United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

K.P., Appellant

and

U.S. POSTAL SERVICE, WESTMONT POST 

OFFICE, Westmont, IL, Employer

__________________________________________

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Docket No. 20-0237

Issued: October 16, 2020

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

JANICE B. ASKIN, Judge

PATRICIA H. FITZGERALD, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

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

September 23, 2019 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 that his left patellar 

tendinitis is causally related to the accepted factors of his federal employment.

FACTUAL HISTORY

On April 9, 2018 appellant, then a 25-year-old mail carrier, filed an occupational disease 

claim (Form CA-2) alleging that his physicians and physical therapists told him that his patellar 

tendinitis was caused by his federal employment duties. He indicated that he first became aware 

of his condition June 1, 2017 and its relationship to factors of his federal employment on 

January 10, 2018. Appellant had stopped work on January 6, 2018. 

In a February 20, 2018 progress note, Dr. Gregory H. Dairyko, a Board-certified 

orthopedic surgeon, indicated that appellant worked as a mail carrier and reported that he may 

walk 10 to 11 miles a day. He noted that appellant reported that he sustained an injury to the left 

knee in June 2017, for which appellant had received a cortisone injection and had performed a 

home exercise program. Dr. Dairyko noted examination findings and indicated that x-ray films of 

the left knee revealed evidence of Osgood-Schlatter’s disease with preservation in the medial, 

lateral, and patellofemoral joint space. He provided an assessment of acute left knee pain and left 

knee pain, unspecified chronicity, and recommended a course of physical therapy. An 

accompanying February 20, 2018 x-ray of appellant’s left knee revealed no acute radiographic 

findings or significant degenerative changes. 

Appellant also submitted a March 5, 2018 medical clearance form and surgical worksheet,

in which Dr. Adam Yanke, a Board-certified orthopedic surgeon, cleared appellant for a left knee 

arthroscopic debridement and possible chondroplasty and patellar tendon injection. The diagnoses 

for the procedure were listed as left knee patellar cartilage defect with patellar tendinitis and 

articular cartilage defect. 

In a progress note dated April 6, 2018, Dr. Dairyko held appellant off work for four weeks. 

In a May 11, 2018 development letter, OWCP advised appellant that additional factual and 

medical evidence was necessary to establish his claim. It requested that he submit additional 

medical evidence, including a rationalized report from his physician addressing causal relationship 

between a diagnosed medical condition and the identified employment factors. OWCP further 

provided a questionnaire for appellant’s completion to substantiate the factual allegations of his 

claim. It afforded him 30 days to submit the necessary evidence. 

On July 3, 2018 appellant completed OWCP’s development questionnaire and explained 

that his left knee pain was due to walking and climbing stairs in all kinds of weather and carrying 

a mail bag in in the performance of his mail carrier duties. He also submitted a copy of his position 

description. 

OWCP continued to receive medical reports. In a January 11, 2018 report, Dr. Siva 

Krishman, a Board-certified family practitioner, reported that appellant injured his left knee about 

five or six years prior playing basketball and, since then, physical activity caused light pain. She 
3

noted that he worked as a letter carrier and had developed a lot of pain and swelling with activity. 

A primary diagnosis of chronic left knee pain was provided. Dr. Krishman held appellant off 

work. In a February 13, 2018 light-duty request, she noted his restrictions. 

A June 12, 2018 magnetic resonance imaging (MRI) scan of appellant’s left knee revealed 

mild edema of the infrapatellar fat pad, mild quadriceps, and proximal patellar tendinosis without 

tear. No acute meniscal or ligamentous injury was seen. 

In medical reports dated April 6, May 11 and 29, and June 19, 2018, Dr. Dairyko noted 

appellant’s MRI scan findings. He diagnosed acute pain of left knee and patellar tendinitis of left 

knee. Dr. Dairyko also provided work excuse and medical restrictions notes dated April 6, 17, and 

24, May 11 and 29, and June 19, 2018. 

