United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

M.B., Appellant

and

DEPARTMENT OF VETERANS AFFAIRS, 

VETERANS HEALTH ADMINISTRATION, 

Ann Arbor, MI, Employer

__________________________________________

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Docket No. 17-1647

Issued: April 2, 2018

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

CHRISTOPHER J. GODFREY, Chief Judge

PATRICIA H. FITZGERALD, Deputy Chief Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On July 25, 2017 appellant, through counsel, filed a timely appeal from a May 18, 2017 

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

In all cases in which a representative has been authorized in a matter before the Board, no claim for a fee for legal 

or other service performed on appeal before the Board is valid unless approved by the Board. 20 C.F.R. § 501.9(e). 

No contract for a stipulated fee or on a contingent fee basis will be approved by the Board. Id. An attorney or 

representative’s collection of a fee without the Board’s approval may constitute a misdemeanor, subject to fine or 

imprisonment for up to one year or both. Id.; see also 18 U.S.C. § 292. Demands for payment of fees to a 

representative, prior to approval by the Board, may be reported to appropriate authorities for investigation.

2 5 U.S.C. § 8101 et seq.
2

ISSUE

The issue is whether appellant has met her burden of proof to establish left knee and lumbar 

conditions causally related to the accepted April 7, 2014 employment incident. 

FACTUAL HISTORY

On April 8, 2014 appellant, then a 53-year-old practical nurse, filed a traumatic injury 

claim (Form CA-1) alleging that on, April 7, 2014, she sustained left shoulder, leg, abdomen, 

cervical, and lumbar injuries when she was involved in a motor vehicle accident while driving in 

the performance of duty. She notified her supervisor, stopped work, and sought emergency

medical treatment on the date of the claimed injury.

3

 That same date, the employing establishment 

issued appellant a properly completed authorization for examination and/or treatment, Form CA16, which authorized medical treatment for her April 7, 2014 motor vehicle accident.

In an April 7, 2014 emergency room (ER) report, Dr. Myles Jan Kin, a doctor of 

osteopathic medicine, reported that appellant was driving approximately 70 miles per hour and did 

not notice that traffic in front of her was stopped, causing her to rear end the vehicle in front of 

her. Appellant complained of neck, back, and left knee pain. Dr. Kin noted mild diffuse cervical 

spine tenderness and some tenderness in the right shoulder. He reviewed diagnostic testing and 

noted normal findings. Dr. Kin reported that appellant had some mild right and left para spinal 

lumbar pain and spasm. He discharged appellant from care.

In an April 7, 2014 diagnostic report, Dr. Lawrence Ashker, a doctor of osteopathic 

medicine, reported that an x-ray of the left knee revealed no fracture, joint effusion, osseous lesion, 

or abnormal joint space narrowing. He further noted that surrounding soft tissues were 

unremarkable.

In an April 7, 2014 diagnostic report, Dr. Robert Yochim, a treating physician, reported 

that an x-ray of the pelvis revealed no fractures. He reported that an x-ray of the chest revealed no 

acute cardiopulmonary disease.

In medical reports dated April 10 through May 6, 2014, Dr. Maria Adela Cordoba-Naguit, 

Board-certified in family medicine, reported that appellant was involved in a car accident on 

April 7, 2014. The impact caused her to hit her left side. She did not lose consciousness. 

Dr. Cordoba-Naguit reported that appellant was wearing a seatbelt, but the airbag did not deploy. 

Appellant was transported to the hospital for emergency medical treatment and released that same 

day. Dr. Cordoba-Naguit noted that x-rays of the entire body revealed no fractures and a CT scan 

of the brain revealed no abnormalities. She also noted a medical history of chronic back and left 

knee pain. Dr. Cordoba-Naguit diagnosed motor vehicle accident with pain in multiple areas and 

 

3

In a July 7, 2014 narrative statement, appellant reported that she was traveling during her normal duty hours when 

she was injured. She explained that her normal workstation was at Ann Arbor Veterans Administration (VA) Medical 

Center, but that on April 7, 2014 she was detailed to work at the Flint Clinic. Appellant had to stop at the Ann Arbor 

VA hospital to pick up work-related equipment and was on her way to the Flint Clinic when the accident occurred. 

