United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

R.H., Appellant

and

U.S. POSTAL SERVICE, STEWARD STATION 

POST OFFICE, Richmond, VA, Employer

__________________________________________

)

)

)

)

)

)

)

)

Docket No. 18-0021

Issued: March 22, 2018

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 October 2, 2017 appellant filed a timely appeal from a September 21, 2017 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 to consider the merits of the case.

ISSUE

The issue is whether appellant has established a right foot sprain causally related to the 

accepted April 14, 2017 employment incident.

FACTUAL HISTORY

On April 27, 2017 appellant, then a 25-year-old letter carrier, filed a traumatic injury 

claim (Form CA-1) alleging that, on April 14, 2017, she noticed a sharp pain in the bottom of her 

right foot as she descended a flight of stairs while in the performance of duty. She provided an 

April 14, 2017 narrative statement again claiming on that date that she ascended 14 steps to 

 

1 5 U.S.C. § 8101 et seq.
2

deliver mail and, when descending the 14 steps, she noticed a very sharp pain in the center 

bottom of her right foot with each stride.2 Appellant stopped work on April 17, 2017. 

In support of her claim, appellant submitted notes dated April 14, 2017 from Dr. Anthony 

Martinez, a Board-certified family practitioner, who diagnosed metatarsalgia, right foot, and 

indicated that appellant was totally disabled.

In a report dated April 14, 2017, Dr. Martinez found that appellant recounted right foot 

pain which occurred at work while she was walking. He noted that she “may have heard a pop.” 

On physical examination Dr. Martinez found diffuse tenderness and swelling. He diagnosed 

metatarsalgia, right foot and provided work restrictions through April 21, 2017. On April 21, 

2017 Dr. Martinez noted that appellant developed foot pain at work after feeling a pop. He 

repeated his diagnosis and recommended continuing light-duty work.

In a development letter dated May 10, 2017, OWCP requested additional factual and 

medical evidence in support of appellant’s traumatic injury claim. It afforded her 30 days to 

respond.

Appellant provided a note dated May 17, 2017 from Dr. Andrew Kolb, an osteopath, 

which indicated that appellant was seeking treatment for a work injury after experiencing

significant intermittent right foot pain. Dr. Kolb diagnosed metatarsalgia, right foot. He

completed an attending physician’s report (Form CA-20) on June 4, 2017 and repeated his 

diagnosis.

On May 26, 2017 Dr. William K. Fleming, an orthopedic surgeon, completed a duty 

status report (Form CA-17) noting appellant’s history of walking down a flight of stairs and 

injuring the bottom of her right foot. He diagnosed right foot pain and provided work 

restrictions. On May 31, 2017 Dr. Fleming completed a Form CA-20 indicating that appellant 

was walking at work when she heard a pop in her right foot on April 14, 2017. He again 

diagnosed right foot pain and provided work restrictions.

By decision dated June 14, 2017, OWCP accepted that the April 14, 2017 incident 

occurred as alleged, but denied the claim as appellant failed to provide evidence containing a 

medical diagnosis in connection with the April 14, 2017 employment incident. It noted that the 

diagnosis of pain was not compensable under FECA.

On June 26, 2017 appellant requested reconsideration. On June 21, 2017 Dr. Fleming 

again completed a Form CA-20 and noted that appellant was walking at work when she heard a 

pop in her foot on April 14, 2017. He diagnosed sprain of the right foot. Dr. Fleming indicated 

by checking the box marked “yes” that he believed that appellant’s condition was caused or 

aggravated by employment activity. He added, “Patient sprained her foot while walking at work 

delivering mail.” Dr. Fleming also completed a narrative note on June 21, 2017 and diagnosed 

right foot pain due to a sprain of the foot. He again noted that the pain in her foot was caused by 

a sprain which was causally related to her initial injury.

 

2 The record indicates that appellant had previously filed four other traumatic injury claims from June 8, 2015 

through December 14, 2016.
3

By decision dated September 21, 2017, OWCP modified its June 14, 2017 decision to 

reflect that appellant had provided medical evidence diagnosing right foot sprain. However, 

OWCP found that Dr. Fleming’s explanation of causal relationship between appellant’s accepted 

employment incident and his diagnosis was insufficient to support appellant’s claim. OWCP 

noted that the mere fact that the claimed injury occurred as she was walking while delivering 

mail was insufficient to establish that the diagnosed foot sprain was a work-related injury.

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 

evidence, including the fact that the individual is an employee of the United States within the 

meaning of FECA, that the claim was timely filed within the applicable time limitation period of 

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

or specific condition for which compensation is claimed is causally related to the employment 

injury.4

OWCP defines a traumatic injury as, “[A] condition of the body caused by a specific 

event or incident, or series of events or incidents, within a single workday or shift. Such 

condition must be caused by external force, including stress or strain which is identifiable as to 

time and place of occurrence and member or function of the body affected.”

5

 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.6 The second component is whether the employment incident 

caused a personal injury.7 An employee may establish that an injury occurred in the performance 

of duty as alleged, but fail to establish that the disability or specific condition for which 

compensation is being claimed is causally related to the injury.8

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

causal relationship is rationalized medical opinion evidence.9 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 

 

3 Supra note 1.

4 Kathryn Haggerty, 45 ECAB 383, 388 (1994).

5 20 C.F.R. § 10.5(ee).

