United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

L.R., Appellant

and

DEPARTMENT OF HEALTH & HUMAN 

SERVICES, CENTERS FOR MEDICARE & 

MEDICAID SERVICES, Baltimore, MD, 

Employer

__________________________________________

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Docket No. 21-0018

Issued: February 17, 2023

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

PATRICIA H. FITZGERALD, Deputy Chief Judge

JANICE B. ASKIN, Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On October 7, 2020 appellant, through counsel, filed a timely appeal from a July 22, 2020 

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 July 22, 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

ISSUES

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

acceptance of her claim should be expanded to include bilateral knee osteoarthritis, 

chondromalacia, and meniscal tears as causally related to the accepted June 25, 2013 employment 

injury; (2) whether OWCP properly denied authorization for right knee arthroscopic surgery 

performed on April 4, 2014; and (3) whether appellant met her burden of proof to establish 

disability from work during the period April 16 through May 2, 2014, causally related to the 

accepted June 25, 2013 employment injury.

FACTUAL HISTORY

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

the Board’s prior decision and order are incorporated herein by reference. The relevant facts are 

as follows.

On September 6, 2013 appellant, then a 41-year-old information technology specialist, 

filed a traumatic injury claim (Form CA-1) alleging that she sustained injuries to her head, neck, 

knees, and left ankle on June 25, 2013 when she fell as she was walking to her vehicle while in the 

performance of duty. She stopped work on June 26, 2013 and returned to work on July 3, 2013. 

In support of her claim, appellant submitted reports dated July 1 through September 11, 

2013 from Dr. Rishi Bhatnagar, a Board-certified orthopedic surgeon. In his July 1, 2013 report,

Dr. Bhatnagar related that appellant injured her left ankle and right knee when she fell one week 

prior. In the July 17, 2013 report, he again noted her history of right knee injury and related that 

x-rays of her knees revealed bilateral mild osteoarthritis. In his September 11, 2013 report,

Dr. Bhatnagar diagnosed left ankle sprain and bilateral knee meniscal tears. 

By decision dated November 14, 2013, OWCP denied the claim, finding that appellant’s 

injury on June 25, 2013 did not arise in the performance of duty. It found that her fall on June 25, 

2013 was idiopathic, noting that the fall was due to syncope and that the evidence of record was 

insufficient to establish that she struck an intervening object prior to landing on the ground. 

By decision dated May 29, 2014, OWCP denied modification of the November 14, 2013 

decision. 

In a July 14, 2014 report, Dr. Scott Adams, a Board-certified orthopedic surgeon, noted 

that appellant was three-to-four months status post bilateral knee arthroscopy. He listed diagnoses 

of lateral meniscus tear, knee joint pain, and knee chondromalacia. 

On August 1, 2014 OWCP received an April 4, 2014 surgical report, which related that 

appellant had undergone right knee arthroscopic surgery with partial lateral meniscectomy, lateral 

tibial plateau chondroplasty, patella and femoral trochlea, and plica excision/partial synovectomy. 

On November 13, 2014 appellant, through counsel, appealed to the Board. By decision 

dated April 1, 2015, the Board set aside the June 25, 2013 decision, finding that OWCP improperly 

determined that appellant’s June 25, 2013 fall was idiopathic in nature. Thus, the Board remanded 

4 Order Dismissing Appeal, Docket No 15-1154 (issued October 1, 2015); Docket No. 15-255 (issued 

April 1, 2015). 
3

the case for further development of the evidence, to be followed by a de novo decision regarding

whether her fall on June 25, 2013 was sustained in the performance of duty and, if so, the nature 

and extent of any injury or disability that resulted. 

On April 4, 2016 OWCP referred appellant, along with a statement of accepted facts 

(SOAF), the medical record, and a series of questions to Dr. Taghi Kimyai-Asadi, a Boardcertified neurologist, for a second-opinion evaluation regarding whether appellant’s June 25, 2013 

fall was due to a nonoccupational injury. 

In April 21 and June 21, 2016 reports, Dr. Kimyai-Asadi noted appellant’s physical 

examination findings and indicated that she sustained a left ankle fracture due to the fall, but he 

also indicated that he was unable to determine the effect of the fall on her bilateral knee 

pathologies, as her knees became symptomatic later on. 

