United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

Z.G., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Jonesboro, GA, Employer

__________________________________________

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Docket No. 19-0967

Issued: October 21, 2019

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

CHRISTOPHER J. GODFREY, Chief Judge

PATRICIA H. FITZGERALD, Deputy Chief Judge

JANICE B. ASKIN, Judge

JURISDICTION

On April 4, 2019 appellant, through counsel, filed a timely appeal from a March 5, 2019 

merit decision of the Office of Workers’ Compensation Programs (OWCP). Pursuant to the 

Federal Employees’ Compensation Act (FECA)2 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 right knee 

condition causally related to the accepted December 19, 2017 employment incident.

FACTUAL HISTORY

On December 19, 2017 appellant, then a 58-year-old letter carrier, filed a traumatic injury 

claim (Form CA-1) alleging that, on that date, she was descending stairs to deliver a package and 

felt pain in the back of her right knee while in the performance of duty. She did not stop work 

following the alleged injury. On the reverse side of the claim form, the employing establishment 

noted that appellant was in the performance of duty when injured, but also controverted her 

entitlement to continuation of pay, noting that she previously fell down her stairs at home and had 

been out of work for at least four weeks. 

On December 19, 2017 the employing establishment executed an authorization for 

examination and/or treatment (Form CA-16) with respect to appellant’s claimed right knee injury. 

Appellant submitted a series of duty status reports (CA-17) and/or physician work activity 

status reports from Dr. Roy E. Hall, a Board-certified family practitioner. Dr. Hall initially

examined appellant on December 19, 2017 and diagnosed right knee sprain. He referred appellant 

for physical therapy and advised that she was unable to work for at least two days.

In a report dated December 21, 2017, Dr. Hall examined appellant’s right knee, noting 

tenderness over the anterior and posterior knee and painful range of motion. He diagnosed right 

knee sprain and recommended a return to work with restrictions. 

On December 28, 2017 Dr. Hall noted that appellant’s right posterior knee symptoms were 

improving. On examination of the right knee, he observed mild posterior swelling and mild diffuse 

tenderness over the posterior knee. Dr. Hall diagnosed right knee sprain and noted that appellant 

was approximately 50 percent of the way to meeting the physical requirements of her job. 

In an unsigned work activity status report dated December 28, 2017, it was recommended 

that appellant return to work on December 28, 2017 with restrictions of sitting 40 percent of the 

time, weight-bearing as tolerated, and no squatting, kneeling, climbing chairs, or climbing ladders. 

In a development letter dated January 12, 2018, OWCP informed appellant that she had 

not submitted sufficient factual or medical evidence to establish her claim. It advised her of the 

type of evidence needed and provided a questionnaire for her completion. OWCP afforded 

appellant 30 days to respond. 

In a narrative statement dated January 31, 2018, appellant explained that she had fallen 

down stairs at a relative’s house on November 5, 2017 and sustained a stress fracture to her left 

foot. She explained that on December 19, 2017 she felt a pull at the back of her right knee while 

descending basement steps at an apartment building to deliver a package while in the performance 

of duty. Appellant clarified that she had not sustained her right knee injury from a fall, but from 

walking down the basement stairs. 
3

In reports dated November 6 through 27, 2017, Dr. Marieli Colon, a podiatric surgery 

specialist, diagnosed a stress fracture of the left foot and localized edema. On December 29, 2017

she reiterated these diagnoses and recommended that appellant continue to wear a brace daily.

OWCP received a January 4, 2018 follow-up report from Dr. Hall who noted that 

appellant’s right knee symptoms had improved. Dr. Hall diagnosed right knee sprain and 

recommended continued work restrictions.

OWCP also received physical therapy notes dated December 20, 2017 through 

January 11, 2018. 

In a report dated January 11, 2018, Dr. Arlene Emmons, an occupational medicine 

specialist, examined appellant for complaints of right knee pain. She noted improved symptoms 

on examination, including diffuse tenderness over the anteromedial, lateral, and posterior knee. 

Dr. Emmons diagnosed right knee sprain and recommended continued work restrictions. 

On January 16, 2018 Dr. Mah-Fri Fomukong, a Board-certified family practitioner, 

examined appellant for complaints of right knee pain. On examination of the right knee, she

observed mild diffuse tenderness over the lateral and medial knee. Dr. Fomukong noted that 

appellant had reached her functional goal and recommended a trial of returning to full duty without 

restrictions. She related that physical therapy notes indicated that appellant had reached 100 

percent of her goals on all examinations. 

