United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

S.O., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

West Seneca, NY, Employer

__________________________________________

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Docket No. 19-0307

Issued: June 18, 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

ALEC J. KOROMILAS, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On November 27, 2018 appellant, through counsel, filed a timely appeal from a

September 26, 2018 merit decision of the Office of Workers’ Compensation Programs (OWCP).2 

 

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, during the pendency of this appeal, OWCP issued a January 3, 2019 decision which 

expanded the acceptance of appellant’s claim to include left plantar fascia tear. This decision, however, is null and 

void as the Board and OWCP may not simultaneously exercise jurisdiction over the same issue(s). See 20 C.F.R. 

§§ 501.2(c)(3), 10.626; see also M.C., Docket No. 18-1278, n.1 (issued March 7, 2019); Lawrence Sherman, 55 ECAB 

359, 360 n.4 (2004); Douglas E. Billings, 41 ECAB 880 (1990).
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.4

ISSUE

The issue is whether appellant has met her burden of proof to establish that the acceptance 

of her claim should be expanded to include additional left foot and left knee conditions causally

related to her accepted May 9, 2017 employment injury.

FACTUAL HISTORY

On May 10, 2017 appellant, then a 53-year-old mail carrier, filed a traumatic injury claim 

(Form CA-1) alleging that on May 9, 2017 she sustained a left foot injury when she stepped on a 

protruding metal pipe (fencing post) as she crossed a corner lawn while in the performance of duty. 

She alleged that it was painful to walk on her swollen and tender foot. Appellant stopped work on 

the filing date of her claim.

On May 9, 2017 the employing establishment executed an authorization for examination

and/or treatment (Form CA-16) authorizing medical treatment for appellant’s claimed employment 

incident on that date. 

OWCP subsequently received a medical report dated May 10, 2017 by Dr. Joseph P. 

Cronin, a Board-certified internist. Dr. Cronin noted a history that appellant sustained a left foot 

injury one day ago while at work. He related her medical history and findings on physical 

examination. Dr. Cronin provided an assessment of left plantar fasciitis and sprain of the left foot.

In a left foot x-ray report dated May 10, 2017, Dr. Mark Perry, a radiologist, provided an 

impression of normal left foot.

A work status report dated May 18, 2017 by Liane Kirchberger, a physician assistant, 

diagnosed left foot strain and plantar fasciitis and provided appellant’s work restrictions. In a duty 

status report (Form CA-17) of the same date, Ms. Kirchberger indicated that appellant sustained a 

left foot strain due to injury. She advised that appellant could resume work with restrictions. 

Dr. Cronin, in an undated Part B of the Form CA-16, attending physician’s report,

reiterated his diagnoses of plantar fasciitis and sprain of the left foot. He also noted appellant’s 

 

3 5 U.S.C. § 8101 et seq.

4 The Board notes that, following the September 26, 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 

evidence for the first time on appeal. Id.
3

work restrictions. In a work status report dated May 10, 2017, Dr. Cronin further addressed her 

work restrictions.

In a letter dated May 19, 2017, Joshua Weeks, a certified physician assistant, noted that 

appellant was seen in his office on that date. He related that she was unable to work due to her 

medical condition. Mr. Weeks indicated that appellant could return to work on May 29, 2017 

without medical restrictions. 

In a report dated May 18, 2017, Dr. Jerry Ulatowski, a pediatrician, noted that appellant 

presented for a follow-up evaluation of her left foot injury which occurred when she stepped on a 

metal post pipe at work on May 9, 2017. He discussed examination findings and provided an 

assessment of left foot strain, subsequent encounter.

A report dated May 19, 2017 by Dr. Robert Erickson, a Board-certified family practitioner, 

noted a history of the May 9, 2017 employment incident. The report provided examination 

findings and assessments of pain in the left ankle and joints of the left foot, and plantar fascial 

fibromatosis. Dr. Erickson checked a box marked “yes” indicating that the described incident was 

the medical cause of appellant’s injury/illness. Additional boxes were checked “yes” indicating 

that her complaints were consistent with her history of injury/illness and that her history of 

injury/illness was consistent with objective findings. It was determined that appellant had 75 

percent temporary impairment. 

Mr. Weeks, in a work capacity evaluation (Form OWCP-5c) dated June 2, 2017, noted that 

although appellant was unable to perform her usual job without restrictions because she was unable 

to walk extended distances, she could work eight hours a day with restrictions for one to two 

weeks. 

