United States Department of Labor

Employees’ Compensation Appeals Board

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R.L., Appellant

and

DEPARTMENT OF THE NAVY, MARINE 

CORPS INSTALLATION FACILITIES & 

ENVIRONMENT DIVISION, Quantico, VA, 

Employer

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Docket No. 20-0284

Issued: June 30, 2020

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

CHRISTOPHER J. GODFREY, Deputy Chief Judge

JANICE B. ASKIN, Judge

JURISDICTION

On November 18, 2019 appellant filed a timely appeal from a June 28, 2019 merit decision 

of the Office of Workers’ Compensation Programs (OWCP). Pursuant to the Federal Employees’

Compensation Act1(FECA) and 20 C.F.R. §§ 501.2(c) and 501.3, the Board has jurisdiction to 

consider the merits of this case.2

ISSUE

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

condition causally related to the accepted April 11, 2018 employment incident.

 

1 5 U.S.C. § 8101 et seq.

2 The Board notes that, following the issuance of the June 28, 2019 decision, and with his appeal form, appellant 

submitted additional evidence. However, 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 additional evidence for the first time on appeal. Id.
2

FACTUAL HISTORY

On April 25, 2018 appellant, then a 60-year-old electrician, filed a traumatic injury claim 

(Form CA-1) alleging that on April 11, 2018 he sustained a right knee injury when he slipped off 

a sidewalk and twisted his knee while moving a mechanical man lift down the sidewalk while in 

the performance of duty. He stopped work on the date of injury. 

Appellant was initially treated on April 11, 2018 by Kimberly McCue, an employing 

establishment physician of nursing and Board-certified family nurse practitioner, who noted a 

history of injury that, on that day, he hurt his right knee while slipping off a sidewalk. He placed 

appellant on restricted activity until April 18, 2018. 

An April 17, 2018 progress note from Dr. Lisa Jones King, a Board-certified internist, 

indicated that appellant was unable to work at that time. 

In an April 11, 2018 attending physician’s report (Form CA-20), Dr. Douglas P. Murphy, 

an attending Board-certified physiatrist, noted a history of injury that, on that day, appellant 

sustained a right knee injury at work. He noted that appellant had a preexisting injury or disease. 

Dr. Murphy diagnosed degenerative joint disease of the right knee. He checked a box marked 

“Yes” indicating that the diagnosed condition was caused or aggravated by an employment 

activity. Dr. Murphy noted that it was unknown as to when appellant could resume regular work. 

Duty status reports (Form CA-17) dated May 18 and August 3, 2018 with illegible 

signatures noted a history that on April 11, 2018 appellant hurt his knee while slipping off a 

sidewalk. Appellant was advised to resume light-duty work with restrictions as of May 28, 2018. 

On October 3, 2018 the employing establishment informed OWCP that appellant required 

surgery. 

OWCP, in a January 15, 2019 development letter, notified 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 had not controverted continuation of pay or challenged the 

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

it had reopened the claim for formal consideration because he had requested authorization for 

surgery. OWCP informed appellant that additional factual and medical evidence was required to 

establish his claim. It advised him of the type of factual and medical evidence necessary to 

establish his claim and attached a questionnaire for his completion. OWCP afforded appellant 30 

days to submit the requested evidence. 

On January 26, 2019 appellant responded to OWCP’s development questionnaire. He 

noted that while pulling a mechanical man lift he twisted his knee and tore his lower meniscus,

which aggravated arthritis in his knee. Appellant indicated that he did not have any prior, similar 

disability or symptoms. 

In a letter dated February 4, 2019, Dr. King noted a history of injury that on April 11, 2018 

appellant slipped and twisted his right knee while helping his coworkers move a single man lift. 

She indicated that he underwent right total knee replacement on December 6, 2018. 
3

Dr. Murphy, in a May 18, 2018 progress note, discussed examination findings and

reviewed diagnostic test results. He provided an impression that appellant had right knee pain due 

to substantial osteoarthritis, tricompartmental. Dr. Murphy advised that appellant was unable to 

return to work and provided work restrictions. 

