United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

V.P., Appellant

and

DEPARTMENT OF THE TREASURY, 

INTERNAL REVENUE SERVICE, 

Fresno, CA, Employer

__________________________________________

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Docket No. 21-1111

Issued: May 23, 2022

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

PATRICIA H. FITZGERALD, Deputy Chief Judge

JANICE B. ASKIN, Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On July 8, 2021 appellant filed a timely appeal from a June 28, 2021 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.2

ISSUES

The issues are: (1) whether appellant has met his burden of proof to establish that the 

acceptance of her claim should be expanded to include an additional condition as causally related 

1

5 U.S.C. § 8101 et seq.

2 The Board notes that OWCP received additional evidence following the June 28, 2021 decision. 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

to her accepted September 18, 2019 employment injury; and (2) whether appellant has met her 

burden of proof to establish disability from work commencing November 12, 2020 causally related 

to her accepted September 18, 2019 employment injury.

FACTUAL HISTORY

On November 7, 2019 appellant, then a 58-year-oldmanager, filed a traumatic injury claim 

(Form CA-1) alleging that, on September 18, 2019, she sustained left knee and calf injuries while 

in the performance of duty when her left foot became stuck in an elevator doorway as she exited, 

causing her left knee to bend. She did not stop work at the time of injury. 

In a development letter dated January 8, 2020, OWCP notified appellant of the deficiencies 

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

questionnaire for her completion. OWCP afforded appellant 30 days to respond. 

In a February 4, 2020 attending physician’s report (Form CA-20), Dr. Sanjay J. Chauhan, 

a Board-certified psychiatrist and neurologist, noted performing an initial physical examination 

and provided a history of the claimed September 18, 2019 employment incident. He prescribed 

medication and returned appellant to full-duty work. 

By decision dated February 18, 2020, OWCP accepted that the September 18, 2019 

employment incident occurred at the time and place, and in the manner alleged. However, it denied 

appellant’s traumatic injury claim, finding that the evidence of record was insufficient to establish 

a diagnosed medical condition in connection with the accepted employment incident. OWCP 

concluded that the requirements had not been met for establishing an injury as defined by FECA.

On February 26, 2020 appellant requested a review of the written record by a representative 

of OWCP’s Branch of Hearings and Review.

OWCP received a February 4, 2020 narrative report by Dr. Chauhan, noting appellant’s 

account of the accepted September 18, 2019 employment incident. Appellant continued to 

experience pain and swelling in the left knee, left ankle pain, and secondary left hip pain. 

Dr. Chauhan related that on November 7, 2019 appellant had been referred for a magnetic 

resonance imaging (MRI) scan of the left knee by Dr. Esmeralda Arreola, a family practitioner and 

her primary care physician, who was no longer treating appellant for the left lower extremity 

injury. He opined that the December 26, 2019 MRI scan study of the left knee demonstrated 

osteoarthritic changes of the left knee, full-thickness cartilage loss in the medial compartment with 

bone-on-bone, a torn medial meniscus, and likely torn lateral meniscus. On examination of the 

left lower extremity, Dr. Chauhan found diminished knee reflexes, an antalgic gait favoring the 

left lower extremity, inability to tandem walk, mild-to-moderate effusion below the knee to midcalf and slightly above the patella, pitting edema of the shin, tenderness to palpation of the anterior 

dorsal aspect of the ankle, and diminished range of ankle motion in all planes. He diagnosed an 

injury to the left knee and ankle, left knee sprain, left ankle ligamentous sprain, aggravation of

osteoarthritis of the left knee, aggravation of left hip trochanteric bursitis, rule out medial and 

lateral meniscus tear of the left knee, and rule out cartilage tear of the left knee and ankle. 

Dr. Chauhan opined that the mechanism of injury was consistent with the listed diagnosis and 

complaints. Appellant had twisted her left knee and ankle when her left foot became caught in the 
3

elevator, which caused “twisting and torqueing forces” to the left knee and ankle, causing a sprain 

of both joints and “probable tears of meniscus and cartilage.” Dr. Chauhan returned appellant to 

regular duty as her tasks were mostly sedentary. 

