United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

L.F., Appellant

and

U.S. POSTAL SERVICE, MARINA STATION, 

San Francisco, CA, Employer

__________________________________________

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Docket No. 18-0327

Issued: August 17, 2018

Appearances: Case Submitted on the Record

Appellant, pro se

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 December 4, 2017 appellant filed a timely appeal from a September 20, 2017 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 to consider the merits of the claim.

ISSUE

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

disability commencing February 11, 2015 causally related to an accepted December 5, 2008

employment incident.

 

1 5 U.S.C. § 8101 et seq.
2

FACTUAL HISTORY

On December 8, 2008 appellant, then a 55-year-old letter carrier, filed a traumatic injury 

claim (Form CA-1) alleging that, on December 5, 2008, he injured his left knee while dragging 

relay sacks while in the performance of duty. He stopped work on December 5, 2008.

2

On December 8, 2008 the employing establishment issued an Authorization for 

Examination and/or Treatment (Form CA-16) to the Multi-Specialty Medical Group. Medical 

evidence received included a December 8, 2008 report with an illegible signature indicating that 

appellant had left knee pain complaints. In an unsigned December 8, 2008 duty status report (Form 

CA-17) a diagnosis of “sprain” caused by the December 5, 2008 employment incident was noted. 

This report also related that appellant was able to return to full-duty work on December 9, 2008. 

The record contains multiple California workers’ compensation form reports from

Dr. Robert Ferretti, a Board-certified orthopedic surgeon. In a January 30, 2009 report, Dr. Ferretti 

indicated that appellant had bilateral knee pain. He stated that appellant developed pain in his left 

knee on December 5, 2008 while pulling sacks of mail. Dr. Ferretti noted that appellant’s right 

knee was slowly worsening. In a March 24, 2010 report, he diagnosed bilateral knee strain/sprain 

and osteoarthritis, and recommended modified duty. In a February 2, 2011 report, Dr. Ferretti 

noted that appellant had chronic bilateral knee pain.

A January 30, 2009 x-ray report was interpreted by Dr. Christophe Yoo, a Board-certified 

radiologist, as showing moderate bilateral tricompartmental osteoarthritis in both knees with small 

effusion.

On July 14, 2014 Dr. William Robert Campbell, an osteopath Board-certified in orthopedic 

surgery, performed a right knee total joint arthroplasty.

On March 17, 2015 appellant filed a notice of recurrence of the claimed December 5, 2008 

injury to his left knee, effective February 11, 2015. He noted that he was limited in performing 

his duties because of his left knee pain. Appellant related that, following his initial injury, his knee 

pain had been bearable but occasionally the stiffness and pain would occur and then go away. He 

then related that, on February 11, 2015 he was at work and bending to pick up a tub of mail when 

he experienced pain in his left knee. Appellant noted that since then his left knee would hurt 

whenever he ascended or descended stairs. He contended that his current condition was related to 

his original injury and noted that it was the same knee.

By development letter dated March 19, 2015, OWCP informed appellant that he must file 

a new claim for the injury of February 11, 2015. It noted that when appellant’s claim was received 

in 2008 it appeared to be a minor injury that resulted in minimal or no lost time from work. Based 

on these criteria, and because the employing establishment did not controvert his claim or 

challenge the case, payment of a limited amount of medical expenses was administratively

 

2 OWCP assigned the present claim OWCP File No. xxxxxx111. Appellant has a previous claim, assigned OWCP 

File No. xxxxxx955, which OWCP accepted for right knee sprain resulting from delivering mail on January 14, 2005. 
3

approved. OWCP indicated that based on the evidence submitted, it appeared that appellant was 

alleging a new injury.

On March 25, 2015 appellant filed a traumatic injury claim (Form CA-1) for a new injury

to his left knee. OWCP denied that claim, assigned OWCP File No. xxxxxx263, on July 29, 2015 

because appellant had not established causal relationship between the employment incident of 

February 11, 2015 and an injury to his left knee. Appellant subsequently requested 

reconsideration. On February 23, 2016 OWCP denied modification of its July 29, 2015 decision.

In a March 4, 2015 report, Dr. Ferretti requested authorization for a left total knee 

replacement. He diagnosed advanced degenerative arthritis of the left knee. Dr. Ferretti also 

indicated that appellant was status post right total knee replacement. He stated that appellant was 

doing well with regard to his right knee replacement and was able to return to modified-duty work 

on November 14, 2014 with restrictions of squatting and no lifting greater than five pounds. 

