United States Department of Labor 

Employees’ Compensation Appeals Board 

___________________________________________

J.G., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Hartford, CT, Employer 

___________________________________________

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Docket No. 14-266 

Issued: September 29, 2014 

Appearances: Case Submitted on the Record 

Appellant, pro se 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

ALEC J. KOROMILAS, Alternate Judge 

MICHAEL E. GROOM, Alternate Judge 

JAMES A. HAYNES, Alternate Judge 

JURISDICTION 

On November 18, 2013 appellant filed a timely appeal from the November 5, 2013 merit 

decision of the Office of Workers’ Compensation Programs’ (OWCP), which denied his claim. 

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 met his burden of proof to establish that he sustained an 

injury causally related to factors of his federal employment. 

FACTUAL HISTORY 

On May 15, 2013 appellant, then a 58-year-old letter carrier, filed an occupational disease 

claim alleging that he felt pain in his left knee as he walked his route. The pain worsened on 

each set of steps that he climbed. Appellant thought the pain would go away, but it continued 

 1

 5 U.S.C. § 8101 et seq. 
2

and he was forced to take two weeks of sick leave and consulted a physician, who diagnosed a 

stress fracture of the left knee. He stated that his injury began on September 25, 2012 and that he 

first became aware of the injury and its relation to his work on that date. Appellant stopped work 

on December 28, 2012 and returned on April 1, 2013. The employing establishment noted that 

he was on light duty, which involved standing two to three hours, walking one hour, driving and 

performing nonwalking duties when available. 

In a May 5, 2013 statement, appellant noted that he started to feel pain in his left knee as 

he walked his route as a letter carrier. The pain worsened with climbing steps. Appellant took 

two weeks of sick leave to let it settle down. He saw an orthopedic surgeon who placed him on 

light duty. Appellant underwent a magnetic resonance imaging (MRI) scan that revealed a 

fracture of the left knee. He was placed on light duty, then no duty for 12 weeks and returned to 

light-duty work on April 1, 2013 but the pain continued. Appellant stated that steps and 

dismounting in and out of vehicles contributed to his pain. He also felt it when bending his knee. 

OWCP received treatment reports dated October 22, 2012 to April 25, 2013 from 

Dr. Louis J. Mariorenzi, a Board-certified orthopedic surgeon, who treated appellant for 

complaint of pain and discomfort along the medial aspect of his left leg. Dr. Mariorenzi reported 

that another physician previously provided injections but the pain continued. He advised that, 

upon returning to work on October 15, 2012, appellant related that excessive walking caused 

pain in his knee, with problems ascending or descending stairs. Findings included minimal 

effusion with the knee joint and some medial joint line tenderness. Dr. Mariorenzi diagnosed 

nonspecific synovitis of the left knee with probable meniscal injury. On November 8, 2012 he 

stated that appellant was five months post right total hip replacement and listed possible medial 

meniscus tear of the left knee and possible sprain of the medial cruciate ligament of the left knee. 

Dr. Mariorenzi subsequently diagnosed stress fracture medial femoral condyle left knee 

(new problem) and right total hip replacement. He prescribed a cane and recommended a desk 

job or staying off work if walking was required. Appellant was placed off work on 

January 3, 2013. On March 28, 2013 Dr. Mariorenzi diagnosed possible stress fracture of the left 

medial femoral condyle and possible left knee osteonecrosis medial femoral condyle. Appellant 

was cleared for limited work on April 1, 2013 with limited standing and walking. On April 11, 

2013 Dr. Mariorenzi repeated his diagnoses and advised that appellant was working as a mail 

carrier. Appellant walked about one hour a day and drove a truck the rest of the day. He 

reported pain in the left knee when loading the mail truck but otherwise was minimally 

symptomatic. Dr. Mariorenzi stated that appellant could resume his activities but should try to 

avoid standing and walking more than three hours a day. On April 25, 2013 he repeated his 

diagnoses and noted that appellant returned earlier than planned because of left knee pain and 

swelling. Dr. Mariorenzi prescribed medication and scheduled further testing. 

By letter dated June 18, 2013, OWCP advised appellant that additional factual and 

medical evidence was needed to support his claim. 

