United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

J.M., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

North Reading, MA, Employer

__________________________________________

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Docket No. 20-0504

Issued: October 21, 2021

Appearances: Case Submitted on the Record

John L. deGeneres, Jr., Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

PATRICIA H. FITZGERALD, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On January 6, 2020 appellant, through counsel, filed a timely appeal from a November 1, 

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 right knee 

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

FACTUAL HISTORY

On September 21, 2018 appellant, then a 64-year-old retired mail handler, filed an 

occupational disease claim (Form CA-2) alleging that she developed right knee osteoarthritis due 

to factors of her federal employment. She noted that she first became aware of her condition on 

October 21, 2016 and realized its relation to her federal employment on May 14, 2018. Appellant 

retired from the employing establishment, effective October 30, 2015.

In medical reports dated May 26 and December 8, 2004, Dr. Tamara L. Martin, a Boardcertified orthopedic surgeon, evaluated appellant for right knee pain that began in March 2004. 

She reviewed x-ray scans of her knee that revealed minimal joint space narrowing on the right 

medial knee and diagnosed patellofemoral tendinitis. Dr. Martin recommended that appellant 

undergo a diagnostic arthroscopy to ensure she did not have a meniscal tear in her right knee.

In a January 18, 2006 medical report, Dr. Martin indicated that appellant underwent a right 

knee arthroscopy, a debridement of medial and lateral meniscal tears, an abrasion chondroplasty 

and an abrasion arthroplasty to treat a radial internal meniscus tear that was consistent with a 

traumatic-type injury. Appellant asserted that her injury was related to her federal employment 

duties requiring her to push heavy loaded carts up an incline. Dr. Martin also observed a medial 

meniscus posterior horn tear and some arthritic changes. She advised that appellant continue her 

physical therapy treatment for her knee condition. 

Subsequent medical reports from Dr. Martin dated from March 15 to October 18, 2006, 

reviewed appellant’s progress with physical therapy for her right knee and recommended that she 

receive a knee brace and consult with an orthopedic surgeon, to determine if she would be a 

candidate for surgical intervention. 

In a November 15, 2011 medical report, Dr. Scott D. Martin, a Board-certified orthopedic 

surgeon, indicated that appellant was electing to undergo a right knee replacement to treat her right 

knee osteoarthritis. In a diagnostic report of even date, Dr. Varand Ghazikhanian, a Boardcertified radiologist, conducted an x-ray scan of appellant’s knees, and observed severe medial 

tibiofemoral osteoarthritis of the right knee and moderate medial tibiofemoral osteoarthritis of the 

left knee.

In a December 5, 2011 medical report, Dr. Christina Iacobo, a Board-certified internist, 

indicated that it was likely that appellant would need to undergo a right knee replacement due to 

increasing pain. On evaluation, she diagnosed right knee arthritis and agreed that appellant would 

require a total knee replacement. 

In a March 22, 2013 medical report,John Macropoulos, a physician assistant, administered 

a cortisone injection to treat appellant’s symptoms relating to her right knee osteoarthritic 

exacerbation.
3

In a January 22, 2014 medical report, Dr. Scott Martin evaluated appellant for osteoarthritis 

of the right knee and noted that she also had posterior pain in her left knee. He observed that her 

symptoms improved with an injection and recommended that she continue performing a nonimpact loading exercise program to treat her condition. In a diagnostic report of even date,

Dr. Chris Chung, a Board-certified radiologist, conducted an x-ray scan of appellant’s knees, 

observing moderate-to-severe medial tibiofemoral osteoarthritis of the right knee and moderate 

medial tibiofemoral osteoarthritis of the left knee. 

An October 26, 2016 discharge summary by Dr. Scott Martin indicated that he performed 

a total right knee arthroplasty on October 21, 2016 to treat appellant’s right knee osteoarthritis. 

In a May 15, 2017 statement, appellant described her history of employment dating back 

16 years. She indicated that she began as a “part-time/flex” mail handler for her first three years, 

working full-time hours and overtime before assuming the role of a full-time regular mail handler. 

Appellant’s employment duties involved being on her feet for approximately eight hours a day to 

move mail, packages, and tubs weighing up to 70 pounds. She assisted with loading and unloading 

mail trucks, which required additional standing, walking, bending, stooping, lifting, carrying, and 

squatting. Appellant also pushed carts weighing hundreds of pounds. She alleged that she 

performed very little physical activity outside of work. Appellant explained that she did not know 

when her arthritis began but, as she worked, her knee, elbow and shoulder became painful, causing 

her to seek medical treatment. 

