United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

I.T., Appellant

and

U.S. POSTAL SERVICE, BERGEN SOUTH

STATION, Jersey City, NJ, Employer

__________________________________________

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Docket No. 20-0001

Issued: July 1, 2021

Appearances: Case Submitted on the Record

Thomas R. Uliase, for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

PATRICIA H. FITZGERALD, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On October 1, 2019 appellant, through counsel, filed a timely appeal from an April 17, 

2019 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 April 17, 2019 decision, OWCP received additional evidence. 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

ISSUES

The issues are: (1) whether appellant has met her burden of proof to establish disability 

from work for the period February 7 to August 7, 2015 causally related to the accepted 

December 23, 2014 employment injury; (2) whether OWCP abused its discretion by denying 

appellant’s request for authorization of left knee surgery due to the accepted left knee contusion;

and (3) whether appellant has met her burden of proof to establish that the acceptance of her claim 

should be expanded to include additional left knee conditions causally related to the December 23, 

2014 employment injury.

FACTUAL HISTORY

This case has previously been before the Board.4 The facts and circumstances as set forth 

in the Board’s prior decisions are incorporated herein by reference. The relevant facts are set forth 

below.

On February 26, 2015 appellant, then a 32-year-old letter carrier, filed a traumatic injury 

claim (Form CA-1) alleging that on December 23, 2014 she tripped when ascending wet steps in 

the rain, striking her left knee while delivering mail in the performance of duty. 

On April 15, 2015 OWCP accepted appellant’s claim for left knee contusion.

In reports dated February 11 and March 23, 2015, Dr. Howard S. Levine, an osteopath

specializing in family medicine and manipulative therapy, noted that he began treating appellant 

on February 4, 2015 for complaints of severe left knee pain. He indicated that a magnetic 

resonance imaging (MRI) scan of her left knee showed a bone bruise. 

Appellant filed claims for compensation (Form CA-7) for disability during the periods 

February 7 to July 10, 2015 and July 11 to August 7, 2015. By decision dated September 17, 2015, 

OWCP denied her claim for disability from February 7 through August 7, 2015. It found that the 

medical evidence was insufficient to establish that the claimed disability was due to the accepted 

condition. 

Dr. Jeffrey F. Augustin, a Board-certified orthopedic surgeon, began treating appellant on 

March 5, 2015. On June 25, 2015 he advised that her left knee x-ray demonstrated mild lateral tilt 

of the patella, and on July 23, 2015. He recommended left knee arthroscopic lateral retinacular 

release. Dr. Augustin requested authorization for left knee surgery on September 9, 2015. 

By decision dated October 26, 2015, OWCP denied appellant’s request for authorization 

of left knee surgery, finding that the medical evidence submitted was of insufficient rationale to 

authorize the requested procedure. 

Dr. Robin R. Innella, an osteopath Board-certified in orthopedic surgery, began treating 

appellant on December 9, 2015. He noted a history that she hurt her left knee at work in 

December 2014 when she slipped on a step while delivering mail in the rain. Dr. Innella described

left knee examination findings and diagnosed left knee chondromalacia patella and contusion. He 

 

4 Docket No. 17-1012 (issued July 24, 2018); Order Dismissing Appeal, Docket No. 19-0706 (issued April 1, 2019). 
3

opined that appellant most likely sustained an articular surface injury, recommended arthroscopy, 

and advised that she could work light duty only. Dr. Innella continued to submit monthly treatment 

notes in describing her continued left knee complaints with consistent examination findings. He

reiterated appellant’s diagnoses, opining that her knee injuries were causally related to the 

December 23, 2014 employment injury. 

Appellant, through counsel, requested reconsideration of the September 17, 2015 decision 

on March 14, 2016. On August 12, 2016 appellant, through counsel, also requested 

reconsideration of the October 26, 2015 decision. 

By decision dated December 14, 2016, OWCP denied modification of the September 17 

and October 26, 2015 decisions, finding that the medical evidence of record was insufficient to 

establish the claimed disability or to authorize left knee arthroscopic surgery.5 

Appellant, through counsel, filed an appeal with the Board on April 10, 2017. By decision 

dated July 24, 2018, the Board found that appellant had not met her burden of proof to establish 

additional left knee conditions causally related to the December 23, 2014 employment injury, nor 

had she established disability from work for the period February 7 to August 7, 2015 causally 

related to the accepted employment injury. The Board further found that OWCP properly 

exercised its discretion by denying her authorization for left knee surgery. It affirmed the 

December 14, 2016 decision.6 

On September 13, 2018 appellant, through counsel, requested reconsideration. 

