United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

J.R., Appellant

and

U.S. POSTAL SERVICE, BROOKHOLLOW 

POST OFFICE, Dallas, TX, Employer

__________________________________________

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Docket No. 22-0272

Issued: September 15, 2022

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

JANICE B. ASKIN, Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JAMES D. McGINLEY, Alternate Judge

JURISDICTION

On December 10, 2021 appellant filed a timely appeal from an October 12, 2021 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 February 6, 2018 appellant, then a 66-year-old city carrier, filed an occupational disease 

claim (Form CA-2), but did not specify an injury or illness. He noted that he first became aware 

of his condition and first realized it relation to his federal employment on September 22, 2017. In 

1

5 U.S.C. § 8101 et seq.
2

a statement submitted with his CA-2, appellant indicated that he began his employment with the 

employing establishment as a letter carrier in 1991 mostly on park and loop routes, and that he was 

no longer able to perform his duties. He noted that he is unable to stand in one place for extended 

periods and that walking and climbing are also a problem. Appellant recounted that management 

and co-workers noticed that he limped when he walked, which appellant explained was due to 

pain. He filed the CA-2 to “find out what is available for me to heal.” Appellant stopped work on 

September 22, 2017.

Appellant submitted a work capacity evaluation (Form OWCP-5c) dated November 21, 

2017 from Dr. Edward Wolski, a Board-certified family practitioner, who noted that appellant was 

totally disabled for one month due to a decrease in range of motion and tenderness.

In a February 12, 2018 development letter, OWCP informed appellant of the deficiencies 

of his claim. It advised him of the type of evidence needed and provided a questionnaire for his 

completion. By separate development letter of even date, OWCP requested additional information 

from the employing establishment. It afforded both parties 30 days to respond.

In reports dated November 6 and December 9, 2017, Dr. Wolski treated appellant for 

bilateral knee pain. Appellant reported working as a letter carrier for 26 years casing mail 

approximately two hours a day while standing and pivoting to the right and left on his knees, 

placing mail in trays, squatting to put trays into a gondola, lifting parcels from the gondola and 

placing them in his truck, mounting and dismounting his truck multiple times a day, and working

approximately 10 to 12 hours of overtime a week. Dr. Wolski opined that the shearing, torsional, 

and compressive forces due to prolonged standing, squatting, pivoting, dismounting his truck, and 

climbing stairs aggravated the degenerative joint disease of both knees. He diagnosed tears of the 

medial meniscus of both knees, aggravation of osteoarthritis of bilateral knees, and aggravation of 

internal derangement of both knees causally related by appellant’s work duties.

X-rays of the left and right knee dated November 6, 2017 revealed small joint effusion of 

traumatic or inflammatory origin and minimal lateral compartment marginal osteophytic ridging. 

A November 10, 2017 magnetic resonance imaging (MRI) scan of the right knee revealed

advanced medial compartment osteoarthritis with free edge tear of the medial meniscus, extensive 

full thickness articular cartilage loss, edema, full thickness patellar cartilage loss, and small joint 

effusion. An MRI scan of the left knee of even date revealed advanced medial compartment 

osteoarthritis with medial meniscal tear, extensive full thickness cartilage loss, edema, multifocal 

areas of partial and full thickness patellar and trochlear cartilage loss, moderate joint effusion, and 

mucoid degeneration of the anterior cruciate ligament (ACL).

In response to the development letter, appellant submitted a statement dated February 28, 

2018 claiming work-related injuries to both knees. He explained that his daily routine over 27 

years of preparing and delivering mail and parcels on his route required walking, climbing steps, 

entering and exiting a vehicle, bending and lifting, all of which contributed to the development of 

his bilateral knee condition.

On April 4, 2018 OWCP referred appellant, the case record and a statement of accepted 

facts (SOAF) for a second opinion examination with Dr. George Wharton, a Board-certified 
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orthopedic surgeon. It requested that Dr. Wharton evaluate whether appellant developed bilateral 

knee conditions causally related to the accepted factors of his federal employment.

