United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

M.M., Appellant

and

DEPARTMENT OF VETERANS AFFAIRS, 

LOUIS A. JOHNSON VA MEDICAL CENTER, 

Clarksburg, WV, Employer

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Docket No. 23-0438

Issued: October 17, 2023

Appearances: Case Submitted on the Record

Michael Overman, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

PATRICIA H. FITZGERALD, Deputy Chief Judge

JANICE B. ASKIN, Judge

JURISDICTION

On February 9, 2023 appellant, through counsel, filed a timely appeal from an August 25, 

2022 merit decision of the Office of Workers’ Compensation Programs (OWCP). Pursuant to the 

Federal Employees’ Compensation Act2(FECA) and 20 C.F.R. §§ 501.2(c) and 501.3, the Board 

has jurisdiction over the merits of this case.

1

In all cases in which a representative has been authorized in a matter before the Board, no claim for a fee for legal 

or other service performed on appeal before the Board is valid unless approved by the Board. 20 C.F.R. § 501.9(e). 

No contract for a stipulated fee or on a contingent fee basis will be approved by the Board. Id. An attorney or 

representative’s collection of a fee without the Board’s approval may constitute a misdemeanor, subject to fine or 

imprisonment for up to one year or both. Id.; see also 18 U.S.C. § 292. Demands for payment of fees to a 

representative, prior to approval by the Board, may be reported to appropriate authorities for investigation.

2

5 U.S.C. § 8101 et seq.
2

ISSUE

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

causally related to the accepted March 20, 2021 employment incident.

FACTUAL HISTORY

On May 18, 2021 appellant, then a 57-year-old custodian, filed a traumatic injury claim 

(Form CA-1) alleging that on March 20, 2021 he suffered a hairline fractured left kneecap when 

he slipped while descending the last two steps on a staircase in the performance of duty. He 

stopped work on April 30, 2021. Appellant resigned from the employing establishment on 

July 13, 2021. 

In support of his claim, appellant submitted a March 22, 2021 report from Dr. Matthew

Verona, an osteopath and Board-certified emergency medicine specialist, who treated him for a

left knee injury reported to have occurred at work on March 20, 2021. He reported slipping on

steps and twisting his left knee and experiencing pain and swelling. Appellant further advised that

he had no prior history of left knee pain or injury. Dr. Verona noted findings on physical

examination of effusion of the anterior and medial knee with limited range of motion. An x-ray

of the left knee revealed an effusion with no fracture. Dr. Verona diagnosed left knee sprain and

returned appellant to work with restrictions. In a March 22, 2021 form report, he noted that

appellant sustained a work-related injury and could return to regular duty on March 29, 2021.

Appellant was also treated on March 22, 2021 by Shawna Wine, a registered nurse, for an

acute onset of left knee pain that occurred on March 20, 2021 when he twisted his left knee while

descending stairs.

On April 4, 2021 Dr. Michael Ferrebbe, Board-certified in emergency medicine, treated

appellant for left knee pain. He noted that appellant reported twisting his left knee at work. 

Appellantindicated that he had been wearinga bandage wrap, butstill experienced persistent pain.

Dr. Ferrebbe detailed findings on examination, including left knee pain and limited range of

motion, and diagnosed left knee pain.

In an April 26, 2021 report, Dr. Khan Tanveer,Board-certified in family medicine, treated

appellant for left knee pain that reportedly began at work a month prior when he fell while

descending stairs. He reviewed a magnetic resonance imaging (MRI) scan of the left knee and

diagnosed left patellar chondral fissures without evidence of ligamentous or osseous injury.

Dr. Tanveer recommended use of a bandage and referred appellant for an orthopedic evaluation.

On April 30, 2021 Dr. George Andrews, a Board-certified orthopedist, examined appellant

in consultation for left knee pain that reportedly began at work on March 20, 2021. Appellant

reported that he was descending stairs at work and experienced left knee pain when he missed a

step. Dr. Andrews noted findings on physical examination of tenderness of the left patellofemoral

joint and positive McMurray’s test medially. He reviewed an April 23, 2021 MRI scan of the left

knee that revealed mild patellar compartment chondral fissures and small knee fusion.

