United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

J.B., Appellant

and

DEPARTMENT OF THE INTERIOR 

NATIONAL PARK SERVICE, Washington, DC, 

Employer

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Docket No. 19-1042

Issued: November 8, 2019

Appearances: Case Submitted on the Record

Thomas R. Uliase, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

JANICE B. ASKIN, Judge

ALEC J. KOROMILAS, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On April 11, 2019 appellant, through counsel, filed a timely appeal from a November 9, 

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 over 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 his burden of proof to establish a right knee 

condition causally related to the accepted factors of his federal employment.

FACTUAL HISTORY

This case has previously been before the Board.3 The facts and circumstances of the case 

as set forth in the prior Board decision are incorporated herein by reference. The relevant facts are 

as follows.

On June 3, 2015 appellant, then a 58-year-old pipefitter, filed an occupational disease claim 

(Form CA-2) alleging that he developed knee osteoarthritis as a result of his federal employment 

duties. He reported that his injury was a result of the repetitious stress to his bilateral knees from 

23 years of work servicing 430 plumbing fixtures. Appellant first became aware of his condition 

on March 1, 2010 and of its relationship to his federal employment on February 1, 2015. He did 

not stop work. OWCP initially denied the claim by decision dated September 8, 2015 as appellant 

had not established that his diagnosed medical condition was causally related to the accepted 

employment factors. 

In a March 29, 2016 narrative report, Dr. Evan Crain, a Board-certified orthopedic surgeon, 

reported that he initially evaluated appellant on December 16, 2015 for bilateral knee pain. He 

reported that appellant had worked for over 23 years, initially as a plumber and later as a pipefitter. 

Dr. Crain noted that appellant’s work required frequent squatting, kneeling, bending, and working 

on his knees. He reported that appellant personally serviced 430 plumbing fixtures over the course 

of 23 years, including toilets, sinks, and water fountains, which required that appellant be on his 

knees to perform the work. Dr. Crain discussed appellant’s x-rays which revealed progressive 

deterioration of the medial compartment in both knees as a result of his employment activities over 

the years. He opined that, as a result of appellant’s employment duties, appellant developed a 

meniscus tear of the right knee, which required arthroscopy, and which had caused deterioration 

of the medial joint space that had collapsed to bone-on-bone contact. Based on these findings,

Dr. Crain concluded that there was a direct causal relationship between appellant’s 

symptomatology and his work activities. 

Following further development of the record, by decisions dated July 28, and 

November 17, 2016, OWCP affirmed the denial of the claim. 

On January 19, 2017 appellant, through counsel, again requested reconsideration and 

submitted a January 9, 2017 report from Dr. Crain. In the January 9, 2017 report, Dr. Crain noted 

submission of his prior March 29, 2016 report which summarized his findings and reviewed 

appellant’s work activities. He opined that appellant experienced bilateral, right greater than left, 

knee pain aggravated by his work activities, which he had performed over a 23-year time frame. 

Dr. Crain also opined that those specific work activities caused further deterioration of his knees 

and an increase in his symptomatology. He reported that appellant had undergone a previous right 

knee arthroscopy for a tear of his medial meniscus. Dr. Crain explained that the tearing of the 

 

3 Docket No. 17-1870 (issued April 11, 2018).
3

meniscus caused further deterioration of the knee joint to the extent that appellant had loss of shock 

absorber on the medial side. He noted an exacerbation and worsening of appellant’s symptoms. 

Dr. Crain reviewed appellant’s prior medical reports which documented prior knee pain. 

Appellant was evaluated by Dr. Ricardo O. Pyfrom, a Board-certified orthopedic surgeon, on 

November 27, 2012 due to complaints of right knee pain for several years. He had also related a 

history that his right knee had been struck by a car 30 years ago. Appellant had previously been 

diagnosed with arthritis and had worn knee braces. A prior magnetic resonance imaging (MRI)

scan was suggestive of a medial meniscus tear and arthroscopic surgery was recommended. On 

April 3, 2013 appellant underwent surgery which revealed a large complex tear of the medial 

meniscus. Surgery further revealed degenerative changes of the medial femoral condyle grade 3

and medial tibial plateau grade 4, as well as a chronically torn anterior cruciate ligament and 

chondromalacia grade 3 of the patella. A partial medial meniscectomy and chondroplasty were 

performed. Dr. Crain reported that appellant returned to work approximately four weeks 

postsurgery. In 2014, appellant began treatment with a Dr. Joly who administered multiple 

injections and provided him with a knee brace. Dr. Crain reported that he initially evaluated 

appellant in December 2015.

