United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

N.L., Appellant 

and 

DEPARTMENT OF THE NAVY, NAVAL AIR 

SYSTEMS COMMAND, China Lake, CA, 

Employer 

__________________________________________ 

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Docket No. 15-306 

Issued: April 15, 2015 

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

CHRISTOPHER J. GODFREY, Chief Judge 

PATRICIA H. FITZGERALD, Deputy Chief Judge 

ALEC J. KOROMILAS, Alternate Judge 

JURISDICTION 

On November 24, 2014 appellant, through her attorney, filed a timely appeal from an 

August 29, 2014 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 her burden of proof to establish that she sustained 

plantar fasciitis, posterior tibial tendon dysfunction, and reflex sympathetic dystrophy (RSD) of 

the lower extremities causally related to an August 26, 2010 employment injury. 

 1

 5 U.S.C. § 8101 et seq. 
2

FACTUAL HISTORY 

On September 16, 2010 appellant, then a 56-year-old resources assistant, filed a traumatic 

injury claim alleging that on August 26, 2010 she injured her left knee, ankle, and foot when she 

twisted her left knee and ankle as she fell onto pavement.2 OWCP accepted the claim for an old 

bucket handle tear of the medial meniscus and left ankle sprain. 

On May 13, 2011 Dr. Todd A. Anderson, a Board-certified orthopedic surgeon, 

performed a partial medial and lateral menisectomy of the left knee and a limited chondroplasty 

of the medial femoral condyle and patellofemoral joint. OWCP paid appellant compensation 

from May 13 until June 13, 2011, when she returned to her usual employment. 

In a report dated July 12, 2011, Dr. Scot L. Roberg, a podiatrist, evaluated appellant for 

pain in her left foot. He discussed her history of a fall at work on August 26, 2010 resulting in 

injuries to her left leg and body and surgery on her knee. Dr. Roberg also noted that appellant 

had a “history of [RSD] to her upper body and upper leg secondary to carpal tunnel, cubital 

tunnel and [a] knee arthroscopy in 1990, 1991, [and] 1998.” He diagnosed posterior tibial 

tendon dysfunction and tendinitis, left ankle sprain, left plantar fasciitis, and a left midfoot sprain 

or arthritis. Dr. Roberg found that appellant’s symptoms were likely caused by twisting when 

she “injured the posterior tibial tendon while spraining the ankle....” He further attributed her 

plantar fascial symptoms to an antalgic gait and a low foot arch. Dr. Roberg recommended 

orthotics. 

Dr. Roberg provided progress reports from July 26, 2011 through March 16, 2012 

describing his treatment of appellant for plantar fasciitis, posterior tibial tendon dysfunction, left 

ankle sprain, and a possible midfoot sprain or arthritis. 

Magnetic resonance imaging (MRI) scan studies of the left ankle performed October 15, 

2011 and May 5, 2012 showed subcutaneous soft tissue swelling. The May 5, 2012 MRI scan 

study also showed either a ganglion cyst or tenosynovitis at the anterior tibial tendon, and a 

ganglion cyst in the navicular bone. 

In a progress report dated June 15, 2012, Dr. Roberg diagnosed possible venous stasis 

disease, and noted that such a condition would not be covered under workers’ compensation. In 

an October 5, 2012 progress report, he evaluated appellant for swelling of both legs and pain in 

the right foot. Dr. Roberg diagnosed left plantar fasciitis, left posterior tibial tendon dysfunction 

and tendinitis, possible Lisfranc joint arthritis on the left, and compensation myositis of the right 

foot. He recommended steroids and noted that appellant had stage III kidney disease. On 

November 19, 2012 Dr. Roberg evaluated her for increased right foot pain. In a progress report 

dated December 14, 2012, he requested a bone scan. A bone scan performed March 5, 2013, 

revealed findings “consistent with active [RSD] of both the right and left ankles.” 

 2

 Appellant related that she began to fall on pavement outside of the employing establishment’s building. In a 

statement received November 22, 2010, she related that she was on the property of the employment establishment 

outside the door of her building. 
3

On June 18, 2013 Dr. Roberg related that in his July 12, 2011 examination of appellant 

he found “multiple diagnoses which accounted for her pain that had been untreated. These 

included posterior tendinitis, plantar fasciitis, along with lateral ankle sprain, which was 

unresolved.” He indicated that her plantar fasciitis improved with treatment but that the 

“reduction in this pain elicited previously undiscovered mid-foot arthritis.” Dr. Roberg noted 

that a bone scan showed bilateral RSD of the ankles. He opined that appellant’s ankle injury 

likely precipitated her RSD. Dr. Roberg determined that the diagnoses of left ankle sprain, left 

plantar fasciitis, and RSD of the lower extremities “should be included in [appellant’s] approved 

diagnoses as a direct or indirect result of her injury on August 26, 2010.” 

On August 12, 2013 OWCP advised appellant that she should provide a written request 

for claim expansion if she believed that she sustained additional conditions due to her work 

injury. It further requested that she submit a reasoned medical report from her attending 

physician explaining the relationship between these conditions and her accepted work injury. 

