United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

C.W., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Kansas City, MO, Employer 

__________________________________________ 

) 

) 

) 

) 

) 

) 

) 

) 

Docket No. 16-1336 

Issued: March 7, 2017 

Appearances: Case Submitted on the Record

Terry Smedley, for the appellant1

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 June 14, 2016 appellant, through his representative, filed a timely appeal from a 

January 6, 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 over the merits of this case. 

ISSUE 

The issue is whether appellant met his burden of proof to establish left knee, hip, neck, 

and back conditions causally related to his federal employment duties. 

 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 November 10, 2014 appellant, then a 61-year-old letter carrier, filed an occupational 

disease claim (Form CA-2) alleging that he sustained continued pain in his knee, hip, neck, and 

back as a result of walking, standing, casing mail, loading his vehicle, and distributing mail as 

part of his federal employment duties. 

In a supplemental statement, appellant explained that he had worked as a letter carrier for 

15 years. He related that as a letter carrier he spent several hours a day casing and sorting letters 

and flats, which required standing, reaching, and twisting his body from side to side. Appellant 

noted that carriers also routinely loaded their vehicles with the cased mail and mounted and 

dismounted vehicles depending on the type of delivery route. He reported that casing and 

delivering mail required repetitively grasping mail, reaching to deposit mail in cases or 

receptacles, and twisting to retrieve mail, as well as intermittent sitting, bending, squatting, 

climbing, walking, and lifting. Appellant related that the pain in his knee, hip, neck, and back 

worsened to the point that he had trouble performing the everyday duties of his job. He 

described the medical treatment he received and asserted that his conditions were a result of 

continued aggravation of his joints and muscles in the performance of his duties as a letter 

carrier. 

Appellant submitted various annual comprehensive physical examinations dated 

August 2, 2007 to July 22, 2010 from Dr. Robert K. Thomen, a Board-certified family 

practitioner. Dr. Thomen noted that appellant had a history of osteoarthritis of the knees, neck, 

back, left inguinal hernia repair in 2006, and right rotator cuff repair in April 2010. He related 

that appellant complained of pain in both feet, left knee, and left shoulder and of pain from 

carrying his mailbag and walking every day. In the July 22, 2010 report, Dr. Thomen related 

that appellant complained of stiffness in his right shoulder with some difficulty with 

weightlifting due to pain. He provided findings on examination. Dr. Thomen diagnosed 

osteoarthritis, history of right inguinal hernia, and status post right rotator cuff repair in 

continued pain. 

Dr. M. Stephen Wilson, an occupational medicine and pain management specialist, began 

to treat appellant in 2014 and indicated in October 21 and 29, 2014 narrative reports that he had 

examined appellant for injuries to appellant’s cervical spine, lumbar spine, left hip, and left knee 

as a result of his work-related duties as a city carrier for the employing establishment. He 

explained that to prepare for his route appellant sorted letters and packages, which required 

repetitive lifting, reaching, bending, and twisting. Dr. Wilson reported that appellant also had to 

walk for prolonged periods on concrete and walked up and down stairs several times a day. He 

related that, over the past couple of years, appellant developed increasing pain in his neck, back, 

left hip, and left knee. Dr. Wilson described appellant’s complaints of increasing pain over the 

years and reviewed his history. He noted that x-rays of the lumbar spine revealed degenerative 

changes and marginal spur formation, x-rays of the left hip were negative for acute 

abnormalities, x-rays of the cervical spine demonstrated changes with large anterior osteophytes 

at C5-6 and C6-7, and x-rays of the left knee revealed moderate medial joint space narrowing 

with small medial osteophytes. 
3

Upon physical examination of appellant’s cervical spine, Dr. Wilson observed tenderness 

to palpation in the bilateral paraspinal musculature from C3 through C6 and restricted range of 

motion. He also reported decreased sensation to monofilament testing at the C7-T1 nerve 

distribution of the bilateral upper extremities. Examination of the lumbar spine revealed muscle 

spasms that were palpable from L1 through S1, multiple trigger points palpable throughout the 

lumbar spine, and restricted range of motion. Straight leg raise testing was negative on the right 

and positive at 50 degrees on the left. Dr. Wilson reported that physical examination of the left 

hip revealed restricted range of motion and tenderness to palpation over the lateral aspect. 

Physical examination of the left knee revealed tenderness to palpation over the medial and lateral 

joint lines and crepitation. Range of motion was restricted and McMurray’s sign was positive, 

medially. 