Dr. Innella continued to submit treatment notes describing her left knee condition from 

February 1 to September 10, 2018 in which he reiterated his findings and conclusions. Beginning

March 28, 2018, he recommended left knee surgery and on August 16, 2018 he requested 

authorization for left knee surgery for a diagnosis of transient synovitis. 

In an August 20, 2018 report, Dr. Innella provided examination findings and diagnosed 

transient synovitis, contusion, and chondromalacia patella of the left knee. He advised that 

appellant’s left knee condition had not changed and reiterated his opinion that she had injured the 

articular surface of the patella of her left knee when she had fallen several years prior, noting that 

her knee had been flexed when she landed on the knee. Dr. Innella indicated that she had 

subsequently developed recurrent symptoms from the chondral injury of traumatic chondromalacia

and synovitis within the knee. 

On September 27, 2018 Dr. Innella performed left knee arthroscopic multiple compartment 

synovectomy and chondroplasty patella. His postoperative diagnoses were transient synovitis, 

chondral injury/chondromalacia patella, and lateral tracking patella of the left knee. On 

October 29, 2018 Dr. Innella noted that appellant was doing well and that he had injected her left 

knee. 

 

5 Appellant continued to submit Form CA-7, claims for compensation, for disability for dates through 

November 11, 2016. By letter dated December 14, 2016, OWCP advised her of the evidence needed to establish these 

claims. 

6 Supra note 4.
4

By decision dated December 4, 2018, OWCP denied modification of its prior decision. It 

found the medical evidence insufficient to establish additional left knee conditions, disability from 

work due to the accepted knee condition, and that knee surgery was necessitated by the accepted 

employment injury. 

OWCP continued to receive progress reports from Dr. Innella dated from January 7 

through March 11, 2019.

In correspondence dated February 12, 2019, Dr. Innella opined, based on reasonable 

probability that appellant’s injuries to her knee occurred during the accident when she fell directly 

on her knee on December 23, 2014, based on the fact that her symptoms developed following this 

incident. He noted that recurrent synovitis and a chondral injury underneath her patella were seen 

on surgery. Dr. Innella opined that the direct impact to the patella caused articular surface injury 

and resulted in the development of type 2 scar cartilage, noting that this type of cartilage 

notoriously caused recurrent symptomatology. He concluded that appellant’s injuries were 

causally related to the events of the December 23, 2014 accident, which caused left knee contusion,

chondral patella injury, and recurrent synovitis. 

On March 6, 2019 appellant, through counsel, requested reconsideration. 

By decision dated April 17, 2019, OWCP denied modification of its December 4, 2018 

decision. 

LEGAL PRECEDENT -- ISSUE 1

An employee seeking benefits under FECA7has the burden of proof to establish the 

essential elements of his or her claim, including that any disability or specific condition for which 

compensation is claimed is causally related to the employment injury.8 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.9 Furthermore, whether a particular injury causes an employee to be 

disabled from work and the duration of that disability are medical issues which must be proven by 

a preponderance of the reliable, probative, and substantial medical evidence.10

 

7 Supra note 2.

8 See D.S., Docket No. 20-0638 (issued November 17, 2020); F.H., Docket No. 18-0160 (issued August 23, 2019); 

C.R., Docket No. 18-1805 (issued May 10, 2019); Kathryn Haggerty, 45 ECAB 383 (1994); Elaine Pendleton, 40 

ECAB 1143 (1989).

9 See 20 C.F.R. § 10.5(f); K.A., Docket No. 19-1564 (issued June 3, 2020); Cheryl L. Decavitch, 50 ECAB 

397 (1999).

10 K.A., id.; Fereidoon Kharabi, 52 ECAB 291 (2001).
5

ANALYSIS -- ISSUE 1

The Board finds that appellant has not established that she was disabled from work due to 

her accepted left knee contusion during the period February 7 to August 7, 2015. 

In his reports, Dr. Innella advised that appellant was restricted to light duty, but he did not 

explain why the accepted left knee contusion caused her disability. Furthermore, he did not offer 

an opinion regarding the period of claimed disability at issue in this case. Similarly, Drs. Levine 

and Augustin, in their reports, also did not provide an opinion regarding the claimed period of 

disability. The Board has held that evidence which does not address the accepted condition and 

explain why the accepted condition caused disability on the specific dates claimed, is insufficient 

to establish a claim for wage-loss benefits.11

As appellant did not submit sufficient rationalized medical opinion evidence to establish 

that she was disabled from work during the period February 7 to August 7, 2015 due to the 

accepted left knee contusion, she failed to meet her burden of proof. She was, thus, not entitled to 

wage-loss compensation for this period.

