United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

R.L., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Englishtown, NJ, Employer 

__________________________________________ 

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Docket No. 15-0699 

Issued: July 27, 2015 

Appearances: Case Submitted on the Record

Jason S. Lomax, Esq., for the appellant 

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 February 2, 2015 appellant, through counsel, filed a timely appeal from the August 5, 

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 this case.2

 

 1

 5 U.S.C. § 8101 et seq. 

2

 Under the Board’s Rules of Procedure, an appeal must be filed within 180 days from the date of issuance of an 

OWCP decision. An appeal is considered filed upon receipt by the Clerk of the Appellate Boards. See 20 C.F.R. 

§ 501.3(e)-(f). One hundred and eighty days from August 5, 2014, the date of OWCP’s last decision was 

February 1, 2015, a Sunday, consequently, the period for filing the appeal ran to the next business day, Monday, 

February 2, 2015. Since using February 6, 2015, the date the appeal was received by the Clerk of the Appellate 

Boards would result in the loss of appeal rights, the date of the postmark is considered the date of filing. The date of 

the U.S. Postal Service postmark is February 2, 2015, rendering the appeal timely filed. See 20 C.F.R. § 501.3(f). 
2

ISSUE 

The issue is whether appellant met her burden of proof to establish that the May 24, 2011 

work injury accelerated or contributed to her preexisting chondromalacia. 

FACTUAL HISTORY 

On May 24, 2011 appellant, then a 44-year-old rural carrier, filed a traumatic injury claim 

alleging that she was injured at work on that date when her feet got stuck between two skids 

causing her to lose her balance and fall into a split position. 

In a May 24, 2011 emergency room report, Dr. Tracey Lee, Board-certified in emergency 

medicine, diagnosed a muscle strain. In a June 22, 2011 report, Dr. Jason Wong, a Boardcertified osteopath specializing in sports medicine, noted the work incident and advised that 

appellant fell in some sort of split position that did not result in direct trauma on the knee, but 

pulled and twisted it. He diagnosed a torn medial meniscus of the left knee. On August 12, 2011 

Dr. Wong advised that a magnetic resonance imaging (MRI) scan confirmed a medial meniscus 

tear of the left knee and indicated possible grade III chondromalacia. 

Initially OWCP denied the claim but, upon reconsideration, it accepted the claim for left 

knee tear of the medial meniscus. On March 12, 2012 appellant underwent a left knee 

arthroscopy authorized by OWCP. She stopped work and received appropriate wage-loss 

compensation. 

In a March 12, 2012 operative report, Dr. Wong noted performing the left knee medial 

meniscectomy, excision of the ligamentum and plica, excision of two bone spurs, and 

chondroplasty of the trochlear groove. Dr. Wong stated that appellant had grade III, near grade 

IV chondromalacia of the trochlear groove. He prescribed physical therapy and continued noting 

appellant’s postoperative status. 

On May 1, 2012 OWCP referred appellant, together with the medical record and a 

statement of accepted facts, to Dr. Jeffrey Lakin, a Board-certified orthopedic surgeon, for a 

second opinion regarding appellant’s work-related condition and work status. In his May 23, 

2012 report, Dr. Lakin noted that appellant’s pain had improved following surgery but she was 

still having difficulty with weakness of the knee. On examination, Dr. Lakin found no effusion, 

well-healed arthroscopic portals anteroinferiorly and medially, no lateral joint line tenderness, 

and minimal tenderness over the arthroscopic portal medially. He noted that there was no 

patellofemoral tenderness, compression, or grind. Dr. Lakin further noted that range of motion 

was less than three degrees of extension to 120 degrees of flexion. Appellant was able to squat 

and bend with no significant difficulty. Quad and hamstring strength was 5/5, and the gait was 

unremarkable. Dr. Lakin stated that appellant had excellent motion and strength of the knee with 

minimal tenderness over the arthroscopic portal. He opined that appellant was not suffering 

from any residuals of the work-related injury and that the accepted condition was resolved. 

Dr. Lakin advised that appellant could perform the duties of her position full time and that she 

had no other orthopedic conditions that prevented her from working. He stated that appellant did 

not require any additional medical care for her work-related injury. 
3

In a July 6, 2012 report, Dr. Wong stated that appellant continued to have pain in the 

medial aspect of her left knee. He diagnosed left knee pain secondary to weakness of the quads 

and recommended a different physical therapy facility. 

