United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

N.F., Appellant

and

DEPARTMENT OF THE INTERIOR, ISLE 

ROYALE NATIONAL PARK SERVICE, 

Houghton, MI, Employer

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Docket No. 21-1145

Issued: January 25, 2023

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JAMES D. McGINLEY, Alternate Judge

JURISDICTION

On July 20, 2021 appellant filed a timely appeal from a June 21, 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 diagnosed medical 

condition causally related to the accepted factors of his federal employment.

FACTUAL HISTORY

On July 30, 2019 appellant, then a 29-year-old maintenance worker, filed a traumatic injury 

claim (Form CA-1) alleging that on July 24, 2019 he sustained a left testicle injury due to vigorous 

1

5 U.S.C. § 8101 et seq.
2

weed trimming, raking, and walking long distances in hot weather while in the performance of 

duty. On the reverse side of the claim form the employing establishment acknowledged that 

appellant was injured in the performance of duty. Appellant stopped work on July 25, 2019. 

In support of his claim, appellant submitted a July 25, 2019 patient care record from 

Michele Devlin, an emergency medical technician (EMT), relating that appellant experienced a 

swollen and painful varicose vein in hisleft groin and testicle area after performing heavy physical 

labor. Ms. Devlin noted that appellant had been diagnosed with a varicose vein in his groin and 

testicle area in 2012 and that it tended to swell and become painful when engaged in heavy physical 

labor. She consulted with “Dr. Patton” who advised that appellant should rest, ice, elevate, and 

support the area until he could undergo an ultrasound.

On August 2, 2019 appellant underwent a testicular ultrasound, interpreted by Dr. Paul 

Lyle, a Board-certified diagnostic radiologist, which revealed a nearly one centimeter epididymal 

cyst on the right testicle, small epididymal cyst on the left testicle, small amount of free fluid about 

each testicle, and large varicocele on the left testicle. Dr. Lyle noted that the ultrasound revealed 

no change in comparison to appellant’s previous March 22, 2018 examination. 

In an August 2, 2019 emergency room report, Dr. Tara Robinette, a Board-certified 

physician specializing in emergency medicine, related appellant’s history of pain and swelling in 

the left testicle starting one week prior to his emergency room visit. It had improved with ice and 

rest, but appellant subsequently began to experience pain in the right testicle radiating into his 

groin. Dr. Robinette noted that appellant had a known varicocele on the left side. An examination 

revealed no testicular swelling, lesions, tenderness, or hernia. Dr. Robinette explained that 

appellant’s urinalysis and ultrasound were “normal besides that varicocele that we see on the left 

side.” She diagnosed left testicular pain with unclear etiology and recommended that appellant 

limit his activity, wear supportive underwear, ice, and take acetaminophen.

On August 4, 2019 appellant underwent a computerized tomography (CT) scan of his 

abdomen and pelvis, which revealed no abnormalities.

In an emergency room report of even date, Dr. Dawn Nulf, a Board-certified physician 

specializing in emergency medicine, summarized appellant’s history and findings from his 

August 2, 2019 emergency room visit, and noted his history of left testicular varicocele. Appellant 

returned to the emergency room, reporting pain in his back, groin, testicles, and the right side of 

his abdomen, as well as orthostatic dizziness, fatigue, headaches, mild anorexia, diarrhea, nausea, 

urinary urgency, occasional paresthesia, and bilateral upper leg muscle soreness and sensation of 

weakness. An examination revealed voluntary abdominal guarding in the right lower quadrant, 

mild abdominal tenderness in the right upper quadrant, moderate abdominal tenderness in the right 

lower quadrant, minimal inguinal and proximalscrotal and glans tenderness, and mild bilateral

tenderness of the medial proximate thighs. Dr. Nulf noted that appellant’s CT scan revealed 

moderate retained stomach contents and right transverse colon stool. She diagnosed right lower 

abdominal pain and right groin pain and advised appellant to take laxatives and increase his fiber 

intake.

OWCP also received an August 30, 2019 statement from appellant. Appellant reported 

that his groin pain began after working several days in extreme heat and humidity. After seeking 
3

medical treatment from an employing establishment EMT, he rested and drank fluids, as advised, 

but his pain did not improve enough for him to return to work. When the pain worsened, appellant 

visited the emergency room twice within three days. Drs. Robinette and Nulf both related

appellant’s condition to dehydration with electrolyte imbalance due to work-related physical labor 

in extreme heat and humidity. Appellant also informed both physicians that he had severe 

abdominal pain spreading to his lower back and right side. However, neither physician 

documented the possible dehydration, nor spreading pain in their report.

In development letters dated September 16 and 20, 2019, OWCP advised appellant that, 

although he submitted a claim for a traumatic injury, he described conditions which occurred over 

a period longer than one workday or shift and, thus, his claim had been converted to an

occupational disease claim. It advised him of the type of medical evidence necessary to establish 

his claim and requested a narrative medical report from appellant’s treating physician, which 

contained a detailed description of findings and diagnoses, explaining how the reported work 

incident caused or aggravated his medical condition. OWCP afforded appellant 30 days to submit 

the necessary evidence.

