United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

K.H., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Atlantic City, NJ, Employer 

__________________________________________ 

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Docket No. 16-0956 

Issued: April 10, 2017 

Appearances: Case Submitted on the Record

Thomas R. Uliase, Esq., for the appellant1

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

PATRICIA H. FITZGERALD, Deputy Chief Judge 

COLLEEN DUFFY KIKO, Judge 

ALEC J. KOROMILAS, Alternate Judge 

JURISDICTION 

On April 4, 2016 appellant, through counsel, filed a timely appeal from a December 1, 

2015 merit decision of the Office of Workers’ Compensation Programs (OWCP). Pursuant to 

the Federal Employees’ Compensation Act2

 (FECA) and 20 C.F.R. §§ 501.2(c) and 501.3, the 

Board has jurisdiction over the merits of this case.3

 1

 In all cases in which a representative has been authorized in a matter before the Board, no claim for a fee for 

legal or other service performed on appeal before the Board is valid unless approved by the Board. 20 C.F.R. 

§ 501.9(e). No contract for a stipulated fee or on a contingent fee basis will be approved by the Board. Id. An 

attorney or representative’s collection of a fee without the Board’s approval may constitute a misdemeanor, subject 

to fine or imprisonment for up to one year or both. Id.; see also 18 U.S.C. § 292. Demands for payment of fees to a 

representative, prior to approval by the Board, may be reported to appropriate authorities for investigation. 

2

 5 U.S.C. § 8101 et seq. 

3

 Appellant timely requested oral argument pursuant to section 501.5(b) of Board procedures. 20 C.F.R. 

§ 501.5(b). By order dated June 24, 2016, the Board exercised its discretion and denied the request, finding that the 

arguments on appeal could adequately be addressed based on the case record. Order Denying Request for Oral 

Argument, Docket No. 16-0956 (issued June 24, 2016). The Board’s Rules of Procedure provide that any appeal in 

which a request for oral argument is not granted by the Board will proceed to a decision based on the case record 

and any pleadings submitted. 20 C.F.R. § 505.5(b). 
2

ISSUE 

The issue is whether appellant met her burden of proof to establish a right knee injury 

causally related to factors of her federal employment. 

On appeal counsel asserts that, based on the opinion of appellant’s attending physician, 

her job duties as a letter carrier aggravated a prior employment-related right knee injury. He 

maintained that, at a minimum, a conflict in medical evidence had been created. 

FACTUAL HISTORY 

On June 3, 2014 appellant, then a 41-year-old letter carrier, filed an occupational disease 

claim (Form CA-2), alleging that she had no problems with her knees until she started work as a 

letter carrier. The employing establishment indicated that she was working light duty and was 

not carrying mail. 

In letters dated August 26, 2014, OWCP informed appellant of the evidence needed to 

support her claim and asked the employing establishment to respond. In statements dated 

August 22, 2014, appellant related a history that she did not have knee problems before working 

as a letter carrier. She reported that on June 14, 2010 she fell while delivering mail, landing on 

her right knee and twisting her left ankle, and that on October 8, 2011 she again fell to her knees 

delivering mail.4 Appellant indicated that her right knee condition worsened beginning in 2012, 

and that her attending physician Dr. John C. Baker, an orthopedic surgeon, performed right knee 

arthroscopic surgery on May 31, 2012. She indicated that she was on Family Medical Leave Act 

(FMLA) for much of 2012, and that her right knee condition did not improve. Appellant 

continued that in January 2013 she saw Dr. Zachary D. Post who advised that she needed a knee 

replacement. Dr. Baker retired and appellant continued to see Dr. Post. Appellant described her 

job history and duties, noting that she delivered long routes that required constant stairclimbing 

and squatting. She reported that at present she was only performing sedentary work and that her 

quality of life had deteriorated due to her knee condition. 

In support of her claim, appellant submitted a number of reports from Dr. Baker and his 

associates, dating from March 9, 2010, when the physician reported a history that appellant fell 

on ice in the employing establishment parking lot and diagnosed left ankle sprain and contusion 

to the right knee. On June 14, 2010 Dr. Baker reported that appellant fell again that day while 

delivering mail. He again diagnosed left ankle sprain and right knee contusion. On July 7, 2010 

Dr. Baker reported that the conditions had resolved and appellant could return to full duty 

without restrictions. 

