United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

S.C., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Louisville, KY, Employer 

__________________________________________ 

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Docket No. 17-0103 

Issued: May 2, 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 

PATRICIA H. FITZGERALD, Deputy Chief Judge 

COLLEEN DUFFY KIKO, Judge 

JURISDICTION 

On October 21, 2016 appellant filed a timely appeal from a September 14, 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 appellant met her burden of proof to establish that her right knee 

condition is causally related to factors of her federal employment. 

FACTUAL HISTORY 

On July 20, 2016 appellant, then a 53-year-old postal clerk, filed an occupational disease 

claim (Form CA-2) alleging that she developed right knee arthritis from standing, bending, and 

walking on the workroom floor. She first became aware of her condition and of its relationship 

 1

 5 U.S.C. § 8101 et seq.
2

to her employment on May 20, 2016. Appellant first received medical care on June 21, 2016 and 

notified her supervisor on June 24, 2016. 

By letter dated July 27, 2016, OWCP informed appellant that the evidence of record was 

insufficient to support her claim. Appellant was advised of the factual and medical evidence 

necessary and afforded 30 days to respond. 

In an undated narrative statement, appellant reported problems with her right knee 

beginning in May 2016, which caused her to seek medical treatment on June 21, 2016. She 

noted that she had fallen on her right knee at work on December 21, 2005. Appellant had a 

recurrence of disability in April 2007 when she underwent right knee surgery.2

 On May 20, 

2016 she began to experience knee pain while standing, walking, and bending. Upon seeking 

medical treatment, appellant’s physician informed her that the pain was related to the fall in 2005 

and surgery in 2007. 

In a July 27, 2016 medical report, Dr. James R. Rollins, a Board-certified orthopedic 

surgeon, reported that appellant sustained a work injury to her right knee in December 2005 

which subsequently resulted in an osteochondral autograft transfer system (OATS) procedure on 

April 20, 2007. He reported that this work-related cartilage injury required the OATS procedure 

which then lead to her post-traumatic osteoarthritis. Dr. Rollins diagnosed primary osteoarthritis 

of the right knee and recommended a future total knee arthroplasty should her knee become 

unmanageable. 

In an August 11, 2016 attending physician’s report (Form CA-20), Dr. Rollins related 

that on December 21, 2005 appellant fell at work resulting in surgical intervention from her 

injury. Appellant subsequently developed post-traumatic arthritis of the right knee. Dr. Rollins 

noted that a June 21, 2016 x-ray revealed tri-compartment joint space narrowing. He diagnosed 

post-traumatic arthritis of the right knee and checked the box marked “yes” when asked if the 

condition was caused or aggravated by the employment activity. 

By decision dated September 14, 2016, OWCP denied appellant’s claim, finding that the 

evidence of record failed to establish that her diagnosed condition was causally related to her 

accepted federal employment duties. 

LEGAL PRECEDENT 

An employee seeking benefits under FECA 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 filed within the applicable 

time limitation, that an injury was sustained while in the performance of duty as alleged, and that 

any disability or specific condition for which compensation is claimed is causally related to the 

 2

 The record reflects that appellant’s December 21, 2005 injury was accepted and this claim remains open for 

medical treatment. 
3

employment injury.3 These are the essential elements of every compensation claim regardless of 

whether the claim is predicated on a traumatic injury or an occupational disease.4

In order to determine whether an employee actually sustained an injury in the 

performance of duty, OWCP begins with an analysis of whether fact of injury has been 

established. Generally, fact of injury consists of two components which must be considered in 

conjunction with one another. The first component to be established is that the employee 

actually experienced the employment incident which is alleged to have occurred.5 The second 

component is whether the employment incident caused a personal injury and generally can be 

established only by medical evidence. 

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.6 

To establish a causal relationship between the condition, as well as any attendant 

disability claimed and the employment event or incident, the employee must submit rationalized 

medical opinion evidence based on a complete factual and medical background, supporting such 

a causal relationship.7 The opinion of the physician 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. This 

medical opinion must include an accurate history of the employee’s employment injury and must 

explain how the condition is related to the injury. The weight of medical evidence is determined 

by its reliability, its probative value, its convincing quality, the care of analysis manifested, and 

the medical rationale expressed in support of the physician’s opinion.8

ANALYSIS 

Appellant has a prior accepted claim for a right knee condition. She filed the current 

claim, however, alleging that new factors of her employment caused or aggravated her current 

right knee condition. OWCP accepted that appellant engaged in repetitive activities of walking, 

standing, and bending in her employment duties as a postal clerk. The Board finds that the 

medical evidence of record is insufficient to establish that appellant developed a right knee 

condition causally related to the alleged factors of her federal employment as a postal clerk. 

