United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

M.D., Appellant

and

U.S. POSTAL SERVICE, DULUTH POST 

OFFICE, Duluth, MN, Employer

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Docket No. 20-0616

Issued: October 2, 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

PATRICIA H. FITZGERALD, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On January 27, 2020 appellant filed a timely appeal from a December 4, 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 her burden of proof to establish a left knee condition 

causally related to the accepted January 31, 2019 employment incident.

FACTUAL HISTORY

On February 1, 2019 appellant, then a 57-year-old city carrier assistant, filed a traumatic 

injury claim (Form CA-1) alleging that on January 31, 2019 she strained her left knee when she 

slipped on ice while in the performance of duty. On the reverse side of the claim form the 

 

1 5 U.S.C. § 8101 et seq.
2

employing establishment acknowledged that she was injured in the performance of duty. 

Appellant stopped work on February 4, 2019. 

X-rays of appellant’s left knee, dated February 1, 2019, revealed mild patellofemoral 

osteoarthritis and possible small suprapatellar loose body or spur. 

In a medical report dated February 4, 2019, Dr. Joshua Rother, a Board-certified orthopedic 

surgeon, noted that appellant injured her left knee after slipping on ice while delivering mail on 

February 1, 2019. He reviewed x-rays of her left knee and diagnosed left knee internal 

derangement with possible meniscal pathology. In an accompanying report, Dr. Rother again 

diagnosed left knee internal derangement and indicated that appellant was unable to work. 

A February 22, 2019 magnetic resonance imaging (MRI) scan of appellant’s left knee, 

demonstrated moderate-to-large knee joint effusion, high-grade chondromalacia patella, and focal 

reactive marrow edema in the lateral tibial plateau. 

In a February 27, 2019 note, Dr. Rother reviewed an MRI scan of appellant’s left knee and 

diagnosed small loose body laterally and a bone contusion of the lateral tibial plateau. He 

recommended a left knee scope with loose body removal chondroplasty. 

In a March 4, 2019 report, Dr. Rother indicated that appellant was unable to work until she 

received surgery. 

In a development letter dated April 2, 2019, OWCP notified appellant of the factual and 

medical deficiencies of her claim. It advised her of the type of evidence required and provided a 

questionnaire for her completion. OWCP afforded appellant 30 days to submit the necessary 

evidence. 

On April 9, 2019 appellant filed a claim for compensation (Form CA-7) for leave without 

pay used from March 16 to 29, 2019. 

In an April 17, 2019 report, Dr. Rother noted that appellant was unable to work until she 

received surgery. 

In a letter dated April 22, 2019, OWCP informed appellant that no action could be taken 

on any Form CA-7 claims for compensation until her traumatic injury claim had been adjudicated. 

By decision dated April 25, 2019, OWCP denied appellant’s traumatic injury claim, 

finding that the medical evidence of record was insufficient to establish a causal relationship 

between her diagnosed conditions and the accepted January 31, 2019 employment incident. 

In a May 20, 2019 report, Dr. Rother again confirmed that appellant experienced a left knee 

injury on January 31, 2019 while slipping on ice at work. He opined that the internal derangement 

process occurred as she had a twisting moment, which caused enough stress upon the meniscus 

and potential tearing to that structure. Dr. Rother noted that appellant did not have a significant 

amount of underlying arthrosis in the left knee and that he did not believe that there were any 

preexisting factors that would have contributed to her current left knee condition. 
3

On May 23, 2019 appellant requested a review of the written record by OWCP’s Branch 

of Hearings and Review. 

By decision dated August 5, 2019, OWCP’s hearing representative set aside the April 25, 

2019 decision and remanded the case for referral to a district medical adviser (DMA) to review 

the medical evidence of record and requested an explanation as to whether there was a causal 

relationship between appellant’s diagnosed left knee condition and the accepted January 31, 2019 

employment incident. 

In a letter dated August 20, 2019, OWCP requested additional factual information from 

appellant regarding the accepted employment incident. 

In a September 3, 2019 narrative statement, appellant explained that on January 31, 2019 

she slipped on ice when returning to her work building after parking her work vehicle. She noted 

that she did not fall, but, slipped with her right foot and caught herself with her left foot to avoid 

falling. 

On October 17, 2019 OWCP forwarded a statement of accepted facts (SOAF) and 

appellant’s medical record to Dr. Nathan Hammel, a Board-certified orthopedic surgeon serving 

as DMA, for an opinion on causal relationship and the necessity of left knee surgery. 

In a November 20, 2019 report, Dr. Hammel advised that, based on the medical evidence 

of record, the proposed left knee scope with loose body removal chondroplasty, was not causally 

related to the accepted medical condition(s). He further indicated that he concurred with

Dr. Rother’s finding of significant preexisting arthritis. Dr. Hammel opined that the proposed 

surgery was only intended to treat arthritis, not appellant’s accepted, diagnosed conditions. He

indicated that no work diagnosis was accepted and that left knee surgery was not medically 

necessary. 

By decision dated December 4, 2019, OWCP denied appellant’s traumatic injury claim, 

finding that the medical evidence of record was insufficient to establish a causal relationship 

between her diagnosed conditions and the accepted January 31, 2019 employment incident. 

LEGAL PRECEDENT

An employee seeking benefits under FECA2 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 

 

2

Id.

