United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

W.G., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Boston, MA, Employer 

__________________________________________ 

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Docket No. 16-0667 

Issued: May 18, 2016 

Appearances: Case Submitted on the Record

Daniel B. Shapiro, Esq., for the appellant 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

CHRISTOPHER J. GODFREY, Chief Judge 

ALEC J. KOROMILAS, Alternate Judge 

VALERIE D. EVANS-HARRELL, Alternate Judge 

JURISDICTION 

On February 22, 2016 appellant, through counsel, filed a timely appeal of a December 9, 

2015 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 to consider the merits of the case. 

ISSUE 

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

the left hip due to factors of his federal employment. 

On appeal counsel argues that the July 31, 2014 report of Dr. Byron V. Hartunian, an 

orthopedic surgeon, was sufficient to meet appellant’s burden of proof. He provided his 

disagreement with each of the points raised by OWCP’s hearing representative in regard to 

Dr. Hartunian’s report. 

 1

 5 U.S.C. § 8101 et seq.
2

FACTUAL HISTORY 

On August 20, 2014 appellant, then a 67-year-old letter carrier, filed an occupational 

disease claim (Form CA-2) alleging that he developed an acceleration of his osteoarthritis in his 

right knee due to his employment duties. He indicated that he first became aware of his 

condition and first attributed his condition to his employment on June 18, 2014. On the reverse 

of the form, appellant’s supervisor indicated that he had retired from the employing 

establishment on August 31, 2011. 

Appellant noted that he was not certain when his right knee arthritis began, but believed 

that this condition was evidenced on x-rays in 2010. He further indicated that his hip arthritis 

was diagnosed in 2010 at the same time as trochanteric bursitis. Appellant described his job 

duties of climbing in and out of his truck 400 times a day, loading and unloading mail and 

parcels, climbing stairs to make deliveries, lifting, carrying, pushing, pulling, climbing, bending, 

stooping, driving a truck, and maneuvering heavy equipment weighing up to 1,000 pounds. He 

indicated that his route required both collections and deliveries and that he spent 8 to 10 hours a 

day performing his job activities. 

Dr. Christopher W. Digiovanni, a Board-certified orthopedic surgeon, examined 

appellant on September 11 and October 2, 2003 due to complaints of right ankle pain. He 

diagnosed early arthrosis and opined that this was a preexisting condition exacerbated by 

appellant’s job duties. In a note dated January 20, 2010, Dr. Randal Kaufman, a Board-certified 

internist and cardiologist, diagnosed “arthritic type” pain in the knees and ankles. 

On January 28, February 11, and June 18, 2010, and February 3 and August 8, 2011 

Dr. Amparo Gordian, a Board-certified internist and rheumatologist, diagnosed trochanteric 

bursitis, osteoarthritis right hip, bilateral knee osteoarthritis, patellafemoral syndrome, 

osteoarthritis, and arthralgia bilateral lower extremities. He indicated that appellant pointed to 

his left trochanteric bursa and described burning pain when walking or sitting. 

Dr. Saul Magitsky, a Board-certified orthopedic surgeon, treated appellant on February 2, 

2010 for bilateral knee pain, as well as right hip, ankle, and heel pain. He reviewed radiographs 

of the knees and right ankle and found evidence of degenerative changes consistent with loss of 

joint space in the medial compartment and early osteophyte formation. 

Dr. Robert M. Shalvoy, a Board-certified orthopedic surgeon, examined appellant on 

December 20, 2012 and reported findings of bilateral knee and right hip pain. He noted that he 

had previously treated appellant for knee osteoarthritis. Appellant had undergone a left knee 

arthroscopy in the past. Dr. Shalvoy found that appellant’s hip motions were full bilaterally 

without any pain or instability. He also found mild varus alignment in appellant’s knees with 

crepitance and diffuse tenderness. Dr. Shalvoy examined x-rays including anteroposterior views 

of the pelvis and lateral views of the right hip and found some sclerosis on the superior rim of the 

acetabulum and some calcification off the greater tuberosity. He concluded that these x-rays 

otherwise demonstrated normal osseous anatomy. Dr. Shalvoy diagnosed right hip strain and 

bilateral knee osteoarthritis. 
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In a report dated January 24, 2013, Dr. Digiovanni examined appellant due to heel and 

ankle pain. 

Appellant’s pelvic x-rays dated March 14, 2014 demonstrated osteoarthritis of the hips 

and lumbosacral spine with mild narrowing of the hip joints, spurring of the acetabula and 

femoral heads, evidence of possible old fractured spurs, and large left lumbosacral osteophytes 

as well as calcification of the bilateral sacrotuberal ligaments. 

