at a time without a break. 

Ms. Bolles advised that these restrictions were to remain in effect until February 1, 2014. 

Appellant was examined by Mary Evenson, a physician assistant, on August 11, 2014. 

Ms. Evenson noted that appellant was unable to work from August 9 through 10, 2014. 

In an August 13, 2014 duty status report, a family practitioner with an illegible signature 

noted that appellant was a mail carrier with right knee pain. Appellant was advised to resume 

work on August 13, 2014. 

 3

 The record reveals that appellant had a previously accepted case (File No. xxxxxx501) for an August 21, 2009 

employment injury to her left knee. Her claim was accepted for aggravation of osteoarthritis of the left knee. 

OWCP reviewed the medical evidence from File No. xxxxxx501 and copied pertinent medical evidence into this 

present claim. 
3

Appellant submitted Family and Medical Leave Act forms dated August 27, 2014, which 

indicated that her leave request was approved and an unsigned August 13, 2014 Form CA-16 

authorization for examination and/or treatment that is mostly illegible. 

By letter dated August 25, 2014, OWCP advised appellant that the evidence submitted 

was insufficient to establish her traumatic injury claim. It requested additional factual evidence 

to substantiate the factual elements of her claim and medical evidence to demonstrate that she 

sustained a diagnosed condition causally related to the July 25, 2014 employment incident. 

Appellant continued to receive treatment from Ms. Evenson. In August 27 and 

September 24, 2014 work restriction notes, Ms. Evenson diagnosed right knee strain and 

answered “yes” regarding whether appellant’s injury was work related. She recommended that 

appellant continue working with restrictions of lifting up to 10 pounds, standing, walking, and 

sitting up to four hours, driving up to eight hours, and using a computer mouse up to eight hours. 

In a decision dated September 29, 2014, OWCP denied appellant’s claim finding that 

appellant failed to establish fact of injury. It determined that the evidence was insufficient to 

substantiate that the alleged July 25, 2014 incident occurred as appellant described and that the 

medical evidence was insufficient to establish that she sustained a medical condition causally 

related to the alleged work event. 

On November 10, 2014 Dr. Geoffrey S. Baer, a Board-certified orthopedic surgeon, 

treated appellant for evaluation of her right knee and related her primary complaint of occasional 

locking of the knee with pain descending steps and kneeling. He discussed how he had treated 

her multiple times over the past couple of years. Upon examination of appellant’s right lower 

extremity, Dr. Baer observed trace effusion with motion 0 to 130 degrees and decreased quad 

tone with poor quad contraction. He also reported tenderness over the medial joint line and 

medial and lateral patellar facets. Sensation was normal to light and patellar apprehension and 

firm endpoint were negative. Dr. Baer reviewed an October 27, 2014 magnetic resonance 

imaging (MRI) scan report of appellant’s right knee which revealed a posterior root tear of the 

medial meniscus with multifocal cartilage loss along the central and posterior weight bearing 

surfaces of the medial and lateral patellofemoral articular surfaces. He stated that she was 

employed as a letter carrier with aggravation of right tricompartmental degenerative knee joint 

disease with underlying medial meniscus tear. Dr. Baer included a November 10, 2014 letter, 

which noted that appellant was his patient and restricted her work to one hour of walking for 

every eight-hour shift. 

Appellant was treated again by Dr. Baer on December 11, 2014 for complaints of 

continued pain localized to the lateral and medial aspects of her right knee. Dr. Baer noted that 

she worked as a letter carrier for the employing establishment and currently had work restrictions 

of walking 1 to 11⁄2 hours on her mail route. Upon examination of appellant’s right knee, he 

observed slight swelling and tenderness to palpation over the medial joint line and the lateral 

joint line. Sensation was intact to light touch throughout the distal lower extremity. Dr. Baer 

opined that appellant’s right knee pain was primarily related to tricompartmental degenerative 

joint disease (DJD). He explained that her pain was more consistent with her arthritic changes 

verses her meniscal tear. 
4

In a February 2, 2015 letter, Dr. Baer confirmed that appellant was his patient. He noted 

that due to worsening knee pain she should remain off work beginning January 31, 2015. 

