United States Department of Labor

Employees’ Compensation Appeals Board

___________________________________________

C.C., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

St. Louis, MO, Employer

___________________________________________

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Docket No. 17-1981

Issued: January 23, 2019

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant1

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 September 25, 2017 appellant, through counsel, filed a timely appeal from an 

August 24, 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.

ISSUE

The issue is whether appellant met his burden of proof to establish a left knee condition 

causally related to the accepted June 16, 2016 employment incident.

 

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

FACTUAL HISTORY

On June 16, 2016 appellant, then a 43-year-old mail carrier, filed a traumatic injury claim

(Form CA-1) alleging that, when delivering mail on that date, he popped his left knee when he 

stepped on an acorn that was in the grass.

In a June 16, 2016 duty status report (Form CA-17), Dr. Gary J. Gray, a Board-certified 

internist, diagnosed sprain of unspecified site of the left knee. He noted that appellant stepped on 

acorns and injured his left knee. Dr. Gray recommended a return to work with restrictions. He

saw appellant on June 24, 2016, and recommended his route be limited to four hours. On June 28, 

2016 Dr. Gray recommended cutting his route walking to three hours maximum and to continue 

knee support. 

OWCP also received physical therapy reports dated June 16, 20, 21, 23, 24, 27, 29, and 

July 1, 2016. 

In a July 5, 2016 report, Dr. Gray noted in his physical examination that the strength and 

appearance were normal and there was no deformity or tenderness in the knee. He diagnosed a

left knee sprain and indicated that appellant had reached maximum medical improvement and 

could return to regular duty. 

In an August 10, 2016 report, Dr. Mark Belew, a Board-certified orthopedic surgeon, noted 

that appellant was seen for left knee pain with unspecified chronicity. He explained that appellant 

had left medial pain after stepping on a “gumball” almost two months prior. Dr. Belew indicated 

that appellant’s x-rays were negative and further noted that his examination and history were 

consistent with a medial meniscus tear. He advised that a magnetic resonance imaging (MRI) scan

was indicated.

An August 15, 2016 MRI scan of the left knee read by Dr. Kimberly Foust, a Boardcertified diagnostic radiologist, revealed a nondisplaced complex tear of the posterior horn and 

body of the left medial meniscus with a predominant horizontal undersurface component, and mild 

medial compartment predominant tricompartmental left knee chondrosis with medium-sized 

effusion. 

In an August 16, 2016 work status note, Dr. Belew noted that appellant was unable to work 

at this time. In an August 22, 2016 follow-up report, he noted that the MRI scan revealed a 

complex tear of the medial meniscus of the left knee as a current injury. Dr. Belew also noted that 

appellant had some underlying arthritis that was “likely preexisting” and may have knee issues 

due to the arthritis. He diagnosed a complex tear of the medial meniscus of the left knee. 

Dr. Belew recommended arthroscopic partial meniscectomy. In an August 22, 2016 work status 

note, he noted that appellant was currently under his care, was having surgery on September 1, 

2016, and would need to remain off work for at least four weeks following surgery.

In a letter dated August 31, 2016, the employing establishment controverted the claim,

contending that appellant never reported any pain or reinjury of the knee to his manager or 

supervisor. It also noted that he had many extracurricular activities.
3

By development letter dated October 17, 2016, OWCP informed appellant that when his 

claim was submitted, it appeared to be a minor injury that resulted in minimal or no lost time from 

work, and that based upon these criteria, the employing establishment did not controvert 

continuation of pay (COP) or challenge the merits of the case, and payment of a limited amount 

of medical expenses was administratively handled. However, as appellant’s expenses had 

exceeded $1,500.00 it was now formally adjudicating his claim. OWCP requested that he 

complete a questionnaire describing any similar disability or left knee medical conditions before 

the injury and to submit a comprehensive narrative medical report from his attending physician, 

which differentiated between the effects of the work incident and the status of the preexisting 

condition before the alleged work incident. It afforded appellant 30 days to submit the requested 

medical evidence.

By decision dated December 9, 2016, OWCP denied appellant’s claim, finding that 

appellant had not established that he sustained a traumatic injury causally related to the accepted 

June 16, 2016 employment incident.

By letter dated December 16, 2016, appellant, through counsel, requested an oral hearing

before a representative of OWCP’s Branch of Hearings and Review.

