United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

S.H., Appellant

and

U.S. POSTAL SERVICE, WEST CHESTER 

PROCESSING & DISTRIBUTION CENTER, 

White Plains, NY, Employer

__________________________________________

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Docket No. 21-0987

Issued: September 1, 2023

Appearances: Case Submitted on the Record

Aaron Aumiller, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

PATRICIA H. FITZGERALD, Deputy Chief Judge

JANICE B. ASKIN, Judge

JURISDICTION

On June 15, 2021 appellant, through counsel, filed a timely appeal from a December 17, 

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 December 17, 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 OWCP properly denied appellant’s request for authorization 

of her September 5, 2017 left knee surgery; and (2) whether appellant has met her burden of proof 

to establish a recurrence of disability, commencing August 31, 2017, causally related to her 

accepted August 1, 2009 employment injury.

FACTUAL HISTORY

On August 2, 2009 appellant, then a 38-year-old mail processing clerk, filed an 

occupational disease claim (Form CA-2) alleging thatshe sustained right foot pain due to factors 

of her federal employment. She noted that she first became aware of her condition and realized 

its relation to her federal employment on August 1, 2009. OWCP accepted the claim for 

aggravation of right tarsal tunnel syndrome, right ankle sprain, and consequential left knee internal 

derangement and left knee torn lateral meniscus. Appellant underwent OWCP-authorized right 

foot surgery (tarsal tunnel release) on December 2, 2010 and authorized left knee surgery 

(arthroscopy for partial lateral meniscectomy and chondroplasty of patellofemoral compartment 

and medial femoral condyle) on November 25, 2015. OWCP paid her wage-loss compensation 

until her return to a full-time modified duty on May 15, 2017.

On January 12, 2017 OWCP referred appellant, along with the medical record, a series of 

questions, and a statement of accepted facts to Dr. Stanley Askin, a Board-certified orthopedic 

surgeon serving as OWCP’s second opinion physician, to determine appellant’s work capacity and 

need for medical treatment.

In a January 30, 2017 report, Dr. Askin noted that appellant returned to work on January 8, 

2014 working four hours a day. He reported his examination findings and opined that she could 

work a full-time sedentary position with restrictions of no more than 1 hour of walking and/or

standing; no more than 2 hours of operating a motor vehicle at work; and no more than 1 hour with 

10 pounds of squatting, kneeling, and/or climbing. Regarding appellant’s left knee, Dr. Askin

noted that she had developed degenerative changes in her weight-bearing joints, which was a 

disease not an injury. He indicated that her arthritic condition had been accepted as work related 

and that she had not fully recovered from the effects of the injury. Dr. Askin noted that, if the knee 

arthritis was intolerable, then a total knee arthroplasty was the only effective management. He

indicated that he was not recommending a total knee replacement, but was merely stating that

arthroplasty was the current standard of care for appellant’s condition. Dr. Askin additionally 

noted that he did not believe that she was a candidate for surgical treatment of her hip, low back,

or feet. 

On July 13, 2017 OWCP requested that Dr. Askin clarify his opinion regarding appellant’s 

left knee condition and surgical recommendation, noting that left knee osteoarthritis/arthritis was 

not part of the accepted claim. 

In a July 24, 2017 addendum report, Dr. Askin indicated that he had understood that 

appellant’s left knee osteoarthritis/arthritis was not an accepted part of the claim and that he had 

specifically noted that the arthritis was “independent of cause.” He additionally noted that his 

answer continues to be “no” in response to the question whether her claim should be expanded to 

include any additional work-related conditions. Dr. Askin explained that osteoarthritis/arthritis 

was a disease rather than an injury. Thus, he did not consider that the claim should be expanded 
3

to include any additional work-related conditions. Consequently, there was no need to contemplate 

whether appellant’s subsequently developed arthritic condition was caused, aggravated, 

accelerated, or precipitated as it was not work related in any matter. 