OWCP received an October 11, 2012 report from Dr. Dennis Botelho, a Board-certified 

internist, who advised that appellant was having left knee pain for the past four days while 

resting and walking. Dr. Botelho noted that appellant denied any trauma. Appellant recently had 
3

a right hip replacement and noted that he “overused his [left] knee avoiding pressure to his 

[right] hip.” Dr. Botelho diagnosed bursitis and limb pain left knee.2 

In a letter dated June 27, 2013, appellant indicated that he had provided the requested 

medical evidence. He also noted that Dr. Mariorenzi did not take workers’ compensation claims 

and was not sure how to proceed with his claim. 

By decision dated August 12, 2013, OWCP denied appellant’s claim. It found that the 

medical evidence did not establish that his left knee condition was causally related to the 

established work-related activities. 

In a letter dated September 11, 2013, appellant requested reconsideration. He stated that 

his injury had progressed and that Dr. Botelho would explain his history. 

In a September 6, 2013 report, Dr. Botelho noted that he was providing clarification with 

regard to appellant’s condition. He had treated appellant for over 18 years. During that time, 

Dr. Botelho noted that appellant worked as a mail carrier and had arthritis of the right hip and, 

despite his discomfort, he walked continuously. He opined that “[i]t is my opinion that daily 

walking with [appellant’s] gait abnormality led to the development of the left knee pain. It is my 

opinion that both [appellant’s] osteoarthritis and left knee pain are causally related to his work 

and work requirement of walking and stair climbing.” Dr. Botelho added that “[appellant’s] 

present work situation has led to his physical problems and current disabilities. In this case, 

there is no specific date of injury, rather an accumulation of many years of repetitive trauma, 

related to the type of work that he performs. Chronic long distance walking in addition to an 

underlying bone condition has resulted in [appellant’s] left knee pain and current problems.” He 

stated that it was clear that daily walking and stair climbing would further aggravate the left 

knee. Dr. Botelho advised that appellant avoid his current activities, which caused inflammation 

and aggravated his physical condition. 

By decision dated November 5, 2013, OWCP denied modification of the August 12, 2013 

decision. 

LEGAL PRECEDENT 

An employee seeking benefits under FECA has the burden of establishing 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, that an injury was sustained in the performance of duty as alleged and 

that any disability and/or specific condition for which compensation is claimed are causally related 

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

 2

 Although Dr. Botelho indicated right knee, this appears to be a typographical error. 

3 Joe D. Cameron, 41 ECAB 153 (1989); Elaine Pendleton, 40 ECAB 1143, 1145 (1989). 

4 Victor J. Woodhams, 41 ECAB 345 (1989). 
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) medical evidence establishing the 

presence or existence of the disease or condition for which compensation is claimed; (2) a factual 

statement identifying employment factors alleged to have caused or contributed to the presence or 

occurrence of the disease or condition; and (3) medical evidence establishing that the employment 

factors identified by the claimant were the proximate cause of the condition for which 

compensation is claimed or, stated differently, medical evidence establishing that the diagnosed 

condition is causally related to the employment factors identified by the claimant. The medical 

evidence required to establish causal relationship, generally, is rationalized medical opinion 

evidence. Rationalized medical opinion evidence is medical evidence which includes a physician’s 

rationalized opinion on the issue of whether there is a causal relationship between the claimant’s 

diagnosed condition and the implicated employment factors. 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.5

ANALYSIS 

The evidence establishes that appellant has a left knee condition and his work involved 

activities such as walking and climbing steps while delivering mail on his route. The Board 

finds that he submitted insufficient medical evidence to establish that his left knee condition was 

caused or aggravated by the activities of his federal employment. 

In an October 11, 2012 report, Dr. Botelho advised that appellant had left knee pain for 

the past four days. He explained that appellant recently underwent a right hip replacement and 

overused his left knee to avoid pressure to his right hip. Dr. Botelho diagnosed bursitis and left 

knee pain. The Board notes that this report is of limited probative value as he did not adequately 

address how specific employment factors contributed to the diagnosed condition.6 In a 

