United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

I.T., Appellant

and

U.S. POSTAL SERVICE, BERGEN SOUTH 

STATION, Jersey City, NJ, Employer

__________________________________________

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Docket No. 17-1012

Issued: July 24, 2018

Appearances: Case Submitted on the Record

Thomas R. Uliase, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

COLLEEN DUFFY KIKO, Judge

ALEC J. KOROMILAS, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On April 10, 2017 appellant, through counsel, filed a timely appeal from a December 14, 

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. 

ISSUES

The issues are: (1) whether appellant met her burden of proof to expand the acceptance of 

her claim to include additional left knee conditions causally related to a December 23, 2014 

 

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

employment injury; (2) whether appellant met her burden of proof to establish disability for the 

period February 7 to August 7, 2015, causally related to the accepted employment injury; and, 

(3) whether OWCP abused its discretion by denying appellant authorization for left knee surgery.

On appeal counsel asserts that the medical evidence of record establishes entitlement to 

disability compensation and the need for left knee surgery.

FACTUAL HISTORY

On February 26, 2015 appellant, then a 32-year-old letter carrier, filed a traumatic injury 

claim (Form CA-1) alleging that on December 23, 2014 she tripped on wet steps in the rain and 

hit her left knee while in the performance of duty. In an undated statement, she described the 

injury and noted that she missed work intermittently between December 23, 2014 and February 25, 

2015 as she continued to have left knee pain and was still limping. Appellant related that, when 

she reported for work on February 26, 2015, a manager sent her home, gave her a claim form, and 

told her that she could not return to work until cleared for full duty by her physician. 

In a February 11, 2015 report, Dr. Howard S. Levine, an attending osteopath, advised that 

appellant could not work for two weeks due to a bruised bone in her left knee, advising that she 

was unable to climb stairs, and was limited in walking and standing. He prescribed physical 

therapy. On March 23, 2015 Dr. Levine noted that he had seen appellant beginning February 4, 

2015 for complaints of severe left knee pain. He related that a magnetic resonance imaging (MRI) 

scan of the left knee showed a bone bruise.3 In an attending physician’s report (Form CA-20) 

dated March 26, 2015, Dr. Levine diagnosed a left knee bone bruise, opined that it was 

employment related, and advised that appellant could only perform sedentary duty. He referred 

her to an orthopedic surgeon. 

On April 15, 2015 OWCP accepted contusion of the left knee. Appellant filed claims for 

compensation (Form CA-7) for the periods February 7 to July 10, 2015 and July 11 to 

August 7, 2015. 

Appellant thereafter submitted an unsigned disability slip from Dr. Levine’s office 

advising that she could not perform her job duties and was excused from work from February 26, 

2015, pending outcome of physical therapy and orthopedic referral. In reports dated May 20 and 

July 8, 2015, Dr. Levine advised that she had been examined that day and was unable to perform 

job duties. 

On March 5, 2015 Dr. Jeffrey F. Augustin, a Board-certified orthopedic surgeon, advised 

that appellant was seen in his office that day. In a treatment note dated April 2, 2015, he noted 

tenderness on left knee examination. Dr. Augustin advised that appellant could not return to work. 

On June 25, 2015 he advised that left knee x-ray demonstrated mild lateral tilt of the patella. On 

July 23, 2015 Dr. Augustin reported that appellant was still complaining of left knee pain. He 

 

3 One page of a February 6, 2016 left knee MRI scan demonstrated intact anterior and posterior cruciate ligaments, 

intact medial and lateral menisci, intact medial and lateral collateral ligaments, and intact quadriceps and patellar 

tendons. 
3

found lateral peripatellar tenderness to palpation and recommended left knee arthroscopic lateral 

retinacular release. 

By development letter dated August 17, 2015, OWCP informed appellant of the evidence 

needed to support her claims for disability from February 7 through August 7, 2015. Appellant

was allotted 30 days to provide the necessary information. 

In an undated statement, appellant reiterated that she was told by a manager on 

February 26, 2015 that she could not return to work until she was fit for full duty. 

Dr. Augustin requested authorization for left knee surgery on September 9, 2015. In 

correspondence that day, OWCP informed appellant that the medical evidence submitted was not 

sufficient to establish that the requested procedure was medically necessary or causally related to 

the accepted condition. It informed her that, if her physician believed a newly diagnosed condition 

was caused by the December 23, 2014 employment injury, the physician should submit a detailed 

narrative report explaining why the condition was caused or aggravated by the employment injury. 

