United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

L.M., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Saint Louis, MO, Employer 

__________________________________________ 

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Docket No. 17-0815 

Issued: August 24, 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 

PATRICIA H. FITZGERALD, Deputy Chief Judge 

VALERIE D. EVANS-HARRELL, Alternate Judge 

JURISDICTION 

On March 2, 2017 appellant filed a timely appeal from a February 7, 2017 merit decision 

of the Office of Workers’ Compensation Programs1

 (OWCP). Pursuant to the Federal 

Employees’ Compensation Act2

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

jurisdiction over the merits of this claim. 

ISSUE 

The issue is whether appellant has met her burden of proof to establish a recurrence of 

medical treatment commencing July 25, 2016 due to her accepted May 5, 2012 federal 

employment injury. 

 1

 The Board notes that appellant submitted additional evidence after OWCP rendered its February 7, 2017 

decision. The Board’s jurisdiction is limited to reviewing the evidence that was before OWCP at the time of its final 

decision and, therefore, this additional evidence cannot be considered on appeal. 20 C.F.R. § 501.2(c)(1); Dennis E. 

Maddy, 47 ECAB 259 (1995); James C. Campbell, 5 ECAB 35, 36 n.2 (1952). 

2

 5 U.S.C. § 8101 et seq.
2

FACTUAL HISTORY 

On May 11, 2012 appellant, then a 54-year-old city carrier, filed a traumatic injury claim 

(Form CA-1) alleging that on May 5, 2012 she sustained tendinitis of the right ankle when she 

stepped on a gumball and twisted her right ankle. She stopped work on the date of injury. 

In a May 7, 2012 emergency department report, Dr. Tara D. Schulte, an osteopath, 

reported that appellant injured herself at work more than two days prior when she sustained a 

slight roll of the right foot. Dr. Schulte noted that x-rays of the right ankle revealed no acute 

fracture or dislocation, normal bone texture and density, smooth articular surfaces, and no lytic 

or blastic lesions. She diagnosed right foot sprain. 

The record reflects that appellant was released to full-time limited-duty work on 

May 11, 2012. Appellant subsequently sought treatment with Dr. Heather Gjorgjievski, Boardcertified in family medicine, who diagnosed right ankle sprain, provided appellant with a right 

leg brace, and released her to work on June 1, 2012. In a June 1, 2012 medical report, 

Dr. Gjorgjievski noted that appellant was not working because light duty was unavailable. Her 

condition had improved though she still experienced occasional aching in the right ankle. 

Physical examination findings revealed no deformity, no ankle swelling, full range of motion, 

negative drawer test, no instability, no tenderness, and equal single leg stance bilaterally. 

Dr. Gjorgjievski diagnosed right sprain/strain of ankle improved and reported that appellant 

could return to regular-duty work without restrictions 

On June 2, 2012 appellant returned to full-time regular-duty work. 

By decision dated November 1, 2012, OWCP accepted the claim for right ankle sprain 

On September 20, 2016 appellant filed a recurrence of disability claim (Form CA-2a) 

alleging a recurrence of medical treatment beginning on July 25, 2016. She reported that she 

was required to wear a brace around her right ankle after receiving therapy which caused 

increased pain and swelling of the right leg. Appellant did not stop work. 

By letter dated September 27, 2016, the employing establishment controverted 

appellant’s recurrence claim indicating that there was no medical evidence to support that the 

recurrence occurred while in the performance of duty on July 25, 2016. It explained that 

appellant was not working on the day of her recurrence, noting that her last day worked before 

the alleged recurrence was July 23, 2016 and she was off on annual leave from July 24 through 

July 28, 2016 

By letter dated October 17, 2016, OWCP informed appellant that the evidence of record 

was insufficient to support her recurrence claim. Appellant was advised of the medical and 

factual evidence needed and provided a questionnaire for completion. She was afforded 30 days 

to submit the necessary evidence. 

In a July 25, 2016 medical report, Dr. John B. Weltmer Jr., a Board-certified orthopedic 

surgeon, reported that appellant had an injury to her right ankle back in March 2013 and was still 

having persistent pain and tenderness in the lateral aspect of her ankle. He explained that she 

had a fall on the job back in March 2013 and injured her ankle after stepping on a gumball, 
3

noting no further treatment since 2013. Dr. Weltmer also noted that she was a postal worker 

who had a walking route of eight hours per day. Physical examination findings revealed 

tenderness with swelling while weight-bearing x-rays revealed negative findings. Dr. Weltmer 

noted that the right ankle was clinically stable to stress with peroneal tendinitis without 

subluxation. He diagnosed right peroneal tendinitis and recommended a magnetic resonance 

imaging (MRI) scan of the right leg 

In an August 12, 2016 diagnostic report, Dr. Amir Momtahen, a Board-certified 

radiologist, reported that a right leg MRI scan revealed findings compatible with tenosynovitis of 

the posterior tibialis tendon without evidence of tear and minimal tibiotalar joint effusion 

In an August 22, 2016 medical report, Dr. Weltmer reported that appellant complained of 

right proximal leg pain with radiation down to her calf. He noted that her MRI scan showed that 

she did not have any peroneal tendinitis, but did have some fluid on the posterior tibialis tendon. 

