United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

T.S., Appellant

and

U.S. POSTAL SERVICE, FRESH MEADOWS 

POST OFFICE, Flushing, NY, Employer

__________________________________________

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Docket No. 20-0343

Issued: July 15, 2020

Appearances: Case Submitted on the Record

Thomas S. Harkins, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

CHRISTOPHER J. GODFREY, Deputy Chief Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On December 2, 2019 appellant, through counsel, filed a timely appeal from a July 5, 2019 

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. 

 

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

ISSUE

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

causally related to the accepted June 16, 2017 employment incident.

FACTUAL HISTORY

On June 16, 2017 appellant, then a 40-year-old letter carrier, filed a traumatic injury claim 

(Form CA-1) alleging that on that same date she sustained torn ligaments to her left knee when 

she stepped out of her van onto wet grass and slipped and fell while in the performance of duty. 

She stopped work on June 16, 2017. On the reverse side, the employing establishment indicated 

that appellant was injured in the performance of duty.

In a June 16, 2017 statement, appellant noted that, while completing her route, she exited 

her van onto wet grass and slipped and fell. She reported finishing her mail route and when she 

returned to the office her left knee was swollen and she had difficulty walking. Appellant sought 

treatment in the emergency room.

In an undated statement, Dionne Avery, a family nurse practitioner, treated appellant on 

June 16, 2017. Appellant reported slipping and injuring her left knee. Ms. Avery referred her for 

left knee imaging. Similarly, a June 16, 2017 report from Narina Palinge, a registered nurse, 

provided discharge instructions for musculoskeletal pain.

A June 16, 2017 note from Dr. Lauren Santiesteban, a resident, advised that appellant could 

return to work when the swelling and pain in the left knee improved. In a duty status report (Form 

CA-17) dated June 18, 2017, she noted clinical findings of left medial knee pain and returned 

appellant to work full-time regular duty on June 22, 2017.

In a June 16, 2017 authorization for examination and/or treatment (Form CA-16), the 

employing establishing authorized appellant to seek medical care for a left knee injury. In Part B 

of the Form CA-16, attending physician’s report, dated June 18, 2017, Dr. Santiesteban reported 

that appellant experienced left knee pain after a twisting injury at work. She noted that x-rays 

revealed no fracture or dislocation. Dr. Santiesteban diagnosed left knee sprain versus possible 

meniscus tear. She checked a box marked “No” indicating that the diagnosed conditions were not 

caused or aggravated by the described employment activity. Dr. Santiesteban opined that appellant 

could work light duty until her symptoms improved. 

In a July 6, 2017 development letter, OWCP advised that, when appellant’s claim was 

received, it appeared to be a minor injury that resulted in minimal or no lost time for work. 

Therefore payment of a limited amount of medical expenses was administratively approved 

without formal consideration of the merits of her claim. OWCP opened her claim for consideration 

of the merits. It advised appellant of the deficiencies of her claim and requested additional factual 

and medical evidence from her. OWCP afforded her 30 days to respond.

OWCP received a July 3, 2017 Form CA-17 report from a health care provider whose 

signature was illegible, who noted clinical findings of left knee swelling and possible meniscal 

tear.
3

A July 8, 2017 magnetic resonance imaging (MRI) scan of the left knee revealed anterior 

cruciate ligament (ACL) tear, likely chronic, and no acute bone contusions.

A Form CA-17 report dated July 17, 2017 from Dr. Walter W. Valesky, a specialist in 

emergency medicine, noted clinical findings of left knee pain and antalgic gait. Dr. Valesky

diagnosed a left medial meniscal tear and found appellant disabled from work. 

By decision dated August 9, 2017, OWCP denied appellant’s traumatic injury claim 

finding that the medical evidence submitted was insufficient to establish causal relationship 

between her diagnosed condition and the accepted June 16, 2017 employment incident.

On August 16, 2017 appellant requested an oral hearing before a representative of OWCP’s 

Branch of Hearings and Review that was held on February 13, 2018.

