United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

L.C., Appellant

and

U.S. POSTAL SERVICE, GRAND CENTRAL 

STATION POST OFFICE, New York, NY, 

Employer

__________________________________________

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Docket No. 18-1707

Issued: April 3, 2019

Appearances: Case Submitted on the Record

Thomas R. Uliase, 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 11, 2018 appellant, through counsel, filed a timely appeal from an April 10, 

2018 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.3

 

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.

3 The Board notes that, following the April 10, 2018 decision, OWCP received additional evidence. However, 

section 501.2(c)(1) of 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 evidence for the first time on appeal. Id.
2

ISSUE

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

conditions causally related to the accepted factors of her federal employment. 

FACTUAL HISTORY

On July 10, 2017 appellant, then a 60-year-old window clerk, filed an occupational disease 

claim (Form CA-2), assigned OWCP File No. xxxxxx319, alleging that her knees swelled from 

walking on the floors in the lobby while at work.4 She related that, after her injury, she worked as 

a window clerk. Appellant further related that, as a lobby director, she was required to stand and 

walk around which caused swelling and pain in her knees. She noted that she returned to her

physician and started treatment for her lower back injury. Appellant reported that her physician 

explained that it was “all related.” She indicated that she first became aware of her condition and 

realized its relationship to her federal employment on May 1, 2017. Appellant stopped work on 

July 3, 2017. No additional evidence was submitted.

By development letter dated July 14, 2017, OWCP informed appellant that the evidence of 

record was insufficient to establish her claim. It advised her of the type of medical and factual 

evidence needed and she was asked to respond to a questionnaire, which sought clarification on 

whether she was claiming an occupational disease or traumatic injury based on the definitions 

provided. In a separate letter of even date, OWCP also requested that the employing establishment 

provide additional information in response to appellant’s allegations.

In a June 21, 2017 attending physician’s report, Dr. Ellen S. Ginsberg, an attending Boardcertified anesthesiologist, noted a history that appellant was a window clerk at the employing 

establishment and that she presented for reevaluation. She recounted that appellant reported a 

history of low back pain radiating to her left hip and left leg, but recently she experienced increased 

pain. Appellant also experienced secondary pain in both knees, but mainly on the left side. 

Dr. Ginsberg noted a history of appellant’s medical, family, and social background. She discussed 

findings on physical examination and assessed sprain of ligaments of the lumbar spine, subsequent 

encounter, unspecified internal derangement of unspecified knee, lumbar radiculopathy, and left 

side lumbago with sciatica. Dr. Ginsberg responded, “yes, see history” when asked whether she 

believed the condition was caused or aggravated by an employment activity. She determined that 

appellant was totally disabled from June 14 through August 2011. Dr. Ginsberg advised that she 

was permanently partially disabled, noting that she had performed light work from August 2011 

through the present with restrictions.

In a July 10, 2017 narrative statement, appellant related that, in June 2011, she fell from a 

chair and injured her lower back. Thereafter, she experienced constant pain from her injury. 

Appellant returned to work with restrictions. She noted that on or about May 1, 2017 she was 

asked to work as a lobby director. Appellant contended that by the end of her workday she had

 

4 Prior to the instant claim, appellant filed a traumatic injury claim (Form CA-1) for a back injury sustained on

June 14, 2011 when she fell against boxes while at work. OWCP accepted her claim, assigned OWCP File No. 

xxxxxx061, for lumbar radiculopathy. By decision dated November 21, 2014, it also accepted that appellant sustained 

a recurrence of disability from March 14 through May 20, 2013 causally related to her accepted June 14, 2011 

employment injury. By decision dated February 11, 2015, OWCP granted her a schedule award for 13 percent 

permanent impairment of the left lower extremity. The award covered a period of 37.44 weeks and ran from April 21, 

2014 through January 8, 2015.
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swelling in her knees and more pain than usual in her lower back. She resumed treatment from 

her physician who advised her to report this new injury to her employer, stop work, and obtain 

treatment for her injury. 

Appellant submitted a July 5, 2017 disability certificate from Dr. Henry Hall, a

chiropractor. Dr. Hall indicated that appellant could return to work on October 3, 2017. He noted 

that she had been unable to work since July 3, 2017. Appellant had a preexisting lower back injury

and a new complaint of a left knee injury.

By letter dated July 18, 2017, an employing establishment customer services supervisor, 

controverted appellant’s claim, contending that she had not established fact of injury.

