United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

V.G., Appellant 

and 

DEPARTMENT OF VETERANS AFFAIRS, 

VETERANS ADMINISTRATION MEDICAL 

CENTER, Murfreesboro, TN, Employer 

__________________________________________ 

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Docket No. 17-0067 

Issued: April 5, 2017 

Appearances: Case Submitted on the Record

Appellant, pro se 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

CHRISTOPHER J. GODFREY, Chief Judge 

ALEC J. KOROMILAS, Alternate Judge 

VALERIE D. EVANS-HARRELL, Alternate Judge 

JURISDICTION 

On October 17, 2016 appellant filed a timely appeal from merit decisions of the Office of 

Workers’ Compensation Programs (OWCP) dated July 28 and October 4, 2016. Pursuant to the 

Federal Employees’ Compensation Act1

 (FECA) and 20 C.F.R. §§ 501.2(c) and 501.3, the Board 

has jurisdiction to consider the merits of this case. 

ISSUE 

The issue is whether appellant met her burden of proof to establish that her right foot 

conditions were causally related to factors of her federal employment. 

FACTUAL HISTORY 

On May 26, 2016 appellant, then a 56-year-old health technician, filed an occupational 

disease claim (Form CA-2) alleging that on December 12, 2015 she first became aware of two 

 1

 5 U.S.C. § 8101 et seq. 
2

bone spurs in her right foot. On May 20, 2016 she first realized this condition was due to her 

standing on her feet at work for the past 33 years. Appellant stopped work on May 19, 2016. 

By correspondence dated June 15, 2016, OWCP informed appellant that the evidence of 

record was insufficient to support her claim. Appellant was advised regarding the medical and 

factual evidence required to establish her claim and was afforded 30 days to provide this 

evidence. 

OWCP thereafter received a May 20, 2016 report from Dr. Jared C. Bramlett, a treating 

podiatrist. Dr. Bramlett noted that appellant was seen for complaints of severe foot pain, with 

the right foot being more painful. He noted that she was required to stand on her feet at work 

and had worked at the employing establishment for over 30 years. An examination revealed 

intact bilateral neurovascular status, medial right ankle edema extending into the medial heel and 

plantar fascia, significant pain on palpation of the right plantar fascia insertion and plantar fascial 

band, right tibial tendon pain, and decreased left plantar insertion, plantar fascia, and posterior 

tendon pain. A review of x-ray interpretations revealed two inferior calcaneal spurrings on the 

right and one on the left, significant mid-foot breakdown, and bilateral degenerative joint 

disease, which was worse on the right side. Dr. Bramlett diagnosed calcaneal spur syndrome, 

plantar fasciitis, and degenerative joint disease. In an attached disability note, he diagnosed 

plantar fasciitis, stress fracture, bilateral arthritis, and bilateral calcaneal spurs. Dr. Bramlett 

indicated that appellant was disabled from work until August 12, 2016. He also related that she 

was to use an ambulatory boot and was required to limit her weight bearing. 

In a report dated May 23, 2016 and signed on May 24, 2016, Dr. Bramlett reported that 

appellant was seen for significant heel and foot pain and that she had worked for the employing 

establishment for 30 years. Diagnoses included calcaneal spur syndrome with degenerative joint 

disease, plantar fasciitis, and right foot calcaneal stress fracture. Physical examination findings 

and findings from review of x-ray interpretations were unchanged from his prior report. 

Dr. Bramlett, in a report dated June 9, 2016, noted that appellant was seen in a follow-up 

visit for calcaneal stress fracture, peroneal tendinitis, plantar fasciitis, and posterior tibial tendon 

dysfunction. Examination findings included significant right foot decreased edema and 

decreased pain in the plantar fascia and peroneal tendon, posterior tibial tendon, and insertion. 

