United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

J.P., Appellant

and

U.S. POSTAL SERVICE, OAKLAND STATION 

POST OFFICE, Pittsburgh, PA, Employer

__________________________________________

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Docket No. 18-0349

Issued: December 30, 2019

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

PATRICIA H. FITZGERALD, Deputy Chief Judge

JANICE B. ASKIN, Judge

JURISDICTION

On December 11, 2017 appellant, through counsel, filed a timely appeal from a 

September 18, 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 to consider 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 her burden of proof to establish a left knee condition 

causally related to the accepted September 9, 2015 employment incident.

FACTUAL HISTORY

On March 3, 2016 appellant, then a 47-year-old city carrier, filed a traumatic injury claim 

(Form CA-1) alleging that on September 9, 2015 she injured her left knee after stumbling on a 

broken sidewalk while in the performance of duty. On the reverse side of the claim form, the 

employing establishment indicated that she stopped work on October 22, 2015, and returned to 

work the following day. It controverted appellant’s claim, noting that she waited more than a 

month before reporting the alleged accident. 

In a February 23, 2016 report, Dr. David P. Fowler, a Board-certified orthopedist,

reviewed the results of a computerized tomography (CT) arthrogram of appellant’s knee. He noted 

that the CT scan revealed a vertical longitudinal tear involving the posterior horn of the medial 

meniscus and moderate patellofemoral compartment arthritis. Dr. Fowler indicated that appellant 

appeared to have a torn meniscus, some of which could be degenerative in nature as there was 

some arthritis in the area. He also discussed the possibility of undergoing arthroscopic surgery. 

In a March 3, 2016 follow-up treatment report, Dr. Fowler diagnosed left medial meniscus 

tear. He indicated that appellant’s left knee CT arthrogram revealed a medial meniscus tear. 

Dr. Fowler further indicated that, although there may be a degenerative component, it was 

primarily a vertical tear with a radial component. He noted that appellant still had pain and 

intermittent swelling, as well as episodes of instability. 

In a separate March 3, 2016 note, Crawford W. Smith, a nurse practitioner, indicated that 

appellant had been seen earlier that day and advised that she should be permitted to work light 

duty. 

In a development letter dated May 17, 2016, OWCP advised appellant of the type of 

evidence needed to establish her claim, particularly requesting that she submit a physician’s 

reasoned opinion addressing the relationship between her claimed condition and specific 

employment factors. It also asked her to respond to a questionnaire to substantiate the factual 

elements of her claim.

In an undated statement received by OWCP on May 16, 2016, appellant indicated that 

while delivering mail on September 9, 2015 she stepped on an area of uneven sidewalk and she 

injured her left knee. She reported finishing her mail route. Approximately two weeks later, after 

“recollecting why [she] was in tremendous pain and walking with a limp,” appellant reported the 

injury to her supervisor and requested a claim form. She indicated that her supervisor was unable 

to provide a claim form, but directed her to the carrier supervisor. Appellant subsequently went 

on vacation and returned to work on October 5, 2015. Her condition became progressively worse 

and she sought medical treatment from her physician on October 9, 2015. Appellant indicated that 

after informing the doctor of how her injury occurred, he noted that her injury should be filed as a 

workers’ compensation claim because it was work related. She contacted her supervisor to relay
3

the information from her physician and to report a work injury, but was informed that because 48 

hours had passed since the incident she could not complete the claim form. Appellant contacted 

the union who provided her with the proper claim form.

On November 3 and 5, 2015 appellant came under the treatment of Dr. Brian A. Klatt, a 

Board-certified orthopedist, for left knee pain. Dr. Klatt noted possible diagnoses of meniscal tear 

and degenerative joint disease. He provided cortisone injections and returned her to light-duty 

work. On November 3, 2015 Dr. Klatt referred appellant for physical therapy. 

Appellant underwent physical therapy from November 9, 2015 to February 9, 2016 for 

acute left knee pain. She submitted exercise instructions.

In a prescription note dated January 28, 2016, a physician assistant continued appellant’s

limited-duty restrictions until evaluated by Dr. Fowler. 

