United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

J.W., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Daytona, FL, Employer

__________________________________________

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Docket No. 19-1201

Issued: November 8, 2019

Appearances: Case Submitted on the Record

Capp P. Taylor, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

JANICE B. ASKIN, Judge

ALEC J. KOROMILAS, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On May 9, 2019 appellant, through counsel, filed a timely appeal from an April 16, 2019 

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 has met his burden of proof to establish a bilateral foot 

condition 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 January 22, 2018 appellant, then a 61-year-old rural mail carrier, filed an occupational 

disease claim (Form CA-2) alleging that he sustained diabetic foot ulcerations as a result of 

walking while in the performance of duty. He indicated that he first became aware of the foot 

ulcerations and first realized that the condition was caused or aggravated by factors of his federal 

employment on December 28, 2017.

In a report dated October 10, 2017, Dr. Jeffrey Jackson, a podiatric surgeon, examined 

appellant for complaints of a left foot wound, noting appellant’s history of diabetes mellitus. 

Appellant told Dr. Jackson that his feet had been getting wet more often due to rain. On 

examination of the lower extremities, Dr. Jackson noted bilateral diminished sensation, bulla 

formation on the left foot with an underlying small ulceration, and hammertoe. He diagnosed a 

nonpressure chronic ulcer of the left foot limited to breakdown of skin and a nonthermal blister of 

the left foot.

On October 24, 2017 Dr. Jackson noted that appellant’s plantar ulcer was doing well, but 

that a new blister on the side of his left great toe had formed. Appellant stated that a new pair of 

shoes he wore while working contributed to this condition. On examination Dr. Jackson observed 

bilateral diminished sensation, ulceration of the plantar aspect of the left foot, and a new bulla 

formation on the dorsal medial aspect of the left hallux. He diagnosed a blister of the left great 

toe, a blister of the left foot, a nonpressure chronic ulcer of the left foot limited to breakdown of 

skin, acquired keratosis palmaris et planteria, and type 2 diabetes mellitus with diabetic

neuropathy. 

In a report dated October 30, 2017, Dr. Emily Ernst, a podiatric surgeon, noted new pain 

under the little toe on his left foot. On examination she observed bilateral diminished sensation, a 

healed lesion on the dorsal medial aspect of the left hallux, an ulcer on the plantar aspect of the 

left foot, a hyperkeratonic lesion below the first metatarsal head of the right foot and medial aspect 

of the right hallux, and hammertoe. Dr. Ernst diagnosed a blister of the left great toe, a blister of 

the left foot, a nonpressure chronic ulcer of the left foot limited to breakdown of skin, acquired 

keratosis palmaris et planteria, type 2 diabetes mellitus with diabetic neuropathy, and left foot pain. 

On December 5, 2017 Dr. Jackson followed up with appellant for evaluation of his left foot 

and to evaluate a new wound on his right foot. On examination he observed bilateral diminished 

sensation, an ulcer on the plantar aspect of the left foot, a lesion below the first metatarsal head of 

the right foot and medial aspect of the right hallux, new bulla formation adjacent to this right foot 

lesion, and hammertoe. Dr. Jackson diagnosed a nonthermal right foot blister, a contusion of the 

right foot, a nonpressure chronic ulcer of the left foot limited to breakdown of skin, type 2 diabetes 

mellitus with diabetic neuropathy, and a nonpressure chronic ulcer of the right foot with fat layer 

exposed. 

In a report dated January 3, 2018, Dr. Ernst noted that appellant had been admitted to 

inpatient care for a right foot blister and abscess. A magnetic resonance imaging (MRI) scan 

demonstrated a possible abscess and appellant underwent incision and drainage. On examination

Dr. Ernst observed bilateral diminished sensation, hammertoe, and a healed ulceration at the first 

metatarsal head of the right foot. She diagnosed a stage 3 pressure ulcer, type 2 diabetes mellitus 
3

with diabetic neuropathy, anhidrosis, neuralgia and neuritis, a nonthermal blister of the left foot, 

and tinea unguium.

On January 8, 2018 Dr. Ernst followed up with appellant for his bilateral foot ulcerations. 

