United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

A.J., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Oklahoma City, OK, Employer 

__________________________________________ 

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Docket No. 16-1282 

Issued: August 24, 2017 

Appearances: Case Submitted on the Record

Appellant, pro se 

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 3, 2016 appellant filed a timely appeal from a February 23, 2016 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 over the merits of this case. 

ISSUE 

The issue is whether appellant met her burden of proof to establish a recurrence of a 

work-related medical condition necessitating her January 4, 2016 left knee surgery. 

FACTUAL HISTORY 

On August 8, 2011 appellant, then a 43-year-old maintenance support clerk, filed an 

occupational disease claim (Form CA-2) alleging that she sustained injury to her left knee due to 

the repetitive knee movements required by her work duties over time. She indicated that she first 

 1

 5 U.S.C. § 8101 et seq. 
2

became aware of her claimed condition on July 11, 2011 and that she first realized on July 24, 

2011 that it was caused or aggravated by her employment.2 Appellant did not stop work, but she 

began working in a sedentary, limited-duty position for the employing establishment. 

OWCP accepted that appellant sustained lateral and medial meniscus tears of her left 

knee. Appellant received disability compensation on the daily rolls beginning 

December 7, 2011. 

On December 13, 2011 Dr. James L. Bond, an attending Board-certified orthopedic 

surgeon, performed surgery on appellant’s left knee, including complete synovectomy of the 

anterior/inferior patella pouches, medial/lateral gutters, and posterior medial aspects of the knee, 

patellar chondroplasty, medial meniscectomy of the medial meniscus (posterior third), anterior 

cruciate ligament reconstruction with hamstring autograft, and chondroplasty of the medial and 

lateral femoral condyles. The procedures were authorized by OWCP. 

On February 27, 2012 appellant returned to work as a modified clerk for the employing 

establishment. In a June 4, 2012 decision, OWCP adjusted her wage-loss compensation based 

on its determination that her actual wages as a modified clerk fairly and reasonably represented 

her wage-earning capacity. On June 18, 2012 appellant returned to her regular work on a fulltime basis and received no disability compensation after that date. 

Appellant filed a schedule award claim (Form CA-7) on July 29, 2012 and, by decision 

dated February 12, 2013, OWCP granted 10 percent permanent impairment of her left lower 

extremity.3 

On December 12, 2012 appellant visited Dr. Bond and reported continued left knee 

problems. Dr. Bond noted that he thought the anterior cruciate ligament and postoperative 

course had caused a considerable amount of postoperative scarring and arthritis. 

The findings of a March 30, 2013 MRI scan of appellant’s left knee contained an 

impression of postoperative changes of an intact anterior cruciate ligament graft repair, 

tricompartimental joint space narrowing with significant thinning/irregularity of the articular 

cartilage throughout, and at least three articular cartilage focal defects (measuring up to five 

millimeters in diameter), small knee joint effusion, morphologic changes of the medial and 

lateral menisci (most likely representing postoperative change), and mild thickening and 

increased signal within the proximal medial collateral ligament without fluid or inflammation 

(suggesting a chronic ligamentous injury).4

 

 2

 The findings of a July 18, 2011 magnetic resonance imaging (MRI) scan of appellant’s left knee contained an 

impression of complete tear of the anterior cruciate ligament and degenerative tears involving the posterior horns of 

the medial and lateral menisci, communicating to the inferior articular surfaces. 

3

 On June 13, 2013 appellant requested reconsideration of OWCP’s February 12, 2013 decision and, in a June 26, 

2013 decision, OWCP denied modification of its February 12, 2013 decision. 

4

 The findings noted that there was loss of the normal volume and morphologic appearance of the posterior horn 

of the medial meniscus, likely related to a previous partial meniscectomy. There was no evidence of a focal linear 

tear. 
3

The evidence of record does not contain any medical reports dated between April 2013 

and May 2015. 

On June 6, 2015 appellant visited Dr. Bond and reported that she worked for the 

employing establishment and that she was getting up out of a chair when her left knee popped a 

week prior. She had been on “desk type duty” since the incident, but still had increasing left 

knee pain. Dr. Bond diagnosed left knee pain secondary to medial meniscus tear and arthrosis of 

the medial compartment. 