In a letter dated December 12, 2013, OWCP noted that it appeared that appellant was 

claiming plantar fasciitis, RSD, and posterior tibial tendon dysfunction as a consequential injury 

and also alleging a recurrence of disability.3

 It advised her that the medical evidence from 

Dr. Roberg was insufficient to meet her burden of proof and requested that she submit a reasoned 

report addressing causation. 

On January 31, 2014 OWCP informed Dr. Roberg that it had accepted only an old bucket 

handle left medial meniscus tear and left ankle sprain due to appellant’s August 26, 2010 work 

injury. It noted that appellant had sustained a left ankle sprain in 2009 and a right knee 

contusion, left ankle strain, a chest contusion, and left wrist sprain in 2004 under other OWCP 

file numbers. OWCP requested that Dr. Roberg submit a report based on a complete medical 

history explaining the relationship between any diagnosed conditions and the August 26, 2010 

employment incident. 

On February 14, 2014 appellant’s attorney requested claim expansion. He submitted a 

November 7, 2013 report from Dr. Roberg in support of his request. Dr. Roberg related that 

appellant continued to have left foot pain and pain on the inside of her ankle. He diagnosed 

posterior tibial tendon dysfunction and likely RSD. 

By decision dated February 24, 2014, OWCP denied appellant’s request to expand her 

claim to include RSD, plantar fasciitis, and posterior tibial tendon dysfunction. It found that the 

medical evidence was insufficient to establish that she sustained additional conditions as a result 

of her accepted August 26, 2010 work injury. 

In a statement dated February 14, 2014, received by OWCP on February 26, 2014, 

appellant related that she periodically experienced pain and swelling of the left ankle and foot. 

She asserted that she did not sprain her ankle on August 26, 2010 but instead sustained posterior 

tibial dysfunction, plantar fasciitis, and RSD. 

 3

 By decision dated December 12, 2013, OWCP denied appellant’s schedule award claim after finding that she 

had not reached maximum medical improvement. 
4

On February 28, 2014 appellant, through counsel, requested a telephone hearing before 

an OWCP hearing representative. At the telephone hearing, held on July 21, 2014, she related 

that she continued to experience RSD bilaterally. Appellant indicated that she had a prior history 

of RSD in the upper extremities but not the feet.4

 The hearing representative asked that she 

submit a comprehensive report addressing whether her RSD was related to her accepted work 

injury. 

By decision dated August 29, 2014, an OWCP hearing representative affirmed the 

February 24, 2014 decision.5

 He determined that Dr. Roberg’s opinion was speculative and 

unrationalized and thus insufficient to meet appellant’s burden of proof. 

On appeal appellant’s counsel contends that the word “likely” is not speculative. 

LEGAL PRECEDENT 

An employee seeking benefits under FECA6 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 of FECA; 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. These are the essential elements of each and every 

compensation claim regardless of whether the claim is predicated upon a traumatic injury or an 

occupational disease.7

Causal relationship is a medical issue, and the medical evidence generally required to 

establish causal relationship is rationalized medical opinion evidence.8 The opinion of the 

physician must be based on a complete factual and medical background of the claimant,9

 must be 

one of reasonable medical certainty10 explaining the nature of the relationship between the 

diagnosed condition and the specific employment factors identified by the claimant.11

 4

 In a report dated March 1, 2002, Dr. Al Katouzian, a Board-certified anesthesiologist, related that appellant had 

a history of complex regional pain syndrome, (CRPS) Type I, of the bilateral upper and lower extremities. He 

diagnosed CRPS, Type 1, or RSD, of the upper and lower extremities. 

5

 The hearing representative indicated that he was affirming a March 5, 2013 decision; however, it is apparent 

from the context that this is a typographical error. 

6 Supra note 1. 

7 Calvin E. King, 51 ECAB 394 (2000); Caroline Thomas, 51 ECAB 451 (2000). 

8 John J. Montoya, 54 ECAB 306 (2003). 

9 Tomas Martinez, 54 ECAB 623 (2003); Gary J. Watling, 52 ECAB 278 (2001). 

10 Supra note 8. 

11 Judy C. Rogers, 54 ECAB 693 (2003). 
5

ANALYSIS 

OWCP accepted that on August 26, 2010 appellant sustained a left ankle sprain and a 

bucket handle tear of the left medial meniscus. It paid her compensation from May 13 until 

June 13, 2011, when she returned to work without restrictions. 

On February 14, 2014 appellant’s counsel requested that her claim be expanded to 

include additional conditions of the left foot and ankle based on the reports of Dr. Roberg. The 

Board finds, however, that the medical evidence is insufficient to support that she sustained 

additional medical conditions as a result of her accepted August 26, 2010 employment injury. 

