United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

A.L., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Warwick, RI, Employer

__________________________________________

)

)

)

)

)

)

)

)

Docket No. 17-2002

Issued: March 23, 2018

Appearances: Case Submitted on the Record

Benjamin R. Zimmermann, 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 September 26, 2017 appellant, through counsel, filed a timely appeal from an

August 18, 2017 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.3

 

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.

3 Appellant timely requested oral argument before the Board pursuant to section 501.5(b) of the Board’s Rules of 

Procedure, 20 C.F.R. § 501.5(b). After exercising its discretion, by order dated January 29, 2018, the Board denied 

the request for oral argument as the issue on appeal could be fully addressed on the record. Order Denying Request 

for Oral Argument, Docket No. 17-2002 (issued January 29, 2018). 
2

ISSUE

The issue is whether appellant has established a right knee condition causally related to 

the accepted April 21, 2015 employment incident. 

FACTUAL HISTORY

On April 27, 2015 appellant, then a 61-year-old letter carrier, filed a traumatic injury 

claim (Form CA-1) alleging that, on April 21, 2015, she was descending steps, while in the 

performance of duty, when she felt a pain in her right knee. In an accompanying statement, she

indicated that she injured her right knee when descending a step at Bay Vista Place at

approximately 3:00 p.m. on April 21, 2015. Appellant did not stop work.

The employing establishment controverted the claim. In a May 4, 2015 letter, the 

postmaster indicated that appellant did not inform management of the injury until six days after it 

allegedly occurred. He argued that appellant was not at the location as stated in her original 

claim form, and an onsite investigation did not show any obvious defects to the walkway. The 

postmaster also alleged that a prior claim for a right knee injury in 2012 was denied.

4

Appellant had a prior history of injury regarding her right knee. In a May 19, 2012 

report, Dr. Matthew Plante, a Board-certified orthopedic surgeon, noted that appellant had a right 

knee medial meniscal tear and some patellofemoral chondromalacia. He noted that given the 

severity of her symptoms along with her diagnostic findings, it was likely that she would not 

experience significant long-term relief with nonsurgical treatments. Dr. Plante noted that 

appellant reported sustaining an injury at work on May 31, 2012. 

In a June 15, 2012 magnetic resonance imaging (MRI) scan of the right knee,

Dr. Krishanu B. Gupta, a Board-certified radiologist, diagnosed: (1) tear of the posterior root of 

the medial meniscus with associated flap tear of the body of the meniscus; (2) moderate 

patellofemoral compartment osteoarthritis; and (3) joint effusion. 

The employing establishment issued a Form CA-16 on April 27, 2015 authorizing 

medical treatment at the Warwick Medical Walk-in Room. 

In an April 27, 2015 note from Warwick Medical Walk-in Room, Nurse J. Coleman 

related that on April 21, 2015 appellant was stepping off a step and felt a “crack.” She diagnosed 

right anterior knee pain. Additional notes indicate that appellant was treated at Warwick 

Medical Walk-In Room for follow-up appointments from May 4 through October 19, 2015.

In an April 28, 2015 attending physician’s report (Form CA-20), Dr. Ricky McCullough, 

Board-certified in emergency medicine, related that appellant reported stepping off a step 

delivering mail and felt a pop in her anterior right knee. He diagnosed internal knee injury. 

Dr. McCullough noted that appellant’s x-rays showed degenerative joint disease and possible 

 

4 Under OWCP File No. xxxxxx905 appellant alleged that she sustained a traumatic right knee injury while 

ascending stairs on June 1, 2012. OWCP denied that claim on August 23, 2012. File No. xxxxxx905 is not 

presently before the Board. 
3

osteochrondral fracture of medial and tibial plateau. He checked a box marked “yes” indicating 

that he believed that the condition was caused or aggravated by the employment incident.

In a May 8, 2015 MRI scan report, Dr. Gupta diagnosed diminutive medial meniscus

which may relate to prior meniscal debridement. He noted a tear/re-tear of the meniscus. 

Dr. Gupta found that appellant had severe patellofemoral and moderate medial compartment 

osteoarthritis and moderate volume joint effusion. 

