L.C. and Department of Agriculture, U.S. Forest Service (Board decision, May 14, 2025)

ECAB final decision. The Board affirmed OWCP's denial of a recurrence of the need for medical treatment. A party may petition the Board for reconsideration within 30 days of issuance unless this order specifies another period, under 20 C.F.R. § 501.7(a). FECA compensation decisions are generally not subject to court review under 5 U.S.C. § 8128(b).

Plain-English summary

A Forest Service employee sought renewed treatment for knee symptoms after an accepted 2022 fall. Her physician discussed possible cartilage and meniscus problems, but the Board found the reports did not adequately explain why the accepted injury caused a renewed need to treat the accepted conditions in 2023. It affirmed OWCP's denial of the recurrence claim.

Decision snapshot

• Authority: Federal Employees' Compensation Act, 5 U.S.C. § 8101 et seq.
• Outcome: Denial of renewed medical treatment affirmed.
• Key point: The physician's reports did not adequately explain the link between the accepted injury and the renewed treatment need.

Full text (ECAB public release)

United States Department of Labor
Employees’ Compensation Appeals Board

________
)
L.C., Appellant
)
)
and ) Docket No. 24-0847
)
Issued: May 14, 2025
DEPARTMENT OF AGRICULTURE, U.S.
)
FOREST SERVICE, Albuquerque, NM, )
Employer
)
__________ )

Appearances: Case Submitted on the Record
Appellant, pro se
Office of Solicitor, for the Director

DECISION AND ORDER

Before:
PATRICIA H. FITZGERALD, Deputy Chief Judge JANICE B. ASKIN, Judge
VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On August 15, 2024 appellant filed a timely appeal from a July 18, 2024 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 July 18, 2024 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.
ISSUE

The issue is whether appellant has met her burden of proof to establish a recurrence of the need for medical treatment, commencing July 7, 2023, causally related to her accepted March 15, 2022 employment injury.

FACTUAL HISTORY

On March 22, 2022 appellant, then a 35-year-old public affairs specialist, filed a traumatic injury claim (Form CA-1) alleging that on March 15, 2022 she sustained a gash to the right knee, a bruise to the left knee, scrapes on the left elbow and palms, and a bruise to the right wrist when she slipped and fell face down onto the street when loading an all-terrain vehicle onto a truck while in the performance of duty. She did not stop work but was placed on modified duty with work restrictions. OWCP accepted the claim for left knee contusion and right knee laceration.

In a duty status report (Form CA-17) dated March 24, 2022, Dr. Paul Kim, Board-certified in occupational medicine, diagnosed right knee laceration and left knee contusion and recommended work restrictions. In progress reports and CA-17 forms dated March 30 and April 18, 2022, he diagnosed right wrist contusion, left elbow contusion, left knee sprain, and right knee laceration and sprain. Dr. Kim again recommended work restrictions.

In progress notes dated May 16, 2022, Dr. Kim recommended that appellant return to full- duty work with no limitations or restrictions, noting that her diagnoses of right wrist and left elbow contusions, bilateral knee sprain, and right knee laceration had resolved.

Appellant returned to full-time regular duty with no restrictions on May 16, 2022.

On November 21, 2023 appellant filed a notice of recurrence (Form CA-2a) alleging a recurrence of the need for medical treatment as of July 7, 2023. She explained that she was unable to perform duties of spending long days working on fires or prescribed burns while wearing appropriate personal protective equipment (PPE) boots, as they irritated her accepted injuries, and had the potential to cause secondary injuries. Appellant indicated that she did not stop work. She explained that her knee pain continued, and was exacerbated by physical activities such as being on her feet for long hours or hiking, running, and biking. Appellant stated that when the prescribed burning season began, she was in the field more often, and would stay there for 12 to 14 hours in her fire boots, which took a greater toll on her knee. She recalled that after the weekend of June 24 and 25, 2023, she worked long days, and that her knee was in incredible pain in the days following. Appellant on July 7, 2023, while walking to her office, felt sharp pain in her knee for no apparent reason, which worsened throughout the day. On July 25, 2023 she experienced new pain in her heel and one of her right toes, which she speculated was related to nerve impingement. Appellant noted that the pain returned in late 2022, but at that time, the pain was minor, and that her knee had been reinjured on July 7, 2023.

In a November 28, 2023 development letter, OWCP informed appellant of the deficiencies of her recurrence claim. It advised her of the type of additional factual and medical evidence needed and provided a questionnaire for her completion. OWCP afforded appellant 30 days to respond.

2
In a form report dated December 19, 2023, Dr. Brian Gilmer, a Board-certified orthopedic surgeon, diagnosed internal derangement of the right knee, noting that it represented a recurrence from a traumatic knee laceration.

Appellant submitted a December 19, 2023 report signed by Brittania Cogan, a physician assistant, wherein she diagnosed internal derangement of the right knee.