Dr. Ginsberg, in an August 22, 2017 letter, reevaluated appellant on that date and verified 

that she had been treating appellant in her office due to injuries sustained from a “workmen’s 

compensation” case. She opined that appellant was unable to engage in full-duty work.

By decision dated September 22, 2017, OWCP denied appellant’s occupational disease 

claim, finding that she had failed to submit a rationalized medical opinion explaining how her 

diagnosed conditions were causally related to the accepted factors of her federal employment.

Reports dated September 6 through 18, 2017 from Dr. Hall were received. Dr. Hall

provided objective findings on examination and assessed thoracic and lumbar subluxation and low 

back pain.

Additional reports dated September 6 through 18, 2017 from Dr. Ginsberg were also 

received. Dr. Ginsberg performed applications of high-frequency transcutaneous neurosimulator

(TENS) therapy to treat appellant’s cervical and lumbar pain.

In a letter received by OWCP on October 10, 2017, appellant, through counsel, requested 

a telephonic hearing before an OWCP hearing representative.

Reports dated September 20, 2017 through March 5, 2018 from Dr. Ginsberg were 

received. Dr. Ginsberg performed further applications of high-frequency TENS therapy to treat 

appellant’s cervical and lumbar pain. In attending physician’s reports dated October 24, 2017 and 

January 10 and March 6, 2018, she listed June 14, 2011 as the date of injury. Dr. Ginsberg

reexamined her and continued to assess sprain of ligaments of the lumbar spine, subsequent 

encounter, unspecified internal derangement of unspecified knee, lumbar radiculopathy, and 

lumbago with sciatica, unspecified side. She continued to respond “yes, see history” when asked 

whether she believed the condition was caused or aggravated by an employment activity. 

Dr. Ginsberg advised that appellant was totally disabled from all work. In a letter dated 

December 30, 2017, she noted that she first treated appellant for a work-related low back injury 

that occurred on June 14, 2011. Dr. Ginsberg related that she subsequently returned to modified 

duties as a window clerk where she sold stamps and money orders and received packages. She 

was able to sit on a stool and avoid excessive sitting, standing, walking, and heavy lifting.

Dr. Ginsberg related that appellant was doing relatively well until around April/May 2017 when 

her job duties were increased to include working as a greeter and customer service representative

in the lobby. Appellant was required to continuously stand for one hour or more per day. 

Dr. Ginsberg indicated that she reevaluated appellant for pain management on June 21, 2017. 

Appellant claimed that constant standing had not only caused an exacerbation of her low back 

injury, but also caused secondary pain in both knees, worse on the left side. Dr. Ginsberg 
4

referenced the findings, lumbar and bilateral knee diagnoses, treatment plan, and work restrictions 

set forth in her June 21, August 22, and October 24, 2017 examinations. She related that, in her 

firm professional opinion, the exacerbation of appellant’s low back injury and new injuries to her

knees were caused by her new job as a greeter and customer service representative. Dr. Ginsberg 

opined that constant standing put undue strain on the lumbosacral disc and caused radiculopathy 

and sciatica to recur. She further opined that the change in mechanics of the lumbosacral spine 

from constant standing put undue pressure on both knees. Dr. Ginsberg indicated that the findings 

of bilateral knee magnetic resonance imaging (MRI) scan reports correlated with the positive 

physical findings in her evaluations. She advised appellant to refrain from all job activities, 

continue chiropractic and physical therapy, and see an orthopedist for treatment and possible 

surgery of the secondary injuries to her knees.

Dr. Hall, in reports dated September 20, 2017 through March 6, 2018, again provided 

objective findings on examination and reiterated his assessment of thoracic and lumbar subluxation

and low back pain.

MRI scan reports dated November 13, 2017 from Dr. Michael Yuz, a diagnostic 

radiologist, revealed an impression of grade 1 degeneration of the posterior horn medial meniscus 

and lateral collateral ligament sprain of the right knee and a high-grade partial thickness 

acromioclavicular tear and marrow edema of the patella with grade 2 to 3 chondromalacia of the 

left knee.

In a report dated December 21, 2017, Dr. David R. Capiola, a Board-certified orthopedic 

surgeon, indicated that a left leg ultrasound was negative for deep venous thrombosis. He found

a 2.5 centimeter popliteal cyst.

On March 20, 2018 appellant submitted March 3 and 8, 2018 letters from two coworkers,

describing their lobby work duties.

