United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

H.L., Appellant 

and 

U.S. POSTAL SERVICE, PROCESSING & 

DISTRIBUTION CENTER, Dallas, TX, 

Employer 

__________________________________________ 

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Docket No. 16-0920 

Issued: January 9, 2017 

Appearances: Case Submitted on the Record

Appellant, pro se 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

CHRISTOPHER J. GODFREY, Chief Judge 

COLLEEN DUFFY KIKO, Judge 

VALERIE D. EVANS-HARRELL, Alternate Judge 

JURISDICTION 

On April 1, 2016 appellant filed a timely appeal from a February 17, 2016 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. 

ISSUE 

The issue is whether OWCP abused its discretion in denying appellant’s request for a 

total left knee arthroplasty. 

FACTUAL HISTORY 

On February 10, 1997 appellant, then a 42-year-old clerk, filed a traumatic injury claim 

(Form CA-1) alleging severe left knee strain as a result of pushing a metal case of magazines. 

 1

 5 U.S.C. § 8101 et seq. 
2

OWCP accepted his claim for left knee strain on August 7, 1997. The record does not reflect 

that appellant received wage-loss compensation on either the supplemental or periodic rolls. 

On June 19, 2009 OWCP received a request for left knee arthroscopy. 

In a report dated July 6, 2009, Dr. James J. Pollifrone, a Board-certified osteopath, noted 

that appellant had been treated for osteoarthritis of his knees since before 2001. 

A statement of accepted facts (SOAF) dated August 11, 2009 reflected that appellant had 

undergone bilateral knee arthroscopies in March 1989. This SOAF also reflected that OWCP 

had accepted a tear of the medial meniscus of the left knee as causally related to the accepted 

February 10, 1997 injury. OWCP requested that a district medical adviser review the claim to 

determine the diagnosis of appellant’s current condition, whether the diagnosed condition 

warranted surgical intervention, and whether the surgical procedure was required due to the 

accepted injury. 

In a report dated August 12, 2009, the district medical adviser reviewed the record and 

concluded that the diagnosis for appellant’s work-related condition should be upgraded to 

include post-traumatic osteoarthritis of the left knee. He also opined that as appellant had 

undergone an adequate trial of conservative treatment, the recommended surgical procedure was 

warranted and was related to the accepted work injury. 

On August 19, 2009 OWCP authorized a left knee arthroplasty. 

In a medical report dated May 2, 2010, Dr. Pollifrone noted that appellant was ready to 

go ahead with a total left knee arthroplasty.2

 He further noted that appellant was retired and not 

working. OWCP reissued authorization for this procedure on June 18, 2010. 

On May 18, 2012 Dr. Pollifrone reported that appellant was ready to proceed with 

bilateral total knee arthroplasties. He also noted that appellant did not wish to have both knees 

surgically treated at the same time, and that appellant wanted to proceed with the right knee 

replacement. The record reflects that appellant underwent a right knee replacement on 

August 31, 2012. Continued treatment for appellant’s left knee is not reflected in the record. 

In a progress note dated October 10, 2015, Dr. Pollifrone examined an x-ray of 

appellant’s left knee and noted tricompartmental arthritis with periarticular osteophytes and a 

large, calcified loose body. He noted that appellant had now chosen to undergo a total left knee 

arthroplasty. 

By letter dated November 2, 2015, appellant stated that he believed his case had been 

“retired” due to lack of medical records, and asked that it be reopened due to the fact that he 

required surgery. 

On November 2, 2015 appellant filed a recurrence claim (Form CA-2a) for medical 

treatment. He did not provide a date of recurrence. 

 2

 The Board notes that, according to the case record, appellant has not yet undergone this authorized procedure. 
3

By letter dated December 24, 2015, OWCP responded to a congressional inquiry. The 

inquiry noted that a review of appellant’s case file indicated that it had been “closed and/or 

retired as of April 1999.” OWCP reported that it had received a telephone call on December 11, 

2015 regarding appellant’s case status and had been advised that the case had been requested 

from storage. The inquiry noted that OWCP was currently awaiting receipt of the case file in 

order to take further action on the claim. 

By letter dated January 6, 2016, OWCP noted that appellant had failed to submit 

sufficient evidence to establish a recurrence of his medical condition for medical treatment. It 

noted that he had last received medical care on October 12, 2015. 

