United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

S.A., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Denver, CO, Employer

__________________________________________

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Docket No. 16-1128

Issued: November 24, 2017

Appearances: Case Submitted on the Record

John S. Evangelisti, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

CHRISTOPHER J. GODFREY, Chief Judge

PATRICIA H. FITZGERALD, Deputy Chief Judge

COLLEEN DUFFY KIKO, Judge

JURISDICTION

On May 6, 2016 appellant, through counsel, filed a timely appeal from a November 30, 

2015 merit decision of the Office of Workers’ Compensation Programs (OWCP). Pursuant to 

the Federal Employees’ Compensation Act2(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 has met her burden of proof to establish an occupational 

disease causally related to factors of her federal employment.

 

1

In all cases in which a representative has been authorized in a matter before the Board, no claim for a fee for 

legal or other service performed on appeal before the Board is valid unless approved by the Board. 20 C.F.R. 

§ 501.9(e). No contract for a stipulated fee or on a contingent fee basis will be approved by the Board. Id. An 

attorney or representative’s collection of a fee without the Board’s approval may constitute a misdemeanor, subject 

to fine or imprisonment for up to one year or both. Id.; see also 18 U.S.C. § 292. Demands for payment of fees to a 

representative, prior to approval by the Board, may be reported to appropriate authorities for investigation.

2

5 U.S.C. § 8101 et seq.
2

FACTUAL HISTORY

On July 1, 2014 appellant then a 54-year-old supervisor, filed an occupational disease 

claim (Form CA-2) alleging that she developed left plantar fasciitis, right soleus rupture, and 

right ankle tendinitis as a result of prolonged walking, bending, and squatting required in her job. 

She first became aware of her condition on January 15, 2013 and realized that it was causally 

related to her federal employment on March 11, 2014. Appellant was last exposed to the 

conditions alleged to have caused her illness on March 11, 2013. She was terminated on 

June 4, 2013.3

In an undated statement, appellant indicated that a Dr. Anthony Valenti, a podiatrist, had 

performed right foot surgery 10 years prior. She noted that Dr. Valenti had diagnosed heel spur 

and plantar fasciitis and indicated that it was caused by prolonged standing and walking at work. 

On March 11, 2013 appellant reported stepping onto a sidewalk with her right foot and felt a pop 

and extreme right leg pain. She also attributed right hip pain to her work.

On July 18, 2014 OWCP advised appellant of the type of evidence needed to establish 

her claim, particularly a physician’s reasoned opinion addressing the relationship between her 

claimed condition and specific work factors. 

Appellant was treated by Dr. Valenti on January 15, 2013 for a one-month history of left 

heel pain. Dr. Valenti noted pain on palpation of the central band of the plantar fascia at the 

insertion to the calcaneus on the left foot. He noted that x-rays revealed significant medial 

spurring and he diagnosed left heel spur and plantar fasci. Dr. Valenti injected the left foot with 

lidocaine and applied a low dye strapping. On February 21, 2013 he again treated appellant for

left heel pain. Dr. Valenti noted her plantar fasciitis was a direct result of standing on her feet at 

work for an extended period. He advised that appellant was currently in a removable cast and 

returned her to sedentary work. In reports dated March 7 and 28, and April 10, 2013, appellant 

presented for follow up of plantar fasciitis of the left foot. She had pain on palpation of the 

central band of the plantar fascia. Dr. Valenti noted a possible oblique fracture to the base of the 

fifth metatarsal. He advised an injection and orthotics. 

On March 11, 2013 appellant complained of a pop associated with the right leg just distal 

to the knee which occurred while walking through a parking lot. Dr. Valenti found appellant 

disabled from work for one week. On May 22, 2013 he treated her for a previous right soleus 

rupture. Dr. Valenti noted pain on palpation of the central band of the left plantar fascia and 

diagnosed plantar fasci and tendinitis. 

On June 5, July 3, and August 23, 2013 appellant continued treatment for left foot plantar 

fasciitis. He reported improvement, but was unable to tolerate walking. Dr. Valenti diagnosed 

plantar fasci and tendinitis. On July 26, 2013 appellant performed a left plantar fasciotomy. In 

reports dated August 9 and 23, and September 6 and 27, 2013, Dr. Valenti noted that appellant 

 

3 On May 15, 2013 appellant filed a traumatic injury claim under OWCP File No. xxxxxx537 alleging that on 

March 11, 2013 she felt something snap in her right leg while stepping up to a sidewalk. By decision dated July 2, 