In a duty status report dated February 8, 2016, Dr. Sachin Bahl, a Board-certified internist, 

noted clinical findings and diagnosed knee pain. She returned appellant to work part-time, light 

duty. Dr. Bahl reexamined appellant on March 3, 2016 for left knee pain. She noted an essentially 

normal physical examination and diagnosed left knee pain, possible meniscal tear, and obesity. In 

a June 14, 2016 report, Dr. Bahl noted that appellant presented on March 3, 2016 with left knee 

pain. Appellant reported sustaining an injury at work on September 9, 2015 when she stumbled 

on a broken sidewalk. She experienced left knee pain since that time and difficulty walking and 

climbing steps.

Appellant was reexamined by Dr. Fowler on February 12, 2016, and he diagnosed a left 

knee effusion. On March 3, 2016 Dr. Fowler noted tenderness and soreness of the left medial joint 

line and diagnosed left knee medial meniscus tear. He opined that appellant most likely had some 

mild underlying degenerative condition and the work injury led to the meniscal tear. Dr. Fowler

noted conservative treatment including cortisone injections and physical therapy did not relieve 

appellant’s symptoms. He advised that appellant could work in a sedentary position. On April 8, 

2016 Dr. Fowler diagnosed osteoarthrosis involving the lower left leg. He continued to treat 

appellant and on May 24, 2016 he noted that x-rays revealed mild-to-moderate medial 

compartment arthritis. Dr. Fowler indicated that a CT arthrogram revealed a vertical longitudinal 

tear involving the posterior horn of the medial meniscus, extrusion of the meniscal body, grade 4 

chondral fissuring of the medial femoral condyle, and moderate patellar arthritis. He noted that 

the grade 4 changes indicated preexisting arthritis, the extrusion represented a degenerative 

component and the vertical tear could be from degeneration or trauma. Dr. Fowler opined that 

appellant had preexisting arthritis which lead to degeneration of the meniscus and susceptibility to 

tearing with a fall or day-to-day activities. However, he advised that there were no objective tests

that could distinguish the etiology of a tear. Dr. Fowler recommended arthroscopic surgery.

On June 6, 2016 appellant was treated by Dr. Adolph J. Yates, a Board-certified 

orthopedist, for left knee pain. Dr. Yates noted that she reported developing left knee pain last fall 

after an injury while carrying mail as a postal worker. He noted findings on examination of 

extension and flexion of 115 degrees, medial joint line tenderness with crepitus, intact extensor 

mechanism, intact cruciate, intact anterior posterior drawer, no gross locking, catching or grating, 

no calf pain, tenderness or swelling, and intact neurovascular examination. Dr. Yates noted that 
4

the CT arthrogram revealed a small vertical tear and areas of significant chondral loss with cyst 

formation in the medial compartment and that x-rays of the left knee revealed moderate-to-severe 

patellofemoral and medial compartmental osteoarthritic changes. He opined that appellant’s 

examination, history, and x-rays were compatible with moderately severe osteoarthritis of the left 

knee with associated degenerative meniscus tear. Dr. Yates noted that it was possible that her 

arthritis was aggravated by an injury, but the documentation was not ideal. He recommended 

light-duty work with no more than one hour of intermittent walking.

By decision dated June 22, 2016, OWCP denied appellant’s traumatic injury claim finding 

that the medical evidence of record was insufficient to establish a causal relationship between 

appellant’s left knee condition and the accepted September 9, 2015 employment incident.

On June 20, 2017 appellant, through counsel, requested reconsideration. 

Appellant attended physical therapy from June 6 to July 8, 2016. 

Dr. Yates reexamined appellant on June 12, 2016 and noted findings of full extension 

without evidence of calf pain tenderness or swelling. He indicated that she had twisted her foot

and knee while working. Dr. Yates opined that appellant’s injury was, at a minimum, an 

aggravation of her underlying osteoarthritis with a possible new onset of medial meniscus tear. He 

indicated that this injury occurred on the job. Dr. Yates noted that he was not the initial surgeon 

to treat appellant and her medical record was “disjointed.” In a duty status report (Form CA-17) 

dated June 16, 2016, Dr. Yates noted clinical findings of knee pain and swelling and diagnosed 

small meniscal tear and osteoarthritis of the knee. He noted that appellant could work full-time, 

light duty.

By decision dated September 18, 2017, OWCP denied modification of its June 22, 2016

decision. 

LEGAL PRECEDENT

An employee seeking benefits under FECA3 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 timely filed within the applicable 

time limitation of FECA,4that an injury was sustained in the performance of duty as alleged, and 

that any disability or medical condition for which compensation is claimed is causally related to 

 

3

Id.

