United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

J.M., Appellant

and

U.S. POSTAL SERVICE, RICHMOND POST 

OFFICE, Richmond, VA, Employer

__________________________________________

)

)

)

)

)

)

)

)

Docket No. 22-0939

Issued: January 9, 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

VALERIE D. EVANS-HARRELL, Alternate Judge

JAMES D. McGINLEY, Alternate Judge

JURISDICTION

On June 1, 2022 appellant, through counsel, filed a timely appeal from a May 9, 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 expand the acceptance of his 

claim to include left hip and left lower extremity conditions as causally related to the accepted 

December 19, 2019 employment injury.

FACTUAL HISTORY

On December 23, 2019 appellant, then a 58-year-old city carrier technician, filed a 

traumatic injury claim (Form CA-1) alleging that on December 19, 2019 he sustained right elbow, 

left lower extremity, and right-sided facial injuries in a motor vehicle accident (MVA) when his 

delivery vehicle skidded on black ice into an embankment while in the performance of duty.

In a development letter dated December 26, 2019, OWCP informed appellant of the 

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

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

In response, appellant submitted reports dated December 19, 2019 by Dr. Jacob A. 

Wayman, an emergency medicine specialist who recounted that appellant had been involved in an 

MVA approximately one hour prior. He had been wearing a seatbelt while driving at 

approximately 25 miles per hour, slid on ice, and skidded into an embankment. The vehicle rolled 

onto its left side. Appellant was able to extricate himself and was able to walk at the accident 

scene. He was transported to the hospital emergency department by ambulance. Appellant 

presented in the emergency department with right elbow pain, left hamstring pain, and pain in the 

left mid-femur when weightbearing. On examination, Dr. Wayman observed no tenderness or 

deformity of the upper or lower extremities, a minor abrasion to the right elbow, and some pain 

with range of motion of the right elbow.3 An ultrasound of the left hamstring demonstrated no 

significant soft tissue injury, and x-rays of the pelvis and left lower extremity demonstrated 

osteoarthritis of the left hip, knee, and ankle without evidence of acute fracture.4 Dr. Wayman 

provided a differential diagnosis of motor vehicle collision, head injury, abrasion, contusion, and 

sprain. Appellant was issued crutches and scheduled for an orthopedic consultation on 

December 20, 2019. Dr. Wayman returned appellant to light-duty work as tolerated effective 

December 21, 2019. 

Appellant also submitted a December 20, 2019 report by Jeffrey Grant, a physician 

assistant.

In a December 24, 2019 report, Dr. John Coles Wiggins, III, an emergency medicine 

specialist, related appellant’s account that he had been in a motor vehicle collision, which resulted 

in a left-sided pelvic fracture. He experienced severe pain and was referred for a computerized

3 December 19, 2019 x-rays of the right elbow revealed soft tissue calcifications anterior to the distal humerus, 

moderate degenerative changes at the elbow joint with osteophytosis, and no evidence of fracture or dislocation.

4 December 19, 2019 x-rays of the pelvis and left lower extremity revealed mild degenerative changes of the left 

hip, no evidence of fracture in the left hip or femur, tricompartmental joint space narrowing in the left knee with 

marginal osteophytosis, and osteoarthritis of the left hip, knee, and ankle.
3

tomography (CT) scan to determine if he required surgery. Dr. Wiggins obtained the CT scan5

and diagnosed a left posterior column acetabular fracture, nondisplaced on previous MRI scan,

6

and left hip pain. 

By decision dated February 5, 2020, OWCP denied appellant’s traumatic injury claim, 

finding that he had established that the incident occurred on December 19, 2019, as alleged. 

However, it further found that he had not submitted medical evidence containing a diagnosis in 

connection with the accepted employment incident. Consequently, OWCP found that appellant

had not met the requirements to establish an injury and/or medical condition.

On February 28, 2020 appellant, through counsel, requested a telephonic hearing before a 

representative of OWCP’s Branch of Hearings and Review, held June 9, 2020. At the hearing 

appellant noted that approximately 20 years prior, he had sustained a hairline fracture of the left 

ankle requiring surgery, and subsequently developed arthritis with occasional pain and swelling.

By decision dated August 24, 2020, OWCP’s hearing representative reversed OWCP’s 

February 5, 2020 decision and directed OWCP to accept the claim for a right elbow contusion and 

abrasion.

On August 25, 2020 OWCP accepted the claim for abrasion and contusion of the right 

elbow, initial encounter. 