3 M.O., Docket No. 19-1398 (issued August 13, 2020); S.B., Docket No. 17-1779 (issued February 7, 2018); 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 has sustained a traumatic injury in the performance of duty, 

OWCP begins with an analysis of whether fact of injury has been established. Fact of injury 

consists of 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.6 The second component is whether the employment incident caused a personal injury.7

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.8 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 incident identified by the claimant.9

In order for a surgical procedure to be authorized, a claimant must submit evidence to show 

that the surgery is for a condition causally related to an employment injury and that it is medically 

warranted. Both of these criteria must be met in order for OWCP to authorize payment.10

ANALYSIS

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

Appellant’s attending physician, Dr. Rother, diagnosed left knee internal derangement, 

small loose body laterally, and a bone contusion of the lateral tibial plateau. He recommended a 

left knee scope with loose body removal chondroplasty. OWCP referred a SOAF along with the 

medical evidence of record to Dr. Hammel, serving as DMA, who opined that the proposed surgery 

was only intended to treat appellant’s preexisting arthritis. The DMA indicated that the proposed 

surgery was not medically necessary and not causally related to the accepted January 31, 2019 

employment incident.

The Board finds that the November 20, 2019 opinion of the DMA fails to appropriately 

address the underlying issues of whether there is a causal relationship between appellant’s 

diagnosed left knee condition and the accepted employment incident and whether the proposed 

 

4

J.R., Docket No. 20-0496 (issued August 13, 2020); R.C., 59 ECAB 427 (2008); James E. Chadden, Sr., 40 ECAB 

312 (1988).

5 B.M., Docket No. 19-1341 (issued August 12, 2020); L.M., Docket No. 13-1402 (issued February 7, 2014); 

Delores C. Ellyett, 41 ECAB 992 (1990).

6 T.J., Docket No. 19-0461 (issued August 11, 2020); Elaine Pendleton, 40 ECAB 1143 (1989).

7 D.M., Docket No. 20-0386 (issued August 10, 2020); John J. Carlone, 41 ECAB 354 (1989).

8 A.R., Docket No. 19-0465 (issued August 10, 2020); Jacqueline M. Nixon-Steward, 52 ECAB 140 (2000).

9 W.L., Docket No. 19-1581 (issued August 5, 2020); Leslie C. Moore, 52 ECAB 132 (2000).

10 M.G., Docket No. 19-1791 (issued August 13, 2020); K.W., Docket No. 18-1523 (issued May 22, 2019).
5

left knee procedure is medically necessary to treat the diagnosed left knee condition. The DMA 

was instructed to provide a clear, rationalized explanation on causal relationship. However, he did 

not offer a rationalized medical opinion on whether appellant’s diagnosed left knee condition was 

causally related to the accepted employment incident. Instead, the DMA merely responded “No”

when answering the question regarding whether the proposed left knee procedure was causally 

related to the diagnosed left knee condition and was medically necessary. He also erroneously 

stated that Dr. Rother noted significant preexisting arthritis and opined that the proposed surgery 

was only related to this preexisting condition. However, Dr. Rother, in his May 20, 2019 report, 

explicitly stated that appellant did “not have a significant amount of underlying arthrosis present 

within the knee” and that he did “not think that there [were] any preexisting factors that would 

necessarily come into play as it pertain[ed] to [appellant’s] knee.”

As such, the Board finds that the DMA failed to provide a rationalized medical opinion 

explaining whether appellant’s diagnosed left knee condition was causally related to the accepted 

employment incident. The DMA further failed to provide a rationalized medical opinion 

explaining whether the left knee scope with loose body removal chondroplasty proposed by

Dr. Rother is medically necessary to treat the diagnosed condition.11

Proceedings under FECA are not adversarial in nature, nor is OWCP a disinterested 

arbiter.12 While the claimant has the responsibility to establish entitlement to compensation, 

OWCP shares responsibility in the development of the evidence to see that justice is done.13 Once 

OWCP undertakes development of the record, it has the responsibility to do so in a manner that 

will resolve the relevant issues in the case.14 Accordingly, as OWCP undertook development of 

the evidence by referring appellant to its DMA, it had a duty to secure an appropriate report 

addressing the relevant issues.15 Because the DMA has not adequately addressed causal 

relationship or the medical necessity of the proposed left knee scope with loose body removal 

chondroplasty, the case must be remanded to OWCP.16

On remand OWCP shall request a supplemental report from Dr. Hammel to obtain a 

rationalized medical opinion on whether there is a causal relationship between appellant’s 

diagnosed left knee condition and the accepted January 31, 2019 employment incident and whether 

the proposed left knee scope with loose body removal chondroplasty is medically necessary to 

treat the diagnosed left knee condition. Following this and other such further development as 

deemed necessary, OWCP shall issue a de novo decision.

 

11 Id.

12 M.T., Docket No. 19-0373 (issued August 22, 2019); B.A., Docket No. 17-1360 (issued January 10, 2018).

13 S.S., Docket No. 18-0397 (issued January 15, 2019); Donald R. Gervasi, 57 ECAB 281, 286 (2005); William J. 

Cantrell, 34 ECAB 1233, 1237 (1983).

14 B.C., Docket No. 19-1983 (issued June 8, 2020).

15 Id.

16 M.G., supra note 10.
6

CONCLUSION

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

ORDER

IT IS HEREBY ORDERED THAT the December 4, 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 2, 2020

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