United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

I.D., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

City of Industry, CA, Employer

__________________________________________

)

)

)

)

)

)

)

)

Docket No. 22-0848

Issued: September 2, 2022

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

JANICE B. ASKIN, Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JAMES D. McGINLEY, Alternate Judge

JURISDICTION

On May 9, 2022 appellant filed a timely appeal from an April 22, 2022 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 his burden of proof to establish a knee condition 

causally related to the accepted factors of his federal employment.

FACTUAL HISTORY

On June 10, 2021 appellant, then a 60-year-old city carrier, filed an occupational disease 

claim (Form CA-2) alleging that he developed a knee condition due to factors of his federal 

employment. He explained that a collection box fell on his knee and caused immediate pain and 

1

5 U.S.C. § 8101 et seq.
2

further noted that his claim was delayed by the prior postmaster as he had informed his supervisor 

of the injury on the same day he was injured. Appellant noted that he became aware of his 

condition and first realized it was caused or aggravated by his federal employment on 

March 27, 2019. He stopped work on March 30, 2021.

In a medical report dated April 6, 2021, Dr. Jay J. Patel, a surgeon, related that appellant 

presented with severe progressive right knee pain over the past year, which was making it difficult 

for him to enter and exit his truck and ascend and descend stairs. He further related that he had 

difficulty walking and could only do so indoors. Dr. Patel diagnosed severe right knee varus

degenerative joint disease (DJD) by way of x-ray examination. He recommended a total knee 

arthroplasty.

A form status report dated June 1, 2021 from Dr. Patel indicated that appellant was in 

temporary total disability status, effective June 1 through October 1, 2021.

In a development letter dated June 17 2021, OWCP informed appellant of the deficiencies 

of his claim. It advised him of the type of factual and medical evidence needed to establish his 

claim and provided a questionnaire for his completion. OWCP afforded appellant 30 days to 

respond.

Thereafter, OWCP received an unsigned medical report dated April 3, 2019 relating that 

appellant had been experiencing knee pain since the summer before, following an incident where 

a mailbox door fell on his knee. 

Appellant submitted various return-to-work notes dated November 20, 2020 through 

March 11, 2021 from Dr. Neal M. Damian, a chiropractor, providing work restrictions of no heavy 

lifting or going up and down stairs due to knee pain.

In a medical report dated June 1, 2021,Dr. Damian noted that appellant had been receiving 

chiropractic treatment for his medical condition since November 4, 2020 for low back and right 

knee pain. He related that appellant’s work duties required him to lift boxes, walk, and climb up 

and down stairs. Dr. Damian noted that a magnetic resonance imaging (MRI) scan revealed a 

meniscal tear of the right knee and discopathy of the lumbar spine. He opined that appellant’s 

injuries were caused or aggravated by his employment factors, including prolonged walking for 

eight hours or more, bending, climbing stairs, and lifting boxes. 

A medical note dated June 28, 2021 from Dr. Patel noted that appellant was scheduled to 

undergo right total knee arthroplasty that day and would be off work for up to three months or until

an estimated return date of October 1, 2021. 

In a medical report dated July 1, 2021, Dr. Damian detailed the results of a right knee and 

lumbar MRI scan and his opinion that appellant’s medical conditions were caused or aggravated 

by his work duties. 

By decision dated August 2, 2021, OWCP denied appellant’s claim, finding that he was 

not injured in the performance of duty as the implicated factors of employment were not 

established. It, therefore, concluded that he had not established an injury and/or a medical 
3

condition that arose during the course of employment and within the scope of compensable work 

factors as defined under FECA. 

On October 20, 2021 appellant requested reconsideration of OWCP’s August 2, 2021 

decision. 

OWCP received additional evidence. In a medical report dated June 28, 2021, Dr. Patel 

noted that appellant underwent surgery for right knee DJD. He indicated that a postoperative 

impression revealed severe osteoarthritis of the knee.

A medical note dated September 10, 2021 from Dr. Damian related that appellant 

continued to experience severe pain and tenderness of the right knee and joints. Dr. Damian opined 

that the initial incident of a mailbox hitting his right knee and the continuous use of his right knee 

as a federal employee caused his knee condition. He further noted that continued work duties 

would aggravate his symptoms and cause inflammation. 

On September 21, 2021 appellant was seen by Dr. Patel for a postoperative examination. 

Dr. Patel related that, following the surgery, appellant experienced minimal knee pain with 

occasional stiffness and swelling. He noted that appellant would be off work through April 1, 

2022 as he was unable to stand or walk for prolonged periods of time. 

By decision dated November 15, 2021, OWCP modified its previous decision, finding that 

appellant had established performance of duty. However, appellant’s claim remained denied as 

the medical evidence of record was insufficient to establish a knee condition causally related to 

the accepted factors of his federal employment. 

On January 24, 2022 appellant requested reconsideration of OWCP’s November 15, 2021 

decision and submitted additional medical evidence. 

In a medical report dated December 14, 2021, Dr. Patel examined appellant five months 

post-knee arthroplasty. He noted that the right knee had moderate swelling and that x-rays revealed 

stable alignment and fixation without fracture, dislocation, loosening, or wear. Dr. Patel indicated 

that appellant could return to work in April, with continued physical therapy and pain medication. 

In a note dated January 5, 2022, Dr. Patel related that appellant was seen on April 6, 2021 

for severe right knee pain following a work-related incident where a mailbox fell onto his knee. 

He noted a diagnosis of a meniscus tear and that appellant underwent surgery for a partial knee 

replacement on June 28, 2021. Dr. Patel indicated that he was continuing physical therapy as part 

of his recovery process.

