United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

J.S., Appellant

and

DEPARTMENT OF VETERANS AFFAIRS, 

HUDSON VALLEY HEALTH CARE SYSTEM, 

Castle Point, NY, Employer

__________________________________________

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Docket No. 18-0128 

Issued: June 1, 2018

Appearances: Case Submitted on the Record

Paul Kalker, 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 October 23, 2017 appellant, through counsel, filed a timely appeal from an August 9, 

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 to consider the merits of this case.

ISSUE

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

causally related to the accepted July 22, 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

On appeal counsel argues that the medical evidence of record establishes appellant’s 

claim.

FACTUAL HISTORY

On July 22, 2016 appellant, then a 60-year-old laborer, filed a traumatic injury claim 

(Form CA-1) alleging that, on that date, he injured his right knee when he tripped over a metal 

bar and fell onto his right knee while in the performance of duty. He stopped work on 

July 22, 2016.

On August 24, 2016 Dr. Louis McIntyre, an attending Board-certified orthopedic 

surgeon, referred appellant for physical therapy for his right knee pain.

Dr. McIntyre, in notes dated October 5 and November 15, 2016, diagnosed patellar 

fracture and recommended rehabilitation services for appellant.

In a November 15, 2016 report, Dr. McIntyre provided examination findings and noted 

appellant’s medical history including a four-month history of right anterior knee pain. His 

diagnoses included left patella closed displaced comminuted fracture with malunion, right patella 

closed nondisplaced transverse fracture with routine healing, and pain.

By development letter dated December 29, 2016, OWCP advised appellant that when his 

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

work and, since the employing establishment did not controvert continuation of pay or challenge 

the case, a limited amount of medical expenses were administratively approved and paid. It 

noted that his claim had been reopened because the medical bills had exceeded $1,500.00. 

OWCP requested that appellant submit additional factual and medical evidence within 30 days. 

Appellant did not submit any additional evidence within the time allotted.

By decision dated February 28, 2017, OWCP denied appellant’s traumatic injury claim. 

It found that the medical evidence of record was insufficient to establish that the diagnosed 

condition was causally related to the accepted July 22, 2016 work incident.

OWCP subsequently received two reports, dated August 22, 2016 and March 27, 2017,

from Dr. McIntyre. 

In the August 22, 2016 report, Dr. McIntyre noted that appellant was seen for right knee 

pain due to a fall at work five weeks prior. He observed appellant using a walker and 

demonstrating an antalgic gait. Appellant’s physical examination revealed right knee swelling 

and tenderness, limited range of motion, no valgus stress or varus stress laxity, and negative 

Lachman’s test. An x-ray interpretation revealed minimally displaced articular surface 

congruent patellar fracture. Dr. McIntyre diagnosed closed nondisplaced right patella traverse 

fracture and referred appellant for physical therapy. He related that appellant could return to 

work in 8 to 10 weeks. 

In the March 27, 2017 report, Dr. McIntyre noted that appellant was first seen on 

August 22, 2016 for a work injury. Appellant related that approximately five weeks prior he fell 

directly on his right knee while at work. Physical examination findings included an antalgic gait 

while using a walker, pain on palpation of the right knee, mild right knee effusion, decreased 
3

right knee range of motion, negative anterior and posterior drawer tests, and negative Lachman 

test. Dr. McIntyre reviewed an x-ray interpretation which revealed a minimally displaced patella 

fracture. He opined that appellant’s right patellar fracture with malunion was directly caused by 

the July 2016 work incident. 

By decision dated August 9, 2017, OWCP denied modification of its prior decision. It 

found that the evidence of record was insufficient to establish causal relationship between the 

diagnosed conditions and the accepted employment incident. 

LEGAL PRECEDENT

An employee seeking benefits under FECA3 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.4 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.5

To determine whether a federal employee has sustained a traumatic injury in the 

performance of duty it must first be determined whether fact of injury has been established.6 

First, the employee must submit sufficient evidence to establish that he or she actually 

experienced the employment incident at the time, place, and in the manner alleged.7 Second, the 

employee must submit sufficient evidence, generally only in the form of medical evidence, to 

establish that the employment incident caused a personal injury.8

Causal relationship is a medical issue and the medical evidence generally required to 

establish causal relationship is rationalized medical opinion evidence.9 Rationalized medical 

opinion evidence is medical evidence which includes a physician’s rationalized opinion on 

whether there is causal relationship between the employee’s diagnosed condition and the 

compensable employment factors.10 The opinion of the physician must be based on a complete 

factual and medical background of the employee, must be one of reasonable medical certainty, 

 

3

Id.

