United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

J.K., Appellant

and

U.S. POSTAL SERVICE, MAIL CARRIER 

ANNEX, San Fernando, CA, Employer

__________________________________________

)

)

)

)

)

)

)

)

Docket No. 19-0462

Issued: August 5, 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

ALEC J. KOROMILAS, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On December 27, 2018 appellant, through counsel, filed a timely appeal from a 

September 21, 2018 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.3

 

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.

3 The Board notes that following the September 21, 2018 decision, OWCP received 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

ISSUE

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

causally related to the accepted May 20, 2017 employment incident.

FACTUAL HISTORY

On May 30, 2017 appellant, then a 54-year-old postmaster, filed a traumatic injury claim 

(Form CA-1) alleging that on May 20, 2017 he was conducting a route inspection in a long-life 

vehicle, and when he pulled himself up to exit the vehicle he felt pain in his left knee. He stopped 

work on May 24, 2017 and returned to work on May 30, 2017. On the reverse side of the claim 

form, the employing establishment controverted the claim noting that appellant had not mentioned 

the incident until four days after it had occurred.

On May 25, 2017 Dr. Patrick Butcher, Board-certified in emergency medicine, 

recommended that appellant be excused from work for the period May 25 through 28, 2017. He 

provided appellant emergency department discharge instructions for knee effusion and knee pain. 

OWCP also received a June 1, 2017 work status report from Dale Pietrowski, a physician assistant, 

who diagnosed left knee strain and left knee effusion and excused appellant from all work through 

June 8, 2017.

In a development letter dated June 7, 2017, OWCP informed appellant that he had not 

submitted sufficient factual or medical evidence to establish his claim. It advised him of the type 

of evidence needed and provided a questionnaire for his completion. OWCP afforded appellant

30 days to respond.

OWCP subsequently received a May 30, 2017 initial examination report from Dr. Carlos 

Garrett, a Board-certified internist. Dr. Garrett examined appellant for complaints of left knee 

pain. Appellant informed him that he had sustained an injury on May 20, 2017 when he stood up 

from a floor-level seat in a postal vehicle and felt a pain shoot through his left knee. He noted that 

on May 24, 2017 he had visited an emergency room where liquid was drained from his left knee. 

On examination, Dr. Garrett observed tenderness without joint effusion, full flexion, and a positive 

patellofemoral grind test. He diagnosed left knee joint effusion, internal derangement of the left 

knee, and a left knee ligament injury. Dr. Garrett recommended use of a cane.

In a June 1, 2017 follow-up report, Dr. Garrett noted that appellant recounted an injury on 

May 20, 2017 when he was sitting in the cargo compartment of a postal vehicle in a seat bolted to 

the floor and pulled himself up, feeling a pain shoot through his left knee. On examination he

noted tenderness, joint effusion, and limited flexion. Dr. Garrett diagnosed left knee effusion and 

strain. 

In a report dated June 8, 2017, Dr. Andree Leroy, Board-certified in physical medicine and 

rehabilitation, diagnosed left knee effusion and recommended that appellant be off work until 

June 15, 2017. He indicated that appellant stated that his left knee was 20 percent better. On 

examination, Dr. Leroy observed joint effusion with limited flexion. He diagnosed left knee 

effusion. After reviewing appellant’s account of the claimed injury, Dr. Leroy indicated that he 

agreed with the mechanism of injury.
3

A June 12, 2017 left knee magnetic resonance imaging (MRI) scan revealed a lateral 

meniscus horizontal oblique tear of the posterior horn, a medial meniscus oblique intermediate 

signal intensity, a grade 1 medial collateral ligament sprain, mild degeneration of the anterior 

cruciate ligament, popliteus moderate tendinosis at the femoral origin, and a moderate-sized joint 

effusion. The diagnostic report noted that the findings were of indeterminate age.

