United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

E.S., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Mesa, AZ, Employer

__________________________________________

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Docket No. 18-1312

Issued: April 3, 2020

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

CHRISTOPHER J. GODFREY, Deputy Chief Judge

JANICE B. ASKIN, Judge

JURISDICTION

On June 20, 2018 appellant, through counsel, filed a timely appeal from an April 18, 2018

merit decision of the Office of Workers’ Compensation Programs (OWCP).2 Pursuant to the 

Federal Employees’ Compensation Act3(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 The Board notes that,following the April18, 2018 decision, OWCP received additional evidence. However, the 

Board’s Rules of Procedure provides: “The Board’s review of a case is limited to the evidence in the case record that 

was before OWCP at the time of its final decision. Evidence not before OWCP will not be considered by the Board 

for the first time on appeal.” 20 C.F.R. § 501.2(c)(1). Thus, the Board is precluded from reviewing this additional 

evidence for the first time on appeal. Id.

3

5 U.S.C. § 8101 et seq.
2

ISSUE

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

causally related to the accepted factors of his federal employment.

FACTUAL HISTORY

On August 2, 2017 appellant, then a 40-year-old city carrier associate, filed an occupational 

disease claim (Form CA-2) alleging that he developed a right foot callous and ulcer due to factors 

of his federal employment including prolonged walking with a mail satchel in varying weather 

conditions.

4

 He noted that he first became aware of his condition on June 15, 2017 and realized 

that it was causally related to his employment on July 25, 2017. Appellant stopped work on 

August 2, 2017. The employing establishment challenged appellant’s claim, noting that he had a 

preexisting foot condition.

Appellant was treated in the emergency room on July 25, 2017 by a physician assistant 

who diagnosed a right foot ulcer due to diabetes mellitus. He was also examined on that date by 

a nurse for his complaint of a “hole” on the bottom of his right foot. The nurse diagnosed a right 

foot ulcer. An x-ray of the right foot also dated July 25, 2017 revealed a plantar soft tissue ulcer 

and no evidence of osteomyelitis, calcaneal spur, or vascular calcification.

On August 1, 2017 Dr. Brett Roeder, a podiatrist, evaluated appellant for a right plantar 

ulcer to the submetatarsal area, a wound to the right ankle, and a callous at the left submetatarsal

area. He noted that appellant reported right foot wounds for one month. On examination

Dr. Roeder found bilateral second and fifth metatarsal head hyperkeratosis, dried blood on the 

plantar right fifth metatarsal head, a central wound of the right second metatarsal head, a partial 

thickness ruptured blister right hallux, and a partial thickness posterior Achilles wound. He

diagnosed diabetes with neuropathy, pes cavus, preulcerative left metatarsal heads, and right foot 

wounds. Dr. Roeder cleaned the right foot wounds and performed excisional debridement with a 

scalpel. He recommended a diabetic insole. In a return to work note dated August 1, 2017,

Dr. Roeder advised that appellant was to remain off work for four weeks.

In an August 2, 2017 statement, appellant reported discomfort on the bottom of his foot,

which began on June 15, 2017. He had attributed his foot pain to his job duties as a mail carrier,

noting that he had continued to work. Appellant indicated that the foot soreness became callouses 

and then ulcers. He explained that he worked in the rain and his shoes and socks became wet,

which softened his skin peeling back the ulcer and callouses and creating a hole in the bottom of 

his foot.

In an August 9, 2017 development letter, OWCP advised appellant of the deficiencies of 

his claim. It requested additional factual and medical information, including a physician’s 

reasoned opinion addressing the causal relationship between his claimed conditions and specific 

work factors. OWCP afforded appellant 30 days to submit the requested information.

In an August 15, 2017 duty status report (Form CA-17), a podiatrist with an illegible 

signature diagnosed a right diabetic foot wound, diabetes, and neuropathy and found that appellant 

 

4 Appellant noted that he was diabetic.
3

could not return to work. The podiatrist noted a history of developing a callous on his foot from 

walking and developed an ulcer. The podiatrist checked both the “Yes” and “No” boxes,

responding to the question of whether the factors identified had caused the diagnosed conditions.