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.

LEGAL PRECEDENT -- ISSUE 2

Section 8103 of FECA provides that the United States shall furnish to an employee who is 

injured while in the performance of duty, the services, appliances, and supplies prescribed or 

recommended by a qualified physician, which OWCP considers likely to cure, give relief, reduce 

the degree or the period of disability, or aid in lessening the amount of the monthly compensation.12 

To be entitled to reimbursement of medical expenses, a claimant has the burden of proof 

to establish that the expenditures were incurred for treatment of the effects of an employmentrelated injury or condition. Proof of causal relationship in a case such as this must include 

supporting rationalized medical evidence.13 In order for a surgical procedure to be authorized, a 

claimant must submit evidence to show that the surgery is for a condition causally related to an 

employment injury and that it is medically warranted. Both of these criteria must be met in order 

for OWCP to authorize payment.14 

In interpreting this section of FECA, the Board has recognized that OWCP has broad 

discretion in approving services provided under FECA. OWCP has the general objective of 

 

11 See W.C., Docket No. 19-1740 (issued June 4, 2020); L.B., Docket No. 18-0533 (issued August 27, 2018); D.K., 

Docket No. 17-1549 (issued July 6, 2018).

12 5 U.S.C. § 8103; see B.H., Docket No. 17-0479 (issued March 19, 2019); Dona M. Mahurin, 54 ECAB 

309 (2003).

13 M.G., Docket No. 19-1791 (issued August 13, 2020); M.B., 58 ECAB 588 (2007).

14 M.G., id.; R.C., 58 ECAB 238 (2006).
6

ensuring that an employee recovers from his or her injury to the fullest extent possible in the 

shortest amount of time. It, therefore, has broad administrative discretion in choosing means to 

achieve this goal. The only limitation on OWCP’s authority is that of reasonableness.15 Abuse of 

discretion is generally shown through proof of manifest error, clearly unreasonable exercise of 

judgment, or actions taken which are contrary to both logic and probable deductions from 

established facts. It is not enough to merely show that the evidence could be construed so as to 

produce a contrary factual conclusion.16

While OWCP is obligated to pay for treatment of employment-related conditions, the 

employee has the burden of proof to establish that the expenditure is incurred for treatment of the 

effects of an employment-related injury or condition.17

ANALYSIS -- ISSUE 2

The Board finds that OWCP did not abuse its discretion in denying appellant’s request for 

authorization of left knee surgery.

For a surgical procedure to be authorized, a claimant must submit evidence to show that 

the surgery is for a condition causally related to an employment injury and that it is medically 

warranted. Both of these criteria must be met in order for OWCP to authorize payment.18 The 

accepted condition in this case is left knee contusion.

Dr. Innella initially requested authorization for arthroscopic left knee surgery for an 

articular surface injury of the patella medial femoral condyle. He continued to recommend left 

knee surgery and on August 16, 2018 requested authorization for left knee surgery for a diagnosis 

of transient synovitis. Dr. Innella did not indicate at any time that it was necessitated by the 

accepted left knee contusion.

As indicated above, no additional left knee conditions have been accepted as employment 

related. Appellant must submit evidence that shows that the requested medical procedure is both 

due to a condition causally related to an employment injury and that it is medically warranted.19 

As the requested surgery has not been established to be causally related to appellant’s employment 

injury, OWCP did not abuse its discretion by denying her requests for surgery. To be entitled to 

reimbursement of medical expenses, a claimant has the burden of proof to establish that the 

expenditures were incurred for treatment of the effects of an employment-related injury or 

condition.20 

 

15 D.K., Docket No. 20-0002 (issued August 25, 2020).

16 Id.; Daniel J. Perea, 42 ECAB 214 (1990).

17 P.L., Docket No. 18-0260 (issued April 14, 2020); Kennett O. Collins, Jr. 55 ECAB 648 (2004). 

18 Supra note 14.

19 Id. 

20 Supra note 13.
7

Based on the evidence of record, the Board finds that OWCP did not abuse it discretion in 

denying the proposed surgical procedure. As noted, the only restriction on OWCP’s authority to 

authorize medical treatment is one of reasonableness.21 Absent sufficient explanation as to why 

the proposed surgery was causally related to the December 23, 2014 employment injury, the Board 

finds that OWCP acted reasonably in denying appellant’s request for left knee surgery.

