United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

S.M., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Cleveland, OH, Employer 

__________________________________________ 

) 

) 

) 

) 

) 

) 

) 

) 

Docket No. 15-582 

Issued: April 22, 2015 

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

PATRICIA H. FITZGERALD, Deputy Chief Judge 

COLLEEN DUFFY KIKO, Judge 

ALEC J. KOROMILAS, Alternate Judge 

JURISDICTION 

On January 23, 2015 appellant, through counsel, filed a timely appeal from a merit 

decision of the Office of Workers’ Compensation Programs (OWCP) dated January 12, 2015. 

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 sustained a left knee condition in the performance of duty. 

FACTUAL HISTORY 

On June 7, 2013 appellant, a 57-year-old clerk, filed a Form CA-2 claim for benefits 

based on an occupational disease. He asserted on the form and in an accompanying statement 

 1

 5 U.S.C. § 8101 et seq. 
2 

that he began experiencing left knee pain on September 17, 2010, which he believed was 

causally related to a work injury he sustained in 2006 under case number xxxxxx504. 

On June 11, 2013 OWCP advised appellant that it required factual and medical evidence 

to determine whether he was eligible for compensation benefits. It asked him to submit a 

comprehensive report from a treating physician describing his symptoms and the medical reasons 

for his condition, with an opinion as to whether his claimed condition was causally related to his 

federal employment. OWCP requested that appellant submit this evidence within 30 days. 

Appellant did not submit any medical evidence. 

By decision dated September 19, 2013, OWCP denied the claim finding that he failed to 

submit medical evidence establishing a left knee condition in the performance of duty. 

Appellant, through his attorney, requested an oral hearing, which was held on 

March 18, 2014. 

By decision dated May 29, 2014, OWCP’s hearing representative affirmed the 

September 19, 2013 decision. She stated that appellant had indicated that he filed a prior knee 

claim in 2006 and underwent surgery, and had returned to work afterward. OWCP denied this 

claim in an August 6, 2008 decision, which the Board affirmed on July 14, 2009. The hearing 

representative found that appellant had asserted that his knee condition continued to worsen due 

to his work duties; he, however, had failed to submit any medical evidence with his claim. 

By letter dated September 22, 2014, appellant, through counsel, requested 

reconsideration. 

In a report dated October 5, 2011, received by OWCP on September 24, 2014, 

Dr. Audley M. Mackel, a specialist in orthopedic surgery, advised that appellant had complaints 

of left knee pain on examination. He stated that appellant underwent an arthroscopy of the left 

knee about four years previously to repair a torn left meniscus and had aggravated his knee 

condition secondary to bumping it approximately a year and a half ago. Dr. Mackel opined that 

the left knee was stable, with some mild, progressive patellar crepitus and some mild quad 

atrophy in the left knee, with minimal joint line tenderness. He recommended that appellant 

undergo a magnetic resonance imaging (MRI) scan of the left knee to rule out a new meniscal 

tear without effusion. 

In a May 9, 2012 report, received by OWCP on September 24, 2014, Dr. Mackel advised 

that appellant continued to have some intermittent pain and swelling in the left knee. He related 

that he was able to walk, but had a sense of giving way and buckling about the knee. Dr. Mackel 

reiterated his recommendation for appellant to have an MRI scan of the left knee to rule out 

recurrent meniscal tear, given that he had been significantly symptomatic since his previous 

surgery. 

In a May 9, 2012 report, received by OWCP on September 24, 2014, Dr. Mackel stated 

that appellant had undergone an MRI scan which showed a complex tear of the posterior horn of 

the left medial meniscus, with some chondral changes are noted. He advised that there was no 

evidence of “re-tear versus new tear.” Dr. Mackel recommended that appellant continue with 
3 

present course of treatment and consider taking injections in his left knee to treat chondral 

changes. 

Dr. Mackel submitted progress reports dated September through November 2012 and 

January, March, and July 2013, received by OWCP on September 24, 2014, in which he 

essentially reiterated his previous findings and conclusions. 