By decision dated September 11, 2017, OWCP denied appellant’s occupational disease 

claim, finding that the medical evidence submitted was insufficient to establish that he sustained a 

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

OWCP received September 3 and 28, 2017 Form CA-17 reports from Dr. Eunis Bello, a 

podiatrist. Dr. Bello diagnosed a right foot infection requiring emergency surgery and checked a 

box marked “yes” in response to whether the history provided by appellant had caused the 

diagnosed conditions. She indicated that he remained unable to work.

In a September 8, 2017 medical report of duty status form, a medical provider with an 

illegible signature indicated that appellant had undergone a hind foot amputation of right foot 

wound and would be disabled for six months in order to heal. The medical provider noted that 

appellant was at risk for leg amputation.

In a letter dated September 27, 2017, Dr. Bello noted that appellant had sustained a right 

foot injury that began as a callous. She noted that mail carriers in appellant’s locale were required 

to walk over varied terrain in both wet and dry weather. Dr. Bello indicated that, due to the 

monsoon rains and wet boots, and socks, the skin on appellant’s foot had become moist and rubbed 

open to expose his ulcer. She indicated that the ulcer then became infected and had necessitated a 

metatarsal amputation of the right foot. Dr. Bello again noted the types of physical activities noted 

in those who have developed callouses and ulcers of the feet. She opined that appellant’s postal 

activities for work required extensive walking over uneven terrain with added pressure on the feet 

from carrying a satchel. Dr. Bello concluded that callouses or blisters can from and thereafter 

result into ulcers. 

In Form CA-17 reports dated October 5, 2017 to January 10, 2018, Dr. Bello continued to 

diagnose a right foot infection requiring emergency surgery. She checked a box marked “yes” that 

the history of injury provided by appellant corresponded to the alleged employment factors. 

Dr. Bello found that he remained disabled from employment.

On October 11, 2017 appellant, through counsel, requested a telephonic hearing before an 

OWCP hearing representative.

In a Form CA-17 report dated October 19, 2017, Dr. D.R. Pena, a podiatrist, diagnosed a 

right foot infection requiring surgery and checked a box marked “yes” that the history of injury 

provided by appellant corresponded to the alleged employment factors. He indicated that appellant

was totally disabled. Dr. Pena provided similar Form CA-17 reports on November 24 and 

December 20, 2017. In January 24 and February 7 and 20, 2018 Form CA-17 reports, he provided 

work restrictions. Dr. Mathew Pettengill, a podiatrist, provided similar Form CA-17 reports on 

November 2 and December 1, 2017.

A telephonic hearing was held on February 26, 2018. Appellant testified that he had 

developed a callous on his foot from walking in wet shoes and socks in June and July 2017 during 

the rainy season. He claimed that his wet socks softened the callous exposing an ulcer. Appellant 

indicated that the ulcer subsequently became infected requiring an amputation.
4

In a letter dated April 2, 2018, counsel referenced an attached laboratory report dated 

July 25, 2017, which reported “A1c” results within normal limits. He indicated that he would 

submit an operative report and an explanation as to why appellant had required an amputation. No 

further evidence was received.

By decision dated April 18, 2018, the hearing representative affirmed the September 11, 

2017 decision.

LEGAL PRECEDENT

An employee seeking benefits under FECA5 has the burden of proof to establish the 

essential elements of his or her claim, including that the individual is an employee of the United 

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

period of FECA,6that 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.7 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. 8

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.9

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

relationship is rationalized medical opinion evidence.10 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

 

5

Supra note 3.

6

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

153 (1989).

7

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

ECAB 312 (1988).

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

DeloresC. Ellyett, 41 ECAB 992 (1990).

9

S.C., Docket No. 18-1242 (issued March 13, 2019); R.H., 59 ECAB 382 (2008).

