United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

B.C., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Takoma Park, MD, Employer

__________________________________________

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Docket No. 21-1339

Issued: June 27, 2022

Appearances: Case Submitted on the Record

Stephen Larkin, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

JANICE B. ASKIN, Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On September 6, 2021 appellant, through counsel, filed a timely appeal from a May 14, 

2021 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 May 14, 2021 decision, appellant submitted additional evidence to OWCP 

and on appeal to the Board. 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

ISSUE

The issue is whether appellant has met his burden of proof to establish a consequential right 

knee injury causally related to his accepted July 28, 1997 employment injury.

FACTUAL HISTORY

On July 28, 1997 appellant, then a 40-year-old city letter carrier, filed a traumatic injury 

claim (Form CA-1) alleging that, on that date, he sustained a left knee injury when he made a turn 

going up stairs on his delivery route and his left knee buckled while in the performance of duty. 

He stopped work on the date of the claimed injury. OWCP accepted appellant’s claim for 

aggravation of osteoarthritis of left knee, effusion of left lower leg joint, and medial meniscus tear 

of the left knee. It paid him wage-loss compensation for periods of disability and authorized left 

knee arthroscopic surgery, which was performed on September 19, 1997.4

In reports dated December 22, 2017 and January 5, 19, and 26 and February 2, 2018,

Dr. Philip B. Bovell, a Board-certified orthopedic surgeon, requested that OWCP expand the 

acceptance of appellant’s claim to include additional consequential conditions of the right knee, 

noting that appellant had to rely on his right leg during ambulation due to his accepted left knee 

conditions. He indicated that appellant sustained a consequential injury in the form of chronic 

right knee pain status postsurgery with residual contractions. 

On March 22, 2018 OWCP referred appellant, along with a statement of accepted facts

(SOAF) and a series of questions, for a second opinion examination and evaluation with

Dr. Chester DiLallo, a Board-certified orthopedic surgeon. It requested that he provide an opinion 

regarding whether appellant sustained a consequential right knee injury related to his accepted 

July 28, 1997 employment injury. In an April 17, 2018 report, Dr. DiLallo reported his physical 

examination findings and determined that appellant did not sustain a consequential right knee 

injury related to his accepted July 28, 1997 employment injury. He noted, “[i]t is my opinion that 

there is no evidence to indicate the presence of a consequential injury to the right knee as due to 

[a] condition exiting in the left knee.” Dr. DiLallo indicated that appellant had a preexisting 

degenerative condition of the right knee, which explained his symptoms.

By decision dated February 28, 2019, OWCP denied the expansion of the acceptance of 

appellant’s claim to include a consequential right knee condition, finding that he did not meet his 

burden of proof to establish a consequential right knee injury causally related to his accepted 

July 28, 1997 employment injury. It later vacated this decision on October 21, 2019 as it had been 

determined that there was a conflict in the medical opinion evidence on the issue between

Dr. DiLallo and appellant’s attending physicians, Dr. Bovell, Dr. Eric Dawson, an orthopedic 

surgeon, and Dr. Daniel Herman, a Board-certified internist. In July 10 and 11 and August 23, 

2019 reports, Dr. Dawson determined that appellant sustained consequential injuries to his right 

knee, including arthritis and a medial meniscus tear, due to extra stress placed on the right knee, a 

phenomenon known as “stress transfer,”by the accepted conditions of the left knee. He maintained 

that the atrophy of appellant’s right leg supported the finding of such consequential injuries. 

4 Appellant later underwent unauthorized left knee surgeries, including a total left knee replacement on July 28, 

2015 and a surgical procedure for adhesion on September 1, 2015. 
3

On remand, OWCP referred appellant, along with a SOAF and a series of questions, for an 

impartial examination and evaluation with Dr. Robert Saltzman, a Board-certified orthopedic 

surgeon. It requested that he provide an opinion regarding whether appellant sustained a 

consequential right knee injury related to appellant’s accepted July 28, 1997 employment injury. 

In a December 18, 2019 report, Dr. Saltzman reviewed appellant’s factual and medical 

history and reported findings of the physical examination he conducted on that date. There was 

no significant effusion of the right knee and it was stable on examination. Dr. Saltzman indicated 

that he was in agreement with Dr. DiLallo that appellant’s right knee osteoarthritis was unrelated 

to the July 28, 1997 employment injury. He opined that development of osteoarthritis in the right 

knee of appellant was significant, but was not related to his osteoarthritis of the contralateral knee 

and the total left knee arthroplasty he underwent in 2015. Dr. Saltzman noted that, although

Dr. Bovell asserted that is a well-accepted fact that damage to one leg leads to increased stress of 

the other side and damage to the contralateral side, he indicated that “this is not the case.”

