United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

R.A., Appellant

and

U.S. POSTAL SERVICE, BLACKWOOD POST 

OFFICE, Blackwood, NJ, Employer

__________________________________________

)

)

)

)

)

)

)

)

Docket No. 22-0307

Issued: August 5, 2022

Appearances: Case Submitted on the Record

Michael D. Overman, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

JANICE B. ASKIN, Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On December 27, 2021 appellant, through counsel, filed a timely appeal from a July 14, 

2021 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 bilateral knee 

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

FACTUAL HISTORY

On July 17, 2018 appellant, then a 58-year-old window distribution clerk, filed an 

occupational disease claim (Form CA-2) alleging that she developed bilateral knee conditions due 

to factors of herfederal employment, including long hours of walking, bending, standing, carrying,

stretching, lifting, and pulling. She first became aware of her condition and its relationship to her 

federal employment on May 31, 2018. Appellant stopped work on July 12, 2018 and has not 

returned. 

In a July 19, 2018 development letter, OWCP informed appellant of the deficiencies of her

claim. It advised her of the type of factual and medical evidence necessary and provided a 

questionnaire for her completion. In a separate development letter of even date, OWCP requested 

that the employing establishment provide comments from a knowledgeable supervisor regarding 

the accuracy of appellant’s allegations. It afforded both parties 30 days to respond. 

In a July 6, 2018 report, Dr. Sunny Gupta, an osteopath Board-certified in sports medicine,

noted that appellant was seen for complaints of bilateral knee pain, which started insidiously 

without any antecedent injury, trauma, falls or accidents; however, which were worsened by 

prolonged standing, sitting and walking. He reviewed x-rays of appellant’s bilateral knees, which 

revealed no acute fractures and moderate tricompartmental degenerative changes with some joint 

space narrowing with marginal osteophyte formation. Dr. Gupta related that appellant’s physical

examination findings included no bilateral knee ecchymosis or edema, normal gait with no 

antalgia, full range of motion (ROM), no effusion, joint line tenderness, and negative Lachman’s, 

anterior/posterior drawer, McMurray’s, and valgus/varus stress testing. He diagnosed bilateral 

knee moderate tricompartmental degenerative joint disease with exacerbation. 

In an August 3, 2018 attending physician’s report (Form CA-20), Dr. Julius Mingroni, an 

osteopath specializing in family medicine, diagnosed severe bilateral knee degenerative joint 

disease. He checked a box marked “Yes” to the questions of whether there was any history or 

evidence of concurrent or preexisting injury or disease or physical impairment and whether the 

diagnosed condition had been caused or aggravated by appellant’s employment. Dr. Mingroni

related that appellant was totally disabled from work. 

By decision dated September 5, 2018, OWCP denied appellant’s claim finding that she 

failed to establish a causal relationship between the diagnosed condition and the accepted factors 

of her federal employment. 

On September 13, 2018 appellant, through counsel, requested an oral hearing before a 

representative of OWCP’s Branch of Hearings and Review. 

Dr. Gupta, in reports dated July 27 and August 17, 2018, diagnosed bilateral knee primary 

osteoarthritis and bilateral knee degenerative joint disease. 
3

In an August 24, 20218 report, Dr. Gupta related appellant’s physical examination 

findings. He diagnosed bilateral knee primary osteoarthritis and bilateral knee degenerative joint 

disease. Appellant related to Dr. Gupta that she did not believe that she could return to work at 

the employing establishment due to pain from her duties of prolonged walking and standing. 

Dr. Gupta agreed to provide appellant with documentation that she was unable to return to work 

at that time. 

In an October 30, 2018 addendum narrative report, Dr. Gupta reviewed a description of 

appellant’s job duties, which included standing, walking twisting, reaching, bending, lifting or 

carryingheavy parcels up to 45 to 50 pounds, and pushing equipment weighingup to 3,000 pounds. 

