United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

J.G., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Boston, MA, Employer

__________________________________________

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Docket No. 17-1062

Issued: February 13, 2018

Appearances: Case Submitted on the Record

Benjamin Zimmerman, 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

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On April 18, 2017 appellant, through counsel, filed a timely appeal from an April 4, 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.3

 

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.

3 Appellant requested oral argument. By order dated August 25, 2017, the Board after exercising its discretion 

denied his request for an oral argument, finding that his arguments on appeal could adequately be addressed in a 

decision based on a review of the case record. Order Denying Request for Oral Argument, Docket No. 17-1062 

(issued August 25, 2017). 
2

ISSUE

The issue is whether appellant met his burden of proof to establish a right knee condition 

causally related to accepted factors of his federal employment.

FACTUAL HISTORY

On November 12, 2014 appellant, then a 57-year-old letter carrier, filed a traumatic 

injury claim (Form CA-1) alleging that on November 6, 2014 he sustained an acute right knee 

injury when that knee buckled while he was pushing a cart in the performance of duty. He 

stopped work and did not return until December 9, 2014. In an attached statement, appellant 

related that, while walking his route between his last two scans, his knee gave him a sharp pain 

and buckled slightly.

Appellant submitted a November 7, 2014 report by Dr. Michael K. Rees, a Boardcertified internist. Dr. Rees indicated that due to an acute injury appellant was currently totally 

disabled and he could not provide an estimated date of return to work.

In a November 7, 2014 right knee magnetic resonance imaging (MRI) scan report,

Dr. Richard B. Schwartz, a Board-certified diagnostic and neuroradiologist, related appellant’s 

complaints of right knee pain. He noted a complex tear of the lateral meniscal remnant, severe 

progressed lateral femorotibial compartment osteoarthritis, moderate-to-severe patellofemoral 

osteoarthritis, small leaking Baker’s cyst, and moderate-sized joint effusion.

The employing establishment provided an authorization for examination and/or treatment 

(Form CA-16) dated November 12, 2014. 

In a November 24, 2014 right knee radiology report, Dr. Justin W. Kung, a Boardcertified diagnostic radiologist, related appellant’s complaints of right knee pain. He reported 

mild-to-moderate degenerative changes of the right knee, most significant in the lateral 

compartment.

Appellant received medical treatment from Dr. Douglas Ayers, a Board-certified 

orthopedic surgeon. In a November 24, 2014 report, Dr. Ayers indicated that appellant was still 

working two jobs, approximately 80 hours a week, with the employing establishment and for 

Amtrak. He related that on November 6, 2014 appellant was carrying letters when he felt a sharp 

pain in his right knee. Appellant claimed that he was in daily pain and had been totally 

incapacitated. Dr. Ayers noted that a November 7, 2014 MRI scan showed a complex tear of the 

lateral meniscus remnant. He related that in 2010 appellant had undergone right knee surgery 

and now demonstrated a worsening of the posterior horn tear, severe lateral femorotibial 

compartment arthritis, and moderate-to-severe patellofemoral arthritis. Dr. Ayers recommended 

keeping appellant out of work for a week.

In December 1, 2014 examination notes, Dr. Ayers reported that appellant was examined 

and/or treated on December 1, 2014 for right knee arthritis. He recommended that appellant be 

excused from work until December 9, 2014 before returning to full duty.
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Dr. Rees authorized appellant to resume work in a December 4, 2014 note. He advised 

that appellant’s work should be limited to his regularly scheduled days and not be more than 

eight and a half hours a day. 

By letter dated December 9, 2014, the employing establishment controverted appellant’s 

claim. It alleged that the medical evidence he submitted did not contain any diagnosis or opinion 

on how his alleged right knee injury was work related.

Appellant submitted a December 16, 2014 attending physician’s report from Dr. Ayers. 