In a May 31, 2018 report, Dr. Wharton discussed appellant’s factual and medical history 

and reported physical examination findings. Examination of the knees revealed degenerative 

osteoarthritis in both knees, varus instability in both knees, left side worse than right, significant 

medial instability of the medial collateral ligament on the left side, restricted range of motion of 

both knees, and varus deformity of both knees, left side worse than right. Dr. Wharton diagnosed 

osteoarthritis and medial meniscus tears of both knees. He opined, based on reasonable medical 

probability, appellant’s bilateral knee osteoarthritic changes were more likely a preexisting and 

age-related disease of life. Dr. Wharton indicated that the MRI scan showed findings consistent 

with degenerative changes present in the articular surfaces as well as degenerative meniscus tear,

which are typical of chronic age-related osteoarthritis. He opined that the diagnosed bilateral knee 

conditions were not caused by his employment duties. Dr. Wharton indicated that “[i]n all 

likelihood the bilateral knee osteoarthritic changes could have occurred with or without performing 

his usual job duties as a city carrier.” He opined that it was “more likely that [appellant’s]

diagnosed bilateral knee degenerative osteoarthritis [had] a congenital component and less likely 

that it was caused or contributed by direct causation, aggravation, precipitation, [or] acceleration”

by his employment duties. Dr. Wharton further found no evidence of aggravation of appellant’s

preexisting or underlying degenerative osteoarthritis by his employment duties. He asserted that 

osteoarthritis in the knees was commonly seen in older individuals. A June 14, 2018 functional 

capacity evaluation revealed that appellant could work in a light physical demand level.

By decision dated July 19, 2018, OWCP denied appellant’s occupational disease claim,

finding that the medical evidence of record was insufficient to establish that his diagnosed bilateral 

knee condition was causally related to the accepted factors of his federal employment.

OWCP received additional evidence. In a Form OWCP-5c dated December 19, 2017,

Dr. Wolski noted that appellant was totally disabled for one month due to a decrease in range of 

motion and tenderness. In an August 14, 2018 disability narrative, he noted a history of injury and 

appellant’s complaints of bilateral knee pain, swelling, and weakness. Dr. Wolski advised that 

appellant was totally disabled from August 14 through September 20, 2018. On January 17, 2019

he diagnosed tear of the medial meniscus of both knees, aggravation of osteoarthritis of both knees 

and internal derangement of both knees. Dr. Wolski opined that the shearing, torsional, and 

compressive forces due to prolonged standing, squatting, pivoting, dismounting his truck , and 

climbing stairs aggravated the degenerative joint disease of both knees.

Appellant was treated by Chad Dugas, a nurse practitioner from December 19, 2017 

through September 21, 2018 for osteoarthritis of the bilateral knees and internal derangement of 

the left knee. Dr. Julian Crutchfield, a chiropractor, treated appellant from January 16 through 

August 14, 2018 for internal derangement of the bilateral knees and osteoarthritis of the bilateral 

knees. On September 21, 2018, Nathan Mahanirananda, a physician assistant, diagnosed bilateral 

osteoarthritis of the knees and patellae and bilateral meniscus tears of the knees.

On May 20, 2019 appellant requested reconsideration.
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By decision dated July 26, 2019, OWCP denied modification of the decision dated 

July 19, 2018.

OWCP received additional evidence. Mr. Dugas continued to treat appellant from 

September 21, 2018 through February 27, 2020, and diagnosed bilateral primary osteoarthritis of 

the knees.