Dr. Byron V. Hartunian, a Board-certified orthopedic surgeon, in a September 4, 2018 

narrative medical report, explained that he examined appellant and reviewed medical records 

regarding her treatment for arthritis in her right knee that culminated in her undergoing a right total 

knee replacement. He also reviewed her statement in which she detailed her employment duties. 

Dr. Hartunian noted that, while she did not recall a specific trauma to her right knee, appellant 

began experiencing pain in her right knee in 2004. On evaluation, he diagnosed end-stage 

degenerative arthritis status post right total knee replacement. Dr. Hartunian explained that 

appellant had been performing repetitive heavy physical activity for approximately 16 years 

through her employment duties, resulting in increased stresses through her right knee that causally 

contributed to the permanent progression of her arthritic condition. He indicated that the many 

hours of standing, pushing, pulling, twisting, and bending caused constant stress to her right knee 

on a daily basis. Dr. Hartunian opined that the physical requirements of appellant’s federal 

employment were causally related to her right knee progressive arthritis, reasoning that, the 

physical requirements of her employment continually hastened and accelerated her right knee 

symptoms. He explained that impact loading and local stresses arising from repetitive motion 

activities from kneeling, lifting, climbing, stooping, twisting, squatting, and carrying contributed 

to the development of knee arthritis. Dr. Hartunian further explained that the arthritis of her right 

lower extremity was “ultimately a failure of articular cartilage resulting in progressive loss of the 

articular surface.” He noted that as the articular surface wore away, the joint space diminished. 

In a development letter dated November 8, 2018, OWCP requested that the employing 

establishment provide information, including comments from a knowledgeable supervisor, 

regarding appellant’s occupational disease claim. It afforded the employing establishment 30 days 

to respond. 
4

In a development letter dated November 14, 2018, OWCP informed appellant of the 

deficiencies of her claim. It advised her of the type of factual and medical evidence necessary to 

establish her claim and provided a questionnaire for her completion to provide further details 

regarding the circumstances of her claimed injury. OWCP also requested a narrative medical 

report from appellant’s treating physician, which contained a detailed description of findings and 

diagnoses, explaining how appellant’s work activities caused, contributed to, or aggravated her 

medical conditions. It afforded her 30 days to respond.

In a December 10, 2018 memorandum, counsel noted that the evidence already of record 

was sufficient to require, at a minimum, further development of the claim. He cited a previous 

decision of the Board in which it found that Dr. Hartunian’s narrative medical report in that claim 

was sufficient to require further development of the lower extremity osteoarthritis claim, 

comparing that claim with appellant’s present claim. Counsel noted the dates from the beginning 

of her treatment for her right knee on May 26, 2004 up through her right knee surgery on 

October 26, 2016 and her subsequent follow-up treatments. This included dates for medical 

treatment, injections, surgeries, physical therapy, and diagnostic studies. Counsel referenced

Dr. Hartunian’s September 4, 2018 medical report and contended that it was sufficient to meet 

appellant’s burden of proof to establish her claim. 

Counsel submitted physical therapy reports dated from November 22, 2016 to January 5, 

2017 detailing her treatment following her surgery to treat her right knee osteoarthritis. 

In a November 30, 2018 response to OWCP’s questionnaire, appellant explained that she 

did not have any prior right knee injuries and that she began treatment for her knee in 2004. She 

indicated that she did not engage in any other outside physical activities other than occasional trips 

to the movies and bingo as her health permitted. Appellant noted all of the times she was out from 

work or on limited duty due to work and non-work injuries to various body parts dating from 2001 

to 2015. 

In a December 3, 2018 letter, Dr. Hartunian repeated that the medical records he reviewed 

during his May 14, 2018 evaluation of appellant’s right knee were sufficiently complete for him 

to provide his opinion on her condition. He further indicated that he had since reviewed additional 

medical evidence and appellant’s recent statement which confirmed his initial opinion on causal 

relationship. 

By decision dated December 18, 2018, OWCP denied appellant’s occupational disease 

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

right knee osteoarthritis was causally related to the accepted factors of her federal employment. 

On January 3, 2019 appellant, through counsel, requested an oral hearing before a 

representative of OWCP’s Branch of Hearings and Review.

On February 20, 2019 counsel requested that appellant’s request for an oral hearing be 

converted to a review of the written record. He attached a February 20, 2019 memorandum in 

which he asserted that OWCP erred in its December 18, 2018 decision and argued that

Dr. Hartunian’s report was based on the review of 140 pages of medical evidence and an interview 

of appellant. Counsel further contended that it was improper for a non-medical lay employee of 
5

OWCP to substitute their own judgment for Dr. Hartunian’s report. He insisted that it also erred 

by failing to undertake any additional medical development of the claim, citing to previous Board 

decisions to support his memorandum. 

