United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

K.P., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Saint Louis, MO, Employer

__________________________________________

)

)

)

)

)

)

)

)

Docket No. 17-1145

Issued: November 15, 2017

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

CHRISTOPHER J. GODFREY, Chief Judge

ALEC J. KOROMILAS, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On May 2, 2017 appellant filed a timely appeal from a March 9, 2017 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 right knee injury 

causally related to an accepted February 20, 2016 employment incident.

FACTUAL HISTORY

On March 31, 2016 appellant, then a 54-year-old city carrier, filed a traumatic injury 

claim (Form CA-1) alleging that on February 20, 2016 she fractured her right knee when she 

 

1

5 U.S.C. § 8101 et seq.
2

tripped on broken concrete in a customer’s driveway. The claim form did not indicate whether 

she stopped work.

Appellant was treated by Dr. Karsten B. Slater, a Board-certified family practitioner. In a 

March 24, 2016 report, Dr. Slater related appellant’s complaints of right knee pain onset about 

two months ago after she stepped wrong on a curb. He indicated that appellant had not been able 

to fully extend her knee for two weeks. Dr. Slater reviewed appellant’s history and noted that a 

March 2, 2016 x-ray scan of the right knee showed degenerative changes. Upon physical 

examination, he reported tenderness along the lateral, popliteal, and medial joint line of 

appellant’s right knee. Dr. Slater also noted posterior knee pain with McMurray’s test. He

diagnosed right knee pain and right knee osteoarthritis.

In work status notes dated March 24 to 31, 2016, Dr. Slater indicated that appellant was 

seen in his office and requested that she be excused from work from March 21 through 31, 2016. 

He related that appellant was being treated for fracture and meniscus tear of the right knee.

Appellant underwent a right knee magnetic resonance imaging (MRI) scan by Dr. H.T. 

Youssef, a Board-certified internist. In a March 29, 2016 report, Dr. Youssef noted a complex 

tear of the posterior horn of the medial meniscus, acute nondepressed subcondylar fracture along 

the weight bearing surface of the medial femoral condyle, small post-traumatic bone contusions, 

grade 1 medial collateral ligament sprain, moderate joint effusion without synovitis, and severe 

arthrosis about the patellofemoral and medial compartments along with mild arthrosis. 

Appellant continued to receive medical treatment from Dr. Slater. In a March 31, 2016 

examination note, Dr. Slater noted appellant’s complaints of right knee pain. He related that a 

recent right knee MRI scan report showed a complex tear posterior horn of the medial meniscus 

along with minimal radial tear and acute nondepressed subcondylar fracture along the weight 

bearing surface of the medial femoral condyle. Dr. Slater reviewed appellant’s history and 

conducted an examination. He reported tenderness along the medial femoral condyle of 

appellant’s right knee. Dr. Slater diagnosed fracture of medial condyle of right femur and 

complex tear of the medial meniscus of the right knee.

Dr. Slater provided an April 1, 2016 attending physician’s report (Form CA-20), which 

noted a history of injury of “right knee pain after stepping wrong on the curb.” He indicated 

examination findings of right femoral subcondylar fracture of the medial meniscus. Dr. Slater 

diagnosed femoral subcondylar fracture and medial meniscus tear. He checked a box marked 

“yes” indicating that appellant’s condition was caused or aggravated by the described injury. 

Dr. Slater reported that appellant was totally disabled beginning March 21, 2016 and that she had 

not been advised to return to work.