In a July 24, 2017 report, Dr. Joshua Lehman, an osteopathic physician Board-certified in 

family medicine, noted appellant’s work-related injury, that she had undergone right tarsal tunnel 

release, and that she had slowly developed left knee pain secondary to compensation with 

subsequent arthroscopic surgery on her left knee. He noted that she had returned to work and that 

she ambulated with a cane. Dr. Lehman reported his examination findings and provided an 

assessment of acute left knee meniscal tear and right tarsal tunnel syndrome. He indicated that 

appellant had instability in herleft knee with severe arthritis and that she could tolerate a sedentary 

job, but had a hard time getting to and from her job and was at a high risk of falling. Dr. Lehman 

also indicated that she could not perform any prolonged standing due to increased pain and 

weakness in her right leg.

On August 15, 2017 OWCP received requests for authorization for additional left knee 

surgery. Evidence received in support of the surgical request included June 28 and July 29, 2017

diagnostic reports and an August 2, 2017 preoperative report from Dr. Gwo Chin Lee, a Boardcertified orthopedic surgeon. In his August 2, 2017 report, Dr. Chin Lee related an impression of

left knee degenerative arthritis with degenerative medial and lateral complex tears of the lateral 

meniscus and medial meniscus, and status postmeniscectomy. He noted that appellant’s left knee 

conditions were an acute exacerbation of a work injury, which caused displacement of the tears.

In an August 15, 2017 letter, OWCP advised appellant that the requested additional left 

knee surgery could not be authorized as the medical evidence of record did not establish the 

medical necessity for the requested procedure. It afforded her 30 days to submit additional 

evidence. 

Appellant subsequently filed a Form CA-2a notice of recurrence, dated August 14, 2017,

claiming wage-loss compensation and medical treatment due to a change or worsening of her 

accepted work-related conditions. She noted a recurrence date of July 28, 2017 and that she 

stopped work on August 31, 2017. 

In another August 2, 2017 progress report, Dr. Lee reported that appellant fell almost on a 

daily basis and that she had recently fallen because her knee suddenly buckled from twisting. He 

provided an impression of degenerative arthritis of the left knee with degenerative medial and 

lateral meniscal tears “causing mechanical symptoms, acute exacerbation following a work injury 

causing displacement of the tears.” Dr. Lee recommended an arthroscopy to eliminate some of the 

mechanical symptoms, noting that appellant would still be limited by arthritis symptoms in the 

future. 

On August 24, 2017 Dr. Lee reported that it was medically necessary for appellant to

undergo a left knee arthroscopy for meniscal debridement. He noted that the July 28, 2017 

magnetic resonance imaging (MRI) scan showed complex left knee lateral meniscus tear and 

evidence of synovitis and that her August 2, 2017 examination revealed significant effusion and 

lateral and medial joint line tenderness. Dr. Lee advised that, while appellant had evidence of 

some mild cartilage loss, the goal of surgery was to diminish her mechanical symptoms and to 

prevent her from suffering due to her knee pain and buckling. He also noted that she had 

undergone a course of physical therapy which was unsuccessful. 
4

OWCP also received a May 11, 2017 report from Dr. Laura E. Ross, an osteopathic 

physician Board-certified in orthopedic surgery. Dr. Ross recommended that appellant consult 

with Dr. Lee for unicompartmental arthroplasty of the left knee which she opined that was 

medically necessary and causally related to the work injury. She also recommended that appellant 

remain off work. 

In an August 29, 2017 development letter, OWCP advised appellant of the deficiencies of 

her recurrence claim. It advised her of the type of medical evidence needed to support her 

recurrence claim and afforded her 30 days to respond. 

OWCP also received a July 29, 2017 MRI scan of appellant’s left knee. 

In an August 15, 2017 report, Dr. Ross diagnosed left knee complex posterior horn of the 

medial meniscus with Baker’s cyst and recommended that appellant undergo further evaluation 

for proposed arthroscopic surgery with Dr. Lee. She noted that appellant’s recommended work 

status was full-time full duty. 

In an August 28, 2017 report, Dr. Lehman noted that appellant ambulated with a cane. He 

reported examination findings and provided an assessment of acute left knee lateral meniscal tear 

and right tarsal tunnel syndrome. Dr. Lehman indicated that appellant had instability in her left 

knee with severe arthritis and that she could only tolerate a sedentary job; however, she was at 

high risk of falling. He also indicated that she was a good candidate for left knee arthroscopic 

surgery. With regard to the right tarsal tunnel syndrome, Dr. Lehman indicated that appellant 

could not perform any prolonged standing with her job secondary to increased chronic pain and 

weakness in the right lower extremity. 

