United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

S.D., Appellant

and

U.S. POSTAL SERVICE, HARKER HEIGHTS 

POST OFFICE, Harker Heights, TX, Employer

__________________________________________

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Docket No. 21-0297

Issued: July 2, 2021

Appearances: Case Submitted on the Record

Alan J. Shapiro, 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 23, 2020 appellant, through counsel, filed a timely appeal from a 

September 4, 2020 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.3

 

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.

3 The Board notes that, following the September 4, 2020 decision, appellant submitted additional evidence to 

OWCP. However, the Board’s Rules of Procedure provides: “The Board’s review of a case is limited to the evidence 

in the case record that was before OWCP at the time of its final decision. Evidence not before OWCP will not be 

considered by the Board for the first time on appeal.” 20 C.F.R. § 501.2(c)(1). Thus, the Board is precluded from 

reviewing this additional evidence for the first time on appeal. Id.
2

ISSUE

The issue is whether appellant has met her burden of proof to establish a consequential left 

knee condition causally related to the accepted November 15, 2017 employment injury.

FACTUAL HISTORY

This case has previously been before the Board on a different issue.

4

 The facts and 

circumstances as set forth in the Board’s prior decision are incorporated herein by reference. The 

relevant facts are as follows. 

On November 16, 2017 appellant, then a 37-year-old postal support employee mail clerk, 

filed a traumatic injury claim (Form CA-1) alleging that on November 15, 2017 she sprained and 

bruised her right foot when an equipment gate fell on her leg while in the performance of duty. 

She stopped work on November 21, 2017 and returned to part-time, limited-duty work for 

approximately six hours per day on December 13, 2017. OWCP accepted appellant’s claim for 

right foot and ankle sprains. On March 28, 2018 appellant stopped work again.

5

On July 31, 2019 appellant underwent OWCP-approved right ankle arthroscopic surgery 

and stopped work. OWCP paid her wage-loss compensation on the supplemental rolls beginning 

July 31, 2019. 

In a report dated August 28, 2019, Dr. Thomas Martens, an osteopath who specializes in 

family medicine, described the history of the November 15, 2017 employment injury and noted 

that appellant recently underwent right ankle surgery. He reported right ankle examination 

findings of mild tenderness over the lateral ligament and two well-healed incisions. Upon 

examination of appellant’s left lower extremity, Dr. Martens observed mild swelling of the left 

ankle and tenderness of the left lateral/medial knee joint with limited range of motion (ROM). He 

diagnosed right foot and right ankle sprains. Dr. Martens opined that appellant was incapacitated 

from work beginning July 31, 2019 due to her work-related injuries. 

On October 26, 2019 appellant returned to part-time, limited-duty work for four hours per 

day. OWCP continued to pay her wage-loss compensation for partial disability. 

In a December 3, 2019 report, Dr. Martens indicated that he had treated appellant for workrelated right ankle and foot sprain injuries. Upon examination of appellant’s right ankle, he 

observed tenderness over the lateral ligament and limited ROM secondary to pain. Examination 

of appellant’s left knee revealed tenderness of the left lateral and medial knee joint, pain on 

palpation, and limited ROM secondary to pain. Dr. Martens noted that a July 17, 2018 left knee 

magnetic resonance imaging (MRI) scan had revealed a complex tear of the lateral meniscus body 

and posterior horn. He requested that the acceptance of appellant’s claim be expanded to include 

complex tear of the lateral meniscus of the left knee as a direct result of appellant’s authorized 

 

4 Docket No. 19-0955 (issued February 3, 2020).

5 Appellant subsequently filed claims for compensation (Form CA-7) for disability for the period March 28 through 

April 28, 2018. OWCP denied appellant’s claim by decision dated August 6, 2018, which was affirmed by an OWCP 

hearing representative on March 11, 2019. Appellant appealed to the Board. By decision dated February 3, 2020, the 

Board affirmed the March 11, 2019 OWCP decision. Id.
3

right ankle surgery. Dr. Martens noted that appellant’s left knee lateral meniscus tear was 

“consequential to the right ankle/foot injury as she was required to wear the boot due to the pain 

and discomfort.” He explained that the lateral meniscus was on the outside of the knee and began 

to lose its resiliency as the altered gait and weight was placed heavily on the left lower extremity. 

Dr. Martens reported that appellant was immobilized in a walking boot on January 5, 2018 and 

recounted how appellant continued to ambulate with a walking boot for months while she 

attempted to return to work. 

