United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

A.G., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Raleigh, NC, Employer

__________________________________________

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Docket No. 19-0153

Issued: May 13, 2019

Appearances: Case Submitted on the Record

Capp P. Taylor, 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

ALEC J. KOROMILAS, Alternate Judge

JURISDICTION

On October 25, 2018 appellant, through counsel, filed a timely appeal from a May 2, 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.

ISSUE

The issue is whether appellant has met his burden of proof to establish bilateral knee 

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

 

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

FACTUAL HISTORY

On January 19, 2016 appellant, then a 62-year-old mail handler, filed an occupational 

disease claim (Form CA-2) alleging that he developed osteoarthritis in his left knee and bursitis in 

his right hip as a result of standing eight hours per day, pushing, pulling, bending, and climbing, 

while in the performance of duty. He indicated that he first became aware of his claimed condition 

in 2004 and first realized it was caused or aggravated by his federal employment in June 2013. 

In a development letter dated February 5, 2016, OWCP informed appellant that the factual 

and medical evidence of record was insufficient to establish his claim. It advised him of the type 

of factual and medical evidence needed and provided a questionnaire for his completion. OWCP 

afforded appellant 30 days to submit the necessary evidence. No response was received.

By decision dated April 13, 2016, OWCP found that the noted employment factors 

occurred as alleged, but denied appellant’s occupational disease claim, finding that the medical 

evidence submitted was insufficient to establish a diagnosed medical condition in connection with 

the accepted employment factors.

Appellant, through counsel, requested reconsideration on April 12, 2017. Along with his

request, he submitted a report dated March 16, 2017 from Dr. Derek L. Reinke, a Board-certified 

orthopedic surgeon. Dr. Reinke indicated that appellant first presented with left knee pain and 

diagnosed medial compartment arthritis of the left knee in 2006 which resulted in a high tibial 

osteotomy which was fully successful. He noted an x-ray examination performed on

November 20, 2012 demonstrated advanced medial compartment arthritis bilaterally, which was

confirmed with clinical examination and magnetic resonance imaging (MRI) scan. Dr. Reinke 

opined that appellant probably had varus alignment congenitally, which possibly made him more 

susceptible to developing osteoarthritic knees. He further noted that appellant’s performance of

his job at the employing establishment required him to stand, walk, and frequently bend and stoop 

and over many years had contributed to the bilateral osteoarthritis. Dr. Reinke explained that 

appellant’s work activity “would provide” repetitive cartilage stress that, coupled with the factor 

of aging, “more likely than not contributed to the worsening of his arthritis.”

By decision dated May 23, 2017, OWCP modified its April 13, 2016 decision, finding that 

the medical evidence provided a diagnosed condition, but the claim remained denied because the 

medical evidence of record was insufficient to establish causal relationship between the accepted 

factors of appellant’s federal employment and his diagnosed conditions. It noted that Dr. Reinke 

had not explained with medical rationale how or why his work factors caused or contributed to his 

diagnosed conditions.

Appellant, through counsel, requested reconsideration on January 17, 2018 and submitted 

a report dated January 4, 2018 from Dr. Reinke. Supplementing his March 16, 2017 report,

Dr. Reinke explained that appellant’s job requirements -- repetitive standing, pushing, pulling, 

climbing, and bending eight hours per day -- contributed to his bilateral knee osteoarthritis. He

explained that osteoarthritis of the knees is a repetitive stress injury which is usually the result of 

the type of job a person has, typically including a lot of activity that puts stress on the joint such 

as kneeling, squatting, or lifting. Dr. Reinke acknowledged that age is also a factor as age affects 

the ability of cartilage to heal and that ability decreases as a person gets older. He explained that 

appellant’s symptoms increased regarding his complaints of pain and such a worsening of 

symptoms is consistent with the x-rays of both knees that demonstrated a progression of the 
3

advance of the medial compartment arthritis bilaterally. Dr. Reinke explained that as repetitive

motions wear down protective cartilage at the knee joints, causing bones to rub together, and cause 

pain and inflammation. He explained that these actions were the pathophysiologic process 

involved in appellant’s osteoarthritis and the forces were sufficiently severe to have led to the need 

for bilateral knee replacements.

