United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

G.B., Appellant 

and 

DEPARTMENT OF VETERANS AFFAIRS, 

VETERANS HEALTH ADMINISTRATION, 

Prescott, AZ, Employer 

__________________________________________ 

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Docket No. 16-1295 

Issued: February 15, 2017 

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant1

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

PATRICIA H. FITZGERALD, Deputy Chief Judge 

ALEC J. KOROMILAS, Alternate Judge 

VALERIE D. EVANS-HARRELL, Alternate Judge 

JURISDICTION 

On June 3, 2016 appellant, through counsel, filed a timely appeal from an April 25, 2016 

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. 

 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. 
2

ISSUE 

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

condition causally related to factors of her federal employment. 

On appeal, counsel contends that OWCP’s decision is contrary to law and fact. 

FACTUAL HISTORY 

This case has previously been before the Board.3 Appellant, a 51-year-old information 

technology specialist, filed an occupational disease claim (Form CA-2) alleging that her job 

duties aggravated her bilateral knee condition. She stated that ascending and descending stairs 

on a daily basis over a period of years aggravated a right knee injury she had sustained at work 

on May 31, 2006. By decisions dated November 10, 2010, August 17, 2011, and February 21, 

2012 OWCP denied appellant’s claim for bilateral knee conditions as the medical evidence failed 

to establish that the claimed conditions were causally related to factors of her federal 

employment. In a decision dated November 16, 2012, the Board affirmed OWCP’s February 21, 

2012 decision, finding that appellant had failed to establish an injury causally related to factors 

of her federal employment.4

 The facts of the case, as set forth in the prior decision, are 

incorporated herein by reference. 

On July 8, 2013 appellant, through counsel, requested reconsideration. Appellant 

submitted May 6, 2010 x-rays of the right and left knees demonstrating small bilateral joint 

effusions and tricompartmental osteoarthritis bilaterally, greatest in the medial and 

patellofemoral compartments. 

In reports dated May 6, 2010 through June 10, 2013, Dr. Jennifer Waara, a Boardcertified family practitioner, diagnosed mild left extremity edema and bilateral osteoarthritis. 

She asserted that appellant had chronic right knee pain felt to have started after an injury at work 

on May 31, 2006 when she was doing inventory, outside of her job description, which involved a 

lot of walking and getting down on her hands and knees in order to obtain serial numbers off of 

desk, etc. This activity commenced on May 30, 2006 and the next day on May 31, 2006 

appellant was walking down stairs and felt a pop in her right knee. She felt immediate pain, 

swelling, and increased warmth to the area. Dr. Waara stated that appellant was seen by the 

employing establishment’s health unit the next day on June 1, 2006 and was diagnosed with a 

medial collateral ligament strain. She was restricted to desk duty for approximately four days. 

Appellant had x-rays taken of both knees on June 12, 2006 due to ongoing pain and the reports 

showed minimal degenerative change of patellofemoral joint and mild degenerative narrowing of 

the medial compartment of the left knee. Dr. Waara noted that she was not able to find a report 

that had a right knee in the impression. Appellant was seen by the employing establishment’s 

health unit on June 7, 2013 and they extended her desk duties through June 12, 2006. Dr. Waara 

reported that appellant had an ongoing condition since a motor vehicle accident in 1999 which 

left her with chronic low back pain and required use of regular medication, noting that this may 

 3

 Docket No. 12-1023 (issued November 16, 2012). 

4 Id.
3

have helped her cope with her ongoing right knee pain. On May 6, 2010 appellant was seen for 

chronic bilateral lower extremity edema which had “gotten worse again in [March 2010].” 

Dr. Waara asserted that appellant did not report until later that she had the injury to her right 

knee in May 2006. 

On May 18, 2010 Dr. Shirley Rheinfelder, a Board-certified family practitioner, 

diagnosed pain in joint involving lower left, unspecified intestinal malabsorption, pernicious 

anemia, and other unspecified hyperlipidemia. She opined that appellant’s right knee pain was 

secondary to arthritis and noted that appellant had received a steroid injection that day. 

In an August 2, 2010 report, Dr. Paul Pfluegar, a Board-certified orthopedic surgeon, 

diagnosed bilateral knee osteoarthritis and bilateral knee internal derangement. He asserted that 

appellant had some underlying degenerative arthritis of both knees, right greater than left, which 

was made worse by her weight. Appellant reported that she first noticed knee pain going up and 

down stairs at work. Dr. Pfluegar opined that appellant had medial meniscus tears of both knees 

and recommended a magnetic resonance imaging (MRI) scan of the right knee since her pain had 

been unrelieved with steroid injections. He noted that the left knee was doing relatively well and 

was stable at that time. 

By decision dated April 25, 2016, OWCP modified its prior decision, finding that the 

medical evidence of record established fact of injury, but failed to establish causal relationship 

between appellant’s condition and factors of her federal employment. 

LEGAL PRECEDENT 

An employee seeking benefits under FECA5 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, that the claim was timely filed within the 

applicable time limitation period of FECA, and that an injury6 was sustained in the performance 

of duty. These are the essential elements of each compensation claim, regardless of whether the 

claim is predicated upon a traumatic injury or an occupational disease.7

To establish that an injury was sustained in the performance of duty in a claim for an 

occupational disease claim, an employee must submit the following: (1) a factual statement 

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

occurrence of the disease or condition; (2) medical evidence establishing the presence or 

existence of the disease or condition for which compensation is claimed; and (3) medical 

evidence establishing that the diagnosed condition is causally related to the employment factors 

identified by the employee.8

 5

 5 U.S.C. § 8101 et seq.

6

 OWCP regulations define an occupational disease or illness as a condition produced by the work environment 

over a period longer than a single workday or shift. 20 C.F.R. § 10.5(q). 

