United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

D.B., Appellant

and

DEPARTMENT OF VETERANS AFFAIRS, 

VETERANS ADMINISTRATION MEDICAL 

CENTER, Mountain Home, TN, Employer

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Docket No. 18-0375

Issued: July 20, 2018

Appearances: Case Submitted on the Record

Cecil Carter, 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 December 13, 2017 appellant, through his representative, filed a timely appeal from a 

September 7, 2017 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.

 

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

ISSUE

The issue is whether appellant has met his burden of proof to establish a bilateral foot 

condition causally related to the accepted factors of his federal employment.

FACTUAL HISTORY

On June 2, 2017 appellant, then a 45-year-old housekeeping aid, filed an occupational 

disease claim (Form CA-2) alleging that he developed blisters, ulcerations, and callouses on both 

feet. He alleged that he first became aware of his claimed conditions on November 1, 2016 and of 

their relationship to his federal employment on November 25, 2016. Appellant asserted that being 

“pulled” to a bed washing assignment, as requested by a supervisor, aggravated his bilateral foot 

condition and diabetic complications. He requested a change in his tour or assignment due to the 

change in his workload and to better monitor his disability. After multiple requests, appellant 

noticed that his condition worsened over subsequent days and work shifts and he was unable to 

walk during the evening on November 25, 2016. He related that he underwent surgery during this 

time period to fix some of his injuries. Appellant did not submit additional evidence in support of 

his claim.

OWCP, by development letter dated June 13, 2017, advised appellant of the deficiencies 

in his claim and afforded him 30 days to submit medical evidence, including a detailed narrative 

report from his physician which included a history of the injury and a medical explanation with 

objective evidence of how the reported work activities caused, contributed to, or aggravated a 

bilateral foot condition. It also requested that the employing establishment submit treatment notes 

indicating whether appellant was treated at an employing establishment medical facility.

In response to OWCP’s June 13, 2016 development letter, appellant submitted various

letters and medical reports from Dr. Ryan Chatelain, a podiatric surgeon. In a December 2, 2016 

report, Dr. Chatelain noted that appellant presented for a follow-up visit of wounds to his feet. He 

discussed findings on physical examination and assessed diabetic neuropathy, pre-ulcerative

calluses, hyperkeratosis, hammertoe, and foot pain. Dr. Chatelain addressed appellant’s treatment 

plan and advised that he should be able to return to activities and shoe gear as tolerated. He 

maintained that it would be difficult for appellant to return to full-duty work given the amount of 

necessary weight bearing, noting that unfortunately, pre-ulcerative lesions were forming even with 

custom offloaded/accommodative inserts and appropriate shoe gear. 

In letters dated December 15, 2016 and January 4, 2017, Dr. Chatelain advised that 

appellant was able to return to work/school on December 16, 2016. He noted that his wounds were 

healed at that time. Dr. Chatelain also noted that appellant needed cutout accommodations for preulcerative lesions in supportive shoes at all times. He again maintained that it would be difficult 

for him to return to full-duty work given the amount of necessary weight bearing and that preulcerative lesions were forming even with custom offloaded/accommodative inserts and 

appropriate shoe gear. Dr. Chatelain indicated that appellant informed him that these lesions 

formed in under two hours of continued ambulatory activity when no accommodations were 

provided. He advised that, given the limited nature of his weight-bearing status and concern for 

recurrent wound formation at his current level of work activity, consideration should be given to 
3

a more sedentary position, including a desk job that would allow him to work, but limit the 

formation of wounds on his feet.

Dr. Chatelain, in a December 28, 2016 prescription note, requested that appellant be 

excused from work through January 4, 2017. He explained that appellant was recovering from a 

health condition that incapacitated him from performing his current job duties. 

In an undated medical certificate, Dr. Chatelain indicated that appellant had been under his 

care from December 2, 2016 for diabetic ulcers and pre-ulcerative lesions with pes cavus

deformity. He indicated by checking the box marked “yes” that appellant’s injury was work

related. Dr. Chatelain advised that on February 15, 2017 appellant could return to his usual duties 

with accommodations. 

On February 15, 2017 Dr. Chatelain reported that appellant returned for a follow-up visit

for callusing to the right great toe. He also needed more documentation for work regarding the 

amount of time he needed to be on and off his foot. Dr. Chatelain examined appellant and 

reiterated his prior assessments of diabetic neuropathy, hammertoe, hyperkeratosis, foot pain, and 

pre-ulcerative calluses. He noted appellant’s request to undergo surgery as conservative treatment 

measures had been exhausted.

In March 2, 2017 hospital records, Dr. Chatelain indicated that he performed a right foot 

flexor tenotomy with extensor halluces longus lengthening to treat appellant’s preoperative and 

postoperative diagnoses of right foot pes cavus with hallux malleus deformity and recurrent preulcerative lesions to the tuft of the great toe secondary to these conditions. 

By letter dated July 6, 2017, the employing establishment controverted appellant’s claim. 

It noted that on October 16, 2016 appellant had been promoted from a wage grade level-2 (WG2) housekeeping aid to a WG-3 housekeeping aid and that bed washing services were part of his 

regular job duties. The employing establishment also noted that appellant’s immediate supervisor 

granted his request for reasonable accommodations regarding his diabetes and foot conditions prior 

to his formal request for such accommodations on November 7, 2016. Actual accommodation was

granted on December 11, 2016. The employing establishment contended that appellant had not 

submitted any medical documentation which provided a physician’s well-reasoned opinion 

regarding causal relationship between his diagnosed condition and factors of his employment. It 

also contended that he had not submitted necessary factual information to support his claim.

By decision dated September 7, 2017, OWCP denied appellant’s occupational disease 

claim. It found that the medical evidence of record was insufficient to establish that the diagnosed 

foot conditions were causally related to the accepted employment factors.