2013, OWCP denied the claim as causal relationship had not been established. By decision dated July 29, 2014, it

denied modification of the July 2, 2013 decision.
3

reported slow postsurgical improvement. He noted findings of pain on palpation of the medial 

band of the plantar fascia which appeared to be a retracted area of the tendon. Dr. Valenti 

diagnosed plantar fasci and tendinitis. January 16 and February 11, March 4, and June 6, 2014

reports related that appellant had pain and swelling associated with the plantar medial aspect of 

the left ankle. Dr. Valenti noted findings and diagnosed plantar fasci and tendinitis. Dr. Valenti

again administered an injection of lidocaine and applied a low dye strapping to her left foot. He

indicated that he had no new treatment options and he opined that appellant could have multiple 

sclerosis.

On March 19, 2013 Dr. Cydney West, an osteopath, saw appellant for right hip pain. 

Appellant reported having low grade hip pain two years ago on the outside of the leg. She noted 

undergoing a prior iliotibial band surgery. Dr. West noted findings of right hip tenderness and 

pain over the lateral upper leg on palpation. She diagnosed hip pain and band friction syndrome. 

Dr. West recommended physical therapy.4

In a January 28, 2014 report, Dr. Jennifer O. Kubista, a Board-certified family 

practitioner, treated appellant for right knee pain. She noted laxity in the bilateral anterior 

cruciate ligaments. Dr. Kubista diagnosed knee pain, overuse injury, and arthritis. She referred 

appellant to an orthopedist. 

On March 6, 2014 appellant was treated by Dr. Douglas Redosh, a Board-certified 

neurologist to whom she was referred by Dr. Valenti, for left foot pain. She reported rupturing

her soleus muscle on the right side after being placed in a cast for left foot pain fracturing a left

metatarsal bone and having had a plantar fasciotomy on July 1, 2013. Dr. Redosh noted findings 

of a mildly obese female, decreased sensation to pinprick in a patchy fashion below the left knee, 

decreased vibration sense in the left toe, and antalgic gait. He noted an electromyogram (EMG) 

was normal and diagnosed left leg pain. On April 3, 2014 appellant reported significant left foot 

pain. Dr. Redosh noted that a cervical spine magnetic resonance imaging (MRI) scan showed

early cervical spondylosis at C5-6 and a thoracic spine MRI scan was normal.

5

 He noted pain in 

both legs with an antalgic gait. Dr. Redosh noted diagnostic testing failed to reveal any

abnormalities to explain her symptoms and diagnosed likely neuropathic pain. He recommended 

a brain MRI scan to rule out any infectious, autoimmune, compressive etiologies of myelopathy, 

including multiple sclerosis.

On June 26, 2014 appellant was treated by Dr. Jack L. Rook, a Board-certified 

physiatrist, for bilateral foot, right calf, and right hip pain. Dr. Rook noted that appellant’s work 

required prolonged walking, standing, and pushing and pulling mail containers. Appellant had 

an antalgic gait as well as exquisite tenderness of the right greater trochanteric bursa. She also 

had severe tenderness of the plantar fascia, left and right Achilles bursa and tendon, and soleus 

muscle/posterior calf on the right side. Dr. Rook diagnosed greater trochanteric bursitis, status 

post rupture of the right soleus muscle with chronic myofascial pain, pain related to scar tissue 

formation, bilateral Achilles tendinitis and bursitis, bilateral plantar fasciitis, and strain of the 

metatarsal phalangeal joints of the great toe, second toe, and third toe on the right. He opined 

 

4 The record indicates that appellant underwent physical therapy from March 14 to April 4, 2013. 

5 An April 10, 2014 cervical spine MRI scan revealed early cervical spondylosis at C5-6.
4

that, based upon appellant’s history and a review of her medical records, she had developed an 

occupational disease involving her right hip approximately nine years earlier, an occupational 

disease involving her left foot in December 2013, and an acute occupational injury of her right 

calf on March 11, 2013. Dr. Rook noted that appellant was wearing a left leg surgical boot and 

had to excessively contract the right calf muscles to get her left leg over the curb to enter her 

workplace and ruptured her right soleus muscle. He believed the soleus rupture was an acute 

injury that was related to the left foot injury. Dr. Rook opined that appellant’s right great toe 

pain and right hip pain probably resulted from altered weight bearing, and that all of her current 

right leg problems were indirectly related to the left foot occupational disease. 