In a follow-up report dated June 15, 2017, Dr. Garrett noted that appellant’s MRI scans

demonstrated a left meniscus tear. He diagnosed a complex tear of the left knee medial meniscus 

and an acute left knee lateral meniscus tear. Dr. Garrett recommended that appellant remain off 

work. On June 22, 2017 he noted that appellant was currently on modified duty. On examination 

of the left knee, Dr. Garrett observed tenderness, no joint effusion, and limited flexion. He 

diagnosed acute medial and lateral meniscus tears of the left knee.

By decision dated July 13, 2017, OWCP denied appellant’s claim finding that he had not 

submitted sufficient evidence to meet his burden of proof to establish causal relationship between 

his diagnosed conditions and the accepted May 20, 2017 employment incident.

OWCP subsequently received a June 27, 2017 report from Dr. Arash Dini, a Boardcertified orthopedic surgeon. Dr. Dini diagnosed a left tear of the medial meniscus and 

recommended that appellant be off work until July 25, 2017. In an initial evaluation of the same 

day, he evaluated appellant for complaints of left knee pain. Appellant informed Dr. Dini that he 

sustained an injury at work on May 20, 2017 by “striking it.” On examination of the left knee, he 

observed unrestricted range of motion, tenderness to palpation, positive lateral joint line 

tenderness, and intact sensation. Dr. Dini referred to the MRI scan taken on June 12, 2017, which 

demonstrated a tear of the lateral and medial menisci, anterior cruciate ligament degeneration, and 

moderate joint effusion. He diagnosed a knee contusion and meniscal tears. Dr. Dini opined that 

it appeared that appellant sustained an injury to the left knee arising out of and caused by industrial 

exposure on May 20, 2017 and recommended that appellant remain off work. 

Appellant submitted unsigned visit summaries dated February 5 through May 7, 2018, as 

well as a report from a physician assistant dated July 12, 2018. 

On June 25, 2018 appellant, through counsel, requested reconsideration of OWCP’s 

July 13, 2017 decision. Counsel noted that a report from Dr. Garrett dated June 19, 2018 was 

enclosed. Appellant resubmitted the reports of Dr. Garret, Dr. Leroy, and Dr. Dini.

By decision dated September 21, 2018, 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 

that any disability or medical condition for which compensation is claimed is causally related to 
4

the employment injury.4 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.5

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.6 The second component is whether the employment incident caused a personal injury.7

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 factor(s) 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.

8

ANALYSIS

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

condition causally related to the accepted May 20, 2017 employment incident.

In support of his claim, appellant submitted medical reports from Dr. Garrett and

Dr. Leroy.

On May 30, 2017 appellant indicated to Dr. Garrett that he had sustained an injury on 

May 20, 2017 when he stood up from a floor-level seat in a postal vehicle and felt a pain shoot 

through his left knee. Dr. Garrett diagnosed left knee joint effusion, internal derangement of the 

left knee, and a left knee ligament injury. This history of injury was replicated in subsequent 

reports from Dr. Garrett. 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 incident of May 20, 2017 actually caused the diagnosed 

condition.9 As such, they are insufficient to satisfy appellant’s burden of proof with respect to 

causal relationship.10

 

4

J.M., Docket No. 17-0284 (issued February 7, 2018); R.C., 59 ECAB 427 (2008); James E. Chadden, Sr., 40 

ECAB 312 (1988).

5 K.M., Docket No. 15-1660 (issued September 16, 2016); L.M., Docket No. 13-1402 (issued February 7, 2014); 

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

6 Elaine Pendleton, 40 ECAB 1143 (1989).

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

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

9 See J.B., Docket No. 18-1006 (issued May 3, 2019); K.W., 59 ECAB 271, 279 (2007).

10 Id.
5

On June 27, 2017 Dr. Dini opined that it appeared appellant sustained an injury to the left 

knee arising out of and caused by industrial exposure on May 20, 2017 and recommended that 

appellant remain off work. Dr. Leroy’s brief statement and reports that he agreed with appellant’s 

account of the mechanism of injury, along with Dr. Dini’s statement that appellant’s left knee 

condition “appeared” to arise out of “industrial exposure” on May 20, 2017, also do not establish 

that appellant’s left knee condition was causally related to the May 20, 2017 employment incident. 

