United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

P.D., Appellant

and

U.S. POSTAL SERVICE, COLLINWOOD POST 

OFFICE, Cleveland, OH, Employer

__________________________________________

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Docket No. 22-1091

Issued: March 8, 2023

Appearances: Case Submitted on the Record

Alan J. Shapiro, 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 July 20, 2022 appellant, through counsel, filed a timely appeal from a June 27, 2022 

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.

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.
2

ISSUE

The issue is whether appellant has met her burden of proof to establish expansion of the 

acceptance of her claim to include osteoarthritis of the right knee causally related to , or as a 

consequence of, her accepted employment injury. 

FACTUAL HISTORY

On November 3, 2000 appellant, then a 44-year-old mail carrier, filed an occupational 

disease claim (Form CA-2) alleging that she sustained a right leg strain causally related to factors 

of her federal employment. OWCP accepted the claim for right leg strain and a right lateral 

popliteal nerve lesion. On December 4, 2002 appellant underwent an excisional biopsy of the 

lipoma and a neurolysis of the peroneal nerve. She stopped work on December 4, 2002, returned 

to part-time modified employment on February 25, 2003, and resumed full-time employment on 

March 7, 2003.3

X-rays of the right knee, obtained on June 10, 2014, showed reasonably maintained joint 

spaces, normal patellofemoral articulation, and no evidence of advanced arthritis changes.

Appellant continued to receive treatment for right knee pain. In a progress report dated 

April 30, 2021, Dr. Bruce T. Cohn, a Board-certified orthopedic surgeon, provided a “follow-up 

on her right knee work[-]related injury.” He noted that appellant had intermittent knee pain 

especially with walking. On examination, Dr. Cohn found a positive McMurray’s test, a negative 

Lachman’s test, abnormal knee alignment, and an antalgic gait. He diagnosed right knee sprain, 

and an aggravation of right knee unilateral primary osteoarthritis. Dr. Cohn opined that the 

aggravation of osteoarthritis directly resulted from the accepted October 19, 2000 employment 

injury. He related, “The mechanism of injury and the description of the incident are consistent. It 

is more likely than not that this diagnosis is the result of the work[-]related injury.”

In a June 2, 2021 progress report, Dr. Cohn diagnosed right knee strain, a lesion of the 

lateral popliteal nerve of the right lower limb, and unilateral primary osteoarthritis of the right 

knee. He opined that appellant had sustained an aggravation of right knee osteoarthritis as a result 

of her accepted employment injury. Dr. Cohn requested that OWCP expand the acceptance of the 

claim to allow the diagnosis of aggravation of right knee osteoarthritis.

On July 1, 2021 OWCP referred appellant to Dr. David K. Halley, a Board-certified 

orthopedic surgeon, for a second opinion examination. 

On July 28, 2021 Dr. Cohn provided a progress report containing similar findings to his 

prior reports of April 20 and June 2, 2021. 

In a report dated August 27, 2021, Dr. Halley provided his review of the history of injury 

and the medical reports of record. He discussed appellant’s continued complaints of right knee 

pain occasionally radiating into the big toe of the right foot. On examination, Dr. Halley found a 

mild antalgic limp on the right side and tenderness to palpation over the medial and lateral joint

3 Appellant retired on disability on April 2, 2011.
3

lines and patellar facet. He further found mild crepitus and effusion with no instability. Dr. Halley

opined that the employment-related right leg sprain had resolved as it was a soft tissue injury that 

resolved within 12 weeks. He determined that the lateral popliteal nerve lesion had not resolved 

based on the diagnostic studies and appellant’s continued symptoms of pain in the lateral aspect 

of the medial proximal right leg. Dr. Halley opined that her preexisting right knee osteoarthritis

resulted from degenerative causes rather than an aggravation of precipitation of her condition 

caused by her right leg sprain or right lateral popliteal nerve lesion. He noted that appellant’s knee 

arthritis did not appear to have progressed significantly based on her 2014 x-rays. Dr. Halley

related that her activity level at work, her weight, and possibly genetics had caused the 

deterioration of her arthritic knee. He asserted that the “deterioration of the arthritis cannot solely 

be attributed to [appellant’s] work-related injury or activities, based upon my examination and the 

records provided for review.” 

