United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

T.F., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Tulsa, OK, Employer 

__________________________________________ 

) 

) 

) 

) 

) 

) 

) 

) 

Docket No. 15-372 

Issued: May 22, 2015 

Appearances: Case Submitted on the Record

Allan J. Shapiro, Esq., for the appellant 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

CHRISTOPHER J. GODFREY, Chief Judge 

COLLEEN DUFFY KIKO, Judge 

JAMES A. HAYNES, Alternate Judge 

JURISDICTION 

On December 8, 2014 appellant, through counsel, filed a timely appeal of the 

November 3, 2014 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 the case. 

ISSUE 

The issue is whether appellant has met her burden of proof to establish a traumatic injury 

in the performance of duty. 

FACTUAL HISTORY 

On January 18, 2013, appellant then a 53-year-old rural carrier, filed a Form CA-1, 

traumatic injury, alleging that on November 6, 2012, while pushing a gurney full of parcels she 

felt a sharp pain in her lower right knee. She stopped work on January 16, 2013. 

 1

 5 U.S.C. §§ 8101-8193. 
2

Appellant submitted a January 7, 2013 report from Dr. Ronald S. LaButti, an osteopath, 

who noted that she had a traumatic onset of left knee pain on November 6, 2012 while walking 

into the employing establishment. Dr. LaButti noted positive findings on examination of an 

antalgic gait, small joint effusion of the left lower extremity, and medial joint line pain. He 

noted x-rays of the left knee revealed medial subchondral fracture along the periphery of the 

medial tibial plateau with some joint space loss of the patellofemoral joint on the left. 

Dr. LaButti diagnosed acute traumatic onset of the left knee pain related to a fracture of the 

periphery of the medial tibial plateau and patellofemoral osteoarthritis. On January 16, 2013 he 

diagnosed acute atraumatic left knee pain ongoing for two months related to a subchondral 

insufficiency fracture of the medial tibial plateau with underlying osteochondral lesion. 

Dr. LaButti recommended double crutches nonweightbearing on the left lower extremity and 

returned appellant to sedentary work. A January 10, 2013 left knee magnetic resonance imaging 

(MRI) scan revealed destabilizing radial tear of the posterior root of the medial meniscus with 

loss of circumferential hoop containment of the meniscus, subchondral insufficient fracture with 

osteonecrosis, medial collateral ligament bursitis, bicompartmental arthrosis, advanced chondral 

loss of the anterior medial tibial plateau and patella, and moderate knee effusion with synovitis 

and plica. 

By letter dated February 1, 2013, OWCP advised appellant of the type of evidence 

needed to establish her claim, particularly requesting that she submit a physician’s reasoned 

opinion addressing the relationship of her claimed condition and specific employment factors. It 

also requested the employing establishment to provide comments from a knowledgeable 

supervisor on the accuracy of her statements and provide witness statements from those who 

witnessed the injury or had immediate knowledge of the injury. 

In a February 12, 2013 statement, appellant noted that she was pushing a gurney to her 

casing area and her knee “popped.” She noted finishing her mail route while in pain and 

stopping for a knee brace while on her route. Appellant indicated that she did not seek medical 

treatment because she believed that her left knee would resolve but it did not. She noted that her 

supervisor informed her that there was no time limit for filing a claim. Appellant submitted 

November 30, 2012 emergency room reports, which noted her treatment for a left foot injury. 

She reported dropping a 30-pound metal object directly on her foot. An x-ray of the left foot was 

negative. Dr. Daniel Feinberg, a Board-certified emergency room physician, diagnosed crush 

injury of the foot. In a January 24, 2013 duty status report, Dr. LaButti diagnosed left knee pain 

and noted that appellant could return to work on January 7, 2013 to a full-time sedentary 

position. 

Also submitted were reports from Dr. LaButti. In a January 25, 2013 attending 

physician’s report, Dr. LaButti diagnosed subchondral insufficiency fracture of medial tibial 

(osteochondral lesion). He checked a box “yes” that appellant’s condition was caused or 

aggravated by an employment activity. Dr. LaButti returned appellant to a sedentary position. 