However, the posterior tibialis tendon was not sore on examination. Dr. Weltmer further noted 

that the right ankle MRI scan revealed some posterior tibialis tendinitis with some ankle 

synovitis, but was otherwise remarkable. 

In a September 29, 2016 medical report, Dr. Weltmer reported that appellant complained 

of continued severe right leg pain despite her right leg MRI scan revealing essentially normal 

findings. 

In a November 8, 2016 report, Dr. Ravindra V. Shitut, a Board-certified orthopedic and 

spine surgeon, reported that appellant was a mail carrier who walked eight miles per day 

delivering mail. Appellant reported that in 2012, approximately four years prior, she fractured 

her ankle while working which was treated by a brace and subsequently healed. More recently 

in the last few months, she complained of pain and numbness in the right leg and foot which she 

believed was related to the right ankle fracture from four years ago. Dr. Shitut noted 

Dr. Weltmer’s evaluation of essentially normal right ankle findings and that appellant had been 

referred for evaluation of the back. He noted that appellant denied any back pain and only 

complained of pain involving the right mid leg down to the foot. Dr. Shitut noted that lumbar 

x-rays revealed a very minute degenerative spondylolisthesis of L4 over L5. He explained that it 

was unclear what was causing appellant’s symptoms and recommended further testing 

In a December 2, 2016 medical report, Dr. Shitut noted that nerve conduction studies 

were reported to be marginally abnormal and did not show any evidence of common peroneal 

nerve palsy. As such, he speculated that there was a good chance appellant’s pain was coming 

from right L5 radiculopathy and scheduled a lumbar spine MRI scan. Dr. Shitut diagnosed L4-5 

spinal stenosis with radiculopathy associated with degenerative spondylolisthesis. Appellant was 

provided with limited-duty work restrictions. 

On December 13, 2016 appellant responded to OWCP’s development questionnaire 

(Form OWCP-20) and explained that she continued to have persistent pain, tenderness, and 

swelling in her right ankle and leg. She reported that Dr. Gjorgjievski prescribed a leg brace 

which she had been wearing since she was released to work on June 1, 2012. Appellant noted 

that her need for additional medical care was related to her original injury because the swelling 
4

in her right ankle worsened and moved up to her leg from having to walk over five miles per day. 

She reported no other injuries since the original work-related injury. 

By decision dated February 7, 2017, OWCP denied appellant’s recurrence claim, finding 

that the medical evidence failed to establish that her need for additional medical treatment was 

due to a material change/worsening of her accepted work-related condition. 

LEGAL PRECEDENT 

A recurrence of a medical condition is defined as a documented need for further medical 

treatment after release from treatment for the accepted condition or injury.3 Continuous 

treatment for the original condition or injury is not considered a recurrence of a medical 

treatment nor is an examination without treatment.4 As distinguished from a recurrence of 

disability, a recurrence of a medical condition does not involve an accompanying work 

stoppage.5 It is the employee’s burden of proof to establish that the claimed recurrence is 

causally related to the original injury.6

If the employee 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.7 To establish causal relationship between the condition, as 

well as any attendant disability, claimed and the employment event or incident, the employee 

must submit rationalized medical opinion evidence, based on a complete factual and medical 

background, supporting such a causal relationship.8 Causal relationship is a medical issue and 

the medical evidence generally required to establish causal relationship is rationalized medical 

opinion evidence.9 A physician’s opinion must be based on a complete factual and medical 

background of the claimant, 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.10

 3

 20 C.F.R. § 10.5(y). 

4 Id. 

5 Id. at § 10.5(x). 

6 Id. at § 10.104. See also Mary A. Ceglia, 55 ECAB 626, 629 (2004); K.H., Docket No. 16-0776 (issued 

October 9, 2016). 

7 Jaja K. Asaramo, 55 ECAB 200 (2004). 

8 Jennifer Atkerson, 55 ECAB 317 (2004). 

9 Elizabeth Stanislav, 49 ECAB 540, 41 (1998). 

10 Gary L. Fowler, 45 ECAB 365, 371 (1994). 
5

ANALYSIS 

OWCP accepted appellant’s claim for right ankle sprain due to her May 5, 2012 

employment injury. Appellant was released to full-duty work without restrictions on 

June 1, 2012. 

Appellant attributes her need for medical treatment commencing July 25, 2016 to a 

change in the nature and extent of her employment-related right ankle condition, requiring 

further medical treatment. She, therefore, has the burden of proof to provide medical evidence to 

establish that her current right ankle condition causally related to her accepted work-related 

condition.11 

The Board finds that appellant has not established a recurrence of medical treatment on 

or after July 25, 2016 causally related to her accepted May 5, 2012 work injury. 

