United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

S.G., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Morrison, IL, Employer

__________________________________________

)

)

)

)

)

)

)

)

Docket No. 19-0041

Issued: May 2, 2019

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 8, 2018 appellant, through counsel, filed a timely appeal from a May 14, 2018 

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 her burden of proof to establish a left ankle condition 

causally related to the accepted factors of her 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 August 17, 2016 appellant, then a 32-year-old city carrier, filed an occupational disease 

claim (Form CA-2) alleging that she developed a left ankle injury, which was swollen and achy,

resulting from the performance of her federal duties. OWCP assigned this claim OWCP File No. 

xxxxxx849. Appellant noted that she first became aware of her claimed condition and its 

relationship to her federal employment on August 10, 2016. She stopped work on August 15, 2016 

and returned to work on August 16, 2016.3

OWCP subsequently received a doctor’s excuse dated August 10, 2016 from

Dr. Michael D. Williams, an attending podiatrist. Dr. Williams indicated that appellant could 

return to work on August 31, 2016. 

In an August 15, 2016 attending physician’s report (Part B of a Form CA-16 authorization

for examination and/or treatment), Dr. Nicole D. Eustace, an attending family practitioner, 

indicated that appellant previously had a complicated sprained left foot and that she presented with 

new symptoms. She provided examination findings of the ankle and diagnosed tendinitis. 

Dr. Eustace checked a box marked “yes” indicating that the diagnosed condition was caused or 

aggravated by the employment activity described. She noted that appellant was disabled from 

August 15 through 16, 2016 and that she could resume her regular work on August 17, 2016.

In a development letter dated August 31, 2016, OWCP notified appellant of the factual and 

medical deficiencies of her claim. It advised her of the type of factual and medical evidence needed 

to establish her claim and provided a questionnaire for her completion. OWCP afforded appellant

30 days to respond.

OWCP subsequently received a duty status report (Form CA-17) dated August 19, 2016 

by Dr. Eustace who provided a history that, on August 10, 2016, appellant had a swollen and very 

painful left ankle. She reiterated her diagnosis of tendinitis and noted that appellant was unable to 

work for two weeks.

X-ray reports dated August 16, 2016 from Dr. Reid M. Schroeder, a Board-certified 

diagnostic radiologist, were also received. In an August 16, 2016 left foot x-ray report,

Dr. Schroeder provided an impression of a normal study. In an August 16, 2016 left ankle x-ray 

report, he provided an impression of no fracture deformity pain. In both reports, Dr. Schroeder 

noted that the reason for the tests was for a work-related injury. 

Appellant submitted a duplicate copy of OWCP’s August 31, 2016 development letter,

which contained handwritten notes indicating that she was scheduled to undergo surgery on

September 13, 2016 by Dr. Williams and that she would submit the results of a magnetic resonance 

imaging (MRI) scan. 

Appellant also submitted additional medical evidence. In a chart note dated August 15, 

2016, Dr. Eustace noted appellant’s complaint of pain in her right ankle and heel and left ankle. 

She also noted that appellant had a history of a prior right ankle injury. Dr. Eustace examined her

 

3 On August 15, 2016 the employing establishment offered appellant a full-time, light-duty position. Appellant 

accepted the position on that date. 
3

right and left lower extremities and diagnosed left foot acute tendinitis. She placed appellant off 

work for the remainder of the day of her examination to rest and elevate the lower extremity.

In a progress note dated August 16, 2016, Dr. Williams reported that appellant related a 

history that approximately one year prior she twisted her left ankle and immediately experienced 

swelling in the ankle while on her mail route. He noted that she continued to have pain. 

Dr. Williams discussed findings on physical examination and reviewed radiographs of the left foot 

and ankle. He assessed appellant as having left foot pain and posterior tibial tendinitis and left 

ankle lateral sprain/instability. Dr. Williams ordered a left foot and ankle MRI scan to evaluate 

lateral ligament structures and medial tenderness structures of the left foot and ankle. He placed

appellant off work for two weeks in anticipation that she would not be able to immediately undergo 

the MRI scan. Dr. Williams discussed left ankle MRI scan results in a progress note dated

August 30, 2016. He reexamined appellant’s left foot and ankle and reported his findings. 

