United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

M.L., Appellant 

and 

DEPARTMENT OF VETERANS AFFAIRS, 

VETERANS ADMINISTRATION MEDICAL 

CENTER, Cincinnati, OH, Employer 

__________________________________________ 

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Docket No. 16-0240 

Issued: March 9, 2016 

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

PATRICIA H. FITZGERALD, Deputy Chief Judge 

ALEC J. KOROMILAS, Alternate Judge 

VALERIE D. EVANS-HARRELL, Alternate Judge 

JURISDICTION 

On November 23, 2015 appellant, through counsel, filed a timely appeal of a June 1, 

2015 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 a traumatic injury, 

causally related to an April 15, 2015 employment incident. 

FACTUAL HISTORY 

On April 23, 2014 appellant then a 46-year-old nurse practitioner, filed a traumatic injury 

claim (Form CA-1), alleging that on April 15, 2014 while quickly walking down the hall at 

 1

 5 U.S.C. § 8101 et seq. 
2

work, she heard a pop in the right outer aspect of her foot which resulted in a break of the right 

fifth metatarsal. She did not stop work. 

By letter dated May 7, 2014, OWCP advised appellant of the type of evidence needed to 

establish her claim, particularly requesting that she submit a physician’s reasoned opinion 

addressing the relationship of her claimed condition, and specific employment factors. 

Appellant was treated in an emergency room on April 16, 2014 by Dr. Joni L. Vest, a 

Board-certified emergency room physician, for a work-related injury to her right foot. Dr. Vest 

indicated that appellant had a history of stress fractures in this foot in the past. Appellant 

reported a “pop” in her right foot while working. She finished her shift and noted that her foot 

was swollen. Dr. Vest noted that appellant’s history was significant for a stress fracture in the 

right foot in the past, left knee arthroscopy, partial left knee medial meniscectomy on 

October 23, 2012, and a total left knee arthroplasty on December 31, 2012. Right foot 

examination showed mild swelling of the lateral aspect of the right midfoot, erythema, 

tenderness to the base of the fifth tarsal region, and mild bruising to the plantar midfoot region. 

An April 16, 2014 x-ray of the right foot revealed mild osteoarthritis of the interphalangeal 

joints, mild osteoarthritis of the first metatarsophalangeal joint, recent transverse fracture of the 

proximal metaphysis of the fifth metatarsal, nonspecific benign-appearing periostitis of the 

second third and fourth metatarsals, healing stress fractures of the second third and fourth 

metatarsals, and the hind foot osteoarthritis and calcaneal spurring. Dr. Vest diagnosed acute 

right fifth metatarsal fracture. 

In an employing establishment treatment note, Dr. Karen J. Barnes, a Board-certified 

family practitioner, noted treating appellant on April 18, 2014 for a right foot injury. Appellant 

reported that she heard a pop and broke a bone in her right foot on April 15, 2014 while walking 

down the hall with her medicine cart. She continued to work until 8:00 p.m. When appellant 

returned home her foot was bruised and painful. She sought treatment at an emergency room 

and was diagnosed with a broken fifth metatarsal in the right foot. Appellant denied any trauma 

to the foot on the date of injury or even prior to this date and stated “I was just walking down the 

hall when I heard a pop.” Dr. Barnes opined that the injury did not appear to have been caused 

by a work-related factor. 

Appellant was treated by Dr. Vincent Sammarco, a Board-certified orthopedist, on 

April 29, 2014, for a right fifth metatarsal fracture. She reported administering medications at 

work when she stepped on her foot and heard a pop. Appellant noted having significant 

difficulty bearing weight on the right foot. Dr. Sammarco noted findings on examination of an 

antalgic gait with diminished stance time on the affected leg, the right foot examination revealed 

marked pain and discomfort on palpation of the base of the fifth metatarsal laterally, swelling, 

but no ecchymosis, mild pes planus, and good strength. X-rays of the right foot revealed a 

fracture of the fifth metatarsal at the metaphyseal diaphyseal junction. Dr. Sammarco diagnosed 

right fifth metatarsal fracture at the metaphyseal diaphyseal junction (Jones fracture) and opined 

that this injury resulted from a twisting injury at work. In a June 24, 2014 report, he treated 

appellant for severe right foot pain. Appellant had severe pain and discomfort with palpation of 

the base of the fifth metatarsal. Dr. Sammarco noted x-rays of the right foot revealed increased 

radiolucency at the Jones fracture site and periosteal reaction with transverse radiolucency 

developing. He diagnosed fracture of the metatarsal. In Dr. Sammarco’s report of ability to 
3

work, he noted that appellant was off work. In a July 16, 2014 report, he treated her for 

worsening right foot pain. Appellant reported that her right foot was not weight bearing and she 

had severe antalgic gait. Dr. Sammarco noted that physical examination revealed marked point 

tenderness at the fracture site and significant swelling laterally. He further noted that x-rays of 

the right foot revealed a frank nonunion of the fifth metatarsal fracture, widening of the fracture, 

gap and no appreciable bone bridging. Dr. Sammarco recommended surgery. 

