United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

M.S., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Portland, ME, Employer 

__________________________________________ 

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Docket No. 16-1362 

Issued: December 7, 2016 

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 

ALEC J. KOROMILAS, Alternate Judge 

VALERIE D. EVANS-HARRELL, Alternate Judge 

JURISDICTION 

On June 22, 2016 appellant filed a timely appeal from a May 13, 2016 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 case. 

ISSUE 

The issue is whether appellant met her burden of proof to establish left ankle and foot 

conditions causally related to the accepted March 21, 2016 employment incident. 

 1

 The Board notes that appellant submitted additional evidence after OWCP rendered its May 13, 2016 decision. 

The Board’s jurisdiction, however, 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 March 30, 2016 appellant, then a 50-year-old mail clerk, filed a traumatic injury 

claim (Form CA-1) alleging that on March 21, 2016 she tripped on a yellow piece of strapping 

which wrapped around her left ankle. The following day she fell in the parking lot due to her 

weakened ankle, causing a sprain. Appellant notified her supervisor on March 23, 2016 and 

stopped work on March 24, 2016. 

In an accompanying narrative statement, appellant reported that in the morning on 

March 21, 2016, she was performing expediting duties on the platform when she felt herself 

about to fall. She caught herself and found a yellow plastic ring of strapping wrapped around her 

left ankle. Appellant finished her shift despite pain. She noted that her foot had been painful 

two months prior, but she thought it had improved until the March 21, 2016 incident. Appellant 

further explained that the following day she returned to work and after finishing her shift, her left 

ankle and heel felt weak, causing her to fall to the ground. She reported that the swelling and 

pain in her ankle and heel worsened, causing her to seek medical treatment. 

By letter dated March 30, 2016, the employing establishment controverted the claim. 

In a March 30, 2016 narrative statement, appellant’s supervisor reported that on 

March 21, 2016 she informed him that while she performed expediting duties on the platform, 

she tripped over a yellow piece of strapping. Appellant returned to work on the following day 

and worked a full shift. On March 23, 2016 she notified him that on March 22, 2016 she had 

“punched out” at the end of the day but, while walking to her car, her ankle gave out, causing her 

to fall to the ground. Appellant’s supervisor argued that her injury did not occur in the 

performance of duty because she fell on her way to her car in the parking lot at the end of her 

shift. He further stated that her foot pain was nonwork related as she had complained about it for 

years. 

In a March 23, 2016 diagnostic report, Dr. Corey A. Couto, a Board-certified diagnostic 

radiologist, reported that an x-ray of the left foot revealed abnormality in the heel region with 

soft tissue thickening present in the region of the distal Achilles. He noted calcifications 

extending to the attachment of the calcaneus and would correlate with heel symptoms. 

Dr. Couto further noted other degenerative changes including enthesophyte at the plantar fascia 

attachment. Findings revealed no acute fracture. 

In another March 23, 2015 diagnostic report, Dr. Couto reported that an x-ray of the left 

ankle revealed generalized soft tissue swelling, more conspicuous medially, and no underlying 

fracture. 

By report dated March 23, 2016, Dr. Joseph A. Sardina, a Board-certified family 

practitioner, related that appellant presented to urgent care with a lower left foot injury. He 

noted that appellant was injured at work on March 21, 2016 when she tripped over a band of 

plastic, causing her to limp due to swelling in her ankle and foot. On March 22, 2016 appellant 

returned to work, but was limping. After work, she again twisted her ankle after her foot seemed 

to give way. Dr. Sardina provided physical examination findings and review of diagnostic 

testing. An x-ray of the left ankle revealed no bony irregularity of the distal fibula or ankle joint. 
3

An x-ray of the foot revealed some calcification of the distal Achilles tendon. Dr. Sardina 

diagnosed left ankle and foot pain, noting pain in vicinity of Achilles tendon at heel. He noted 

no fracture, but some calcifications at distal most portion of Achilles tendon, which could be 

preexisting to the injuries suffered recently, although her symptoms were new. Dr. Sardina 

concluded that appellant sustained a strain/sprain of her left ankle and foot. He restricted her 

from work for seven days pending follow up. 

In March 23 and 30, 2016 duty status reports (Form CA-17), Dr. Sardina restricted 

appellant from work. 

By letter dated April 12, 2016, OWCP informed appellant that the evidence of record was 

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

needed and was afforded 30 days to submit the requested evidence. 

In April 13 and 27, 2016 CA-17 reports, Dr. Sardina diagnosed ankle injury and checked 

the box marked “work related” when asked about the cause of injury. He restricted appellant to 

limited duty for four hours per day and recommended physical therapy. 

By decision dated May 13, 2016, OWCP accepted that appellant tripped over strapping 

on March 21, 2016, but denied her claim finding that the evidence of record failed to establish 

that her diagnosed conditions were causally related to the accepted March 21, 2016 employment 

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, that an injury was sustained while in the performance of duty as alleged, and that any 

disability 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

In order to determine whether an employee actually sustained an injury in the 

performance of duty, OWCP begins with an analysis of whether fact of injury has been 

established. Generally, fact of injury consists of two components which must be considered in 

conjunction with one another. The first component to be established is that the employee 

actually experienced the employment incident which is alleged to have occurred.5

 The second 

component is whether the employment incident caused a personal injury and generally can be 

established only by medical evidence. 