In a June 18, 2018 right knee magnetic resonance imaging (MRI) scan report,

Dr. Muhammad R. Khan, a Board-certified diagnostic radiologist, provided impressions of 

moderate-to-severe osteoarthritis involving the medial compartment with degenerative tear 

involving the medial meniscus; mild-to-moderate osteoarthritis involving the patellofemoral joint 

with thinning of the hyaline cartilage; and varicosities in the medial aspect of the left, clinically 

indicated interventional radiology can be consulted for venous insufficiency. 

In consult requests dated October 2, 2018, Dr. Robert S. Adelaar, a Board-certified 

orthopedic surgeon, discussed examination findings and reviewed diagnostic test results. He 

provided an impression of right knee osteoarthritis. 

OWCP, by decision dated March 5, 2019, denied appellant’s traumatic injury claim finding 

that the evidence of record was insufficient to establish a diagnosed condition in connection with 

the accepted April 11, 2018 employment incident. It concluded therefore that the requirements 

had not been met to establish an injury as defined by FECA. 

A September 4, 2018 report by Dr. Young Seo, a Board-certified physiatrist, and

Dr. Murphy indicated that appellant received an injection to treat his right knee pain and 

degenerative joint disease. 

Dr. Murphy, in an August 30, 2018 note, provided an impression of right knee pain due to 

moderate-to-severe osteoarthritis. He also noted that appellant had a meniscal tear. 

In a March 20, 2019 letter, Dr. Murphy noted that appellant reported that he had kicked 

something and subsequently experienced pain and swelling. He also noted a history of his medical 

treatment, including his December 6, 2018 right total knee replacement. Dr. Murphy advised that 

appellant’s fall clearly was an exacerbating factor contributing to the need for surgery.

On April 2, 2019 appellant requested a review of the written record before a representative 

of OWCP’s Branch of Hearings and Review regarding the March 5, 2019 decision. He submitted 

physical therapy daily notes dated June 21, 2018 to March 1, 2019.

In a March 21, 2019 progress note and certificate of illness/injury, Dr. Varatharaj J. 

Mounasamy, a Board-certified orthopedic surgeon, reported that appellant was status post right 

total knee arthroplasty. He advised that appellant could resume regular duties on March 25, 2019.

An operative report signed by Dr. Alexandria O. Starks, a surgical resident physician, 

indicated that she performed right total knee arthroplasty on December 6, 2018 to treat appellant’s 

right knee osteoarthritis. 

By decision dated June 28, 2019, an OWCP hearing representative affirmed, the March 5, 

2019 decision, as modified, finding that appellant had established a medical diagnosis in 

connection with the accepted April 11, 2018 employment incident. The hearing representative 
4

determined, however, that the medical evidence of record was insufficient to establish that his 

diagnosed condition was caused or aggravated by the accepted employment incident.

LEGAL PRECEDENT

An employee seeking benefits under FECA3has 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,4that 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.5 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.6

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 

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

caused a personal injury and this component can be established only by medical evidence.7

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

condition and an employment incident is rationalized medical opinion evidence.8 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.9

In a 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, the 

 

3 Supra note 1.

4 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).

5 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).

6 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).

7 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). 

8 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).

9 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).
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physician must provide a rationalized medical opinion that differentiates between the effects of the 

work-related injury or disease and the preexisting condition.10

ANALYSIS

The Board finds that appellant has not met his burden of proof to establish a right condition 

causally related to the accepted April 11, 2018 employment incident.

In an April 11, 2018 Form CA-20 report, Dr. Murphy checked a box marked “Yes”

indicating that appellant’s diagnosed right knee degenerative joint disease was caused or 

aggravated by the April 11, 2018 employment incident. While his report generally supports causal 

relationship, he did not offer medical rationale sufficient to explain how and why he believes that 

the April 11, 2018 employment incident could have resulted in or contributed to the diagnosed 

condition. When a physician’s opinion on causal relationship consists only of checking a box

marked “Yes” in response to a form question, without explanation or rationale, that opinion has 

limited probative value and is insufficient to establish a claim.11 Such rationale is particularly 

important since Dr. Murphy noted that appellant had a preexisting injury or disease.12 Thus, his

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

In his March 20, 2019 letter, Dr. Murphy opined that appellant’s fall was clearly an 

exacerbating factor that contributed to his need to undergo right total knee placement on 

December 6, 2018. He did not, however, explain how the April 11, 2018 employment incident 

was sufficient to have resulted in the need for surgery. 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.13 Therefore,

Dr. Murphy’s report is insufficient to establish appellant’s claim. 