She reported her normal hours of duty as 7:30 a.m. to 4:00 p.m. and that the accident occurred a few minutes before 

8:00 a.m. The employing establishment confirmed that appellant was travelling between the Ann Arbor VA Medical 

Center and the Flint Clinic, in the performance of duty, at the time the accident occurred.
3

restricted appellant from returning to work. She noted that appellant underwent left knee surgery 

on April 17, 2014 for a meniscal tear.

In a May 7, 2014 diagnostic report, Dr. George Arnold, a Board-certified diagnostic 

radiologist, reported that a computer tomography (CT) angiography of the neck revealed normal 

findings and some degenerative changes to the cervical spine. A CT scan of the brain revealed no 

evidence for acute intracranial process. Dr. Arnold reported that a CT scan of the chest revealed 

no significant trauma of the chest or abdomen. He further reported that a CT scan of the cervical 

spine revealed no fracture, minimal anterolisthesis of C3-4 and C4-5 presumably degenerative, 

and mild kyphosis centered at moderate degenerative change at C5-6 and C6-7 contributing to 

bilateral bony foraminal narrowing, worse at C6-7 on the left. 

In a development letter dated June 20, 2014, OWCP informed appellant that the evidence 

of record was insufficient to establish her traumatic injury claim. Appellant was advised of the 

medical and factual evidence needed and afforded her 30 days to submit the additional evidence. 

OWCP provided a factual development questionnaire for completion requesting further 

information pertaining to the April 7, 2014 motor vehicle accident.

By decision dated September 17, 2014, OWCP denied appellant’s claim, finding that the 

evidence of record failed to establish a diagnosed condition causally related to the accepted April 7, 

2014 employment incident. It noted that the only diagnosis provided was pain which was 

considered a symptom and not a definitive diagnosis.

On September 29, 2014 appellant requested an oral hearing before an OWCP hearing 

representative. In support of her claim, she submitted an April 7, 2014 police report documenting 

her motor vehicle accident. Appellant also submitted additional medical evidence. 

In an April 11, 2014 medical report, Dr. Alan Snider, a doctor of osteopathic medicine, 

reported that appellant was scheduled to undergo a series of left knee injections, but presented for 

evaluation following a motor vehicle accident. He noted that x-rays of the left knee revealed that 

she continued to have grade II medial osteoarthritis of the knee. Dr. Snider reported clicking 

within the knee on examination which he opined was consistent with a meniscal tear, but was 

uncertain if this was caused by the motor vehicle accident. He noted a moderate amount of left 

knee swelling present from the impact of the auto injury and recommended left knee arthroscopy.

In an April 17, 2014 operative report, Dr. Snider noted a preoperative diagnosis of possible 

torn meniscus with degenerative joint disease (DJD) of the left knee. Operative findings noted no 

acute tears of the medial or lateral menisci and intact anterior cruciate ligament (ACL) and 

posterior cruciate ligament (PCL). Dr. Snider provided a postoperative diagnosis of left knee DJD, 

grade II to grade III medial osteoarthritis, and medial patellofemoral osteoarthritis of the left knee.

In an April 30, 2014 medical report, Dr. Snider reported that appellant was doing well two 

weeks post left knee arthroscopy for DJD with a meniscal tear. He noted that her primary 

complaints involved her lower back with spasms, including some left buttock and leg pain.

In a May 30, 2014 medical report, Dr. Snider reported that appellant was happy with her 

left knee arthroscopy for DJD cleanout. He noted that she also had arthritis in her left knee which 

was not going away.
4

In a September 23, 2014 medical report, Dr. Cordoba-Naguit reported that she initially 

examined appellant on April 10, 2014 following her motor vehicle accident. She noted tenderness 

of the left knee, causing her to refer her to Dr. Snider, who believed that she had a meniscal tear 

and performed arthroscopic surgery. Dr. Cordoba-Naguit explained that she could not accurately 

say for sure that the left knee pain and/or the meniscal tear was caused from the accident.

In a February 5, 2015 medical report, Dr. Cordoba-Naguit reported that appellant’s left 

knee was very tender following her motor vehicle accident. There was no ligament testing done 

at the time, but active range of motion examination which was normal. Dr. Cordoba-Naguit 

reported that she could not say that appellant’s left knee pain was directly secondary to the motor 

vehicle accident.

