United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

L.M., Appellant

and

U.S. POSTAL SERVICE, NEWBURG POST 

OFFICE, Cleveland, OH, Employer

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Docket No. 23-1040

Issued: December 29, 2023

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant1

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 August 1, 2023 appellant, through counsel, filed a timely appeal from a July 12, 2023 

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.

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.
2

ISSUE

The issue is whether appellant has met his burden of proof to expand the acceptance of his 

claim to include left knee substantial aggravation of lateral meniscus tear, causally related to the 

accepted October 28, 2021 employment injury.

FACTUAL HISTORY

On November 1, 2021 appellant, then a 36-year-old postal collection and delivery 

employee, filed a traumatic injury claim (Form CA-1) alleging that on October 28, 2021 he 

sustained a left knee injury when he tripped on the bar that closed the back door of his vehicle and 

he hit his left knee on a tray while in the performance of duty. He stopped work that same day. 

On November 15, 2021 OWCP accepted the claim for contusion of the left knee.

A December 20, 2021 magnetic resonance imaging (MRI) scan of the left knee read by

Dr. Michael Paley, Board-certified in diagnostic radiology, revealed that appellant was postlateral 

meniscectomy and that he had arthritic changes of the lateral compartment, with prominent 

subchondral cystic changes and edema, and flattening of the articular surface of the lateral femoral 

condyle. Dr. Paley noted that a developing avascular necrosis (AVN)was difficult to fully exclude 

and there was an intrasubstance signal in the medial meniscus without articular surface tear.

In a February 14, 2022 report, Dr. Louis Keppler, a Board-certified orthopedic surgeon, 

noted appellant’s history of injury. He noted that appellant’s prior history included a remote lateral 

meniscectomy and related that he had done well with that procedure and was able to work as a 

mail delivery worker without difficulties until his most recent incident. Dr. Keppler related that 

appellant indicated his pain was in the peripatellar region. He noted that appellant did not have an 

effusion, that at the time of his injury the knee was swollen, and that the swelling had resolved,

but the pain persisted. Dr. Keppler related that a recent MRI scan revealed evidence of a previous 

lateral meniscectomy and some changes of the lateral femoral condyle. He opined that th e most 

recent injury was not reflected in the MRI scan of the posterior aspect of the lateral femoral condyle 

and that the injury was more likely a deep soft tissue contusion with possible chondral injury to 

the patellofemoral joint. Dr. Keppler gave appellant an intra-articular injection. He explained that 

appellant might require an arthroscopic examination of the joint to deal with post-traumatic plica 

or injury to the articular surface of the patellofemoral condyle. 

In a report dated March 14, 2022, Dr. Teresa Griffin, Board-certified in family practice, 

provided an assessment of left knee contusion, and left knee strain. She reviewed appellant’s 

recent left knee MRI scan and noted a truncated lateral meniscus from a prior surgery; thinning of 

the cartilage of the lateral femoral condyle;subchondral cystic change; as well as edema of the 

lateral femoral condyle with flattening of the lateral femoral condyle, suggesting avascular 

necrosis; and thinning of the articular cartilage of the lateral tibial plateau. 

Appellant was evaluated again on April 11, 2022 by Dr. Keppler. Dr. Keppler noted 

appellant’s physical examination findings. He related that he was concerned that appellant may 

have sustained an injury to his articular cartilage of the patellofemoral joint and that he may have 

a post-traumatic plica associated with the deep contusion of the retro patellar fat pad, or that he 
3

may have further injured his lateral joint and meniscus with hyperflexion associated with the 

injury. 

In a June 1, 2022 report, Dr. George Bertalan, an internist, noted appellant’s history of 

injury and explained that appellant continued to have uncontrolled pain. He requested that 

acceptance of appellant’s claim be expanded to include the diagnosis of substantial aggravation of 

the underlying left meniscus tear, which he opined was ongoing and was visualized on appellant’s 

recent MRI scan.

