United States Department of Labor

Employees’ Compensation Appeals Board

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K.B., Appellant

and

U.S. POSTAL SERVICE, TROY POST OFFICE, 

Troy, PA, Employer

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Docket No. 21-0953

Issued: October 12, 2022

Appearances: Case Submitted on the Record

Sherry A. Berardinelli, for the appellant

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Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

PATRICIA H. FITZGERALD, Deputy Chief Judge

JAMES D. McGINLEY, Alternate Judge

JURISDICTION

On June 7, 2021 appellant, through his representative, filed a timely appeal from a 

December 23, 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.

ISSUE

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

causally related to the accepted April 12, 2019 employment incident.

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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.

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5 U.S.C. § 8101 et seq.
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FACTUAL HISTORY

On April 15, 2019 appellant, then a 51-year-old rural carrier, filed a traumatic injury claim 

(Form CA-1) alleging that on April 12, 2019, when pushing his mail cart across the employing 

establishment parking lot, he stepped into a hole and his right knee twisted and buckled while in 

the performance of duty. He stopped work on April 12, 2019.

In an April 25, 2019 development letter, OWCP informed appellant of the deficiencies of 

his claim. It advised him as to the type of factual and medical evidence required and provided a 

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

A magnetic resonance imaging (MRI) scan of the right lower extremity dated April 22, 

2019 revealed fissuring in the medial femoral condylar cartilage and a small partially ruptured 

Baker’s cyst. 

In an April 24, 2019 authorization for examination and/or treatment (Form CA-16), the 

employing establishment authorized appellant to seek medical care from Dr. Stephen J. Renzi, a 

Board-certified internist. In Part B of the Form CA-16, attending physician’s report, Dr. Renzi, 

reported that appellant twisted his right knee at work. He diagnosed fissuring in the medial femoral 

condylar cartilage and ruptured Baker’s cyst. Dr. Renzi checked a box marked “Yes” indicating 

that the diagnosed conditions were caused or aggravated by the described employment activity. 

He opined that appellant was totally disabled from work beginning April 13, 2019. 

In an attending physician’s report (Form CA-20) dated April 26, 2019, Dr. Renzi noted

that appellant twisted his right knee while delivering mail on April 12, 2019. He diagnosed right 

knee pain and checked a box marked “Yes” indicating that appellant’s condition had been caused 

or aggravated by an employment activity. Dr. Renzi noted that appellant was totally disabled from 

work beginning April 12, 2019. In a work capacity evaluation (Form OWCP-5c) of even date, he 

noted that appellant was unable to resume work due to right knee pain. In an April 29, 2019 work 

excuse form, Dr. Renzi noted that appellant was off work from April 29 through May 7, 2019 and 

would be reevaluated on May 7, 2019. Similarly, in a note dated May 7, 2019, he opined that 

appellant sustained an injury to his right knee while loading mail into his work vehicle.

On May 6, 2019 Dr. Brett Auerbach, a Board-certified orthopedist, treated appellant for 

right knee pain. Appellant reported a history of two previous right knee arthroscopies in 1987 and 

1993. Findings on examination revealed antalgic gait secondary to right knee pain and tenderness 

of the medial joint line. X-rays of the right knee revealed no acute findings. Dr. Auerbach

diagnosed chondromalacia of the right medial femoral condyle and prescribed a hinged knee brace, 

physical therapy, and modified activity. In a May 6, 2019 note, he advised that appellant was 

totally disabled until a follow-up examination scheduled on June 10, 2019. In a May 15, 2019 

Form CA-20, Dr. Auerbach noted findings of chondromalacia of the right medial femoral condyle 

and checked a box marked “No” indicating that appellant’s condition was not caused or aggravated 

by an employment activity. He noted that appellant was totally disabled from work from May 6 

through June 10, 2019.

