United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

P.A., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Buston, OH, Employer

__________________________________________

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Docket No. 17-1013

Issued: November 1, 2017

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant1

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 April 10, 2017 appellant, through counsel, filed a timely appeal from a February 27, 

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.

ISSUE

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

osteoarthritis is causally related to factors of her federal employment.

 

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 February 24, 2016 appellant, then a 64-year-old rural carrier, filed an occupational 

disease claim (Form CA-2) alleging that she sustained osteoarthritis of the left knee as a result of 

bending and pulling heavy objects in the course of her federal employment. She first became 

aware of her condition and its relationship to her employment on January 21, 2016. Appellant

did not stop work. 

In a written statement, appellant explained that the use of her knees was an integral part 

of her duties, which consisted of standing and casing mail for four to five hours per day 

depending on the volume of mail, loading mail into trays and carts, pushing the carts to the dock, 

and loading the trays of mail onto a truck. She noted that performing these duties required 

bending and twisting of the knees.

In a progress note dated June 8, 2012, Dr. Michael Kellis, Board-certified in sports 

medicine, noted that appellant visited his office for evaluation of her left knee. Appellant told

Dr. Kellis that she had bumped her left knee on a bin and had begun to experience pain and 

swelling of the left knee. She denied any other trauma or injury. Dr. Kellis diagnosed her with 

osteoarthritic changes of the left knee, aggravated at the time of impact.

On September 9, 2013 Dr. Kellis noted that appellant had returned for evaluation of her 

left knee condition, which she had been dealing with for many years. He noted that her knee was 

“bone-on-bone” and would eventually require knee replacement.

In a progress note dated November 11, 2013, Dr. Kellis noted that appellant had been 

experiencing pain in her left knee, and that she had recently tripped over a dog biscuit on the 

floor, which tweaked and sprained the knee. He noted that he was concerned about additional 

trauma, and would schedule a Supartz injection.

In an operative report dated November 21, 2016, Dr. Kellis recorded an infrapatellar 

Supartz injection to appellant’s left knee. He noted that prior injections had resulted in 

substantial improvement.

In a report dated January 21, 2016, Dr. Kellis examined appellant and diagnosed her with 

unilateral primary osteoarthritis of the left knee. He noted that appellant’s knee needed to be 

replaced. Dr. Kellis noted no acute trauma, but noted that appellant had fractured her patella 

many years before the visit.

By letter dated April 8, 2016, OWCP informed appellant that she had not submitted 

sufficient documentation to support her claim. It noted that she had not submitted medical 

reports establishing that her diagnosed left knee osteoarthritis was caused or aggravated by duties 

of her federal employment. OWCP asked appellant to respond to a questionnaire. Appellant 

was afforded 30 days to submit the additional evidence. 

On May 10, 2016 appellant responded to the questionnaire. She detailed the duties her 

federal employment she alleged had aggravated her left knee condition, including standing while 

casing mail, putting cased mail into trays, loading the trays onto carts, pushing carts out to a 

loading dock, and loading the mail delivery truck. Appellant further explained the delivery 
3

process itself, particularly the cramped conditions of her delivery truck. She noted that she 

attended football games, but did not play any sports or participate in strenuous activities because 

she was too tired after work. Appellant explained that the date of injury she reported was the 

date that she found out that her knee had to be replaced.

By letter dated April 25, 2016, Dr. Kellis noted that appellant had osteoarthritic changes 

of the left knee and had worked for the Federal Government as a rural mail carrier for 29 years. 

He explained, “[appellant] has had a contusion of the patella in the past, as well as various other 

over-use syndromes related to her employment. She has been climbing in and out of the mail 

truck for many years, and her knee is in a very precarious position while driving the mail truck. 

It puts her at an angle that causes a lot of pressure to be placed onto the patella, as well as onto 

the medial joint surface.” Dr. Kellis opined:

“I do believe that [appellant’s] condition of osteoarthritis was caused and/or 

aggravated by factors of her employment. I believe her duties as a rural mail 

carrier caused the problem versus any natural aging process. It is important to 

note that this has been the knee that has been repetitively stressed on the job and 

that her opposite knee is pristine. There has never been a significant problem or 

aggravation of the opposite knee.”

