United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

J.B., Appellant

and

DEPARTMENT OF THE INTERIOR, 

NATIONAL PARK SERVICE, Washington, DC, 

Employer

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Docket No. 17-1870

Issued: April 11, 2018

Appearances: Case Submitted on the Record

Thomas R. Uliase, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

CHRISTOPHER J. GODFREY, Chief Judge

PATRICIA H. FITZGERALD, Deputy Chief Judge

ALEC J. KOROMILAS, Alternate Judge

JURISDICTION

On September 5, 2016 appellant, through counsel, filed a timely appeal from an April 25, 

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.

 

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

ISSUE

The issue is whether appellant met his burden of proof to establish knee osteoarthritis

causally related to the accepted factors of his federal employment.

FACTUAL HISTORY

On June 3, 2015 appellant, then a 58-year-old pipefitter, filed an occupational disease claim 

(Form CA-2) alleging that he developed knee osteoarthritis as a result of his federal employment 

duties. He reported that his injury was a result of the repetitious stress from 23 years of work 

servicing 430 plumbing fixtures. Appellant first became aware of his condition on March 1, 2010 

and of its relationship to his employment on February 1, 2015. He did not stop work. 

By development letter dated July 8, 2015, OWCP informed appellant that the evidence of 

record was insufficient to support his claim. OWCP advised appellant of the type of factual and 

medical evidence needed and afforded him 30 days to submit the necessary evidence. 

In a June 3, 2015 e-mail correspondence, appellant’s supervisor reported that appellant 

worked on 432 plumbing fixtures throughout National Capital Parks East.

In an August 13, 2015 medical report, Dr. J. Michael Joly, a Board-certified orthopedic 

surgeon, reported that appellant had symptomatic moderate-to-severe right medial compartment 

osteoarthritis, as well as a lesser mild-to-moderate left medial compartment osteoarthritis. He

noted that he began examining appellant on March 4, 2014 for recurrent pain localized to the 

medial compartment of his right knee due to moderate-to-severe medial compartment 

osteoarthritis. Dr. Joly noted that the only diagnostic testing performed were x-rays during his 

initial March 2014 evaluation. He opined within a reasonable degree of medical certainty that 

appellant’s wear and tear osteoarthritis of the right medial compartment, and to a lesser extent the

left medial compartment, could have resulted from employment activities over many years. 

In a September 2, 2015 e-mail correspondence, appellant’s supervisor reported that 

appellant’s employment duties involved repairing and replacing plumbing fixtures and water lines. 

He noted that appellant was recently provided a stool and given knee pads after his physician 

informed him that he could not perform his employment tasks on his knees. The supervisor noted 

that appellant’s duties involved walking, bending, stooping, twisting, pushing, pulling, and lifting. 

By decision dated September 8, 2015, OWCP denied appellant’s claim, finding that the 

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

accepted federal employment duties. 

On September 24, 2015 appellant, through counsel, requested a telephone hearing before 

an OWCP hearing representative. 

In support of his claim, appellant submitted medical reports dated March 4, 2014 through 

September 29, 2015 from Dr. Joly documenting treatment for his knee condition. In a March 4, 

2014 report, Dr. Joly reported that appellant developed insidious onset of bilateral knee pain due 

to osteoarthritis. He noted a prior right-sided arthroscopic surgery several years ago which was 

minimally effective. X-rays taken on that date revealed moderate-to-severe right medial 
3

compartment osteoarthritis and mild-to-moderate left medial compartment osteoarthritis. In a 

May 19, 2015 medical report, Dr. Joly reported reviewing appellant’s job description, noting that 

he worked as a pipefitter and had performed a lot of plumbing work. He reported that his recurrent 

severe right knee pain due to medial compartment osteoarthritis could be a workplace injury. 

Dr. Joly’s remaining medical reports documented physical examination findings and hyaluronic 

injection treatments administered to the right knee. 

By letter dated April 12, 2016, counsel noted submission of a March 29, 2016 medical 

report from Dr. Evan Crain, a Board-certified orthopedic surgeon, in support of his occupational 

disease claim. 

