United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

T.W., Appellant

and

DEPARTMENT OF THE TREASURY, 

BUREAU OF ENGRAVING & PRINTING, 

Fort Worth, TX, Employer

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Docket No. 17-1908

Issued: February 16, 2018

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

PATRICIA H. FITZGERALD, Deputy Chief Judge

ALEC J. KOROMILAS, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On September 11, 2017 appellant filed a timely appeal from an August 18, 2017 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 his burden of proof to establish that his degenerative 

left knee condition was causally related to factors of his federal employment.

On appeal appellant asserts that factors of his federal employment are making his 

preexisting condition worse. 

 

1 5 U.S.C. § 8101 et seq.
2

FACTUAL HISTORY

On June 12, 2017 appellant, then a 59-year-old bookbinder assistant supervisor, filed an 

occupational disease claim (Form CA-2), alleging that walking on concrete floors in required 

safety shoes in the performance of duty for many years exacerbated his degenerative arthritis of 

the left knee. He indicated that he initially became aware of the condition on June 9, 2014 and 

its relationship to his federal employment on March 27, 2017. In an attached statement,

appellant indicated that in about 2014 he had left knee surgery and began injections in his left

knee in June 2016 and noted that his health insurance did not cover all the needed injections. He

maintained that he would continue to need injections until a left knee replacement was necessary, 

and that walking in steel-toed shoes altered his gait. Appellant indicated that he worked many 

12-hour days and described job duties of using floor jacks, moving loads around, lifting, and 

carrying, twisting, turning, and abruptly stopping -- all of which jarred and jerked his knee. He

further related that he was expected to walk upstairs quickly in order to address small 

emergencies and perceived emergencies encountered each workweek. Appellant concluded that 

he was forced to work long hours and weekends which put more stress on his knee.

A May 16, 2011 magnetic resonance imaging (MRI) scan of the left knee provided by

Dr. Vaibhav Khasgiwala, the interpreting physician, demonstrated a tear of the posterior horn of 

the medial meniscus, moderate chondromalacia, moderate joint effusion, and the suggestion of a 

low grade sprain.

In a June 9, 2014 report, Dr. John Ribeiro, a Board-certified orthopedic surgeon, noted 

left knee examination findings of crepitus, parapatellar and joint line tenderness, with normal 

stability. He reviewed a left knee x-ray noting mild-to-moderate degenerative changes and 

diagnosed left knee pain and degenerative joint disease of the left knee. Dr. Ribeiro injected 

appellant’s left knee. In a February 22, 2016 report, he noting seeing appellant for a left knee 

injection. Dr. Ribeiro described symptoms of pain, difficulty walking, stiffness, and swelling. 

He noted that appellant was obese and described left knee examination findings of joint line 

tenderness and a positive patellar grind test. Range of motion was within normal limits. Left 

knee x-ray demonstrated advanced degenerative joint disease. 

In correspondence dated June 13, 2017, V.P., an employing establishment human 

resources benefits specialist, maintained that there was no evidence to support that the claimed 

condition was caused or aggravated by appellant’s federal employment.

By development letter dated June 19, 2017, OWCP informed appellant of the type of 

evidence needed to support his claim, including a comprehensive medical report in which his 

physician explained how his federal employment duties caused, contributed to, or aggravated his 

claimed condition. In a separate letter that day it asked the employing establishment to respond 

with comments from a knowledgeable supervisor on the accuracy of appellant’s statements.

A position description for bookbinder assistant supervisor was submitted by the 

employing establishment. It did not include a description of the physical requirements of the 

position. In correspondence dated June 29, 2017, V.P. reiterated the employing establishment’s 

position that no work injury occurred and that the medical evidence was insufficient to establish 

causal relationship. In statements dated June 22 and 23, 2017, F.P., an employing establishment 
3

supervisor, advised that appellant did a fair amount of walking on concrete in his position, and 

that he had worked 6- and 7-day weeks, and 12-hour days. F.P. further indicated that appellant 

regularly used a variety of material handling equipment such as electric and manual lifts, and 

racks containing currency which could weigh in excess of 1,400 pounds. 

