United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

P.H., Appellant 

and 

DEPARTMENT OF THE AIR FORCE, AIR 

FORCE SPACE COMMAND, 

Cape Canaveral, FL, Employer 

__________________________________________ 

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Docket No. 16-0654 

Issued: July 21, 2016 

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 

COLLEEN DUFFY KIKO, Judge 

ALEC J. KOROMILAS, Alternate Judge 

JURISDICTION 

On February 2, 20161 appellant filed a timely appeal from an August 11, 2015 merit 

decision of the Office of Workers’ Compensation Programs (OWCP). Pursuant to the Federal 

Employees’ Compensation Act2

 (FECA) and 20 C.F.R. §§ 501.2(c) and 501.3, the Board has 

jurisdiction over the merits of this case. 

 1

 Under the Board’s Rules of Procedure, an appeal must be filed within 180 days from the date of issuance of an 

OWCP decision. An appeal is considered filed upon receipt by the Clerk of the Appellate Boards. See 

20 C.F.R. § 501.3(e)-(f). One hundred and eighty days from August 11, 2015, the date of OWCP’s last decision, 

was February 7, 2016. As this fell on a Sunday, the appeal would have been due to the next business day which 

was Monday, February 8, 2016. Since using February 19, 2015, the date the appeal was received by the Clerk of the 

Appellate Boards would result in the loss of appeal rights, the date of the postmark is considered the date of filing. 

The date of the U.S. Postal Service postmark is February 2, 2016, rendering the appeal timely filed. See 20 C.F.R. 

§ 501.3(f)(1). 

2

 5 U.S.C. § 8101 et seq. 
2

ISSUE 

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

causally related to a September 25, 2014 employment incident. 

On appeal, appellant contends that OWCP did not properly consider all of the medical 

evidence submitted and argues that if he had prior damage to his right knee his physicians would 

not have let him run the day of the injury. 

FACTUAL HISTORY 

On October 1, 2014 appellant, a 63-year-old police officer, filed a traumatic injury claim 

(Form CA-1), alleging that he sustained a right knee injury on September 25, 2014 as a result of 

performing mandatory exercise testing. He was running the 300-meter dash as part of the Air 

Force Physical Agility Test (AFPAT) at the time of injury. Appellant stopped work on 

September 26, 2014 and returned on September 29, 2014. The employing establishment agreed 

that he was in the performance of duty at the time of the incident. 

In an October 10, 2014 letter, OWCP advised appellant of the deficiencies of his claim 

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

Appellant submitted a position description and an AFPAT worksheet dated 

September 25, 2014, indicating that on that date he performed sit-ups and push-ups, but did not 

finish the 300-meter or 1.5-mile run due to right knee pain. He also submitted an April 10, 2013 

x-ray of the right knee, which demonstrated large suprapatellar joint effusion and trace spurring 

about the bony patella. 

An OWCP Form CA-16, authorization for examination, was issued by the employing 

establishment on September 25, 2014. Appellant was authorized to visit Health First Urgent 

Care in Cocoa Beach, Florida. In a September 25, 2014 report, Dr. Sara J. Switzer, a Boardcertified internist at Health First, noted seeing him for a right knee injury that day. She 

diagnosed right knee internal derangement, prescribed a right knee brace, and released appellant 

to modified work on September 29, 2014 with the following restrictions: no prolonged standing 

or walking; no climbing, bending, or stooping; sitting jobs only. On October 25 and 28, 2014 

Dr. Switzer rechecked his right knee internal derangement and opined that he was unable to 

return to work. 

In a November 5, 2014 report Dr. Ramesh Girjashanker, a Board-certified internist, 

asserted that appellant suffered an injury at work on September 25, 2014 as he was running on a 

wet surface and slipped and injured his right knee. He found that a magnetic resonance imaging 

(MRI) scan of the right knee revealed evidence of torn meniscus and strain anterior cruciate 

ligament (ACL) insertion at the tibia. Dr. Girjashanker reported that appellant continued with 

pain and discomfort, especially walking and standing. He diagnosed right knee meniscal tear 

and internal derangement. Dr. Girjashanker released appellant to modified work on 

November 10, 2014 with the following restrictions: sitting jobs only. 
3

On November 10, 2014 Dr. Hani H. El-Kommos, a Board-certified orthopedic surgeon, 

indicated that appellant would be scheduled for a right knee arthroscopy in the next couple of 

weeks. 