On August 21, 2012 OWCP referred appellant, together with the medical record and a 

statement of accepted facts, to Dr. Melvin Vigman, a Board-certified neurologist, for a second 

opinion to determine whether appellant suffered any neurological deficit related to the workrelated condition. In a September 13, 2012 report, Dr. Vigman reiterated the history of 

appellant’s injury and her treatment history. He advised that appellant reported continued left 

knee pain, particularly when she put weight on it. On examination, appellant had normal 

strength, coordination, sensation, and reflexes of the lower extremities. Dr. Vigman assessed no 

neurological disease or damage. He advised that appellant could perform her regular duties from 

a neurological standpoint and that there was no need for neurological treatment. 

In an October 11, 2012 report, Dr. Wong noted that appellant reported anteromedial joint 

discomfort as well as discomfort over the superolateral aspect of the patella. He noted findings 

and opined that she had a bit of chondromalacia in the patella. However, Dr. Wong advised that 

he did not believe chondromalacia to be the cause of appellant’s pain. Rather, he attributed it to 

quad weakness. Dr. Wong noted that he would likely discharge her from his care at her next 

appointment and that she could return to work at that time. He advised that at the present time 

appellant should only do sedentary work due to her inability to carry any significant weight. On 

November 9, 2012 Dr. Wong noted that appellant had continued pain, diagnosed 

chondromalacia, and advised that she needed further treatment and therapy. 

By letter dated November 15, 2012, OWCP sent Dr. Lakin appellant’s position 

description. It requested an addendum report addressing whether appellant would have difficulty 

performing any aspect of her job. In a November 15, 2012 report, Dr. Lakin advised that he 

reviewed appellant’s job description and concluded that she could return to full-time work. He 

reiterated the findings from his May 23, 2012 examination and opined that appellant had 

excellent function of her knees, strength and motion. 

By letter dated December 13, 2012, OWCP advised appellant that it proposed to 

terminate her wage-loss and medical benefits. It advised that the weight of the evidence was 

represented by Dr. Lakin who found that there were no residuals of her accepted condition and 

that she was no longer disabled from work. 

In a January 4, 2013 report, Dr. Wong advised that appellant continued to have 

discomfort of her left knee due to incomplete rehabilitation of the quads and chondromalacia of 

the knee. Examination of the left knee revealed no significant effusion, heat, or warmth. 

Dr. Wong noted that she could fully extend and flex her knee. He advised that there was some 

tenderness in the patellofemoral joint medially, no medial joint line tenderness, and anteromedial 

soreness. Dr. Wong assessed mild chondromalacia of the left knee with some anterior knee pain 

secondary to quad weakness. He advised that appellant was undergoing injections into her left 

knee for her chondromalacia. 

In a January 11, 2013 report, Dr. Wong advised that appellant was still experiencing pain 

on the medial side of the knee. He advised that examination revealed no heat, warmth, or any 
4

significant effusion. Dr. Wong assessed chondromalacia of the left knee in the anterior knee as 

well as irritation of the medial joint space. 

By decision dated January 28, 2013, OWCP terminated appellant’s wage-loss and 

medical benefits effective January 28, 2013. 

In a January 18, 2013 report, Dr. Wong advised that appellant completed her final 

injection. However, appellant still complained of pain and discomfort in the left knee. Her 

biggest complaint was discomfort over the anteromedial joint line, but arthroscopic pictures 

revealed that it appeared stable and should not cause her any problems. Dr. Wong noted that he 

would see appellant again in one month and at that time she would be at maximum medical 

improvement. 

By letter dated January 31, 2013, appellant, through counsel, requested an oral telephone 

hearing. 

In a February 12, 2013 addendum report, Dr. Wong reiterated the findings of his earlier 

reports. He noted that in his initial examination he assessed a torn medial meniscus which he 

attributed to the work accident and chondromalacia of the trochlear groove. Dr. Wong noted that 

appellant’s chondromalacia may have been present priory to the injury, but he advised that she 

had no symptoms of pain or discomfort to the anterior aspect of the knee prior to the injury. He 

opined that the work-related injury caused appellant to have a permanent injury to the medial 

meniscus of the knee and exacerbated the chondromalacia of the joint and trochlear groove. 

Dr. Wong further opined that appellant would always have residual pain and discomfort of the 

medial joint as well as to the patellofemoral joint. He noted that the damage to the cartilage 

could not be repaired, only mitigated. 