Dr. Brian Rogers, an occupational medicine specialist, treated appellant from 

November 13, 2019 through April 16, 2020 and diagnosed tear of the medial meniscus of the right 

and left knees, bilateral primary osteoarthritis of the knees, and internal derangement of the right 

and left knees. He opined with reasonable medical certainty that appellant’s injuries were work 

related. Dr. Rogers further indicated that the severity of the degeneration of the knees could “only 

be explained by occupational overuse required by his job.” On April 16, 2020 he opined that 

appellant’s claim should be accepted for bilateral post-traumatic osteoarthritis of the knees.

On April 20, 2020 appellant requested reconsideration.

By decision dated June 8, 2020, OWCP denied modification of the decision dated 

July 26, 2019.

OWCP received additional evidence. Mr. Dugas, a nurse practitioner, treated appellant on 

May 27, 2020 and indicated that appellant’s condition was unchanged since the last evaluation.

On May 19, 2021, Dr. Juan L. Zamora, a Board-certified family practitioner,related that 

appellant worked as a letter carrier for 27 years and his employment duties included casing mail 

on a concrete floor for two hours a day, pushing gondolas and transports full of mail weighing 200 

to 300 pounds, lifting heavy trays of mail, parcels, and packages, carrying mailbags weighin g up 

to 35 pounds, walking on uneven terrain, repetitive climbing in and out of his work vehicle, 

delivering mail to over 300 businesses daily, and working overtime walking and delivering mail 

and parcels. He reviewed Dr. Wharton’s second report dated May 31, 2018 and disagreed with 

his findings noting that appellant’s job duties as a letter carrier over 27 years was a direct cause of 

the acceleration of his bilateral knees natural wear, which produced permanent damage including

a meniscus tear and osteoarthritis, more than expected for an individual in his age group. 

Dr. Zamora explained that lifting, carrying, and manipulating medium-to-heavy loads for extended 

periods of time lead to muscle fatigue which reduced joint integrity increasing the susceptibility 

to musculoskeletal injuries. He advised that although appellant’s conditions may consist of some 

effects from age there was a clear causation of work to musculoskeletal injuries. Dr. Zamora 

further noted that cumulative exposure to lifting, bending, and squatting while carrying heavy 

loads and performing these maneuvers repetitively over time increases the risk of developing 

meniscus tears and osteoarthritis in his knees. He opined that these diagnoses were a direct and 

causal result of repetitive stress and overexertion from standing, walking, bending, twisting, 

squatting, lifting, pushing, carrying consistent with being a letter carrier. On June 2, 2021

Dr. Zamora diagnosed bilateral primary osteoarthritis of the knees and tear of the medial meniscus 

of the left and right knee.

On May 24, 2021, Dr. Edward Amadi, a chiropractor, diagnosed work-related bilateral 

primary osteoarthritis of the knees and tear of the medial meniscus of the right and left knees.
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A May 26, 2021 MRI scan of the left knee revealed tricompartmental osteoarthritis with

severe medial, moderate patellofemoral, mild lateral compartment osteoarthritis, knee effusion

with synovitis, intraligamentous ACL mucinous cyst, posterior horn tear of the medial meniscus

and loose bodies in the posterior/central knee. An MRI scan of the right knee of even date revealed 

tricompartmental osteoarthritis, complex tearing of the maceration of the body and posterior horn 

of the medial meniscus, small knee effusion, and mild synovitis.

On June 2, 2021 appellant requested reconsideration.

By decision dated June 10, 2021, OWCP denied modification of the decision dated 

June 8, 2020.

OWCP received additional evidence. On February 17, 2020, Dr. Gregg T. Podleski, a 

Board-certified orthopedic surgeon, noted appellant’s history as a letter carrier and diagnosed acute 

medial meniscus tear of the right and left knees and degenerative joint disease of the left and right 

knees. He recommended intra-articular injections.

Dr. Jack M. Thomas, a Board-certified orthopedist, evaluated appellant on June 17, 2021

and diagnosed sprain of the medial collateral ligament of the right and left knees and bilateral 

primary osteoarthritis of the knees. He opined that throughout appellant’s career as a postal 

employee he sustained repetitive injury of the knee joints, which led to degenerative arthritis. 