Dr. Williams reiterated his assessment of chronic left ankle sprain and lateral instability. He

further assessed appellant as having mild peroneus brevis tendinitis. Dr. Williams addressed her 

treatment plan, including surgical intervention for the left ankle.

An unsigned report dated August 16, 2016 noted appellant’s medical and social history. 

A chart note dated August 19, 2016 by Kimberly Feary4indicated that Dr. Williams had 

ordered a left ankle MRI scan. She noted that appellant claimed that this was a workers’

compensation claim against the employing establishment. 

On August 22, 2016 Dr. Keith I. Pham, a Board-certified diagnostic radiologist, performed 

an MRI examination of appellant’s left ankle. He provided an impression of posterior tibialis 

tendinosis and likely longitudinal split of the peroneus brevis tendon. Dr. Pham found that the 

peroneus brevis tendon remained attached to the fifth metatarsal base. He also provided an 

impression of likely partial-thickness ligamentous sprain involving the posterior talofibular 

ligament component of the deltoid ligament. Dr. Pham related that the thickening of the anterior 

talofibular ligament was most likely a previous partial thickness injury with resulting scar/fibrosis. 

He further provided an impression of no fracture and unremarkable ankle and subtalar joints.

In a chart note dated September 2, 2016, Dr. Eustace indicated that appellant presented for 

preoperative history and physical examination for her left ankle surgery to be performed on 

September 13, 2016 by Dr. Williams. She related appellant’s history and reported examination 

findings. Dr. Eustace provided preoperative clearance for the planned podiatric procedure. 

Dr. David Yeager, a podiatrist, completed a duty status report (Form CA-17) on

October 3, 2016. He noted the date of injury as August 10, 2016. Dr. Yeager also noted that 

appellant had recurring left ankle pain. He described clinical findings of positive pain in the medial 

and lateral aspects of the right ankle. Dr. Yeager indicated that a diagnosis due to injury was not 

applicable. He related that appellant had been advised to resume work with restrictions on the date 

of his examination.

 

4 The Board notes that Ms. Feary’s professional qualifications are not contained in the case record.
4

By decision dated November 2, 2016, OWCP denied appellant’s occupational disease 

claim finding that the evidence of record was insufficient to establish that her claimed employment 

factors occurred as alleged.

OWCP subsequently received an additional duty status report (Form CA-17) dated 

December 28, 2016, wherein Dr. Yeager reiterated the date of injury as August 10, 2016. 

Dr. Yeager noted a history of left ankle stabilization. He described clinical findings of past left 

ankle lateral stabilization. Dr. Yeager related that on January 23, 2017 appellant had been advised 

to resume work with restrictions. He indicated that she was transitioning from a controlled ankle

motion (CAM) boot. In discharge instructions dated January 18, 2017, Dr. Yeager restated 

appellant’s work capacity and need to wear a CAM boot.

On January 30, 2017 appellant, through counsel, requested reconsideration of OWCP’s 

November 2, 2016 decision. She submitted a December 6, 2016 office note by Dr. Yeager in 

which he noted that he concurred with appellant who maintained that her surgery was due to a 

November incident where she twisted her left ankle and sustained ligamentous damage when a 

friendly dog jumped on her and there was a crack in a driveway while she was delivering mail.5 

Dr. Yeager also noted that she received conservative medical treatment and obviously opted for 

surgical intervention. He discussed findings on examination and assessed appellant as doing fine 

status post lateral ankle stabilization with medial ankle stabilization of the peroneous brevis tendon 

and delayed primary repair of a ruptured anterior talofibular ligament, and ankle athrotomy. 

Dr. Yeager advised that appellant would remain off work. In a February 13, 2017 duty status 

report (Form CA-17), he restated the findings and statements set forth in his December 28, 2016

report. 

By decision dated March 9, 2017, OWCP denied modification of its November 2, 2016 

decision, finding that Dr. Yeager’s reports failed to address causal relationship between appellant’s 

left ankle condition and her work duties.

