United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

Y.S., Appellant

and

DEPARTMENT OF THE ARMY, 

EXPEDITIONARY CONTRACTING 

COMMAND, Camp Arifjan, Kuwait, Employer

__________________________________________

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Docket No. 19-1572

Issued: March 12, 2020

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

CHRISTOPHER J. GODFREY, Deputy Chief Judge

PATRICIA H. FITZGERALD, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On July 18, 2019 appellant, through counsel, filed a timely appeal from an April 10, 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 her burden of proof to establish a left knee condition 

causally related to the accepted October 22, 2017 employment incident.

FACTUAL HISTORY

On December 19, 2017 appellant, then a 56-year-old quality assurance specialist, filed a 

traumatic injury claim (Form CA-1) alleging that on October 22, 2017 she tripped over debris and 

fell face down in the employing establishment’s Outside Dining Facility parking lot when walking 

with a coworker during her lunchbreak while in the performance of duty. The employing 

establishment controverted the claim, asserting that the alleged injury occurred during her 

lunchbreak and that evidence was not provided to support an employment-related injury or 

entitlement to continuation of pay. No evidence was received with the claim.

In a December 27, 2017 development letter, OWCP requested that appellant provide 

additional factual and medical information in support of her claim, including a report from her 

attending physician which addressed causal relationship between a diagnosed condition and the 

claimed October 22, 2017 employment incident. It afforded her 30 days to submit the necessary 

evidence. 

In response, appellant submitted a November 22, 2017 witness statement from D.H. 

attesting to her trip and fall on October 22, 2017.

A copy of appellant’s chronological record of medical care, with a date range from 

September 19, 2016 through November 13, 2017, was also provided. In a November 6, 2017 entry,

Dr. Jason Alisangco, Board-certified in family practice and sports medicine, reported the history 

of injury as “[patient] states she tripped two weeks ago, but did not feel pain until a week later.” 

He noted that appellant was diagnosed with arthritis two months prior. Dr. Alisangco indicated 

that she had abnormal movement of all extremities, normal motor strength, and no weakness 

observed of the left knee. Examination findings of the left knee revealed effusion and tenderness 

on palpation joint capsule. Dr. Alisangco diagnosed osteoarthritis of the knee with symptomatic 

knee effusion. Treatment consisted of aspiration with steroid. 

After a November 6, 2017 steroid injection, appellant developed increased pain and 

inability to bear weight or flex her knee. The record reflects that she was admitted to the military 

hospital on November 13, 2017 at the employing establishment. In a partially redacted 

November 10, 2017 memorandum, Maj. (Dr.) Jeremy K. Rush, a Board-certified orthopedic 

surgeon, indicated that appellant was admitted for left septic knee arthritis and that she required 

evacuation. He opined that she would not be fit for duty for four to six months. On November 18, 

2017 appellant was admitted to the hospital in Landstuhl, Germany and was released on 

November 27, 2017. She was then transported to Walter Reed Hospital in Bethesda, Maryland. 

By decision dated January 29, 2018, OWCP accepted that the October 22, 2017 

employment incident occurred while in the performance of duty as alleged. However, it denied 

her claim finding that the medical evidence of record was insufficient to establish that her 

diagnosed left knee osteoarthritis, synovitis, and sepsis conditions were caused or aggravated by 

the accepted October 22, 2017 employment incident. 
3

On January 11, 2019 appellant, through counsel, requested reconsideration. 

Medical records were received consisting of laboratory and diagnostic tests results, medical 

procedure notes, and counseling records related to appellant’s treatment for septic arthritis. 

