United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

M.S., Appellant

and

DEPARTMENT OF VETERANS AFFAIRS, 

VETERANS ADMINISTRATION MEDICAL 

CENTER, San Diego, CA, Employer

__________________________________________

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Docket No. 17-1044

Issued: February 2, 2018

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

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On April 12, 2017 appellant filed a timely appeal from a November 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.2

ISSUE

The issue is whether appellant met her burden of proof to establish a left knee meniscal

tear causally related to the accepted December 13, 2012 employment injury.

 

1 5 U.S.C. § 8101 et seq.

2 Appellant submitted additional evidence with her appeal. However, the Board’s Rules of Procedure provide 

that the Board is precluded from reviewing evidence that was not part of the record at the time OWCP issued its 

final decision on November 14, 2016. Therefore, the Board may not consider this evidence for the first time on 

appeal. See 20 C.F.R. § 501.2(c)(1); Sandra D. Pruitt, 57 ECAB 126 (2005). 
2

FACTUAL HISTORY

On December 14, 2012 appellant, then a 61-year-old medical supply technician, filed a 

traumatic injury claim (Form CA-1). This form related that, on December 13, 2012, she

sustained injuries to her left leg, arm, shoulder, and knee in the performance of duty when she 

was squeezed between racks of inventory. The form did not indicate whether appellant stopped

work. OWCP paid appellant wage-loss compensation for intermittent disability on the 

supplemental rolls as of January 8, 2013. 

OWCP accepted her claim for multiple contusions, left upper arm contusion, and left 

lower leg contusion.

3

Appellant submitted an August 11, 2014 progress report from Dr. Rajy S. Abulhosn, a 

Board-certified family practitioner. Dr. Abulhosn related that he was asked to provide 

clarification regarding appellant’s left shoulder condition. He noted diagnoses of multiple 

contusions of the left shoulder, left lower extremity, and back, and left shoulder bursal-sided tear 

of the supraspinatus and complete tear of the intraarticular biceps tendon. Dr. Abulhosn

indicated that he initially examined appellant on December 14, 2012 and related a “mechanism 

of injury” that a metal rack slammed into her left shoulder, upper arm, knee, and lower leg area. 

He reported that initial examination of appellant’s left shoulder showed tenderness to palpation 

and range of motion deficits. Dr. Abulhosn explained that after all conservative management 

was provided and appellant still complained of left shoulder pain, she underwent a left shoulder 

magnetic resonance imaging (MRI) scan, which confirmed the left shoulder tear.

In a December 29, 2014 progress report, Dr. Abulhosn noted a date of incident of 

December 13, 2012 and that appellant related no significant changes in her symptoms, with 

ongoing pain throughout the left side of her body, primarily in the left shoulder and knee. Upon 

physical examination he reported continued diffuse tenderness to palpation throughout 

appellant’s left side, but focused more on the left shoulder and knee. Range of motion was 

decreased to both the left shoulder and knee. Dr. Abulhosn diagnosed status post multiple 

contusions occurring at work, including the left shoulder, left upper arm, back, and left lower 

extremity with persistent ongoing complaints and left shoulder injury with small, partial bursalsided tear of the supraspinatus and complete tear of the biceps tendon. 

OWCP also received a January 2, 2015 left knee MRI scan report from Dr. Anthony 

Chang, a Board-certified diagnostic radiologist, who noted chronic appearing osteochondral 

abnormalities at the posterior lateral femoral condyle and tibial plateau, soft tissue edema within 

the suprapatellar fat, and abnormal signal intensity within the body segment of the lateral 

meniscus possibly related to a nondisplaced vertical longitudinal tear. 