By development letter to appellant dated October 29, 2015, OWCP informed her that her 

claim initially appeared to be a minor injury that resulted in minimal or no lost time from work, 

and that the merits were not addressed. However, as the employing establishment had now 

submitted a challenge, further factual and medical information was necessary to support her 

claim. OWCP afforded appellant 30 days to submit further evidence.

In a November 17, 2015 report, Dr. Brett D. Owens, a Board-certified orthopedic 

surgeon, noted that appellant presented with right knee pain associated with an injury that 

occurred on the job in April 2015. He reviewed her MRI scan and noted that she had a truncated 

posterior horn of the medial meniscus. Dr. Owens also noted wear in appellant’s patellofemoral 

compartment as well as the medial compartment. He diagnosed right knee medial meniscus tear 

and osteoarthritis. 

In answers to questions by OWCP, appellant noted that although she had pain when she 

descended a step on April 21, 2015, she was not extremely concerned at first. She noted that she 

was afraid to report the injury due to prior experiences. Appellant noted that she had prior 

employment injuries in May 2012 and the winter of 2013, but neither significantly limited her 

ability to work. 

By decision dated December 9, 2015, OWCP denied appellant’s claim, finding that the 

medical evidence of record did not demonstrate that the claimed medical condition was causally 

related to the accepted employment incident. 

On February 1, 2016 appellant requested reconsideration. 

In support of her reconsideration request, appellant submitted a December 1, 2015 report, 

wherein Dr. Owens noted that appellant first presented to him with regard to right knee pain on 

November 17, 2015. He opined that appellant’s pain was associated with an injury that occurred 

on the job as a mail carrier in April 2015. Dr. Owens noted that since that time appellant 

indicated that her pain had not subsided. He noted that on her right side her knee had mostly full 

range of motion and stable ligamentous examination. Dr. Owens noted that her most recent MRI 

scan indicated that she had a truncation posterior horn of the medial meniscus. He stated that,

while it was certainly torn, it was unclear how long it had been that way. Dr. Owens indicated 

that appellant had worked as a mail carrier for 32 years and had a very physically demanding job 

which required loading her truck with weight up to 70 pounds, driving long distances, and 

walking while carrying a bag that weighed up to 35 pounds. He noted that mounting and 

dismounting her truck and walking steep driveways and stairs exacerbated, and most likely 

permanently accelerated, her meniscus tear as well as her osteoarthritis. In a December 24, 2015 
4

report, Dr. Owens again diagnosed right knee medial meniscus tear and osteoarthritis. He related 

that appellant would be able to return to work as of December 26, 2015.

By decision dated March 30, 2016, OWCP denied modification of is prior decisions as it 

determined that the evidence of record failed to establish that appellant’s right knee condition 

was causally related to the accepted employment incident of April 21, 2015. 

On March 23, 2017 appellant, through counsel, requested reconsideration, alleging that 

the medical evidence submitted established that the claim should be accepted for meniscal tear 

and for permanent aggravation and acceleration of left knee arthritis. 

In support of her request for reconsideration, appellant submitted a March 13, 2017 report

wherein Dr. Byron V. Hartunian, an orthopedic surgeon, reviewed appellant’s employment 

history, medical history, and the results of his physical examination. Dr. Hartunian diagnosed 

torn medial meniscus, right knee; and osteoarthritis right knee with patellofemoral and medial 

compartment cartilage degeneration. He opined that appellant’s work duties caused and 

contributed to both of these conditions, as clearly reflected in her medical records and the reports 

of Dr. Owens. Dr. Hartunian stated that it was clear that appellant suffered a right medial 

meniscus tear/re-tear directly as a result of her job duties on April 21, 2015. He noted that her 

history of pain while going down stairs at work on April 21, 2015, the failure of that pain to 

improve with time, and her subsequent presentation with swelling and tenderness in the weeks 

that followed, were classic presentations of a meniscus tear. Dr. Hartunian also noted that the 

mechanism of injury -- a downward force going down stairs, was also a classic mechanism of 

injury. He explained that appellant’s MRI scan taken less than three weeks after her injury 

objectively showed a tear/re-tear of the meniscus. Dr. Hartunian concluded that, given 