Dr. Kellis noted that he had reviewed appellant’s employment, as well as pictures and videos of 

her mail truck. He concluded, “There is no question in my mind that this patient’s osteoarthritic 

changes were a direct and proximate result of her employment.”

By decision dated May 23, 2016, OWCP denied appellant’s claim. It found that although

Dr. Kellis had rendered a medical opinion on the cause and/or aggravation of appellant’s left 

knee condition, his report was insufficient because he failed to opine whether the condition was 

actually caused by duties of her employment, or merely aggravated. OWCP determined that 

because Dr. Kellis had not sufficiently discussed how past trauma to her left knee could have 

resulted in her current condition, his opinion on the cause or aggravation of the condition was not 

well rationalized.

On June 6, 2016 appellant, through counsel, requested a telephonic hearing before an

OWCP hearing representative.

By letter dated September 27, 2016, the employing establishment notified OWCP that 

appellant planned to retire effective November 10, 2016.

The hearing was held on January 23, 2017. At the hearing, appellant noted that when she 

first began working at the employing establishment, she used her own vehicle for mail delivery. 

She stated that she had to straddle the seat for about 15 years, while she drove on the wrong side 

of the car, using her left knee as the accelerator and the gas. For seven years, she had used a 

truck supplied by the employing establishment, which she stated was very small, and required 

her to bend to enter the vehicle and to load it, and that all of her duties required using her knee. 

Appellant stated that Dr. Kellis had told her that her problem was work related, and that duties of 

her employment had caused an aggravation of osteoarthritis. Counsel argued that Dr. Kellis’ 

April 25, 2016 report had been improperly rejected as not establishing appellant’s claim because
4

even if it was not fully rationalized, it was the only medical evidence of record and it, therefore, 

established a prima facie claim requiring OWCP to further develop the medical evidence. He 

requested that OWCP direct appellant to a second opinion examination and further develop the 

medical evidence.

By decision dated February 27, 2017, the hearing representative affirmed OWCP’s 

May 23, 2016 decision. She found that because Dr. Kellis’ report of April 25, 2016 did not 

mention appellant tripping at home or striking her knee against a bin, it did not suffice to 

establish causal relationship. The hearing representative explained that omitting appellant’s 

history of tripping at home or striking her knee against the bin amounted to “not giv[ing] a 

rationalized opinion based upon a complete history.”

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 every compensation claim regardless of 

whether the claim is predicated on a traumatic injury or an occupational disease.4

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 claimant has the burden of establishing by the weight of reliable, probative, and 

substantial evidence that the condition for which compensation is sought is causally related to a 

specific employment incident or to specific conditions of employment.5 An award of 

compensation may not be based on appellant’s belief of causal relationship. 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 a causal relationship.

6

 

3 Gary J. Watling, 52 ECAB 278, 279 (2001); Elaine Pendleton, 40 ECAB 1143, 1145 (1989).

4 Michael E. Smith, 50 ECAB 313, 315 (1999).

5 Roma A. Mortenson-Kindschi, 57 ECAB 418, 428 n.37 (2006); Katherine J. Friday, 47 ECAB 591, 594 (1996).

6 P.K., Docket No. 08-2551 (issued June 2, 2009); Dennis M. Mascarenas, 49 ECAB 215, 218 (1997).
5

Causal relationship is a medical issue and the medical evidence generally required to 

establish causal relationship is rationalized medical opinion evidence.7 Rationalized medical 

opinion evidence is medical evidence which includes a physician’s reasoned opinion on whether 

there is a causal relationship between the claimant’s diagnosed condition and the compensable 

employment factors. 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.8 The weight of 

medical evidence is 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.9

ANALYSIS

Appellant alleged that she sustained osteoarthritis of the left knee as a result of factors of 

her federal employment. OWCP denied her claim finding that she had not submitted sufficient 

medical evidence to establish a causal relationship between her claimed condition and factors of 

her federal employment. 