In an August 5, 2020 report, Dr. Bennett B. Lee, a Board-certified internist, noted that 

appellant’s “[i]nitial injuries began” after the December 19, 2019 employment injury. He noted 

that appellant’s left hip condition had improved and recommended additional evaluation for low 

back pain. Dr. Lee authorized continued work restrictions. 

In a form report dated September 19, 2020, Mr. Grant noted work restrictions. 

In a February 1, 2021 letter, appellant, through counsel, requested that OWCP expand 

acceptance of the claim to include nondisplaced posterior column fracture of the left acetabulum, 

and osteoarthritis of the left hip, knee, and ankle.

On February 10, 2021 OWCP received duty status reports (Form CA-17) by Mr. Grant 

dated from January 11 through May 20, 2020, and a May 15, 2020 treatment summary signed by

Mr. Grant. 

In a development letter dated March 12, 2021, OWCP indicated that it had received a 

request for claim expansion. It advised that the medical evidence of record indicated that the 

5 December 24, 2019 CT scans of the bony pelvis demonstrated an oblique intra-articular nondisplaced fracture of 

the posterior column of the left acetabulum, and thickening of the obturator internus on the left with a small amount 

of adjacent fat stranding/hemorrhage, and a left-sided joint effusion. December 24, 2019 x-rays of the pelvis 

demonstrated bilateral iliac enthesopathy, with appellant’s known left posterior acetabular fracture not well 

appreciated. 

6 A December 22, 2019 magnetic resonance imaging (MRI) scan demonstrated a nondisplaced left posterior column 

acetabulum fracture. X-rays of the pelvis obtained from December 30, 2019 through February 20, 2020 revealed a 

healing nondisplaced left posterior wall acetabular fracture. 
4

accepted December 19, 2019 employment injury may have caused a nondisplaced left posterior 

column acetabulum fracture and osteoarthritis of the left hip, knee, and ankle. OWCP requested 

additional evidence on the history of appellant’s injury and whether he had similar preexisting 

medical conditions. It provided questions for his physician. OWCP afforded 30 days for 

submission of the requested evidence.

OWCP received reports dated April 6 and May 11, 2021 by Katherine Houston, a family 

nurse practitioner, and a May 28, 2021 report by Mr. Grant. 

May 28, 2021 x-rays demonstrated mild-to-moderate medial joint space narrowing with 

marginal osteophytes in the left knee, and mild bilateral hip joint space narrowing.

A June 13, 2021 MRI scan of the left hip demonstrated peritendinitis of the left gluteal 

tendon insertion, tendinosis versus small partial tear of the conjoined tendon of the hamstring, 

degenerative superior and anterosuperior labral tearing with joint space narrowing and subchondral 

cystic changes in the acetabulum, and a lumbosacral segmentation anomaly with 

pseudoarticulation in the left sacrum and associated marrow edema. 

On June 15, 2021 OWCP received a report dated August 19, 2020 by Lynn Gufeld, a nurse 

practitioner.

In a report dated August 10, 2021, Dr. Kevin E. Larkin, an orthopedic surgeon, recounted 

appellant’s history of left knee osteoarthritis and a left posterior column acetabular fracture in 

2019. On examination, he observed minimal effusion in the left knee with some tenderness to 

palpation along the medial joint line, and some limitation of left hip range of motion. Dr. Larkin 

reviewed a CT scan of the pelvis and opined that the left posterior column fracture had healed with 

no significant articular incongruity. He diagnosed a healed left posterior wall fracture, left hip 

osteoarthritis, and moderate left knee osteoarthritis. 

By decision dated November 2, 2021, OWCP denied appellant’s request to expand

acceptance of his claim to include nondisplaced left posterior column acetabulum fracture, and 

osteoarthritis of the left hip, knee, and ankle. It found that the medical evidence of record did not 

establish a causal relationship between the accepted December 19, 2019 employment injury and 

the additional conditions.

On November 9, 2021 appellant, through counsel, requested a telephonic hearing before a 

representative of OWCP’s Branch of Hearings and Review, which was held on March 3, 2022. 

Appellant submitted an August 25, 2021 report of an intra-articular injection of the left hip 

joint, performed by Dr. Aram Salem, a Board-certified diagnostic radiologist.

By decision dated May 9, 2022, OWCP’s hearing representative affirmed OWCP’s 

November 2, 2021 decision.
5

LEGAL PRECEDENT

When an employee claims that a condition not accepted or approved by OWCP was due to 

an employment injury, he or she bears the burden of proof to establish that the condition is causally 

related to the employment injury.7

To establish causal relationship, the employee must submit rationalized medical opinion 

evidence.8 The opinion of the physician must be based on a complete factual and medical 

background of the claimant, 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 identified by the claimant.9 The weight of medical evidence is 

determined by its reliability, its probative value, its convincing quality, the care of analysis 

manifested, and the medical rationale expressed in support of the physician’s opinion.10

In a case in which 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 expand the acceptance of 

his claim to include left hip and left lower extremity conditions as causally related to the accepted 

December 19, 2019 employment injury.

