United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

C.M., Appellant

and

DEPARTMENT OF THE NAVY, PUGET 

SOUND NAVAL SHIPYARD &

INTERMEDIATE MAINTENANCE FACILITY, 

Bremerton, WA, Employer

__________________________________________

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Docket No. 21-0435

Issued: October 22, 2021

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

JANICE B. ASKIN, Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On January 31, 2021 appellant filed a timely appeal from a January 19, 2021merit 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.

ISSUE

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

causally related to the accepted August 22, 2019 employment incident.

1

5 U.S.C. § 8101 et seq.
2

FACTUAL HISTORY

On August 26, 2019 appellant, then a 54-year-old painter, filed a traumatic injury claim 

(Form CA-1) alleging that on August 22, 2019 her left knee collapsed when she was walking to 

catch a bus while in the performance of duty.2 She stopped work on August 23, 2019.3

In an undated attending physician’s report (Form CA-20), an unidentifiable healthcare 

provider indicated diagnosed left knee pain as a result of collapsing while walking on 

August 22, 2019. 

Dr. Christopher R. Becker, Board-certified in emergency medicine, noted on August 22, 

2019 that appellant was seen that day in the emergency department and that appellant should 

remain off work for at least one week. In an after visit summary report of even date, Dr. Becker 

diagnosed acute left knee pain. 

In an August 22, 2019 activity prescription form, an unidentifiable healthcare provider 

provided a diagnosis with left knee pain and found that she was unable to work. 

In an August 22, 2019 work capacity evaluation (Form OWCP-5c), Dr. Marc Suffis, 

Board-certified in emergency medicine, diagnosed left knee strain and osteoarthritis. 

In an August 27, 2019 Form CA-20, Dr. Suffis diagnosed left knee arthritis and sprain. He 

indicated that appellant was walking when she experienced left knee pain and buckling on 

August 22, 2019. Dr. Suffis noted that she had preexisting arthritis and a history of degenerative 

meniscus tear. He opined that it was “possible” that appellant’s conditions were caused or 

aggravated by her employment activity. In a medical report of even date, Dr. Suffis reiterated 

appellant’s history of osteoarthritis and a medial meniscus tear of the right knee. Appellant

reported that her left knee was injured on August 22, 2019 from overuse due to the right knee 

injury. Dr. Suffis reviewed x-rays of the left knee, which revealed bone-on-bone medial 

compartment osteoarthritis. He diagnosed left knee sprain superimposed upon osteoarthritis. 

Dr. Suffis opined that his findings did not support the correlation between appellant’s previous 

right knee injury and left knee condition. He further opined that her main problem with the left 

knee was arthritis. In another report of even date, Dr. Suffis again noted that appellant believed 

that her left knee pain and buckling were correlated to her right knee injury. He conducted a 

physical examination and diagnosed left knee strain and exacerbation of the preexisting 

osteoarthritis. 

In an August 28, 2019 dispensary permit, Dr. Bruce Christen, an occupational medicine 

specialist, indicated that appellant injured her left knee on August 22, 2019.

2 The record reflects that appellant has a prior August 13, 2018 traumatic injury claim that OWCP accepted for 

right knee strain and medial meniscus tear under OWCP File No. xxxxxx483. OWCP has not administratively 

combined the claims.

3 An undated work status report (Form CA-3) from the employing establishment indicated that appellant returned 

to full-time modified-duty work with restrictions on September 9, 2019. 
3

In a separate August 28, 2019 medical document, Dr. Christen noted that appellant was 

injured on August 22, 2019 and provided work restrictions. 

OWCP received a notification of personnel action (Standard Form (SF)-50), a painter 

apprentice position description, and a portion of a certificate of medical examination pertaining to 

the functional requirements and environmental factors involved to perform the duties of a painter 

apprentice. 