Following a preliminary review, by decision dated May 4, 2020, an OWCP hearing 

representative set aside the February 18, 2020 decision, finding that Dr. Chauhan’s February 4, 

2020 report had raised an inference of causal relationship between the diagnosed conditions and 

the September 18, 2019 employment incident. The hearing representative remanded the case to 

OWCP to refer appellant, the medical record, and a statement of accepted facts (SOAF) to a 

specialist in the appropriate field of medicine for a second opinion evaluation, to be followed by 

issuance of a de novo decision. 

On May 19, 2020 OWCP requested that appellant submit a copy of the December 26, 2019 

MRI scan study referenced by Dr. Chauhan. 

On June 30, 2020 OWCP referred appellant, the medical record, a May 18, 2020 SOAF,

and a series of questions for a second opinion by Dr. Don Kevin Lester, a Board-certified 

orthopedic surgeon, regarding the status of appellant’s accepted conditions. In his July 22, 2020

report, Dr. Lester reviewed the medical record and SOAF. He noted a history of accepted April 30, 

2015 and November 28, 2016 right meniscal tears.3 Dr. Lester noted that appellant had worked 

daily from the time of the September 18, 2019 employment incident until March 18, 2020. 

Appellant had a blood clot in her left lower extremity, which required hospitalization on July 2, 

2020, and was on a prescription anticoagulant. Dr. Lester noted appellant’s symptoms of left 

medial proximal tibial pain, and some pain at the dorsum, anteromedial, and posteromed ial aspects 

of the left ankle. He observed that appellant ambulated with a walker. On examination, Dr. Lester

observed limited left knee extension with stable ligaments, tenderness throughout the left lower 

extremity, edema in the left lower extremity, which appellant attributed to a blood clot, and 

tenderness of the left ankle. He diagnosed degenerative arthritis of the left knee, edema with pain 

about the left ankle, left meniscal tears, edema of the bilateral legs, left worse than right, deep vein 

thrombosis (DVT) of the left lower extremity, morbid obesity, resolved bursitis of the left hip and 

left shoulder, and status post right knee injuries with meniscal tears, resolved. Dr. Lester opined 

that the September 18, 2019 employment incident aggravated left knee arthritis and left ankle soft 

tissues, “may or may not have” torn her left knee cartilage, but did not accelerate or precipitate left 

knee arthritis. He noted that appellant’s morbid obesity made it difficult for her to remain upright, 

increasing her risk of falls and lower extremity injuries. Dr. Lester commented that left ankle xrays would be helpful in assessing her condition, although her left ankle pain was “as likely due to 

edema as her near fall.” He also opined that the September 18, 2019 employment incident, in 

combination with her obesity, “could aggravate the preexisting condition of degenerative arthritis.”

Dr. Lester noted that it did not “appear as though her work-related injury is likely causing her 

current problems.” He noted that the September 18, 2019 employment incident “would not likely 

3 Under OWCP File No. xxxxxx074, OWCP accepted an April 30, 2015 right medial meniscus tear and right knee 

sprain, with OWCP-authorized December 2, 2015 arthroscopic repair. Under OWCP File No. xxxxxx442, OWCP 

accepted a November 28, 2016 right knee sprain with complex medial meniscal tear. OWCP authorized April 18, 

2018 arthroscopic repair. OWCP has not administratively combined these claims with the current claim, OWCP File 

No. xxxxxx127.
4

be associated” with the DVT or left knee osteoarthritis, and that her left ankle problem was likely 

caused by edema. Dr. Lester returned appellant to full, unrestricted duty. 

OWCP received a May 31, 2020 report by Dr. Chauhan, who opined that the September 18, 

2019 employment incident “by direct causation caused twisting, torqueing forces to the left knee 

and ankle causing injury to the left knee and ankle,” with the diagnoses noted in his February 4, 

2020 report.

