United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

W.C., Appellant

and

U.S. POSTAL SERVICE, WOODSTOCK POST 

OFFICE, Woodstock, IL, Employer

__________________________________________

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Docket No. 19-1740

Issued: June 4, 2020

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

CHRISTOPHER J. GODFREY, Deputy Chief Judge

JANICE B. ASKIN, Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On August 16, 2019 appellant filed a timely appeal from March 1 and 15 and April 15, 

2019 merit decisions 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.

ISSUES

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

to wage-loss compensation for the period December 8, 2018 through January 18, 2019 and 

January 19 through February 1, 2019 causally related to the December 5, 2016 employment injury; 

and (2) whether appellant has met his burden of proof to establish that the acceptance of his claim 

should be expanded to include an additional right knee condition as a consequence of the

December 5, 2016 employment injury. 

 

1 5 U.S.C. § 8101 et seq.
2

FACTUAL HISTORY

On December 8, 2016 appellant, then a 54-year-old mail carrier, filed a traumatic injury 

claim (Form CA-1) alleging that on December 5, 2016 he injured his right foot and ankle after his 

foot gave way when stepping on a curb as he was delivering mail while in the performance of duty. 

OWCP accepted his claim for right ankle sprain. Appellant stopped work on December 5, 2016 

and worked intermittently thereafter.

On February 1, 2017 the employing establishment offered appellant a part-time limitedduty position as a city carrier associate effective January 24, 2017. On January 31, 2017 appellant 

accepted the position and returned to work.

Appellant filed a claim for compensation (Form CA-7) requesting intermittent 

compensation for disability for four hours per day beginning January 21, 2017. 

On February 24, 2017 appellant filed a notice of recurrence (Form CA-2a) for disability 

alleging that, after returning to part-time limited-duty work on February 6, 2017, he experienced 

right knee pain causally related to the accepted December 5, 2016 employment injury. He asserted 

that the manner in which he walked due to his right ankle injury caused him to overcompensate 

and injure his right knee. Appellant stopped work on February 13, 2017.

In a development letter dated March 3, 2017, OWCP notified appellant of the definition of 

a recurrence of disability and informed him of the type of evidence necessary to establish his 

recurrence claim. It afforded appellant 30 days to submit additional evidence.

By decision dated April 26, 2017, OWCP denied appellant’s wage-loss compensation

claim finding that the medical evidence of record failed to establish that he was disabled as a result 

of the accepted work-related medical conditions. It explained that it had not accepted a right knee 

condition and that compensation benefits for disability could not be paid for a condition not 

accepted as work related.

Reports from Dr. Robert T. Nixon, Jr., a Board-certified orthopedist, dated December 19, 

2016 to January 30, 2017, noted treatment for right ankle pain after a twisting injury at work on 

December 6, 2016. He diagnosed right ankle sprain and right Achilles tendinitis and 

recommended a controlled ankle movement (CAM) walker boot, physical therapy, and sedentary 

work. Dr. Nixon continued to treat appellant from February 27 to April 14, 2017 for right knee 

pain. He diagnosed right knee meniscal tear and opined that appellant’s right knee was injured at 

the time of his ankle injury. Dr. Nixon recommended arthroscopic surgery. In a duty status report 

(Form CA-17) dated March 17, 2017, he again diagnosed right knee meniscus tear and opined that 

appellant required right knee surgery. Dr. Nixon returned him to sedentary work. 

A magnetic resonance imaging (MRI) scan of the right knee dated March 10, 2017 revealed 

thickening and signal abnormality of the anterior cruciate ligament (ACL) compatible with old 

avulsion injury and mucinous degeneration, attenuation of the medial meniscus surgery, and 

arthritis from degenerative joint disease (DJD)/osteoarthritis (OA), medial worse than lateral.

In a report dated April 18, 2017, Dr. Nathan Hammel, a Board-certified orthopedic surgeon 

serving as a district medical adviser (DMA), reviewed the statement of accepted facts (SOAF) and 
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medical records. He noted that appellant sought authorization for an arthroscopy and 

meniscectomy for the right knee. The DMA opined that there was no causal relationship between 

the accepted right ankle sprain and the proposed arthroscopy and meniscectomy of the right knee. 

He noted that the MRI scan did not demonstrate clear evidence of a meniscal tear, appellant had

not reported symptoms suggestive of a tear, he had a prior history of right knee arthroscopy, and 

he was obese. The DMA further opined that the proposed surgical procedures were not medically 

necessary.