On May 15, 2019 appellant responded to the development letter, noting that on April 12, 

2019 he was pushing his mail cart across the parking lot of the employing establishment when he 
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stepped into a hole causing his knee to twist and buckle. He continued on his mail route because 

he thought the pain would resolve, but with each passing hour his knee pain progressed. 

By decision dated May 31, 2019, OWCP denied appellant’s traumatic injury claim, finding 

that the medical evidence submitted was insufficient to establish causal relationship between his 

diagnosed conditions and the accepted April 12, 2019 employment incident.

OWCP received additional evidence. On April 15, 2019 Dr. Renzi treated appellant for 

right knee pain that began at work. Appellant’s history was significant for two prior knee surgeries. 

Findings on examination revealed positive anterior drawer test of the right knee along the medial 

collateral ligament and positive McMurray test. Dr. Renzi diagnosed right knee pain, applied an 

Ace bandage, and excused appellant from work. On April 23 and 29, 2019 he reevaluated 

appellant for worsening right knee pain and swelling. Dr. Renzi diagnosed right knee pain and 

performed a right knee steroid injection on April 23, 2019. 

Dr. Auerbach evaluated appellant on June 5, 2019 for improving right knee pain after a 

work-related injury on April 12, 2019. Appellant reported being asymptomatic for 15 years prior 

to his most recent injury. Dr. Auerbach diagnosed chondromalacia of the right medial femoral 

condyle. He opined to a reasonable degree of medical certainty, the incident described by 

appellant, was the competent medical cause of his injury/illness. Dr. Auerbach advised that, upon 

review of the medical documentation previously submitted, there was a clerical error in which the 

wrong box was checked. He clarified that appellant’s condition appeared to be related to a work 

injury and indicated that he would make corrections to the medical record. Dr. Auerbach noted 

that appellant was disabled from work. In a work restriction form dated June 5, 2019, he noted 

that appellant was out of work until his follow-up examinationin four weeks. Dr. Auerbach treated

appellant in a follow up on July 10, 2019 for right knee pain and swelling after a fall on 

July 5, 2019. Appellant reported an acute exacerbation of right knee pain on the lateral knee over 

the distal iliotibial tract that became worse during physical therapy and a recent fall in July. 

Dr. Auerbach noted x-rays revealed no acute fracture or dislocation. He diagnosed 

chondromalacia of the right femoral condyle and iliotibial band syndrome affecting the right lower 

leg. Dr. Auerbach opined that appellant’s rehabilitation was complicated by an acute exacerbation 

of the iliotibial band syndrome.

X-rays of the right knee dated July 10, 2019 revealed no fractures, minimal joint fluid, and 

lucency involving the medial femoral condyle possibly degenerative geode.

On July 22, 2019 appellant requested reconsideration.

Appellant was seen again by Dr. Auerbach on August 12, 2019 for severe worsening right 

knee pain after the April 12, 2019 work injury. Dr. Auerbach diagnosed chondromalacia of the 

right medial condyle and iliotibial band syndrome affecting the right lower leg. He recommended 

an updated MRI scan of the right knee and continued his work restrictions. Dr. Auerbach 

continued to treat appellant on September 4, 2019 who reported improved right knee symptoms 

since attending physical therapy treatment. He noted a recent MRI scan of the right knee revealed 

moderate joint effusion, leaking Baker’s cyst, articular cartilage defect on the weight bearing

posterior central aspect of the medial femoral condyle, and mild chondromalacia of the lateral facet 
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of the patella near the apex. Dr. Auerbach diagnosed chondromalacia of the right medial condyle

femur and performed an intra-articular cortisone injection.

By decision dated October 25, 2019, OWCP denied modification of the May 31, 2019 

decision. 

OWCP received additional evidence. In a return-to-work slip dated April 23, 2019,

Dr. Renzi excused appellant from work from April 23 through 29, 2019 due to a work injury. 

On October 6, 2020 appellant requested reconsideration. 

