United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

H.H., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Greensboro, NC, Employer 

__________________________________________

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Docket No. 14-1609 

Issued: January 2, 2015 

Appearances: Case Submitted on the Record

Martin Kaplan, Esq., for the appellant 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

COLLEEN DUFFY KIKO, Judge 

PATRICIA HOWARD FITZGERALD, Judge 

JAMES A. HAYNES, Alternate Judge 

JURISDICTION 

On July 14, 2014 appellant, through counsel, filed a timely appeal from a May 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 met her burden of proof to establish a left leg injury in the 

performance of duty on May 21, 2013. 

FACTUAL HISTORY 

On June 13, 2013 appellant, then a 52-year-old mail processing clerk, filed a traumatic 

injury claim (Form CA-1) alleging a left leg injury on May 21, 2013 when she was pulling the 

 1

 5 U.S.C. § 8101 et seq.
2

Automated Postal Center (APC) machine (hereinafter referred to as post-con). She notified her 

supervisor of her injury on June 8, 2013.2 

By letter dated June 14, 2013, OWCP informed appellant that the evidence of record was 

insufficient to support her claim. Appellant was advised of the medical and factual evidence 

needed and was directed to submit it within 30 days. 

In an undated narrative statement, appellant reported that she previously felt a sharp pain 

in her left leg on April 20, 2013 when she was pulling a basket of mail to the post-con. The 

following day she experienced pain when walking up and down the stairs for work. Appellant 

reported that she was on vacation from April 25 to May 12, 2013 and did not experience 

discomfort other than walking up and down stairs. On May 21, 2013 she pulled three post-cons 

to unload trays of mail and felt a sharp pain in her left leg on the third pull. Appellant sought 

treatment on May 23, 2013. 

In a June 19, 2013 medical report, Dr. Brian Donoghue, Board-certified in emergency 

medicine, reported that appellant complained of leg pain from pulling large mail bins in 

May 2013. He later clarified that he misunderstood her and that the incident occurred in 

April 2013. Dr. Donoghue diagnosed chronic leg pain. 

A July 19, 2013 duty status report (Form CA-17) from Dr. Stephen Lang, a Boardcertified orthopedic surgeon, noted left knee swelling and pain. He diagnosed left knee sprain, 

meniscus, and synovitis as a result of pulling two to three post-cons on May 21, 2013. Dr. Lang 

provided appellant with work restrictions. 

By letter dated July 23, 2013, the employing establishment controverted the claim. 

OWCP denied appellant’s claim on July 25, 2013, finding that the evidence did not 

establish that the incident occurred as alleged. It noted that there were inconsistencies in the date 

of injury as her statement and medical report indicated an injury on April 20, 2013. OWCP 

further noted that the medical evidence failed to establish a firm medical diagnosis. It noted that 

a diagnosis of “pain” is a symptom and not a diagnosed medical condition. 

On August 9, 2013 appellant requested review of the written record before the Branch of 

Hearings and Review. 

A hearing was held on January 22, 2014. Counsel for appellant argued that she was 

alleging an occupational disease claim (Form CA-2) because her leg pain initially occurred on 

April 21, 2013. He noted that she was incorrectly provided a CA-1 form and chose the May 21, 

2013 date of injury because she recalled feeling pain on that date. Counsel further contended 

that appellant’s left leg pain developed from April to May 2013 and that OWCP should develop 

the claim as an occupational disease injury. At the hearing, appellant testified that she had 

worked for the employing establishment for the past 15 years. She described her employment 

duties which entailed processing magazines and oversized mail, setting up post-cons, loading 

 2

 The employing establishment issued a properly completed (Form CA-16), authorization for examination, dated 

June 13, 2013, which authorized appellant to seek medical treatment related to the May 21, 2013 injury. The 

description of injury was reported as injury to the left leg from pulling two to three post-cons to the delivery 

machine. 
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post-cons with packs of mail, dropping packs of mail and pulling packs into the post-con. 