Dr. Crain noted that, after review of subsequently provided medical records, there was no 

change in his opinion with regard to appellant’s condition. Appellant’s medical history reflected 

that, following his April 3, 2013 surgery, he did not experience a distinct injury, but rather had a 

progressive increase in knee pain which he attributed to his work activities. After having reviewed 

the nature of appellant’s employment, job description, and self-reported work activities, Dr. Crain 

opined that appellant’s employment duties aggravated an underlying degenerative condition. He 

reported that, if appellant were in a different job that did not require the employment activities 

required of him, appellant would not have experienced the symptoms necessitating his current 

treatment. Dr. Crain concluded that appellant developed further deterioration of his knees and an 

increase in symptomatology. He opined that the need for treatment was, therefore, related to 

appellant’s work activities. 

By decision dated April 25, 2017, OWCP denied modification of its November 17, 2016 

decision, finding that the medical evidence of record failed to establish that appellant’s diagnosed 

conditions were causally related to his accepted factors of his federal employment. 

On September 5, 2017 appellant, through counsel, requested an appeal before the Board. 

By decision dated April 11, 2018, the Board affirmed OWCP’s April 25, 2017 decision, finding 

that appellant had not met his burden of proof to establish a bilateral knee condition causally related 

to the accepted factors of his federal employment.4 

On August 14, 2018 appellant, through counsel, requested reconsideration and submitted 

a July 25, 2018 medical report from Dr. Crain. 

In his July 25, 2018 report, Dr. Crain reported that he last evaluated appellant on May 29, 

2018 for a follow-up due to continued severe right medial knee pain. He reported that appellant 

experienced a lot of pain with prolonged standing, getting up from a seated position, and going up 

 

4

Id.
4

and down stairs, noting that the pain was localized to the medial aspect of the knee. Physical 

examination revealed varus alignment because appellant was bone-on-bone, pain with varus 

compression of the medial compartment, and trace swelling. Dr. Crain noted review of x-rays 

which showed that appellant’s right knee was completely bone-on-bone. He further noted that 

there was cupping and spur formation on the patella and the left knee showed minor narrowing.

Dr. Crain recommended right total knee replacement. He opined that, based on appellant’s 

employment duties, he sustained a tear of the medial meniscus that led to the deterioration of the 

medial compartment. Dr. Crain explained that the medial meniscus was an important shock 

absorber to the medial aspect of the knee. He opined that, due to this repetitive positional 

requirement, appellant sustained a medial meniscus tear during the scope of his employment in 

which he performed this specific mechanism of activity for many years. Dr. Crain noted that, once 

the medial meniscus tore, appellant lost the shock absorber in the medial compartment of the knee 

and this caused deterioration and further deterioration of the medial compartment of the knee to 

the extent that appellant was now bone-on-bone. Dr. Crain reported that this mechanism was 

clearly supported in orthopedic practice as a common mechanism of developing post-traumatic 

arthritis of the knee. He explained that kneeling, squatting, bending, stooping, and twisting 

increase pressure on the meniscus and when done repetitively or with one single event, a tear can 

occur. Based on the tear and the lack of shock absorption, Dr. Crain opined that appellant’s knee 

progressed to bone-on-bone contact. He concluded that, as a result of appellant’s job activities, 

the progression of appellant’s knee condition occurred, causing him to become symptomatic, and 

require treatment including knee replacement surgery. 

By decision dated November 9, 2018, OWCP denied modification of its prior decision, 

finding that the evidence of record was insufficient to establish causal relationship between the 

accepted employment factors and the diagnosed right knee conditions. 

LEGAL PRECEDENT

An employee seeking benefits under FECA 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, that the claim was timely filed within the applicable 

time limitation period of FECA,5that an injury was sustained in the performance of duty as alleged, 

and that any disability or medical condition for which compensation is claimed is causally related 

to the employment 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

To establish that an injury was sustained in the performance of duty in a claim for 

occupational disease, appellant’s burden of proof requires submission of the following: (1) a 

factual statement identifying employment factors alleged to have caused or contributed to the 

 

5 S.B., Docket No. 17-1779 (issued February 7, 2018); J.P., 59 ECAB 178 (2007); Joe D. Cameron, 41 ECAB 

153 (1989).

6

J.M., Docket No. 17-0284 (issued February 7, 2018); R.C., 59 ECAB 427 (2008); James E. Chadden, Sr., 40 

ECAB 312 (1988).

7 K.M., Docket No. 15-1660 (issued September 16, 2016); L.M., Docket No. 13-1402 (issued February 7, 2014); 

Delores C. Ellyett, 41 ECAB 992 (1990).
5

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 required to establish causal

relationship is rationalized medical evidence.9 The opinion of the physician must be based on a 

complete factual and medical background, 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 appellant.10 

ANALYSIS

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

condition causally related to the accepted factors of his federal employment.