The Board finds that appellant has not submitted sufficient evidence to establish that her 

left knee osteoarthritic condition was caused or aggravated by factors of her federal employment.

By letter dated April 25, 2016, Dr. Kellis noted that appellant had osteoarthritic changes 

of the left knee and had worked for the Federal Government as a rural mail carrier for 29 years. 

He explained that appellant had over-use symptoms related to her employment, and noted that 

she had previously had a contusion of her patella. Dr. Kellis noted that, when she was driving 

her mail truck, it put her knee in a very precarious position, placing pressure on her patella and 

medial joint surface. He opined:

“I do believe that [appellant’s] condition of osteoarthritis was caused and/or 

aggravated by factors of her employment. I believe her duties as a rural mail 

carrier caused the problem versus any natural aging process. It is important to 

note that this has been the knee that has been repetitively stressed on the job and 

that her opposite knee is pristine. There has never been a significant problem or 

aggravation of the opposite knee.”

Dr. Kellis noted that he had reviewed appellant’s employment, as well as pictures and videos of 

her mail truck. He concluded, “There is no question in my mind that this patient’s osteoarthritic 

changes were a direct and proximate result of her employment.”

Appellant also submitted an operative report and office notes from Dr. Kellis from 2012 

through 2016. In these notes, Dr. Kellis recounts that she visited him on June 8, 2012 due to 

 

7 Elizabeth H. Kramm (Leonard O. Kramm), 57 ECAB 117, 123 (2005).

8

Leslie C. Moore, 52 ECAB 132, 134 (2000).

9

Jennifer Atkerson, 55 ECAB 317, 319 (2004); Naomi A. Lilly, 10 ECAB 560, 573 (1959).
6

knee pain after she bumped her knee on a bin; and that she visited him on November 11, 2013 

after she tripped on a dog biscuit, resulting in knee sprain and “tweaking.”

The Board finds that Dr. Kellis’ April 25, 2016 report does not provide a complete 

history of injury, and is, therefore, of limited probative value regarding the issue of causal 

relationship. The Board has explained that a medical opinion regarding causal relationship must 

be based on a complete, accurate factual and medical history. Therefore the opinion cannot omit 

discussion of other factors that affect appellant’s condition.10 Dr. Kellis’ April 25, 2016 report 

did not contain a discussion of any prior traumatic injuries to the same bodily member, despite at 

least two prior injuries being documented in his earlier reports. While, in his June 8, 2012 

report, Dr. Kellis related that appellant had osteoarthritic changes which were aggravated when 

she bumped her knee on a bin, and in September 2013 he related that appellant’s knee was boneon-bone, he did not explain why appellant’s prior knee condition did not relate to her current left 

knee condition. A well-rationalized opinion is particularly warranted when there is a history of 

preexisting condition.11

Dr. Kellis also did not provide a biomechanical explanation of how appellant’s federal 

employment duties resulted in her left knee condition, either by direct causation or aggravation. 

Without explaining how physiologically the movements involved in appellant’s employment 

duties caused or contributed to her diagnosed condition, his opinion on causal relationship is 

equivocal in nature and of limited probative value.12 His reports therefore did not provide the 

necessary medical rationale explaining the nature of the relationship between the diagnosed 

condition and the specific employment factors identified by the claimant.13 

As appellant has not submitted any rationalized medical evidence to support her claim for 

compensation for left knee osteoarthritis, she has not met her burden of proof to establish a 

claim.

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 failed to meet her burden of proof to establish that her left 

knee osteoarthritis is causally related to factors of her federal employment.

 

10 See J.S., Docket No. 15-0619 (issued July 17, 2015). 

11 See D.M., Docket No. 16-0346 (issued June 15, 2017). 

12 See S.C., Docket No. 17-0103 (issued May 2, 2017). 

13 Supra note 8. 
7

ORDER

IT IS HEREBY ORDERED THAT the February 27, 2017 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: November 1, 2017

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