United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

E.H., Appellant

and

DEPARTMENT OF THE ARMY, U.S. ARMY 

RESERVE COMMAND, Fort McCoy, WI, 

Employer

__________________________________________

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Docket No. 20-0663

Issued: September 23, 2020

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

JANICE B. ASKIN, Judge

PATRICIA H. FITZGERALD, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On February 3, 2020 appellant, through counsel, filed a timely appeal from a 

September 30, 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 a left knee condition 

causally related to the accepted February 13, 2018 employment incident.

FACTUAL HISTORY

On February 22, 2018 appellant, then a 32-year-old heavy mobile equipment repairer, filed 

a traumatic injury claim (Form CA-1) alleging that on February 13, 2018 he experienced left knee 

pain and left hip discomfort when changing hydraulic cylinders while in the performance of duty. 

He noted that, after squatting and sitting for approximately 30 minutes, he stood up and heard a 

loud crack and popping sound from his left knee. On the reverse side of the claim form the 

employing establishment checked a box marked “Yes” to indicate that appellant was injured in the 

performance of duty. Appellant stopped work on February 15, 2018 and returned to work on

February 20, 2018.

A February 27, 2018 witness statement by A.G., appellant’s coworker, corroborated 

appellant’s account of the employment incident.

In a development letter dated March 16, 2018, OWCP informed appellant that additional 

evidence was required to establish his claim. It advised him of the type of medical evidence 

needed, including a rationalized medical opinion from a qualified physician explaining how the 

claimed employment incident caused or aggravated a diagnosed medical condition. OWCP 

afforded appellant 30 days to submit the necessary evidence.

OWCP subsequently received x-rays of appellant’s left knee, dated February 14, 2018, 

which revealed no fracture or dislocation.

In a February 14, 2018 report, Dr. Matthew Gordon, a Board-certified orthopedic surgeon, 

noted that appellant felt a pop and had acute “knee pain of one day duration” after standing up 

while fixing a truck at work. He reviewed x-rays of appellant’s left knee and diagnosed 

chondromalacia of the left patella.

In a February 27, 2018 report, Dr. Gordon noted that appellant felt some clicking and 

popping in his left knee and had returned to full-duty work. He examined appellant and again 

diagnosed chondromalacia of the left patella. Dr. Gordon opined that the described employment 

incident was the competent medical cause of his left knee condition.

By decision dated April 20, 2018, OWCP denied appellant’s traumatic injury claim. It 

found that the medical evidence of record was insufficient to establish a causal relationship 

between appellant’s diagnosed conditions and the accepted February 13, 2018 employment 

incident.

On May 18, 2018 appellant requested a review of the written record by a representative of 

OWCP’s Branch of Hearings and Review.

OWCP subsequently received additional medical evidence. X-rays of appellant’s left hip 

and left knee, dated March 8, 2018, revealed no significant abnormalities.
3

In a March 8, 2018 report, Dr. Shewli Roy, a Board-certified specialist in internal 

medicine, noted that on February 14, 2018 appellant was lifting heavy weight and he felt left knee 

and left hip pain after standing up from a squatting position. She indicated that, “[t]here was no 

injury mechanism.” Dr. Roy examined appellant and diagnosed left hip pain and acute pain of the 

left knee.

In a March 9, 2018 report, David W. Varian, a physician assistant, noted that appellant 

injured his left knee at work changing hydraulic cylinders on a truck. He indicated that appellant 

experienced continued pain in the left knee and hip. Mr. Varian examined appellant and diagnosed 

left hip arthritis, left hip sprain, left knee osteoarthritis, and left knee strain.

In a March 20, 2018 report, Mr. Varian noted that appellant’s knee was improving and that 

he had a minor episode of lateral hip pain. He examined appellant and diagnosed left hip arthritis, 

left hip sprain, left knee osteoarthritis, and left knee strain. Mr. Varian opined that there was a 

causal relationship between the stated conditions and the employment incident.

Dr. Roy noted, in an April 10, 2018 report, that appellant’s pain and swelling had 

improved, but he still had some discomfort. She examined him and diagnosed left knee pain.

In an April 24, 2018 report, Mr. Varian noted that appellant’s knee pain had returned 

because of repetitive stress at work. He examined appellant and diagnosed left hip arthritis, left 

hip sprain, left knee osteoarthritis, and left knee strain. Mr. Varian opined that there was a causal 

relationship between the stated conditions and the employment incident.