Preliminarily, the Board notes that it is unnecessary for it to consider the evidence appellant 

submitted prior to the issuance of OWCP’s April 25, 2017 decision because the Board considered 

that evidence in its April 11, 2018 decision and found it insufficient to establish causal relationship. 

Findings made in prior Board decisions are res judicata absent any further review by OWCP under 

section 8128 of FECA.11

In further support of his claim, appellant submitted a July 25, 2018 medical report from

Dr. Crain discussing his right knee condition. The Board finds that the opinion of Dr. Crain is not 

well rationalized and fails to establish appellant’s occupational disease claim.12 In his July 25, 

2018 report, Dr. Crain opined that, based on appellant’s employment duties, he sustained a tear of 

the medial meniscus that led to the deterioration of the medial compartment. He noted that, once 

the medial meniscus tore, appellant lost the shock absorber in the medial compartment of the knee 

and this caused deterioration and further deterioration of the medial compartment of the knee to 

the extent that he was now bone-on-bone. The Board notes that Dr. Crain’s July 25, 2018 medical 

report is largely duplicative of the opinions expressed in his prior reports.

13

 While Dr. Crain 

provided some additional discussion pertaining to mechanism of injury, he failed to clearly 

describe the specific physiological mechanism through which specific work activities could have 

caused or aggravated appellant’s diagnosed medical condition. He explained that kneeling, 

squatting, bending, stooping, and twisting increased pressure on the meniscus and when done 

repetitively or with one single event, a tear could occur. Dr. Crain opined that, due to this repetitive 

 

8 See M.W., Docket No. 18-1555 (issued March 20, 2019); Roy L. Humphrey, 57 ECAB 238, 241 (2005); Ruby I. 

Fish, 46 ECAB 276, 279 (1994). 

9 B.K., Docket No. 19-0829 (issued September 25, 2019). 

10 S.S., Docket No. 18-1488 (issued March 11, 2019). 

11 See L.E., Docket No. 18-1138 (issued February 1, 2019); B.R., Docket No. 17-0294 (issued May 11, 2018).

12 S.F., Docket No. 18-1030 (issued April 5, 2019).

13 S.S., Docket No. 17-1106 (issued June 5, 2018).
6

positional requirement, appellant sustained a medial meniscus tear during the scope of his 

employment as he performed this specific mechanism of activity for many years. The Board finds 

his explanation to be generalized and of limited probative value on the issue of causal 

relationship.14 Dr. Crain failed to adequately describe appellant’s employment duties, during any 

specific time period, but instead referred to appellant’s employment as a whole. His generalized 

explanation pertaining to the mechanism of injury addresses a meniscus tear occurring from one 

single event, as well as from repetitive movements. Therefore, it is unclear whether appellant’s 

right meniscus tear was the result of his repetitive employment duties, rather then caused by a 

single traumatic occurrence. 

Moreover, the record reflects that appellant had a preexisting right knee condition from a 

motor vehicle accident, as well as a degenerative osteoarthritic condition. However, Dr. Crain 

failed to discuss whether appellant’s preexisting conditions had progressed beyond what might be 

expected from the natural progression of that condition.15 A well-rationalized opinion is 

particularly warranted when there is a history of a preexisting condition.16 The Board finds that

Dr. Crain’s July 25, 2018 report is insufficient to establish appellant’s claim.

17

 

The Board finds that the record lacks rationalized medical evidence establishing causal 

relationship between the accepted employment factors and appellant’s diagnosed right knee

condition.

18

 Thus, appellant has not met his burden of proof.19

Appellant may submit new evidence or argument with a written request for reconsideration 

to OWCP within one year of the Board’s 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 a right knee 

condition causally related to the accepted factors of his federal employment. 

 

14 D.M., Docket No. 19-0389 (issued July 16, 2019).

15 C.E., Docket No. 19-0192 (issued July 16, 2019); R.E., Docket No. 14-0868 (issued September 24, 2014).

16 E.B., Docket No. 17-1497 (issued March 19, 2019).

17 See C.D., Docket No. 19-0611 (issued August 9, 2019).

18 K.L., Docket No. 18-1029 (issued January 9, 2019).

19 T.O., Docket No. 18-0139 (issued May 24, 2018).
7

ORDER

IT IS HEREBY ORDERED THAT the November 9, 2018 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: November 8, 2019

Washington, DC

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Alec J. Koromilas, Alternate Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board