A hearing was held before an OWCP hearing representative on April 20, 2015, during 

which appellant described the circumstances surrounding the April 7, 2014 motor vehicle accident 

and her subsequent course of treatment. She alleged that her conditions were caused by the motor 

vehicle accident.

Following the hearing, appellant submitted diagnostic reports dated April 23, 2014 which 

provided normal pelvic, sacrum, and coccyx findings. In another April 23, 2014 diagnostic report,

Dr. Joshua Rubin, a Board-certified radiologist, reported that a CT scan of the lumbar spine 

revealed five lumbar-type vertebral bodies, mild straightening of the lumbar lordosis, mild disc 

space height loss at L2-3 and L3-4, mild osteophytosis, and mild lower lumbar facet osteoarthritis.

In an April 24, 2015 diagnostic report, Dr. James Landi, a Board-certified diagnostic 

radiologist, reported that a magnetic resonance imaging (MRI) scan of the lumbar spine revealed

mild-to-moderate lumbar spondylosis which had worsened since an October 15, 2008 study, mild 

lumbar facet hypertrophy contributed to neural foraminal narrowing, and mild-to-moderate 

discogenic degenerative changes within the lumbar vertebral column.

By decision dated June 23, 2015, an OWCP hearing representative affirmed the 

September 17, 2014 decision, finding that the evidence of record failed to establish that her 

diagnosed knee condition was causally related to the accepted April 7, 2014 employment incident. 

On May 24, 2016 appellant, through counsel, requested reconsideration. Appellant 

provided a summary of the medical reports submitted in support of her traumatic injury claim. She 

also submitted additional medical evidence.

In an April 14, 2015 report, Dr. Cordoba-Naguit reported that she last evaluated appellant 

on March 16, 2015 for worsening radiculopathy and weakness due to her back pain.

In medical reports dated June 1, 2015 through March 24, 2016, Dr. Louis Bojrab, Boardcertified in pain medicine, reported that appellant complained of constant lumbar spine pain and 

bilateral lower extremity radiculopathy since her April 7, 2014 motor vehicle accident.4 

Dr. Bojrab noted foraminal stenosis mild-to-moderate right L3-4, moderate left L3-4, mild-tomoderate right L4-5, moderate left L4-5, and facet hypotrophy causing the majority of the 

 

4 Dr. Bojrab incorrectly noted the date of the employment injury as April 4, 2014, rather than April 7, 2014. 
5

foraminal narrowing. He diagnosed low back pain, depression, migraine, bulge of lumbar disc 

without myelopathy, lumbosacral spondylosis, spondylosis without myelopathy or radiculopathy

lumbar region, and spinal stenosis lumbar region. Dr. Bojrab administered treatment via epidural 

steroid injections to the lumbar spine and radiofrequency ablations. Accompanying his reports 

were treatment notes from his physician assistants.

In a March 31, 2016 medical report, Dr. Luke Y. Kim, Board-certified in physical medicine 

and rehabilitation, reported that he had been treating appellant since August 17, 2015. He reported 

that she was involved in a motor vehicle accident on April 7, 2014 and sustained significant low 

back problems. Dr. Kim noted treatment with Dr. Bojrab via epidural steroid injections, 

radiofrequency ablations, and a spinal column stimulator. He reported that appellant could not lift 

anything heavier than a gallon of milk, and standing and walking for any length of time increased 

her pain. Dr. Kim noted treatment including physical therapy and injections to the sacroiliac joints, 

trochanteric bursitis, and myofascial trigger points. He evaluated appellant on March 29, 2016 

and released her to return to work on April 4, 2016 with permanent restrictions.

By decision dated May 18, 2017, OWCP denied modification of its June 23, 2015 decision,

finding that the evidence of record failed to establish that appellant’s diagnosed conditions were

causally related to the accepted April 7, 2014 employment incident.

LEGAL PRECEDENT

An employee seeking benefits under FECA5 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 or specific condition for which compensation is claimed is causally related to the 

employment injury.6 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.7

In order to determine whether an employee actually sustained an injury in the performance 

of duty, OWCP begins with an analysis of whether fact of injury has been established. Generally, 

fact of injury consists of two components which must be considered in conjunction with one 

another. The first component to be established is that the employee actually experienced the 

employment incident which is alleged to have occurred.8 The second component is whether the 

employment incident caused a personal injury and generally can be established only by medical 

evidence. 

