United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

K.T., Appellant 

and 

DEPARTMENT OF JUSTICE, BUREAU OF 

PRISONS, Ayer, MA, Employer 

__________________________________________ 

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Docket No. 15-1758 

Issued: May 24, 2016 

Appearances: Case Submitted on the Record

Appellant, pro se 

Sarah Tunney, Esq., for the Director 

DECISION AND ORDER 

 

Before: 

CHRISTOPHER J. GODFREY, Chief Judge 

COLLEEN DUFFY KIKO, Judge 

VALERIE D. EVANS-HARRELL, Alternate Judge 

JURISDICTION 

On August 19, 2015 appellant filed a timely appeal from a March 4, 2015 merit decision 

of the Office of Workers’ Compensation Programs (OWCP). Pursuant to 20 C.F.R. §§ 501.2 and 

501.3, the Board has jurisdiction over the merits of the claim. 

ISSUE 

The issue is whether appellant met her burden of proof to establish a recurrence of her 

medical condition causally related to her December 27, 2010 employment injury. 

On appeal a memorandum of justification was received on behalf of the Director of 

OWCP. In this memorandum, the Director argues that appellant has not met her burden of proof 

to establish a recurrence of medical condition because more than 90 days elapsed after 

appellant’s release from medical care to the alleged recurrence; therefore, appellant was 

responsible for submitting a medical report supporting causal relationship between her current 

condition and the accepted injury. 
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FACTUAL HISTORY 

On December 28, 2010 appellant, then a 38-year-old nurse, filed a traumatic injury claim 

(Form CA-1) alleging that on December 27, 2010 she slipped on ice on the compound walkway 

and sustained a right knee strain. The record does not indicate that she stopped work. OWCP 

accepted the claim for right knee strain. On February 16, 2011 Dr. Robert O. Voight, a Boardcertified internist, diagnosed improved right knee strain and released appellant from medical care 

for her work-related condition. He advised that she could continue to work without restrictions 

and should transition from physical therapy to a home exercise program. 

On December 4, 2014 OWCP received appellant’s September 8, 2014 claim for 

recurrence of disability for medical treatment (Form CA-2a) of the accepted right knee condition. 

Evidence submitted with the claim included appellant’s undated statement received December 4, 

2014 and a September 3, 2014 right knee magnetic resonance imaging (MRI) scan report. 

In a September 2, 2013 report, Dr. Eric Holstein, a Board-certified orthopedic surgeon, 

reported a history of an initial right knee injury playing basketball in 1988 and right knee anterior 

cruciate ligament (ACL) reconstruction in 1991. He noted that appellant reinjured her right knee 

at work on December 27, 2010 during a fall and he noted her current complaints of right and left 

knee pain. Dr. Holstein diagnosed severe right knee degenerative joint disease and mild left 

knee degenerative joint disease. He reported no change on physical examination. An assessment 

of knee degenerative joint disease and arthropathy of knee joint was provided. In a November 4, 

2013 attending physicians report, Dr. Holstein noted that appellant had preexisting knee 

osteoarthritis and injured her right knee at work on December 27, 2010. He opined with a 

checkmark in a box marked “yes” that her current severe medial bone-on-bone arthropathy and 

lower leg joint pain was caused or aggravated by employment activity. Dr. Holstein noted that 

appellant had not been disabled since 2011. A return to work slip noted that appellant has been 

seen on October 24, 2013 for knee arthritis related to a fall at work on December 27, 2010. 

In an August 28, 2014 report, Dr. Gregory Soghikian, a Board-certified orthopedic 

surgeon, noted that appellant’s history of problems with the right knee dated back to high school 

sports and an ACL reconstruction in 1991. He also noted that she had a slip and fall on ice at 

work in 2010. The knee did relatively well until October 2013 when appellant started to 

complain of right knee pain. Dr. Soghikian presented examination findings and noted that the xrays obtained showed severe osteoarthritic collapse of the medial joint and a screw in the 

proximal lateral femur consistent with a prior ACL reconstruction. He diagnosed severe 

osteoarthritis, medial compartment, which he opined was due to appellant’s old injury and her 

old surgery, which was likely a meniscectomy. Dr. Soghikian opined that her work-related 

injury in 2010 was not a substantial contributing factor as she had not sought treatment for the 

knee ongoing since 2010 and osteoarthritic changes after meniscectomy were fairly well 

established complications of ACL injury and meniscectomy. A total knee replacement was 

recommended. 