In a September 6, 2019 medical report, Dr. Suffis noted that appellant believed that her 

previous right knee injury led to her present left knee injury. He opined that there was “no 

scientific validity to” appellant’s belief and stated that he could not support it “based on the 

standing scientific knowledge.” Dr. Suffis conducted a physical examination, which revealed mild 

gait disturbance with a mild limp, and diagnosed advanced osteoarthritis in her left knee and left 

knee arthritis with generative meniscal tear. He opined that it would be unlikely that her claim 

would be approved for the left knee. Dr. Suffis recommended physical therapy treatment. In a 

medical note of even date, he noted that appellant could return to work with restrictions. In a Form 

OWCP-5c of even date, Dr. Suffis diagnosed left knee sprain and arthritis and indicated that 

appellant was unable to work without restrictions. In a medical document of even date, he again 

indicated that appellant was injured on August 22, 2019 and provided work restrictions. Dr. Suffis 

noted that she required a splint and crutches. 

In an October 31, 2019 medical report, Dr. Suffis noted that appellant continued to 

experience pain in her left knee. He indicated that she had a history of degenerative medial 

meniscus tear with osteoarthritis. Dr. Suffis noted that although appellant had similar findings on 

the right knee, they were administratively under different claims. He reviewed an x-ray studies of 

both knees, which revealed medial meniscus tear of the left knee with traumatic osteoarthritis. 

On November 27, 2019 appellant presented to Dr. Suffis for a follow-up examination of 

her left knee. Dr. Suffis indicated that she suffered from bilateral medial meniscus tears with 

arthritis, right knee more severe than left knee. He diagnosed left knee medial meniscus tear with 

traumatic osteoarthritis. In a Form OWCP-5c of even date, Dr. Suffis reiterated his diagnosis and 

provided work restrictions. 

In a December 30, 2019 medical report, Dr. Erin P. Moyer, a Board-certified orthopedic 

surgeon, noted that appellant presented with bilateral knee pain from separate injuries she 

sustained at work. She noted that appellant sustained her right knee injury on August 6, 2018 and

her left knee injury on August 22, 2019. Dr. Moyer conducted a physical examination and 

diagnosed left knee mild osteoarthritis. In a Form OWCP-5c of even date, she diagnosed left knee 

arthritis and indicated that appellant could work with restrictions. 

In a January 9, 2020 medical report, Dr. Suffis reiterated his diagnoses. 

In a November 18, 2020 medical report, Dr. Suffis noted that appellant was previously 

diagnosed with left knee medial meniscal tear with traumatic osteoarthritis. He cond ucted a 

physical examination and reviewed an October 31, 2019 x-ray of the left knee, which demonstrated 

cartilage interval of the left knee of 3.8 mm medial and 5 mm lateral. Dr. Suffis diagnosed left 
4

knee osteoarthritis. He noted that appellant’s left knee was worsened from his last evaluation on 

January 9, 2020. 

On November 30, 2020 appellant filed a notice of recurrence (Form CA-2a) alleging that 

she sustained a recurrence of disability on July 20, 2020. She contended that overuse of her left 

knee due to her right knee injury led to weakening of the left knee after the alleged August 22, 

2019 employment incident. 

In a December 2, 2020 development letter, OWCP informed appellant of the deficiencies 

of her claim, requested additional factual and medical evidence, and provided a factual 

questionnaire for her completion. It afforded her 30 days to respond. 

In a December 7, 2020 development letter, OWCP informed appellant that additional 

evidence was needed to support her claim. It provided an additional factual questionnaire for her 

completion. A separate development letter of even date was sent to the employing establishment 

requesting information surrounding the circumstances of the alleged injury. OWCP afforded both 

parties 30 days to respond.

In an undated response to OWCP’s development questionnaire, the employing 

establishment indicated that on the date of injury appellant was leaving work after her shift ended 

when she was injured on the employing establishment’s premises. 

By decision dated January 19, 2021, OWCP accepted that the August 22, 2019 

employment incident occurred, as alleged. However, it denied appellant’s traumatic injury claim 

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

between her diagnosed conditions and the accepted employment incident.

LEGAL PRECEDENT

An employee seeking benefits under FECA4 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,5that 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.6 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.7

4

Supra note 1.

5

S.C., Docket No. 18-1242 (issued March 13, 2019); S.B., Docket No. 17-1779(issued February 7, 2018); J.P., 59 

ECAB 178 (2007); Joe D. Cameron, 41 ECAB 153 (1989).

