United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

J.C., Appellant

and

DEPARTMENT OF JUSTICE, FEDERAL 

BUREAU OF PRISONS, FCI MEMPHIS, 

Memphis, TN, Employer

__________________________________________

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Docket No. 21-0301

Issued: March 3, 2022

Appearances: Case Submitted on the Record

Daniel DeCiccio, Esq., for the appellant

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

JANICE B. ASKIN, Judge

PATRICIA H. FITZGERALD, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On December 24, 2020 appellant, through counsel, filed a timely appeal from a 

December 3, 2020 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 expand the acceptance 

of the claim to include additional conditions of left knee primary osteoarthritis and a right medial 

1

5 U.S.C. § 8101 et seq.

2 The Board notes that, following the December 3, 2020 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

meniscus tear causally related to the accepted August 23, 2019 employment injury; and 

(2) whether OWCP abused its discretion by denying appellant’s requests for authorization of a left 

knee injection and right knee surgery.

FACTUAL HISTORY

On August 23, 2019 appellant, then a 49-year-old corrections officer, filed a traumatic 

injury claim (Form CA-1) alleging that on that date he sustained injuries to his knees as a result of 

a partial floor cave-in while in the performance of duty. OWCP accepted the claim for bilateral 

knee contusions.

In a report dated September 5, 2019, Dr. Robert H. Miller, a Board-certified orthopedic 

surgeon, diagnosed bilateral knee contusions. He noted that on August 23, 2019 appellant was 

walking on an elevated floor when his right leg fell through the floor. Appellant landed on his 

kneecaps. Since that time, he had significant pain in both knees, left worse than right. Appellant 

told Dr. Miller that he had previous intermittent pain and swelling in the left knee requiring him 

to use a cane and that he had been given a cane several years prior “for preexisting knee arthritis.”

A magnetic resonance imaging (MRI) scan of the left knee obtained on September 26, 2019 

demonstrated a small free edge tear in the body of the lateral meniscus and mild and moderate 

patellofemoral compartment osteoarthritis.

In a follow-up report dated January 30, 2020, Dr. Miller noted that an MRI scan of the left 

knee demonstrated a small free edge tear in the body of the lateral meniscus and low-grade 

chondral loss in the lateral compartment. He advised that appellant should treat his arthritis with 

continued therapy, anti-inflammatories, a cortisone injection, and he would attempt to obtain 

approval for a hyaluronic acid injection.

An MRI scan of appellant’s right knee obtained on February 13, 2020 demonstrated a 

horizontal tear of the posterior horn and body of the medial meniscus and mild tricompartmental 

osteoarthritis. It was also noted that the medial collateral ligament was thickened proximally 

consistent with a remote injury.

In a follow-up report dated March 5, 2020, Dr. Miller noted that the MRI scan of 

appellant’s right knee demonstrated a horizontal tear of the posterior horn body of the medial 

meniscus and mild tricompartmental osteoarthritis. He recommended right knee surgery and a 

hyaluronic acid injection to the left knee, to which appellant agreed.

On March 9, 2020 appellant requested authorization for right knee surgery.

In a development letter dated March 11, 2020, OWCP advised appellant that, at that time, 

the proposed right knee surgery could not be approved. It found that the request for surgery did 

not match his approved condition of right knee contusion. OWCP requested that appellant submit 

a narrative report from his physician explaining how the new diagnosis of right knee meniscus tear 

was causally related to the accepted traumatic injury. It afforded him 30 days to submit the 

requested evidence.

On April 2, 2020 appellant requested authorization for a left knee injection.
3

In a development letter dated April 8, 2020, OWCP advised appellant that, at that time the 

proposed left knee injections could not be approved. It found that the request for a left knee 

injection did not match his approved condition of left knee contusion. OWCP requested that 

appellant submit a narrative report from his physician explaining how the new diagnosis of left 

knee osteoarthritis was causally related to the accepted traumatic injury. It afforded him 30 days 

to submit the requested evidence. No response was received within the time allotted.

By decision dated May 18, 2020, OWCP denied appellant’s request to expand the 

acceptance of his claim to include left knee primary osteoarthritis as causally related to the 

accepted August 23, 2019 employment injury and denied his request for authorization for a left 

knee injection. 

