United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

C.C., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Newmanstown, PA, Employer

__________________________________________

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Docket No. 20-1497

Issued: August 8, 2023

Appearances: Case Submitted on the Record

Jason J. Schlibinger, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

PATRICIA H. FITZGERALD, Deputy Chief Judge

JANICE B. ASKIN, Judge

JURISDICTION

On July 29, 2020 appellant, through counsel, filed a timely appeal from a January 31, 2020 

merit decision of the Office of Workers’ Compensation Programs (OWCP).2 Pursuant to the 

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 authoritie s for investigation.

2 Under the Board’s Rules of Procedure, an appeal must be filed within 180 days from the date of the last OWCP 

decision. An appeal is considered filed upon receipt by the Clerk of the Appellate Boards. See 20 C.F.R. 

§ 501.3(e)-(f). One hundred and eighty days from January 31, 2020, the date of OWCP’s decision, wasJuly 29, 2020. 

Since using August 4, 2020, the date the appeal was received by the Clerk of the Appellate Boards would result in the 

loss of appeal rights, the date of the postmark is considered the date of filing. The date of the U.S. Postal Service

postmark is July 29, 2020, which renders the appeal timely filed. See 20 C.F.R. § 501.3(f)(1).
2

Federal Employees’ Compensation Act3(FECA) and 20 C.F.R. §§ 501.2(c) and 501.3, the Board

has jurisdiction over the merits of this case.

ISSUES

The issues are: (1) whether appellant has met her burden of proof to expand the acceptance 

of her claim to include additional conditions as causally related to her accepted July 29, 2017 

employment injury; and (2) whether OWCP met its burden of proof to terminate appellant’s wageloss compensation and medical benefits, effective January 31, 2020.

FACTUAL HISTORY

On August 8, 2017 appellant, then a 62-year-old rural carrier, filed a traumatic injury claim 

(Form CA-1) alleging that on July 29, 2017 she sustained a left knee sprain when she slipped

descending steps while in the performance of duty. She did not stop work, but began working 

limited duty following the injury. OWCP accepted the claim for left knee sprain.4

Appellant was initially treated on August 14, 2017 by Dr. Paul Curtin, a Board-certified

osteopathic physician specializing in family medicine. In progress notes dated August 14, 2017,

Dr. Curtin noted that she was seen for frequent falls starting with a July 29, 2017 fall at work, a 

fall at home three to four days later, and a fall in a parking lot on August 4, 2017. He noted that 

appellant was currently being treated for a pulled ligament due to the first fall on July 29, 2017. 

In an attending physician’s report (Form CA-20) dated August 14, 2017, Dr. Curtin indicated no

findings of fracture and diagnosed left knee sprain/strain. He checked boxesmarked “No” to the 

questions of whether there was evidence of any preexisting condition and whether the diagnosed 

condition was caused or aggravated by the employment activity. On a Form CA-20 dated 

September 26, 2017 Dr. Curtin noted appellant’s left knee pain and weakness and checked a box 

marked “Yes” indicating that these symptoms were related to her fall on July 29, 2017. He

indicated that he had released her to return to work on August 28, 2017.

In a September 12, 2017 return-to-work note, Lisa Fuhrman related that appellant was 

released to return to work with no restrictions on September 14, 2017.5

A July 30, 2017 x-ray of appellant’s left knee revealed moderate-to-advanced left knee 

tricompartmental arthritic changes without fracture.

An October 2, 2017 left knee magnetic resonance imaging (MRI) scan demonstrated 

moderate-to-severe tricompartmental osteoarthrosis, grade 1 medial collateral ligament sprain, 

Baker’s cyst, joint effusion, superior cyst dehiscence, and complete or near complete medial 

meniscus tear.

3

5 U.S.C. § 8101 et seq.

4 Appellant retired from the employing establishment, effective July 1, 2018.

5 Ms. Fuhrman’s medical credentials are unknown. 
3

An October 17, 2017 left knee x-ray revealed findings of primary left knee osteoarthritis. 

Dr. Curtin, in progress notes dated October 23, 2017, provided examination findings, 

diagnosed chronic left knee osteoarthritis, and noted that appellant was scheduled for left total 

knee replacement surgery.

