United States Department of Labor

Employees’ Compensation Appeals Board

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A.S., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Baltimore, MD, Employer

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Docket No. 19-1766

Issued: March 26, 2020

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

CHRISTOPHER J. GODFREY, Deputy Chief Judge

JANICE B. ASKIN, Judge

JURISDICTION

On August 19, 2019 appellant filed a timely appeal from a June 20, 2019 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 his burden of proof to establish a left knee condition 

causally related to the accepted factors of his federal employment. 

FACTUAL HISTORY

On March 26, 2019 appellant, then a 57-year-old city mail carrier, filed an occupational 

disease claim (Form CA-2) alleging that he developed left knee arthritis due to factors of his federal 

employment, including walking and climbing up stairs and hills. He noted that he first became 

 

1 5 U.S.C. § 8101 et seq.
2

aware of his condition and first realized that it was caused or aggravated by factors of his federal 

employment on January 30, 2019. On the reverse side of the claim form the employing 

establishment indicated that appellant stopped work on March 26, 2019. 

A March 27, 2019 verification of treatment note signed by Dr. Jeremy Michalke, Boardcertified in emergency medicine, noted that appellant was seen for left knee pain on January 30, 

February 11, 15, and 20, and March 12, 2019.

In an April 2, 2019 narrative statement, appellant’s supervisor indicated that on March 26, 

2019 appellant related that he could not continue to deliver mail because of his knee pain. 

Appellant indicated that his knee had been bothering him, since January 2019, and he believed his 

knee condition was due to years of walking and climbing. Appellant’s supervisor noted that 

appellant’s statements about where and how the injury occurred had changed multiple times. 

In an April 12, 2019 development letter, OWCP informed appellant that additional factual 

and medical evidence were required to support his claim. It advised him of the type of factual and 

medical evidence necessary to establish his claim and attached a questionnaire for his completion. 

OWCP afforded appellant 30 days to submit the requested evidence. 

In a separate development letter to the employing establishment of even date, OWCP

indicated that it required additional information to determine whether appellant was eligible for 

FECA benefits. It listed the information needed and noted that, in the absence of a full reply, it 

may accept appellant’s allegations as factual. OWCP afforded the employing establishment 30 

days to submit the requested evidence.

An April 1, 2019 verification of treatment note signed by Dr. Alexander Choo, an 

orthopedic hand and upper extremity surgery specialist, indicated that appellant received medical 

treatment on that day. Dr. Choo opined that his left knee pain was related to his occupation as a 

mail carrier and he recommended holding appellant off work for two weeks.

In an April 25, 2019 attending physician’s report (Form CA-20), Dr. Jerry Varghese, 

Board-certified in internal medicine, noted appellant’s complaints of left knee pain. He noted that 

he was unaware if appellant had a history of a preexisting condition or injury. Appellant’s current 

physical examination findings included tenderness along the left knee with crepitus, an x-ray of 

the left knee revealed arthritis, and a magnetic resonance imaging (MRI) scan revealed a meniscus 

tear. Dr. Varghese diagnosed left knee arthritis and left knee medial meniscus tear. He checked a 

box marked “yes” in response to the question whether the diagnosed conditions were caused or 

aggravated by an employment injury and responded that appellant’s arthritis was “possibly”

aggravated by walking. Dr. Varghese treated appellant with anti-inflammatories and administered 

a left knee injection. He noted that he treated appellant on January 30, February 11 and 20, and 

March 17, 2019. Dr. Varghese related that appellant’s period of total disability was from April 1 

to 15, 2019 and that he could resume light-duty work on April 26, 2019 with the restriction of no 

walking for over three hours daily.

On May 7, 2019 OWCP received an undated narrative statement from another employing 

establishment manager. The employing manager noted that he disagreed with appellant’s 

allegations because appellant’s statements about when and how the incident occurred and his 
3

required work restrictions were inconsistent. The supervisor also listed appellant’s required duties, 

which included kneeling, bending, walking, and climbing for up to six hours a day for five days a 

week. 

