United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

D.L., Appellant

and

U.S. POSTAL SERVICE, DENVER POST 

OFFICE, Denver, CO, Employer

__________________________________________

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Docket No. 23-0219

Issued: June 21, 2023

Appearances: Case Submitted on the Record

David G. Miller, 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 December 1, 2022 appellant, through her representative, filed a timely appeal from a 

September 16, 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.

ISSUE

The issue is whether appellant has met her burden of proof to establish a bilateral knee 

condition causally related to the accepted factors of her federal employment.

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

FACTUAL HISTORY

On December 30, 2019 appellant, then a 59-year-old carrier technician, filed an 

occupational disease claim (Form CA-2) alleging that she sustained bilateral knee conditions for 

which she underwent left knee replacement in September 2019 due to factors of her federal 

employment, including continuous walking, climbing, getting in and out of her vehicle, and 

pivoting on her feet. She noted that she first became aware of her condition on September 1, 

2016 and its relationship to her federal employment on September 30, 2019. 

In a statement accompanying her claim, appellant related that her last exposure to the 

employment factors described herein was on September 30, 2017 the date she retired from the 

employing establishment after working 36 years. She noted that she worked as a city letter 

carrier until the last 18 years of her employment. Appellant previously worked as a carrier 

technician on five delivery routes, including a park and loop route. She alleged that her duties as 

a carrier technician, included casing mail; bundling and placing mail into trays and loading the 

trays into a hamper; pushing the hamper weighing several 100 pounds to her vehicle and 

unloading trays from the hamper into her vehicle; carrying a mail satchel with mail weighing up 

to 35 pounds; walking door-to-door 25 miles per week to deliver letter mail, magazines, and 

small parcels; and dismounting her vehicle, solely caused her bilateral knee injury. Appellant 

noted that in 2004 she tore the anterior cruciate ligament (ACL) in her left knee for which she 

underwent reconstructive surgery. She fully recovered from her injury and returned to work 

without restriction. Later in 2004 appellant twisted her left knee and sustained no additional 

injury to her reconstructed ACL. She returned to full-duty work without restriction. Appellant 

related that her right knee was in bad condition and knee replacement was possible. 

In a narrative statement dated December 30, 2019, J.R., appellant’s supervisor, related 

appellant’s work schedule and duties as a letter carrier, which included preparing, carrying, and 

delivering mail, and loading and driving a vehicle. He indicated that she never performed

walking routes in the 10 years he knew her. Instead, appellant delivered mail to a cluster of 

boxes that contained 12 to 16 compartments. J.R. contended that she did not report her knee 

injury to management or submit medical documentation. He further contended that he was not 

aware of any employees who had knowledge of appellant’s alleged injury. 

OWCP, by development letter dated December 31, 2019, informed appellant of the 

deficiencies of her claim. It advised her of the type of factual and medical evidence needed to 

establish her claim and provided a questionnaire for her completion. By separate development 

letter of even date, OWCP requested additional information from the employing establishment, 

including a description of precautions taken to minimize effects of the employment activities and

a copy of appellant’s position description. It afforded both parties 30 days to respond. 

In a January 2, 2020 response, the employing establishment related that appellant 

received two 10-minute breaks and one 30-minute lunch break during a workday. It submitted 

an official copy of her carrier technician position and a summary of her letter carrier position. 

OWCP subsequently received a November 15, 2019 report, wherein, Dr. Chad B. 

Carlson, an attending Board-certified orthopedic surgeon, related appellant’s history of a total

left knee replacement, along with left ACL surgery and ACL reconstruction in 2004. 

Dr. Carlson opined that her work duties as a letter carrier, including walking and carrying on 
3

uneven ground, contributed with a reasonable degree of medical certainty to the progressive 

nature of degenerative changes in her knee as demonstrated by x-ray, which required a total knee 

replacement.

