United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

K.W., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Marrero, LA, Employer 

__________________________________________ 

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Docket No. 16-0838 

Issued: July 25, 2016 

Appearances: Case Submitted on the Record

Appellant, pro se 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

CHRISTOPHER J. GODFREY, Chief Judge 

PATRICIA H. FITZGERALD, Deputy Chief Judge 

COLLEEN DUFFY KIKO, Judge 

JURISDICTION 

On March 5, 20161 appellant filed a timely appeal from a September 10, 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. 

ISSUE 

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

conditions causally related to factors of her federal employment. 

                                                             1

 Under the Board’s Rules of Procedure, an appeal must be filed within 180 days from the date of issuance of an 

OWCP decision. An appeal is considered filed upon receipt by the Clerk of the Appellate Boards. See 20 C.F.R. 

§ 501.3(e)-(f). One hundred and eighty days from September 10, 2015, the date of OWCP’s last decision was 

March 8, 2016. Since using March 15, 2016, the date the appeal was received by the Clerk of the Appellate Boards, 

would result in the loss of appeal rights, the date of the postmark is considered the date of filing. The date of the 

U.S. Postal Service postmark is March 5, 2016, rendering the appeal timely filed. See 20 C.F.R. § 501.3(f)(1). 

2

 5 U.S.C. § 8101 et seq. 
2

On appeal appellant contends that the evidence of record is sufficient to support her 

claim. 

FACTUAL HISTORY 

On January 8, 2015 appellant, then a 45-year-old distribution clerk, filed an occupational 

disease claim (Form-CA-2) alleging bilateral knee degenerative arthritis and would need bilateral 

knee replacement surgery. She alleged that this condition was caused by her federal 

employment, noting that her job consisted of distribution and sorting of mail and parcels, 

pushing/pulling equipment, lifting, bending, and a great deal of walking. Appellant also noted 

that she previously carried mail for eight years. 

By letter dated January 14, 2015, OWCP informed appellant that further evidence was 

necessary to support her claim, and afforded her 30 days to submit this information. 

In a May 20, 2014 medical report, Dr. John L. Ochsner, Jr., a Board-certified orthopedic 

surgeon, noted that appellant presented with bilateral knee pain of severe intensity with a 

duration of six months. He diagnosed bone-on-bone degenerative arthritis in the medial 

compartment of both knees. Dr. Ochsner performed knee arthrocentesis with injection on both 

of appellant’s knees. He noted that appellant could need knee replacements at some point. In a 

June 9, 2014 note, Dr. Ochsner noted that appellant had severe osteoarthritis of the knees and 

that he had advised her not to do heavy lifting, pushing, or pulling. He also noted that appellant 

would have to limit the amount of time she stands and walks and that, if she continued to stress 

her knees, the arthritis would progress faster. Dr. Ochsner further noted that appellant would 

require further medical treatment and most likely would need knee surgery. 

At Dr. Ochsner’s request, appellant had x-rays of both knees on May 20, 2014, which 

were interpreted by Dr. Matthew LaFleur, a Board-certified radiologist, as evincing no 

radiographic evidence of acute osseous, articular, or soft tissue abnormality, and mild-tomoderate joint space loss in the medial tibiofemoral compartment. Dr. LaFleur also noted that 

small patellofemoral marginal osteophytes were present. 

By decision dated April 15, 2015, OWCP denied appellant’s claim as appellant had failed 

to establish that her bilateral knee condition was causally related to the accepted employment 

factors. 

OWCP received additional medical evidence. In a September 2, 2014 progress note, 

Dr. Ochsner noted that he had aspirated appellant’s knee three and one-half months ago and she 

did well for at least two months. He again conducted bilateral knee arthroscentesis with injection 

on that date and repeated this procedure on December 16, 2014. In his December 16, 2014 

progress note, Dr. Ochsner noted that appellant’s knee pain was worse on the left, that it 

increased with activity, and that it interfered with activities of daily living. He noted that 

appellant decided to proceed with bilateral knee replacement. On March 23, 2015 Dr. Ochsner 

performed bilateral total knee arthroplasties for treatment of appellant’s bilateral knee 

osteoarthritis. 
3

X-rays taken on March 23, 2015 were interpreted by Dr. Nancy Diethelm, a Boardcertified radiologist, as showing bilateral total knee arthroplasties with posterior resurfacing of 

the patella and prosthetic components in satisfactory position and alignment. 

In an April 14, 2015 report, Dr. Ochsner noted that appellant’s symptoms of bilateral 

knee pain started several years ago and that appellant noted significant problems on 

August 18, 2013. He indicated that appellant lifted and transported mail which caused 

significant pain and discomfort. Dr. Ochsner noted that radiographs showed severe degenerative 

arthritis of both knees. He noted that appellant was initially treated with arthritis medication and 

rest, but unfortunately the arthritis progressed and appellant required bilateral knee replacements. 

Dr. Ochsner noted that lifting, standing and moving mail caused significant aggravation of 

appellant’s arthritis, and that the arthritis progressed to the point where appellant required 

surgery. He opined that the physical activities of working for the employing establishment 

aggravated her knee conditions to progress to the point where she required surgery and that 

appellant’s x-rays showed severe deformity and destruction of the joint surface which required 

knee surgery. Dr. Ochsner summarized by stating that appellant “worked standing and moving 

mail which caused severe osteoarthritis of her knees.” 