In a December 31, 2018 report, Dr. Joshua B. Macht, a Board-certified internist, noted his 

December 20, 2018 review of appellant’s medical records. He diagnosed left knee sprain injury 

treated with left knee injection complicated by septic arthritis. Dr. Macht opined that appellant 

sustained an acute left knee sprain injury when she fell on October 22, 2017 as her medical records

documented the onset of swelling and pain a few days later. He noted that appellant ultimately 

sought medical attention and was diagnosed with a symptomatic left knee effusion and had an 

aspiration and injection procedure. Dr. Macht noted that procedure was complicated by septic 

arthritis and she had to undergo additional treatment as a result. He indicated that appellant also 

has a documented history of left knee osteoarthritis. Dr. Macht further opined that appellant 

suffered an acute exacerbation of her chronic left knee symptoms when she fell on 

October 22, 2017. He explained that the mechanism of appellant losing balance and falling, and 

her attempt to maintain her balance, put an unexpected strain on the musculoligamentous structures 

of the knee. This unexpected stretching of the tendons, ligaments, and muscle tissue of the left 

knee joint structure and the stretching beyond its normal functional range of motion led to pain, 

swelling, inflammation, and potentially tearing of the involved structures. Dr. Macht noted that 

appellant had presented for examination with evidence of this mechanism of injury on 

November 6, 2017 when she was found to have a knee effusion (swelling of the knee joint) and 

acute pain. He opined that this was the direct result of the October 22, 2017 strain injury and, per 

her documented history, she did not have this degree of pain or swelling with the left knee prior to 

the October 22, 2017 accident. Dr. Macht therefore concluded that appellant suffered an acute left 

knee sprain injury with exacerbation of her chronic left knee symptoms. He also opined that 

appellant’s subsequent diagnosis of left knee septic arthritis was also causally related to the 

October 22, 2017 accident as it developed as a post-procedural complication incurred during the 

treatment of the October 22, 2017 injury.

By decision dated April 10, 2019, OWCP denied modification of its January 29, 2018 

decision.

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 

 

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

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 

To determine if an employee sustained a traumatic injury in the performance of duty, 

OWCP begins with an analysis of whether fact of injury has been established.6 There are two 

components that must be considered in conjunction with one another. The first component is 

whether the employee actually experienced the employment incident that allegedly occurred.7 The 

second component is whether the employment incident caused a personal injury.8

The medical evidence required to establish causal relationship between a claimed specific 

condition and an employment incident is rationalized medical opinion evidence. 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.9 The absence of a physical examination by a physician may affect the 

weight to be a given medical report, but does not necessarily render it incompetent as medical 

evidence.10 In cases where the sole issue is one of causal relationship, a physical examination is 

unnecessary as it would be of no consequence and would only result in additional delay and cost.11

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.12 

ANALYSIS

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

 

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 See C.C., Docket No. 18-1453 (issued January 28, 2020); 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 S.S., Docket No. 18-1488 (issued March 11, 2019); T.H., 59 ECAB 388, 393-94 (2008).

7 E.M., Docket No. 18-1599 (issued March 7, 2019); Elaine Pendleton, 40 ECAB 1143 (1989).

8 E.M., id.; John J. Carlone, 41 ECAB 354 (1989).

9 See E.J., Docket No. 09-1481 (issued February 19, 2010).

10 See W.C., Docket No. 18-1386 (issued January 22, 2019); M.M., Docket No. 17-0438 (issued March 13, 2018); 

C.B., Docket No. 17-0726 (issued July 3, 2017); Melvina Jackson, 38 ECAB 443, 447-52 (1987).

11 See Sherry Shreiber, Docket No. 04-1966 (issued January 24, 2005) (the Board held that the fact that an OWCPselected second opinion physician had not physically examined the claimant was of no consequence as the diagnosis 

had already been established, and thus the only question was causal relationship).