On September 5, 2017 appellant underwent an unauthorized left knee arthroscopic surgery 

performed by Dr. Lee. 

By decision dated October 10, 2017, OWCP denied appellant’s recurrence claim, finding 

that the medical evidence of record was insufficient to establish disability from work due to a 

material change/worsening of her accepted work-related conditions. It noted that her work 

restrictions were outlined in Dr. Askin’s January 30, 2017 second opinion report, butthatDr. Ross 

had recommended on August 15, 2017 that appellant could perform full-time full-duty work. 

OWCP also found that the recommended left knee surgery appeared to be due to her arthritis, and 

not the accepted conditions. Thus, it was unclear as to why appellant stopped work, and why the 

surgery was work related. 

By separate decision dated October 10, 2017, OWCP denied appellant’s request for 

authorization of additional left knee surgery. It found that the evidence of record did not support 

that the requested left knee surgery was medically necessary to address the effects of her August 1, 

2009 employment injury as it was for treatment of arthritis and not for an accepted work-related 

condition. 

On October 13, 2017 appellant, through counsel, requested an oral hearing before a

representative of OWCP’s Branch of Hearings and Review. 

In an August 30, 2017 report, Dr. Lee noted his findings on examination and diagnosed 

degenerative left knee arthritis and medial meniscus tear. He indicated that appellant’s clinical 
5

symptoms had worsened following a fall. Dr. Lee also provided an August 30, 2017 note wherein 

he indicated that she was scheduled for surgery on September 5, 2017 and would be unable to 

return to work for four weeks thereafter. 

A hearing was held on March 8, 2018. By decision dated April 12, 2018, OWCP’s hearing 

representative affirmed both October 10, 2017 decisions. 

On January 29, 2019 appellant, through counsel, requested reconsideration and submitted 

additional medical evidence. 

A September 5, 2017 surgical report documented appellant’s left knee arthroscopy, which

was performed by Dr. Lee. The arthroscopy involved loose body removal, partial lateral 

meniscectomy, and debridement chondroplasty of unstable cartilage flap of the femoral condyle. 

In an October 10, 2018 report, Dr. Lee summarized appellant’s examination findings and 

his impressions since she began treatment for her left knee on June 28, 2017. He noted that her 

mechanical symptoms caused several falls and that her July 29, 2017 MRI scan revealed prior 

surgical changes, osteoarthritis of the knee, and a complex lateral meniscal tear worse compared 

to prior imaging in July 2016. Dr. Lee indicated that appellant underwent a repeat left knee 

arthroscopy for lateral meniscus tear on September 5, 2017 per his recommendation. He opined 

that, while she could not return to her prior work duties, which required significant periods of 

standing and driving, she could perform sedentary work so long as periodic stretching to alleviate 

joint stiffness was allowed. Dr. Lee stated that, while appellant had undergone prior left knee 

surgery and history of meniscal tears and osteoarthritis, she did not have any symptoms and was 

working until her fall. He stated that the fall did not cause the arthritis or tear, but exacerbated her 

conditions to the point that they became symptomatic. Dr. Lee opined that appellant’s fall had 

exacerbated her preexisting left knee arthritis and worsened her lateral meniscus tear and resulted 

in the need for subsequent arthroscopy. 

By decision dated October 9, 2019, OWCP denied modification of its April 12, 2018 

decision.

On September 18, 2020 appellant, through counsel, requested reconsideration. 

In an August 24, 2020 report, Dr. Joshua B. Macht, a Board-certified internist, explained 

that the purpose of appellant’s September 5, 2017 procedure was to clean up left knee degenerative 

changes of the lateral meniscus, degenerative changes of the articular cartilage, and to remove a 

loose body that had developed due to degeneration of the bone. He noted her accepted conditions

and opined that the procedure was causally related to the August 1, 2009 incident as it sought to 

correct “internal derangement” of the left knee that developed in accelerated fashion due to 

favoring the right ankle which was directly injured in the August 1, 2009 work-related incident. 

Dr. Macht indicated that appellant’s initial left knee problems developed as a compensatory injury 

from favoring her right ankle and underwent an accelerated progression due to continued favoring 

of the right ankle and by the performance of her routine work duties. He indicated that her

symptoms gradually progressed in severity which led to additional surgical intervention. 