By decision dated November 18, 2014, OWCP denied the claim because appellant had 

failed to establish that the alleged work incident occurred as alleged. 

On December 8, 2014 appellant requested an oral hearing before the Branch of Hearings 

and Review and submitted a September 25, 2014 attending physician’s report from Dr. Switzer. 

He diagnosed a suspected right knee internal derangement as a result of slipping on wet 

pavement while performing a physical agility test for employment. A physical examination 

revealed right knee effusion, positive anterior drawer sign, lateral tenderness, and medial 

tenderness. On October 3, 2014 Dr. Switzer found no improvement and appellant had advised 

having to do quite a bit of walking at work, which was very painful. She released him to 

modified work on October 6, 2014 with the following restrictions: sitting jobs only. On 

November 28, 2014 Dr. Switzer opined that appellant was unable to work due to constant pain 

and inability to walk very far. Upon physical examination, she found right knee decreased range 

of motion, effusion, lateral tenderness, medial tenderness, and a positive Lachman and 

McMurray test. 

An x-ray of the right knee dated October 22, 2014 revealed evidence of severe sprain of 

the tibial insertion of the ACL, tear of both the medial and lateral meniscus, solitary focus of 

chondromalacia patella along the upper pole at lateral patellar facet, and high probability benign 

cystic change in the lateral aspect of the lateral femoral condyle. 

In a November 5, 2014 report, Dr. Girjashanker opined that appellant sustained an injury 

to his right knee on September 25, 2014 while he was in training for physical fitness at work. A 

physical examination revealed limping, mild-to-moderate pain at extreme flexion or extension. 

Dr. Girjashanker diagnosed right knee meniscal tear and internal derangement. He released 

appellant to sitting jobs only, effective November 10, 2012. 

On November 10, 2014 Dr. El-Kommos reported that on October 25, 2014 appellant was 

performing an agility test and ever since that date he started complaining of significant pain and 

discomfort in his right knee. He found that x-rays of the right knee showed good joint space and 

that it was well preserved. A physical examination revealed marked tenderness along the medial 

joint line and a positive McMurray test. Dr. El-Kommos found that Lachman and drawer tests 

were negative. He recommended a knee arthroscopy. On May 6, 2015 Dr. El-Kommos reported 

that appellant had gout and when he visited the emergency room they aspirated his knee and 

found uric acid. 

A telephonic hearing was held before an OWCP hearing representative on June 26, 2015. 

Appellant provided testimony and the hearing representative held the record open for 30 days for 

the submission of additional evidence. He testified that he previously had restrictions for his 

right knee in 2010 when it was swollen with gout. 

Appellant submitted an April 4, 2013 report from Dr. Anh N. Chau, a Board-certified 

family practitioner, who diagnosed sinusitis and knee pain. Dr. Chau advised that appellant 
4

reported right knee swelling for six days. Appellant also resubmitted an x-ray of the right knee 

dated in which Dr. Chau had found a large amount of swelling in the knee and had referred 

appellant to an orthopedic specialist. 

By decision dated August 11, 2015, an OWCP hearing representative found that appellant 

had established an incident occurring in the performance of duty, but failed to submit medical 

evidence sufficient to establish a causal relationship between his right knee conditions and the 

September 25, 2014 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 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 a “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 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

 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.
5

ANALYSIS 

OWCP has accepted that the employment incident of September 25, 2014 occurred at the 

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

resulted from the September 25, 2014 employment incident. The Board finds he has not met his 

burden of proof to establish causal relationship. 