Appellant reported that on April 20, 2013 she had issues climbing stairs and also experienced 

problems the following day. She went on vacation shortly thereafter and her condition had 

improved. On May 21, 2013 appellant felt a sharp pain in her left leg after the third pull of the 

post-con. She first sought medical treatment on May 23, 2013 and described her treatment 

history. Appellant argued that her supervisor provided her with the incorrect CA-1 form and she 

was unaware that she could file an occupational disease claim. The record was held open for 30 

days. 

In a June 14, 2013 diagnostic report, Dr. John D. Reeder, a Board-certified diagnostic 

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

moderate posterior medial meniscal degeneration with radial tear, subchondral osseous stress 

reaction, large knee joint effusion, and high grade patellar chondromalacia. 

In medical reports dated June 11 to September 2, 2013, Dr. Lang reported that appellant 

initially sought treatment with another physician on May 23, 2013 due to complaints of left leg 

pain. He noted that she had been symptomatic for about two months and complained of left knee 

and leg pain. Appellant believed that her symptoms started on April 21, 2013 when she was 

going up and down stairs for work. Her employment also required her to push and pull material. 

Appellant’s symptoms improved when she was on vacation, but after returning to work on 

May 15, 2013, her pain increased. Dr. Lang reviewed diagnostic testing and provided findings 

on physical examination. He initially diagnosed left knee synovitis, mild degenerative arthritis, 

possible meniscus tear, patellofemoral left knee pain syndrome, subchondral osseous stress 

reaction medial tibial plateau, and unspecified derangement of medial meniscus. In a June 20, 

2013 report, Dr. Lang noted that appellant’s employment activities included rotating back and 

forth to lift and move heavy material, which he speculated could have either created or 

aggravated her symptoms. He stated that he was not obtaining a history of any one specific 

incident that caused her left knee problem. Dr. Lang further stated, “I cannot deny the fact that 

[appellant’s] initial job duties holding heavy material, carrying material, or rotating may be 

associated with the onset of her symptoms.” 

Subsequently, in an August 26, 2013 report, Dr. Lang provided the additional diagnoses 

of low back strain/degenerative changes. He reported that appellant should limit kneeling, 

squatting, and twisting and avoid lifting more than 10 pounds in any repetitive fashion, as well as 

avoid rotating, or twisting while carrying material. Dr. Lang reported that the restrictions were 

made to limit stressful activity and abnormal forces to the knee which could aggravate 

appellant’s symptoms and conditions. He further explained that rotation and twisting of the knee 

could create more meniscus strain and tear and that repetitive and sustained squatting places 

more pressure on the kneecap and articular surfaces of the medial and lateral joint. In a 

September 2, 2014 report, Dr. Lang opined that appellant’s original employment activities likely 

contributed to or aggravated her present left knee and low back injuries. 

Physical therapy notes dated July 18 to September 18, 2013 were also submitted. 

By decision dated May 2, 2014, the Branch of Hearings and Review denied appellant’s 

claim. The hearing representative determined that based upon the record and after listening to 

appellant’s testimony the incident alleged by the claimant occurred. Having reversed the earlier 

OWCP decision on this point, she found that the evidence failed to establish that her left knee 
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injury was caused by the accepted May 21, 2013 employment incident. The hearing 

representative noted that OWCP properly adjudicated the claim as a traumatic injury. 

LEGAL PRECEDENT 

An employee seeking benefits under FECA has the burden of proof to establish 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 is causally related to the 

employment injury.3 These are the essential elements of every compensation claim regardless of 

whether the claim is predicated on a traumatic injury or an occupational disease.4

In order 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 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. 