4

J.P., Docket No. 19-0129 (issued April 26, 2019); S.B., Docket No. 17-1779 (issued February 7, 2018); Joe D. 

Cameron, 41 ECAB 153 (1989). 
5

the employment injury.5 These are the essential elements of each and every compensation claim, 

regardless of whether the claim is predicated upon a traumatic injury or an occupational disease.6

To determine if an employee sustained a traumatic injury in the performance of duty, 

OWCP begins with an analysis of whether fact of injury has been established.7 Fact of injury 

consists of two components that must be considered in conjunction with one another. The first

component is whether the employee actually experienced the employment incident that allegedly 

occurred.8 The second component is whether the employment incident caused a personal injury.9 

An employee may establish that an injury occurred in the performance of duty as alleged, but fail

to establish that the disability or specific condition for which compensation is being claimed is 

causally related to the injury.10

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.11 A physician’s opinion on whether there is a causal relationship 

between the diagnosed condition and the implicated employment factor(s) must be based on a 

complete factual and medical background.12 Additionally, the physician’s opinion must be 

expressed in terms of a reasonable degree of medical certainty, and must be supported by medical 

rationale, explaining the nature of the relationship between the diagnosed condition and appellant’s 

specific employment factor(s).13

In any case where a preexisting condition involving the same part of the body is present 

and the issue of causal relationship therefore involves aggravation, acceleration, or precipitation, 

the physician must provide a rationalized medical opinion that differentiates between the effects 

of the work-related injury or disease and the preexisting condition.14

 

5

J.M., Docket No. 17-0284 (issued February 7, 2018); R.C., 59 ECAB 427 (2008); James E. Chadden, Sr., 40 

ECAB 312 (1988). 

6 R.R., Docket No. 19-0048 (issued April 25, 2019); L.M., Docket No. 13-1402 (issued February 7, 2014); 

Delores C. Ellyett, 41 ECAB 992 (1990). 

7 E.M., Docket No. 18-1599 (issued March 7, 2019); T.H., 59 ECAB 388, 393-94 (2008). 

8 L.T., Docket No. 18-1603 (issued February 21, 2019); Elaine Pendleton, 40 ECAB 1143 (1989).

9 B.M., Docket No. 17-0796 (issued July 5, 2018); John J. Carlone, 41 ECAB 354 (1989).

10 J.P., supra note 4; L.T., supra note 8; Shirley A. Temple, 48 ECAB 404, 407 (1997).

11 E.M., supra note 7; Robert G. Morris, 48 ECAB 238 (1996). 

12 M.V., Docket No. 18-0884 (issued December 28, 2018).

13 Id.; Victor J. Woodhams, 41 ECAB 345, 352 (1989).

14 Federal (FECA) Procedure Manual, Part 2 -- Claims, Causal Relationship, Chapter 2.805.3e (January 2013).
6

ANALYSIS

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

condition is causally related to the accepted September 9, 2015 employment incident.

Appellant submitted February 12 and 23, 2016 reports from Dr. Fowler who noted that a 

left knee CT arthrogram revealed a vertical longitudinal tear involving the posterior horn of the 

medial meniscus and moderate patellofemoral compartment arthritis. Dr. Fowler diagnosed tear 

of the meniscus and opined that some of the findings could be degenerative in nature as there was 

arthritis in this area. However, he did not address whether appellant’s meniscal tear was causally 

related to the accepted employment incident on September 9, 2015. The Board has held that 

medical evidence that does not offer an opinion regarding the cause of an employee’s condition is 

of no probative value on the issue of causal relationship.15 These reports, therefore, are insufficient 

to establish appellant’s claim. 

In his March 3 and April 8, 2016 reports, Dr. Fowler diagnosed left knee medial meniscus 

tear and opined that appellant most likely had some mild underlying degeneration and the work 

injury led to the meniscal tear. The Board notes while these reports from Dr. Fowler are generally 

supportive of causal relationship, they are insufficient to establish the claimed left knee condition 

was causally related to her employment duties. 

In a May 24, 2016 report, Dr. Fowler noted that the CT arthrogram revealed preexisting 

arthritis, a degenerative component, and the vertical tear that could be from degeneration or 

trauma. He noted that appellant had preexisting arthritis which led to degeneration within the 

meniscus and made it easier to tear, but he opined that there was no objective test that could 

distinguish the etiology of a tear. The Board has long held, however, that medical opinions that 

are speculative or equivocal in character have little probative value.16 Therefore this report is 

insufficient to establish her claim. 