The findings of an August 19, 2016 left knee MRI scan contained an impression of intact 

reconstructed anterior cruciate ligament with somewhat of an undulating course as it crossed 

through the intercondylar notch and widened fluid signal within the tibial tunnel (measuring up 

to 1.47 millimeters in diameter), postoperative changes of prior partial meniscectomy within the 

medial meniscus with no convincing evidence of a recurrent medial meniscus tear, 

intrasubstance degeneration within the posterior horn of the lateral meniscus, tricompartmental 

articular cartilage loss throughout the knee, and small joint effusion.5

 

On August 31, 2015 Dr. Bond referenced the findings of the August 19, 2016 MRI scan 

and opined that, secondary to her increased chondral damage, appellant was a candidate for a left 

total knee arthroplasty. He noted that she had failed conservative treatment and suggested that, 

secondary to her age, she should undergo left knee arthroscopy with chondroplasty and possible 

subchondroplasty/cartilage harvest. In a December 30, 2015 report, Dr. Bond advised that 

appellant would be undergoing the suggested left knee surgery. 

On December 29, 2015 appellant requested authorization from OWCP for left knee 

arthroscopy surgery (Procedure Code 29877) and left tibial arthroscopy surgery (Procedure Code 

29855). In a December 15, 2015 form entitled “Preadmission Surgery Information/Orders” and 

received on December 29, 2015, Dr. Bond described the surgery scheduled for January 4, 2016 

as left knee scope surgery with possible subchondroplasty and possible cartilage harvest. He 

diagnosed unilateral primary osteoarthritis of the left knee, left knee pain, and other tear of the 

medial meniscus of the left knee (current injury). 

Appellant stopped work on January 4, 2016 to undergo left knee surgery. In a January 4, 

2016 report, Dr. Bond detailed the left knee surgery he performed on that date, including 

extensive synovitis, partial medial meniscectomy, and chondroplasty of the patella, trochlear 

groove, lateral femoral condyle, and medial femoral condyle.6

 The surgery was not authorized 

by OWCP. 

 5

 The findings portion of the report also noted that the posterior cruciate ligament was intact without evidence of 

injury or pathology, and that the medial/lateral collateral ligament structures, popliteus muscle/tendon, pes 

anserinus, and semimembranosus tendons were unremarkable. There was increased signal within the posterior horn 

of the lateral meniscus, which was unchanged in its appearance from the March 30, 2013 MRI scan and likely 

reflected intrasubstance degeneration. 

6

 In the “Indications” portion of the surgery report, Dr. Bond noted that appellant was a 47-year-old who had 

sustained a work-related injury. He indicated that she had an anterior cruciate ligament tear and then had a 

continued chondral defect secondary to this injury. Dr. Bond advised that appellant wished for definitive 

management after risks and benefits of operative and nonoperative treatments were explained to her in detail. 
4

In a January 6, 2016 letter, OWCP advised appellant that it was unable, at the time, to 

authorize her request for left knee arthroscopy surgery and left tibial arthroscopy surgery because 

the evidence of record did not explain how the need for the surgery resulted from factors of 

employment. In a separate January 6, 2016 recurrence claim development letter, OWCP 

provided appellant 30 days to complete an attached questionnaire posing questions about her 

work activities and medical symptoms, and to submit additional medical evidence. 

On January 11, 2016 OWCP received a claim for compensation (Form CA-7), dated 

January 8, 2016, alleging entitlement to disability compensation for the period January 4 

to 15, 2016. 

On January 29, 2016 OWCP received a notice of recurrence (Form CA-2a), dated 

January 25, 2016, in which appellant asserted that, since returning to work, her left knee 

condition had progressively worsened. Appellant did not check either the box marked 

“Recurrence due to Medical Treatment Only” or the box marked “Recurrence due to Time Loss 

From Work.”7

 

Appellant submitted a January 14, 2016 report in which Dr. Bond discussed her 

postsurgery progress and noted that she was totally disabled, but would be able to perform 

“desk[-]type work” in four weeks.8 

In a report dated February 11, 2016, Dr. Bond noted that appellant underwent a left 

anterior cruciate ligament reconstruction in December 2011, but continued to have increasing 

pain on the outside of her left knee after the surgery. Appellant had failed all conservative 

treatment prior to the recommendation for additional left knee surgery. Dr. Bond indicated that 

his comparison of a left knee MRI scan from July 2011 with an August 2015 left knee MRI scan 

revealed that she sustained a severe loss of articular cartilage within the lateral, patellofemoral, 

and medial compartments of her left knee. He indicated that, due to these cartilage losses, 

appellant had subtle laxity and continued pain/stiffness with ambulation, as well as an altered 

gait. Appellant also had muscle weakness and atrophy secondary to the pain associated with the 

cartilage defect. Dr. Bond referenced his prior surgery recommendation for left knee scope with 

chondroplasty and possible subchondroplasty/cartilage harvest. He reported physical 

examination findings and diagnosed left knee pain secondary to lateral meniscus tear and 

arthrosis of knee. Dr. Bond noted that it was his medical opinion, based upon examination of the 

employee, review of the medical records, and his education, training, and experience, that it was 

more probable than not that the diagnosed conditions/disability arose out of and in the course of 

appellant’s federal employment. He further noted, “It is also my opinion that the current need 

for treatment is related to [appellant’s] original injury that occurred in 2011. As previously 

mentioned she sustained a tricompartmental articular cartilage loss with continued pain and 

stiffness.” 