By decision dated February 2, 2024, OWCP denied appellant’s recurrence claim, finding that she had not established that she required additional medical treatment due to a worsening of the accepted work-related conditions without intervening cause.

In a report dated March 11, 2024, Dr. Gilmer related that he examined appellant for complaints of right knee pain. He reviewed appellant’s history of injury, noting that her right knee pain had returned when she worked while wearing fire boots all day. The pain continued and appellant stated that physical therapy no longer helped. On physical examination of the right knee, Dr. Gilmer observed positive medial joint line tenderness, positive McMurray, Thessaly, and Apley tenderness about the patella over the medial facet, patellar crepitance and grind, and pain with deep knee flexion. He diagnosed right knee pain with concern for posterior horn medial meniscus tear and potential chondral defect of the patella. Dr. Gilmer explained that appellant exhibited a course of migratory symptoms consistent with a loose body, and that while a meniscal tear may have responded well to initial physical therapy, her right knee became more symptomatic after returning to field work. He noted that since spring and summer 2023, the symptoms consistent with a loose body had largely abated, but appellant continued to have examination findings consistent with a medial meniscus tear and chondromalacia patella.

Dr. Gilmer opined that it was more probable than not that the March 15, 2022 injury, which was initially assumed to be a mere laceration and contusion, continued to have residual symptoms and subsequent flare-ups due to an undertreated medial meniscal pathology. He recommended obtaining a magnetic resonance imaging (MRI) scan of the right knee.

On March 29, 2024 appellant requested reconsideration.

By decision dated April 5, 2024, OWCP denied modification of its February 2, 2024 decision.

In notes dated July 10, 2023, Dr. Gilmer followed up for evaluation of appellant’s right knee condition. He noted that she experienced a flare-up of symptoms as of July 7, 2023. Dr. Gilmer reviewed her history of injury and conducted a physical examination of her right knee, observing a well-healed laceration with patellofemoral crepitance and grind . He diagnosed a chondral defect of the patella, noting that she had sustained a direct blow to the patella as part of her work-related injury, and suspected underlying cartilage damage. In notes dated December 20, 2023, Dr. Gilmer reviewed the history of appellant’s right knee pain. He conducted a physical examination of the right knee, observing medial and lateral joint line tenderness, popping with flexion to extension, and a positive McMurray test. Dr. Gilmer diagnosed internal derangement of the right knee. He opined that it was medically necessary to reopen appellant’s claim in order to obtain an MRI scan.

3
Appellant resubmitted an x-ray of the right knee obtained on March 15, 2022, which demonstrated no evidence of fracture, dislocation, joint effusion of the patella bursa, radio opaque foreign body, or other acute traumatic abnormality.

Appellant submitted physical therapy notes dated from December 7, 2022 through April 17, 2023. She also resubmitted a March 15, 2022 report signed by a nurse practitioner, and notes signed by physician assistants dated November 10, 2022, and December 19, 2023.

On July 11, 2024 appellant requested reconsideration. In an attached undated letter, Dr. Gilmer stated that his March 11, 2024 medical note contained sufficient justification for approval of a request for imaging to corroborate suspected diagnoses of meniscal tear or chondral injury of the patella. He noted that appellant returned on July 8, 2024 with increased swelling and mechanical symptoms after hiking, explaining that he suspected the symptoms were due to persistent popping and catching about the patella. Dr. Gilmer further noted lateral tenderness, and stated that a small loose body was present, likely with a donor site from the patella. He opined that it was medically probable that there was a causal relationship between appellant’s recurrence of symptoms and the original injury.

By decision dated July 18, 2024, OWCP denied modification of its April 5, 2024 decision.

LEGAL PRECEDENT

The United States shall furnish to an employee who is injured while in the performance of duty the services, appliances, and supplies prescribed or recommended by a qualified physician that the Secretary of Labor considers likely to cure, give relief, reduce the degree or the period of any disability, or aid in lessening the amount of any monthly compensation. 3

A recurrence of a medical condition means a documented need for further medical treatment after release from treatment for the accepted condition or injury when there is no accompanying work stoppage. 4 An employee has the burden of proof to establish that he or she sustained a recurrence of a medical condition that is causally related to his or her accepted employment injury without intervening cause.5 If a claim for recurrence of medical condition is made more than 90 days after release from medical care, a claimant is responsible for submitting a medical report supporting a causal relationship between the employee ’s current condition and the original injury in order to meet his or her burden. 6

3
Supra note 1 at § 8103(a).
4
20 C.F.R. § 10.5(y).
5
W.B., Docket No. 22-0985 (issued March 27, 2023); S.P., Docket No. 19-0573 (issued May 6, 2021); M.P., Docket No. 19-0161 (issued August 16, 2019); E.R., Docket No. 18-0202 (issued June 5, 2018); Mary A. Ceglia, 55 ECAB 626 (2004). 6 Federal (FECA) Procedural Manual, Part 2 -- Claims, Recurrences, Chapter 2.1500.4b (June 2013); see also M.S., Docket No. 24-0689 (issued July 26, 2024); M.F., Docket No. 21-1221 (issued March 28, 2022); J.M., Docket No. 09-2041 (issued May 6, 2010).