By decision dated January 12, 2015, OWCP denied modification of the prior decision. 

LEGAL PRECEDENT 

An employee seeking benefits under FECA2 has the burden of establishing that 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

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 is usually rationalized medical 

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

Appellant has the burden of establishing by the weight of the substantial, reliable and 

probative evidence, a causal relationship between his claimed left knee condition and his federal 

employment. This burden includes providing medical evidence from a physician who concludes 

 2

 5 U.S.C. §§ 8101-8193. 

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

4 Victor J. Woodhams, 41 ECAB 345 (1989). 

5 Id.
4 

that the medical condition is causally related to employment factors and supports that conclusion 

with sound medical reasoning.6

ANALYSIS 

Appellant has failed to submit any medical opinion containing a rationalized, probative 

report which relates his claimed left knee condition to factors of his employment. For this 

reason, he has not discharged his burden of proof to establish his claim that these conditions 

were sustained in the performance of duty. 

Appellant submitted numerous reports from Dr. Mackel who related appellant’s 

complaints of left knee pain and presented diagnoses of left meniscus tear and chondral changes. 

However, in these reports he did not provide a rationalized medical opinion that these findings 

were causally related to factors of his employment. In his October 5, 2011 report, Dr. Mackel 

advised that he had undergone a left knee arthroscopy four years prior to repair a torn left 

meniscus and had aggravated his knee condition secondary to bumping it about a year and a half 

prior. He referred appellant for a left knee MRI scan because he believed appellant may have 

sustained a new meniscus tear. Dr. Mackel stated that appellant continued to have some 

significant symptoms, including intermittent pain, swelling and instability in the left knee. In his 

May 9, 2012 report, he stated that a left knee MRI scan revealed a complex tear of the posterior 

horn of the medial meniscus, with some chondral changes. Dr. Mackel instructed him to 

continue with his present course of treatment and consider having injections in his knee to treat 

the chondral changes. His reports, however, did not provide a probative, rationalized medical 

opinion that the claimed condition was causally related to employment factors. Dr. Mackel’s 

opinion on causal relationship is of limited probative value as it does not contain any medical 

rationale as to how or why appellant’s claimed left knee condition was currently affected by or 

related to factors of employment.7

 

The weight of medical opinion is determined by the opportunity for and thoroughness of 

examination, the accuracy and completeness of physician’s knowledge of the facts of the case, 

the medical history provided, the care of analysis manifested and the medical rationale expressed 

in support of stated conclusions.8

 Dr. Mackel did not sufficiently describe appellant’s job duties 

or explain the medical process through which such duties would have been competent to cause 

the claimed condition. His opinion is of limited probative value as it does not contain any 

medical rationale explaining how appellant’s job duties physiologically caused the diagnosed left 

knee condition. Dr. Mackel’s reports thus did not constitute adequate medical evidence to 

establish that appellant’s claimed left knee condition was causally related to his employment. 

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

Neither the fact that appellant’s condition became apparent during a period of employment nor 

the belief that his condition was caused, precipitated or aggravated by his employment is 

 6 See Nicolea Bruso, 33 ECAB 1138, 1140 (1982). 

7 William C. Thomas, 45 ECAB 591 (1994). 

8 See Anna C. Leanza, 48 ECAB 115 (1996). 
5 

sufficient to establish causal relationship.9

 Causal relationship must be established by 

rationalized medical opinion evidence and appellant failed to submit such evidence. 

OWCP advised appellant of the evidence required to establish his claim; however, 

appellant failed to submit such evidence. Consequently, appellant has not met his burden of 

proof in establishing that his claimed left knee condition was causally related to his employment. 

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 in establish that his 

claimed left knee condition was sustained in the performance of duty. 

ORDER 

IT IS HEREBY ORDERED THAT the January 12, 2015 decision of the Office of 

Workers’ Compensation Programs be affirmed. 

Issued: April 22, 2015 

Washington, DC 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board 

 9 Id.