In a July 7, 2016 report, Dr. Bramlett provided a history of his treatment of appellant with 

an initial evaluation in May 2016 for complaints of severe right foot pain which began in 

October 2015. He noted appellant’s work history and foot complaints. Dr. Bramlett provided a 

summary of physical examination findings from his prior reports and findings from review of 

two x-ray interpretations. Diagnoses included calcaneal spur syndrome, chronic plantar fasciitis, 

some subtalar joint arthritis, and bilateral degenerative joint disease, more prominent on the 

right. Dr. Bramlett attributed the diagnosed conditions to biomechanical factors. 

By decision dated July 28, 2016, OWCP denied appellant’s claim. It found that the 

medical evidence of record was insufficient to establish a causal relationship between the 

diagnosed conditions and the accepted employment factors. 
3

In a form dated August 29, 2016, received by OWCP on September 28, 2016, appellant 

requested reconsideration. 

In an accompanying statement dated September 18, 2016, appellant described the duties 

she performed while working for the employing establishment for approximately 30 years. She 

stated that she was required to do a lot of walking and standing. Appellant alleged that the 

prolonged walking and standing required of her job was hard on her feet, knees, and back. She 

also alleged that walking and standing was aggravating her sciatic nerve. 

By decision dated October 4, 2016, OWCP denied modification. It found the evidence of 

record failed to establish that the diagnosed foot conditions had been caused or aggravated by the 

accepted employment factors. 

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 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.3 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.4 

To establish that an injury was sustained in the performance of duty in a claim for 

occupational disease, an employee must submit: (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 employment factors identified by the employee.5

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

establish causal relationship is rationalized medical opinion evidence.6

 Rationalized medical 

opinion evidence is medical evidence which includes a physician’s rationalized opinion on 

whether there is a causal relationship between the employee’s diagnosed condition and the 

compensable employment factors.7 The opinion of the physician must be based on a complete 

 2

 5 U.S.C. § 8101 et seq. 

3 C.S., Docket No. 08-1585 (issued March 3, 2009); Bonnie A. Contreras, 57 ECAB 364 (2006). 

4 S.P., 59 ECAB 184 (2007); Joe D. Cameron, 41 ECAB 153 (1989). 

5 D.U., Docket No. 10-144 (issued July 27, 2010); R.H., 59 ECAB 382 (2008); Roy L. Humphrey, 57 ECAB 238 

(2005); Donald W. Wenzel, 56 ECAB 390 (2005). 

6 Y.J., Docket No. 08-1167 (issued October 7, 2008); A.D., 58 ECAB 149 (2006); D’Wayne Avila, 57 ECAB 

642 (2006). 

7 J.J., Docket No. 09-27 (issued February 10, 2009); Michael S. Mina, 57 ECAB 379 (2006). 
4

factual and medical background of the employee, 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 employee.8

ANALYSIS 

The Board finds that appellant failed to meet her burden of proof to establish that the 

identified employment factors caused or aggravated her right foot conditions. Appellant 

identified the factors of employment that she believed caused the condition, including prolonged 

walking and standing for over 30 years at work. OWCP accepted these activities as factors of 

her federal employment. However, in order to establish a claim for an employment-related 

injury, appellant must also submit rationalized medical evidence which explains how her medical 

condition was caused or aggravated by the accepted employment factors.9

The issue of causal relationship is a medical one and must be resolved by a probative 

medical opinion from a physician.10 OWCP received a July 7, 2016 report from Dr. Bramlett 

diagnosing chronic plantar fasciitis, subtalar joint arthritis, calcaneal spur syndrome, and bilateral 

degenerative joint disease. Dr. Bramlett noted appellant’s work history and attributed her right 

foot conditions to biomechanical factors. He did not explain the biomechanical factors he was 

referring to or why walking or standing for prolonged periods of time would physiologically 

cause or aggravate appellant’s right foot conditions. The Board has found that rationalized 

medical opinion evidence must relate specific employment factors identified by the claimant to 

the claimant’s condition, with medical rationale explaining how the employment factors 

physiologically caused the diagnosed condition.11 The Board has also found that a mere 

conclusion without the necessary rationale is insufficient to meet a claimant’s burden of proof.12 

Accordingly, Dr. Bramlett’s reports are insufficient to meet appellant’s burden of proof. 

