United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

K.G., Appellant

and

DEPARTMENT OF VETERANS AFFAIRS, 

VETERANS ADMINISTRATION MEDICAL 

CENTER, Houston, TX, Employer

__________________________________________

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Docket No. 18-1691

Issued: May 1, 2019

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

CHRISTOPHER J. GODFREY, Chief Judge

PATRICIA H. FITZGERALD, Deputy Chief Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On September 7, 2018 appellant filed a timely appeal from an August 13, 2018 merit 

decision of the Office of Workers’ Compensation Programs (OWCP).1 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 Appellant timely requested oral argument pursuant to section 501.5(b) of the Board’s Rules of Procedure. 20 

C.F.R. § 501.5(b). By order dated March 8, 2019, the Board exercised its discretion and denied the request, finding 

that the arguments on appeal could adequately be addressed in a decision based on the case record. Order Denying 

Request for Oral Argument, Docket No. 18-1691 (issued March 8, 2019). 

2 5 U.S.C. § 8101 et seq.

3 The Board notes that following the April 13, 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 evidence for 

the first time on appeal. Id.
2

ISSUE

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

causally related to the accepted September 28, 2017 employment incident.

FACTUAL HISTORY

On October 4, 2017 appellant, then a 46-year-old nurse, filed a traumatic injury claim 

(Form CA-1) alleging that she injured her left knee on September 28, 2017 while in the 

performance of duty. She reported that as she turned away after obtaining patient information 

from a coworker she twisted her knee and it popped, and then developed pain and swelling. The 

employing establishment indicated on the reverse side of the claim form that an investigation of 

the incident did not support appellant’s statement.

In an October 4, 2017 authorization for examination and/or treatment (Form CA-16), W.T., 

a workers’ compensation program manager at the employing establishment, authorized medical 

treatment by Dr. George Ozoude, a Board-certified orthopedic surgeon. W.T. checked a form box 

indicating doubt that her condition was caused by an injury sustained in the performance of duty.

In a development letter dated October 10, 2017, OWCP advised appellant of the type of 

factual and medical evidence needed to establish her claim and provided a questionnaire for her 

completion. It afforded her 30 days to respond.

In a November 2, 2017 statement, appellant wrote that she injured her left knee at 

approximately 8:30 a.m. on September 28, 2017 when she turned from talking with a team leader 

regarding a patient. She indicated that, as she turned and twisted to return to her desk, she heard

her left knee pop and was unable to put pressure on her left leg, but that after a few minutes she 

could limp to her desk. Appellant related that after a few minutes the sharp pain diminished and 

she continued to work from her desk, ambulating only when necessary. She also reported that she 

was also experiencing shortness of breath and coughing that morning, which eventually worsened, 

and that at approximately 9:30 a.m. she called her supervisor who advised her to go to her doctor. 

Appellant indicated that she also informed her supervisor regarding the left knee incident that day. 

She reported that she was treated for acute bronchitis/pneumonia that day, remained off work, and 

saw an orthopedic surgeon on October 1, 2017. Appellant described medical treatment and 

indicated that she had not returned to work.

On disability slips dated October 1 and 6, 2017 Dr. Ozoude indicated that appellant should 

be out of work due to a left knee medial meniscus tear. On a Family and Medical Leave Act 

(FMLA) form dated November 7, 2017, he noted that appellant’s condition commenced on 

September 28, 2017 and that she was unable to work due to a left knee medial meniscus tear, which 

did not allow her to lift, push, pull, or put any strain on the knee. Dr. Ozoude recommended 

physical therapy and advised that she would be out of work for approximately six months.

By decision dated November 14, 2017, OWCP denied the claim. It found the 

September 28, 2017 incident occurred as alleged, but denied the claim because the medical 

evidence submitted was insufficient to establish that the diagnosed condition was causally related 

to the September 28, 2017 employment incident.
3

On January 16, 2018 appellant requested reconsideration. She resubmitted her 

November 2, 2017 statement. In December 8, 2017 correspondence, Dr. Ozoude advised that 

appellant was under his care. He noted that appellant was first seen on October 2, 2017 when she 

related that she had injured her left knee by twisting it while in a standing position at work on 

September 28, 2017. Dr. Ozoude reported that a magnetic resonance imaging (MRI) scan was 

performed on October 4, 2017, which revealed a left medial meniscus tear. He indicated that 

appellant’s explanation of her injury demonstrated the cause of her diagnosed left medial meniscal 

tear, noting that the injury was often caused by a twisting motion.

By decision dated January 17, 2018, OWCP reviewed the merits of appellant’s claim, but

denied modification of its prior decision, finding that the medical evidence submitted was of 

insufficient rationale to establish causal relationship.

