United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

R.C., Appellant

and

DEPARTMENT OF THE NAVY, NAVAL 

REGION SOUTHWEST, FIRE & 

EMERGENCY, San Diego, CA, Employer

__________________________________________

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Docket No. 21-1018

Issued: September 1, 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

JAMES D. McGINLEY, Alternate Judge

JURISDICTION

On June 25, 2021 appellant, through counsel, filed a timely appeal from a May 7, 2021 

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 to consider 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

ISSUES

The issues are: (1) whether appellant has met his burden of proof to expand the acceptance 

of his claim to include right knee medial meniscus tear as causally related to his accepted 

March 12, 2016 employment injury; and (2) whether OWCP properly denied authorization for 

right knee surgeries performed on April 14, 2017 and June 21, 2018.

FACTUAL HISTORY

On March 17, 2016 appellant, then a 36-year-old firefighter, filed a traumatic injury claim 

(Form CA-1) alleging that on March 12, 2016 he injured his right knee when he slipped on metal 

steps as he was entering an aircraft during a fire training exercise while in the performance of duty. 

Appellant stopped work on that date. OWCP accepted the claim for sprain of the right knee and 

paid appellant wage-loss compensation. Appellant returned to light duty on April 5, 2016 and full

duty on May 30, 2017.

In a report dated August 1, 2016, Dr. Richard Greenfield, a Board-certified orthopedic 

surgeon, reviewed appellant’s history of injury on March 12, 2016and noted that he had previously 

sustain a fracture of the right tibial plateau treated with surgical open reduction and internal 

fixation (ORIF). He diagnosed a contusion of the anterior aspect of the right knee. Dr. Greenfield 

related that appellant required surgery to remove the previously inserted plate and screws to reduce 

his pain, which had become aggravated on March 12, 2016. He attributed the need for surgery to 

the March 12, 2016 employment injury.

On September 8, 2016 Dr. Todd Fellars, a Board-certified orthopedic surgeon serving as a

district medical adviser (DMA), reviewed the medical record and statement of accepted facts 

(SOAF) and concluded that the requested right knee surgery was not causally related to the 

accepted March 12, 2016 right knee strain.

On October 10, 2016 Dr. Greenfield provided findings on physical examination including 

moderate effusion, loss of range of motion (ROM), a positive McMurray test, and medial joint line 

tenderness in the right knee. He diagnosed right knee pain following trauma on March 12, 2016 

including tearing of the right medial meniscus, persistent effusion, pain about the metallic implant, 

and pain and discomfort of the right knee after the March 12, 2016 injury. Dr. Greenfield advised

that appellant was partially disabled. He opined that the previously-asymptomatic metallic fixation 

device had become symptomatic as a result of the March 12, 2016 employment injury.

In a report dated February 9, 2017, Dr. Greenfield reviewed appellant’s December 20, 

2016 magnetic resonance imaging (MRI) scan of the right knee, which demonstrated a medial 

meniscus partially obscured by hardware artifact and mild degenerative blunting of the body of 

the medial meniscus with no unstable medial meniscus tear. Dr. Greenfield opined that it was 

medically probable that appellant tore his right medial meniscus on March 12, 2016. He 

determined that appellant had failed conservative care. On examination, Dr. Greenfield found 

positive medial joint line tenderness; a positive medial McMurray test, which was compatible with 

a torn medial meniscus; and limited ROM. He requested authorization for a right knee arthroscopy 

with partial medial meniscectomy.
3

In a March 3, 2017 development letter, OWCP informed appellant that the evidence of 

record was insufficient to authorize the proposed surgery as it did not appear to be medically 

necessary for and/or causally related to the accepted conditions. A copy of the DMA’s report was 

attached for his review. OWCP requested that appellant provide a detailed narrative report from 

his physician explaining how the requested surgery was medically necessary for his accepted 

employment injury. It afforded him 30 days to submit the necessary evidence.

On July 5, 2017 appellant, through counsel, requested that OWCP expand the acceptance 

of his claim based on reports from Dr. Greenfield.

In an August 8, 2017 development letter, OWCP requested that appellant submit additional 

medical evidence to support that the additional medical diagnosis was causally related to the 

accepted March 12, 2016 employment injury. It afforded him 30 days to submit the requested 

evidence.

By decision dated November 17, 2017, OWCP denied expansion of the acceptance of the

claim to include right knee meniscal tear.