Dr. Hartunian completed a report on July 31, 2014. He noted reviewing appellant’s 

medical records and job description. Dr. Hartunian described appellant’s right ankle condition 

and treatment as well as his right knee pain beginning in 2010. He indicated that in 

February 2010 appellant received a diagnosis of right hip bursitis. Dr. Hartunian reviewed 

Drs. Gordian’s and Shalvoy’s reports regarding appellant’s lower extremities including left knee 

arthroscopy in 2006. He found that Dr. Gordian followed appellant for left hip pain and 

diagnosed osteoarthritis and bursitis. Dr. Hartunian examined the December 20, 2012 x-rays 

from Dr. Shalvoy and found arthritis of the hip specifically the superior rim of the acetabulum on 

the right. He found that x-rays indicated that the femoral heads were spherical with narrowing of 

the medial femoralacetabular joint bilaterally to two millimeters of cartilage interval. 

Dr. Hartunian noted that there was no separate radiological report of the December 20, 2012 

x-rays, but that the record of Dr. Shalvoy was consistent with this assessment. 

Dr. Hartunian examined appellant and found palpable tenderness over the greater 

trochanter area of the hips bilaterally, with limited range of motion, and groin pain on combined 

flexion and rotation. He diagnosed right and left hip trochanteric bursitis and arthritis with two 

millimeters of cartilage interval at the medial femoralacetabular joint, right knee arthritis with 

three millimeters of cartilage interval at the medial femorotibial, and knee joint arthritis on the 

left. 

Dr. Hartunian defined arthritis as a failure and loss of articular cartilage surface. He 

opined that the progression of arthritis was accelerated through a process of impact loading 

resulting from repeated local stresses causing chronic inflammation. Dr. Hartunian noted that 

appellant’s job required constant and repetitive walking, squatting, stooping, climbing, bending, 

lifting, carrying, stair climbing, and twisting. He found, “It is the impact loading resulting from 

these heavy physical duties and the constant and continuous repeated local stresses regularly 

occurring over the course of a workday and which is repeated day after day that accelerates the 

progression of the underlying arthritis.” Dr. Hartunian further indicated, “The primary chemical 

change is the loss of proteoglycans and is initiated by activation of degradative enzymes 

associated with inflammation. These proteoglycans are responsible for cartilage resilience and 

their loss from the cartilage results in a stiffer material that is more easily damages by ‘wear and 

tear.’” He concluded that appellant’s job duties were causative contributing factors to the 

development and progression of lower extremity arthritis. Dr. Hartunian noted that had 

appellant’s work-related activities been of sedentary nature those activities would not have 

contributed to the progression of his bilateral hip and right knee arthritis to the same extent. 

In a letter dated October 3, 2014, OWCP requested that appellant provide evidence that 

his claim was timely as well as supportive factual and medical evidence. It noted that he had 

previously filed a Form CA-2 for right hip, bilateral knee, right ankle, and right heel on 
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January 28, 2010. Appellant responded and indicated that he was not aware of the relationship 

between his employment and his conditions until he was examined by Dr. Hartunian on 

June 18, 2014. He further noted that OWCP denied his prior claim on March 30, 2010. 

Appellant submitted his medical records from Dr. Shalvoy’s office regarding his left knee 

dated from August 24, 2006, including the September 8, 2006 surgery, through June 2007. 

OWCP referred the medical evidence in appellant’s claim to the OWCP medical adviser 

on February 3, 2015. The medical adviser reviewed this evidence on February 5, 2015 and 

found that appellant had a history of right knee and right hip symptoms which were in part 

related to his work duties. He found that appellant’s work-related duties aggravated the 

underlying degenerative changes in the right knee and hip advancing his osteoarthritis. The 

medical adviser further found that there was no evidence to support ongoing left hip issues. He 

noted that Dr. Hartunian found that Dr. Gordian was treating appellant for a left hip condition, 

but that the medical evidence did not support this finding. The medical adviser found that on 

January 28, 2010 Dr. Gordian noted that appellant was experiencing problems with his left 

trochanteric bursae, but noted no left hip abnormalities on examination on that date, nor on 

February 11, 2010. He noted that Dr. Shalvoy did not mention left hip symptoms. 

By decision dated February 11, 2015, OWCP accepted appellant’s claim for acceleration 

of right hip and right knee osteoarthritis, but denied acceptance of the left hip osteoarthritis. 

Counsel requested an oral hearing with OWCP’s Branch of Hearings and Review 

(BH&R) on February 23, 2015. In a memorandum dated September 23, 2015, he argued that 

Dr. Hartunian’s report was sufficiently detailed and well reasoned to establish appellant’s claim 

for left hip osteoarthritis as well as the two other conditions accepted by OWCP. Counsel 

appeared at the oral hearing before a hearing representative of OWCP’s BH&R on 

September 23, 2015 and argued that x-rays supported the diagnosis of left hip osteoarthritis due 

to appellant’s employment duties. 