September 6, 2013 report, Dr. Botelho advised that he had treated appellant for over 18 years and 

noted that he worked as a mail carrier and had right hip arthritis. He stated generally that 

appellant walked continuously. Dr. Botelho stated that “[i]t is my opinion that daily walking 

with [appellant’s] gait abnormality led to the development of the left knee pain. It is my opinion 

that both [appellant’s] osteoarthritis and left knee pain are causally related to his work and work 

requirement of walking and stair climbing.” He stated his conclusion that appellant’s work led to 

his physical problems and current disabilities, attributing it to an accumulation of many years of 

repetitive trauma, related to the work he performed. “Chronic long distance walking in addition 

to an underlying bone condition has resulted in [appellant’s] left knee pain and current 

problems.” The Board notes that this opinion is insufficient to establish causal relation. The 

opinion of a physician supporting causal relationship must be one of reasonable medical 

certainty that the condition for which compensation is claimed is causally related to federal 

employment and such relationship must be supported with affirmative evidence, explained by 

 5 Id. 

6 S.E., Docket No. 08-2214 (issued May 6, 2009) (medical evidence that does not offer any opinion regarding the 

cause of an employee’s condition is of limited probative value on the issue of causal relationship). 
5

medical rationale and be based upon a complete and accurate medical and factual background of 

the claimant.7 Dr. Botelho did not address the medical reasons why walking or other work 

factors caused or aggravated the diagnosed knee condition. Thus, his reports are of limited 

probative value. 

Appellant also submitted reports from Dr. Mariorenzi. In his October 23, 2012 report, 

Dr. Mariorenzi noted that appellant advised him that, upon returning to work on October 15, 

2012, excessive walking caused pain in the knee with appellant particularly having problems 

with “ascending/descending stairs.” He diagnosed nonspecific synovitis of the left knee with 

probable meniscal injury. In his November 8, 2012 report, Dr. Mariorenzi indicated that 

appellant was five months post right total hip replacement, possible tear medial meniscus of the 

left knee and possible sprain of the left knee. In an April 11, 2013 report, he repeated his 

diagnoses and indicated that appellant was back at work as a mail carrier. Dr. Mariorenzi noted 

that appellant was walking about one hour a day and driving a truck the rest of the day. 

Appellant reported pain in the left knee when loading the mail truck but otherwise was 

minimally symptomatic. Dr. Mariorenzi stated that appellant could resume his activities but 

should try to avoid standing and walking more than three hours a day. Other reports from him 

also noted appellant’s status and diagnoses. However, these reports are insufficient to establish 

appellant’s claim as Dr. Mariorenzi did not specifically address whether and how appellant’s 

work duties contributed to a diagnosed medical condition.8 Although Dr. Mariorenzi stated that 

appellant reported left knee pain when loading a mail truck, the physician did not provide his 

own opinion explaining how this activity caused or contributed to a diagnosed medical condition. 

The Board has held that the mere fact that a condition manifests itself during a period of 

employment does not raise an inference that there is a causal relationship between the two.9 

Neither the fact that the condition became apparent during a period of employment nor the belief 

that the condition was caused or aggravated by employment factors or incidents is sufficient to 

establish causal relationship.10 Causal relationship must be substantiated by reasoned medical 

opinion evidence, which is appellant’s responsibility to submit. 

As there is no reasoned medical evidence explaining how appellant’s employment duties 

caused or aggravated a medical condition involving his left knee, he has not met his burden of 

proof in establishing that he sustained a medical condition causally related to factors of his 

employment. 

On appeal, appellant argues that his physician, Dr. Botelho, provided a rationalized 

opinion. As noted, the reports are insufficiently rationalized to establish his claim. Appellant 

may submit evidence or argument with a written request for reconsideration 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. 

 7 Thomas A. Faber, 50 ECAB 566 (1999); Samuel Senkow, 50 ECAB 370 (1999). 

8 See supra note 6. 

9 See Joe T. Williams, 44 ECAB 518, 521 (1993). 

10 Id.
6

CONCLUSION 

The Board finds that appellant has not met his burden of proof in establishing that he 

sustained an injury causally related to factors of his federal employment. 

ORDER 

IT IS HEREBY ORDERED THAT the November 5, 2013 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: September 29, 2014 

Washington, DC 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board 

 

 Michael E. Groom, Alternate Judge 

 Employees’ Compensation Appeals Board 

 

 James A. Haynes, Alternate Judge 

 Employees’ Compensation Appeals Board