Dr. Ferretti noted that appellant was working. He referred appellant to Dr. Campbell, who 

performed the right knee surgery, for evaluation, and returned appellant to modified work status 

with the same restrictions. 

On June 15, 2017 appellant filed a recurrence claim (Form CA-2a), alleging a recurrence 

of his claimed December 5, 2008 injury on February 11, 2015. He noted that since his return to 

work his left knee had been bearable, but stiffness and pain would occur. Appellant noted that he 

was bending on February 11, 2015 to pick up a tub of mail and felt pain in his left knee. 

In a July 13, 2017 development letter, OWCP summarized the history of appellant’s claim 

and explained that additional medical evidence was necessary to support his claim. It afforded 

him 30 days to submit the necessary evidence. 

In a response received by OWCP on August 2, 2017, appellant stated that after his right 

knee surgery, he informed his doctor that his left knee was hurting, and that his doctor found that 

it was aggravated by his right knee. He indicated that he was recovering from his July 14, 2014 

right knee surgery, and that his doctor released him to return to modified-duty work on 

November 14 or 15, 2014. Appellant stated that when he lifted a tub or tray of mail, he was putting 

weight on his left knee because the right knee surgery had not healed. 

Appellant also submitted multiple reports by Dr. Campbell dated from June 1, 2016 

through September 7, 2017. In a June 1, 2017 report, Dr. Campbell noted that appellant had tried 

and failed all reasonable conservative treatment measures, including therapy and injections, but 

that his symptoms were worsening. He noted that appellant’s magnetic resonance imaging (MRI)

scan showed significantly advanced degenerative joint disease in the medial and patella femoral 

compartments. Dr. Campbell stated that appellant’s complaints, clinical presentation and MRI

scan/arthroscopic findings are all in harmony. He recommended a left total knee arthroplasty and 

physical therapy follow up. In a July 7, 2016 x-ray report, Dr. Campbell, found no acute osseous 

abnormality. In the left knee, he found tricompartmental arthrosis, small joint effusion, and 

possible intra-articular body. In the right knee, Dr. Campbell noted that appellant was status post 

total knee arthroplasty without hardware complication. In a July 20, 2017 report, he stated that 

appellant’s complaints, clinical presentation, and MRI scan/arthroscopic findings are all in 

harmony. Dr. Campbell noted that he was submitting an authorization on appellant’s behalf 
4

regarding a left knee total arthroplasty, and was also requesting postoperative therapy visits. In a

September 7, 2017 report, he noted that he was awaiting response from OWCP.

By decision dated September 20, 2017, OWCP denied appellant’s claim for recurrence of 

disability. It explained that while his claimed December 5, 2008 injury had been administratively 

accepted, appellant had not established a diagnosed left knee condition as a result of the accepted 

incident. OWCP thereafter found that appellant had not established a recurrence of disability as 

he had not established a material change or worsening of “accepted work[-]related conditions.” 

LEGAL PRECEDENT

To determine whether a federal employee has sustained a traumatic injury in the 

performance of duty, it first must be determined whether fact of injury has been established. There 

are two components involved in establishing fact of injury. First, the employee must submit 

sufficient evidence to establish that he or she actually experienced the employment incident at the 

time, place, and in the manner alleged. Second, the employee must submit medical evidence to 

establish that the employment incident caused a personal injury.3 Rationalized medical opinion 

evidence is generally required to establish causal relationship. The opinion of the physician must 

be based on a complete factual and medical background, 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.4

A recurrence of disability means an inability to work after an employee has returned to 

work caused by a spontaneous change in a medical condition which resulted from a previous injury 

or illness without an intervening injury or new exposure to the work environment that caused the 

illness.

5

When an employee claims a recurrence of disability due to an accepted employmentrelated injury, he or she has the burden of establishing that the recurrence is causally related to the 

original injury.6 This burden includes the necessity of furnishing evidence from a qualified 

physician who concludes that the condition is causally related to the employment injury.7 The 

physician’s opinion must be based on a complete and accurate factual and medical history and 

supported by sound medical reasoning.8

 

3 Elaine Pendleton, 40 ECAB 1143, 1145 (1989).

4 T.H., 59 ECAB 388 (2008).

5 Theresa L Andrews, 55 ECAB 719, 722 (2004); see also C.S., Docket No. 17-1345 (issued May 24, 2018). 

6 20 C.F.R. § 10.104(b); see Federal (FECA) Procedure Manual, Part 2 -- Claims, Recurrences, Chapter 2.1500.5 

and 2.1500.6 (June 2013). 