OWCP received additional duty status reports (Form CA-17) dated April 18, May 24, 

June 27, and September 25, 2017 by Dr. Yeager who continued to reiterate the findings and 

statements set forth in his December 28, 2016 report with the exception that in his June 27 and 

September 25, 2017 reports he advised that appellant could perform her regular work with 

restrictions. In the September 25, 2017 report, Dr. Yeager indicated that she could work four hours 

a day. He listed appellant’s work restrictions in discharge instructions dated April 20, 2017.

On March 9, 2018 appellant, through counsel, requested reconsideration of OWCP’s 

March 9, 2017 decision. She submitted a July 25, 2017 letter from Dr. Yeager. Dr. Yeager related 

a history that appellant sustained a left ankle injury due to the dog jumping incident that occurred 

on November 13, 2015. He noted that she was diagnosed as having a severe sprained ankle. 

Appellant was off work for about 12 to 16 weeks and returned to light-duty work wearing an ankle 

brace at all times. Dr. Yeager noted that she struggled to perform her work duties due to worsening 

left ankle problems. He further noted that Dr. Williams referred appellant to him for surgical

consultation and evaluation. Dr. Yeager maintained that she was progressing nicely. He related, 

 

5 Appellant filed a traumatic injury claim (Form CA-1) under OWCP File No. xxxxxx205 for an injury sustained 

on November 5, 2015. OWCP accepted the claim for sprain of unspecified ligament of the left ankle and sprain of 

unspecified part of the left wrist and hand.
5

however, that appellant had not yet reached maximum medical improvement. Dr. Yeager 

indicated that she believed that she would be ready in one month. 

In a left foot x-ray report dated September 23, 2016, Dr. Cheryl A. Schwalm, a diagnostic 

radiologist, provided an impression of no acute traumatic abnormalities shown. 

In an October 19, 2016 left ankle x-ray report, Dr. Donald Pierantozzi, a Board-certified 

diagnostic radiologist, found an overlying cast that obscured bony detail. He also found that 

alignment was satisfactory. In addition, Dr. Pierantozzi found no acute fracture or dislocation and 

postsurgical hardware that overlaid the anterior calcaneus.

In an October 19, 2016 operative report, Dr. Yeager provided a preoperative and postoperative diagnosis of chronic left ankle lateral ankle instability. He performed Lee lateral ankle 

stabilization using screw fixation, ankle arthrotomy, delayed primary repair of anterior talofibular 

ligament, primary deltoid repair, and peroneus brevis tubularization and repair of the left ankle. 

Dr. Yeager, in an office note dated October 28, 2016, continued to examine appellant. He 

reviewed diagnostic test results and provided an assessment that appellant was doing fine status 

post one week her October 19, 2016 surgery. In prescriptions dated December 6 and 27, 2016,

Dr. Yeager ordered crutches, a CAM boot, rehabilitation services, and physical therapy for 

appellant. 

Treatment notes dated December 23 and 29, 2016 from appellant’s physical therapist 

addressed the treatment of appellant’s left ankle and foot. 

On March 27, 2017 Dr. Stephen D. Palmer, a podiatrist, reported that appellant was

examined for follow-up of her left ankle lateral stabilization. He discussed findings on physical 

examination and assessed her as having an unstable left ankle that was improving based on clinical 

status details. 

On April 3, 2018 appellant responded to OWCP’s August 31, 2016 development 

questionnaire. She described the employment duties that she believed contributed to her 

condition/injury. Appellant alleged that her job duties involved walking/delivering mail to each 

box along a designated route on different surfaces and under different hazards on a daily basis. 

She maintained that the surfaces had uneven grass/dirt and unexpected drops or holes, especially 

when a surface met with landscaping such as, sidewalks, wooden timbers, and/or edging used on 

different property markers, decorations, and/or entrances/exits. Appellant related that daily 

hazards and factors included animals which may be unexpectedly outside or natural hazards such 

as, rocks, sticks and holes. She worked 8 to 10 hours a day. Appellant stood for two hours a day 

while sorting mail and loading her truck. The remaining five to seven hours involved returning 

empty equipment and bringing mail back to the office. Appellant contended that she sustained an 

ankle injury when a resident’s dog jumped on her while she was walking across a driveway to 

deliver mail. She maintained that her foot hit a large crack in the resident’s driveway and it became 

swollen and she was unable to walk. Appellant claimed that her ankle was not an issue prior to 

her injury. She never had any injuries, aches, pain, and did not need any treatment. Appellant also 

claimed that she had no activities outside her federal employment other than raising her daughter, 

did not participate in any sports, and was on her computer for a maximum of two hours a week.
6

By decision dated May 14, 2018, OWCP affirmed its March 9, 2017 decision, as modified. 

