United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

M.P., Appellant 

and 

DEPARTMENT OF THE AIR FORCE, AIR 

FORCE NATIONAL GUARD, Latham, NY, 

Employer 

__________________________________________ 

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Docket No. 15-1857 

Issued: March 14, 2016 

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 September 12, 2015 appellant filed a timely appeal from a July 15, 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

 1

 5 U.S.C. § 8101 et seq.

2

 The Board notes that appellant submitted additional evidence after OWCP rendered its July 15, 2015 decision. 

The Board’s jurisdiction is limited to reviewing the evidence that was before OWCP at the time of its final decision. 

Therefore, this additional evidence cannot be considered by the Board. 20 C.F.R. § 510.2(c)(1); Dennis E. Maddy, 

47 ECAB 259 (1995); James C. Campbell, 5 ECAB 35, 36 n.2 (1952). Appellant may submit this evidence to 

OWCP, together with a formal request for reconsideration, pursuant to 5 U.S.C. § 8128(a) and 20 C.F.R. 

§ 10.606(b)(2). 
2

ISSUE 

The issue is whether appellant met his burden of proof to establish an injury causally 

related to the accepted April 29, 2015 work incident. 

FACTUAL HISTORY 

On April 30, 2015 appellant, then a 43-year-old aircraft electrician, filed a traumatic 

injury claim (Form CA-1) alleging that on April 29, 2015 he sustained a left knee injury when he 

was carrying maintenance equipment, made a change of direction, and felt a pop in his knee and 

slight pain. The following morning the pain in his left knee had increased. Appellant stopped 

work, notified his supervisor, and first received medical care on April 30, 2015. 

OWCP received a hospital record from Dr. Wei Fan, an emergency physician, dated 

December 18, 2014, which noted that appellant had been seen that day for epigastric pain after 

he ran into a large piece of machinery. Appellant was diagnosed with a contusion, and was 

restricted from lifting for seven days. 

In support of his claim, appellant submitted an April 30, 2015 emergency room report 

from Gordon O’Dell, a nurse practitioner, and May 4, 2015 treatment notes from Christopher 

Jones, a physician’s assistant, which documented treatment for his left knee injury. 

In an April 30, 2015 diagnostic report, Dr. Chris Donikyan, a doctor of osteopathic 

medicine, reported that an x-ray of the left knee revealed no evidence of acute fracture or 

malalignment. 

In a May 18, 2015 diagnostic report, Dr. Steve Sharon, a Board-certified diagnostic 

radiologist, reported that the magnetic resonance imaging (MRI) scan of the left knee revealed 

subtle tearing along the free edge of the posterior horn of the medial meniscus and undersurface 

of the posterior horn with mild surrounding synovitis, mild effusion of a plica and small popliteal 

cyst, and slight chondromalacia patella. 

In another May 18, 2015 diagnostic report, Dr. Sharon reported that the MRI scan of the 

right knee revealed slight effusion medial synovial plica and small popliteal cyst, mild distal 

quadriceps tendinopathy without tear, slight prepatella soft tissue swelling, and no meniscal tear. 

In a May 26, 2015 medical report, Dr. John Uhorchak, a Board-certified orthopedic 

surgeon, reported that on April 29, 2015 appellant was moving equipment when he stepped in a 

different direction and felt two pops in his left knee. Appellant sought emergency medical 

treatment the following day, but complained of continued sharp pain. Dr. Uhorchak noted no 

significant past medical history, reviewed diagnostic testing, and provided findings on physical 

examination. He diagnosed left knee tear of the medial meniscus and recommended arthroscopic 

surgery. Dr. Uhorchak noted that if appellant’s symptoms were caused by arthritis, knee surgery 

would not alleviate his symptoms, and could cause it to worsen. He further noted that appellant 

could expect improvement of his symptoms if a mechanical cause was found which could be 

treated arthroscopically. Dr. Uhorchak opined that appellant’s current symptoms were causally 

related to his work injury and complaints were consistent with the history of injury and the 
3

objective findings. In a May 28, 2015 authorization request form, he requested authorization for 

arthroscopic knee surgery. 

By letter dated June 12, 2015, OWCP notified appellant that his claim had been initially 

handled administratively to allow medical payments, as his claim appeared to involve a minor 

injury resulting in minimal or no lost time from work. However, the merits of appellant’s claim 

had not been formally considered and his claim had been reopened for consideration of the 

merits because he now had requested authorization for surgery. OWCP informed him that the 

evidence of record was insufficient to support his claim. Appellant was advised of the medical 

and factual evidence needed and was afforded 30 days to respond. 

