United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

M.M., Appellant 

and 

DEPARTMENT OF LABOR, MINE SAFETY & 

HEALTH ADMINISTRATION, 

Madisonville, KY, Employer 

__________________________________________ 

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Docket No. 14-1034 

Issued: November 24, 2014 

Appearances: Case Submitted on the Record

Ronald K. Bruce, Esq., for the appellant 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

CHRISTOPHER J. GODFREY, Chief Judge 

ALEC J. KOROMILAS, Alternate Judge 

MICHAEL E. GROOM, Alternate Judge 

JURISDICTION 

On April 1, 2014 appellant, through his representative, filed a timely appeal from the 

February 4, 2014 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 the advanced degenerative arthritis in appellant’s right knee, for 

which he underwent a total right knee replacement in 2007, was causally related to the accepted 

work injury on September 18, 1987. 

 1

 5 U.S.C. § 8101 et seq.
2

FACTUAL HISTORY 

On September 18, 1987 appellant, a 38-year-old coal mine inspector (electrical), 

sustained a traumatic right knee injury in the performance of duty while crawling during an 

electrical inspection. Dr. James M. Donley, a Board-certified orthopedic surgeon, evaluated him 

on September 23, 1987. He diagnosed tendinitis in the anterior aspect of the right knee. 

Dr. Donley noted preexisting degenerative arthritis in the right knee and unstable knee ligaments. 

He advised that appellant needed no further medical treatment and added that appellant had 

maintained his regular work activities. OWCP accepted appellant’s claim for tendinitis of the 

right knee. 

In 2002 x-rays showed significant degenerative arthritis of the right knee with cystic 

changes in the osseous structure with what appeared to be multiple spurs and possible loose 

bodies. In 2003 Dr. Donley diagnosed osteoarthritis and administered regular injections of 

viscosupplementation. 

In 2007 appellant underwent a total right knee replacement. Indications for surgery 

included advanced degenerative arthritis and failed conservative treatment. 

On October 5, 2011 appellant filed a claim for a schedule award. In support thereof, he 

submitted a September 20, 2011 impairment evaluation performed by Joseph D. Chenger, MD, 

finding his good result following total knee replacement represented a 37 percent impairment of 

the right lower extremity. 

In a decision dated May 23, 2013, OWCP found that the medical evidence did not 

establish that appellant required additional medical treatment due to a worsening of the accepted 

work injury and the resulting right knee tendinitis without intervening cause. 

Dr. David W. Gaw, a Board-certified orthopedic surgeon, examined appellant on 

May 21, 2013. With respect to any preexisting problems, he noted that appellant was involved in 

a motorcycle accident in 1975, at which time he bruised the right knee “but there was no surgery 

involved following that accident although he apparently had a fracture of his right leg at that 

time.” Dr. Gaw described the physical demands of appellant’s job as an underground coal miner 

since 1969. Appellant began to have bilateral knee problems soon thereafter, including soreness 

and swelling that would come and go. In September 1987, after he became an electrical 

inspector, the pain and swelling became worse, so he sought medical attention. Appellant 

continued to do his job but with increasing bilateral knee pain, more on the right, the severity of 

which waxed and waned. In 2007 he had a total right knee replacement. 

Dr. Gaw examined appellant and offered the following opinion on causal relationship: 

“Based upon the history as given by the patient and the type of work that he 

describes doing, it is more likely than not that the underground coal mining-type 

work activities for 25 plus years, prior to the knee replacement, is the cause of his 

need for the knee replacement surgery. These work activities were either the 

significant factor in the development of arthritis involving the knee or it 
3

aggravated an arthritic condition but his work activities are the most likely major 

factor in his need for the total knee replacement.” 

Dr. Gaw determined that appellant’s good result following surgery represented a 25 

percent impairment of the right lower extremity under the American Medical Association, 

Guides to the Evaluation of Permanent Impairment (6th ed. 2009). He stated that he had 

reviewed the notes and operative reports of Dr. Chenger and Dr. Donley. 

In a decision dated February 4, 2014, an OWCP hearing representative noted that 

appellant had testified that his condition continued to worsen over the years, and he continued to 

work underground, which aggravated his right knee symptoms. Therefore, appellant appeared to 

be alleging a new injury for which he should pursue an occupational disease claim. The hearing 

representative also noted that Dr. Gaw attributed appellant’s right knee surgery to ongoing 

employment exposure, which implicated a new injury. She found that the medical evidence 

failed to establish a recurrence of a medical condition causally related to the September 18, 1987 

work injury. 

Appellant’s representative argues that the finding that appellant’s accepted employment 

has not remained active is not supported by the evidence. 