Dr. Wilson diagnosed cumulative trauma injury to the cervical spine resulting in 

anatomical abnormalities due to degenerative changes and possible disc bulges causing upper 

extremity radiculopathy, cumulative trauma injury to the lumbar spine resulting in anatomical 

abnormalities due to degenerative changes in disc bulging causing lower extremity 

radiculopathy, cumulative trauma injury to the left hip resulting in anatomical abnormalities 

consistent with trochanteric bursitis, and cumulative trauma injury to the left knee resulting in 

anatomical abnormalities consistent with chondromalacia and degenerative joint disease. He 

opined that appellant had sustained injury to his cervical spine, lumbar spine, left hip, and left 

knee as a result of his work-related duties while employed by the employing establishment as a 

letter carrier. 

By letter dated December 11, 2014, OWCP advised appellant that the evidence submitted 

was insufficient to establish his claim. It requested that he respond to the attached questionnaire 

in order to substantiate the factual elements of his claim and that he provide additional medical 

evidence to establish a diagnosed condition causally related to his federal employment. A 

similar letter was sent to the employing establishment. 

On December 24, 2014 OWCP received appellant’s response to its request for further 

information. Appellant asserted that he believed that his original narrative statement was explicit 

regarding his job duties as a letter carrier and substantiated how the cumulative effect of the job 

duties contributed to his diagnosis. He resubmitted the statement he provided with his claim 

form. 

OWCP also received progress reports dated November 19, 2014 and January 6, 2015, 

from Dr. Wilson. Dr. Wilson noted that appellant had begun wearing braces on his left knee and 

believed that they helped. Upon examination of appellant’s cervical spine, he observed 

decreased range of motion and strength in all planes, as well as tenderness to palpation over the 

paraspinal musculature. Examination of his lumbar spine demonstrated decreased range of 

motion and strength and radicular symptoms on the left in the L5 and S1 distribution. Straight 

leg raise testing was negative on the right and positive on the left. Upon examination of 

appellant’s left hip, Dr. Wilson noted tenderness to palpation over the lateral aspect of the hip 

and weakness in all planes. Examination of the left knee revealed restricted range of motion and 

decreased strength, as well as tenderness to palpation over the joint medial line. McMurray’s 

sign was positive, medially. Dr. Wilson diagnosed cumulative trauma injury to the cervical 

spine resulting in anatomical abnormalities due to degenerative changes and possible disc 
4

bulging causing upper extremity radiculopathy, cumulative trauma injury to the lumbar spine 

resulting in anatomical abnormalities due to degenerative changes in disc bulging causing lower 

extremity radiculopathy, cumulative trauma injury to the left hip resulting in anatomical 

abnormalities consistent with trochanteric bursitis, and cumulative trauma injury to the left knee 

resulting in anatomical abnormalities consistent with chondromalacia and degenerative joint 

disease. 

On January 13, 2015 OWCP received a letter dated January 7, 2015 from an employing 

establishment health and resource management specialist, in response to its development letter. 

Ms. Anderson related that appellant’s supervisor confirmed that appellant had told him on a few 

occasions that he was going to a massage therapist to help with his back pain. She reported that 

appellant’s duties as a city carrier required frequent lifting, pushing, pulling, bending, and 

stooping. Ms. Anderson explained that all city carriers were given a 10-minute break in the 

morning and a 10-minute break in the afternoon, as well as a 30-minute lunch break. She 

provided a position description for a city carrier. 

OWCP denied appellant’s claim in a decision dated February 20, 2015. It accepted 

appellant’s employment duties as a letter carrier and that he sustained various diagnosed 

conditions to his lumbar spine, cervical spine, left knee, and left hip, but denied his claim finding 

that the medical evidence submitted failed to establish that his condition was causally related to 

factors of his federal employment. 

On March 16, 2015 OWCP received appellant’s request for a telephone hearing before an 

OWCP hearing representative, held on October 16, 2015. Appellant stated that he had worked 

for the employing establishment since April 2000 and retired on May 30, 2015 because the pain 

was too great. He related that he walked anywhere from 12 to 15 miles a day delivering mail and 

began experiencing pain in his neck, back, and left leg in 2014. Appellant noted that he did not 

experience any pain in his leg and back before he worked for the employing establishment. He 

reported that he had hernia surgery in 2006 and two shoulder surgeries in 2009 and 2011, but he 

pointed out that he used his own sick leave and insurance because none of his doctors handled 

workers’ compensation cases. Appellant indicated that his union representative recommended 

Dr. Wilson, so when he began to experience pain in his neck and back he went to see him. He 

noted that he worked with restrictions up until he retired and the aspect of his job that he found 

more difficult was carrying the satchel on his back and having to twist to retrieve mail if he had a 

third bundle. Appellant related that his route was all walking and no mounted delivery. He 

alleged that Dr. Wilson’s reports were sufficient to establish his claim. 