OWCP subsequently received a June 16, 2016 x-ray of the left knee read by Dr. Cary G. 

Stolar, a diagnostic radiologist, which revealed findings which included no fracture or 

malalignment of the preserved joint spaces and no evidence of arthritis. Dr. Stolar indicated that 

the examination was normal. 

In a January 30, 2017 report, Dr. Belew explained that a complex tear of the medial 

meniscus of the left knee was the current injury. He related that appellant described the acute 

injury that “occurred at work in which he slipped and fell.” Dr. Belew noted that he developed an 

acute effusion of the knee. He advised that appellant’s MRI scan, revealed a meniscal tear, which 

was confirmed at the time of surgery. Dr. Belew opined that it was “extremely unlikely this 

individual would have had a complex tear of the medial meniscus and be able to perform any kind 

a manual labor.” He noted that appellant’s “injury was fitting of the description of his fall with no 

prior history available of any issues with the knee.” Dr. Belew further explained that the injury 

“[u]ndoubtedly occurred as a direct result of the acute injury,” as he “did have several partial 

thickness chondral irregularities of the joint surface with loose bodies in the joint.” He noted that 

“this portion of pathology in the knee certainly could have been preexisting; however, a fall could 

have aggravated existing irregularities of the chondral surfaces as well.” Dr. Belew further opined

that “[t]he meniscal tear however was clearly acute, indicating of the injury.” He also noted that 

appellant had no prior history of knee problems.

A hearing was held before an OWCP hearing representative via teleconference on 

June 13, 2017. 

By decision dated August 24, 2017, OWCP’s hearing representative affirmed the 

December 9, 2016 decision. She found that the medical evidence was insufficient to establish 

causal relationship in this case.
4

LEGAL PRECEDENT

A claimant seeking benefits under FECA 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, 

including that an injury was sustained in the performance of duty as alleged, and that any specific 

condition or disability claimed is causally related to the employment injury.3

To determine if an employee sustained a traumatic 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 that must be considered in conjunction with one another. 

The first component is whether the employee actually experienced the employment incident that 

allegedly occurred.4 The second component is whether the employment incident caused a personal 

injury.5 An employee may establish that an injury occurred in the performance of duty as alleged, 

but fail to establish that the disability or specific condition for which compensation is being 

claimed is causally related to the injury.6

Causal relationship is a medical question that generally requires rationalized medical 

opinion evidence to resolve the issue.7 A physician’s opinion on whether there is a causal 

relationship between the diagnosed condition and the implicated employment factor(s) must be 

based on a complete factual and medical background.8 Additionally, the physician’s opinion must 

be expressed in terms of a reasonable degree of medical certainty, and must be supported by 

medical rationale, explaining the nature of the relationship between the diagnosed condition and 

appellant’s specific employment factor(s).9

Certain healthcare providers such as physician assistants, nurse practitioners, physical 

therapists, and social workers are not considered “physician[s]” as defined under FECA.10 

Consequently, their medical findings and/or opinions will not suffice for purposes of establishing 

entitlement to FECA benefits.11

 

3 20 C.F.R. § 10.115(e), (f); see Jacquelyn L. Oliver, 48 ECAB 232, 235-36 (1996).

4 Elaine Pendleton, 40 ECAB 1143 (1989).

5

John J. Carlone, 41 ECAB 354 (1989); Victor J. Woodhams, 41 ECAB 345 (1989). 

6 Shirley A. Temple, 48 ECAB 404, 407 (1997).

7 Robert G. Morris, 48 ECAB 238 (1996). 

8 Victor J. Woodhams, supra note 5.

9

Id.

10 5 U.S.C. § 8101(2); 20 C.F.R. § 10.5(t).