In a letter dated April 1, 2016, a health and resource management specialist for the 

employing establishment controverted appellant’s claim. She asserted that appellant’s 

employment injury did not occur as appellant did not report the injury in a timely manner and 

that there were no witnesses to the February 20, 2016 incident. The health and resource 

management specialist also claimed that it seemed unlikely that such severe medical findings 

could have been caused by stepping wrong on a curb.
3

Appellant was treated by Dr. Justin Miller, a Board-certified orthopedic surgeon. In an 

April 5, 2016 report, he noted appellant’s complaints of right knee pain. Dr. Miller related that 

appellant was a mail carrier and in approximately January 2016 appellant had stepped down off a 

curb and fell into a driveway. Appellant indicated that her pain had worsened since March 20, 

2016 and that she had significant swelling in her knee. Dr. Miller reviewed appellant’s history 

and conducted an examination. He noted active range of motion of appellant’s right knee and 

normal neurovascular examination. Dr. Miller also reported tenderness along the medial joint 

line and mild crepitation of appellant’s right patella. He diagnosed complex tear of medial 

meniscus of the right knee and primary osteoarthritis of the right knee.

Dr. Slater continued to treat appellant. In an April 8, 2016 report, he related appellant’s 

complaints of right knee pain and conducted an examination. Dr. Slater reported tenderness 

along the medial femoral condyle of appellant’s right knee. He diagnosed nondisplaced fracture 

of appellant’s right femur and complex tear of right knee medial meniscus.

In a letter dated April 13, 2016, OWCP advised appellant that the evidence submitted was 

insufficient to establish her claim. It requested that she respond to an attached questionnaire in 

order to substantiate that the February 20, 2016 incident occurred as alleged and that she provide 

additional medical evidence to establish a diagnosed condition causally related to the alleged 

employment incident. Appellant was afforded 30 days to submit additional evidence.

On April 28, 2016 OWCP received appellant’s response to its questionnaire form. 

Appellant explained that she did not file a Form CA-1 within 30 days because she did not realize 

the severity of her injury. Appellant also described the February 20, 2016 incident as “fell on 

driveway in need of repair.” She indicated that she did not sustain any other injuries between the 

date of injury and the date she first reported it to the employing establishment. Appellant noted 

that she was previously diagnosed with rheumatoid arthritis.

OWCP denied appellant’s claim in a decision dated May 16, 2016. It accepted that the 

February 20, 2016 employment incident occurred as alleged and that appellant was diagnosed 

with a right knee condition. However, OWCP denied appellant’s claim because the medical 

evidence of record failed to establish a causal relationship between her right knee condition and 

the accepted February 20, 2016 employment incident. Thus appellant did not establish fact of 

injury.

On June 6, 2016 appellant requested reconsideration.

Appellant submitted a May 24, 2016 letter from Dr. Miller. Dr. Miller indicated that he 

had treated appellant for a right knee injury that she sustained approximately in January when 

she stepped off of a curb at work. He related that x-ray scans showed mild osteoarthritic changes 

in appellant’s right knee and that a right knee MRI scan showed a tear of the medial meniscus 

and osteochondral lesion of the medial femoral condyle. Dr. Miller opined that “based on the 

patient’s prior pain free knee that her current injury is likely related to her work-related injury.” 

By decision dated July 22, 2016, OWCP denied modification of the May 16, 2016 

decision because the medical evidence of record failed to establish that appellant’s right knee 

condition was causally related to the accepted February 20, 2016 employment incident. It 
4

determined that the new medical evidence was of diminished probative value and failed to 

establish appellant’s traumatic injury claim.

On December 16, 2016 appellant again requested reconsideration. She submitted various 

hospital records dated November 2 to 21, 2016, which indicated that she underwent right knee 

surgery on November 11, 2016.

In a November 2, 2016 preoperative examination note, Chelsea A. Horn, a physician 

assistant, related that appellant had a history of ongoing right knee pain since a fall at work in 

March 2016. She noted that a March 29, 2016 right knee MRI scan showed a complex 

degenerative tear of the posterior horn of the medial meniscus. Examination of appellant’s right 

knee showed mild effusion and tenderness along the medial joint line.

Appellant also provided a November 21, 2016 postoperative examination note from Gail 

Greathouse, a nurse practitioner, who indicated that appellant returned for follow up of right 

knee surgery.

By decision dated March 9, 2017, OWCP denied modification of the July 22, 2016 

decision. It found that the medical evidence of record did not contain a well-rationalized medical 

opinion from a physician explaining how appellant’s right knee condition was causally related to 

the February 20, 2016 employment incident.