By decision dated December 9, 2015, OWCP’s hearing representative found that the 

medical evidence did not establish appellant’s claim for a left hip condition due to his federal job 

duties. 

LEGAL PRECEDENT 

To establish that an injury was sustained in the performance of duty in an occupational 

disease claim, a claimant must submit the following: (1) medical evidence establishing the 

presence or existence of the disease or condition for which compensation is claimed; (2) a factual 

statement identifying employment factors alleged to have caused or contributed to the presence 

or occurrence of the disease or condition; and (3) medical evidence establishing that the 

employment factors identified by the claimant were the proximate cause of the condition for 

which compensation is claimed or, stated differently, medical evidence establishing that the 

diagnosed condition is causally related to the employment factors identified by the claimant. 

The evidence required to establish causal relationship is rationalized medical opinion evidence, 

based upon a complete factual and medical background, showing a causal relationship between 
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the claimed condition and identified factors. The belief of a claimant that a condition was caused 

or aggravated by the employment is not sufficient to establish causal relation.2

ANALYSIS 

The Board finds that appellant has not submitted the necessary medical evidence to 

establish a causal relationship between his diagnosed left hip osteoarthritis and his accepted 

employment duties. 

Appellant submitted a report dated July 31, 2014 from Dr. Hartunian addressing the 

causal relationship between appellant’s left hip condition and his employment duties. He relied 

on appellant’s medical record finding that Dr. Gordian diagnosed left hip pain with osteoarthritis 

and bursitis. The Board found in reviewing Dr. Gordian’s reports that he indicated that appellant 

pointed to his left trochanteric bursa and described burning pain when walking or sitting. While 

Dr. Gordian diagnosed right knee and hip osteoarthritis he did not diagnose any left lower 

extremity condition other than arthralgia bilateral lower extremities. Given his clear diagnosis of 

osteoarthritis when addressing appellant’s right lower extremity conditions, the Board finds this 

distinction with regard to appellant’s left hip compelling evidence that he was not supporting 

osteoarthritis of the left hip. 

Dr. Hartunian further relied on December 20, 2012 x-rays taken by Dr. Shalvoy finding 

that these demonstrated left hip osteoarthritis. Dr. Shalvoy reviewed these x-rays in his 

December 20, 2012 report, but did not explicitly diagnose left hip osteoarthritis or any left hip 

condition. He found some sclerosis on the superior rim of the acetabulum and some calcification 

of the greater tuberosity on the right hip. Dr. Shalvoy concluded that these x-rays otherwise 

demonstrated normal osseous anatomy. He diagnosed right hip strain. The Board is unable to 

determine how Dr. Hartunian extrapolated Dr. Shalvoy’s findings and conclusions based on 

review of his report without a separate review of the prior x-rays or a separate x-ray report 

including additional findings of cartilage intervals and specific findings on the left. 

The Board finds that the first clear and exact diagnosis of left hip osteoarthritis is made in 

appellant’s pelvic x-rays dated March 14, 2014. Dr. Hartunian’s July 31, 2014 report also 

provided findings on physical examination and a diagnosis of both left hip trochanteric bursitis 

and arthritis. Although he explained how appellant’s employment duties accelerated the 

previously diagnosed conditions of right knee and right hip osteoarthritis, Dr. Hartunian did not 

provide a separate explanation of how or why appellant’s left hip osteoarthritis would be 

impacted by his employment almost three years after this employment ended. 

The Board further notes that OWCP’s medical adviser reviewed the medical record and 

found that the evidence was insufficient to support Dr. Hartunian’s findings of left hip arthritis 

accelerated by appellant’s employment. The medical adviser disagreed with Dr. Hartunian’s 

characterization of Drs. Gordian’s and Shalvoy’s reports with regard to appellant’s ongoing left 

hip condition. Only Dr. Shalvoy read appellant’s December 2012 x-rays on a date several 

months after appellant’s employment ceased and he did not diagnose a specific left hip condition 

 2 Lourdes Harris, 45 ECAB 545, 547 (1994). 
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based on those x-rays. Contrary to counsel’s arguments on appeal, the Board finds that as 

Dr. Hartunian mischaracterized the contemporaneous medical evidence with regard to 

appellant’s left hip condition, his report dated July 31, 2014, is not sufficiently detailed to 

establish a causal relationship between appellant’s employment exposures ending in 2011 and his 

left hip osteoarthritis diagnosed in 2014. 

CONCLUSION 

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

osteoarthritis due to factors of his federal employment. 

ORDER 

IT IS HEREBY ORDERED THAT the December 9, 2015 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: May 18, 2016 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board 

 

 Valerie D. Evans-Harrell, Alternate Judge 

 Employees’ Compensation Appeals Board