United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

M.B., Appellant

and

DEPARTMENT OF THE ARMY, U.S. ARMY 

CORPS OF ENGINEERS, Seattle, WA, 

Employer

__________________________________________

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Docket No. 19-1655

Issued: April 7, 2020

Appearances: Case Submitted on the Record

Howard L. Graham, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

PATRICIA H. FITZGERALD, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On August 1, 2019 appellant, through counsel, filed a timely appeal from a February 28, 

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 his burden of proof to establish that the acceptance 

of his claim should be expanded to include additional conditions as causally related to his accepted 

April 21, 2016 employment injury. 

FACTUAL HISTORY

On May 24, 2016 appellant, then a 49-year-old power plant operator, filed a traumatic 

injury claim (Form CA-1) alleging that on April 21, 2016 he tripped over low hanging wires and 

struck the concrete floor with both knees while in the performance of duty. On June 8, 2017

OWCP accepted the claim for contusion of the right knee and meniscus tear of the right knee. 

Appellant stopped work on May 23, 2016.

Appellant treated with Dr. Navin Nagaraj, a Board-certified internist, on August 7, 2017 

for chronic knee and back pain. Dr. Nagaraj reported that in April 2016 appellant tripped at work 

and wrenched both knees and sprained his back. Appellant related that his back pain was

progressively worsening and associated with leg pain and weakness. Dr. Nagaraj noted an x-ray 

of the thoracic spine from August 2016 revealed mild multilevel thoracic disc space narrowing, 

endplate spurring, with significant spondylosis within the cervical spine. Similarly, an x-ray of 

the lumbar spine revealed trace anterolisthesis of L5 upon S1, pars interarticularis defect, facet 

athropathy at L2-S1, and mild degenerative endplate spurring at L4-5. Findings on examination

of the knees revealed decreased range of motion, patellar tendon tenderness, and tenderness of the 

thoracic and lumbar spine. Dr. Nagaraj diagnosed osteoarthritis of the lumbar and thoracic spines 

with radiculopathy, chronic instability of the right knee, and chondromalacia of the right knee.

Appellant followed up with Dr. Nagaraj again on August 17, 2017 and issued a progress 

note and letter. Dr. Nagaraj noted that appellant presented with worsening back and bilateral knee 

pain. Appellant reported that there was a delay of nine months in OWCP in accepting his claim 

and as a result he lost his job and his back condition progressed to the point where he was unable 

to do the lightest of labor without aggravating his condition. He asserted that the delay and time 

spent without treatment for his knee injuries caused his lower back injury. Appellant also reported 

that earlier in the year he felt a “pop” in his back and sharp pain shooting down both legs while 

trying to pick up his daughter. Findings on examination revealed decreased range of motion and 

tenderness of the thoracic and lumbar spine, positive straight leg raises bilaterally, and crepitus in 

the bilateral knees. Dr. Nagaraj diagnosed acute meniscal tear of the right knee, contusion of the 

right knee, and lumbar radiculopathy. He opined that lumbar radiculopathy was a consequential 

injury to the right knee injury sustained in April 2016. Dr. Nagaraj explained that the right knee 

injury caused appellant to favor his left knee and left side thereby changing the way he walked.

On August 22, 2017 Dr. Casey Cornelius, an osteopath and orthopedic surgeon, evaluated 

appellant for right knee injury which occurred at work. He diagnosed chondromalacia patella of 

the right knee.

Appellant was treated by Dr. Neil N. Saldua, a Board-certified orthopedist, on October 22, 

2017 for lumbar and thoracic spine pain. Dr. Saldua reported an onset in April 2016 when 

appellant fell approximately three feet at work. Findings on examination revealed tenderness of 
3

the cervical, thoracic and lumbar areas of the spine, and restricted range of motion of the lumbar 

spine. Dr. Saldua diagnosed low back pain after an on-the-job injury.

An x-ray of the lumbar spine dated October 23, 2017 revealed no fractures or dislocations, 

and no dynamic instability or spondylolisthesis.

A magnetic resonance imaging (MRI) scan of the lumbar spine dated October 31, 2017 

revealed mild grade 1 anterolisthesis at L4-5, mild central canal narrowing at L4-5, mild 

neuroforaminal narrowing at L4-5 and L5-S1, small anterior endplate osteophytes at L2-3, and no 

evidence of herniated nucleus pulposus.

