United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

L.K., Appellant 

and 

DEPARTMENT OF HOMELAND SECURITY, 

TRANSPORTATION SECURITY 

ADMINISTRATION, Las Vegas, NV, Employer 

__________________________________________ 

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Docket No. 15-0675 

Issued: October 1, 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 

JAMES A. HAYNES, Alternate Judge 

JURISDICTION 

On February 9, 2015 appellant, through counsel, filed a timely appeal from a January 2, 

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. 

ISSUES 

The issues are: (1) whether OWCP met its burden of proof to terminate appellant’s 

compensation benefits effective March 21, 2014; and (2) whether appellant met her burden of 

proof to establish that she sustained a tear of the of the left knee or aggravation of degenerative 

joint disease causally related to the accepted injury. 

 1

 5 U.S.C. § 8101 et seq. 
2

FACTUAL HISTORY 

On April 30, 2012 appellant, then a 49-year-old transportation security officer, filed a 

traumatic injury claim alleging that on that date she twisted her left knee while walking to a 

briefing. OWCP accepted the claim for left knee sprain and paid benefits. The employing 

establishment offered appellant a light-duty position on May 21, 2012 and she returned to work. 

The exact date that appellant returned to work is unclear from the record. 

A June 1, 2012 magnetic resonance imaging (MRI) scan of appellant’s left knee was 

interpreted by Dr. Alison Nguyen, a diagnostic radiologist, as revealing medial meniscal 

posterior horn/posterior root ligament junction deep radial tear, moderate osteoarthrosis of the 

medial knee compartment, and patellofemoral chondral injury. 

In a June 20, 2012 report, Dr. Eugene P. Libby, a Board-certified orthopedic surgeon, 

noted that this was appellant’s initial office visit. He reported that she somehow misstepped and 

suffered a twisting injury to her left knee on April 30, 2012. Appellant noted immediate pain 

along the medial side of her left knee and was unable to bear full weight and suffered from sharp 

stabbing pain along the medial side of her left knee causing her to limp. Dr. Libby noted that her 

history was complicated by the fact that she had recently started treatment for left knee pain 

approximately one month or so before her April 30, 2012 injury and had received two viscos 

supplementation injections. Appellant indicated that her pain was different than the pain she 

experienced before the April 30, 2012 injury because the pain was sharper and located along the 

medial joint line of the left knee. The left knee also felt like it wanted to catch, which it never 

did before. 

Dr. Libby provided examination findings and noted the June 1, 2012 MRI scan showed 

tear of the medial meniscus, moderate osteoarthrosis medial compartment, and patellofemoral 

chondral injury left knee. An impression of symptomatic traumatic medial meniscus tear left 

knee and decompensation preexisting degenerative joint disease left knee was provided. 

Dr. Libby indicated that with this episode there was a change in the left knee pain type, 

frequency, and intensity which went along with new meniscal injury on top of appellant’s 

preexisting arthritic left knee pain. He opined that this was a classic mechanism of injury which 

can result in new onset meniscus injury/tear in a knee with preexisting degenerative joint disease. 

Dr. Libby explained that, with the intrinsic forces generated within the knee, what had the 

outward appearance of being a trivial injury was in reality significant and severe enough to result 

in meniscus tear with resultant pain. He concluded that the tear of medial cartilage or meniscus 

of knee occurred as a direct result of the April 30, 2012 left knee injury. 

In a November 30, 2012 report, Dr. Bernard C. Ong, a Board-certified orthopedic 

surgeon, noted the history of injury and stated that the most probable diagnosis was medial 

meniscus tear with preexisting arthritis. He also noted that there were other possibilities in the 

differential diagnosis. Dr. Ong requested a left knee arthroscopic surgery to treat left knee 

meniscus tear and arthritis. 

In a March 15, 2013 report, Dr. Ong noted that appellant reinjured her knee at work on 

March 9, 2013. He diagnosed left knee medial meniscus tear and arthritis and opined that she 

aggravated her left knee after twisting it. 
3

In an April 22, 2013 report, Dr. Ong noted that appellant reported her left knee pain 

worsened since the reinjury of the left knee. He diagnosed left knee medial meniscus tear and 

arthritis. Dr. Ong stated that appellant aggravated her left knee after twisting it during a reinjury 

at work. 