In a development letter dated June 7, 2017, OWCP advised appellant that when her claim 

was received it appeared to be a minor injury that resulted in minimal or no lost time from work. 

The claim was administratively approved to allow payment for limited medical expenses, but the 

merits of the claim had not been formally adjudicated. OWCP advised that, because appellant had 

not returned to full-time work, her claim would be formally adjudicated. It requested that she 

submit factual and medical information, including a comprehensive report from her physician 

regarding how the reported work incident caused or aggravated her claimed injury. OWCP 

afforded appellant 30 days to submit the necessary evidence.

In a letter dated May 26, 2017, Mr. Weeks noted that appellant was seen in his office on 

that date and that she was unable to return to work until further notice.

In a narrative report dated June 19, 2017, Dr. Lee D. Billing, an attending podiatrist, noted 

a history and reported examination findings and provided assessments of other sprain of the left 

foot, initial encounter, and left foot pain. Dr. Billing, in a June 26, 2017 duty status report (Form 

CA-17), diagnosed other specified injury of intrinsic muscle and tendon at ankle and foot level, 

left foot, subsequent encounter due to appellant’s May 9, 2017 injury. He advised that she was 

unable to perform her regular work duties. In an attending physician’s report (Form CA-20) dated 

June 28, 2017, Dr. Billing reiterated appellant’s history of injury. He diagnosed tear of the plantar 

fasciitis and tendinitis of the left foot. Dr. Billing checked a box marked “yes” indicating that the 
4

diagnosed conditions were caused or aggravated by the described employment activity. He 

advised that appellant was totally disabled from June 19, 2017 through the date of his examination. 

By decision dated July 21, 2017, OWCP accepted that the May 9, 2017 employment 

incident occurred as alleged. However, appellant’s claim remained denied because the medical 

evidence of record did not contain a rationalized opinion relating her diagnosed left foot conditions 

to the accepted employment incident.

OWCP received an additional report dated July 17, 2017 by Dr. Billing in which he 

continued to assess appellant as having a sprain of the left foot, initial encounter, and left foot pain. 

In a report dated July 27, 2017, Dr. Billing maintained that appellant’s left foot injury, which 

occurred while she was on her route on May 9, 2017, was definitely a workers’ compensation 

injury as she was injured while delivering mail.

In a left foot magnetic resonance imaging (MRI) scan report dated June 26, 2017, Dr. Paul 

Pizzella, a Board-certified diagnostic radiologist, provided an impression of tear of the medial 

band of the plantar fascia with splitting, thickening, and internal edema. He indicated that 

inflammatory changes were seen in the adjacent flexor digitorum brevis muscle and subcutaneous 

tissues. Dr. Pizzella related that the findings were acute in nature.

On August 11, 2017 appellant requested reconsideration of OWCP’s July 21, 2017 

decision and submitted additional medical evidence. In an additional report dated July 27, 2017,

Dr. Billing diagnosed left foot tear of the plantar fasciitis, as verified by a left foot MRI scan. 

In attending physician reports (Form CA-20) dated August 16 and 30, 2017, Dr. Billing 

continued to diagnose tear of the plantar fasciitis and tendinitis of the left foot. He again checked 

a box marked “yes” indicating that the diagnosed conditions were caused or aggravated by the 

described employment activity. Dr. Billing noted that appellant was totally disabled for the period 

June 19 through September 29, 2017. In reports dated July 17 and August 15, 2017, he continued 

to provide assessments of left foot pain and sprain of the left foot, initial encounter. Dr. Billing 

also provided an assessment of other sprain of the left foot, subsequent encounter. 

In an August 21, 2017 report, Dr. Erickson noted a history that appellant was injured while 

working as a mail carrier. He diagnosed a rupture of the plantar fasciitis of the left foot. 

Dr. Erickson advised that appellant was unable to work from May 9 through October 30, 2017. 

In a duty status report (Form CA-17) dated July 13, 2017, Dr. Billing provided a diagnosis

of healing plantar fascial tear, left foot. He indicated that the diagnosis was due to the accepted 

May 9, 2017 employment incident. Dr. Billing advised that appellant could return to work with 

restrictions, four hours a day. In attending physician reports (Form CA-20) dated September 13

through October 31, 2017, he continued to diagnose plantar fasciitis tear of the left foot. 

