United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

A.A., Appellant 

and 

DEPARTMENT OF VETERANS AFFAIRS, 

VETERANS HEALTH ADMINISTRATION, 

Dallas, TX, Employer 

__________________________________________ 

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Docket No. 14-1155 

Issued: September 24, 2014 

Appearances: Case Submitted on the Record

Appellant, pro se 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

CHRISTOPHER J. GODFREY, Chief Judge 

PATRICIA HOWARD FITZGERALD, Judge 

MICHAEL E. GROOM, Alternate Judge 

JURISDICTION 

On April 21, 2014 appellant filed a timely appeal from an April 10, 2014 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. 

ISSUE 

The issue is whether appellant established a recurrence of a medical condition due to the 

accepted May 22, 2002 injury. 

FACTUAL HISTORY 

On May 22, 2002 appellant, then a 46-year-old police officer, sustained a right knee 

injury when he stepped from a curb and twisted his knee. On August 16, 2002 OWCP accepted 

 1

 5 U.S.C. § 8101 et seq. 
2

his claim for knee strain. Appellant did not claim wage loss as a result of his condition and 

received authorization for medical procedures, including x-rays, magnetic resonance imaging 

(MRI) scan, arthroscopy, braces/splints, a myelogram and orthopedic/neurological referral. He 

returned to work on July 2, 2002 at regular duty. 

On July 1, 2002 Dr. Harold G. Weems, Jr., a Board-certified orthopedist, examined a 

MRI scan of appellant’s right knee. He found that appellant’s medial and lateral menisci, 

anterior and posterior cruciate ligaments and medial and lateral collateral ligaments to be intact. 

The bone signal of the distal femur, proximal tibia and patella were also within normal limits, as 

was the surrounding soft tissue. Dr. Weems stated his impression that appellant had a normal 

MRI scan of the right knee. In a report dated July 3, 2002, he noted that appellant’s MRI scan 

was essentially negative and believed that the majority of pain was coming from “a bit of 

tendinitis on his patellar tendon.” Dr. Weems stated that he would see appellant on an as needed 

basis. 

In a report dated February 16, 2005, Dr. William F. King, a Board-certified radiologist, 

examined the results of x-rays of appellant’s knees and compared them to a previous study of 

appellant’s right knee dated May 23, 2002. There was no acute or recent healing or unhealed 

fractures or dislocations of either knee. In the right knee, Dr. King observed smooth and wellmaintained articular surfaces of the femoral condyles and tibial plateaus without significant 

arthritis. There was a small spur on the superior pole of the right patella and two small 

calcifications nearby in the insertion of the quadriceps tendon to the patella. Dr. King noted 

another small spur on the inferior pole of the right patella, which was slightly larger than it was 

on the May 23, 2002 study. He observed no focal areas of bone erosion or destruction and 

normal and equal medial and lateral knee joint cartilage spaces. In the left knee, Dr. King noted 

smooth and well-maintained articular surfaces without significant arthritis, normal joint cartilage 

spaces and no focal areas of bony erosion or destruction. He found a small spur on the superior 

pole of the left patella. 

On the same date, Dr. Oleg I. Zhukovskiy, a Board-certified internist, noted that appellant 

had degenerative changes of the shoulder and lower back, along with bilateral knee pain. 

On January 8, 2014 appellant filed a notice of recurrence seeking medical treatment 

related to the May 22, 2002 employment injury. He did not claim wage-loss compensation and 

listed the date of recurrence as July 4, 2002. Appellant stated that he had been seen by his 

physician every six months for his knee and that his pain and restricted movements had existed 

since the 2002 injury. 

By letter dated January 15, 2014, OWCP requested additional medical evidence from 

appellant to support his claim for a recurrence of his medical condition. It noted that the 

evidence of record was insufficient to support his claim as there was no bridging medical 

evidence to establish ongoing medical complications as a result of the accepted injury. OWCP 

stated that the MRI scan of appellant’s right knee dated July 1, 2002 was normal and that the 

medical records revealed that he was released from medical care for his work-related condition 

on July 3, 2002. 
3

On July 30, 2010 Dr. Zhukovskiy diagnosed appellant with degenerative joint disease and 

increased his prescription for Lortab. 