In a March 29, 2016 narrative report, Dr. Crain reported that he initially evaluated appellant 

on December 16, 2015 for bilateral knee pain. He reported that appellant had worked for over 23 

years, initially as a plumber and later as a pipefitter. Dr. Crain noted that appellant’s work required

frequent squatting, kneeling, bending, and working on his knees on a regular basis. He reported 

that appellant personally serviced 430 plumbing fixtures over the course of 23 years that involved 

toilets, sinks, and fountains which required him to be on his knees. Dr. Crain discussed appellant’s 

x-rays which revealed progressive deterioration of the medial compartment in both knees as a 

result of his employment activities over the years. He noted that appellant’s bilateral knee pain 

was aggravated by his work activities over the past 23 years which caused further deterioration of 

his knees and the increase in symptomatology. Dr. Crain opined that, as a result of his employment 

duties which entailed repetitive bending, squatting, and kneeling, appellant developed a meniscus 

tear of the right knee that led to the arthroscopy, which further caused deterioration of the medial 

joint space that had now collapsed to bone-on-bone contact. Based on these findings, he reported 

a direct causal relationship to appellant’s symptomatology as it related to his work activities, noting

that these activities caused an exacerbation of his symptomatology and continued to do so on a 

daily basis.

A hearing was held on May 16, 2016 before an OWCP hearing representative. Appellant 

testified in support of his occupational disease claim, treatment pertaining to his injury, and prior 

right knee surgery. Counsel noted that he would attempt to obtain appellant’s prior medical records 

related to his right knee surgery. The record was held open for 30 days. No additional evidence 

was received. 

By decision dated July 28, 2016, an OWCP hearing representative affirmed the 

September 8, 2015 decision, finding that the medical evidence of record failed to establish that 

appellant’s diagnosed condition was causally related to his accepted federal employment duties. 

The hearing representative noted that appellant’s physicians were relying on his self-reported 

history with no medical records to support his preexisting condition. 

On October 31, 2016 appellant, through counsel, requested reconsideration of the July 28, 

2016 hearing representative’s decision. Along with the request, counsel submitted an April 3, 

2013 operative report, as well as medical reports from 2012 through 2015 in support of appellant’s

claim.

In an April 3, 2013 operative report, Dr. Ricardo O. Pyfrom, a Board-certified orthopedic 

surgeon, provided operative findings pertaining to a right knee torn medial meniscus and 
4

chondromalacia arthroscopy. In progress noted dated November 27, 2012 through May 17, 2013, 

he discussed appellant’s bilateral knee treatment. Physical therapy notes from Sports Pro Physical 

Therapy were also submitted. 

By decision dated November 17, 2016, OWCP denied modification of the July 28, 2016 

decision, finding that the medical evidence of record failed to establish that appellant’s diagnosed 

condition was causally related to the accepted factors of his federal employment. 

On January 19, 2017 appellant, through counsel, again requested reconsideration and

submitted a January 9, 2017 medical report from Dr. Crain in support of appellant’s claim. 

In the January 9, 2017 medical report, Dr. Crain noted submission of his prior March 29, 

2016 report which summarized his findings and reviewed appellant’s work activities. He opined 

that appellant experienced bilateral, right greater than left, knee pain aggravated by his work 

activities, which he had performed over a 23-year time frame. Dr. Crain also opined that those 

specific work activities caused further deterioration of his knees and an increase in his 

symptomatology. He reported that appellant had undergone a previous right knee arthroscopy for 

a tear of his medial meniscus. Dr. Crain explained that the tearing of the meniscus caused further 

deterioration of the knee joint to the extent that appellant had loss of shock absorber on the medial 

side. He noted an exacerbation and worsening of appellant’s symptoms. 

Dr. Crain noted that he reviewed appellant’s prior medical reports which documented knee 

pain as far back as 2012. Appellant was initially evaluated by Dr. Pyfrom on November 27, 2012 

due to complaints of right knee pain for several years. He was also hit by a car in the right knee

30 years ago. Appellant had previously been diagnosed with arthritis and wore knee braces. A 

prior MRI scan reviewed was suggestive of a medial meniscus tear and arthroscopic surgery was 

recommended. On April 3, 2013 appellant underwent surgery which revealed a large complex tear 

of the medial meniscus. Surgery further revealed degenerative changes of the medial femoral 

condyle grade III and medial tibial plateau grade IV, as well as a chronically torn anterior cruciate 

ligament and chondromalacia grade III of the patella. A partial medial meniscectomy and 

chondroplasty were performed. Dr. Crain reported that appellant returned to work approximately 

four weeks following his surgery. In 2014, he began treatment with Dr. Joly who administered 

multiple injections and provided him with a knee brace. Dr. Crain reported that he initially 

evaluated appellant in December 2015.