To establish causal relationship between the condition, as well as any attendant disability 

claimed and the employment event or incident, the employee must submit rationalized medical 

 

5 Supra note 2.

6 Gary J. Watling, 52 ECAB 278 (2001); Elaine Pendleton, 40 ECAB 1143, 1154 (1989).

7 Michael E. Smith, 50 ECAB 313 (1999).

8 Elaine Pendleton, supra note 6.
6

opinion evidence supporting such causal relationship.9 The opinion of the physician must be based 

on a complete factual and medical background of the claimant, 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 claimant. 

This medical opinion must include an accurate history of the employee’s employment injury and 

must explain how the condition is related to the injury. The weight of 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.10

ANALYSIS

OWCP accepted that the April 7, 2014 motor vehicle accident occurred in the performance 

of duty, as alleged. The issue is whether appellant has established that the incident caused her 

diagnosed lumbar spine and left knee conditions. The Board finds that she has not submitted

sufficient medical evidence to establish that her diagnosed conditions were causally related to the 

April 7, 2014 employment incident.11

On the date of injury, appellant sought emergency medical treatment with Dr. Kin due to 

complaints of back, neck, and left knee pain. While Dr. Kin’s report documents immediate 

treatment for her injury, he failed to provide a firm medical diagnosis as he only diagnosed neck 

and back pain. The Board has consistently held that pain is a symptom, not a compensable medical 

diagnosis.12 Moreover, Dr. Kin reported that CT scans from the head to the pelvis revealed normal 

findings, as did appellant’s knee films. As he explained that appellant’s diagnostic test results

revealed normal findings, his reports do not provide support that appellant sustained traumatic 

injury.

13

In medical reports dated April 10 through May 6, 2014, Dr. Cordoba-Naguit reported that 

she evaluated appellant following an April 7, 2014 motor vehicle accident. She noted a medical 

history of chronic back and left knee pain. As noted above, the Board has held that pain is not a 

compensable medical diagnosis.14 Dr. Cordoba-Naguit’s September 23, 2014 and February 5,

2015 medical reports are also insufficient to establish appellant’s claim. While she noted left knee 

tenderness on examination following the motor vehicle accident, she referred appellant to

Dr. Snider and failed to provide any medical diagnosis based on her own examination. 

Dr. Cordoba-Naguit’s reports fail to provide support for a work-related traumatic injury as they 

contain no diagnosis which could be related to the April 7, 2014 motor vehicle accident. Her 

April 14, 2015 report also fails to provide any opinion regarding the cause of appellant’s injury, 

only generally noting that she had worsening radiculopathy and weakness due to back pain. 

 

9 See 20 C.F.R. § 10.110(a); John M. Tornello, 35 ECAB 234 (1983).

10 James Mack, 43 ECAB 321 (1991).

11 See Robert Broome, 55 ECAB 339 (2004).

12 C.F., Docket No. 08-1102 (issued October 10, 2008).

13 J.P., Docket No. 14-0087 (issued March 14, 2014).

14 Supra note 12.
7

Dr. Cordoba-Naguit generally repeated appellant’s allegations pertaining to the employment 

incident and noted examination findings. Such generalized statements do not establish causal 

relationship because they merely repeat appellant’s allegations and are unsupported by adequate 

rationale explaining how the motor vehicle accident actually caused a diagnosed injury.

15

 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.16 Thus,

Dr. Cordoba-Naguit’s reports are of limited probative value and insufficient to meet appellant’s 

burden of proof.17 

Dr. Snider’s medical reports dated April 11 through May 30, 2014 are also insufficient to 

establish appellant’s claim. In his April 11, 2014 report, Dr. Snider reported that appellant had 

previously been under his care for left knee grade II medial osteoarthritis, noted swelling of the 

left knee following her motor vehicle accident, and speculated that appellant had a possible left 

knee meniscal tear. The Board notes that his report fails to provide support for a work-related left 

knee injury as he reported that he did not know the cause of appellant’s potential meniscal tear. 

