United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

M.P., Appellant 

and 

DEPARTMENT OF THE AIR FORCE, TINKER 

AIR FORCE BASE, OK, Employer 

__________________________________________ 

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Docket No. 14-1289 

Issued: September 26, 2014 

Appearances: Case Submitted on the Record

Richard A. Daniels, for the appellant 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

CHRISTOPHER J. GODFREY, Chief Judge 

PATRICIA HOWARD FITZGERALD, Judge 

JAMES A. HAYNES, Alternate Judge 

JURISDICTION 

On May 15, 2014 appellant, through his representative, filed a timely appeal from the 

December 18, 2013 merit decision of the Office of Workers’ Compensation Programs (OWCP), 

which denied his consequential injury claim. 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’s accepted right knee injury on September 21, 2007 caused 

a consequential back injury. 

FACTUAL HISTORY 

On September 21, 2007 appellant, a 32-year-old sheet metal mechanic (aircraft), 

sustained a traumatic injury in the performance of duty while squatting. OWCP accepted his 

 1

 5 U.S.C. § 8101 et seq.
2

claim for a torn right medial meniscus. On June 2, 2009 appellant underwent an arthroscopic 

partial meniscectomy. 

Dr. Anthony L. Cruse, the attending orthopedic surgeon, saw appellant on July 29, 2009 

and noted that “he does better.” Findings were negative. Appellant stated that he was ready to 

return to full duty. 

Dr. Cruse followed up on August 25, 2009. Appellant stated that “he is doing all right.” 

Findings were again negative. Dr. Cruse released appellant from care. 

On February 1, 2010 Dr. John W. Ellis, the attending Board-certified family physician, 

related appellant’s history. After noting the right knee surgery, he commented that, due to an 

altered gait from the injury, appellant started to have problems with his lower back. “He states 

that the last couple of months it has gotten worse.” A magnetic resonance imaging scan (MRI) 

showed no herniation but did show a small left paracentral disc protrusion at L4-5 and a small 

contained midline disc protrusion at L5-S1. Dr. Ellis offered the following on the cause of 

injury: 

“It is my medical opinion, based upon my examination of the employee, review of 

available medical records, my education, training, experience and upon 

reasonable medical certainty, that the injuries, impairments and disabilities set 

forth in my diagnosis and findings arose out of and in the course of the 

employee’s employment and that said employment and work duties contributed 

to, aggravated and caused this employee’s said injuries, disabilities and 

impairments.” 

Appellant claimed compensation for total disability beginning August 2, 2009. 

An OWCP medical adviser found insufficient evidence in the medical record to warrant 

the acceptance of disc protrusions or other lumbar conditions. He noted that the attending 

surgeon made no mention of any back complaints at the time of initial presentation for treatment. 

Further, Dr. Ellis’ comment about gait disturbance appeared in conflict with the attending 

surgeon’s specific right knee physical examination findings, which were in close temporal 

proximity. 

In a decision dated March 2, 2011, OWCP denied appellant’s wage-loss claim. 

On April 28, 2011 Dr. Ellis advised that when he first saw appellant on April 28, 2008, 

he had no symptoms or complaints regarding his back. It was his opinion that appellant’s current 

back symptoms and complaints were entirely related to the right knee. “The patient has had to 

walk with an altered gait for so long prior to his surgery and even after his surgery that his back 

complaints and problems are related to his right knee injury.” 

An OWCP hearing representative affirmed the denial of appellant’s wage-loss claim. 

She noted that although it was the strong belief of appellant’s representative that appellant’s back 

condition was related to his injury-related altered gait, the issue was whether appellant had 

provided evidence of his total disability beginning August 2, 2009, and that his surgeon had 

released him to full duty on July 29, 2009. 
3

On May 15, 2013 OWCP reviewed the merits of appellant’s case and denied his lumbar 

injury claim on the grounds that the medical evidence was insufficient to establish that his 

lumbar condition was causally related to the September 21, 2007 work injury. 

In a decision dated December 18, 2013, an OWCP hearing representative affirmed. She 

noted that appellant began complaining about low back pain in April 2009, and the medical 

records indicated that he believed this was due to his altered gait following the right knee injury. 

There was no mention of an altered gait in any of the medical records prior to April 2009. 

Dr. Ellis opined that the work injury caused or contributed the disc protrusions at L4-5 and L5-

S1, but he did not discuss how he arrived at this conclusion. No other treating physician reported 

an altered gait or any objective findings to support that appellant’s right knee condition was 

sufficient to cause an altered gait or contribute to a lumbar condition. 

On appeal, appellant’s representative argues that Dr. Ellis’ February 1, 2010 opinion, 

reiterated on April 28, 2011, is a well-reasoned opinion supported by sound medical rationale. 

He adds that, if the opinion of OWCP’s medical adviser carried any weight, it would create a 

conflict. 

LEGAL PRECEDENT 

FECA provides compensation for the disability of an employee resulting from personal 

injury sustained while in the performance of duty.2 A claimant seeking benefits under FECA has 

the burden of proof to establish the essential elements of his claim by the weight of the 

evidence,3 including that he sustained an injury in the performance of duty and that any specific 

condition or disability for work for which he claims compensation is causally related to that 

employment injury.4

Causal relationship is a medical issue,5 and the medical evidence generally required to 

establish causal relationship is rationalized medical opinion evidence. The opinion of the 

physician must be based on a complete factual and medical background of the claimant,6 must be 

one of reasonable medical certainty,7 and must be supported by medical rationale explaining the 

nature of the relationship between the diagnosed condition and the established incident or factor 

of employment.8

 2

 5 U.S.C. § 8102(a). 

3 Nathaniel Milton, 37 ECAB 712 (1986); Joseph M. Whelan, 20 ECAB 55 (1968) and cases cited therein. 

4 Elaine Pendleton, 40 ECAB 1143, 1145 (1989). 

5 Mary J. Briggs, 37 ECAB 578 (1986). 

6 William Nimitz, Jr., 30 ECAB 567, 570 (1979). 

7 See Morris Scanlon, 11 ECAB 384, 385 (1960). 

8 See William E. Enright, 31 ECAB 426, 430 (1980). 
4

It is an accepted principle of workers’ compensation law 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 attributable to the employee’s own intentional conduct.9

ANALYSIS 

OWCP accepts that on September 21, 2007 appellant tore his right medial meniscus in 

the performance of duty, for which he underwent an arthroscopic meniscectomy on June 2, 2009. 