In a duty status report (Form CA-17) dated February 8, 2016, Dr. Bahl noted clinical 

findings and diagnosed knee pain. She returned appellant to part-time, light-duty work. Dr. Bahl

reexamined appellant on March 3, 2016 for left knee pain and diagnosed left knee pain, possible 

meniscal tear and obesity. Similarly, on June 14, 2016, she noted that appellant sustained an injury 

at work on September 9, 2015 when she stumbled on a broken sidewalk. As these reports do not 

address whether appellant’s employment incident caused or aggravated a diagnosed medical 

condition, they are insufficient to establish the claim.17

Appellant submitted a report from Dr. Yates dated June 6, 2016. Dr. Yates opined that 

appellant’s examination, history, and x-rays were compatible with moderately severe osteoarthritis 

of the left knee with associated degenerative meniscus tear. He noted that it was “possible” that 

her arthritis was aggravated by an injury, but the documentation was not ideal. The Board notes 

 

15 See L.B., Docket No. 18-0533 (issued August 27, 2018); D.K., Docket No. 17-1549 (issued July 6, 2018).

16 T.M., Docket No. 08-0975 (issued February 6, 2009).

17 Supra note 15.
7

that Dr. Yates’ report is speculative as the physician qualifies his support by noting that it was 

“possible” that her arthritis was aggravated by an injury. Therefore, this report is insufficient to 

meet appellant’s burden of proof.18

In a June 12, 2016 report, Dr. Yates opined that upon review of appellant’s chart and 

history, at a minimum, appellant had sustained an aggravation of her underlying osteoarthritis with 

a possible new onset of medial meniscus tear. He agreed that this injury occurred on the job. In a 

duty status report (Form CA-17) dated June 16, 2016, Dr. Yates noted clinical findings of knee 

pain and swelling and diagnosed small meniscal tear and osteoarthritis of the knee. The Board 

finds that, although Dr. Yates supported causal relationship, he did not provide medical rationale 

explaining the basis of his conclusory opinion regarding the causal relationship between 

appellant’s left knee condition and the factors of employment.19 Therefore, this report is 

insufficient to meet appellant’s burden of proof. 

Appellant submitted reports from Dr. Klatt dated November 3 and 5, 2015, who treated her 

for left knee pain. Dr. Klatt noted a possible diagnoses of meniscal tear and degenerative joint 

disease. His notes are insufficient to establish the claim as he did not address whether appellant’s 

employment incident was sufficient to have caused or aggravated a diagnosed medical condition.20 

Appellant also submitted physical therapy notes and a note from a nurse practitioner. The 

Board has held that treatment notes signed by a nurse practitioners or physical therapists are

insufficient to establish the claim as these providers are not considered physicians as defined under 

FECA21 and are not competent to render a medical opinion under FECA. Thus, these reports are 

insufficient to meet appellant’s burden of proof.

The remainder of the medical evidence including x-rays of the left knee and a CT 

arthrogram are of limited probative value as they fail to provide a physician’s opinion on the causal 

relationship between appellant’s work incident and her diagnosed left knee meniscal tear.

22

 For 

this reason, this evidence is insufficient to meet her burden of proof. 

As the record does not contain rationalized medical opinion evidence sufficient to establish 

causal relationship, appellant has not met her burden of proof.

 

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

19 See T.M., supra note 16 (a medical report is of limited probative value on the issue of causal relationship if it 

contains a conclusion regarding causal relationship which is unsupported by medical rationale).

20 Supra note 15. 

21 See David P. Sawchuk, 57 ECAB 316 (2006) (lay individuals such as physician assistants, nurses, and physical 

therapists are not competent to render a medical opinion under FECA); 5 U.S.C. § 8101(2) (this subsection defines a 

“physician” as surgeons, podiatrists, dentists, clinical psychologists, optometrists, chiropractors, and osteopathic 

practitioners within the scope of their practice as defined by State law).

22 See S.E., Docket No. 08-2214 (issued May 6, 2009).
8

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 has not met her burden of proof to establish a left knee 

condition causally related to the accepted September 9, 2015 employment incident. 

ORDER

IT IS HEREBY ORDERED THAT the September 18, 2017 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: December 30, 2019

Washington, DC

Christopher J. Godfrey, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board