 

3 Under OWCP File No. xxxxxx800, OWCP accepted that on October 8, 2013 appellant sustained a traumatic 

injury when she slipped and fell on a plastic bag while in the performance of duty. It accepted her claim for multiple 

contusions to the right elbow, forearm, and face; abrasion or friction burn of the left leg; and right rotator cuff 

sprain. Under OWCP File No. xxxxxx198, appellant filed an occupational disease claim (Form CA-2) alleging that 

she experienced stress and panic attacks as a result of working in a hostile work environment. That claim is 

currently under development. File Nos. xxxxxx800 and xxxxxx198 are not presently before the Board and will, 

therefore, not be addressed in this decision.
3

In a January 29, 2015 report, Dr. Abulhosn related that appellant continued to complain 

of pain in her affected body parts. Upon musculoskeletal examination, he reported that it was 

positive for joint pain, stiffness, muscle aches, and weakness. Dr. Abulhosn further noted 

tenderness to palpation in the left shoulder area and throughout the entire left side of her body. 

He diagnosed status post multiple contusions of the left shoulder, left upper arm, back, and left 

lower extremity, with persistent ongoing complaints, and left shoulder tear injury. 

OWCP received a February 18, 2015 letter from appellant who requested that the

diagnostic codes for her left knee injury be changed to match the results of the January 2, 2015 

MRI scan, which showed a left knee tear. Appellant asserted that her left knee continued to 

cause her moderate-to-severe pain every day.

OWCP subsequently expanded acceptance of appellant’s claim to include a left shoulder 

rotator cuff tear and sprain on March 2, 2015. On June 15, 2015 appellant underwent authorized 

left shoulder surgery. She stopped work and OWCP paid her wage-loss compensation. On 

August 10, 2015 appellant returned to full-time modified duty. 

In an October 7, 2015 report, Dr. Jon Kelly, a Board-certified diagnostic radiologist,

related appellant’s complaints of pain in the left shoulder, low back, left knee, and right shoulder. 

Examination of appellant’s left knee revealed an antalgic gait. Dr. Kelly recommended that 

appellant return to modified duty.

Dr. Kelly further noted in a November 18, 2015 report appellant’s frustration that OWCP 

would not expand her claim to include the left knee. He indicated that appellant’s symptoms had 

worsened since her last visit and there had been no change in the character or location of the 

problem. Upon physical examination of appellant’s left knee, Dr. Kelly reported no effusion. 

He diagnosed left shoulder calcific tendinitis, left knee derangement of unspecified medial 

meniscus due to an old tear or injury, and low back pain. Dr. Kelly recommended that appellant 

return to modified duty.

In a letter dated December 7, 2015, appellant requested that OWCP expand her claim to 

accept torn tendons and meniscus tear of the left knee. She explained that on December 13, 2012 

a heavy steel supply rack was slammed into the left side of her body, which caused chronic pain 

along the left side of her body. Appellant described the medical treatment she received for her 

back, left shoulder, and left knee. She listed the medical reports and diagnostic scan reports, 

which she alleged established torn tendons and a meniscus tear in her left knee.

On December 14, 2015 appellant stopped work again because the employing 

establishment was unable to accommodate her work restrictions. OWCP paid wage-loss 

compensation and placed appellant back on the periodic rolls.

In a December 30, 2015 progress report, Dr. Kelly noted that appellant was frustrated 

about the lack of progress regarding authorization for treatment. He related appellant’s 

complaints of continued left knee and back pain despite physical therapy treatment. Upon 

examination of appellant’s left knee, Dr. Kelly noted pain at the patellofemoral joint and medial 

joint line and medial crepitus. Examination of the lumbar spine showed file lumborum 

tenderness and limited flexion. Dr. Kelly diagnosed calcific tendinitis of the left shoulder, left 
4

knee cystic meniscus, other medial meniscus, right knee medial meniscus tear confirmed by MRI

scan, lumbar spine pain, left hip gluteal buttock pain, and right shoulder pain.

By letter dated January 14, 2016, OWCP advised appellant that the evidence submitted 

was insufficient to establish that it should expand her claim to include a left knee meniscal tear. 

It requested additional medical evidence to establish a diagnosed left knee condition causally 

related to the accepted December 13, 2012 employment incident. Appellant was afforded 30 

days to submit the additional evidence. A similar letter was sent to Dr. Kelly.