It found that appellant had established the factual portion of her claim. However, the claim

remained denied as appellant had not provided a rationalized medical opinion explaining how her 

diagnosed left ankle condition and October 19, 2016 surgery were causally related to the accepted 

employment factors.

LEGAL PRECEDENT

An employee seeking benefits under FECA 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 period of FECA,6that 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.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 

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;9(2) a factual statement 

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

of the disease or condition;10 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.11 

The medical evidence required to establish causal relationship is rationalized medical 

opinion evidence. The opinion of the physician must be based on a complete factual and medical 

background of the employee, must be one of reasonable 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.12

 

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); 

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

9 Michael R. Shaffer, 55 ECAB 386 (2004).

10 Marlon Vera, 54 ECAB 834 (2003); Roger Williams, 52 ECAB 468 (2001).

11 Beverly A. Spencer, 55 ECAB 501 (2004).

12 See J.R., Docket No. 17-1781 (issued January 16, 2018); I.J., 59 ECAB 408 (2008).
7

ANALYSIS

The Board finds that appellant has not met her burden of proof to establish a left ankle 

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

In support of her claim, appellant submitted a series of reports from Dr. Eustace, an

attending physician. In an attending physician’s report (Part B for a Form CA-16) dated 

August 15, 2016, Dr. Eustace indicated that she examined appellant on that date. She discussed 

appellant’s history of a prior complicated sprained left foot and noted that appellant presented with 

new symptoms. Dr. Eustace noted findings on examination of the left ankle and diagnosed 

tendinitis. She checked a box marked “yes” indicating that the diagnosed condition was caused or 

aggravated by the employment activity described. Dr. Eustace advised that appellant was disabled 

from August 15 through 16, 2016 and that she could resume her regular work on August 17, 2016. 

The Board has held that a medical report that addresses causal relationship with a checkmark, 

without rationale explaining how the employment incident caused or aggravated the diagnosed 

condition, is of diminished probative value and insufficient to establish causal relationship.13 

Dr. Eustace failed to offer medical rationale explaining how appellant’s diagnosed left ankle

condition was caused or aggravated by the accepted employment factors. The need for rationale

is particularly important as the record indicates that she had a prior history of left ankle 

conditions.

14

 Dr. Eustace’s remaining reports and chart notes are of no probative value because 

they did not relate appellant’s diagnosis of left ankle and foot tendinitis, September 13, 2016 

surgery, and disability from work to the accepted employment factors.15 For the reasons stated, 

the Board finds that Dr. Eustace’s reports and chart notes are insufficient to establish appellant’s

burden of proof.

Appellant also submitted a series of reports from Dr. Yeager. In a December 6, 2016 office 

note and July 25, 2017 report, Dr. Yeager discussed appellant’s previously accepted employmentrelated left ankle condition and resultant surgery. In the December 6, 2016 office note, he reported 

examination findings and provided an assessment that appellant was doing fine status postsurgery. 

Dr. Yeager did not attribute appellant’s left ankle surgery to the established employment factors. 

He agreed with her belief that her surgery was due to the previously accepted November 5, 2015 

employment-related injury. In the July 25, 2017 report, Dr. Yeager noted that appellant’s left

ankle condition worsened after she returned to light-duty work, but such a generalized statement

is insufficient to establish causal relationship. He did not provide sufficient medical rationale

explaining how appellant’s new or preexisting left ankle conditions were caused or aggravated by

the accepted employment factors. As noted above, the need for rationale is particularly important

as the record indicates that appellant had a prior history of left ankle conditions.