LEGAL PRECEDENT

An employee seeking benefits under FECA2has the burden of proof to establish the 

essential elements of his or her claim by the weight of the reliable, probative, and substantial 

evidence3including that he or she sustained an injury in the performance of duty and that any 

specific condition or disability for work for which he or she claims compensation is causally 

related to that employment injury.4

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

performance of duty, it first must be determined whether “fact of injury” has been established.5 

There are two components involved in establishing the fact of injury. First, the employee must 

submit sufficient evidence to establish that she actually experienced the employment incident at 

the time, place, and in the manner alleged.6 Second, the employee must submit evidence, 

generally only in the form of probative medical evidence, to establish that the employment 

incident caused a personal injury.7 An employee may establish that the employment incident 

 

2

Id.

3

 J.P., 59 ECAB 178 (2007); Joseph M. Whelan, 20 ECAB 55, 58 (1968). 

4 G.T., 59 ECAB 447 (2008); Elaine Pendleton, 40 ECAB 1143, 1145 (1989).

5

S.P., 59 ECAB 184 (2007); Alvin V. Gadd, 57 ECAB 172 (2005).

6 Bonnie A. Contreras, 57 ECAB 364 (2006); Edward C. Lawrence, 19 ECAB 442 (1968).

7 David Apgar, 57 ECAB 137 (2005); John J. Carlone, 41 ECAB 354 (1989). 
5

occurred as alleged, but fail to show that his or her disability or condition relates to the 

employment incident.8

Whether an employee sustained an injury in the performance of duty requires the 

submission of rationalized medical opinion evidence.9 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.10 The weight of the 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

Appellant alleged that on February 20, 2016 she sustained a right knee fracture when she 

tripped on broken concrete in a customer’s driveway at work. OWCP accepted that the 

February 20, 2016 incident occurred as alleged and that she was diagnosed with a right knee 

condition. However, it denied appellant’s claim finding insufficient medical evidence to 

establish that her diagnosed right knee condition was causally related to the accepted 

employment incident. 

The Board finds that appellant failed to meet her burden of proof to establish a right knee 

injury causally related to the accepted February 20, 2016 employment incident.

Dr. Slater initially treated appellant and provided reports from March 24 to April 8, 2016. 

He related appellant’s complaints of “right knee pain, which began about two months ago when 

she stepped wrong on a curb.” Dr. Slater reported physical examination findings of tenderness 

along the lateral, popliteal, and medial joint line of appellant’s right knee and posterior knee pain 

with McMurray’s test. He further noted that a March 2, 2016 right knee x-ray scan showed 

degenerative changes. Dr. Slater diagnosed right knee pain, right knee osteoarthritis, 

nondisplaced fracture of the right femur, and complex tear of the right knee medial meniscus. In 

an April 1, 2016 Form CA-20, he checked a box marked “yes” indicating that appellant’s 

condition was caused or aggravated by the described injury. The Board has held, however, 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.12 Because Dr. Slater has not provided medical rationale or 

explanation for his opinion on causal relationship, his medical opinion is insufficient to establish 

appellant’s claim. To be of probative value the medical evidence must contain a sufficient 

 

8

T.H., 59 ECAB 388 (2008); see also Roma A. Mortenson-Kindschi, 57 ECAB 418 (2006).

9

See J.Z., 58 ECAB 529 (2007); Paul E. Thams, 56 ECAB 503 (2005).