On February 2, 2013 he noted that she could return to work with temporary restrictions and 

recommended physical therapy. In a February 11, 2013 report, Dr. LaButti treated appellant for 

left knee pain which began on November 6, 2012 while she was walking into the employing 

establishment. He noted findings on examination and diagnosed exacerbation of patellofemoral 

osteoarthritis and insufficiency fracture of the medial tibial plateau with an underlying 

osteochondral lesion. Dr. LaButti returned appellant to work with restrictions. In a February 18, 

2013 report, he diagnosed exacerbation of patellofemoral osteoarthritis and insufficiency fracture 
3

of the medial tibial plateau with an underlying osteochondral lesion. Dr. LaButti noted that 

based on appellant’s history she had an asymptomatic left knee until November 6, 2012 when 

she walked into the employing establishment. He noted that his opinion and diagnoses were 

based on her history, a physical examination, and radiographic findings. 

In a March 8, 2013 decision, OWCP denied the claim as the evidence was insufficient to 

establish the events occurred as described. 

On April 2, 2013 appellant requested a review of the written record. She submitted a 

March 13, 2013 report from Dr. LaButti who summarized her injury and history of treatment. 

Dr. LaButti noted that appellant presented only 50 percent improved and continued to have pain 

in the medial aspect of the left knee and could not fully extend her knee. He noted findings on 

examination with x-rays revealing progression of the osteochondral injury to the medial tibial 

plateau, sclerosis, patellofemoral osteophytes, and patellofemoral joint space loss. Dr. LaButti 

diagnosed left knee pain related to osteochondral injury to the medial tibial plateau and 

osteoarthritis of the patellofemoral, and medial joint compartment. In a March 18, 2013 report, 

he noted that appellant had a work-related injury while walking into her place of employment. 

Dr. LaButti diagnosed medial tibial plateau fracture with underlying osteochondral injury. He 

diagnosed a work-related left knee injury, which occurred on November 6, 2012 osteochondral 

injury of the medial tibial plateau and medial femoral condyle and exacerbation of preexisting 

osteoarthritis of the patellofemoral joint. Dr. LaButti noted that given the changes on the MRI 

scan and appellant’s failure to progress or improve over six months following her injury he 

recommended a total left knee replacement. 

In a March 18, 2013 note, Dr. LaButti provided clarification of the history of her left 

sided knee pain. He noted initially dictating that appellant had onset of knee pain while walking 

into her place of work. However, upon obtaining further history from appellant, Dr. LaButti 

noted that she was actually at work when injured. On April 1, 2013 he diagnosed traumatic 

osteochondritis desiccans with underlying osteonecrosis of the medial tibial plateau and 

bicompartmental osteoarthritis. Dr. LaButti noted worsening progression of the osteochondral 

injury and avascular necrosis. He diagnosed traumatic osteochondritis dissecans and worsening 

avascular necrosis of the medial femoral condyle of the left knee and recommended a left knee 

replacement due to severe disabling pain with daily living activities. 

On April 9, 2013 Dr. LaButti performed a left total knee arthroplasty, partial lateral 

patellectomy, reduction osteotomy of the proximal tibia, and diagnosed end stage osteoarthritis 

of the left knee. A March 13, 2013 left knee MRI scan revealed interval development of a very 

small subchondral fracture central to posterior weight bearing medial femoral condyle, stable full 

thickness radial tear of the posterior root attachment of the medial meniscus with mild 

subluxation of the medial meniscus, stable grade 2 cartilage loss, no ligament tear, and stable 

grade four chondromalacia of the medial patellar facette. 

On March 11, 2013 appellant’s supervisor, Julie Minyard, noted that, on November 6, 

2013, appellant reported that during the morning her knee popped and she was having pain. 

Ms. Minyard noted that at that time and on subsequent occasions appellant indicated that she did 

not want to file a claim, but one month later, her physician noted that it was probably work 

related, and she wished to file a claim. 
4

In a decision dated July 24, 2013, an OWCP hearing representative affirmed as modified 

the March 8, 2013 decision. She found that the gurney pushing incident was established, but 

denied the claim because the medical evidence was insufficient to establish causal relationship. 

