United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

D.M., Appellant

and

DEPARTMENT OF VETERANS AFFAIRS, 

EDWARD P. BOLAND VA MEDICAL 

CENTER, Leeds, MA, Employer

__________________________________________

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Docket No. 22-0107

Issued: June 27, 2022

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

PATRICIA H. FITZGERALD, Deputy Chief Judge

JANICE B. ASKIN, Judge

JAMES D. McGINLEY, Alternate Judge

JURISDICTION

On October 31, 2021 appellant filed a timely appeal from a July 6, 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.

ISSUE

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

condition causally related to the accepted January 10, 2020 employment incident.

FACTUAL HISTORY

On January 24, 2020appellant, then a 61-year-old electrician, filed a traumatic injury claim 

(Form CA-1) alleging that on January 3, 2020 he sustained pain and swelling in his knee when he 

1

5 U.S.C. § 8101 et seq.
2

was looking for electrical parts to repair a switch while in the performance of duty. He noted that 

he was getting up from the floor, pushing with his right knee, when he heard a popping noise from 

his knee, followed by severe pain and slight swelling. On the reverse side of the claim form,

appellant’s supervisor, T.F., acknowledged that appellant was injured in the performance of duty.

On January 12, 2020 appellant underwent an x-ray scan of his right knee, which revealed 

mild anterior soft tissue swelling and edema, but no significant bony or articular findings.

In a January 20, 2020 work excuse note, Dr. Agnieszka Nicora, a Board-certified 

emergency medicine physician, advised that appellant should be off work for three days, followed 

by light-duty work pending evaluation by a physician for clearance. She also instructed appellant 

to avoid repetitive bending and kneeling and to protect the injured area.

Appellant stopped work on January 21, 2020. 

A January 23, 2020 work excuse note from David Allen, a nurse practitioner, noted that 

appellant was seen on that date and advised that appellant could return to work on February 3, 

2020 pending an appointment with a specialist.

January 27, 2020 progress notes by Dr. Robert Cross, a Board-certified physician

specializing in occupational medicine, related that appellant worked as an electrician and, while 

getting off the floor after replacing a switch, pushed up on his right knee and felt an immed iate 

“pop,” pain, and swelling. Dr. Cross indicated that appellant believed the injury occurred on 

January 3, 2020 and related his history of treatment. Appellant reported that he was unable to 

work on the day of his visit because of the pain. Dr. Cross noted that appellant was ambulating 

with one crutch with difficulty. Examination of appellant’s right knee revealed mild swelling 

around the patella, tenderness along bilateral meniscus, decreased flexion and extension, and an 

inability to bear weight without significant grimacing. Dr. Cross diagnosed right knee pain and 

advised that appellant should be off work pending evaluation by an orthopedist.

In a January 29, 2020 report, Dr. Andrew Chertoff, a Board-certified orthopedic surgeon, 

related that on January 3, 2020 appellant felt a pop in his knee when he got up off the floor while 

in the performance of duty and had right knee pain since then. He reviewed appellant’s x-ray scans 

and ultrasound, which revealed no abnormalities. Dr. Chertoff recommended a magnetic 

resonance imaging (MRI) scan. In a work excuse note of even date, he advised that appellant 

should be off work pending MRI scan results.

In a development letter dated March 13, 2020, OWCP informed appellant of the 

deficiencies of his claim. It advised him of the type of factual and medical evidence needed and 

provided a questionnaire for his completion. OWCP afforded appellant 30 days to respond. 

In an undated statement, appellant responded to OWCP’s development questionnaire, 

explaining that he was sitting on the floor in the electric shop, looking for parts to repair a switch, 

when he tried to get up off the floor using his right leg to push up. He heard a pop from his knee 

and felt pain. Appellant noted that he had not sustained any other injuries and did not have any 

similar disability or symptoms before the claimed employment incident.
3

Appellant also submitted an undated witness statement from a coworker, G.S., who noted 

that on January 10, 2020 he and appellant were looking for repair parts for a switch. He was 

looking in the lower cabinets and tried to stand up. G.S. indicated that appellant said he heard a 

pop from his knee and needed help getting off the floor. He also noted that appellant appeared to 

be in pain. 