OWCP allotted appellant 30 days to provide the medical report. 

By decision dated September 17, 2015, OWCP denied appellant’s claim for disability from 

February 7 through August 7, 2015. It found the medical evidence insufficient to establish that 

the claimed disability was due to the accepted employment injury. 

Appellant thereafter submitted a complete copy of the February 6, 2015 left knee MRI 

scan. This revealed a small bone bruise in the medial femoral condyles adjacent to the articular 

surface. In a March 5, 2015 treatment note, Dr. Augustin noted that appellant was referred to him 

for left knee pain. He reported left knee findings of some tenderness along the medial femoral 

condyle with full extension and flexion, stable varus and valgus stress, and a negative Lachman’s 

sign. Dr. Augustin described MRI scan findings of what appeared to be a bone contusion of the 

medial femoral condyle with no obvious ligament tears and intact menisci. He diagnosed left knee 

contusion. On September 29, 2015 Dr. Augustin advised that appellant had been under his care 

since March 2015 for a left knee injury, with six months of failed nonsurgical management 

including bracing, cortisone injections, physical therapy, and oral nonsteroidal anti-inflammatory 

medication. He noted her continued complaint of left knee pain when last seen on September 28, 

2015 and advised that, due to failed nonsurgical management, it was necessary to proceed with 

left knee arthroscopy for lateral retinacular release. 

By decision dated October 26, 2015, OWCP denied appellant’s request for authorization 

of left knee surgery, finding the medical evidence submitted of insufficient rationale to authorize 

the requested procedure. 

On March 14, 2016 appellant, through counsel, requested reconsideration of the 

September 17, 2015 decision denying disability compensation. In a March 3, 2016 statement, she

related that a manager told her not to return to work until she was cleared by a physician for full 

duty. 

On August 12, 2016 counsel requested reconsideration of the October 26, 2015 decision 

denying authorization for surgery. He also requested that the acceptance of the claim be expanded 
4

to include lateral tilt of left patella, chondromalacia of the patella of the left knee, and articular 

surface damage of the left knee. 

Appellant submitted additional evidence on March 14, 2016. In a September 2, 2015 

report, Dr. Levine described the employment injury and noted that he began treating her on 

February 4, 2015 for left knee pain. He described the MRI scan findings and noted that appellant 

was referred to Dr. Augustin, who recommended left knee surgery. Dr. Levine indicated that 

further testing showed that the December 2014 fall caused her left knee cap to become dislocated 

which required surgery for realignment. He concluded that, due to the employment-related 

condition, appellant was disabled until surgery and postsurgery recovery were completed and, 

pending the surgical outcome, she should then be able to return to full duty.4 

Appellant also submitted reports from Dr. Robin R. Innella, a Board-certified osteopath

specializing in orthopedic surgery, who began treating appellant on December 9, 2015. Dr. Innella 

noted a history that appellant hurt her left knee at work in December 2014 when she slipped on a 

step while delivering mail in the rain. She described appellant’s medical care to date and

appellant’s complaints of frequent buckling of the knee and difficulty walking, sitting, and 

ambulating on stairs. Dr. Innella reported positive left knee findings of periarticular swelling and 

medial and lateral joint line tenderness. She diagnosed left knee chondromalacia patella and 

contusion. Dr. Innella opined that appellant most likely sustained an articular surface injury and 

recommended arthroscopy. She advised that appellant could work light duty only. Dr. Innella 

continued to submit monthly treatment notes in describing appellant’s continued left knee 

complaints with consistent examination findings. She reiterated her diagnoses, opining that, with 

a reasonable degree of medical probability, appellant’s knee injuries were causally related to the 

December 23, 2014 employment injury. Dr. Innella advised that appellant was refractory to 

conservative care. She continued to advise that appellant could perform light duty and 

recommended arthroscopic surgery. 

On February 15, 2016 Dr. Innella requested authorization for left knee surgery. In reports 

dated March 9 and April 6, 2016, she provided specific restrictions to appellant’s physical activity. 

On April 11, 2016 Dr. Innella additionally diagnosed contusion of left knee with articular surface

injury of patella medial femoral condyle and post-traumatic synovitis. On July 10, 2016 she

advised that appellant’s left knee condition caused her to be unable to work from the time of injury

until December 2015, at which time she recommended that appellant could return to modified 

duty. 