6 T.H., Docket No. 18-1736 (issued March 13, 2019); J.M., Docket No. 17-0284 (issued February 7, 2018); R.C., 

59 ECAB 427 (2008); James E. Chadden, Sr., 40 ECAB 312 (1988).

7 T.E., Docket No. 18-1595 (issued March 13, 2019); 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). 
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.8 There are 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. 9 The 

second component is whether the employment incident caused a personal injury.10

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.11 A physician’s opinion on whether there is causal relationship 

between the diagnosed condition and the implicated employment incident must be based on a 

complete factual and medical background.12 Additionally, the physician’s opinion must be 

expressed in terms of a reasonable degree of medical certainty, and must be supported by medical 

rationale, explaining the nature of the relationship between the diagnosed condition, and 

appellant’s specific employment incident.13

In any 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 physician must provide a rationalized medical opinion that differentiates between the effects 

of the work-related injury or disease and the preexisting condition.14

ANALYSIS

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

condition causally related to the accepted August 22, 2019 employment incident.

In an August 27, 2019 Form CA-20, Dr. Suffis described the accepted August 22, 2019 

employment incident and diagnosed left knee arthritis and sprain. He opined that it was “possible”

that appellant’s conditions were caused or aggravated by the employment activity. However, 

Dr. Suffis’ opinion is speculative in nature. The Board has held that medical opinions that are 

speculative and equivocal are of diminished probative value. 15 Moreover, although Dr. Suffis 

indicated that appellant had a history of preexisting arthritis and degenerative meniscus tear, he 

failed to distinguish between the effects of the work-related injury and appellant’s preexisting 

conditions. The Board has consistently held that complete medical rationalization is particularly 

necessary when there is a preexisting condition involving the same body part, and has required 

8

S.S., Docket No. 18-1488 (issued March 11, 2019); T.H., 59 ECAB 388, 393-94 (2008).

9 E.M., Docket No. 18-1599 (issued March 7, 2019); Elaine Pendleton, 40 ECAB 1143 (1989).

10 E.M., id.; John J. Carlone, 41 ECAB 354 (1989).

11 S.S., supra note 8; RobertG. Morris, 48 ECAB 238 (1996).

12 C.F., Docket No. 18-0791 (issued February 26, 2019); Jacqueline M. Nixon-Steward, 52 ECAB 140 (2000).

13 Id. 

14 Federal (FECA) Procedure Manual, Part 2 --Claims, Causal Relationship, Chapter 2.805.3e (January 2013). See 

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

15 S.O., Docket No. 21-0002 (issued April29, 2021); H.A., Docket No. 18-1455 (issued August23, 2019).
6

medical rationale differentiating between the effects of the work-related injury and the preexisting 

condition in such cases.16 As such, this report is insufficient to establish appellant’s claim.

In OWCP-5c forms dated August 22 and September 6, 2019, Dr. Suffis diagnosed left knee 

strain and osteoarthritis/arthritis and indicated that appellant was unable to return to work without 

restrictions. Similarly, on October 31 and November 27, 2019, and January 9, 2020, he diagnosed 

left knee medial meniscus tear with traumatic osteoarthritis and, on November 18, 2020 he 

diagnosed left knee osteoarthritis. However, Dr. Suffis offered no opinion on causal relationship. 

The Board has held that medical evidence that does not offer an opinion regarding the cause of an 

employee’s condition or disability is of no probative value on the issue of causal relationship. 17 

Therefore, these reports are also insufficient to establish appellant’s burden of proof. 

In a medical report and a Form OWCP-5c dated December 30, 2019, Dr. Moyer noted that 

appellant sustained a left knee injury on August 22, 2019 and diagnosed mild left knee 

osteoarthritis. However, she did not describe the accepted August 22, 2019 employment incident 

in detail or explain the pathophysiological process through which it could have caused appellant’s 

diagnosed left knee conditions. The Board has held that a report is of limited probative value 

regarding causal relationship if it does not contain medical rationale explaining how an

employment activity could have caused or aggravated a medical condition. 18 These reports are, 

therefore, insufficient to establish causal relationship.