In support of her claim, appellant submitted medical reports dated July 25 through 

September 29, 2016 from Dr. Weltmer. The Board notes that Dr. Weltmer’s reports failed to 

provide a proper history of the May 5, 2012 work injury. Rather, Dr. Weltmer referenced a 

March 2013 right ankle injury with regard to complaints of persistent pain and tenderness in the 

lateral aspect of the ankle. The Board has previously explained that medical conclusions based 

on inaccurate or incomplete histories are of little probative value.12 Furthermore, Dr. Weltmer 

noted that the findings of the August 12, 2016 right leg MRI scan did not correlate with 

appellant’s complaints of pain. He noted that the right leg MRI scan revealed posterior tibialis 

tendinitis with some ankle synovitis, yet findings on physical examination revealed no soreness. 

Moreover, Dr. Weltmer could not determine the cause of appellant’s symptoms as he noted 

complaints of severe leg pain despite essentially normal MRI scan findings. The Board notes 

that an increase in pain alone does not constitute objective evidence of disability.13 Dr. Weltmer 

did not address whether appellant’s posterior tibialis tendinitis was causally related to the 

accepted May 5, 2012 employment injury, nor did he provide adequate bridging evidence to 

show a worsening of the accepted right ankle sprain, requiring further medical treatment. For 

these reasons, Dr. Weltmer’s reports do not provide support for a recurrence of medical 

treatment for the May 5, 2012 work injury.14

Dr. Shitut’s November 8 and December 2, 2016 medical reports are also insufficient to 

establish appellant’s recurrence claim. His November 8, 2012 report referenced a 2012 workrelated right ankle injury, noting that appellant fractured her ankle and was treated by a brace 

until it subsequently healed. The Board notes that Dr. Shitut also did not have an accurate 

 11 D.L., Docket No. 13-1653 (issued November 22, 2013). 

12 See M.L, Docket No. 06-835 (issued October 27, 2016). 

13 See Federal (FECA) Procedure Manual, Part 2 -- Claims, Recurrences, Chapter 2.1500.6.a(2) (June 2013). 

14 R.A., Docket No. 14-1327 (issued October 10, 2014). 
6

history of injury as appellant was never diagnosed with right ankle fracture. Dr. Shitut’s report is 

therefore also of limited probative value.15

The Board further notes that Dr. Shitut’s reports provide no rationale explaining how or 

why appellant required continued treatment due to her original right ankle injury on or after 

July 25, 2016, nor did he establish that the claim should be expanded to include conditions.16 

Dr. Shitut failed to provide a firm medical diagnosis which could be related to the accepted 

May 5, 2012 right ankle sprain. He speculated that appellant’s pain could be coming from right 

L5 radiculopathy and recommended further testing via lumbar spine MRI scan. As Dr. Shitut 

failed to present a clear indication of the diagnosed condition that was causing appellant’s 

symptoms, his opinion is insufficient to support that appellant sustained a spontaneous 

worsening of her work-related condition.17

When seeking treatment for her injury in May 2012, both Dr. Schulte and 

Dr. Gjorgjievski diagnosed right ankle sprain. Moreover, a May 7, 2012 x-ray of the right ankle 

revealed no acute fracture or dislocation. Without an accurate history of injury, any opinion 

pertaining to a worsening of appellant’s right ankle condition is of limited probative value.18 

Appellant did not submit any medical reports from a physician who, on the basis of a 

complete and accurate factual and medical history, concluded that she required continued 

medical treatment due to her accepted May 5, 2012 right ankle sprain. As appellant has not 

submitted any medical evidence showing that she sustained a recurrence of medical treatment 

due to her accepted employment injury, the Board finds that she has not met her burden of 

proof.19

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 a recurrence 

of medical treatment commencing on July 25, 2016 causally related to her accepted May 5, 2012 

employment injury. 

 15 Supra note 8. 

16 For conditions not accepted by OWCP as being employment related, it is the employee’s burden to provide 

rationalized medical evidence sufficient to establish causal relation, not OWCP’s burden to disprove such a 

relationship. P.P., Docket No. 16-1232 (issued December 23, 2016). See also P.O., Docket No. 14-1675 (issued 

December 3, 2015). 

17 See Sedi L. Graham, 57 ECAB 494 (2006) (medical form reports and narrative statements merely asserting 

causal relationship generally do not discharge a claimant’s burden of proof). 

18 Supra note 8. 

19 L.L., Docket No. 13-2146 (issued March 12, 2014). See also William A. Archer 55 ECAB 674, 679 (2004). 
7

ORDER 

IT IS HEREBY ORDERED THAT the February 7, 2017 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: August 24, 2017 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Valerie D. Evans-Harrell, Alternate Judge 

 Employees’ Compensation Appeals Board