By decision dated January 31, 2020, OWCP denied appellant’s occupational disease 

claim, finding that the evidence of record was insufficient to establish the implicated factors of 

her federal employment. It noted that she had not responded to its development questionnaire. 

Thus, OWCP concluded that requirements had not been met to establish an injury as defined by 

FECA. 

On February 23, 2020 appellant requested an oral hearing before a representative of 

OWCP’s Branch of Hearings and Review. A telephonic hearing was held on May 29, 2020. 

By decision dated July 7, 2020, OWCP’s hearing representative modified, the January 31, 

2020 decision to find that appellant had established the factual component of her claim; however, 

the claim remained denied as she had not provided medical evidence establishing a bilateral knee

condition causally related to the accepted factors of her federal employment.

OWCP subsequently received an April 2, 2021 letter from Dr. Carlson. Dr. Carlson 

noted that appellant initially presented for bilateral knee pain in March 2019. He also noted her 

work duties as a carrier technician, which included walking, driving, standing, lifting, and casing 

and delivering mail. Dr. Carlson indicated that in 2019 appellant developed symptoms of 

degenerative changes in both knees and she required a total left knee replacement in

September 2019. He related that her right knee also suffered progressive degenerative changes.

Dr. Carlson reviewed medical records regarding appellant’s left knee conditions and medical 

treatment. He provided an assessment of bilateral knee osteoarthritis as confirmed by imaging 

and x-ray. Dr. Carlson opined that the diagnosed condition was accelerated by the described 

factors of appellant’s employment. He explained that her condition was easily caused by her

repetitive work duties, which included walking, pivoting, use of stairs, getting in and out of her 

delivery vehicle, and walking on uneven surfaces, with repetitive knee strain. Dr. Carlson 

maintained that appellant’s bilateral knee condition would not have progressively deteriorated if 

not for her work as a letter carrier.

On April 16, 2021 appellant, through her representative, requested reconsideration of the 

July 7, 2020 decision. 

OWCP, by decision dated July 14, 2021, denied modification of the July 7, 2020 

decision, finding that appellant had not submitted rationalized medical evidence establishing 

causal relationship between her diagnosed medical condition and the accepted factors of her 

federal employment. 

OWCP received additional medical evidence. In a December 28, 2021 letter, Dr. Carlson 

reiterated appellant’s history of injury and medical treatment. He also reiterated his diagnosis of 

bilateral knee primary osteoarthritis. Dr. Carlson referenced an article in medical literature 

regarding the cause of osteoarthritis. He opined that, although it was not possible to determine 

whether appellant’s previous knee injuries contributed to her current bilateral knee condition, her 

work as a letter carrier, which required walking, standing, working on hard surfaces, going up 

and downstairs, and entering and exiting her work vehicle, had accelerated the degenerative 
4

changes in her knees. Dr. Carlson explained that walking up to 25 miles per week at work far 

exceeded the normal time the average person walked and placed her in a higher risk category for 

the development of osteoarthritis in both knees. He further reasoned that walking up and 

downstairs to deliver mail resulted in flexion of the knee joint more than the average person 

during the day, which also resulted in a greater risk of developing bilateral knee osteoarthritis. 

Dr. Carlson noted that repetitive motion of appellant’s knees while working resulted in the 

breakdown of the articular cartilage that coats the ends of the femur, tibia, and backside of the 

patella bones, which serves as a cushion and allows the knee to smoothly bend and straighten. 

He related that as the cartilage wears away the space between the bones narrows and, in her case, 

rubbed bone on bone. Based on Dr. Carlson’s consideration of appellant’s work history, medical 

records, previous injuries, medical treatment, and nonwork-related activities, and his review of 

peer literature and his own physical examination and treatment, he opined that, with a reasonable 

degree of medical certainty, the above-described work duties accelerated her bilateral knee 

degenerative changes.

OWCP also received reports dated May 18, 2005 through October 26, 2012 regarding 

appellant’s left knee conditions and medical treatment.