On December 5, 2017 appellant underwent a total left knee arthroplasty. The preoperative 

and postoperative diagnoses were end-stage primary left knee osteoarthritis. 

In progress notes dated January 31, 2018, Dr. Scott King, an osteopath specializing in 

orthopedic surgery, provided examination findings and related that appellant was progressing well 

two months post total left knee arthroplasty.

On December 27, 2018 OWCP referred appellant, along with a statement of accepted facts 

(SOAF), a copy of the case record, and a series of questions to Dr. Peter A. Feinstein, a Boardcertified orthopedic surgeon, for a second opinion evaluation to clarify the status of her accepted 

conditions and assess her work capacity. The SOAF noted that on July 29, 2017 appellant slipped 

while descending steps, and on July 30, 2017 she began working full time as a limited-duty rural 

letter carrier. It also noted that, following the accepted July 29, 2017 injury, appellant fell several 

times and underwent total left knee arthroplasty on December 5, 2017. 

In a report dated January 17, 2019, Dr. Feinstein noted his review of the SOAF and the 

medical evidence of record. He accurately described the July 29, 2017 employment injury and 

recounted appellant’s left knee complaints. Appellant denied having any knee problems prior to 

the July 29, 2017 injury, but noted that she fell twice following the July 29, 2017 injury. An 

examination of her left knee revealed no swelling or effusion, a limp to the left lower extremity, 

healed anterior total knee replacement scar, excellent patellofemoral tracking, and no medial and 

lateral collateral ligaments instability. Dr. Feinstein reported full left knee flexion and extension 

when compared to the right knee. He concluded that appellant no longer had any residuals due to 

the accepted employment injury. Dr. Feinstein opined that her total left knee arthroplasty would 

have been required regardless of the July 29, 2017 employment injury due to her significant 

preexisting arthritic changes and her morbid obesity. He explained that the torn meniscus found 

on the MRI scan was not traumatic or acute due to the accepted employment injury given the extent 

of arthritis present. In addition, Dr. Feinstein explained that the torn meniscus could have occurred 

following appellant’s two subsequent falls. He explained that a case could be made for a temporary 

aggravation of the underlying arthritis impacting function, but not impacting the actual arthritic 

change. Dr. Feinstein concluded that appellant did not require further medical treatment for her 

left knee sprain/strain or for her total left knee arthroplasty. He completed a work capacity 

evaluation (Form OWCP-5c) indicating that she was restricted to sedentary work due to her 

nonwork-related underlying preexisting arthritis. 

On February 20, 2019 OWCP proposed to terminate appellant’s wage-loss compensation 

benefits and medical benefits because she was no longer disabled and no longer required medical 

treatment due to her accepted July 29, 2017 employment injury. It found that the weight of the 

medical evidence rested with the January 17, 2019 report of Dr. Feinstein, who found that she was 

no longer disabled from work and no longer had residuals due to her accepted left knee injury. 
4

OWCP afforded appellant 30 days to submit additional evidence or argument, in writing, if she 

disagreed with the proposed termination.

In response, appellantsubmitted an October 12, 2017 reportfrom Dr. King, who noted that 

she had been seen for knee complaints since her July 29, 2017 fall at work. He detailed 

examination findings, reviewed an October 2, 2017 MRI scan, and diagnosed left knee primary 

osteoarthritis.

Dr. King, in progress notes dated December 15, 2017, noted that appellant was 

approximately two weeks post knee arthroplasty. Left knee findings included some ecchymosis 

and moderate swelling, no erythema, and 0 to 90 degrees range of motion (ROM).

In a report dated April 29, 2018, Dr. King noted a July 29, 2017 employment injury and 

his treatment of appellant, which began on October 12, 2017. He related that he was unaware of 

any left knee medical treatment prior to her employment injury, and that she had related no knee 

problems prior to the work injury. Dr. King diagnosed acute traumatic medial meniscus posterior 

horn tear and aggravation of a preexisting left knee condition. He attributed the diagnosed 

conditions and resulting total knee replacement surgery to appellant’s work injury. 