appellant’s history and presentation, he could say with a great degree of medical certainty that 

her meniscal tear/re-tear was caused by descending stairs at work on April 21, 2015. He 

explained that appellant experienced acute pain on April 21, 2015 while descending stairs at 

work, her knee was described in records as going into hyperextension, she reported the injury in 

less than a week when the pain did not subside, internal derangement of the knee was suspected, 

and her radiology studies and examinations confirmed the injury. Dr. Hartunian opined that 

appellant’s history left very little doubt, but that her meniscus was torn as a result of descending

stairs at work, as reported. Finally, he concluded that appellant’s work as a letter carrier over the 

years contributed to both her meniscal tear and her osteoarthritis which was identified in her 

knee during work-up for the April 21, 2015 injury.

By decision dated August 18, 2017, OWCP denied modification of its prior decision, 

finding that the evidence of record was insufficient to establish causal relationship between the 

diagnosed conditions and the April 21, 2015 employment incident.

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 

 

5 Supra note 2.
5

time limitation period of FECA, that an injury was caused in the performance of duty as alleged, 

and that any disability or specific condition for which compensation is claimed is causally related 

to the employment injury.6 These are the essential elements of each and every compensation 

claim regardless of whether the claim is predicated upon a traumatic injury or an occupational 

disease.7

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

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

First, the employee must submit sufficient evidence to establish that she actually experienced the 

employment incident at the time, place, and in the manner alleged.8 Second, the employee must 

submit sufficient evidence, generally only in the form of medical evidence, to establish that the 

employment incident caused a personal injury.9

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.10 The weight of the 

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.11

ANALYSIS

OWCP accepted that appellant had established that the claimed incident occurred as 

alleged on April 21, 2015. However, it denied her claim, finding that she failed to submit 

medical evidence sufficient to establish that her medical diagnoses were causally related to the 

accepted employment incident.

The Board finds that appellant has not established that her right knee condition was 

caused by descending stairs on April 21, 2015 in the performance of her federal employment 

duties. 

Following the April 21, 2015 incident appellant was treated by Dr. McCullough. In his 

report dated April 28, 2015, Dr. McCullough checked a box marked “yes” indicating that he 

believed that appellant’s degenerative joint disease and possible osteochondral fracture of medial 

and tibial plateau was caused by the employment incident. However, the Board has held that 

when a physician’s opinion on causal relationship consists of only checking a box marked “yes”

 

6

Joe D. Cameron, 42 ECAB 153 (1989); Elaine Pendleton, 40 ECAB 1143 (1989).

7 Victor J. Woodhams, 41 ECAB 345 (1989).

8

John J. Carlone, 41 ECAB 354 (1989).

9

Id. 

10 I.J., 59 ECAB 408 (2008); supra note 8. 

11 James Mack, 43 ECAB 321 (1991). 
6

to a form question, without the addition of adequate medical rationale, the opinion has little 

probative value and is insufficient to establish causal relationship.12 

Similarly, the reports of Dr. Owens are insufficient to establish causal relationship 

between the April 21, 2015 employment incident and the diagnosed conditions of right knee 

medial meniscus tear and arthritis. In his December 1, 2015 report, Dr. Owens stated that 

appellant’s pain in her right knee occurred on the job as a mail carrier in April 2015. However, 

he admitted that it was unclear how long appellant’s meniscus was torn. The Board has held that 

an opinion which is equivocal in nature is of limited probative value regarding the issue of causal 

relationship.13 Dr. Owens’ opinion was equivocal as he admitted that he did not know when 

appellant’s meniscus tear occurred. The Board also finds that he did not adequately explain how

the accepted April 21, 2015 employment incident would have medically caused appellant’s right 

knee conditions, nor did he explain why the conditions were not related to preexisting conditions.