 3 Gary J. Watling, 52 ECAB 278 (2001); Elaine Pendleton, 40 ECAB 1143, 1154 (1989). 

4 Michael E. Smith, 50 ECAB 313 (1999). 

5 Elaine Pendleton, supra note 3. 

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

7 See 20 C.F.R. § 10.110(a); John M. Tornello, 35 ECAB 234 (1983). 

8 James Mack, 43 ECAB 321 (1991). 
4

The only medical reports received in support of appellant’s claim was a July 27, 2016 

report and an August 11, 2016 Form CA-20 from Dr. Rollins, her treating physician. The Board 

finds that the reports of Dr. Rollins are not well rationalized. Dr. Rollins did not provide a 

medical opinion, supported by medical rationale, explaining the nature of the relationship 

between the diagnosed condition and the specific new employment factors alleged by appellant.9 

Dr. Rollins failed to discuss appellant’s employment duties with a clear understanding of 

the number of hours per day spent performing each task and the frequency of the physical 

movements which she attributes to her injury. His statement on causation failed to provide a 

sufficient explanation as to the mechanism of injury pertaining to this occupational disease claim 

as alleged by appellant, namely, how standing, walking, and bending would cause or aggravate 

her right knee osteoarthritis.10 Without explaining how physiologically the movements involved 

in appellant’s employment duties caused or contributed to her diagnosed condition, his opinion 

on causal relationship is equivocal in nature and of limited probative value.11 

The Board notes that Dr. Rollins attributed appellant’s right knee osteoarthritis to a 

preexisting right knee injury for which she underwent surgery in 2007. A well-rationalized 

opinion is particularly warranted when there is a history of a preexisting condition.12 

In his August 11, 2016 Form CA-20, Dr. Rollins diagnosed right knee osteoarthritis and 

checked the box marked “yes” when asked if the condition was caused or aggravated by the 

employment activities. The Board has held that a report that addresses causal relationship with a 

check mark, without medical rationale explaining how the work factors caused the alleged 

injury, is of diminished probative value and insufficient to establish causal relationship.13 

Appellant’s honest belief that her occupational employment duties caused her medical 

injury is not in question, but that belief, however sincerely held, does not constitute the medical 

evidence necessary to establish causal relationship. An award of compensation may not be based 

on surmise, conjecture, speculation, or on the employee’s own belief of causal relation.14 

In the instant case, the record lacks rationalized medical evidence establishing a causal 

relationship between appellant’s federal employment duties as a postal clerk and her diagnosed 

right knee condition. Thus, appellant has failed to meet her burden of proof.15

 9 Id. 

10 S.W., Docket 08-2538 (issued May 21, 2009). 

11 See L.M., Docket No. 14-973 (issued August 25, 2014); R.G., Docket No. 14-113 (issued April 25, 2014); 

K.M., Docket No. 13-1459 (issued December 5, 2013); A.J., Docket No. 12-548 (issued November 16, 2012). 

12 T.M., Docket No. 08-975 (issued February 6, 2009); Michael S. Mina, 57 ECAB 379 (2006). 

13 See Calvin E. King, Jr., 51 ECAB 394 (2000); see also Frederick E. Howard, Jr., 41 ECAB 843 (1990). 

14 D.D., 57 ECAB 734 (2006). 

15 R.M., Docket No. 11-1921 (issued April 10, 2012). 
5

Appellant may submit additional evidence, together with a written request for 

reconsideration, to OWCP within one year of the Board’s merit decision, pursuant to 5 U.S.C. 

§ 8128(a) and 20 C.F.R. §§ 10.606 and 10.607. 

CONCLUSION 

The Board finds that appellant has failed to meet her burden of proof to establish that her 

right knee condition was causally related to factors of her federal employment. 

ORDER 

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

decision dated September 14, 2016 is affirmed. 

Issued: May 2, 2017 

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