In a July 16, 2013 report, Dr. Libby opined that appellant’s traumatic left knee sprain had 

resolved. He noted that she continued to have symptomatic traumatic medial meniscus tear of 

the left knee, for which he requested permission for her to undergo arthroscopic debridement 

surgery. 

Appellant was thereafter referred for a second opinion examination. In an October 28, 

2013 report, Dr. Aubrey A. Swartz, a Board-certified orthopedic surgeon serving as an OWCP 

second opinion physician, reviewed the statement of accepted facts, her medical history and 

reported physical examination findings. He indicated that appellant had a long history of 

osteoarthritis in the left knee, which was advanced in the medial compartment, and also had 

degenerative changes in the patellofemoral compartment that were associated with her genu 

varus deformities of both knees, which were congenital. Dr. Swartz reported that she was 

received viscos supplementation and injections a few weeks before the reported injury. A review 

of the records indicated that appellant had chronic painful osteoarthritis, which required 

treatment before her April 30, 2012 claim. He indicated that there was no specific evidence that 

a new medial meniscus tear resulted from the April 30, 2012 injury as a prior MRI scan was not 

available to compare pre-incident the status of the medial meniscus. Dr. Swartz noted that 

appellant had severe pain with bone-on-bone arthritis prior to her claim and continued with such 

pain. He found no evidence either way as to whether the undersurface tear of the medial 

meniscus related to appellant’s claim or was simply part of an advanced degenerative process 

occurring in the left knee. Dr. Swartz found that appellant required a total joint replacement of 

the left knee, but stated that it was not related to the April 30, 2012 claim. He explained that she 

was having substantial problems before and after the twisting injury and it was unlikely that an 

undersurface tear could make any difference with respect to the painful advanced arthritic 

condition appellant was experiencing. Dr. Swartz reported her restrictions were attributable to 

her preexisting condition. 

In a December 4, 2013 letter to appellant and Dr. Libby, OWCP provided a copy of 

Dr. Swartz’ second opinion report and requested that Dr. Libby submit a report with objective 

findings and rationale which explained how the incident on April 30, 2012 aggravated her 

underlying degenerative condition and/or caused the medial meniscus tear. 

In an August 14, 2013 report, Dr. Libby opined that the left knee traumatic sprain had 

resolved. In medical reports dated December 2 and 17, 2013, he continued to diagnose a left 

knee medial meniscal tear and degenerative joint disease left knee. In his December 17, 2013 

report, Dr. Libby noted that appellant reported to him that she had felt no pain or problems with 

left knee before the April 30, 2012 incident. After reviewing Dr. Swartz’ report, he reported that 

it appeared she was receiving Supartz injections into her left knee before her claimed work 

injury. Dr. Libby opined that appellant would benefit from a left knee replacement arthroplasty, 

but it would be best handled under her private health insurance. He discharged her from care and 

requested that her care be transferred to a pain management subspecialist for her future pain 

medication needs. No opinion on causation was provided. 
4

In a January 21, 2014 report, Dr. Robert W. Patti, a Board-certified orthopedic surgeon, 

noted the history of injury and provided an impression of internal derangement of the left knee, 

likely torn medial and/or lateral meniscus; and marked quadriceps and hamstring weakness. He 

reported that he did not review any MRI scan reports. Dr. Patti also provided work restrictions. 

No opinion on causation was provided. In a January 21, 2014 Form CA-20, Dr. Patti reported 

that appellant twisted her knee at work and diagnosed internal derangement which he opined 

with a checkmark “yes” was caused or aggravated by employment activity. In a January 28, 

2014 report, he provided a clinical impression of advancing degenerative arthritis of the knee and 

advancing medial meniscal tearing pathology, and some ongoing weakness bilaterally. Dr. Patti 

opined that appellant’s left knee has on sequential MRI scans a worsening medial meniscal 

condition from a work-related injury. He also opined that her left knee condition was work 

related and total knee replacements of both knees were needed. 

In a February 14, 2014 letter, OWCP advised appellant that it proposed to terminate her 

benefits on the grounds that she ceased to have residuals of her accepted work-related medical 

condition and no medical had been submitted to establish that the April 30, 2012 work incident 

caused or aggravated a meniscal tear or arthritis of the left knee. The termination was based on 

the opinion of Dr. Swartz, the second opinion referral physician. Appellant was provided 30 

days to respond. 