By decision dated July 15, 2016, OWCP accepted the claim for left ankle ligament sprain. 

On February 7, 2017 it expanded the acceptance of the claim to include displaced avulsion fracture 

of the left ilium. 

On March 6, 2017 OWCP received additional evidence. In a November 25, 2013 report,

Dr. Michael J. Wallace, a Board-certified orthopedic surgeon, noted that appellant slipped and fell 

on her knees on June 25, 2013 and thereafter experienced bilateral knee symptoms. He noted that

the injury occurred at work, but advised that some documents that she provided indicated that her

bilateral knee conditions were likely preexisting. Dr. Wallace related that appellant reported 

bilateral knee pain, which was worse on the left. A review of appellant’s bilateral knee magnetic 

resonance imaging (MRI) scans revealed bilateral knee posterior horn lateral meniscus tears and 

chondromalacia patellae. 

In an April 1, 2014 note, Dr. Wallace explained that appellant was unable to work until 

further notice due to recent left knee surgery and due to her right knee surgery which wasscheduled 

for April 2, 2014. He released her to return to work on June 2, 2014. 

On April 28, 2017 appellant, through counsel, requested expansion of the acceptance of 

appellant’s claim to include bilateral knee meniscal tears based on the April 21, 2016 reports of

Dr. Kimyai-Asadi. 

On May 3, 2017 appellant filed a claim for compensation (Form CA-7) for disability from 

work during the period April 16 through May 2, 2014. 

In a June 6, 2018 letter, OWCP informed appellant of the deficiencies of her claim for 

expansion. It advised her of the type of additional medical evidence required to establish her claim 

and afforded her 30 days to provide the necessary evidence. 

In a letter dated August 16, 2018, OWCP informed appellant of the deficiencies of her 

claim for wage-loss compensation. It advised her of the type of medical evidence required and 

afforded her 30 days to provide the necessary evidence. No further evidence was received.

By decision dated October 4, 2018, OWCP denied appellant’s claim for wage-loss 

compensation for disability from work during the period April 16 through May 2, 2014.

On October 11, 2018 appellant, through counsel, requested a telephonic hearing before a

representative of OWCP’s Branch of Hearings and Review. 
4

OWCP subsequently received a September 19, 2018 report from Dr. Wallace diagnosing 

bilateral knee chondromalacia patellae. Dr. Wallace related that he first evaluated appellant on 

November 25, 2013 at which time she related a June 25, 2013 work injury where she fell onto her 

knees and felt immediate bilateral knee pain. According to appellant, she had no knee conditions 

or symptoms prior to her June 25, 2013 fall. Her MRI scans revealed bilateral knee lateral 

meniscal tears, which Dr. Wallace opined were likely a direct result of the June 25, 2013 work 

trauma. Appellant underwent surgery for the lateral meniscal tears as conservative treatment had 

failed. Dr. Wallace explained that she was off work for a period of time due to her inability to 

perform her work duties and her inability to drive. 

On November 2, 2018 OWCP referred appellant, together with a SOAF, the medical 

record, and series of questions, to Dr. Willie E. Thompson, a Board-certified orthopedic surgeon, 

for a second opinion evaluation with regard to her work-related conditions, need for surgery, and 

resultant disability. 

Following a preliminary review, by decision dated December 28, 2018, OWCP’s hearing 

representative set aside the October 4, 2018 decision and remanded the case for further 

development of the evidence with regard to whether the acceptance of the claim should be 

expanded to include bilateral knee osteoarthritis, chondromalacia, and meniscus tears. The hearing 

representative noted that if OWCP determined that expansion of the acceptance of the claim was 

warranted, it must then consider whether the April 4, 2014 surgery was medically necessary due 

to an accepted employment condition, and whether the accepted conditions caused any additional

periods of disability. 