After further development of the evidence, which included vacating an additional denial of 

appellant’s consequential injury claim, OWCP requested a supplemental report from Dr. Saltzman

in August 2020.

5

In a September 1, 2020 supplemental report, Dr. Saltzman indicated that he 

reviewed the July 10 and 11 and August 23, 2019 reports of Dr. Dawson. He noted that it was

Dr. Dawson’s opinion that the only two etiologic factors for development of right knee 

osteoarthritis were on-the-job usage of almost 25 years and the stress transfer phenomenon. 

Dr. Saltzman indicated that Dr. Dawson found that a medial meniscus tear was an objective finding 

of consequential injury and that he attached importance to the atrophy of the quadriceps of 

appellant’s right leg. He noted, “I am of the opinion that the arthritis that has developed in the 

right knee is the result of normal wear and tear over the course of life for [appellant].... I was

unable to find any studies of scientific value that support the stress transfer phenomenon.”

Dr. Saltzman opined that the atrophy of appellant’s right leg was due to nonwork-related 

osteoarthritis and “not indicative of a work-related injury.” He further noted that appellant’s right 

knee arthritis was not related to any employment injury or to his work activities for the employing 

establishment.

By decision dated November 13, 2020, OWCP determined that appellant had not met his 

burden of proof to expand the acceptance of his claim to include a consequential injury causally 

related to his accepted July 28, 1997 employment injury. It found that the special weight of the 

medical opinion evidence rested with the opinion of Dr. Saltzman. 

Appellant, through counsel, requested reconsideration of the November 13, 2020 decision 

and argued that the opinion of Dr. Saltzman was not entitled to special weight. He submitted a 

January 1, 2021 report from Dr. Bovell who asserted that Dr. Saltzman did not adequately discuss 

the postsurgery status of appellant’s left knee. In a January 13, 2021 report, Dr. Herman indicated 

that appellant had been favoring his right leg since 2015. 

By decision dated May 14, 2021, OWCP denied modification of its November 13, 2020

decision. 

5 OWCP indicated that Dr.Saltzman should review the reports of Dr.Dawson before rendering his supplemental 

opinion.
4

LEGAL PRECEDENT

The claimant bears the burden of proof to establish a claim for a consequential injury.6 As 

part of this burden, he or she must present rationalized medical opinion evidence, based on a 

complete factual and medical background, establishing causal relationship. The opinion must be 

one of reasonable medical certainty and must be supported by medical rationale explaining the 

nature of the relationship of the diagnosed condition and the specific employment factors or 

employment injury.7

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

relationship is rationalized medical evidence.8 Neither the mere fact that a disease or condition 

manifests itself during a period of employment, nor the belief that the disease or condition was 

caused or aggravated by employment factors or incidents, is sufficient to establish causal 

relationship.9

In discussing the range of compensable consequences, once the primary injury is causally

connected with the employment, the question is whether compensability should be extended to a 

subsequent injury or aggravation related in some way to the primary injury. 10 The basic rule is 

that, a subsequent injury, whether an aggravation of the original injury or a new and distinct injury, 

is compensable if it is the direct and natural result of a compensable primary injury. 11 When an 

injury arises in the course of employment, every natural consequence that flows from that injury 

likewise arises out of the employment, unless it is the result of an independent intervening cause 

attributable to the claimant’s own conduct.12

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 Secretary shall 

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

make an examination.13 For a conflict to arise, the opposing physicians’ opinions must be of 

virtually equal weight and rationale.14 In situations where the case is properly referred to an 

impartial medical specialist for the purpose of resolving the conflict, the opinion of such specialist, 

6 V.K., Docket No. 19-0422 (issued June10, 2020); A.H., Docket No. 18-1632 (issued June1, 2020); I.S., Docket 

No. 19-1461 (issued April30, 2020).

7 K.W., Docket No. 18-0991 (issued December 11, 2018).

8 G.R., Docket No. 18-0735 (issued November 15, 2018).

9

Id.

10 K.S., Docket No. 17-1583 (issued May 10, 2018).

11 Id.

12 A.M., Docket No. 18-0685 (issued October 26, 2018); Mary Poller, 55 ECAB 483, 487 (2004).

13 5 U.S.C. § 8123(a); see E.L., Docket No. 20-0944 (issued August 30, 2021); R.S., Docket No. 10-1704 (issued 

May 13, 2011); S.T., Docket No. 08-1675 (issued May 4, 2009); M.S., 58 ECAB 328 (2007).

14 P.R., Docket No. 18-0022 (issued April9, 2018).
5

if sufficiently well rationalized and based upon a proper factual background, must be given special 

weight.15

ANALYSIS

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

right knee injury causally related to his accepted July 28, 1997 employment injury.