 3 Gary J. Watling, 52 ECAB 278 (2001); Elaine Pendleton, 40 ECAB 1143, 1154 (1989). 

4 Michael E. Smith, 50 ECAB 313 (1999). 

5 Elaine Pendleton, supra note 3. 
4

To establish causal relationship between the condition and the employment event or 

incident, the employee must submit rationalized medical opinion evidence supporting such a 

causal relationship.6

 The opinion of the physician 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. This medical opinion 

must include an accurate history of the employee’s employment injury and must explain how the 

condition is related to the injury. The weight of medical evidence is determined by its reliability, 

its probative value, its convincing quality, the care of analysis manifested, and the medical 

rationale expressed in support of the physician’s opinion.7

ANALYSIS 

OWCP accepted that the March 21, 2016 employment incident occurred as alleged. The 

issue is whether appellant established that the incident caused her left ankle and foot conditions. 

The Board finds that she did not submit sufficient medical evidence to support that her left ankle 

and foot conditions were causally related to the accepted March 21, 2016 employment incident.8 

Appellant sought treatment with Dr. Sardina from March 23 through April 27, 2016. In a 

March 23, 2016 report, Dr. Sardina noted a history of the employment incident, provided 

physical examination findings, and reviewed diagnostic testing. He diagnosed strain/sprain of 

the left ankle and foot. The Board finds that the opinion of Dr. Sardina is not well rationalized. 

Dr. Sardina related that appellant could have preexisting conditions related to the left foot. The 

March 23, 2016 x-ray of the left foot revealed degenerative changes, as well as calcifications 

extending to the attachment of the calcaneus, which would correlate with heel symptoms. 

Dr. Sardina speculated that the calcification of the distal Achilles tendon could be preexisting to 

the injuries suffered, although appellant’s symptoms were new. While Dr. Sardina noted new 

symptoms, such generalized statements do not establish causal relationship because they merely 

repeat appellant’s allegations and are unsupported by adequate medical rationale explaining how 

this physical activity actually caused the diagnosed conditions.9 He failed to provide any support 

that appellant’s injury was caused or aggravated by the March 21, 2016 employment incident 

and, did not address why her complaints were not caused by her preexisting conditions.10 A 

well-rationalized opinion is particularly warranted when there is a history of preexisting 

condition.11 Medical evidence that does not offer any opinion regarding the cause of an 

 6 See 20 C.F.R. § 10.110(a); John M. Tornello, 35 ECAB 234 (1983). 

7 James Mack, 43 ECAB 321 (1991). 

8 See Robert Broome, 55 ECAB 339 (2004). 

9 K.W., Docket No. 10-98 (issued September 10, 2010). 

10 A well-rationalized opinion is particularly warranted when there is a history of preexisting condition. R.E., 

Docket No. 14-868 (issued September 24, 2014); T.M., Docket No. 08-975 (issued February 6, 2009); Michael S. 

Mina, 57 ECAB 379 (2006). 

11 T.M., id.; Michael S. Mina, id. 
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employee’s condition is of limited probative value on the issue of causal relationship.12 Thus, 

his opinion is of limited probative value.13

Dr. Sardina’s remaining reports are also insufficient to establish appellant’s claim. His 

April 13, 2016 form report checked the box marked “work related” when asked about the cause 

of appellant’s injury. The Board has held that a report that addresses causal relationship with a 

checkmark, without medical rationale explaining how the work condition caused the alleged 

injury, is of diminished probative value and insufficient to establish causal relationship.14 

Without explaining how physiologically the movements involved in the employment incident 

caused or contributed to the diagnosed conditions, Dr. Sardina’s opinion is of limited probative 

value.15 

Dr. Couto’s March 23, 2016 diagnostic reports are also insufficient to establish 

appellant’s claim as he just interpreted diagnostic imaging studies and provided no opinion on 

the cause of appellant’s injury.16 In the instant case, the record lacks rationalized medical 

evidence establishing causal relationship between the March 21, 2016 employment incident and 

appellant’s strain/sprain of the left ankle and foot. Thus, appellant has failed to meet her burden 

of proof. 

Appellant may submit new evidence, together with a written request for reconsideration, 

to OWCP within one year of the Board’s decision, pursuant to 5 U.S.C. § 8128(a) and 20 C.F.R. 

§§ 10.605 and 10.607. 

CONCLUSION 

The Board finds that appellant did not meet her burden of proof to establish that she 

sustained a left ankle and foot injury causally related to the accepted March 21, 2016 

employment incident. 

 12 The opinion of a physician supporting causal relationship must rest on a complete factual and medical 

background supported by affirmative evidence, address the specific factual and medical evidence of record, and 

provide medical rationale explaining the relationship between the diagnosed condition and the established incident 

or factor of employment. C.B., Docket No. 09-2027 (issued May 12, 2010); S.E., Docket No. 08-2214 (issued 

May 6, 2009).

13 P.O., Docket No. 14-1675 (issued December 3, 2015). 

14 C.Y., Docket No. 14-2075 (issued March 2, 2015); Deborah L. Beatty, 54 ECAB 334 (2003) (the checking of a 

box yes in a form report, without additional explanation or rationale, is insufficient to establish causal relationship). 

15 See L.M., Docket No. 14-973 (issued August 25, 2014); R.G., Docket No. 14-113 (issued April 25, 2014); 

K.M., Docket No. 13-1459 (issued December 5, 2013); A.J., Docket No. 12-548 (issued November 16, 2012). 

16 J.P., Docket No. 14-87 (issued March 14, 2014). 
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ORDER 

IT IS HEREBY ORDERED THAT the May 13, 2016 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: December 7, 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