On examination she observed bilateral diminished sensation, a healed lesion at the dorsal medial 

aspect of the left hallux, ulceration remaining at the plantar aspect of the left foot, ulceration below 

the right first metatarsophalangeal (MTP) joint with incision edges macerated and sloughing, and 

hammertoe. Dr. Ernst diagnosed type 2 diabetes mellitus with foot ulcer, a nonpressure chronic 

ulcer of the right foot with necrosis of muscle, acquired keratosis palmaris et plantaris, and edema. 

She cleaned and debrided the ulcerations.

In a report dated January 15, 2018, Dr. Ernst followed up with appellant for his bilateral 

foot ulcerations. On examination she observed that appellant’s left foot ulceration at the plantar 

aspect and right foot ulceration below the right first MTP joint were still present. Dr. Ernst

diagnosed type 2 diabetes with foot ulcer, a nonpressure chronic ulcer of the right foot with 

necrosis of muscle, acquired keratosis palmaris et plantaris, and edema. She cleaned and debrided 

the ulcerations. 

In an attending physician’s statement dated January 24, 2018, Dr. Ernst diagnosed a 

diabetic ulcer infection. She noted that appellant had sustained multiple wounds to both feet over 

the past several years and that diabetes had affected the present condition. Dr. Ernst recommended 

work restrictions of no weight bearing on the right foot, no driving, and no walking. She checked 

a box indicating that appellant’s condition arose out of his employment, explaining that increased 

distance of walking and standing put excess pressure on his feet, causing the wounds. In an 

accompanying duty status report of the same date, Dr. Ernst diagnosed large infected ulcers of the 

bilateral feet, stated that appellant was unable to perform regular work duties, and recommended 

that he not return to work. 

In a development letter dated February 2, 2018, OWCP informed appellant that he had not 

submitted sufficient factual and medical evidence to establish his claim. It advised him of the type 

of evidence needed and provided a questionnaire for his completion. OWCP afforded appellant 

30 days to respond. 

In a duty status report dated February 7, 2018, Dr. Ernst diagnosed ulceration of the 

bilateral feet and continued to advise that appellant should not return to work.

In a Certification of Health Care Provider for Employee’s Serious Health Condition 

(Family and Medical Leave Act) (Form WH-380-E), Dr. Ernst diagnosed bilateral foot ulceration 

due to increased walking, noting worsening with distance to walk to the parking lot and a direct 

correlation. She explained that the increased distance appellant had to walk due to limited disabled 

parking spaces had caused breakdown in previously-healed wounds. Dr. Ernst noted that appellant 

was diabetic with a long history of open wounds and bone infection. She stated that he had to be 

accommodated in order to heal from his current infection and wounds. 

In a statement dated February 5, 2018, appellant noted that he had been given medical 

accommodation parking on the north side of the premises of the employing establishment. Later, 

the accommodation ended, requiring him to walk an additional several hundred yards every day. 
4

Within three weeks, appellant’s previously-closed ulceration of the right foot broke open and 

became infected, requiring hospitalization on December 29, 2017. 

OWCP received duty status reports (Form CA-17) from Dr. Ernst dated from February 21 

through March 21, 2018 in which she recommended that appellant remain off work. 

By decision dated March 22, 2018, OWCP denied appellant’s claim, finding that he had 

not submitted sufficient evidence to establish causal relationship between the accepted 

employment factors and the diagnosed conditions. 

On April 30, 2018 appellant requested reconsideration of the March 22, 2018 decision and 

submitted additional evidence.

In a letter dated April 23, 2018, Dr. Ernst stated that she had treated appellant for various 

podiatry-related issues over the past several years. She noted that he had a history of ulcerations 

on each foot at various times over the years. Appellant had been able to heal from them with 

proper medical care and rest. Dr. Ernst noted that unfortunately, during the past winter, appellant’s 

increased workload and increased walking distance had made it increasingly difficult to maintain 

a healthy foot. Appellant attempted to alleviate these issues with parking accommodation and 

modifying how he worked, but was unsuccessful, especially when he was denied parking 

accommodation. Dr. Ernst explained that long hours standing sorting mail and delivering mail put 

increased stress on the tissues of the foot, causing wounds and deformities of the toes. She stated 

that, due to the increased activity, appellant sustained a large ulceration on his right foot that led 

to an infection that traveled to the bone. Appellant was hospitalized due to the infection and had 

to undergo procedures and extensive wound care. It became medically necessary that surgery was 

again performed to attempt to reconstruct a contracture of a joint, remove a portion of his bone, 

and then apply a specialized vacuum closure system to avoid amputation of the foot. 