By decision dated May 25, 2017, OWCP denied appellant’s claim for a recurrence of 

disability finding that the medical evidence he submitted failed to establish that his accepted 

December 5, 2016 employment injury had worsened to the extent that he was disabled from his 

work duties.

On June 22, 2017 appellant, through his then counsel, requested an oral hearing before an 

OWCP hearing representative which was held on November 17, 2017.

In a June 19, 2017 report, Dr. Nixon noted that appellant sustained a work-related right 

ankle injury on December 5, 2016. He indicated that appellant was prescribed a CAM walker boot 

for his ankle condition and reported experiencing increasing right knee pain with use of the boot. 

Dr. Nixon advised that the right knee injury was causally related to the ankle injury as it had been 

aggravated due to the sprain and the use of the CAM walker boot. In reports dated October 23, 

2017, he noted that after wearing the CAM walker boot for the right ankle appellant developed 

increasing right knee pain. Dr. Nixon advised that appellant had prior treatment for right patella 

femoral arthritic changes and the most recent MRI scan revealed chondromalacia and an 

abnormality of the meniscus. 

By decision dated January 26, 2018, OWCP’s hearing representative vacated the April 26 

and May 25, 2017 decisions and remanded the case for further medical development. She 

determined that appellant submitted sufficient medical evidence from Dr. Nixon supporting that 

he injured his right knee or aggravated a preexisting right knee condition causally related to the 

December 5, 2016 employment injury and that further development was merited. The hearing 

representative instructed OWCP to refer appellant for a second opinion evaluation.

On February 13, 2018 OWCP referred appellant, the case file, a SOAF, and a series of 

questions to Dr. Mysore S. Shivaram, a Board-certified orthopedic surgeon, for a second opinion 

examination and an opinion on appellant’s employment-related conditions and disability.

Appellant continued to submit reports from Dr. Nixon dated from January 24 to March 28, 

2018, in which he diagnosed right knee pain, probable meniscal tear, patellofemoral 

chondromalacia, and right ankle pain. Dr. Nixon opined that appellant’s right knee injury was 

causally related to his accepted ankle injury and recommended right knee arthroscopic surgery.

In a March 5, 2018 medical report, Dr. Shivaram described appellant’s December 5, 2016

employment injury, noting that he stepped on a curb and slipped injuring his right ankle. He 

diagnosed mild right ankle sprain, sprain of the right Achilles tendon, both resolved, and 

degenerative arthritis of the right knee and right big toe. Dr. Shivaram indicated that appellant had 

no complaints of right knee symptoms until two and a half months following the ankle injury at 
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work. He further noted that MRI scan findings demonstrated significant degenerative changes 

involving the medial compartment and patellofemoral joint of the right knee suggesting a 

preexisting right knee condition. Dr. Shivaram opined that, based on the available medical records,

appellant sustained a mild sprain of the right ankle and right Achilles tendon which should have 

resolved by March 5, 2017. He determined appellant’s right knee problems were unrelated to the 

December 5, 2016 employment injury. In an addendum report, Dr. Shivaram opined that the use 

of a CAM walker was not responsible for the onset of right knee pain. He noted appellant’s 

symptoms were secondary to preexisting degenerative arthritis of the right knee and there was 

insufficient evidence to support that the CAM boot contributed to the knee condition. 

Dr. Shivaram opined that there was no relationship between the employment injury and the right 

knee condition.

In a letter dated June 12, 2018, OWCP advised appellant that a conflict in medical opinion 

existed between Dr. Shivaram, OWCP’s second opinion examiner, and Dr. Nixon, appellant’s 

treating physician, regarding whether the right knee condition was causally related to the 

December 5, 2016 employment injury. It referred him, along with the case record, a list of 

questions, and a SOAF, to Dr. David A. Fetter, a Board-certified orthopedic surgeon, for an 

impartial medical examination. 

In reports dated April 25 to August 29, 2018, Dr. Nixon noted that appellant remained 

symptomatic with right knee pain on posterior lateral and anteromedial aspect of the knee. He 

diagnosed right knee medial meniscus tear and right knee chondromalacia and again recommended 

arthroscopic surgery.

On August 17, 2018 the employing establishment offered appellant a sedentary limitedduty position for five hours a day. Appellant accepted the position. 