Dr. Saluda treated appellant in follow up on November 7, 2017 and January 9, 2018 for 

low back pain with radiation into the left lower extremity. He noted an essentially normal physical 

examination. Dr. Saluda reviewed the MRI scan and diagnosed grade 1 degenerative 

spondylolisthesis at L4-5 with right-sided L4-5 facet cyst. He recommended physical therapy and 

activity modification.

In a letter dated January 9, 2018, Dr. Saluda diagnosed grade 1 degenerative 

spondylolisthesis at L4-5. He indicated that appellant was injured on April 21, 2016 when he fell 

three feet at work. Dr. Saluda noted that on initial evaluation appellant’s knees were the focus as 

they were bothering him the most. He opined that the work-related injury caused greater than 51 

percent of his current symptoms. 

Dr. Cornelius treated appellant in follow-up on January 12 and March 14, 2018 for 

persistent popping of the right knee with activity. He diagnosed right knee osteoarthritis and 

recommended platelet rich plasma (PRP) injections.

Appellant received physical therapy treatment on January 15 and March 12, 2018.

An x-ray of the right knee dated March 19, 2018 revealed narrowing of the medial joint 

space and patellofemoral space, and small osteophyte formation.

On April 30, 2018 OWCP referred appellant, the case file, a statement of accepted facts 

(SOAF), and a series of questions to Dr. Mary Rose Anne Cunningham, a Board-certified 

orthopedic surgeon, for a second opinion examination and opinion on appellant’s employmentrelated conditions and disability. It requested that Dr. Cunningham determine whether appellant 

continued to suffer from residuals of his work-related injury and whether he was capable of 

returning to gainful employment. 

In a May 10, 2018 medical report, Dr. Cunningham described appellant’s April 21, 2016 

employment injury, noting that he tripped on wires and struck the concrete with both knees. She 

discussed appellant’s medical history, reviewed diagnostic reports, and provided findings on 

physical examination. Dr. Cunningham diagnosed bilateral patellofemoral osteoarthritis, 

preexisting, low back pain, secondary to degenerative spondylotic changes, not work related, and 

right knee contusion and right knee medial meniscal tear. She opined that the diagnosed conditions 

were not considered to be related to the incident of April 21, 2016 by direct cause, aggravation, 

precipitation, or acceleration. Dr. Cunningham noted that appellant sustained a mechanical, low 

energy, ground level fall and would not be expected to have ongoing sequelae. She noted that 
4

there was no mention of a low back injury until August 7, 2017, nearly 16 months after the work 

event. Dr. Cunningham further noted multiple areas of degenerative changes in his lumbar and 

thoracic spine and patellofemoral arthrosis which developed over a prolonged time (even decades)

and would not be the result of the ground level fall in April 2016. She noted that appellant’s active 

lifestyle including playing ice hockey and international mountain climbing would be expected to 

cause more significant impact upon appellant’s arthritic conditions than a ground level fall. 

Dr. Cunningham opined that, based on these factors, she could not relate the back symptomology 

or ongoing knee symptoms to the alleged work event. She found no residuals of the work injury 

which was considered resolved and concluded that appellant did not require any further treatment 

or work restrictions related to the accepted conditions. 

By decision dated June 20, 2018, OWCP denied expansion of the acceptance of appellant’s 

claim, finding that the medical evidence of record was insufficient to establish that the additional 

condition of degenerative spondylolisthesis of the lumbar spine was causally related to the 

accepted April 21, 2016 employment injury. It noted that the second opinion report of

Dr. Cunningham established that appellant did not develop degenerative spondylolisthesis of the 

lumbar spine as a consequence of his accepted injury.

On July 19, 2018 appellant, through counsel, requested an oral hearing before an OWCP 

hearing representative which was held on December 14, 2018.

OWCP subsequently received a December 19, 2018 report wherein Dr. Cornelius noted 

that he treated appellant in follow up and diagnosed right knee osteoarthritis. 