In support of her request, appellant submitted an undated attending physician’s report 

(Form CA-20) from Dr. Valesky who reported that she slipped off a bus and experienced left knee 

pain. Dr. Valesky diagnosed pain in the left knee/medial meniscal tear and checked a box marked 

“Yes” indicating that appellant’s injury was work related. He further indicated that she could 

return to light-duty work. In an undated progress note, Dr. Valesky reported treating appellant 

after a fall while exiting a bus on June 16, 2017. A left knee MRI scan revealed an ACL tear and 

a medial meniscal tear. Dr. Valesky referred appellant to an orthopedic surgeon.3

Prescription notes from Dr. Scott E. Barbash, a Board-certified orthopedist, dated 

September 28, 2017, diagnosed left ACL tear and prescribed crutches and postoperative hinged 

knee brace. On October 5, 2017 he performed a left knee arthroscopic ACL reconstruction with 

hamstring allograft, medial meniscus repair, and partial medial meniscectomy. Dr. Barbash

diagnosed left knee ACL tear and left knee medial meniscal tear. In a progress note dated 

October 12, 2017, he noted treatment of appellant following her left knee ACL reconstruction. 

Dr. Barbash diagnosed rupture of the ACL and sprain of the ACL and recommended physical 

therapy. In Form CA-17 reports dated December 20, 2017 and January 12, 2018, he diagnosed 

ACL meniscal tear and noted that appellant was totally disabled. In a note dated January 12, 2018,

Dr. Barbash diagnosed left knee ACL reconstruction and advised that appellant remain off work 

postoperatively. He noted that she sustained an ACL tear while delivering mail.

Appellant was treated by Dr. William Urban, a Board-certified orthopedist, on 

February 16, 2018. Dr. Urban diagnosed left knee pain and opined that her ACL injury was not a 

chronic injury, rather it was the result of an accident. On March 1, 2018 he noted treating appellant 

after a fall which occurred when she was exiting a bus on June 16, 2017. Dr. Urban opined that 

her symptoms commenced with the injury and were directly related to those injuries. He reviewed 

the MRI scan of the left knee which revealed an ACL tear and medial meniscus tear and referred 

appellant to an orthopedic surgeon. 

By decision dated April 17, 2018, OWCP’s hearing representative affirmed the August 9, 

2017 decision.

 

3 Appellant attended physical therapy treatment on August 7 and 16, 2017.
4

OWCP received reports from Dr. Valesky dated from July 3 to September 8, 2017 in which 

he noted that he administered corticosteroid injections into appellant’s left knee on July 3 

and 17, 2017. The notes indicated that appellant reported that on June 16, 2017 her left foot 

slipped off a bus and she experienced a popping sensation in her left knee. Dr. Valesky diagnosed 

left knee pain and tear of the medial meniscus. In reports dated September 27, 2017 to 

February 28, 2018, he noted his treatment of appellant in follow up and diagnosed left knee pain. 

On April 9, 2019 appellant requested reconsideration. In support of her request, she

submitted reports from Dr. Urban dated May 25 and July 6, 2018 documenting treatment 

following her left ACL reconstruction with medial meniscal repair. Appellant reported injuring 

herself at work. She presented with symptoms of left knee popping and clicking and difficulty 

with stair climbing. Dr. Urban diagnosed rupture of ACL and patellofemoral stress syndrome and 

returned appellant to light-duty work on June 5, 2018. 

On May 17, 2019 appellant was evaluated by Dr. Mohammed Emam, a Board-certified 

physiatrist. Dr. Emam advised her to avoid repetitive bending, lifting/carrying heavy objects, 

twisting, or prolonged standing or walking until she was reevaluated on July 26, 2019.

By decision dated July 5, 2019, OWCP denied modification of the decision dated 

April 17, 2018.

LEGAL PRECEDENT

An employee seeking benefits under FECA4 has the burden of proof to establish the 

essential elements of his or her claim, including 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 of FECA,5that 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.6 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.7

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

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

are two components involved in establishing fact of injury. First, the employee must submit 

sufficient evidence to establish that he or she actually experienced the employment incident at the 

 

4

Id.

5 F.H., Docket No. 18-0869 (issued January 29, 2020); J.P., Docket No. 19-0129 (issued April 26, 2019); Joe D. 

Cameron, 41 ECAB 153 (1989).

6 L.C., Docket No. 19-1301 (issued January 29, 2020); J.H., Docket No. 18-1637 (issued January 29, 2020);

James E. Chadden, Sr., 40 ECAB 312 (1988).

7 P.A., Docket No. 18-0559 (issued January 29, 2020); K.M., Docket No. 15-1660 (issued September 16, 2016);

Delores C. Ellyett, 41 ECAB 992 (1990).
5

time, place, and in the manner alleged. The second component is whether the employment incident 

caused a personal injury and can be established only by medical evidence.8

The medical evidence required to establish causal relationship between a claimed specific 

condition and an employment incident is rationalized medical opinion evidence.9 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, and must be supported by medical rationale explaining the 

nature of the relationship between the diagnosed condition and specific employment factors 

identified by the employee.10

ANALYSIS

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

condition causally related to the accepted June 16, 2017 employment incident.

