United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

O.R., Appellant

and

DEPARTMENT OF HOMELAND SECURITY, 

TRANSPORTATION SECURITY 

ADMINISTRATION, Miami, FL, Employer

__________________________________________

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Docket No. 23-0158

Issued: August 22, 2023

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

PATRICIA H. FITZGERALD, Deputy Chief Judge

JANICE B. ASKIN, Judge

JAMES D. McGINLEY, Alternate Judge

JURISDICTION

On August 17, 2020 appellant filed a timely appeal from an August 5, 2020 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 right knee 

condition causally related to the accepted August 6, 2014 employment incident.

1

5 U.S.C. § 8101 et seq.
2

FACTUAL HISTORY

This case has previously been before the Board.2 The facts and circumstances of the case 

as set forth in the Board’s prior decision and orders are incorporated herein by reference. The 

relevant facts are as follows.

On May 22, 2017 appellant, then a 34-year-old former transportation security officer, filed 

a traumatic injury claim (Form CA-1) alleging that on August 6, 2014 he injured his right knee 

doing lunges as part of a physical therapy/work conditioning program while in the performance of 

duty. He maintained that his right knee pain worsened over time at work. Appellant described his 

claimed condition as right knee joint effusion with a ruptured popliteal cyst and vastus medialis 

obliquus atrophy. He stopped work on November 16, 2015.3 On the reverse side of the claim 

form, a supervisor indicated that August 6, 2014 was a scheduled day off for appellant. OWCP 

assigned OWCP File No. xxxxxx404.

OWCP previously accepted that on April 22, 2013 appellant sustained lumbar sprain, 

displacement of a lumbar intervertebral disc without myelopathy, and right thoracic or lumbar 

neuritis or radiculitis, assigned OWCP File No. xxxxxx033, and an aggravation of a herniated disc 

at L5-S1 on May 14, 2013, assigned OWCP File No. xxxxxx403.4

Appellant submitted physical therapy treatment records covering the period August 6 

through 11, 2014 as part of his treatment for his April 22, 2013 employment injury. An August 6, 

2014 physical therapy record indicated that he had complained of increased right knee pain after 

he performed lunges. 

On April 8, 2015 Dr. Francis McCormick, an orthopedic surgeon, evaluated appellant for 

complaints of right knee pain exacerbated by activity. She noted that he had undergone a

laminectomy a year earlier. On examination Dr. McCormick found no instability and medial and 

joint line tenderness. She diagnosed right knee pain. 

An April 23, 2015 magnetic resonance imaging (MRI) scan of appellant’s right knee 

revealed a cartilage defect superiorly in the trochlea, joint effusion and intact cruciate ligaments 

and menisci. 

In a report dated April 5, 2016, Dr. Samy Bishai, an orthopedic surgeon, recounted the 

history of appellant’s April 22, 2013 employment injury lifting luggage. He diagnosed a herniated 

lumbar disc at L5-S1 with right-sided radiculopathy, status post right surgery, and slight atrophy 

2 Order Remanding Case, Docket No. 18-0013 (issued April9, 2018); Docket No. 18-1458 (issued August 2, 2019); 

Order Dismissing Appeal, Docket No. 20-0373 (issued June 23, 2020). 

3 Appellant was removed from employment, effective April 14, 2016. 

4 Under OWCP File No. xxxxxx033 OWCP accepted that appellant sustained a lumbar sprain and herniated disc at 

L5-S1 on April22, 2013. Under OWCP File No. xxxxxx403 OWCP accepted that appellant sustained an aggravation 

of herniated disc at L5-S1 on May14, 2013. OWCP denied appellant’s claims for a traumatic injury on December 9, 

2014, assigned OWCP File No. xxxxxx125, and his occupational disease claim for an emotional condition, assigned 

OWCP File No. xxxxxx667. Appellant’s claims have been administratively combined, with OWCP File No. 

xxxxxx033 serving as the master file. 
3

of the vastus medialis right knee joint. Dr. Bishai opined that appellant’s vastus medialis atrophy 

was not related to a primary pathology of the right knee joint, but instead due to a back condition 

arising from the May 14, 2013 injury. 

On May 12, 2017 appellant advised that he had attended physical therapy and/or a work 

conditioning program following employment-related back surgery. On or around August 6, 2014 

he experienced pain in his right knee after performing lunges. Appellant’s knee pain worsened 

with time. After he returned to his usual employment on August 25, 2014 his right leg and back 

condition deteriorated. Appellant asserted that he was unable to bend, squat, push, drag, or lift 

more than 50 pounds. 

