United States Department of Labor 

Employees’ Compensation Appeals Board 

_________________________________________ 

D.R., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Springfield, IL, Employer 

__________________________________________ 

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Docket No. 15-1764 

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 

VALERIE D. EVANS-HARRELL, Alternate Judge 

JURISDICTION 

On August 21, 2015 appellant filed a timely appeal from the July 16, 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 his burden of proof to establish an injury causally 

related to factors of his federal employment. 

                                                             1

 5 U.S.C. § 8101 et seq.

2

 On appeal, appellant submitted new evidence. The Board cannot consider this evidence on appeal, however, as 

its review of the case is limited to the evidence of record which was before OWCP at the time of its final decision. 

20 C.F.R. § 501.2(c)(1); see Steven S. Saleh, 55 ECAB 169 (2003). 
2

FACTUAL HISTORY 

On April 16, 2015 appellant, then a 49-year-old carrier technician, filed an occupational 

disease claim (Form CA-2) alleging that he sustained inflamed cartilage under his knee caps in 

the performance of duty. He explained that he walked for six hours a day and the stress of 

walking had taken its toll on both knees. Appellant stated that he first became aware of the 

injury and its relation to his work on April 16, 2015. He did not stop work. 

By letter dated May 7, 2015, OWCP informed appellant of the type of evidence needed to 

support his claim and requested that he submit such evidence within 30 days. It particularly 

requested that he have his physician provide an opinion, supported by a medical explanation, as 

to how work activities caused or aggravated his claimed condition. 

In a March 16, 2015 report, Dr. Winston Townsend, a Board-certified internist, noted that 

appellant was seen for a re-check of the right knee. He advised that the pain in the right lateral 

area of the knee that was painful on his last visit had resolved and he was now experiencing pain 

on top of the knee that was constant. Dr. Townsend noted that the discomfort was exacerbated 

by movement and walking steps. He further noted that appellant was employed as a medic and 

walked several miles daily. Dr. Townsend diagnosed right knee pain. Right knee x-rays were 

negative for significant arthritis. Dr. Townsend noted that he believed appellant had 

chondromalacia that would be treated with anti-inflammatory medication and a brace. He stated, 

“obviously, his occupation precludes him from resting as he should.” 

In a May 21, 2015 report, Dr. Townsend noted that appellant presented with a recurrence 

of right knee pain since stopping Ibuprofen prescribed previously for the pain. He advised that 

appellant indicated that his pain was mostly around the patella area. Dr. Townsend indicated that 

appellant had ongoing right knee pain and discomfort intermittently for the last six months. He 

noted that x-rays were nondiagnostic. Dr. Townsend related that appellant had transient relief 

with anti-inflammatory medication. He also advised that appellant wore a brace at work and 

worked a full schedule as an “EMT/paramedic.” Dr. Townsend explained that appellant denied 

any specific injury or trauma and reported previously having a lot of pain which was assumed to 

be a ligamentous strain. He indicated that the condition had resolved and he now had discomfort 

under the patella. Dr. Townsend diagnosed right knee pain and recommend a magnetic 

resonance imaging (MRI) scan. 

A June 3, 2015 MRI scan of the right knee read by Dr. Gregory Gregg, a Board-certified 

diagnostic radiologist, revealed a small partial patellar tendon tear or patellar sleeve abnormality 

and small joint effusion. Dr. Gregg found no meniscal tear. 

In a June 4, 2015 report, Dr. Rodney Herrin, a Board-certified orthopedic surgeon, noted 

that appellant presented with a right knee problem and related the pain to his work activities. He 

advised that appellant worked as a letter carrier and walked approximately five miles a day. 

Dr. Herrin indicated that appellant did not remember a specific injury. He advised that appellant 

had mostly anterior knee pain and did not mention swelling. Dr. Herrin advised that appellant 

related that it started bothering him in November or December of last year and he took some 

Ibuprofen. He advised that the MRI scan revealed a small partial patellar tendon tear or sleeve 

abnormality and small joint effusion. Dr. Herrin examined appellant and diagnosed joint pain, in 
3

the knee. He advised that appellant related his problems with the right knee to his work 

activities. Dr. Herrin advised that he appeared to have infrapatellar tendinitis with the possibility 

of a small partial tear. He recommended physical therapy, for the eccentric strengthening of the 

right knee and advised that appellant was going to continue working regular job duties. 

Dr. Herrin noted that appellant had active problems that included ankle sprain, difficulty 

walking, joint effusion of the lower leg, joint pain in the knee, pain in the ankle, and a sprain of 

the calcaneofibular ligament of the ankle. OWCP also received physical therapy notes and 

requests for physical therapy. 

By decision dated July 16, 2015, OWCP denied appellant’s claim as fact of injury had 

not been established. It found that appellant did not submit any medical evidence containing a 

firm medical diagnosis in connection with the claimed injury, work factors, or events. 

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 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.3

 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.4

To establish that an injury was sustained in the performance of duty in an occupational 

disease claim, a claimant must submit the following: (1) medical evidence establishing the 

presence or existence of the disease or condition for which compensation is claimed; (2) a factual 

statement identifying employment factors alleged to have caused or contributed to the presence or 

occurrence of the disease or condition; and (3) medical evidence establishing that the employment 

factors identified by the claimant were the proximate cause of the condition for which 

compensation is claimed or, stated differently, medical evidence establishing that the diagnosed 

condition is causally related to the employment factors identified by the claimant. The medical 

evidence required to establish causal relationship, generally, is rationalized medical opinion 

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.5

                                                             3 Joe D. Cameron, 41 ECAB 153 (1989); Elaine Pendleton, 40 ECAB 1143, 1145 (1989). 

4 Victor J. Woodhams, 41 ECAB 345 (1989). 

5 Id. 
4

ANALYSIS 

Appellant alleged that he developed a right knee condition due to daily walking as part of 

his work as a carrier technician. The evidence supports that he walked at work as part of his 

carrier technician duties. However, appellant submitted insufficient medical evidence to 

establish a firm medical diagnosis that was caused or aggravated by these activities or any other 

specific factors of his federal employment. 

