United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

S.P., Appellant

and

DEPARTMENT OF VETERANS AFFAIRS, VA

MEDICAL CENTER, Jackson, MS, Employer

__________________________________________

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Docket No. 23-0622

Issued: September 13, 2023

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

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On March 23, 2023 appellant filed a timely appeal from a November 28, 2022 merit 

decision and a December 14, 2022 nonmerit 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

ISSUES

The issues are: (1) whether appellant has met her burden of proof to establish a recurrence 

of the need for medical treatment, commencing August 15, 2022, causally related to the accepted 

1

5 U.S.C. § 8101 et seq.

2 The Board notes that, following the issuance of the December 14, 2022 decision, OWCP received additional 

evidence. However, the Board’s Rules of Procedureprovides: “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

October 11, 2012 employment injury; and (2) whether OWCP properly denied appellant’s request 

for reconsideration of the merits of her claim, pursuant to 5 U.S.C. § 8128(a).

FACTUAL HISTORY

This case has previously been before the Board.3 The facts and circumstances as set forth 

in the Board’s prior decision are incorporated herein by reference. The relevant facts are as 

follows. 

On October 11, 2012 appellant, then a 26-year-old nursing assistant, filed a traumatic 

injury claim (Form CA-1) alleging that on that day she sustained a bruise on both knee caps when

she helped a co-employee change a patient while in the performance of duty. On January 14, 2015, 

OWCP accepted appellant’s claim for right knee sprain.

In an October 22, 2018 medical report, Dr. Christopher Kneip, a Board-certified orthopedic 

surgeon, noted appellant’s complaint of moderate bilateral knee pain, right worse than left. He 

also noted that she experienced swelling, stiffness, limping, clicking, popping, tingling, and giving 

way, which started after an injury at work. Dr. Kneip reported his findings on physical and x-ray 

examination. He diagnosed bilateral knee chondromalacia patellae. Dr. Kneip recommended an 

injection to resolve appellant’s symptoms since arthroscopy for chondromalacia was marginally 

helpful.

In a December 6, 2018 report, Dr. Kneip noted improvement in appellant’s bilateral knee 

symptoms after she received an injection. He reexamined her and reiterated his diagnosis of 

bilateral knee chondromalacia patellae.

On October 6, 2022 appellant filed a notice of recurrence (Form CA-2a) alleging that she 

sustained a recurrence of the need for medical treatment, commencing August 15, 2022 due to her 

accepted October 11, 2012 employment injury. She noted that from time to time she experienced 

swelling and tightness in her lower extremities. Appellant also noted that she had not been off 

work because she had sedentary work duties, however, she had to rise after sitting every 10 to 20 

minutes because her knees/legs would begin to ache, and when she stretched her legs her knees 

would pop. 

In a development letter dated October 18, 2022, OWCP informed appellant of the 

deficiencies of her recurrence claim. It advised her of the type of additional medical evidence 

needed and provided a questionnaire for her completion. OWCP afforded appellant 30 days to 

respond.

On November 10, 2022 appellant responded to OWCP’s development questionnaire. She 

claimed that her recurrence was due to chronic pain in her knees. Appellant also claimed that her 

pain worsened while standing/sitting 5 to 10 minutes, exercising, and sometimes when bending. 

She could not climb into bed with both knees. At rest, appellant experienced cramps and tightness 

in her legs. She related that, in a September 29, 2014 note, Dr. Anand related to her that her injury 

would manifest as early arthritis/possible iliotibial band tendinitis. Additionally, appellant

3 Docket No. 18-1419 (issued February 27, 2019).
3

indicated that Dr. Seshadri Raju, a Board-certified thoracic cardiovascular surgeon, noted on 

November 9, 2022 that she had lymphatic nerve damage due to her injury. She claimed that further 

medical treatment was needed because she had ongoing pain and she was going to start therapy 

soon according to Dr. Raju.

Appellant submitted additional medical evidence. In an October 26, 2022 report,

Dr. Kneip reexamined appellant and continued to diagnose bilateral patellar chondromalacia. He 

also performed an injection into her right knee and recommended an injection into her left knee.

In a November 3, 2022 report, Kristen Degelman, a nurse practitioner, providedappellant’s 

physical examination findings. She diagnosed localized edema, new; pain in right and left legs, 

new; other skin changes, new; peripheral vascular disease, unspecified, new; and paresthesia of 

skin, new.

In a November 9, 2022 report, Dr. Taimur Saleem, a Board-certified general and vascular 

surgeon, noted that appellant presented with suspected venous insufficiency of both lower 

extremities but, no ulcer. Appellant also had splotchy hyperpigmentation of the affected extremity. 