OWCP defines a traumatic injury as a condition of the body caused by a specific event or 

incident, or series of events or incidents, within a single workday or shift. Such condition must 

be caused by external force, including stress or strain which is identifiable as to time and place of 

occurrence and member of function of the body affected.6 To determine whether a federal 

employee has sustained a traumatic injury in the performance of duty, it must first be determined 

whether a fact of injury has been established. First the employee must submit sufficient evidence 

to establish that he or she actually experienced the employment incident at the time, place, and in 

the manner alleged.7

 Second, the employee must submit sufficient evidence, general only in the 

form of medical evidence, to establish that the employment incident caused a personal injury.8

To establish that an injury was sustained in the performance of duty in a claim for 

occupational disease, an employee must submit: (1) a factual statement identifying employment 

factors alleged to have caused or contributed to the presence or occurrence of the disease or 

condition; (2) medical evidence establishing the presence or existence of the disease or condition 

for which compensation is claimed; and (3) medical evidence establishing that the diagnosed 

condition is causally related to the employment factors identified by the employee.9 

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

4 Michael E. Smith, 50 ECAB 313 (1999). 

5 Elaine Pendleton, supra note 3. 

6

 20 C.F.R. § 10.5(ee). 

7 John J. Carlone, 41 ECAB 354 (1989). 

8 J.Z., 58 ECAB 529 (2007). 

9 See Roy L. Humphrey, 57 ECAB 238, 241 (2005); Ruby I. Fish, 46 ECAB 276, 279 (1994). 
5

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 based on a complete factual and medical background, supporting such 

a causal relationship.10 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.11

ANALYSIS 

As appellant is alleging separate incidents, rather than a cumulative effect of employment 

activities, the Board finds that OWCP properly developed her claim as a traumatic injury.12 

OWCP accepted that the May 21, 2013 employment incident occurred as alleged. The issue is 

whether appellant established that the accepted incident caused a left knee injury. The Board 

finds that she did not submit sufficient medical evidence to support that her left knee injury was 

causally related to the May 21, 2013 employment incident. 

In medical reports dated June 11 to September 2, 2013, Dr. Lang reported that appellant’s 

left knee symptoms initially began on April 21, 2013 when she was climbing stairs, that her 

symptoms improved when she went on vacation, but increased once she resumed work on 

May 15, 2013. While the date of injury was noted as May 21, 2013, he stated that there was no 

history of any one specific incident that caused her left knee problem. Dr. Lang further stated, “I 

cannot deny the fact that [appellant’s] initial job duties holding heavy material, carrying material 

or rotating may be associated with the onset of her symptoms.” He diagnosed left knee 

synovitis, mild degenerative arthritis, possible meniscus tear, patellofemoral left knee pain 

syndrome, subchondral osseous stress reaction medial tibial plateau, unspecified derangement of 

medial meniscus, and back strain. Dr. Lang further opined that appellant’s original employment 

activities likely contributed to or aggravated her present left knee and low back condition. 

The Board finds that the opinion of Dr. Lang is not sufficiently rationalized. Dr. Lang 

provided a limited description of appellant’s employment duties, noting rotating back and forth 

to lift and move heavy material. His statement that her initial job duties of holding heavy 

material, carrying material, or rotating could be associated with the onset of her symptoms is 

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

11 James Mack, 43 ECAB 321 (1991). 

12 Richard D. Wray, 45 ECAB 758 (issued July 8, 1994). If the actual benefits claimed by the claimant cannot be 

determined from review of the form, OWCP should develop the claim based upon the claim form filed and direct 

questions to the claimant to determine the type of benefits claimed. Based upon the response to the development 

letter, it should make a determination as to whether the correct claim was established and, if not, OWCP should 

convert the claim to the proper type of claim and notify the claimant and employing establishment (and any 

representative, if applicable) of the conversion. Federal (FECA) Procedure Manual, Part 2 -- Claims, Development 

of Claims, Chapter 2.800.3(c)(2)(b) (June 2011). C.f. S.N., Docket No. 12-1814 (issued March 11, 2013). 
6

highly speculative.13 Dr. Lang failed to address each condition specifically with an opinion on 

how the May 21, 2013 employment pushing/pulling incident would have caused or aggravated 

each of the diagnoses provided. Moreover, his statement on causation fails to provide a 

sufficient explanation as to the mechanism of injury pertaining to this traumatic injury claim, 

namely, how pulling post-cons would cause or aggravate appellant’s multiple knee injuries.14 