Beginning on March 31, 2011 appellant was seen by Dr. Joseph S. Harhay, an orthopedic 

surgeon and associate of Dr. Baker. Dr. Harhay noted appellant’s report of left knee and right 

 4

 The record indicates that the June 14, 2010 injury was adjudicated under OWCP File No. xxxxxx562 as a short 

form closure. The October 8, 2011 injury, adjudicated under File No. xxxxxx842, was accepted for right ankle 

sprain. Appellant had two additional injuries, including a February 11, 2010 injury, adjudicated under File No. 

xxxxxx977, accepted for left ankle sprain, and a January 15, 2014 injury, adjudicated under File No. xxxxxx795. 

The instant case was adjudicated under File No. xxxxxx008. Only File No. xxxxxx008 is before the Board on the 

present appeal. 
3

hip pain since May 2010 and diagnosed left knee patellofemoral tracking disorder with 

developing arthritis and hip impingement. On October 20, 2011 Dr. Harhay noted that on 

October 8, 2011 appellant fell while delivering mail. He diagnosed right ankle sprain. On 

November 29, 2011 Dr. Harhay reported that appellant’s ankle was improving and that she could 

continue working full duty. 

On April 6, 2012 Dr. Baker reported that appellant had a new problem of intermittent, 

throbbing right knee pain. Following examination, he diagnosed primary localized 

osteoarthrosis of the lower leg and recommended a magnetic resonance imaging (MRI) scan. An 

April 26, 2012 right knee MRI scan showed tiny joint effusion, tiny intra-articular body, a tiny 

amount of focal deep chondral erosion, and slight fraying of the medial meniscus. Dr. Baker 

performed right knee arthroscopic chondroplasty and drilling on May 31, 2012. Postoperative 

diagnosis was grade 4 chondromalacia of the medial femoral condyle. Dr. Baker provided 

postoperative care noting effusion and pain. A December 4, 2012 MRI scan of the right knee 

demonstrated bone marrow edema and cystic change most likely related to cartilage loss; 

fracture could be considered. An October 21, 2013 right knee MRI scan showed new truncation 

of the free edge of the body of the medial meniscus, progression of osteoarthritis at the medial 

compartment, new small subchondral fracture of the medial femoral condyle, and a mediumsized ruptured Baker’s cyst. 

Dr. Baker continued to follow appellant. On March 4, 2014 he noted symptoms of right 

knee stiffness and decreased range of motion with pain when walking and an occasional giveway sensation. An April 6, 2014 MRI scan study demonstrated medial meniscal fraying and 

osteoarthritis with mild fraying in the lateral meniscal horn and focal delamination in the patellar 

cartilage. On April 8, 2014 Dr. Baker noted the MRI scan findings and appellant’s continued 

complaints. He reported that he was retiring. 

In a report dated September 15, 2014, Dr. Baker indicated that he first saw appellant on 

June 14, 2010. He described her medical care, noting the May 31, 2012 surgery. Dr. Baker 

opined that the chondral lesion seen on surgery was very consistent with trauma, noting that 

appellant continued to have complaints with swelling and tenderness over the medial joint line. 

He noted that, after the December 2012 MRI scan, surgery was discussed, and that throughout 

2013 appellant continued to have pain, with arthritis changes demonstrated on x-ray, and 

confirmed by the October 2013 MRI scan. Dr. Baker advised that appellant’s complaints 

continued until he last saw her on April 8, 2014. He opined that, within a reasonable degree of 

probability and certainty, appellant’s right knee condition was caused by a work-related injury 

when she fell on her knees. Dr. Baker maintained that, over time, the direct trauma and injury to 

the articular cartilage progressed and became worse, and obviously became more symptomatic. 

He further noted that appellant’s job duties such as lifting heavy bags, walking constantly for 

hours on end every day, up and down steps, pivoting, bending, and squatting, for someone like 

appellant who had a chondral lesion or chondral fracture, which occurred when she fell at work, 

would, in all probability, make the knee condition progress over time. Dr. Baker concluded that 

a unilateral hemiarthroplasty knee replacement was the only option to resolve her continued 

complaints, and this would allow her to continue to work, opining that without the procedure, 
4

with a reasonable degree of medical certainty, her degenerative arthritis in the right knee would 

continue to progress.5

By decision dated October 30, 2014, OWCP denied the claim. It found that the medical 

evidence of record was insufficient to establish that the claimed medical condition was caused by 

work events. 