By decision dated April 22, 2022, OWCP denied modification of its prior decision. 
4

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, that an injury was sustained in the performance of duty as alleged, 

and that any disability or specific condition for which compensation is claimed is causally related 

to the employment injury.3 These are the essential elements of every compensation claim 

regardless of whether the claim is predicated on a traumatic injury or an occupational disease.

4

To establish that an injury was sustained in the performance of duty in an occupational 

disease claim, an employee must submit the following: (1) a factual statement identifying 

employment factors alleged to have caused or contributed to the presence or occurrence o f 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 employment factors identified by the employee. 5

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.6 A physician’s opinion on whether there is causal relationship 

between the diagnosed condition and the implicated employment factor(s) must be based on a 

complete factual and medical background.7 Additionally, the physician’s opinion must be 

expressed in terms of a reasonable degree of medical certainty, and must be supported by medical 

rationale explaining the nature of the relationship between the diagnosed condition and appellant’s 

specific employment factor(s).8

ANALYSIS

The Board finds that appellant has not met his burden of proof to establish a knee condition 

causally related to the accepted factors of his federal employment.

In support of his claim, appellant submitted a January 5, 2022 note from Dr. Patel, wherein 

he noted that appellant was first seen on April 6, 2021 with severe right knee pain as a result of a 

mailbox falling on his knee at work causing a right knee meniscus tear. While Dr. Patel attributed

2

Id.

3 K.V., Docket No. 18-0947 (issued March4, 2019); M.E.,Docket No. 18-1135 (issued January 4, 2019);Kathryn 

Haggerty, 45 ECAB 383, 388 (1994).

4 K.V. and M.E., id.; Elaine Pendleton, 40 ECAB 1143 (1989).

5 R.G., Docket No. 19-0233 (issued July 16, 2019). See also Roy L. Humphrey, 57 ECAB 238, 241 (2005);Ruby I. 

Fish, 46 ECAB 276, 279 (1994);Victor J. Woodhams, 41 ECAB 345 (1989).

6 T.H., 59 ECAB 388, 393 (2008);Robert G. Morris 48 ECAB 238 (1996).

7 M.V., Docket No. 18-0884 (issued December 28, 2018).

8

Id.; Victor J.Woodhams, supra note 5.
5

the diagnosed medical condition to a work-related incident, he did not provide a rationalized 

medical opinion containing a pathophysiological explanation of how the accepted factors of 

appellant’s federal employment were competent to cause his diagnosed knee condition. The Board 

has held that a report is of limited probative value regarding causal relationship if it does not 

contain medical rationale explaining how a given medical condition was related to accepted 

employment factors.9 Consequently, Dr. Patel’s report is insufficient to meet appellant’s burden 

of proof.

In his medical reports dated April 6, June 1 and 28, September 21, and December 14, 2021,

Dr. Patel provided diagnoses, detailed appellant’s medical treatment and progress, and noted work 

restrictions. However, he did not provide an opinion on causal relationship. The Board has held 

that medical evidence that does not offer an opinion regarding the cause of an employee’s 

condition is of no probative value on the issue of causal relationship.10 As such, these reports are 

also insufficient to meet appellant’s burden of proof.

The remaining medical evidence of record consists of reports dated June 1, July 1, and 

September 10, 2021, as well as various return-to-work notes dated November 20, 2020 through 

March 11, 2021 from Dr. Damian, a chiropractor, who opined that appellant’s diagnosed knee 

condition was causally related to his accepted employment factors. A chiropractor, however, is 

only considered a physician for purposes of FECA if he or she diagnoses subluxation based upon 

x-ray evidence.11 As Dr. Damian has not diagnosed subluxation based upon x-ray evidence, he is 

not considered a physician as defined under FECA and his medical report does not constitute 

competent medical evidence.12 

As the medical evidence of record is insufficient to establish causal relationship between 

appellant’s diagnosed knee condition and the accepted employment factors, the Board finds that 

he has not met his burden of proof.

Appellant may submit new evidence or argument with a written request for reconsideration 

to OWCP within one year of this merit decision, pursuant to 5 U.S.C. § 8128(a) and 20 C.F.R. 

§§ 10.605 through 10.607.

9

J.W., Docket No. 18-0678 (issued March 3, 2020); G.R., Docket No. 19-0940 (issued December 20, 2019); D.L., 

Docket No. 19-0900 (issued October 28, 2019); see also V.T., Docket No. 18-0881 (issued November 19, 2018); Y.D., 

Docket No. 16-1896 (issued February 10, 2017); T.M., Docket No. 08-975 (issued February 6, 2009); S.E., Docket 

No. 08-2214 (issued May 6, 2009).

10 L.B., Docket No. 18-0533 (issued August 27, 2018); see D.K., Docket No. 17-1549 (issued July 6, 2018).

11 Section 8101(2) of FECA provides that the term physician includes chiropractors only if the treatment consists 

of manual manipulation of the spine to correct a subluxation as demonstrated by x-ray to exist. 5 U.S.C. § 8101(2).

See also S.L., Docket No. 21-0760 (issued January 6, 2022); T.T., Docket No. 18-0838 (issued September 19, 2019); 

Thomas W. Stevens, 50 ECAB 288 (1999); George E. Williams, 44 ECAB 530 (1993).

12 S.L., id.; J.D., Docket No. 19-1953 (issued January 11, 2021); C.S., Docket No. 19-1279 (issued 

December 30, 2019); RobertH. St. Onge, 43 ECAB 1169 (1992).
6

CONCLUSION

The Board finds that appellant has not met his burden of proof to establish a knee condition

causally related to the accepted factors of his federal employment.

ORDER

IT IS HEREBY ORDERED THAT the April 22, 2022 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: September 2, 2022

Washington, DC

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board

James D. McGinley, Alternate Judge

Employees’ Compensation Appeals Board