Appellant underwent an ultrasound on January 20, 2020, which revealed no evidence of 

deep venous thrombosis. 

In the January 20, 2020 emergency medicine notes, Dr. Nicora related that, due to recent 

inflammation and discomfort in appellant’s left knee, he had been putting more pressure on his 

right leg. She noted that appellant worked as an electrician and it was typical for him to work on 

his knees with repeated kneeling, standing, and changing position. Specifically, two days prior to 

his visit, he was bending down and put a great deal of pressure on his right knee to stand up and

had right knee pain since. Dr. Nicora’s examination revealed bilateral inferior patellar skin 

hypertrophy consistent with repeated kneeling, and an ultrasound revealed no venous 

thromboembolism or Baker’s cyst. She diagnosed right knee patellar bursitis “likely from repeated 

trauma at work (kneeling)” and advised appellant to avoid kneeling and repetitive bending until

his symptoms improved. 

A March 24, 2020 narrative medical report from Dr. Chertoff related appellant’s history of 

injury and noted that appellant reported no previous symptoms or treatment to his right knee. 

Dr. Chertoff noted that appellant continued to complain of pain, tenderness, and aching with 

locking, buckling, and giving way. He diagnosed internal derangement of the right knee and again 

recommended an MRI scan of the right knee to better understand the cause of appellant’s 

symptoms. In an April 29, 2020 addendum, Dr. Chertoff corrected appellant’s date of injury from 

January 3 to 10, 2020. 

By decision dated May 1, 2020, OWCP denied appellant’s traumatic injury claim, finding 

that the medical evidence submitted was insufficient to establish causal relationship between his 

diagnosed condition and the accepted January 3 or January 10, 2020 employment incident.

In a May 26, 2020 narrative medical report, Dr. Chertoff added that appellant was 

employed as an electrician and his work included constant standing, bending, kneeling, lifting, 

twisting, and pivoting. Based on appellant’s history of injury, his review of appellant’s knee 

x-rays, his evaluation of appellant’s knee, and appellant’s employment factors, he opined that 

“there is a possibility that the knee situation could have been caused by the injury of January 10, 

20[2]0.”

Appellant also submitted a number of addenda to earlier-submitted medical reports. In a 

July 13, 2020 addendum to her January 20, 2020 report, Dr. Nicora noted patient’s assertion that, 

at the time of the January 20, 2020 examination, his knee pain had been ongoing for more than 10

days. In a July 27, 2020 addendum to a January 27, 2020 report, Kelly Loven, a nurse practitioner,

corrected appellant’s date of injury to January 10, 2020. In March 9 and 17, 2021 addenda,

Dr. Nicora clarified that appellant was treated for right knee pain.
4

On April 7, 2021 appellant requested reconsideration. He submitted a statement describing 

his history of injury and treatment and clarifying that he had initially misstated his date of injury 

as January 3, 2020, when it actually occurred on January 10, 2020.

By decision dated July 6, 2021, OWCP denied modification of its prior decision. 

LEGAL PRECEDENT

An employee seeking benefits under FECA2 has the burden of proof to establish the 

essential elements of his or her claim, including 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 of FECA,3that 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 and 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 a 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 

2

Supra note 1.

3 F.H., Docket No.18-0869 (issued January 29, 2020); J.P., Docket No. 19-0129 (issued April26, 2019); JoeD. 

Cameron, 41 ECAB 153 (1989).

4 L.C., Docket No. 19-1301 (issued January 29, 2020); J.H., Docket No. 18-1637 (issued January 29, 2020);

James E. Chadden, Sr., 40 ECAB 312 (1988).

5 P.A., Docket No. 18-0559 (issued January 29, 2020); K.M., Docket No. 15-1660 (issued September 16, 2016);

DeloresC. Ellyett, 41 ECAB 992 (1990).

