United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

S.A., Appellant 

and 

U.S. POSTAL SERVICE, SAINT LOUIS NDC, 

Hazelwood, MO, Employer 

__________________________________________ 

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Docket No. 15-1268 

Issued: December 10, 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 

PATRICIA H. FITZGERALD, Deputy Chief Judge 

COLLEEN DUFFY KIKO, Judge 

JURISDICTION 

On May 19, 2015 appellant filed a timely appeal of a February 17, 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.2

ISSUE 

The issue is whether appellant met her burden of proof to establish a consequential left 

ankle condition, lymphedema, and a right knee condition due to her accepted December 3, 2011 

employment injury. 

 1

 5 U.S.C. § 8101 et seq. 

2

 The Board notes that appellant submitted new evidence with her appeal to the Board and following the 

February 17, 2015 decision. However, the Board may only review evidence that was in the record at the time 

OWCP issued its final decision. See 20 C.F.R. § 501.2(c)(1); M.B., Docket No. 09-176 (issued September 23, 

2009); J.T., 59 ECAB 293 (2008); G.G., 58 ECAB 389 (2007); Donald R. Gervasi, 57 ECAB 281 (2005); 

Rosemary A. Kayes, 54 ECAB 373 (2003). 
2

On appeal appellant argues that the evidence establishes her consequential injury claim.3

FACTUAL HISTORY 

On December 3, 2011 appellant, then a 47-year-old mail handler, filed a traumatic injury 

claim (Form CA-1) alleging that on that day she sustained left hip and knee conditions due to 

twisting her left leg in the performance of duty. OWCP accepted the claim for left lower leg 

joint effusion, left lateral collateral ligament knee sprain, and left lateral meniscal knee tear and 

authorized left knee arthroscopic surgery, which was performed on October 16, 2012.4

On January 13, 2013 appellant requested that OWCP expand her claim to include 

additional conditions as consequential injuries from her accepted left knee injury. She believed 

that she sustained irreversible injuries to her right knee and left ankle as the result of her 

accepted left knee employment injuries. With respect to the initial accepted left knee strain in 

February 2003, appellant contended that she had not received proper treatment for that injury and 

as a result her left leg and knee continued to hurt and swell daily. Next, she related that her left 

knee had been repeatedly injured since February 2003 as she had fallen down due to the knee 

giving out, from moving the wrong way, and from performing her job duties. When she injured 

her left knee on December 3, 2011, appellant went to physical therapy every day for 

approximately seven months and her knee continued to swell up and cause extreme pain. On 

December 14, 2012 she returned to work and her left leg and knee immediately swelled. 

Appellant stated that there was swelling and tremendous pain in both knees and her left ankle. 

As a result of the left knee surgery due to her December 3, 2011 injury, there was more strain on 

appellant’s right knee and left ankle. In concluding, appellant alleged that the left knee injury 

resulted in consequential right knee and left ankle injuries including the loss of strength. 

In an April 18, 2013 attending physician’s report (Form CA-20), Dr. Jody T. Jachna, an 

attending Board-certified orthopedic surgeon, noted a February 2003 injury date. He diagnosed 

right knee degenerative joint disease, left ankle swelling, and left knee post meniscectomy, and 

degenerative joint disease. Dr. Jachna checked a box marked “yes” to the question of whether 

the diagnosed conditions were employment related. He opined that appellant’s right knee and 

left ankle conditions were consequential injuries of the accepted left knee injury. 

 3

 Appellant also requested a review of her schedule award claim. OWCP granted a schedule award for three 

percent left lower extremity permanent impairment on August 22, 2013 and it denied her request for reconsideration 

in a nonmerit decision dated October 24, 2013. The Board’s review authority is limited to appeals which are filed 

within 180 days from the date of issuance of OWCP’s decision. See 20 C.F.R. § 501.3(e). As appellant did not file 

her appeal until May 19, 2015, the Board lacks jurisdiction to review the decisions concerning her schedule award 

claim. 

