United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

T.H., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Buffalo, NY, Employer 

__________________________________________ 

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Docket No. 17-0091 

Issued: July 25, 2017 

Appearances: Case Submitted on the Record

Alan J. Shapiro, 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 

VALERIE D. EVANS-HARRELL, Alternate Judge 

JURISDICTION 

On October 21, 2016 appellant, through counsel, filed a timely appeal from an August 19, 

2016 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 over the merits of this case. 

ISSUE 

The issue is whether appellant met his burden of proof to establish an occupational 

disease causally related to the accepted factors of his 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 May 4, 2015 appellant, then a 58-year-old letter carrier, filed an occupational disease 

claim (Form CA-2) alleging that he experienced pain and difficulty walking as a result of 

repetitively standing, climbing, driving, and walking a minimum of eight hours a day in the 

performance of duty. He did not stop work. 

In an attached narrative statement, appellant indicated that he was diagnosed with 

peripheral polyneuropathy in both feet on October 8, 2013. He described that his employment 

duties involved casing mail, which required walking to and from a letter case and to receive 

letters and flats. Appellant related that he also walked to receive his parcel bucket and to load 

his truck for distribution. He alleged that his feet were very sore to walk on and that he 

experienced significant pain after work. 

Appellant was treated by Dr. David E. Hoffman, a Board-certified neurologist. In an 

October 8, 2013 report, Dr. Hoffman indicated that he examined appellant due to paresthesia in 

both feet, which had been ongoing for about 18 months. He noted that appellant worked as a 

mail carrier and that his job involved walking for about seven hours a day. Dr. Hoffman related 

that appellant complained of tingling in his toes and adjacent soles, tightness, and feeling 

constricted in his forefeet. He reviewed appellant’s history and provided findings on physical 

examination. Dr. Hoffman observed unelicitable ankle reflexes and distal sensory loss over the 

lower limbs including vibration. He opined that appellant had peripheral polyneuropathy, which 

was “aggravated by being on his feet virtually 8 hours a day, 5 days a week.” Dr. Hoffman 

recommended that appellant retire at the end of the year since “walking [had] been an 

aggravating factor regarding the symptomatic polyneuropathy.” 

In an October 8, 2013 electromyography (EMG) and nerve conductive velocity (NCV) 

study report, Dr. Hoffman related appellant’s complaints of tightness and numbness affecting 

both feet for the past 18 months. He observed electrical evidence of a length-dependent, 

predominantly axonal sensorimotor polyneuropathy. Dr. Hoffman concluded that the 

electrodiagnostic study was abnormal. 

Dr. Hoffman continued to treat appellant. In an October 13, 2014 report, he indicated 

that appellant returned for follow-up examination of remote seizures and polyneuropathy. 

Dr. Hoffman related that appellant’s clinical examination and electrodiagnostic testing done a 

year ago confirmed a length-dependent, predominantly axonal, sensorimotor polyneuropathy. 

He explained that appellant had worked for the employing establishment for 29 years and that he 

drove a mail truck. Dr. Hoffman related appellant’s complaints that his feet were bothersome 

and that his neuropathy became symptomatic as the day progressed, especially on cold days. He 

reported that appellant should limit his workweek to 40 hours. 

In an April 23, 2015 report, Dr. Hoffman noted that appellant had worked for nearly 30 

years for the employing establishment delivering mail on foot. He opined that appellant’s “work 

activities [were] definitely aggravating the preexisting condition of polyneuropathy.” Upon 

examination, Dr. Hoffman reported good gait balance with no falls. He also observed palpable 

low pulses and no trophic changes over appellant’s feet. Dr. Hoffman indicated that clinical 

neurological examination was abnormal. He explained that there was distal hypesthesia over 
3

both legs, including vibration, temperature perception, light touch, and to a lesser extent, 

kinesthesia. Dr. Hoffman related that electrodiagnostic testing on that date was again abnormal, 

diagnosing a length-dependent, predominately axonal, sensorimotor polyneuropathy. He opined 

that appellant had a symptomatic polyneuropathy, primarily involving sensory complaints, as 

confirmed by electrodiagnostic testing and clinical neurologic examination. 

By letter dated June 18, 2015, OWCP advised appellant that the evidence submitted was 

insufficient to establish an occupational disease claim. It requested that he submit additional 

medical evidence to establish that the diagnosed condition of peripheral polyneuropathy was 

caused or aggravated by his employment. Appellant was afforded 30 days to submit the 

requested information. OWCP issued a similar letter dated June 18, 2015 to the employing 

establishment. 