In a progress report dated September 24, 2021, Dr. Cohn treated appellant for right knee 

sprain, a right lesion of the lateral popliteal nerve, and right knee osteoarthritis. He again attributed 

the aggravation of right knee osteoarthritis to the accepted employment injury based on the 

mechanism and description of injury.

On October 13, 2021 OWCP provided Dr. Cohn with Dr. Halley’s report and requested 

that he address whether he agreed or disagreed with his findings.

On October 27, 2021 counsel advised that OWCP should inform Dr. Halley of the legal 

definition of aggravation, noting that he found that appellant’s worsening arthritis did not result 

solely from the accepted work injury.

In an October 25, 2021 progress report, Dr. Cohn indicated that he agreed with Dr. Halley 

that appellant’s right knee preexisting osteoarthritis was causally related to the October 19, 2000 

employment injury. 

OWCP requested that Dr. Halley review the definition of aggravation and provide a 

clarifying opinion. In a supplemental report dated December 27, 2021, Dr. Halley opined that 

appellant had preexisting osteoarthritis, but that the “subsequent course is that of the natural 

progression of osteoarthritis rather than injury to the knee joint, leading to a deterioration of the 

knee joint.” He further opined that her surgery caused scarring around the nerve and surgical site 

resulting in pain. Dr. Halley noted that appellant had slowly progressing preexisting knee 

osteoarthritis, observing that x-rays obtained 14 years after the injury showed no significant 

arthritic changes and that he would have anticipated severe arthritis after that amount of time. He

asserted that arthritis commonly resulted in the need for a total knee replacement in under 14 years. 

Dr. Halley related, “Within a reasonably medical probability, I believe the injury had no influence 

on the natural progression of [appellant’s] preexisting arthritis in the right knee.” He further found 

that the right leg sprain and lateral popliteal nerve lesion had not aggravated or accelerated her 

osteoarthritis. Dr. Halley opined that it was a “preexisting condition which is actually progressing 

slower than what I would anticipate in the normal progression of arthritis.” 

By decision dated January 5, 2022, OWCP denied appellant’s request to expand the 

acceptance of her claim to include right knee osteoarthritis as causally related to her accepted 

employment injury. 
4

On January 13, 2022 appellant, through counsel, requested a telephonic hearing before a 

representative of OWCP’s Branch of Hearings and Review. 

A telephonic hearing was held on April 11, 2022. Counsel asserted that Dr. Cohn was also 

a joint replacement surgeon and that his opinion had the same probative value as the opinion of

Dr. Halley. He maintained that Dr. Halley did not understand the definition of aggravation and 

had not ruled out the injury as a cause of the of the arthritis. Alternatively, counsel maintained 

that a conflict existed.

By decision dated June 27, 2022, OWCP’s hearing representative affirmed the January 5, 

2022 decision. 

LEGAL PRECEDENT

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.4

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.5 A physician’s opinion on whether there is a causal relationship 

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

complete factual and medical background.6 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

employment injury.7

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 the claimant’s own intentional misconduct.8 The basic rule is 

that, a subsequent injury, whether an aggravation of the original injury or a new and distinct injury, 

is compensable if it is the direct and natural result of a compensable primary injury. 9

4

J.R., Docket No. 20-0292 (issued June 26, 2020); W.L., Docket No. 17-1965 (issued September 12, 2018); JajaK. 

Asaramo, 55 ECAB 200, 204 (2004).

5 W.N., Docket No. 21-0123 (issued December 29, 2021); E.M., Docket No. 18-1599 (issued March 7, 2019); 

Robert G. Morris, 48 ECAB 238 (1996).

6 F.A., Docket No. 20-1652 (issued May 21, 2021); M.V., Docket No. 18-0884 (issued December 28, 2018); 

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

7

Id.

8

I.S., Docket No. 19-1461 (issued April30, 2020); A.M.,Docket No. 18-0685 (issued October 26, 2018); Mary 

Poller, 55 ECAB 483, 487 (2004).