Dr. Billing also diagnosed possible complex regional pain syndrome, peroneal tendinitis, and 

stress fracture of the fifth metatarsal of the left foot. He checked a box marked “yes” indicating 

that the diagnosed conditions were caused or aggravated by the accepted May 9, 2017 employment 

incident. Dr. Billing also advised that appellant was totally disabled for the period June 19 through

September 27, 2017. Appellant could resume light-duty work on September 18, 2017 and regular 

work on October 16, 2017. Dr. Billing later determined that she was unable to resume her regular 
5

work. In a prescription note dated September 13, 2017, he indicated that appellant may return to 

work, four hours a day, on September 18, 2017.

By decision dated November 9, 2017, OWCP modified its July 21, 2017 decision to reflect 

that the medical evidence of record was sufficient to establish that appellant sustained a left foot 

sprain as a result of the accepted May 9, 2017 employment incident. However, the claim remained 

denied as causal relationship had not been established between the other diagnosed left foot 

medical conditions and the accepted employment injury.

OWCP received additional reports by Dr. Billing. In attending physician reports (Form 

CA-20) dated November 8, 22, and 29, 2017, Dr. Billing continued to check a box marked “yes”

indicating that appellant’s diagnosed tear of the plantar fasciitis, stress fracture of the fifth 

metatarsal, and peroneal tendinitis of the left foot were caused or aggravated by the accepted 

May 9, 2017 employment injury. He also continued to address appellant’s work capacity. In a 

November 21, 2017 narrative report, Dr. Billing noted appellant’s left foot complaints and findings 

on physical examination. He provided assessments of peroneal tendinitis of the left leg and 

reiterated his diagnosis of other specified injury of intrinsic muscle and tendon at ankle and foot 

level, left foot, subsequent encounter. In a Form OWCP-5c report dated November 29, 2017,

Dr. Billing indicated that appellant was restricted to four hours of sitting work. On that same day,

he prescribed an MRI scan of her left foot and reiterated his diagnosis of left foot plantar fasciitis

tear.

On December 4, 2017 the employing establishment informed OWCP that appellant had 

returned to work on September 18, 2017 for four hours and stopped work again on 

September 23, 2018. Appellant returned to work again on October 2, 2017 for four hours a day 

with restrictions. 

OWCP received additional reports dated December 7, 2017 through June 6, 2018 from

Dr. Billing who reiterated his prior diagnoses and opinion on causal relationship. Dr. Billing also 

diagnosed other enthesopathy of the left foot. He advised that appellant was totally disabled for 

the period December 21, 2017 through March 5, 2018. In a prescription dated January 25, 2018,

Dr. Billing noted that appellant was disabled from December 21, 2017 through February 12, 2018 

due to her plantar fasciitis tear. He ordered post-cast rehabilitation for four weeks in an additional

prescription of the same date. In reports dated January 30, February 14, and March 19, 2018,

Dr. Billing reiterated that appellant was restricted to four hours of sitting work. He subsequently 

advised that she could work with restrictions, six hours a day.

In an additional left foot MRI scan report dated December 19, 2017, Dr. Pizzella provided 

impressions of persistent tear involving the medial band plantar fascia showing, intrasubstance

component with resolution of the surface component, and edema/inflammation along the plantar 

soft tissues of the heel with no discrete hematoma. He also provided an impression of resolution 

of the inflammatory change/tear involving the flexor digitorum brevis muscle.

A report from appellant’s physical therapist addressed the treatment of her left foot 

conditions on January 30, 2018. 
6

On June 28, 2018 appellant, through counsel, requested reconsideration of OWCP’s 

November 9, 2017 decision.

OWCP received additional reports dated June 27, July 18, August 9 and 22, and 

September 5 and 19, 2018 by Dr. Billing in which he continued to note her condition was work 

related. In a prescription dated July 18, 2018, Dr. Billing indicated that appellant could work eight

hours a day, but the last two hours of the day should be limited-duty work. Appellant’s work 

schedule was for three months. 

By decision dated September 26, 2018, OWCP denied modification of its November 9, 

2017 decision.