For the right hip condition, Dr. Rook noted that appellant first had right hip pain at work

performing job duties which included prolonged standing, and pushing and pulling of heavy mail

containers. He indicated that the right hip condition was aggravated because of the alteration of 

appellant’s gait which required her to bear most of her weight on her right leg. The altered 

weight-bearing resulted in excessive contraction of thigh musculature, repetitive irritation of that 

structure and inflammation with the severe pain. For the left plantar fasciitis, appellant first 

noted pain on the bottom of her left foot while she was at work engaging in prolonged standing 

and walking which progressively worsened as the holiday season progressed. Dr. Rook 

indicated that plantar fasciitis occurs when the longitudinal arch collapses causing stretching of 

the ligamentous tissue which can lead to inflammation along the fascia at the metatarsal heads 

and the heel. Appellant’s job required standing on a hard floor all day long, walking on a hard 

floor, carrying heavy boxes while walking on a hard floor and forcefully pushing and pulling 

heavy objects. Dr. Rook opined that it is more than likely that the plantar fasciitis in her left foot 

was caused by the activities required of her job. He found that the right soleus muscle ruptured

while contracting in an effort to raise appellant’s body over the curb, and to allow her left foot 

(which had on a surgical boot) to clear the curb. The excessive contraction then precipitated the 

muscle rupture. Dr. Rook further opined that the right foot condition developed because of the 

increased weight bearing of her right leg to compensate for the painful left plantar fasciitis 

condition. He indicated that prolonged weight-bearing activities required in appellant’s job 

contributed to the development of plantar fasciitis, Achilles bursitis, and tendinitis on the right 

side. Dr. Rook found that appellant had no traumatic events outside of work.

In a January 30, 2015 decision, OWCP denied appellant’s claim finding that she had 

failed to establish that her claimed medical condition was causally related to the established work 

factors.

On February 15, 2015 appellant requested an oral hearing which was held on 

September 17, 2015. She also submitted additional medical evidence. 

Appellant was treated by Dr. Redosh on March 7 and April 3, 2014 for left foot pain. 

Dr. Redosh restated appellant’s history and diagnosed left lower extremity pain, likely 

neuropathic pain. On August 4, 2014 he noted her EMG was normal and her recent cervical and 

thoracic spine MRI scans did not show abnormalities to explain her symptoms. Dr. Redosh 

diagnosed idiopathic painful neuropathy in her left foot and recommended that appellant 

continue on her current medical regimen.
5

Appellant was seen by Dr. Valenti on July 11, July 28, and August 14, and December 9, 

2014 for a swollen right foot. Right foot x-rays revealed excellent osseous fixation position. 

Dr. Valenti diagnosed right second metatarsal fracture, ganglion cyst, plantar fasci, and tendinitis 

and placed appellant in a removable cast. On December 31, 2014 he saw appellant in follow up 

for a stress fracture of the left second metatarsal. Dr. Valenti diagnosed metatarsal fracture, 

ganglion cyst, plantar fasciitis, and tendinitis. On January 21, February 11, and June 10, 2015,

he reiterated appellant’s diagnoses and recommended she continue to transition back to regular 

shoes and avoid overuse of the right foot. On June 23, 2015 Dr. Valenti treated appellant in 

follow up for neuritis of the right second digit. Appellant reported total relief from an injection

on June 10, 2015. Dr. Valenti diagnosed neuritis, arthritis of the joint, metatarsal fracture, 

ganglion cyst, plantar fasciitis, and tendinitis and discharged appellant from his care. On 

August 19, 2015 he noted treating her since December 2012 for foot pain. Dr. Valenti initiated a 

change in appellant’s medications to control her neuropathic pain.

Appellant was treated by Dr. Brian D. Shannon, a Board-certified orthopedist, on 

April 23 and May 7, 2014, for right hip pain. Dr. Shannon noted that appellant had a

trochanteric bursa excised eight years prior. He noted point tenderness over the greater 

trochanter, pain with resisted hip abduction, and intact sensation. Dr. Shannon indicated that the 

trochanteric bursitis was refractory to physical therapy and he recommended a corticosteroid 

injection. On July 2 and August 1, 2014 he noted that appellant had significant hip pain that was 

refractory to conservative measures and recommended surgery.6 On August 12, 2014

Dr. Shannon performed a right hip trochanteric bursa excision and diagnosed right hip 

trochanteric bursitis. On August 20, 2014 he treated appellant in follow up and noted that 

appellant was doing well and ambulating without assistive devices. Dr. Shannon noted mild 

swelling, no erythema, and a healed incision. He recommended that appellant advance her 

activities as tolerated.