On November 28, 2017 appellant, through counsel, requested an oral hearing before a 

representative of OWCP’s Branch of Hearings and Review. 

By decision dated April 20, 2018, OWCP’s hearing representative vacated the 

November 17, 2017 OWCP decision and remanded the claim for additional review by the DMA, 

and a second opinion evaluation.

On remand OWCP referred the case record, along with a SOAF, to Dr. Nathan Hammel, a 

Board-certified orthopedic surgeon serving as a DMA. In a report dated May 2, 2018, Dr. Hammel

reviewed the SOAF and found that the MRI scan did not show a clear meniscal tear, and that the 

proposed right knee arthroscopy to include removal of screws and plates was not medically 

necessary as there was no indication of intra-articular pathology on the MRI scan. In a May 9, 

2018 supplemental report, the DMA reviewed the medical records and continued to find that the 

requested right knee surgery was not medically necessary.

On May 22, 2018 OWCP referred appellant, a SOAF, and a list of questions to

Dr. William P. Curran, a Board-certified orthopedic surgeon, for a second opinion examination.

In his June 19, 2018 report, Dr. Curran provided appellant’s history of injury and his 

review of the medical evidence, including the results of diagnostic studies. He found a small 

partial tear of the lateral meniscus on the March 21, 2018 MRI scan. Dr. Curran diagnosed 

tricompartmental osteoarthritis of the right knee and a contusion of the right knee causally related 

to a March 12, 2016 employment injury. He opined that appellant’s employment injury caused a 

right knee contusion and a temporary aggravation of appellant’s preexisting, asymptomatic 

tricompartmental osteoarthritis without causing damage to his preexisting right knee hardware. 

Dr. Curran opined that the temporary aggravation should have resolved within six to eight weeks. 

He further opined that appellant did not sustain a tear of his right medial meniscus on March 12, 

2016 as there was no evidence on MRI scan or physical examination of a torn meniscus. 

Dr. Curran attributed the right knee surgery to appellant’s preexisting tricompartmental 

osteoarthritis changes in the right knee and his previous knee surgery rather than the accepted 
4

March 12, 2016 employment injury. He concluded that he would eventually require total right 

knee arthroplasty due to the progressive deterioration of appellant’s tricompartmental arthritis.

By decision dated July 2, 2018, OWCP denied both appellant’s request to expand the 

acceptance of his claim to include right knee medial meniscus tear and his request for authorization 

for right knee surgery.

On July 6, 2018 appellant, through counsel, requested an oral hearing before a 

representative of OWCP’s Branch of Hearings and Review. A hearing was held on 

November 8, 2018. 

Thereafter, appellant submitted an operative report from his April 14, 2017 right knee 

arthroscopy with partial meniscectomy, debridement, and removal of one screw. The preoperative 

notes dated April 13, 2017, indicate that he had sustained a new injury snowboarding a few months 

earlier. On June 21, 2018 appellant underwent additional right knee surgery including right knee 

diagnostic arthroscopy, right knee partial lateral meniscectomy, right knee removal of deep 

hardware, and scar revision.

By decision dated January 23, 2019, OWCP’s hearing representative vacated the July 2, 

2018 OWCP decision and remanded the case for OWCP to prepare an updated SOAF that included 

appellant’s surgical history and obtain a supplemental report from Dr. Curran.

In his February 26, 2019 supplemental report, Dr. Curran indicated that he had reviewed 

additional medical records, including operative reports dated April 14, 2017 and June 21, 2018. 

He again opined that on March 12, 2016 appellant sustained a contusion to his right knee. 

Dr. Curran attributed the partial tear of the lateral meniscus to traumatic arthritis as a result of the 

nonemployment-related tibial plateau fracture in 2010 and to a snowmobile accident in 2017 that 

had occurred after the employment injury. He found that the 2010 right lateral tibial plateau 

fracture caused appellant to develop right knee osteoarthritis which was temporarily aggravated 

for one to two months by the March 12, 2016 employment injury.

By decision dated May 13, 2019, OWCP again denied both appellant’s request to expand 

the acceptance of his claim to include right knee medial meniscus tear and authorization for right 

knee surgery.

On May 20, 2019 appellant, through counsel, requested an oral hearing before a 

representative of OWCP’s Branch of Hearings and Review.

