United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

T.M., Appellant 

and 

DEPARTMENT OF JUSTICE, FEDERAL 

BUREAU OF PRISONS, Fort Worth, TX, 

Employer 

__________________________________________ 

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Docket No. 15-1471 

Issued: December 16, 2015 

Appearances: Case Submitted on the Record

Appellant, pro se 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

CHRISTOPHER J. GODFREY, Chief Judge 

COLLEEN DUFFY KIKO, Judge 

VALERIE D. EVANS-HARRELL, Alternate Judge 

JURISDICTION 

On June 29, 2015 appellant filed a timely appeal of a June 2, 2015 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)(1) and 501.3, the Board has jurisdiction 

over the merits of the case. 

ISSUE 

The issue is whether appellant has met his burden of proof to establish a consequential 

left knee injury as a result of his accepted right knee conditions. 

FACTUAL HISTORY 

On February 24, 2010 appellant, then a 39-year-old correctional officer, filed a traumatic 

injury claim (Form CA-1) alleging that he sustained right shoulder and right knee pain in the 

 1

 5 U.S.C. § 8101 et seq.
2

performance of duty on that date. He described that while escorting two inmates on February 24, 

2010 one of the inmates attempted to block appellant’s path so that another inmate could dispose 

of contraband. Appellant had to use immediate force, place the inmate on the ground, and use 

restraints. OWCP accepted his claim for condition of the right shoulder, internal derangement of 

the right knee, and prepatellar bursitis on the right on March 31, 2010. 

Appellant underwent right shoulder arthroscopic debridement of the glenoid with repair 

of superior labrum anterior to posterior (SLAP) lesion, arthroscopic bursectomy, acromioplasty, 

and mumford procedure on June 3, 2010. On December 9, 2010 he underwent arthroscopic 

adhesiolysis and debridement of partial thickness rotator cuff tear and glenoid lesion, 

acromioplasty, and intra-articular adhesiolysis. Appellant underwent a right arthroscopy with 

abrasion arthroplasty of the medial patellar facet and complete synovectomy on April 14, 2011. 

On July 25, 2011 he underwent patellofemoral arthrosis of the right knee. OWCP authorized the 

surgeries. 

By decision dated April 9, 2012, OWCP accepted the additional condition of right radial 

styloid tenosynovitis as due to appellant’s employment injury. 

On May 10, 2012 appellant underwent excision of a cyst and de Quervain’s release in the 

right wrist. Appellant’s attending physician, Dr. Joseph Daniels, an osteopath, performed a right 

knee arthroscopy with complete synovectomy and intra-articular lysis of adhesions on 

June 21, 2012. Appellant underwent additional right arm surgery on October 24, 2013 due to 

biceps tenodeses with lysis of adhesions. These surgeries were also authorized by OWCP. 

Appellant continued to report right shoulder pain on February 3, April 2, and 16, 2014. 

Dr. Daniels examined appellant due to right knee pain on May 22, 2014. On August 20, 2014 he 

described appellant’s continuing right knee pain. Dr. Daniels examined appellant on 

September 5, 2014 due to right knee pain and giving way. He reported that appellant had 

developed a blood clot on May 8, 2014 in his right leg. In a report dated September 30, 2014, 

Dr. Daniels treated him due to low back and right lower extremity pain with paresthesias. 

Appellant telephoned OWCP on January 23, 2015 regarding expanding his claim to 

include a left knee condition. He asked if OWCP had received a report from Dr. Daniels on 

April 2, 2015. 

In a report dated March 24, 2015, Dr. Daniels described appellant’s treatment for right 

knee pain. He noted that appellant underwent right knee surgeries on April 14, and July 25, 2011 

as well as June 21, 2012. Dr. Daniels indicated that appellant utilized a walking cane and 

experienced moderate daily symptoms which limited activities. He also described tenderness 

and joint effusion in the left lower extremity. Dr. Daniels found that appellant’s left knee 

demonstrated “a lot of patellofemoral pain which could be due to overcompensation from 

chronic right knee pain and internal derangement.” He recommended a one-time evaluation to 

rule out acute or chronic issues. 

On April 28, 2015 appellant telephoned OWCP and requested that his claim be expanded 

to include his left knee condition. 
3

In a report dated May 26, 2015, an OWCP medical adviser reviewed the statement of 

accepted facts and noted the accepted conditions of right knee internal derangement, prepatellar 

bursitis, loose body, and traumatic arthropathy. He noted that the question was whether 

appellant had developed left knee pain or another left knee condition as a consequence from 

overuse as a result of the accepted right knee disorders. The medical adviser reviewed 

Dr. Daniels’ March 24, 2015 report which, in his words, suggested that the left knee 

patellofemoral joint pain could be due to overcompensation from the chronic right knee pain and 

internal derangement. He pointed out that based on review of the literature2

 there was no clear 

evidence that an injury to one lower extremity would have any significant impact on the opposite 

uninjured limb, unless the injury resulted in partial or complete paralysis of the damaged leg or a 

shortening of the injured lower extremity resulting in limb length discrepancy of more than four 

centimeters. The medical adviser concluded that appellant’s left knee disorder was not a 

consequence of the February 14, 2010 employment injuries. 