By decision dated July 29, 2014, OWCP denied appellant’s claim for a traumatic injury 

on the grounds that she failed to establish that the events occurred as alleged. 

Appellant requested an oral hearing which was held before an OWCP hearing 

representative on March 16, 2015. Following the hearing, she submitted records of her previous 

right foot treatment. In an October 18, 2013 report, Dr. Mathew J. Connelly, a podiatrist, treated 

appellant for pain and right foot swelling. Appellant reported no trauma. Findings on physical 

examination revealed edema surrounding the forefoot, pain on palpation of the second and fourth 

metatarsals, and altered gait. Dr. Connelly diagnosed stress fractures at second and fourth 

metatarsals of the right foot with an unknown etiology. He recommended immobilization of the 

right foot. Dr. Connelly noted x-rays of the right foot revealed a definite cortical thickening 

along the medial aspect of the second metatarsal and cortical thickening and obliteration of the 

central area of the bone on the fourth metatarsal. On October 30, 2013 he diagnosed stress 

fractures of the fourth and fifth metatarsals and recommended immobilization. On 

November 20, 2013 Dr. Connelly treated appellant status postsurgery for stress fractures of the 

fourth and fifth metatarsals. He noted no evidence of neurovascular or dermatologic damage on 

the right foot. Palpation of the metatarsals was pain-free, and weight bearing was very mildly 

antalgic with decreased range of motion of the ankle. Dr. Connelly diagnosed improving stress 

fractures, fourth and fifth metatarsals, right foot. He noted that appellant could not return to full 

weight bearing at work. On December 6, 2013 Dr. Connelly noted continuing treatment of the 

stress fractures of the fourth and fifth metatarsals. He reported that examination was normal and 

appellant was out of her boot and showed no evidence of dysfunction, edema, or pain. 

Dr. Connelly diagnosed resolved right fourth and fifth metatarsal stress fractures and returned 

appellant to weight bearing work without restrictions. Appellant also resubmitted various 

medical records. 

On August 12, 2014 Dr. Sammarco noted that appellant continued to have intractable 

foot pain. Examination revealed marked tenderness to palpation of the lateral column of the foot 

and in particular the fifth metatarsal. Right foot x-rays revealed a nonunion of the fifth 

metatarsal fracture. Dr. Sammarco diagnosed intractable pain and discomfort from a fifth 

metatarsal nonunion and recommended surgery. On August 26, September 23, October 28, and 

November 25, 2014, he saw appellant in follow up after bone grafting and plating of a fifth 

metatarsal nonunion. Dr. Sammarco noted that she was clinically doing well with mild pain and 

an intact neurological examination. In a January 27, 2015 report, he treated appellant for status 

right fifth metatarsal fracture repair. Dr. Sammarco noted that she was weight bearing using the 

walker. Examination of the right foot revealed no tenderness to palpation of the fracture site and 

a well-healed surgical wound. X-rays of the right foot revealed compressive healing of the fifth 

metatarsal fracture with good bony remodeling. Dr. Sammarco diagnosed fracture of the 

metatarsal. An magnetic resonance imaging scan of the right foot dated October 24, 2013 
4

revealed stress abnormalities about the fourth and fifth greater than third metatarsal bones and 

grade 1 tenosynovitis of the peroneal longus. 

In a decision dated June 1, 2015, an OWCP hearing representative affirmed the July 29, 

2014 decision, as modified. The hearing representative found that the April 15, 2014 work 

incident occurred as alleged, but appellant failed to establish that the diagnosed foot condition 

was causally related to the incident. 

LEGAL PRECEDENT 

An employee seeking benefits under FECA 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 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.2

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

performance of duty, it first must be determined whether fact of injury has been established. 

There are two components involved in establishing fact of injury. First, the employee must 

submit sufficient evidence to establish that he actually experienced the employment incident at 

the time, place, and in the manner alleged. Second, the employee must submit medical evidence 

to establish that the employment incident caused a personal injury.3

Rationalized medical opinion evidence is generally required to establish causal 

relationship. The opinion of the physician must be based on 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 factors identified by the claimant.4

ANALYSIS 

It is not disputed that on April 15, 2014 appellant was performing her practitioner nurse 

duties which required walking. It is also not disputed that she was diagnosed with acute right 

fifth metatarsal fracture and frank nonunion of the fracture. However, appellant has not 

submitted sufficient medical evidence to establish that her diagnosed conditions were caused or 

aggravated by the April 15, 2014 work incident. 

