United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

E.M., Appellant

and

U.S. POSTAL SERVICE, GENERAL MAIL 

FACILITY, San Antonio, TX, Employer

__________________________________________

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Docket No. 18-1599

Issued: March 7, 2019

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 August 20, 2018 appellant filed a timely appeal from an August 1, 2018 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 to 

consider the merits of this case.

ISSUE

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

condition causally related to the accepted April 16, 2018 employment incident.

FACTUAL HISTORY

On April 23, 2018 appellant, then a 62-year-old general clerk, filed a traumatic injury claim 

(Form CA-1) alleging that on April 16, 2018 he injured his right knee while in the performance of 

duty. He explained that his right shoe got caught on a chair, which restrained him from getting 

 

1 5 U.S.C. § 8101 et seq.
2

up and caused his right knee to pop. Appellant stopped work on April 17, 2018 and returned to 

work on April 22, 2018. 

In an April 23, 2018 statement, D.B., a coworker, indicated that on April 16, 2018 she and 

appellant were in the general clerk’s office discussing work that needed to be done and when he

started to stand his knee popped, which D.B. heard. She asked him if he was okay, and commented 

that “he could not walk on it for a while.” D.B. further commented that, “when appellant did walk 

on it, he had a limp and was in pain.” 

Appellant visited an Emergency Clinic on the date of the injury. The discharge notes 

document treatment for a “knee/lower-leg problem,” noted that the pain began around 4:45 a.m., 

and also noted that “[appellant’s] symptoms were not related to any recent trauma.” The authoring 

nurse practitioner diagnosed “pain in right knee,” and prescribed a knee immobilizer, steroidal 

injections, and anti-inflammatory medication. 

Appellant submitted April 16, 2018 emergency clinic treatment notes, which included a 

right knee x-ray, discharge/home-care instructions for right knee pain and use of a knee 

immobilizer, a list of various prescription medications, and a note excusing him from work until 

April 19, 2018. 

An April 16, 2018 right knee x-ray revealed mild tricompartmental degenerative change, a 

nonspecific, small suprapatellar joint effusion, and no evidence of an acute facture or dislocation. 

By way of patient history, the x-ray report noted that appellant stood up and heard a pop in his 

right knee and experienced generalized right knee pain. The radiology report further noted that he

reported that he had his right anterior cruciate ligament removed after a prior injury and that he 

had ongoing joint injections. 

In an April 16, 2018 note, Dr. Aruna Chhabria, a Board-certified family practitioner, 

advised that appellant had been treated in the emergency room that day and was released. She 

further advised that he should not return to work until April 19, 2018. 

By development letter dated June 25, 2018, OWCP advised appellant of the deficiencies 

of his claim with respect to the medical evidence. It explained that the claim required a valid 

diagnosis and a physician’s opinion explaining how the employment activities caused, contributed 

to, or aggravated his medical condition. OWCP afforded appellant 30 days to submit 

documentation, including a comprehensive narrative medical report by his attending physician. 

No further evidence was received.

By decision dated August 1, 2018, OWCP accepted that the April 16, 2018 employment 

incident occurred as alleged, but denied appellant’s claim because the medical evidence of record 

did not contain a diagnosis in connection with the injury. Specifically, it noted that “pain” is not 

a diagnosis of a medical condition under FECA. 

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 
3

time limitation period of FECA,2that 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.3 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.4

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.5 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.6 The second component is whether the employment incident caused a personal 

injury.7 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.8

Causal relationship is a medical question that generally requires rationalized medical 

opinion evidence to resolve the issue.9 A physician’s opinion on whether there is causal 

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

based on a complete factual and medical background.10 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).11

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

therapists, and social workers are not considered “physician[s]” as defined under FECA.12 

 

2 S.B., Docket No. 17-1779 (issued February 7, 2018); J.P., 59 ECAB 178 (2007); Joe D. Cameron, 41 ECAB 

153 (1989).

3

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

ECAB 312 (1988).

4 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).

5 D.B., Docket No. 18-1348 (issued January 4, 2019); T.H., 59 ECAB 388, 393-94 (2008).

6 D.S., Docket No. 17-1422 (issued November 9, 2017); Elaine Pendleton, 40 ECAB 1143 (1989).

7 B.M., Docket No. 17-0796 (issued July 5, 2018); John J. Carlone, 41 ECAB 354 (1989).

8 D.D., Docket No. 18-0648 (issued October 15, 2018); Shirley A. Temple, 48 ECAB 404, 407 (1997).

9 T.H., supra note 5; Robert G. Morris, 48 ECAB 238 (1996).

10 M.V., Docket No. 18-0884 (issued December 28, 2018); Victor J. Woodhams, 41 ECAB 345, 352 (1989).

11 Id.

12 5 U.S.C. § 8101(2); 20 C.F.R. § 10.5(t).
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Consequently, their medical findings and/or opinions will not suffice for purposes of establishing 

entitlement to FECA benefits.

ANALYSIS

The Board finds that appellant has not met his burden of proof to establish a right knee 

condition causally related to the accepted April 16, 2018 employment incident.

The April 16, 2018 emergency clinic records13 documented treatment for knee pain, and 

prescribed a knee brace, steroidal injections, and anti-inflammatory medication. However, “pain”

is not a compensable condition for the purposes of FECA, but is rather a symptom.14 

Appellant’s April 16, 2018 right knee x-ray revealed mild tricompartmental degenerative 

change, a nonspecific, small suprapatellar joint effusion, and no evidence of an acute facture or 

dislocation, Given the often minimalistic nature of diagnostic reports (such as x-ray and magnetic 

resonance imaging scan readings), diagnostic studies standing alone lack probative value.15 Here, 

the x-ray report lacks probative value because it does not address whether the April 16, 2018 

workplace incident either caused or aggravated the identified right knee condition(s).

16

The remainder of the April 16, 2018 medical documents do not establish an injury or 

condition causally related to the accepted April 16, 2018 employment incident. Although

Dr. Chhabria excused appellant from work for three days, she did not provide a specific diagnosis. 

The discharge/home-care instructions detail self-treatment for unspecified “knee pain.” As 

previously stated, “pain” is a symptom, not a diagnosis.17 It is appellant’s burden of proof to obtain 

and submit medical documentation containing a firm diagnosis, and that diagnosis must have 

medical evidence upon which it stands.18 Without it, the Board finds that he has not met his burden 

of proof to show that he sustained any medical condition as a result of the accepted employment 

incident of April 16, 2018. 

 

13 The Board notes that the emergency clinic records were completed by a nurse practitioner. However, notes 

prepared by a nurse practitioner are of no probative value on the issue of causation as a nurse is not considered a 

physician as defined under FECA. Consequently, the nurse practitioner’s medical findings and/or opinion do not 

satisfy appellant’s burden of proof to establish a diagnosis in connection with the accepted employment incident. 

K.W., 59 ECAB 271, 279 (2007); David P. Sawchuk, 57 ECAB 316, 320 n.11 (2006). A report from a physician 

assistant or certified nurse practitioner will be considered medical evidence if countersigned by a qualified physician. 

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

14 B.B., Docket No. 18-1036 (issued December 31, 2018).

15 K.L., Docket No. 18-1029 (issued January 9, 2019); P.Y., Docket No. 18-1136 (issued January 7, 2019). 

16 Id.

17 Supra note 11. 

18 See M.B., Docket No. 17-1647 (issued April 2, 2018).
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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 right knee 

condition causally related to the accepted April 16, 2018 employment incident.

ORDER

IT IS HEREBY ORDERED THAT the August 1, 2018 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: March 7, 2019

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