On April 24, 2015 appellant requested review of the written record before an OWCP 

hearing representative. 

By decision dated September 10, 2015, the hearing representative affirmed the April 15, 

2015 decision. He found that appellant had not established that her diagnosed bilateral knee 

condition was causally related to the accepted factors of her federal employment. 

LEGAL PRECEDENT 

An employee seeking compensation under FECA3 has the burden of proof to establish the 

essential elements of his or her claim by the weight of the reliable, probative, and substantial 

evidence,4 including that he or she is an “employee” within the meaning of FECA5 and that he or 

she filed his or her claim within the applicable time limitation.6 The employee must also 

establish that she sustained an injury in the performance of duty as alleged and that her disability 

for work, if any, was causally related to the employment injury.7

 These are the essential 

elements of each and every compensation claim regardless of whether the claim is predicated on 

a traumatic injury or an occupational disease.8

                                                             3 Supra note 2. 

4 J.P., 59 ECAB 178 (2007); Joseph M. Whelan, 20 ECAB 55, 57 (1968). 

5

 See M.H., 59 ECAB 461 (2008); see also 5 U.S.C. § 8101(1). 

6 R.C., 59 ECAB 427 (2008); Kathryn A. O’Donnell, 7 ECAB 227, 231 (1954); see 5 U.S.C. § 8122. 

7 G.T., 59 ECAB 447 (2008); Elaine Pendleton, 40 ECAB 1143, 1145 (1989). 

8 See Irene St. John, 50 ECAB 521 (1999); Michael E. Smith, 50 ECAB 313 (1999). 
4

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

occupational disease, an employee must submit: (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.9 

Causal relationship is a medical issue,10 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,11 must 

be one of reasonable medical certainty,12 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.13

ANALYSIS 

OWCP accepted factors of federal employment as distribution and sorting of mail and 

parcels, pushing and pulling equipment, lifting, bending, and significant walking. The medical 

evidence of record also establishes that appellant suffered from severe degenerative arthritis in 

both her knees. However, OWCP denied appellant’s claim as she failed to submit rationalized 

medical evidence describing how the accepted factors of employment caused or aggravated her 

diagnosed condition. 

Appellant submitted multiple reports from her treating orthopedic surgeon, Dr. Ochsner, 

who performed appellant’s bilateral knee replacement on March 23, 2015. Dr. Ochsner’s initial 

reports failed to address causal relationship. In an April 14, 2015 report, he did address the issue 

of causal relationship, but the opinion is not sufficiently detailed and rationalized to constitute 

persuasive medical evidence. Dr. Ochsner noted that appellant’s employment duties of lifting, 

standing, and moving mail caused a significant aggravation of her arthritis, and that this caused 

the arthritis to progress to the point where she required surgery. He noted that appellant’s 

radiographs showed severe deformity and destruction of the joint surface which required knee 

surgery. However, Dr. Ochsner’s opinion is conclusory. He failed to provide a detailed 

explanation with regard to how appellant’s specific factors of federal employment caused or 

aggravated her degenerative arthritis. Dr. Ochsner did not explain how specific activities of 

appellant’s position caused or aggravated her degenerative arthritis. A mere conclusion without 

the necessary rationale explaining how and why the physician believes that a claimant’s accepted 

exposure resulted in the diagnosed condition is not sufficient to meet appellant’s burden of 

                                                             9 See Roy L. Humphrey, 57 ECAB 238, 241 (2005); Ruby I. Fish, 46 ECAB 276, 279 (1994). 

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

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

12 See Morris Scanlon, 11 ECAB 384, 285 (1960). 

13 See William E. Enright, 31 ECAB 426, 430 (1980). 
5

proof.14 Dr. Ochsner did not adequately explain why his findings and experience brought him to 

the conclusion that there was causal relationship.15 Although he suggested that appellant’s work 

aggravated her arthritic condition, he also did not explain why appellant’s diagnosed condition 

was not caused by nonwork factors.16 Neither the fact that a disease or condition manifests itself 

during a period of employment nor the belief that the disease or condition was caused or 

aggravated by the employment factors or incident is sufficient to establish causal relationship.17 

None of the other medical reports of record are sufficient to establish causal relationship. 

Dr. LaFleur and Dr. Diethelm interpreted diagnostic studies, but at no point did these doctors 

address causation. As these reports do not address causation, they are of limited probative 

value.18

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

bilateral degenerative arthritis was causally related to the accepted factors of her federal 

employment. 

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 established that she sustained bilateral knee 

conditions causally related to the accepted employment factors. 

                                                             14 G.M., Docket No. 14-2057 (issued May 12, 2015). 

15 See R.E., Docket No. 14-868 (issued September 24, 2014). 

16 J.S., Docket No. 14-818 (issued August 7, 2014). 

17 See Dennis M. Mascarenas, 49 ECAB 215 (1997). 

18 See J.G., Docket No. 15-1468 (issued October 7, 2015). 
6

ORDER 

IT IS HEREBY ORDERED THAT the decision of the Office of Workers’ 

Compensation Programs dated September 10, 2015 is affirmed. 

Issued: July 25, 2016 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board