7 See S.S., 59 ECAB 315, 318-19 (2008).

8

Id. at 319. 
5

ANALYSIS

The Board finds that appellant has not met his burden of proof to establish that he sustained 

a recurrence of disability commencing February 11, 2015 as he has not established that the 

accepted December 5, 2008 employment incident caused an injury. 

Appellant alleged that on February 11, 2015 he was picking up a tub of mail when his left 

knee became painful. He stated that he believed he sustained a recurrence of his claimed 

December 5, 2008 injury because the same knee was involved. OWCP noted that appellant’s 

December 5, 2008 injury claim had been administratively accepted, but had not been formally 

accepted because the medical evidence of record did not establish a diagnosed left knee condition 

causally related to the employment incident. It denied his recurrence claim finding that as 

appellant had not established a diagnosed left knee condition causally related to the accepted 

December 5, 2008 employment incident, he had also not established a recurrence of an accepted 

condition on February 11, 2015. 

The initial medical evidence of record included December 8, 2008 reports which noted left 

knee pain and sprain. However these reports were unsigned or bore an illegible signature. As 

reports bearing no signature or an illegible signature cannot be identified as having been prepared 

by a physician and they do not constitute competent medical opinion evidence.9 

Appellant submitted multiple reports from Dr. Ferretti dating from 2009. Dr. Ferretti 

diagnosed bilateral knee strain and degenerative arthritis. He did not address causal relationship. 

As Dr. Ferretti did not provide a rationalized medical opinion which explained how the diagnosed 

bilateral knee strain and degenerative arthritic knee conditions were causally related to the 

accepted December 5, 2008 employment incident, his reports are of limited probative value.10

Appellant also submitted a January 30, 2009 x-ray report from Dr. Yoo. However this 

diagnostic report is of diminished probative value. Diagnostic test reports are not probative to the 

issue of causal relationship as they do not offer any opinion regarding the cause of an employee’s 

condition.11 

The Board finds that the medical evidence of record is insufficient to establish that 

appellant sustained a diagnosed left knee condition on December 5, 2008 causally related to his 

accepted employment incident. While appellant submitted additional medical evidence pertaining 

to medical treatment of his left knee condition after 2015 that evidence also does not establish that 

appellant initially sustained a diagnosed left knee condition on December 5, 2008. 

In a March 4, 2015 report, Dr. Ferretti diagnosed advanced degenerative arthritis of the left 

knee and requested authorization for a total left knee replacement; however, he offered no opinion 

 

9 A medical report may not be considered as probative medical evidence if there is no indication that the person 

completing the report qualifies as a “physician” as defined in 5 U.S.C. § 8101(2); Merton J. Sills, 39 ECAB 

572 (1988).

10 Supra note 4.

11 J.O., Docket No. 18-0057 (issued May 29, 2018). 
6

causally relating this diagnosis to appellant’s December 5, 2008 employment incident. Similarly

Dr. Campbell reported in multiple reports from June 1, 2016 through September 7, 2017 that 

appellant had advanced degenerative joint disease in the medial and patella femoral compartments 

of his left knee. However, he offered no medical opinion regarding the cause of these conditions. 

As neither physician’s opinions addressed the cause of appellant’s diagnosed conditions, these 

reports are insufficient to establish causal relationship.

12

As previously noted, it is axiomic that appellant has not established a recurrence of an 

accepted injury, if no initial injury has been accepted.13 As appellant has not established that he 

sustained a diagnosed left knee condition causally related to his accepted December 5, 2008 

employment incident, he has not met his burden of proof to establish an injury causally related to 

the accepted December 5, 2008 employment incident. 

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 his burden of proof to establish a recurrence of

disability commencing February 11, 2015 causally related to an accepted December 5, 2008

employment incident. 

 

12 See B.A., Docket No. 17-1130 (issued November 24, 2017); S.S., 59 ECAB 315 (2008); J.M., 58 ECAB 303 

(2007); Donald W. Long, 41 ECAB 142 (1989).

13 Supra note 6. 
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ORDER

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

Programs dated September 20, 2017 is affirmed.

Issued: August 17, 2018

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