He stated that he could not definitely attribute her bilateral knee degenerative joint disease to her 

work, but that the job duties as described by her would aggravate the condition. Dr. Gupta

explained the biomechanics of appellant’s job duties, including standing for many hours at a time

would cause muscle fatigue, decreasing the body’s ability to withstand these forces. Appellant’s

bending and lifting activities would place significant compressive forces across the knee joints. 

Cumulatively, these forces would aggravate her preexisting degenerative joint disease. 

Following a preliminary review, by decision dated December 11, 2018, an OWCP hearing 

representative set aside OWCP’s September 5, 2018 decision and remanded the case for referral 

for a second opinion evaluation. 

On January 25, 2019 OWCP referred appellant, together with a statement of accepted facts 

(SOAF), list of questions, and medical record, for a second opinion evaluation with Dr. Stanley 

Askin, a Board-certified orthopedic surgeon, to determine whether she sustained a diagnosed 

medical condition causally related to accepted employment factors. 

In a report dated February 15, 2019, Dr. Askin related appellant’s physical examination 

findings and noted that she had developed bilateral knee osteoarthritis as early as 2015. He opined 

that the accepted employment factors did not cause or aggravate her diagnosed bilateral knee 

osteoarthritis. Dr. Askin observed that, once appellant developed osteoarthritis, it became 

uncomfortable for her to be physically active. He explained that this was a reflection of the disease 

process and not related to any employment factors. In an attached work capacity evaluation (Form 

OWCP-5c), Dr. Askin checked a box marked “Yes” to the question of whether appellant was 

capable of performing her usual job without restriction. 

OWCP thereafter found that a conflict existed in the medical opinion evidence as to 

whether appellant’s bilateral knee conditions were caused or aggravated by her employment 

factors. On July 31, 2019 it referred her, along with the medical record and a SOAF, to Dr. Ian 

Blair Fries, a Board-certified orthopedic surgeon, for an impartial medical examination to resolve 

the conflict of medical opinion between Dr. Askin and Dr. Gupta. The April 9, 2019 SOAF 

provided to Dr. Fries noted the physical requirements of appellant’s position as lifting/carrying 35 

pounds continuously/intermittently up to eight hours a day, standing continuously/intermittently 

six hours a day, walking continuously/intermittently six hours a day, bending/stooping 

continuously/intermittently two hours a day, and pushing/pulling continuously/ intermittently one

hour a day. 
4

In a report dated August 9, 2019, Dr. Manny D. Porat, a Board-certified orthopedic 

surgeon, diagnosed left knee pain, status post left knee replacement, and right knee primary

osteoarthritis. He noted that appellant had undergone total left knee replacement on 

April 15, 2019. 

In a report dated January 21, 2020, Dr. Fries reviewed appellant’s medical history and

noted the physical requirements of her job duties. He diagnosed bilateral tricompartmental 

degenerative knee joint disease and post left total knee replacement. On physical examination of 

appellant’s bilateral knees, Dr. Fries reported normal gait with no antalgia, no ecchymoses, edema 

or effusion, tenderness of the joint line, functionally full ROM without pain, intake strength, and 

negative Lachman, anterior and posterior drawer, McMurray, and varus valgus stress tests. He

explained that degenerative knee arthritis is not caused nor permanently aggravated by standing 

walking or performing moderate activities based on medical science. The accepted factors for 

knee arthritis included obesity, prior surgery, and age. Dr. Fries reported that there was some 

evidence in the medical science that squatting, kneeling, and bending together with heavy lifting 

and physical demands can be considered as factors in the development o f knee osteoarthritis, 

however, these factors were not part of appellant’s job duties. He concluded that appellant’s 

bilateral knee degenerative osteoarthritis was not permanently nor measurably aggravated by her 

job duties and that there was no evidence of a work-related knee injury due to a specific traumatic 

incident. 