In a June 2, 2017 development letter, OWCP advised appellant of the deficiencies of his 

claim. It informed him of the type of additional factual and medical information needed and

afforded him 30 days to submit the necessary evidence. No additional evidence was received.

By decision dated July 7, 2017, OWCP denied appellant’s traumatic injury claim. It found 

that the evidence of record was insufficient to establish that the August 6, 2014 employment 

incident occurred as alleged. 

On August 14, 2017 appellant requested reconsideration. He submitted an August 6, 2014 

report from Dr. Jesse Z. Shaw, an osteopath, who advised that he was treating appellant for 

April 22 and May 14, 2013 employment injuries. Appellant noted that, during visit 15 of physical 

therapy, he had experienced right knee pain performing lunges. Dr. Shaw described findings on 

MRI scans of the right knee, and found that appellant was disabled from his usual employment 

due to his right knee condition beginning October 5, 2015. 

In a treatment note dated January 23, 2015, Dr. Jonathan A. Hyde, an orthopedic surgeon,

provided findings on examination, and diagnosed lumbar disc displacement and 

lumbar/lumbosacral disc degeneration. His examination findings of the right knee were benign 

with full joint strength and motion.

In a report dated June 14, 2017, Dr. Bishai repeated his priorfinding that appellant’s vastus 

medialis atrophy was not related to a primary pathology in the right knee joint, but rather to his 

back condition and to a second injury on May 14, 2013. He asserted that appellant’s work duties 

may have contributed to his right knee joint problems. 

By decision dated September 20, 2017, OWCP modified its July 7, 2017 decision to find 

that appellant had established the employment incident occurred as alleged and that he had a 

medical diagnosis in connection with the accepted employment incident. It determined, however, 

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

conditions and the accepted employment incident.

Appellant appealed the September 20, 2017 decision to the Board. By order dated April 9, 

2018, the Board set aside OWCP’s September 20, 2017 decision and remanded the case for further 

development.5It found that OWCP had referenced an August 22, 2014 treatment note from

5

Supra note 2.
4

Dr. Hyde, and an undated report from Dr. Shaw, an osteopath, both obtained from OWCP File No. 

xxxxxx033, but had not included the referenced evidence in the current case record, OWCP File 

No. xxxxxx404.

On remand, OWCP received additional evidence. In an August 22, 2014 treatment note,

Dr. Hyde examined appellant for a follow-up after physical therapy. He found that physical 

therapy had helped appellant, and that he was ready to return to work. Dr. Hyde noted that 

appellant described pain radiating down his left leg with flexibility stretches. On examination, he 

provided normal findings in the right knee and bilateral lower extremities. Dr. Hyde diagnosed 

lumbar disc displacement, and opined that appellant had reached maximum medical improvement. 

In a report dated October 5, 2015, Dr. Shaw evaluated appellant for an April 22, 2013 

injury lifting luggage at work. He noted that appellant complained of right knee pain and leg 

spasms after a lumbar laminectomy/discectomy on April 1, 2014. Dr. Shaw diagnosed right 

quadriceps atrophy due to appellant’s April 22, 2013 lumbar spine injury, which he found had led 

to altered gait mechanics and pathologic knee symptoms.

On October 26, 2015 Dr. Shaw evaluated appellant for pain in the right thigh and knee. On 

examination of the right thigh, he found tenderness on palpation, 4/5 strength, and full active and 

passive range of motion without pain. Dr. Shaw diagnosed right joint effusion, right muscle 

wasting and atrophy, and generalized right muscle weakness. He opined that appellant had atrophy 

of the right quadriceps, leading to a nonphysiologically altered gait and pathological knee 

symptoms. Dr. Shaw attributed appellant’s symptoms to a prior injury.

In an accompanying undated letter, Dr. Shaw discussed appellant’s history of an April 22, 

2013 employment injury to his back lifting luggage at work and complaints of pain radiating down 

his right leg. He noted that, after lumbar surgery on April 1, 2014, he underwent physical therapy 

and began having right knee pain and spasms. On examination, Dr. Shaw observed tenderness of 

the right thigh with weakness on strength testing of the quadriceps. He diagnosed right quadriceps 

muscle weakness and atrophy, right knee effusion, and right knee cartilage defect of the trochlea. 

Dr. Shaw opined that the atrophy of the right quadriceps resulted from the April 22, 2013 lumbar 

spine injury, which caused a nonphysiological altered gait and pathologic knee symptoms.

In a report dated October 26, 2017, Dr. Sarnia Fahmi Zaki, Board-certified in family 

medicine, treated appellant for an acute exacerbation of chronic back pain. 

