United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

G.L., Appellant

and

U.S. POSTAL SERVICE, PITTSBURGH POST 

OFFICE, Pittsburgh, PA, Employer

__________________________________________

)

)

)

)

)

)

)

)

Docket No. 23-0093

Issued: June 1, 2023

Appearances: Case Submitted on the Record

Alan J. Shapiro, 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

JAMES D. McGINLEY, Alternate Judge

JURISDICTION

On October 31, 2022 appellant, through counsel, filed a timely appeal from an October 4, 

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.

ISSUE

The issue is whether appellant has met her burden of proof to establish bilateral knee 

conditions causally related to the accepted factors of her federal employment.

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

FACTUAL HISTORY

On June 7, 2022 appellant, then a 30-year-old postal clerk, filed an occupational disease 

claim (Form CA-2) alleging leg, knee, foot, and arm injuries due to factors of her federal 

employment as a career employee. She noted that she first became aware of the conditions on 

May 18, 2022 and of its relation to her federal employment on June 3, 2022. 

By development letter dated June 14, 2022, OWCP informed appellant of the deficiencies 

of her claim. It advised her of the type of factual and medical evidence needed and provided a

questionnaire for her completion. Appellant was also requested to provide a narrative report 

from a physician containing a detailed description of findings and a diagnosis, as well as a 

medical explanation of how the work factors caused or aggravated a medical condition. OWCP 

afforded her 30 days to respond. 

Appellant submitted her completed responses to the development questionnaire on 

June 15, 2022. She indicated her belief that lengthy standing and walking on hard flooring, as 

well as repetitive lifting and sweeping of mail and trays in the performance of duty caused her 

conditions. 

An unsigned magnetic resonance imaging (MRI) scan report of the left knee dated 

June 3, 2022 found: intact menisci, cruciate, and collateral ligaments; focal high-grade chondral 

fissure of the deep flexion zone lateral femoral condyle; and mild patellofemoral compartment 

chondrosis.

Appellant submitted a work status note dated June 23, 2022 signed by Dr. Anthony 

Nicolas, a Board-certified rheumatologist and internist, which recommended that she transition 

to light-duty work and that she avoid activities involving continuous standing for long hours 

and/or excessive lifting that would place undue stress on her joints. 

In a letter dated July 21, 2022, the employing establishment controverted appellant’s

claim, contending that the medical documentation submitted did not establish that her claim was 

“remotely” related to her employment. 

By decision dated August 1, 2022, OWCP denied appellant’s occupational disease claim,

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

connection with the accepted employment factors. It concluded, therefore, that the requirements 

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

OWCP continued to receive medical evidence. 

On June 23, 2022 appellant was seen by Dr. Nicolas. She related that, since her last 

appointment, she had noticed swelling in multiple joints whereas previously it was limited only

to her left foot. Appellant further related intermittent swelling in her hands, knees, shoulders, 

ankles, and wrists, and that the swelling was random, but typically occurred at work after 

standing for long hours and bending or squatting repeatedly. She indicated that the swelling 

healed after a period of rest. Dr. Nicolas reviewed an MRI scan report of appellant’s left knee 

dated June 3, 2022 and assessed arthralgia, quadriceps tendonitis, and patellar maltracking. He

also noted a low suspicion for systemic autoimmune rhematic disease, and he related that she had 
3

“good reason” for mechanical arthralgia secondary to her demanding work which required 

prolonged hours of standing on hard surfaces, frequent bending, and squatting. Dr. Nicolas also

opined that appellant’s current work schedule would likely lead to early osteoarthritis. 

In a report dated July 18, 2022, Dr. Nicolas related that appellant continued to complain 

of bilateral knee pain, worsened by movement or activity and improved with rest. Appellant also 

noted that she began physical therapy. Dr. Nicolas assessed quadriceps tendonitis,

polyarthralgia, and patellar maltracking. He opined that appellant’s polyarthralgia was very 

likely mechanical, secondary to her demanding work duties that involved prolonged standing on 

hard surfaces with repeated squatting/bending, and no opportunity to sit during her shifts to take 

pressure off her knees. 

In a work status note dated July 18, 2022, Dr. Christine Mackey, an internist, 

recommended that appellant transition to light-duty work. 

In a letter dated July 25, 2022, Dr. Nicolas opined that the clinical evidence of appellant’s 

bilateral quadriceps tendonitis and polyarthralgia were “most likely” caused by repetitive workrelated mechanical strain on her joints and periarticular soft tissue. He further related that 

examples of such a strain included prolonged standing without breaks, repeated bending, and 

squatting. 

On August 22, 2022 appellant requested reconsideration. 

On August 29, 2022 appellant was seen by Dr. Stephen J. Rabuck, a Board-certified 

orthopedic surgeon where she related bilateral knee pain with greater pain in the left knee. She

indicated that her knee pain worsened after walking on concrete floors at work. Dr. Rabuck 

diagnosed left knee pain, right knee pain, primary osteoarthritis of left knee, and primary 

osteoarthritis of right knee. In a work status note of even date, he released appellant to return to 

light-duty work with restrictions. 

OWCP also received a September 12, 2022 request for light duty signed by Jessica Yohe, 

a certified physician assistant. The request noted a diagnosis of bilateral knee osteoarthritis.

Appellant filed claims for compensation (Form CA-7) on September 6, 2022 claiming 

disability from work from July 30 through August 26, 2022. 

On September 26, 2022 appellant filed an additional occupational disease claim (Form 

CA-2). She noted that she had sustained foot, arm, and knee swelling and pain, bilateral 

quadriceps tendonitis, polyarthralgia, fissuring articular cartridge of the left knee, chondral 

fissuring of the lateral femoral condyle, and restricted popliteal angles on both knees due to 

factors of her federal employment. Appellant reiterated the dates that she first became aware of 

the conditions and realized their relation to her federal employment. 