Appellant also submitted a March 16, 2018 letter from Dr. Ginsberg. Dr. Ginsberg 

clarified her December 30, 2017 report by noting that the employing establishment had 

acknowledged that appellant was required to stand one hour each day as part of her increased work 

duties. She advised that, in her professional opinion, standing continuously for one hour a day 

was the direct precipitating cause of the exacerbation of appellant’s low back pain, as well as, the 

cause of her bilateral knee derangement.

In subsequent reports dated March 13 through 30, 2018, Dr. Ginsberg performed additional 

applications of high-frequency TENS therapy to treat appellant’s cervical and lumbar pain.

Dr. Hall, in reports dated March 13 through April 3, 2018, restated his thoracic and lumbar 

assessments.

By decision dated April 10, 2018, an OWCP hearing representative affirmed the 

September 22, 2017 decision, finding that Dr. Ginsberg had failed to provide a rationalized opinion 

explaining how the diagnosed conditions were caused or aggravated by appellant’s federal 

employment factors. She further found that appellant’s claims under OWCP File No. xxxxxx319 

and OWCP File No. xxxxxx061 should be administratively combined as her prior work-related 
5

back injury had been cross-referenced in the present claim for work-related knee and back 

conditions.

5

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,6that 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.7 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.8 

To establish that an injury was sustained in the performance of duty in an occupational disease 

claim, a claimant must submit the following: (1) medical evidence establishing the presence or 

existence of the disease or condition for which compensation is claimed;9(2) a factual statement 

identifying employment factors alleged to have caused or contributed to the presence or occurrence 

of the disease or condition;10 and (3) medical evidence establishing that the employment factors 

identified by the claimant were the proximate cause of the condition for which compensation is 

claimed or, stated differently, medical evidence establishing that the diagnosed condition is 

causally related to the employment factors identified by the claimant.11 

The medical evidence required to establish causal relationship is rationalized medical 

opinion evidence. The opinion of the physician must be based on a complete factual and medical 

background of the employee, must be one of reasonable 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.12

In any case where a preexisting condition involving the same part of the body is present 

and the issue of causal relationship therefore involves aggravation, acceleration, or precipitation, 

 

5 OWCP subsequently combined OWCP File Nos. xxxxxx061 and xxxxxx319 with OWCP File No. xxxxxx319 

identified as the master file.

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

153 (1989).

7

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

ECAB 312 (1988).

8 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).

9 Michael R. Shaffer, 55 ECAB 386 (2004).

10 Marlon Vera, 54 ECAB 834 (2003); Roger Williams, 52 ECAB 468 (2001).

11 Beverly A. Spencer, 55 ECAB 501 (2004).

12 See J.R., Docket No. 17-1781 (issued January 16, 2018); I.J., 59 ECAB 408 (2008).
6

the physician must provide a rationalized medical opinion that differentiates between the effects 

of the work-related injury or disease and the preexisting condition.13

ANALYSIS

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

conditions causally related to the accepted factors of her federal employment. 

In support of her claim, appellant submitted medical evidence, including a series of reports 

from her physician, Dr. Ginsberg. In her reports, Dr. Ginsberg indicated that appellant reported a 

history that she was employed as a window clerk at the employing establishment and that she 

always suffered from low back pain radiating to her left hip and left leg, but recently she 

experienced increased pain. She also indicated that appellant reported having secondary pain in 

both knees, mainly on the left side. Dr. Ginsberg discussed findings on examination and diagnosed 

sprain of ligaments of the lumbar spine, subsequent encounter; unspecified internal derangement 

of unspecified knee; lumbar radiculopathy; and left side lumbago with sciatica. She performed 

high-frequency TENS therapy to treat appellant’s lumbar and cervical pain and restricted appellant 

from a return to work. 

Dr. Ginsberg, in her October 24, 2017 and January 10 and March 6, 2018 reports, 

responded “yes, see history” with regard to whether she believed that the condition was caused or 

aggravated by an employment activity. 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 has little probative value and is insufficient to establish a 

claim.14

In reports dated December 30, 2017 and March 16, 2018, Dr. Ginsberg opined that an 

exacerbation of appellant’s June 14, 2011 employment-related back condition and her new knee 

injuries had been caused by her employment duties as a greeter and customer service 

representative. She noted that, following appellant’s accepted June 14, 2011 employment-related 

back injury, appellant returned to work in a modified-duty window clerk position, which allowed 

her to perform her duties while sitting on a stool to avoid excessive sitting, standing, walking, and 

heavy lifting. Dr. Ginsberg further noted, however, that, in April/May 2017, appellant was 

assigned increased work duties as a greeter and customer service representative in the lobby, which 

required her to continuously stand for one hour or more a day. She explained that constant standing 

put undue strain on the lumbosacral disc and caused radiculopathy and sciatica to recur. 

