United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

L.G., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Cinnaminson, NJ, Employer 

__________________________________________ 

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Docket No. 15-1226 

Issued: November 16, 2015 

Appearances: Case Submitted on the Record

Thomas R. Uliase, Esq. for the appellant 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

CHRISTOPHER J. GODFREY, Chief Judge 

PATRICIA H. FITZGERALD, Deputy Chief Judge 

COLLEEN DUFFY KIKO, Judge 

JURISDICTION 

On May 8, 2015 appellant, through counsel, filed a timely appeal from a February 26, 

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) and 501.3, the 

Board has jurisdiction over the merits of this case. 

ISSUE 

The issue is whether appellant has established a left knee condition causally related to the 

July 5, 2013 employment incident. 

FACTUAL HISTORY 

On August 9, 2013 appellant, then a 49-year-old distribution clerk, filed a traumatic 

injury claim (Form CA-1) alleging that on July 5, 2013 she sustained an anterior cruciate 

ligament (ACL) tear to her left knee. She related that, after pulling equipment from loading 

 1

 5 U.S.C. § 8101 et seq. 
2

dock, her left knee felt strange and was clicking, popping, and unstable. After going to the 

branch office, appellant noticed that her knee had started to swell. She stopped work on July 8, 

2013 and returned to work on July 22, 2013. The employing establishment indicated that 

appellant failed to follow instructions and failed to obey safety policy to push mail transportation 

equipment. 

In July 8, 2013 reports, Dr. Susan W. Laws-Mobilio, an osteopath and family 

practitioner, noted that appellant was under her care for internal derangement of the left knee. 

She indicated that appellant needed x-rays and magnetic resonance imaging (MRI) scans and 

would be referred to orthopedics. Dr. Laws-Mobilio took appellant off work through 

July 22, 2013. 

Several reports were received from Dr. Mitesh Patel, a Board-certified family practitioner 

also certified in sports medicine. In an August 9, 2013 note, Dr. Patel reported that appellant 

was seen for her “knees” and that she could work with restrictions. In an August 16, 2013 

attending physician’s report, he reported the history of injury as left knee locked up at work, 

resulting in pain. Dr. Patel also noted that appellant had evidence of advanced osteoarthritis. He 

diagnosed left knee degenerative joint disease (DJD) with ACL tear, as evidenced by MRI scan. 

Dr. Patel opined with a checkmark “yes” that appellant’s DJD was aggravated by work, but that 

the ACL tear was acute. In an August 16, 2013 work note, he opined that she could work light 

duty for only six hours per day. In an August 29, 2013 duty status report, Dr. Patel noted that 

appellant was pulling mail filled equipment, and felt clicking and popping in her knee. He 

diagnosed knee pain due to the injury and provided work restrictions. 

In a January 11, 2014 report, Dr. Patel noted that appellant had a chronic history of 

osteoarthritis in both knees which, prior to his evaluation, was being managed conservatively 

with corticosteroid injections, anti-inflammatories, and analgesics and recommendations for lowimpact exercises. He noted that she initially presented to him on July 11, 2013 with complaints 

of chronic bilateral knee pain, with left knee worse than the right. Appellant informed Dr. Patel 

that she had injured her left knee on July 5, 2013 while at work pulling some equipment from the 

loading dock. She reported clicking and popping in the left knee, her knee locking up later that 

shift, followed by significant swelling, with no ability to bear weight. Appellant also reported 

that the knee felt unstable. 

Dr. Patel reported that, on the July 11, 2013 initial examination, appellant had no 

ecchymosis or erythema, but had trace swelling in the left knee. Appellant had a significant 

varus deformity of both knees with tenderness in the joint lines, severe retropatellar crepitus with 

limited range of motion in both knees. Her strength was 5/5 in flexion and extension bilaterally. 