In a June 21, 2022 report, Dr. Muyuan Ma, a family medicine specialist, noted the history 

of injury and explained that appellant continued to have uncontrolled pain. She reiterated that 

findings of appellant’s recent MRI scan, as reported by Dr. Griffin. Dr. Ma diagnosed contusion 

of left knee, initial encounter, and left knee sprain and other meniscus derangements, unspecified 

lateral meniscus. She also noted that a request to expand acceptance of the claim to include lateral 

meniscus tear, substantial aggravation was pending.

On August 3, 26, and October 25, 2022 appellant, through counsel, requested that 

acceptance of the claim be expanded to include substantial aggravation of the lateral meniscus tear 

of the left knee.

On November 7, 2022 OWCP referred appellant, along with the case record, a statement 

of accepted facts (SOAF), and a series of questions to Dr. David K. Halley, a Board-certified 

orthopedic surgeon, for a second opinion examination.

In a November 29, 2022 report, Dr. Halley noted appellant’s history and treatment. He 

examined appellant and found “exquisite” tenderness to palpation over the lateral joint line. 

Dr. Halley noted that there were no current objective findings of the accepted condition of 

contusion of the left knee. He noted that normally a soft tissue contusion would resolve in a matter 

of 6 to 12 weeks, which appeared to be the case. Dr. Halley further explained that there was 

indirect evidence that it was more than a simple contusion, citing the MRI scan two months later, 

which revealed edema along the flattening of the articular surface of the lateral femoral condyle.

He opined that the force of the injury was significant enough to cause edema in the femoral 

condyle. Dr. Halley explained thatAVN, if fully developed, would not improve, but only progress 

and lead to further arthritic changes in the lateral femoral condyle, which he opined explained the 

objective findings and ongoing symptomatology. He further noted that AVN was not attributed to 

the accepted contusion, which was a self-limiting, soft tissue condition, and that appellant did not 

have residuals from the left knee contusion. 

Dr. Halley opined that based upon the MRI scan evidence, appellant’s claim should be 

expanded to include left knee aggravation of other unspecified arthritis. He explained that the 

diagnosis provided by Dr. Bertalan of substantial aggravation of left lateral meniscus tear was not 

correct. Dr. Halley noted that the code referred to by Dr. Bertalan specifically states other 

derangement, unspecified lateral meniscus, rather than substantial aggravation of an underlying 

meniscal tear. Additionally, he explained that he did not have any idea what Dr. Bertalan meant 

by substantial aggravation of the underlying meniscal tear. Dr. Halley opined that the only thing 

he could think of would be that it was a retear of the residual discoid meniscus of the lateral discoid 

meniscus of the left knee; there was no evidence on the MRI scan of any additional tear to the 
4

lateral discoid meniscus of the left knee. Also, for the requested additional condition of left knee 

strain, he explained that this diagnosis was a soft tissue condition which would resolve in a matter 

of 6 to 12 weeks. Dr. Halley opined that appellant reached maximum medical improvement (MMI) 

for the contusion; however, the work-related aggravation of other specified arthritis of the left knee 

was not at MMI. He further opined that the development of AVN could be a result of the work 

injury; however, AVN also can be caused by obesity, and he noted that appellant was morbidly 

obese and also had nonwork symptoms in the right knee. Dr. Halley provided work restrictions in 

a work capacity evaluation (Form OWCP-5c). 

On December 21, 2022 OWCP expanded the acceptance of appellant’s claim to include 

left knee other specified arthritis, and left knee strain. It noted that the contusion of the left knee 

was resolved.

In a separate decision also dated December 21, 2022, OWCP denied expansion of the 

acceptance of appellant’s claim to include an additional diagnosis of left knee substantial 

aggravation of lateral meniscus tear, causally related to the accepted October 28, 2021 employment 

injury. 

On January 4, 2023 appellant, through counsel, requested a telephonic hearing before a 

representative of OWCP’s Branch of Hearings and Review. 