The evidence submitted by appellant includes reports from Dr. Townsend. In a 

March 16, 2015 report, he noted that appellant was experiencing constant pain on top of the right 

knee with the discomfort exacerbated by movement and walking steps. Dr. Townsend also noted 

that appellant was employed as a medic and walked several miles daily and diagnosed right knee 

pain. He indicated that appellant could not rest his knee due to his occupation. However, 

Dr. Townsend did not clearly indicate that work activities as a carrier technician caused or 

aggravated a diagnosed condition.6

 

On May 21, 2015 Dr. Townsend noted that appellant presented with a reoccurrence of 

right knee pain and discomfort intermittently for the last six months. He advised that appellant 

wore a brace at work and worked a full schedule as an “EMT/paramedic.” Dr. Townsend 

explained that appellant denied any specific injury or trauma and reported previously having a lot 

of pain which was assumed to be a ligamentous strain. He indicated that the condition had 

resolved, but he now had discomfort under the patella. Dr. Townsend diagnosed right knee pain. 

The Board has held, however, that pain is generally considered a symptom and not a firm 

medical diagnosis.7

 This report does not indicate that appellant’s activities as a carrier technician 

caused or aggravated a specific condition. 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.8 These reports are of limited probative value. 

In a June 4, 2015 report, Dr. Herrin, indicated that appellant presented with a problem 

with his right knee and related the pain to his work activities. He diagnosed knee joint pain and 

advised that appellant appeared to have infrapatellar tendinitis with the possibility of a small 

partial tear. Medical opinions based on an incomplete history or which are speculative or 

equivocal are of diminished probative value.9

 Dr. Herrin noted that appellant worked as a letter 

carrier and walked about five miles a day. The Board notes that Dr. Herrin indicated that 

appellant related his knee to his work activities. Dr. Herrin does not provide his own opinion on 

                                                             6

 Dr. Townsend’s reports indicate that appellant works as a paramedic. It is unclear whether appellant has a 

separate job as a paramedic or if Dr. Townsend’s reports are based on an erroneous factual history. Dr. Townsend’s 

reports do not indicate awareness that appellant works as a carrier technician. The Board has held that a physician’s 

opinion must be based upon a complete and accurate medical and factual background of the claimant. Conard 

Hightower, 54 ECAB 796 (2003). 

7 P.S., Docket No. 12-1601 (issued January 2, 2013); Robert Broome, 55 ECAB 339 (2004). 

8 S.E., Docket No. 08-2214 (issued May 6, 2009). 

9 L.G., Docket No. 09-1692 (issued August 11, 2010); Cecelia M. Corley, 56 ECAB 662 (2005). 
5

causal relationship.10 Neither Dr. Herrin’s report nor Dr. Townsend’s reports provide medical 

reasoning, or rationale, explaining why appellant’s work activity caused or aggravated a 

particular diagnosed condition.11 

OWCP also received diagnostic reports to include a June 3, 2015 MRI scan of the right 

knee. However, this evidence is of limited probative value as it does not address whether the 

work activities caused or aggravated a diagnosed condition. 

OWCP received physical therapy notes and requests for physical therapy. Health care 

providers such as nurses, acupuncturists, physician assistants, and physical therapists are not 

physicians under FECA.12 Thus, their opinions on causal relationship do not constitute 

rationalized medical opinions and have no weight or probative value.13 

The Board has held that the mere fact that a condition manifests itself during a period of 

employment does not raise an inference that there is a causal relationship between the two.14 

Neither the fact that the condition became apparent during a period of employment nor the belief 

that the condition was caused or aggravated by employment factors or incidents is sufficient to 

establish causal relationship.15 

As there is no reasoned medical evidence explaining how appellant’s employment duties 

caused or aggravated a firm medically diagnosed condition involving his knees, appellant has not 

met 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 has not met his burden of proof to establish an injury 

causally related to factors of his federal employment. 

                                                             10 See A.M., Docket No. 10-205 (issued October 5, 2010) (a physician’s opinion must be independent from a 

claimant’s belief regarding causal relationship).

11 See George Randolph Taylor, 6 ECAB 986, 988 (1954) (where the Board found that a medical opinion not 

fortified by medical rationale is of little probative value). 

12 5 U.S.C. § 8101(2) of FECA provides as follows: (2) physician includes surgeons, podiatrist, dentists, clinical 

psychologists, optometrist, chiropractors, and osteopathic practitioners within the scope of their practice as defined 

by State law. See B.B., Docket No. 09 1858 (issued April 16, 2010); Roy L. Humphrey, 57 ECAB 238 (2005). 

13 Jane A. White, 34 ECAB 515, 518 (1983). See 5 U.S.C. § 8101(2). 

14 See Joe T. Williams, 44 ECAB 518, 521 (1993). 

15 Id.
6

ORDER 

IT IS HEREBY ORDERED THAT the July 16, 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 

 

 Valerie D. Evans-Harrell, Alternate Judge 

 Employees’ Compensation Appeals Board