By separate decision also dated May 18, 2020, OWCP denied appellant’s request to expand 

the acceptance of his claim to include a right knee medial meniscus tear as causally related to the 

accepted employment injury and denied his request for authorization for right knee surgery.

On June 2, 2020 appellant, through counsel, requested an oral hearing before a 

representative of OWCP’s Branch of Hearings and Review.

On October 5, 2020, counsel submitted the results of a May 12, 2015 MRI scan, which 

demonstrated minimal lateral compartment chondromalacia and minimal chondromalacia of the 

patella and minimal signal in the posterior horn of the medial meniscus, likely reflecting 

intrasubstance degeneration. He also enclosed a note dated September 30, 2020 from Dr. Miller 

in which he described the results of the May 12, 2015 MRI scan.

A hearing was held on October 8, 2020. The hearing representative afforded appellant 30 

days to submit additional medical evidence.

In a narrative report dated November 5, 2020, Dr. Miller noted that appellant’s claim was 

currently accepted for bilateral knee contusions. He opined that the acceptance of the claim should 

be expanded to include an aggravation of left knee primary osteoarthritis and a left la teral meniscus 

tear, as well as a right horizontal tear of the posterior horn and body of the medial meniscus, which 

was “possibly caused by the accident” and right knee osteoarthritis “possibly aggravated by the 

accident.” Dr. Miller noted that, when appellant fell on August 23, 2019, he twisted his knees and 

slammed into the floor, which due to appellant’s height and weight could have created sufficient 

torque and force to tear the menisci in his knees and possibly aggravate his preexisting 

degenerative arthritis. He noted that an MRI scan from 2015 did not show any tears in the menisci, 

though there was a minimal signal in the posterior horn of the right medial meniscus. Dr. Miller 

noted that there were no injuries between the 2015 MRI scan and the August 23, 2019 incident, 

and no injuries after that incident. He stated that medical literature supported that trauma like the 

type appellant experienced could make preexisting arthritis worse. Dr. Miller opined that the left 

knee injections were necessary to avoid surgery.

By decision dated December 3, 2020, the hearing representative affirmed the May 18, 2020

decisions.
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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.3

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.4 A physician’s opinion on whether there is causal relationship 

between the diagnosed condition and an accepted injury must be based on a complete factual and 

medical background.5 Additionally, the physician’s opinion must be expressed in terms of a 

reasonable degree of medical certainty and must be supported by medical rationale which, explains 

the nature of the relationship between the diagnosed condition and the accepted employment 

injury.6

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.7 

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

approving services provided under FECA.8 OWCP has the general objective of 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.9 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.10

3 A.A., Docket No. 19-1165 (issued December 16, 2019); M.B., Docket No. 19-0485 (issued August22, 2019); R.J., 

Docket No. 17-1365 (issued May 8, 2019); JajaK. Asaramo, 55 ECAB 200 (2004).

4 E.M., Docket No. 18-1599 (issued March 7, 2019); Robert G. Morris, 48 ECAB 238 (1996).

5 M.V., Docket No. 18-0884 (issued December 28, 2018); Victor J. Woodhams, 41 ECAB 345, 352 (1989).

6

Id.

7

5 U.S.C. § 8103.

8 M.C.,Docket No. 17-1615 (issued August 23, 2018). 

9

Id.

10 Id.
5

ANALYSIS -- ISSUE 1

The Board finds that appellant has not met his burden of proof to expand the acceptance of 

the claim to include additional conditions of left knee primary osteoarthritis and a right medial 

meniscus tear as causally related to the accepted August 23, 2019 employment injury.

In his September 5, 2019 report, Dr. Miller diagnosed bilateral knee contusions, and noted 

that appellant had related he had been given a cane some years prior for preexisting left knee 

arthritis. This report merely diagnosed the accepted bilateral knee contusions, but did not offer

Dr. Miller’s diagnosis of any other bilateral knee conditions. The Board has held that a medical 

report lacking a firm diagnosis and a rationalized medical opinion that the medical condition is 

causally related to the employment incident is of no probative value. 11 Therefore, Dr. Miller’s 

report is insufficient to establish appellant’s request for expansion of the claim.