10 A.M., Docket No. 18-1748 (issued April24, 2019); T.H., 59 ECAB 388 (2008).

11 M.V., Docket No. 18-0884 (issued December 28, 2018); I.J., 59 ECAB 408 (2008).
5

ANALYSIS

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

In support of his claim, appellant submitted a series of medical reports from his attending 

podiatrists which generally supported that his employment duties resulted in his diagnosed right 

foot conditions. In a September 27, 2017 report, Dr. Bello noted that appellant had a callous on 

his foot, which was aggravated to become an ulcer, that the ulcer became infected, and that his 

condition ultimately required an amputation. She explained that the callous turned into an ulcer 

because appellant’s employment duties as a mail carrier required walking on different terrain, 

carrying a heavy satchel, which put pressure on his feet, and enduring wet and dry temperatures. 

Dr. Bello indicated that having wet boots and socks as the result of rain had moistened the skin on 

appellant’s foot and exposed the ulcer. She noted that, due to an infection of the work-related 

ulcer, appellant had undergone a metatarsal amputation of the right foot. Dr. Bello opined that the 

accepted employment duties of miles of walking, the weight of the satchel he carried, and weather 

conditions in which he worked were sufficient so that blistering and calluses could form and 

develop into ulcers, as is alleged in this claim. 

The Board finds that the September 27, 2017 report of Dr. Bello is sufficient to require 

further development of the medical evidence to see that justice is done.12 Dr. Bello is a specialist 

in podiatry who is qualified in her field of medicine to render rationalized opinions on the issue of 

causal relationship and she provided a comprehensive understanding of the claimed mechanism of 

injury. It is further found that she suggested a pathophysiological explanation as to how appellant’s 

employment duties as a city carrier associate were sufficient to cause the diagnosed right foot 

conditions which resulted in an amputation. Dr. Bello explained how a callous had been 

aggravated by pressures while walking and carrying a heavy satchel with moisture in his socks due 

to rainy weather such that an ulcer occurred. The Board has long held that it is unnecessary that 

the evidence of record in a case be so conclusive as to suggest causal relationship beyond all 

possible doubt. Rather, the evidence required is only that which is necessary to convince the 

adjudicator that the conclusion drawn is rational, sound, and logical such that a logical inference 

can be drawn.13 Accordingly, the Board finds that Dr. Bello’s medical opinion is rationalized and 

logical and is therefore sufficient to require further development of appellant’s claim.14

It is well established that proceedings under FECA are not adversarial in nature and, while 

appellant has the burden of proof to establish entitlement to compensation, OWCP shares 

 

12 J.H., Docket No. 18-1637 (issued January 29, 2020); D.S., Docket No. 17-1359 (issued May 3, 2019); X.V.,

Docket No. 18-1360 (issued April 12, 2019); C.M., Docket No. 17-1977 (issued January 29, 2019); William J. 

Cantrell, 34 ECAB 1223 (1983).

13 See Docket No. N.L., 19-1592 (issued March 12, 2020); John J. Carlone, 41 ECAB 354 (1989); Kenneth J. 

Deerman, 34 ECAB 641, 645 (1983) and cases cited therein.

14 See J.H., supra note 12.
6

responsibility in the development of the evidence.15 OWCP has an obligation to see that justice is 

done.16

On remand OWCP shall refer appellant to an appropriate specialist, along with the case 

record and a statement of accepted facts. Its referral physician shall review the reports of Dr. Bello 

and, thereafter, provide a well-rationalized opinion as to whether appellant’s right foot conditions 

are causally related to, or had been aggravated by, the accepted factors of his federal employment. 

After such further development of the case record as OWCP deems necessary, it shall issue a 

de novo decision. 

CONCLUSION

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

ORDER

IT IS HEREBY ORDERED THAT the April 18, 2018 decision of the Office of Workers’

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

this decision of the Board

Issued: April 3, 2020

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Christopher J. Godfrey, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

 

15 See id. See also A.P., Docket No. 17-0813 (issued January 3, 2018); Jimmy A. Hammons, 51 ECAB 219, 

223 (1999).

16 See B.C., Docket No. 15-1853 (issued January 19, 2016).