Dr. Macht opined that appellant was temporarily totally disabled at the time of surgery and the 

postoperative recovery period. 

By decision dated December 17, 2020, OWCP denied modification of its prior decision. 
6

LEGAL PRECEDENT -- ISSUE 1

Section 8103 of FECA4 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.5 In interpreting this section of FECA, the 

Board has recognized that OWCP has broad discretion in approving services provided under 

section 8103, and the only limitation on OWCP’s authority is that of reasonableness.6 Abuse of 

discretion is 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.7

While OWCP is obligated to pay for treatment of employment-related conditions, appellant 

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 to prove that the procedure is 

warranted, appellant 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.10

ANALYSIS -- ISSUE 1

The Board finds that OWCP properly denied appellant’s request for authorization of her 

September 5, 2017 left knee surgery.

In the present case, OWCP accepted that appellant sustained an aggravation of right tarsal 

tunnel syndrome, right ankle sprain, and consequential left knee internal derangement and left knee 

torn lateral meniscus. Appellant underwent OWCP-authorized left knee surgery (arthroscopy for 

partial lateral meniscectomy and chondroplasty of patellofemoral compartment and medial 

femoral condyle) on November 25, 2015. The Board finds that OWCP properly found that she

had not submitted rationalized medical evidence establishing that her September 5, 2017 left knee 

4

Supra note 2.

5

5 U.S.C. § 8103(a);see L.K., Docket No. 18-1183 (issued May 12, 2020); M.P., Docket No. 19-1557 (issued 

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

6 B.I., Docket No. 18-0988 (issued March 13, 2020);see also Daniel J. Perea, 42 ECAB 214, 221 (1990) (holding 

that abuse of discretion by OWCP is generally shown through proof of manifest error, clearly unreasonable exercise 

of judgment, or administrative actions which are contrary to both logic, and probable deductions from established 

facts).

7

See D.S., Docket No. 18-0353 (issued May 18, 2020);P.L., Docket No. 18-0260 (issued April14, 2020); L.W., 

59 ECAB 471 (2008).

8

See R.M., Docket No. 19-1319 (issued December 10, 2019); Debra S. King, 44 ECAB 209 (1992).

9 B.I., supra note 6; see also K.W., Docket No. 18-1523 (issued May 22, 2019); Bertha L. Arnold, 38 ECAB 

282 (1986).

10 See T.A., Docket No. 19-1030 (issued November 22, 2019); Cathy B. Millin, 51 ECAB 331, 333 (2000).
7

arthroscopic procedure was medically necessary and causally related to the accepted employment 

injury.11 

In his July 24, 2017 report, Dr. Askin related that appellant’s arthritis was “independent of 

cause” as it was a disease not an injury, therefore, there was no need to consider whether her

arthritic condition was caused, accelerated, or precipitated by her work-related injury. The Board 

finds that he sufficiently responded to OWCP’s request for clarification. In his combined reports,

Dr. Askin reviewed appellant’s history of injury and treatment along with the medical and 

diagnostic reports in her record. He also performed a physical examination and provided a 

rationalized explanation that her left knee arthritic condition was a disease and was, therefore, not 

due to her accepted injury. Accordingly, Dr. Askin’s opinion is sufficiently rationalized and 

constitutes the weight of the medical evidence.12 

In his August 2, 24, and 30, 2017 reports, Dr. Lee related that appellant’s left knee 

conditions of degenerative arthritis with degenerative medial and lateral complex tears of the 

lateral meniscus and medial meniscus, and status postmeniscectomy were an acute exacerbation 

of a work injury which caused displacement of the tears, he did not provide medical rationale 

which explained how the work injury caused an acute exacerbation of her degenerative knee 

arthritis and displacement of the tears. Furthermore, he described the lateral meniscal tear as 

progressive, but offered no rationale as to how a worsening lateral meniscal tear was attributable 

to her accepted employment injury. The Board has held that conclusory opinions are insufficient 

to meet a claimant’s burden of proof.13 In his October 10, 2018 report, Dr. Lee noted that, while 

appellant had undergone prior left knee surgery and had a history of meniscal tears and 

osteoarthritis, she was asymptomatic and working prior to her fall. He concluded that her fall 