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ANALYSIS

The Board finds that appellant has not met her burden of proof to establish a recurrence of the need for medical treatment, commencing July 7, 2023, causally related to her accepted March 15, 2022 employment injury.

On July 10, 2023 Dr. Gilmer diagnosed a chondral defect of the patella, noting that appellant had sustained a direct blow to the patella as part of her work -related injury and that he suspected underlying cartilage damage. The Board has long held that medical opinions that are speculative or equivocal in character are of diminished probative value.7 Therefore, this evidence is insufficient to establish appellant’s recurrence claim.

On December 19 and 20, 2023 Dr. Gilmer diagnosed internal derangement of the right knee, noting that it represented a recurrence of her accepted right knee laceration. However, he did not explain with rationale how this resulted in a recurrence of the need for medical treatment of the accepted employment-related conditions. The Board has held that a medical report is of limited probative value on the issue of causal relationship if it contains a conclusion regarding causal relationship which is unsupported by medical rationale.8 Therefore, this evidence is insufficient to establish appellant’s recurrence claim.

On March 11, 2024 Dr. Gilmer explained that appellant’s right knee became more symptomatic after returning to field work. He noted that since the Spring of 2023, appellant’s symptoms consistent with a loose body had largely abated, but she continued to have examination findings consistent with a medial meniscus tear and chondromalacia patella. Dr. Gilmer opined that it was more probable than not that the March 15, 2022 injury, which was initially assumed to be a mere laceration and contusion, continued to have residual symptoms and subsequent flare- ups due to an undertreated medial meniscal pathology. In an undated letter, he stated that his March 11, 2024 medical note contained sufficient justification for approval of a request for imaging to corroborate suspected diagnoses of meniscal tear or chondral injury of the patella. Dr. Gilmer noted that appellant returned on July 8, 2024 with increased swelling and mechanical symptoms after hiking. He opined that there was a causal relationship between appellant’s recurrence of symptoms and the original injury. However, Dr. Gilmer did not explain with rationale how this resulted in a recurrence of the need for medical treatment o f the accepted employment-related conditions. As noted above, the Board has held that a mere conclusion without the necessary rationale is insufficient to meet a claimant’s burden of proof. 9 As such, these reports are of limited probative value regarding appellant’s claim for a recurrence of the need for medical treatment.

OWCP also received evidence signed solely by a physician assistant and a physical therapist. However, certain healthcare providers such as physician assistants and physical

7
C.H., Docket No. 19-0409 (issued August 5, 2019); A.B., Docket No. 16-1163 (issued September 8, 2017).
8
See C.B. (S.B.), Docket No. 19-1629 (issued April 7, 2020); V.T., Docket No. 18-0881 (issued November 19, 2018); S.E., Docket No. 08-2214 (issued May 6, 2009); T.M., Docket No. 08-0975 (issued February 6, 2009). 9 Id.

5 therapists are not considered physicians as defined under FECA. 10 Thus, this evidence is of no probative value and is insufficient to establish appellant’s claim.

The record also contains an x-ray scan. The Board has held, however, that diagnostic studies, standing alone, lack probative value on the issue of causal relationship as they do not address whether the accepted employment injury resulted in appellant’s diagnosed medical conditions. 11

As appellant has not submitted rationalized medical evidence establishing a recurrence of the need for medical treatment, commencing July 7, 2023, causally related to her accepted March 15, 2022 employment injury, she has not met her burden of proof.12

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 a recurrence of the need for medical treatment, commencing July 7, 2023, causally related to her accepted March 15, 2022 employment injury.

10
Section 8101(2) of FECA provides that medical opinions can only be given by a qualified physician. This section defines a physician as 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) (May 2023); 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 also L.C., Docket No. 25- 0444 (issued April 23, 2025) (physician assistants are not considered physicians as defined by FECA); K.H., Docket No. 25-0439 (issued April 23, 2025) (physical therapists are not considered physicians as defined under FECA). 11 L.A., Docket No. 22-0463 (issued September 29, 2022); D.K., Docket No. 21-0082 (issued October 26, 2021);
O.C., Docket No. 20-0514 (issued October 8, 2020); R.J., Docket No. 19-0179 (issued May 26, 2020). 12 Appellant may file an occupational disease claim (Form CA-2) if she believes that her conditions arose due to work factors occurring over the course of more than one work shift. See 20 C.F.R. § 10.5(g), which defines an occupational disease.

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ORDER

IT IS HEREBY ORDERED THAT the July 18, 2024 decision of the Office of Workers’ Compensation Programs is affirmed.

Issued: May 14, 2025
Washington, DC

Patricia H. Fitzgerald, Deputy Chief Judge Employees’ Compensation Appeals Board

Janice B. Askin, Judge
Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge Employees’ Compensation Appeals Board

7