By decision dated May 10, 2018, OWCP denied reconsideration of the merits of appellant’s 

claim. 

On January 26, 2019 appellant, through counsel, requested reconsideration of OWCP’s 

March 22, 2018 decision.

By letter dated December 17, 2018, Dr. Ernst stated that she had treated appellant for 

several years with regard to his bilateral diabetic foot ulcers. She explained that a diabetic foot 

ulcer was an open sore or wound occurring in patients with diabetes and are commonly caused by 

irritated or wounded feet. Dr. Ernst noted that people like appellant with type 2 diabetes often had 

a difficult time fighting off infections from ulcers. She explained that her office notes and records 

had recorded a new blister on the side of appellant’s left great toe due to a new pair of shoes used 

while working, and that appellant’s increased workload in the winter of 2017 to 2018 included 

increased walking distance, long hours of standing, and delivering mail. Dr. Ernst noted that long 

hours of being on his feet put increased stress on the tissues of the foot, causing wounds and 

contributing to the difficulty in healing these diabetic foot ulcers. She stated that, due to increased 

activity, appellant sustained a large ulceration on his right foot that led to an infection, requiring 

hospitalization and surgery. Dr. Ernst explained that appellant’s diabetic condition made him 

susceptible to foot ulcerations. The extent of time appellant was required to be on his feet with 

regard to walking, standing, casing, sorting mail, as well as mounting and dismounting from his 
5

vehicle, contributed to the risk of ulceration and infections of the bilateral foot ulcerations. 

Appellant’s poor fitting shoes would have also contributed to the ulcerations, as would age and 

weight. Dr. Ernst stated that the friction on appellant’s wounds performing work duties would 

contribute or cause the infection to the wounds, as well as the moisture on the feet due to 

perspiration or surface water entering the shoes. She opined that the infection and exacerbations 

of appellant’s diagnosed bilateral foot ulcerations were caused by these work duties within a 

reasonable degree of medical podiatric probability. 

By decision dated April 16, 2019, OWCP denied modification of the decision dated 

March 22, 2018. 

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 timely filed within the applicable 

time limitation of FECA,4that an injury was sustained in the performance of duty, as alleged, and 

that any disability or medical condition for which compensation is claimed is causally related to 

the employment injury.5 These are the essential elements of each and every compensation claim, 

regardless of whether the claim is predicated upon a traumatic injury or an occupational disease.6

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

disease claim, a claimant 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 identified employment factors.7

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.8 A physician’s opinion on whether there is causal relationship 

between the diagnosed condition and the implicated employment factor(s) must be based on a 

complete factual and medical background.9 Additionally, the physician’s opinion must be 

expressed in terms of a reasonable degree of medical certainty, and must be supported by medical 

 

3

Id.

4 S.B., Docket No. 17-1779 (issued February 7, 2018); J.P., 59 ECAB 178 (2007); Joe D. Cameron, 41 ECAB 

153 (1989).

5

J.M., Docket No. 17-0284 (issued February 7, 2018); R.C., 59 ECAB 427 (2008); James E. Chadden, Sr., 40 

ECAB 312 (1988).

6 K.M., Docket No. 15-1660 (issued September 16, 2016); L.M., Docket No. 13-1402 (issued February 7, 2014); 

Delores C. Ellyett, 41 ECAB 992 (1990).

7 S.C., Docket No. 18-1242 (issued March 13, 2019); Victor J. Woodhams, 41 ECAB 345, 352 (1989).

8 T.H., 59 ECAB 388, 393 (2008); Robert G. Morris, 48 ECAB 238 (1996).

9 M.V., Docket No. 18-0884 (issued December 28, 2018).
6

rationale that explains the nature of the relationship between the diagnosed condition and 

appellant’s specific employment factor(s).10

ANALYSIS

The Board finds that this case is not in posture for a decision.