By decision dated March 16, 2020, OWCP denied appellant’s claim finding the evidence 

insufficient to establish that the diagnosed bilateral knee osteoarthritis had been caused or 

aggravated by the accepted employment factors. 

On March 26, 2020 appellant, through counsel, requested a hearing before a representative 

of OWCP’s Branch of Hearings and Review. A telephonic hearing was held on July 6, 2020. 

By decision dated September 18, 2020, OWCP’s hearing representative set aside the 

March 16, 2020 decision and remanded the case for OWCP to obtain a supplemental report from

Dr. Fries, regarding causal relationship. 

OWCP prepared an updated SOAF on October 7, 2020, which again noted the physical 

requirements of appellant’s job duties. On October 8, 2020 it referred the updated SOAF to

Dr. Fries and requested that he provide a supplemental report, with detailed medical rationale 

explaining his opinion that appellant’s job duties did not cause or aggravate her bilateral knee 

condition. 

In a December 22, 2020 supplemental report, Dr. Fries summarized appellant’s medical

history regarding her development of bilateral knee degenerative arthritis. He questioned the need 

for her left total knee replacement performed by Dr. Porat on April 15, 2019. Dr. Fries reiterated 

that degenerative knee arthritis was not caused by walking, standing, and performing moderate

activities, nor were these permanent aggravating factors according to medical science. Next, he 

attributed appellant’s claimed work disability and subjective complaints to symptom 

magnification. Dr. Fries concluded that bilateral knee osteoarthritis was an age-related condition, 

which was neither caused nor measurably aggravated by her job duties. He noted that, as the 

SOAF was substantially similar, his opinions did not change.
5

By decision dated January 21, 2021, OWCP denied appellant’s claim finding Dr. Fries’

opinion was entitled to the special weight of the medical opinion evidence. 

On January 27, 2021 appellant, through counsel, requested a hearing before a

representative of OWCP’s Branch of Hearings and Review. A telephonic hearing was held on 

April 30, 2021. 

By decision dated July 14, 2021, OWCP’s hearing representative affirmed OWCP’s 

January 21, 2021 decision. 

LEGAL PRECEDENT

An employee seeking benefits under FECA3 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,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 

casually related to the identified employment factors.

7

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue. 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. Additionally, the physician’s opinion must be 

expressed in terms of a reasonable degree of medical certainty, and must be supported by medical 

3

Id.

4

J.V., Docket No. 21-1353(issuedMarch21, 2022); J.P., Docket No. 19-0129 (issued April26, 2019); S.B., Docket 

No. 17-1779 (issued February 7, 2018); Joe D. Cameron, 41 ECAB 153 (1989).

5 D.B., Docket No. 21-0550 (issued March 7, 2022); J.P., id.; S.B., id.; Joe D. Cameron, id.

6

J.V., supra note 4; R.R., Docket No. 19-0048 (issued April25, 2019); L.M., Docket No. 13-1402 (issued 

February7, 2014); DeloresC. Ellyett, 41 ECAB 992 (1990).

7

J.V., id.; 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).
6

rationale, explaining the nature of the relationship between the diagnosed condition and appellant’s 

specific employment factor(s).8

ANALYSIS

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

OWCP properly determined that there was a conflict in the medical opinion evidence 

between Dr. Gupta, an attending physician, and Dr. Askin, an OWCP referral physician, as to 

whether appellant’s bilateral knee osteoarthritis had been caused or aggravated by the accepted 

factors of her federal employment. In order to resolve the conflict, it properly referred appellant, 

pursuant to 5 U.S.C. § 8123(a), to Dr. Fries for an impartial medical examination and an opinion 

on causation.

In a situation where OWCP secures an opinion from an impartial medical specialist for the 

purpose of resolving a conflict in the medical evidence and the opinion from such examiner 

requires clarification of elaboration, it has the responsibility to secure a supplemental report from 

the specialist for the purpose of correcting the defect in the original opinion.