In a February 10, 2016 report, Dr. Kelly related appellant’s complaints of left shoulder, 

left knee, and low back pain as a result of the initial injury. He described that appellant was 

struck with significant force by a rack, which was being pushed by a coworker. Upon physical 

examination, Dr. Kelly reported tenderness in the left knee and lumbar spine. He diagnosed left 

shoulder calcific tendinitis, low back pain, and left knee derangement of the unspecified medial 

meniscus due to an old tear or injury. Dr. Kelly indicated that appellant could return to modified 

duty.

Dr. David C. Majors, Board-certified in physical medicine and rehabilitation, noted in a 

February 16, 2016 progress report that appellant was seen for follow-up examination for 

complaints of neck pain, increase in low back pain radiating down to the lateral thigh, lateral left 

knee, and calf, left knee pain that worsened with prolonged standing and walking, and left 

shoulder pain. He reviewed appellant’s history and conducted an examination. Dr. Majors 

reported moderate tenderness to palpation of the lumbar paraspinal muscles and limited range of 

motion of the lumbar spine. He indicated that sensation to light touch was diminished 

throughout the left lower extremity. Dr. Majors noted that lower extremity deep tendon reflexes 

were within normal limits bilaterally. He diagnosed left shoulder rotator cuff tear and superior 

labral tear, cervical strain, lumbar strain, and lumbar radiculitis.

In a March 23, 2016 report, Dr. Kelly related appellant’s complaints of bilateral shoulder, 

left knee, and low back pain. He indicated that appellant’s left knee and back remained the most 

significant issues. Upon physical examination of appellant’s left knee, Dr. Kelly reported 

tenderness along the medial joint line and pain with McMurray testing. He diagnosed calcific 

tendinitis of the left shoulder, pain in left shoulder, derangement of unspecified medial meniscus 

due to old tear or injury of the left knee, and low back pain. Dr. Kelly concluded that appellant’s 

condition had not improved significantly.

By letter dated March 25, 2016, OWCP informed appellant that it had reviewed

Dr. Kelly’s medical reports in order to determine whether it should expand her claim to include 

additional diagnoses of the lumbar spine and left knee. It advised appellant that the medical 

reports submitted were insufficient to establish that her diagnosed lumbar and left knee 

conditions were causally related to the accepted December 13, 2012 employment injury. OWCP 

requested additional information and evidence to establish her request to expand her claim. 

Appellant was afforded 30 days to submit the necessary evidence.

On April 14, 2016 OWCP received appellant’s letter dated April 5, 2016 in which she 

asserted that OWCP’s March 25, 2016 letter contained factually incorrect information. 

Appellant explained that she was not “squeezed” between racks of inventory, but that another 
5

employee slammed a supply rack into her left side at work. She alleged that the employee 

provided a false version of the December 13, 2012 work injury to her supervisor while she was 

getting medical treatment in the emergency room. Appellant asserted that MRI scans showed a 

torn rotator cuff of her left shoulder and meniscus tear of her left knee. She related that she 

continued to experience severe, chronic pain from these injuries. Appellant alleged that her 

treating physicians, Drs. Abulhosn and Kelly, each diagnosed torn meniscus of her left knee as 

being directly caused by the December 13, 2012 employment injury. She requested that OWCP 

review Dr. Kelly’s December 30, 2015 and February 10, 2016 reports.

By decision dated April 25, 2016, OWCP denied expansion of appellant’s claim to 

include an additional left knee meniscus tear condition. It found that the medical evidence of 

record was insufficient to establish that her left knee condition was causally related to the 

accepted December 13, 2012 employment injury. OWCP determined that Dr. Kelly failed to 

provide a rationalized medical opinion explaining how her left knee condition resulted from the 

December 13, 2012 employment incident. 