He noted a date of injury of November 6, 2014 and described a history of injury of “knee 

buckling” and noted a preexisting injury of arthritis. Dr. Ayers diagnosed arthritis exacerbated 

by event and checked a box marked “yes” indicating that the diagnosed condition was caused or 

aggravated by the employment activity described above. He indicated that appellant was totally 

disabled from November 6 to December 4, 2014 and partially disabled beginning 

December 4, 2014.

In a December 16, 2014 duty status report (Form CA-17), Kristen Rodehoist, a certified 

physician assistant, noted a date of injury of November 6, 2014 and described that appellant was 

walking on his route when he felt sharp right knee pain. She diagnosed right knee arthritis and 

indicated that appellant could resume work.

By letter dated December 18, 2014, OWCP advised appellant that the evidence submitted 

was insufficient to establish a traumatic injury claim. It requested that he respond to the attached 

development questionnaire and submit additional medical evidence to establish a diagnosed 

condition causally related to the alleged employment incident. Appellant was afforded 30 days 

to submit the additional information.

Appellant submitted various medical reports dated from July 2009 to June 2013, which 

indicated that he was receiving medical treatment for a right knee torn lateral meniscus and 

moderate osteoarthritis. 

On January 20, 2015 OWCP received appellant’s response to its December 18, 2014 

development letter. Appellant explained that on November 6, 2014 he was on his mail route 

when he felt a sharp pain in his right knee. He related that his right knee buckled slightly and he 

took hold of his mail cart and a fence to avoid falling. Appellant indicated that after a couple of 

minutes the pain subsided and he was able to finish delivering the last seven stops on the route. 

He notified his supervisor when he returned to the employing establishment. Appellant noted 

that his right knee was operated on in March 2010. 

Appellant also related that he had been a city letter carrier since December 8, 1984. He

described his office duties to include standing while casing mail, bending, stooping, carrying 

mail from the distribution area, turning from side to side while casing mail, and loading push 

trucks to bring mail and packages from the office. Appellant also listed his street duties to 

include bending and twisting while loading a vehicle, getting in and out of a vehicle 

(approximately 12 to 15 times per day), pushing a mail cart up and down inclines, and walking 

on uneven sidewalks and pathways. 
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OWCP denied appellant’s claim in a January 21, 2015 decision. It found that the factual 

evidence of record was insufficient to establish that the November 6, 2014 incident occurred as 

alleged. OWCP also determined that the medical evidence of record failed to establish a 

diagnosed condition causally related to the alleged employment incident. 

On February 19, 2015 OWCP received appellant’s request for an oral hearing before an 

OWCP hearing representative. 

In a March 23, 2015 progress note, Dr. Rees related that appellant had an initial injury in 

November 1996 and continued to work steadily until the current onset of disability. He indicated 

that appellant had increasing difficulty with right knee pain over the past several years, but 

continued to work. Dr. Rees noted that as a letter carrier appellant spent long hours standing, 

walking, step climbing, bending, and stooping to take up packages. He opined that appellant’s 

occupation “has been a direct cause of the deterioration of the knee.”

Ms. Rodehoist indicated in a March 24, 2015 letter that appellant would be having right 

total knee arthroplasty on April 2, 2015. She advised that appellant would need to remain out of 

work while recovering from his surgery and would have monthly follow-up visits to determine 

his ability to return to work. 

A hearing was held on June 22, 2015. Counsel asserted that appellant incorrectly filed a 

Form CA-1 for a traumatic injury, but he should have filed a Form CA-2 because the medical 

evidence of record clearly demonstrated that appellant had sustained an occupational illness as a 

result of factors of his federal employment. He requested that OWCP consider appellant’s claim 

as an occupational disease claim. Counsel alleged that the medical evidence of record, 

specifically a series of MRI scan reports from 2010, 2013, and 2014, showed an acceleration of 

right knee arthritis. He further noted that the most recent medical record from Dr. Rees 

contained his opinion that appellant’s occupation was a direct cause of the deterioration of his

right knee condition. Appellant explained that he had experienced right knee problems since 

1990 and had right knee surgery in 2010, but that was unrelated to his employment. He 

described his duties as a letter carrier on a walking route and also described the work he did for 

Amtrak as a car cleaner. Appellant explained that he filled all the water tanks on the passenger 

cars by attaching a water hose to the water inlet. He noted that there was no incline or stair 

walking and no heavy lifting at his Amtrak job. 