Medical reports from Dr. Kathleen Hogan, a Board-certified orthopedic surgeon, were 

also received. In a September 16, 2014 report, Dr. Hogan noted the history of injury as well as 

the initial right knee injury in high school and ACL reconstruction. She noted that appellant was 

diagnosed in 2013 with arthritis and that anti-inflammatories did not help. Dr. Soghikian had 
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referred appellant to her. She provided examination findings and reviewed x-rays and diagnosed 

knee arthritis. Dr. Hogan agreed with Dr. Soghikian that a total knee replacement was the best 

option for appellant. She advised that, based on the history of the fall, it was difficult for her to 

make a clear determination of whether or not this injury was related to the development of 

arthritis without more information. Progress reports dated October 28 and November 14, 2014 

were also provided. It was noted that, while a knee replacement was in appellant’s future, it 

should be put off as along as possible. 

In a January 30, 2015 letter, OWCP acknowledged appellant’s request for continued 

medical treatment due to a consequential condition, specifically an aggravation of her right knee 

arthritis caused by the original injury. It advised that for her to be entitled to additional medical 

treatment for her work injury after being released from care, or not receiving care for a 

significant period of time, she needed to provide evidence that her need for treatment was due to 

a worsening of the accepted medical condition without an intervening cause. OWCP noted that 

appellant was released from medical care for her work-related condition on February 16, 2011. 

It explained that the medical evidence submitted was insufficient to establish her recurrence 

claim. It requested that she provide additional factual evidence along with copies of all medical 

records for the work-related knee condition and a comprehensive, narrative medical report from 

her treating physician, which contained an opinion supported by medical rationale as the 

relationship between her current medical condition and need for treatment and the original 

injury. Appellant was accorded 30 days to submit the requested evidence. 

In response, OWCP received evidence previously of record along with a February 21, 

2015 authorization request form. 

By decision dated March 4, 2015, OWCP denied the claimed recurrence of medical 

condition. It found that the evidence was insufficient to establish that appellant required 

additional medical treatment due to the December 27, 2010 work injury. OWCP advised that her 

claim remained closed for medical care. 

LEGAL PRECEDENT 

The United States shall furnish to an employee who is injured while in the performance 

of duty the services, appliances, and supplies prescribed or recommended by a qualified 

physician that the Secretary of Labor considers likely to cure, give relief, reduce the degree or 

the period of any disability, or aid in lessening the amount of any monthly compensation.1

 

Recurrence of medical condition means a documented need for further medical treatment 

after release from treatment for the accepted condition or injury when there is no accompanying 

work stoppage. Continuous treatment for the original condition or injury is not considered a 

need for further medical treatment after release from treatment, nor is an examination without 

treatment.2 

 1

 5 U.S.C. § 8103(a). 

2

 20 C.F.R. § 10.5(y). 
4

If a claim for recurrence of medical condition is made more than 90 days after release 

from medical care, a claimant is responsible for submitting a medical report supporting a causal 

relationship between the employee’s current condition and the original injury in order to meet 

her burden.3

An employee has the burden of proof to establish that he or she sustained a recurrence of 

a medical condition that is causally related to his or her accepted employment injury. To meet 

this burden, the employee must submit medical evidence from a physician who, on the basis of a 

complete and accurate factual and medical history, supports that the condition is causally related 

and supports her conclusion with sound medical rationale.4 

ANALYSIS 

OWCP accepted that appellant’s December 27, 2010 employment injury resulted in right 

knee strain. On December 4, 2014 it received her September 8, 2014 claim for a recurrence of 

medical condition for medical treatment of the accepted right knee condition. 