Dr. Hoffman responded to OWCP’s development letter in a letter dated July 7, 2015. He 

indicated that he was enclosing an October 8, 2013 electrodiagnostic study report and 

October 13, 2014 examination note, which clearly defined appellant’s problem. Dr. Hoffman 

reported that appellant had polyneuropathy in both feet and that his symptoms worsened as the 

day progressed. He related that appellant had worked for the employing establishment for more 

than 29 years driving a truck and walking on his feet much of the day. Dr. Hoffman noted that 

the temperature in New York was often very cold, which was an aggravating factor to increase 

his foot discomfort. He explained: 

“The polyneuropathy was not caused by his employment. Nevertheless, the 

neuropathy is permanent and his work duties significantly aggravate symptoms 

related to his preexisting condition. The neuropathy was confirmed by 

electrodiagnostic testing. In my professional opinion, his duties as a postal 

worker (standing and walking for several hours each day) substantially aggravates 

the pain associated with his polyneuropathy.” 

OWCP denied appellant’s claim in a decision dated August 5, 2015. It accepted his 

repetitive duties as a letter carrier, especially walking, and a diagnosis of peripheral 

polyneuropathy. OWCP denied appellant’s claim because the medical evidence of record failed 

to establish that his diagnosed condition was causally related to the accepted employment 

factors. It determined that Dr. Hoffman failed to provide medical rationale explaining how 

appellant’s employment aggravated his bilateral foot condition. 

On September 29, 2015 OWCP received appellant’s request for reconsideration. 

Appellant also submitted a letter from Dr. Hoffman dated September 9, 2015. 

Dr. Hoffman explained that because of appellant’s neurological condition, he was rendered more 

vulnerable in the effects of walking. He related that appellant’s condition limited his ability to 

be on his feet for extended periods without significant foot pain. Dr. Hoffman noted, however, 

that his neurological condition was not caused by walking and was not secondary to “repetitive 

stress.” He reported that given the severity of appellant’s underlying neurological condition, 

prolonged walking was more painful than it would have been if appellant did not have that 

condition. 
4

By decision dated February 23, 2015, OWCP denied modification of its prior decision. It 

found that the new medical evidence from Dr. Hoffman lacked a well-reasoned medical 

explanation as to how appellant’s mail carrier duties aggravated his preexisting peripheral 

polyneuropathy. 

On May 23, 2016 OWCP received appellant’s request, through counsel, for 

reconsideration. Counsel noted that he was enclosing a medical report dated January 26, 2016 

from Dr. Hoffman, which was not previously considered. 

In a January 26, 2016 letter, Dr. Hoffman clarified that the underlying neuropathy itself 

was not worsened by walking, but the symptoms of neuropathy were intensified by walking. He 

indicated that when neuropathic pain developed while walking, the appropriate choice was to 

stop walking and rest. Dr. Hoffman noted that when walking is a mandatory part of a job 

description, such as mail delivery, the choice of sitting and resting was not available because the 

job must be completed. He related that the required walking for mail carriers translated into foot 

pain and disability that could have been eased if walking could have been curtailed. 

Dr. Hoffman opined that the “disability from [appellant’s] neuropathy was significantly 

contributed to by the imperative of having to be on his feet several hours a day delivering mail.” 

He indicated that walking “provoke[d] symptoms of the underlying neuropathy” similar to the 

way sitting provoked symptoms of underlying spinal disease. Dr. Hoffman reported that the 

demands of job-related walking significantly increased disability (pain) related to appellant’s 

neuropathy. 

Dr. Hoffman provided a June 27, 2016 letter in which he reiterated that appellant’s work 

did not cause his polyneuropathy nor aggravate the underlying pathology of his polyneuropathy. 

He noted that regardless of the cause of appellant’s condition, worsening pain while walking 

could be an uncomfortable by-product. Dr. Hoffman opined: “I do not believe that the repetitive 

activities of walking his postal route constituted a medical problem. I do believe that those 

activities intensified the symptoms of his preexisting medical condition.” He further clarified 

that appellant’s neuropathy was not caused or worsened by his work activities, but the 

underlying neuropathy itself rendered his feet more sensitive to walking. Dr. Hoffman 

concluded that appellant’s “job duties involved considerable walking, which served to aggravate 

his preexisting condition, from a symptomatic point of view only.” 

By decision dated August 19, 2016, OWCP denied modification of its prior decision. It 

found that the medical evidence of record failed to establish causal relationship between 

appellant’s peripheral polyneuropathy and his employment duties. OWCP determined that 

Dr. Hoffman merely opined that appellant’s repetitive walking worsened the symptoms of 

appellant’s peripheral neuropathy, but he did not provide a well-rationalized opinion that 

appellant’s medical condition was caused or aggravated by his employment. 