McMurray’s testing was positive for reproduction of pain medially in the left knee. Lachman’s 

examination was 2+ in the left knee with a soft endpoint. X-rays of the bilateral knees 

demonstrated complete joint space collapse at the medial tibiofemoral compartments bilaterally 

with marginal osteophytes and advanced degeneration of the patellofemoral compartments 

bilaterally. Appellant also had some medial migration of her right femur. Dr. Patel’s impression 

was end-stage osteoarthritis in both knees. He noted that the July 10, 2013 MRI scan of the left 

knee revealed advanced tricompartmental osteoarthritis, complex medial meniscus tear, and an 

anterior cruciate ligament tear. Dr. Patel noted the medical treatment for appellant’s other office 

visits, noting that her left knee was still painful, unstable, and limiting in terms of how much 
3

activity she could tolerate. He reported that she remained on partial disability to this date and it 

was his understanding that she was only working a six-hour shift. 

Dr. Patel opined that appellant’s left knee arthritic condition was aggravated by the 

July 5, 2013 injury. He noted that she has experienced minimal improvement with aggressive 

conservative treatment and needed a total knee replacement. Dr. Patel also indicated that 

appellant’s knee was unstable because she was ACL deficient. He noted “it is possible that the 

ACL was an acute tear from the incident that [appellant] described on July 5, 2013 and this 

certainly could have aggravated the arthritis and overall stability of her left knee.” Dr. Patel 

further opined that appellant’s left knee pain “is an exacerbation and perhaps an acceleration of 

the injury that occurred on July 5, 2013.” 

In a June 5, 2014 supplemental report, Dr. Patel clarified his medical rationale for his 

conclusion. He indicated that he felt on July 5, 2013 appellant injured her left knee, which 

resulted in an acute exacerbation of her underlying osteoarthritis as well as acute instability from 

an ACL tear. The rationale behind this conclusion was based on her clinical evaluation and the 

July 18, 2013 MRI scan imaging of the left knee, which showed osteoarthritis along with an 

ACL tear and medial meniscus tear. Dr. Patel noted that appellant had permanent work 

restrictions as a result of the injury and would need a total knee replacement. 

In a June 25, 2014 letter, OWCP advised appellant of the deficiencies in her claim and 

provided her the opportunity to submit additional factual and medical evidence. This included a 

physician’s rationalized opinion as to how her work factors resulted in the diagnosed condition. 

Appellant was afforded 30 days in which to provide such information. No further evidence was 

received. 

By decision dated July 30, 2014, OWCP denied the claim as the medical evidence failed 

to establish that the diagnosed left knee conditions were causally related to the established workrelated event(s). 

In an August 5, 2014 letter, appellant, through counsel, requested a hearing, which was 

held by video on December 5, 2014. A copy of a May 16, 2006 MRI scan report and the July 18, 

2013 MRI scan report of the bilateral knees were provided. Dr. Patel’s July 11 and August 2, 

2013 reports were also provided. In his August 2, 2013 report, he noted that appellant has an 

ACL tear in the left knee, which may have been acute since early July 2013. Dr. Patel also noted 

that she had a significant medial meniscus tear of the left knee. 

By decision dated February 26, 2015, an OWCP hearing representative affirmed the 

July 30, 2014 OWCP decision. 

LEGAL PRECEDENT 

An employee seeking benefits under FECA2

 has the burden of proof to establish the 

essential elements of his or her claim by the weight of the reliable, probative, and substantial 

 2 Id. at §§ 8101-8193. 
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evidence3

 including that he or she sustained an injury in the performance of duty and that any 

specific condition or disability for work for which she claims compensation is causally related to 

that employment injury.4

 

To determine whether a federal employee has sustained a traumatic injury in the 

performance of duty, it first must be determined whether fact of injury has been established.5 

There are two components involved in establishing the fact of injury. First, the employee must 

submit sufficient evidence to establish that she actually experienced the employment incident at 

the time, place, and in the manner alleged.6 Second, the employee must submit evidence, 

generally only in the form of probative medical evidence, to establish that the employment 

incident caused a personal injury.7 An employee may establish that the employment incident 

occurred as alleged, but fail to show that his or her disability or condition relates to the 

employment incident.8

 