In a February 15, 2013 report, Dr. Wong advised that appellant had completed her series 

of injections and noted that she still had discomfort over the anteromedial joint line. Left knee 

examination showed a slight valgus deformity, tenderness over the anteromedial joint line, no 

significant pain over the anterior aspect of the knee, discomfort with crepitance, and no effusion. 

Appellant could fully extend her knee and flex it without any difficulty. She could fire her right 

quad a little better than she could on the left. Dr. Wong assessed osteoarthritis of the trochlear 

groove. He advised that appellant had reached maximum medical improvement. 

During the May 17, 2013 hearing, appellant’s counsel argued that the there was a conflict 

in the medical evidence regarding the duration and extent of appellant’s injuries. He noted that 

appellant’s benefits were terminated on January 28, 2013, but that Dr. Wong found that appellant 

had not recovered at that time. 

By decision dated July 31, 2013, an OWCP hearing representative affirmed the 

January 28, 2013 termination of appellant’s compensation benefits. She found that although 

Dr. Wong’s report was not sufficiently rationalized to establish causal relationship between 

appellant’s preexisting chondromalacia and the work injury, he raised a new issue that required 

further development of the medical evidence. The hearing representative directed further 
5

development as to whether appellant’s preexisting chondromalacia of the trochlear groove was 

aggravated, exacerbated, or precipitated by the work injury.3

On August 13, 2013 OWCP referred appellant to Dr. Lakin for a second opinion 

regarding whether appellant’s chondromalacia was causally related to the work injury. In his 

September 9, 2013 report, Dr. Lakin stated that he reexamined appellant on August 28, 2013. He 

noted that appellant still complained of left knee pain worsened by prolonged walking and 

getting up from a sitting position. Dr. Lakin related that appellant last saw Dr. Wong 

approximately three to four months ago and that she was not presently under the care of any 

physician. On examination he found well-healed arthroscopic portals anteroinferiorly and 

anteromedially. Dr. Lakin noted that there was no joint line tenderness medially or laterally and 

no patellofemoral crepitus or compression. He noted that quadriceps and hamstring strength was 

5/5. Dr. Lakin opined that the work incident did not aggravate appellant’s preexisting left knee 

chondromalacia of the patellofemoral joint and trochlear groove. He noted that the left knee, 

including the patellofemoral joint was unremarkable currently, and unremarkable at the time of 

his original May 23, 2012 examination. Dr. Lakin advised that it is well known in orthopedic 

literature that osteochondral changes can be present radiographically, yet many of these lesions 

are asymptomatic. He noted that appellant had no clinical symptomology of the left knee 

patellofemoral joint and, therefore, there was no aggravation by the employment incident. 

Dr. Lakin advised that there was no reason why appellant could not return to work full time. 

By decision dated November 20, 2013, OWCP denied appellant’s claim for aggravation 

or precipitation of chondromalacia of the trochlear groove. 

By letter dated December 20, 2013, appellant, through counsel, requested an oral 

telephone hearing. 

At the June 23, 2014 hearing, counsel argued that there was a conflict in the medical 

evidence. He argued that, while Dr. Lakin found that there were no objective findings on 

examination, Dr. Wong offered objective findings including crepitus. 

By decision dated August 5, 2014, an OWCP hearing representative affirmed the 

November 20, 2013 decision, finding that appellant did not establish that the accepted work 

incident aggravated her preexisting chondromalacia. 

On appeal counsel maintains that there is an unresolved conflict in the medical record. 

LEGAL PRECEDENT 

Where 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.4

 3

 Appellant did not appeal the affirmance aspect of this decision. 

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

Causal relationship is a medical issue that must be established by rationalized medical 

opinion evidence.5

 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.6 The weight of medical evidence is determined by its reliability, its 

probative value, its convincing quality, the care of analysis manifested and the medical rationale 

expressed in support of the physician’s opinion.7

ANALYSIS 

OWCP accepted appellant’s claim for left knee tear of the medial meniscus. On 

January 28, 2013 appellant’s compensation benefits were terminated based on the opinion of 

Dr. Lakin, who opined that appellant no longer had residuals of the accepted condition. On 

July 31, 2013, 00an OWCP hearing representative affirmed the January 28, 2013 termination but 

found that the medical evidence needed further development with regard to whether appellant’s 

preexisting chondromalacia was accelerated by the work injury. 