Following the April 25, 2016 decision, OWCP received a March 29, 2016 report by

Dr. Fernando Kwiatkowski, Board-certified in psychiatry and neurology, who related appellant’s 

history of depression and anxiety as a result of harassment at work. Dr. Kwiatkowski reviewed 

appellant’s history and provided his examination findings. He diagnosed post-traumatic stress 

disorder and major depressive disorder related to finances and occupation.

Appellant submitted a May 4, 2016 report by Dr. Kelly who indicated that “it is the left 

knee which had been struck by the metal rack on the day of injury, and the knee pain has been 

present since that time.” He noted a date of injury of December 13, 2012 and explained that the 

confusion appeared to stem from the fact that both of appellant’s knees were injured during the 

work accident. Dr. Kelly related appellant’s complaints of continued bilateral shoulder, left 

knee, and lumbar pain with no significant changes in the current symptoms. He reviewed 

appellant’s history and conducted an examination. Dr. Kelly reported no crepitus, effusion, 

swelling, or ecchymosis upon inspection of appellant’s left knee. Sensation was intact and 

strength was normal. Dr. Kelly diagnosed “left knee medial meniscus tear due to impact by 

metal cart on date of injury.” He also noted diagnoses of left shoulder calcific tendinitis, right 

knee strain, lumbar spine pain and strain, and left hip radiculopathy. Dr. Kelly indicated that 

appellant’s condition had not significantly improved and that she could work modified duty.

On May 27, 2016 appellant requested a review of the written record before an OWCP 

hearing representative. She submitted various handwritten progress notes dated April 30, 2015 

to May 16, 2016 from an unknown provider.

Appellant provided a May 22, 2016 statement and noted that she was enclosing a new 

medical report dated May 4, 2016 from Dr. Kelly as additional evidence to support the expansion 

of her claim to include left knee meniscus tear. She alleged that she sustained tears in her left 

shoulder, a torn meniscus in her left knee, and injuries to her back and other areas, including her 

left upper arm when a coworker slammed a heavy steel supply rack into the left side of her body. 

Appellant described the medial treatment that she received for her various conditions. She 

explained that, after unsatisfactory recovery following physical therapy treatment, she underwent 

a left knee MRI scan, which revealed a torn meniscus. Appellant noted that in his May 4, 2016 
6

report, Dr. Kelly attributed appellant’s left knee meniscus tear due to impact by a metal cart on 

the date of injury. She related that her knee had never been injured and she never experienced 

left knee pain before the December 13, 2012 employment injury. Appellant asserted that all of 

the evidence overwhelmingly supported her claim of the left knee meniscus tear occurring on 

December 13, 2012. She resubmitted Dr. Kelly’s May 4, 2016 report.

In a June 2, 2016 left knee MRI scan report, Dr. Brian J. Moffit, Board-certified in 

diagnostic radiology and neuroradiology, noted mild-to-moderate sized tear involving the midzone segment of the lateral meniscus and mild-to-moderate osteochondral damage over the 

posterior aspects of the lateral femoral condyle and lateral tibial plateau. 

OWCP also received a June 8, 2016 report by Dr. Kelly who related that appellant 

continued to complain of pain in all body parts, but primary pain was in her left knee. Dr. Kelly

noted that he reviewed appellant’s most recent left knee MRI scan, which revealed a tear along 

the joint line in the region of the lateral meniscus tear. Appellant confirmed that this was the 

area of the knee where she experienced left knee pain. Dr. Kelly reviewed appellant’s history 

and conducted an examination. He reported tenderness to palpation in the posterior lateral aspect 

of the left knee along the joint line and over the medial femoral condyle. Dr. Kelly diagnosed 

other tear of the lateral meniscus of the left knee, left shoulder impingement syndrome, left 

shoulder bursitis, calcific tendinitis, and bicipital tendinitis, low back pain, left hip pain, and 

right shoulder unspecified rotator cuff tear. He noted that appellant’s left knee lateral meniscus 

tear was aggravated by impact by metal cart on the date of injury. 

