United States Department of Labor

Employees’ Compensation Appeals Board

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S.D., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Brockport, NY, Employer

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Docket No. 16-0999

Issued: October 16, 2017

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

COLLEEN DUFFY KIKO, Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On April 11, 2016 appellant filed a timely appeal from a January 4, 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 his burden of proof to establish that his claimed endstage left knee osteoarthritis was causally related to factors of his federal employment.

FACTUAL HISTORY

On December 19, 2014 appellant, then a 60-year-old letter carrier, filed an occupational 

disease claim (Form CA-2) for end-stage left knee osteoarthritis, which he attributed to “all the 

walking and stairs....” He identified September 10, 2014 as the date he first realized that his 

 

1

5 U.S.C. § 810 et seq.
2

employment either caused or aggravated his claimed left knee condition. Appellant stopped 

work on December 11, 2014. The employing establishment indicated that appellant’s left knee 

condition predated his June 2002 employment and, in fact, was originally injured while 

employed at another federal agency in 1979.

OWCP had accepted the 1979 injury for hemarthrosis secondary to trauma, left knee 

synovitis, and left medial meniscus tears under File No. xxxxxx725. On February 13, 1980 

appellant underwent arthroscopy and left medial meniscectomy, which OWCP authorized. 

Additionally, on July 14, 1983 appellant received a schedule award for 15 percent permanent 

impairment of the left leg.

In support of his current occupational disease claim for end-stage left knee osteoarthritis, 

appellant submitted a December 4, 2014 report from Dr. Mark J. Stenclik, a Board-certified 

orthopedic surgeon. Dr. Stenclik noted that appellant was seen for his “very arthritic left knee,”

and would “acquiesce” to surgery as the knee was no longer functional. He explained that “the 

total knee should have been done a decade ago.” Dr. Stenclik examined appellant and noted a 

fixed varus contracture. He also noted that appellant flexed surprisingly well to about 100 

degrees, and had a huge amount of crepitus. Dr. Stenclik obtained new x-rays, noting that the 

left knee revealed “horrible varus arthritis.” He indicated that appellant was walking on a 

depressed medial tibial plateau, depressed about a centimeter, and probably had a 25 degree 

fixed varus contracture. Dr. Stenclik also advised that appellant was walking on his tibial spines 

as well. He indicated that the left knee demonstrated spurs both anterior and posterior on the 

femur. Dr. Stenclik diagnosed horrible end-stage osteoarthritis of the left knee with fixed varus 

malalignment, bone on bone, and depressed medial tibia. He advised that, “if anybody needs a 

total knee arthroplasty, [appellant] does.” Dr. Stenclik discussed surgical intervention with 

appellant and requested authorization for surgery “from a residual compensation claim back in 

1979.”

2

 He recommended continued light-duty work where appellant did not have to be on his 

feet for more than a couple hours per day.

By letter dated February 4, 2015, OWCP advised appellant that the current factual and 

medical evidence was insufficient to establish entitlement to FECA benefits. Specifically, it

noted that the evidence was insufficient to establish that appellant actually experienced the 

employment factor(s) alleged to have caused his injury. Additionally, OWCP noted that 

appellant had not provided a physician’s opinion explaining how employment activities either 

caused, contributed to, or aggravated appellant’s medical condition. It afforded appellant 30 

days to submit the requested information. No evidence was received within the time allotted.

By decision dated March 27, 2015, OWCP denied appellant’s claim. It found that 

appellant had not established that the event(s) occurred as alleged. OWCP noted that it had not 

received any additional factual or medical evidence in response to its February 4, 2015 

development letter. Additionally, it found that Dr. Stenclik failed to explain how appellant’s 

end-stage left knee arthritis was employment related.

On April 7, 2015 appellant timely requested an oral hearing before a representative of the 

Branch of Hearings and Review, which was held on October 28, 2015.

 

2 Dr. Stenclik specifically identified June 12, 1979 as the date of injury. 
3

OWCP received an April 1, 2015 operative report from Dr. Stenclik, who performed a 

total left knee arthroplasty. The pre- and postoperative diagnosis was severe post-traumatic left 

knee arthritis with fixed varus and fixed flexion contracture, 15 degrees. Appellant also 

submitted treatment records pertaining to his hospitalization from April 1 through 4, 2015, which 

included nurses’ notes and inpatient physical therapy notes. OWCP also received a postsurgery 

treatment plan, as well as additional outpatient physical therapy records.

In an April 23, 2015 report, Dr. Stenclik noted that appellant was status post left total 

knee arthroplasty on April 1, 2015. Appellant was reportedly doing okay. Dr. Stenclik indicated 

that appellant would transition to outpatient therapy.