By decision dated September 2, 2015, an OWCP hearing representative affirmed the 

January 21, 2015 decision, with modification. She noted that appellant now attributed his right 

knee condition to his federal employment duties. The hearing representative accepted 

appellant’s duties as a letter carrier and that he established a diagnosed right knee condition, but 

denied his claim because the medical evidence of record failed to establish that his current right 

knee condition was caused or aggravated by factors of his federal employment. 

On August 19, 2016 appellant, through counsel, requested reconsideration. Counsel 

asserted in a memorandum that new medical evidence established appellant’s occupational 

disease claim for permanent aggravation of right knee arthritis. He alleged that the new evidence 

fit within the description of the term “acceleration” as defined in OWCP’s procedures. Counsel 
5

related that Dr. Rees’ August 9, 2016 report would address how appellant’s duties as a letter 

carrier contributed to the development, aggravation, and acceleration of his right knee arthritis. 

Appellant submitted an August 9, 2016 report by Dr. Rees. He indicated that in response 

to the question of whether appellant’s duties as a letter carrier for 30 years contributed in any 

way to the development, acceleration, or aggravation of his right knee arthritis, his answer was 

yes. Dr. Rees related that appellant’s job as a letter carrier required long periods of standing, 

walking, ascending and descending steps, twisting, bending, stooping, lifting, and carrying mail 

each day for the past 30 years. He noted that it was well-documented that these types of highimpact activities contributed to and accelerated degenerative arthritis of the knee. Dr. Rees 

explained that appellant’s radiology studies clearly demonstrated the progression of appellant’s 

right knee arthritis as he worked as a letter carrier. He reported:

“Once the knee has sustained an injury that damages bone, cartilage -- or both --

the joint becomes increasingly vulnerable to further injury from high impact 

activities, such as those suffered by letter carriers. Thus, we see that not only did 

[appellant’s] work directly initiate knee damage; it was the major contributor to 

progressive deterioration caused by his long years of service.” 

Dr. Rees further explained that, although appellant had another job working for Amtrak 

that required walking, which might have contributed to his arthritis, it was of minimal 

importance compared to his 30 years of daily high-impact activity as a letter carrier. He 

concluded that appellant’s initial injury while working as a letter carrier and his continued 

working as a letter carrier for 30 years was the cause of his disability, which otherwise would not 

have developed or progressed as soon and as quickly as it did. 

OWCP received a statement from appellant who related that he had worked for the 

employing establishment as a letter carrier for almost 32 years. Appellant explained that his 

duties involved a significant amount of standing, bending, twisting, squatting, kneeling, 

ascending and descending stairs, ascending and descending hills, lifting, and carrying. He

estimated that during an average workday, he walked three miles, climbed and descended 400 

stairs, spent over 1.5 hours standing and casing mail, and lifted or carried well over 100 pounds 

of mail per day. 

Appellant submitted an April 2, 2015 operative report, which indicated that he underwent 

right total knee arthroplasty for a diagnosis of right knee osteoarthritis.

By decision dated September 19, 2016, OWCP denied modification of its prior decision. 

It found that the new medical evidence from Dr. Rees was not based on a complete and accurate 

history and was thus insufficient to establish that appellant’s employment duties aggravated or 

precipitated his right knee osteoarthritis.

On November 15, 2016 appellant, through counsel, again requested reconsideration. He 

indicated that he was submitting a new medical report by Dr. Rees that addressed all the 

deficiencies noted by OWCP. Counsel noted that Dr. Rees submitted yet another report 

thoroughly rationalizing his opinion that appellant’s work duties contributed to his right knee 
6

acute meniscal tear and arthritis. He further alleged that the case of Matter of Stanczak v. U.S. 