Moreover, Dr. Snider’s diagnosis was incorrect as his April 17, 2014 operative report found no 

tear of the medial or lateral meniscus. Rather, he provided a postoperative diagnosis of left knee 

DJD, grade II to grade III medial osteoarthritis, and medial patellofemoral osteoarthritis of the left 

knee, explaining that the operation cleaned up issues related to appellant’s preexisting left knee 

DJD. The Board notes that given Dr. Snider’s operative findings, it appears that appellant’s left 

knee injury and surgery was a result of a preexisting condition unrelated to the April 7, 2014 motor 

vehicle accident. Dr. Snider failed to provide an opinion on causal relationship sufficient to 

establish that appellant’s left knee injury was caused or aggravated by the April 7, 2014 motor 

vehicle accident. A well-rationalized opinion is particularly warranted when there is a history of 

preexisting condition.18 Without explaining how, physiologically, the employment incident 

caused or contributed to the diagnosed conditions, Dr. Snider’s opinion on causal relationship is

insufficiently rationalized and of limited probative value.19

The remaining medical evidence of record is also insufficient to establish appellant’s claim. 

While Dr. Bojrab’s medical reports dated June 1, 2015 through March 24, 2016 provided multiple 

diagnoses, the physician failed to discuss appellant’s preexisting medical history or provide any 

opinion on the cause of appellant’s injury.20 Dr. Kim’s March 31, 2016 report is also insufficient 

 

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

16 C.B., Docket No. 09-2027 (issued May 12, 2010); S.E., Docket No. 08-2214 (issued May 6, 2009).

17 John W. Montoya, 54 ECAB 306 (2003).

18 T.M., Docket No. 08-0975 (issued February 6, 2009); Michael S. Mina, 57 ECAB 379 (2006).

19 See L.M., Docket No. 14-0973 (issued August 25, 2014); R.G., Docket No. 14-0113 (issued April 25, 2014); 

K.M., Docket No. 13-1459 (issued December 5, 2013); A.J., Docket No. 12-0548 (issued November 16, 2012).

20 R.E., Docket No. 14-0868 (issued September 24, 2014).
8

to establish appellant’s claim as the physician failed to provide a firm medical diagnosis, only 

noting that he was treating appellant for low back problems.

21

 

The Board also notes that the record reflects diagnostic reports dated April 7, 2014 through 

April 24, 2015. Diagnostic reports are of limited probative value as they do not provide an opinion 

regarding the cause of the diagnosed conditions.22 

The Board has held that the mere fact that a condition manifests itself during a period of 

employment does not raise an inference of causal relation.23 An award of compensation may not 

be based on surmise, conjecture, speculation, or on the employee’s own belief of causal 

relationship.

24

 Appellant’s honest belief that the April 7, 2014 employment incident caused injury, 

however sincerely held, does not constitute medical evidence sufficient to establish causal 

relationship.25 

Herein, the record lacks rationalized medical evidence establishing causal relationship 

between the accepted April 7, 2014 employment incident and her left knee and lumbar conditions. 

Thus, appellant has failed to meet her burden of proof.26

Appellant may submit additional evidence, together with a written request for 

reconsideration, to OWCP within one year of the Board’s 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 left knee and 

lumbar conditions causally related to the accepted April 7, 2014 employment incident. 

 

21 See B.P., Docket No. 12-1345 (issued November 13, 2012) (regarding pain); C.F., supra note 12 (regarding pain); 

J.S., Docket No. 07-0881 (issued August 1, 2007) (regarding spasm).

22 S.H., Docket No. 17-1447 (issued January 11, 2018).

23 Daniel O. Vasquez, 57 ECAB 559 (2006).

24 D.D., 57 ECAB 734 (2006).

25 H.H., Docket No. 16-0897 (issued September 21, 2016). 

26 The record contains a Form CA-16 signed by the employing establishment official on April 7, 2014. When the 

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, the CA-16 form creates a contractual obligation, which does not 

involve the employee directly, to pay for the cost of the examination or treatment regardless of the action taken on the 

claim. The period for which treatment is authorized by a Form CA-16 is limited to 60 days from the date of issuance, 

unless terminated earlier by OWCP. See 20 C.F.R. § 10.300(c); Tracy P. Spillane, 54 ECAB 608 (2003). The record 

is silent as to whether OWCP paid for the cost of appellant’s examination or treatment for the period noted on the 

form.
9

ORDER

IT IS HEREBY ORDERED THAT the Office of Workers’ Compensation Programs’

decision dated May 18, 2017 is affirmed.

Issued: April 2, 2018

Washington, DC

Christopher J. Godfrey, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board