United States Department of Labor

Employees’ Compensation Appeals Board

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L.S., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE,

Great Barrington, MA, Employer

__________________________________________

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Docket No. 18-0518

Issued: February 19, 2020

Appearances: Case Submitted on the Record

Appellant, pro se

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 January 16, 2018 appellant filed a timely appeal from an August 31, 2017 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 has met her burden of proof to establish left ankle and

bilateral knee conditions causally related to the accepted factors of her federal employment.

FACTUAL HISTORY

On June 1, 2016 appellant, a 51-year-old city letter carrier, filed an occupational disease 

claim (Form CA-2) alleging that she sustained an injury due to factors of her federal employment. 

She indicated that she first became aware of her condition and first realized it was caused or 

 

1 5 U.S.C. § 8101 et seq.
2

aggravated by factors of her federal employment on September 2, 2015. Appellant stopped work 

and has not returned.2

In a narrative statement submitted with her claim, appellant indicated that she transferred

to her duty station in January 1997 and had walked with a 35-pound bag six days a week, up to 56 

hours per week while delivering her mail route. She identified the factors of employment that she 

believed caused her conditions including standing, walking, carrying heavy packages, climbing 

stairs, climbing in and out of vehicles, and walking on uneven ground. Appellant indicated that as 

time went on she had experienced left ankle pain and right knee pain. She noted that she could 

not walk longer than 15 minutes with pain shooting up her leg and around her knee. Appellant 

noted that she was waiting for a total knee replacement.

In a March 18, 2016 report, Dr. Albert A. Bravo, a podiatrist, noted that appellant had been 

seen and treated for pain in her left hindfoot and ankle area. He reported that she had long-standing 

problems with her feet and in March 2007 noticed a change in the configuration of her arch. In 

November 2007, the pain had recurred and appellant wore various types of arch supports and heel 

lifts, which were unable to alleviate her symptoms. Dr. Bravo noted that in September 2014 

appellant had undergone injection therapy and options concerning more aggressive bracing were 

discussed. Appellant underwent triple arthrodesis surgery in an effort to stabilize the foot and 

alleviate her symptoms. Dr. Bravo opined that her symptomatology was significantly aggravated 

by her work activities and noted that her duties required significant amounts of standing, walking, 

carrying heavy packages, climbing stairs, and climbing in and out of vehicles which caused 

excessive mechanical strain on the foot. He further opined that this contributed to the chronic pain 

requiring surgery at the left hindfoot area and appellant’s foot condition also directly contributed 

to her knee problems.

On May 26, 2016 Dr. Pier B. Boutin, a Board-certified orthopedic surgeon, noted that 

appellant first consulted his office on August 25, 2014 after injuring her left knee and ankle. He

indicated that she had reported an employment injury on April 8, 2014 and her symptoms 

apparently began as a result of excessive walking and stairs and that the pain became so severe 

that she had difficulty performing her duties. Dr. Boutin diagnosed an aggravation of knee arthritis 

and ankle arthritis based on x-rays from August 26, 2014 and June 5, 2015 and based upon 

appellant’s physical examination. He opined that her symptoms were no longer controlled with 

conservative treatment and she was a candidate for bilateral total knee replacements. Dr. Boutin 

further opined that appellant’s federal duties for the past 20 years had markedly aggravated her 

condition and were also a major contribution to her present condition. He recommended a future 

knee replacements and an ankle fusion.

In a development letter dated June 14, 2016, OWCP advised appellant of the deficiencies 

in her claim and informed her of the additional evidence necessary to establish her claim. It 

provided a questionnaire for her completion and afforded her 30 days to respond.

 

2

In a letter dated June 14, 2016, OWCP informed appellant that it had inadvertently created a duplicate claim file 

and thus deleted OWCP File No. xxxxxx111. It further informed her that the case would proceed under OWCP File 

No. xxxxxx133, the current claim.
3

On June 17, 2018 the employing establishment controverted the claim asserting that 

appellant failed to establish causal relationship. It provided a statement from her postmaster who 

noted embellishment on the part of appellant in describing the employment duties of her position.

