United States Department of Labor

Employees’ Compensation Appeals Board

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P.W., Appellant

and

DEPARTMENT OF HOMELAND SECURITY, 

EMERGENCY PREPAREDNESS & 

RESPONSE, Washington, DC, Employer

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Docket No. 17-0163

Issued: June 13, 2018

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

PATRICIA H. FITZGERALD, Deputy Chief Judge

ALEC J. KOROMILAS, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On November 1, 2016 appellant filed a timely appeal from a September 16, 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 met her burden of proof to establish that her cervical and 

right knee conditions are causally related to a January 20, 2016 employment incident.

FACTUAL HISTORY

On January 20, 2016 appellant, a 49-year-old program manager, filed a traumatic injury 

claim (Form CA-1) alleging that she sustained injuries to her head and right knee as a result of an 

 

1 5 U.S.C. § 8101 et seq.
2

employment-related motor vehicle accident occurring that same day. She stated that she was hit 

by another moving vehicle on the driver’s side while driving to lunch. Appellant did not stop 

work.

In support of her claim, appellant submitted medical bills for an emergency visit on 

January 20, 2016 and radiological services dated February 2, 2016.

In a February 17, 2016 development letter, OWCP advised appellant of the deficiencies of 

her claim and afforded her 30 days to submit additional evidence and respond to its inquiries. 

Subsequently, appellant submitted a March 8, 2016 narrative statement indicating that she 

was in a temporary duty (TDY) travel status, and that there was no place at the duty station to 

obtain lunch. As such, she claimed that she had to go off-premises to obtain lunch. Appellant

recounted that the incident happened in front of the employing establishment building when she 

was leaving the parking lot. She submitted a copy of the police report and a witness statement 

dated January 21, 2016. Appellant further submitted a medical bill for radiological services dated 

March 8, 2016. 

In a January 20, 2016 report, Dr. Sidney Ware, an emergency medicine specialist, indicated 

that appellant was in a recent motor vehicle accident and diagnosed cervicalgia and pain in right 

knee. 

On January 20, 2016 a nurse practitioner stated that appellant was seen and treated in the 

emergency department and was released to work that same day. 

By decision dated March 18, 2016, OWCP accepted that the January 20, 2016 incident 

occurred in the performance of duty as alleged. However, it denied appellant’s claim, finding that 

she failed to submit evidence containing a medical diagnosis in connection with the injury or 

events. Thus, OWCP concluded that she had not established fact of injury.

On April 27, 2016 appellant requested reconsideration and submitted hospital records 

dated January 20, 2016, including diagnostic testing results. On January 20, 2016 Dr. Ware 

asserted that appellant had been involved in a motor vehicle accident and diagnosed cervicalgia 

and pain in the right knee. 

By decision dated September 16, 2016, OWCP modified its March 18, 2016 decision to 

reflect that the medical evidence submitted established a diagnosis. Thus, appellant had 

established the medical component of fact of injury. However, the claim remained denied as 

appellant failed to submit sufficient medical evidence to establish causal relationship between her

diagnosed conditions and the January 20, 2016 employment incident. 

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 

 

2

Id.
3

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 or she actually experienced the employment incident at the time and

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

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 has accepted that the January 20, 2016 employment incident occurred at the time,

place, and in the manner alleged. The issue is whether appellant’s diagnosed conditions resulted 

from the January 20, 2016 employment incident. The Board finds that appellant has not met her 

burden of proof to establish causal relationship between the conditions for which compensation is 

claimed and the accepted employment incident.

In a January 20, 2016 report, Dr. Ware asserted that appellant had been involved in a motor 

vehicle accident and diagnosed cervicalgia and pain in right knee. The Board finds that Dr. Ware’s

diagnosis of pain in the right knee is a description of a symptom rather than a clear diagnosis of 

the medical condition.7 The Board further finds that Dr. Ware failed to provide sufficient medical 

rationale explaining the mechanism of how being involved in a motor vehicle accident at work on 

January 20, 2016 caused appellant’s cervicalgia condition. Dr. Ware noted that her condition 

 

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.

6

Id.

7 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).
4

occurred while she 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 her physical activity at work actually caused or aggravated the 

diagnosed condition.8 Dr. Ware’s opinion was based, in part, on 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 causal relationship.9 Dr. Ware did not 

otherwise sufficiently explain the reasons why diagnostic testing and examination findings led him 

to conclude that the accepted January 20, 2016 incident at work caused or contributed to the 

diagnosed condition. Thus, the Board finds that the reports from Dr. Ware are insufficient to 

establish that appellant sustained an employment-related injury.

Appellant further submitted evidence from a nurse practitioner. These reports do not 

constitute competent medical evidence because a nurse practitioner is not a “physician” as defined 

under FECA.10 As such, this evidence is also insufficient to meet appellant’s burden of proof. 

Other medical evidence of record, including diagnostic testing reports, is of limited 

probative value and insufficient to establish the claim as it does not specifically address whether 

appellant’s diagnosed conditions are causally related to the January 20, 2016 work incident.11

The Board finds that appellant has not submitted rationalized medical evidence sufficient

to establish that she sustained an injury causally related to the accepted January 20, 2016 

employment incident. Thus, she has not met her 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 her burden of proof to establish that her cervical 

and right knee conditions are causally related to a January 20, 2016 employment incident.

 

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

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

10 5 U.S.C. § 8101(2); Sean O’Connell, 56 ECAB 195 (2004) (reports by nurse practitioners and physician assistants 

are not considered medical evidence as these health care providers are not considered physicians under FECA). 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).

11 See K.W., 59 ECAB 271 (2007); A.D., 58 ECAB 149 (2006); Linda I. Sprague, 48 ECAB 386 (1997) (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).
5

ORDER

IT IS HEREBY ORDERED THAT the September 16, 2016 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: June 13, 2018

Washington, DC

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Alec J. Koromilas, Alternate Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board