Appellant provided a July 17, 2018 left knee MRI scan, which revealed a complex tear of 

the lateral meniscus body and posterior horn, moderate lateral compartment arthrosis, and mild 

medial compartment arthrosis with articular cartilage thinning. She also submitted reports dated 

January 5 through October 4, 2018 from Dr. Ryan Shock, a podiatrist, who treated appellant for 

her right ankle sprain and indicated that appellant’s right foot was immobilized in a walking boot. 

In a February 11, 2020 report, Dr. Martens indicated that appellant was treated for follow

up of her work-related right ankle and foot injuries. He noted that they were waiting for appellant’s 

claim to be expanded to include a left knee injury. Dr. Martens conducted an examination and 

diagnosed right foot and ankle sprains. 

On February 21, 2020 OWCP requested that a district medical adviser (DMA) review

Dr. Martens’ reports and comment on whether he agreed with his opinion that appellant’s left knee 

condition was a consequence of the accepted November 15, 2017 employment injury. 

In a March 10, 2020 report, Dr. Nathan Hammel, a Board-certified orthopedic surgeon

serving as the DMA, noted his review of appellant’s history and referenced appellant’s accepted 

conditions of right ankle and right foot sprains. He expressed his disagreement with Dr. Martens’

opinion that appellant sustained a consequential left knee injury due to her November 15, 2017 

employment injury. Dr. Hammel indicated that the mechanism of injury was incapable of 

producing a meniscus tear and that there was no correlation between temporary immobilization 

and contralateral meniscus tear. In response to the questions posed by OWCP, he reported that 

there was a delay complaint of left knee symptoms and the mechanism of injury listed on the 

statement of accepted facts (SOAF) was incapable of producing a meniscus tear. Dr. Hammel

postulated that there is no generally accepted practice, which correlates temporary immobilization 

with contralateral meniscus tear. He further indicated that there was “no medical literature to 

support that temporary gait alterations from surgery or immobilization causes degenerative 

conditions like the complex tear of the lateral meniscus.”

By decision dated April 8, 2020, OWCP denied the expansion of the acceptance of 

appellant’s claim to include a consequential left knee condition, finding that the medical evidence 

of record was insufficient to establish that the additional condition was caused or aggravated by 

her accepted November 15, 2017 employment injury. 

On April 14, 2020 appellant, through counsel, requested a telephonic hearing before a 

representative of OWCP’s Branch of Hearings and Review, which was held on July 7, 2020. 

OWCP subsequently received reports dated March 16 through August 20, 2020 from

Dr. Shock regarding his medical treatment for appellant’s right ankle and foot sprains.
4

By decision dated September 4, 2020, OWCP’s hearing representative affirmed the 

April 8, 2020 decision. 

LEGAL PRECEDENT

When an employee claims that a condition not accepted or approved by OWCP was due to 

an employment injury, he or she bears the burden of proof to establish that the condition is causally 

related to the employment injury.6

To establish causal relationship, the employee must submit rationalized medical opinion 

evidence.7 The opinion of the physician must be based on a complete factual and medical 

background of the employee, 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 accepted employment injury.8 The weight of the medical evidence is determined by its 

reliability, its probative value, its convincing quality, the care of analysis manifested, and the 

medical rationale expressed in support of the physician’s opinion.9

When an injury arises in the course of employment, every natural consequence that flows 

from that injury likewise arises out of the employment, unless it is the result of an independent 

intervening cause attributable to a claimant’s own intentional misconduct.10 Thus, a subsequent 

injury, be it an aggravation of the original injury or a new and distinct injury, is compensable if it 

is the direct and natural consequence of a compensable primary injury.11

ANALYSIS

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

In a December 3, 2019report, Dr. Martens, appellant’s treating physician, requested that 

the acceptance of appellant’s claim be expanded to include complex tear of the lateral meniscus of 

the left knee as a direct result of appellant’s authorized right ankle surgery. He opined that 

appellant’s left knee condition was consequential to her right ankle and foot injury because she 

was required to wear a walking boot. On February 21, 2020 OWCP requested that a DMA review

 

6

J.R., Docket No. 20-0292 (issued June 26, 2020); W.L., Docket No. 17-1965 (issued September 12, 2018); V.B., 

Docket No. 12-0599 (issued October 2, 2012); Jaja K. Asaramo, 55 ECAB 200, 204 (2004).

7 See W.C., Docket No. 19-1740 (issued June 4, 2020); S.A., Docket No. 18-0399 (issued October 16, 2018); see 

also Robert G. Morris, 48 ECAB 238 (1996).

8 E.M., Docket No. 18-1599 (issued March 7, 2019); I.J., 59 ECAB 408 (2008); Victor J. Woodhams, 41 ECAB 

345 (1989).