On March 16, 2022 appellant, through her representative, requested reconsideration of 

the July 14, 2021 decision. 

By decision dated September 16, 2022, OWCP denied modification of its July 14, 2021 

decision.

LEGAL PRECEDENT

An employee seeking benefits under FECA3 has the burden of establishing 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 filed within the applicable time 

limitation, that an injury was sustained while in the performance of duty as alleged, and that any 

disability and/or specific condition for which compensation is claimed are 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 on 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;6(2) medical evidence establishing the presence or existence of the disease 

3

Id.

4 C.S., Docket No. 08-1585 (issued March 3, 2009); Elaine Pendleton, 40 ECAB 1143 (1989).

5

S.P., 59 ECAB 184 (2007); Victor J. Woodhams, 41 ECAB 345 (1989); Joe D. Cameron, 41 ECAB 153 (1989).

6 Marlon Vera, 54 ECAB 834 (2003); Roger Williams, 52 ECAB 468 (2001).
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or condition for which compensation is claimed;7 and (3) medical evidence establishing that the 

diagnosed condition is causally related to the employment factors identified by the claimant. 8 

The medical evidence required to establish causal relationship is rationalized medical 

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

background of the employee, must be one of reasonable 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 employee. 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, 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.

Dr. Carlson, in his December 28, 2021 letter, noted in appellant’s repetitive job duties, 

including walking, standing, working on hard surfaces, going up and downstairs, and entering 

and exiting her work vehicle. He explained that, in performing these duties, she underwent 

accelerated degenerative changes in both knees because she walked and experienced knee joint 

flexion more than the average person, which resulted in a greater risk of developing bilateral 

knee osteoarthritis. Dr. Carlson related that repetitive walking resulted in the breakdown of the 

articular cartilage that coats the ends of the femur, tibia, and backside of the patella bones which 

serves as a cushion and allows the knee to smoothly bend and straighten. He further related that 

as the cartilage wears away the space between the bones narrows and, in appellant’s case, rubbed 

bone on bone. Dr. Carlson concluded that performing these duties accelerated her bilateral knee 

osteoarthritis.

The Board finds that, while Dr. Carlson’s report is not fully rationalized, it did provide a

pathophysiological explanation that appellant sustained bilateral knee osteoarthritis due to 

repetitive motions required in the delivery of mail. Although this report is insufficient to meet 

appellant’s burden of proof to establish the claim, it is sufficient to require OWCP to further 

develop the medical evidence.11

Proceedings under FECA are not adversarial in nature, nor is OWCP a disinterested 

arbiter. While it is appellant’s burden of proof to establish the claim, OWCP shares 

7 Michael R. Shaffer, 55 ECAB 386 (2004).

8 Beverly A. Spencer, 55 ECAB 501 (2004).

9

See J.R., Docket No. 17-1781 (issued January 16, 2018); I.J., 59 ECAB 408 (2008).

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

see G.M., Docket No. 22-0730 (issued October 26, 2022).

11 See C.A., Docket No. 22-0764 (issuedNovember 30, 2022); M.R.,Docket No. 20-0101 (issued September 14, 

2021), Richard E. Simpson, 55 ECAB 490, 500 (2004); John J. Carlone, 41 ECAB 354, 360 (1989).
6

responsibility in the development of the evidence.12 It has the obligation to see that justice is 

done.13

The case must therefore be remanded to OWCP for further development of the medical 

evidence. On remand, OWCP shall refer appellant, a statement of accepted facts, and the 

medical evidence of record to a physician in the appropriate field of medicine. The referral 

physician shall provide a rationalized opinion on whether the diagnosed bilateral knee condition

is causally related to the accepted employment factors. If the physician opines that the diagnosed 

condition is not causally related, he or she must explain with rationale how or why his or her 

opinion differs from that of Dr. Carlson. Following this and other such further development as 

deemed necessary, OWCP 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 September 16, 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: June 21, 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 Id.

13 Id.