In a report dated January 24, 2018, Dr. Fomukong noted that appellant’s subjective right 

knee symptoms had worsened. On examination, she observed normal appearance, no deformity, 

no tenderness, full range of motion, and full strength. Dr. Fomukong diagnosed right knee sprain 

and ordered a magnetic resonance imaging (MRI) scan.

In an attending physician’s report (Form CA-20) dated February 12, 2018, Dr. Hall noted 

that appellant had told him that she had walked down stairs and suddenly experienced knee pain. 

He diagnosed right knee sprain, but left boxes indicating whether he believed appellant’s condition 

was caused or aggravated by employment activity unchecked, noting that he was unsure what 

caused the knee to begin hurting. Dr. Hall noted that appellant was able to resume regular work 

on January 16, 2018. 

In a note dated February 9, 2018, Dr. Fomukong diagnosed right knee sprain, reported that 

appellant was released from care, and recommended that she return to regular-duty work on that 

date. 

By decision dated February 15, 2018, OWCP denied appellant’s claim, finding that she 

had not submitted sufficient evidence to meet her burden of proof to establish causal relationship 

between her diagnosed condition and the accepted December 19, 2017 employment incident. 

OWCP subsequently received a December 19, 2017 narrative report from Dr. Hall who 

examined appellant for complaints of right knee pain after stepping down from stairs the wrong 

way at work on that date. Dr. Hall noted that appellant had walked down stairs and suddenly 

experienced sharp pain in her right knee, which had not improved. On examination of the right 

knee, he observed diffuse tenderness over the anterior and posterior knee, as well as pain on range 
4

of motion testing. Dr. Hall diagnosed right knee sprain, referred appellant for physical therapy, 

and recommended that she remain off work. 

In a follow-up report dated February 9, 2018, Dr. Fomukong noted that appellant’s 

symptoms were improving. On examination of the right knee she observed normal appearance, 

no deformity, no tenderness, full range of motion, and full strength. Dr. Fomukong advised that 

there was no indication for a referral at that time because her physical examination was normal. 

She opined that appellant had reached maximum medical improvement and that she was released 

from care. 

In a letter dated February 23, 2018, Dr. Hall opined that appellant’s pain occurred while 

she was walking down stairs at work. He reported that even though he could not explain how or 

why walking down stairs caused her right knee injury, according to appellant, it did occur while 

she was walking down stairs at work. 

On February 26, 2018 appellant requested a review of the written record before a 

representative of OWCP’s Branch of Hearings and Review. 

By decision dated July 2, 2018, the hearing representative affirmed OWCP’s February 15, 

2018 decision. He found that the opinion contained in Dr. Hall’s February 23, 2018 letter was 

equivocal in nature and insufficient to establish appellant’s claim for a medical condition causally 

related to the accepted incident of December 19, 2017.

An August 14, 2018 right knee MRI scan demonstrated a near complete radial tear near the 

posterior root attachment of the medial meniscus with horizontal extension into the meniscal body 

and associated peripheral extrusion and inflammation along the medial joint line; grade III/IV 

chondromalacia of the weight-bearing medial compartment; grade II/III chondromalacia of the 

patella; grade II chondromalacia of the weight-bearing lateral compartment; small knee joint 

effusion with synovitis; and a small popliteal cyst.

On December 5, 2018 appellant, through counsel, requested reconsideration of OWCP’s 

July 2, 2018 decision. Counsel enclosed reports from Dr. Hall dated November 19, 2018 and 

November 23, 2018. In the November 19, 2018 report, Dr. Hall recalled that, on December 19, 

2017, appellant had relayed that she was walking down steps and suddenly felt sharp pain in her 

knee without falling, twisting, or tripping. He indicated that appellant was descending stairs 

normally and felt pain in her knee. Dr. Hall noted that, with this information, he could not, with 

any certainty, describe the physical process of how walking down stairs could have caused her 

diagnosed condition. The report dated November 23, 2018 was a duplicate of Dr. Hall’s letter 

dated February 23, 2018.

By decision dated March 5, 2019, OWCP denied modification of the prior decision. 

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 of FECA, that an injury was sustained in the performance of duty as alleged, and 
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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. 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.5 The second component is whether the employment incident caused a personal injury.6

Causal relationship is a medical question that generally requires rationalized medical 

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

between the diagnosed condition and the implicated employment incident must be based on a 

complete factual and medical background. Additionally, the physician’s opinion must be 

expressed in terms of a reasonable degree of medical certainty and must be supported by medical 

rationale that explains the nature of the relationship between the diagnosed condition and 

appellant’s employment incident.7

ANALYSIS

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

condition causally related to the accepted December 19, 2017 employment incident.