Dr. Lang’s July 19, 2013 CA-17 form is the only report which identifies the May 21, 

2013 employment incident as pulling two to three post-cons. While he noted a May 21, 2013 

date of injury, it appears that he is attributing appellant’s left knee conditions to an occupational 

injury produced by her work environment over a period longer than a single workday or shift 

rather than an injury from a single occurrence within a single workday as alleged by her in this 

claim.15 Thus, Dr. Lang’s opinion pertaining to her work-related duties as the cause of her 

injuries does not provide support for the traumatic injury claim.16

The remaining medical evidence is also insufficient to establish her traumatic injury 

claim. While Dr. Reeder’s June 14, 2013 diagnostic report provided findings pertaining to the 

left knee, his report is of limited probative value as he offers no opinion on the cause of her 

injury.17 Dr. Donoghue’s June 19, 2013 report provided only a diagnosis of chronic leg pain. 

The Board has held that pain is a description of a symptom rather than a clear diagnosis of the 

medical condition.18 It is not possible to establish the cause of a medical condition if the 

physician only refers to pain and not a specific diagnosis.19 The physical therapy notes dated 

July 18 to September 18, 2013 are also insufficient to establish appellant’s claim as they were 

not signed by a physician.20 

Appellant claims that her injury was produced from her work environment over a 

cumulative period longer than a single workday or shift. However, the factual evidence is 

 13 M.R., Docket No. 14-11 (issued August 27, 2014). 

14 S.W., Docket 08-2538 (issued May 21, 2009). 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 A traumatic injury means a condition of the body caused by a specific event or incident, or series of events or 

incidents, within a single workday or shift. 20 C.F.R. § 10.5(ee). An occupational disease is defined as a condition 

produced by the work environment over a period longer than a single workday or shift. 20 C.F.R. § 10.5(q). 

16 S.R., Docket No. 12-1098 (issued September 19, 2012). 

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

18 C.F., Docket No. 08-1102 (issued October 10, 2008). 

19 T.G., Docket No. 13-76 (issued March 22, 2013). 

20 5 U.S.C. § 8102(2) of FECA provides as follows: (2) physician includes surgeons, podiatrists, dentists, clinical 

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

by State law. 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. See also Roy L. Humphrey, supra note 9 at 238 (2005). 
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insufficient to support an occupational disease claim (Form CA-2). OWCP correctly evaluated 

the facts presented and handled the claim as a traumatic injury.21 

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 10.607.22

CONCLUSION 

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

leg injury was causally related to the accepted May 21, 2013 employment incident, as alleged. 

ORDER 

IT IS HEREBY ORDERED THAT the May 2, 2014 decision of the Office of Workers’ 

Compensation Programs is affirmed. 

Issued: January 2, 2015 

Washington, DC 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 Patricia Howard Fitzgerald, Judge 

 Employees’ Compensation Appeals Board 

 

 James A. Haynes, Alternate Judge 

 Employees’ Compensation Appeals Board 

 21 Supra note 12. 

22 The record contains a CA-16 form signed by the employing establishment official on June 13, 2013. When the 

employing establishment properly executes a CA-16 form, which authorizes medical treatment as a result of an 

employee’s claim for an employment-related injury, the CA-16 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 period for which treatment is authorized by a CA-16 form is limited to 60 days from the date of 

issuance, unless terminated earlier by OWCP. See 20 C.F.R. § 10.300(c); Tracy P. Spillane, 54 ECAB 608 (2003). 

The record is silent as to whether OWCP paid for the cost of appellant’s examination or treatment for the period 

noted on the form.