11 K.W., 59 ECAB 271, 279 (2007); David P. Sawchuk, 57 ECAB 316, 320 n.11 (2006). 
5

ANALYSIS

The Board finds that appellant has not met his burden of proof as the medical evidence of 

record does not contain a reasoned explanation of how the June 16, 2016 employment incident

caused or aggravated appellant’s claimed left knee condition.12 

The Board notes that OWCP received several physical therapy reports dating from June 16, 

to July 1, 2016. However, physical therapists are not considered physicians as defined under 

FECA, and thus their findings are insufficient to establish entitlement to FECA benefits.13 

The record also includes diagnostic reports. However, these reports merely reported 

findings and did not contain an opinion regarding the cause of the reported condition. Thus, they 

lack probative value on the issue of causal relationship.14

The Board notes that OWCP initially received a series of reports from Dr. Gray, where he

repeated his diagnosis of sprain of an unspecified part of the left knee and provided work 

restrictions. Dr. Gray indicated that he believed that appellant had a mild sprain injury of the left 

knee. During follow-up examinations, he augmented his various work restrictions culminating in 

a July 5, 2016 report, where he indicated that appellant’s left knee was doing well. Dr. Gray

explained that he conducted a physical examination and the appearance was normal and diagnosed 

a left knee sprain. He indicated that appellant reached maximum medical improvement and could 

return to regular duty. Dr. Gray’s reports did not provide an opinion on causal relationship. 

Medical evidence that does not offer an opinion regarding the cause of an employee’s condition is 

of no probative value on the issue of causal relationship.15 These reports are therefore insufficient 

to establish appellant’s claim.

Appellant also submitted reports from Dr. Belew. In an August 10, 2016 report, Dr. Belew 

noted appellant’s complaints of left knee medial pain and indicated that appellant’s x-rays were 

negative and explained that his examination and history were consistent with a medial meniscus 

tear. However, he did not offer any opinion regarding the cause of an employee’s condition.16 

Likewise, Dr. Belew did not provide any opinion on causal relationship in his August 16 and 22, 

2016 work status notes and August 22, 2016 follow-up report. Medical evidence that does not 

offer an opinion regarding the cause of an employee’s condition is of no probative value on the 

issue of causal relationship.17 Thus, these reports are also insufficient to establish the claim.

 

12 See George Randolph Taylor, 6 ECAB 986, 988 (1954) (a medical opinion not fortified by medical rationale is of 

diminished probative value).

13 See supra note11.

14 See M.V., Docket No. 18-0884 (issued December 28, 2018); J.S., Docket No. 17-1039 (issued October 6, 2017).

15 See L.B., Docket No. 18-0533 (issued August 27, 2018); D.K., Docket No. 17-1549 (issued July 6, 2018).

16 Id.

17 Id.
6

In a January 30, 2017 report, Dr. Belew noted that appellant developed an acute effusion 

of the knee. He advised that on workup by MRI scan, he was found to have a meniscal tear, which 

was confirmed at the time of surgery. Dr. Belew opined that it was “extremely unlikely this 

individual would have had a complex tear of the medial meniscus and be able to perform any kind 

a manual labor.” He noted that appellant’s “injury was fitting of the description of his fall with no 

prior history available of any issues with the knee.” Dr. Belew further explained that the injury 

“[u]ndoubtedly occurred as a direct result of the acute injury....” He explained that appellant did 

have several partial thickness chondral irregularities of the joint surface with loose bodies in the 

joint. Dr. Belew noted that “this portion of pathology in the knee certainly could have been

preexisting; however, a fall could have aggravated existing irregularities of the chondral surfaces 

as well.” He opined that the meniscal tear, however, was “clearly acute, indicating of the injury.” 

Dr. Belew also noted that appellant had no prior history of knee problems. The Board has held 

that an opinion that a condition is causally related to an employment injury because the employee 

was asymptomatic before the injury, but symptomatic after it is insufficient, without supporting 

rationale, to establish causal relationship.18 The Board also notes that Dr. Belew did not explain 

his conclusion that the diagnosis was a result of the injury. A medical opinion not fortified by 

medical rationale is of diminished probative value.19 A rationalized opinion is especially important 

as the evidence supports that appellant has a preexisting left knee condition.20 Thus, Dr. Belew’s 

January 30, 2017 report is also insufficient to establish appellant’s claim.

Accordingly, the Board finds that appellant has not met his 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 his burden of proof to establish a left knee 

condition causally related to the accepted June 16, 2016 employment incident.

 

18 John F. Glynn, 53 ECAB 562, 567 (2002).

19 Supra note 12.

20 See S.D., Docket No. 16-0999 (issued October 16, 2017).
7

ORDER

IT IS HEREBY ORDERED THAT the August 24, 2017 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: January 23, 2019

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