In correspondence dated August 12, 2016, appellant reiterated that on February 26, 2015 a 

manager told her she could not work until she was cleared for full duty. She described her medical 

management, noting that both Dr. Augustin and Dr. Innella recommended surgery. Appellant 

maintained that, beginning in March 2016, she had contacted the employing establishment 

requesting light duty, but had not received a response. 

On November 9, 2016 Dr. Innella reported that appellant had continued complaints of 

constant left knee pain, and noted that she previously had physical therapy and injections without 

 

4 OWCP referenced a September 2, 2015 report in its September 17, 2015 decision. The report was not found in 

the case record at that time.
5

improvement. She provided physical examination findings and advised that appellant’s condition 

was essentially unchanged, she could perform light duty, and was awaiting approval for surgery. 

In a merit decision dated December 14, 2017, OWCP denied modification of the 

September 17 and October 26, 2015 decisions. It found the medical evidence insufficient to 

establish “any other medical conditions” causally related to the accepted employment injury and 

any claimed employment-related disability. Additionally, OWCP found that, as the medical 

evidence was insufficient to establish the necessity for left knee arthroscopic surgery, it was not 

authorized.

5

 

LEGAL PRECEDENT -- ISSUE 1

An employee has the burden of proof to establish that any specific condition for which 

compensation is claimed is causally related to the employment injury.6 Causal relationship is a 

medical issue, and the medical evidence required to establish a causal relationship is rationalized 

medical evidence.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 employee.8 Neither the mere 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.9

ANALYSIS -- ISSUE 1 

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

left knee conditions were caused or aggravated by, or were a consequence of the accepted 

December 23, 2014 employment injury. OWCP accepted contusion of the left knee caused by the 

December 23, 2014 employment injury. 

The opinion of a physician supporting causal relationship must be based on a complete 

factual and medical background, supported by affirmative evidence, must address the specific 

factual and medical evidence of record, and must provide medical rationale explaining the nature 

of the relationship between the diagnosed condition and the established incident or factor of 

employment.10 No physician did so in this case.

 

5 Appellant continued to submit Form CA-7, claims for compensation, for dates through November 11, 2016. By 

letter dated December 14, 2016, it advised her of the evidence needed to establish these claims. 

6 Kenneth R. Love, 50 ECAB 276 (1999).

7

Jacqueline M. Nixon-Steward, 52 ECAB 140 (2000).

8 Leslie C. Moore, 52 ECAB 132 (2000); Gary L. Fowler, 45 ECAB 365 (1994).

9 Dennis M. Mascarenas, 49 ECAB 215 (1997).

10 Robert Broome, 55 ECAB 339 (2004).
6

Diagnostic studies of the left knee did not provide a cause of any diagnosed conditions and 

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.11 

The medical reports most contemporaneous with the December 23, 2014 employment 

injury were those of Dr. Levine who first saw appellant on February 11, 2015 and diagnosed a 

bone bruise. While he continued to submit reports in which he noted severe left knee pain and

advised that appellant’s condition was employment related, at no time did he mention the 

December 23, 2014 employment injury or provide an opinion of how this injury caused any other 

left knee condition, including the bone bruise he diagnosed. Dr. Levine’s reports are, therefore, of 

insufficient probative value to establish causal relationship.12

Likewise Dr. Augustin, who first saw appellant on March 2, 2015, did not relate any 

diagnosed condition to the December 23, 2014 employment injury. On March 5, 2015 he noted 

tenderness on knee examination and diagnosed left knee contusion, the accepted condition. On 

June 25, 2015 Dr. Augustin noted that a left knee x-ray demonstrated a mild lateral title to the 

patella and recommended left knee arthroscopic surgery on July 23, 2015. 

Dr. Innella began treating appellant on December 9, 2015. She noted a history that 

appellant hurt her left knee at work in December 2014 when she slipped on a step while delivering 

mail in the rain. Dr. Innella described appellant’s medical care to date, her complaints of frequent 

buckling of the knee and difficulty walking, sitting, and ambulating on stairs, and reported positive 

left knee findings of periarticular swelling and medial and lateral joint line tenderness. She

diagnosed left knee chondromalacia patella and contusion and opined that appellant most likely 

sustained an articular surface injury related to the December 23, 2014 employment injury. 