Dr. Andrews diagnosed chondral injury to the left patella. He noted that appellant was disabled
3

from work for one month and then could return to light-duty work. In an undated note,

Dr. Andrews returned appellant to light-duty work effective May 31, 2021.

In a development letter dated May 26, 2021, OWCP informed appellant of the deficiencies 

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

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

provide the necessary information. 

In response to the development letter, appellant submitted an incident report dated June 1, 

2021 and noted that on March 20, 2021 he was descending stairs at work when he missed the last 

two steps and fell backwards on his buttocks. He experienced persistent left knee pain and sought 

medical treatment. Appellant reported that he was diagnosed with a fractured kneecap and

continued to work limited duty wearing a knee wrap and brace.

On June 2, 2021 appellant accepted a temporary light-duty position with the employing 

establishment as a custodian, working eight hours per day with Saturdays and Sundays as his

scheduled days off. The physical requirements noted no carrying equipment up or down stairs, 

use of an elevator, and no overtime work. 

In an undated note, Dr. Andrews returned appellant to regular-duty work on July 12, 2021.

By decision dated July 8, 2021, OWCP denied appellant’s traumatic injury claim, finding 

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

diagnosed conditions and the accepted March 20, 2021 employment incident. It concluded, 

therefore, that the requirements had not been met to establish an injury as defined by FECA.

OWCP received additional evidence. Dr. Andrews treated appellant in follow up on 

June 11, 2021 for persistent left knee pain beginning March 20, 2021. He noted findings on 

physical examination of tenderness at the patellofemoral joint, limited range of motion, and 

positive McMurray’s test medially. Dr. Andrews diagnosed chondral injury to the left patella and 

took appellant off work for four weeks due to increased symptoms.

On July 23, 2021 appellant requested reconsideration of the July 8, 2021 decision. He 

resubmitted documentation that was previously of record.

By decision dated August 11, 2021, OWCP denied appellant’s request for reconsideration 

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

OWCP received additional evidence. Dr. Andrews related in a March 23, 2022 report that 

appellant returned to work on a full-time basis and experienced increasing pain in the anterior 

aspect of the left knee. He diagnosed chondral injury to the left patella. Dr. Andrews 

recommended that appellant avoid bending the left knee beyond 90 degrees, climbing, and carrying 

heavy objects. Appellant was treated by Dr. Andrews on June 9, 2022 who noted a history of 

injury and subsequent medical treatment. He reported persistent pain in the anterior aspect of the 

left knee. Dr. Andrews explained that the MRI scan revealed a cartilage injury to the patella and 

that, due to the nature of the injury, appellant would continue to experience pain in the knee with 

increased activity. He opined that the clinical evaluation and MRI scan findings support a chondral 

injury to the left patella, which occurred when appellant fell on March 20, 2021. Dr. Andrews
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advised that appellant would continue to be symptomatic because of the poor healing potential of 

the patellar cartilage.

Appellant submitted an x-ray of the left knee dated March 23, 2022, which contained an 

impression of unremarkable examination of the left knee.

On June 14, 2022 appellant through counsel, requested reconsideration of the August 11, 

2021 decision.

By decision dated August 25, 2022, OWCP denied modification of the July 8, 2021 

decision. 

LEGAL PRECEDENT

An employee seeking benefits under FECA3 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,4that 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.5 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.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. First, 

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. Second, the employee must 

submit sufficient evidence to establish that the employment incident caused a personal injury. 7

The medical evidence required to establish a causal relationship is rationalized medical 

opinion evidence.8 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 

3

Id.

4 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).

5 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).

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

Delores C. Ellyett, 41 ECAB 992 (1990).

7 T.J., Docket No. 19-0461 (issued August 11, 2020); K.L., Docket No. 18-1029 (issued January 9, 2019); John J. 

Carlone, 41 ECAB 354 (1989).

8

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).
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by medical rationale explaining the nature of the relationship between the diagnosed condition and 

specific employment incident identified by the employee. 9

ANALYSIS

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

condition causally related to the accepted March 20, 2021 employment incident.