A May 7, 2018 magnetic resonance imaging (MRI) scan of appellant’s left knee revealed 

tears of the posterior horn and body of the medial meniscus.

OWCP also received a May 10, 2018 report wherein, Dr. Eric Martin, a Board-certified 

orthopedic surgeon, noted that appellant had problems with knee bending and extended walking. 

Dr. Martin examined appellant and diagnosed patellofemoral dysfunction of the left knee and acute 

medial meniscus tear of the left knee. He opined that there was a causal relationship between the 

stated conditions and the employment incident.

Dr. Martin, in an undated state workers’ compensation report, diagnosed joint disorder of 

the left knee and medial meniscus tear of the left knee. He replied “Yes” to the question of whether 

the employment incident was the medical cause of appellant’s left knee conditions and noted a 

temporary impairment of 20 percent.

In an August 20, 2018 note, Dr. Martin opined that appellant’s meniscal tear required 

surgical intervention and the recovery time would be four to six weeks.

By decision dated October 19, 2018, OWCP’s hearing representative affirmed the 

April 20, 2018 decision.

On May 2, 2019 appellant, through counsel, requested reconsideration.

In an April 24, 2019 report, Dr. Kevin White, a Board-certified osteopathic physician 

specializing in orthopedic surgery, noted that on February 13, 2018 appellant felt a pop and had 
4

acute knee pain while fixing a truck at work. He listed appellant’s medical history and indicated 

that he had a prior history of right hip surgery on January 10, 2017. Dr. White reviewed the 

medical evidence of record and diagnosed left complex medial meniscus tear. He opined that 

appellant’s condition was causally related to the February 13, 2018 employment incident. 

Dr. White noted that appellant would need surgery in the form of left knee arthroscopy with partial 

medial meniscectomy. He indicated that appellant could continue working in a light-duty capacity.

By decision dated September 30, 2019, OWCP denied modification of the October 19, 

2018 decision.

LEGAL PRECEDENT

An employee seeking benefits under FECA3 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 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 if an employee has 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.7 The second component is whether the employment incident caused a personal injury.8

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.9 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 

 

3 Supra note 2.

4 M.O., Docket No. 19-1398 (issued August 13, 2020); S.B., Docket No. 17-1779 (issued February 7, 2018); Joe D. 

Cameron, 41 ECAB 153 (1989).

5

J.R., Docket No. 20-0496 (issued August 13, 2020); R.C., 59 ECAB 427 (2008); James E. Chadden, Sr., 40 ECAB 

312 (1988).

6 B.M., Docket No. 19-1341 (issued August 12, 2020); L.M., Docket No. 13-1402 (issued February 7, 2014); 

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

7 T.J., Docket No. 19-0461 (issued August 11, 2020); Elaine Pendleton, 40 ECAB 1143 (1989).

8 D.M., Docket No. 20-0386 (issued August 10, 2020); John J. Carlone, 41 ECAB 354 (1989).

9 A.R., Docket No. 19-0465 (issued August 10, 2020); Jacqueline M. Nixon-Steward, 52 ECAB 140 (2000).
5

be supported by medical rationale explaining the nature of the relationship between the diagnosed 

condition and the specific employment incident identified by the claimant.10

ANALYSIS

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

condition causally related to the accepted February 13, 2018 employment incident.

In support of his claim, appellant submitted reports from Dr. Gordon, dated February 14 

and 27, 2018, who noted that appellant felt a pop and had acute pain after standing up while fixing 

a truck at work. Dr. Gordon diagnosed chondromalacia of the left patella and opined that the 

employment incident was the competent medical cause of appellant’s left knee condition. While 

he identified the accepted employment incident, he offered only a conclusory statement regarding 

causal relationship and failed to provide medical rationale as to how the employment incident was 

causally related to appellant’s diagnosed condition. The Board has held that a medical report is of 

limited probative value on a given medical issue if it contains an opinion which is unsupported by 

medical rationale.11 Accordingly, Dr. Gordon’s opinion is insufficient to meet appellant’s burden 

of proof to establish his claim.

In reports dated March 8 and April 10, 2018, Dr. Roy diagnosed left hip pain and left knee 

pain. The Board has consistently held that a diagnosis of “pain” does not constitute the basis for 

payment of compensation, as pain is a symptom not a specific diagnosis.12 As Dr. Roy did not 

offer a valid medical diagnosis, her reports are insufficient to establish appellant’s claim.