6 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

S.S., Docket No. 19-0688 (issued January 24, 2020); A.M., Docket No. 18-1748 (issued April24, 2019); RobertG. 

Morris, 48 ECAB 238 (1996).
5

nature of the relationship between the diagnosed condition and specific employment factors 

identified by the employee.8

ANALYSIS

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

condition causally related to the accepted January 10, 2020 employment incident.

In her January 20, 2020 emergency medicine notes, Dr. Nicora related appellant’s history 

of injury and diagnosed right knee patellar bursitis “likely from repeated trauma at work 

(kneeling).” Although she suggested a work-related cause for appellant’s knee condition, she did 

not provide a rationalized medical opinion relating the specific diagnosed condition to the

January 10, 2020 employment incident. 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.9 Therefore, this report 

is insufficient to establish appellant’s traumatic injury claim.

In his May 26, 2020 narrative medical report, Dr. Chertoff opined that, based on 

appellant’s history of injury, his review of appellant’s knee x-rays, his evaluation of appellant’s 

knee, and appellant’s employment factors, “there is a possibility that the knee situation could have 

been caused by the injury of January 10, 20[2]0.” The Board has held that medical opinions that 

suggest that a condition “could” be caused by work activities are speculative or equivocal in 

character and have limited probative value.10 Accordingly, this report is also insufficient to 

establish causal relationship.

The January 27, 2020 progress notes signed by Dr. Cross described the accepted 

January 10, 2020 employment incident and diagnosed right knee pain. Similarly, in January 29

and March 24, 2020 reports, Dr. Chertoff described the employment incident and, in the March 24 

report, diagnosed internal derangement of the right knee and recommended an MRI scan to better 

understand the cause of appellant’s symptoms. However, none of these reports offered an opinion 

on causal relationship. The Board has held that medical evidence that lacks an opinion regarding 

the cause of an employee’s condition is of no probative value on the issue of causal relationship.11 

For this reason, this medical evidence is insufficient to meet appellant’s burden of proof.

In support of his claim, appellant submitted a January 23, 2020 report from a nurse 

practitioner. However, certain healthcare providers such as nurse practitioners 12 are not considered 

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

10 J.W., Docket No. 18-0678 (issued March 3, 2020).

11 S.J., Docket No. 19-0696 (issued August23, 2019); M.C., Docket No. 18-0951 (issued January 7, 2019); L.B., 

Docket No. 18-0533 (issued August27, 2018); D.K., Docket No. 17-1549 (issued July 6, 2018).

12 S.J., Docket No. 17-0783, n.2 (issued April9, 2018) (nurse practitioners are not considered physicians under 

FECA).
6

“physician[s]” as defined under FECA.13 Consequently, their medical findings and/or opinions 

will not suffice for purposes of establishing entitlement to FECA benefits. 14

The remaining medical evidence consisted of a January 12, 2020 x-ray scan of appellant’s

right knee and a January 20, 2020 ultrasound. The Board has held, however, that diagnostic testing 

reports, standing alone, lack probative value on the issue of causal relationship as they do not 

address the relationship between the accepted employment factors and a diagnosed condition. 15 

For this reason, this evidence is also insufficient to meet appellant’s burden of proof.

As appellant has not submitted medical evidence sufficient to establish that his right knee 

condition is causally related to the accepted January 10, 2020 employment incident, the Board 

finds that she has not met her burden of proof to establish her 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 his burden of proof to establish a right knee 

condition causally related to the accepted January 10, 2020 employment incident.

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

under FECA); T.J., Docket No. 19-1339 (issued March 4, 2020) (nurse practitioners are not considered physicians 

under FECA).

14 Id. 

15 W.M., Docket No. 19-1853 (issued May 13, 2020); L.F., Docket No. 19-1905 (issued April10, 2020).
7

ORDER

IT IS HEREBY ORDERED THAT the July 6, 2021 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: June 27, 2022

Washington, DC

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

James D. McGinley, Alternate Judge

Employees’ Compensation Appeals Board