United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

S.F., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Southampton, NY, Employer

__________________________________________

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Docket No. 20-1503

Issued: August 3, 2021

Appearances: Case Submitted on the Record

Capp P. Taylor, for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

JANICE B. ASKIN, Judge

PATRICIA H. FITZGERALD, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

On August 11, 2020 appellant, through her representative, filed a timely appeal from a 

June 24, 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.

ISSUE

The issue is whether appellant has met her burden of proof to establish a bilateral knee 

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

 

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

FACTUAL HISTORY

This case has previously been before the Board.3 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 May 15, 2014 appellant, then a 53-year-old letter carrier, filed an occupational disease 

claim (Form CA-2) alleging that she sustained a bilateral knee condition due to factors of her 

federal employment, including standing for long periods of time. She noted that she first became 

aware of her condition and its relationship to her federal employment on April 29, 2014. Appellant 

stopped work on April 29, 2014 and returned to work in a modified-duty capacity on 

May 10, 2014.

In support of her claim, appellant submitted a June 12, 2014 report from Dr. Allen Fein, a 

Board-certified specialist in family medicine, who provided physical examination findings and 

diagnosed osteoarthritis. Dr. Fein opined that appellant’s federal employment was partially 

responsible, along with her weight, for her bilateral knee condition.

By decision dated August 8, 2014, OWCP denied appellant’s claim, finding that the 

medical evidence of record was insufficient to establish that her diagnosed knee condition was 

causally related to the accepted factors of her federal employment.

On September 4, 2014 appellant requested an oral hearing before a representative of 

OWCP’s Branch of Hearings and Review.

In support of her request, appellant submitted medical reports, dated April 25, 2013 

through August 28, 2014, from Dr. Peter G. Sultan, a Board-certified orthopedic surgeon.

A hearing was held on February 9, 2015. During the hearing, appellant discussed her 

employment duties and indicated that she required bilateral knee replacement surgery.

By decision dated March 18, 2015, OWCP’s hearing representative affirmed the August 8, 

2014 decision, finding that the evidence of record was insufficient to establish that appellant’s 

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

On June 9, 2015 appellant requested reconsideration and submitted additional medical 

evidence, including a March 12, 2015 report from Dr. Fein and an April 17, 2015 report from a 

physician assistant.

By decision dated September 2, 2015, OWCP denied modification of the March 18, 2015 

decision.

On August 15, 2016 appellant, through counsel, requested reconsideration.

 

3 Docket No. 18-1030 (issued April 5, 2019).
3

In an August 9, 2016 report, Dr. Fein described appellant’s employment duties and history 

of injury. He indicated that appellant’s employment duties and obesity caused abnormal wear and 

tear on her knees and hips sufficient to wear down the cartilage.

By decision dated December 26, 2017, OWCP denied modification of the September 2, 

2015 decision.

On April 23, 2018 appellant, through counsel, appealed to the Board. By decision dated

April 5, 2019,4the Board affirmed the December 26, 2017 decision, finding that appellant had not 

met her burden of proof to establish a bilateral knee condition causally related to the accepted 

factors of her federal employment.

On April 9, 2020 appellant, through counsel, requested reconsideration.

In a February 20, 2020 report, Dr. Fein reviewed Dr. Sultan’s May 23, 2013 and August 28, 

2014 reports. He noted that osteoarthritis in the knees caused cartilage to become stiff and lose 

elasticity, making the knees more susceptible to damage. Dr. Fein indicated that, over time, 

cartilage degradation stretched the tendons and ligaments causing pain. He described appellant’s 

employment activities and noted that she frequently walked on uneven concrete surfaces, entered 

and exited her vehicle, and ascended and descended stairs. Dr. Fein opined that appellant’s 

employment duties caused wear and tear in the cartilage of her knees. He found that the thinning 

of the cartilage and the smaller than usual joint space could be seen in appellant’s x-rays. Dr. Fein 

noted that the osteophytes on the edges of the joint reflected inflammation usually caused by 

repeated wear as opposed to a single event. He opined that appellant’s obesity was a contributing 

factor to her osteoarthritis, but indicated that the movement of her knees provided the wear and 

tear on the cartilage and not the weight itself. Dr. Fein explained that appellant’s diagnoses of 

hypertension, Type 2 diabetes mellitus, thrombocytopenia, and leukopenia were not known causes 

of osteoarthritis.

By decision dated June 24, 2020, OWCP denied modification, finding that the medical 

evidence of record was insufficient to establish causal relationship between the diagnosed bilateral 

knee condition and the accepted factors of appellant’s federal employment.

