United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

M.G., Appellant

and

U.S. POSTAL SERVICE, LOMA CARRIER 

ANNEX, Long Beach, CA, Employer

__________________________________________

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Docket No. 21-0879

Issued: November 19, 2021

Appearances: Case Submitted on the Record

Kelley Craig, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

JANICE B. ASKIN, Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On May 21, 2021 appellant, through counsel, filed a timely appeal from a December 1, 

2020 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 her burden of proof to establish a medical condition

causally related to the accepted factors of her federal employment.

FACTUAL HISTORY

On June 14, 2018 appellant, then a 54-year-old city carrier, filed an occupational disease 

claim (Form CA-2) alleging that she sustained a right foot injury at work due to walking on 

driveways, asphalt surfaces, uneven paving, and stairs. She asserted that she first became aware 

of her claimed injury and its relation to her federal employment on April 14, 2018. Appellant 

stopped work on April 21, 2018. In a June 7, 2018 statement, she alleged that her prolonged 

walking duties had caused the arch on her right foot to swell.

Appellant submitted an April 22, 2018 report of Dr. Mariela I. Garcia, a Board-certified 

family medicine specialist, who diagnosed right plantar fasciitis and indicated that she was placing 

appellant off work from April 22 through 25, 2018. Dr. Garcia further advised that appellant could 

return to full-capacity work on April 26, 2018. In an April 25, 2018 report, Dr. Susanne T. Lam, 

a Board-certified family medicine specialist, diagnosed left ankle joint pain and noted that she was 

placing appellant off work from April 26 through May 2, 2018.

In a May 3, 2018 report, Dr. Michael F. Low, a podiatrist, advised that he was placing

appellant off work from May 3 through 13, 2018 and on modified activity at work and home from 

May 14 through June 10, 2018. He found that appellant could return to full-capacity work on

June 11, 2018.3 On May 15, 2018 Dr. Anjum Sameena, a Board-certified family medicine 

specialist, noted that she was placing appellant off work for May 15, 2018 and that she could return 

to full-capacity work on May 16, 2018. In a May 31, 2018 report, Dr. Stephen H. Phan, a Boardcertified emergency medicine specialist, advised that he was placing appellant off work from 

May 31 through June 2, 2018.

In a June 22, 2018 development letter, OWCP informed appellant of the deficiencies of her 

claim. It advised her as to the type of additional factual and medical evidence required and 

provided a questionnaire for her completion. OWCP afforded appellant 30 days to respond.

In response, appellant submitted a July 18, 2018 narrative report from Dr. Theodore J. 

Sung, a Board-certified occupational disease specialist, who discussed diagnostic testing of the 

right foot/ankle, reported physical examination findings, and diagnosed mass of the right foot 

joint.4 In a July 18, 2018 attending physician’s report (Form CA-20), Dr. Sung listed the date of 

injury as April 22, 2018. However, on an attached sheet, he noted that appellant reported her date 

of injury date was “more accurately reflected” as April 14, 2018 when she twisted her right ankle 

 

3 OWCP also received May 29 and June 5, 2018 reports in whichDr.Low placed appellant off work for the periods 

May 14 through 31, and June 5 through July 15, 2018, respectively.

4 Dr. Sung’s report includes the findings of a June 26, 2018 evaluation by Dr.Angela K. Heinen, an osteopath 

Board-certified in orthopedic surgery, at which time she diagnosed a right posterior tibialis tendinitis tear.
3

at work on that date and had experienced pain since then. Dr. Sung diagnosed mass of right foot 

joint and indicated that appellant had been capable of resuming her regular work on July 17, 2018.

By decision dated August 7, 2018, OWCP accepted that appellant’s job required extensive 

walking, as alleged. However, it denied her claim, finding that she had not submitted sufficient 

medical evidence to establish a medical condition causally related to the accepted employment 

factors. OWCP noted that appellant had not established “an injury and/or medical condition 

causally related to the accepted work event(s).”

On August 6, 2019 appellant, through counsel, requested reconsideration of the August 7, 

2018 decision. OWCP received July 31 and August 21, 2019 reports from Dr. Ryan Culver, a 

podiatrist, who noted that appellant complained of right foot pain due to walking on uneven 

pavement, stairs, and surfaces covered with ice/snow. Upon physical examination, appellant 

exhibited 4/5 inversion strength in the right foot/ankle. In a July 31, 2019 progress report,

Dr. Culver diagnosed posterior tibial tendinitis of the right leg and pain in the right ankle and foot

joints, and indicated that appellant could return to modified-duty work on that date. In an 

August 21, 2019 progress report, he provided the additional diagnosis of plantar fascial 

fibromatosis and advised that appellant could return to modified-duty work on that date.

