United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

W.C., Appellant 

and 

U.S. POSTAL SERVICE, HEALTH & 

RESOURCE MANAGEMENT OFFICE, 

Charlotte, NC, Employer 

__________________________________________ 

) 

) 

) 

) 

) 

) 

) 

) 

) 

Docket No. 16-0643 

Issued: July 20, 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 

COLLEEN DUFFY KIKO, Judge 

ALEC J. KOROMILAS, Alternate Judge 

JURISDICTION 

On February 17, 2016 appellant filed a timely appeal of a February 2, 2016 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 to consider the merits of this case. 

ISSUE 

The issue is whether appellant has met his burden of proof to establish a left quadriceps 

muscle rupture causally related to an accepted July 13, 2015 employment incident. 

 1

 5 U.S.C. § 8101 et seq. 
2

FACTUAL HISTORY 

On July 14, 2015 appellant, then a 56-year-old human resources management specialist, 

filed a traumatic injury claim (Form CA-1) alleging that on July 13, 2015 he injured his left knee 

when he squatted and bent down to retrieve a marker he had dropped under his workstation. 

A July 14, 2015 authorization for examination and treatment (Form CA-16) was 

completed by Barbara J. Brown an authorizing official. Ms. Brown noted an injury date of 

July 13, 2015 and listed left knee as the injury or disease. She approved treatment for the effects 

of the listed conditions by the Novant Health Lakeside Family Physicians. 

In a July 14, 2015 report, Dr. Jeffrey A. Berger, a treating Board-certified family 

medicine practitioner, diagnosed left quadriceps muscle rupture. He reported that appellant was 

seen for left knee pain. Appellant related to Dr. Berger that he felt a pulling/straining sensation 

after squatting down on July 13, 2015, and that he had experienced a similar incident in 

December. 

By letter dated July 23, 2015, OWCP informed appellant that the evidence of record was 

insufficient to establish his claim. Appellant was advised as to the medical and factual evidence 

required to establish his claim and afforded 30 days to provide this information. 

In a July 23, 2015 attending physician’s report (Form CA-20), Dr. Berger diagnosed left 

quadriceps muscle rupture. Under history of injury, he noted that appellant described left knee 

pain when bending his knees to squat down to pick up a marker. Appellant also related that he 

had felt a left knee cap strain and then felt another strain when he tried to stand up. Dr. Berger 

checked a box marked “no” to the questions of whether there was any history of a concurrent or 

preexisting injury, physical impairment or disease, and whether the diagnosed condition was 

caused or aggravated by the employment activity. Physical findings included mild effusion, 

restricted range of motion especially flexion, and tenderness on palpation of the quadriceps 

muscle. 

In a July 23, 2015 duty status report (Form CA-17), Dr. Berger indicated that appellant 

could return to full-duty work on July 15, 2015. He noted appellant’s history of injury, 

diagnosed left quadriceps muscle rupture due to July 13, 2015 incident, and provided physical 

examination findings. 

By decision dated August 26, 2015, OWCP denied appellant’s claim. It found the 

medical evidence of record was insufficient to establish that the diagnosed condition was 

causally related to the accepted July 13, 2015 employment incident. 

On September 4, 2015 appellant requested review of the written record by an OWCP 

hearing representative and submitted additional evidence. 

Dr. Berger, in a July 14, 2015 office visit report, noted that appellant was seen for 

complaints of left knee pain. He again related appellant’s history of injury. Physical 

examination findings revealed limited left knee range of motion particularly flexion, tenderness 

on palpation of the distal quadriceps muscle, and mild effusion. Dr. Berger again diagnosed a 

ruptured left quadriceps muscle. 
3

In a September 3, 2015 report, Dr. Berger opined that on July 13, 2015 appellant 

sustained a work injury to his right2

 quadriceps muscle due to kneeling down to pick up a 

marker. He noted that appellant’s injury was consistent with the description of the July 13, 2015 

work incident. 

By decision dated February 2, 2016, an OWCP hearing representative affirmed the 

August 26, 2015 decision. He found the medical evidence of record was insufficiently 

rationalized to explain how appellant’s ruptured left quadriceps muscle was causally related to 

the July 13, 2015 incident. 

LEGAL PRECEDENT 

An employee seeking benefits under FECA3 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 and/or specific condition for which compensation is claimed are causally related to the 

employment injury.4

 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.5 

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.6 

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.7 Second, the employee must 

submit sufficient evidence, generally only in the form of medical evidence, to establish that the 

employment incident caused a personal injury.8 

Causal relationship is a medical issue and the medical evidence generally required to 

establish causal relationship is rationalized medical opinion evidence.9

 Rationalized medical 

opinion evidence is medical evidence which includes a physician’s rationalized opinion on 

whether there is a causal relationship between the employee’s diagnosed condition and the 

 2

 This appears to be a typographical error as the left quadriceps muscle had been mentioned in prior reports. 