The record reflects that appellant’s employment factors consist of prolonged walking, 

standing, casing mail, and sorting mail, as well as mounting and dismounting from his vehicle. 

Therefore, the issue is whether he has submitted sufficient medical evidence to establish that the 

factors of his federal employment caused or aggravated the diagnosed medical conditions.

In an April 23, 2018 letter, Dr. Ernst stated that she had treated appellant for various 

podiatry-related issues over the past several years. She noted that, during the past winter, 

appellant’s increased workload and increased walking distance had made it increasingly difficult 

to maintain a healthy foot. Dr. Ernst explained that long hours standing sorting mail and delivering 

mail put increased stress on the tissues of the foot, causing wounds and deformities of the toes. 

She opined that, due to the increased activity, appellant sustained a large ulceration on his right 

foot that led to an infection that traveled to the bone. 

On December 17, 2018 Dr. Ernst explained that her office notes and records had recorded 

a new blister on the side of appellant’s left great toe due to a new pair of shoes used while working, 

and that appellant’s increased workload in the winter of 2017 to 2018 included increased walking 

distance, long hours of standing, and delivering mail. She noted that long hours of being on his 

feet put increased stress on the tissues of the foot, causing wounds and contributing to the difficulty

in healing these diabetic foot ulcers. Dr. Ernst stated that, due to increased activity, appellant 

sustained a large ulceration on his right foot that led to an infection, requiring hospitalization and 

surgery. She explained that appellant’s diabetic condition made him susceptible to foot 

ulcerations. The extent of time appellant was required to be on his feet with regard to walking, 

standing, casing, sorting mail, and mounting and dismounting from his vehicle, contributed to the 

risk of ulceration and infections of the bilateral foot ulcerations. Dr. Ernst noted that appellant’s 

poor fitting shoes would have also contributed to the ulcerations, as would age and weight. She 

also stated that the friction on appellant’s wounds performing work duties would contribute or 

cause the infection to the wounds, as well as the moisture on the feet due to perspiration or surface 

water entering the shoes. Dr. Ernst opined that the infection and exacerbations of appellant’s 

diagnosed bilateral foot ulcerations were caused by these work duties within a reasonable degree 

of medical podiatric probability.

The Board finds that, while Dr. Ernst’s April 23 and December 17, 2018 letters were not 

fully rationalized, she explained the physiological process by which the accepted factors of 

appellant’s federal employment caused his diagnosed bilateral lower extremity conditions. 

Although the medical letters are insufficient to meet appellant’s burden of proof to establish his 

 

10 Id.; Victor J. Woodhams, supra note 7.
7

claim, they raise an inference between the diagnosed conditions and the accepted work factors, 

sufficient to require OWCP to further develop the claim.11

Proceedings under FECA are not adversarial in nature, nor is OWCP a disinterested arbiter. 

While it is appellant’s burden of proof to establish the claim, OWCP shares responsibility in the 

development of the evidence. It has the obligation to see that justice is done.12 The Board will, 

therefore, remand the case to OWCP for further development. On remand OWCP should prepare 

a statement of accepted facts and obtain a rationalized opinion from an appropriate Board-certified 

physician as to whether appellant’s bilateral lower extremity conditions are causally related to the 

accepted factors of his federal employment. Following this and any other further development as 

deemed necessary, OWCP shall issue a de novo decision on appellant’s claim.

CONCLUSION

The Board finds that this case is not in posture for a decision.

ORDER

IT IS HEREBY ORDERED THAT the April 16, 2019 decision of the Office of Workers’

Compensation Programs is set aside, and the case remanded for further action consistent with this 

decision of the Board.

Issued: November 8, 2019

Washington, DC

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Alec J. Koromilas, Alternate Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board

 

11 See D.V., Docket No. 17-1590 (issued December 12, 2018); E.J., Docket No. 09-1481 (issued February 19, 2010); 

John J. Carlone, 41 ECAB 354 (1989); Horace Langhorne, 29 ECAB 820 (1978).

12 J.G., Docket No. 18-1484 (issued June 14, 2019); D.V., id.; D.G., Docket No. 15-0702 (issued August 27, 2015); 

Donald R. Gervasi, 57 ECAB 281, 286 (2005); William J. Cantrell, 34 ECAB 1233, 1237 (1983).