United States Department of Labor

Employees’ Compensation Appeals Board

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K.D., Appellant

and

DEPARTMENT OF THE NAVY, MARINE 

CORPS AIR STATION, Cherry Point, NC, 

Employer

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Docket No. 23-0799

Issued: December 19, 2023

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

JANICE B. ASKIN, Judge

JAMES D. McGINLEY, Alternate Judge

JURISDICTION

On May 10, 2023 appellant filed a timely appeal from a February 2, 2023 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

ISSUE

The issue is whether OWCP properly denied authorization for right knee arthroscopy.

1

5 U.S.C. § 8101 et seq.

2 The Board notes that, following the February 2, 2023 decision, appellant submitted additional evidence to OWCP. 

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

FACTUAL HISTORY

On October 15, 2010 appellant, then a 58-year-old transportation assistant, filed a traumatic 

injury claim (Form CA-1) alleging that on October 13, 2010 she heard a pop in her right knee, 

experienced immediate and severe pain when descending stairs while in the performance of duty. 

By decision dated November 17, 2020, OWCP accepted the claim for tear of medial meniscus of

right knee, tear of lateral meniscus of right knee, and chondromalacia patellae of the right knee.

Appellant stopped work on the date of injury and returned to work on November 17, 2010. On 

December 17, 2010 she underwent OWCP-approved right knee arthroscopy.3 On October 31, 

2011 OWCP expanded the acceptance of the claim to include and localized primary osteoarthritis, 

lower leg, right.

On January 19, 2023 OWCP referred the case record and a statement of accepted facts 

(SOAF) to Dr. Arthur S. Harris, a Board-certified orthopedic surgeon serving as OWCP’s district 

medical adviser (DMA), for review and an opinion on whether the right knee arthroplasty proposed 

by Dr. Brian B. Battersby, an orthopedic surgeon, was medically warranted and causally related 

to the accepted, work-related medical conditions.

In a memorandum dated January 23, 2023, Dr. Harris reviewed the medical record and 

SOAF. He noted the medical records document appellant’s treatment for a work-related injury 

including right knee arthroscopic synovectomy, cartilaginous drilling of the trochlear groove, 

abrasion arthroplasty, and partial lateral meniscectomy on December 17, 2010. Dr. Harris noted 

that appellant developed right knee osteoarthritis, which has remained symptomatic, and on 

October 7, 2021 had a right knee intra-articular injection. He further explained that there were no 

reports documenting appellant’s response to this injection or the need for any additional treatment, 

documenting appellant’s conservative care before proceeding with surgery or results of diagnostic 

studies demonstrating the extent of osteoarthritis or joint space narrowing. Dr. Harris advised that

the case file did not contain any reports documenting the need for right total knee arthroplasty. He 

concluded that there was insufficient information in the reviewed medical records as there were no 

reports documenting appellant’s response to the intra-articular injection, diagnostic studies 

demonstrating the extent of osteoarthritis and joint space narrowing, or recommendations with 

request for authorization for right total knee arthroplasty.

By decision dated February 2, 2023, OWCP denied appellant’s request for authorization 

for right knee arthroplasty. It found that the medical evidence of record was insufficient to 

establish that the procedure was medically necessary to treat the effects of her accepted workrelated conditions.

LEGAL PRECEDENT

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

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

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

3 Appellant voluntarily retired on December 31, 2010. 
3

aid in lessening the amount of monthly compensation.4 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.5 It therefore has broad administrative discretion in choosing means to achieve 

this goal. The only limitation on OWCP’s authority is that of reasonableness.6 

In order to be entitled to reimbursement for medical expenses, a claimant must establish 

that the expenditures were incurred for treatment of the effects of an employment-related injury 

by submitting rationalized medical evidence that supports such a connection and demonstrates that 

the treatment is necessary and reasonable.7 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.8 

Proof of causal relationship in a case such as this must include supporting rationalized medical 

evidence.9 In order for a surgical procedure to be authorized, a claimant must submit evidence to 

show that the surgery is for a condition causally related to an employment injury and that it is 

medically warranted. Both of these criteria must be met in order for OWCP to authorize 

payment.10

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. 11

ANALYSIS

The Board finds that OWCP properly denied authorization for right knee arthroplasty.

The Board finds that appellant failed to provide a medical report from her physician 

indicating the medical necessity for the surgery as it relates to her accepted work -related 

conditions. The record reflects that appellant underwent a prior right knee arthroscopy in 2010. 

However, the record is void of information from a qualified physician indicating why a total right 

knee arthroplasty is needed for treatment of her accepted work-related conditions. 

4

5 U.S.C. § 8103(a).

5

See Dale E. Jones, 48 ECAB 648, 649 (1997).

6 D.C., Docket No. 18-0080 (issued May 22, 2018); Mira R. Adams, 48 ECAB 504 (1997).

7 R.M., Docket No. 19-1319 (issued December 10, 2019); J.T., Docket No. 18-0503 (issued October 16, 2018); 

Debra S. King, 44 ECAB 203 (1992).

8 Kennett O. Collins, Jr., 55 ECAB 648, 654 (2004).

9 M.B., 58 ECAB 588 (2007).

10 J.L., Docket No. 18-0990 (issued March 5, 2019); R.C., 58 ECAB 238 (2006).

11 E.L., Docket No. 17-1445 (issued December 18, 2018); L.W., 59 ECAB 471 (2008); P.P., 58 ECAB 673 (2007).
4

In a report dated January 23, 2023, Dr. Harris, serving as the DMA, reviewed the medical 

record and SOAF. He noted that the case file did not contain any reports from a physician 

documenting the need for right total knee arthroplasty. Dr. Harris concluded that there was 

insufficient information in the medical record as there were no reports documenting appellant’s 

response to intra-articular injections, diagnostic studies demonstrating the extent of osteoarthritis 

and joint space narrowing, or recommendations with request for authorization for right total knee 

arthroplasty. As he provided a well-reasoned opinion explaining that appellant had not met the 

criteria needed for approval of the proposed right knee arthroplasty, Dr. Harris’ opinion represents 

the weight of the medical evidence.12 Thus, the Board finds that OWCP has not abused its 

discretion by denying appellant authorization for right arthroplasty. 13

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 OWCP properly denied authorization for right knee arthroplasty.

12 See A.S., Docket No. 19-0745 (issued October 10, 2019); M.M., Docket No. 19-0491 (issued August 14, 2019); 

N.M., Docket No. 18-1584 (issued March 15, 2019).

13 M.S., Docket No. 22-0113 (issued June 7, 2022).
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ORDER

IT IS HEREBY ORDERED THAT the February 2, 2023 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: December 19, 2023

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

James D. McGinley, Alternate Judge

Employees’ Compensation Appeals Board