On May 19, 2018 appellant asserted that physical therapy notes supported that he 

experienced knee pain around August 11, 2014. He noted that he had no history of knee pain prior 

to his physical therapy sessions. Appellant attributed his knee condition to physical therapy and 

subsequent duties of his federal employment.

By decision dated July 9, 2018, OWCP denied appellant’s traumatic injury claim. It found 

that the medical evidence was insufficient to establish that performing lunge exercises on 

August 6, 2014 had caused his diagnosed right knee conditions. 

Thereafter, OWCP received an unsigned March 7, 2016 report from Dr. Stephen S. 

Wender, who found that appellant was status post an April 22, 2013 work injury and right L5-S1 

hemilaminectomy. Dr. Wender opined that he had 10 percent whole person impairment.
5

Appellant appealed to the Board. By decision dated August 2, 2019, the Board affirmed 

the July 9, 2018 decision.6 

In a report dated August 21, 2019, Dr. Shaw evaluated appellant for bilateral pain in his 

thighs. He noted that appellant had complained of an “injury during physical therapy” and listed 

the date of onset as August 6, 2014. Dr. Shaw provided findings on examination, and diagnosed 

left hip pain, a strain of the bilateral thighs, and right thigh pain. He advised that appellant’s right 

knee was higher than his left knee when he squatted. Dr. Shaw reviewed his postoperative notes 

which he indicated showed that appellant experienced right knee pain after performing lunges. 

Appellant further described symptoms “associated with a rupture cyst or joint effusion such as 

swelling and pain behind the knee and right calf muscle.” Dr. Shaw noted that he had attributed 

appellant’s right thigh atrophy to his lumbar injury. He related, “Now with respect to the other 

symptoms of mild joint effusion found on the MRI [scan] of April 23, 2015 and joint effusion with 

a ruptured popliteal cyst found on the MRI [scan] of April 1, 2016, in my opinion these symptoms 

can be directly attributed to the exercises [appellant] performed as part of his mandatory 

post[operative] physical therapy around/or on August 6, 2014 and due to other work[-]related 

factors.” Dr. Shaw noted that after appellant’s back surgery he had pain performing lunges and 

symptoms consistent with a ruptured cyst or joint effusion. He advised that appellant had no 

history of a previous injury to the right knee, and opined that the swelling around the S1 nerve root 

following his lumbar surgery caused an imbalance between the lower extremities, “ultimately 

rendering his right leg to become more injury prone to the rapid physical exercise activity he 

experience[d]” during his two months of physical therapy. Dr. Shaw further attributed the 

worsening of appellant’s right knee condition to repeated kneeling and squatting while performing 

his job duties.

In a report dated September 5, 2019, an unidentified physician treated appellant for chronic 

back pain. 

On September 5, 2019 appellant requested reconsideration. 

By decision dated December 2, 2019, OWCP denied modification. 

By decision dated August 5, 2020, OWCP denied modification. 

LEGAL PRECEDENT

An employee seeking benefits under FECA7 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 filed within the applicable time 

limitation of FECA,8that an injury was sustained while in the performance of duty as alleged; and 

that any disability or specific condition for which compensation is claimed is causally related to 

6

Id.

7

Supra note 1.

8 C.B., Docket No. 21-1291 (issued April28, 2022); S.C., Docket No. 18-1242 (issued March 13, 2019); J.P., 59 

ECAB 178 (2007); Joe D. Cameron, 41 ECAB 153 (1989).
6

the employment injury.9 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. 10

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

performance of duty, it first must be determined whether f act of injury has been established.11 

Generally, fact of injury consists of two components that must be considered in conjunction with 

one another. The first component is whether the employee actually experienced the employment 

incident that allegedly occurred.12 The second component is whether the employment incident 

caused a personal injury.13 

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.14 The opinion of the physician must be based upon a complete 

factual and medical background, 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 incident.15

ANALYSIS

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

condition causally related to the accepted August 6, 2014 employment incident.

Preliminarily, the Board notes that it is unnecessary for it to consider the evidence that was 

previously considered in its August 2, 2019 decision. Findings made in prior Board decisions are 

res judicata absent any further review by OWCP under section 8128 of FECA.16

In a report dated August 21, 2019, Dr. Shaw evaluated appellant for bilateral pain in his 

thighs. He indicated that appellant described an injury during physical therapy and listed the date 

of onset as August 6, 2014. Dr. Shaw provided findings on examination, and diagnosed left hip 

pain, a strain of the bilateral thighs, and right thigh pain. He advised that appellant’s right knee 

9 L.C., Docket No. 19-1301 (issued January 29, 2020); T.H., Docket No. 18-1736 (issued March 13, 2019); R.C., 

59 ECAB 427 (2008).

10 P.A., Docket No. 18-0559 (issued January 29, 2020); T.E., Docket No. 18-1595 (issued March 13, 2019); 

Delores C. Ellyett, 41 ECAB 992 (1990).

