United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

T.W., Appellant

and

DEPARTMENT OF VETERANS AFFAIRS, 

VETERANS HEALTH ADMINISTRATION, 

Birmingham, AL, Employer

__________________________________________

)

)

)

)

)

)

)

)

)

Docket No. 17-0328

Issued: June 13, 2018

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

ALEC J. KOROMILAS, Alternate Judge

JURISDICTION

On November 30, 2016 appellant filed a timely appeal from a July 28, 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 over 

the merits of this case.

ISSUE

The issue is whether appellant has met his burden of proof to establish that his right knee 

and lower back conditions are causally related to the accepted April 10, 2015 employment 

incident.

 

1 5 U.S.C. § 8101 et seq.
2

FACTUAL HISTORY

On April 13, 2015 appellant, a 58-year-old maintenance mechanic, filed a traumatic injury 

claim (Form CA-1) alleging that, on April 10, 2015, he injured his right knee and lower back as a 

result of slipping and falling on rainwater on the floor while in the performance of duty. He did 

not stop work. 

Appellant submitted physical therapy reports dated June 3 to 29, 2015 in support of his 

claim. 

In an April 10, 2015 report, Dr. Isabel Baren, a Board-certified internist, noted that 

appellant sustained an injury to his right knee and lower back that day due to slipping and falling 

on a wet floor at work while checking out a rain leak by an elevator. Appellant reported having 

pain and discomfort in both areas, but had no obvious fracture and was able to walk, bend, sit, and 

stand. 

On April 21, 2015 Dr. J. Todd Smith, a Board-certified orthopedic surgeon, diagnosed 

lumbar spondylosis, right knee osteoarthritis, lumbar strain, and knee strain. He asserted that 

appellant fell at work on April 10, 2015 as a result of slipping on a rainwater leak near an elevator. 

Dr. Smith noted that appellant had fallen on his back and started experiencing back pain and right 

knee pain. Appellant reported having a back condition 10 years prior, but had not seen a physician 

since that time. He further reported that he occasionally felt like his right knee would slip or give 

way, but he had not fallen because of this feeling of instability.

In a May 12, 2015 report, Dr. Smith noted that appellant was very elusive in his 

conversation and never directly answered questions. When he discussed appellant’s underlying 

spondylosis and right knee osteoarthritis, Dr. Smith found that appellant was very defensive and 

refused to answer whether or not he believed that he had these conditions.

On June 2, 2015 Dr. Smith reported that appellant had not yet attended physical therapy

and released him to work with the restrictions of lifting a maximum of 30 pounds and frequent 

lifting and/or carrying of objects weighing a maximum of 20 pounds. 

In a July 7, 2015 report, Dr. Smith found that appellant continued to experience pain in his

right knee. He found that appellant had a known underlying spondylosis of the lumbar spine, some 

underlying right knee osteoarthritis, and possibly some right knee internal derangement. 

In a July 20, 2015 development letter, OWCP indicated that when appellant’s claim was 

first received it appeared to be a minor injury that resulted in minimal or no lost time from work 

and, based on these criteria and because the employing establishment did not controvert 

continuation of pay or challenge the case, payment of a limited amount of medical expenses was 

administratively approved. It indicated that it had reopened the claim for consideration because 

appellant’s medical bills had exceeded $1,500.00. OWCP requested additional evidence and 

afforded appellant 30 days to respond to its inquiries. 

Appellant subsequently submitted a narrative statement dated July 27, 2015 reiterating the 

factual history of his claim. 
3

By decision dated August 24, 2015, OWCP denied appellant’s claim, finding that the 

medical evidence of record was insufficient to establish causal relationship between his diagnosed 

conditions and the April 10, 2015 employment incident. 

On September 9, 2015 appellant requested an oral hearing before OWCP’s Branch of 

Hearings and Review. He also submitted a physical therapy report dated June 30, 2015. 

In a June 16, 2015 report, Dr. Smith diagnosed low back pain, right knee pain with 

spondylosis of the lumbar spine, and right knee pain with lumbar strain and right knee strain. He 

found that appellant was increasing his strength and range of motion with physical therapy and 

anticipated that he would reach maximum medical improvement in three weeks. Dr. Smith 

released appellant to light/medium work with restrictions on bending, lifting, and climbing. 

A telephonic hearing was held before an OWCP hearing representative on May 12, 2016. 

Appellant provided testimony regarding his claim. 

By decision dated July 28, 2016, an OWCP hearing representative affirmed the prior 

decision. 

LEGAL PRECEDENT

An employee seeking benefits under FECA2 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 timely filed within the applicable 

time limitation period of FECA, that an injury3 was sustained in the performance of duty, as 

alleged, and that any disability or medical condition for which compensation is claimed is causally 

related to the employment injury.4

To determine whether a federal employee has sustained a traumatic injury in the 

performance of duty, it must first be determined whether fact of injury has been established. A 

fact of injury determination is based on two elements. 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. 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. 

An employee may establish that the employment incident occurred as alleged, but fail to show that 

his or her condition relates to the employment incident.5

 

2

Id.