A February 16, 2018 report from Dr. Urban diagnosed left knee pain and opined that 

appellant’s ACL injury was the result of her accident. The Board has consistently held that a 

diagnosis of “pain” does not constitute the basis for payment of compensation, as pain is a 

symptom rather than a specific diagnosis.11 Therefore, this report is insufficient to establish 

appellant’s claim. 

In other reports from Dr. Urban dated May 25 and July 6, 2018, he noted that appellant 

reported injuring herself at work and diagnosed rupture of ACL and patellofemoral stress 

syndrome. However, such generalized statements do not establish causal relationship because they 

merely repeat appellant’s allegations and are unsupported by adequate medical rationale 

explaining how the accepted June 16, 2017 employment incident actually caused a diagnosed 

medical condition. Thus, these reports are of limited probative value and insufficient to establish 

that appellant sustained an employment-related injury on June 16, 2017.

In a March 1, 2018 report, Dr. Urban diagnosed ACL tear and meniscal tear and opined 

that her symptoms commenced with the injury and were directly related to those injuries. Although

Dr. Urban opined that appellant’s symptoms were directly related to the injury, he failed to provide 

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

the described incident caused or contributed to a diagnosed medical condition.12 Due to this 

deficiency, Dr. Urban’s March 1, 2018 report is also insufficient to establish appellant’s claim.

 

8 T.H., Docket No. 19-0599 (issued January 28, 2020); K.L., Docket No. 18-1029 (issued January 9, 2019); John J. 

Carlone, 41 ECAB 354 (1989).

9 S.S., Docket No. 19-0688 (issued January 24, 2020); A.M., Docket No. 18-1748 (issued April 24, 2019); Robert G. 

Morris, 48 ECAB 238 (1996).

10 T.L., Docket No. 18-0778 (issued January 22, 2020); Y.S., Docket No. 18-0366 (issued January 22, 2020);

Victor J. Woodhams, 41 ECAB 345, 352 (1989).

11 J.P., Docket No. 19-0303 (issued August 13, 2019).

12 K.B., Docket No. 19-0398 (issued December 18, 2019).
6

In an undated progress note, Dr. Valesky reported treating appellant after a fall on 

June 16, 2017. Reports dated July 3, 2017 to February 28, 2018 diagnosed pain in the left knee. 

However, as previously noted, the Board has held that pain is a symptom and not a compensable 

medical diagnosis.13 These notes from Dr. Valesky are therefore, insufficient to establish 

appellant’s claim.

In a Form CA-17 report dated July 17, 2017, Dr. Valesky noted clinical findings of left 

knee pain and antalgic gait and diagnosed left medial meniscal tear. However, he does not render 

an opinion on causation. 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.14 In an undated attending physician’s report, Dr. Valesky indicated by checking a 

box marked “Yes” that appellant’s left knee pain was causally related to the accepted June 16, 

2017 employment incident. The Board has held that an opinion on causal relationship with an 

affirmative check mark, without more by way of medical rationale, is insufficient to establish the 

claim.15 Moreover, pain is a symptom and not a clear diagnosis of a medical condition.16 As such, 

this report is insufficient to establish appellant’s claim. 

Dr. Barbash, in his reports dated September 28 to October 12, 2017, diagnosed left knee 

ACL tear and left knee medial meniscal tear. In Form CA-17 reports dated December 20, 2017

and January 12, 2018, he diagnosed ACL meniscal tear and noted that appellant was totally

disabled. Similarly, in a note dated January 12, 2018, Dr. Barbash diagnosed left knee ACL 

reconstruction and advised that appellant was disabled. While he indicated that appellant was 

disabled from work, he did not provide a history of injury or opinion regarding causal relationship.