In her September 25, 2014 report, Dr. Switzer diagnosed right knee internal derangement 

as a result of slipping on wet pavement while doing a physical agility test for employment that 

day. Upon physical examination, she found right knee effusion, positive anterior drawer sign, 

lateral tenderness, and medial tenderness. On October 3, 2014 Dr. Switzer asserted that 

appellant had no improvement and was having to do quite a bit of walking at work, which was 

very painful. She released him to modified work on October 6, 2014 with the following 

restrictions: sitting jobs only. On November 28, 2014 Dr. Switzer opined that appellant was 

unable to work due to constant pain and inability to walk very far. Examination revealed right 

knee decreased range of motion, effusion, lateral tenderness, medial tenderness, and a positive 

Lachman and McMurray test. The Board finds that Dr. Switzer has failed to provide sufficient 

medical rationale explaining the mechanism of how running a 300-meter dash at work on 

September 25, 2014 caused appellant’s right knee condition. Dr. Switzer noted that appellant’s 

condition occurred while he was at work, but such generalized statements do not establish causal 

relationship as they merely repeat his allegations and are unsupported by adequate medical 

rationale explaining how his physical activity at work actually caused or aggravated the 

diagnosed conditions.7

 The need for rationale is particularly important as the evidence of record 

indicates that appellant had a preexisting right knee condition from at least 2013. Dr. Switzer’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 a causal relationship.8 Dr. Switzer did not otherwise sufficiently explain 

how the diagnostic testing and examination findings led her to conclude that the September 25, 

2014 incident at work caused or contributed to the diagnosed conditions. 

On November 5, 2014 Dr. Girjashanker asserted that appellant was running on a wet 

surface during training for physical fitness at work on September 25, 2014 when he slipped and 

injured his right knee. An MRI scan of the right knee revealed evidence of torn meniscus and 

strained ACL insertion at the tibia and a physical examination revealed limping, mild-tomoderate pain at extreme flexion or extension. Dr. Girjashanker diagnosed right knee meniscal 

tear and internal derangement. He noted that appellant’s conditions occurred while he was at 

work, but as noted above, such generalized statements do not establish causal relationship.9

 

Dr. Girjashanker did not provide sufficient medical rationale explaining how appellant’s new or 

preexisting right knee conditions were caused or aggravated by running a 300-meter dash at 

 7 See K.W., Docket No. 10-98 (issued September 10, 2010). 

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

9 Supra note 7. 
6

work on September 25, 2014. Again, the need for rationale is particularly important as the 

evidence of record indicates that appellant had a preexisting right knee condition. 

Dr. El-Kommos asserted that on October 25, 2014 appellant was doing an agility test and 

ever since that date appellant had significant pain and discomfort in his right knee. He attributed 

appellant’s condition to an October 25, 2014 incident. Dr. El-Kommos did not provide any 

medical rationale explaining how appellant’s running of a 300-meter dash at work on 

September 25, 2014 caused or aggravated his right knee condition. OWCP has not accepted an 

October 25, 2014 work incident in this case. 

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 September 25, 2014 work incident.10 

Dr. Chau’s reports from April 2013 are also of limited probative value as they predate the 

claimed injury. 

On appeal, appellant contends that OWCP did not properly consider all of the medical 

evidence submitted and argues that if he had prior damage to his right knee his physicians would 

not have let him run the day of the injury. The Board finds that OWCP properly reviewed all of 

the medical evidence of record. As appellant has not submitted any rationalized medical 

evidence to support his allegation that he sustained an injury causally related to the 

September 25, 2014 employment incident, he has failed to meet his burden of proof to establish a 

claim for compensation. 

The Board also notes that the employing establishment issued appellant a Form CA-16 on 

September 25, 2014 authorizing medical treatment. The Board has held that where an employing 

establishment properly executes a Form CA-16, which authorizes medical treatment as a result of 

an employee’s claim for an employment-related injury, it creates a contractual obligation, which 

does not involve the employee directly, to pay the cost of the examination or treatment regardless 

of the action taken on the claim.11 Although OWCP denied appellant’s claim for an injury, it did 

not address whether he is entitled to reimbursement of medical expenses pursuant to the Form 

CA-16. Upon return of the case record, OWCP should further address this matter. 

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 right knee 

conditions causally related to the accepted September 25, 2014 employment incident. 

 10 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). 

11 See D.M., Docket No. 13-535 (issued June 6, 2013). See also 20 C.F.R. §§ 10.300, 10.304. 
7

ORDER 

IT IS HEREBY ORDERED THAT the August 11, 2015 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: July 21, 2016 

Washington, DC 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board