Dr. Crain noted that after review of the subsequently provided medical records, there was 

no change in his opinion in regard to appellant’s condition. The medical history reflected that,

following his April 3, 2013 surgery, appellant did not develop a distinct injury, but rather a 

progressive increase in knee pain which he attributed to his work activities. After having reviewed 

the nature of his employment, job description, and self-reported work activities, Dr. Crain opined 

that appellant’s employment duties aggravated an underlying degenerative condition. He reported 

that, if appellant were in a different job that did not require those employment activities required 

of him, he would not experience the symptoms necessitating his current treatment. Dr. Crain 

concluded that appellant developed further deterioration of his knees and an increase in 

symptomatology related to his work activities. The need for treatment was, therefore, related to 

his work activities.
5

By decision dated April 25, 2017, OWCP denied modification of its November 17, 2016 

decision, finding that the medical evidence of record failed to establish that appellant’s diagnosed 

condition was causally related to his accepted factors of his federal employment. 

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 

employment injury.3 These are the essential elements of each and 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 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 supporting such causal relationship.7 The opinion of the physician must be based 

on a complete factual and medical background of the claimant, 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 

 

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).
6

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

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

appellant developed knee osteoarthritis causally related to the accepted factors of his federal 

employment as a pipefitter.

In support of his claim, appellant submitted medical reports dated March 4, 2014 through 

September 29, 2015 from Dr. Joly documenting the treatment of his right knee. Dr. Joly provided 

a diagnosis of moderate-to-severe right medial compartment osteoarthritis. He opined that 

appellant’s medial compartment osteoarthritis could have resulted from his employment activities 

over many years. 

The Board notes that Dr. Joly’s opinion on causation is highly speculative as he notes that 

appellant’s employment duties could aggravate his condition without a firm conclusion that these 

duties did in fact cause or aggravate his injury.

9

 To be of probative value, a physician’s opinion 

on causal relationship should be one of reasonable medical certainty.10 While the physician noted 

that appellant worked as a pipefitter and performed a lot of plumbing work, he failed to discuss 

appellant’s repetitive employment duties or explain how these movements would have caused or 

contributed to his diagnosed condition. Furthermore, Dr. Joly noted appellant’s right knee 

arthroscopy yet failed to provide a detailed medical history to gain any understanding of his 

preexisting condition or prior injuries. He never addressed what caused the underlying condition 

nor did he discuss whether his preexisting injury had progressed beyond what might be expected 

from the natural progression of that condition.11 A well-rationalized opinion is particularly 

warranted when there is a history of preexisting condition.12 As such, Dr. Joly’s reports lack the 

specificity and detail needed to establish that appellant’s injuries are a result of a work-related 

occupational exposure.13 

In medical reports dated March 29, 2016 and January 9, 2017, Dr. Crain described 

appellant’s employment duties as a pipefitter over the course of 23 years which entailed frequent 

squatting, kneeling, bending, and working on his knees. He opined that as a result of appellant’s 

employment duties which entailed repetitive bending, squatting, and kneeling, he developed a 

meniscus tear of the right knee that led to his right knee arthroscopy, leading to further 

deterioration of the medial joint space that had currently collapsed to bone-on-bone contact. 

 

8

James Mack, 43 ECAB 321 (1991).

9 See Michael R. Shaffer, 55 ECAB 339 (2004).

10 See Beverly R. Jones, 55 ECAB 411 (2004).

11 R.E., Docket No. 14-0868 (issued September 24, 2014).

12 T.M., Docket No. 08-0975 (issued February 6, 2009); Michael S. Mina, 57 ECAB 379 (2006).

13 P.O., Docket No. 14-1675 (issued December 3, 2015); S.R., Docket No. 12-1098 (issued September 19, 2012).
7

The Board finds that the opinion of Dr. Crain is not well rationalized. The Board notes 

that the record reflects that appellant had a preexisting right knee meniscus tear which resulted in 