She reported swelling in the leg below the knee absent a history of cellulitis. Dr. Saleem related a 

history of the October 11, 2012 employment injury. He provided examination findings. 

Dr. Saleem diagnosed encounter for observation for other suspected diseases and conditions ruled 

out, stable; essential (primary) hypertension, not documented; localized edema, stable; pain in right 

and left legs, stable; other skin changes, stable; peripheral vascular disease, unspecified, stable; 

paresthesia of skin, stable; compression of vein, new; venous insufficiency (chronic)(peripheral), 

new; and lymphedema, not elsewhere classified, new. He referred appellant to edema therapy.

A vascular laboratory testing report dated November 9, 2022 was submitted.

By decision dated November 28, 2022, OWCP denied appellant’s claim for a recurrence 

of the need for medical treatment, finding that the medical evidence of record was insufficient to 

establish a need for medical treatment due to a worsening of the accepted work-related condition, 

without intervening cause. 

On December 7, 2022 appellant requested reconsideration.

OWCP thereafter received additional medical evidence. In a November 9, 2022 report,

Dr. Benton C. Parker, a diagnostic radiologist, indicated that a nuclear medicine lymphangiogram 

was unremarkable. 

OWCP also received a December 7, 2022 report by Kimberley Yates, a licensed 

occupational therapist. 

Appellant also resubmitted Ms. Degelman’s November 3, 2022 report, Dr. Saleem’s 

November 9, 2022 report, and the November 9, 2022 vascular laboratory testing report.

By decision dated December 14, 2022, OWCP denied appellant’s request for 

reconsideration of the merits of her claim, pursuant to 5 U.S.C. § 8128(a).
4

LEGAL PRECEDENT -- ISSUE 1

The United States shall furnish to an employee who is injured while in the performance of 

duty the services, appliances, and supplies prescribed or recommended by a qualified physician 

that the Secretary of Labor considers likely to cure, give relief, reduce the degree or the period of 

any disability, or aid in lessening the amount of any monthly compensation.4

A recurrence of a medical condition means a documented need for further medical 

treatment after release from treatment for the accepted condition or injury when there is no 

accompanying work stoppage.5 An employee has the burden of proof to establish that he or she 

sustained a recurrence of a medical condition that is causally related to his or her accepted 

employment injury without intervening cause.6

If a claim for recurrence of medical condition is made more than 90 days after release from 

medical care, a claimant is responsible for submitting a medical report supporting a causal 

relationship between the employee’s current condition and the original injury in order to meet his 

or her burden.7 To meet this burden, the employee must submit medical evidence from a physician 

who, on the basis of a complete and accurate factual and medical history, supports that the 

condition is causally related and supports his or her conclusion with sound medical rationale. 8 

Where no such rationale is present, medical evidence is of diminished probative value. 9

ANALYSIS -- ISSUE 1

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

the need for medical treatment, commencing August 15, 2022, causally related to the accepted 

October 11, 2012 employment injury.

In reports dated October 22 and December 6, 2018 and October 26, 2022, Dr. Kneip noted

appellant’s bilateral knee symptoms following a work injury. He discussed his examination 

findings and diagnosed bilateral knee chondromalacia patellae. Dr. Kneip performed injections 

into appellant’s knees to treat her diagnosed bilateral knee condition. He indicated that appellant 

experienced bilateral knee symptoms following a work-related injury. Dr. Kneip failed to explain 

with rationale, how appellant’s accepted conditions worsened such that it caused a need for 

4

5 U.S.C. § 8103(a).

5

20 C.F.R. § 10.5(y).

6

See K.H., Docket No. 22-0579 (issued September 15, 2022); B.B.,Docket No. 21-1359 (issued May 11, 2022);

S.P.,Docket No. 19-0573 (issued May 6, 2021); M.P.,Docket No. 19-0161 (issued August16, 2019); E.R.,Docket 

No. 18-0202 (issued June 5, 2018); Mary A. Ceglia, Docket No. 04-113 (issued July 22, 2004).

7 Federal (FECA) Procedural Manual, Part 2 -- Claims, Recurrences, Chapter 2.1500.4b (June 2013);see also 

S.W., Docket No. 21-1094 (issued April 18, 2022); J.M., Docket No. 09-2041 (issued May 6, 2010).

8

S.W., id.; A.C.,Docket No. 17-0521 (issued April24, 2018);O.H.,Docket No. 15-0778 (issued June 25, 2015).