LEGAL PRECEDENT

An employee seeking benefits under FECA3 has the burden of proof to establish 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 

 

3 Supra note 2.
4

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 is causally related to the 

employment injury.4 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.5

To establish that an injury was sustained in the performance of duty in an occupational 

disease claim, a claimant must submit the following: (1) medical evidence establishing the 

presence or existence of the disease or condition for which compensation is claimed; (2) a factual 

statement identifying employment factors alleged to have caused or contributed to the presence or 

occurrence of the disease or condition; and (3) medical evidence establishing that the employment 

factors identified by the claimant were the proximate cause of the condition for which 

compensation is claimed or, stated differently, medical evidence establishing that the diagnosed 

condition is causally related to the employment factors identified by the claimant. 

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

establish causal relationship is rationalized medical opinion evidence.6 Rationalized medical 

opinion evidence is medical evidence which includes a physician’s rationalized opinion on 

whether there is causal relationship between the employee’s diagnosed condition and the 

compensable employment factors.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

OWCP accepted as factual that appellant washed beds while working as a housekeeping 

aid. The Board finds, however, that the medical evidence of record is insufficient to establish that 

he sustained a bilateral foot condition caused or aggravated by these accepted work factors.

Appellant submitted a series of reports from his attending physician, Dr. Chatelain. In an 

undated medical certificate, Dr. Chatelain diagnosed diabetic ulcers and pre-ulcerative lesions with 

pes cavus deformity. He advised that appellant could return to his usual work duties with 

accommodations on February 15, 2017. Although Dr. Chatelain answered “yes” on a form report

when asked if the diagnosis was work related, 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 is insufficient to establish causal 

 

4 T.H., Docket No. 17-0747 (issued May 14, 2018); C.S., Docket No. 08-1585 (issued March 3, 2009); Elaine 

Pendleton, 40 ECAB 1143 (1989).

5 T.H., id.; S.P., 59 ECAB 184 (2007); Victor J. Woodhams, 41 ECAB 345 (1989); Joe D. Cameron, 41 ECAB 

153 (1989).

6 Y.J., Docket No. 08-1167 (issued October 7, 2008); A.D. 58 ECAB 149 (2006); D’Wayne Avila, 57 ECAB 

642 (2006).

7

J.J., Docket No. 09-0027 (issued February 10, 2009); Michael S. Mina, 57 ECAB 379 (2006).

8

I.J., 59 ECAB 408 (2008); Victor J. Woodhams, 41 ECAB 345 (1989).
5

relationship.9 He failed to explain how appellant’s diabetic ulcers and pre-ulcerative lesions with 

pes cavus deformity, resultant disability, and work restrictions were caused or aggravated by 

washing beds at work. Because Dr. Chatelain failed to provide a well-rationalized explanation 

regarding causal relationship between appellant’s diagnosed conditions, resultant disability, and 

work restrictions and the accepted employment factors, his medical certificate is of limited

probative value.

In reports dated December 15, 2016 and January 4, 2017, Dr. Chatelin related a history that 

appellant’s pre-ulcerative lesions on his feet formed under two hours of continued ambulatory 

activity when no accommodations were made for his condition at work. However, he appears 

merely to repeat the history of injury as reported by appellant without providing his own opinion 

regarding whether appellant’s condition was work related. To the extent that Dr. Chatelain is 

providing his own opinion, he failed to provide a rationalized opinion based on objective findings 

regarding causal relationship between appellant’s pre-ulcerative lesions and the established

employment factors.

10

 As such, the Board finds that his reports are insufficient to meet appellant’s 

burden of proof.

Similarly, Dr. Chatelain’s remaining reports are insufficient to meet appellant’s burden of 

proof. Within these additional reports, he did not provide an opinion stating that the accepted

employment factors caused or aggravated appellant’s diagnosed right foot conditions, resultant 

surgery, and disability status.

11

The Board finds that appellant has failed to submit rationalized, probative medical evidence 

sufficient to establish bilateral foot conditions causally related to the accepted employment factor. 

Appellant therefore did not meet his burden of proof. 

On appeal appellant’s representative contends that appellant sustained a work-related 

injury and disability based on Dr. Chatelain’s medical opinion. He further contends that his injury 

could have been avoided if the employing establishment had complied with Dr. Chatelain’s orders 

by providing him with a sedentary position. The representative maintains that instead it kept 

appellant in his duty position which caused his bilateral foot condition and worsened his disability. 

However, for the reasons set forth above, Dr. Chatelain failed to explain with medical rationale 

how the accepted employment factors caused or aggravated appellant’s diagnosed foot conditions, 

resultant surgery, disability status, and work restrictions.

12

 Thus, Dr. Chatelain’s opinion is 

 

9 A.C., Docket No. 17-1869 (issued March 1, 2018); see also Calvin E. King, Jr., 51 ECAB 394 (2000); see also

Frederick E. Howard, Jr., 41 ECAB 843 (1990).

10 M.G., Docket No. 16-1791 (issued February 22, 2017); Franklin D. Haislah, 52 ECAB 457 (2001); Jimmie H. 

Duckett, 52 ECAB 332 (2001) (medical reports not containing rationale on causal relationship are entitled to little 

probative value).

11 See T.M., Docket No. 16-1456 (issued January 10, 2017); S.E., Docket No. 08-2214 (issued May 6, 2009); A.D.,

58 ECAB 149 (2006) (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).

12 See supra note 7.
6

insufficient to establish that appellant sustained a bilateral foot condition causally related to the 

accepted 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 has failed to meet his burden of proof to establish a bilateral 

foot condition causally related to the accepted factors of his federal employment.

ORDER

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

Workers’ Compensation Programs is affirmed.

Issued: July 20, 2018

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