On June 8, 2017, after reviewing appellant’s account of the claimed injury, Dr. Leroy indicated 

that he agreed with the mechanism of injury. The Board has held that a medical opinion is of 

limited value if it is conclusory or speculative in nature.11 Dr. Leroy’s brief statement that he 

agreed with appellant’s account of the mechanism of injury is conclusory in nature, as it does not 

contain an explanation of how the incident of May 20, 2017 physiologically caused, contributed 

to, or aggravated the specific diagnosed conditions.12 Similarly, Dr. Dini’s opinion refers to the 

cause as “industrial exposure” and does not describe in physiological terms how the incident of 

May 20, 2017 caused the diagnosed left knee conditions. Furthermore, Dr. Dini’s opinion was 

couched in speculative terms, noting that appellant’s condition “appeared” to have been caused by 

the incident of May 20, 2017. Entitlement to FECA benefits may not be based on surmise, 

conjecture, speculation, or on the employee’s own belief of a causal relationship.13 While the 

opinion supporting causal relationship does not have to reduce the cause or etiology of a disease 

or condition to an absolute certainty, the opinion must be one of reasonable medical certainty and 

not speculative or equivocal in character.14 As Dr. Dini’s opinion is speculative and equivocal in 

nature, it does not carry appellant’s burden of proof as to causal relationship.

Appellant submitted reports from Dr. Butcher dated May 25, June 8 and 15, 2017, 

respectively. However, these reports did not include opinions as to causal relationship. Medical 

evidence which does not offer an opinion on causal relationship is of no probative value to the 

issue of causal relationship.15 Therefore, these reports are insufficient to establish appellant’s 

claim.

Appellant submitted unsigned visit summaries dated February 5 through May 7, 2018, as 

well as a report from a physician assistant dated July 12, 2018. Reports that are unsigned or that 

bear illegible signatures cannot be considered as probative medical evidence because they lack 

proper identification.16 The Board has consistently held that physician assistants are not competent 

 

11 See M.S., Docket No. 19-0189 (issued May 14, 2019); L.T., Docket No. 18-1603 (issued February 21, 2019); 

B.H., Docket No. 18-1219 (issued January 25, 2019); Birger Areskog, 30 ECAB 571 (1979).

12 Id. 

13 Id.

14 C.L., Docket No. 18-1379 (issued February 5, 2019).

15 See L.T., supra note 11.

16 T.C., Docket No. 18-1351 (issued May 9, 2019); Thomas L. Agee, 56 ECAB 465 (2005); Richard F. Williams, 

55 ECAB 343 (2004).
6

to render a medical opinion.17 As such, the reports of physician assistants are entitled to no 

probative weight because a physician assistant is not a “physician” as defined by section 8101(2).18

Finally, appellant submitted a June 12, 2017 left knee MRI scan. The Board has previously 

held, however, that diagnostic studies lack probative value as they do not address whether the 

employment incident caused any of the diagnosed conditions.19 This report is therefore 

insufficient to establish his claim.

For these reasons, the Board finds the evidence of record is insufficient to meet appellant’s 

burden of proof on the issue of causal relationship.

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 left knee 

condition causally related to the accepted May 20, 2017 employment incident.

 

17 See K.C., Docket No. 16-1181 (issued July 26, 2017); Janet L. Terry, 53 ECAB 570 (2002); Allen C. Hundley, 

53 ECAB 551 (2002).

18 Id.

19 See J.S., Docket No. 17-1039 (issued October 6, 2017). 
7

ORDER

IT IS HEREBY ORDERED THAT the September 21, 2018 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: August 5, 2019

Washington, DC

Christopher J. Godfrey, 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