By decision dated May 2, 2018, OWCP denied appellant’s claim, finding that causal 

relationship had not been established. It noted that Dr. Reinke opined that appellant’s work factors 

contributed to the diagnosed conditions of bilateral osteoarthritis, but offered no definitive opinion 

indicating that factors of his federal employment caused or aggravated his bilateral knee 

osteoarthritis.

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,3that 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.4 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.5

In an occupational disease claim, 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 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.6

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

relationship is rationalized medical opinion evidence.7 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.8

 

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

153 (1989).

4

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

ECAB 312 (1988).

5 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).

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

7

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

8

I.J., 59 ECAB 408 (2008); Victor J. Woodhams, 41 ECAB 345 (1989).
4

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.9

ANALYSIS

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

In support of his claim appellant submitted medical reports from his attending physician,

Dr. Reinke. In his March 16, 2017 report, Dr. Reinke opined that appellant’s repetitive standing, 

pushing, pulling, climbing, and bending at work caused a worsening of appellant’s symptoms 

consistent with a progression of the advance of medial compartment arthritis bilaterally. He 

acknowledged appellant’s prior history of a knee injury in 2006 and noted that appellant had 

returned to full-duty employment working 8 to 10 hours per day performing repetitive tasks as a 

mail carrier. Dr. Reinke explained that appellant’s work activity “would provide” repetitive 

cartilage stress that, coupled with the factor of aging, “more likely than not contributed to the 

worsening of his arthritis.” 

On January 4, 2018 Dr. Reinke provided a supplemental statement in which he addressed, 

to a reasonable degree of medical certainty, his opinion on whether appellant’s employment duties 

had caused, contributed to, or aggravated appellant’s diagnosed condition of osteoarthritis. He

accurately reported the history of injury, appellant’s prior medical history, and the accepted 

employment factors including repetitive standing, pushing, pulling, climbing, and bending for 

eight hours a day. Dr. Reinke explained that osteoarthritis of the knees is a repetitive stress injury 

which is usually the result of the type of job a person has, typically including a lot of activity that 

puts stress on the joint such as kneeling, squatting, or lifting. He acknowledged that age is also a 

factor as it affects the ability of cartilage to heal and that ability decreases as a person gets older. 

Dr. Reinke explained that as repetitive motions wear down protective cartilage at the knee joints, 

causing bones to rub together, and cause pain and inflammation. He explained that these actions 

were the pathophysiologic process involved in appellant’s osteoarthritis

Accordingly, the Board finds that Dr. Reinke provided an affirmative opinion on causal 

relationship. The Board further finds that Dr. Reinke’s 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, had aggravated appellant’s right knee osteoarthritis. The Board finds 

that Dr. Reinke’s 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.10

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 

 

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

10 See J.G., Docket No. 17-1062 (issued February 13, 2018); 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).
5

responsibility in the development of the evidence.11 OWCP has an obligation to see that justice is 

done.12

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

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

issue a de novo decision. 

CONCLUSION

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

ORDER

IT IS HEREBY ORDERED THAT the May 2, 2018 decision of the Office of Workers’

Compensation Programs is set aside and the case is remanded for further development consistent 

with this decision of the Board.

Issued: May 13, 2019

Washington, DC

Christopher J. Godfrey, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Alec J. Koromilas, Alternate Judge

Employees’ Compensation Appeals Board

 

11 A.P., Docket No. 17-0813 (issued January 3, 2018); Jimmy A. Hammons, 51 ECAB 219, 223 (1999); William J. 

Cantrell, 34 ECAB 1233, 1237 (1983).

12 See B.C., Docket No. 15-1853 (issued January 19, 2016).