Appellant also submitted reports and disability notes from Dr. Bramlett diagnosing 

calcaneal spur syndrome, plantar fasciitis, degenerative joint disease, calcaneal spur syndrome 

with degenerative joint disease, right foot calcaneal stress, subtalar joint arthritis, and bilateral 

joint disease. Dr. Bramlett offered no opinion as to the cause of these conditions in the disability 

notes, or the May 20, 23, or June 9, 2016 reports. The Board has held that medical evidence 

offering no opinion regarding the cause of an employee’s condition is of limited probative value 

on the issue of causal relationship.13

 8 I.J., 59 ECAB 408 (2008); Victor J. Woodhams, 41 ECAB 345, 352 (1989). 

9 See A.C., Docket No. 08-1453 (issued November 18, 2008); Donald W. Wenzel, supra note 5. 

10 I.A., Docket No. 13-1701 (issued January 17, 2014); Ronald K. Jablanski, 56 ECAB 616 (2005). 

11 See T.C., Docket No. 16-1052 (issued November 8, 2016). 

12 See T.M., Docket No. 08-975 (issued February 6, 2009); Roma A. Mortenson-Kindschi, 57 ECAB 418 (2006); 

William C. Thomas, 45 ECAB 591 (1994) (a medical report is of limited probative value on the issue of causal 

relationship if it contains a conclusion regarding causal relationship which is unsupported by medical rationale).

13 C.B., Docket No. 09-2027 (issued May 12, 2010); J.F., Docket No. 09-1061 (issued November 17, 2009); A.D.,

supra note 6; Jaja K. Asaramo, 55 ECAB 200 (2004). 
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The Board has held that the fact that a condition manifests itself during a period of 

employment does not raise an inference of causal relation.14 An award of compensation may not 

be based on surmise, conjecture, or speculation. Neither the fact that appellant’s condition 

became apparent during a period of employment nor the belief that her condition was caused, 

precipitated, or aggravated by her employment is sufficient to establish causal relationship.15 To 

establish a firm medical diagnosis and causal relationship, appellant must submit a physician’s 

report that addresses how her prolonged walking and standing at work for approximately 30 

years caused or aggravated the two bone spurs in her right foot or any foot condition.16

OWCP advised appellant that it was her responsibility to provide a comprehensive 

medical report which described her symptoms, test results, diagnosis, treatment, and a 

rationalized medical opinion causally relating the diagnosed conditions to the accepted factors of 

employment. Appellant failed to do so. As there is no probative, rationalized medical evidence 

addressing how appellant’s claimed right foot conditions were caused or aggravated by her 

employment, she has not met her burden of proof to establish an occupational disease causally 

related to factors of employment. 

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. 

CONCLUSION 

The Board finds that appellant has not met her burden of proof to establish that her right 

foot conditions were causally related to factors of her federal employment. 

 14 L.D., Docket No. 09-1503 (issued April 15, 2010); D.I., 59 ECAB 158 (2007); Daniel O. Vasquez, 57 ECAB 

559 (2006). 

15 See D.U., supra note 5; Robert Broome, 55 ECAB 339 (2004); Anna C. Leanza, 48 ECAB 115 (1996). 

16 Michael S. Mina, supra note 7; Michael E. Smith, 50 ECAB 313 (1999). 
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ORDER 

IT IS HEREBY ORDERED THAT the decisions of the Office of Workers’ 

Compensation Programs dated October 4 and July 28, 2016 are affirmed. 

Issued: April 5, 2017 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board 

 

 Valerie D. Evans-Harrell, Alternate Judge 

 Employees’ Compensation Appeals Board