9

S.W., id.; M.P., supra note 5; Michael Stockert, 39 ECAB 1186 (1988).
5

medical treatment as of August 15, 2022.

10

 This evidence is, therefore, insufficient to establish 

appellant’s recurrence claim.11

Dr. Saleem’s November 9, 2022 report noted a history of the October 11, 2012 

employment injury and appellant’s bilateral knee complaints. He diagnosed encounter for 

observation for other suspected diseases and conditions ruled out, stable; essential (primary) 

hypertension, not documented; localized edema, stable; pain in right and left legs, stable; other 

skin changes, stable; peripheral vascular disease, unspecified, stable; paresthesia of skin, stable; 

compression of vein, new; venous insufficiency (chronic)(peripheral), new; and lymphedema, not 

elsewhere classified, new. Dr. Saleem referred appellant to edema therapy. However, he did not 

offer an opinion addressing whether the need for medical treatment was causally related to the 

accepted employment injury. Dr. Saleem’s report is of no probative value as he failed to offer an 

opinion regarding causal relationship. The Board has held that a medical report is of no probative 

value on a given medical matter if it does not contain an opinion on that matter. 12 Thus, this report 

is insufficient to establish appellant’s recurrence claim.

Similarly, the November 9, 2022 vascular laboratory testing report is insufficient to 

establish appellant’s claim for a recurrence of the need for medical treatment. The Board has held 

that reports of diagnostic tests, standing alone, lack probative value as they do not provide an 

opinion as to whether the accepted employment factors caused the diagnosed condition. 13 Thus 

this evidence is insufficient to establish appellant’s recurrence claim. 

Appellant also submitted a report by a nurse practitioner. The Board has held that certain 

healthcare providers such as nurse practitioners, physical/occupational therapists, and social 

workers are not considered physicians as defined under FECA and, therefore, are not competent 

to provide a medical opinion. Therefore, this evidence is insufficient to establish appellant’s 

recurrence claim.14

10 See R.B., Docket No. 22-0980 (issued October 18, 2022); S.W., id.; B.R., Docket No. 21-1109 (issued 

December 28, 2021).

11 Id.

12 See K.H., Docket No. 22-0579 (issued September 15, 2022); M.F.,Docket No. 21-1221 (issued March 28, 2022);

S.P.,Docket No. 19-0573 (issued May 6, 2021); T.H.,Docket No. 18-0704 (issued September 6, 2018); L.B., Docket 

No. 18-0533 (issued August27, 2018); D.K.,Docket No. 17-1549 (issued July 6, 2018); Charles H. Tomaszewski, 39 

ECAB 461 (1988).

13 W.T., Docket No. 23-0323 (issued August15, 2023); V.Y., Docket No. 18-0610 (issued March 6, 2020); G.S., 

Docket No. 18-1696 (issued March 26, 2019); A.B., Docket No. 17-0301 (issued May 19, 2017).

14 Section 8101(2) of FECA provides that a 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 

nurses, physician assistants, and physical therapists are not competent to render a medical opinion under FECA); see 

also L.S., Docket No. 19-1768 (issued March 24, 2020) (nurse practitioners and physical therapists are not considered 

physicians under FECA).
6

As the medical evidence of record is insufficient to establish a recurrence of the need for 

medical treatment causally related to her accepted October 11, 2012employment injury, 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.

LEGAL PRECEDENT -- ISSUE 2

Section 8128(a) of FECA vests OWCP with discretionary authority to determine whether 

to review an award for or against compensation. The Secretary of Labor may review an award for 

or against compensation at any time on his own motion or on application. 15

To require OWCP to reopen a case for merit review pursuant to FECA, the claimant must 

provide evidence or an argument which: (1) shows that OWCP erroneously applied or interpreted 

a specific point of law; (2) advances a relevant legal argument not previously considered by 

OWCP; or (3) constitutes relevant and pertinent new evidence not previously considered by 

OWCP.16

A request for reconsideration must be received by OWCP within one year of the date of 

OWCP’s decision for which review is sought.17 If it chooses to grant reconsideration, it reopens 

and reviews the case on its merits.18 If the request is timely but fails to meet at least one of the 

requirements for reconsideration, OWCP will deny the request for reconsideration without 

reopening the case for review on the merits.19

ANALYSIS -- ISSUE 2

The Board finds that OWCP properly denied appellant’s request for reconsideration of the 

merits of her claim, pursuant to 5 U.S.C. § 8128(a).