In response to the notice of proposed termination, OWCP received copies of previously 

submitted reports along with new evidence, which included January 28, 2014 work restrictions 

from Dr. Patti. In a February 27, 2014 report, Dr. Patti indicated that appellant has bilateral 

advanced degenerative arthritis of her knees, a nonindustrial condition. With that background, 

appellant had a noted twist of her knee as mechanism with acute onset of pain in her knee that 

has not gone away. The twisting was a trauma with the weakness of the tissues from the 

degenerative changes. Appellant has a torn medial meniscus likely attributable to that twisting 

injury a year and a half ago and she has loose bodies which could also be from the traumatic 

source. Dr. Patti stated that appellant needed a total knee replacement. He indicated that the 

current reason she still has significant disability was historically related to the medial tearing. 

Dr. Patti stated that he did not know whether the acute onset of appellant’s prominent discomfort 

medially and deep was from the knee being twisted and progressing or tearing the medial 

meniscus. He also indicted that he reviewed records from Dr. Swartz. 

In a March 10, 2014 report, Dr. Ong indicated that appellant had a left knee medial 

meniscus tear and severe arthritis. He stated that he had not treated her for nine months and felt 

questions regarding her left knee and treatment were best answered by her most current treating 

physicians, Dr. Libby and/or Dr. Patti. 

By decision dated March 21, 2014, OWCP terminated appellant’s benefits effective that 

day. Weight of the medical evidence was accorded to Dr. Swartz’ opinion. 

On April 2, 2014 OWCP received appellant’s March 31, 2014 request for a telephonic 

hearing before the Branch of Hearings and Review, which was held October 17, 2014. Appellant 

explained that she had some minor treatment to her knee prior to the April 2012 injury and an 

injury on March 9, 2013, but she did not have any specific injuries to her knee prior to the 
5

April 2012 work event. Counsel argued that the claim should be expanded to include the 

diagnosed meniscal injury. 

OWCP received a June 1, 2012 left knee MRI scan report and a duplicate copy of 

Dr. Libby’s June 20, 2012 report. 

In a June 7, 2012 report, Dr. Robert P. Kaplan, a family practitioner, noted that appellant 

was walking and her left knee twisted on April 30, 2012. He reported on her physical 

examination of May 2, 2012 and the results of MRI scan and x-ray testing. Dr. Kaplan 

diagnosed torn meniscus of left knee and opined that the injury to appellant’s left knee was 

related to her April 30, 2012 incident at work. 

By decision dated January 2, 2015, an OWCP hearing representative affirmed OWCP’s 

March 21, 2014 decision. She found that OWCP had met its burden of proof to establish that the 

accepted condition of left knee strain had resolved, and that appellant had not met her burden of 

proof to establish that any additional conditions were causally related to the accepted incident. 

LEGAL PRECEDENT -- ISSUE 1 

Once OWCP accepts a claim, it has the burden of justifying termination or modification 

of compensation. After it has been determined that, an employee has disability causally related 

to his or her employment, OWCP may not terminate compensation without establishing that the 

disability had ceased or that it was no longer related to the employment.2 OWCP’s burden of 

proof includes the necessity of furnishing rationalized medical opinion evidence based on a 

proper factual and medical background.3 Furthermore, the right to medical benefits for an 

accepted condition is not limited to the period of entitlement for disability. To terminate 

authorization for medical treatment, OWCP must establish that a claimant no longer has 

residuals of an employment-related condition that requires further medical treatment.4

ANALYSIS -- ISSUE 1 

OWCP accepted that appellant sustained a left knee sprain on April 30, 2012 when she 

twisted her knee. The issue is whether it properly terminated her benefits effective March 21, 

2014 as she no longer had residuals of the April 30, 2012 injury. 

The Board finds that OWCP met its burden of proof to terminate appellant’s benefits for 

the accepted left knee sprain condition. In his July 16 and August 14, 2013 reports, Dr. Libby, 

appellant’s treating physician, opined that the traumatic left knee sprain had resolved. There is 

no medical evidence of record to dispute that the traumatic left knee sprain had, in fact, resolved. 