Appellant, through counsel, timely requested a hearing with OWCP’s Branch of Hearings 

and Review. In a January 27, 2015 decision, an OWCP hearing representative set aside the 

October 30, 2014 decision. She found that, based on her review of the record, the case should be 

remanded for referral for a second opinion evaluation regarding whether appellant’s right knee 

condition was due to factors of her federal employment. 

On remand OWCP prepared a statement of accepted facts and referred appellant to 

Dr. Stanley Askin, a Board-certified orthopedic surgeon, for a second opinion examination. In a 

February 27, 2015 report, Dr. Askin noted appellant’s complaint of a painful right knee that 

limited her activity. He described that appellant claimed her right knee problems began on 

June 14, 2010. Following his review of the medical record, including the May 31, 2012 

operative report and statement of accepted facts, Dr. Askin surmised that appellant’s presentation 

was consistent with a diagnosis of degenerative joint disease of both knees. Examination of the 

right knee demonstrated effusion, tenderness in the medial aspect, and no ligamentous laxity, 

with normal patellofemoral tracking. In answer to specific OWCP questions, Dr. Askin opined 

that appellant’s right knee condition was not causally related to employment, advising that she 

had arthritic changes that would progress over time. He noted that appellant had arthritic 

changes in both knees and that, while she might have discomfort walking at work, work 

activities were not a cause of her condition. Dr. Askin recommended weight loss and did not 

recommend a knee replacement. In an attached work capacity evaluation (Form 5c), he advised 

that appellant could work eight hours a day, again noting that she had knee arthritis, unrelated to 

work. 

OWCP forwarded a letter carrier job description to Dr. Askin and asked whether 

appellant’s right knee condition was caused, aggravated, or exacerbated by her job duties. In a 

supplemental report dated April 2, 2013, Dr. Askin noted his review of the job description. He 

advised that, although someone with knee arthritis would have pain, this would occur whether at 

home or at work and, therefore, he did not feel that her right knee arthritis was caused, 

aggravated, or exacerbated by her work duties. 

In an April 20, 2015 decision, OWCP found the weight of the medical evidence rested 

with the opinion of Dr. Askin and denied appellant’s occupational disease right knee claim. 

Appellant, through counsel, timely requested a hearing, that was held on 

September 11, 2015. Appellant was not present at the hearing. Counsel asserted that Dr. Baker 

provided a clear explanation of how appellant’s work injuries and job duties aggravated her right 

knee condition such that the April 20, 2015 decision should be reversed, or, at a minimum, a 

conflict in medical opinion evidence should be found. 

 5

 Appellant also submitted a number of unsigned, unidentified treatment notes dated June 17, 2009 to 

March 31, 2011. 
5

By decision dated December 1, 2015, an OWCP hearing representative affirmed the 

April 20, 2015 decision finding that the weight of the medical evidence rested with Dr. Askin. 

LEGAL PRECEDENT 

An employee seeking benefits under FECA has the burden of proof to establish 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, and that the claim was timely filed within the 

applicable time limitation period of FECA.6

 When an employee claims that he or she sustained 

an injury in the performance of duty,7

 he or she must submit sufficient evidence to establish that 

he or she experienced a specific event, incident, or exposure occurring at the time, place, and in 

the manner alleged.8

 The employee must also establish that such event, incident, or exposure 

caused an injury.9 These are the essential elements of each and every compensation claim 

regardless of whether the claim is predicated upon a traumatic injury or an occupational 

disease.10

 OWCP regulations define the term “occupational disease or illness” as a condition 

produced by the work environment over a period longer than a single workday or shift.”11 To 

establish that an injury was sustained in the performance of duty in an occupational disease 

claim, a claimant must submit the following: (1) medical evidence establishing the presence or 

existence of the disease or condition for which compensation is claimed; (2) a factual statement 

identifying employment factors alleged to have caused or contributed to the presence or 

occurrence of the disease or condition; and (3) medical evidence establishing that the diagnosed 

condition is causally related to the employment factors identified by the claimant. The medical 

opinion 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.12 

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

causal relationship is rationalized medical evidence.13 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 employee.14 Neither the mere fact that a disease or condition manifests itself during a period 

 6

 5 U.S.C. § 8101(1); L.M., Docket No. 16-0143 (issued February 19, 2016); B.B., 59 ECAB 234 (2007). 

7 Id. at § 8102(a). 

8 J.C., Docket No. 16-0057 (issued February 10, 2016); E.A., 58 ECAB 677 (2007). 

9 Id. 

10 R.H., 59 ECAB 382 (2008). 

11 20 C.F.R. § 10.5(ee). 