arthroscopy on April 3, 2013. Dr. Crain opined that appellant’s repetitive employment duties 

caused his underlying right knee meniscus tear. While Dr. Crain reviewed and discussed 

appellant’s prior medical history, he failed to provide any explanation pertaining to the mechanism 

of injury to establish that the initial right knee meniscus tear was work related. His statement that 

tearing of the meniscus caused further deterioration of the knee joint to the extent that appellant 

had loss of shock absorber on the medial side is insufficient. Without explaining how 

physiologically the movements involved in appellant’s employment duties caused or contributed 

to the tearing of the meniscus, his diagnosed condition, his opinion on causal relationship is 

equivocal in nature and of limited probative value.14 

Dr. Crain did not explain whether appellant’s preexisting injury had progressed beyond 

what might be expected from the natural progression of that condition.15 It is unclear if appellant’s 

injury was caused or aggravated by his occupational employment duties, a result of a preexisting 

condition, or due to degenerative changes. The Board has held that medical reports without 

adequate rationale on causal relationship are of diminished probative value and do not meet an 

employee’s burden of proof.16

The remaining medical evidence of record is also insufficient to establish appellant’s 

occupational disease claim. Dr. Pyfrom’s medical reports dated November 27, 2012 through 

May 17, 2013 document treatment for a preexisting right torn medial meniscus and 

chondromalacia and April 3, 2013 arthroscopy. While the reports reflect that appellant sought 

medical treatment stemming back to 2012 for his right knee injury, Dr. Pyfrom failed to discuss

appellant’s employment duties and provided no opinion regarding the cause of his injury.17 The 

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

employee’s condition is of limited probative value.18 

The Sports Pro Physical Therapy notes documenting treatment for his right knee are also 

insufficient to establish his claim. Physical therapists are not physicians as defined under FECA, 

their opinions are of no probative value.19 

 

14 See L.M., Docket No. 14-0973 (issued August 25, 2014); R.G., Docket No. 14-0113 (issued April 25, 2014); 

K.M., Docket No. 13-1459 (issued December 5, 2013); A.J., Docket No. 12-0548 (issued November 16, 2012).

15 Supra note 11.

16 S.R., supra note 13.

17 C.B., Docket No. 09-2027 (issued May 12, 2010); S.E., Docket No. 08-2214 (issued May 6, 2009).

18 Id.

19 5 U.S.C. § 8102(2) of FECA provides as follows: (2) physician includes surgeons, podiatrists, dentists, clinical 

psychologists, optometrists, chiropractors, and osteopathic practitioners within the scope of their practice as defined 

by State law. See also Roy L. Humphrey, 57 ECAB 238 (2005). See also J.A., Docket No. 17-0119 (issued 

July 11, 2017). A physical therapist is not a physician under FECA. 
8

The Board notes that there is no requirement that the federal employment be the only cause 

of appellant’s injury. An employee is not required to prove that occupational factors are the sole 

cause of his claimed condition. If work-related exposures caused, aggravated, or accelerated 

appellant’s condition, he is entitled to compensation.20 However, an award of compensation may 

not be based on surmise, conjecture, speculation, or on the employee’s own belief of causal 

relation.21 Appellant’s honest belief that his occupational employment duties caused his medical 

injury is not in question,

22 but that belief, however sincerely held, does not constitute the medical 

evidence necessary to establish causal relationship.23 

The evidence of record lacks rationalized medical evidence establishing a causal 

relationship between appellant’s federal employment duties as a pipefitter and his diagnosed knee

osteoarthritis. Thus, appellant has failed to meet his burden of proof. 

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. §§ 10.605 through 10.607.

CONCLUSION

The Board finds that appellant has not met his burden of proof to establish a knee 

osteoarthritis causally related to the accepted factors of his federal employment. 

 

20 See Beth P. Chaput, 37 ECAB 158, 161 (1985); S.S., Docket No. 08-2386 (issued June 5, 2008). 

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

22 See M.C., Docket No. 17-1579 (issued November 28, 2017). 

23 Id.
9

ORDER

IT IS HEREBY ORDERED THAT the April 25, 2017 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: April 11, 2018

Washington, DC

Christopher J. Godfrey, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Alec J. Koromilas, Alternate Judge

Employees’ Compensation Appeals Board