By decision dated July 25, 2018, OWCP denied appellant’s occupational disease claim,

finding that the medical evidence of record was insufficient to establish that his diagnosed left 

knee condition was causally related to the accepted employment factors. 

On August 12, 2018 appellant, through counsel, requested a telephonic hearing before an 

OWCP hearing representative, which was later converted to a review of the written record at

counsel’s request. No additional evidence was submitted.

By decision dated February 25, 2019, an OWCP hearing representative affirmed the 

July 25, 2018 decision. 

On March 19, 2019 OWCP received appellant’s undated request for reconsideration. In a 

March 4, 2019 report, Dr. Henry Legaspi, an osteopath Board-certified in physiatry, opined that 

appellant’s left chronic patellar tendinosis could have been a result of his work as a mail carrier 

given the required repetitive knee flexion and extension.3 

On June 26, 2019 appellant, through counsel, requested reconsideration. OWCP continued 

to receive medical evidence. 

In support of his request, appellant submitted an April 17, 2019 report by Dr. Legaspi, who

indicated that appellant’s pain at the inferolateral corner of the left patella began while he was 

working as a letter carrier. His job required walking approximately 8 to 14 miles per day, 

sometimes on uneven surfaces. Dr. Legaspi advised that patellar tendinosis is a chronic overuse 

injury that is usually seen in younger patients who perform sports activities that involve repetitive 

flexion and extension of the knees and typical symptoms are felt at the inferior pole of the patella. 

He opined that, given the repetitive nature of appellant’s job, and no other reported activities that 

can cause patellar tendinosis such as sports or running, it was “entirely possible that appellant’s 

patellar tendinosis was caused by his occupation as a mailman.” 

 

3 Appellant appealed OWCP’s February 25, 2019 decision to the Board on April 1, 2019; however, he subsequently 

withdrew his request. By order dated June 25, 2019, the Board dismissed the appeal at the request of appellant’s 

counsel. Order Dismissing Appeal, Docket No. 19-0956 (issued June 25, 2019).
4

By decision dated September 23, 2019, OWCP denied modification of its February 25, 

2019 decision. 

LEGAL PRECEDENT

An employee seeking benefits under FECA4 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 filed within the applicable time limitation

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

that any disability or specific 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

In an occupational disease claim, appellant’s burden 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.8

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

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

on a complete factual and medical background of the claimant, 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 claimant.10

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, 

 

4 Supra note 2.

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).

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

9 A.M., Docket No. 18-1748 (issued April 24, 2019); T.H., 59 ECAB 388 (2008).

10 W.R., Docket No. 19-0460 (issued May 18, 2020); M.V., Docket No. 18-0884 (issued December 28, 2018); I.J., 

59 ECAB 408 (2008).
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the physician must provide a rationalized medical opinion that differentiates between the effects 

of the work-related injury or disease and the preexisting condition.11

ANALYSIS

The Board finds that appellant has not met his burden of proof to establish that his left 

patellar tendinitis is causally related to the accepted factors of his federal employment.

In her January 11, 2018 report, Dr. Krishman provided an assessment of chronic pain of 

the left knee. She reported a history of appellant injuring his left knee approximately five to six

years prior playing basketball, that he worked as a mail carrier, and that he developed a lot of pain 

and swelling with activity. Dr. Krishman’s report is of no probative value as she did not provide 

a firm diagnosis of a particular medical condition.12 The Board has explained that pain is a 

symptom and not a compensable medical diagnosis.13 Dr. Krishman did not provide a specific 

diagnosis of a medical condition of the left knee.14 Additionally, while she noted that appellant 

worked as a letter carrier and had developed a lot of pain and swelling with activity, she did not 

discuss his job duties or explain whether his work duties caused or contributed to his left knee 

condition. A medical opinion must explain how the implicated employment factors 

physiologically caused, contributed to, or aggravated the specific diagnosed conditions.15 Thus,

Dr. Krishman’s report is insufficient to establish appellant’s claim. 