Appellant submitted an April 29, 2014 report from Dr. Sammarco who treated her for a 

right fifth metatarsal fracture. She reported walking while she was administering medications at 

work when she stepped on her foot and heard a pop. Dr. Sammarco noted radiologic 

 2 Gary J. Watling, 52 ECAB 357 (2001). 

3

 T.H., 59 ECAB 388 (2008). 

4 I.J., 59 ECAB 408 (2008); Victor J. Woodhams, 41 ECAB 345 (1989). 
5

examination of the right foot revealed a fracture of the fifth metatarsal at the metaphyseal 

diaphyseal junction. He diagnosed right fifth metatarsal fracture at the metaphyseal diaphyseal 

junction (Jones fracture) and opined that this injury was the result of a twisting injury at work. 

The Board finds that, although Dr. Sammarco supported causal relationship, he did not provide 

medical rationale explaining the basis of his conclusory opinion regarding the causal relationship 

between appellant’s right foot condition and the factors of her federal employment.5

 For 

instance Dr. Sammarco did not explain how walking on her right foot would cause a fracture of 

the fifth metatarsal and why this injury would not be caused by nonwork-related factors such as 

her prior right foot condition from 2013. This evidence was insufficient to show that appellant 

sustained a work-related injury in the performance of duty. Other reports from Dr. Sammarco 

are also insufficient to establish the claim as the physician did not provide a history of injury6 or 

specifically address whether her employment activities had caused or aggravated a diagnosed 

medical condition.7

Appellant submitted emergency room notes from Dr. Vest dated April 16, 2014 who 

treated appellant for a right foot injury. She reported a history of stress fractures and stated that 

she heard a “pop” in the right foot while working which became swollen and painful. Dr. Vest 

noted appellant’s history was significant for a stress fracture in the right foot. However, she 

appears merely to be repeating the history of injury as reported by appellant without providing 

her own opinion regarding whether appellant’s condition was work related. To the extent that 

Dr. Vest is providing her own opinion, she failed to provide a rationalized opinion regarding the 

causal relationship between appellant’s transverse fracture of the fifth metatarsal of the foot and 

the factors of employment believed to have caused or contributed to such condition. Therefore, 

this report is insufficient to meet appellant’s burden of proof. 

Appellant submitted an April 18, 2014 report from Dr. Barnes who treated her for a right 

foot injury. She reported walking down the hall with her medicine cart on April 15, 2014 when 

she heard a pop in her right foot. Appellant was treated in the emergency room and was 

diagnosed with a broken fifth metatarsal in the right foot. She denied any trauma to the foot on 

the date of injury or prior to this date. This report does not support that appellant’s right foot 

condition was causally related to her employment as Dr. Barnes opined that the injury did not 

appear to have been caused by a work-related factor. Therefore, this report is insufficient to 

meet appellant’s burden of proof. 

 5 See T.M., Docket No. 08-975 (issued February 6, 2009) (where the Board found that 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). 

6 Frank Luis Rembisz, 52 ECAB 147 (2000) (medical opinions based on an incomplete history or which are 

speculative or equivocal in character have little probative value). 

7 A.D., 58 ECAB 149 Docket No. 06-1183 (issued November 14, 2006) (medical evidence which does not offer 

any opinion regarding the cause of an employee’s condition is of limited probative value on the issue of causal 

relationship). 
6

The remainder of the medical evidence is of limited probative value as it fails to provide 

an opinion on the causal relationship between appellant’s diagnosed conditions and the April 15, 

2014 work incident. For this reason, this evidence is not sufficient to meet her burden of proof.8 

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. Causal relationship must be established by 

rationalized medical opinion evidence.9 Appellant failed to submit such evidence, and OWCP 

therefore properly denied her claim for compensation. 

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 did not meet her burden of proof to establish a traumatic 

injury causally related to an April 15, 2015 employment incident. 

 8 See id. 

9

 See Dennis M. Mascarenas, 49 ECAB 215 (1997). 
7

ORDER 

IT IS HEREBY ORDERED THAT the June 1, 2015 decision of the Office of Workers’ 

Compensation Programs is affirmed. 

Issued: March 9, 2016 

Washington, DC 

 

 Patricia H. Fitzgerald, Deputy 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