By decision dated September 23, 2020, OWCP accepted the claim for left knee sprain, left 

ankle sprain, and temporary aggravation of left knee arthritis.

OWCP received a September 3, 2020 report by Dr. Chauhan, noting that appellant had 

been prescribed Eliquis, a blood thinner, due to a DVT in the left lower extremity that developed 

on approximately July 10, 2020. Dr. Chauhan indicated that appellant was off work due to the 

DVT as she had been directed by her primary care physician to keep her left lower extremity 

extended. He related that appellant experienced worsening left knee and ankle pain with secondary 

left hip pain. Dr. Chauhan commented that appellant ambulated with a walker due to bilateral 

knee pain. On examination of the left lower extremity,he noted 4+/5 muscle weakness, diminished 

knee reflexes, knee effusion, restricted knee flexion, and limited range of ankle motion in all 

planes. Dr. Chauhan diagnosed an acute DVT of the left lower extremity, and reiterated the 

diagnoses provided in his February 4, 2020 report. He opined that the DVT was caused by the 

September 18, 2019 employment injury by precipitation, due to prolonged sitting at work 

superimposed on preexisting conditions of obesity and borderline diabetes. Dr. Chauhan found 

appellant totally disabled for work due to the DVT from July 1 through September 15, 2020. 

OWCP received a September 26, 2020 report by Dr. Chauhan, noting his disagreement 

with Dr. Lester’s July 22, 2020 report. Dr. Chauhan opined that appellant sustained a permanent 

aggravation of left knee osteoarthritis triggered by synovial and ligamentous inflammation 

precipitated by the accepted September 18, 2019 employment injury. He noted that appellant’s 

obesity had made her more susceptible to serious injury from this type of incident, with swelling 

of the menisci, joint capsule, ligaments, and secondary edema of the bony structure due to twisting 

forces and weight bearing. Dr. Chauhan concurred that left ankle x-rays would be necessary to 

fully assess appellant’s condition. Regarding the etiology of the DVT, he opined that the clot had 

formed in the injured leg due to hypomobility as appellant was unable to move her left knee and 

ankle fully after the September 18, 2019 employment injury. Dr. Chauhan explained that joint 

swelling also caused venous stasis, ultimately leading to DVT.4

On December 1, 2020 appellant filed a claim for compensation (Form CA-7) for

intermittent disability forthe period November 12 through December 23, 2020. On December 30, 

2020 appellant filed a Form CA-7 for intermittent disability for the period December 23, 2020 

through February 4, 2021.5 In support of the claims, she submitted a December 23, 2020 duty 

4 A November 20, 2020 MRI scan of the left ankle demonstrated low signal thickening of the anterior inferior 

tibiofibular ligament and the deltoid ligament on the medial side, suggesting prior injury and bulky scar formation, 

posterior and inferior calcaneal spurring, slight enesopathy at the Achilles tendon insertion on the posterior calcaneus, 

and extensive subcutaneous edema around the ankle and lower leg.

5 Appellant submitted additional CA-7 forms for periods after February 4, 2021. 
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status report (Form CA-17) by Dr. Chauhan, holding her off work from December 23, 2020 

through February 4, 2021.

In a development letter dated January 27, 2021, OWCP notified appellant of the 

deficiencies of her claim for compensation. It explained that it was not clear when or why she had 

stopped working. OWCP requested that appellant submit a report from her attending physician, 

with medical rationale and objective findings, explaining how and why the accepted conditions 

had disabled her from work for the claimed period. It afforded her 30 days to submit the requested 

evidence.

In a separate development letter also dated January 27, 2021, OWCP noted that appellant 

had implicated the left lower extremity DVT as a consequential condition. It requested that she

provide additional medical records and a rationalized report from her attending physician on the 

cause of the left lower extremity DVT. OWCP afforded appellant 30 days to submit the requested 

evidence. 