Dr. Innella, however, did not provide a rationalized explanation of how the December 23, 2014 

employment injury when appellant tripped and hit her left knee caused the diagnosed conditions.13 

As such, her opinion is insufficient to establish additional accepted conditions. 

To establish causal relationship, a claimant must submit a physician’s report in which the 

physician reviews the employment factors identified as causing the claimed condition and, taking 

these factors into consideration as well as findings upon examination, states whether the 

employment injury caused or aggravated the diagnosed conditions and presents medical rationale 

in support of her opinion.14 Moreover, the Board has long held that contemporaneous evidence is 

entitled to greater probative value than later evidence,

15 and Dr. Innella did not begin treatment 

with appellant until almost one year after the employment injury.

 

11 Willie M. Miller, 53 ECAB 697 (2002).

12 Leslie C. Moore, supra note 8.

13 See J.M., Docket No. 15-1906 (issued January 7, 2016).

14 D.E., 58 ECAB 448 (2007).

15 S.S., 59 ECAB 315 (2008).
7

Rationalized medical evidence is evidence which relates a work incident or factors of 

employment to a claimant’s condition, with stated reasons of a physician. The opinion must be 

one of reasonable medical certainty and must be supported by medical rationale explaining the 

nature of the relationship of the diagnosed condition and the specific employment factors or 

employment injury.16 The Board finds that appellant has not submitted sufficient rationalized 

medical evidence supporting a causal relationship between any of the claimed additional left knee 

conditions and the December 23, 2014 employment injury. As such, appellant has failed to meet 

her burden of proof.

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.

LEGAL PRECEDENT -- ISSUE 2

Under FECA the term “disability” means the incapacity, because of an employment injury, 

to earn the wages that the employee was receiving at the time of injury. Disability is thus not 

synonymous with physical impairment, which may or may not result in an incapacity to earn 

wages. An employee who has a physical impairment causally related to a federal employment 

injury, but who nevertheless has the capacity to earn the wages he or she was receiving at the time 

of injury, has no disability as that term is used in FECA.17 Furthermore, whether a particular injury 

causes an employee to be disabled for employment and the duration of that disability are medical 

issues which must be proved by a preponderance of the reliable, probative, and substantial medical 

evidence.18

ANALYSIS -- ISSUE 2 

The Board finds that appellant has not establish that she was disabled due to the accepted 

left knee contusion.

As noted above, appellant did not establish that the December 23, 2014 employment injury 

caused additional left knee conditions. 

The issue of disability from work can only be resolved by competent medical evidence.19 

Whether a claimant’s disability is related to an accepted condition is a medical question which 

must be established by a physician who, on the basis of a complete and accurate factual and 

medical history, concludes that the disability is causally related to employment factors and 

supports that conclusion with sound medical reasoning.20 The record contains no medical opinion 

 

16 C.O., Docket No. 10-0189 (issued July 15, 2010).

17 See 20 C.F.R. § 10.5(f); Cheryl L. Decavitch, 50 ECAB 397 (1999).

18 Fereidoon Kharabi, 52 ECAB 291 (2001).

19 R.C., 59 ECAB 546 (2008).

20 See Sandra D. Pruitt, 57 ECAB 126 (2005).
8

of sufficient rationale to establish that appellant was disabled due to the accepted left knee 

contusion.

In reports beginning on February 11, 2015, Dr. Levine advised that appellant could not 

work and diagnosed a bruised bone in her left knee. A bruised bone has not been accepted as 

employment related, and he did not explain in any of his reports through July 8, 2015 how or why 

the accepted left knee contusion caused her any disability from work. Likewise, while

Dr. Augustin advised that appellant could not work, he too did not explain how or why the left 

knee contusion caused total disability. Dr. Innella advised that appellant was restricted to light 

duty, but she too did not explain why the accepted left knee contusion rendered appellant totally 

disabled. 