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.

LEGAL PRECEDENT -- ISSUE 3

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.22

The medical evidence required to establish a causal relationship between a claimed specific

condition and an employment injury is rationalized medical opinion evidence.23 The opinion of

the physician must be based on a complete factual and medical background, 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 injury.24

ANALYSIS -- ISSUE 3

The Board finds this case not in posture for decision with regard to whether appellant has

additional left knee conditions causally related to the accepted December 23, 2014 employment

injury.

Dr. Innella, in his December 9, 2015 report, indicated that appellant developed recurrent

symptoms from a chondral injury with articular cartilage traumatic chondromalacia and recurrent

synovitis within the knee and opined that, based on reasonable probability, her left knee injuries

occurred during the December 23, 2014 incident when she fell directly on her knee. He stated that

his opinion was based on the fact that her symptoms developed following this incident, and noted

his surgical findings of recurrent left knee synovitis and chondral injury underneath her patella.

Dr. Innella reiterated that this direct impact to the patella caused articular surface injury underneath

her patella, which resulted in the development of type 2 scar cartilage, noting that this type of

cartilage notoriously caused recurrent symptomatology. Dr. Innella continued to submit monthly

treatment notes in describing her continued left knee complaints with consistent examination

findings. He reiterated appellant’s diagnoses, opining that her knee injuries were causally related

to the December 23, 2014 employment injury. 

 

21 Supra note 15.

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

23 B.C., Docket No. 20-0498 (issued August 27, 2020).

24 T.L., Docket No. 19-1467 (issued July 24, 2020); Victor J. Woodhams, 41 ECAB 345 (1989).
8

In an August 20, 2018 report, Dr. Innella provided examination findings and diagnosed

transient synovitis, contusion, and chondromalacia patella of the left knee. He advised that

appellant’s left knee condition had not changed and reiterated his opinion that she had injured the

articular surface of the patella of her left knee when she had fallen several years prior, noting that

her knee had been flexed when she landed on the knee. Dr. Innella indicated that she had

subsequently developed recurrent symptoms from the chondral injury, of traumatic

chondromalacia and synovitis within the knee. 

In correspondence dated February 12, 2019, Dr. Innella opined that, based on reasonable

probability, appellant’s injuries to her knee occurred during the accident when she fell directly on

her knee on December 23, 2014, based on the fact that her symptoms developed following this

incident. He noted that recurrent synovitis and a chondral injury underneath her patella were seen

on surgery. Dr. Innella opined that the direct impact to the patella caused articular surface injury

and resulted in the development of type 2 scar cartilage, noting that this type of cartilage

notoriously caused recurrent symptomatology. He concluded that appellant’s injuries were

causally related to the events of the December 23, 2014 accident, which caused left knee contusion,

chondral patella injury, and recurrent synovitis. 

The Board finds that, while Dr. Innella’s reports are not fully rationalized and are

insufficient to meet appellant’s burden of proof to establish her occupational disease claim, they

are consistent in indicating that she sustained a medical condition due to the accepted employment

incident.

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

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

responsibility in the development of the evidence to see that justice is done.25

The Board will therefore remand the case for further development of the medical evidence. 

On remand OWCP shall prepare a statement of accepted facts and obtain a rationalized opinion

from a physician in the appropriate field of medicine as to whether appellant has additional left

knee conditions causally related to the accepted injury. If the referral physician disagrees with the

explanations provided by Dr. Innella, he or she must provide a fully-rationalized explanation

explaining why Dr. Innella’s opinion is unsupported. Following this and other such further

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

CONCLUSION

The Board finds that appellant has not established disability from work for the period 

February 7 to August 7, 2015 causally related to the accepted employment injury. The Board also 

finds that OWCP did not abuse its discretion by denying her request for authorization of left knee 

surgery. The Board further finds that this case is not in posture for decision with regard to whether 

the acceptance of her claim should be expanded to include additional left knee conditions causally 

related to her December 23, 2014 employment injury. 

 

25 S.W., Docket No. 18-0119 (issued October 5, 2018); William J. Cantrell, 34 ECAB 1233 (1993).
9

ORDER

IT IS HEREBY ORDERED THAT the April 17, 2019 decision of the Office of Workers’

Compensation Programs is affirmed in part and set aside in part. The case is remanded for further 

proceedings consistent with this decision of the Board. 

Issued: July 1, 2021

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Alternate Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board