4

 This claim was assigned OWCP File No. xxxxxx499. On October 25, 2013 OWCP combined OWCP File No. 

xxxxxx499 with OWCP File No. xxxxxx614. Under OWCP File No. xxxxxx614 OWCP had accepted that 

appellant sustained a left knee strain as the result of a February 2003 traumatic injury. Appellant was released to full 

duty with no restrictions effective March 5, 2003 and she returned to work on March 12, 2003. By decision dated 

August 22, 2013, OWCP granted a schedule award for three percent left lower extremity. It denied appellant’s 

request for modification in a merit decision dated October 24, 2013. In a nonmerit decision dated July 24, 2013, 

OWCP denied reconsideration of the August 22, 2013 decision. 
3

In statements of accepted facts dated June 5 and July 9, 2013, OWCP related that 

appellant was currently working full time in a limited-duty job. It noted that she had two other 

accepted claims. Under OWCP File No. xxxxxx114, OWCP accepted a lumbar strain as the 

result of an August 5, 1997 traumatic injury and under OWCP File No. xxxxxx614 a left knee 

strain was accepted as the result of a February 2003 traumatic injury. 

In a June 6, 2013 report, Dr. Jachna noted that since 2012 he has treated appellant for a 

2003 left knee injury, which was reinjured on December 3, 2011. The reinjury on December 3, 

2011 resulted in increasing instability and pain. A computerized tomography (CT) scan showed 

medial compartment arthritic changes with a lateral patella subluxation and loss of anterior 

cruciate ligament and effusion. On October 16, 2012 arthroscopic surgery with chondroplasty 

and meniscectomy was performed and followed by a normal postoperative course. Nonethless, 

the swelling continued and extended into her left leg. The swelling caused left ankle pain and 

aggravated her right knee. A January 15, 2013 CT scan showed bilateral chronic degenerative 

medial and lateral menisci degenerative joint changes incuding lateral moderately severe 

degenerative compartment changes. Dr. Jachna attributed appellant’s right knee degenerative 

changes to her favoring the left knee and placing her weight on the right leg. He diagnosed left 

knee post-traumatic degenerative joint disease and meniscal tear; postoperative left lower 

extremity chronic insuffiicenty and venous stasis; and right knee degenerative joint disease. 

The claim was reviewed by an OWCP medical adviser on June 28, 2013. The medical 

adviser noted that the prior medical records of Dr. Jachna failed to document the existence of any 

right knee or left ankle diagnoses or conditions. 

On July 16, 2013 OWCP referred appellant to Dr. Robert Sciortino, a Board-certified 

orthopedic surgeon, for a second opinion evaluation to determine whether appellant sustained 

any consequential injuires. 

In an August 2, 2013 report, Dr. Sciortino provided a history of appellant’s December 3, 

2011 injury, the accepted diagnoses, and the treatment provided. He diagnosed left knee 

degenerative lateral meniscus tear, bilateral knee osteoarthritis, and left lower extremity chronic 

lymphedema. A physical examination revealed bilateral intact neurovascular extremities, 

bilateral intact capillary refill, bilateral palpable distal pulses, left knee intact range of motion, 

and full range of motion in the right knee. Dr. Sciortino reported fairly extensive pitting edema 

in the left leg from above the knee to the ankle and foot. In response to OWCP’s question, he 

noted that there was evidence of a large amount of left lower extremity chronic lymphedema, but 

he was unclear as to the exact etiology. Dr. Sciortino elaborated that he was unsure whether this 

condition was caused or related to her surgery or due to the enlarged lymph nodes in the left 

groin. Next, he attributed appellant’s left ankle condition to her chronic lympedema. 

By decision dated October 24, 2013, OWCP denied appellant’s request to expand her 

claim to include consequential injuries of lymphedema, right knee conditon, and left ankle 

condition. It found that the medical evidence of record clearly documents a history of left lower 

extremity edema as early as February 12, 2003 and continuing through at least 2007, as well as 

bilateral lower extremity denegerative changes as early as 2010. OWCP also found that the 

opinion of Dr. Sciortino constituted the weight of the medical evidence as Dr. Jachna did not 

provide a well rationalized and clear medical opinion on diagnosis and causation. 
4

On November 5, 2013 counsel requested reconsideration of OWCP’s October 24, 2013 

decision and submitted new medical evidence. 

In progress notes dated November 25, 2013, Dr. Jachna diagnosed left knee degnerative 

disc joint disease with lymphedema. Physical examination findings included left knee effusion, 

crepitus, and joint line tenderness and left leg swelling above the knee due to lymphedema. 

Dr. Jachna, in progress notes dated January 9 and 16, 2014, noted that appellant was seen 

for her chrondoplasty with left lower extremity lymphedema, left knee degenerative joint disease 

status post menisectomy, and right knee concurrent injury. He reported that appellant’s right 

knee and ankle pain had worsened due to increased usage following her left knee arthroscopy. 

Physical examination findings included: antalgic gait while walking; swelling in the left knee 

down to the ankle with prominent lymphedema changes; minimal right lower extremity 

lymphedema changes; right knee crepitus, effusion and joint line tenderness; and reduced left 

ankle range of motion with pain, swelling, and lymphedema. 