In his February 20, 2018 report, Dr. Dairyko noted that appellant may walk 10 to 11 miles 

a day as a mail carrier. In that, report and in subsequent reports dated from April 6 to June 19, 

2018, he diagnosed left knee pain and patellar tendinitis of left knee. While Dr. Dairyko noted 

that appellant walked several miles a day as a mail carrier, he failed to specifically address whether 

appellant’s work duties caused or aggravated the diagnosed medical condition of patellar tendinitis 

of left knee. Medical evidence that does not offer an opinion regarding the cause of an employee’s 

condition is of no probative value on the issue of causal relationship.16

Dr. Yanke’s March 5, 2018 medical clearance form and surgical worksheet, which cleared 

appellant for a left knee arthroscopic debridement and possible chondroplasty and patellar tendon 

injection, is of no probative value as he did not offer an opinion about the cause of appellant’s need 

 

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

A.S., Docket No. 19-1955 (issued April 9, 2020).

12 See A.R., Docket No. 19-1560 (issued March 2, 2020).

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

14 See T.H., Docket No. 19-1891 (issued April 3, 2020).

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

16 See L.B., Docket No. 18-0533 (issued August 27, 2018); D.K., Docket No. 17-1549 (issued July 6, 2018).
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for surgery. As noted, medical evidence that does not offer an opinion regarding the cause of an 

employee’s condition is of no probative value on the issue of causal relationship.17

Medical reports from Dr. Legaspi dated March 4 and April 17, 2019, indicated that 

appellant’s left chronic patellar tendinosis could have been a result of his work as a letter carrier 

given the required repetitive knee flexion and extension and no other reported activities that could

cause patellar tendinosis. However, Dr. Legaspi did not explain how appellant’s prior left knee 

conditions, which the record reflects as Osgood-Schlatter’s disease, or a history of a prior left knee 

injury due to playing basketball five to six years prior, related to appellant’s current left knee 

condition.18 A well-rationalized opinion is particularly warranted when there is a history of 

preexisting conditions.19 While the opinion supporting causal relationship does not have to reduce 

the cause or etiology of a disease or a condition to an absolute certainty, the opinion must be one 

of reasonable medical certainty and not speculative or equivocal in character.20 As Dr. Legaspi’s 

opinion regarding causal relationship was speculative and conclusory, it is insufficient to meet 

appellant’s burden of proof to establish his claim.21

Appellant also submitted the results of diagnostic testing. The Board has held, however, 

that diagnostic studies, standing alone, lack probative value as they do not address whether the 

employment incident caused any of the diagnosed conditions.22

As the record lacks rationalized medical evidence establishing causal relationship between 

appellant’s patellar tendinitis of left knee and the accepted employment factors, the Board finds 

that he has not met his burden of proof.

On appeal counsel asserts that OWCP failed to apply the proper standard of causation and 

failed to give due deference to the findings of the attending physician. As explained above, 

however, the medical evidence of record is insufficient to establish causal relationship between 

appellant’s patellar tendinitis of left knee and the accepted employment factors. Consequently, 

appellant 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.

 

17 Id.

18 P.S., Docket No. 17-1013 (issued November 1, 2017).

19 D.M., Docket No. 16-0346 (issued June 15, 2017).

20 C.H., Docket No 19-0409 (issued August 5, 2019).

21 P.A., Docket No. 18-0559 (issued January 29, 2020).

22 K.S., Docket No. 19-1623 (issued March 19, 2020); J.M., Docket No. 18-0853 (issued March 9, 2020).
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CONCLUSION

The Board finds that appellant has not met his burden of proof to establish that his left 

patellar tendinitis is causally related to the accepted factors of his federal employment.

ORDER

IT IS HEREBY ORDERED THAT the September 23, 2019 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: October 16, 2020

Washington, DC

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Alternate Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board