In a report dated February 25, 2019, Dr. Nagaraj noted treating appellant since February 28, 

2013 for lumbar and knee injuries sustained at work on August 7, 2011.3 He described appellant’s 

April 21, 2016 employment injury, noting that he tripped on wires and struck the concrete with 

both knees. Dr. Nagaraj opined that appellant’s lumbar condition arose as a consequential 

condition due to the delay in seeking treatment for his right knee condition and the ergonomic 

issues it caused to appellant’s gait and change in walk. He concluded with a reasonable medical 

certainty that the April 21, 2016 accepted employment injury contributed to the current lumbar 

condition which was diagnosed by MRI scan on October 31, 2017. Dr. Nagaraj diagnosed mild 

grade 1 anterolisthesis at L4-5 and mild central canal narrowing at L4-5, mild right neuroforaminal 

narrowing at L4-5 and mild left neuroforaminal narrowing at L5-S1, small anterior endplate 

osteophytes present at L2-3, and no evidence of acute herniated nucleus pulposus.

By decision dated February 28, 2019, an OWCP hearing representative affirmed the 

June 20, 2018 decision.

 

3 OWCP assigned that claim File No. xxxxxx575 and accepted it for bilateral sprain of the lateral collateral ligament 

of the knee. Appellant’s claims have not been administratively combined.
5

LEGAL PRECEDENT

When an employee claims that a condition not accepted or approved by OWCP was due to 

an employment injury, he or she bears the burden of proof to establish that the condition is causally 

related to the employment injury.4 

To establish causal relationship, the employee must submit rationalized medical opinion 

evidence.5 The opinion of the physician must be based on a complete factual and medical 

background of the claimant, 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 

the accepted employment injury.

6

 The weight of medical evidence is determined by its reliability, 

its probative value, its convincing quality, the care of analysis manifested, and the medical 

rationale expressed in support of the physician’s opinion.7

ANALYSIS

The Board finds that appellant has not established that the acceptance of his claim should 

be expanded to include additional conditions as causally related to his accepted April 21, 2016 

employment injury. 

In support of his request for claim expansion, appellant submitted an August 7, 2017 report 

from Dr. Nagaraj who noted that, while at work in April 2016, appellant tripped and wrenched 

both knees and sprained his back. Dr. Nagaraj diagnosed osteoarthritis of the lumbar and thoracic 

spines with radiculopathy, chronic instability of the right knee, and chondromalacia of the right 

knee. However, he did not offer medical rationale explaining how the accepted employment injury 

caused the diagnosed lumbar condition.8 Dr. Nagaraj did not explain how the mechanism of injury 

would have physiologically caused or aggravated the additional diagnosed conditions.

9

On August 17, 2017 Dr. Nagaraj diagnosed acute meniscal tear of the right knee, contusion 

of the right knee, and lumbar radiculopathy. He opined that the lumbar radiculopathy was a 

consequential injury as a result of the right knee injury sustained in April 2016. Dr. Nagaraj 

explained that the right knee injury caused appellant to favor his left knee and left side thereby 

changing the way he walked causing the left knee and lumbar back conditions. He further 

determined that the nine-month delay by OWCP in accepting his claim for his knee injuries caused 

his lower back injury. Similarly, in a report dated February 25, 2019, Dr. Nagaraj noted diagnoses 

 

4

See T.F., Docket No. 17-0645 (issued August 15, 2018); Jaja K. Asaramo, 55 ECAB 200 (2004).

5

See S.A.,Docket No. 18-0399 (issued October 16, 2018).

6

See P.M.,Docket No. 18-0287 (issued October 11, 2018).

7

Id.

8

See C.F., Docket No. 18-1156 (issued January 22, 2019); T.M.,Docket No. 08-0975 (issued February 6, 2009) (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).

9

See F.H., Docket No. 18-1238 (issued January 18, 2019); J.R., Docket No. 18-0206 (issued October 15, 2018).
6

and opined that appellant’s lumbar condition arose as a consequential condition due to the delay 

in seeking treatment for his right knee condition and the ergonomic issues it caused to appellant’s 

gait and change in walk. He noted with a reasonable medical certainty the accepted injury of 

April 21, 2016 contributed to the current lumbar condition. While he provided affirmative 

opinions which supported causal relationship, Dr. Nagaraj did not offer a rationalized medical 

explanation in any of his reports to support his opinion. Medical evidence that provides a 

conclusion, but does not offer a rationalized medical explanation regarding the cause of an 

employee’s condition is of limited probative value on the issue of causal relationship.10

Other reports from Dr. Cornelius dated August 22, 2017 to December 19, 2018, evaluated 

appellant for right knee injury which occurred at work and diagnosed chondromalacia patella of 

the right knee and osteoarthritis. These reports are of no probative value as to whether acceptance 

of the claim should be expanded as they do not address the additional 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 probative value on the issue of causal relationship.11 Thus, these 

reports are insufficient to meet appellant’s burden of proof.