In a September 6, 2018 report, Dr. Fetter described a history of the December 5, 2016 

employment injury, noted his review of the medical reports, and reported appellant’s continued 

complaints. Upon physical examination of appellant’s lower extremity there was mild antalgic 

gait, negative effusion and swelling of either knee, no right ankle instability, and intact motor and 

sensory examination of the lower extremities other than global decreased right foot sensation. 

Dr. Fetter noted that x-rays of the knees and ankles revealed degenerative changes. He reported 

diagnoses of right ankle sprain resolved, preexistent degenerative right knee condition not caused 

by the employment injury, and right gastrocnemius muscle weakness, etiology undetermined. 

Dr. Fetter opined that appellant sustained a temporary work-related right ankle sprain which 

resolved on March 5, 2017. He concluded that appellant’s right knee condition was not related to 

the December 5, 2016 employment injury. Dr. Fetter returned appellant to work regular duty 

without restrictions.

OWCP subsequently received a July 7, 2015 operative report from Dr. Nixon, who 

performed an arthroscopy of the right knee with chondroplasty and limited synovectomy. He

provided post-surgical diagnoses of right knee patellofemoral chondromalacia and right knee 

synovitis. 

On July 27, 2018 Dr. Nixon noted that appellant presented with persistent right knee pain 

localized in the posterolateral and anterior aspect of the knee. He diagnosed right knee pain with 
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patellofemoral chondromalacia and possible meniscus tear. Dr. Nixon provided work restrictions 

of primarily sedentary work due to limitations on standing and walking. He recommended 

arthroscopic surgery.

In a September 26, 2018 report, Dr. Nixon treated appellant for right knee pain, slightly 

improved since the last visit. He reported standing and walking limits which prevented him from 

his full activities. Dr. Nixon diagnosed right knee medial meniscus tear and right knee 

chondromalacia and again recommended arthroscopic surgery. 

Appellant was treated by Dr. Dana Tarandy, a Board-certified orthopedist, on October 23, 

2018 who returned him to full-duty work on November 3, 2018. Dr. Tarandy noted that appellant 

was scheduled to have surgery on November 21, 2018 and would be off work for 8 to 12 weeks. 

On January 18, 2019 appellant filed a Form CA-7 for disability from work for four hours 

per day for the period December 8, 2018 through January 18, 2019. He filed a Form CA-7 for 

disability from work for four hours per day for the period January 19 through February 1, 2019. 

In development letters dated January 29 and February 12, 2019, OWCP requested that 

appellant submit additional information to support his claim for compensation beginning 

December 8, 2018, including medical evidence establishing that his partial disability was due to 

the accepted condition for the period claimed. It afforded him 30 days to respond. No additional 

evidence was received.

By decision dated March 1, 2019, OWCP denied appellant’s claim for compensation for 

the period December 8, 2018 through January 18, 2019. It indicated that on January 29, 2019 he

was instructed to submit medical evidence supporting disability during the period claimed within 

30 days, but he failed to respond. 

By decision dated March 15, 2019, OWCP denied appellant’s claim for compensation for 

the period January 19 through February 1, 2019. It indicated that on February 12, 2019 he was 

instructed to submit medical evidence supporting disability during the period claimed within 30 

days, but he failed to respond. 

By decision dated April 15, 2019, OWCP denied appellant’s request to expand the 

acceptance of his claim to include a right knee condition finding the special weight of medical 

evidence rested with the opinion of Dr. Fetter, the impartial medical examiner, who opined in a 

September 6, 2018 report that the right knee condition was not causally related to the December 5, 

2016 employment injury. 

LEGAL PRECEDENT -- ISSUE 1

An employee seeking benefits under FECA2 has the burden of proof to establish the 

essential elements of his or her claim by the preponderance of the evidence.3 Under FECA the 

 

2

Id.

3 M.C., Docket No. 18-0919 (issued October 18, 2018); Amelia S. Jefferson, 57 ECAB 183 (2005); see also 

Nathaniel Milton, 37 ECAB 712 (1986).
6

term disability means incapacity, because of an employment injury, to earn the wages that the 

employee was receiving at the time of injury.4 For each period of disability claimed, the employee 

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

employment injury.5 Whether a particular injury caused an employee to be disabled from 

employment and the duration of that disability are medical issues which must be proven by the 

preponderance of the reliable, probative, and substantial medical evidence.6

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.7

ANALYSIS -- ISSUE 1

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

wage-loss compensation for the periods December 8, 2018 through January 18, 2019 and

January 19 through February 1, 2019 causally related to the accepted December 5, 2016 

employment injury. 

