United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

M.E., Appellant

and

U.S. POSTAL SERVICE, ELMHURST POST 

OFFICE, Elmhurst, IL Employer

__________________________________________

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Docket No. 18-1135

Issued: January 4, 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

ALEC J. KOROMILAS, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On May 15, 2018 appellant, through counsel, filed a timely appeal from a March 22, 2018

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 has met her burden of proof to establish a bilateral knee 

injury causally related to the accepted factors of her federal employment.

FACTUAL HISTORY

On September 6, 2017 appellant, then a 57-year-old mail carrier, filed an occupational 

disease claim (Form CA-2) alleging that she developed unilateral primary osteoarthritis of the right 

knee due to her employment duties. She first became aware of her condition of bilateral knee pain 

on December 14, 2016 and first attributed the condition to her federal employment on 

August 28, 2017. In her accompanying narrative statement, appellant attributed her right knee 

condition to standing for two to three hours a day casing mail for 33 years. She was also required 

to walk up to eight hours a day delivering mail with a 35-pound mailbag walking on uneven grass 

and concrete, and walking up and down stairs. 

In a report dated August 28, 2017, Dr. Sean D. Odell, a Board-certified orthopedic surgeon,

examined appellant due to bilateral knee pain, greater on the right. He noted that she had 

previously undergone two right knee arthroscopies on April 15, 1999 for partial medial 

meniscectomy and chondroplasty of the patella and on April 12, 2007 for partial lateral 

meniscectomy and chondroplasty of the patella, which was work related. Dr. Odell examined 

appellant’s right knee and found positive medial joint line tenderness, positive patellofemoral 

tenderness, and crepitus with range of motion from 0 to 125. Appellant’s left knee demonstrated 

mild medial joint line tenderness as well as discomfort with McMurray’s and Apley’s tests. 

Dr. Odell reviewed appellant’s knee x-rays and on the right found significant medial joint space 

narrowing with medial and patellofemoral osteophyte formation. On the left appellant’s x-ray 

demonstrated mild medial joint space narrowing with osteophyte formation. Dr. Odell diagnosed 

right knee osteoarthritis exacerbation and pain, work related and left knee mild osteoarthritis, work

related. He explained that the 2007 work-related right knee arthroscopy with partial meniscectomy 

and chondroplasty had increased the rate of arthritic changes in her right knee, combined with 

significant walking at work and carrying mail, resulting in exacerbation of her arthritic symptoms.

In a development letter dated September 19, 2017, OWCP requested additional medical 

evidence in support of appellant’s occupational disease claim. It noted that a physician’s opinion 

as to how employment activities caused, contributed to, or aggravated her medical condition had 

not been provided. OWCP afforded appellant 30 days to submit the requested information.

Dr. Odell authored a report of October 2, 2017 and repeated his physical findings and 

diagnoses. He described appellant’s work duties including carrying a 30-pound mailbag and 

walking up to 8 hours a day as well as traversing stairs for 33 years. Dr. Odell opined:

“[Appellant] is carrying extra weight in the mailbag, walking all day, and going up 

and down stairs repeatedly, this could, and I believe did, aggravate the arthritic 

changes in her knees. In specific regards to her right knee, she had two prior knee 

arthroscopies that were both due to work-related injuries.... These two workrelated injuries to her right knee with subsequent surgical intervention increased the 

rate of her arthritic progression in the right knee.
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“Therefore, it is my belief that the exacerbation of bilateral knee [osteoarthritis] is 

due to her work activities.”

By decision dated November 15, 2017, OWCP denied appellant’s occupational disease 

claim finding that Dr. Odell’s reports were insufficiently rationalized to establish causal 

relationship between appellant’s diagnosed condition and her work events.

On December 26, 2017 appellant requested reconsideration of the November 15, 2017 

decision. She resubmitted the August 28, 2017 report from Dr. Odell as well as additional 

treatment notes. On November 2, 2017 Dr. Odell noted that he had previously described why he 

felt appellant’s knee pain was work related. In a report dated December 12, 2017, he described 

her history of knee pain in December 2016 and her two right knee surgeries. Dr. Odell provided 

his finding on physical examination and reviewed bilateral knee x-rays. He opined:

“It is with medical certainty that [appellant] sustained a work-related injury which 

was directly caused by aggravation that is permanent.... The surgeries to her 

meniscus and chondral damage discussed on the arthroscopies increased the rate of 

arthritic changes in her right knee. That combined with significant walking at work 

and carrying mail had exacerbated her arthritic symptoms. This has occurred in the 

right knee greater than [the] left. [Appellant] suffers from bilateral knee 

osteoarthritis due to the wear and tear on her knees while working. She is required 

to bend, lift, carry, push, pull, and perform heavy work duties which make it 

strenuous on her lower extremities.”