In a July 20, 2016 progress report, Dr. Kelly noted a date of injury of December 13, 2012. 

He related that appellant presented for left shoulder pain, low back pain, and left knee pain. 

Dr. Kelly noted that appellant’s symptoms appeared to have worsened since the last visit. He 

reviewed appellant’s history and conducted an examination. Dr. Kelly reported tenderness to 

palpation along the patellofemoral and patellolateral joint of appellant’s left knee. He diagnosed 

left knee tear of the lateral meniscus, left shoulder impingement syndrome, left shoulder bursitis, 

left shoulder calcific tendinitis, left shoulder bicipital tendinitis, right shoulder unspecified 

rotator cuff tear, not specified as traumatic, low back pain, and left hip pain. Dr. Kelly related 

that appellant had left knee lateral meniscus tear “aggravated by impact by metal cart on date of 

injury.”

By decision dated November 14, 2016, an OWCP hearing representative affirmed the 

April 25, 2016 decision. She found that the medical evidence of record was insufficient to 

establish expansion of appellant’s claim to include left knee meniscal tear condition causally 

related to the accepted December 13, 2012 employment injury.

LEGAL PRECEDENT

Where an employee claims that a condition not accepted or approved by OWCP was due 

to an employment injury, he or she bears the burden of proof to establish that the condition is 

causally related to the employment injury.4 To establish causal relationship between the 

condition as well as any attendant disability claimed and the employment injury, an employee 

 

4

Jaja K. Asaramo, 55 ECAB 200 (2004).
7

must submit rationalized medical evidence based on a complete medical and factual background 

supporting such causal relationship.5 Causal relationship is a medical issue and the medical 

evidence generally required to establish causal relationship is rationalized medical opinion 

evidence.6 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.7 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 employment factors or incidents, is sufficient 

to establish causal relationship.8

ANALYSIS

OWCP accepted that on December 13, 2012 appellant sustained injuries to her left leg, 

arm, shoulder, and knee in the performance of duty. Appellant’s claim was accepted for multiple 

contusions to the left upper arm and left lower leg and for left shoulder rotator cuff tear and 

sprain. On December 16, 2015 she requested that OWCP expand her claim to include a left knee 

meniscal tear. OWCP denied appellant’s request to expand her claim finding insufficient 

medical evidence to establish that her left knee condition was causally related to the accepted 

employment injury. 

The Board finds that appellant has not met her burden of proof to establish that her left 

knee meniscal tear resulted from the accepted December 13, 2012 employment injury.

Appellant received medical treatment from Dr. Abulhosn who related in reports dated 

August 11, 2014 to January 29, 2015 that he initially examined appellant on December 14, 2012. 

Dr. Abulhosn noted appellant’s history of injury that a metal rack slammed into her left shoulder, 

upper arm, knee, and lower leg area. He provided examination findings and diagnosed status

post multiple contusions of the left shoulder, left upper arm, back, and left lower extremity, with 

persistent ongoing complaints, and left shoulder tear injury. Dr. Abulhosn did not, however, 

provide any rationalized medical explanation regarding the cause of these conditions, nor did he 

not relate appellant’s diagnosed conditions to the December 13, 2012 employment injury. The 

Board has found that medical evidence that does not offer any opinion regarding the cause of an 

employee’s condition is of limited probative value on the issue of causal relationship.9 

Likewise, the additional diagnostic reports, including Dr. Chang’s January 2, 2015 and

Dr. Moffit’s June 2, 2016 left knee MRI scan reports also provided no opinion on the cause of 

appellant’s left knee condition. Medical evidence of diagnostic testing is of limited probative 

 

5 M.W., 57 ECAB 710 (2006); John D. Jackson, 55 ECAB 465 (2004). 

6

I.R., Docket No. 09-1229 (issued February 24, 2010); D.I., 59 ECAB 158 (2007).

7

I.J., 59 ECAB 408 (2008); Victor J. Woodhams, 41 ECAB 465 (2005).