In a report dated May 10, 2018, Dr. Martin diagnosed patellofemoral dysfunction of the 

left knee and acute medial meniscus tear of the left knee. He opined that there was a causal 

relationship between the stated conditions and the employment incident, but offered no medical 

rationale to support his conclusory statement. The Board has held that a conclusory opinion 

provided by a physician without the necessary rationale explaining how and why the incident or 

work factors were sufficient to result in the diagnosed medical condition, is insufficient to meet a 

claimant’s burden of proof to establish a claim.13 This report is therefore insufficient to establish 

appellant’s claim.

Appellant also submitted an undated state workers’ compensation report from Dr. Martin 

who diagnosed joint disorder of the left knee and medial meniscus tear of the left knee. Dr. Martin

answered “Yes” to a question to indicate that the employment incident was the medical cause of 

appellant’s left knee conditions. The Board has held that when a physician’s opinion on causal 

 

10 W.L., Docket No. 19-1581 (issued August 5, 2020); Leslie C. Moore, 52 ECAB 132 (2000).

11 B.M., supra note 6.

12 T.S., Docket No. 20-0343 (issued July 15, 2020); D.H., Docket No. 19-0931 (issued October 2, 2019); R.R.,

Docket No. 18-1093 (issued December 18, 2018); A.C., Docket No. 16-1587 (issued December 27, 2016); Robert 

Broome, 55 ECAB 339 (2004).

13 A.M., Docket No. 18-1748 (issued April 24, 2019); R.D., Docket No. 18-1551 (issued March 1, 2019); B.M., 

Docket No. 17-0324 (issued March 24, 2017); J.D., Docket No. 14-2061 (issued February 27, 2015).
6

relationship consists only of responding “Yes” to a form question, without more by the way of 

medical rationale, that opinion is of limited probative value and is insufficient to establish causal 

relationship.14 As such, this report by Dr. Martin is insufficient to establish appellant’s claim.

In a report dated April 24, 2019, Dr. White noted appellant’s history of illness and 

reviewed the medical evidence of record. He diagnosed left complex medial meniscus tear and 

opined that appellant’s condition was causally related to the February 13, 2018 employment 

incident. Dr. White indicated that appellant sustained an injury to his left knee after standing up 

from a squatting position, but offered no rationalized medical explanation as to how standing up 

could have caused a complex medial meniscus tear. As previously noted, conclusory opinion, 

unsupported by medical rationale, is of limited probative value and insufficient to establish 

appellant’s claim.15

Additionally, appellant submitted reports from a physician assistant, dated March 9 

through April 24, 2018. The Board has held that medical reports signed solely by a physician 

assistant are of no probative value as physician assistants are not considered physicians as defined 

under FECA.16 These reports are therefore insufficient to establish appellant’s claim.

The record also contains x-rays, dated February 14 and March 8, 2018, and an MRI scan, 

dated May 7, 2018. The Board has held, however, that diagnostic studies standing alone are of no 

probative value on the issue of causal relationship as they do not provide an opinion on whether 

the accepted employment incident caused any of the diagnosed conditions.

17

As appellant has not submitted rationalized medical evidence explaining causal 

relationship between the accepted February 13, 2018 employment incident and his diagnosed 

conditions, the Board finds that he has not met his burden of proof.

On appeal counsel argues that causation was clear and unequivocal and that OWCP 

required biomechanical causation instead of medical causation. As explained above, the evidence 

of record does not contain a medical report from a physician that provides sufficient medical 

rationale to establish causal relationship. 

 

14 M.S., Docket No. 20-0437 (issued July 14, 2020).

15 See A.M., R.D., and J.D., supra note 13.

16 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); 20 C.F.R. § 10.5(t). See also Federal (FECA) Procedure Manual, Part 2 -- Claims, Causal 

Relationship, Chapter 2.805.3a(1) (January 2013); 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); J.R., Docket No. 20-0496 (issued August 13, 2020) (physician assistants are not considered physicians under 

FECA).

17 C.B., Docket No. 20-0464 (issued July 21, 2020).
7

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 February 13, 2018 employment incident.

ORDER

IT IS HEREBY ORDERED THAT the September 30, 2019 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: September 23, 2020

Washington, DC

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Alternate Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board