Appellant submitted a March 5, 2015 report from Dr. Rook, who reviewed his 

June 26, 2014 evaluation. Dr. Rook opined that, based upon reasonable medical probability,

appellant’s right hip condition, left plantar fasciitis, and right soleus muscle rupture were workrelated conditions. On April 27, 2015 he reiterated that her diagnosed conditions were 

employment related.

Appellant also provided treatment records from a physician assistant who diagnosed 

neuropathy and major depressive disorder.

In a decision dated November 30, 2015, an OWCP hearing representative affirmed the 

January 3, 2015 decision.

LEGAL PRECEDENT

An employee seeking benefits under FECA7has the burden of proof to establish the 

essential elements of his or her claim. When an employee claims an injury in the performance of 

 

6 A July 30, 2014 right hip MRI scan revealed no acute or focal abnormality and possible surgical repair of the 

gluteus medius syndrome at the right hip.

7

Supra note 2.
6

duty, the employee must submit sufficient evidence to establish that he experienced a specific 

event, incident or exposure occurring at the time, place, and in the manner alleged. The 

employee must also establish that such event, incident or exposure caused an injury.8

Whether an employee actually sustained an injury in the performance of duty begins with 

an analysis of whether fact of injury has been established.9 To establish fact of injury in an 

occupational disease claim, 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.10

The medical evidence required to establish causal relationship is generally rationalized 

medical opinion evidence. Rationalized medical opinion evidence is medical evidence which 

includes a physician’s rationalized opinion on the issue of whether there is causal relationship 

between the claimant’s diagnosed condition and the implicated employment factors. 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.11

ANALYSIS

It is undisputed that appellant’s duties as a supervisor included walking, bending, and 

squatting. However, she failed to submit sufficient medical evidence to establish that her 

diagnosed medical conditions were causally related to the specific accepted factors of her federal 

employment. 

Appellant submitted a June 26, 2014 report from Dr. Rook who noted appellant’s work 

duties and her examination findings. Dr. Rook opined that, based upon appellant’s history and 

her medical records, she developed an occupational right hip condition nine years earlier, a left 

foot occupational disease in December 2013, and an acute occupational injury of her right calf on 

March 11, 2013. He noted that she was wearing a left leg surgical boot and had to excessively 

contract the right calf muscles to get her left leg over the curb to enter her workplace and 

ruptured her right soleus muscle. Dr. Rook believed the soleus rupture was an acute injury that 

was related to the left foot injury. He opined that all of the current problems with appellant’s

right lower extremity were indirectly related to the left foot occupational disease. Dr. Rook

indicated that she first had right hip pain at the post office performing job duties which included 

 

8

See Walter D. Morehead, 31 ECAB 188, 194 (1979) (occupational disease or illness); Max Haber, 19 ECAB 

243, 247 (1967) (traumatic injury). See generally John J. Carlone, 41 ECAB 354 (1989); Elaine Pendleton, 40 

ECAB 1143 (1989). 

9

S.P., 59 ECAB 184, 188 (2007).

10 R.R., Docket No. 08-2010 (issued April 3, 2009); Roy L. Humphrey, 57 ECAB 238, 241 (2005).

11 Solomon Polen, 51 ECAB 341 (2000).
7

prolonged standing and pushing and pulling of heavy containers. He noted that appellant first 

reported left foot pain while she was at work engaging in prolonged standing and walking which 

progressively worsened during the holiday season. Dr. Rook advised that plantar fasciitis occurs 

when the longitudinal arch collapses due to prolonged standing on a hard floor, being on one’s 

feet all day long, walking on a hard floor, carrying heavy boxes while walking on a hard floor 

and forcefully pushing and pulling heavy objects. He opined that it was more than likely that the 

plantar fasciitis in her left foot was caused by the activities required of her job at the post office. 

Dr. Rook indicated that prolonged weight-bearing activities contributed to the development of 

plantar fasciitis, Achilles bursitis, and tendinitis on the right. On March 5, 2015 and April 27, 

2015 he reiterated that appellant’s conditions were employment related. 

Although Dr. Rook supported causal relationship, he provided only general and 

speculative reasoning regarding how work factors caused the diagnosed conditions. He indicated 

that the left foot condition largely led to all of the other diagnosed conditions, but in doing so 

offered equivocal support for causal relationship noting that prolonged standing can lead to 

inflammation along the fascia at the metatarsal heads.12 Dr. Rook also supported his conclusion 

on causal relationship of the diagnosed conditions by noting that appellant had no traumatic 

events outside of work. However, the Board has held that the fact that a condition manifests 

itself during a period of employment alone does not raise an inference that there is a causal 

relationship between the two.13 Dr. Rook also did not have a complete understanding of 

appellant’s history as he did not address other possible causes of appellant’s condition as noted 

by other physicians.