On June 3, 2014 appellant, through counsel, requested reconsideration. She submitted a 

December 11, 2013 report from Dr. M. Stephen Wilson, a Board-certified orthopedist, who noted 

on November 6, 2012 that she was pushing a gurney of parcels and felt a left knee popping 

sensation. Dr. Wilson noted that appellant was treated by Dr. LaButti and underwent a total left 

knee replacement on April 9, 2013. He noted normal range of motion, weakness against 

resistance with flexion and extension, mild laxity was exhibited on stressing the medial collateral 

ligaments, tenderness to palpation over the medial, and lateral joint lines. Dr. Wilson opined that 

appellant sustained an injury on November 6, 2012 to her knee due to a work-related accident 

while employed as a letter carrier. He noted that she attempted to self-treat her symptoms 

without improvement, but her condition worsened. Dr. Wilson noted that by the time appellant 

presented to Dr. LaButti the fracture was minimally displaced and diagnostic studies revealed 

osteonecrosis caused by a stress fracture. He noted that she continued to weight bear and work 

which caused daily increased trauma which can result in altered blood supply to the bone and 

cause progressively worsening symptoms over the two months she attempted to self-treat. 

Dr. Wilson opined that the major cause of appellant’s condition was the November 6, 2012 

accident and she sustained an acute injury to her left knee, superimposed on some preexisting 

changes. He noted the fact that she did not seek immediate treatment more likely than not 

caused a progressive increase in her condition which then resulted in osteonecrosis, secondary 

collapse, resulting in a total knee replacement. 

In a decision dated November 3, 2014, OWCP denied modification of the July 24, 2013 

decision. 

LEGAL PRECEDENT 

An employee seeking benefits under FECA has the burden of establishing 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 filed within the applicable time limitation 

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 is causally related to the 

employment injury. These are the essential elements of each and every compensation claim 

regardless of whether the claim is predicated upon a traumatic injury or occupational disease.2

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. 

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

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

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

to establish that the employment incident caused a personal injury.3

 2 Gary J. Watling, 52 ECAB 357 (2001). 

3

 T.H., 59 ECAB 388 (2008). 
5

Rationalized medical opinion evidence is generally required to establish causal 

relationship. The opinion of the physician must be based on a complete factual and medical 

background, 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.4

ANALYSIS 

It is not disputed that, on November 6, 2012, appellant was pushing a gurney full of 

parcels to a casing area. It is also established that she has been diagnosed with left knee 

traumatic osteochondritis desiccans with underlying osteonecrosis of the medial tibial plateau 

and bicompartmental osteoarthritis. However, appellant has not submitted sufficient medical 

evidence to establish that her diagnosed conditions were caused or aggravated by this pushing 

incident. 

Appellant submitted reports dated January 7 and February 11, 2013 from Dr. LaButti 

who noted that she had a traumatic onset of left knee pain on November 6, 2012 while walking 

into the employing establishment. Dr. LaButti noted findings and diagnosed an acute atraumatic 

onset of the left knee pain related to a fracture of the medial tibial plateau and also 

patellofemoral osteoarthritis as confirmed by x-rays. On February 11, 2013 he treated appellant 

for left knee pain which began on November 6, 2012 while she was walking into the employing 

establishment. Dr. LaButti diagnosed exacerbation of patellofemoral osteoarthritis and an 

insufficiency fracture of the medial tibial plateau with an underlying osteochondral lesion. In a 

February 18, 2013 report, he noted diagnoses and stated that, based on appellant’s history, she 

had an asymptomatic left knee until November 6, 2012 when she walked into the employing 

establishment. However, Dr. LaButti’s reports did not provide an accurate history of the 

November 6, 2012 injury to the extent that he indicated the injury occurred when she was 

walking into the employing establishment. This account differed from the history provided by 

appellant that she injured her knee at work pushing a gurney full of parcels to the casing area.5

 

Dr. LaButti also failed to provide a rationalized opinion explaining the causal relationship 

between appellant’s left knee condition and her factors of employment.6 In a January 25, 2013 

attending physician’s report, he diagnosed a subchondral insufficiency fracture of the medial 

tibia and checked a box “yes” to indicate that the condition was employment related. However, 

the Board has held that an opinion on causal relationship which consists only of a physician 

checking a box “yes” regarding causal relationship is of little probative value. Without any 

explanation or rationale for the conclusion reached, such report is insufficient to establish causal 

relationship.7

 4 I.J., 59 ECAB 408 (2008); Victor J. Woodhams, 41 ECAB 345 (1989). 

5 See Frank Luis Rembisz, 52 ECAB 147 (2000) (medical opinions based on an incomplete history or which are 

speculative or equivocal in character have little probative value). 