5

LEGAL PRECEDENT

An employee seeking benefits under FECA6 has the burden of proof to establish the 

essential elements of his or her claim, including the fact that he or she is an employee of the United 

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

When an employee claims that a condition not accepted or approved by OWCP was due to 

an employment injury, he or she bears the burden of proof to establish that the condition is causally 

related to the employment injury.9 To establish causal relationship between the condition, as well 

as any attendant disability claimed and the employment event or incident, the employee must 

submit rationalized medical opinion evidence based on a complete factual and medical 

background, supporting such a causal relationship.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 

The weight of medical evidence is determined by its reliability, its probative value, its convincing 

 

5 By decision dated April 12, 2018, OWCP denied appellant’s claim for a recurrence of disability from 

September 23 through October 1, 2017 causally related to her accepted May 9, 2017 employment injuries. Also, by 

decision dated April 13, 2018, it denied her additional claim for an employment-related recurrence of disability 

December 21, 2017 through January 5, 2018.

6

Id.

7 See F.H., Docket No. 18-1238 (issued January 18, 2019); Tracey P. Spillane, 54 ECAB 608 (2003).

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 See T.F., Docket No. 17-0645 (issued August 15, 2018); Jaja K. Asaramo, 55 ECAB 200 (2004).

10 See S.A., Docket No. 18-0399 (issued October 16, 2018).

11 See P.M., Docket No. 18-0287 (issued October 11, 2018).
7

quality, the care of analysis manifested, and the medical rationale expressed in support of the 

physician’s opinion.12

ANALYSIS

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

acceptance of her claim should be expanded to include the additional left foot conditions causally

related to her accepted May 9, 2017 employment injuries.

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

physician, Dr. Billing. In attending physician’s reports (Form CA-20) Dr. Billing diagnosed 

various left ankle and foot conditions, including plantar fasciitis tear, peroneal tendinitis, possible 

regional pain syndrome, and stress fracture of the fifth metatarsal of the left foot. He checked a 

box marked “yes” indicating that the diagnosed conditions were caused or aggravated by the 

accepted May 9, 2017 employment injuries. Dr. Billing also indicated that appellant was either 

partially or totally disabled from work on intermittent dates from June 19, 2017 through 

September 29, 2017. The Board has held that when a physician’s opinion on causal relationship 

consists only of a checkmark on a form, without more by way of medical rationale, the opinion is 

of diminished probative value.

13

 Dr. Billing has not provided the necessary medical rationale 

explaining how appellant’s left foot sprain caused or aggravated her diagnosed conditions and 

resulted in her total disability from work. Therefore, the Board finds that his reports are 

insufficient to establish her burden of proof.14

Similarly, Dr. Erickson’s May 19, 2017 report is insufficient to establish appellant’s 

burden of proof. He diagnosed pain in the left ankle and joints of the left foot, and plantar fascial 

fibromatosis. Dr. Erickson checked a box marked “yes” indicating that the accepted May 9, 2017 

employment incident caused the diagnosed conditions. He reasoned that appellant’s complaints 

were consistent with her history of injury/illness and that her history of injury/illness was 

consistent with his objective findings. The Board finds, however, that Dr. Erickson has not

specifically identified the physical or objective findings that supported his conclusion. He did not 

provide adequate rationale explaining the basis of his opinion on causal relationship.

15

 

Dr. Erickson’s remaining August 21, 2017 report diagnosed rupture of the plantar fasciitis of the 

left foot and found that appellant was totally disabled from work from May 9 through 

October 30, 2017. He opined that she was injured while working as a mail carrier. While

Dr. Erickson’s opinion is generally supportive of causal relationship, he again did not provide

 

12 F.H., supra note 7.

13 See J.L., Docket No. 18-0698 (issued November 5, 2018); R.A., Docket No. 17-1472 (issued December 6, 2017); 

Sedi L. Graham, 57 ECAB 494 (2006); Deborah L. Beatty, 54 ECAB 340 (2003).

14 See V.H., Docket No. 18-1282 (issued April 2, 2019).

15 See M.B., Docket No. 18-0906 (issued November 21, 2018).
8

adequate medical rationale explaining the basis of his opinion on causal relationship.16 Thus, the 

Board finds that his reports are insufficient to establish appellant’s burden of proof.