9

J.M., Docket No. 19-1926 (issued March 19, 2021); SusanneW. Underwood (Randall L. Underwood), 53 ECAB 

139, 141 n.7 (2001).
5

ANALYSIS

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

the acceptance of her claim to include osteoarthritis of the right knee causally related to , or as a 

consequence of, her accepted employment injury. 

In a report dated August 27, 2021, Dr. Halley, an OWCP referral physician, opined that 

appellant had no residuals of her right leg sprain but had continued symptoms due to her lateral 

popliteal nerve lesion. He opined that her preexisting right knee osteoarthritis resulted from 

degenerative causes and had not been aggravated or accelerated by her right leg sprain or lateral 

popliteal nerve lesion. Dr. Halley indicated that the medical evidence failed to establish that 

appellant’s worsening arthritis of the right knee was due solely to her employment injury or other 

activities. In a supplemental report dated December 27, 2021, Dr. Halley reviewed OWCP’s 

definition of aggravation and attributed her knee joint condition to the natural progression of 

osteoarthritis. He observed that 2014 x-rays of the right knee had not shown significant arthritic 

changes and that the progression osteoarthritis had been slower than normal. Dr. Halley concluded 

that the accepted employment injury had not affected the natural progression of her preexisting 

right knee osteoarthritis and further found that the right leg sprain and lateral popliteal nerve 

lesions had not aggravated or accelerated her osteoarthritis. 

The Board has reviewed the opinion of Dr. Halley and finds that it has reliability, probative 

value, and convincing quality with respect to its conclusions regarding whether appellant’s claim 

should be expanded to include an aggravation of right knee osteoarthritis causally related to or as 

a consequence of her accepted employment injury. Dr. Halley provided a thorough factual and 

medical history and accurately summarized the relevant medical evidence. He provided medical 

rationale for his opinion by explaining that appellant’s 2014 x-rays had shown a slower than 

expected progression of osteoarthritis and opined that the injury had not affected the natural 

progression of her condition. As Dr. Halley’s report is rationalized and based on an accurate 

factual history, his opinion constitutes the weight of the medical evidence. 10

In a report dated April 30, 2021, Dr. Cohn opined that appellant had sustained an 

aggravation of osteoarthritis of the right knee causally related to her accepted employment injury

on a more likely than not basis. He indicated that the mechanism and description of injury was 

consistent with the diagnosis. On June 2, 2021 Dr. Cohn requested that OWCP expand the 

acceptance of the claim to include an aggravation of right knee osteoarthritis. He provided similar 

progress reports through September 24, 2021. The Board has held, however, that a medical 

opinion should offer a medically-sound explanation regarding how the employment factors 

physiologically caused the diagnosed condition.11 While Dr. Cohn generally asserted that the 

mechanism of injury was consistent with the condition, he did not explain with reference to the 

specific facts of the case how it resulted in the diagnosed condition. As his reports are conclusory,

they fail to provide a rationalized medical opinion to explain how aggravation of right knee 

10 See B.P., Docket No. 20-0820 (issued July 12, 2022); R.P., Docket No. 20-0891 (issued September 20, 2021); 

S.B., Docket No. 20-0648 (issued January 27, 2021); E.T., Docket No. 19-0948 (issued July 27, 2020).

11 See K.C., Docket No. 22-0212 (issued June 14, 2022); N.C., Docket No. 21-0934 (issued February 7, 2022); 

M.G., Docket No. 21-0727 (issued October 15, 2021).
6

osteoarthritis was caused by the accepted employment-related injury, they are insufficient to meet 

appellant’s burden of proof.12

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 her burden of proof to establish expansion of

the acceptance of her claim to include osteoarthritis of the right knee causally related to , or as a 

consequence of her accepted employment injury. 

ORDER

IT IS HEREBY ORDERED THAT the June 27, 2022 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: March 8, 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

12 Federal (FECA) Procedure Manual, Part 2 --Claims, Causal Relationship, Chapter 2.805.3e (January 2013);see 

also K.C., id.; R.D., Docket No. 18-1551 (issued March 1, 2019).