By decision dated November 1, 2019, OWCP’s hearing representative affirmed the 

December 18, 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 

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

disease claim, a claimant 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 identified employment factors.6

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.7 A physician’s opinion on whether there is causal relationship 

between the diagnosed condition and the implicated employment factor(s) must be based on a 

complete factual and medical background.8 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 factor(s).9

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); 

DeloresC. Ellyett, 41 ECAB 992 (1990).

6 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).

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

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

9

Id.; Victor J. Woodhams, supra note 6.
6

ANALYSIS

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

The issue in the present case is whether appellant has established causal relationship 

between her diagnosed right knee osteoarthritis condition and her accepted employment duties, 

including standing, walking, bending, stooping, lifting, carrying, and squatting, pushing and 

pulling as she worked with various mail containers and parcels. In his September 4, 2018 narrative 

medical report, Dr. Hartunian interviewed appellant and reviewed her statement detailing her 

various employment duties over her 16 years of employment. He utilized her medical records, 

noting her history of treatment of her right knee osteoarthritis beginning in 2004 that ultimately 

culminated in her undergoing a right total knee replacement in October 2016. Dr. Hartunian 

described appellant’s duties as repetitive heavy physical activity and opined that this type of work 

resulted in increased stresses through her right knee that causally contributed to the permanent 

progression of her arthritic condition. On evaluation, he diagnosed end-stage degenerative arthritis 

status post right total knee replacement. Dr. Hartunian opined that the many hours of standing, 

pushing, pulling, twisting, and bending caused constant stress to appellant’s right knee on a daily 

basis contributed to the development of knee arthritis. He explained that the physical requirements 

of her federal employment were causally related to her right knee progressive arthritis, reasoning 

that the physical requirements of her employment continually hastened and accelerated her right 

knee symptoms. Dr. Hartunian further opined that arthritis of appellant’s right lower extremity 

was a failure of articular cartilage that resulted in progressive loss of the articular surface and that, 

as the articular surface wore away, the joint space diminished and caused the worsening of her 

condition.

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.10 

Dr. Hartunian is a Board-certified orthopedic surgeon who is qualified in his field of 

medicine to render rationalized opinions on the issue of causal relationship. In his September 4, 

2018 report, he demonstrated a comprehensive understanding of the medical record and case 

history. Dr. Hartunian provided a pathophysiological explanation explaining how appellant’s job 

duties resulted in the progression of her right knee condition. Although his September 4, 2018 

report is insufficient to meet appellant’s burden of proof to establish her claim, it raises an 

uncontroverted inference between her diagnosed right knee condition and the accepted factors of 

her federal employment. Accordingly, Dr. Hartunian’s medical opinion is sufficiently rationalized 

to require further development of appellant’s claim.11

10 B.C., Docket No. 20-0498 (issued August27, 2020); L.P., Docket No. 18-1252 (issued June4, 2020); W.M., 

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

Deerman, 34 ECAB 641, 645 (1983).

11 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 April12, 2019); C.M., Docket No. 17-1977 (issued January 29, 2019); WilliamJ. 

Cantrell, 34 ECAB 1223 (1983).
7

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 

responsibility in the development of the evidence.12 OWCP has an obligation to see that justice is 

done.13

On remand, OWCP shall refer appellant to a physician in the appropriate field of medicine, 

along with the case record and a statement of accepted facts, for an examination and a rationalized 

medical opinion as to whether the accepted employment factors either caused or aggravated 

appellant’s diagnosed condition.14 If the second opinion disagrees with the explanation provided 

by Dr. Hartunian, he or she must provide a fully-rationalized explanation explaining why the 

accepted employment factors were insufficient to have caused or aggravated her diagnosed right 

knee condition. After this and other such further development of the case record as deemed 

necessary, OWCP shall issue a de novo decision.

CONCLUSION

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

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

223 (1999).

13 See B.C., supra note 10; N.L., Docket No. 19-1592 (issued March 12, 2020); E.J., Docket No. 09-1481 (issued 

February19, 2010); JohnJ. Carlone, 41 ECAB 354 (1989).

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

C.C., Docket No. 19-1631 (issued February 12, 2020).
8

ORDER

IT IS HEREBY ORDERED THAT the November 1, 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: October 21, 2021

Washington, DC

Alec J. Koromilas, 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