In a report dated December 7, 2018, Dr. Thompson noted appellant’s history of injury and 

medical treatment. He noted that she related that her condition had improved, but that she 

continued to have right knee and left ankle pain and swelling. Dr. Thompson reported examination 

findings for both knees demonstrated full bilateral range of motion, no joint line tenderness, no 

joint effusion, negative Lachman’s and McMurrary tests, negative posterior and anterior drawer 

signs, and well healed bilateral knee arthroscopic wounds. His review of the hospital emergency 

triage note dated June 27, 2013 indicated a right knee contusion while the recorded history 

contained no mention of any right knee complaint. Based on examination findings and record 

review, Dr. Thompson concluded that there was insufficient documentation to support any right 

or left knee injury due to the June 25, 2013 fall. He determined that there was no need for any 

additional treatment for the left ankle or bilateral knee conditions. Dr. Thompson also opined that 

there was no aggravation of a preexisting condition as the record was devoid of any evidence 

supporting the existence of a preexisting condition. He opined that there was no evidence that the 

diagnosed right knee meniscal tear and resulting surgery and bilateral knee chondromalacia and 

osteoarthritis had been caused or aggravated by the accepted June 25, 2013 employment injury. 

Additionally, Dr. Thompson found no evidence of any work-related disability and concluded that

appellant was capable of returning to work without restrictions. 

By decision dated January 30, 2019, OWCP denied appellant’s request for expansion of 

her claim to include bilateral knee patellae chondromalacia and right knee lateral meniscal tear. It 

also denied authorization for right arthroscopic knee surgery performed on April 4, 2014 and 

resulting disability for the period April 16 through May 2, 2014. 

On February 7, 2019 appellant, through counsel, requested a telephonic hearing before a 

representative of OWCP’s Branch of Hearings and Review, which was held on June 6, 2019. 
5

By decision dated August 20, 2019, OWCP’s hearing representative set aside the 

January 30, 2019 decision, finding that a conflict in medical opinion existed between Dr. Wallace, 

appellant’s treating physician, and Dr. Thompson, OWCP’s second opinion physician, regarding 

whether appellant sustained bilateral knee conditions causally related to the June 25, 2019 

employment injury, whether surgery was necessitated, and whether any resultant disability should 

be compensated. The case was therefore remanded for referral for an impartial medical 

examination to resolve the conflict. 

On September 12, 2019 OWCP referred appellant, together with a SOAF, the medical 

record, and series of questions, to Dr. Richard H. Conant, a Board-certified orthopedic surgeon

serving as the impartial medical examiner (IME), for resolution of the conflict in the medical 

opinion evidence. 

In a report dated October 21, 2019, Dr. Conant noted his review of the SOAF and

appellant’s medical records. He described the June 25, 2013 employment injury and noted that 

she was unable to recall any prior knee conditions. Dr. Conant recounted appellant’s medical 

history, reviewed diagnostic reports, and provided findings on physical examination. Examination 

of appellant’s extremities revealed a nonantalgic gait pattern, standing bilateral genu valgum, and 

bilateral knee anteromedial and anterolateral joint line tenderness with no effusion, patellofemoral 

crepitus, or instability. Bilateral knee range of motion was 110 degrees left knee flexion and 100 

degrees right knee flexion. Dr. Conant opined that the June 25, 2013 injury did not cause or 

aggravate any meniscal tears and did not aggravate or accelerate or contribute in any progression 

to appellant’s preexisting osteoarthritis, chondromalacia patellae, or any bilateral knee 

degenerative condition. He attributed the bilateral meniscal tears to the natural progression of her 

preexisting bilateral knee osteoarthritis. Thus, Dr. Conant concluded that there was no medical 

necessity for any surgical procedure or any future medical treatment for bilateral knee conditions. 

In support of his conclusion, he noted that there was no mention of any left knee complaints and 

right knee examination findings revealed 90 degrees of motion and a small abrasion during the 

June 25 and 27, 2013 emergency room visits. In addition, the first mention of left knee 

degenerative joint narrowing was first noted on August 14, 2013 and left knee medial meniscal 

tear on August 28, 2013. Dr. Conant further explained that the lateral meniscal findings in the 

operative notes of March 21 and April 1, 2014, and April 25, 2019 clearly demonstrated 

preexisting arthritic findings, which Dr. Wallace referenced in his report. He opined that appellant 

was not disabled from work due to the accepted conditions. 

By decision dated December 20, 2019, OWCP denied expansion of the acceptance of 

appellant’s claim to include bilateral knee chondromalacia patellae, osteoarthritis, and meniscal 

tears. It also denied authorization for right arthroscopic knee surgery performed on April 4, 2014 

and resulting disability for the period April 16 through May 2, 2014. 