Following a preliminary review, by decision dated August 9, 2019, OWCP’s hearing 

representative set aside the May 13, 2019 decision. She found that a conflict existed between

Dr. Curran and Dr. Greenfield of whether appellant sustained a right knee medial meniscus tear 

causally related to the March 12, 2016 employment injury and whether appellant’s April 14, 2017 

and June 21, 2018 surgeries were medically necessary and causally related to the accepted 

employment injury.

On September 13, 2019 OWCP referred appellant, a SOAF, and a series of questions to

Dr. Neil J. Halbridge, a Board-certified orthopedic surgeon, for an impartial medical examination.
5

In a report dated October 15, 2019, Dr. Halbridge, serving as the impartial medical 

examiner (IME), provided his review of the SOAF and the medical reports of record. He noted 

that appellant had undergone an internal fixation for a lateral tibial plateau fracture and proximal 

fibular fracture of the right knee in April 2010 and had sustained a snowboarding injury to his right 

knee in February 2017. Dr. Halbridge observed that a December 20, 2016 MRI scan failed to 

demonstrate a right knee medial meniscal tear and thus determined that this condition had not been 

established as employment related. He opined that the right knee medial meniscal injury was not 

medically connected to the March 12, 2016 employment injury. Dr. Halbridge related that 

appellant had sustained “a contusion of the right knee in the specific work injury of March 12, 

2016, but absent the underlying post-traumatic arthritis resulting from the lateral tibia plateau 

fracture that [appellant] sustained and for which he underwentsurgery in April 2010, the contusion

would have resolved and become asymptomatic in six to eight weeks.” He also diagnosed right 

knee strain due to the February 2017 snowboarding accident. Dr. Halbridge determined that 

appellant had an underlying preexisting condition involving an intraarticular fracture of the lateral 

tibial plateau of his right knee with resulting mild osteoarthritis in the medial and lateral femoral 

condyles. He opined that appellant’s April 14, 2017 and June 21, 2018 surgeries were not 

medically necessary to treat the March 12, 2016 employment injury. Dr. Halbridge found that 

appellant had no employment-related residuals.

By decision dated December 10, 2019, OWCP again denied both expansion of the 

acceptance of the claim to include right knee medial meniscus tear and authorization for right knee 

surgery. 

On December 17, 2019 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 7, 2020.

By decision dated June 4, 2020, OWCP’s hearing representative affirmed OWCP’s 

December 10, 2019 decision, finding that the October 15, 2019 report from Dr. Halbridge, the 

IME, was entitled to the special weight of the evidence.

On February 10, 2021 appellant, through counsel, requested reconsideration of the June 4, 

2020 decision. In support of his request, he provided an October 21, 2020 report from Dr. Chad 

Elsner, a Board-certified orthopedic surgeon, who found mild joint effusion, Baker’s cyst, and 

edema compatible with a strain. Dr. Elsner noted that diagnostic testing demonstrated chronic 

tearing of the anterior horn, body, and posterior horn of the lateral meniscus as well as areas of 

high-grade full and near full-thickness cartilage loss along the lateral aspects of the femoral 

condyle. He did not address the need for surgery on April 14, 2017 and June 21, 2018.

By decision dated May 7, 2021, OWCP denied modification of its June 4, 2020 decision.
6

LEGAL PRECEDENT -- ISSUE 1

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.3 

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.4 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.5 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.6

The Board has held that when the medical evidence supports an aggravation or acceleration 

of an underlying condition precipitated by working conditions or injuries, such disability is 

compensable.7 However, the normal progression of untreated disease cannot be stated to constitute 

“aggravation” of a condition merely because the performance of normal work duties reveals the 

underlying condition.8

Section 8123(a) of FECA provides, in pertinent part: “If there is disagreement between 

the physician making the examination for the United States and the physician of the employee, the 

Secretary shall appoint a third physician who shall make an examination.”

9

 This is called an 

impartial examination and OWCP will select a physician who is qualified in the appropriate 

specialty and who has no prior connection with the case.10 Where a case is referred to an IME for 

3 G.C., Docket No. 21-0527 (issued September 20, 2021); J.R., Docket No. 20-0292 (issued June 26, 2020); W.L., 

Docket No. 17-1965 (issued September 12, 2018); V.B., Docket No. 12-0599 (issued October 2, 2012); JajaK. 

Asaramo, 55 ECAB 200, 204 (2004).

4 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).

5 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).

6

Id.