exacerbated her arthritic and tear conditions to the point that they became symptomatic. However, 

the Board has held that an opinion that a condition is causally related to an employment incident 

simply because the employee was asymptomatic before the injury, is insufficient, without adequate 

rationale, to establish causal relationship.14 Consequently, Dr. Lee’s reports lacks probative value 

regarding the issue of whether the requested procedure was medically necessary due to the 

accepted employment injury.15 

In her May 11, 2017 report, Dr. Ross opined that the recommended unicompartmental 

arthroplasty of appellant’s left knee was medically necessary and causally related to the work 

injury. This opinion, however, is conclusory as she did not provide medical rationale explaining 

how the additional knee surgery was causally related to the accepted August 1, 2009 employment 

11 See A.K., Docket No. 22-1213 (issued April 27, 2023); P.S., Docket No. 20-0075 (issued July 12, 2021).

12 S.K, Docket No. 22-0950 (issued June23, 2023); T.K.,Docket No. 18-1239 (issued May 29, 2019); M.W., 57 

ECAB 710 (2006); John D. Jackson, 55 ECAB 465 (2004).

13 D.R., Docket No. 21-1056 (issued April 13, 2023); J.O., Docket No. 19-0326 (issued July 16, 2019).

14 See D.V., Docket No. 21-1259 (issued March 15, 2022); S.D.,Docket No. 20-1255 (issued February 3, 2021);

F.H., Docket No. 18-1238 (issued January 18, 2019).

15 M.P., Docket No. 19-1557 (issued February 24, 2020); M.M., Docket No. 19-0563 (issued August 1, 2019); N.G., 

Docket No. 18-1340 (issued March 6, 2019).
8

injury.16 Consequently, Dr. Ross’ report is insufficient to establish that the requested surgical 

procedure is causally related to the accepted employment injury.17

In a July 24, 2017 report, Dr. Lehman noted that appellant had slowly developed left knee 

pain secondary to compensation for her right ankle condition. While he provided an assessment 

of acute left meniscal tear and indicated that she had instability in her knee with severe arthritis, 

he offered no rationalized opinion explaining the cause of her conditions. Dr. Lehman’s report is,

therefore, insufficient to establish the requested surgical procedure is causally related to the 

accepted employment injury.18 

In an August 24, 2020 report, Dr. Macht advised that the purpose of appellant’s 

September 5, 2017 procedure was to clean up degenerative changes of the left lateral meniscus 

and articular cartilage and to remove a loose body that had developed due to degeneration of the 

bone. He opined that the September 5, 2017 procedure was causally related to the August 1, 2009 

incident as it sought to correct “internal derangement”of the left knee that developed in accelerated 

fashion due to favoring the right ankle which was directly injured in the August 1, 2009 incident. 

Dr. Macht, however, failed to explain the pathophysiological process of how the accepted 

employment injury contributed to the acceleration of appellant’s degenerative changes.19 

Therefore, he failed to provide a clear rationalized medical opinion and his opinion is 

insufficient.20

The record also contains several diagnostic studies. However, the Board has held that

diagnostic studies, standing alone, lack probative value as they do not address whether the 

employment incident caused any of the diagnosed conditions. 21 

The only limitation on OWCP’s authority to authorize medical treatment is one of 

reasonableness.22 As the medical evidence does not establish that appellant’s September 5, 2017

left knee surgery was medically necessary and causally related to the accepted conditions under 

this claim, the Board finds that OWCP acted reasonably in denying her request for surgical 

authorization.

16 P.S., supra note 11; J.O., Docket No. 19-0326 (issued July 16, 2019).

17 P.S., id.; N.G., Docket No. 18-1340 (issued March 6, 2019).

18 The Board has held that medical evidence that does not offer an opinion regarding the cause of an employee’s 

condition is of no probative value on the issue of causalrelationship. See C.R., Docket No. 23-0330 (issued July 28, 

2023); S.J., Docket No. 19-0696 (issued August23, 2019); M.C., Docket No. 18-0951 (issued January 7, 2019); L.B., 

Docket No. 18-0533 (issued August 27, 2018); D.K., Docket No. 17-1549 (issued July 6, 2018).