In response to the development letter, appellant submitted an x-ray of her right knee dated 

June 5, 2015 which showed osteoarthritis and patellofemoral joint, as well as evidence of a joint 

effusion with a fatty structure in the suprapatellar region. An August 26, 2014 x-ray of her left 

ankle demonstrated mild lateral ankle soft tissue swelling, mild anterior ankle soft tissue swelling, 

and mild osteoarthritis changes at the tibiotalar joint and distal fibula. An August 26, 2014 x-ray 

of appellant’s knees, read by Dr. Sanjay Kedia, a diagnostic radiologist, revealed chronic 

appearing depression of the articular surface of the right lateral tibial plateau “may be due to old 

trauma,” small periarticular osteophytes of the right knee, and unremarkable left knee.

By decision dated September 6, 2016, OWCP denied the claim finding that the medical 

evidence of record failed to establish a causal relationship between appellant’s diagnosed

conditions and the accepted factors of her federal employment.

Appellant subsequently submitted work excuse notes dated August 1, September 29, and 

October 27, 2016 from Dr. Jeffrey P. Cella, a Board-certified orthopedic surgeon, who diagnosed 

right knee degenerative joint disease (DJD) status post right knee replacement and moderate 

arthritis of the left knee. Dr. Cella opined that she was capable of working six hours per day with 

minimal walking and standing and lifting no more than 20 pounds.

On June 7, 2017 appellant requested reconsideration.

In an October 12, 2016 report, Dr. Cella opined that appellant’s diagnosed condition of 

knee DJD status post right total knee replacement was significantly aggravated by her work 

activities as they included significant amounts of standing, walking, carrying heavy packages, 

climbing stairs, climbing in and out of vehicles, and walking on uneven ground. He further opined 

that her duties had caused an excessive mechanical strain on the right knee.

On January 31, 2017 Dr. David Dixon, a Board-certified orthopedic surgeon, reviewed 

appellant’s left foot and ankle x-rays and found that they revealed healed triple arthrodesis for the 

most part, good alignment noted, and almost full healing across all three joints. He opined that 

she was not capable of fully standing all day at work and could only return to a sedentary position. 

Dr. Dixon further opined that appellant was totally disabled for work due to her left ankle condition

and right end-stage knee arthritis.

In a May 23, 2017 report, Dr. Cella indicated that he had treated appellant for her bilateral 

knee issues and had only examined her left ankle for stability to support her right knee replacement. 

He noted that she had recovered from her knee replacement and was doing well. Dr. Cella 

indicated that he had returned appellant to work with no formal restrictions.

By decision dated August 31, 2017, OWCP denied modification of its prior decision.
4

LEGAL PRECEDENT

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

essential elements of his or her claim, including 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 of FECA,4that 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.5 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.6

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

disease claim, a claimant must submit: (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 claimant.7 

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

relationship is rationalized medical opinion evidence.8 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 specific employment factors identified by the employee.9

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.10

 

3 Supra note 1.

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

153 (1989). 

5

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

ECAB 312 (1988).

6 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).

7 S.C., Docket No. 18-1242 (issued March 13, 2019); R.H., 59 ECAB 382 (2008).

8 A.M., Docket No. 18-1748 (issued April 24, 2019); T.H., 59 ECAB 388, 393 (2008); Robert G. Morris, 48 ECAB 

238 (1996).

9 M.V., Docket No. 18-0884 (issued December 28, 2018); I.J., 59 ECAB 408 (2008); Victor J. Woodhams, 41 ECAB 

345, 352 (1989).

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

N.C., Docket No. 19-1191 (issued December 19, 2019); R.D., Docket No. 18-1551 (issued March 1, 2019) .
5

ANALYSIS

The Board finds that appellant has not met her burden of proof to establish left ankle and 

bilateral knee conditions causally related to the accepted factors of her federal employment.

In his March 18, 2016 report, Dr. Bravo noted that treatment was provided for appellant’s 

left hindfoot and ankle. He noted her long-standing problems with her feet. Dr. Bravo opined that 

appellant’s symptomatology had been significantly aggravated by her work activities and noted 

that her duties required significant amounts of standing, walking, carrying heavy packages, 

climbing stairs, and climbing in and out of vehicles, which caused excessive mechanical strain on 

the foot. He further opined that her duties contributed to the chronic pain requiring surgery at the 

left hindfoot area and that her foot condition also directly contributed to her knee problems. 