7 G.C., Docket No. 21-0176 (issued July 6, 2022); R.K., Docket No. 21-0387 (issued May 20, 2022); C.H., Docket 

No. 17-0488 (issued September 12, 2017).

8

Id.

9

5 U.S.C. § 8123(a).

10 20 C.F.R. § 10.321; L.R., Docket No. 21-0018 (issued February 17, 2023); J.K., Docket No. 21-0007 (issued 

July 30, 2021); C.W., Docket No. 18-1536 (issued June 24, 2019).
7

the purpose of resolving the conflict, the opinion of such specialist, if sufficiently well rationalized 

and based on a proper factual background, must be given special weight.11

ANALYSIS -- ISSUE 1

The Board finds that appellant has not met his burden of proof to expand the acceptance of 

his claim to include right knee medial meniscus tear as causally related to his accepted March 12, 

2016 employment injury.

OWCP properly determined that a conflict in medical opinion existed between

Dr. Greenfield, appellant’s treating physician, and Dr. Curran, who provided a second opinion 

examination, regarding whether the acceptance of appellant’s claim should be expanded to include 

a right knee medial meniscal tear due to his accepted March 12, 2016 employment injury that 

necessitated surgeries. It referred appellant to Dr. Halbridge, a Board-certified orthopedic 

surgeon, for an impartial medical examination pursuant to 5 U.S.C. § 8123(a).12

In his October 15, 2019 report, Dr. Halbridge described the March 12, 2016 work injury 

and noted that appellant had preexisting knee conditions including post-traumatic arthritis. He

opined that the right knee medial meniscal injury was not medically connected to the March 12, 

2016 employment injury. Dr. Halbridge explained that appellant had sustained a contusion of the 

right knee on March 12, 2016, and that absent the underlying post-traumatic arthritis resulting from 

the previous lateral tibia plateau fracture, the contusion would have resolved and become 

asymptomatic in six to eight weeks. Thus, he concluded that there was no evidence of a right 

medial meniscal injury causally related to the accepted March 12, 2016 employment injury.

The Board finds that Dr. Halbridge accurately described the accepted employment injury 

and noted his review of the medical record. Dr. Halbridge performed a thorough clinical 

examination and provided detailed findings. He provided a rationalized opinion regarding whether 

appellant’s claim should be expanded, finding that there was no evidence to find causal 

relationship between the right medial meniscal injury and the accepted employment injury.13 

Dr. Halbridge’s opinion, as set forth in his October 15, 2019 report, constitutes probative and 

reliable evidence. The Board, therefore, finds that his opinion is entitled to the special weight 

accorded to an IME with regard to the issue of whether acceptance of appellant’s claim should be 

expanded to include additional right knee meniscal injuries. 14

In his October 21, 2020 report, Dr. Elsner provided findings including mild joint effusion, 

Baker’s cyst, and edema compatible with a strain. He noted that diagnostic testing demonstrated 

chronic tearing of the anterior horn, body, and posterior horn of the lateral meniscus as well as 

11 V.K., Docket No. 18-1005 (issued February 1, 2019); D.M., Docket No. 17-1411 (issued June 7, 2018).

12 G.B., Docket No. 19-1510 (issued February 12, 2020); R.H., 59 ECAB 382 (2008).

13 See L.R., Docket No. 21-0018 (issued February 17, 2023); F.A., Docket No. 20-1652 (issued May 21, 2021); 

R.R., Docket No. 19-0086 (issued February 10, 2021); see also D.S.,Docket No. 18-0353 (issued February 18, 2020).

14 L.R., F.A., id.; W.C., Docket No. 19-1740 (issued June 4, 2020); M.M., Docket No. 16-1655 (issued 

April 4, 2018).
8

areas of high-grade full and near full-thickness cartilage loss along the lateral aspects of the 

femoral condyle. However, Dr. Elsner did not provide an opinion on causal relationship between 

the additional conditions claimed and the accepted employment injury. His opinion, therefore, is 

insufficient to expand the acceptance of appellant’s claim.