Postal Service4supported appellant’s occupational disease claim. 

Appellant submitted an October 19, 2016 report by Dr. Rees. Dr. Rees asserted that as 

appellant’s treating physician for several decades, no one would have more knowledge of 

appellant’s medical history. He noted that he was aware of appellant’s nonwork-related knee 

injuries over the years, including in 1990, 1996, and 2010, as well as the work injury he reported 

in November 2014. Dr. Rees explained:

“In knees like [appellant’s] that have sustained multiple traumas (whether workrelated or not), impact-loading activities such as standing, walking, step climbing 

and descending, twisting, bending and stooping, lifting, and carrying will 

accelerate and aggravate arthritis even more so than in someone who has not 

suffered prior trauma. These traumatic events combined with [appellant’s] work 

activities hastened the chemical process that destroys cartilage over time, and, 

therefore, aggravated and accelerated the arthritis, to the point of undergoing 

arthroplasty.”

Dr. Rees reported that the fact that appellant had repeated, nonwork-related trauma in his 

right knee fully supported and strengthened his opinion that appellant’s 30 years of impactloading activities as a letter carrier had accelerated and aggravated his arthritis. He further 

related that appellant’s obesity, like his prior traumatic events, also made his work activities even 

more contributory to his arthritis than if he were not obese and had no prior trauma. Dr. Rees 

noted that the extra weight of carrying his mail satchel and packages weighing up to 70 pounds 

was also a direct contributing factor. He concluded that appellant’s work duties for 30 years and 

the November 6, 2014 incident contributed to the acceleration and aggravation of appellant’s 

arthritis.

By decision dated April 4, 2017, OWCP denied modification of its prior decision. It 

found that the medical evidence of record failed to establish causal relationship between 

appellant’s current right knee condition and his employment duties. OWCP found that Dr. Rees 

did not provide a well-rationalized opinion that appellant’s medical condition was aggravated by 

factors of his federal employment.

LEGAL PRECEDENT

An employee seeking benefits under FECA5 has the burden of proof to establish the 

essential elements of his or her claim by the weight of the reliable, probative, and substantial 

evidence6including that he or she sustained an injury in the performance of duty and that any 

specific condition or disability for work for which he or she claims compensation is causally 

 

4 Ted A. Stanczak, Docket No. 99-0682 (issued November 4, 1999).

5 Supra note 2.

6

J.P., 59 ECAB 178 (2007); Joseph M. Whelan, 20 ECAB 55, 58 (1968).
7

related to that employment injury.7 In an occupational disease claim, appellant’s burden requires 

submission of the following: (1) a factual statement identifying employment factors alleged to 

have caused or contributed to the presence or occurrence of the disease or condition; (2) medical 

evidence establishing the presence or existence of the disease or condition for which 

compensation is claimed; and (3) medical evidence establishing that the diagnosed condition is 

causally related to the employment factors identified by the employee.8

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

establish causal relationship is rationalized medical opinion evidence.9 The opinion of the 

physician must be based on a complete factual and medical background of the employee, 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.10

ANALYSIS

The Board finds that this case is not in posture for a decision.

Appellant alleged that he sustained permanent aggravation of right knee osteoarthritis as 

a result of the repetitive duties of working as a letter carrier over the course of 30 years. In a 

detailed statement, he explained that his duties as a letter carrier involved casing mail, bending, 

stooping, carrying mail from the distribution area, turning from side to side while casing mail, 

loading push trucks to bring mail and packages from the office, bending and twisting while 

loading a vehicle, getting in and out of a vehicle (approximately 12 to 15 times per day), pushing 

a mail cart up and down inclines, and walking on uneven sidewalks and pathways. 