In response, appellant submitted a November 12, 2020 report by Dr. Chauhan, who noted 

appellant’s continuing left knee and ankle pain, with cramping in the left lower extremity 

interfering with sleep. Dr. Chauhan opined that the left lower extremity DVT had been aggravated 

by the accepted left knee conditions.

In a February 4, 2021 Form CA-17, Dr. Chauhan found appellant totally disabled from 

work for the period February 4 through March 18, 2021.

In a report dated February 12, 2021, Dr. Arreola held appellant off work from July 2 

through November 15, 2020 due to the left lower extremity DVT.

In a February 15, 2021 statement, appellant asserted that she had no personal or family 

history of DVT prior to the accepted September 18, 2019 employment injury. She noted that 

approximately one week prior to July 2, 2020, she experienced significant swelling and 

discoloration of the left lower extremity with a sensation of pressure. Appellant’s physician 

hospitalized her on July 2, 2020. She had been prescribed blood thinners to treat the DVT.

Appellant submitted unsigned hospital discharge instructions dated July 9, 2020 for DVT. 

On March 18, 2021 OWCP routed the medical record, a March 17, 2021 SOAF, and a list 

of questions to Dr. David I. Krohn, a Board-certified internist serving as an OWCP district medical 

adviser (DMA), for review and determination regarding whether the acceptance of the claim 

should be expanded to include the diagnosis of left lower extremity DVT as a consequential injury. 

OWCP requested that Dr. Krohn discuss any disagreement he may have with the findings and 

conclusions of Dr. Chauhan. 

OWCP received a March 18, 2021 report by Dr. Chauhan, who opined that the left lower 

extremity DVT was caused by immobility due to the accepted left knee injury and pro longed sitting 

while at work, superimposed on a history of obesity and borderline diabetes. Dr. Chauhan noted 

that appellant underwent a left ankle injection on or about January 18, 2021 that alleviated her pain 

symptoms for only a few days.
6

In reports dated April 27, 2021, Dr. Krohn reviewed the SOAF and medical record. He 

noted that DVTs developed in individuals with inherited thrombophilia, which could be diagnosed 

through screening for prothrombin mutations. Dr. Krohn explained that while medical studies 

supported that immobility was a potential causal factor in the development of a DVT, those studies 

reflected venous stasis associated with bed rest or immobilization in a cast, and not a relative 

decrease in mobility in a previously fully ambulatory individual such as appellant. He also noted 

that appellant’s history of diabetes, hypertension, and morbid obesity were important risk factors 

for the development of DVT. Dr. Krohn, therefore, concluded that Dr. Chauhan’s opinion that 

appellant’s DVT was causally related to the accepted September 18, 2019 employment injury was 

not consistent with the factual history of the case or the medical findings of record. 

By decision dated June 28, 2021, OWCP denied the claim under section 10.501(a) of 

FECA,6finding that the medical evidence of record was insufficient to establish that appellant was 

disabled for work from November 12, 2020 onward due to the accepted left lower extremity 

conditions. It noted that she had been off work “at least since July 2, 2020 due to deep venous 

thrombosis, which had not been accepted as work related.”

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.7

To establish causal relationship between the condition, as well as any attendant disability 

claimed and the employment event or incident, the employee must submit rationalized medical 

opinion evidence based on a complete factual and medical background, supporting such a causal 

relationship.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 factors identified by the claimant.9 The weight of medical evidence is 

6

20 C.F.R. § 10.501(a).

7

S.B., Docket No. 19-0634 (issued September 19, 2019).

8 T.K., Docket No. 18-1239 (issued May 29, 2019).

9 R.P., Docket No. 18-1591 (issued May 8, 2019).
7

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.10

ANALYSIS -- ISSUE 1

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

OWCP accepted that appellant sustained a left knee sprain, left ankle sprain, and temporary 

aggravation of left knee arthritis causally related to the September 18, 2019 employment injury. 