19 J.D., Docket No. 19-1953 (issued January 11, 2021); J.C., Docket No. 18-1474 (issued March 20, 2019); M.M., 

Docket No. 15-0607 (issued May 15, 2015); M.W., Docket No. 14-1664 (issued December 5, 2014).

20 R.L., Docket No. 23-0098 (issued June 20, 2023); A.S., Docket No. 19-1955 (issued April9, 2020); C.H., Docket 

No. 19-0409 (issued August 5, 2019).

21 See C.S., Docket No. 22-0545 (issued March 22, 2023); H.E., Docket No. 22-1129 (issued December 16, 2022); 

M.S., Docket No. 22-0586 (issued July 12, 2022); C.B., Docket No. 20-0464 (issued July 21, 2020).

22 D.C., Docket No. 20-0854 (issued July 19, 2021);C.L., Docket No. 17-0230 (issued April24, 2018);D.K., supra

note 18.
9

LEGAL PRECEDENT -- ISSUE 2

A recurrence of disability means an inability to work after an employee has returned to 

work, caused by a spontaneous change in a medical condition which resulted from a previous 

compensable injury or illness and without an intervening injury or new exposure in the work 

environment.23 This term also means an inability to work because a light-duty assignment made 

specifically to accommodate an employee’s physical limitations, and which is necessary because 

of a work-related injury or illness, is withdrawn or altered so that the assignment exceeds the 

employee’s physical limitations. Absent a change or withdrawal of a light-duty assignment, a 

recurrence of disability following a return to light duty may be established by showing a change 

in the nature and extent of the injury-related condition such that the employee could no longer 

perform the light-duty assignment.24

When an employee claims a recurrence of disability due to an accepted employmentrelated injury, he or she has the burden of proof to establish that the recurrence for which he or she 

claims compensation is causally related to the original injury.25 This burden of proof requires that 

a claimant furnish medical evidence from a qualified physician who concludes that the recurrent 

disability is causally related to employment injury.26 The physician’s opinion must be based on a 

complete and accurate factual and medical history and it must be supported by sound medical 

reasoning.27 Where no such rationale is present, the medical evidence is of diminished probative 

value.28

ANALYSIS -- ISSUE 2

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

disability, commencing August 31, 2017, causally related to her accepted August 1, 2009 

employment injury. 

Dr. Lehman opined in his August 28, 2017 report, that appellant could tolerate a sedentary 

job without any prolonged standing due to increased pain and weakness in her right leg. He,

however, offered no explanation that she had objective findings from her accepted right tarsal 

tunnel syndrome which caused total disability as of August 31, 2017. The Board has held that a 

report that does not provide an opinion on causal relationship is of no probative value.

29

 

Dr. Lehman’s report is, therefore, insufficient to establish appellant’s recurrence claim. 

23 20 C.F.R. § 10.5(x); J.D., Docket No. 18-1533 (issued February 27, 2019).

24 R.H., Docket No. 21-0717 (issued June 12, 2023); G.L., Docket No. 16-1542 (issued August 25, 2017);

Theresa L. Andrews, 55 ECAB 719, 722 (2004). See also Albert C. Brown, 52 ECAB 152 (2000); Terry R. Hedman, 

38 ECAB 222 (1986).

25 H.T., Docket No. 17-0209 (issued February 8, 2019); S.S., 59 ECAB 315, 218-19 (2008).

26 Id.

27 Id.

28 E.M., Docket No. 19-0251 (issued May 16, 2019);MaryA. Ceglia, Docket No. 04-0113 (issued July 22, 2004).

29 See L.B. and D.K. supra note 18.
10

Dr. Ross, in her August 15, 2017 report, had opined that appellant’s work status should be 

full-time full duty. She, therefore, negated a finding that appellant was totally disabled due to a 

recurrence of disability as of August 31, 2017.30

As the medical evidence of record is insufficient to establish a recurrence of disability 

commencing August 31, 2017 causally related to the accepted August 1, 2009 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 OWCP properly denied appellant’s request for authorization of her 

September 5, 2017 left knee surgery. The Board further finds that she has not met her burden of 

proof to establish a recurrence of disability, commencing August 31, 2017, causally related to her 

accepted August 1, 2009 employment injury. 

ORDER

IT IS HEREBY ORDERED THAT the December 17, 2020 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: September 1, 2023

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

30 Id.