Dr. Swartz, OWCP’s second opinion physician, stated in his October 28, 2013 report that 

appellant had a long-standing preexisting arthritic condition of the left knee, as well as 

congenital deformity. He concluded that, while appellant now required total knee replacement, 

 2 Jason C. Armstrong, 40 ECAB 907 (1989). 

3 See Del K. Rykert, 40 ECAB 284, 295-96 (1988). 

4 Mary A. Lowe, 52 ECAB 223 (2001); Wiley Richey, 49 ECAB 166 (1997). 
6

her current condition was not related to the accepted work injury. The other physicians of record 

discussed her current diagnoses, but did not find residuals of the accepted condition. 

Thus, OWCP properly terminated appellant’s benefits for the accepted left knee sprain 

condition as there was no evidence of residuals of the accepted condition. 

LEGAL PRECEDENT -- ISSUE 2 

For conditions not accepted by OWCP as being employment related, it is the employee’s 

burden to provide rationalized medical evidence sufficient to establish causal relationship. It is 

not OWCP’s burden to disprove such relationship.5

 

To establish a causal relationship between the condition as well as any attendant 

disability claimed and the employment injury, an employee must submit rationalized medical 

evidence based on a complete medical and factual background, supporting such a causal 

relationship.6

 Causal relationship is a medical issue and the medical evidence required to 

establish a causal relationship is rationalized medical evidence.7

ANALYSIS -- ISSUE 2 

Appellant had a history of left knee medial meniscus tear and degenerative arthritis in her 

left knee, OWCP developed the issue of whether the April 30, 2012 twisting injury permanently 

or temporary aggravated her degenerative condition and/or caused the medial meniscus tear. 

OWCP determined that the weight of the medical evidence rested with Dr. Swartz, a Boardcertified orthopedic surgeon serving as the second opinion physician. 

Based on a clinical examination, review of the medical record, and statement of accepted 

facts, Dr. Swartz opined that the medical record did not show a new medial meniscus tear 

resulting from the April 30, 2012 twisting injury. He explained that there were no MRI scan 

findings to compare the status of the medial meniscus before the incident to the recent MRI scan. 

Appellant had consistent, chronic painful osteoarthritis which required three visits in April 2012 

in which she received viscos supplementation injections in her left knee antedating her April 30, 

2012 claim. Dr. Swartz further explained that appellant had a long history of osteoarthritis in the 

left knee and the June 1, 2012 MRI scan noted a progression of tear involving the posterior horn 

medial meniscus which would not indicate previous tear. He stated that she was having 

substantial problems immediately before the April 30, 2012 incident and was having substantial 

problems since the incident. Dr. Swartz indicated that she required a total joint replacement of 

the left knee, but it was not related to the April 30, 2012 claim. He attributed appellant’s 

meniscus tear and degenerative condition to other conditions not accepted by OWCP. 

 5 G.A., Docket No. 09-2153 (issued June 10, 2010); Jaja K. Asaramo, 55 ECAB 200 (2004); Alice J. Tysinger, 51 

ECAB 638 (2000). 

6 See Manuel Gill, 52 ECAB 282 (2001). 

7 Paul Foster, 56 ECAB 208 (2004); Jacqueline M. Nixon-Steward, 52 ECAB 140 (2000). 
7

The Board finds that OWCP properly accorded the weight of the evidence to the medical 

opinion of Dr. Swartz. Dr. Swartz’ report contains an extensive review of the medical record, 

discusses appellant’s prior history of arthritis in the left knee and her treatment with injections to 

the knee shortly before this incident and supports his opinion with reasoning.8

The reports from appellant’s physicians are insufficient to cause a conflict of medical 

opinion with that of Dr. Swartz regarding causal relationship. 

In his initial report of June 20, 2012, Dr. Libby opined that the tear of medial cartilage or 

meniscus of knee occurred as a direct result of the April 30, 2012 left knee injury. He stated that 

with this episode there was a change in the left knee pain type, frequency, and intensity which 

went along with a new meniscal injury on top of appellant’s preexisting arthritic achy left knee 

pain. Dr. Libby indicated that twisting was a classic mechanism of injury which could result in 

new onset meniscus injury/tear in a knee with preexisting degenerative joint disease, as the 

intrinsic forces generated within the knee were significant and severe enough to result in 

meniscus tear with resultant pain. However, the conclusory findings do not explain how the 

meniscus tear could be separated from appellant’s serious preexisting knee condition. Although 