LEGAL PRECEDENT

An employee seeking benefits under FECA5has 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,6that 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 

 

4

Id.

5 Supra note 2.

6 R.M., Docket No. 20-0342 (issued July 30, 2020); J.P., 59 ECAB 178 (2007); Joe D. Cameron, 41 ECAB 

153 (1989).
4

to the employment injury.7 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.8

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.9

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.

10

 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.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.

In support of her claim, appellant submitted a February 20, 2020 report from Dr. Fein who

reviewed Dr. Sultan’s May 23, 2013 and August 28, 2014 reports and described appellant’s work 

activities. Dr. Fein explained that osteoarthritis in the knees caused cartilage to become stiff and 

lose elasticity, making the knees more susceptible to damage. He noted that over time, cartilage 

degradation stretched the tendons and ligaments causing pain. Dr. Fein indicated that appellant

frequently walked on uneven concrete surfaces, entered and exited her vehicle, and ascended and 

descended stairs. He opined that appellant’s employment activities caused wear and tear in the 

cartilage of her knees. Dr. Fein noted that the thinning of the cartilage and the smaller than usual 

 

7 V.P., Docket No. 20-0415 (issued July 30, 2020); R.C., 59 ECAB 427 (2008); James E. Chadden, Sr., 40 ECAB 

312 (1988).

8 20 C.F.R. § 10.115; S.A., Docket No. 20-0458 (issued July 23, 2020); L.M., Docket No. 13-1402 (issued 

February 7, 2014); Delores C. Ellyett, 41 ECAB 992 (1990).

9 See B.H., Docket No. 18-1693 (issued July 20, 2020); Roy L. Humphrey, 57 ECAB 238, 241 (2005); Victor J. 

Woodhams, 41 ECAB 345, 352 (1989).

10 L.S., Docket No. 19-1769 (issued July 10, 2020); Jacqueline M. Nixon-Steward, 52 ECAB 140 (2000).

11 B.C., Docket No. 20-0221 (issued July 10, 2020); Leslie C. Moore, 52 ECAB 132 (2000).

12 Federal (FECA) Procedure Manual, Part 2 – Claims, Causal Relationship, Chapter 2.805.3e (January 2013); see 

S.M., Docket No. 19-1634 (issued August 25, 2020).
5

joint space could be seen in appellant’s x-rays. He indicated that the osteophytes on the edges of 

the joint reflected inflammation usually caused by repeated wear as opposed to a single event. Dr. 

Fein opined that appellant’s obesity was a contributing factor to her osteoarthritis, but indicated 

that the movement of her knees provided the wear and tear on the cartilage and not the weight 

itself. He advised that appellant’s hypertension, Type 2 diabetes mellitus, thrombocytopenia, and 

leukopenia were not known causes of osteoarthritis.

The Board finds that this report from Dr. Fein is sufficient to require further development 

of the medical evidence. Dr. Fein provided a comprehensive understanding of the medical record 

and case history. His affirmative opinion on causal relationship provides a pathophysiological 

explanation as to how appellant’s work activities caused her diagnosed condition. Accordingly, 

the Board finds that Dr. Fein’s opinion, while insufficiently rationalized to meet appellant’s burden 

of proof, is sufficient, to require further development of the medical record as to whether her 

bilateral knee osteoarthritis is causally related to the accepted factors of her federal employment.13

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

while appellant has the burden of proof to establish entitlement to compensation, OWCP shares 

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

done.14 

On remand, OWCP shall refer appellant, a statement of accepted facts, and the medical 

record to a specialist in the appropriate field of medicine. The chosen physician shall provide a 

rationalized opinion as to whether appellant’s diagnosed conditions are causally related to the 

accepted factors of her federal employment. If the physician opines that the diagnosed conditions 

are not causally related, he or she must explain, with rationale, how or why the opinion differs 

from that of Dr. Fein. Following this and such other further development as deemed necessary, 

OWCP shall issue a de novo decision on appellant’s claim.

CONCLUSION

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

 

13 See J.S., Docket No. 19-0892 (issued November 4, 2020); E.J., Docket No. 09-1481 (issued February 19, 2010); 

John J. Carlone, 41 ECAB 354, 360 (1989).

14 T.S., Docket No. 20-1177 and 20-1296 (issued May 28, 2021).
6

ORDER

IT IS HEREBY ORDERED THAT the June 24, 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: August 3, 2021

Washington, DC

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Alternate Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board