9

 If an impartial 

medical specialist is unable to clarify or elaborate on his or her original report, or if his or her 

supplemental report is also vague, speculative, or lacking in rationale, OWCP must submit the case 

record and a detailed SOAF to a second impartial medical specialist for the purpose of obtaining 

his or her rationalized medical opinion on the issue.

10

In his reports dated January 21 and December 22, 2020, Dr. Fries opined that the accepted 

employment factors did not measurably aggravate or accelerate bilateral knee osteoarthritis as

medical science did not support that appellant’s job duties of walking, standing and moderate 

activity were aggravating factors. He reported that there was some evidence in the medical science 

that squatting, kneeling, and bending together with heavy lifting could be considered as factors in 

the development of knee osteoarthritis, however, these factors were not part of appellant’s job 

duties. The Board notes that the SOAFs OWCP provided to Dr. Fries clearly indicated that 

appellant did perform lifting/carrying 35 pounds continuously/intermittently, as well as 

bending/stooping continuously/intermittently two hours a day. It is well established that medical 

reports must be based on a complete and accurate factual and medical background and that medical 

opinions based on an incomplete or inaccurate history are of limited probative value.11 As

Dr. Fries did not acknowledge that appellant did perform these job duties, his opinion was not 

sufficiently rationalized. 

8

J.V., id.; John J. Carlone, 41 ECAB 354 (1989).

9 M.M., Docket No. 20-1524 (issued April20, 2021); S.R., Docket No. 17-1118 (issued April5, 2018); Nancy 

Lackner(JackD. Lackner), 40 ECAB 232, 238 (1988).

10 M.M., id.; M.D., Docket No. 19-0510 (issued August 6, 2019); Talmadge Miller, 47 ECAB 673 (1996); Harold 

Travis, 30 ECAB 1071, 1078 (1979).

11 A.C., Docket No. 19-1522 (issued July 27, 2020); J.R., Docket No. 12-1099 (issued November 7, 2012);

DouglasM. McQuaid, 52 ECAB 382 (2001).
7

In a December 22, 2020 supplemental report, Dr. Fries reiterated that appellant’s bilateral 

knee degenerative osteoarthritis was not permanently nor measurably aggravated by her job duties 

and that there was no evidence of a work-related knee injury due to a specific traumatic incident. 

The Board has held that any contribution to her condition by the accepted employment factors 

would render the condition compensable.12 Dr. Fries noted that, as the SOAF was substantially 

similar, his opinions did not change. He did not provide sufficient medical rationale explaining 

whether appellant’s accepted job duties, caused or aggravated her bilateral knee conditions 

temporarily or permanently, by any degree. As such Dr. Fries’ report is insufficient to resolve the 

conflict of medical opinion evidence. 

For these reasons, the Board finds that Dr. Fries’ reports cannot be afforded the special 

weight of an impartial medical specialist. Therefore, in order to resolve the conflict in medical 

opinion evidence, the case will be remanded to OWCP for referral of the case record, including an 

updated SOAF, and appellant to a new impartial medical specialist for physical examination and 

an opinion, which evaluates whether she sustained a bilateral knee condition causally related to 

the accepted factors of her federal employment.

13

 After this and other such further development 

as deemed necessary, OWCP shall issue a de novo decision.

CONCLUSION

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

12 R.G., Docket No. 21-0812 (issued February 28, 2022); F.K., Docket No.19-1804 (issued April27, 2020); J.B., 

Docket No. 17-2021 (issued August 8, 2018); G.G., Docket No. 17-0504 (issued August 8, 2017); Beth C. Chaput, 37 

ECAB 158 (1985) (it is not necessary to show a significant contribution of employment factors to a diagnosed 

condition to establish causal relationship).

13 G.B., Docket No. 19-1510 (issued February 12, 2020);see supra note 11.
8

ORDER

IT IS HEREBY ORDERED THAT the July 14, 2021 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: August 5, 2022

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board