On October 2, 2019 appellant responded to OWCP’s development letter. His response 

letter reiterated his prior statement, but provided additional details. Appellant noted that his 

medical provider was unwilling to provide a diagnosis other than “pain.” He further explained 

that, though he had discussed his work conditions with Dr. Nulf, she had since left the employment 

of the emergency department where appellant was treated and was, thus, unable to assist in the 

development of his case.

OWCP received a September 29, 2019 note by Dr. Robinette. Dr. Robinette related

appellant’s history of treatment, adding that Dr. Nulf diagnosed abdominal pain, groin pain, and 

possible constipation. She further explained that “pain” had always been an acceptable diagnosis 

within the provider group, and that no insurance company had ever denied a claim due to this 

terminology.

By decision dated June 21, 2021, OWCP denied appellant’s occupational disease claim, 

finding that the medical evidence of record was insufficient to establish a medical diagnosis in 

connection with the accepted factors of his federal employment. It concluded, therefore, that the 

requirements had not been met to establish an injury as defined by FECA. 

LEGAL PRECEDENT

An employee seeking benefits under FECA 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,2that 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 

2

S.B., Docket No. 17-1779 (issued February 7, 2018); J.P., 59 ECAB 178 (2007); Joe D. Cameron, 41 ECAB 

153 (1989).
4

to the employment injury.3 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.4

To establish that an injury was sustained in the performance of duty in an occupational 

disease claim, a claimant must submit the following: (1) a factual statement identifying 

employment factors alleged to have caused or contributed to the presence or occurrence of the 

disease or condition; (2) medical evidence establishing the presence or existence of the disease or 

condition for which compensation is claimed; and (3) medical evidence establishing that the 

diagnosed condition is causally related to the identified employment factors. 5

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.6 A physician’s opinion on whether there is causal relationship 

between the diagnosed condition and the implicated employment factor(s) must be ba sed on a 

complete factual and medical background.7 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 factor(s).8

ANALYSIS

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

medical condition causally related to the accepted factors of his federal employment. 

In support of his claim, appellant submitted an emergency room report dated August 2, 

2019, wherein Dr. Robinette diagnosed left testicular pain. In an August 4, 2019 emergency room 

report, Dr. Nulf diagnosed right lower abdominal pain and right groin pain. In a September 29, 

2019 note, Dr. Robinette related appellant’s history of treatment, reporting that Dr. Nulf diagnosed 

abdominal pain, groin pain and possible constipation. She further explained that “pain” had always 

been an acceptable diagnosis within the provider group and that no insurance company had ever 

denied a claim due to this terminology. However, the Board has held that pain is a description of 

a symptom, not a diagnosis of a medical condition.9 It is appellant’s burden of proof to obtain and 

submit medical documentation containing a firm diagnosis causally related to the accepted 

3

J.M., Docket No. 17-0284 (issued February 7, 2018); R.C., 59 ECAB 427 (2008); James E. Chadden, Sr., 40 

ECAB 312 (1988).

4 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 R.G., Docket No. 19-0233 (issued July 16, 2019). See also Roy L. Humphrey, 57 ECAB 238, 241 (2005); Ruby I. 

Fish, 46 ECAB 276, 279 (1994); Victor J. Woodhams, 41 ECAB 345 (1989).

6 T.H., 59 ECAB 388, 393 (2008); Robert G. Morris, 48 ECAB 238 (1996).

7 M.V., Docket No. 18-0884 (issued December 28, 2018).

8

Id.; Victor J. Woodhams,supra note 55.

9

See K.S., Docket No. 19-1433 (issued April26, 2021); S.L., Docket No. 19-1536 (issued June 26, 2020); D.Y., 

Docket No. 20-0112 (issued June 25, 2020).
5

employment incident.10 These reports are, therefore, insufficient to meet appellant’s burden of 

proof.

Appellant also submitted a July 25, 2019 patient care record from an EMT. The Board has 

held that medical reports signed solely by an EMT, physician assistant, registered nurse, or medical 

assistant are of no probative value because these healthcareproviders are not considered physicians 

as defined under FECA and are, therefore, not competent to provide medical opinions.11 

Consequently, their medical findings and/or opinions will not suffice for the purpose of 

establishing entitlement to FECA benefits.

The remaining medical evidence consisted of an August 2, 2019 testicular ultrasound and 

an August 4, 2019 CT scan of appellant’s abdomen and pelvis. The Board has held, however, that 

diagnostic testing reports, standing alone, lack probative value as they do not address the 

relationship between the accepted employment factors and a diagnosed condition. 12 For this 

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

As appellant has not submitted rationalized medical evidence establishing a diagnosed 

medical condition causally related to the accepted factors of his federal employment, the Board 

finds that he has not met his burden of proof to establish his 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 diagnosed 

medical condition causally related to the accepted factors of his federal employment. 

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

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

Relationship, Chapter 2.805.3a(1) (January 2013); D.B.,Docket No. 16-1219 (issued November 8, 2016) (an EMT is 

not considered a physician under FECA); R.L., Docket No. 19-0440 (issued July 8, 2019) (nurse practitioners are not 

considered physicians under FECA); 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). 

12 D.D., Docket No. 20-0626 (issued September 14, 2020); B.M., Docket No. 19-1341 (issued August 12, 2020).
6

ORDER

IT IS HEREBY ORDERED THAT the June 21, 2021 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: January 25, 2023

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board

James D. McGinley, Alternate Judge

Employees’ Compensation Appeals Board