In a narrative report dated November 5, 2020, Dr. Miller noted that appellant’s claim was 

currently approved for bilateral knee contusions. He opined that the acceptance of the case should 

be expanded to include an aggravation of left knee primary osteoarthritis and a left lateral meniscus 

tear, as well as a right horizontal tear of the posterior horn and body of the medial meniscus, which 

was “possibly caused by the accident” and right knee osteoarthritis “possibly aggravated by the 

accident.” Dr. Miller noted that, when appellant fell on August 23, 2019, he twisted his knees and 

slammed into the floor, which due to appellant’s height and weight could have created sufficient 

torque and force to tear the menisci in his knees and possibly aggravate his preexisting 

degenerative arthritis. He noted that an MRI scan from 2015 did not show any tears in the menisci, 

though there was a minimal signal in the posterior horn of the right medial meniscus. Dr. Miller 

noted that there were no injuries between the 2015 MRI scan and the August 23, 2019 incident, 

and no injuries after that incident. He stated that medical literature supported that trauma like the 

type appellant experienced could make preexisting arthritis worse. Dr. Miller opined that the left 

knee injections were necessary and could avoid surgery. The Board finds that Dr. Miller’s 

November 5, 2020 report is insufficient to establish appellant’s request for expansion of the claim. 

Dr. Miller’s explanation that appellant’s left knee osteoarthritis and right knee meniscal tear were

“possibly” secondary to the August 23, 2019 incident is speculative in nature. The Board has held 

that medical opinions that are speculative or equivocal are of diminished probative value.12 While

Dr. Miller provided a possible explanation as to how the incident of August 23, 2019 caused or 

aggravated appellant’s left knee primary osteoarthritis and a right medial meniscus tear, his 

opinion was couched in speculative terms, and did not fully address appellant’s history and 

preexisting bilateral knee conditions. In any case where a preexistingcondition involving the same 

part of the body is present and the issue of causal relationship, therefore, involves aggravation, 

acceleration or precipitation, the physician must provide a rationalized medical opinion that 

differentiates between the effects of the work-related injury or disease and the preexisting

11 J.P., Docket No. 20-0381 (issued July 28, 2020);R.L., Docket No. 20-0284 (issued June 30, 2020).

12 Federal (FECA) Procedure Manual, Part 2 -- Claims, Developing and Evaluating Medical Evidence, Chapter 

2.810.5(c)(3); D.S., Docket No. 20-0384 (issued October 8, 2020); H.A., Docket No. 18-1455 (issued 

August 23, 2019).
6

condition.13 In addition, while Dr. Miller noted that medical literature supported a finding that 

appellant’s diagnosed conditions could have been caused by the type of trauma he experienced, 

the Board has held that reliance on medical literature has little probative value in resolving medical 

questions unless a physician shows the applicability of the general medical principles discussed in 

the articles to the specific factual situation at issue in the case. 14 Therefore, Dr. Miller’s 

November 5, 2020 report is insufficient to meet appellant’s burden of proof.15

OWCP also received MRI scan reports. The Board, however, has held that diagnostic tests, 

standing alone, lack probative value as they do not provide a physician’s opinion on whether there 

is a causal relationship between appellant’s accepted employment incident/exposure and a 

diagnosed condition.16 This evidence is, therefore, insufficient to establish expansion of his claim.

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

additional diagnosed medical conditions and the accepted employment injury, appellant has not 

met his burden of proof to expand the acceptance of his claim.

LEGAL PRECEDENT -- ISSUE 2

Section 8103(a) of FECA17 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 

by 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.18 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.19

Section 10.310(a) of OWCP’s implementing regulations provide that an employee is 

entitled to receive all medical services, appliances, or supplies which a qualified physician 

prescribes or recommends and which OWCP considers necessary to treat the work-related injury.20

13 Federal (FECA) Procedure Manual, Part 2 -- Claims, Causal Relationship, Chapter 2.805.3e (January 2013); 

M.B., Docket No. 20-1275 (issued January 29, 2021); see R.D.,Docket No. 18-1551 (issued March 1, 2019).