3 Supra note 1. 

4 C.S., Docket No. 08-1585 (issued March 3, 2009); Bonnie A. Contreras, 57 ECAB 364 (2006). 

5 S.P., 59 ECAB 184 (2007); Joe D. Cameron, 41 ECAB 153 (1989). 

6 B.F., Docket No. 09-60 (issued March 17, 2009); Bonnie A. Contreras, supra note 4. 

7 D.B., 58 ECAB 464 (2007); David Apgar, 57 ECAB 137 (2005). 

8 C.B., Docket No. 08-1583 (issued December 9, 2008); D.G., 59 ECAB 734 (2008); Bonnie A. Contreras, supra

note 4. 

9 Y.J., Docket No. 08-1167 (issued October 7, 2008); A.D., 58 ECAB 149 (2006); D’Wayne Avila, 57 ECAB 

642 (2006). 
4

compensable employment factors.10 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.11 

ANALYSIS 

OWCP accepted that the July 13, 2015 incident occurred as alleged, but denied the claim 

as it found the medical evidence of record insufficient to establish causal relationship. The 

Board finds that appellant failed to meet his burden of proof. 

The medical evidence includes several reports from Dr. Berger which diagnosed left 

quadriceps muscle rupture, provided examination findings, and related appellant’s description of 

the mechanism of injury. In reports dated July 14, 2015, Dr. Berger noted that appellant felt a 

pulling/straining sensation after squatting on July 13, 2015 and that he had experienced a similar 

episode the previous December. Dr. Berger, in his September 3, 2015 report, noted appellant’s 

injury occurred on July 13, 2015 due to kneeling down to pick up a marker. He opined that 

appellant’s quadriceps injury was consistent with the description of the July 13, 2015 incident. 

In a July 23, 2015 CA-17 form, Dr. Berger diagnosed left quadriceps muscle rupture which he 

attributed to the July 13, 2015 incident. While Dr. Berger’s reports contain affirmative 

statements of causation and history of injury, they do not contain a sufficient explanation of the 

process through which the July 13, 2015 incident physiologically caused or aggravated 

appellant’s claimed left quadriceps muscle rupture. Medical conclusions unsupported by 

rationale are of little probative value.12 Thus, these reports are insufficient to meet appellant’s 

burden of proof to establish causal relationship. 

The record also contains form reports from Dr. Berger diagnosing left quadriceps muscle 

rupture. In a July 23, 2015 CA-20 form, Dr. Berger checked a box marked “yes” to the question 

of whether the diagnosed left quadriceps muscle rupture was causally related to the July 13, 2015 

incident. The Board has held 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.13 

The Board notes, however, that the record does not verify that the issue of appellant’s 

incurred medical expenses has been addressed. The record contains an undated Form CA-16 

noting a July 13, 2015 injury date and signed by Ms. Brown authorizing medical treatment. 

Ordinarily, where the employing establishment authorizes treatment of a job-related injury by 

 10 J.J., Docket No. 09-27 (issued February 10, 2009); Michael S. Mina, 57 ECAB 379 (2006). 

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

12 C.B., Docket No. 08-2268 (issued May 22, 2009); Roma A. Mortenson-Kindschi, 57 ECAB 418 (2006); 

Willa M. Frazier, 55 ECAB 379 (2004). 

13 Sedi L. Graham, 57 ECAB 494 (2006). 
5

providing the employee a properly executed Form CA-16,14 OWCP is under contractual 

obligation to pay for the authorized medical treatment.15 The Board finds that upon return of the 

case record, this matter should be addressed. 

On appeal, appellant expresses his belief that his left quadriceps muscle rupture resulted 

from the July 13, 2015 employment incident. The Board has held that the fact that a condition 

manifests itself or worsens during a period of employment16 or that work activities produce 

symptoms revelatory of an underlying condition does not raise an inference of causal 

relationship between a claimed condition and employment factors.17 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.18 Causal relationship must be substantiated by rationalized medical opinion 

evidence, which it is appellant’s responsibility to submit. Therefore, his belief that his condition 

was caused by the work-related incident is not determinative. 

The hearing representative advised appellant that it was his responsibility to provide a 

rationalized medical opinion regarding causal relationship. Appellant failed to submit 

appropriate medical documentation in response. As there is no probative, rationalized medical 

evidence addressing how his claimed left quadriceps muscle rupture was caused or aggravated 

by his employment, he 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 a left ruptured 

quadriceps muscle injury causally related to the accepted July 13, 2015 employment incident. 

 14 See Val D. Wynn, 40 ECAB 666 (1989); see also Federal (FECA) Procedure Manual, Part 3 -- Medical, 

Authorizing Examination and Treatment, Chapter 3.300.3(a)(3) (February 2012). 

15 5 U.S.C. § 8103; 20 C.F.R. § 10.304. See L.B., Docket No. 10-469 (issued June 2, 2010); see also Federal 

(FECA) Procedure Manual, Part 3 -- Medical, Authorizing Examination and Treatment, Chapter 3.300.3(a)(3) 

(February 2012).

16 Roy L. Humphrey, 57 ECAB 238 (2005). 

17 Michael S. Mina, supra note 10. 

18 Id. 
6

ORDER 

IT IS HEREBY ORDERED THAT the decision of the Office of Workers’ 

Compensation Programs dated February 2, 2016 is affirmed. 

Issued: July 20, 2016 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board