Reports from Dr. Saldua dated October 22, 2017 to January 9, 2018 noted a history of 

injury and diagnosed grade 1 degenerative spondylolisthesis at L4-5. Dr. Saldua opined that the 

work-related injury was greater than 51 percent of the cause of his current symptoms. While his

opinion is generally supportive of causal relationship, Dr. Saldua again did not provide adequate 

medical rationale explaining the basis of his opinion on causal relationship.12 Thus, the Board 

finds that his reports are insufficient to establish appellant’s burden of proof. 

OWCP further developed the issue of whether the acceptance of appellant’s claim should 

be expanded to include degenerative spondylolisthesis of the lumbar spine by referring him to

Dr. Cunningham, a second opinion examining physician. On May 10, 2018 Dr. Cunningham

discussed appellant’s April 21, 2016 employment injury and subsequent complaints of bilateral 

knee and lumbar pain. She diagnosed bilateral patellofemoral osteoarthritis, preexisting, low back 

pain, secondary to degenerative spondylotic changes, not work related, and right knee contusion 

and right knee medial meniscal tear. Dr. Cunningham opined that the diagnosed conditions were 

not considered to be related to the incident of April 21, 2016 by direct cause, aggravation, 

precipitation, or acceleration. She noted that appellant sustained a mechanical, low energy, ground 

level fall which would not have caused the ongoing sequelae. Rather, Dr. Cunningham noted that 

appellant’s active lifestyle including playing ice hockey and international mountain climbing trips 

would have a more significant impact upon his arthritic condition than the April 21, 2016 incident. 

She noted multiple areas of degenerative changes in his lumbar and thoracic spine and 

patellofemoral arthrosis which developed over a prolonged time (decades) and would not be the 

result of the ground level fall in April 2016. Dr. Cunningham further noted that there was no 

 

10 C.V., Docket No. 18-1106 (issued March 20, 2019); M.E., Docket No. 18-0330 (issued September 14, 2018); 

A.D., 58 ECAB 149 (2006).

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

12 See M.B.,Docket No. 18-0906 (issued November 21, 2018). 
7

mention of a low back injury until August 7, 2017, nearly 16 months after the work event. She 

found no residuals of the work injury which was considered resolved. 

The record contained x-ray and MRI scan reports; however, the Board has held that 

diagnostic studies standing alone lack probative value as they do not address whether the 

employment injury caused any of the diagnosed conditions.13 Appellant also submitted reports 

from a physical therapist. This evidence has no probative value; however, because physical 

therapists are not considered physicians as defined under FECA.14

The Board thus finds that appellant has not met his burden of proof to establish that the 

acceptance of his claim should be expanded to include additional conditions as causally related to 

the accepted April 21, 2016 employment injury.

On appeal counsel argues that the statement of accepted facts (SOAF) did not contain all 

the accepted conditions and that appellant sustained additional disabling injuries and conditions 

causally related to the accepted April 21, 2016 employment injury. The Board notes that the SOAF 

was accurate and complete noting accepted conditions of right knee contusion and right meniscus 

tear. As explained above, the evidence of record does not contain sufficient medical rationale to 

expand appellant’s claim to include additional diagnosed conditions.15

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 established that the acceptance of his claim should 

be expanded to include additional conditions as causally related to the accepted April 21, 2016 

employment injury.

 

13 See V.H., Docket No. 18-1282 (issued April2, 2019); J.S.,Docket No. 17-1039 (issued October 6, 2017).

14 5 U.S.C. § 8102(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. See also Roy L. Humphrey, 57 ECAB 238 (2005). 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); 5 U.S.C. § 8101(2); 20 C.F.R. § 10.5(t). Jane A. White, 34 ECAB 515, 518 (1983) (physical 

therapists are not considered physicians under FECA).

15 See M.M., Docket No. 19-0951 (issued October 24, 2019) (where an employee claims that a condition not 

accepted or approved by OWCP was due to an employment injury, he or she bears the burden of proof to establish 

that the condition is causally related to the employment injury); R.J.,Docket No. 17-1365 (issued May 8, 2019).
8

ORDER

IT IS HEREBY ORDERED THAT the February 28, 2019 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: April 7, 2020

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Alternate Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board