As appellant did not submit sufficient rationalized medical opinion evidence to establish 

that she was disabled for work during the period February 7 to August 7, 2015 due to the accepted 

left knee contusion, she failed to meet her burden of proof. She was thus not entitled to wage-loss 

compensation for this period.21

LEGAL PRECEDENT -- ISSUE 3

Section 8103 of FECA provides that the United States shall furnish to an employee who is 

injured while in the performance of duty, the services, appliances, and supplies prescribed or 

recommended by a qualified physician, which OWCP considers likely to cure, give relief, reduce 

the degree or the period of disability, or aid in lessening the amount of the monthly compensation.22 

To be entitled to reimbursement of medical expenses, a claimant has the burden of proof 

to establish that the expenditures were incurred for treatment of the effects of an employmentrelated injury or condition. Proof of causal relationship in a case such as this must include 

supporting rationalized medical evidence.23 In order for a surgical procedure to be authorized, a 

claimant must submit evidence to show that the surgery is for a condition causally related to an 

employment injury and that it is medically warranted. Both of these criteria must be met in order 

for OWCP to authorize payment.24 

 

In interpreting this section of FECA, the Board has recognized that OWCP has broad 

discretion in approving services provided under FECA. OWCP has the general objective of 

ensuring that an employee recovers from his or her injury to the fullest extent possible in the 

shortest amount of time. It, therefore, has broad administrative discretion in choosing means to 

achieve this goal. The only limitation on OWCP’s authority is that of reasonableness. Abuse of 

discretion is generally shown through proof of manifest error, clearly unreasonable exercise of 

judgment, or actions taken which are contrary to both logic and probable deductions from 

 

21 R.R., Docket No. 17-1223 (issued February 6, 2018).

22 5 U.S.C. § 8103; see Dona M. Mahurin, 54 ECAB 309 (2003).

23 M.B., 58 ECAB 588 (2007).

24 R.C., 58 ECAB 238 (2006).
9

established facts. It is not enough to merely show that the evidence could be construed so as to 

produce a contrary factual conclusion.25

While OWCP is obligated to pay for treatment of employment-related conditions, the 

employee has the burden of proof to establish that the expenditure is incurred for treatment of the 

effects of an employment-related injury or condition.26

ANALYSIS -- ISSUE 3

The Board finds that OWCP did not abuse its discretion in denying authorization for left 

knee surgery.

For a surgical procedure to be authorized, a claimant must submit evidence to show that 

the surgery is for a condition causally related to an employment injury and that it is medically 

warranted. Both of these criteria must be met in order for OWCP to authorize payment.27 

Dr. Augustin who began treating appellant in March 2015 recommended left knee 

arthroscopic lateral retinacular release for left patellar tilt. Dr. Levine who diagnosed a dislocated 

left knee cap also recommended surgery. Dr. Innella requested authorization for arthroscopic left 

knee surgery for articular surface injury of patella medial femoral condyle. 

As indicated above, none of these conditions have been accepted as employment related. 

Appellant must submit evidence that shows that the requested medical procedure is both due to a 

condition causally related to an employment injury and that it is medically warranted. In the 

preceding analysis, the Board explained why the medical evidence did not support that additional 

left knee conditions were causally related to the December 23, 2014 employment injury. As the 

requested surgery has not been established to be causally related to appellant’s employment injury, 

OWCP did not abuse its discretion by denying her requests for surgery. 

Based on the evidence of record, the Board finds that OWCP did not abuse it discretion in 

denying the proposed surgical procedure. As noted above, the only restriction on OWCP’s 

authority to authorize medical treatment is one of reasonableness.28 Absent sufficient explanation 

as to why the proposed surgery was causally related to the December 23, 2014 employment injury, 

the Board finds that OWCP acted reasonably in denying appellant’s request for left knee surgery.

29

CONCLUSION

The Board finds that appellant failed to meet her burden of proof to expand the acceptance 

of her claim to include additional left knee conditions causally related to a December 23, 2014 

 

25 Daniel J. Perea, 42 ECAB 214 (1990).

26 Kennett O. Collins, Jr. 55 ECAB 648 (2004). 

27 Supra note 24.

28 See D.C., 58 ECAB 629 (2007).

29 B.L., Docket No. 15-1452 (issued September 20, 2016).
10

employment injury and did not establish disability for the period February 7 to August 7, 2015, 

causally related to the accepted injury. The Board further finds that OWCP properly exercised its 

discretion by denying appellant authorization for left knee surgery.30

ORDER

IT IS HEREBY ORDERED THAT the December 14, 2016 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: July 24, 2018

Washington, DC

Alec J. Koromilas, Alternate Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board

 

30 Colleen Duffy Kiko, Judge, participated in the preparation of the decision, but was no longer a member of the 

Board effective December 11, 2017.