12 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).
5

In his December 31, 2018 report, Dr. Macht opined that appellant suffered an acute sprain 

injury of the left knee and an acute exacerbation of her chronic left knee symptoms when she fell 

on October 22, 2017. He provided a proper factual and medical history of injury, noting that 

review of her medical records documented the onset of swelling and pain a few days later. This 

was collaborated by Dr. Alisangco’s November 6, 2017 entry wherein he reported that appellant 

felt pain about a week after she tripped. Dr. Macht further noted that appellant had a history of 

left knee osteoarthritis and, per her documented history, she did not have this degree of pain or 

swelling with the left knee prior to the October 22, 2017 employment incident. He noted a 

diagnosis of symptomatic left knee effusion and that she underwent an aspiration and injection 

procedure, which was complicated by septic arthritis. Dr. Macht explained that, when appellant 

attempted to maintain her balance and avoid falling to the ground, the mechanism of losing balance 

when falling put an unexpected strain on the musculoligamentous structures of the knee and that 

unexpected stretching of the tendons, ligaments, and muscle tissue of the left knee joint structure 

led to pain, swelling, inflammation, and potentially tearing of the involved structures. Dr. Macht 

indicated that she presented with evidence of this mechanism of injury on November 6, 2017 when 

she was found to have a knee effusion (swelling of the knee joint) and acute pain. He concluded 

that appellant suffered an acute left knee sprain injury with exacerbation of her chronic left knee 

symptoms as a result of the October 22, 2017 injury. Dr. Macht also opined that the subsequent 

diagnosis of left knee septic arthritis was also causally related to the accepted October 22, 2017 

employment incident as it developed as a post-procedural complication incurred during the 

treatment of the October 22, 2017 injury.

The Board finds that the December 31, 2018 report of Dr. Macht is sufficient to require 

further development of the medical evidence to see that justice is done.13 Dr. Macht is a Boardcertified physician in internal medicine who is qualified in his field of medicine to render 

rationalized opinions on the issue of causal relationship and he provided a comprehensive and 

convincing review of the medical record and case history. It is further found that he provided a 

comprehensive and convincing pathophysiological explanation as to how the mechanism of the 

accepted employment trip and fall was sufficient to cause the conditions of an acute sprain injury 

of the left knee and acute exacerbation of her chronic left knee symptoms. The Board has long 

held that it is unnecessary that the evidence of record in a case be so conclusive as to suggest causal 

connection beyond all possible doubt. Rather, the evidence required is only that necessary to 

convince the adjudicator that the conclusion drawn is rational, sound, and logical.14 Accordingly,

Dr. Macht’s medical opinion is well rationalized and logical and is therefore sufficient to require 

further development of appellant’s claim.15

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 

 

13 J.H., Docket No. 18-1637 (issued January 29, 2020); D.S., Docket No. 17-1359 (issued May 3, 2019); X.V.,

Docket No. 18-1360 (issued April 12, 2019); C.M., Docket No. 17-1977 (issued January 29, 2019); William J. 

Cantrell, 34 ECAB 1223 (1983).

14 W.M., Docket No. 17-1244 (issued November 7, 2017); E.M., Docket No. 11-1106 (issued December 28, 2011); 

Kenneth J. Deerman, 34 ECAB 641, 645 (1983) and cases cited therein).

15 See J.H., supra note 13.
6

responsibility in the development of the evidence.16 OWCP has an obligation to see that justice is 

done.17

On remand OWCP shall refer appellant to an appropriate specialist, along with the case 

record and a statement of accepted facts. Its referral physician shall provide a well-rationalized 

opinion as to whether appellant’s diagnosed left knee conditions are causally related to or 

aggravated by the accepted October 22, 2017 employment incident. After such further 

development of the case record as OWCP deems necessary, it shall issue a de novo decision. 

CONCLUSION

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

ORDER

IT IS HEREBY ORDERED THAT the April 10, 2019 decision of the Office of Workers’

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

with this decision of the Board. 

Issued: March 12, 2020

Washington, DC

Christopher J. Godfrey, Deputy Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Alternate Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board

 

16 See id. See also A.P., Docket No. 17-0813 (issued January 3, 2018); Jimmy A. Hammons, 51 ECAB 219, 

223 (1999).

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