The record reflects that appellant last sought treatment for her work-related knee 

condition on February 16, 2011, when Dr. Voight diagnosed improved right knee strain and 

released her from medical care. Although Dr. Voight did not formally discharge appellant from 

treatment for her work-related condition, a sufficiently lengthy gap in treatment has the same 

effect as a formal discharge.5

 

Appellant then briefly sought treatment from Dr. Holstein from September through 

November 2013, where she was diagnosed with severe right knee degenerative joint disease and 

mild left knee degenerative joint disease. Dr. Holstein reported a history of an initial right knee 

injury in 1988, ACL reconstruction in 1991, and a fall at work on December 27, 2010. While he 

opined in a November 4, 2013 attending physician’s report that her current severe medial boneon-bone arthropathy and lower leg joint pain was caused or aggravated by employment activity 

and had advised in a return to work slip of October 24, 2013 that the knee arthritis was related to 

fall at work on December 27, 2010, Dr. Holstein failed to provide a well-rationalized medical 

opinion regarding the relationship between the currently diagnosed arthritis to either the 1999 

right knee injury, the 1991 surgery or the December 27, 2010 work injury. While in his 

November 4, 2013 attending physician’s report Dr. Holstein noted by checking a box marked 

“yes” that appellant’s current condition was caused or aggravated by her employment, the Board 

has held that a checkmark “yes” or affirmative notation in response to a form question on causal 

relationship is insufficient, without medical rationale, to establish causal relationship.6

 Medical 

 

 3 Federal (FECA) Procedure Manual, Part 2 -- Recurrences, Chapter 2.1500.4(b). (June 2013); see also J.M., 

Docket No. 09-2041 (issued May 6, 2010). 

4 O.H., Docket No. 15-0778 (issued June 25, 2015). 

5 See Kent W. Rasmusen, Docket No. 04-1137 (issued August 4, 2004). 

6 B.M., Docket No. 15-1233 (issued October 1, 2015). 
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evidence that does not offer any rationalized opinion regarding the cause of an employee’s 

condition is of limited probative value on the issue of causal relationship.7 

Appellant’s release from active treatment in 2011 followed by the periods of relative 

inactivity beginning at that time and after 2011 justify OWCP’s request that she submit a 

reasoned medical opinion establishing that the additional medical treatment was causally related 

to an objective worsening of the accepted medical condition without intervening cause.8

 As 

noted by the Director, because more than 90 days elapsed from appellant’s last medical treatment 

to her claim of recurrence of disability, it is appellant’s burden of proof to establish causal 

relationship. 

The evidence of record does not establish that appellant’s current need for medical care is 

related to the work-related injury of December 27, 2010. Dr. Soghikian, in his August 28, 2014 

report, opined that the severe osteoarthritis found in the medial compartment, was due to her old 

injury and her old surgery, which was likely a meniscectomy. He explained that her workrelated injury in 2010 was not a substantial contributing factor as she had not sought treatment 

for the knee since 2010 through now and that osteoarthritic changes after meniscectomy were a 

fairly well-established complication of ACL injury and meniscectomy. In her September 15, 

2014 report, Dr. Hogan noted the history of the work injury, the prior right knee injury in high 

school, the ACL reconstruction, and that appellant was diagnosed in 2013 with arthritis. She 

advised that, based on the history of the work-related fall, it was difficult for her to make a clear 

determination of whether or not this injury was in anyway related to the development of arthritis 

without more information. 

The Board finds that the evidence submitted by appellant lacks adequate rationale to 

establish a causal connection between the alleged recurrence of her medical condition and the 

accepted employment injury. Appellant maintains the burden to submit sufficient medical 

evidence to document the need for further medical treatment. If she is alleging that her current 

condition is consequential to her accepted December 27, 2010 injury, she must submit medical 

evidence which establishes that her condition is a natural consequence of the accepted injury.9

 

Appellant did not submit such evidence as required and failed to establish a need for continuing 

medical treatment.10

Appellant may submit new evidence or argument as part of 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. 

 7 Jaja K. Asaramo, 55 ECAB 200 (2004). 

8 See C.T., Docket No. 15-0634 (issued September 9, 2015). 

9 Supra note 4. 

10 See P.Q., Docket No. 14-1905 (issued May 26, 2015); J.F., 58 ECAB 331 (2006). 
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CONCLUSION 

The Board finds that appellant has not met her burden of proof to establish a recurrence 

of her medical condition causally related to her December 27, 2010 employment injury. 

ORDER 

IT IS HEREBY ORDERED THAT the Office of Workers’ Compensation Programs’ 

decision dated March 4, 2015 is affirmed. 

Issued: May 24, 2016 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees' Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees' Compensation Appeals Board 

 

 Valerie D. Evans-Harrell, Alternate Judge 

 Employees' Compensation Appeals Board