In support of his claim, appellant submitted various reports dated March 23, 2015 to 

October 19, 2016 from Dr. Rees. Dr. Rees noted that appellant worked as a letter carrier for 30 

years and described appellant’s duties to include long periods of standing, walking, ascending 

and descending steps, twisting, bending, stooping, lifting, and carrying mail. He reviewed 

appellant’s history and provided findings on examination. Dr. Rees diagnosed aggravation of 

right knee osteoarthritis. He opined that appellant’s work was the major contributor to the 

progressive deterioration of his right knee. In an August 9, 2016 report, Dr. Rees explained that 

high-impact activities, such as those he described, contributed to and accelerated degenerative 

arthritis of the knee. He reported that, although appellant had another job, it was of minimal 

importance compared to appellant’s 30 years of daily high-impact activity as a letter carrier. In 

an October 19, 2016 report, Dr. Rees further noted that appellant’s multiple traumas, whether 

work-related or not, combined with appellant’s high-impact work activities “hastened the 

chemical process that destroys cartilage over time, and, therefore, aggravated and accelerated the 

arthritis.”

 

7 M.M., Docket No. 08-1510 (issued November 25, 2010); G.T., 59 ECAB 447 (2008); Elaine Pendleton, 40 

ECAB 1143, 1145 (1989).

8 R.H., 59 ECAB 382 (2008); Ernest St. Pierre, 51 ECAB 623 (2000).

9

I.R., Docket No. 09-1229 (issued February 24, 2010); D.I., 59 ECAB 158 (2007).

10 I.J., 59 ECAB 408 (2008); Victor J. Woodhams, 41 ECAB 465 (2005).
8

Accordingly, the Board notes that Dr. Rees provided an affirmative opinion on causal 

relationship. The Board further finds that Dr. Rees’ reports, when read together, identified 

employment factors which appellant claimed caused his condition, identified findings upon 

examination, and explained how the identified employment factors, specifically the repetitive 

high-impact work activities, aggravated appellant’s right knee osteoarthritis. The Board finds 

that Dr. Rees’ opinion, while not sufficiently rationalized to meet appellant’s burden of proof, is 

sufficient, given the absence of any opposing medical evidence, to require further development 

of the record.11 It is well established that proceedings under FECA are not adversarial in nature, 

and while appellant has the burden of proof to establish entitlement to compensation, OWCP 

shares responsibility in the development of the evidence.12 OWCP has an obligation to see that 

justice is done.13

The case will be remanded to OWCP for further action consistent with this decision.14 

On remand, after such further development of the case record as OWCP deems necessary, it shall 

issue a de novo decision.

CONCLUSION

The Board finds that this case is not in posture for decision.

 

11 See A.F., Docket No. 15-1687 (issued June 9, 2016). See also John J. Carlone, 41 ECAB 354 (1989); Horace 

Langhorne, 29 ECAB 820 (1978).

12 See, e.g., Walter A. Fundinger, Jr., 37 ECAB 200, 204 (1985); Michael Gallo, 29 ECAB 159, 161 (1978); 

William N. Saathoff, 8 ECAB 769, 770–71; Dorothy L. Sidwell, 36 ECAB 699, 707 (1985).

13 William J. Cantrell, 34 ECAB 1233, 1237 (1983); Gertrude E. Evans, 26 ECAB 195 (1974).

14 A properly completed Form CA-16 authorization may constitute a contract for payment of medical expenses to 

a medical facility or physician, when properly executed. The form creates a contractual obligation, which does not 

involve the employee directly, to pay for the cost of the examination or treatment regardless of the action taken on 

the claim. See 20 C.F.R. § 10.300(c); Tracy P. Spillane, 54 ECAB 608 (2003). On return of the case, OWCP shall 

also determine whether the CA-16 form of record in this case properly authorized any medical treatment.
9

ORDER

IT IS HEREBY ORDERED THAT the April 4, 2017 decision of the Office of 

Workers’ Compensation Programs is set aside and the case is remanded for additional 

development consistent with this decision.

Issued: February 13, 2018

Washington, DC

Christopher J. Godfrey, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board