United States Department of Labor

Employees’ Compensation Appeals Board

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G.M., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Detroit, MI, Employer

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Docket No. 22-0730

Issued: October 26, 2022

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

PATRICIA H. FITZGERALD, Deputy Chief Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On April 4, 2022 appellant filed a timely appeal from a February 17, 2022 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.

ISSUE

The issue is whether appellant has met his burden of proof to establish a medical condition 

causally related to the accepted factors of his federal employment.

FACTUAL HISTORY

On September 23, 2020 appellant, then a 66-year-old city carrier, filed an occupational 

disease claim (Form CA-2) alleging that he had “bone on bone” arthritis in both knees due to 

factors of his federal employment, including carrying mail for 43 years, daily ascending and 

1

5 U.S.C. § 8101 et seq.
2

descending stairs, mounting and dismounting his postal vehicle while picking up parcels and mail 

tubs weighing 70 pounds or more. He noted that he first became aware of his claimed injury on 

August 3, 2020 and realized its relation to his federal employment on September 9, 2020. On the 

reverse side of the claim form, appellant’s supervisor, M.M., indicated that appellant did not 

inform management of any on-the-job injury on August 3, 2020 but instead first reported his 

condition on September 23, 2020. Appellant stopped work on September 8, 2020. 

In support of his claim, appellant submitted a September 7, 2020 work excuse note bearing 

an illegible signature indicating that he should be off work for one week.

In a September 9, 2020 work excuse note, Dr. Donald F. Garver, a Board-certified 

orthopedic surgeon, indicated that appellant could return to full-duty work on September 14, 2020. 

On September 16, 2020 he extended the out of work period until October 19, 2020. 

In a development letter dated September 24, 2020, OWCP informed appellant of the 

deficiencies of his claim. It explained the type of additional evidence required and provided a 

questionnaire for his completion. OWCP afforded appellant 30 days to respond. 

Appellant subsequently submitted a September 9, 2020 medical note, in which Dr. Garver 

indicated that appellant was having trouble with his knees, with more pain on the left than the 

right. Dr. Garver noted that, x-rays demonstrated that appellant’s right knee looked worse than 

the left, both knees were down to the bone medially, there was some fluid on the left, but the bump 

on the inside was appellant’s vastus medialis obliques, and he had bone-on-bone on the medial 

side of his knees. He administered an intra-articular injection to appellant’s left knee. Dr. Garver 

indicated concern that appellant’s knees would wear out quickly and noted that appellant might 

soon be in need of a total knee replacement or unicompartmental replacement. He opined that, as 

appellant had worn out both knees and had no family history, appellant’s condition was probably 

related to his work activities over the past 40 years, including carrying mail. Dr. Garver held 

appellant off work until September 13, 2021. He saw appellant for a follow-up appointment on 

September 16, 2020 and indicated that appellant underwent an ultrasound, which showed that he 

still had fluid in his knee. Dr. Garver drew out fluid from the knee and administered an intraarticular injection. He held appellant of work until October 19, 2021. Dr. Garver noted that 

appellant “has worked 43 years and I think [appellant’s] knees are just worn down.”

In an October 1, 2020 form report, Dr. Garver indicated that he had treated appellant for 

an ongoing, chronic condition that rendered him unable to perform his job functions such as 

standing, walking, bending, twisting, or squatting for any period of time. He noted that appellant 

had left knee pain and swelling. Dr. Garver advised that appellant was disabled from work from 

approximately September 9 through October 19, 2020. He additionally indicated that appellant 

would need time for follow-up treatment and that his condition could cause flare-ups of severe 

pain making it hard to stand and walk, which could necessitate absence from work. 

By decision dated November 3, 2020, OWCP denied appellant’s traumatic injury claim, 

finding that the medical evidence submitted was insufficient to establish causa l relationship 

between his diagnosed condition and the accepted factors of his federal employment.
3

On July 22, 2021 appellant requested reconsideration. He asserted that a July 7, 2021 

report of Dr. Garver provided “unequivocal evidence” that his injury occurred in the performance 

of duty on August 3, 2020. 

