United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

M.S., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

San Francisco, CA, Employer 

__________________________________________ 

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Docket No. 16-1743 

Issued: May 18, 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 

COLLEEN DUFFY KIKO, Judge 

ALEC J. KOROMILAS, Alternate Judge 

JURISDICTION 

On August 31, 2016 appellant, through counsel, filed a timely appeal from a July 20, 

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 to consider the merits of the case. 

ISSUE 

The issue is whether appellant has met her burden of proof to establish aggravation of left 

knee arthritis causally related to factors of her federal employment. 

 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

FACTUAL HISTORY 

On April 13, 2015 appellant, then a 60-year-old letter carrier, filed an occupational 

disease claim (Form CA-2) alleging that she developed left knee pain, swelling, weakness, and 

stiffness. She attributed her condition to lifting, pushing, pulling, standing, and walking while 

performing her job duties. Appellant first became aware of her left knee condition in 

November 2011 and first attributed this condition to her employment on October 16, 2012. 

Appellant underwent a left knee magnetic resonance imaging (MRI) scan on October 16, 

2012 which demonstrated extensive horizontal tearing of the lateral meniscus, advanced cartilage 

wear in the lateral compartment, joint effusion, and popliteal cyst. 

In a letter dated April 30, 2015, OWCP requested additional factual and medical evidence 

from appellant in support of her occupational disease claim. It allowed her 30 days to respond. 

By decision dated July 1, 2015, OWCP denied appellant’s occupational disease claim, 

finding that she had failed to submit the necessary factual and medical evidence to establish her 

claim. It noted previously accepted conditions of lumbar sprain as well as thoracic or lumbar 

neuritis or radiculitis under OWCP File No. xxxxxx296. 

On July 17, 2015 appellant requested reconsideration of the July 1, 2015 decision. She 

noted that she planned to submit additional medical evidence. 

By decision dated October 8, 2015, OWCP denied appellant’s request for reconsideration 

of the merits as she had failed to submit any additional new evidence or argument in support of 

her request for reconsideration. 

On April 21, 2016 appellant, through counsel, requested reconsideration. In support of 

this request, he submitted a report dated April 12, 2016 from Dr. Michael E. Hebrard, a Boardcertified physiatrist. Dr. Hebrard noted that OWCP had denied appellant’s claims for right knee 

and bilateral hip conditions. He then indicated that for her accepted right knee condition3

 he 

reviewed x-rays dated September 5, 2014 which demonstrated severe medial joint line narrowing 

in the right knee, and moderate narrowing in the left knee. Dr. Hebrard noted that these x-rays 

suggested that there was a preexisting condition of appellant’s knees. He also reviewed 

appellant’s March 6, 2014 left knee MRI scan and noted the findings of tear of the lateral 

meniscus, cartilage wear in the lateral compartment, joint effusion and cyst, preexisting 

pathology of the left knee. Dr. Hebrard then described appellant’s work duties of repetitive 

squatting, bending at the knees and hips, reaching, pushing, and pulling in order to sort mail. He

opined that work-related repetitive squatting and bending at the knees increased the 

biomechanical stress along the arthritic knee joint, increasing inflammation, and overuse of the 

surrounding muscles to provide structural support. Dr. Hebrard noted that prolonged sitting 

increased pressure on the hip and knee joints and contributed to acceleration of the preexisting 

condition. He concluded, “It is my opinion with a reasonable degree of medical certainty ... that 

[appellant] had a preexisting condition involving the knees and hips; that this is causal 

relationship between her work duties over many years and her current condition; that the 

mechanical stresses on the hip and knee joints that were involved as part of her job, including 

 3

 Dr. Hebrard referenced claim No. xxxxxx433. That claim is not presently before the Board.
3

standing, sitting, stooping, crouching, and bending through the day, accelerated the preexisting 

arthritic condition and contributed proximally to her ongoing functional impairment.” 

Dr. Hebrard found that appellant had sustained a permanent aggravation of her right knee and 

both hips. 

By decision dated July 20, 2016, OWCP found that Dr. Hebrard’s April 12, 2016 report 

established a diagnosed condition, arthritis of the left knee. However, it determined that he had 

not provided rationalized medical opinion evidence describing how appellant’s left knee arthritis 

was caused or aggravated by her work duties. 

LEGAL PRECEDENT 

OWCP’s regulations define an occupational disease as “a condition produced by the work 

environment over a period longer than a single workday or shift.”4

 To establish that an injury 

was sustained in the performance of duty in an occupational disease claim, a claimant must 

submit the following: (1) medical evidence establishing the presence or existence of the disease 

or condition for which compensation is claimed; (2) a factual statement identifying employment 

factors alleged to have caused or contributed to the presence or occurrence of the disease or 

condition; and (3) medical evidence establishing that the employment factors identified by the 

claimant were the proximate cause of the condition for which compensation is claimed or, stated 

differently, medical evidence establishing that the diagnosed condition is causally related to the 

employment factors identified by the claimant. 

The evidence required to establish causal relationship is rationalized medical opinion 

evidence, based upon a complete factual and medical background, showing a causal relationship 

between the claimed condition and identified factors. The belief of a claimant that a condition 

was caused or aggravated by the employment is not sufficient to establish causal relation.5

ANALYSIS 

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

aggravation of left knee arthritis due to factors of her federal employment. 

In support of her claim for an employment-related aggravation of her left knee arthritis, 

appellant submitted a report dated April 12, 2016 from Dr. Hebrard. Dr. Hebrard reviewed the 

diagnostic studies including MRI scans and x-rays. He diagnosed preexisting bilateral knee 

arthritis. Dr. Hebrard described appellant’s employment duties including squatting and bending 

at the knees while sorting mail. He explained that work-related repetitive squatting and bending 

at the knees increased the stress along appellant’s arthritis knee joint which increased 

inflammation as well as overuse of the surrounding muscles. Dr. Hebrard also explained that 

prolonged sitting increased pressure on the knee joints and contributed to acceleration of the 

preexisting condition. He concluded that appellant had a preexisting condition of her knees, that 

there was a causal relationship between her work duties and her current right knee condition due 

to mechanical stresses including standing, sitting, stooping, crouching, and bending. Dr. Hebrard 

 4

 20 C.F.R. § 10.5(q). 

5 Lourdes Harris, 45 ECAB 545, 547 (1994). 
4

opined that appellant had a permanent aggravation of her right knee, but did not specifically 

address the left knee. 

Appellant filed her Form CA-2 alleging a left knee injury due to factors of her federal 

employment. Rather than addressing the left knee, Dr. Hebrard’s report focuses on appellant’s 

right knee and bilateral hip condition. He does not describe how the left knee condition was 

caused or aggravated by appellant’s federal employment. Therefore, the Board finds that this 

report is not relevant to the current issue of causation and is of limited probative value regarding 

this claim.6

 

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 failed to meet her burden of proof to establish an 

aggravation of her left knee arthritis causally related to factors of her federal employment. 

ORDER 

IT IS HEREBY ORDERED THAT the July 20, 2016 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: May 18, 2017 

Washington, DC 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board 

 6 See generally D.R., Docket No. 16-0528 (issued August 24, 2016); C.A., Docket No. 13-1364 (issued 

May 13, 2014).