Appellant submitted a narrative report dated March 5, 2015 by Dr. Wilson who noted that 

he was treating appellant in regard to injuries he sustained to his cervical spine, lumbar spine, left 

hip, and left leg/knee as a result of his work-related duties as a city carrier for the employing 

establishment. Dr. Wilson related that, as he mentioned in his October 21, 2014 report, appellant 

worked for the employing establishment for over 15 years. He described that in order to sort 

letters and packages appellant performed repetitive lifting, reaching, bending, and twisting while 

pushing, and handling mail on a daily basis. Dr. Wilson noted that appellant also walked for 

prolonged periods of time on concrete and up and down stairs several times per day on his 

delivery route. He explained that the repetitive motion could cause undue pressure and trauma to 

the muscle, tendons, and ligaments of the neck and back, as well as to the hip and knee joints, 
5

which could result in progressively worsening pain. Dr. Wilson reported that these repetitive 

motions could also cause disc injury, often resulting in compression of the nerves due to disc 

bulging. He opined that appellant performed physically demanding repetitive job movements 

which caused progressively worsening pain in his neck and low back and radiculopathy into his 

left lower extremity, which limited his ability to function normally on a daily basis. Dr. Wilson 

related that appellant’s repetitive work activities required him to bend, stoop, squat, and walk for 

prolonged periods as well as to climb up and down stairs daily, which has caused significant 

issues with his left hip and left knee. This type of activity has also been known to exacerbate any 

underlying changes causing pain, weakness, and loss of range of motion. 

Dr. Wilson further explained that cumulative trauma disorders were injuries of the 

musculoskeletal system to include joints, muscles, tendons, and ligaments, due to overuse 

syndrome and repetitive motion. He noted that these symptoms developed from the 

accumulation of repeated small injuries or stresses to our musculoskeletal system in response to 

excessive or repeated demands on our body without enough time to recover before adding more 

stress. Dr. Wilson related that appellant was performing his repetitive duties on a daily basis and 

had little to no rest. He diagnosed cumulative trauma injury to the cervical spine resulting in 

anatomical abnormalities due to degenerative changes and possible disc bulging causing upper 

extremity radiculopathy, cumulative trauma injury to the lumbar spine resulting in anatomical 

abnormalities due to degenerative changes in disc bulging causing lower extremity 

radiculopathy, cumulative trauma injury to the left hip resulting in anatomical abnormalities 

consistent with trochanteric bursitis, and cumulative trauma injury to the left knee resulting in 

anatomical abnormalities consistent with chondromalacia and degenerative joint disease. 

In a decision dated January 6, 2016, an OWCP hearing representative affirmed the 

February 20, 2015 decision. She found that the medical evidence of record failed to provide 

adequate medical rationale to support a causal relationship between appellant’s medical 

conditions and his employment. The hearing representative noted that Dr. Wilson failed to 

address the related progress of the degenerative conditions and determined that his opinion 

regarding causal relationship was speculative. 

LEGAL PRECEDENT 

An employee seeking benefits under FECA has the burden of proof to establish the 

essential elements of his claim by the weight of the reliable, probative, and substantial evidence3

including that he or she sustained an injury in the performance of duty and that any specific 

condition or disability for work for which he or she claims compensation is causally related to 

that employment injury.4

 In an occupational disease claim, appellant’s burden requires 

submission of the following: (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 

 3 J.P., 59 ECAB 178 (2007); Joseph M. Whelan, 20 ECAB 55, 58 (1968). 

4 M.M., Docket No. 08-1510 (issued November 25, 2010); G.T., 59 ECAB 447 (2008); Elaine Pendleton, 40 

ECAB 1143, 1145 (1989). 
6

compensation is claimed; and (3) medical evidence establishing that the diagnosed condition is 

causally related to the employment factors identified by the employee.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

 

ANALYSIS 

The Board finds that this case is not in posture for a decision. 