Under FECA, when employment factors cause an aggravation of an underlying physical 

condition, the employee is entitled to compensation for the periods of disability related to the 

aggravation.9

 Where the medical evidence supports an aggravation or acceleration of an 

underlying condition precipitated by working conditions or injuries, such disability is 

compensable.10 However, the normal progression of untreated disease cannot be stated to 

constitute aggravation of a condition merely because the performance of normal work duties 

reveals the underlying condition.11 For the conditions of employment to bring about an 

aggravation of preexisting disease, the employment must cause acceleration of the disease or 

precipitate disability. When the aggravation is temporary and leaves no permanent residuals, 

compensation is not payable for periods after the aggravation ceased.12 

Whether an employee sustained an injury in the performance of duty requires the 

submission of rationalized medical opinion evidence.13 The opinion of the physician must be 

based on a complete factual and medical background of the employee, must be one of reasonable 

medical certainty, and must be supported by medical rationale explaining the nature of the 

 3 J.P., 59 ECAB 178 (2007); Joseph M. Whelan, 20 ECAB 55, 58 (1968). 

4 G.T., 59 ECAB 447 (2008); Elaine Pendleton, 40 ECAB 1143, 1145 (1989). 

5 S.P., 59 ECAB 184 (2007); Alvin V. Gadd, 57 ECAB 172 (2005). 

6 Bonnie A. Contreras, 57 ECAB 364 (2006); Edward C. Lawrence, 19 ECAB 442 (1968). 

7 David Apgar, 57 ECAB 137 (2005); John J. Carlone, 41 ECAB 354 (1989). 

8 T.H., 59 ECAB 388 (2008); see also Roma A. Mortenson-Kindschi, 57 ECAB 418 (2006). 

9 Raymond W. Behrens, 50 ECAB 221 (1999); James L. Hearn, 29 ECAB 278 (1978). 

10 A.C., Docket No. 08-1453 (issued November 18, 2008). 

11 Glenn C. Chasteen, 42 ECAB 493 (1991). 

12 Raymond W. Behrens, supra note 9. 

13 See J.Z., 58 ECAB 529 (2007); Paul E. Thams, 56 ECAB 503 (2005). 
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relationship between the diagnosed condition and the specific employment factors identified by 

the employee.14 The weight of the 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.15 

ANALYSIS 

Appellant alleged that on July 5, 2013 she injured her left knee when pulling equipment 

from the loading dock. OWCP accepted that the incident occurred as alleged, but denied her 

traumatic injury claim finding insufficient medical evidence to establish that her diagnosed left 

knee conditions were caused or aggravated by the July 5, 2013 incident. 

In support of her claim, appellant submitted reports by Dr. Laws-Mobilio dated 

July 8, 2013. While Dr. Laws-Mobilio diagnosed internal derangement of the left knee, she did 

not provide a history of the July 5, 2013 work incident or an opinion on how the diagnosis was 

causally related to the accepted July 5, 2013 work incident. The Board has held that 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.16 

Appellant also submitted numerous reports from Dr. Patel. In his August 2, 2013 report, 

Dr. Patel noted that she had an ACL tear in the left knee, which may be acute since early 

July 2013. He also related that appellant had significant medial meniscus tear in the knee. 

However, Dr. Patel failed to provide a well-rationalized medical opinion which explained how 

the July 5, 2013 work incident caused either the ACL tear or the medial meniscus tear in her left 

knee.17 Moreover, his opinion that the ACL tear in the left knee may be acute since early 

July 2013 is speculative in nature. The Board has held that medical opinions that are speculative 

or equivocal in character are of diminished probative value.18

In the August 16, 2013 attending physician’s report, Dr. Patel reported the history of 

injury and that appellant had a history of advanced osteoarthritis. He diagnosed left knee 

degenerative disc disease with ACL tear, as evidenced by MRI scan. Dr. Patel opined with a 

checkmark “yes” that appellant’s condition was caused or aggravated by the work incident. The 

Board has previously explained that a report that addresses causal relationship with a checkmark

is of diminished probative value and insufficient to establish causal relationship.19 Dr. Patel 

noted that appellant’s degenerative disc disease was aggravated, but the ACL tear was acute. 