By decision dated June 2, 2015, OWCP denied appellant’s claim for a consequential 

injury to his left knee. It found that the medical adviser’s determination that there was no 

evidence that appellant’s right knee condition was of the type to impact his left knee was entitled 

to the weight of the medical evidence. 

LEGAL PRECEDENT 

 It is an accepted principle of workers’ compensation law that when the primary injury is 

shown to have arisen out of and in the course of employment, every natural consequence that 

flows from the injury is deemed to arise out of the employment, unless it is the result of an 

independent intervening cause which is attributable to the employee’s own intentional 

misconduct.3 Once the work-connected character of any injury has been established, the 

subsequent progression of that condition remains compensable so long as the worsening is not 

shown to have been produced by an independent nonindustrial cause and so long as it is clear 

that the real operative factor is the progression of the compensable injury, associated with an 

exertion that in itself would not be unreasonable under the circumstances.4

A claimant bears the burden of proof to establish a claim for a consequential injury. As 

part of this burden, he must present rationalized medical opinion evidence, based on a complete 

factual and medical background, showing causal relationship. Rationalized medical evidence is 

evidence which relates a work incident or factors of employment to a claimant’s condition, with 

stated reasons of a physician. The opinion must be one of reasonable medical certainty and must 

be supported by medical rationale explaining the nature of the relationship of the diagnosed 

condition and the specific employment factors or employment injury.5

 2

 Specifically, Dr. Daniels referred to the American Medical Association (A.M.A.) Guides Newsletter, the 

May/June 2012 edition. See The Guides Newsletter, May/June 2012. 

3 Mary Poller, 55 ECAB 483, 487 (2004); 1 Arthur Larson & Lex K. Larson, The Law of Workers’ 

Compensation, 10-1 (2006). 

4 Clement Jay After Buffalo, 45 ECAB 707, 715 (1994). 

5 Charles W. Downey, 54 ECAB 421 (2003). 
4

ANALYSIS 

The only medical evidence supporting a causal relationship between appellant’s accepted 

right knee conditions and his alleged consequential left knee condition is the March 24, 2015 

report from Dr. Daniels. In this report Dr. Daniels described appellant’s history of injury as well 

as his medical treatments for his right knee. He reported that appellant walked with a cane and 

that he experienced moderate daily symptoms which limited his activities. Dr. Daniels found 

tenderness and joint effusion in the left lower extremity. He concluded that appellant’s left knee 

pain “could be due to overcompensation from chronic right knee pain and internal derangement.” 

Dr. Daniels recommended a one-time evaluation to rule out acute or chronic issues. 

The Board finds that Dr. Daniels’ report is not sufficiently detailed and reasoned to meet 

appellant’s burden of proof. Dr. Daniels’ report is couched in speculative terms noting only that 

appellant’s left knee pain “could” be the result of overcompensation due to his right knee 

conditions. Medical opinions that are speculative or equivocal in character are of diminished 

probative value.6 Without a clear diagnosis of appellant’s left knee condition, a history which 

includes the previous left knee injuries and a definitive opinion that this condition was caused or 

aggravated by appellant’s employment, this report is insufficient to meet appellant’s burden of 

proof or to create a conflict with the opinion of OWCP’s medical adviser. 

OWCP’s medical adviser based his May 26, 2015 report on a review of the statement of 

accepted facts and Dr. Daniels’ March 24, 2015 report. He also reviewed medical literature and 

concluded, based on this review, that unless the employment-related injury resulted in partial or 

complete paralysis of the damaged leg or a shortening of the injured lower extremity resulting in 

limb length discrepancy of more than four centimeters, then there should not be a resulting 

significant impact on the opposite uninjured limb. This report does not support appellant’s claim 

for a consequential injury and it is detailed and well reasoned. 

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 failed to meet his burden of proof to establish that he 

developed a left knee consequential injury as a result of his accepted right knee conditions. 

 6 E.K., Docket No. 15-1381 (issued September 18, 2015). 
5

ORDER 

IT IS HEREBY ORDERED THAT the June 2, 2015 decision of the Office of Workers’ 

Compensation Programs is affirmed. 

Issued: December 16, 2015 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 Valerie D. Evans-Harrell, Alternate Judge 

 Employees’ Compensation Appeals Board