In his July 7, 2021 report, Dr. Garver explained that he had treated appellant for several 

years prior and that he had undergone a left total knee arthroplasty on February 26, 2021. He noted 

that appellant had struggled with degenerative arthritis of both knees for some time and underwent 

a meniscectomy over 20 years ago. Since the meniscectomy, appellant had been treated 

conservatively. However, Dr. Garver opined that appellant’s activity level as a mail carrier led to 

excessive deterioration of his knees, leading to his present condition of needing left knee 

replacement, as well his right knee being in varus and showing extensive wear on the medial joint 

space. Imaging showed that appellant was down to the bone on the medial side of his right knee, 

which would require future surgery. Dr. Garver explained that appellant had lost articular cartilage 

on multiple surfaces of both knees. He diagnosed bilateral knee osteoarthritis and opined, based 

on his over 40 years of experience as an orthopedic surgeon, that appellant’s prolonged walking, 

excessive steps, and carrying excessive weights at times “certainly precipitated and likely 

exacerbated the symptoms of [appellant’s] present condition.” Dr. Garver further opined that 

appellant’s condition “is absolutely the result of the excessive wear and tear” of appellant’s 43 

years as a mail carrier. He added that, in people, such as appellant, with no genetic history of 

degenerative arthritis, the occurrence of the condition is a result of overactivity and the number of 

steps walked during their lifetime.

By decision dated September 1, 2021, OWCP denied modification of the November 3, 

2020 decision. 

Appellant requested reconsideration. He asserted that a November 4, 2021 report of

Dr. Garver provided “unequivocal evidence” that his injury occurred in the performance of duty 

on August 3, 2020. 

In his November 4, 2021 report, Dr. Garver reiterated that appellant’s bilateral knee pain 

was caused by severe arthritic change in both knees and that appellant had no family history of 

arthritis. He asserted that, given the lack of family history, “there must be some other convening 

circumstances to cause such a radical change in both knees.” Dr. Garver described appellant’s 

employment duties during appellant’s 43 years as a letter carrier, including carrying up to 30 

pounds of mail in his satchel, lifting packages up to 70 pounds, walking on deteriorating and 

uneven sidewalks, and going up and down several hundred steps each day in all types of weather. 

He stated that, while he could not opine whether appellant’s federal employment caused his 

bilateral knee osteoarthritis, in his professional opinion to a reasonable degree of medical certainty,

“the conditions of [appellant’s] employment did in many ways exacerbate the osteoarthritis to the 

state that it is today.”

By decision dated February 17, 2022, OWCP denied modification of the September 1, 

2021 decision. 
4

LEGAL PRECEDENT

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

essential elements of his or her claim, including the fact that the individual is an employee of the 

United States within the meaning of FECA, that the claim was timely filed within the applicable 

time limitation period of FECA,3that an injury was sustained in the performance of duty as alleged, 

and that any disability or medical condition for which compensation is claimed is causally related 

to the employment injury.4 These are the essential elements of each and every compensation claim, 

regardless of whether the claim is predicated upon a traumatic injury or an occupational disease.5

To establish that an injury was sustained in the performance of duty in an occupational 

disease claim, a claimant must submit the following: (1) a factual statement identifying 

employment factors alleged to have caused or contributed to the presence or occurrence of the 

disease or condition; (2) medical evidence establishing the presence or existence of the disease or 

condition for which compensation is claimed; and (3) medical evidence establishing that the 

diagnosed condition is causally related to the identified employment factors. 6

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.7 A physician’s opinion on whether there is causal relationship 

between the diagnosed condition and the implicated employment factor(s) must be based on a 

complete factual and medical background.8 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).9

In any case where a preexisting condition involving the same part of the body is present 

and the issue of causal relationship, therefore, involves aggravation, acceleration, or precipitation, 

2

Id.

3

S.B., Docket No. 17-1779 (issued February 7, 2018); J.P., 59 ECAB 178 (2007); Joe D. Cameron, 41 ECAB 

153 (1989).

4

J.M., Docket No. 17-0284 (issued February 7, 2018); R.C., 59 ECAB 427 (2008); James E. Chadden, Sr., 40 

ECAB 312 (1988).

5 K.M., Docket No. 15-1660 (issued September 16, 2016); L.M., Docket No. 13-1402 (issued February 7, 2014); 

DeloresC. Ellyett, 41 ECAB 992 (1990).

6 R.G., Docket No. 19-0233 (issued July 16, 2019). See also Roy L. Humphrey, 57 ECAB 238, 241 (2005); Ruby I. 

Fish, 46 ECAB 276, 279 (1994); Victor J. Woodhams, 41 ECAB 345 (1989).

