United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

J.O., Appellant

and

DEPARTMENT OF THE ARMY, DURHAM 

U.S. ARMY HEALTH CLINIC, Carlisle, PA, 

Employer

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Docket No. 19-0839

Issued: November 12, 2019

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 March 13, 2019 appellant filed a timely appeal from a February 28, 2019 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.2

 

1 5 U.S.C. § 8101 et seq.

2 The Board notes that, following the February 28, 2019 decision, OWCP received additional evidence. However, 

the Board’s Rules of Procedure provides: “The Board’s review of a case is limited to the evidence in the case record 

that was before OWCP at the time of its final decision. Evidence not before OWCP will not be considered by the 

Board for the first time on appeal.” 20 C.F.R. § 501.2(c)(1). Thus, the Board is precluded from reviewing this 

additional evidence for the first time on appeal. Id. 
2

ISSUE

The issue is whether appellant has met her burden of proof to establish that her conditions

were causally related to the accepted September 14, 2018 employment incident.

FACTUAL HISTORY

On January 10, 2019 appellant, then a 53-year-old custodian, filed a traumatic injury claim 

(Form CA-1) alleging that she sustained hip and knee injuries on September 14, 2018 when her 

legs straddled “like doing a split” when she was mopping while in the performance of duty. She 

indicated that she did not immediately report her injury because she did not think anything was 

wrong until she started experiencing knee problems. On the reverse side of the claim form, the 

employing establishment controverted the claim. J.B., a supervisor, explained that appellant did 

not report her injury within 30 days of the date of injury and that no medical evidence supporting 

causal relationship was provided. 

OWCP received work excuse slips dated October 5 and 15, November 13, and 

December 5, 2018, and January 9, 2019, from Dr. James A. Oliverio, a Board-certified orthopedic 

surgeon. A January 4, 2019 note from a nurse was also received regarding treatment provided. 

A January 15, 2019 magnetic resonance imaging (MRI) scan of appellant’s left hip 

interpreted by Dr. Elie M. Azar, an interventional radiologist, demonstrated signal changes in the 

left femoral neck and intertrochanteric region consistent with bone infarcts. 

In a January 22, 2019 treatment note, Dr. Adam Buerk, a Board-certified orthopedic 

surgeon, indicated that appellant was seen for evaluation of left hip pain following an employment 

injury. He noted that she had a “mechanical fall in September 2018 while mopping a floor at work 

causing her to do a split.” Dr. Buerk diagnosed avascular necrosis with collapse, left hip. 

In a development letter dated January 25, 2019, OWCP advised appellant that the evidence 

received to date was insufficient to establish her claim. It informed her of the type of factual and 

medical evidence necessary to establish her claim and provided a questionnaire for her completion. 

OWCP afforded appellant 30 days to submit the necessary evidence.

OWCP received appellant’s supplemental statement describing the employment incident. 

Appellant noted that her left leg straddled faster than her right leg; however, she was able to pull 

herself back up. She explained that, while she experienced pain, she did not initially report the 

incident because she did not believe that she was injured. Appellant continued to work, however, 

a few days later, her knee swelled and she saw her physician. She explained that she did not 

mention the incident to her physician because she did not realize that it was related. Appellant 

explained that, when she saw an orthopedic surgeon, she informed him that she had slipped. 

In an October 5, 2018 report, Dr. Oliverio noted that appellant presented for evaluation of 

bilateral knee pain. He indicated that she began to develop swelling over the posterior aspects of 

the knees. Dr. Oliverio noted that appellant denied any known injury or trauma. He diagnosed 

intermittent synovitis, and bilateral knees. An October 5, 2018 x-ray of the right knee read by

Dr. Oliverio, revealed intermittent synovitis of the bilateral knees. 
3

A January 5, 2019 x-ray of the left hip interpreted by Dr. Raymond Dahl, a Board-certified 

orthopedic surgeon, revealed ilio tibial band syndrome with trochanteric bursitis. 