10 I.J., 59 ECAB 408 (2008); Victor J. Woodhams, 41 ECAB 465 (2005).

11 James Mack, 43 ECAB 321 (1991).

12 D.D., 57 ECAB 734, 738 (2006); Deborah L. Beatty, 54 ECAB 340 (2003).
6

explanation of the process through which the accepted employment incident physiologically 

caused or aggravated appellant’s diagnosed condition.13 Medical conclusions unsupported by 

rationale are of little probative value.14

Appellant was also treated by Dr. Miller. In reports dated April 5 and May 24, 2016,

Dr. Miller related that appellant was a mail carrier and that in approximately January 2016 she 

experienced right knee pain after she stepped off a curb and fell down in a driveway. Upon 

physical examination, he reported tenderness along the medial joint line and mild crepitation of 

appellant’s right patella. Dr. Miller noted that diagnostic scans of appellant’s right knee showed 

mild osteoarthritic changes, a tear of the medial meniscus, and osteochondral lesion of the medial 

femoral condyle. He diagnosed complex tear of medial meniscus of the right knee and primary 

osteoarthritis of the right knee. Dr. Miller opined that because of appellant’s prior pain free knee 

her current injury was “likely related” to her work-related injury. The Board finds that

Dr. Miller’s opinion that appellant’s right knee injury was “likely” work related is speculative in 

nature. The Board has held that medical opinions that are speculative or equivocal in character 

are of diminished probative value.15 An award of compensation may not be based on surmise, 

conjecture, speculation, or upon appellant’s own belief that there is causal relationship between 

his claimed condition and his employment.16 Furthermore, Dr. Miller’s opinion on causal 

relationship was also based on the fact that appellant was “pain free” prior to her work injury. 

The Board has held that an opinion that a condition is causally related because the employee was 

asymptomatic before the injury is insufficient, without sufficient rationale, to establish causal 

relationship.17

Dr. Youssef’s March 29, 2016 right knee MRI scan report is also insufficient to establish 

causal relationship. Although he provided several diagnosed conditions, Dr. Youssef did not 

provide any opinion on the cause of appellant’s right knee condition. The Board has held that 

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.18 Diagnostic tests are of limited 

probative value as they fail to provide an opinion as to the causal relationship between 

appellant’s accepted employment incident and her diagnosed right knee condition. For this 

reason, this evidence is insufficient to meet appellant’s burden of proof.19

Appellant also provided a November 2, 2016 preoperative examination note by

Ms. Horn, a physician assistant, and a November 21, 2016 postoperative examination note by

 

13 M.S., Docket No. 16-1497 (issued December 20, 2016).

14 K.N., Docket No. 16-1900 (issued March 9, 2017). 

15 Id.; Kathy A. Kelley, 55 ECAB 206 (2004).

16 Robert A. Boyle, 54 ECAB 381 (2003); Patricia J. Glenn, 53 ECAB 159 (2001).

17 T.M., Docket No. 08-975 (issued February 6, 2009); Michael S. Mina, 57 ECAB 379 (2006).

18 C.B., Docket No. 09-2027 (issued May 12, 2010); J.F., Docket No. 09-1061 (issued November 17, 2009); A.D., 

58 ECAB 149 (2006).

19 See A.B., Docket No. 17-0301 (issued May 19, 2017). 
7

Ms. Greathouse, a nurse practitioner. Evidence from a physician assistant or nurse practitioner 

does not constitute competent medical evidence under FECA as neither is considered as a 

physician as defined under section 8102(2) of FECA.20

In order to obtain benefits under FECA an employee has the burden of proof to establish 

the essential elements of his or her claim by the weight of the reliable, probative, and substantial 

evidence.21 Because appellant has failed to provide such evidence demonstrating that her right 

knee condition was causally related to the accepted February 20, 2016 employment incident, she 

has failed to meet her burden of proof to establish her claim. 

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 a right knee 

injury causally related to the accepted February 20, 2016 employment incident.

 

20 5 U.S.C. § 8101(2) provides that a physician includes surgeons, podiatrists, dentists, clinical psychologists, 

optometrists, chiropractors, and osteopathic practitioners within the scope of their practice as defined by state law. 

V.C., Docket No. 16-0642 (issued April 19, 2016); Allen C. Hundley, 53 ECAB 551, 554 (2002) (physician 

assistant).

21 Supra note 1.
8

ORDER

IT IS HEREBY ORDERED THAT the March 9, 2017 merit decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: November 15, 2017

Washington, DC

Christopher J. Godfrey, 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