By decision dated December 23, 2020, OWCP denied modification of the October 25,

2019 decision.

LEGAL PRECEDENT

An employee seeking benefits under FECA3 has the burden of proof to establish the 

essential elements of his or her claim, including 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 of FECA,4that 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.5 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.6

To determine whether a federal employee has sustained a traumatic injury in the 

performance of duty, it first must be determined whether fact of injury has been established. First, 

the employee must submit sufficient evidence to establish that he or she actually experienced the 

employment incident at the time and place, and in the manner alleged. Second, the employee must 

submit sufficient evidence to establish that the employment incident caused a personal injury. 7

The medical evidence required to establish causal relationship is rationalized medical 

opinion evidence.8 The opinion of the physician must be based on a complete factual and medical 

3

Supra note 2.

4 F.H., Docket No. 18-0869 (issued January 29, 2020); J.P., Docket No. 19-0129 (issued April26, 2019); JoeD. 

Cameron, 41 ECAB 153 (1989).

5 L.C., Docket No. 19-1301 (issued January 29, 2020); J.H., Docket No. 18-1637 (issued January 29, 2020); 

James E. Chadden, Sr., 40 ECAB 312 (1988).

6 P.A., Docket No. 18-0559 (issued January 29, 2020); K.M., Docket No. 15-1660 (issued September 16, 2016); 

DeloresC. Ellyett, 41 ECAB 992 (1990).

7 T.J., Docket No. 19-0461 (issued August 11, 2020); K.L., Docket No. 18-1029 (issued January 9, 2019); John J. 

Carlone, 41 ECAB354(1989).

8

S.S.,Docket No. 19-0688 (issued January 24, 2020); A.M., Docket No. 18-1748 (issued April24, 2019); RobertG. 

Morris, 48 ECAB 238 (1996).
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background of the employee, 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 

specific employment incident identified by the employee.9

ANALYSIS

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

condition causally related to the accepted April 12, 2019 employment incident.

In an April 24, 2019 Form CA-20 report, Dr. Renzi checked a box marked “Yes” indicating 

that appellant’s diagnosed fissuring in the medial femoral condylar cartilage and ruptured Baker’s

cyst were caused or aggravated by the described employment activity. Similarly, in an April 26, 

2019 Form CA-20, he checked a box marked “Yes” indicating that appellant’s diagnosed right 

knee pain and condition had been caused or aggravated by the April 12, 2019 employment activity. 

However, the Board has held that an opinion on causal relationship with an affirmative check 

mark, without more by way of medical rationale, is insufficient to establish the claim. 10 As such, 

this report is insufficient to establish appellant’s claim. 

In an April 26, 2019 Form OWCP-5c, Dr. Renzi noted that appellant was unable to work 

due to right knee pain. In work excuse forms dated April 23 and 29, 2019, he noted that appellant 

was off work from April 23 through May 7, 2019. Similarly, in a May 6, 2019 note, Dr. Auerbach 

noted that appellant was disabled until follow-up examination on June 10, 2019. Likewise, in a 

work restriction form dated June 5, 2019, he noted that appellant was out of work until his followup examination in four weeks. In these notes, Drs. Renzi and Auerbach did not offer a medical 

diagnosis or provide an opinion as to whether a diagnosed condition was causally related to the 

accepted employment incident. The Board has held that medical evidence that does not include 

an opinion regarding the cause of an employee’s condition is of no probative value on the issue of 

causal relationship.11 These notes from Drs. Renzi and Auerbach are, therefore, insufficient to 

establish appellant’s claim.

On April 15, 23 and 29, 2019 Dr. Renzi diagnosed right knee pain that began at work. The 

Board has held that pain is a symptom and not a compensable medical diagnosis.12 Accordingly, 

these reports are insufficient to meet appellant’s burden of proof.