 7

 On January 29, 2016 OWCP also received appellant’s responses to the questionnaire it sent to her on 

January 6, 2016. Appellant noted that she had been performing “desk[-]type duties” and that she experienced 

aching, stiffening, and swelling in her left knee. 

8

 Appellant also submitted notes of periodic physical therapy sessions beginning January 20, 2016. 
5

In a decision dated February 23, 2016, OWCP denied appellant’s claim because she had 

failed to submit sufficient medical evidence to establish a recurrence of a work-related medical 

condition necessitating her January 4, 2016 left knee surgery.9 It found that the reports of 

Dr. Bond did not contain adequate medical rationale explaining how appellant’s January 4, 2016 

surgery was related to her accepted work conditions. 

LEGAL PRECEDENT 

Recurrence of a medical condition means a documented need for further medical 

treatment after release from treatment for the accepted condition or injury when there is no 

accompanying work stoppage. Continuous treatment for the original condition or injury is not 

considered a need for further medical treatment after release from treatment, nor is an 

examination without treatment.10 An employee has the burden of proof to establish a recurrence 

of a medical condition that is causally related to his or her accepted employment injury. To meet 

this burden, the employee must submit medical evidence from a physician who, on the basis of a 

complete and accurate factual and medical history, supports that the condition is causally related 

and supports the conclusion with sound medical rationale.11

Section 8103(a) of FECA states in pertinent part: “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 the Secretary of Labor considers 

likely to cure, give relief, reduce the degree or the period of disability, or aid in lessening the 

amount of the monthly compensation.”12 The Board has found that OWCP has great discretion 

in determining whether a particular type of treatment is likely to cure or give relief.13 The only 

limitation on OWCP’s authority is that of reasonableness.14 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 established facts. It is not 

enough to merely show that the evidence could be construed so as to produce a contrary factual 

conclusion.15

ANALYSIS 

OWCP accepted that appellant sustained lateral and medial meniscus tears of her left 

knee due to performing her work duties over time. On December 13, 2011 Dr. Bond performed 

 9

 OWCP interpreted appellant’s Form CA-2a as a claim for a recurrence of a medical condition which appellant 

claimed necessitated the January 4, 2016 left knee surgery. 

10 20 C.F.R. § 10.5(y); D.L., Docket No. 17-0306 (issued April 25, 2017). 

11 See K.T., Docket No. 15-1758 (issued May 24, 2016). 

12 5 U.S.C. § 8103. 

13 Vicky C. Randall, 51 ECAB 357 (2000). 

14 Lecil E. Stevens, 49 ECAB 673, 675 (1998). 

15 Rosa Lee Jones, 36 ECAB 679 (1985). 
6

surgery on her left knee, including complete synovectomy of the anterior/inferior patella 

pouches, medial/lateral gutters, and posterior medial aspects of the knee, patellar chondroplasty, 

medial meniscectomy of the medial meniscus (posterior third), anterior cruciate ligament 

reconstruction with hamstring autograft, and chondroplasty of the medial and lateral femoral 

condyles. Appellant returned to full-time regular duty on June 18, 2012, but she stopped work 

on January 4, 2016 to undergo additional left knee surgery.16 On that date Dr. Bond performed 

extensive synovitis, partial medial meniscectomy, and chondroplasty of the patella, trochlear 

groove, lateral femoral condyle, and medial femoral condyle. The surgery was not authorized by 

OWCP and appellant claimed that she sustained a recurrence of a work-related medical condition 

which necessitated the January 4, 2016 left knee surgery.17

The Board finds that OWCP properly denied appellant’s request for authorization of left 

knee surgery on January 4, 2016 and properly determined that she had not sustained a recurrence 

of a work-related medical condition necessitating such surgery. OWCP properly exercised its 

discretion in finding that the evidence of record did not show that the proposed surgery was 

likely to cure or give relief for her accepted work-related conditions.18

In a report dated February 11, 2016, Dr. Bond noted that appellant underwent a left 

anterior cruciate ligament reconstruction in December 2011, but continued to have increasing 

pain on the outside of her left knee after the surgery. He noted that his comparison of the left 

knee MRI scan from July 2011 with the left knee MRI scan from August 2015 revealed that she 

had sustained a severe loss of articular cartilage within the lateral, patellofemoral, and medial 

compartments of her left knee. Dr. Bond indicated that, due to these cartilage losses, appellant 