Appellant also received treatment from Dr. Mark D. Wilson, an orthopedic surgeon, on 

February 12, 2015. Dr. Wilson discussed her medical history and conducted an examination. He 

observed limited range of motion of appellant’s right knee and tenderness along her medial and 

lateral joint line and along the medial aspect of the patellofemoral. Lachman, Posterior drawer, 

McMurray, and Thessaly tests were negative. Dr. Wilson reported that appellant had right knee 

tricompartmental DJD with mechanical symptoms. He noted that she decided to undergo right 

knee arthroscopic surgery. Dr. Wilson provided a return to work form and indicated “yes” that 

appellant’s injury was work related. 

On February 17, 2015 OWCP received appellant’s request for reconsideration. 

On February 23, 2015 OWCP received appellant’s response to the August 25, 2014 

development letter. Appellant explained that on July 25, 2014 she was delivering mail when her 

right knee gave out while she went down some steps. She noted that July 25, 2014 was a Friday 

and she stayed off her feet over the weekend. Appellant went to the doctor’s office on August 8, 

2014 and submitted her claim on August 9, 2014. She stated that she had an MRI scan and 

x-rays completed. Appellant reported that she had a previous job-related knee injury when she 

fell in a pothole cover onto both her knees. 

In a March 5, 2015 preoperative evaluation, Leslie L. Goodavish, a physician assistant, 

discussed appellant’s history and conducted an examination. She observed tenderness over the 

medial line and pain on the patella. Ms. Goodavish reported that appellant had full sensation of 

the lower extremity and 2+ dorsal pedal pulses. She diagnosed right knee medial meniscus tear. 

By decision dated April 9, 2015, OWCP affirmed the September 29, 2014 denial decision 

with modification. It accepted that the July 25, 2014 employment incident occurred as alleged, 

but denied the claim finding insufficient medical evidence to establish that she sustained a right 

knee condition causally related to the accepted incident. 

LEGAL PRECEDENT 

An employee seeking benefits under FECA4

 has the burden of proof to establish the 

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

evidence5

 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.6

 4

 5 U.S.C. §§ 8101-8193. 

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

6 G.T., 59 ECAB 447 (2008); Elaine Pendleton, 40 ECAB 1143, 1145 (1989). 
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.7 

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.8

 Second, the employee must submit evidence, 

generally only in the form of probative medical evidence, to establish that the employment 

incident caused a personal injury.9

 An employee may establish that the employment incident 

occurred as alleged, but fail to show that his or her disability or condition relates to the 

employment incident.10

Whether an employee sustained an injury in the performance of duty requires the 

submission of rationalized medical opinion evidence.11 The opinion of the physician must be 

based on a complete factual and medical background of the employee, 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 employee.12 The weight of the medical evidence is determined by its reliability, its probative 

value, its convincing quality, the care of analysis manifested, and the medical rationale expressed 

in support of the physician’s opinion.13

ANALYSIS 

Appellant has alleged that on July 25, 2014 she injured her right knee when she fell down 

at work. OWCP accepted that the July 25, 2014 incident occurred as alleged, but denied the 

claim finding insufficient medical evidence to establish that her right knee condition was 

causally related to the accepted incident. The Board finds that appellant has failed to meet her 

burden of proof to establish her traumatic injury claim. 

In support of her claim appellant submitted an x-ray report of the right knee from 

Dr. Stephenson, dated April 8, 2013, which predated the date of this alleged traumatic injury. 

This x-ray confirmed that she had preexisting mild patellofemoral joint and medial compartment 

osteophyte formation without joint space narrowing. Appellant also submitted an April 8, 2013 

report from Dr. Vanderbilt, who noted her belief that she might be placing more stress on her 

right knee to protect her left knee, which had an accepted claim for aggravation of left knee 

osteoarthritis. It is an accepted principle of workers’ compensation law that when the primary 

injury is shown to have arisen out of and in the course of employment, every natural 

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

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

9

 David Apgar, 57 ECAB 137 (2005); John J. Carlone, 41 ECAB 354 (1989). 

10 T.H., 59 ECAB 388 (2008); see also Roma A. Mortenson-Kindschi, 57 ECAB 418 (2006). 

11 See J.Z., 58 ECAB 529 (2007); Paul E. Thams, 56 ECAB 503 (2005). 

12 I.J., 59 ECAB 408 (2008); Victor J. Woodhams, 41 ECAB 465 (2005). 

13 James Mack, 43 ECAB 321 (1991). 
6

consequence that flows from the injury is deemed to arise out of the employment, unless it is the 

result of an independent, intervening cause attributable to the employee’s own intentional 

conduct.14 While these reports document appellant’s preexisting right knee conditions, neither 

the x-ray, report of April 8, 2013, nor the report from Dr. Vanderbilt offer any medical opinion 

to explain how her right knee condition on the date of this alleged injury, July 25, 2014, would 

have been caused by her previously accepted left knee injury, sufficient to establish a 

consequential injury. 