Dr. Ginsberg further explained that the change in mechanics of the lumbosacral spine from 

constant standing put undue pressure on both knees. The Board has held that a report is of limited 

probative value regarding causal relationship if it does not contain medical rationale explaining 

how a given medical condition/disability was related to employment factors.15 While Dr. Ginsberg 

generally noted that standing for one hour or more per day caused strain resulting in radiculopathy 

and put pressure on both knees, this explanation does not provide sufficient rationale to explain 

 

13 Federal (FECA) Procedure Manual, Part 2 -- Claims, Causal Relationship, Chapter 2.805.3e (January 2013).

14 See M.O., Docket No. 18-1056 (issued November 6, 2018); Deborah L. Beatty, 54 ECAB 340 (2003).

15 See Y.D., Docket No. 16-1896 (issued February 10, 2017) (finding that a report is of limited probative value 

regarding causal relationship if it does not contain medical rationale describing the relation between work factors and 

a diagnosed condition/disability).
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the specific mechanism of injury. A mere conclusory opinion provided by a physician without the 

necessary rationale explaining how and why the incident or work factors were sufficient to result 

in the diagnosed medical condition is insufficient to meet a claimant’s burden of proof to establish 

a claim.16 

Appellant also submitted a report dated December 21, 2017 by Dr. Capiola who indicated 

that a left leg ultrasound was negative for deep venous thrombosis and who found a 2.5 centimeter 

popliteal cyst. 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.17 

This report, therefore, is insufficient to establish appellant’s claim.

Appellant also submitted a series of chiropractic treatment reports completed by Dr. Hall, 

who noted that she had a preexisting lower back injury and a new complaint of a left knee injury. 

Section 8101(2) of FECA provides that the term physician, as used therein, includes chiropractors 

only to the extent that their reimbursable services are limited to treatment consisting of manual 

manipulation of the spine to correct a subluxation, as demonstrated by x-ray to exist and subject 

to regulation by the Secretary.18 These reports of Dr. Henry are of no probative value on the 

relevant issue of causal relationship as he is not considered a physician as he did not diagnose a 

subluxation based on the results of an x-ray.19

The record also contains diagnostic testing reports including the results of a November 13, 

2017 MRI scan. However, diagnostic studies lack probative value as they do not address whether 

the employment incident caused any of the diagnosed conditions.20 Therefore, such reports are 

insufficient to establish appellants claim.

Finally, appellant submitted statements from coworkers as to her employment duties. 

These statements are irrelevant to the issue of causal relationship and, additionally, lay persons

such as coworkers are not competent to render a medical opinion.21 

The Board finds that appellant has not submitted rationalized, probative medical evidence 

sufficient to establish knee and back conditions causally related to the accepted factors of her 

federal employment. Appellant therefore has not met her burden of proof.

On appeal counsel contends that appellant has submitted sufficient medical evidence to 

establish causal relationship and therefore her claim should be accepted. For the reasons explained 

 

16 J.D., Docket No. 14-2061 (issued February 27, 2015).

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

18 See 20 C.F.R. § 10.311; M.B., Docket No. 17-1378 (issued December 13, 2018).

19 See 5 U.S.C. § 8101(2) of FECA provides as follows: (2) physician includes surgeons, podiatrists, dentists, 

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

defined by State law. The term physician includes chiropractors only to the extent that their reimbursable services are 

limited to treatment consisting of manual manipulation of the spine to correct a subluxation as demonstrated by x-ray 

to exist and subject to regulation by the secretary. See M.B., Docket No. 17-1378 (issued December 17, 2018);

Merton J. Sills, 39 ECAB 572, 575 (1988).

20 See J.S., Docket No. 17-1039 (issued October 6, 2017). 

21 See B.R., Docket No. 17-1661 (issued January 4, 2018); James A. Long, 40 ECAB 538 (1989).
8

above, the Board finds that the evidence of record is insufficient to meet appellant’s 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 knee and back 

conditions causally related to the accepted factors of her federal employment. 

ORDER

IT IS HEREBY ORDERED THAT the April 10, 2018 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: April 3, 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