In support of his claim appellant submitted reports from Dr. Nixon dated December 19, 

2016 to September 26, 2018. Dr. Nixon diagnosed right ankle sprain, right knee medial meniscus 

tear, and right knee chondromalacia and recommended arthroscopic surgery. Appellant also 

submitted an October 23, 2018 report from Dr. Tarandy who noted that he could return to work 

full duty on November 3, 2018. Dr. Tarandy also noted that appellant was scheduled to have 

surgery on November 21, 2018 and would be off work for 8 to 12 weeks. These reports lack

probative value in addressing appellant’s claimed period of disability commencing December 8, 

2018 as they predate the claimed period and do not specifically address or attribute the period of 

disability to the accepted right ankle sprain.

8

 Evidence that does not address his accepted 

conditions and dates of disability is insufficient to establish his claim.9

Appellant has not submitted other medical evidence to support that his claimed periods of 

disability were due to the accepted ankle condition related to his December 5, 2016 employment

 

4 A.S., Docket No. 17-2010 (issued October 12, 2018); S.M., 58 ECAB 166 (2006); Bobbie F. Cowart, 55 ECAB 

746 (2004); 20 C.F.R. § 10.5(f).

5 K.C., Docket No. 17-1612 (issued October 16, 2018); William A. Archer, 55 ECAB 674 (2004).

6 S.G., Docket No. 18-1076 (issued April 11, 2019); Fereidoon Kharabi, 52 ECAB 291, 292 (2001).

7

J.B., Docket No. 19-0715 (issued September 12, 2019).

8 D.J., Docket No. 18-0200 (issued August 12, 2019); V.G., Docket No. 17-1425 (issued February 16, 2018).

9 T.L., Docket No. 18-0934 (issued May 8, 2019); Sandra D. Pruitt, 57 ECAB 126 (2005).
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injury. Therefore, the Board finds that he has not met his burden of proof to establish his wageloss compensation claim.

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LEGAL PRECEDENT -- ISSUE 2

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.11 

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.12 A physician’s opinion on whether there is a causal relationship 

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

factual and medical background.13 Additionally, the physician’s opinion must be expressed in 

terms of a reasonable degree of medical certainty, and must be supported by medical rationale, 

explaining the nature of the relationship between the diagnosed condition and appellant’s specific 

employment factor(s).14

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 a claimant’s own intentional misconduct.15 Thus, a subsequent 

injury, be it an aggravation of the original injury or a new and distinct injury, is compensable if it 

is the direct and natural consequence of a compensable primary injury.16

FECA provides that if there is disagreement between an OWCP-designated physician and 

the employee’s physician, OWCP shall appoint a third physician who shall make an examination.17 

For a conflict to arise the opposing physicians’ viewpoints must be of virtually equal weight and 

rationale.18 Where OWCP has referred the case to an impartial medical examiner to resolve a 

 

10 See K.A., Docket No. 17-1718 (issued February 12, 2018).

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

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

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

14 Id.

15 See S.M., Docket No. 19-0397 (issued August 7, 2019); Mary Poller, 55 ECAB 483, 487 (2004); 1 Arthur Larson 

& Lex K. Larson, The Law of Workers’ Compensation 10-1 (2006).

16 A.T., Docket No. 18-1717 (issued May 10, 2019); Susanne W. Underwood (Randall L. Underwood), 53 ECAB 

139 (2001).

17 5 U.S.C. § 8123(a); see 20 C.F.R. § 10.321; Shirley L. Steib, 46 ECAB 309, 317 (1994).

18 Darlene R. Kennedy, 57 ECAB 414, 416 (2006).
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conflict in the medical evidence, the opinion of such a specialist, if sufficiently well reasoned and 

based upon a proper factual background, must be given special weight.19

ANALYSIS -- ISSUE 2

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

acceptance of his claim should be expanded to include an additional right knee condition as a 

consequence of the accepted December 5, 2016 employment injury. 