12 Roy L. Humphrey, 57 ECAB 238 (2005). 

13 Jacqueline M. Nixon-Steward, 52 ECAB 140 (2000). 

14 Leslie C. Moore, 52 ECAB 132 (2000); Gary L. Fowler, 45 ECAB 365 (1994). 
6

of employment nor the belief that the disease or condition was caused or aggravated by 

employment factors or incidents is sufficient to establish causal relationship.15

ANALYSIS 

The Board finds that appellant did not meet her burden of proof to establish a right knee 

injury causally related to factors of employment. 

Medical evidence submitted to support a claim for compensation should reflect a correct 

history, and the physician should offer a medically sound explanation of how the claimed work 

event caused or aggravated the claimed condition.16 

The MRI scans dated April 26, 2012 to April 6, 2014 did not provide a cause of any 

diagnosed conditions, and 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.17 

Likewise, Dr. Harhay merely discussed appellant’s left knee, right hip, and right ankle conditions 

and provided no opinion regarding her right knee. 

The opinion of a physician supporting causal relationship must be one of reasonable 

medical certainty that the condition for which compensation is claimed is causally related to a 

claimant’s federal employment and such relationship must be supported with affirmative 

evidence, explained by medical rationale and be based upon a complete and accurate medical 

and factual background of the claimant.18 

Appellant’s physician, Dr. Baker submitted a number of reports describing appellant’s 

right knee condition dating from March 9, 2010 when he reported that she fell at work and 

diagnosed left ankle sprain and right knee contusion. On June 14, 2010 he reported that she fell 

again that day while delivering mail, and again injured her left ankle and right knee. On July 7, 

2010 Dr. Baker reported that the conditions had resolved and appellant could return to full duty 

without restrictions. The record indicates that appellant has a February 11, 2010 injury accepted 

for left ankle sprain and a June 11, 2010 short form closure claim.19 It was not until April 6, 

2012, 21 months after his July 7, 2010 report, that Dr. Baker reported “a new problem” with 

appellant’s right knee and diagnosed primary localized osteoarthrosis and performed 

arthroscopic surgery on May 31, 2012. He did not offer an opinion on causal relationship until 

July 15, 2014 when he maintained that the chondral lesion seen on surgery was very consistent 

with trauma, noting that appellant continued to have complaints of swelling and tenderness. 

Dr. Baker did not explain the absence of symptoms between July 2010 and April 2012. To 

establish that a claimed condition was caused by the accepted injury, medical evidence of 

 15 Dennis M. Mascarenas, 49 ECAB 215 (1997). 

16 D.D., Docket No. 13-1517 (issued April 14, 2014). 

17 Willie M. Miller, 53 ECAB 697 (2002). 

18 A.D., 58 ECAB 149 (2006). 

19 Supra note 4. 
7

bridging symptoms between the present condition and, as in this case, the accepted injury must 

support the physician’s conclusion of a causal relationship.20 

While Dr. Baker further explained that appellant’s letter carrier duties would, in all 

probability, worsen her knee condition over time, he did not adequately explain or describe 

physiologically how or why either of the 2010 employment injuries or appellant’s work duties as 

a letter carrier caused her current right knee condition. His opinion is, therefore, of diminished 

probative value.21

Following his review of the medical record and performing physical examination, in 

reports dated February 27 and April 2, 2013 Dr. Askin clearly explained that appellant’s 

presentation was consistent with a diagnosis of degenerative joint disease of both knees. 

Examination of the right knee demonstrated effusion, tenderness in the medial aspect, and no 

ligamentous laxity, with normal patellofemoral tracking. In answer to specific OWCP questions, 

Dr. Askin opined that appellant’s right knee condition was not causally related to employment. 

He explained that appellant’s arthritic changes would have progressed over time, no matter what 

she was doing, whether at home or at work. He concluded that appellant’s right knee arthritis 

was not caused, aggravated, or exacerbated by her work duties, and advised that appellant could 

work eight hours a day. 

The Board therefore finds that OWCP properly accorded the weight of the medical 

evidence to Dr. Askin. 

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 a right knee 

condition causally related to factors of her federal employment. 

 20 Mary A. Ceglia, 55 ECAB 626 (2004). 

21 See M.L., Docket No. 14-1128 (issued September 17, 2014). 
8

ORDER 

IT IS HEREBY ORDERED THAT the December 1, 2015 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: April 10, 2017 

Washington, DC 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board