In a May 20, 2015 report, Dr. Stenclik noted that appellant was under his care for pain 

due to arthritic hip and knees. Regarding the left knee, he explained that this “has been a 

compensation event.” Dr. Stenclik noted that appellant had “what was probably an open 

meniscectomy at a young age, he was doing well with that, but he has some 13 or 14 years 

pounding on this knee sometimes four to five miles a day with the [employing establishment].” 

He indicated that appellant underwent a total knee replacement on April 1, 2015 and was in the 

process of recovering. Dr. Stenclik explained that appellant had a fixed varus contracture, which 

had to be corrected at the time of the surgery and still impeded his motion a bit. He diagnosed 

slight flexion contracture posttotal knee replacement, and recommended continued physical 

therapy. Dr. Stenclik opined that the “prolonged walking as a letter carrier ... contributed to and 

aggravated [appellant’s] arthritic condition of the knee to the point that he required knee 

replacement.” He further noted that walking all those years also resulted in a fixed varus and 

flexion contracture, which was being addressed. Dr. Stenclik anticipated better motion and 

endurance within a two-month period.

In a May 27, 2015 statement, appellant indicated that he was a letter carrier for 14 years. 

His duties included carrying mail 5 to 6 days a week, for up to 6 miles a day, and up to 10 hours 

a day. Appellant noted that during those 10 hours he would have to climb stairs to deliver mail 

and parcels. He also noted that he had to climb three flights of stairs in some apartment 

buildings. Appellant indicated that the constant pounding that his knees took contributed to his 

condition. He advised that for 14 years, he carried mail 5 to 6 days a week for up to 10 hours a 

day in all sorts of weather. Appellant explained that he first started noticing his knee in 2010,

but kept delivering mail. He started seeing a doctor in 2011 and he also had to carry up to 35 

pounds per bundle, with up to 12 bundles a day and his knee continued to worsen. Appellant 

explained that he filed an occupational disease claim on September 10, 2014 because his knee 

could not take the daily pounding anymore and he worked light duty until December 10, 2014. 

He noted that the employing establishment told them it did not have any more work for him and 

sent him home. Appellant did not indicate whether he had previous similar conditions.

OWCP received records from Dr. Stenclik dating from April 14, 2011 to May 17, 2012 

advising that appellant had left knee pain. Dr. Stenclik referred to a July 1978 date of injury. He 

found fixed varus contracture and horrible end-stage medial compartment arthrosis with a very 

posterior medial dished bone deficiency in the proximal tibia which may be difficult to correct 

without an augment and a total knee arthroplasty, which he recommended. Dr. Stenclik also 

performed a right total hip arthroplasty on February 28, 2012. Records concerning the hip were 

also received.
4

OWCP received a June 10, 2014 treatment note from a physician assistant who 

referenced that appellant indicated his original problem with his knee began when he was 

working in New York City.

In a November 9, 2015 statement, appellant indicated that Dr. Stenclik performed his 

total knee replacement and retired in September 2015. He indicated that Dr. Stenclik was the 

only doctor on his case and it was “impossible” to obtain additional information. Appellant also 

noted that he started with the employing establishment in 2001 and was cleared for duty with no 

problems with his knee at that time. He explained that in 2001 he saw Dr. Stenclik and his 

deterioration of his knee caused his right hip to become very painful. Appellant advised that his 

right hip was replaced on February 28, 2012. After he returned to work, the left knee continued 

to worsen until he was placed on light duty on September 10, 2014. Appellant noted that he 

worked light duty until December 10, 2014, when he was taken off work. He further noted that 

he scheduled his left total knee replacement for April 1, 2015 and he returned to work on 

August 1, 2015.

By decision dated January 4, 2016, OWCP’s hearing representative found that appellant 

established both the factual and medical components of fact of injury. However, she denied 

appellant’s occupational disease claim because the medical evidence was insufficient to establish 

causal relationship between appellant’s current left knee condition and the accepted employment 

factors. Consequently, the hearing representative modified and affirmed OWCP’s March 27, 

2015 decision, as modified.

LEGAL PRECEDENT

A claimant seeking benefits under FECA3has 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 that an injury was sustained in the performance of duty as alleged and that 

any specific condition or disability claimed is causally related to the employment injury.4

To establish that an injury was sustained in the performance of duty in an occupational 

disease claim, a claimant must submit: (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 

 

3

See supra note 1.