A January 3, 2019 hospital report from Dr. Gerald E. Willwerth, an interventional 

radiology specialist, noted that appellant presented with left hip and left-sided back pain. He 

indicated that, approximately two months prior, she sustained an injury to her low back and left 

hip when she slipped and “did a split.” Dr. Willwerth diagnosed acute low back pain and acute 

left hip pain. 

A January 24, 2019 MRI scan of the left hip, interpreted by Dr. Azar, revealed findings 

consistent with bone infarcts and no convincing evidence of an acute fracture. 

In response to a series of questions from OWCP, Dr. Buerk in a February 1, 2019 letter,

indicated that he had appended his notes to answer all, but one of the questions. In response to the 

remaining question, as to whether the September 14, 2018 injury necessitated surgery, he opined 

that “[i]t is with a reasonable degree of medical certainty the current treatment and need for surgery 

is directly related to the September 14, 2018 work injury. The mechanism of injury as described 

by [appellant] directly correlates to her clinical examination.”

By decision dated February 28, 2019, OWCP accepted that the September 14, 2018 

employment incident occurred as alleged. However, it denied appellant’s traumatic injury claim,

finding that the medical evidence of record was insufficient to establish causal relationship 

between her diagnosed conditions and the accepted September 14, 2018 employment incident.

LEGAL PRECEDENT

An employee seeking benefits under FECA 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 timely filed within the applicable 

time limitation period of FECA,3that an injury 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 These are the essential elements of each and every compensation claim, 

regardless of whether the claim is predicated upon a traumatic injury or an occupational disease.5 

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 

 

3 S.N., Docket No. 18-1627 (issued May 15, 2019); S.B., Docket No. 17-1779 (issued February 7, 2018); J.P., 59 

ECAB 178 (2007); Joe D. Cameron, 41 ECAB 153 (1989).

4

J.M., Docket No. 17-0284 (issued February 7, 2018); R.C., 59 ECAB 427 (2008); James E. Chadden, Sr., 40 

ECAB 312 (1988).

5 K.M., Docket No. 15-1660 (issued September 16, 2016); L.M., Docket No. 13-1402 (issued February 7, 2014); 

Delores C. Ellyett, 41 ECAB 992 (1990).
4

allegedly occurred.6 The second component is whether the employment incident caused a personal 

injury.7 

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve.8 A physician’s opinion regarding causal relationship between the diagnosed 

condition and the implicated employment incident must be based on a complete factual and 

medical background.9 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 an employment incident.10

ANALYSIS

The Board finds that appellant has not met her burden of proof to establish that her 

conditions were causally related to the accepted September 14, 2018 employment incident. 

OWCP received work excuse notes in support of appellant’s claim. The notes dated 

October 5 and 15, November 13, and December 5, 2018, and January 9, 2019, from Dr. Oliverio, 

and the January 22, 2019 work excuse from Dr. Buerk, do not provide an opinion on the issue of 

causal relationship. The Board has held that 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.11 These reports, therefore, are insufficient to establish appellant’s claim.

Similarly, in a January 3, 2019 hospital report, Dr. Willwerth diagnosed acute low back 

pain and acute left hip pain. However, pain is a symptom and not a valid diagnosis.12 This report 

was insufficient to establish appellant’s claim as it did not provide a firm diagnosis of a medical 

condition causally related to the accepted employment incident.13 

In an October 5, 2018 report, Dr. Oliverio noted that appellant began to develop swelling 

over the posterior aspects of the knees, but denied any known injury or trauma. He diagnosed 

intermittent synovitis, bilateral knees. The Board finds that Dr. Oliverio did not offer an opinion 

as to the cause of appellant’s diagnosed conditions and did not describe any injury as occurring at

work. As noted above, the Board has held that medical evidence that does not offer an opinion 

 