6 Elaine Pendleton, 40 ECAB 1143 (1989).

7

Id.; M.P., Docket No. 17-1221 (issued August 21, 2017). 

8 Shirley A. Temple, 48 ECAB 404, 407 (1997); M.P., id.

9

Jacqueline M. Nixon-Steward, 52 ECAB 140 (2000).
4

identified by the employee.10 Neither the mere fact that a disease or condition manifests itself 

during a period of employment nor the belief that the disease or condition was caused or 

aggravated by employment factors or incidents is sufficient to establish causal relationship.11

ANALYSIS

The Board finds that appellant has not met her burden of proof to establish that her right 

foot sprain was causally related to the accepted April 14, 2017 employment incident.

Appellant filed a traumatic injury claim on April 27, 2017 alleging that on April 14, 2017 

she injured her right foot descending stairs while performing her federal employment duties. 

OWCP accepted that the April 14, 2017 incident occurred as alleged, but denied appellant’s 

claim as she had not submitted rationalized medical opinion evidence sufficient to establish 

causal relationship between her diagnosed medical condition and the April 14, 2017 incident.

Appellant initially submitted medical evidence from Drs. Kalb and Martinez relating 

diagnoses of right foot pain and metatarsalgia, right foot. The Board has held that a symptom is 

not a diagnosis and the mere diagnosis of “pain” does not constitute the basis for payment of 

compensation.12 This medical evidence from Drs. Kalb and Martinez therefore lacks probative 

value and is insufficient to establish appellant’s traumatic injury claim.

Medical evidence submitted to support a claim for compensation should reflect a correct 

history of injury and should offer a medically-sound explanation of how the employment 

incident caused or aggravated the diagnosed condition.13 Appellant did not submit the necessary 

medical evidence to meet her burden of proof.

Beginning with his June 21, 2017 reports, Dr. Fleming clarified his diagnoses as right 

foot sprain, an acceptable diagnosis under FECA. He also provided a history of injury noting 

that appellant was walking at work when she heard a pop in her foot on April 14, 2017. The 

Board notes that this history of injury differs from appellant’s claim that she experienced a sharp 

pain in her foot while descending stairs. Dr. Fleming’s inconsistent history of injury limits the 

probative value of his opinion.14 He indicated by checking the box marked “yes” that he 

believed that appellant’s condition was caused or aggravated by employment activity. The Board 

has held that an opinion on causal relationship which consists only of a physician checking a box 

marked “yes” to a medical form report question on whether the claimant’s condition was related to 

the history given is of little probative value. Without any explanation or rationale for the 

conclusion reached, such report is insufficient to establish causal relationship.15 Dr. Fleming failed 

 

10 Leslie C. Moore, 52 ECAB 132 (2000); Gary L. Fowler, 45 ECAB 365 (1994).

11 Dennis M. Mascarenas, 49 ECAB 215 (1997).

12 Robert Broome, 55 ECAB 339 (2004); see also L.L., Docket No. 17-1764 (issued December 28, 2017). 

13 S.H., Docket No. 17-1447 (issued January 11, 2018); D.D., Docket No. 13-1517 (issued April 14, 2014); 

Michael S. Mina, 57 ECAB 379 (2006).

14 See S.L., Docket No. 16-0222 (issued August1, 2016).

15 Lucrecia M. Nielson, 41 ECAB 583, 594 (1991).
5

to sufficiently explain how appellant’s diagnosed right foot sprain occurred, noting only that she 

sprained her foot while walking at work delivering mail. Medical evidence that offers a 

conclusion, but does not provide any rationalized medical explanation regarding the cause of an 

employee’s condition is of limited probative value on the issue of causal relationship.16 While

Dr. Fleming provided a medical diagnosis of right foot sprain, he did not, however, provide any 

rationalized explanation as to how physiologically the accepted incident would have caused 

appellant’s diagnosed conditions.17

An award of compensation may not be based on surmise, conjecture, speculation, or on 

the employee’s own belief of causal relation.18 Appellant’s honest belief that the April 14, 2017 

employment incident caused a right foot injury, however sincerely held, does not constitute 

medical evidence sufficient to establish causal relationship.19 As she has failed to provide a 

rationalized medical opinion sufficient to establish causal relationship between her claimed 

injury and the accepted April 14, 2017 employment incident, she has failed to meet her burden of 

proof.

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 established that her right foot sprain was causally 

related to the accepted April 14, 2017 employment incident.

 

16 J.F., Docket No. 09-1061 (issued November 17, 2009); A.D., 58 ECAB 149 (2006).

17 See S.H., supra note 13; E.R., Docket No. 16-1634 (issued May 25, 2017).

18 See S.H., supra note 13; D.D., 57 ECAB 734 (2006).

19 See S.H., supra note 13; H.H., Docket No. 16-0897 (issued September 21, 2016).
6

ORDER

IT IS HEREBY ORDERED THAT the September 21, 2017 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: March 22, 2018

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