Appellant claims that this knee injury and surgery caused an altered gait, which in turned caused 

a low back injury that totally disabled him from work beginning August 2, 2009. He therefore 

carries the burden of proof to establish the element of causal relationship. 

The Board has reviewed the medical record and can find only two reports that provide an 

affirmative support for appellant’s consequential injury claim. The first is the February 1, 2010 

report from Dr. Ellis, the attending family physician. In relating appellant’s history, Dr. Ellis 

commented that, due to an altered gait from the injury, appellant began to have problems with his 

lower back, which worsened over the last couple of months. It is not clear to the Board whether 

Dr. Ellis was simply reporting what appellant had told him. 

Dr. Ellis described the small disc protrusions seen on the MRI scan of appellant’s lumbar 

spine and included a statement of opinion on cause of injury, which expressed his medical 

opinion that the employee’s diagnoses and findings arose out of and in the course of 

employment. However, there is nothing specific to appellant in this statement. It does not 

address appellant by name or identify his injury or refer to any particular medical record or 

finding or diagnosis. It does not explain from a medical or physiological point of view how an 

altered gait caused or aggravated the small disc protrusions found on the MRI scan or otherwise 

caused total disability for work beginning August 2, 2009. 

Medical conclusions unsupported by rationale are of little probative value.10

The second such opinion in the record is also from Dr. Ellis date April 28, 2011. On that 

date, Dr. Ellis addressed appellant’s claim more directly. It was his opinion, he reported, that 

appellant’s current back symptoms and complaints were entirely related to the right knee. “The 

patient has had to walk with an altered gait for so long prior to his surgery and even after his 

surgery that his back complaints and problems are related to his right knee injury.” 

Although this is supportive of appellant’s claim, it still fails to provide sufficient medical 

rationale to establish causal relationship. Dr. Ellis did not offer a diagnosis for appellant’s low 

back complaints and problems. If he meant the small left paracentral disc protrusion at L4-5 and 

the small contained midline disc protrusion at L5-S1, he did not explain how an altered gait 

could biomechanically affect these protrusions, or what evidence there was beyond appellant’s 

subjective complaints that demonstrated an aggravation of these protrusions. 

 9 John R. Knox, 42 ECAB 193 (1990); Lee A. Holle, 7 ECAB 448 (1955). 

10 Ceferino L. Gonzales, 32 ECAB 1591 (1981); George Randolph Taylor, 6 ECAB 968 (1954). 
5

OWCP observed that the medical record made no mention of an altered gait prior to 

April 2009, and that Dr. Cruse, the attending surgeon who saw appellant that year, made no 

mention of low back symptoms or complaints. The Board notes that appellant was improving 

when he saw Dr. Cruse on July 29, 2009. A physical examination of his right knee was negative, 

and appellant stated he was ready to start back to full duty. Further, when appellant saw 

Dr. Cruse on August 25, 2009, approximately three weeks after he claimed his low back 

condition had totally disabled him for work and advised that he was doing all right. His right 

knee findings were once again negative, and Dr. Cruse released him from further care. 

Dr. Ellis failed to address the relevant facts in his medical opinions. He did not reconcile 

this opinion with the rest of the medical evidence of record, including the benign examination 

findings reported by Dr. Cruse and appellant’s representations that he was doing all right and 

was ready to start back to full duty. 

Medical conclusions based on inaccurate or incomplete histories are of little probative 

value.11

The Board finds that Dr. Ellis’ opinion on causal relationship lacks sufficient probative 

value to establish the critical element of causal relationship. Accordingly, the Board finds that 

appellant has not met his burden to establish that his accepted right knee injury on September 21, 

2007 caused a consequential low back injury. The Board will therefore affirm OWCP’s 

December 18, 2013 decision denying his 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. 

Appellant’s representative asserts that Dr. Ellis’ February 1, 2010 opinion, reiterated on 

April 28, 2011, is a well-reasoned opinion supported by sound medical rationale. As explained 

above, the Board rejects such assertion. OWCP’s medical adviser did not rebut Dr. Ellis’ 

professional opinion. Rather he reviewed the record before him and advised OWCP, consistent 

with the Board’s finding on appeal, that there is insufficient medical support for OWCP to 

expand its acceptance of appellant’s case. 

CONCLUSION 

The Board finds that appellant has not met his burden to establish that his accepted right 

knee injury on September 21, 2007 caused a consequential low back injury. 

 11 James A. Wyrick, 31 ECAB 1805 (1980) (physician’s report was entitled to little probative value because the 

history was both inaccurate and incomplete). See generally Melvina Jackson, 38 ECAB 443, 450 (1987) (addressing 

factors that bear on the probative value of medical opinions). 
6

ORDER 

IT IS HEREBY ORDERED THAT the December 18, 2013 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: September 26, 2014 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Patricia Howard Fitzgerald, Judge 

 Employees’ Compensation Appeals Board 

 

 James A. Haynes, Alternate Judge 

 Employees’ Compensation Appeals Board