6 See Jimmie H. Duckett, 52 ECAB 332 (2001); Franklin D. Haislah, 52 ECAB 457 (2001) (medical reports not 

containing rationale on causal relationship are entitled to little probative value). 

7 Lucrecia M. Nielson, 41 ECAB 583, 594 (1991). 
6

In a March 18, 2013 note, Dr. LaButti corrected his history of the injury and noted that 

initially he had reported that appellant had an onset of knee pain while walking into her place of 

employment; however, he clarified that she was actually at work and walking in her place of 

employment at the time of the onset of the injury. In a March 18, 2013 report, he diagnosed a 

work-related left knee injury which occurred on November 6, 2012. Dr. LaButti found an 

osteochondral injury of the medial tibial plateau and a medial femoral condyle and an 

exacerbation of preexisting osteoarthritis of the patellofemoral joint. Although he supported 

causal relationship, he did not provide sufficient medical rationale to explain his conclusion 

regarding the causal relationship. Dr. LaButti did not explain how “walking in [appellant’s] 

place of employment” would have caused or aggravate the diagnosed conditions or why the 

osteochondral injury of the medial tibial plateau and medial femoral condyle and exacerbation of 

preexisting osteoarthritis of the patellofemoral joint was not the result of nonwork-related 

factors. 

A December 11, 2013 report from Dr. Wilson noted that on November 6, 2012 appellant 

was pushing a gurney of parcels and felt a popping sensation in her left knee. He diagnosed an 

injury on November 6, 2012 to her knee on that date due to a work-related accident. Dr. Wilson 

noted that appellant attempted to self-treat her symptoms without improvement. Appellant also 

continued to use the knee and to work which caused increased trauma and progressively 

worsening symptoms. Dr. Wilson opined that the major cause of her condition was the acute 

injury to her left knee, superimposed on some preexisting changes. He noted that the fact that 

appellant did not seek immediate medical treatment more likely than not caused a progressive 

worsening of her condition which then resulted in osteonecrosis, secondary collapse, and a total 

knee replacement. Although Dr. Wilson supported causal relationship, he did not provide 

sufficient medical rationale explaining the basis of his conclusion opinion. He did not explain 

how pushing a gurney of parcels would have caused or aggravated the diagnosed conditions. 

Rather, Dr. Wilson did not clarify how preexisting changes of the left knee and lack of 

immediate medical treatment interacted with the November 6, 2012 incident to cause her 

condition and the need for a total knee replacement. 

Appellant submitted a November 30, 2012 emergency room report from Dr. Feinberg 

who noted her treatment for a left foot injury. She reported injuring her left foot at work when 

she dropped a 30-pound metal object directly on the foot. Dr. Feinberg noted an x-ray of the left 

foot was negative for fracture or dislocation and diagnosed crush injury of the foot. However, 

his report that appellant dropped a 30-pound metal object directly on the foot, differs from the 

history provided by her that she injured her knee pushing a gurney full of parcels to the casing 

area.8

 

The remainder of the medical evidence, including diagnostic test reports, fails to provide 

an opinion on the causal relationship between appellant’s job and her diagnosed left knee 

condition. For this reason, this evidence is insufficient to meet her burden of proof.9

 

 8 See supra note 5. 

9 A.D., 58 ECAB 149 Docket No. 06-1183 (issued November 14, 2006) (medical evidence which does not offer 

any opinion regarding the cause of an employee’s condition is of limited probative value on the issue of causal 

relationship). 
7

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 her condition was caused, precipitated, or aggravated by her employment is 

sufficient to establish causal relationship. Causal relationships must be established by 

rationalized medical opinion evidence.10 Appellant failed to submit such evidence, and OWCP 

therefore properly denied her claim for compensation. 

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 meet her burden of proof to establish that her 

claimed conditions were causally related to her employment. 

ORDER 

IT IS HEREBY ORDERED THAT the November 3, 2014 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: May 22, 2015 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 James A. Haynes, Alternate Judge 

 Employees’ Compensation Appeals Board 

 10 See Dennis M. Mascarenas, 49 ECAB 215 (1997).