By decision dated March 27, 2019, OWCP terminated appellant’s wage-loss compensation 

and medical benefits, effective that date. It found that the opinion of the second opinion physician,

Dr. Feinstein, constituted the weight of the evidence and established that she had no further 

disability or residuals of her accepted employment injury. 

On April 16, 2019 appellant requested an oral hearing before a representative of OWCP’s 

Branch of Hearings and Review, which was held on August 8, 2019. 

In a report dated May 12, 2019, Dr. King noted that appellant had been seen for a July 29, 

2017 work-related injury when she fell down stairs and injured her left knee. He opined that her 

work injury had been a factor in her knee replacement surgery. In support of his conclusion,

Dr. King explained that appellant had preexisting arthritis prior to the work injury, but that she did 

not have a preexisting meniscus tear, and required no treatment for her left knee until her work 

injury on July 29, 2017. He, therefore, opined that the July 29, 2019 work injury permanently 

aggravated her left knee osteoarthritis as well as causing an acute meniscus tear and left knee 

instability. Furthermore, due to this injury appellant sustained subsequent falls at home and work, 

which he explained were due to her meniscus tear and knee instability. Dr. King noted that his 

disagreement with Dr. Feinstein’s opinion that she only sustained a left knee sprain/strain. 

By decision dated October 21, 2019, OWCP’s hearing representative found an unresolved 

conflict in the medical opinion evidence between Dr. King, appellant’s treating physician, and

Dr. Feinstein, an OWCP referral physician, as to whether the accepted July 29, 2017 employment 

injury caused or aggravated appellant’s left knee medial meniscus tear and osteoarthritis. Thus, 

she set aside the March 27, 2019 decision and remanded the case for resolution of the conflict in 

the medical opinion evidence.

On October 29, 2019 OWCP referred appellant for an impartial medical examination 

(IME) with Dr. Thomas DiBenedetto, a Board-certified orthopedic surgeon, to resolve the conflict 

of medical opinion between Drs. Kingand Feinstein regarding her continuing employment-related 
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disability and medical residuals, and whether her left knee medial meniscus tear and osteoarthritis 

conditions were related to the July 29, 2017 employment injury. 

In a report dated November 19, 2019, Dr. DiBenedetto, based upon a review of the medical 

record and SOAF, opined that appellant had no residuals or disability due to her accepted left knee 

sprain. He related that her physical examination revealed left knee ROM 0 to 110 degrees; no 

knee effusion; normal ligament stability, quadriceps, and neurovascular examination; periincisional numbness; and lower extremity stasis changes. Dr. DiBenedetto opined that appellant 

would have recovered from her left knee sprain within 6 to 12 weeks of even if there had been a 

complete medial collateral ligament tear. He also concluded that her left knee sprain did not 

contribute in any way to her left knee osteoarthritis. In support of this conclusion, Dr. DiBenedetto 

noted that the period of time involved was too short to develop osteoarthritis based on the date of 

appellant’s injury, x-rays, and a postinjury MRI scan which showed significant osteoarthritis. He 

opined that he could not conclude that her left knee osteoarthritis had been caused, aggravated, or 

precipitated by the accepted employment injury. With respect to the meniscal tear,

Dr. DiBenedetto explained that it was a central root tear which is usually nontraumatic and caused 

by knee degeneration and medial joint space narrowing. He opined that appellant’s subsequent 

falls were unrelated to her left knee injury. Dr. DiBenedetto opined that, while her total knee 

replacement surgery on December 5, 2017 was necessary, it was not causally related to the 

accepted July 29, 2017 left knee sprain. He noted his disagreement with Dr. King and agreement 

with Dr. Feinstein that appellant only sustained a left knee sprain due to the accepted July 29, 2017 

employment injury. Any restrictions were due to appellant’s nonrelated and preexisting bilateral 

knee osteoarthritis. 

By decision dated January 31, 2020, OWCP terminated appellant’s wage-loss 

compensation and medical benefits, effective January 31, 2020. It accorded the special weight to

Dr. DiBenedetto as the IME. It further found that the accepted July 29, 2017 work injury did not 

cause or aggravate the diagnosed left knee meniscal tear and osteoarthritis and that the total left 

knee replacement surgery was unrelated to the accepted July 29, 2017 work injury. 