LEGAL PRECEDENT 

FECA provides compensation for the disability of an employee resulting from personal 

injury sustained while in the performance of his or her duty.2

 A claimant seeking benefits under 

FECA has the burden of proof to establish the essential elements of his or her claim by the weight 

of the evidence,3 including that he or she sustained an injury in the performance of duty and that 

any specific condition or disability for work for which he or she claims compensation is causally 

related to that employment injury.4

The evidence generally required to establish causal relationship is rationalized medical 

opinion evidence. The claimant must submit a rationalized medical opinion that supports a causal 

connection between his or her claimed condition and the employment injury. The medical opinion 

must be based on a complete factual and medical background with an accurate history of the 

claimant’s employment injury, and must explain from a medical perspective how the claimed 

condition is related to the injury.5

 2 Id. at § 8102(a). 

3 Nathaniel Milton, 37 ECAB 712 (1986); Joseph M. Whelan, 20 ECAB 55 (1968) and cases cited therein. 

4 Elaine Pendleton, 40 ECAB 1143, 1145 (1989). 

5 John A. Ceresoli, Sr., 40 ECAB 305 (1988). 
4

When an employee claims that a condition not accepted or approved by OWCP was due 

to an employment injury, he or she bears the burden of proof to establish that the condition is 

causally related to the employment injury.6

ANALYSIS 

OWCP accepts that appellant sustained a traumatic injury in the performance duty on 

September 18, 1987 while crawling during an electrical inspection. Dr. Donley, an orthopedic 

surgeon, saw him five days later and diagnosed tendinitis in the anterior aspect of the right knee. 

OWCP accepted appellant’s traumatic injury claim for tendinitis. 

In 2007 appellant underwent a total right knee replacement, for which he filed a schedule 

award claim. 

The question that arises is relationship of the knee replacement surgery to the accepted 

work injury on September 18, 1987. The record indicates that the work injury was not severe 

enough to prevent appellant from performing his usual duties as a mine inspector. It appears the 

only medical attention he required was an appointment with Dr. Donley on September 23, 1987. 

Dr. Donley examined him and found that no further medical attention was necessary. 

Dr. Gaw, an orthopedic surgeon, did not offer a rationalized opinion on causal 

relationship. He did not address what happened on September 18, 1987 or otherwise 

acknowledge the traumatic nature of appellant’s accepted tendinitis injury. Instead, Dr. Gaw 

stated that appellant had developed an occupational disease over the course of his career. He 

mentioned that appellant’s pain and swelling had become worse in September 1987, but he did 

not discuss Dr. Donley’s diagnosis of tendinitis or appellant’s discharge from further care 

following the September 18, 1987 work injury, or OWCP’s acceptance of tendinitis. Medical 

conclusions based on inaccurate or incomplete histories are of diminished probative value.7

It was Dr. Gaw’s opinion that underground coal mining activities over 25-plus years 

more likely than not caused the need for appellant’s knee replacement surgery. Such work 

activities were either the significant factor in the development of arthritis or had aggravated 

appellant’s arthritic condition, but Dr. Gaw did not explain from an orthopedic or physiological 

point of view how underground coal mining activities over many years caused or aggravated 

degenerative arthritis. He did not adequately address what evidence demonstrated to him that 

appellant’s degenerative arthritis was materially affected by coal mine work in federal 

employment, as opposed to the natural progression of a preexisting condition. Dr. Gaw gave no 

indication how he distinguished the two. The mere fact that a condition manifests itself or 

worsens during a period of federal employment raises no inference of causal relationship.8

 

 6 Jaja K. Asaramo, 55 ECAB 200, 204 (2004). 

7 James A. Wyrick, 31 ECAB 1805 (1980) (the physician’s report was entitled to little probative value because the 

history was both inaccurate and incomplete). See generally Melvina Jackson, 38 ECAB 443, 450 (1987) (addressing 

factors that bear on the probative value of medical opinions). 

8 Steven R. Piper, 39 ECAB 312 (1987). 
5

Temporal relationships are thus distinguished from causal relationships, the former being necessary 

but not sufficient to establish the latter. Medical conclusions unsupported by rationale are of 

diminished probative value.9

The Board finds that the medical evidence of record does not support that the need for 

surgery arose from the injury of September 18, 1987. The medical evidence tends to support, but 

does not establish, that the need for surgery arose from a different injury, namely, degenerative 

arthritis developed over the course of appellant’s career. As noted by the hearing representative, 

appellant may pursue an occupational disease claim. 

Given the record presented on appeal, the Board finds that appellant has not met his 

burden to establish the degenerative arthritis in his right knee, for which he underwent a total 

right knee replacement in 2007, was causally related to the September 18, 1987 work injury. 

Dr. Gaw based his opinion on an incomplete history and did not offer medical rationale to 

establish the critical element of causal relationship. The Board will therefore affirm OWCP’s 

February 4, 2014 decision. 

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 his burden to establish that the advanced 

degenerative arthritis in his right knee, for which he underwent a total right knee replacement in 

2007, was causally related to the accepted work injury on September 18, 1987. 

 9 Ceferino L. Gonzales, 32 ECAB 1591 (1981); George Randolph Taylor, 6 ECAB 968 (1954). 
6

ORDER 

IT IS HEREBY ORDERED THAT the February 4, 2014 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: November 24, 2014 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board 

 

 Michael E. Groom, Alternate Judge 

 Employees’ Compensation Appeals Board