 14 I.J., 59 ECAB 408 (2008); Victor J. Woodhams, 41 ECAB 465 (2005). 

15 James Mack, 43 ECAB 321 (1991). 

16 C.B., Docket No. 09-2027 (issued May 12, 2010). 

17 Medical evidence that states a conclusion, but does not offer any rationalized medical explanation regarding the 

cause of an employee’s condition is of limited probative value on the issue of causal relationship. See J.F., Docket 

No. 09-1061 (issued November 17, 2009); A.D., 58 ECAB 149 (2006). 

18 D.D., 57 ECAB 734, 738 (2006); Kathy A. Kelley, 55 ECAB 206 (2004). 

19 See N.M., Docket No. 15-0704 (issued June 22, 2015). 
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However, he failed to provide a well-rationalized medical opinion which explained how the 

July 5, 2013 work incident aggravated the degenerative disc disease or resulted in an acute ACL 

tear.20 

In his August 29, 2013 duty status report, Dr. Patel noted the history of injury and 

diagnosed knee pain due to the injury.21 However, he does not provide any opinion on the cause 

of appellant’s knee pain. The Board has held that 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.22

In his January 11, 2014 report, Dr. Patel provided an accurate history of injury and noted 

his examination findings on appellant’s visits. He opined that her left knee arthritic condition 

was aggravated by the July 5, 2013 injury and that her knee was unstable because her ACL was 

deficient. Dr. Patel noted “it is possible that ACL is an acute tear from the incident that 

[appellant] described on July 5, 2013 and this certainly could have aggravated the arthritis and 

overall stability of her left knee.” He further opined that appellant’s left knee pain “is an 

exacerbation and perhaps an acceleration of the injury that occurred on July 5, 2013.” The Board 

notes that Dr. Patel’s opinion on causal relation is again couched in possibility and is therefore 

speculative in nature.23 Furthermore, Dr. Patel fails to provide an explanation as to how the 

July 5, 2013 incident caused an aggravation and/or an acceleration of appellant’s left knee 

arthritic condition. 

On June 5, 2014 Dr. Patel wrote a supplemental narrative indicating that the July 5, 2013 

work incident caused an aggravation which resulted in an exacerbation of appellant’s 

osteoarthritis and acute instability from an ACL tear. However, he failed to provide a wellrationalized medical opinion which explained how the July 5, 2013 work incident aggravated the 

degenerative disc disease or resulted in an acute ACL tear.24 Likewise, Dr. Patel’s reference to 

the MRI scan reports are also insufficient to establish causal relationship as there is no medical 

opinion on the cause of appellant’s left knee conditions. 

On appeal appellant, through counsel, contends that the evidence is sufficient to accept 

her claim. Several paragraphs from Dr. Patel’s January 11 and June 5, 2014 reports were cited as 

evidence of a causal relationship. As previously discussed, however, Dr. Patel’s reports lack the 

level of probative value necessary and are thus insufficient to establish that the July 5, 2013 

employment incident caused her current left knee conditions or aggravated her preexisting 

condition. An employee’s belief that the disease or condition was caused or aggravated by 

employment factors or incidents is insufficient to establish causal relationship.25 Causal 

 20 Supra note 17. 

21 The Board has held that pain is a description of a symptom, and not considered compensable medical diagnosis. 

B.P., Docket No. 12-1345 (issued November 13, 2012); C.F., Docket No. 08-1102 (issued October 2008). 

22 Supra note 16. 

23 D.D., 57 ECAB 734, 738 (2006); Kathy A. Kelley, 55 ECAB 206 (2004). 

24 Supra note 17. 

25 Jennifer Atkerson, 55 ECAB 317 (2004). 
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relationship is a medical question that must be established by probative medical opinion from a 

physician.26 As appellant failed to provide such probative medical opinion in this case, the 

Board finds that she did not meet her burden of proof to establish her 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. 

CONCLUSION 

The Board finds that appellant did not establish that her left knee conditions were 

causally related to the July 5, 2013 employment incident. 

ORDER 

IT IS HEREBY ORDERED THAT the February 26, 2015 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: November 16, 2015 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 26 W.W., Docket No. 09-1619 (issued June 2, 2010); David Apgar, supra note 7.