United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

J.O., Appellant

and

U.S. POSTAL SERVICE, TW HOUSE POST 

OFFICE, Houston, TX, Employer

__________________________________________

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Docket No. 22-0240

Issued: June 8, 2022

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

PATRICIA H. FITZGERALD, Deputy Chief Judge

JAMES D. McGINLEY, Alternate Judge

JURISDICTION

On December 3, 2021 appellant filed a timely appeal from a December 2, 2021 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 over the merits of this case.2

ISSUE

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

causally related to the accepted October 16, 2021 employment incident.

1

5 U.S.C. § 8101 et seq.

2 The Board notes that,following the December 2, 2021 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

FACTUAL HISTORY

On October 25, 2021 appellant, then a 26-year-old city carrier, filed a traumatic injury 

claim (Form CA-1) alleging that on October 16, 2021 injured his left knee when his foot hit the 

ground and heard a pop as he stepped out of his motor work vehicle while in the performance of 

duty. He stopped work on October 23, 2021. 

In an October 26, 2021 development letter, OWCP advised appellant that additional factual 

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

and medical evidence necessary and provided a questionnaire for his completion. OWCPafforded 

appellant 30 days to respond. 

OWCP subsequently received an October 18, 2021 excuse slip from an urgent care 

provider with an illegible signature which indicted that appellant would be unable to return to work 

until October 21, 2021. On an October 29, 2021 Duty Status Report (Form CA-17) a provider 

with an illegible signature noted a diagnosis of left knee lateral collateral pain and indicated that

appellant was disabled from work. 

In an October 29, 2021 report, Dr. Dan Ung, a chiropractor, related that appellant was seen 

for left knee pain due to an employment injury which occurred when appellant placed his left foot 

on the ground while stepping out of his truck. He related that, on physical examination, appellant 

had restricted left knee flexion, positive anterior draw test, and positive valgus stress test. Dr. Ung 

also noted that appellant had diminished left knee flexor and extensor muscles motor strength, 

which indicated L1-3 nerve root involvement. He diagnosed left knee lateral collateral ligament 

internal derangement and anterior cruciate ligament internal derangement and recommended 

physical therapy. 

In a report dated October 30, 2021, Timothy Holcomb, a nurse practitioner noted that 

appellant was evaluated for an October 16, 2021 injury when appellant heard his left knee pop 

while stepping down out of his motor vehicle onto his left foot. On physical examination of the 

left knee he found palpable tenderness over the lateral aspect, painful extension, and positive stress 

test. Appellant’s diagnosis was noted as probable left knee sprain to the collateral ligament. 

On an October 30, 2021 Form CA-17, Mr. Holcomb noted that on October 16, 2021

appellant’s left knee popped when appellant stepped out of his motor vehicle. He indicated that 

appellant had a left knee sprain and that he was temporarily totally disabled.

In a November 4, 2021 attending physician’s report, Part B of an Authorization for 

Examination and/or Medical Treatment (Form CA-16), Dr. Lubor Jarolimek, an orthopedic 

surgeon, noted that appellant experienced left knee pain back while stepping out of his vehicle. 

He diagnosed left knee strain and found appellant totally disabled for the period November 4 to 

December 5, 2021. Dr. Jarolimek checked a box marked “Yes” to the question of whether the 

diagnosed condition was caused or aggravated by the employment activity described. 

In a Form CA-17 of even date, Dr. Jarolimek noted that on October 16, 2021 appellant 

popped his knee when he stepped out of his truck and popped his knee. He noted clinical findings 
3

of swelling and locking, diagnosed left knee sprain, and responded, “Yes” that the diagnosis was 

due to injury. 

By decision dated December 2, 2021, OWCP denied appellant’s traumatic injury claim, 

finding that he had not submitted medical evidence explaining how his diagnosed left knee 

condition was causally related to the accepted October 16, 2021 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,3that the claim was timely filed within the applicable 

time limitation period 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 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 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. The first component is that 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 can be established only by medical 

evidence.6

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

condition and an employment incident is rationalized medical opinion evidence. 7 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 

3 D.A., Docket No. 21-0478 (issued October 14, 2021); K.R., Docket No. 20-0995 (issued January 29, 2021); A.W., 

Docket No. 19-0327 (issued July 19, 2019); S.B., Docket No. 17-1779 (issued February 7, 2018); J.P., 59 ECAB 178 

(2007); JoeD. Cameron, 41 ECAB 153 (1989).

4 D.A., id.; 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

J.B., Docket No. 20-1566 (issued August 31, 2021); K.M., Docket No. 15-1660 (issued September 16, 2016);

L.M., Docket No. 13-1402 (issued February 7, 2014);DeloresC. Ellyett, 41 ECAB 992 (1990).

6 D.A., supra note 3; 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).

7 D.A., id.; 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).
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nature of the relationship between the diagnosed condition and spec ific employment factors 

identified by the employee.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 October 16, 2021 employment incident.