Appellant claimed compensation commencing November 12, 2020 due to disability precipitated 

by the accepted employment conditions and a left lower extremity DVT.

OWCP had previously obtained a second opinion from Dr. Lester, who provided a July 22, 

2020 report asserting that the September 18, 2019 employment injury “would not likely be 

associated” with the diagnosed left lower extremity DVT. 

Dr. Chauhan, a treating neurologist and psychiatrist, provided reports dated from 

September 3, 2020 through March 18, 2021 supporting a causal relationship between the DVT and 

the September 18, 2019 employment injury. In his September 3, 2020 report, he opined that the 

DVT was caused by the prolonged sitting at work superimposed on preexisting nonoccupational 

conditions. Dr. Chauhan noted in his November 12, 2020 report that appellant experienced 

continued left knee and ankle pain with cramping in the left lower extremity, which aggravated 

the DVT. He explained in his September 26, 2020 and March 18, 2021 reports that immobility in 

the injured left lower extremity due to a permanent aggravation of left knee osteoarthritis with 

joint swelling contributed to venous stasis leading to formation of the DVT. In reports dated 

December 23, 2020 and February 4, 2021, Dr. Chauhan held appellant off work from 

November 12, 2020 through February 4, 2021.

In a report dated April 27, 2021, Dr. Krohn, the DMA, opined that the degree of 

immobilization caused by the September 18, 2019 employment injury was insufficient to cause 

the left lower extremity DVT. He, therefore, characterized Dr. Chauhan’s opinion that appellant’s 

DVT was causally related to the accepted September 18, 2019 employment injury as inconsistent 

with the factual and medical history of the case.

As Dr. Lester and Dr. Krohn, for the government, both opined that the left lower extremity 

DVT was unrelated to the September 18, 2019 employment injury, andDr. Chauhan, for appellant, 

supported a causal relationship between development of the DVT and the accepted injury, the 

Board finds that there is an unresolved conflict of medical opinion regarding whether appellant 

has established an additional condition as causally related to the accepted September 18, 2019 

employment injury.

OWCP’s regulations provide that, if a conflict exists between the medical opinion of the 

employee’s physician and the medical opinion of either a second opinion physician or an OWCP 

10 Id.
8

medical adviser, OWCP shall appoint a third physician to make an examination. 11 The Board will, 

therefore, remand the case to OWCP for referral to an impartial medical specialist regarding 

whether she has submitted sufficient evidence to establish disability for work beginning 

November 12, 2020 due to the accepted September 18, 2019 employment injury. Following this 

and other such further development as deemed necessary, OWCP shall issue a de novo decision.

LEGAL PRECEDENT -- ISSUE 2

An employee seeking benefits under FECA has the burden of proof to establish the 

essential elements of his or her claim by the weight of the evidence, including that any disability 

or specific condition for which compensation is claimed is causally related to the employment 

injury.

12

 For each period of disability claimed, the employee has the burden of proof to establish 

that he or she was disabled from work as a result of the accepted employment injury. 13 Whether a 

particular injury causes an employee to become disabled from work, and the duration of that 

disability, are medical issues that must be proven by a preponderance of probative and reliable 

medical opinion evidence.14

Under FECA the term “disability” means the incapacity, because of an employment injury, 

to earn the wages that the employee was receiving at the time of injury. Disability is thus not 

synonymous with physical impairment, which may or may not result in an incapacity to earn 

wages. An employee who has a physical impairment causally related to a federal employment 

injury, but who nevertheless has the capacity to earn the wages he or she was receiving at the time 

of injury, has no disability as that term is used in FECA.15

Causal relationship is a medical issue, and the medical evidence required to establish causal 

relationship is rationalized medical evidence.16 Rationalized medical evidence is medical 

evidence, which includes a physician’s detailed medical opinion on the issue of whether there is a 

causal relationship between the claimant’s claimed disability and the accepted employment injury. 