OWCP properly determined that there was a conflict in the medical opinion evidence on 

the issue between Dr. DiLallo, OWCP referral physician, and appellant’s attending physicians,

Dr. Bovell, Dr. Dawson, and Dr. Herman. It then, pursuant to 5 U.S.C. § 8123(a), properly 

referred appellant to Dr. Saltzman for an impartial medical examination and opinion of appellant’s 

consequential injury claim.

In a December 18, 2019 report, Dr. Saltzman discussed appellant’s factual and medical 

history and reported findings of the physical examination he conducted on that date. There was 

no significant effusion of the right knee and it was stable on examination. Dr. Saltzman indicated 

that appellant’s right knee osteoarthritis was unrelated to the employment injury from 

July 28, 1997. He opined that development of osteoarthritis in the right knee of appellant was 

significant, but was not related to appellant’s osteoarthritis of the contralateral knee and the total 

left knee arthroplasty he underwent in 2015. Dr. Saltzman noted that, although Dr. Bovell asserted 

that is a well-accepted fact that damage to one leg leads to increased stress of the other side and 

damage to the contralateral side, he indicated that “this is not the case.”

In a September 1, 2020 supplemental report, Dr. Saltzman indicated that he reviewed the 

July 10 and 11 and August 23, 2019 reports of Dr. Dawson. He noted that it was Dr. Dawson’s

opinion that the only two etiologic factors for development of right knee osteoarthritis were on -thejob usage of almost 25 years and the stress transfer phenomenon. Dr. Saltzman indicated that

Dr. Dawson found that a medial meniscus tear was an objective finding of consequential injury 

and that he attached importance to the atrophy of the quadriceps of appellant’s right leg. He noted, 

“I am of the opinion that the arthritis that has developed in the right knee is the result of normal 

wear and tear over the course of life for [appellant].... I was unable to find any studies of scientific 

value that support the stress transfer phenomenon.” Dr. Saltzman opined that the atrophy of 

appellant’s right leg was due to nonwork-related osteoarthritis and “not indicative of a 

work-related injury.” He further noted that appellant’s right knee arthritis was not related to any 

work injury or to appellant’s work activities for the employing establishment.

The Board has reviewed the opinion of Dr. Saltzman and finds that it has reliability, 

probative value and convincing quality with respect to its conclusions regarding appellant’s 

consequential injury claim. Dr. Saltzman provided a thorough factual and medical history and 

accurately summarized the relevant medical evidence. He provided medical rationale for his 

15 See D.M., Docket No. 18-0746 (issued November 26, 2018); R.H., 59 ECAB 382 (2008); James P. Roberts, 31 

ECAB 1010 (1980).
6

opinion by explaining that appellant’s right knee condition was due to nonwork-related factors, 

including the natural progression of his underlying degenerative condition.

16

The Board finds that the special weight of the medical evidence is represented by the 

thorough, well-rationalized opinion of Dr. Saltzman, the impartial medical specialist selected to 

resolve the conflict in the medical opinion evidence. The December 18, 2019 and September 1, 

2020 reports of Dr. Saltzman establish that appellant did not sustain a right knee injury as a 

consequence of his accepted July 28, 1997 employment injury.

Appellant submitted a January 1, 2021 report from Dr. Bovell who asserted that

Dr. Saltzman did not adequately discuss the postsurgery status of his left knee. In a January 13, 

2021 report, Dr. Herman indicated that appellant had been favoring his right leg since 2015. 

However, these reports do not contain medical rationale on the relevant issue of the ca se, which 

would overcome the probative value of Dr. Saltzman’s opinion. The Board has held that a report 

is of limited probative value regarding causal relationship if it does not contain supporting medical 

rationale.17 These reports, therefore, are insufficient to establish appellant’s consequential injury 

claim.

On appeal, counsel contends that the special weight of the medical opinion evidence 

regarding appellant’s consequential injury claim does not rest with the opinion of Dr. Saltzman. 

However, the Board has explained why Dr. Saltzman’s well-rationalized opinion warrants such 

special weight.

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.

CONCLUSION

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

right knee injury causally related to his accepted July 28, 1997 employment injury.

16 See W.C., Docket No. 18-1386 (issued January 22, 2019); D.W., Docket No. 18-0123 (issued October 4, 2018); 

Melvina Jackson, 38 ECAB 443 (1987) (regarding the importance, when assessing medical evidence, of such factors 

as a physician’s knowledge of the facts and medical history, and the care of analysis manifested and the medical 

rationale expressed in support of the physician’s opinion).

17 See Y.D., Docket No. 16-1896 (issued February 10, 2017).
7

ORDER

IT IS HEREBY ORDERED THAT the May 14, 2021 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: June 27, 2022

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board