3 OWCP regulations define 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 or function of the body 

affected. 20 C.F.R. § 10.5(ee).

4 See T.H., 59 ECAB 388 (2008).

5

Id.
4

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

establish causal relationship is rationalized medical opinion evidence. 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.6

ANALYSIS

OWCP accepted that the employment incident of April 10, 2015 occurred at the time,

place, and in the manner alleged. The issue, therefore, is whether appellant’s right knee and lower 

back conditions resulted from the April 10, 2015 employment incident. The Board finds that 

appellant has not met his burden of proof to establish causal relationship.

In his reports, Dr. Smith diagnosed lumbar spondylosis, right knee osteoarthritis, lumbar 

strain, and knee strain. He found that appellant had a known underlying spondylosis of the lumbar 

spine, some underlying right knee osteoarthritis, and possibly some right knee internal 

derangement. Dr. Smith noted that appellant fell at work on April 10, 2015 as a result of slipping 

on a leak by an elevator. Appellant fell on his back and started experiencing back pain and right 

knee pain. He reported having a back issue 10 years ago, but had not seen a physician since that 

time. Appellant further reported that he occasionally felt like his right knee would slip or give 

way, but he had not fallen because of this. The Board finds that Dr. Smith failed to provide 

sufficient medical rationale to explain the mechanism of how falling on a wet floor at work on 

April 10, 2015 caused or aggravated appellant’s right knee and lower back conditions.7 Dr. Smith 

noted that appellant’s conditions occurred while he was at work, but such generalized statements 

do not establish causal relationship because they merely repeat appellant’s allegations and are 

unsupported by adequate medical rationale explaining how his physical activity at work actually 

caused or aggravated the diagnosed conditions.8 Dr. Smith’s opinion was based, in part, on a 

temporal correlation. However, the Board has held that neither the mere fact that a disease or

condition manifests itself during a period of employment nor the belief that the disease or condition 

was caused or aggravated by employment factors or incidents is sufficient to establish a causal 

relationship.9 The need for rationale is particularly important as the evidence of record indicates 

that appellant had preexisting right knee and lower back conditions. Dr. Smith did not otherwise 

sufficiently explain how or why diagnostic testing and examination findings led him to conclude 

that the April 10, 2015 incident at work caused or contributed to the diagnosed conditions. Thus, 

the Board finds that the reports from Dr. Smith are insufficient to establish that appellant sustained 

an employment-related injury.

 

6

Id.

7 The Board notes that Dr. Smith was limited in his ability to explain the mechanism of injury as he reported that 

appellant was very elusive in his conversation and never directly answered questions.

8 See K.W., Docket No. 10-0098 (issued September 10, 2010).

9 See E.J., Docket No. 09-1481 (issued February 19, 2010).
5

In her report, Dr. Baren noted that appellant sustained an injury to the right knee and lower 

back on April 10, 2015 due to slipping and falling on a wet floor at work while checking out a rain 

leak by an elevator. Appellant reported having pain and discomfort in both areas, but had no 

obvious fracture and was able to walk, bend, sit, and stand. The Board finds that Dr. Baren’s 

diagnosis of right knee and lower back pain is a description of a symptom rather than a clear 

diagnosis of the medical condition.10 Moreover, the Board has held that the mere fact that 

appellant’s symptoms arise during a period of employment or produce symptoms revelatory of an 

underlying condition does not establish causal relationship between the appellant’s condition and 

his or her employment factors.11 Therefore, the Board finds that Dr. Baren’s report is insufficient 

to establish that appellant sustained an employment-related injury.

Appellant further submitted evidence from physical therapists. These documents do not 

constitute competent medical evidence because a physical therapist is not considered a “physician”

as defined under FECA.12 As such, this evidence is also insufficient to meet appellant’s burden of 

proof.

The Board finds that appellant has not submitted any rationalized medical evidence to 

support his allegation that he sustained an injury causally related to the accepted April 10, 2015 

employment incident and failed to meet his burden of proof to establish a claim for compensation.

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 that his right 

knee and lower back conditions are causally related to the accepted April 10, 2015 employment 

incident.

 

10 The Board has consistently held that pain is a symptom, rather than a compensable medical diagnosis. See P.S., 

Docket No. 12-1601 (issued January 2, 2013); C.F., Docket No. 08-1102 (issued October 10, 2008). 

11 See Richard B. Cissel, 32 ECAB 1910, 1917 (1981); William Nimitz, Jr., 30 ECAB 567, 570 (1979). 

12 5 U.S.C. § 8101(2); Jennifer L. Sharp, 48 ECAB 209 (1996) (physical therapists). See also Gloria J. McPherson, 

51 ECAB 441 (2000); Charley V.B. Harley, 2 ECAB 208, 211 (1949) (a medical issue such as causal relationship can 

only be resolved through the submission of probative medical evidence from a physician).
6

ORDER

IT IS HEREBY ORDERED THAT the July 28, 2016 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: June 13, 2018

Washington, DC

Christopher J. Godfrey, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Alec J. Koromilas, Alternate Judge

Employees’ Compensation Appeals Board