Appellant submitted a March 22, 2021 report from Dr. Verona who diagnosed left knee 

sprain. Dr. Verona noted that appellant reported slipping on steps at work and twisting his left 

knee. In a March 22, 2021 form report, he noted that appellant sustained a work-related injury. 

On April 4, 2021 Dr. Ferrebbe diagnosed left knee pain after a twisting injury at work. On 

April 26, 2021 Dr. Tanveer diagnosed left patellar chondral fissures. He noted that appellant had 

reported falling when descending stairs at work. On April 30, 2021 Dr. Andrews diagnosed 

chondral injury to the left patella that occurred on March 20, 2021 when appellant fell while 

descending stairs at work. On June 9, 2022 he opined that the clinical evaluation and MRI scan 

findings supported a chondral injury to the patella, which occurred when appellant fell on 

March 20, 2021. While Drs. Verona, Ferrebbe, Tanveer, and Andrews opined that appellant’s left 

knee condition was work related, they failed to provide medical sufficient rationale explaining the 

basis of their opinions. Without explaining, physiologically, how the March 20, 2021 employment 

incident caused or aggravated the diagnosed condition, the opinions on causal relationship of 

Drs. Verona, Ferrebbe, Tanveer, and Andrews are of limited probative value and are insufficient 

to establish appellant’s claim.10 

In undated notes, Dr. Andrews returned appellant to light-duty work on May 31, 2021, and 

to regular duty on July 12, 2021. In these notes, he did provide an opinion as to whether a 

diagnosed condition was causally related to the accepted March 20, 2021 employment incident. 

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

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

from Dr. Andrews are therefore insufficient to establish appellant’s claim.

Dr. Andrews treated appellant in follow up on June 11, 2021 for persistent left knee pain 

since March 20, 2021. He diagnosed chondral injury to the left patella and took appellant off work. 

Similarly, on March 23, 2022, Dr. Andrews reported that appellant experienced increasing pain in 

the anterior aspect of the left knee and diagnosed chondral injury to the left patella. However, he 

did not relate the diagnosed conditions to the accepted March 20, 2021 employment incident. As 

noted above, medical evidence that does not offer an opinion regarding the cause of a diagnosed 

9 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).

10 G.L., Docket No. 18-1057 (issued April14, 2020); J.P., 59 ECAB 178 (2007); Joe D. Cameron, 41 ECAB 

153 (1989).

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

condition or disability is of no probative value on the issue of causal relationship. 12 Therefore, 

these reports are insufficient to meet appellant’s burden of proof. 

Appellant submitted a report from a registered nurse. However, certain healthcare 

providers such as registered nurses13 are not considered “physician[s]” as defined under FECA.14 

Consequently, their medical findings and/or opinions will not suffice for purposes of establishing 

entitlement to FECA benefits.

15

 

Appellant also submitted an x-ray of his left knee. The Board has held that diagnostic 

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

provide an opinion as to whether the employment incident caused any of the diagnosed 

conditions.16 This evidence is therefore insufficient to establish appellant’s claim.

As the medical evidence of record is insufficient to establish a medical condition causally

related to the accepted March 20, 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 medical 

condition causally related to the accepted March 20, 2021 employment incident.

12 Id.

13 B.B., Docket No. 09-1858 (issued April16, 2010) (nurse’s reports are of no probative medical value as nurses 

are not physicians under FECA).

14 Section 8102(2) of FECA provides as follows: (2) 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. § 8102(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); 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 alsoB.D.,Docket No. 22-0503 (issued September 27, 2022)(nurse practitioners are not considered 

physicians as defined under FECA and their medical findings and/or opinions will not suffice for purposes of 

establishing entitlement to FECA benefits); L.S., Docket No. 19-1231 (issued March 30, 2021) (a nurse practitioner 

is not considered a physician as defined under FECA).

15 Id.

16 C.B., Docket No. 20-0464 (issued July 21, 2020).
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ORDER

IT IS HEREBY ORDERED THAT the August 25, 2022 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: October 17, 2023

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board