4 C.S., Docket No. 08-1585 (issued March 3, 2009); Bonnie A. Contreras, 57 ECAB 364 (2006).

5 S.P., 59 ECAB 184 (2007); Joe D. Cameron, 41 ECAB 153 (1989).

6 B.F., Docket No. 09-60 (issued March 17, 2009); Bonnie A. Contreras, supra note 4.

7 D.B., 58 ECAB 464 (2007); David Apgar, 57 ECAB 137 (2005).

8 C.B., Docket No. 08-1583 (issued December 9, 2008); D.G., 59 ECAB 734 (2008); Bonnie A. Contreras, supra

note 4.

9 Y.J., Docket No. 08-1167 (issued October 7, 2008); A.D., 58 ECAB 149 (2006); D’Wayne Avila, 57 ECAB 

642 (2006).

10 J.J., Docket No. 09-27 (issued February 10, 2009); Michael S. Mina, 57 ECAB 379 (2006)
4

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.11 

ANALYSIS

The Board finds that appellant has failed to meet his burden of proof to establish a right 

knee condition causally related to the accepted July 22, 2016 employment incident.

In support of his claim appellant submitted reports from Dr. McIntyre. In the August 22, 

2016 report, Dr. McIntyre diagnosed closed nondisplaced right patella traverse fracture. He, 

however, did not address causation condition in the August 22, 2016 report. 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.12 Thus, this report is insufficient to meet 

appellant’s burden of proof.

In a March 27, 2107 report, Dr. McIntrye noted that appellant fell on his right knee at 

work approximately five weeks prior. He diagnosed right patellar fracture with malunion which 

he attributed to the July 2016 work incident. To establish causal relationship, a physician must 

provide a narrative description of the identified employment incident and a reasoned opinion on 

whether the employment incident described caused or contributed to appellant’s diagnosed 

medical condition.13 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.14 Dr. McIntrye provided no supporting rationale explaining his conclusion, and thus, this 

report is insufficient to meet appellant’s burden of proof.

In order to establish causal relationship, a physician must provide an opinion that the 

condition for which compensation is claimed is causally related to federal employment and such 

relationship must be supported with affirmative evidence, explained by medical rationale, and be 

based upon a complete and accurate medical and factual background of the claimant.15 

Appellant has not submitted a medical report sufficient to show a diagnosed condition causally 

related to the accepted July 22, 2016 employment incident, and thus has not met his burden of 

proof.

On appeal counsel argues that the medical evidence of record establishes appellant’s 

claim for a work-related traumatic injury on July 22, 2016. However, the Board has explained 

 

11 I.J., 59 ECAB 408 (2008); Victor J. Woodhams, 41 ECAB 345 (1989).

12 See T.W., Docket No. 17-1904 (issued February 16, 2018); S.E., Docket No. 08-2214 (issued May 6, 

2009); Conard Hightower, 54 ECAB 796 (2003); Willie M. Miller, 53 ECAB 697 (2002).

13 See K.B., Docket No. 17-1363 (issued February 14, 2018); John W. Montoya, 54 ECAB 306 (2003).

14 D.R., Docket No. 17-1584 (issued February 8, 2018); Docket No. 08-0975 (issued February 6, 2009); Roma A. 

Mortenson-Kindschi, 57 ECAB 418 (2006); William C. Thomas, 45 ECAB 591 (1994) (a medical report is of 

limited probative value on the issue of causal relationship if it contains a conclusion regarding causal relationship 

which is unsupported by medical rationale).

15 See J.W., Docket No. 17-0870 (issued July 12, 2017).
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the deficiencies in the reports contained in the record and, thus, why appellant has failed to 

establish his claim.

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 July 22, 2016 employment incident.

ORDER

IT IS HEREBY ORDERED THAT the decision of the Office of Workers’

Compensation Programs dated August 9, 2017 is affirmed.

Issued: June 1, 2018

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