LEGAL PRECEDENT -- ISSUE 1

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 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

6 D.T., Docket No. 20-0234 (issued January 8, 2021);see T.E., Docket No. 18-1595 (issued March 13, 2019);T.F., 

Docket No. 17-0645 (issued August 15, 2018); Jaja K. Asaramo, 55 ECAB 200 (2004).

7 D.T., id.; T.K., Docket No. 18-1239 (issued May 29, 2019); M.W., 57 ECAB 710 (2006); JohnD. Jackson, 55 

ECAB 465 (2004).
6

the accepted employment injury.8 The weight of 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

Section 8123(a) of FECA provides, in pertinent part: “If there is disagreement between 

the physician making the examination for the United States and the physician of the employee, the 

Secretary shall appoint a third physician who shall make an examination.”

10

 When there are 

opposing reports of virtually equal weight and rationale, the case must be referred to an impartial 

medical specialist, pursuant to section 8123(a) of FECA, to resolve the conflict in the medical 

evidence.

11

ANALYSIS -- ISSUE 1

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

The Board finds that OWCP improperly determined that there was a conflict in the medical 

opinion between Dr. King, an attending physician, and Dr. Feinstein, an OWCP referral physician, 

on the issue of whether appellant sustained a left knee meniscus tear and aggravation of her 

preexisting left knee arthritis due to her July 29, 2017 employment injury. Dr. King, in reports 

dated April 29, 2018 and May 12, 2019, diagnosed left knee acute meniscus tear and left knee 

instability and permanent aggravation of left knee osteoarthritis causally related to the accepted 

July 29, 2017 employment injury. In a January 17, 2019 report, Dr. Feinstein opined that appellant 

might have had a temporary aggravation of her underlying left knee arthritis and her left knee 

meniscal tear could have been the result of her two subsequent falls.

As noted above, for a conflict to arise the opposing physicians’ viewpoints must be of 

virtually equal weight and rationale.

12

 The Board finds that Dr. Feinstein’s report required 

clarification as his statements raised the question of whether the left knee meniscal tear and 

temporary aggravation of underlying left knee arthritis were caused or aggravated by the accepted 

July 29, 2017 employment injury. Therefore, the Board finds that Dr. Feinstein’s opinion was not 

of equal weight and was, thus, insufficient to create a conflict with Dr. King.

13

 As no true conflict 

existed in the medical evidence at the time of the referral to Dr. DiBenedetto, the Board finds that

Dr. DiBenedetto’s report may not be afforded the special weight of an IME and should be 

8 R.M., Docket No. 20-0452 (issued March 4, 2021); D.S., Docket No. 18-0353 (issued February 18, 2020); 

T.K., id.; I.J. 59 ECAB 408 (2008); Victor J. Woodhams, 41 ECAB 345 (1989).

9

Id.

10 5 U.S.C. § 8123(a).

11 R.M., supra note 8; D.B., Docket No. 19-0663 (issued August 27, 2020).

12 A.P., Docket No. 22-1054 (issued January 6, 2023); H.B.,Docket No. 19-0926 (issued September 10, 2020); 

C.H., Docket No. 18-1065 (issued November 29, 2018); Darlene R. Kennedy, 57 ECAB 414, 416 (2006).

13 A.P., id.; Y.J.,Docket No. 20-1337 (issued February 7, 2022) (the Board found that a second opinion examiner’s 

report was of limited probative value and insufficient to create a conflict in medical opinion with the claimant’s 

treating physician); see also R.B., Docket No. 20-0109 (issued June 25, 2020).
7

considered for its own intrinsic value.

14

 The referral to Dr. DiBenedetto is therefore considered to 

be a second opinion evaluation.

15

The Board, however, finds that a conflict in the medical opinion evidence now exists 

between Dr. Kingand Dr. DiBenedetto regarding whether appellant sustained a left knee meniscus 

tear and aggravation of her preexisting left knee arthritis due to her July 29, 2017 employment 

injury. 

