United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

M.G., Appellant

and

DEPARTMENT OF THE ARMY, U.S. ARMY 

INSTALLATION MANAGEMENT COMMAND, 

DIRECTORATE OF EMERGENCY SERVICES, 

Fort Hood, TX, Employer

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Docket No. 23-0656

Issued: January 26, 2024

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

JANICE B. ASKIN, Judge

JURISDICTION

On April 5, 2023 appellant filed a timely appeal from a February 23, 2023 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 February 23, 2023 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 met his burden of proof to establish a lower right 

extremity condition causally related to the accepted September 30, 2022 employment incident.

FACTUAL HISTORY

On July 7, 2022 appellant, then a 57-year-old police officer, filed a traumatic injury claim 

(Form CA-1) alleging that on June 30, 2022 he sustained a right knee sprain when climbing up 

into the passenger side of his patrol truck and felt a “sharp pain” in his right knee while in the 

performance of duty. On the reverse side of the claim form, appellant’s supervisor 

acknowledged that appellant was injured in the performance of duty. 

A magnetic resonance imaging (MRI) scan report of appellant’s right knee dated 

December 12, 2022 and signed by Dr. Gregory Connor, a Board-certified diagnostic radiologist, 

related findings of radial tear through the root of the posterior horn medial meniscus with partial 

extrusion of the medial meniscal body from the medial tibiofemoral compartment; foci of 

degenerative chondral loss along the anterior weightbearing surface of the medial tibial plateau 

and the lateral weightbearing surface and lateral slope of the medial femoral condyle with 

adjacent subchondral reactive marrow change; and small knee joint effusion. 

In a development letter dated January 18, 2023, 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 him 30 days to respond. 

OWCP subsequently received an undated letter, wherein Dr. Jeffrey Padalecki, a Boardcertified orthopedic surgeon, noted his treatment of appellant on December 19, 2022. 

Dr. Padalecki related that, in June 2022, appellant was stepping down on the right knee while 

getting into his patrol truck at work and began to feel significant pain afterwards. He noted that 

appellant was given a steroid injection after the December 2022 MRI scan. Dr. Padalecki opined 

that the work injury exacerbated appellant’s knee symptoms and had been a significant 

component to the development of his knee arthritis.

On June 30, 2022 appellant was seen in an emergency department by Justin Stevenson, a 

registered nurse. The discharge note indicated a diagnosis of right knee injury. 

On December 19, 2022 appellant was treated by Thea Libbos, a physician assistant, who

related that appellant was stepping into a patrol truck when he stepped down hard on the right 

knee and felt sharp pain. Appellant received a right knee injection. Ms. Libbos diagnosed acute 

pain of right knee.

OWCP received a narrative statement from a coworker, dated January 26, 2023, 

indicating that appellant was climbing into his vehicle when the alleged incident took place. He

reiterated appellant’s history of injury. 

By decision dated February 23, 2023, OWCP denied appellant’s traumatic injury claim, 

finding that he had not established that his diagnosed condition was causally related to the 

accepted employment incident.
3

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, that 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 

whether the employee 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 n 

injury.

6

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.7 A physician’s opinion on whether there is a causal relationship 

between the diagnosed condition and the employment injury must be based on a complete factual 

and medical background.8 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 employment 

injury.9 Neither the mere fact that a disease or condition manifests itself during a period of 

employment, nor the belief that the disease or condition was caused or aggravated by 

employment factors or incidents is sufficient to establish causal relationship. 10

3

Id.

4

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

ECAB 312 (1988).

5 B.H., Docket No. 20-0777 (issued October 21, 2020); K.M., Docket No. 15-1660 (issued September 16, 2016); 

L.M., Docket No. 13-1402 (issued February 7, 2014); Delores C. 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 R.P., Docket No. 21-1189 (issued July 29, 2022); E.M., Docket No. 18-1599 (issued March 7, 2019); Robert G. 

Morris, 48 ECAB 238 (1996).

8 R.P., id.; F.A., Docket No. 20-1652 (issued May 21, 2021); M.V., Docket No. 18-0884 (issued 

December 28, 2018); Victor J. Woodhams, 41 ECAB 345, 352 (1989).

9

Id.

10 T.M., Docket No. 22-0220 (issued July29, 2022); S.S., Docket No. 18-1488 (issued March 11, 2019); see also

J.L., Docket No. 18-1804 (issued April 12, 2019).
4

In any case where a preexisting condition involving the same part of the body is present 

and the issue of causal relationship, therefore, involves aggravation, acceleration, or 

precipitation, the physician must provide a rationalized medical opinion that differentiates 

between the effects of the work-related injury or disease and the preexisting condition.11

ANALYSIS

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

extremity condition causally related to the accepted June 30, 2022 employment incident.

Appellant submitted an undated letter wherein Dr. Padalecki opined that appellant’s work 

injury exacerbated his knee symptoms and had been a significant component to the development 

of his knee arthritis. While Dr. Padalecki offered an opinion on the relationship between the 

diagnosed condition and the employment incident, he did not provide sufficient medical rationale

explaining how the employment incident physiologically caused or contributed to the lower back 

condition. Medical opinion evidence must offer a medically-sound explanation of how the 

specific employment incident or work factors physiologically caused or contributed to an

injury.12 This letter is, therefore, insufficient to establish the claim. 

On June 30, 2022 appellant was treated by Mr. Stevenson, a registered nurse. On 

December 19, 2022 he was seen by Ms. Libbos, a physician assistant. However, certain 

healthcare providers such as physician assistants, nurse practitioners, physical therapists, and 

social workers are not considered “physician[s]” as defined under FECA and their reports do not 

constitute competent medical evidence.13 This evidence is, therefore, of no probative value and 

is insufficient to establish the claim.

An MRI scan report of the right knee dated December 12, 2022 was also received. 

However, the Board has held that diagnostic studies, standing alone, lack probative value as they 

do not address whether the employment incident caused any of the diagnosed conditions. 14

Appellant further submitted narrative statements in support of his claim. As noted above, 

causal relationship is a medical question that requires rationalized medical opinion evidence to 

11 Federal (FECA) Procedure Manual, Part 2 --Claims, Causal Relationship,Chapter 2.805.3e (January 2013). 

See R.D., Docket No. 18-1551 (issued March 1, 2019).

12 O.E., Docket No. 20-0554 (issued October 16, 2020); L.R., Docket No. 16-0736 (issued September 2, 2016).

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 B.D., Docket No. 22-0503 (issued September 27, 2022) (nurse practitioners are not

considered physicians as defined under FECA); H.S.,Docket No. 20-0939 (issued February 12, 2021) (physician 

assistants are not considered physicians as defined under FECA). 

14 A.O., Docket No. 21-0968 (issued March 18, 2022); see M.S., Docket No. 19-0587 (issued July 22, 2019).
5

resolve the issue.15 A lay opinion regarding causal relationship does not constitute probative 

medical evidence.16 These statements are therefore insufficient to establish the claim.

As the medical evidence of record is insufficient to establish causal relationship between 

a diagnosed medical condition and the accepted June 30, 2022 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 lower right 

extremity condition causally related to the accepted June 30, 2022 employment incident.

ORDER

IT IS HEREBY ORDERED THAT the February 23, 2023 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: January 26, 2024

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

15 Supra note 7. 

16 See E.H., Docket No. 19-0365 (issued March 17, 2021).