On January 6, 2020 appellant, through counsel, requested a telephonic hearing before a

representative of OWCP’s Branch of Hearings and Review, which was held on May 18, 2020. 

By decision dated July 22, 2020, OWCP’s hearing representative affirmed the 

December 20, 2019 decision. 
6

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.5

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

evidence.6 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.7 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.8

Section 8123(a) of FECA which provides that, if there is disagreement between the 

physician making the examination for the United States and the physician of the employee, OWCP 

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

shall make an examination.9 This is called a referee examination and OWCP will select a physician 

who is qualified in the appropriate specialty and who has no prior connection with the case.10 

When there exist opposing medical reports of virtually equal weight and rationale and the case is 

referred to an IME for the purpose of resolving the conflict, the opinion of such specialist, if 

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

weight.11

ANALYSIS -- ISSUE 1

The Board finds that appellant has not met her burden of proof to establish that the 

acceptance of her claim should be expanded to include bilateral knee chondromalacia patellae, 

osteoarthritis, and meniscal tears as causally related to her accepted June 25, 2013 employment 

injury.

OWCP properly determined that, a conflict in medical evidence existed between 

appellant’s treating physician, Dr. Wallace, who opined that the diagnosed bilateral knee 

conditions were employment related, and Dr. Thompson, who determined that the diagnosed 

bilateral knee conditions were nonwork related. It properly referred appellant to Dr. Conant for 

an impartial medical examination to resolve the conflict, pursuant to 5 U.S.C. § 8123(a).

5 D.H., Docket No. 19-9687 (issued March 31, 2021); J.R., Docket No. 20-0292 (issued June 26, 2020); Jaja K. 

Asaramo, 55 ECAB 200 (2004).

6 D.H., id.; E.W., Docket No. 20-0338 (issued October 9, 2020).

7 D.H., id.; L.P., Docket No. 20-0609 (issued October 15, 2020); Leslie C. Moore, 52 ECAB 132 (2000).

8 D.H., id.; J.L., Docket No. 20-0717 (issued October 15, 2020); James Mack, 43 ECAB 321 (1991).

9 5 U.S.C. § 8123(a); L.S., Docket No. 19-1730 (issued August 26, 2020); M.S., 58 ECAB 328 (2007).

10 20 C.F.R. § 10.321; P.B., Docket No. 20-0984 (issued November 25, 2020); R.C., 58 ECAB 238 (2006).

11 See Y.I., Docket No. 20-0263 (issued November 30, 2020); Darlene R. Kennedy, 57 ECAB 414 (2006).
7

In an October 21, 2019 report, Dr. Conant described the June 25, 2013 work injury and 

noted that appellant denied the existence of any preexisting knee conditions. He attributed her

bilateral meniscal tears to the natural progression of her preexisting bilateral knee osteoarthritis. 

Dr. Conant explained that the record was devoid of any left knee complaints during the June 25 

and 27, 2013 emergency room visit and that the lateral meniscal findings in the operative notes of 

March 21 and April 1, 2014, and April 25, 2019 clearly demonstrated preexisting arthritic findings 

as referenced by Dr. Wallace in his report. Thus, he concluded that there was no evidence of 

bilateral knee conditions causally related to the accepted June 25, 2013 employment injury.

The Board finds that Dr. Conant accurately described the accepted employment injury and 

noted his review of the medical record. Dr. Conant performed a thorough clinical examination 

and provided detailed findings. He provided a rationalized opinion regarding whether appellant’s 

claim should be expanded, finding that there was no evidence to find causal relationship between 

bilateral knee conditions and the accepted employment injury.12 Dr. Conant’s opinion, as set forth 

in his October 21, 2019 report, constitutes probative and reliable evidence. The Board, therefore, 

finds that his opinion is entitled to the special weight accorded to an IME with regard to the issue 

of whether acceptance of appellant’s claim should be expanded to include additional bilateral knee 

conditions.13 Consequently, appellant has not met her burden of proof to expand the acceptance

of her claim.