In reports dated January 23 and 30, February 8, March 9, 23, and 29, and May 30, 2023,

Dr. Ma diagnosed other specified arthritis of the left knee, strain of unspecified muscle and tendon 

of the lower left leg, and contusion of the left knee. She added that appellant was having difficulty 

mentally dealing with the possibility that he may require knee replacement surgery. 

In a report dated March 2, 2023, Dr. Keppler related that he was concerned that appellant’s 

chondral injury may have progressed to post-traumatic arthritis. He recommended that appellant 

undergo another MRI scan of the left knee to direct further care.

A March 8, 2023 MRI scan of the left knee read by Dr. RobertJ. Steffy, a diagnostic 

radiologist, revealed weight bearing lateral femoral condyle which may represent sequela of 

impaction fracture or may be post-surgical, bone marrow edema within the posterior nonweightbearing lateral femoral condyle that was likely degenerative given the tiny overlying full 

thickness cartilage defect, and post-surgical changes of partial meniscectomy through the posterior 

horn of the medial meniscus. 

In a report dated April 14, 2023, Dr. Daniel Zanotti, an orthopedic surgeon, noted that 

appellant indicated that he had undergone a prior meniscectomy during which 80 percent of his 

meniscus was removed. He related that x-ray evaluation of appellant’s left knee revealed moderate 

to advanced osteoarthritis of the left knee, worse laterally.

On June 8, 2023 a telephonic hearing was held before a representative of OWCP’s Branch 

of Hearings and Review. 

In reports dated June 19, 26, and 30, 2023, Dr. Ma requested that the acceptance of 

appellant’s claim be expanded to include right knee sprain, anxiety, and depression. She related 

that appellant’s left leg strain caused him to develop a flow through condition of right knee strain. 
5

By decision dated July 12, 2023, OWCP’s hearing representative affirmed the 

December 21, 2022 decision. The hearing representative found that the weight of the evidence 

was accorded to the second opinion physician, Dr. Halley, who did not support the requested

expansion of the acceptance of the claim to include left knee substantial aggravation of the lateral 

meniscus tear. 

LEGAL PRECEDENT

Where 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

To establish causal relationship, the employee must submit rationalized medical opinion 

evidence.4 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 accepted employment injury.5 The weight of medical evidence is 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.6

ANALYSIS

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

his claim to include left knee substantial aggravation of lateral meniscus tear as causally related to 

the accepted October 28, 2021 employment injury.

OWCP initially received multiple reports from appellant’s treating physician Dr. Keppler, 

who did not diagnose left knee aggravation of lateral meniscus tear. In his February 14, 2022 

report, Dr. Keppler found that appellant’s work injury was not reflected in the MRI scan of the 

posterior aspect of the lateral femoral condyle and that the injury was more likely a deep soft tissue 

contusion with possible chondral injury to the patellofemoral joint. He explained that appellant 

might require an arthroscopic examination of the joint to deal with a post-traumatic plica or injury 

to the articular surface of the patellofemoral condyle. In his April 11, 2022 report, Dr. Keppler 

noted that he was concerned that appellant may have sustained an injury to his articular cartilage 

of the patellofemoral joint and that he may have a post-traumatic plica associated with the deep 

contusion of the retro patellar fat pad, or that he may have further injured his lateral joint and 

meniscus with hyperflexion associated with the injury. In a report dated March 2, 2023, he related 

that he was concerned that appellant’s chondral injury may have progressed to post-traumatic 

arthritis. In so far as Dr. Keppler related that appellant may have further injured his left meniscus, 

3

See K.B., Docket No. 22-0842 (issued April25, 2023);see T.F., Docket No. 17-0645 (issued August 15, 2018);

Jaja K. Asaramo, 55 ECAB 200, 204 (2004).

4

See S.A., Docket No. 18-0399 (issued October 16, 2018).

5

See P.M., Docket No. 18-0287 (issued October 11, 2018).