Dr. King continued to opine that appellant’s left knee meniscus tear, aggravation of her 

preexisting left knee arthritis, and subsequent fall were causally related to her accepted July 29, 

2017 employment injury. Dr. DiBenedetto noted that the period of time involved was too short to 

develop osteoarthritis based on the date of appellant’s injury, x-rays, and a postinjury MRI scan 

which showed significant osteoarthritis. With respect to the meniscal tear, he explained that it was 

a central roottear which is usually nontraumatic and caused by knee degeneration and medial joint 

space narrowing. Dr. DiBenedetto opined that appellant’s subsequent falls were unrelated to her 

left knee injury.

Therefore, as a conflict currently exists in the medical opinion evidence, OWCP shall refer 

to appellant an impartial medical specialist for a resolution of the conflict in medical opinion 

evidence in accordance with 5 U.S.C. § 8123(a). After this and other such further development of 

the case record as OWCP deems necessary, it shall issue a de novo decision.

LEGAL PRECEDENT -- ISSUE 2

According to FECA,16 once OWCP accepts a claim and pays compensation, it has the

burden of proof to justify termination or modification of benefits. 17 It may not terminate 

compensation without establishing either that the disability has ceased or that it is no longer related

to the employment.18 OWCP’s burden of proof includes the necessity of furnishing rationalized 

medical opinion evidence based on a proper factual and medical background. 19

14 Id.

15 See A.D., id.; M.G.,Docket No. 19-1627 (issued April17, 2020); S.M.,Docket No. 19-0397 (issued August 7, 

2019) (the Board found that at the time of the referral for an impartial medical examination there was no conflict in 

medical opinion evidence; therefore, the referral was for a second opinion examination); Cleopatra McDougalSaddler, 47 ECAB 480 (1996).

16 Supra note 3.

17 C.B., Docket No. 20-0629 (issued May 26, 2021); A.D.,Docket No. 18-0497 (issued July 25, 2018); S.F., 59 

ECAB 642 (2008); Kelly Y. Simpson, 57 ECAB 197 (2005); Paul L. Stewart, 54 ECAB 824 (2003).

18 Y.I., Docket No. 20-0623 (issued November 30, 2020); A.G., Docket No. 18-0749 (issued November 7, 2018);

see also I.J., 59 ECAB 408 (2008); Elsie L. Price, 54 ECAB 734 (2003).

19 C.B., supra note 17; R.R., Docket No. 19-0173 (issued May 2, 2019); T.P., 58 ECAB 524 (2007); Del K. 

Rykert, 40 ECAB 284 (1988).
8

The right to medical benefits for an accepted condition is not limited to the period of 

entitlement for disability compensation.20 To terminate authorization for medical treatment, 

OWCP must establish that the employee no longer has residuals of an employment-related 

condition, which require further medical treatment.21

ANALYSIS -- ISSUE 2

The Board finds that OWCP improperly terminated appellant’s wage-loss compensation 

and medical benefits, effective January 31, 2020.

As explained above, OWCP undertook development of the medical record to determine 

whether the acceptance of appellant’s claim should be expanded but did not resolve the issue. As 

the issue of expansion is not in posture for decision, the Board finds that OWCP did not meet its 

burden of proof to terminate appellant’s wage-loss compensation and medical benefits.22

CONCLUSION

The Board finds that this case is not in posture for a decision on the issue of claim 

expansion. The Board further finds that OWCP failed to meet its burden of proof to terminate 

appellant’s wage-loss compensation and medical benefits.

20 C.B., id.; L.W.,Docket No. 18-1372 (issued February 27, 2019); Kathryn E. Demarsh, 56 ECAB 677 (2005).

21 C.B., id.; R.P., Docket No. 17-1133 (issued January 18, 2018); A.P.,Docket No. 08-1822 (issued 

August 5, 2009).

22 See D.F., Docket No.20-0690 (issued June 2, 2022); C.S., Docket No. 20-0621 (issued December 22, 2020); 

D.F., Docket No. 19-1257 (issued July 14, 2020).
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ORDER

IT IS HEREBY ORDERED THAT the January 31, 2020 decision of the Office of 

Workers’ Compensation Programs is reversed. The case is remanded for further proceedings 

consistent with this decision of the Board. 

Issued: August 8, 2023

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board