Dr. Murphy’s remaining May 18 and August 30, 2018 progress notes provided impressions

of right knee pain due to moderate-to-severe osteoarthritis, tricompartmental, and meniscal tear, 

but this evidence 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 Therefore, these reports are insufficient to 

establish appellant’s claim. 

Dr. King’s April 17, 2018 progress note and February 4, 2019 letter noted a history of the 

April 11, 2018 employment incident and appellant’s December 6, 2018 right total knee 

replacement. She also advised that he was totally disabled from work. Dr. King did not, however, 

 

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

V.W., Docket No. 19-1537 (issued May 13, 2020); N.C., Docket No. 19-1191 (issued December 19, 2019); R.D., 

Docket No. 18-1551 (issued March 1, 2019).

11 V.W., id. K.R., Docket No. 19-0375 (issued July 3, 2019).

12 See K.M., Docket No. 19-1247 (issued February 21, 2020); B.R., Docket No. 16-0456 (issued April 25, 2016). 

13 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).

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

provide a specific diagnosis of an injury or medical condition nor did she provide an opinion as to 

causal relationship. The Board has held that a medical report lacking a firm diagnosis and a 

rationalized medical opinion regarding causal relationship is of no probative value.15 As such,

Dr. King’s medical evidence is insufficient to meet appellant’s burden of proof.

While the September 4 and October 2, 2018 reports of Dr. Seo and Dr. Adelaar indicated 

that appellant had degenerative joint disease and osteoarthritis of the right knee, neither physician 

provided a history of injury or an opinion regarding causal relationship. Lacking these elements, 

their reports are insufficient to establish appellant’s claim.16

Similarly, Dr. Mounasamy’s March 21, 2019 progress note and Dr. Starks’ operative 

reports are also insufficient to establish causal relationship. The physicians noted appellant’s 

December 6, 2018 right total knee arthroplasty, but did not provide a history of injury or an opinion 

that his right knee condition and need for surgery were causally related the April 11, 2018 

employment incident.

17

Appellant submitted Dr. Khan’s June 18, 2018 MRI scan report which addressed 

appellant’s right knee conditions. The Board has held, however, that diagnostic test reports 

standing alone lack probative value as they do not provide an opinion on causal relationship 

between an employment incident and a diagnosed condition.18

Appellant also submitted May 18 and August 3, 2018 Form CA-17 reports containing

illegible signatures. The Board has held that reports that are unsigned or bear an illegible signature 

lack proper identification and cannot be considered probative medical evidence as the author 

cannot be identified as a physician.19 Therefore, these reports have no probative value and are 

insufficient to establish the claim.

Additionally, appellant submitted reports signed solely by a nurse practitioner or a physical 

therapist. The Board has held that medical reports signed solely by a nurse practitioner or a 

physical therapist are of no probative value as neither a nurse practitioner nor a physical therapist 

is considered physician as defined under FECA and are therefore not competent to render a medical 

opinion.20 These reports are therefore insufficient to establish the claim.

 

15 L.P., Docket No. 19-1812 (issued April 16, 2020); S.J., Docket No. 20-0157 (issued April 1, 2020); P.C., Docket 

No. 18-0167 (issued May 7, 2019).

16 Id.

17 Id.

18 W.M., Docket No. 19-1853 (issued May 13, 2020); L.F., Docket No. 19-1905 (issued April 10, 2020).

19 M.A., Docket No. 19-1551 (issued April 30, 2020); T.O., Docket No. 19-1291 (issued December 11, 2019).

20 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); L.F., supra

note 18. (physical therapist); T.J., Docket No. 19-1339 (issued March 4, 2020) (nurse practitioner).
7

As there is no well-rationalized medical opinion presently of record before the Board, 

previously considered by OWCP, establishing appellant’s traumatic injury claim the Board finds 

that he has not met his burden of proof.21

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 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 April 11, 2018 employment incident.

ORDER

IT IS HEREBY ORDERED THAT the June 28, 2019 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: June 30, 2020

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Christopher J. Godfrey, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

 

21 T.J., id.; F.D., Docket No. 19-0932 (issued October 3, 2019); D.N., Docket No. 19-0070 (issued May 10, 2019); 

R.B., Docket No. 18-1327 (issued December 31, 2018).