By decision dated October 30, 2019, OWCP denied modification of the August 7, 2018 

decision.

On October 20, 2020 appellant, through counsel, requested reconsideration of the 

October 30, 2019 decision.

OWCP received a February 3, 2020 report from Dr. Hamid Rahman, a Board-certified 

orthopedic surgeon, who indicated that appellant reported her job duties for 15 years included a 

considerable amount of repetitive walking, standing, and lifting. Appellant further reported that 

she injured her right leg, joints, and ankle over time while performing these duties and that on 

April 14, 2018 she fell and twisted her right ankle while she was walking on uneven ground during 

her mail delivery route. Dr. Rahman advised that appellant underwent right ankle surgery on 

August 31, 2018 and noted that she currently complained of intermittent right ankle pain, which 

she rated at 5 through 7 out of a scale of 10. Upon physical examination, appellant exhibited 

antalgic gait, gross deformity of the right foot/ankle, and tenderness to palpation and swelling over 

the surgical scar and medial aspect of the right ankle. Dr. Rahman diagnosed history of plantar 

fibromatosis, right foot sprain/strain, right ankle sprain/strain, surgical release/excision of the 

plantar fibromatosis, and residual pain of the right ankle/foot. He noted, in the discussion section 

of the report, “This patient was employed with the [employing establishment] sustained an 

industrial injury on [April 14, 2018] to the right ankle. The injury occurred when she tripped on 

uneven ground in a parking lot, outside of the post office in Long Beach.”

In an addendum report dated May 28, 2020, Dr. Rahman advised that he wished to further 

explain how appellant’s work injuries occurred and caused her to suffer from posterior tibial 

tendinitis, plantar fascial fibromatosis, right foot sprain/strain, and right ankle sprain/strain. He 

indicated that the posterior tibial tendon is located in the back of the leg and passes underneath the 

inside of the medial malleolar, which is inserted over the medial aspect of the navicular bone,

which is posted to the arches of the foot and helps with locomotion. Tibial inflammation or 
4

tendinitis is caused by inflammation along with the partial-to-complete tear resulting in the 

infirmity process, and that the condition results in ongoing pain, swelling, and difficulty with 

walking and weight bearing, which results in awkward, unsteady gait, antalgic gait, and weakness 

in motion of the foot. Dr. Rahman indicated that the posterior tibial tendinitis can slowly result in 

chronicity of the complaints and trauma can cause symptoms to flare up. He opined that it was 

within a reasonable degree of medical certainty that appellant developed posterior tibial tendinitis 

caused by the work-related injury on April 14, 2018, which was due to her work-related activities 

as a city carrier. Dr. Rahman further indicated that appellant’s job required her to walk, stand, and 

move continuously for at least eight hours per day. He noted, “[t]his is exactly the kind of overuse 

and repeated trauma to the tendon[,] which makes the posterior tibial tendon to become inflamed.”

Dr. Rahman opined that appellant’s April 14, 2018 fall was more likely to have happened

due to her unsteady gait from the posterior tibial tendinitis and noted that appellant’s symptoms 

were at the medial aspect of the foot, the point where the tendon passes before it is attached to the

tuberosity of the navicular bone. He advised that, when the foot arch collapses, the heel bone shifts 

to a new position outward and puts pressure on the outward ankle bones/leg joint such that the 

antalgic gait creates further deterioration of the symptoms. Dr. Rahman indicated that a foot sprain 

often happens when the foot lands awkwardly and the person rolls or turns the ankle. Walking on 

an uneven surface plays a larger role in these types of injuries, and these conditions are associated 

with pain, tenderness, bruising, swelling, and inability to put body weight on the extremity.

Dr. Rahman indicated that, when appellant fell and twisted her ankle while walking on uneven

surfaces and performing her duties on April 14, 2018, she experienced precisely the type of injury 

that leads to a foot/ankle sprain. He opined that there was nothing in appellant’s history to explain 

the type of her right foot/ankle injury other than the performance of her work-related activities and 

the further aggravation of the condition from the injury on April 14, 2018. Dr. Rahman noted, 

“[i]t is my medical opinion that, based on the objective findings and the reason of medical 

certainty, it remains my medical opinion that the continued performance of her job duties as a mail 

handler for the [employing establishment] over time caused her right leg posterior tibial tendinitis 

as well as the plantar fascial fibromatosis.”