Dr. Wayman, in his December 19, 2019 report, noted the accepted employment injury and 

provided a differential diagnosis of MVA, head injury, abrasion, contusion, and sprain. 

Dr. Wiggins, in his December 24, 2019 report, recounted appellant’s belief that the December 19, 

2019 MVA had caused a left-sided pelvic fracture, but did not express an independent opinion 

addressing causal relationship. Dr. Salem, in his August 25, 2021 report, administered an injection 

but did not address causal relationship. As appellant had a history of a left ankle fracture and 

surgery, as well as osteoarthritis of the left hip, knee, and ankle, detailed medical rationale 

addressing the effect of the accepted December 19, 2019 employment incident on these preexisting 

7

J.R., Docket No. 21-0790 (issued June 21, 2022); J.R., Docket No. 20-0292 (issued June26, 2020); W.L., Docket 

No. 17-1965 (issued September 12, 2018); V.B., Docket No. 12-0599 (issued October 2, 2012); JajaK. Asaramo, 55 

ECAB 200, 204 (2004). 

8 R.H., Docket No. 21-0493 (issued March 4, 2022);E.W., Docket No. 20-0338 (issued October 9, 2020).

9 D.S., Docket No. 18-0353 (issued February 18, 2020); T.K., Docket No. 18-1239 (issued May 29, 2019); I.J., 59 

ECAB 408 (2008);Victor J. Woodhams, 41 ECAB 345(1989).

10 R.H., supra note 8; C.L., 20-0213 (issued September 15, 2021); J.L., Docket No. 20-0717 (issued October 15, 

2020); James Mack, 43 ECAB 321 (1991).

11 G.D., Docket No. 20-0966 (issued July 21, 2022); R.C., Docket No. 19-0376 (issued July 15, 2019); Federal 

(FECA) Procedure Manual, Part 2 --Claims, Causal Relationship, Chapter 2.805.3e (January 2013).
6

conditions is particularly crucial in this case.12 However, Dr. Wayman, Dr. Wiggins, and

Dr. Salem did not provide an opinion regarding how appellant’s accepted employment injury 

caused or aggravated additional diagnosed conditions. As the Board has held, medical evidence 

which does not offer an opinion regarding the cause of an employee’s condition is of no probative 

value on the issue of causal relationship.13 Therefore, their reports are insufficient to meet 

appellant’s burden of proof.14 

Dr. Lee, in a report dated September 4, 2020, noted that appellant’s injuries began after the 

accepted December 19, 2019 employment injury. The Board has held, however, that the fact that 

a condition manifests itself during a period of employment is insufficient to establish causal 

relationship. Temporal relationship alone will not suffice.15

OWCP also received reports by Mr. Grant, a physician assistant, Ms. Gufeld, a nurse 

practitioner, Ms. Houston, a family nurse practitioner, and physical therapy treatment notes. The 

Board has held, however, that medical reports signed solely by a nurse practitioner, physician 

assistant, or physical therapist are of no probative value, as such healthcare providers are not 

considered physicians as defined under FECA and, therefore, are not competent to provide a 

medical opinion.16

Appellant has also submitted diagnostic studies addressing the left lower extremity. 

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

issue of causal relationship.

17

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

finds that appellant has not met his burden of proof to establish the additional conditions of left 

posterior column acetabulum fracture and osteoarthritis of the left knee, hip, and ankle.

12 Id.

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

14 G.D., supra note 11; T.D., Docket No. 19-1506 (issued November 4, 2020); L.G., Docket No. 19-0142 (issued 

August 8, 2019).

15 R.G., Docket No. 21-1238 (issued May 9, 2022); see also Z.S.,Docket No. 19-1010 (issued October 1, 2020);

S.S.,Docket No. 19-0675 (issued August 22, 2019); M.H.,Docket No. 18-1737 (issued March 13, 2019); Daniel O. 

Vasquez, 57 ECAB 559 (2006).

16 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, supra note 11 at

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 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).

17 A.P., Docket No. 20-1668 (issued March 2, 2022);see Y.D., Docket No. 16-1896(issued February 9, 2017).
7

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 expand the acceptance of 

his claim to include left hip and left lower extremity conditions as causally related to the accepted 

December 19, 2019 employment injury.

ORDER

IT IS HEREBY ORDERED THAT the May 9, 2022 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: January 9, 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