On July 18, 2013 Dr. Gina C. Sims, a Board-certified radiologist, examined the results of 

x-rays of appellant’s knees. In the right knee, she found osteopenia with mild tricompartmental 

degenerative changes, with a prominent enthesophyte along the extensor mechanism. Dr. Sims 

noted no large right knee effusion, no acute displaced fracture or dislocation and no significant 

patellar tilt or subluxation. She observed, “Regions of heterotopic ossification along the 

proximal patellar tendon could be related to old injury were degenerative changes.” In the left 

knee, Dr. Sims found osteopenia with mild tricompartmental degenerative changes and small 

patellar enthesophytes. She stated her impression of bilateral mild tricompartmental 

degenerative changes with no acute osseous abnormality. 

Appellant responded to OWCP’s inquiries on February 22, 2014. He stated that his knee 

hurt since after the 2002 injury and continued to cause the same problems. Appellant noted that 

additional medical care was required because he had received care after the injury. The injury 

caused him to miss work and, while the injury was to his right knee, his left knee was now also 

in pain. Appellant stated that his medical records would bridge the gap between his date of 

discharge in 2002 from medical care through the present because he received medical care for 

his knee after the injury. He also submitted several unsigned and incomplete medical reports. 

By decision dated April 10, 2014, OWCP denied appellant’s recurrence claim of a 

medical condition. It found that the medical evidence was insufficient to establish that his 

current right knee condition was causally related to the May 22, 2002 employment-related injury. 

LEGAL PRECEDENT 

Appellant has the burden of establishing that he sustained a recurrence of a medical 

condition that is causally related to his accepted employment injury. To meet his burden, he 

must furnish medical evidence from a physician who, on the basis of a complete and accurate 

factual and medical history, concludes that the condition is causally related to the employment 

injury and supports that conclusion with sound medical rationale.2

 Where no such rationale is 

present, the medical evidence is of diminished probative value.3

OWCP regulations define a recurrence of medical condition as the documented need for 

further medical treatment after release from treatment of the accepted condition when there is no 

work stoppage. Continued treatment for the original condition is not considered a renewed need 

for medical care, nor is examination without treatment.4

OWCP’s procedure manual provides that, after 90 days of release from medical care 

(based on the physician’s statement or instruction to return as needed or computed by the claims 

examiner from the date of last examination), a claimant is responsible for submitting an 

 2 Ronald A. Eldridge, 53 ECAB 218, 220 (2001). 

3 Mary A. Ceglia, 55 ECAB 626, 629 (2004); Albert C. Brown, 52 ECAB 152, 155 (2000). 

4

 20 C.F.R. § 10.5(y). 
4

attending physician’s report which contains a description of the objective findings and supports 

causal relationship between the claimant’s current condition and the previously accepted work 

injury.5

ANALYSIS 

The Board finds that appellant has not established that he sustained a recurrence of a 

medical condition. OWCP accepted his traumatic injury claim for right knee strain on 

August 16, 2002. In 2014, appellant claimed entitlement to compensation for medical treatment 

of his condition. The Board finds that there is insufficient medical evidence to establish that he 

required further medical treatment for a continuing employment-related condition. 

In a report dated July 3, 2002, Dr. Weems noted that appellant’s right knee MRI scan was 

essentially negative and determined that the majority of his pain was coming from “a bit of 

tendinitis on his patellar tendon.” He released appellant from treatment on an as needed basis. 

This latter statement from Dr. Weems constituted a release from medical care under OWCP’s 

procedures.6 Appellant submitted no further medical evidence until January 8, 2014, when he 

filed his recurrence claim. His visits with physicians related to his right knee, beginning with 

Dr. King’s report of February 16, 2005, were more than 90 days after Dr. Weems’ release from 

medical care. Therefore, appellant must submit an attending physician’s report that provides a 

full and accurate medical history, a description of the objective findings and supports a causal 

relationship between his current right knee condition and the previously accepted right knee 

strain.7

 He has the burden of submitting sufficient medical evidence to document the need for 

further medical treatment.8 Appellant did not submit such evidence and failed to establish a need 

for continuing medical care. 