On May 15, 2018 appellant again requested reconsideration. She submitted an April 30, 

2018 treatment note in which Dr. Alan Tran, Board-certified in family medicine, noted that 

appellant was seen for left knee pain. Dr. Tran wrote that appellant related that, while working on 

September 28, 2017, she twisted her left knee as she turned around and felt it pop. He described 

her complaint of sharp left knee pain, provoked with weight bearing, and noted that she walked 

with a visual limp. Physical examination demonstrated moderate tenderness in the right knee with 

a positive McMurray’s test. Dr. Tran diagnosed internal derangement of the left knee and advised 

that appellant could perform modified duties. In a July 12, 2018 report, he noted her complaint of 

mild sharp left knee pain with difficulty walking. Dr. Tran described mild tenderness on palpation 

of the left knee with a positive McMurray’s test on the left and repeated his diagnosis.

By decision dated August 13, 2018, OWCP reviewed the merits of appellant’s claim, but

denied modification of its prior decisions. It found that appellant had not provided rationalized 

medical opinion evidence sufficient to establish causal relationship between the diagnosed 

conditions and the accepted September 28, 2017 employment incident.

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 period,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 if an employee has sustained an injury in the performance of duty, OWCP begins 

 

4 S.B., Docket No. 17-1779 (issued February 7, 2018); J.P., 59 ECAB 178 (2007); Joe D. Cameron, 41 ECAB 

153 (1989).

5

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

ECAB 312 (1988).

6 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).
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with an analysis of whether fact of injury has been established. Generally, fact of injury consists 

of two components which must be considered in conjunction with one another. The first 

component to be established is that the employee actually experienced the employment incident 

which is alleged to have occurred. The second component is whether the employment incident 

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

Rationalized medical opinion evidence is required to establish causal relationship. The 

opinion of the physician must be based on a complete factual and medical background, 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 specific employment incident.8

ANALYSIS

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

condition causally related to the accepted September 28, 2017 employment incident.

In support of her claim, appellant submitted disability slips dated October 1 and 6, 2017

and an FMLA form dated November 7, 2017 from Dr. Ozoude. In these reports, however,

Dr. Ozoude did not provide a medical opinion that the accepted September 28, 2017 incident 

caused or aggravated appellant’s left knee 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.9 These reports, therefore, are insufficient to establish 

appellant’s claim. 

Dr. Ozoude also provided correspondence, dated December 8, 2017, in which he described 

appellant’s recitation that she injured her left knee by twisting it while in a standing position at 

work on September 28, 2017. He indicated that an MRI scan was done on October 4, 2017, which 

revealed a left medial meniscus tear. Dr. Ozoude opined that appellant’s explanation of her injury 

demonstrated that the left medial meniscal tear was caused by this incident, noting that such an

injury was often caused by a twisting motion. The Board initially notes that a copy of the MRI 

scan report, which would confirm a medial meniscus tear, is not found in the record before the 

Board. The Board has held that a report is of limited probative value regarding causal relationship 

if it does not contain medical rationale explaining how a given medical condition/disability was 

related to employment factors.10

While Dr. Tran provided treatment notes dated April 30 and July 12, 2018 in which he 

discussed appellant’s left knee condition, he did not provide a medical opinion that the accepted 

September 28, 2017 employment incident caused or aggravated her left knee condition. Lacking 

 

7 K.L., Docket No. 18-1029 (issued January 9, 2019).

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

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

10 See Y.D., Docket No. 16-1896 (issued February 10, 2017).
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a rationalized medical opinion regarding causal relationship, his reports are therefore of no 

probative value.

11

As the record lacks rationalized medical evidence establishing causal relationship between 

the September 28, 2017 employment incident and appellant’s diagnosed left knee condition, the 

Board finds that she has not met her burden of proof.12

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 her burden of proof to establish a left knee 

condition causally related to the accepted September 28, 2017 employment incident.

 

11 Id.

12 The Board notes that the employing establishment issued appellant a signed authorization for examination and/or 

treatment (Form CA-16) authorizing medical treatment. The Board has held that where an employing establishment 

properly executes a CA-16 form, which authorizes medical treatment as a result of an employee’s claim for an 

employment-related injury, it creates a contractual obligation, which does not involve the employee directly to pay 

the cost of the examination or treatment regardless of the action taken on the claim. See 20 C.F.R. §§ 10.300, 10.304; 

G.T., Docket No. 18-1369 (issued March 13, 2019).
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ORDER

IT IS HEREBY ORDERED THAT the August 13, 2018 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: May 1, 2019

Washington, DC

Christopher J. Godfrey, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board