15

As the medical evidence of record is insufficient to overcome the weight accorded to the 

IME, Dr. Halbridge, or to create an additional conflict in medical opinion, the Board finds that 

appellant has not met his burden of proof to expand the acceptance of his claim.16

LEGAL PRECEDENT -- ISSUE 2

Section 8103(a) of FECA 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.17 In interpreting section 8103(a), the Board 

has recognized that OWCP has broad discretion in approving services provided under FECA to 

ensure that an employee recovers from his or her injury to the fullest extent possible in the shortest 

amount of time.18 OWCP has administrative discretion in choosing the means to achieve this goal 

and the only limitation on OWCP’s authority is that of reasonableness. Abuse of discretion is 

generally 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.19

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

claimant has the burden of proof to establish that the expenditure is incurred for treatment of the 

effects of an employment-related injury or condition.20 Causal relationship requires supporting 

rationalized medical evidence.21 Therefore, in order to prove that, a procedure is warranted, a 

claimant must establish that the procedure was for a condition causally related to the employment 

15 R.P., Docket No. 22-1349 (issued June12, 2023); F.S.,Docket No. 23-0112 (issued April26, 2023); L.B.,Docket 

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

16 R.P., id.; D.L., Docket No. 22-0161 (issued March 10, 2023).

17 5 U.S.C. § 8103(a); see L.R., supra note 13; A.N.,Docket No. 20-0320 (issued March 31, 2021); M.P.,Docket 

No. 19-1557 (issued February 24, 2020); M.B., 58 ECAB 588 (2007).

18 Id. at § 8103.

19 L.R., A.N., supra note 17; E.L., Docket No. 17-1445 (issued December 18, 2018); L.W., 59 ECAB 471 (2008); 

P.P., 58 ECAB 673 (2007); Daniel J. Perea, 42 ECAB 214 (1990).

20 See L.R., A.N., id.; L.S., Docket No. 18-1746 (issued April9, 2019); Kennett O. Collins, Jr., 55 ECAB 648, 

654 (2004).

21 L.R., A.N., id.; K.W., Docket No. 18-1523 (issued May 22, 2019).
9

injury and that the procedure was medically warranted. Both of these criteria must be met in order 

for OWCP to authorize payment.22

ANALYSIS -- ISSUE 2

The Board finds that OWCP properly denied authorization for the right knee surgeries 

performed on April 14, 2017 and June 21, 2018.

As found above, OWCP properly found a conflict in the medical opinion evidence relating 

to whether appellant’s claim should be expanded to include right knee medial meniscal tear. In 

his October 15, 2019 report, Dr. Halbridge, the IME, opined that the acceptance of his claim should 

not be expanded to include right knee medial meniscal conditions causally related to his accepted 

employment injury and that right knee surgeries was not necessary or appropriate to treat his 

accepted work-related conditions. His opinion is entitled to the special weight accorded to an IME 

with regard to the authorization for the right knee surgeries performed on April 14, 2017 and 

June 21, 2018.23

The Board further finds that Dr. Elsner’s October 21, 2020 report did not address the issue 

of whether the right knee surgeries performed on April 14, 2017 and June 21, 2018 were causally 

related to the accepted March 12, 2016 employment injury.

24

 This report is therefore insufficient 

to overcome the special weight accorded to the IME, Dr. Halbridge or to create an additional 

conflict in medical opinion.25

As the conditions for which surgery was requested are not employment related, the 

procedure was not medically warranted.26 The only limitation on OWCP’s authority in approving 

or denying service under FECA is one of reasonableness.27 OWCP obtained an impartial medical 

examination by Dr. Halbridge who opined that the April 14, 2017 and June 21, 2018 right knee

surgeries was not causally related to the accepted employment conditions. It, therefore, had 

sufficient evidence upon which to deny surgery and did not abuse its discretion. 28

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.

22 Id.

23 See L.R., supra note 13; Y.I., Docket No. 20-0263 (issued November 30, 2020); Darlene R. Kennedy, 57 ECAB 

414 (2006).

24 J.B., Docket No. 21-0854 (issued May 18, 2023).

25 Supra note 16.

26 Id.

27 See J.B., supra note 24; T.A.,Docket No. 19-1030 (issued November 22, 2019); Cathy B. Millin, 51 ECAB 331, 

333 (2000).

28 Id.
10

CONCLUSION

The Board finds that appellant has not met his burden of proof to expand the acceptance of 

his claim to include an additional condition of right knee medial meniscus tear as causally related 

to his accepted March 12, 2016 employment injury. The Board further finds that OWCP properly 

denied his authorization for the right knee surgeries performed on April 14, 2017 and 

June 21, 2018.

ORDER

IT IS HEREBY ORDERED THAT the May 7, 2021 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

James D. McGinley, Alternate Judge

Employees’ Compensation Appeals Board