6

Id.
6

the Board finds that his opinion is speculative. Dr. Keppler did not provide a firm diagnosis of left 

knee meniscal tear aggravation.7

In a report dated March 14, 2022, Dr. Griffin diagnosed left knee contusion, and left knee 

strain. In multiple reports commencing June 21, 2022, Dr. Ma diagnosed contusion of left knee, 

initial encounter, and left knee sprain and other meniscus derangements, unspecified lateral 

meniscus. She also noted that a request to expand acceptance of the claim to include lateral 

meniscus tear, substantial aggravation was pending, however, she did not specifically diagnose 

this condition. On April 14, 2023 Dr. Zanotti related that x-ray evaluation of appellant’s left knee 

revealed moderate-to-advanced osteoarthritis of the left knee, worse laterally. The Board finds 

that these physicians did not diagnose aggravation of the left knee meniscal tear, therefore their 

reports do not support acceptance of this diagnosis. 

In a June 1, 2022 report, Dr. Bertalan requested expansion of the acceptance of the claim 

to include left knee substantial aggravation of the underlying meniscus tear. However, he offered 

no rationalized medical opinion, which explained the basis of his diagnosis and causal relationship 

to the accepted October 28, 2021 employment injury. Medical opinion evidence must offer a 

rationalized explanation of how the specific employment incident or work factors, physiologically 

caused the diagnosed condition.8 As Dr. Bertalan did not explain how the accepted employment 

injury caused or contributed to the additional diagnosis of substantial aggravation of lateral 

meniscus tear of left knee, his report is therefore, insufficient to establish causal relationship.

In a November 29, 2022 report, the second opinion physician, Dr. Halley specifically 

disagreed with Dr. Bertalan’s diagnosis of substantial aggravation of left lateral meniscus tear. He 

noted that the diagnosis code referred to by Dr. Bertalan referred to other derangement, unspecified 

lateral meniscus, rather than substantial aggravation of an underlying meniscal tear. Dr. Halley 

explained that it was therefore unclear what Dr. Bertalan meant by substantial aggravation of the 

underlying meniscal tear. He further noted that if Dr. Bertalan was referring to a retear of the 

residual discoid meniscus of the lateral discoid meniscus of the left knee, there was no evidence 

on the MRI scan of any additional tear to the lateral discoid meniscus of the left knee. The Board 

notes that the second opinion physician, Dr. Halley, explained his findings, provided a rationalized 

opinion, and specifically disagreed with Dr. Bertalan’s diagnosis of substantial aggravation of 

lateral meniscus tear of left knee. As such, the Board finds that the opinion of Dr. Halley 

constitutes the weight of the medical evidence.9

7 B.B., Docket No. 21-0284 (October 5, 2022); E.W.,Docket No. 19-1393 (issued January 29, 2020); GaryL. 

Fowler, 45 ECAB 365 (1994).

8

See G.R., Docket No. 21-1196 (issued March 16, 2022); K.J., Docket No. 21-0020 (issued October 22, 2021);

L.R., Docket No. 16-0736 (issued September 2, 2016); J.R., Docket No. 12-1099 (issued November 7, 2012);

Douglas M. McQuaid, 52 ECAB 382 (2001).

9

See supra note 5.
7

OWCP also received diagnostic studies of appellant’s left knee. The Board has held, 

however, that diagnostic studies, standing alone, lack probative value as they do not provide an 

opinion on causal relationship between an employment injury, and a diagnosed condition. 10

The Board finds that appellant has not submitted rationalized medical evidence sufficient 

to meet his burden of proof to expand acceptance of his claim to include an additional diagnosis 

of left knee substantial aggravation of lateral meniscus tear, causally related to the accepted 

October 28, 2021 employment injury.

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 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 acceptance of his 

claim to include left knee substantial aggravation of lateral meniscus tear as causally related to the 

accepted October 28, 2021 employment injury. 

10 M.E., Docket No. 18-0940 (issued June11, 2019); V.J., Docket No. 17-0358 (issued July 24, 2018); JohnW. 

Montoya, 54 ECAB 306 (2003).
8

ORDER

IT IS HEREBY ORDERED THAT the July 12, 2023 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: December 29, 2023

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