On December 19, 2017 Dr. Hall noted that appellant had walked down stairs and suddenly 

had sharp pain in her right knee, which had not improved. He diagnosed right knee sprain and 

referred her for physical therapy. On February 12, 2018 Dr. Hall noted that appellant had informed 

him that she had walked down stairs and suddenly experienced knee pain. He diagnosed right 

knee sprain and left boxes indicating whether he believed appellant’s condition was caused or 

aggravated by employment activity unchecked, noting that he was unsure what caused the knee to 

begin hurting. On February 23, 2018 Dr. Hall opined that appellant’s pain occurred while she was 

walking down stairs at work, but he could not explain how or why walking down stairs caused her 

knee injury. On November 19, 2018 he noted that he could not, with any certainty, describe the 

physical process of how walking down stairs could have caused her diagnosed condition. None 

of these medical reports offer an opinion as to whether the accepted employment incident either 

caused or had not caused appellant’s diagnosed conditions. The Board has held that medical 

evidence that does not offer an opinion regarding the cause of an employee’s condition is of no 

 

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); 

DeloresC. Ellyett, 41 ECAB 992 (1990).

5 M.A., Docket No. 19-0656 (issued September 13, 2019); D.S., Docket No. 17-1422 (issued November 9, 

2017); Elaine Pendleton, 40 ECAB 1143 (1989).

6 M.H., Docket No. 18-1737 (issued March 13, 2019); John J. Carlone, 41 ECAB 354 (1989).

7

S.S., Docket No. 18-1488 (issued March 11, 2019).
6

probative value on the issue of causal relationship.8 These reports, therefore, are insufficient to 

establish appellant’s claim. 

Appellant also submitted reports from Dr. Emmons dated January 11, 2018; from

Dr. Fomukong dated January 16 and 24, and February 9, 2018; and from Dr. Colon dated 

December 29, 2017. However, these reports did not include opinions regarding causal relationship 

between appellant’s right knee condition and the accepted employment incident of 

December 19, 2017. These reports are therefore insufficient to establish appellant’s claim.

9

Appellant also submitted a work activity status report dated December 28, 2017 that was 

unsigned. The Board has held, a report that is unsigned or bears an illegible signature lacks proper 

identification and cannot be considered probative medical evidence.10 This report therefore is 

insufficient to establish the claim.

The record also includes a diagnostic report dated August 14, 2018. However, diagnostic 

testing reports lack probative value on the issue of causal relationship as they do not provide an 

opinion regarding the cause of the diagnosed conditions.11

The physical therapy notes dated December 20, 2017 through January 11, 2018 are also 

insufficient to establish appellant’s burden of proof. Certain healthcare providers such as 

physician assistants, nurse practitioners, physical therapists, and social workers are not considered 

“physician[s]” as defined under FECA.12 Consequently, their medical findings and/or opinions 

will not suffice for purposes of establishing entitlement to FECA benefits.13

The Board finds that because appellant has not submitted medical evidence providing a 

rationalized medical opinion that her diagnosed right knee condition was causally related to the 

accepted December 19, 2017 employment incident, she has not met her burden of proof to establish 

her 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.

 

8

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

9

See L.T., Docket No. 18-1603 (issued February 21, 2019).

10 See L.M.,Docket No. 18-0473 (issued October 22, 2018); Merton J. Sills, 39 ECAB 572, 575 (1988).

11 See L.M., Docket No. 14-0973 (issued August25, 2014); R.G., Docket No. 14-0113 (issued April25, 2014); 

K.M., Docket No. 13-1459 (issued December 5, 2013); A.J., Docket No. 12-0548 (issued November 16, 2012).

12 5 U.S.C. § 8101(2); 20 C.F.R. § 10.5(t).

13 See M.F.,Docket No. 17-1973 (issued December 31, 2018); K.W., 59 ECAB 271, 279 (2007); David P. Sawchuk, 

57 ECAB 316, 320 n.11 (2006). A report from a physician assistantor 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) (January 2013).
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CONCLUSION

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

condition causally related to the accepted December 19, 2017 employment incident.

ORDER

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

Compensation Programs is affirmed.

Issued: October 21, 2019

Washington, DC

Christopher J. Godfrey, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board