9 D.S., Docket No. 20-0146 (issued June 11, 2020); M.V., Docket No. 18-0884 (issued December 28, 2018); James 

Mack, 43 ECAB 321 (1991).

10 See S.M., Docket No. 19-0397 (issued August 7, 2019); Mary Poller, 55 ECAB 483, 487 (2004).

11 A.T., Docket No. 18-1717 (issued May 10, 2019); Susanne W. Underwood (Randall L. Underwood), 53 ECAB 

139 (2001).
5

Dr. Martens’ report and comment on whether he agreed with his opinion that appellant’s left knee 

condition was a consequence of the accepted November 15, 2017 employment injury. 

In a March 10, 2020 report, the DMA indicated that the described mechanism of injury was 

incapable of producing a meniscus tear. In response to OWCP’s questions, he reported that there 

was a delay in reporting the complaint of left knee symptoms, and that the mechanism of injury 

listed on the SOAF was incapable of producing a meniscus tear. The DMA postulated that there 

is no generally accepted practice, which correlates temporary immobilization with contralateral 

meniscus tear. He further indicated that there was “no medical literature to support that temporary 

gait alterations from surgery or immobilization causes degenerative conditions like the complex 

tear of the lateral meniscus.” The DMA, however, did not provide sufficient medical reasoning to 

support his conclusory statements that appellant had not developed a consequential left knee 

condition.12 He opined that mechanism of injury listed on the SOAF was incapable of producing 

a meniscus tear; however, he did not provide an explanation for his opinion. The DMA failed to 

explain how walking with an altered gait due to immobilization did not contribute to a 

consequential left knee condition.13 The Board has held that a report is of limited probative value 

if a physician does not provide medical rationale explaining his or her conclusion on that matter.14 

It is well established that proceedings under FECA are not adversarial in nature and, while 

appellant has the burden to establish entitlement to compensation, OWCP shares responsibility in 

the development of the evidence.15 It has an obligation to see that justice is done.16 Accordingly, 

once OWCP undertakes to develop the medical evidence, it has the responsibility to do so in a 

manner that will resolve the relevant issues in the case.17 In this case, the DMA failed to offer a 

rationalized medical explanation regarding why appellant did not sustain a consequential left knee 

condition causally related to the accepted November 15, 2017 employment injury. Due to the 

deficiencies in the DMA’s report, OWCP should have sought clarification or referred appellant for 

a second opinion evaluation.18 

On remand OWCP shall refer appellant, together with a SOAF and a list of specific 

questions, to a specialist in the appropriate field of medicine, for a second opinion evaluation in 

order to resolve the issue of whether appellant developed a consequential left knee condition 

 

12 See D.T., Docket No. 20-0234 (issued January 8, 2021); see also K.C., Docket No. 19-1251 (issued 

January 24, 2020).

13 See T.B., Docket No. 20-0182 (issued April 23, 2021); see also J.H., Docket No. 19-0513 (issued 

September 24, 2019).

14 L.G., Docket No. 19-0142 (issued August 8, 2019); C.M., Docket No. 14-0088 (issued April 18, 2014).

15 See e.g., M.G., Docket No. 18-1310 (issued April 16, 2019); Walter A. Fundinger, Jr., 37 ECAB 200, 204 (1985); 

Michael Gallo, 29 ECAB 159, 161 (1978); William N. Saathoff, 8 ECAB 769, 770-71; Dorothy L. Sidwell, 36 ECAB 

699, 707 (1985).

16 See A.J., Docket No. 18-0905 (issued December 10, 2018); William J. Cantrell, 34 ECAB 1233, 1237 (1983); 

Gertrude E. Evans, 26 ECAB 195 (1974).

17 T.K., Docket No. 20-0150 (issued July 9, 2020); T.C., Docket No. 17-1906 (issued January 10, 2018).

18 M.S., Docket No. 19-0282 (issued August 2, 2019); V.H., Docket No. 14-0433 (issued July 3, 2014).
6

causally related to the accepted November 15, 2017 employment injury.19 If the second opinion 

physician disagrees with the explanations provided by Dr. Martens, he or she must provide a fullyrationalized explanation regarding why the accepted employment injury was insufficient to have 

caused or contributed to his current left knee meniscal tear. Following this and any other such 

further development deemed necessary, OWCP shall issue a de novo decision.

CONCLUSION

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

ORDER

IT IS HEREBY ORDERED THAT the September 4, 2020 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: July 2, 2021

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

 

19 T.S., Docket No. 18-1702 (issued October 4, 2019).