By decision dated October 4, 2022, OWCP modified its August 1, 2022 decision to find 

that appellant had established diagnosed bilateral knee conditions in connection with the 

accepted employment incident. However, it further found, that the medical evidence of record 

was insufficient to establish causal relationship between the diagnosed bilateral knee conditions

and the accepted employment factors. 
4

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

disease claim, a claimant must submit: (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 f actors by the claimant.6

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.7 The opinion of the physician must be based on a complete factual 

and medical background, must be one of reasonable medical certainty, and must be supported by 

medical rationale explaining the nature of the relationship between the diagnosed condition and 

the specific employment factors.8 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. 9

ANALYSIS

The Board finds that appellant has not met her burden of proof to establish bilateral knee

conditions causally related to the accepted factors of her federal employment.

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

S.H., Docket No. 22-0391 (issued June 29, 2022); T.W., Docket No. 20-0767 (issued January 13, 2021); L.D., 

Docket No. 19-1301 (issued January 29, 2020); S.C., Docket No. 18-1242 (issued March 13, 2019).

7 D.S., Docket No. 21-1388 (issued May 12, 2022); I.J., Docket No. 19-1343 (issued February 26, 2020); T.H., 59 

ECAB 388 (2008); Robert G. Morris, 48 ECAB 238 (1996).

8 D.S. id.; D.J., Docket No. 19-1301 (issued January 29, 2020).

9 T.M., Docket No. 22-0220 (issued July 29, 2022); S.S., Docket No. 18-1488 (issued March 11, 2019); see also

J.L., Docket No. 18-1804 (issued April 12, 2019).
5

Appellant submitted progress notes from Dr. Nicolas dated June 23 and July 18, 2022. In 

both reports, Dr. Nicolas reviewed the MRI scan report of her left knee dated June 3, 2022 and 

assessed arthralgia, quadriceps tendonitis, and patellar maltracking. In the June 23, 2022 report,

he related that appellant had “good reason” for mechanical arthralgia secondary to her 

demanding work which required prolonged hours of standing on hard surfaces, frequent bending, 

and squatting. Dr. Nicolas also indicated a low suspicion for systemic autoimmune rhematic 

disease, and he opined that her current work schedule would likely lead to early osteoarthritis. In 

his July 18, 2022 report, he opined that appellant’s polyarthralgia was very likely mechanical, 

secondary to her demanding work duties. In a letter dated July 25, 2022, Dr. Nicolas opined that 

her bilateral quadriceps tendonitis and polyarthralgia were “most likely” caused by repetitive 

work-related mechanical strain on her joints and periarticular soft tissue. However, the Board 

has held that medical opinions that are speculative or equivocal are of diminished probative 

value.10 These reports are, therefore, insufficient to establish causal relationship.

Appellant also submitted a work status note dated June 23, 2022 from Dr. Nicolas, and a 

July 18, 2022 note from Dr. Mackey which recommended transitioning to light-duty work, but 

did not provide an opinion regarding diagnosis or causal relationship. The Board has held that 

medical evidence that does not offer an opinion regarding the cause of an employee ’s condition 

is of no probative value on the issue of causal relationship.11 These reports from Dr. Nicolas are,

therefore, insufficient to establish appellant’s claim.

On August 29, 2022 appellant was seen by Dr. Rabuck who diagnosed left knee pain, 

right knee pain, primary osteoarthritis of left knee, and primary osteoarthritis of right knee. A

signed work status note of even date allowed appellant to return to work at light duty with 

restrictions. These reports do not offer an opinion on causal relationship and thus are insufficient 

to establish her claim.12

OWCP also received a request on September 12, 2022 for temporary light-duty 

assignment, which indicated a diagnosis of bilateral knee osteoarthritis, signed by Ms. Yohe, 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.

10 Federal (FECA) Procedure Manual, Part 2 --Claims, Developing and Evaluating Medical Evidence, Chapter 

2.810.5(c)(3); D.S., Docket No. 20-0384 (issued October 8, 2020); H.A., Docket No. 18-1455 (issued 

August 23, 2019).

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

12 Supra note 10.

13 H.S., Docket No. 20-0939 (issued February 12, 2021); Section 8101(2) of FECA provides that physician 

“includes surgeons, podiatrists, dentists, clinical psychologists, optometrists, chiropractors, and osteopathic 

practitioners within the scope of their pra ctice as defined by State law.” 5 U.S.C. § 8101(2); 20 C.F.R. § 10.5(t). 

See also supranote 10 atChapter 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); R.L., Docket No. 19-0440 (issued July 8, 2019) (physical therapists are not considered 

physicians under FECA).
6

Appellant also submitted an unsigned MRI scan report of the left knee dated June 3, 

2022, which found intact menisci, cruciate, and collateral ligaments; focal high-grade chondral 

fissure of the deep flexion zone lateral femoral condyle; and mild patellofemoral compartment 

chondrosis with findings that can be seen in the setting of patellar maltracking. However, 

diagnostic studies standing alone lack probative value as they do not address whether the 

employment factors caused the diagnosed condition(s).

14

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

appellant’s diagnosed medical conditions and her accepted employment factors, 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 her burden of proof to establish bilateral knee 

conditions causally related to the accepted factors of her employment.

14 A.O., Docket No. 21-0968 (issued March 18, 2022); see M.S., Docket No. 19-0587 (issued July 22, 2019).
7

ORDER

IT IS HEREBY ORDERED THAT the October 4, 2022 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: June 1, 2023

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

James D. McGinley, Alternate Judge

Employees’ Compensation Appeals Board