Dr. King’s February 16, 2005 radiological report is insufficient to establish appellant’s 

claim. In the right knee, Dr. King observed smooth and well-maintained articular surfaces of the 

femoral condyles and tibial plateaus without significant arthritis. There was a small spur on the 

superior pole of the right patella and two small calcifications nearby in the insertion of the 

quadriceps tendon to the patella. Dr. King noted another small spur on the inferior pole of the 

right patella. This report merely provides an interpretation of appellant’s right knee x-ray 

without an opinion addressing the causal relationship between any findings to his accepted injury 

of right knee strain. Dr. Zhukovskiy’s reports of February 16, 2005 diagnosed degenerative 

changes of the shoulders and lower back, with bilateral knee pain. His progress notes of July 30, 

2010, diagnosed appellant with degenerative joint disease, but did not offer any opinion on the 

 5

 Federal (FECA) Procedure Manual, Part 2 -- Claims, Recurrences, Chapter 2.1500.4(b) (June 2013). The 

procedure manual provides, with certain exceptions, that, within 90 days of release from medical care (as stated by 

the physician or computed from the date of last examination or the physician’s instruction to return PRN), a claims 

examiner may accept the attending physician’s statement supporting causal relationship between appellant’s current 

condition and the accepted condition, even if the statement contains no rationale. Id., Chapter 2.1500.4(a). 

6 See id.

7 Id. 

8 Supra note 2. 
5

cause of the right knee condition or need for treatment. 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.9

On July 18, 2013, Dr. Sims, a Board-certified radiologist, examined the results of x-rays 

of appellant’s knees. In the right knee, she found osteopenia with mild tricompartmental 

degenerative changes, with a prominent enthesophyte along the extensor mechanism. Dr. Sims 

found no large right knee effusion, no acute displaced fracture or dislocation and no significant 

patellar tilt or subluxation. She observed, “Regions of heterotopic ossification along the 

proximal patellar tendon could be related to old injury were degenerative changes.” This 

statement referencing causal relationship to an “old injury,” is unclear on the issue of etiology. 

Dr. Sims did not address the work-related injury of May 22, 2002 or other injury to the right 

knee. She is equivocal, noting that the condition “could be” related to an “old injury.” The 

Board has held that medical opinions which are speculative or equivocal are of diminished 

probative value.10 Dr. Sims did not provide adequate medical rationale in addressing the 

relationship between appellant’s current knee condition and need for treatment to the 2002 right 

knee strain. There are no further medical reports of record addressing his right knee condition.11

Appellant submitted several incomplete medical reports, containing no signature, such 

that their authors cannot readily be identified. The Board has found that reports lacking proper 

identification, such as unsigned notes, do not constitute probative medical evidence.12 These 

reports are also not sufficient to establish a recurrence of his medical condition. 

Appellant must submit a rationalized medical opinion addressing the causal relationship 

between his right knee condition in 2014 to his accepted condition of right knee strain in 2002. 

An award of compensation may not be based on surmise, conjecture, speculation or upon his 

own belief that there was a causal relationship between his condition and his employment.13 

Appellant has not submitted a rationalized medical opinion addressing causal relationship. The 

Board finds that OWCP properly denied his 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. 

 9 Michael E. Smith, 50 ECAB 313, 316 (1999). 

10 See S.E., Docket No. 08-2214 (issued May 6, 2009) (finding that opinions such as the condition is probably 

related, most likely related or could be related are speculative and diminish the probative value of the medical 

opinion); Cecilia M. Corley, 56 ECAB 662, 669 (2005) (finding that medical opinions which are speculative or 

equivocal are of diminished probative value). 

11 Appellant submitted several medical reports detailing shoulder and back conditions, but as these reports did not 

address his accepted right knee condition, they were of no probative value to his claim for recurrence. 

12 R.M., 59 ECAB 690, 693 (2008). 

13 Patricia J. Glenn, 53 ECAB 159, 160 (2001). 
6

CONCLUSION 

The Board finds that appellant did not meet his burden of proof to establish that he 

sustained a recurrence of a medical condition causally related to his accepted injury. 

ORDER 

IT IS HEREBY ORDERED THAT the April 10, 2014 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: September 24, 2014 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Patricia Howard Fitzgerald, Judge 

 Employees’ Compensation Appeals Board 

 

 Michael E. Groom, Alternate Judge 

 Employees’ Compensation Appeals Board