By decision dated March 22, 2018, OWCP reviewed appellant’s occupational disease 

claim on the merits and denied modification, finding that the medical evidence did not establish 

that her diagnosed condition of bilateral osteoarthritis of the knees was causally related to her 

accepted employment duties. It further found that the opinion of Dr. Odell was insufficient to 

establish an acceleration of her underlying condition.

LEGAL PRECEDENT

An employee seeking benefits under FECA3 has the burden of proof to establish the 

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

evidence, 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 period of 

FECA, that an injury was sustained 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.4 These are the essential elements of every compensation claim regardless of whether the 

claim is predicated on a traumatic injury or an occupational disease.5

 

3 Supra note 2.

4 Kathryn Haggerty, 45 ECAB 383, 388 (1994).

5 K.B., Docket No. 17-1997 (issued July 27, 2018).
4

OWCP’s regulations define an occupational disease as “a condition produced by the work 

environment over a period longer than a single workday or shift.”

6

 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 evidence required to establish causal relationship is rationalized 

medical opinion evidence, based upon a complete factual and medical background, showing a 

causal relationship between the claimed condition and identified factors. 

ANALYSIS

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

injuries causally related to the accepted factors of her federal employment.

Appellant’s attending physician, Dr. Odell, has provided several reports attributing her 

bilateral knee osteoarthritis to her employment duties as well as to her two previous employmentrelated right knee surgeries. He explained that the surgeries to her meniscus and chondral damage 

discussed on the arthroscopies increased the rate of arthritic changes in her right knee and that her

significant walking at work, carrying extra weight in the mailbag and going up and down stairs 

repeatedly, aggravated the arthritic changes in her knees bilaterally. 

While he provided an affirmative opinion on causal relationship, Dr. Odell’s conclusory 

opinion is insufficiently rationalized. He failed to provide an explanation pertaining to the 

mechanism of injury to establish that appellant’s bilateral knee osteoarthritis initial right knee

meniscus tear was work related. Without explaining how physiologically the movements involved 

in appellant’s employment duties caused or contributed to the arthritic process, Dr. Odell’s opinion 

on causal relationship is equivocal in nature and of limited probative value.7

Furthermore, Dr. Odell noted appellant’s prior history of right knee arthroscopy yet failed 

to provide a detailed medical history to provide an understanding of her preexisting condition or 

prior injuries. He failed to address what caused the underlying condition and he did not discuss 

whether her preexisting injury had progressed beyond what might be expected from the natural 

progression of that condition.8 A well-rationalized opinion is particularly warranted when there is 

a history of preexisting condition.9 As such, Dr. Odell’s reports lack the specificity and detail 

 

6 20 C.F.R. § 10.5(q).

7 See J.B., Docket No. 17-1870 (issued April 11, 2018). 

8 R.E., Docket No. 14-0868 (issued September 24, 2014).

9 T.M., Docket No. 08-0975 (issued February 6, 2009); Michael S. Mina, 57 ECAB 379 (2006).
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needed to establish that appellant’s bilateral knee conditions are a result of a work-related 

occupational exposure.10

The Board notes that there is no requirement that the federal employment be the only cause 

of appellant’s injury. An employee is not required to prove that occupational factors are the sole 

cause of his or her claimed condition. If work-related exposures caused, aggravated, or accelerated 

appellant’s condition, she is entitled to compensation.11 However, an award of compensation may 

not be based on surmise, conjecture, speculation, or on the employee’s own belief of causal 

relation.12 Appellant’s honest belief that her occupational employment duties caused her medical 

injury is not in question,13 but that belief, however sincerely held, does not constitute the medical 

evidence necessary to establish causal relationship.14

The evidence of record lacks sufficient rationalized medical evidence establishing a causal 

relationship between the accepted factors of appellant’s federal employment and her diagnosed 

knee osteoarthritis. Thus, appellant has failed to meet her burden of proof. 

Appellant may submit new evidence 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 bilateral knee 

injury causally related to the accepted factors of her federal employment. 

 

10 P.O., Docket No. 14-1675 (issued December 3, 2015); S.R., Docket No. 12-1098 (issued September 19, 2012).

11 See Beth P. Chaput, 37 ECAB 158, 161 (1985); S.S., Docket No. 08-2386 (issued June 5, 2008).

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

13 See M.C., Docket No. 17-1579 (issued November 28, 2017).

14 Id.
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ORDER

IT IS HEREBY ORDERED THAT the March 22, 2018 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: January 4, 2019

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