In support of his claim, appellant submitted an attending physician’s report, Part B of a 

Form CA-16, dated November 4, 2021, wherein Dr. Jarolimek diagnosed left knee strain and 

checked a box marked “Yes” indicating that the condition was caused or aggravated by the 

employment incident. Similarly, Dr. Jarolimek, on a Form CA-17 dated November 4, 2021, noted 

clinical findings of left-sided injury and responded “Yes” that the diagnosis was due to injury. The 

Board has held, however, that reports that address causal relationship only by checkmark, without 

medical rationale explaining how the employment incident caused or aggravated the diagnosed 

condition, are of diminished probative value.

9

 These reports are, therefore,insufficient to establish 

causal relationship. 

OWCP received an October 29, 2021 report from Dr. Ung, a chiropractor, who diagnosed 

left knee lateral collateral ligament internal derangement and anterior cruciate ligament internal 

derangement. A chiropractor, however, is only considered a physician for purposes of FECA if 

he or she diagnoses subluxation based upon x-ray evidence.10 As Dr. Ung has not diagnosed

subluxation based upon x-ray evidence, he is not considered a physician as defined under FECA 

and his medical report does not constitute competent medical evidence.

11

The record contains an October 18, 2021 excuse slip from an urgent care provider whose 

signature was illegible, finding that appellant was disabled from work until October 21, 2021. 

Similarly, in partially legible Form CA-17 dated October 29, 2021, the healthcare provider 

diagnosed left knee lateral collateral pain and indicated that appellant was disabled from work. 

The Board has held that a report that is unsigned or bears an illegible signature lacks proper 

8 D.A., id.; 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).

9

See R.C., Docket No. 20-1525 (issued June 8, 2021); K.R.,Docket No. 19-0375 (issued July 3, 2019); DeborahL. 

Beatty, 54 ECAB 340 (2003).

10 Section 8101(2) of FECA provides that the term physician includes chiropractors only if the treatment consists 

of manual manipulation of the spine to correct a subluxation as demonstrated by x-ray to exist. 5 U.S.C. § 8101(2). 

See also S.L., Docket No. 21-0760 (issued January6, 2022); T.T., Docket No. 18-0838 (issued September 19, 2019); 

Thomas W. Stevens, 50 ECAB 288 (1999); George E.Williams, 44 ECAB 530 (1993).

11 S.L., id.; J.D., Docket No. 19-1953 (issued January 11, 2021); C.S., Docket No. 19-1279 (issued 

December 30, 2019).
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identification and cannot be considered probative medical evidence as the author cannot be 

identified as a physician.

12

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

Appellant submitted a medical report and Form CA-17 dated October 30, 2021 from

Mr. Holcomb, a nurse practitioner. However, certain healthcare providers such as nurse 

practitioners,13 are not considered “physician[s]” as defined under FECA.

14

 Consequently, 

medical findings and/or opinions by a nurse practitioner will not suffice for purposes of 

establishing entitlement to FECA benefits.

15

 These reports are therefore also insufficient to 

establish the claim.

As the medical evidence of record is insufficient to establish causal relationship between 

appellant’s diagnosed medical conditions and the accepted October 16, 2021 employment 

incident, the Board finds that appellant has not met his burden of proof.

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 October 16, 2021 employment incident.

16

12 R.C., supra note 9; I.M., Docket No. 19-1038 (issued January 23, 2020); T.O., Docket No. 19-1291 (issued 

December 11, 2019).

13 B.P., Docket No. 21-0872 (issued December 8, 2021); S.J., Docket No. 17-0783 (issued April9, 2018) (nurse 

practitioners are not considered physicians under FECA).

14 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 Federal (FECA) Procedure Manual, Part 2 -- Claims, Causal 

Relationship, Chapter 2.805.3(a)(1) (January 2013);B.P., id.; 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); see also T.J., Docket No. 19-1339 (issued March 4, 2020) (nurse practitioners are not considered 

physicians under FECA).

15 Id.

16 The Board notes that the employing establishment issued a Form CA-16, dated November 4, 2021. A completed 

Form CA-16 authorization may constitute a contract for payment of medical expenses to a medical facility or 

physician, when properly executed. The form creates a contractual obligation, which does not involve the employee 

directly, to pay for the cost of the examination or treatment regardless of the action taken on the claim. See 20 C.F.R. 

§ 10.300(c); V.S., Docket No. 20-1034 (issued November 25, 2020); J.G., Docket No. 17-1062 (issued February 13, 

2018); Tracy P. Spillane, 54 ECAB 608 (2003).
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ORDER

IT IS HEREBY ORDERED THAT December 2, 2021 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: June 8, 2022

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

James D. McGinley, Alternate Judge

Employees’ Compensation Appeals Board