6 See T.O., Docket No. 18-1012 (issued October 29, 2018); Elaine Pendleton, 40 ECAB 1143 (1989).

7 See T.O., id.; John J. Carlone, 41 ECAB 354 (1989).

8 See K.C., Docket 17-1693 (issued October 29, 2018); Robert G. Morris, 48 ECAB 238 (1996).

9 See K.C., id.; Victor J. Woodhams, 41 ECAB 345, 352 (1989).

10 Id.

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

12 D.B., Docket No. 18-1359 (issued May 14, 2019).

13 Id.
5

regarding the cause of an employee’s condition is of no probative value on the issue of causal

relationship.14 This report is insufficient to establish appellant’s claim.

In a January 22, 2019 treatment note, Dr. Buerk reported that, in September 2018, 

appellant’s legs split while mopping at work. He diagnosed avascular necrosis with collapse, left 

hip; however, he offered no opinion that the diagnosed condition was the result of the employment 

incident. As previously noted, the Board has held that 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 This report is also insufficient to establish appellant’s claim.

In a February 1, 2019 report, Dr. Buerk opined: ‘‘[i]t is with a reasonable degree of 

medical certainty the current treatment and need for surgery is directly related to the 

[September] 14, 2018 work injury.” He explained that “the mechanism of injury as described by 

[appellant] directly correlates to her clinical examination.” However, Dr. Buerk did not provide a

history of injury or offer medical rationale explaining how appellant’s conditions were caused by 

the employment incident. Simply, offering a conclusion is insufficient to establish a causal 

relationship.16 To be of probative medical value, a medical opinion must explain how 

physiologically the movements involved in the employment incident caused or contributed to the 

diagnosed conditions.17 Lacking this rationalized explanation, Dr. Buerk’s reports are therefore 

insufficient to establish appellant’s claim.

OWCP also received a January 4, 2019 note from a nurse. Nurses, however, are not

considered “physician[s]” as defined under FECA.18 Consequently, their medical findings and/or 

opinions will not suffice for purposes of establishing entitlement to FECA benefits.19

Appellant submitted diagnostic imaging studies in the form of an October 5, 2018 x-ray of 

the right knee, a January 5, 2019 x-ray of the left hip, and MRI scans of the left hip dated

January 15 and 24, 2019. The Board has held that diagnostic studies lack probative value as they 

 

14 Supra note 11. 

15 Id. 

16 See id.

17 T.C., Docket No. 18-1498 (issued February 13, 2019).

18 5 U.S.C. § 8102(2) of FECA provides that the term “physician” includes surgeons, podiatrists, dentists, clinical 

psychologists, optometrists, chiropractors, and osteopathic practitioners within the scope of their practice as defined 

by State law; see T.T., Docket No. 18-0838 (issued September 19, 2019). See also David P. Sawchuk, 57 ECAB 316, 

320 n.11 (2006) (lay individuals such as physician assistants, nurses, and physical therapists are not competent to 

render a medical opinion under FECA). 5 U.S.C. § 8101(2); 20 C.F.R. § 10.5(t). O.R., Docket No. 18-1458 (issued 

August 2, 2019) (nurse practitioners are not considered a physician as defined under FECA).

19 Federal (FECA) Procedure Manual, Part 2 -- Claims, Causal Relationship, Chapter 2.805.3a(1) (January 2013).
6

do not provide an opinion on causal relationship between the employment incident and her

diagnosed conditions.20 These reports are therefore also insufficient to establish appellant’s claim.

As there is no well-reasoned medical opinion establishing appellant’s claim for 

compensation, the Board finds that 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 

conditions were causally related to the accepted September 14, 2018 employment incident.

ORDER

IT IS HEREBY ORDERED THAT the February 28, 2019 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: November 12, 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

 

20 See R.C., Docket No. 19-0376 (issued July 15, 2019); C.B., Docket No. 18-0071 (issued May 13, 2019).