14

 Therefore, these reports are of limited probative value and insufficient to 

meet appellant’s burden of proof.

Appellant submitted a February 21, 2013 report from Dr. Valenti who treated her for left 

heel pain. Dr. Valenti noted appellant’s plantar fasciitis was a direct result of prolonged standing 

at work. He indicated that she was currently in a removable cast and required a sitting job. 

Although Dr. Valenti supported causal relationship, he did not provide medical rationale 

explaining the basis of his conclusory opinion regarding the causal relationship.15 He did not 

explain the process by which standing for an extended period of time at work would cause or 

aggravate the diagnosed conditions. This report is thus insufficient to establish appellant’s 

claim. Other reports from Dr. Valenti are also insufficient to establish the claim as he did not 

 

12 See Leonard J. O’Keefe, 14 ECAB 42, 48 (1962) (where the Board held that medical opinions based upon an 

incomplete history or which are speculative or equivocal in character have little probative value).

13 L.D., Docket No. 09-1503 (issued April 15, 2010).

14 Dr. Valenti on June 6, 2014 indicated that he identified no new treatment options and opined that appellant 

could have multiple sclerosis. Dr. Redosh on March 6, 2014 suggested a brain MRI scan to rule out any infectious, 

autoimmune, compressive etiologies of myelopathy, including multiple sclerosis. See supra note 10.

15 See T.M., Docket No. 08-975 (issued February 6, 2009) (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).
8

provide an opinion on the causal relationship between appellant’s work factors and her 

diagnosed conditions.

16

 

Appellant submitted reports from Dr. Redosh dated March 6 to April 3, 2014, who 

treated her for left foot pain since 2012. Dr. Redosh noted that appellant was placed in a cast and 

ruptured her soleus muscle on the right side and fractured her metatarsal bone on the left foot. 

Appellant underwent a plantar fasciotomy in July 2013. On August 4, 2014 Dr. Redosh noted 

that diagnostic studies failed to show abnormalities to explain her symptoms. He diagnosed 

idiopathic painful neuropathy in her left foot and recommended appellant continue on current 

medical regimen. Dr. Redosh’s reports are insufficient to establish the claim as he did not 

provide a history of injury17 or specifically address whether the accepted work duties caused or 

aggravated a diagnosed medical condition.18 

Similarly, reports from other physicians, such as Drs. West, Kubista, and Shannon, as 

well as reports of diagnostic testing, are of limited probative value and insufficient to establish 

the claim as these reports do not contain a physician’s opinion specifically addressing whether 

appellant’s work duties had caused or aggravated a diagnosed medical condition.19

Appellant also submitted reports from a physician assistant and a physical therapist. The 

Board has held that treatment notes signed by physician assistants or physical therapists have no 

probative value as these providers are not considered physicians under FECA.20 

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.21 Appellant failed to submit such evidence and OWCP 

therefore properly denied appellant’s claim for compensation.

On appeal appellant, through counsel, disagrees with OWCP’s decision denying her 

claim for compensation and noted that she submitted sufficient evidence to establish her claim. 

As noted above, the Board finds the medical evidence insufficient to establish that appellant’s 

diagnosed conditions are causally related to her employment. Reports from her physicians failed 

 

16 See S.E., Docket No. 08-2214 (issued May 6, 2009) (medical evidence that does not offer any opinion 

regarding the cause of an employee’s condition is of limited probative value on the issue of causal relationship). 

17 Frank Luis Rembisz, 52 ECAB 147 (2000). 

18 See supra note 16. 

19 See id.

20 See David P. Sawchuk, 57 ECAB 316 (2006) (lay individuals such as physician assistants, nurses and physical 

therapists are not competent to render a medical opinion under the FECA); 5 U.S.C. § 8101(2) (this subsection 

defines a “physician” as surgeons, podiatrists, dentists, clinical psychologists, optometrists, chiropractors, and 

osteopathic practitioners within the scope of their practice as defined by State law).

21 See Dennis M. Mascarenas, 49 ECAB 215 (1997).
9

to provide sufficient medical rationale explaining how appellant’s injuries are causally related to 

particular employment factors.

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 an 

occupational disease causally related to factors of her federal employment.

ORDER

IT IS HEREBY ORDERED THAT the November 30, 2015 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: November 24, 2017

Washington, DC

Christopher J. Godfrey, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Colleen Duffy Kiko, Judge

Employees’ Compensation Appeals Board