Dr. Owens did not explain the process by which appellant’s particular work duties would cause 

or contribute to the diagnosed condition or why such condition would not be due to any other 

factors. His reports are, therefore, insufficient to meet appellant’s burden of proof.14

Dr. Hartunian addressed appellant’s medical history, his findings upon physical 

examination of appellant, and her employment history. He opined that her employment duties as 

of April 21, 2015 caused her right medial meniscus tear/re-tear. Dr. Hartunian noted that the 

acute pain appellant experienced on April 21, 2015 while descending stairs at work, the fact that 

the pain did not subside within a week, the fact that internal derangement of the knee was 

suspected, and her radiological studies and examinations, confirmed the injury. He related that a 

downward force, descending stairs, was a classic mechanism of injury. However, Dr. Hartunian 

noted that appellant initially developed pain in her right knee in 2012 and that an MRI scan of 

that time was suspicious of a meniscus tear. The Board finds that the MRI scan of June 15, 2012 

was clearly interpreted by Dr. Gupta as showing a tear of the posterior root of the medial 

meniscus with associated flap tear of the body of the meniscus. Dr. Hartunian never explained 

why appellant’s current right knee conditions were not preexisting or caused by some other 

factor. As discussed above, the medical evidence submitted must include proper medical and 

factual histories and an opinion explaining the causal relationship between the diagnosed 

condition and the April 21, 2015 employment incident.15 

None of the other evidence is sufficient to establish causal relationship. Dr. Gupta’s 

interpretations of diagnostic studies are of limited probative value as he did not discuss causal 

relationship.16 The Board has held that reports of diagnostic tests are of limited probative value 

 

12 See D.D., 57 ECAB 734, 739 (2006). 

13 See Leonard J. O’Keefe, 14 ECAB 42, 48 (1962); James P. Reed, 9 ECAB 193, 195 (1956).

14 J.S., Docket No. 14-0818 (issued August 7, 2014). 

15 J.F., Docket No. 17-1075 (issued January 8, 2018). In so far as Dr. Hartunian supports an occupational disease 

caused by appellant’s employment duties over years of employment, appellant may file an occupational disease 

claim. 

16 G.M., Docket No. 14-2057 (issued May 12, 2015). 
7

as they fail to provide an opinion on the causal relationship between appellant’s employment 

duties and the diagnosed conditions.17

Finally, the Board notes that the nursing notes from appellant’s treatment at Warwick 

Medical Walk-In Room are of no probative value. Reports from nurses do not constitute 

competent medical evidence under FECA as nurses are not considered physicians as defined

under section 8102(2) of FECA.18

An award of compensation may not be based on surmise, conjecture, speculation, or on 

the employee’s own belief of causal relationship.

19

 Because appellant has not provided a 

rationalized opinion supporting causal relationship, she has not met her burden of proof.20

On appeal appellant, through counsel, argues that the claims examiners substituted their 

opinions for those of appellant’s physicians. Counsel contends that the medical evidence 

established that appellant sustained a meniscal injury directly related to an April 21, 2015 

employment incident. He concludes that appellant’s claim must be accepted for acute meniscal 

tear and permanent aggravation and acceleration of arthritis. As explained above, the Board 

finds that the medical evidence of record is insufficient to establish appellant’s traumatic injury 

claim.

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 10.607.21

CONCLUSION

The Board finds that appellant has not established a right knee condition causally related 

to the accepted April 21, 2015 employment incident. 

 

17 S.G., Docket No. 17-1054 (issued September 14, 2017).

18 5 U.S.C. § 8101(2) provides that a physician includes, surgeons, podiatrists, dentists, clinical psychologists, 

optometrists, chiropractors, and osteopathic practitioners within the scope of their practice as defined by state law. 

V.C., Docket No. 16-0642 (issued April 19, 2016); Allen C. Hundley, 53 ECAB 551 (2002).

19 Supra note 13.

20 See J.E., Docket No. 16-0509 (issued September 16, 2016).

21 When an employing establishment properly executes a Form CA-16 authorizing medical treatment related to a 

claim for a work injury, the form creates a contractual obligation, which does not involve the employee directly, to 

pay for the cost of the examination/treatment regardless of the action taken on the claim. See Tracy P. Spillane, 54 

ECAB 608 (2003). The period for which treatment is authorized by a Form CA-16 is limited to 60 days from the 

date of issuance, unless terminated earlier by OWCP. See 20 C.F.R. § 10.300(c).
8

ORDER

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

Compensation Programs dated August 18, 2017 is affirmed.

Issued: March 23, 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