Following July 25, 2014 appellant submitted a report by Dr. Baer dated November 10, 

2014 for her complaints of right knee pain and locking. Upon examination, Dr. Baer observed 

slight swelling and tenderness to palpation over the medial joint line and medial and lateral 

patellar facets. Sensation was normal to light and patellar apprehension and firm endpoint were 

negative. Dr. Baer related that an October 27, 2014 MRI scan of appellant’s right knee revealed 

a posterior root tear of the medial meniscus with multifocal cartilage loss along the central and 

posterior weight bearing surfaces of the medial and lateral patellofemoral articular surfaces. He 

noted that she was employed as a letter carrier with aggravation of right tricompartmental 

degenerative knee joint disease with underlying medial meniscus tear. In a December 11, 2014 

report, Dr. Baer explained that appellant’s pain was more consistent with her arthritic changes 

verses her meniscal tear. While he provided examination findings and a diagnosed right knee 

condition the Board notes that he does not mention the July 25, 2014 employment incident nor 

opine on whether her right knee condition resulted from the July 25, 2014 work event. On the 

other hand, Dr. Baer attributes appellant’s right knee condition as consistent with arthritic 

changes. The Board has found that a physician must provide a narrative description of the 

identified employment incident and a reasoned opinion on whether the employment incident 

described caused or contributed to her diagnosed medical condition.15 In his February 2, 2015 

report, Dr. Baer merely noted appellant’s worsening knee pain, but offered no medical 

explanation as to the cause. As he does not attribute her current right knee condition to the 

July 25, 2014 employment incident, his reports are insufficient to establish her traumatic injury 

claim. 

Appellant was also treated by Dr. Wilson, who in a February 12, 2015 report, discussed 

her medical history and conducted an examination. Dr. Wilson diagnosed right knee 

tricompartmental DJD with mechanical symptoms. He provided a return to work form and 

reported “yes” that appellant’s injury was work related. Although Dr. Wilson indicates that her 

injury was work related, the Board has found that when a physician’s opinion on causal 

relationship consists only of checking “yes” to a form question, without explanation or rationale, 

that opinion is of diminished probative value and is insufficient to establish a claim.16

The additional reports provided by physician assistants Ms. Evenson, Ms. Bolles, and 

Ms. Goodavish dated January 3, 2014 to March 5, 2015, are likewise insufficient to establish 

 14 See R.S., Docket No. 15-0576 (issued June 9, 2015). 

15 John W. Montoya, 54 ECAB 306 (2003). 

16 D.D., 57 ECAB 734, 738 (2006); Deborah L. Beatty, 54 ECAB 340 (2003). 
7

appellant’s claim. These reports are of no probative value as physician assistants and nurse 

practitioners, are not considered physicians as defined under FECA.17 

Appellant submitted a duty status report dated August 13, 2014 with an illegible 

signature. A report that is unsigned or bears an illegible signature lacks proper identification and 

cannot be considered probative medical evidence as the author cannot be identified as a 

physician.18 

A partially completed and unsigned Form CA-16 was also submitted. A properly 

completed Form CA-16 authorization may constitute a contract for payment of medical expense 

to a medical facility or physician, when properly executed. The form 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 Form CA-16 of record was not 

fully executed by the employing establishment as it bore no signature authorizing treatment.19 

On appeal, appellant alleged that Dr. Baer indicated in his report that his right knee injury 

was work related. As previously stated, however, Dr. Baer’s reports are insufficient to establish 

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

medical opinion from a physician.20 Because appellant has not provided such probative medical 

evidence in this case, the Board finds that she did not meet her burden of proof to establish her 

claim. 

CONCLUSION 

The Board finds that appellant did not meet her burden of proof to establish that she 

sustained a right knee condition causally related to the July 25, 2014 employment incident. 

 17 Section 8102(2) of FECA provides that the term “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); Roy L. Humphrey, 57 ECAB 238 (2005). 

18 See S.A., Docket No. 15-1092 (issued August 3, 2015). 

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

20 W.W., Docket No. 09-1619 (issued June 2, 2010); David Apgar supra note 9. 
8

ORDER 

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

Workers’ Compensation Programs is affirmed. 

Issued: October 9, 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