On May 6 and September 4, 2019 Dr. Auerbach diagnosed chondromalacia of the right 

medial femoral condyle and performed an intra-articular cortisone injection. However, he did not 

specifically relate the diagnosed conditions to the accepted April 12, 2019 employment incident. 

9 T.L., Docket No. 18-0778 (issued January 22, 2020); Y.S., Docket No. 18-0366 (issued January 22, 2020); 

Victor J. Woodhams, 41 ECAB 345, 352 (1989).

10 See C.S., Docket No. 18-1633 (issued December 30, 2019); D.S., Docket No. 17-1566 (issued 

December 31, 2018).

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

12 G.L., Docket No. 18-1057 (issued April14, 2020); J.P., 59 ECAB 178 (2007); Joe D. Cameron, 41 ECAB 

153 (1989).
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The Board has held that medical evidence that does not offer an opinion regarding the cause of a 

diagnosed condition or disability is of no probative value on the issue of causal relationship. 13 

Therefore, the Board finds that these reports are insufficient to establish appellant’s burden of 

proof. 

In a note dated May 7, 2019, Dr. Renzi opined that appellant twisted his right knee while 

loading mail into his work vehicle. In a May 15, 2019 Form CA-20, Dr. Auerbach indicated by 

checking a box marked “No” that appellant’s condition was not caused or aggravated by an 

employment activity. He evaluated appellant on June 5, 2019 for a work-related right knee injury 

and diagnosed chondromalacia of the right medial femoral condyle. Appellant reported being 

asymptomatic for 15 years prior to the most recent injury. Dr. Auerbach advised that, upon review 

of the medical documentation previously submitted, there was a clerical error in which the wrong 

box was checked. He clarified that appellant’s condition appeared to be related to a work injury 

and indicated that he would make corrections to the medical record. Dr. Auerbach opined to a 

reasonable degree of medical certainty, the incident described by appellant, was the competent 

medical cause of his injury/illness and disability. In an August 12, 2019 report, he treated appellant 

for severe worsening right knee pain after the April 12, 2019 work injury and diagnosed 

chondromalacia of the right medial condyle and iliotibial band syndrome affecting the right lower 

leg. While Dr. Renzi and Dr. Auerbach indicated that appellant’s right knee condition was work 

related, they failed to provide medical rationale explaining the basis of their opinion. Without 

explaining, physiologically, how the specific employment incident or employment factors caused 

or aggravated the diagnosed condition, Dr. Renzi and Dr. Auerbach’s opinions on causal 

relationship are of limited probative value and insufficient to establish appellant’s claim.14 

Appellant submitted multiple diagnostic testing reports. The Board has held that diagnostic 

studies, standing alone, are of limited probative value as they do not address whether the 

employment incident caused any of the diagnosed conditions.15 

As the record lacks rationalized medical evidence establishing causal relationship between 

appellant’s diagnosed right knee condition and the accepted April 12, 2020 employment incident, 

the Board finds that appellant has not met his 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.

13 See L.B., supra note 11.

14 G.L., supra note 12.

15 J.P., Docket No. 19-0216 (issued December 13, 2019); A.B.,Docket No. 17-0301 (issued May 19, 2017).
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CONCLUSION

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

condition causally related to the accepted April 12, 2019 employment incident.16

ORDER

IT IS HEREBY ORDERED THAT the December 23, 2020 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: October 12, 2022

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

James D. McGinley, Alternate Judge

Employees’ Compensation Appeals Board

16 The Board notes that the employing establishment issued a Form CA-16. A completed Form CA-16 authorization 

may constitute a contract for payment of medical expenses to a medicalfacility or physician, when properly executed. 

The form creates a contractual obligation, which does not involve the employee directly, to pay for the cost of the 

examination or treatment regardless of the action taken on the claim. See 20 C.F.R. § 10.300(c); J.G.,Docket No. 17-

1062 (issued February 13, 2018); Tracy P. Spillane, 54 ECAB 608 (2003).