In a June 19, 2015 narrative statement, appellant explained that he was not claiming 

injury to his right knee and mistakenly submitted a right knee MRI scan. He further stated that, 

prior to the April 29, 2015 employment incident, he had no history of knee injury, disability, or 

symptoms pertaining to his left knee and thus, had no prior medical records to submit. 

By report dated July 2, 2015, Dr. Uhorchak related that he had treated appellant on May 4 

and 26, 2015 for a left knee injury. He repeated the history of injury and findings made in his 

May 26, 2015 report. Dr. Uhorchak diagnosed left knee sprain and meniscus tear, 

recommending arthroscopic surgery. Pertaining to the mechanism of injury, he opined that 

moving equipment at work and stepping in a different direction caused appellant’s left knee to 

pop which was a direct cause of his injury. Dr. Uhorchak opined that appellant’s symptoms were 

causally related to the work injury because his complaints were consistent with the history of 

injury and objective findings. 

By decision dated July 15, 2015, OWCP denied appellant’s claim finding that the 

evidence of record failed to establish that his left knee sprain and meniscus tear were causally 

related to the accepted April 29, 2015 employment incident. 

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 filed within the applicable time 

limitation, that an injury was sustained while in the performance of duty as alleged; and that any 

disability 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 on a traumatic injury or an occupational disease.4

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 

 3 Gary J. Watling, 52 ECAB 278 (2001); Elaine Pendleton, 40 ECAB 1143, 1154 (1989). 

4 Michael E. Smith, 50 ECAB 313 (1999). 
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employment incident which is alleged to have occurred.5

 The second component is whether the 

employment incident caused a personal injury and generally can be established only by medical 

evidence. 

To establish a causal relationship between the condition, as well as any attendant 

disability claimed and the employment event or incident, the employee must submit rationalized 

medical opinion evidence supporting such a causal relationship.6 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. This medical opinion must include an accurate history of the 

employee’s employment injury and must explain how the condition is related to the injury. The 

weight of 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.7

ANALYSIS 

OWCP accepted that the April 29, 2015 employment incident occurred as alleged. The 

issue is whether appellant established that the incident caused a left knee injury. The Board finds 

that he failed to submit sufficient medical evidence to support that his left knee strain and tear of 

the medial meniscus are causally related to the accepted April 29, 2015 employment incident.8 

In support of his claim, appellant submitted medical reports dated May 26 and July 2, 

2015 from Dr. Uhorchak. Dr. Uhorchak diagnosed left knee sprain and meniscus tear and opined 

that the injury was caused by the April 29, 2015 employment incident. The Board finds, 

however, that his opinion was not well rationalized. Dr. Uhorchak provided a vague description 

of the April 29, 2015 employment incident and simply repeated appellant’s assertions pertaining 

to the history of injury. He explained that appellant’s symptoms were causally related to the 

work injury because his complaints were consistent with the history of injury and objective 

findings. The Board finds this vague and generalized statement on causation fails to provide a 

sufficient explanation as to the mechanism of injury and does not adequately explain how the 

April 29, 2015 employment incident would have caused or aggravated appellant’s left knee 

sprain and meniscus tear.9

 Moreover, this statement is equivocal as Dr. Uhorchak noted that the 

cause of appellant’s symptoms were unclear, specifically noting that he was unsure if the 

symptoms were caused by arthritis or a mechanical cause which could be treated 

 5 Elaine Pendleton, supra note 3 at 1143. 

6 See 20 C.F.R. § 10.110(a); John M. Tornello, 35 ECAB 234 (1983). 

7 James Mack, 43 ECAB 321 (1991). 

8 See Robert Broome, 55 ECAB 339 (2004). 

9 M.R., Docket No. 14-11 (issued August 27, 2014). 
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arthroscopically.10 Given this assessment, it is unclear how he related appellant’s symptoms and 

injury to the April 29, 2015 incident.11 

Dr. Uhorchak further opined that moving equipment at work and stepping in a different 

direction caused appellant’s left knee to pop which was a direct cause of his injury. However, he 

failed to explain how stepping in a different direction while carrying equipment would cause 

appellant’s left knee injury.12 Medical reports without adequate rationale on causal relationship 

are of diminished probative value and do not meet an employee’s burden of proof.13 Without 

explaining how physiologically the movements involved in the employment incident caused or 

contributed to the diagnosed conditions, Dr. Uhorchak’s opinion is of limited probative value 

and insufficient to meet appellant’s burden of proof.14 

The remaining medical evidence of record is also insufficient to establish causal 

relationship between appellant’s left knee injury and the April 29, 2015 employment incident. 