On June 23, 2017 appellant completed an OWCP questionnaire in which he reiterated 

that he worked long days and walked on concrete up to seven days weekly, and that he used 

equipment which aggravated his left knee condition. He indicated that he could no longer run 

and did some weight lifting. Appellant maintained that his work duties exacerbated his 

preexisting degenerative condition. 

On July 17, 2017 V.P. noted that appellant was allowed to sit in an office the majority of 

his shift, and that the employing establishment furnished two pairs of safety shoes per year. She 

forwarded undated correspondence in which Dr. Ribeiro indicated that appellant had been 

undergoing treatment for degenerative joint disease in the left knee. Dr. Ribeiro noted that 

appellant previously had left knee surgery to remove damaged articular cartilage. He related that 

appellant’s current condition was not related to a work incident, was controlled with injections,

and was degenerative in nature. Dr. Ribeiro indicated that appellant’s job demands required that 

he work on hard surfaces and wear certain footwear which would most certainly worsen his 

degenerative condition over time. He advised that appellant would ultimately require a total 

knee arthroplasty due to the degenerative nature of his condition. A treatment note dated 

May 24, 2017 indicated that appellant’s left knee was injected. 

By decision dated August 18, 2017, OWCP denied the claim. It found that Dr. Ribeiro 

did not provide sufficient rationale to establish that accepted work factors caused the diagnosed 

conditions.

LEGAL PRECEDENT

An employee seeking benefits under FECA2 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, and that the claim was timely filed within the 

applicable time limitation period of FECA.3 When an employee claims that he or she sustained 

an injury in the performance of duty,4 he or she must submit sufficient evidence to establish that 

he or she experienced a specific event, incident, or exposure occurring at the time, place, and in 

the manner alleged.5 The employee must also establish that such event, incident, or exposure 

 

2

Id.

3 5 U.S.C. § 8101(1); L.M., Docket No. 16-0143 (issued February 19, 2016); B.B., 59 ECAB 234 (2007).

4

Id. at § 8102(a).

5

J.C., Docket No. 16-0057 (issued February 10, 2016); E.A., 58 ECAB 677 (2007). 
4

caused an injury.6 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.7

OWCP regulations define the term “occupational disease or illness” as a condition 

produced by the work environment over a period longer than a single workday or shift.”

8

 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 diagnosed 

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

opinion 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.9

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

causal relationship is rationalized medical evidence.10 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.11 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.12

ANALYSIS

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

degenerative left knee condition was causally related to factors of his federal employment.

The May 16, 2011 MRI scan interpreted by Dr. Khasgiwala did not provide a cause of 

any diagnosed conditions. 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.13 

 

6

Id.

7 R.H., 59 ECAB 382 (2008).

8 20 C.F.R. § 10.5(ee).

9 Roy L. Humphrey, 57 ECAB 238 (2005).

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

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

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

13 Willie M. Miller, 53 ECAB 697 (2002).
5

The only report that discussed causal relationship was Dr. Ribeiro’s undated report. This 

report, however, was of insufficient rationale to establish that the diagnosed condition was 

caused or aggravated by appellant’s federal employment. In that report, while Dr. Ribeiro noted 

that appellant previously had left knee surgery to remove damaged articular cartilage, and that he 

was being treated with injections, he merely reported that appellant had to work on hard surfaces 

and wear certain footwear which would most certainly worsen his degenerative condition over 

time. He advised that appellant would ultimately require a total knee arthroplasty due to the 

degenerative nature of his condition. 

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 his or her opinion.14 The Board finds Dr. Ribeiro’s opinion conclusory and 

insufficient to meet appellant’s burden of proof.15

As the record contains insufficient explanation regarding whether appellant’s left knee 

degenerative condition was caused or aggravated by his federal employment, he did not meet his 

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.

CONCLUSION

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

knee degenerative condition was causally related to factors of his federal employment.

 

14 J.M., 58 ECAB 303 (2007).

15 Id.
6

ORDER

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

Workers’ Compensation Programs is affirmed.

Issued: February 16, 2018

Washington, DC

Patricia H. Fitzgerald, Deputy 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