7 T.H., 59 ECAB 388, 393 (2008); Robert G. Morris, 48 ECAB 238 (1996).

8 M.V., Docket No. 18-0884 (issued December 28, 2018).

9

Id.; Victor J. Woodhams, supra note 6.
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the physician must provide a rationalized medical opinion that differentiates between the effects 

of the work-related injury or disease and the preexisting condition.10

ANALYSIS

The Board finds that this case is not in posture for decision.

In a report dated July 7, 2021, Dr. Garverrelated appellant’s history of injury and treatment 

and diagnosed bilateral knee osteoarthritis. He explained that appellant’s federal employment 

required prolonged walking, excessive steps, and carrying excessive weights at times, which led 

to excessive deterioration of his knees and loss of articular cartilage on multiple surfaces in both 

knees. Dr. Garver opined that appellant’s condition “is absolutely the result of the excessive wear 

and tear” of appellant’s 43 years as a mail carrier. He added that, in people such as appellant, with 

no genetic history of degenerative arthritis, the occurrence of the condition is a result of 

overactivity, and the number of steps walked during their lifetime. 

In his November 4, 2021 report, Dr. Garver further described appellant’s employment 

duties during his 43 years as a letter carrier, including carrying up to 30 pounds of mail in his 

satchel, lifting packages up to 70 pounds, walking on deteriorating and uneven sidewalks, and 

ascending and descending several hundred steps each day in all types of weather. He clarified

that, in his professional opinion to a reasonable degree of medical certainty, “the conditions of 

[appellant’s] employment did in many ways exacerbate the osteoarthritis to the state that it is 

today.”

The Board finds that Dr. Garver’s July 7 and November 4, 2021 reports are sufficient to 

require further development of the medical evidence. Dr. Garver demonstrated a comprehensive 

understanding of the medical record and case history. His reports explain that appellant’s 

employment duties over 43 years, including prolonged walking, excessive steps, and carrying 

excessive weight exacerbated his diagnosed condition. 

The Board has long held that it is unnecessary that the evidence of record in a case be so 

conclusive as to suggest causal connection beyond all possible doubt. 11 Rather, the evidence 

required is only that necessary to convince the adjudicator that the conclusion drawn is rational, 

sound, and logical.12 Accordingly, the Board finds that Dr. Garver’s medical opinion is sufficient 

to require further development of appellant’s claim.13

It is well established that, proceedings under FECA are not adversarial in nature and, while 

appellant has the burden of proof to establish entitlement to compensation, OWCP shares 

10 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).

11 See D.M., Docket No. 21-0908 (issued March 4, 2022).

12 C.S., Docket No. 19-1809 (issued July 29, 2020); W.M., Docket No. 17-1244 (issued November 7, 2017).

13 See J.H., Docket No. 18-1637 (issued January 29, 2020); D.S., Docket No. 17-1359 (issued May 3, 2019);

WilliamJ. Cantrell, 34 ECAB 1223 (1983).
6

responsibility in the development of the evidence.14 OWCP has an obligation to see that justice is 

done.15

On remand, OWCP shall refer appellant, along with the case record and a statement of 

accepted facts, to a specialist in the appropriate field of medicine for a reasoned opinion regarding 

whether appellant sustained a medical condition causally related to the accepted employment 

factors. If the second opinion physician disagrees with the opinion of Dr. Garver, he or she must 

provide a fully-rationalized explanation of why the accepted employment factors were insufficient 

to have caused or aggravated appellant’s medical condition. After this and other such further 

development of the case record as OWCP deems necessary, it shall issue a de novo decision.

CONCLUSION

The Board finds that this case is not in posture for decision.

ORDER

IT IS HEREBY ORDERED THAT the February 17, 2022 decision of the Office of 

Workers’ Compensation Programs is set aside and the case is remanded for further proceedings 

consistent with this decision of the Board.

Issued: October 26, 2022

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board

14 Id.;see also A.P., Docket No. 17-0813 (issued January 3, 2018); JimmyA. Hammons, 51 ECAB 219, 223 (1999).

15 See B.C., Docket No. 15-1853 (issued January 19, 2016);E.J., Docket No. 09-1481 (issued February 19, 

2010); JohnJ. Carlone, 41 ECAB 354 (1989).