By decision dated December 1, 2020, OWCP denied modification of the October 30, 2019 

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 the fact that the individual is an employee of the 

United States within the meaning of FECA, that the claim was filed with 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 

 

5

Supra note 2.
5

employment injury.6 These are the essential elements of every compensation claim regardless of 

whether the claim is predicated upon a traumatic injury or an occupational disease. 7

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

disease claim, a claimant must submit the following: (1) a factual statement identifying 

employment factors alleged to have caused or contributed to the presence or occurrence o f 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 employmentfactors.8

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.9 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.10 Additionally, the physician’s opinion must be 

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

rationale explaining the nature of the relationship between the diagnosed condition and appellant’s 

specific employment factor(s).11

ANALYSIS

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

Appellant submitted a February 3, 2020 report from Dr. Rahman, who indicated that 

appellant reported her job duties for 15 years included a considerable amount of repetitive walking, 

standing, and lifting. Dr. Rahman diagnosed history of plantar fibromatosis, right foot 

sprain/strain, right ankle sprain/strain, surgical release/excision of the plantar fibromatosis, and 

residual pain of the right ankle/foot.

Appellant also submitted an addendum report dated May 28, 2020 in which Dr. Rahman 

discussed the physiological nature of the posterior tibial tendon and noted that inflammation or 

tendinitis is caused by inflammation along with the partial to complete tear resulting in the 

infirmity process, and that the condition results in ongoing pain, swelling, and difficulty with 

walking and weight bearing, which results in awkward, unsteady gait, antalgic gait, and weakness 

 

6 E.S., Docket No. 18-1580 (issued January 23, 2020); M.E., Docket No. 18-1135 (issued January 4, 2019); C.S., 

Docket No. 08-1585 (issued March 3, 2009); Bonnie A. Contreras, 57 ECAB 364 (2006).

 

7 E.S., id.; S.P., 59 ECAB 184 (2007); Joe D. Cameron, 41 ECAB 153 (1989); Elaine Pendleton, 40 ECAB 

1143 (1989).

 

8 R.G., Docket No. 19-0233 (issued July 16, 2019). See also RoyL. Humphrey, 57 ECAB 238, 241 (2005); Ruby I. 

Fish, 46 ECAB 276, 279 (1994); Victor J. Woodhams, 41 ECAB 345 (1989).

 

9 W.M., Docket No. 14-1853 (issued May 13, 2020); T.H., 59 ECAB 388, 393 (2008); Robert G. Morris, 48 ECAB 

238 (1996).

 

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

 

11 Id.; Victor J. Woodhams, supra note 8.
6

in motion of the foot. Dr. Rahman opined that it was within a reasonable degree of medical 

certainty that appellant developed posterior tibial tendinitis caused by the work-related injury on 

April 14, 2018, which was due to her work-related activities as a city carrier. He further indicated 

that appellant’s job required her to walk, stand, and move continuously for at least eight hours per 

day and noted, “[t]his is exactly the kind of overuse and repeated trauma to the tendon[,] which 

makes the posterior tibial tendon to become inflamed.” Dr. Rahman found that there was nothing 

in appellant’s history to explain the type of her right foot/ankle injury other than the performance 

of her work-related activities. He noted, “[i]t is my medical opinion that based on the objective 

findings and the reason of medical certainty it remains my medical opinion that the continued 

performance of her job duties as a mail handler for the [employing establishment] over time caused 

her right leg posterior tibial tendinitis as well as the plantar fascial fibromatosis.”

The Board notes that proceedings under FECA are not adversarial in nature and OWCP is 

not a disinterested arbiter.12 The Board finds that, while Dr. Rahman’s reports are insufficient to 

meet appellant’s burden of proof, they raise an uncontroverted inference of causal relation between 

her claimed right foot/ankle conditions and the accepted factors of her federal employment. He 

provided a comprehensive understanding of the medical record and case history, and a 

pathophysiological explanation as to how the mechanism of the accepted employment factors were

sufficient to cause the diagnosed conditions. Dr. Rahman’s opinion is not contradicted by any 

substantial medical or factor evidence of record. Therefore, f urther development of appellant’s 

claim is required.13

On remand OWCP shall refer appellant, along with the case record, and a statement of 

accepted facts to a specialist in the appropriate field of medicine for a second opinion examination 

and an evaluation regarding whether she sustained a right foot/ankle condition causally related to 

the accepted factors of her employment. If the physician opines that the diagnosed conditions are 

not causally related, he or she must explain with rationale how or why the opinion differs from 

that of Dr. Rahman. Following this and other such further development as deemed necessary, 

OWCP shall issue a de novo decision regarding appellant’s claim. 

CONCLUSION

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

 

12 See B.B., Docket No. 18-1321 (issued April5, 2019).

 

13 See C.M., Docket No. 17-1977 (issued January 29, 2019); JohnJ. Carlone, 41 ECAB 354 (1989).
7

ORDER

IT IS HEREBY ORDERED THAT the December 1, 2020 decision of the Office of 

Workers’ Compensation Programs is set aside and the case is remanded to OWCP for further 

proceedings consistent with this decision of the Board.

Issued: November 19, 2021

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board