On July 7, 2021 Dr. Zamora clarified his opinion of causal relationship dated June 2, 2021 

pursuant to the OWCP decision dated June 10, 2021. He disagreed with the second opinion 

physician Dr. Wharton and found hisstatement that the “bilateral knee osteoarthritic changes could 

have occurred with or without performing his usual job duties as a city carrier” contradictory and 

non-conclusive. Dr. Zamora reported that appellant’s job duties as a letter carrier over 27 years 

were the direct cause of acceleration of his bilateral knees natural wear producing permanent 

damage including meniscus tear and osteoarthritis. He explained that the integrity of the joints 

and supporting joint structure rely on the strength of muscles surrounding the joint and lifting, 

carrying, and manipulation of medium-to-heavy loads for extended periods of time lead to muscle 

fatigue. Dr. Zamora noted that these factors were all a part of appellant’s job duties as fatigue 

reduces joint integrity increasing susceptibility to musculoskeletal injuries within the joint 

structure and was the causation of the bilateral knee osteoarthritic and medial meniscus tear. He

opined that appellant’s cumulative exposure to lifting, bending, and squatting while carrying heavy 

loads and performing maneuvers repetitively over time led to the development of meniscus tear 

and osteoarthritis in the knees. Dr. Zamora indicated that Dr. Wharton failed to consider the 

overall totality of appellant’s job duties on his bilateral knee condition.

On July 14, 2021 appellant requested reconsideration.

On October 8, 2021, Dr. Michael Castro, a chiropractor, diagnosed bilateral primary 

osteoarthritis of the knees and tear of the medial meniscus of the right and left knees.

By decision dated October 12, 2021, OWCP denied modification of the decision dated 

June 10, 2021.
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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 FECA3, that 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 based 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 The opinion of the physician must be based on a complete factual 

and medical background of the claimant, 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 the specific employment factors identified by the claimant. 8 Neither the mere fact 

that a disease or condition manifests itself during a period of employment, nor the belief that the 

disease or condition was caused or aggravated by employment factors or incidents, is sufficient to 

establish causal relationship.9

Section 8123(a) of FECA provides that, if there is a disagreement between the physician 

making the examination for the United States and the physician of an employee, the Se cretary shall 

appoint a third physician (known as a referee physician or impartial medical specialist) who shall 

2

5 U.S.C. § 8101 et seq.

3 E.W., Docket No. 19-1393 (issued January 29, 2020); J.P., 59 ECAB 178 (2007); JoeD. Cameron, 41 ECAB 

153 (1989).

4 L.C., Docket No. 19-1301 (issued January 29, 2020); R.C., 59 ECAB 427 (2008); James E. Chadden, Sr., 40 

ECAB 312 (1988).

5

20 C.F.R. § 10.115; E.S., Docket No. 18-1580 (issued January 23, 2020); L.M., Docket No. 13-1402 (issued 

February7, 2014); DeloresC. Ellyett, 41 ECAB 992 (1990).

6

See T.L., Docket No. 18-0778 (issued January 22, 2020); RoyL. Humphrey, 57 ECAB 238, 241 (2005);Victor J. 

Woodhams, 41 ECAB 345, 352 (1989).

7

J.F., Docket No. 18-0492 (issued January 16, 2020); Jacqueline M. Nixon-Steward, 52 ECAB 140 (2000).

8 A.M., Docket No. 18-0562 (issued January 23, 2020); LeslieC. Moore, 52 ECAB 132 (2000).

9 E.W., supra note 3; Gary L. Fowler, 45 ECAB 365 (1994).
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make an examination.10 This is called a referee examination and OWCP will select a physician 

who is qualified in the appropriate specialty and who has no prior connection with the case.11 

When there exists opposing medical reports of virtually equal weight and rationale and the case is 

referred to an impartial medical specialist for the purpose of resolving the conflict, the opinion of 

such specialist, if sufficiently well rationalized and based upon a proper factual background, must 

be given special weight.12

ANALYSIS

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

A conflict in medical opinion evidence exists between Dr. Zamora, appellant’s treating

physician, and Dr. Wharton, OWCP’s second opinion physician, regarding whether appellant 

developed bilateral osteoarthritis of the knees and tears of the medial meniscus of both knees

causally related to the accepted factors of his federal employment. 