LEGAL PRECEDENT 

An employee seeking benefits under FECA3

 has the burden of proof to establish the 

essential elements of his or her claim by the weight of the reliable, probative, and substantial 

 3 Supra note 2. 
5

evidence4

 including that he or she sustained an injury in the performance of duty and that any 

specific condition or disability for work for which he or she claims compensation is causally 

related to that employment injury.5

 In an occupational disease claim, appellant’s burden requires 

submission of the following: (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.6

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

establish causal relationship is rationalized medical opinion evidence.7 The opinion of the 

physician must be based on a complete 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 

Appellant has alleged that he developed peripheral polyneuropathy in both feet as a result 

of his employment duties. OWCP accepted his employment factors and a diagnosis of peripheral 

polyneuropathy, but it denied his claim because the medical evidence of record failed to establish 

causal relationship between appellant’s medical condition and the accepted factors of 

employment. The Board finds that appellant has not met his burden of proof to establish that his 

bilateral foot condition was causally related to his employment. 

In support of his claim, appellant submitted various reports and letters by Dr. Hoffman 

dated October 8, 2013 to June 27, 2016. He related appellant’s complaints of paresthesia, 

tingling, and tightness in his feet and toes. Dr. Hoffman reviewed appellant’s history and noted 

that he worked as a mail carrier for nearly 30 years, which required walking for about seven 

hours a day. Appellant indicated that his feet became symptomatic as the day progressed, 

especially on cold days. Upon initial examination on October 8, 2013, Dr. Hoffman observed 

unelicitable ankle reflexes and distal sensory loss over the lower limbs including vibration. He 

noted that neurological examination and electrodiagnostic testing were abnormal for lengthdependent, predominately axonal, sensorimotor polyneuropathy. Dr. Hoffman opined that 

appellant had peripheral polyneuropathy, which was “aggravated by being on his feet virtually 8 

hours a day, 5 days a week.” The Board finds that Dr. Hoffman accurately described appellant’s 

history and provided findings on physical examination. Although he provided an opinion on 

 4 J.P., 59 ECAB 178 (2007); Joseph M. Whelan, 20 ECAB 55, 58 (1968). 

5 M.M., Docket No. 08-1510 (issued November 25, 2010); G.T., 59 ECAB 447 (2008); Elaine Pendleton, 40 

ECAB 1143, 1145 (1989). 

6 R.H., 59 ECAB 382 (2008); Ernest St. Pierre, 51 ECAB 623 (2000). 

7 I.R., Docket No. 09-1229 (issued February 24, 2010); D.I., 59 ECAB 158 (2007). 

8

 I.J., 59 ECAB 408 (2008); Victor J. Woodhams, 41 ECAB 465 (2005). 
6

causal relationship, he did not provide any medical rationale or explanation as to how appellant’s 

bilateral foot condition was aggravated by being on his feet all day. The Board has 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.9

In a letter dated July 7, 2015, Dr. Hoffman clarified that appellant’s polyneuropathy was 

not caused by his employment. He explained that appellant’s “work duties significantly 

aggravate symptoms related to his preexisting condition.” Dr. Hoffman related that appellant’s 

employment duties, specifically standing and walking for several hours each day, substantially 

aggravated the pain associated with appellant’s polyneuropathy. In a June 27, 2016 letter, he 

concluded that considerable walking, which was one of appellant’s job duties, served to 

aggravate appellant’s preexisting condition, from a “symptomatic point of view only.” 

It is undisputed that appellant has a diagnosed peripheral polyneuropathy. His work 

duties are also undisputed. However, Dr. Hoffman did not provide an explanation, based on 

medical rationale, as to how appellant’s employment duties would have physiologically caused 

or contributed to his polyneuropathy condition.10 On the contrary, he explicitly denied that 

appellant’s employment duties caused or aggravated appellant’s bilateral feet condition, but 

instead appears to attribute a worsening of appellant’s symptom of pain to his employment 

duties. The mere fact that work activities may produce symptoms revelatory of an underlying 

condition does not raise an inference of an employment relation. Such a relationship must be 

shown by rationalized medical evidence of causal relationship based upon a specific and accurate 

history of employment conditions which are alleged to have caused or exacerbated a disabling 

condition.11 

On appeal, counsel alleges that the August 18, 2016 OWCP decision was contrary to fact 

and law. He has not, however, provided any evidence or additional argument to establish that 

OWCP improperly denied appellant’s occupational disease claim. Causal relationship is a 

medical question that must be established by probative medical opinion from a physician.12 The 

Board finds that appellant has not met his burden of proof to establish his claim. 

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 his burden of proof to establish an 

occupational disease claim causally related to the accepted factors of his federal employment. 

 9 S.E., Docket No. 08-2214 (issued May 6, 2009); T.M., Docket No. 08-975 (issued February 6, 2009). 

10 See M.M., Docket No. 15-607 (issued May 15, 2015); M.W., Docket No. 14-1664 (issued December 5, 2014). 

11 Patricia J. Bolleter, 40 ECAB 373 (1988). 

12 W.W., Docket No. 09-1619 (issued June 2010); David Apgar, 57 ECAB 137 (2005). 
7

ORDER 

IT IS HEREBY ORDERED THAT the August 19, 2016 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: July 25, 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