Dr. Donikyan’s April 30, 2015 x-ray of the left knee revealed normal findings and does not 

provide support for injury. Dr. Sharon’s May 18, 2015 reports interpreted diagnostic imaging 

studies and provided no opinion on the cause of appellant’s injury. The Board has held that 

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

is of limited probative value.15 

Ms. Gordon and Mr. Jones’ reports are insufficient to establish appellant’s claim as the 

reports were not signed by a physician. Registered nurses, physical therapists, and physician 

assistants, are not considered physicians as defined under FECA, therefore, their opinions are of 

no probative value.16 

The December 18, 2014 report from Dr. Fan is irrelevant to appellant’s claim as it 

predates the April 29, 2015 employment incident and provides no findings pertaining to the left 

knee. Any medical opinion evidence should reflect a correct history and offer a medically sound 

 10 Ricky E. Storms, 52 ECAB 349 (2001) (medical opinions which are speculative or equivocal in character have 

little probative value). 

11 The Board has held that an opinion that a condition is causally related because the employee was asymptomatic 

before the injury is insufficient, without adequate rationale, to establish causal relationship. T.M., Docket No. 08-

975 (issued February 6, 2009); Michael S. Mina, 57 ECAB 379 (2006). 

12 S.W., Docket 08-2538 (issued May 21, 2009). 

13 Ceferino L. Gonzales, 32 ECAB 1591 (1981). 

14 See L.M., Docket No. 14-973 (issued August 25, 2014); R.G., Docket No. 14-113 (issued April 25, 2014); 

K.M., Docket No. 13-1459 (issued December 5, 2013); A.J., Docket No. 12-548 (issued November 16, 2012). 

15 C.B., Docket No. 09-2027 (issued May 12, 2010); S.E., Docket No. 08-2214 (issued May 6, 2009).

16 In Roy L. Humphrey, 57 ECAB 238 (2005) the Board explained that as registered nurses, licensed practical 

nurses, and physician assistants are not considered physicians as defined under FECA. Their opinions are of no 

probative value. 5 U.S.C. § 8102(2) 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. 
6

explanation by the physician of how the specific employment incident, in particular 

physiologically, caused or aggravated his left knee injury.17

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

employment does not raise an inference of causal relation.18 An award of compensation may not 

be based on surmise, conjecture, speculation, or on the employee’s own belief of causal 

relation.19 Appellant’s belief that the April 29, 2015 employment incident caused his medical 

injury is not in question, but that belief, however, sincerely held, does not constitute the medical 

evidence necessary to establish causal relationship. To establish a firm medical diagnosis and 

causal relationship, appellant must submit a physician’s report in which the physician reviews 

those factors of employment alleged to have caused his condition and, taking these factors into 

consideration, as well as findings upon examination and his medical history, explain how these 

employment factors caused or aggravated any diagnosed condition, and present medical rationale 

in support of his opinion.20 

In the instant case, the record lacks rationalized medical evidence establishing a causal 

relationship between the April 29, 2015 employment incident and the left knee sprain and 

meniscus tear. Thus, appellant has failed to meet his burden of proof. 

Appellant may submit additional evidence, together with a written request for 

reconsideration, to OWCP within one year of the Board’s merit decision, pursuant to 5 U.S.C. 

§ 8128(a) and 20 C.F.R. §§ 10.606 and 10.607. 

CONCLUSION 

The Board finds that appellant did not meet his burden of proof to establish an injury 

causally related to the accepted April 29, 2015 employment incident, as alleged. 

 17 T.G., Docket No. 14-751 (issued October 20, 2014). 

18 Daniel O. Vasquez, 57 ECAB 559 (2006). 

19 D.D., 57 ECAB 734 (2006). 

20 Supra note 15. 
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ORDER 

IT IS HEREBY ORDERED THAT the Office of Workers’ Compensation Programs’ 

decision dated July 15, 2015 is affirmed. 

Issued: March 14, 2016 

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