Dr. Jachna, in a progress note dated March 27, 2014, related that appellant’s bilateral leg 

lymphedema was worsening. A physical examination showed an antalgic gait and bilateral knee 

crepitus, joint line tenderness, and effusion as the result of increased pain. 

On June 12, 2014 counsel clarified that appellant was seeking reconsideration of the 

decision denying her request to expand her claim to include consequential injuries. 

By decision dated July 25, 2014, OWCP denied modification of the request for 

reconsideration. 

In an August 10, 2014 report, Dr. Jachna noted physical examination findings and 

subjective complaints and left knee post meniscectomy arthrosis was diagnosed. 

In a form dated November 4, 2014, appellant again requested reconsideration. 

In progress notes dated December 18, 2014, Kathleen M. Nikodym, a physician assistant, 

diagnosed left knee post meniscectomy and provided physical examination findings. 

By decision dated February 17, 2015, OWCP denied modification. 

LEGAL PRECEDENT 

The general rule regarding consequential injuries is 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 conduct.5 

The subsequent injury is compensable if it is the direct and natural result of a compensable 

primary injury.6

 With respect to consequential injuries, the Board has found that, where an 

 5 Albert F. Ranieri, 55 ECAB 598 (2004). 

6 S.M., 58 ECAB 166 (2006); Debra L. Dillworth, 57 ECAB 516 (2006); Carlos A. Marrero, 50 ECAB 117 

(1998); A. Larson, The Law of Workers’ Compensation § 10.01 (2005). 
5

injury is sustained as a consequence of an impairment residual to an employment injury, the new 

or second injury, even though nonemployment related, is deemed, because of the chain of 

causation to arise out of and in the course of employment and is compensable.7

ANALYSIS 

The Board finds that the case is not in posture for decision as to whether appellant 

sustained a consequential left ankle condition, lymphedema, and a right knee condition causally 

related to a December 3, 2011 employment injury. 

In an August 2, 2013 report, Dr. Sciortino, an OWCP referral physician, provided his 

medical findings. He diagnosed left knee degenerative lateral meniscus tear, bilateral knee 

osteoarthritis, and left lower extremity chronic lymphedema. Dr. Sciortino reported intact 

neurovascular extremities, bilateral intact capillary refill, bilateral palpable distal pulses, left 

knee intact range of motion, and full range of motion in the right knee. He also found fairly 

extensive pitting edema from above the left knee to the ankle and foot. Dr. Sciortino expressed 

uncertainty as to the etiology of appellant’s left lower extremity chronic lymphedema and the 

enlarged lymph nodes in the left groin. He was unsure whether these conditions were caused or 

related to her accepted conditions or the surgery. Dr. Sciortino attributed appellant’s left ankle 

condition to her chronic lymphedema, but failed to adequately determine whether it was 

consequential to the accepted conditions. The Board has held that medical opinions that are 

speculative or equivocal in nature are of diminished probative value.8

 The Board finds that 

Dr. Sciortino’s opinion is insufficient to determine the issue of whether these additional 

conditions are causally related to the accepted injuries. 

Once OWCP undertakes to develop the medical aspects of a case, it has the responsibility 

to do so in a proper manner.9 Given the deficiencies in Dr. Sciortino’s report, the case is 

remanded to OWCP to secure a medical opinion that resolves the question of whether appellant 

sustained a consequential left ankle condition, lymphedema, and a right knee condition causally 

related to the accepted December 3, 2011 employment condition. Following this and such other 

development as deemed necessary, it shall issue a de novo decision. 

CONCLUSION 

The Board finds that the case is not in posture for decision. 

 7 L.S., Docket No. 08-1270 (issued July 2, 2009); Kathy A. Kelley, 55 ECAB 206 (2004). 

8 L.R. (E.R.), 58 ECAB 369 (2007); D.D. 57 ECAB 734 (2006); M.W., 57 ECAB 710 (2006); Ceclia M. Corley, 

56 ECAB 662 (2005).

9 See P.K., Docket No. 08-2551 (issued June 2, 2009); Peter C. Belkind, 56 ECAB 580 (2005); Melvin James, 55 

ECAB 662 (2005). 
6

ORDER 

IT IS HEREBY ORDERED THAT the decision of the Office of Workers’ 

Compensation Programs dated February 17, 2015 is set aside and the case remanded for further 

proceedings consistent with the above opinion. 

Issued: December 10, 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