14 S.J., Docket No. 20-0896 (issued January 11, 2021); R.G., Docket No. 18-0917 (issued March 9, 2020); T.S.,

Docket No. 18-1518 (issued April17, 2019); K.U.,Docket No. 15-1771 (issued August 26, 2016); Roger D. Payne, 

55 ECAB 535 (2004).

15 See C.B., Docket No. 20-0464 (issued July 21, 2020).

16 See P.A., Docket No. 18-0559 (issued January 29, 2020); A.P., Docket No. 18-1690 (issued December 12, 2019); 

R.M., Docket No. 18-0976 (issued January 3, 2019).

17 Supra note 1 at § 8103(a).

18 Id.; see D.S., Docket No. 18-0353 (issued May 18, 2020); L.D., 59 ECAB 648 (2008); Thomas W. Stevens, 50 

ECAB 288 (1999).

19 M.P., Docket No. 19-1557 (issued February 24, 2020); M.B., 58 ECAB 588 (2007).

20 20 C.F.R. § 10.310(a); see D.W., Docket No. 19-0402 (issued November 13, 2019).
7

In interpreting section 8103 of FECA, the Board has recognized that OWCP has broad 

discretion in approving services provided, with the only limitation on OWCP’s authority being 

that of reasonableness.21 OWCP has the general objective of 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. 22

Abuse of discretion is 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.23

ANALYSIS -- ISSUE 2

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

for authorization for a left knee injection and right knee surgery.

On March 9, 2020 appellant requested authorization for right knee surgery. On April 2, 

2020 appellant requested authorization for a left knee injection.

In a January 30, 2020 report, Dr. Miller noted that an MRI scan of the left knee 

demonstrated a small free edge tear in the body of the lateral meniscus and low-grade chondral 

loss in the lateral compartment. He advised that appellant should treat his arthritis with continued 

therapy, anti-inflammatories, a cortisone injection, and he would attempt to obtain approval for a 

hyaluronic acid injection.

In a follow-up report dated March 5, 2020, Dr. Miller noted that the MRI scan of 

appellant’s right knee demonstrated a horizontal tear of the posterior horn body of the medial 

meniscus and mild tricompartmental osteoarthritis. He recommended right knee surgery and a 

hyaluronic acid injection to the left knee, to which appellant agreed.

In a narrative report dated November 5, 2020, Dr. Miller opined that the left knee 

injections were necessary to avoid surgery.

As noted, the only restriction on OWCP’s authority to authorize medical treatment is one 

of reasonableness.24 In the instant case, appellant did not submit evidence to support that the 

requested left knee injection and right knee surgery were medically necessary to treat his accepted 

conditions. The Board thus finds that OWCP did not abuse its discretion by denying her request 

21 B.I., Docket No. 18-0988 (issued March 13, 2020);see also Daniel J. Perea, 42 ECAB 214, 221 (1990) (holding 

that abuse of discretion by OWCP is generally shown through proof of manifest error, clearly unreasonable exercise 

of judgment, or administrative actions which are contrary to both logic, and probable deductions from established 

facts).

22 D.S., Docket No. 18-0353 (issued May 18, 2020).

23 Id.; P.L., Docket No. 18-0260 (issued April14, 2020); L.W., 59 ECAB 471 (2008).

24 Supra note 22; see also A.W., Docket No. 14-0708 (issued January 2, 2015).
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for authorization for physical therapy.25 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 expand the acceptance of 

the claim to include additional conditions of left knee primary osteoarthritis and a right medial 

meniscus tear as causally related to the accepted August 23, 2019 employment injury. The Board 

further finds that OWCP did not abuse its discretion by denying appellant’s requests for

authorization of a left knee injection and right knee surgery.

ORDER

IT IS HEREBY ORDERED THAT the December 3, 2020 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: March 3, 2022

Washington, DC

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Alternate Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board

25 D.C., Docket No. 18-0080 (issued May 22, 2018); B.J.,Docket No. 17-1825 (issued February 23, 2018).