Dr. Libby discusses generally the possibility that it could occur, there are no diagnostic studies to 

confirm that the meniscus tear was not also preexisting. Following a review of Dr. Swartz’ 

report, Dr. Libby continued to attribute appellant’s traumatic medial meniscus tear of the left 

knee and decompensation of the degenerative joint disease left knee to the mechanism of the 

twisting injury on April 30, 2012. He acknowledged that she had received injections into her left 

knee before the alleged injury and had reported the pain and problems with the left knee prior to 

the April 30, 2012 incident. Dr. Libby based his belief that the meniscus tear was work related 

on appellant’s description of the pain as being “different.” His reports contain no significant 

record review and his opinion is not based on comparative diagnostic tests. Dr. Libby’s opinion 

relies almost entirely on appellant’s perception that her pain changed after her April 30, 2012 

occurrence. He offered better medical support for his conclusory opinion that she suffered a torn 

meniscus as a result of that occurrence.9

 Thus, Dr. Libby’s reports are of diminished probative 

value and are insufficient to create a conflict in medical opinion. 

In his November 30, 2012 report, Dr. Ong noted the history of injury and stated that the 

most probable diagnosis was medial meniscus tear with preexisting arthritis. The Board has held 

that medical opinions that are speculative or equivocal in character are of diminished probative 

value.10 In March 15 and April 22, 2013 reports, Dr. Ong noted that appellant reinjured her knee 

at work on March 9, 2013 and her left knee pain worsened. While he opined that she aggravated 

her left knee after twisting it during a reinjury at work, he based the reinjury on a March 9, 2013 

occurrence and not the April 30, 2012 occurrence. Thus, these reports do not discuss the 

April 30, 2012 occurrence and are of limited probative value. 

 8 See James Mack, 43 ECAB 321 (1991). 

9

 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). 

10 D.D., 57 ECAB 734, 738 (2006); Kathy A. Kelley, 55 ECAB 206 (2004). 
8

In a January 21, 2014 report, Dr. Patti noted the history of injury and provided an 

impression of internal derangement of the left knee, likely torn medial and/or lateral meniscus 

and marked quadriceps, and hamstring weakness. However, he offered no opinion on causation. 

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.11 In 

January 21 and 28, 2014 reports, Dr. Patti related that appellant had twisted her knee at work and 

the diagnosed conditions of internal derangement and advancing degenerative arthritis of the 

knee and advancing medial meniscal tear pathology and ongoing bilateral weakness were caused 

or aggravated by employment injury. While he explained in his January 28, 2013 report that the 

sequential MRI scans of her left knee showed a worsening medial meniscal condition from a 

work-related injury, he offered no medical support for his opinion.12 In his February 27, 2014 

report, Dr. Patti explained that the twisting was a trauma with the weakness of the tissues from 

the degenerative arthritis of her knees. He opined, however, that he did not know whether the 

acute onset of appellant’s prominent discomfort medially and deep was from the knee being 

twisted and progressing or from the tearing of the medial meniscus. 

In his June 7, 2012 report, Dr. Kaplan noted the history of injury, diagnostic testing, and 

examination findings. He diagnosed torn meniscus of the left knee and opined that the injury to 

appellant’s left knee was related to the April 30, 2012 occurrence. The Board finds, however, 

that Dr. Kaplan did not provide sufficient medical rationale explaining how her twisting 

occurrence of April 30, 2012 caused a new condition.13

On appeal appellant alleges that OWCP’s decision is contrary to fact and law. However, 

there is no medical evidence that she has any residuals of her accepted left knee sprain. 

Furthermore, appellant’s physicians lack the probative value necessary and those reports do not 

establish that the April 30, 2012 occurrence caused appellant’s current left knee condition or 

aggravated a preexisting condition.14 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 OWCP met its burden of proof to terminate appellant’s benefits 

effective March 21, 2014 as she no longer had any residuals causally related to her accepted left 

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

12 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 

supra note 9; A.D., 58 ECAB 149 (2006). 

13 See J.F., supra note 9; A.D., supra note 9. 

14 W.W., Docket No. 09-1619 (issued June 2, 2010). 
9

knee sprain. The Board further finds that she did not meet her burden of proof to establish that 

the April 30, 2012 twisting injury permanently or temporary aggravated her degenerative 

condition and/or caused the medial meniscus tear. 

ORDER 

IT IS HEREBY ORDERED THAT the January 2, 2015 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: October 1, 2015 

Washington, DC 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 James A. Haynes, Alternate Judge 

 Employees’ Compensation Appeals Board