OWCP determined that a conflict in the medical opinion evidence was created between

Dr. Nixon, appellant’s treating physician, who opined that appellant’s diagnosed right knee 

condition should be included in his claim, and Dr. Shivaram, OWCP’s referral physician, who 

concluded that there was no medical evidence to support a causal relationship between the 

December 5, 2016 employment injury and an additional right knee condition. It properly referred 

appellant to Dr. Fetter for an impartial medical examination in order to resolve the conflict in 

medical evidence, pursuant to 5 U.S.C. § 8123(a). 

In a September 6, 2018 report, Dr. Fetter noted his review of the SOAF and the medical 

record. He related appellant’s continued complaints of right ankle and right knee pain. Upon 

examination of appellant’s lower right extremity, Dr. Fetter observed mild antalgic gait, negative 

effusion and swelling of the bilateral knees, no right ankle instability, and intact motor and sensory 

examination of the lower extremities except for decreased right foot sensation. He noted that a 

right knee x-ray examination revealed degenerative changes in the right knee. Dr. Fetter diagnosed 

right ankle sprain resolved, preexistent degenerative right knee condition not caused by work 

injury, and right gastrocnemius muscle weakness, etiology undetermined. He concluded that the 

preexistent degenerative right knee condition was not causally related to the December 5, 2016

employment injury.

The Board finds that Dr. Fetter’s opinion is entitled to the special weight of the medical 

opinion evidence and establishes that appellant’s right knee condition was not causally related to 

the accepted December 5, 2016 employment injury. Dr. Fetter accurately described the 

employment injury and noted his review of the medical record, including the SOAF. He performed 

a thorough, clinical examination and provided findings on examination. Dr. Fetter noted that 

x-rays of the right knee revealed preexisting degenerative changes not causally related to the 

December 5, 2016 employment injury. The Board concludes that Dr. Fetter’s opinion is entitled 

to the special weight accorded an impartial medical examiner with regard to the issue of whether 

the acceptance of appellant’s claim should be expanded to include a right knee condition.20 As 

such, appellant has not met his burden of proof to expand the accepted conditions of his claim. 

Following Dr. Fetter’s report, appellant submitted a September 26, 2018 report from

Dr. Nixon who diagnosed right knee medial meniscus tear and right knee chondromalacia and 

recommended arthroscopic surgery. Similarly, an October 23, 2018 report from Dr. Tarandy noted 

 

19 Gary R. Sieber, 46 ECAB 215, 225 (1994).

20 See M.M., Docket No. 16-1655 (issued April 4, 2018); D.G., Docket No. 17-0608 (issued March 19, 2018). 
9

that appellant was scheduled to have surgery on November 21, 2018 and would be off work for 8

to 12 weeks. However, these reports are insufficient to establish the claim as the physicians did 

not specifically address whether appellant’s employment activities had caused or aggravated a 

diagnosed right knee condition.21 Additionally, Dr. Nixon was on one side of the conflict resolved 

by Dr. Fetter. The Board has held that reports from a physician who was on one side of a medical 

conflict are generally insufficient to overcome the special weight accorded to the IME, or to create 

a new conflict.22 Dr. Nixon’s report is thus insufficient to overcome the special weight accorded 

to Dr. Fetter’s opinion or to create a new conflict in medical opinion.23

On appeal appellant asserts that he submitted sufficient medical evidence supporting

disability for the period claimed. As explained above, he failed to submit rationalized medical 

evidence establishing a causal relationship between the specific period of claimed disability and 

the accepted conditions. 

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 entitlement to 

wage-loss compensation for the periods December 8, 2018 through January 18, 2019 and 

January 19 through February 1, 2019 causally related to the accepted December 5, 2016 

employment injury. The Board further finds that appellant has not met his burden of proof to 

establish that the acceptance of his claim should be expanded to include an additional right knee 

condition as a consequence of the accepted December 5, 2016 employment injury. 

 

21 A.D., 58 ECAB 149 (2006) (medical evidence which does not offer any opinion regarding the cause of an 

employee’s condition is of limited probative value on the issue of causal relationship). 

22 See S.S., Docket No. 17-1361 (issued January 8, 2018); Jaja K. Asaramo, 55 ECAB 200 (2004); Michael Hughes, 

52 ECAB 387 (2001).

23 See S.S., id.; K.R., Docket No. 16-0542 (issued December 21, 2016).
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ORDER

IT IS HEREBY ORDERED THAT the April 15 and March 1 and 15, 2019 decisions of 

the Office of Workers’ Compensation Programs are affirmed.

Issued: June 4, 2020

Washington, DC

Christopher J. Godfrey, 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