15 Id. at § 8128(a); see L.D., Docket No. 18-1468 (issued February 11, 2019); see also V.P., Docket No. 17-1287 

(issued October 10, 2017); D.L., Docket No. 09-1549 (issued February 23, 2010); W.C., 59 ECAB 372 (2008).

16 20 C.F.R. § 10.606(b)(3); see L.D., id.; see also L.G.,Docket No. 09-1517 (issued March 3, 2010); C.N.,Docket 

No. 08-1569 (issued December 9, 2008).

17 Id. at § 10.607(a). The one-year period begins on the next day after the date of the original contested decision. 

For merit decisions issued on or after August 29, 2011, a request for reconsideration must be received by OWCP 

within one year of OWCP’s decision forwhich review is sought. Federal (FECA) Procedure Manual, Part 2 --Claims, 

Reconsiderations, Chapter 2.1602.4 (September 2020). Timeliness is determined by the document receipt date of the 

request for reconsideration as indicated by the received date in the Integrated Federal Employees’ Compensation 

System (iFECS). Id. at Chapter 2.1602.4b.

18 Id. at § 10.608(a); see also F.V., Docket No. 18-0239 (issued May 8, 2020); M.S., 59 ECAB 231 (2007).

19 Id. at § 10.608(b); E.R., Docket No. 09-1655 (issued March 18, 2010).
7

Appellant’s December 7, 2022 request for reconsideration does not demonstrate that 

OWCP erroneously applied or interpreted a specific point of law. Moreover, she has not advanced 

a relevant legal argument not previously considered by OWCP. Consequently, appellant is not 

entitled to a review of the merits based on the first and second above-noted requirements under 20 

C.F.R. § 10.606(b)(3).

Appellant also did not submit any relevant and pertinent new evidence with her 

December 7, 2022 request for reconsideration. The underlying issue on reconsideration is whether 

appellant has met her burden of proof to establish a recurrence of the need for medical treatment

commencing August 15, 2022 causally related to her accepted October 11, 2012 employment 

injury. On reconsideration, appellant submitted a November 9, 2022 report by Dr. Parker, which 

addressed his unremarkable findings on a nuclear medicine lymphangiogram. He did not, 

however, provide an opinion on causal relationship. The Board has held that the submission of

evidence which does not address the particular issue involved does not constitute a basis for 

reopening a case.20 Therefore, this report does not constitute new, relevant medical evidence 

warranting a review of the merits of appellant’s claim.21 Additionally, appellant submitted a 

December 7, 2022 report by Ms. Yates, a licensed occupational therapist. As noted above, the 

Board has held that physical/occupational therapists are not considered physicians as defined under 

FECA and, therefore, are not competent to provide a medical opinion under FECA.

22

 Therefore, 

given their lack of probative value on medical matters, this report is not relevant to the underlying 

medical issue of the present case. As noted above, the submission of evidence or argument which 

does not address the particular issue involved does not constitute a basis for reopening a case.23 

Appellant also resubmitted Ms. Degelman’s November 3, 2022 report, Dr. Saleem’s November 9, 

2022 report, and the November 9, 2022 vascular laboratory report. However, the Board has held 

that the submission of evidence or argument, which repeats or duplicates evidence or argument 

already of record does not constitute a basis for reopening a case. 24

As appellant has not submitted pertinent new and relevant evidence in connection with her 

reconsideration request, she is not entitled to a review of the merits of her claim based on the third 

above-noted requirement under 20 C.F.R. § 10.606(b)(3).

The Board accordingly finds that appellant has not met any of the requirements of 20 C.F.R. 

§ 10.606(b)(3). Pursuant to 20 C.F.R. § 10.608, OWCP properly denied merit review.

20 M.N., Docket No. 15-1868 (issued February 4, 2016); Nina Corazon Pelejo, Docket No. 05-1063 (issued 

August 9, 2005); Edward Matthew Diekemper, 31 ECAB 224-25 (1979).

21 Id.

22 Supra note 14.

23 Supra note 20.

24 J.L., Docket No. 21-1373 (issued March 27, 2023); Eugene F. Butler, 36 ECAB 393, 398 (1984).
8

CONCLUSION

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

the need for medical treatment, commencing August 15, 2022, causally related to the accepted 

October 11, 2012 employment injury. The Board further finds that OWCP properly denied 

appellant’s request for reconsideration of the merits of her claim, pursuant to 5 U.S.C. § 8128(a).

ORDER

IT IS HEREBY ORDERED THAT the November 28 and December 14, 2022 decisions 

of the Office of Workers’ Compensation Programs are affirmed.

Issued: September 13, 2023

Washington, DC

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board