The Board has held that a medical opinion should reflect a correct history and offer a medically 

sound explanation by the physician of how the specific employment incident caused or aggravated 

the diagnosed conditions.17 Lacking these elements, these reports are insufficient to establish 

appellant’s claim.18

A June 16, 2017 note from Dr. Santiesteban advised that appellant could return to work 

when the swelling and pain in the left knee improved. In a Form CA-17 report dated June 18, 

2017, she noted clinical findings of left medial knee pain and returned appellant to work full-time 

regular duty. In a Form CA-20 report of even date, Dr. Santiesteban checked a box marked “No”

indicating that the diagnosed conditions were not caused or aggravated by the described 

employment activity and opined that appellant could return to light-duty work. As

 

13 G.L., Docket No. 18-1057 (issued April 14, 2020); J.P., 59 ECAB 178 (2007); Joe D. Cameron, 41 ECAB 

153 (1989).

14 Id.

15 See C.S., Docket No. 18-1633 (issued December 30, 2019); D.S., Docket No. 17-1566 (issued 

December 31, 2018).

16 D.S., id.; see also P.S., Docket No. 12-1601 (issued January 2, 2013).

17 T.M., Docket No. 19-1283 (issued December 2, 2019).

18 Id.; T.G., Docket No. 19-1441 (issued January 28, 2020).
7

Dr. Santiesteban’s reports are unsupportive of appellant’s claim, they are insufficient to meet her 

burden of proof.19

In a May 17, 2019 report, Dr. Emam advised appellant to avoid repetitive bending, 

lifting/carrying heavy objects, twisting, or prolonged standing or walking until she was reevaluated 

on July 26, 2019. He did not offer a medical diagnosis or provide an opinion as to whether a 

diagnosed condition was causally related to the accepted employment incident. The Board has 

held that medical evidence that does not include an opinion regarding the cause of an employee’s 

condition is of no probative value on the issue of causal relationship.20 This report is therefore,

insufficient to establish appellant’s claim.

OWCP also received an MRI scan and x-rays of the left knee. The Board has held, 

however, that reports of diagnostic tests, standing alone, lack probative value as they do not 

provide an opinion on causal relationship between an employment incident and a diagnosed 

condition.21 

Appellant also submitted reports from a nurse practitioner, registered nurse, and physical 

therapist. Certain healthcare providers such as nurse practitioners, registered nurses, and physical 

therapists are not considered “physician[s]” as defined under FECA.22 Consequently, their 

medical findings and/or opinions will not suffice for purposes of establishing entitlement to FECA 

benefits.

23

Finally, OWCP received a July 3, 2017 Form CA-17 report bearing an illegible signature. 

A report that is unsigned or bears an illegible signature lacks proper identification and cannot be 

considered probative medical evidence as the author cannot be identified as a physician.24

On appeal appellant, through counsel, asserted that she submitted sufficient medical 

evidence to establish that she sustained disabling injuries causally related to the employment 

incident on June 16, 2017. As explained above, the evidence of record does not contain an accurate 

history of injury and sufficient medical rationale to establish that appellant’s left knee condition 

was causally related to the accepted June 16, 2017 employment incident. 

 

19 See L.W., Docket No. 19-0698 (issued September 3, 2019).

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

21 See J.M., Docket No. 17-1688 (issued December 13, 2018).

22 Section 8101(2) of FECA provides that physician “includes surgeons, podiatrists, dentists, clinical psychologists, 

optometrists, chiropractors, and osteopathic practitioners within the scope of their practice as defined by State law.” 

5 U.S.C. § 8101(2). 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); R.L., Docket 

No. 19-0440 (issued July 8, 2019) (physical therapists); T.J., Docket No. 19-1339 (issued March 4, 2020) (nurse 

practitioner).

23 K.W., 59 ECAB 271, 279 (2007); see also C.K., Docket No. 19-1549 (issued June 30, 2020).

24 I.M., Docket No. 19-1038 (issued January 23, 2020); K.C., Docket No. 18-1330 (issued March 11, 2019).
8

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 did not meet her burden of proof to establish a left knee 

condition causally related to a June 16, 2017 employment incident.

ORDER

IT IS HEREBY ORDERED THAT the July 5, 2019 decision of the Office of Workers’

Compensation Programs is affirmed.25

Issued: July 15, 2020

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Christopher J. Godfrey, Deputy Chief Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board

 

25 The Board notes that the employing establishment issued a Form CA-16. A completed Form CA-16 authorization 

may constitute a contract for payment of medical expenses to a medical facility or physician, when properly executed.

The form creates a contractual obligation, which does not involve the employee directly, to pay for the cost of the 

examination or treatment regardless of the action taken on the claim. See 20 C.F.R. § 10.300(c); J.G., Docket No. 

17-1062 (issued February 13, 2018); Tracy P. Spillane, 54 ECAB 608 (2003).