In an August 27, 2019 report, Dr. Suffis conducted a physical examination and diagnosed 

knee strain and exacerbation of the preexisting osteoarthritis. He noted that appellant believed that 

her left knee injury on August 22, 2019 was correlated to her right knee injury. Dr. Suffis, 

however, did not provide his own opinion addressing the cause of the diagnosed conditions. As 

previously noted, medical evidence that fails to address causation is of no probative value on that 

issue.19 Thus, this report is insufficient to establish causal relationship.

Dr. Suffis, in his medical documents dated September 6, 2019, noted that appellant was 

injured on August 22, 2019, found that she could return to work with restrictions, and provided 

work restrictions. However, he did not provide a specific diagnosis. 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.20 Thus, these documents are also insufficient to establish 

causal relationship.

16 Supra note 14;see also J.A., Docket No. 20-1195 (issued February 3, 2021). 

17 R.O., Docket No. 20-1243 (issued May28, 2021); P.B.,Docket No. 20-1602 (issued May 26, 2021); L.B., Docket 

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

18 See A.M., Docket No. 19-1394 (issued February 23, 2021); V.D., Docket No. 20-0884 (issued February 12, 2021); 

Y.D., Docket No. 16-1896 (issued February 10, 2017).

19 Supra note 17; see also L.G., Docket No. 20-0433 (issued August 6, 2020); S.D., Docket No. 20-0413 (issued 

July 28, 2020); S.K., Docket No. 20-0102 (issued June 12, 2020).

20 J.P., Docket No. 20-0381 (issued July 28, 2020); R.L., Docket No. 20-0284 (issued June 30, 2020).
7

In a medical note and an after visit summary report dated August 22, 2019, Dr. Becker, 

noted that appellant was seen that day in the emergency department and was diagnosed with left 

knee pain. This Board has held that pain is a description of a symptom and not a compensable 

medical diagnosis.

21

 Therefore, these documents are insufficient to establish appellant’s burden 

of proof.

In an August 27, 2019 medical report, Dr. Suffis reviewed the x-rays of appellant’s left 

knee and diagnosed left knee sprain superimposed upon osteoarthritis. He opined that his findings 

did not support the correlation between her right knee injury and left knee condition. Similarly, in

his September 6, 2019 medical report, Dr. Suffis noted that appellant believed that her previous 

right knee injury led to her present left knee injury. He opined that, “based on the standing 

scientific knowledge,” appellant’s left knee condition was not related to her previous right knee 

injury. Dr. Suffis further opined that it would be unlikely that her claim would be approved for 

her left knee. The Board has held that medical evidence that negates causal relationship is of no 

probative value.22 For this reason, these reports are insufficient to establish causal relationship. 

Dr. Christen’s reports did not contain an opinion on causal relationship. As such, they are 

of no probative value and are insufficient to establish appellant’s claim.23

The remaining records are undated and unsigned. 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. 24 Thus, these medical 

documents are also insufficient to establish appellant’s claim.

As appellant has not submitted rationalized medical evidence establishing a left knee 

condition causally related to the accepted August 22, 2019 employment incident, the Board finds 

that she has not met her 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 her burden of proof to establish a left knee 

condition causally related to the accepted August 22, 2019 employment incident.

21 See K.S., Docket No. 19-1433 (issued April26, 2021); E.M., Docket No. 20-0678 (issued January 11, 2021);

S.L., Docket No. 19-1536 (issued June 26, 2020).

22 E.T., Docket No. 21-0014 (issued May 20, 2021); C.M., Docket No. 19-1211 (issued August 5, 2020); M.C., 

Docket No. 19-1074 (issued June 12, 2020).

23 See supra note 17.

24 C.M., Docket No. 21-0004 (issued May 24, 2021); T.D., Docket No. 20-0835 (issued February2, 2021); 

Merton J. Sills, 39 ECAB 572, 575 (1988).
8

ORDER

IT IS HEREBY ORDERED THAT the January 19, 2021 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: October 22, 2021

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board