In a report dated January 27, 2016, Dr. Pollifrone noted that he and appellant had been 

discussing a total left knee arthroplasty since 2007. He further noted that appellant had a 

separate work-related injury to his right knee and had already undergone total right knee 

arthroplasty. Dr. Pollifrone noted that appellant’s current diagnosis was traumatic osteoarthritis 

of the left knee and that he was a candidate for a total left knee arthroplasty. It was his continued 

recommendation that appellant undergo this procedure. 

By decision dated February 17, 2016, OWCP denied appellant’s claim for recurrence of a 

medical condition. It noted that Dr. Pollifrone’s January 27, 2016 report was insufficient to 

establish a spontaneous change in appellant’s accepted medical condition that resulted from a 

previous injury without any intervening injury or new exposure to factors that caused the 

additional injury. 

LEGAL PRECEDENT 

Section 8103(a) of FECA provides for the furnishing of services, appliances, and supplies 

prescribed or recommended by a qualified physician who OWCP, under authority delegated by 

the Secretary, considers likely to cure, give relief, reduce the degree or the period of disability, or 

aid in lessening the amount of monthly compensation.3

 In interpreting section 8103(a), the 

Board has recognized that OWCP has broad discretion in approving services provided under 

FECA to ensure that an employee recovers from his or her injury to the fullest extent possible in 

the shortest amount of time.4

OWCP has administrative discretion in choosing the means to achieve the goal of 

recovery from a work-related injury and the only limitation on OWCP’s authority is that of 

reasonableness.5

Abuse of discretion is generally shown through proof of manifest error, clearly 

unreasonable exercise of judgment, or actions taken which are contrary to both logic and 

 3

 5 U.S.C. § 8103(a). 

4 See Dale E. Jones, 48 ECAB 648, 649 (1997). 

5 See Daniel J. Perea, 42 ECAB 214, 221 (1990) (holding that abuse of discretion by OWCP is generally shown 

through proof of manifest error, clearly unreasonable exercise of judgment or administrative actions which are 

contrary to both logic and probable deductions from established facts). 
4

probable deductions from established facts. It is not enough to merely show that the evidence 

could be construed so as to produce a contrary factual conclusion.6

ANALYSIS 

The Board finds that OWCP abused its discretion in denying a total left knee 

arthroplasty, because it had already approved the procedure and because the medical evidence 

supports that the procedure was necessary for treatment of appellant’s work-related condition. 

In his report dated January 27, 2016, Dr. Pollifrone noted that he and appellant had been 

discussing a total left knee arthroplasty since 2007. He indicated that appellant had a separate 

work-related injury to his right knee and had already undergone total right knee arthroplasty. 

Dr. Pollifrone noted that appellant was a candidate for a total left knee arthroplasty and that it 

was his recommendation that appellant undergo this procedure. 

The only limitation on OWCP’s approving or disapproving service under FECA is one of 

reasonableness.7

 In the instant case, OWCP had already authorized appellant’s total left knee 

arthroplasty, on two separate occasions but which had not at that time been performed. The left 

knee replacement was authorized following review of appellant’s medical records by the district 

medical adviser on August 12, 2009. On August 19, 2009 OWCP authorized a left knee 

arthroplasty. It reissued authorization for this procedure on June 18, 2010. As such, OWCP has 

already determined that appellant had met his burden of proof that the treatment was for his 

continuing employment-related condition. While this case was adjudicated on February 17, 2016 

by OWCP as a recurrence, the central issue in the case is authorization for surgery. 

The Board finds that these prior authorizations for surgery, taken together with 

Dr. Pollifrone’s January 27, 2016 report, which articulated a rationalized opinion that his current 

condition and requested surgery were causally related to the employment injury, and the lack of 

any rationalized medical opinion finding the surgery no longer reasonable, are sufficient to 

demonstrate that OWCP abused its discretion in denying authorization for the left knee surgery.8

Therefore, the decision of OWCP dated February 17, 2016 is vacated, and the case 

remanded to OWCP for action consistent with this decision. 

CONCLUSION 

The Board finds that OWCP abused its discretion in denying appellant’s request for a 

total left knee arthroplasty. 

 6 See Minnie B. Lewis, 53 ECAB 606 (2002). 

7 Supra note 5. 

8 D.K., Docket No. 13-230 (issued June 17, 2013). 
5

ORDER 

IT IS HEREBY ORDERED THAT the February 17, 2016 decision of the Office of 

Workers’ Compensation Programs is set aside, and the case remanded for additional action 

consistent with the Board’s decision. 

Issued: January 9, 2017 

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