Similarly, Dr. Billing’s duty status reports (Form CA-17) and July 27, 2017 report are 

insufficient to establish appellant’s burden of proof. In the Form CA-17 reports, he diagnosed 

other specified injury of intrinsic muscle and tendon at ankle and foot level, left foot, subsequent 

encounter due to the accepted May 9, 2017 employment injuries. Dr. Billing initially opined that 

appellant was unable to perform her regular work duties and subsequently found that she could 

work four hours a day with restrictions. In the July 27, 2017 report, he opined that appellant’s left 

foot injury was employment related. Dr. Billing did not explain how appellant’s accepted 

condition of left knee sprain caused her other specified injury of intrinsic muscle and tendon at 

ankle and foot level, left foot, subsequent encounter and disability.17 Thus, his reports are 

insufficient to establish her burden of proof.18 Dr. Billing’s remaining reports and prescriptions 

addressed appellant’s left knee conditions, disability from work, and work restrictions, but did not 

offer a medical opinion finding that the diagnosed conditions were causally related to the accepted 

work injuries.19 The Board finds, therefore, that Dr. Billing’s reports are insufficient to establish 

appellant’s burden of proof.

Likewise, the reports of Dr. Cronin and Dr. Ulatowski are insufficient to establish 

appellant’s burden of proof. The physicians diagnosed plantar fasciitis and left foot strain and 

addressed appellant’s work restrictions, but did not provide an opinion that the diagnosed 

conditions and work restrictions were caused by the accepted employment injuries.20

While the x-ray and MRI scan reports of Dr. Perry and Dr. Pizzella offered left knee 

diagnoses, the Board has held that diagnostic studies lack probative value as they do not address 

whether the employment injury caused any of the diagnosed conditions.21

Appellant also submitted reports from Ms. Kirchberger and Mr. Weeks, physician 

assistants, and appellant’s physical therapist. This evidence has no probative because neither a

physician assistant nor a physical therapist is considered a “physician” as defined under FECA.22

 

16 Id.

17 See P.J., Docket No. 17-0570 (issued October 26, 2017).

18 V.H., supra note 14.

19 See C.N., Docket No. 17-1321 (issued January 16, 2018).

20 Id.

21 See V.H., supra note 14; J.S., Docket No. 17-1039 (issued October 6, 2017).

22 5 U.S.C. § 8102(2) of FECA provides as follows: (2) physician includes surgeons, podiatrists, dentists, clinical 

psychologists, optometrists, chiropractors, and osteopathic practitioners within the scope of their practice as defined 

by State law. See also Roy L. Humphrey, 57 ECAB 238 (2005). David P. Sawchuk, 57 ECAB 316, 320 n.11 (2006) 

(lay individuals such as physician assistants, nurses, and physical therapists are not competent to render a medical 

opinion under FECA); 5 U.S.C. § 8101(2); 20 C.F.R. § 10.5(t). George H. Clark, 56 ECAB 162 (2004) (physician

assistant); Jane A. White, 34 ECAB 515, 518 (1983) (physical therapist).
9

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

establish causal relationship is rationalized medical evidence.23 Appellant failed to provide 

reasoned medical evidence demonstrating that she sustained additional left knee conditions that 

were caused or aggravated by the accepted May 9, 2017 employment injuries. Accordingly, the 

Board finds that she has failed to meet her burden of proof to establish expansion of the accepted 

conditions of her claim.24

On appeal counsel contends that OWCP failed to adjudicate the claim in accordance with 

the causation standard. He further contends that it also failed to give due deference to an attending 

physician’s findings. However, as discussed above, appellant’s physicians, included Dr. Billing, 

did not provide a rationalized opinion sufficient to show that appellant’s diagnosed left knee 

conditions were causally related to the accepted employment-related injuries.25

Appellant may submit new evidence or argument with a written request for reconsideration, 

to OWCP within one year of the Board’s 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 that the 

acceptance of her claim should be expanded to include the additional left foot and left knee

conditions causally related to her accepted May 9, 2017 employment injuries.

 

23 Supra note 9.

24 Supra note 10; J.C., Docket No. 18-1722 (issued April 5, 2019).

25 The Board notes that on May 9, 2017 the employing establishment issued appellant a signed authorization for 

examination and/or treatment (Form CA-16) authorizing medical treatment. The Board has held that where an 

employing establishment properly executes a CA-16 form, which authorizes medical treatment as a result of an 

employee’s claim for an employment-related injury, it creates a contractual obligation which does not involve the 

employee directly to pay the cost of the examination or treatment regardless of the action taken on the claim. See 20 

C.F.R. §§ 10.300, 10.304; R.W., Docket No. 18-0894 (issued December 4, 2018).
10

ORDER

IT IS HEREBY ORDERED THAT the September 26, 2018 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: June 18, 2019

Washington, DC

Christopher J. Godfrey, 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