United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

S.K., Appellant

and

DEPARTMENT OF VETERANS AFFAIRS, 

VETERANS AFFAIRS MEDICAL CENTER, 

Decatur, GA, Employer

__________________________________________

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Docket No. 22-0432

Issued: June 27, 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 January 28, 2022 appellant filed a timely appeal from an October 15, 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 

1

5 U.S.C. § 8101 et seq.

2 The Board notes that,following the October 15, 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

ISSUE

The issue is whether appellant has met her burden of proof to establish medical condition

causally related to the accepted May 29, 2021 employment incident.

FACTUAL HISTORY

On June 16, 2021 appellant, then a 51-year-old diagnostic radiology technician, filed a 

traumatic injury claim (Form CA-1) alleging that on May 29, 2021 she injured her left wrist when 

moving a heavy patient while in the performance of duty. She stopped work on June 14, 2021.

In a May 29, 2021 form report, a nurse practitioner with the employing establishment 

evaluated appellant for left wrist pain after pushing a patient weighing over 300 pounds in a 

wheelchair. She provided work restrictions.

A June 12, 2021 magnetic resonance imaging (MRI) scan of the left wrist demonstrated a 

triangular fibrocartilage complex (TFCC) sprain and/or intrasubstance tear. 

On June 16, 2021 a nurse practitioner discussed appellant’s history of wrist pain after 

moving a heavy patient three weeks earlier. She diagnosed a left wrist injury.

In work status forms dated June 17 and 23, 2021, Dr. Hodari Brooks, a Board-certified 

orthopedic surgeon, diagnosed a TFCC tear of the left wrist and opined that appellant could work 

with restrictions. 

On June 23, 2021 Dr. Brooks obtained a history of appellant experiencing left wrist pain 

after pushing a patient weighing over 300 pounds in a wheelchair. He noted that she had stopped 

work on May 29, 2021. Dr. Brooks diagnosed a TFCC tear and referred appellant to a hand 

surgeon.

In a report dated July 1, 2021, Dr. Gary M. Lourie, a Board-certified orthopedic surgeon, 

advised that appellant had “sustained an on-the-job injury to her left wrist with ulnar-sided wrist 

pain when she was pushing a patient in a wheelchair and felt a sharp pain. He noted that an MRI 

scan demonstrated a TFCC sprain and possible tear. Dr. Lourie recommended treatment with a 

cast and therapy. 

In a development letter dated September 2, 2021, OWCP requested that appellant submit 

factual and medical information, including a comprehensive report from her physician regarding 

how a specific work incident contributed to her claimed injury. It provided her with a 

questionnaire for completion and afforded her 30 days to submit the necessary evidence. 

Subsequently, OWCP received an August 12, 2021 progress report from Dr. Lourie, who 

recommended against surgery. Dr. Lourie noted that she “clearly had this injury” and also “clearly 

has findings.”

In a September 6, 2021 statement, appellant advised that she had moved a patient who 

appeared to weight over 300 pounds from a bed to a wheelchair. While pushing the wheelchair 

she felt pain in her left wrist.
3

By decision dated October 15, 2021, OWCP denied appellant’s traumatic injury claim. It 

found that she had not established a medical condition causally related to the accepted May 29, 

2021 employment incident.

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 filed within the applicable time 

limitation of FECA,4that an injury was sustained while in the performance of duty as alleged; and 

that any disability or specific 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 on a traumatic injury or an occupational disease. 6

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.7 

Generally, 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.8 The second component is whether employment incident caused 

a personal injury.9 An employee may establish that an injury occurred in the performance of duty 

as alleged, but fail to establish that the disability or specific condition for which compensation is 

being claimed is causally related to the 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 a causal relationship 

between the diagnosed condition and the accepted 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 

3

Supra note 1.

4

S.C., Docket No. 18-1242 (issued March 13, 2019); J.P., 59 ECAB 178 (2007); Joe D. Cameron, 41 ECAB 

153 (1989).

5 T.H., Docket No. 18-1736 (issued March 13, 2019); R.C., 59 ECAB 427 (2008).

6 T.E., Docket No. 18-1595 (issued March 13, 2019); DeloresC. Ellyett, 41 ECAB 992 (1990).

7

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

8 E.M., Docket No. 18-1599 (issued March 7, 2019); BonnieA. Contreras, 57 ECAB 364 (2006).

9

Id.

10 D.V., Docket No. 19-1642 (issued June4, 2020); ShirleyA. Temple, 48 ECAB 404 (1997).

11 E.G., Docket No. 20-1184 (issued March 1, 2021); T.H., 59 ECAB 388 (2008).

12 M.V., Docket No. 18-0884 (issued December 28, 2018).
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rationale, explaining the nature of the relationship between the diagnosed condition and the 

specific employment incident.13

ANALYSIS

The Board finds that appellant has not met her burden of proof to establish medical 

condition causally related to the accepted May 29, 2021 employment incident.

On July 1, 2021 Dr. Lourie obtained a history of appellant injuring her left wrist at work 

pushing a patient in a wheelchair. He diagnosed a TFCC sprain and possible tear. In a progress 

report dated August 12, 2021, Dr. Lourie advised that appellant “clearly had this injury” and also 

“clearly has findings.” However, Dr. Lourie did not offer an 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 is of no probative value on the issue of causal relationship. 14 These reports, 

therefore, are insufficient to establish appellant’s claim.

In a report dated June 23, 2021, Dr. Brooks indicated that appellant had experienced pain 

in her left wrist after pushing a patient who weighed more than 300 pounds in a wheelchair. He 

diagnosed a TFCC tear. In work status forms dated June 17 and 23, 2021, Dr. Brooks diagnosed 

a TFCC tear of the left wrist and provided work restrictions. In these reports, however, he did not 

address the cause of the diagnosed condition or relate it to the employment incident. 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.15 

Appellant submitted reports dated May 29 and June 16, 2021 from a nurse practitioner. 

The Board has long held that certain healthcare providers such as physician assistants, nurses, 

nurse practitioners, physical therapists, and social workers are not considered physician[s] as 

defined under FECA.16 Consequently, their medical findings and/or opinions will not suffice for 

purposes of establishing entitlement to FECA benefits.17

The record further contains a June 12, 2021 MRI scan which demonstrated a TFCC sprain 

and/or intrasubstance tear. The Board has held, however, that diagnostic studies, standing alone, 

lack probative value on the issue of causal relationship as they do not address whether the 

13 B.C., Docket No. 20-0221 (issued July 10, 2020); Leslie C. Moore, 52 ECAB 132 (2000).

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

15 R.O., Docket No. 20-1243 (issued May 28, 2021); D.C., Docket No. 19-1093 (issued June 25, 2020).

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

Chapter 2.805.3a(1) (January 2013); DavidP. 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); 

R.L., Docket No. 19-0440 (issued July 8, 2019) (physical therapists are not considered physicians under FECA).

17 Id.
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employment incident caused any of the diagnosed conditions. 18 This report, therefore, is 

insufficient to establish the claim.

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 medical 

condition causally related to the accepted May 29, 2021 employment incident.

ORDER

IT IS HEREBY ORDERED THAT the October 15, 2021 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: June 27, 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

18 K.S., Docket No. 19-1623 (issued March 19, 2020); M.J., Docket No. 19-1287 (issued January 13, 2020).