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 

11 5 U.S.C. § 8123(a); S.C.,Docket No. 20-0856 (issued August 26, 2021); K.C.,Docket No. 19-0137 (issued 

May 29, 2020); M.W.,Docket No. 19-1347 (issued December 5, 2019).

12 See C.B., Docket No. 20-0629 (issued May 26, 2021); D.S., Docket No. 20-0638 (issued November 17, 2020); 

B.O., Docket No. 19-0392 (issued July 12, 2019); D.W.,Docket No. 18-0644 (issued November 15, 2018); Kathryn 

Haggerty, 45 ECAB 383 (1994); Elaine Pendleton, 40 ECAB 1143 (1989).

13 Id.

14 20 C.F.R. § 10.5(f); B.O., supra note 12; N.M.,Docket No. 18-0939 (issued December 6, 2018).

15 Id.

16 J.M., Docket No. 19-0478 (issued August 9, 2019).
9

explaining the nature of the relationship between the claimed period of disability and the accepted 

employment injury.17

For each period of disability claimed, the employee has the burden of proof to establish 

that he or she was disabled from work as a result of the accepted employment injury.18 The Board 

will not require OWCP to pay compensation for disability in the absence of medical evidence 

directly addressing the specific dates of disability for which compensation is claimed. To do so 

would essentially allow an employee to self-certify his or her disability and entitlement to 

compensation.19

Section 8123(a) of FECA provides that, if there is a disagreement between the physician 

making the examination for the United States and the physician of an employee, the Sec retary shall 

appoint a third physician (known as a referee physician or impartial medical specialist) who shall 

make an examination.20 This is called a referee examination and OWCP will select a physician 

who is qualified in the appropriate specialty and who has no prior connection with the case.21 

When there exist opposing medical reports of virtually equal weight and rationale and the case is 

referred to an impartial medical specialist for the purpose of resolving the conflict, the opinion of 

such specialist, if sufficiently well rationalized and based upon a proper factual background, must 

be given special weight.22 

ANALYSIS -- ISSUE 2

In light of the Board’s disposition of the issue of whether appellant sustained an additional 

condition as causally related to his accepted employment injury, it is premature to address the issue 

of disability.23

CONCLUSION

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

17 R.H., Docket No. 18-1382 (issued February 14, 2019).

18 20 C.F.R. § 10.501(a); C.E., Docket No. 19-1617 (issued June 3, 2020); M.M., Docket No. 18-0817 (issued 

May 17, 2019); see T.A.,Docket No. 18-0431 (issued November 7, 2018); see also Amelia S. Jefferson, 57 ECAB 

183 (2005).

19 C.E., id.; M.M., id.; see V.B.,Docket No. 18-1273 (issued March 4, 2019); S.M.,Docket No. 17-1557 (issued 

September 4, 2018); WilliamA. Archer, 55 ECAB 674, 679 (2004);Fereidoon Kharabi, 52 ECAB 291, 293 (2001).

20 5 U.S.C. § 8123(a); K.C., supra note 11; M.W., supra note 11; C.T., Docket No. 19-0508 (issued September 5,

2019); R.S., Docket No. 10-1704 (issued May 13, 2011); S.T., Docket No. 08-1675 (issued May 4, 2009).

21 20 C.F.R. § 10.321.

22 S.C., supra note 11; K.C., supra note 11; M.W., supra note 11; C.T., supra note 20; Darlene R. Kennedy, 57 

ECAB 414 (2006);Gloria J. Godfrey, 52 ECAB 486 (2001).

23 See C.N., Docket No. 19-0621 (issued September 10, 2019).
10

ORDER

IT IS HEREBY ORDERED THAT the June 28, 2021 decision of the Office of Workers’

Compensation Programs is set aside, and the case is remanded to OWCP for further proceedings 

consistent with this decision of the Board. 

Issued: May 23, 2022

Washington, DC

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board