16

 Dr. Yeager’s 

October 19, 2016 operative report did not contain an opinion on the cause of appellant’s diagnosed 

 

13 See S.C., Docket No. 18-1242 (issued March 13, 2019).

14 See M.B., Docket No. 17-0688 (issued March 15, 2018).

15 See L.B., Docket No. 18-0533 (issued August 27, 2018); D.K., Docket No. 17-1549 (issued July 6, 2018)

(medical evidence that does not offer an opinion regarding the cause of an employee’s condition is of no probative 

value on the issue of causal relationship).

16 M.B., supra note 14.
8

conditions.17 His remaining reports did not provide a history of injury, a firm diagnosis of a 

particular medical condition, nor a rationalized opinion regarding causal relationship.

18

 For the 

reasons set forth above, the Board finds that Dr. Yeager’s office note and reports are insufficient 

to establish appellant’s burden of proof. 

Dr. Williams’ medical notes diagnosed left foot pain and posterior tibial tendinitis and left 

ankle lateral sprain/instability and addressed appellant’s disability from work. Dr. Palmer’s report 

diagnosed unstable left ankle that was improving based on clinical status details following 

appellant’s left ankle lateral stabilization. Neither physician provided an opinion that the 

diagnosed conditions and appellant’s surgical treatment and disability were caused or contributed 

to by the accepted employment factors.19 The Board finds, therefore, that the reports of

Dr. Williams and Dr. Palmer are insufficient to establish appellant’s burden of proof.

The diagnostic studies of record from Drs. Schroeder, Pham, Schwalm, and Pierantozzi 

failed to provide firm left foot and ankle diagnoses resulting from the accepted employment 

factors. The Board has held that reports of diagnostic tests lack probative value as they do not 

provide an opinion on causal relationship between the accepted employment factors and a 

diagnosed condition.20

The treatment notes from appellant’s physical therapist have no probative medical value in 

establishing appellant’s claim as a physical therapist is not considered a “physician” as defined

under FECA.21 As such, this evidence is also insufficient to meet appellant’s burden of proof.

Appellant also submitted an unsigned report dated August 16, 2016 and a chart note dated 

August 19, 2016 from Ms. Feary. However, such evidence has no probative medical value on the 

issue of causal relationship as these reports were not signed by a physician.22

 

17 Supra note 15.

18 See L.M., Docket No. 18-0473 (issued October 22, 2018).

19 Supra note 15.

20 See E.V., Docket No. 18-1617 (issued February 26, 2019); R.G., Docket No. 18-1045 (issued February 1, 2019).

21 5 U.S.C. § 8101(2) provides that a physician includes surgeons, podiatrists, dentists, clinical psychologists, 

optometrists, chiropractors, and osteopathic practitioners within the scope of their practice as defined by state law. 

See 5 U.S.C. § 8102(2); S.A., Docket No. 16-1128 (issued November 24, 2017); M.M., Docket No. 16-1617 (issued 

January 24, 2017); David P. Sawchuk, 57 ECAB 316, 320 n.11 (2006) (lay individuals such as nurses, physician 

assistants and physical therapists are not competent to render a medical opinion under FECA). See also Gloria J. 

McPherson, 51 ECAB 441 (2000); Charley V.B. Harley, 2 ECAB 208, 211 (1949) (a medical issue such as causal 

relationship can only be resolved through the submission of probative medical evidence from a physician).

22 See 5 U.S.C. § 8101(2); J.R., Docket No. 17-1781 (issued January 16, 2018); Merton J. Sills, 39 ECAB 572, 

575 (1988).
9

As appellant has not submitted rationalized medical evidence sufficient to establish an 

injury causally related to the accepted employment factors she has not met her burden of proof.23

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 her burden of proof to establish a left ankle 

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

ORDER

IT IS HEREBY ORDERED THAT the May 14, 2018 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: May 2, 2019

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

 

23 The Board notes that the case record contains a portion of a Form CA-16 Authorization for Examination and/or 

Treatment. However, a Form CA-16, when fully completed and properly executed would relieve appellant of financial 

responsibility for the medical service(s) received. See N.B., Docket No. 17-0927 (issued April 18, 2018); Tracy P. 

Spillane, 54 ECAB 608 (2003). The period for which treatment is authorized by a Form CA-16 is limited to 60 days 

from the date of issuance, unless terminated earlier by OWCP. See 20 C.F.R. § 10.300(c).