Appellant alleged that he sustained various conditions to his neck, back, left knee, and 

left hip as a result of the repetitive duties of working as a letter carrier. In a detailed statement, 

he explained that as a letter carrier he spent several hours a day casing and sorting letters and 

flats, which required standing, reaching, and twisting his body from side to side and delivering 

mail, which required repetitively grasping mail, reaching to deposit mail in cases, and 

intermittent bending squatting, climbing, walking, and lifting. 

In support of his claim, appellant submitted various reports dated October 21, 2014 to 

March 5, 2015 from Dr. Wilson, who noted that appellant worked as a city carrier. He related 

that appellant sorted letters and packages, which required repetitive lifting, reaching, bending, 

and twisting, and walking for prolonged periods of time. Dr. Wilson reviewed appellant’s 

history and provided findings on examination. He diagnosed degenerative changes and disc 

bulges in the cervical and lumbar spines, upper and lower extremity radiculopathy, trochanteric 

bursitis of the left hip, and chondromalacia and degenerative joint disease of the left knee. He 

opined that appellant sustained an injury to his cervical spine, lumbar spine, left hip, and left 

knee as a result of his work-related duties while employed by the employing establishment as a 

letter carrier. In a March 5, 2015 report, Dr. Wilson explained how repetitive motion could 

cause undue pressure and trauma to the muscle, tendons, and ligaments of the neck, back, hip, 

and knee joints, as well as disc injury often resulting in compression of the nerves due to disc 

bulging. He reported that appellant’s repetitive activities requiring him to bend, stoop, squat, 

climb stairs, and walk for prolonged periods daily caused significant issues with his left hip and 

left knee. Dr. Wilson further described that this type of activity had also been known to 

exacerbate underlying changes causing pain, weakness, and loss of range of motion. Dr. Wilson 

noted that appellant performed repetitive duties on a daily basis without rest and diagnosed 

cumulative trauma injury to the cervical spine resulting in anatomical abnormalities due to 

degenerative changes and possible disc bulging causing upper extremity radiculopathy, 

cumulative trauma injury to the lumbar spine resulting in anatomical abnormalities due to 

 5 R.H., 59 ECAB 382 (2008); Ernest St. Pierre, 51 ECAB 623 (2000). 

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). 
7

degenerative changes in disc bulging causing lower extremity radiculopathy, cumulative trauma 

injury to the left hip resulting in anatomical abnormalities consistent with trochanteric bursitis, 

and cumulative trauma injury to the left knee resulting in anatomical abnormalities consistent 

with chondromalacia and degenerative joint disease. 

Accordingly, the Board notes that Dr. Wilson provided an affirmative opinion on causal 

relationship. The Board further finds that Dr. Wilson’s reports, when read together, identified 

employment factors which appellant claimed caused his condition, identified findings upon 

examination, and explained how the identified employment factors, specifically the repetitive 

duties of bending, stooping, squatting, and walking for prolonged periods, caused or aggravated 

appellant’s medical conditions. The Board finds that Dr. Wilson’s opinion, while not sufficiently 

rationalized to meet appellant’s burden of proof, is sufficient, given the absence of any opposing 

medical evidence, to require further development of the record.8

 It is well established that 

proceedings under FECA are not adversarial in nature, and while appellant has the burden to 

establish entitlement to compensation, OWCP shares responsibility in the development of the 

evidence.9

 OWCP has an obligation to see that justice is done.10

The case will be remanded to OWCP for further action consistent with this decision. On 

remand, after such further development of the case record as OWCP deems necessary, a de novo 

decision shall be issued. 

CONCLUSION 

The Board finds that this case is not in posture for a decision. 

 8 See A.F., Docket No. 15-1687 (issued June 9, 2016). See also John J. Carlone, 41 ECAB 354 (1989); Horace 

Langhorne, 29 ECAB 820 (1978). 

9 See e.g., Walter A. Fundinger, Jr., 37 ECAB 200, 204 (1985); Michael Gallo, 29 ECAB 159, 161 (1978); 

William N. Saathoff, 8 ECAB 769, 770-71; Dorothy L. Sidwell, 36 ECAB 699, 707 (1985). 

10 William J. Cantrell, 34 ECAB 1233, 1237 (1983); Gertrude E. Evans, 26 ECAB 195 (1974). 
8

ORDER 

IT IS HEREBY ORDERED THAT the January 6, 2016 decision of the Office of 

Workers’ Compensation Programs is set aside and the case is remanded for additional 

development consistent with this decision. 

Issued: March 7, 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