In his February 12, 2013 report, Dr. Wong acknowledged that appellant’s 

chondromalacia may have been present before the work injury, but advised that she had no 

symptoms of pain or discomfort prior to the injury. He opined that the work-related injury 

caused appellant to have a permanent injury to the medical meniscus of the knee and exacerbated 

the chondromalacia of the joint and trochlear groove. Dr. Wong further opined that appellant 

would always have residual pain and discomfort of the medial joint as well as to the 

patellofemoral joint. The Board finds that, although he opined that the work-related injury 

exacerbated appellant’s chondromalacia, Dr. Wong failed to provide sufficient medical rationale 

supporting his opinion. The Board has held that an opinion that a condition is causally related to 

an employment injury because the employee was asymptomatic before the injury but 

symptomatic after it is insufficient, without supporting rationale, to establish causal relationship.8

 

This report is of diminished probative value because it fails to explain how the accepted left knee 

tear of the medial meniscus accelerated appellant’s preexisting chondromalacia. The need for 

medical reasoning is particularly important in view of Dr. Wong’s October 11, 2012 report in 

which he opined that he did not believe chondromalacia to be the cause of appellant’s pain which 

he attributed to quad weakness. Other reports from Dr. Wong are also insufficient to discharge 

appellant’s burden of proof as they do not offer a specific opinion on causal relationship between 

the diagnosed condition and the work-related injury. 

 5 Elizabeth H. Kramm (Leonard O. Kramm), 57 ECAB 117 (2005). 

6 Leslie C. Moore, 52 ECAB 132 (2000). 

7 Franklin D. Haislah, 52 ECAB 457 (2001) (medical reports not containing rationale on causal relationship are 

entitled to little probative value); Jimmie H. Duckett, 52 ECAB 332 (2001). 

8 Thomas D. Petrylak, 39 ECAB 276 (1987). 
7

In his September 9, 2013 report, Dr. Lakin noted that appellant complained of left knee 

pain worsened by prolonged walking and getting up from a sitting position. He opined that the 

work incident did not aggravate appellant’s preexisting left knee chondromalacia of the 

patellofemoral joint and trochlear groove. Dr. Lakin noted that the left knee, including the 

patellofemoral joint was unremarkable currently and unremarkable at the time of his original 

May 23, 2012 examination. He advised that it is well known that osteochondral changes can be 

present radiographically and yet many of these lesions are asymptomatic. Dr. Lakin noted that 

appellant had no clinical symptomology of the left knee patellofemoral joint on his examinations 

and, therefore, there was no aggravation by the employment incident. He found no basis on 

which to support that appellant’s chondromalacia was aggravated by the May 24, 2011 work 

injury. The Board also notes that initial medical reports, including those from Dr. Wong in 2011, 

do not indicate that appellant had chondromalacia which was aggravated by the May 24, 2011 

work injury. 

Consequently, the weight of the medical evidence does not establish that appellant’s 

chondromalacia was aggravated by the May 24, 2011 work injury. 

On appeal, counsel asserts that there is an unresolved conflict in the medical evidence 

under 5 U.S.C. § 8123(a). However, a conflict only occurs when there are two reports of 

virtually equal weight and rationale that reach opposing conclusions.9

 Here, Dr. Wong’s reports 

are of diminished probative value for the reasons previously provided. As noted, causal 

relationship is a medical question that must be established by probative medical opinion from a 

physician.10 The physician must accurately describe appellant’s work duties and medically 

explain the pathophysiological process by which these duties would have caused or aggravated 

the condition.11 Because appellant has not provided such medical opinion evidence in this case, 

she has failed to meet her burden of proof. 

Appellant may submit new evidence or argument as part of a formal 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 the 

May 24, 2011 work injury accelerated or contributed to her preexisting chondromalacia. 

 9 See James P. Roberts, 31 ECAB 1010 (1980). See John D. Jackson, 55 ECAB 465 (2004) (a simple 

disagreement between two physicians does not, of itself, establish a conflict; to constitute a conflict of medical 

opinion, the opposing physicians’ reports must be of virtually equal weight and rationale). 

10 See supra note 5. 

11 Solomon Polen, 51 ECAB 341 (2000) (rationalized medical evidence must relate specific employment factors 

identified by the claimant to the claimant’s condition, with stated reasons by a physician). See also S.T., Docket 

No. 11-237 (issued September 9, 2011). 
8

ORDER 

IT IS HEREBY ORDERED THAT the August 5, 2014 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: July 27, 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