8

Jennifer Atkerson, 55 ECAB 317 (2004).

9 R.E., Docket No. 10-679 (issued November 16, 2010); K.W., 59 ECAB 271 (2007).
8

value as it fails to provide a physician’s opinion on the causal relationship between appellant’s 

work incident and the diagnosed conditions.10 These reports, therefore, fail to establish causal 

relationship.

In support of her request for expansion of acceptance of her claim to include her left knee 

condition, appellant submitted various reports dated October 7, 2015 to July 20, 2016 from

Dr. Kelly. Dr. Kelly related appellant’s complaints of ongoing pain in her left knee. He reported 

that examination of appellant’s left knee revealed pain at the patellofemoral joint and medial 

joint line and medial crepitus. In a May 4, 2016 report, Dr. Kelly noted a date of injury of 

December 13, 2012 and related that appellant’s left knee was struck by a metal rack. He 

indicated that appellant’s knee pain had persisted since that time. Dr. Kelly further related in 

reports dated June 8 and July 20, 2016 that a left knee MRI scan revealed a tear along the joint 

line of the lateral meniscus tear. He diagnosed left knee lateral meniscus tear and reported that 

appellant’s left knee tear was “aggravated by impact by metal cart on the date of injury.” 

Dr. Kelly provided an accurate description of the December 13, 2012 employment injury 

and diagnosed a left knee condition based on examination findings. Although he provided an 

affirmative opinion that appellant’s left knee meniscal tear was aggravated by the December 13, 

2012 employment injury, he provided no rationale for his opinion.11 The Board has held that a 

medical report is of limited probative value on the issue of causal relationship if it contains a 

conclusion regarding causal relationship which is unsupported by medical rationale.12 A 

physician must provide a narrative description of the identified employment incident and a 

reasoned opinion on whether the employment incident described caused or contributed to 

appellant’s diagnosed medical condition.13 A reasoned medical opinion is particularly necessary 

in this case, since Dr. Kelly did not provide his affirmative opinion on causal relationship until 

almost four years after the December 13, 2012 employment injury. Because Dr. Kelly failed to 

provide adequate medical rationale explaining how the accepted December 13, 2012 

employment injury contributed to or aggravated her left knee condition, his reports are 

insufficient to establish appellant’s claim. 

Dr. Majors’ February 16, 2016 report is also insufficient to support expansion of 

appellant’s claim as he did not mention any left knee condition. He diagnosed left shoulder 

rotator cuff tear, cervical strain, lumbar strain, and lumbar radiculitis. Similarly,

Dr. Kwiatkowski’s March 29, 2016 report described appellant’s treatment for psychological and 

mental disorders and did not mention any left knee injury.

On appeal appellant alleges that OWCP’s decision was based on factually incorrect 

information. She further relates that three doctors had diagnosed her left knee torn meniscus as 

caused by the December 13, 2012 employment injury. The Board notes that Dr. Kelly accurately 

described that appellant was struck by a metal rack on December 13, 2012 at work. However, as 

 

10 See G.C., Docket No. 17-0675 (issued June 15, 2017). 

11 See A.C., Docket No. 16-1506 (issued January 5, 2017).

12 T.M., Docket No. 08-975 (issued February 6, 2009); S.E., Docket No. 08-2214 (issued May 6, 2009).

13 John W. Montoya, 54 ECAB 306 (2003).
9

previously explained, the medical evidence of record fails to establish that appellant sustained a

torn left knee meniscus as a result of the accepted December 13, 2012 employment injury. 

Because appellant has failed to provide such evidence, she has not met her burden of proof to 

establish her claim.14

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 her burden of proof to establish a left knee 

meniscal tear causally related to the accepted December 13, 2012 employment injury.

ORDER

IT IS HEREBY ORDERED THAT the November 14, 2016 merit decision of the 

Office of Workers’ Compensation Programs is affirmed.

Issued: February 2, 2018

Washington, DC

Christopher J. Godfrey, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board

 

14 Supra note 4.