Although he provided an opinion on causal relationship, Dr. Bravo did not specifically diagnose 

either a left ankle or knee conditions and generally noted appellant’s pain. It is not possible to 

establish the cause of a medical condition if the physician has not provided a diagnosis, but only 

notes pain.

11

 The Board has consistently held that pain is a symptom and not a compensable 

medical diagnosis.12 For these reasons, this report from Dr. Bravo is insufficient to establish a 

medical diagnosis in connection with the accepted employment factors.

Dr. Dixon, in his January 31, 2017 report, opined that appellant was totally disabled for 

work due to her left ankle condition and right end-stage knee arthritis. He also failed to provide a 

specific diagnosis, merely noting her continued symptoms.13 Thus, Dr. Dixon’s reports are also 

insufficient to establish a medical condition causally related to the accepted employment factors.

On May 26, 2016 Dr. Boutin noted that appellant had reported an employment injury on 

April 8, 2014 and her symptoms apparently began as a result of excessive walking and stairs and 

the pain became so severe that she had difficulty performing her duties. He diagnosed an 

aggravation of knee arthritis and ankle arthritis based on x-ray results and upon her physical 

examination. Dr. Boutin opined that appellant’s federal duties for the past 20 years had markedly 

aggravated her condition and were also a major contribution to her present condition. However,

while he diagnosed medical conditions and provided an opinion that they were work related, he 

failed to provide the necessary rationale in support of his opinion. The Board has held that a report 

is of limited probative value regarding causal relationship if it does not contain medical rationale 

explaining how a given medical condition was related to employment factors.14 Due to this 

deficiency, Dr. Boutin’s report is insufficient to establish the claim. 

In his reports, Dr. Cella diagnosed right knee DJD status post right knee replacement and 

moderate arthritis of the left knee. He opined that appellant’s right knee condition was 

significantly aggravated by her work activities as they included significant amounts of standing, 

 

11 See A.C., Docket No. 16-1587 (issued December 27, 2016).

12 B.P., Docket No. 12-1345 (issued November 13, 2012); C.F., Docket No. 08-1102 (issued October 2008).

13 Supra note 11.

14 D.L., Docket No. 19-0900 (issued October 28, 2019); Y.D., Docket No. 16-1896 (issued February 10, 2017);

C.M., Docket No. 14-0088 (issued April 18, 2014).
6

walking, carrying heavy packages, climbing stairs, climbing in and out of vehicles, and walking 

on uneven ground. Dr. Cella further opined that her employment duties had caused an excessive 

mechanical strain on the right knee. On May 23, 2017 he indicated that he had treated appellant 

for her knees and had only examined her left ankle for stability to support her right knee 

replacement. The Board finds that Dr. Cella failed to provide sufficient medical rationale 

explaining how standing, walking, carrying heavy packages, climbing stairs, climbing in and out 

of vehicles, and walking on uneven ground at work either caused or contributed to her diagnosed 

conditions. While Dr. Cella diagnosed medical conditions, his opinion lacksthe necessary medical 

rationale to explain how and why the accepted factors were sufficient to result in the diagnosed 

medical conditions.15 Such rationale is especially important in this case as he noted appellant’s 

preexisting lower extremity conditions.16 Therefore, the reports from Dr. Cella are insufficient to 

meet her burden of proof to establish her claim. 

The x-rays of the left ankle and knees, read by Dr. Kedia, confirmed the diagnoses for 

appellant’s left ankle and knee conditions. The Board has held, however, that diagnostic studies 

such as x-rays lack probative value on the issue of causal relationship as they do not address 

whether the employment incident caused any of the diagnosed conditions.17

The Board thus finds that appellant has not submitted rationalized medical evidence of 

sufficient probative value to support her claim for left ankle and bilateral knee conditions causally 

related to the accepted factors of her federal employment and therefore she has not met her burden 

of proof to establish her claim.

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 has not met her burden of proof to establish left ankle and 

bilateral knee conditions causally related to the accepted factors of her federal employment.

 

15 J.D., Docket No. 14-2061 (issued February 27, 2015).

16 Supra note 10.

17 J.P., Docket No. 19-0216 (issued December 13, 2019); A.B., Docket No. 17-0301 (issued May 19, 2017).
7

ORDER

IT IS HEREBY ORDERED THAT the August 31, 2017 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: February 19, 2020

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