4

20 C.F.R. § 10.115(e), (f); see Jacquelyn L. Oliver, 48 ECAB 232, 235-36 (1996). Causal relationship is a 

medical question, which generally requires rationalized medical opinion evidence to resolve the issue. See 

Robert G. Morris, 48 ECAB 238 (1996). A physician’s opinion on whether there is a causal relationship between 

the diagnosed condition and the implicated employment factors must be based on a complete factual and medical 

background. Victor J. Woodhams, 41 ECAB 345, 352 (1989). 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 

factors. Id.
5

occurrence of the disease or condition; and (3) medical evidence establishing that the diagnosed 

condition is causally related to the identified employment factors.5

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.6

Certain healthcare providers such as physician assistants, nurse practitioners, physical 

therapists, and social workers are not considered “physician[s]” as defined under FECA.7 

Consequently, their medical findings and/or opinions will not suffice for purposes of establishing 

entitlement to FECA benefits.8

ANALYSIS

Appellant alleged that he developed a left knee condition due to daily walking as part of 

his work as a mail carrier. The evidence supports that appellant walked and climbed stairs as 

part of his mail carrier duties. Appellant was diagnosed with end-stage left knee osteoarthritis. 

OWCP accepted that appellant established fact of injury. However, it denied his claim, finding 

there was insufficient medical evidence to establish that appellant’s left knee condition was 

caused or aggravated by his work duties. The Board finds that appellant failed to meet his 

burden of proof to establish that his left knee condition is causally related to factors of his federal

employment. It is particularly important to note that appellant had a prior accepted left knee 

condition caused by his mail carrier duties.

The evidence submitted by appellant includes several reports from Dr. Stenclik. The 

most relevant report is his May 20, 2015 report in which Dr. Stenclik noted that appellant was 

under his care for an arthritic hip and knees. Regarding the left knee, he explained that this “has 

been a compensation event.” Dr. Stenclik explained that appallant had “what was probably an 

open meniscectomy at a young age, he was doing well with that, but he has some 13 or 14 years 

pounding on this knee sometimes four to five miles a day with the [employing establishment].” 

He indicated that appellant underwent a total knee replacement on April 1, 2015 and was 

recovering. Dr. Stenclik opined that appellant’s “prolonged walking as a letter carrier ... 

contributed to and aggravated his arthritic condition of the knee to the point that he required knee 

replacement....” He explained that walking all those years also resulted in a fixed varus and 

flexion contracture. The Board notes that, while his report generally suggests that walking all 

those years in his capacity as a letter carrier caused appellant’s left knee condition, Dr. Stenclik 

 

5 Victor J. Woodhams, id.

6

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

7

5 U.S.C. § 8101(2); 20 C.F.R. § 10.5(t).

8 K.W., 59 ECAB 271, 279 (2007); David P. Sawchuk, 57 ECAB 316, 320 n.11 (2006). A report from a physician

assistant or certified nurse practitioner will be considered medical evidence if countersigned by a qualified 

physician. Federal (FECA) Procedure Manual, Part 2 -- Claims, Causal Relationship, Chapter 2.805.3a(1)

(January 2013).
6

did not explain how the work-related activities caused his left knee condition. This is especially 

important because appellant had a preexisting left knee condition dating back to 1979. The 

Board finds that such generalized statements do not establish causal relationship because they 

merely repeat appellant’s allegations and are unsupported by adequate medical rationale 

explaining how his physical activity at work actually caused or aggravated the diagnosed 

conditions.9 The Board has held that the mere fact that appellant’s symptoms arise during a 

period of employment or produce symptoms revelatory of an underlying condition does not 

establish a causal relationship between appellant’s condition and his employment factors.10 

Thus, the Board finds that Dr. Stenclik’s reports are insufficiently rationalized to establish that 

appellant’s condition was caused or aggravated by the accepted factors of his federal 

employment.

Appellant also submitted physical therapy treatment records, as well as nursing notes. 

However, these healthcare providers are not considered physicians under FECA. Therefore, 

their respective reports will not suffice for purposes of establishing entitlement to FECA 

benefits.11

On appeal appellant argued that he submitted sufficient medical evidence from his 

physician to establish his claim. However, as found above, the medical evidence of record is 

insufficiently rationalized. 

The Board finds that the evidence of record fails to establish causal relationship between 

appellant’s end-stage left knee osteoarthritis and his accepted factors of federal employment.

12

 

Accordingly, appellant has failed to 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 failed to meet his burden of proof to establish that his 

claimed end-stage left knee osteoarthritis was causally related to factors of his federal 

employment.

 

9

See K.W., Docket No. 10-0098 (issued September 10, 2010).

10 See Richard B. Cissel, 32 ECAB 1910, 1917 (1981); William Nimitz, Jr., 30 ECAB 567, 570 (1979).

11 See supra notes 7 and 8.

12 Appellant’s personal belief that his employment activities either caused or contributed to his condition is 

insufficient, by itself, to establish causal relationship. 20 C.F.R. § 10.115(e); Phillip L. Barnes, 55 ECAB 426, 

440 (2004).
7

ORDER

IT IS HEREBY ORDERED THAT the January 4, 2016 decision of the Office of 

Workers Compensation Programs is affirmed.

Issued: October 16, 2017

Washington, DC

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Colleen Duffy Kiko, Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board