On July 12, 2011 Dr. Roberg discussed appellant’s history of injuring her left leg and 

side of body on August 26, 2010 and her prior history of RSD of the upper extremity and upper 

leg due to prior surgeries in 1990, 1991, and 1998. He diagnosed posterior tibial tendon 

dysfunction and tendinitis, left ankle sprain, left plantar fasciitis, and a left midfoot sprain or 

arthritis. Dr. Roberg opined that appellant’s current condition likely resulted from a twisting 

injury to the posterior tibial tendon when she sprained her ankle. He further attributed the 

plantar fasciitis to a gait change and low foot arch. Dr. Roberg’s opinion that appellant 

sustained posterior tendinitis and dysfunction “likely” due to twisting her ankle is couched in 

speculative terms and thus of diminished probative value.12 Further, he did not provide any 

rationale for his causation finding. A mere conclusion without the necessary rationale explaining 

how and why the physician believes that a claimant’s accepted exposure could result in a 

diagnosed condition is not sufficient to meet a claimant’s burden of proof.13 Dr. Roberg also 

attributed the diagnosed left plantar fasciitis to a gait change after her ankle sprain and a low foot 

arch. He did not, however, provide any rationale for his opinion that she sustained left plantar 

fasciitis as a consequence of her work injury and thus it is of little probative value.14

In progress reports dated July 26, 2011 to March 16, 2012, Dr. Roberg treated appellant 

for plantar fasciitis, posterior tibial tendon dysfunction, left ankle sprain, and a possible midfoot 

sprain or arthritis. On June 15, 2012 Dr. Roberg diagnosed possible venous stasis disease, and 

noted that such a condition would not be covered under workers’ compensation. In a progress 

report dated October 5, 2012 he noted that appellant had bilateral pain and swelling of the legs 

and right foot pain. Dr. Roberg diagnosed left plantar fasciitis, left posterior tibial tendon 

dysfunction and tendinitis, possible Lisfranc joint arthritis on the left, and compensation myositis 

of the right foot. He also noted that appellant had stage III kidney disease. On November 19, 

2012 Dr. Roberg evaluated her for increased right foot pain. In his progress reports, however, he 

did not address causation. Medical evidence that does not offer any opinion regarding the cause 

of an employee’s condition is of diminished probative value on the issue of causal relationship.15 

 12 Id. 

13 See Beverly A. Spencer, 55 ECAB 501 (2004). 

14 See V.G., Docket No. 13-1462 (issued November 26, 2013); C.S., Docket No. 12-1573 (issued April 2, 2013). 

15 S.E., Docket No. 08-2214 (issued May 6, 2009); Conard Hightower, 54 ECAB 796 (2003). 
6

In a report dated June 8, 2013, Dr. Roberg advised that he had found additional diagnoses 

causing appellant’s symptoms of pain at the time of his June 12, 2011 evaluation, including 

plantar fasciitis, unresolved ankle sprain, and posterior tendinitis. He noted that a bone scan 

showed RSD of the ankles bilaterally. Dr. Roberg opined that appellant’s ankle sprain was 

“likely” the precipitating cause of her RSD and determined that she sustained a left ankle sprain, 

left plantar fasciitis, and RSD of the lower extremities as a result of her August 26, 2010 work 

injury. His finding that her ankle sprain “likely” caused RSD is speculative in nature and thus 

insufficient to meet her burden of proof.16 Further, Dr. Roberg did not provide rationale in 

support of his causation finding to explain how the sprain could have precipitated the diagnosed 

conditions. Where appellant claims that a condition not accepted or approved by OWCP was 

due to her employment injury, she bears the burden of proof to establish that the condition is 

causally related to the employment injury through the submission of rationalized medical 

evidence.17 Such rationale is particularly necessary given that Dr. Roberg found a preexisting 

history of RSD in the upper leg in his June 12, 2011 report and as appellant has evidence of RSD 

bilaterally rather than only on the injured side. 

In a progress report dated November 7, 2013, Dr. Roberg listed findings on examination 

and diagnosed dysfunction of the posterior tibial tendon and likely RSD. He did not, however, 

address causation and thus his report is of little probative value on the issue of causal 

relationship.18

On appeal appellant’s counsel argues that “likely” is not speculative. The Board has 

held, however, that while the opinion of a physician supporting causal relationship need not be 

one of absolute medical certainty, the opinion must not be speculative or equivocal. The opinion 

must be expressed in terms of a reasonable degree of medical certainty.19 Dr. Roberg’s finding 

that appellant’s ankle sprain “likely” caused her RSD and other left foot and ankle conditions is 

equivocal in nature and thus of diminished probative value20 especially in light of the lack of any 

medical rationale for such a conclusory statement. 

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. 

 16 See Ricky E. Storms, 52 ECAB 349 (2001). 

17 See Jaja K. Asaramo, 55 ECAB 200, 204 (2004). 

18 See A.D., 58 ECAB 149 (2006). 

19 See G.J., Docket No. 14-907 (issued November 10, 2014); Caroline Thomas, supra note 7. 

20 B.S., Docket No. 15-2 (issued February 27, 2015); Cecilia M. Corley, 56 ECAB 662 (finding that medical 

opinions which are speculative or equivocal are of diminished probative value). 
7

CONCLUSION 

The Board finds that appellant has not met her burden of proof that she sustained plantar 

fasciitis, posterior tibial tendon dysfunction, and RSD of the lower extremities causally related to 

an August 26, 2010 employment injury. 

ORDER 

IT IS HEREBY ORDERED THAT the August 29, 2014 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: April 15, 2015 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board