7 See O.W., Docket No. 09-2110 (issued April 22, 2010); Ellen L. Noble, 55 ECAB 530 (2004). 

8 See D.R., Docket No. 09-1723 (issued May 20, 2010). 
4

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

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

be based on a complete factual and medical background of the employee, 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.9

ANALYSIS 

The Board finds that appellant did not meet her burden of proof to establish that federal 

employment factors caused or aggravated her bilateral knee condition. Appellant identified the 

factors of employment that she believed caused the condition, including walking and ascending 

and descending stairs at work, which OWCP accepted as factual. However, in order to establish 

a claim that she sustained an employment-related injury, she must also submit rationalized 

medical evidence which explains how her medical condition was caused or aggravated by the 

implicated employment factors.10

In her reports, Dr. Waara indicated that appellant had ongoing conditions since a motor 

vehicle accident in 1999. She diagnosed mild left extremity edema and bilateral osteoarthritis. 

Dr. Waara noted that appellant had chronic right knee pain, which began after an injury at work 

on May 31, 2006 when she was doing inventory, outside of her job description, which involved a 

lot of walking and getting down on her hands and knees in order to obtain serial numbers off of 

desk, etc. This activity commenced on May 30, 2006 and the next day on May 31, 2006 

appellant was descending stairs and felt a pop in her right knee. Dr. Waara did not provide any 

medical rationale explaining how appellant’s employment activity of ascending and descending 

stairs caused or aggravated the diagnosed conditions.11 Thus, the Board finds that the reports 

from Dr. Waara are insufficient to establish appellant’s claim. 

In his August 2, 2010 report, Dr. Pfluegar diagnosed bilateral knee osteoarthritis and 

bilateral knee internal derangement and opined that appellant had medial meniscus tears of both 

knees. He asserted that appellant had some underlying degenerative arthritis of both knees, right 

greater than left, which was worsened by her weight. Appellant reported that she first noticed 

knee pain going up and down stairs at work. Dr. Pfluegar failed to provide a rationalized opinion 

explaining how factors of appellant’s federal employment, such as walking and going up and 

down stairs at work, caused or aggravated her bilateral knee condition. He noted that appellant’s 

condition occurred while she was at work, but, as noted above, such generalized statements do 

not establish causal relationship because they merely repeat appellant’s allegations and are 

unsupported by adequate medical rationale explaining how her physical activity at work actually 

caused or aggravated the diagnosed conditions.12 The Board has held that the mere fact that 

 9 See O.W., supra note 7. 

10 See A.C., Docket No. 08-1453 (issued November 18, 2008). 

11 Supra note 8. 

12 See K.W., Docket No. 10-98 (issued September 10, 2010). 
5

appellant’s symptoms arise during a period of employment or produce symptoms revelatory of 

an underlying condition does not establish a causal relationship between appellant’s condition 

and her employment factors.13 Thus, the Board finds that Dr. Pfluegar’s report is insufficiently 

rationalized to establish that appellant’s condition was caused or aggravated by factors of her 

federal employment. 

On May 18, 2010 Dr. Rheinfelder diagnosed pain in joint involving lower left and opined 

that appellant’s right knee pain was secondary to arthritis. The Board finds that 

Dr. Rheinfelder’s diagnosis of bilateral knee pain is a description of a symptom rather than a 

clear diagnosis of the medical condition.14 Moreover, the Board finds that Dr. Rheinfelder failed 

to provide a rationalized opinion explaining how walking and ascending and descending stairs at 

work caused or aggravated appellant’s bilateral knee condition. Dr. Rheinfelder’s opinion is 

therefore of diminished probative value on the issue of causal relationship and is not sufficient to 

establish an employment-related injury. 

Other medical evidence of record, including diagnostic test reports, is of limited 

probative value and insufficient to establish the claim as it does not specifically address whether 

appellant’s diagnosed conditions are causally related to factors of her federal employment.15

On appeal, counsel contends that OWCP’s decision is contrary to fact and law. Based on 

the findings and reasons stated above, the Board finds that counsel’s arguments are without 

merit. As appellant has not submitted any rationalized medical evidence to support her 

allegation that she sustained an injury causally related to the accepted employment factors, she 

failed to meet her burden of proof. 

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 has not met her burden of proof to establish a bilateral 

knee condition causally related to factors of her federal employment. 

 13 See Richard B. Cissel, 32 ECAB 1910, 1917 (1981); William Nimitz, Jr., 30 ECAB 567, 570 (1979). 

14 The Board has consistently held that pain is a symptom, rather than a compensable medical diagnosis. See P.S., 

Docket No. 12-1601 (issued January 2, 2013); C.F., Docket No. 08-1102 (issued October 10, 2008). 

15 See K.W., 59 ECAB 271 (2007); A.D., 58 ECAB 149 (2006); Linda I. Sprague, 48 ECAB 386 (1997) (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). 
6

ORDER 

IT IS HEREBY ORDERED THAT the April 25, 2016 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: February 15, 2017 

Washington, DC 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board 

 

 Valerie D. Evans-Harrell, Alternate Judge 

 Employees’ Compensation Appeals Board