On May 9, 2019 appellant completed the OWCP questionnaire. He indicated that his workrelated injury occurred in December 2018 when he stood up while delivering mail and his knee 

locked. While he did not realize he was injured at the time, appellant noticed it later that month

while delivering Christmas packages. He related that 30 days after his injury his knee began to 

swell, and the swelling had not dissipated. Appellant’s other symptoms included excruciating pain 

and difficulty bending his knee. Walking up and down stairs exacerbated his symptoms while pain 

medication and staying off of his knee alleviated them. Appellant noted that he had no prior or 

similar disability or injury. He listed the employment factors of walking, delivering packages, and 

excessive twisting and turning of his knee as the cause of his left knee injury, and he related that 

he performed those activities for eight hours a day and five days a week. 

By decision dated June 20, 2019, OWCP denied appellant’s occupational disease claim,

finding that the evidence of record failed to establish that his diagnosed conditions were causally 

related to his accepted factors of federal employment. 

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,2that 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.3 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.4

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

disease claim, an employee must submit 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.5

 

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

153 (1989).

3

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

ECAB 312 (1988).

4 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 R.G., Docket No. 19-0233 (issued July 16, 2019). See also Roy L. Humphrey, 57 ECAB 238, 241 (2005); Ruby I. 

Fish, 46 ECAB 276, 279 (1994); Victor J. Woodhams, 41 ECAB 345 (1989).
4

Causal relationship is a medical question that requires rationalized medical opinion

evidence to resolve the issue.6 A physician’s opinion on whether there is causal relationship 

between the diagnosed condition and the implicated employment factors must be based on a 

complete factual and medical background.7 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.8

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 appellant has not met his burden of proof to establish a left knee 

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

In support of his claim, appellant submitted a March 27, 2019 verification of treatment 

notes from Dr. Michalke, which listed the dates appellant was seen for left knee pain. The Board 

has held that pain is a symptom and not a compensable medical diagnosis.10 Furthermore,

Dr. Michalke offered no opinion regarding causal relationship. Medical evidence which does not 

offer an opinion regarding the cause of an employee’s conditions is of no probative value.11 

Appellant also submitted an April 1, 2019 verification of a treatment notes from Dr. Choo 

which indicated that he received medical treatment on that day and that his left knee pain was 

related to his occupation as a mail carrier. As previously noted, pain is not a compensable medical 

diagnosis.12 Additionally, while Dr. Choo indicated, in his April 1, 2019 report, that appellant’s 

knee pain was related to his occupation, he failed to identify specific factors of his federal 

employment responsible for appellant’s claimed injury. To be of probative value, a physician’s 

 

6 T.H., 59 ECAB 388, 393 (2008); Robert G. Morris, 48 ECAB 238 (1996).

7 M.V., Docket No. 18-0884 (issued December 28, 2018).

8

Id.; Victor J. Woodhams, supra note 5.

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

R.D., Docket No. 18-1551 (issued March 1, 2019).

10 T.G., Docket No. 19-0904 (issued November 25, 2019). 

11 T.K., 19-0055 (issued May 2, 2019); L.B., Docket No. 18-0533 (issued August 27, 2018); D.K., Docket No. 

17-1549 (issued July 6, 2018).

12 Supra note 10. 
5

opinion must explain the nature of the relationship between a diagnosed medical condition and 

appellant’s specific employment factors.13

Dr. Varghese diagnosed left knee arthritis and left knee medial meniscus tear in his 

April 25, 2019 attending physician’s report. He checked a box marked “yes” in response to the 

question as to whether the conditions found were caused or aggravated by employment activity, 

and he noted that appellant’s arthritis was possibly aggravated by walking. The Board has held 

that when a physician’s opinion on causal relationship consists only of checking “yes” to a form 

question, without explanation or rationale, that opinion is of diminished probative value and is 

insufficient to establish a claim.

14

 A physician’s opinion as to whether there was causal 

relationship between the diagnosed condition and the implicated employment factors must be 

based on a complete factual and medical background.15 A medical opinion must provide an 

explanation of how the specific employment factors physiologically caused or aggravated the 

diagnosed conditions.16 

As appellant has not submitted the rationalized medical evidence necessary to establish 

that he sustained a left knee condition causally related to the accepted factors of his federal 

employment, he has not met 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 has not met his burden of proof to establish a left knee 

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

 

13 See supra note 8. 

14 K.G., Docket No. 18-1598 (issued January 7, 2020). 

15 Supra note 7. 

16 T.L., Docket No. 18-0778 (issued January 22, 2020).
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ORDER

IT IS HEREBY ORDERED THAT the June 20, 2019 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: March 26, 2020

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Christopher J. Godfrey, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board