11 T.H., Docket No. 19-0599 (issued January 28, 2020); S.S., Docket No. 18-1488 (issued March 11, 2019); T.H., 

59 ECAB 388 (2008).

12 S.S., Docket No. 19-0688 (issued January 24, 2020); E.M., Docket No. 18-1599 (issued March 7, 2019); 

Bonnie A. Contreras, 57 ECAB 364 (2006).

13 Id.

14 E.G., Docket No. 20-1184 (issued March 1, 2021); T.H., 59 ECAB 388 (2008).

15 D.C., Docket No. 19-1093 (issued June 25, 2020); see L.B., Docket No. 18-0533 (issued August 27, 2018).

16 N.T., Docket No. 21-0236 (issued January 24, 2023); T.B., Docket No. 20-1413 (issued July 1, 2021);

M.D., Docket No. 20-0007 (issued May 13, 2020); Clinton E. Anthony, Jr., 49 ECAB 476 (1998).
7

was higher than his left knee when he squatted. Dr. Shaw related that appellant had experienced 

right knee pain after performing lunges and had also described symptoms suggesting a ruptured 

cyst or joint effusion. He attributed the findings of joint effusion found on the April 23, 2015 MRI 

scan and the joint effusion and ruptured popliteal cyst found on the April 1, 2016 MRI scan to 

appellant’s performing physical therapy exercises on August 6, 2014, as well as other work factors. 

Dr. Shaw advised that he had no history of a previous injury to the right knee and opined that the 

swelling around the S1 nerve root following his lumbar surgery had caused an imbalance between 

the lower extremities resulting in his right leg becoming prone to injury during physical exercises 

in his two months of physical therapy. He further attributed the worsening of appellant’s right 

knee condition to repeated kneeling and squatting performing his job duties. While Dr. Shaw

advised that appellant’s back injury had caused him to become more susceptible to injury, he did 

not explain physiologically how performing lunges on August 6, 2014 caused the diagnosed 

condition of joint effusion with a ruptured popliteal cyst. The Board has held that a medical 

opinion should offer a medically-sound explanation of how the specific employment incident 

physiologically caused the diagnosed condition.17 Such rationale is particularly necessary given 

that, in his October 5, 2015 report, which was significantly more contemporaneous to the accepted 

incident, Dr. Shaw attributed appellant’s knee symptoms to atrophy from the right quadriceps 

leading to an altered gait. Further, while he noted that appellant had not sustained a prior right 

knee injury, the Board has held that an opinion finding causal relationship because an employee 

was asymptomatic before the injury, but symptomatic after is insufficient, without supporting 

rationale, to establish causal relationship.18 As Dr. Shaw failed to provide sufficient rationale 

explaining how appellant’s participation in physical therapy on August 6, 2014 caused or 

aggravated a diagnosed condition, his opinion is insufficient to meet appellant’s burden of proof.19

Appellant further submitted an unsigned March 7, 2016 report from Dr. Wender and a 

September 5, 2019 report from an unidentified healthcare provider. The Board has held that 

reports that are unsigned or bear an illegible signature lack proper identification and cannot be 

considered probative medical evidence as the author cannot be identified as a physician. 20 

Accordingly, these reports are also insufficient to establish appellant’s claim.

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 and 20 C.F.R. 

§§ 10.605 through 10.607.

17 See G.H., Docket No. 21-1225 (issued January 30, 2023); M.O., Docket No. 21-0940 (issued January 25, 2023).

18 See V.V., Docket No. 20-0175 (issued May 22, 2022); J.F.,Docket No. 19-1694 (issued March 18, 2020); JohnF. 

Glynn, 53 ECAB 562 (2002); Thomas Petrylak, 39 ECAB 276, 281 (1987).

19 Id.

20 A.H., Docket No. 22-0001 (issued July 29, 2022); M.A.,Docket No. 19-1551 (issued April 30, 2020);

T.O., Docket No. 19-1291 (issued December 11, 2019); Merton J. Sills, 39 ECAB 572, 575 (1988).
8

CONCLUSION

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

condition causally related to the accepted August 6, 2014 employment incident. 

ORDER

IT IS HEREBY ORDERED THAT the August 5, 2020 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: August 22, 2023

Washington, DC

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

James D. McGinley, Alternate Judge

Employees’ Compensation Appeals Board