LEGAL PRECEDENT -- ISSUE 2

Section 8103(a) of FECA provides for the furnishing of services, appliances, and supplies 

prescribed or recommended by a qualified physician which OWCP, under authority delegated by 

the Secretary, considers likely to cure, give relief, reduce the degree or the period of disability, or 

aid in lessening the amount of monthly compensation.14 In interpreting section 8103(a), the Board 

has recognized that OWCP has broad discretion in approving services provided under FECA to 

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

amount of time.15 OWCP has administrative discretion in choosing the means to achieve this goal 

and the only limitation on OWCP’s authority is that of reasonableness. 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, a 

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

12 See F.A., Docket No. 20-1652 (issued May 21, 2021); R.R., Docket No. 19-0086 (issued February 10, 2021); see 

also D.S., Docket No. 18-0353 (issued February 18, 2020).

13 F.A., id.; W.C., Docket No. 19-1740 (issued June 4, 2020); M.M., Docket No. 16-1655 (issued April 4, 2018).

14 5 U.S.C. § 8103(a); see A.N., Docket No. 20-0320 (issued March 31, 2021); M.P., Docket No. 19-1557 (issued 

February 24, 2020); M.B., 58 ECAB 588 (2007).

15 Id. at § 8103.

16 A.N., supra note 14; E.L., Docket No. 17-1445 (issued December 18, 2018); L.W., 59 ECAB 471 (2008); P.P., 

58 ECAB 673 (2007); Daniel J. Perea, 42 ECAB 214 (1990).
8

effects of an employment-related injury or condition.17 Causal relationship requires supporting 

rationalized medical evidence.18 Therefore, in order to prove that, a procedure is warranted, a 

claimant must establish that the procedure was for a condition causally related to the employment 

injury and that the procedure was medically warranted. Both of these criteria must be met in order 

for OWCP to authorize payment.19

ANALYSIS -- ISSUE 2

The Board finds that OWCP properly denied authorization for the right arthroscopic knee

surgery performed on April 4, 2014.

As found above, OWCP properly found a conflict in the medical opinion evidence relating 

to whether appellant’s claim should be expanded to include bilateral knee patellae chondromalacia

and right knee lateral meniscal tear. In his October 21, 2019 report, Dr. Conant, the IME, opined 

that the acceptance of her claim should not be expanded to include bilateral knee conditions 

causally related to her accepted employment injury and that right knee arthroscopic surgery was 

not necessary or appropriate to treat her accepted work-related conditions. His opinion is entitled 

to the special weight accorded to an IME with regard to the issue of authorization for the right 

arthroscopic knee surgery performed on April 4, 2014.

20

 As the conditions for which surgery was 

requested are not employment related, the procedure was not medically warranted.21 Thus, the 

Board finds that OWCP has not abused its discretion by denying appellant authorization for the 

April 4, 2014 right arthroscopic knee surgery.

LEGAL PRECEDENT -- ISSUE 3

An employee seeking benefits under FECA22 has 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.

23

 The term disability is 

defined as the incapacity, because of an employment injury, to earn the wages the employee was 

receiving at the time of the injury.24 For each period of disability claimed, the employee has the 

17 See A.N., id.; L.S., Docket No. 18-1746 (issued April 9, 2019); Kennett O. Collins, Jr., 55 ECAB 648, 654 (2004).

18 A.N., id.; K.W., Docket No. 18-1523 (issued May 22, 2019).

19 Id.

20 Supra note 11.

21 Id.

22 Supra note 2.

23 See C.B., Docket No. 20-0629 (issued May 26, 2021); 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; see also Amelia S. Jefferson, 57 ECAB 

183 (2005); Nathaniel Milton, 37 ECAB 712 (1986).

24 20 C.F.R. § 10.5(f); A.N., supra note 14; S.T., Docket No. 18-0412 (issued October 22, 2018); Cheryl L. 

Decavitch, 50 ECAB 397 (1999).
9

burden of proof to establish that he or she was disabled from work as a result of the accepted 

employment injury.25

Whether a particular injury causes an employee to become disabled from work, and the 

duration of that disability, are medical issues that must be proven by a preponderance of the 

reliable, probative, and substantial medical evidence. The Board will not require OWCP to pay 

compensation for disability in the absence of medical evidence directly addressing the specific 

dates of disability for which compensation is claimed. To do so would essentially allow an 

employee to self-certify his or her disability and entitlement to compensation.26

ANALYSIS -- ISSUE 3

The Board finds that appellant has not met her burden of proof to establish entitlement to 

disability from work during the period April 16 through May 2, 2014, causally related to the 

accepted June 25, 2013 employment injury.