had subtle laxity, continued pain/stiffness with ambulation, altered gait, muscle weakness, and 

atrophy. He referenced his prior surgery recommendation for left knee scope with chondroplasty 

and possible subchondroplasty/cartilage harvest and diagnosed left knee pain secondary to lateral 

meniscus tear and arthrosis of knee. Dr. Bond noted that it was his medical opinion, based upon 

examination of the employee, review of the medical records, and his education, training, and 

experience, that it is more probable than not that the diagnosed conditions/disability arose out of 

and in the course of appellant’s federal employment. He further noted, “It is also my opinion 

that the current need for treatment is related to her original injury that occurred in 2011. As 

previously mentioned she sustained a tricompartmental articular cartilage loss with continued 

pain and stiffness.” 

In this report, Dr. Bond provides an opinion that appellant sustained work-related 

tricompartmental articular cartilage loss and that symptoms from this cartilage loss necessitated 

the left knee surgery he performed on January 4, 2016. However, the Board notes that her claim 

has only been accepted for the conditions of lateral and medial meniscus tears of her left knee 

 16 In early-June 2016, appellant reported to Dr. Bond that she was getting up out of a chair when her left knee 

popped a week prior and that she had been on “desk[-]type duty” since the incident. She did not clearly indicate 

whether this incident occurred at work and the evidence of record does not contain any claim for a new work injury. 

17 On December 29, 2015 OWCP received a request for authorization of the surgery later performed on 

January 4, 2016. On January 29, 2016 it received a Form CA-2a which it interpreted as a claim for recurrence of a 

work-related medical condition. 

18 See supra notes 13 through 15. 
7

and he has not provided a clear opinion that the January 4, 2016 surgery was necessitated by 

these accepted conditions.19 Dr. Bond’s February 11, 2016 report is of limited probative value 

because he failed to provide any medical rationale for his opinion that appellant sustained 

tricompartmental articular cartilage loss in her left knee related to her employment, which in turn 

necessitated the January 4, 2016 surgery.20 He did not explain how or why her need for left knee 

surgery on January 4, 2016 would not have been solely due to natural progression of a 

degenerative process of her left knee. For these reasons, Dr. Bond failed to explain his 

conclusion that appellant’s January 4, 2016 surgery was related to a work-related condition. The 

Board has held that 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.21

On appeal, appellant argues that residuals of OWCP-authorized December 13, 2011 

surgery caused her to undergo surgery on January 4, 2016. The Board has held that authorization 

by OWCP for medical examination and/or treatment constitutes a contractual agreement to pay 

for the services if the services are rendered, regardless of whether a compensable 

injury/condition exists, and that any medical condition resulting from authorized examination or 

treatment (such as residuals from surgery) may form the basis of a compensation claim for 

impairment or disability, regardless of the compensability of the original injury.22 The Board 

finds, however, that Dr. Bond did not provide an opinion that the January 4, 2016 surgery was 

necessary to address the effects of appellant’s OWCP-authorized December 13, 2011 surgery.23 

For these reasons, the Board finds that appellant failed to submit sufficient medical 

evidence to establish a recurrence of a work-related medical condition necessitating her 

January 4, 2016 left knee surgery. 

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. 

 19 An August 19, 2016 MRI scan of appellant’s left knee contained an impression which showed, inter alia, 

postoperative changes of the December 13, 2011 surgery within the medial meniscus with no convincing evidence 

of a recurrent medial meniscus tear and intrasubstance degeneration within the posterior horn of the lateral 

meniscus. There is no indication in the evidence of record that the intrasubstance degeneration within the posterior 

horn of the lateral meniscus was in any way related to the medical conditions accepted by OWCP in 2011. 

20 See supra note 11. 

21 C.M., Docket No. 14-0088 (issued April 18, 2014). 

22 See G.C., Docket No. 15-0370 (issued December 2, 2015); see also Federal (FECA) Procedure Manual, Part 

3 -- Medical, Authorizing Examination and Treatment, Chapter 3.300.2b (February 2012). 

23 On December 12, 2012 Dr. Bond noted that he thought the anterior cruciate ligament and postoperative course 

had caused a considerable amount of postoperative scarring and arthritis. He did not make any further reference to 

scarring from the December 13, 2011 surgery or otherwise indicate that effects of the December 13, 2011 surgery 

contributed to the need for the January 4, 2016 surgery. 
8

CONCLUSION 

The Board finds that appellant did not meet her burden of proof to establish a recurrence 

of a work-related medical condition necessitating her January 4, 2016 left knee surgery. 

ORDER 

IT IS HEREBY ORDERED THAT the February 23, 2016 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: August 24, 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