Dr. Zamora, appellant’s treating physician, opined that the performance of appellant’s job 

duties including casing mail on a concrete floor, pushing gondolas and transports full of mail, 

lifting heavy trays of mail, carrying mailbags, walking on uneven terrain, and repetitive climbing 

led to the development of meniscus tears and osteoarthritis in appellant’s knees. He opined that 

the cumulative exposure to lifting, bending, and squatting while carrying heavy loads repetitively 

over time compromised the integrity of the knee joints and supporting joint structure causing 

bilateral knee osteoarthritis and medial meniscus tear. Dr. Zamora explained that these diagnoses 

were a direct and causal result of repetitive stress and overexertion of appellant’s areas of 

complaints from standing, walking, bending, twisting, squatting, lifting, pushing, carrying 

consistent with being a letter carrier.

By contrast, Dr. Wharton, the second opinion physician, opined in his May 31, 2018 report 

that appellant’s bilateral osteoarthritis of the knees and tears of the medial meniscus of both knees

were not related to his work activities. He opined that appellant’s bilateral knee osteoarthritic 

changes were more likely preexisting and consistent with chronic age-related osteoarthritis. 

Dr. Wharton opined that the diagnosed bilateral knee conditions were congenital in nature and less 

likely caused, contributed by direct causation, aggravation, precipitation, or acceleration by his 

employment duties. 

Dr. Zamora provided a rationalized description of how the accepted work factors caused 

or contributed to the diagnosed bilateral osteoarthritis of the knees and tears of the medial meniscus

of both knees. Dr. Wharton, however, opined that there was no causal relationship between the 

identified employment factors and appellant’s bilateral osteoarthritis of the knees and tears of the 

10 5 U.S.C. § 8123(a); M.W., Docket No. 19-1347 (issued December 5, 2019); C.T., Docket No. 19-0508 (issued 

September 5, 2019); R.S., Docket No. 10-1704 (issued May 13, 2011); S.T., Docket No. 08-1675 (issued 

May 4, 2009).

11 20 C.F.R. § 10.321.

12 M.W., supra note 10; C.T., supra note 10; Darlene R. Kennedy, 57 ECAB 414 (2006); Gloria J. Godfrey, 52 

ECAB 486 (2001).
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medial meniscus of both knees. The Board, therefore, finds that a conflict in medical opinion 

exists regarding whether he developed bilateral osteoarthritis of the knees and tears of the medial 

meniscus of both knees due to the factors of his federal employment. 

OWCP’s regulations provide that, if a conflict exists between the medical opinion of the 

employee’s physicians and the medical opinion of a second-opinion physician or an OWCP 

medical adviser, OWCP shall appoint a third physician to make an examination , pursuant to 

section 8123(a) of FECA.13 The Board will thus remand the case to OWCP for referral to an 

impartial medical specialist regarding whether appellant has met his burden of proof to establish 

that he developed bilateral osteoarthritis of the knees and tears of the medial meniscus of both 

knees due to factors of his federal employment.14 Following this and any such other further 

development as may be deemed necessary, OWCP shall issue a de novo decision.

CONCLUSION

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

13 5 U.S.C. § 8123(a); M.W., supra note 10.

14 Id.
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ORDER

IT IS HEREBY ORDERED THAT the October 12, 2021 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: September 15, 2022

Washington, DC

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board

James D. McGinley, Alternate Judge

Employees’ Compensation Appeals Board