On May 3, 2017 appellant filed a claim for compensation (Form CA-7) for disability from 

work during the period April 16 through May 2, 2014. OWCP’s hearing representative, in the 

August 20, 2019 decision, properly determined that a conflict in medical opinion existed between

Dr. Wallace, appellant’s treating physician, and Dr. Thompson, OWCP’s second opinion 

physician, regarding whether appellant sustained bilateral knee conditions causally related to the 

June 25, 2019 employment injury, whether surgery was necessitated, and whether any resultant 

disability should be compensated. On September 12, 2019 OWCP properly referred appellant, 

together with a SOAF, the medical record, and series of questions, to Dr. Conant for resolution of 

the conflict in the medical opinion evidence. 

In a report dated October 21, 2019, Dr. Conant noted his review of the SOAF and medical 

record, and opined that the June 25, 2013 injury did not cause or aggravate any meniscal tears and 

did not aggravate or accelerate or contribute in any progression to appellant’s preexisting 

osteoarthritis, chondromalacia patellae, or any bilateral knee degenerative condition. Rather, he 

attributed the bilateral meniscal tears to the natural progression of her preexisting bilateral knee 

osteoarthritis. Dr. Conant, therefore, opined that there was no need for surgery and no disability 

due to the accepted employment injury. 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.27 Therefore, Dr. Conant’s 

opinion constitutes the special weight of the medical evidence.

The case record contains an April 1, 2014 note, wherein Dr. Wallace explained that 

appellant was unable to work until further notice due to recent left knee surgery and due to her 

right knee surgery which was scheduled for April 2, 2014. He released her to return to work on 

June 2, 2014. In a September 19, 2018 report, Dr. Wallace diagnosed bilateral knee 

chondromalacia patellae. He noted that appellant related having no knee conditions or symptoms 

prior to her June 25, 2013 fall. Dr. Wallace explained that she underwent surgery for lateral 

meniscal tears and was off work for a period of time due to her inability to perform her work duties 

25 See A.N., supra note 14; D.G., Docket No. 18-0597 (issued October 3, 2018); Amelia S. Jefferson, supra note 23.

26 W.C., Docket No. 19-1740 (issued June 4, 2020); J.B., Docket No. 19-0715 (issued September 12, 2019).

27 James Mack, 43 ECAB 321 (1991).
10

and her inability to drive. He, however, did not provide sufficient rationale explaining causal 

relationship between the claimed disability during the period April 16 through May 2, 2014 and 

the accepted employment injury. The Board has held that a report is of limited probative value 

regarding causal relationship if it does not contain sufficient medical rationale explaining how the 

claimed disability was causally related to the accepted employment injury.28 Dr. Wallace’s 

September 19, 2018 report is, therefore, of diminished probative value and insufficient to meet 

appellant’s burden of proof. 

As the medical evidence of record is insufficient to establish disability from work during 

the period April 16 through May 2, 2014 causally related to the accepted employment injury, the

Board finds that appellant has not met her 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.

CONCLUSION

The Board finds that appellant has not met her burden of proof to establish that the 

acceptance of her claim should be expanded to include bilateral knee osteoarthritis, 

chondromalacia, and meniscal tears as causally related to the accepted June 25, 2013 employment 

injury. The Board further finds that OWCP properly denied her authorization for an April 4, 2014 

right knee arthroscopic surgery. The Board also finds that appellant has not met her burden of 

proof to establish disability from work during the period April 16 through May 2, 2014 causally 

related to the accepted June 25, 2013 employment injury.

28 See Y.D., Docket No. 16-1896 (issued February 10, 2017) (finding that a report is of limited probative value 

regarding causal relationship if it does not contain medical rationale describing the relation between work factors and 

a diagnosed condition/disability).
11

ORDER

IT IS HEREBY ORDERED THAT the July 22, 2020 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: February 17, 2023

Washington, DC

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board