United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

G.W., Appellant

and

DEPARTMENT OF VETERANS AFFAIRS, VA 

CENTRAL CALIFORNIA HEALTH CARE 

SYSTEM, Fresno, CA, Employer

__________________________________________

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Docket No. 20-0507

Issued: March 4, 2021

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

JANICE B. ASKIN, Judge

PATRICIA H. FITZGERALD, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On January 6, 2020 appellant, through counsel, filed a timely appeal from an October 28, 

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.

 

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 left foot condition

causally related to the accepted October 17, 2018 employment incident.

FACTUAL HISTORY

On January 17, 2019 appellant, then a 55-year-old nurse, filed an occupational disease 

claim (Form CA-2) alleging that she sustained a fracture of her left foot, immobility, pain, and 

swelling due to factors of her federal employment. She noted that, as she was preparing a patient 

for transfer to an outpatient facility, a gurney rolled over her foot. Appellant noted that she first 

became aware of her condition and realized its relation to her federal employment on 

October 23, 2018. She did not initially stop work.

In an October 23, 2018 report, Jessica Huipio, a physician assistant, noted that appellant 

was at work trying to move a patient when the rail of the bed hit the top of her foot. Appellant 

continued working, and after two 12-hour shifts her foot swelled and was painful. She diagnosed 

left foot pain and calcaneal spur of the left foot. Ms. Huipio completed a work status form, also 

dated October 23, 2018, advising appellant to return to work on November 3, 2018.

An October 23, 2018 x-ray of appellant’s left foot read by Dr. Te-Chung Hsu, a Boardcertified diagnostic radiologist, revealed degenerative change and no acute fracture or findings.

In a December 10, 2018 report, Dr. Olubukunola M. Oseni-Olalemi, a podiatrist, noted that 

appellant denied trauma to the left foot. She indicated that appellant had known medical 

comorbidities significant for chronic lower back pain, glaucoma, and obesity. Dr. Oseni-Olalemi 

diagnosed left foot pain.

A January 3, 2019 magnetic resonance imaging (MRI) scan of the left foot without 

contrast, read by Dr. Mariela Resendes, a Board-certified diagnostic radiologist, revealed an 

insufficiency fracture of the medial cuneiform and proximal second metatarsal bone and 

degenerative changes at the second metatarsophalangeal joint. 

In a January 8, 2019 report, Dr. Oseni-Olalemi noted that appellant was seen for complaints 

of left foot pain and that she denied trauma to the painful extremity. She noted that appellant 

reported a fall at work a few months earlier. Dr. Oseni-Olalemi diagnosed contusion of fifth toe, 

left foot, subsequent encounter.

A January 8, 2019 work status report from a physician with an illegible signature, indicated 

that appellant was unable to return to work due to fractures of the left foot. A cam boot was 

recommended prior to a return to work.

In a development letter dated February 13, 2019, OWCP informed appellant of the 

deficiencies of her claim and advised her of the type of factual and medical evidence necessary to 

establish her claim. It provided a questionnaire for her completion regarding the circumstances of 

the claimed October 23, 2018 employment injury. OWCP requested that appellant submit a 

narrative medical report from her treating physician which provided a diagnosis and the 
3

physician’s rationalized medical explanation as to how the alleged employment incident caused 

the diagnosed condition. It afforded her 30 days to submit the necessary evidence.

In a letter dated March 12, 2019, appellant indicated that she was resubmitting her medical 

reports from a physician assistant, with the cosignature of the supervising/attending physician. She 

explained that the injury occurred as she was assisting with the transfer of a patient and she and 

the transporters were aligning the gurney next to and parallel to the bed. Appellant noted that 

when they began to initiate movement of the patient, the gurney moved from its position and the 

wheel rolled over a portion of the top of her left foot. She explained that when she realized what 

was happening, her spontaneous reaction was to try to move her foot from the path of the wheel. 

Appellant noted that at that point, she jerked her foot to move it and the top of her foot hit the rail 

to which the wheel was attached. She explained that since the incident, she experienced consistent 

swelling and pain to the left foot. Appellant noted that transferring patients and moving them from 

a bed to a gurney was part of her job.

OWCP received a copy of the October 23, 2018 report from Ms. Huipio, which was 

cosigned on February 28, 2019 by Dr. Robin R. Linscheid Janzen, a family medicine specialist. 

Dr. Linscheid Janzen indicated that appellant was at work moving a patient when the rail of the 

bed fell and hit the top of her left foot. She diagnosed left foot pain and a calcaneal spur.

A witness statement dated March 10, 2019, from W.S., a coworker, indicated that he saw 

that appellant had injured her left foot and was limping when making the transfer of a patient. He 

also noted that he made this statement to J.S., the assistant unit manager. The date of the incident 

was not provided. 

A witness statement dated March 11, 2019, from M.B., a coworker, advised that he could 

verify and attest that he observed that appellant injured her left foot and was in pain and limping, 

following transfer of a patient. The date of the incident was not provided. 

In a report dated March 14, 2019, Dr. Daniel B. Brubaker, an osteopath Board-certified in 

anatomic and clinical pathology, noted that appellant was seen for complaints of pain in her left 

foot due to a work injury. He explained that appellant was performing her usual and customary 

duties assisting a patient from a bed to a gurney, when the gurney shifted, the wheel rolled on top 

of her left foot, she jerked her foot to remove it, and the top of her foot hit a rail to which the wheel 

was attached, causing more pain and injury to the foot. Dr. Brubaker noted that appellant related 

that her foot had been swollen and painful since the date of injury, which he listed as 

October 17, 2018. He indicated that appellant denied any prior work injury, motor vehicle 

accident, or sports injury. Dr. Brubaker noted appellant’s history, provided examination finding, 

and discussed the diagnostic testing, x-rays, and MRI scan of the left foot. He diagnosed work 

injury, left foot pain, and a calcaneal spur of left foot, and referred appellant to an orthopedic 

surgeon who specialized in podiatry.

By decision dated April 24, 2019, OWCP denied appellant’s claim. It found that the 

medical evidence of record was insufficient to establish causal relationship between appellant’s 

medical condition and the accepted employment incident.
4

On May 8, 2019 appellant, through counsel, requested a telephonic hearing before a 

representative of OWCP’s Branch of Hearings and Review. 

A telephonic hearing was held before an OWCP hearing representative on 

August 12, 2019. During the hearing, appellant clarified that her claim was for a traumatic injury, 

not an occupational disease. She also explained that the work incident occurred on October 17, 

2018, but she was not able to see a physician for initial treatment until October 23, 2018. The 

hearing representative advised appellant of the type of medical evidence necessary to establish her 

traumatic injury claim and held the case record open for 30 days for the submission of additional 

evidence. 

OWCP received April 3, 2019 progress notes from Dr. Francis E. Glaser, a Board-certified 

orthopedic surgeon, who noted that appellant was seen for complaints of left dorsal mid foot pain 

and swelling that began acutely in October 2018, when she was at work and a gurney rolled over 

her left foot. Dr. Glaser indicated that the history of injury and diagnostic reports demonstrated 

soft tissue swelling, but no fractures and that a follow-up MRI scan revealed a nondisplaced 

fracture. He diagnosed “left mid foot pain, etiology undefined,” he further explained that since 

there was no evidence on x-ray of a resolving or unresolved fracture, he opined that opined “[t]his 

may in fact represent a bone contusion or even arthritis.”

In April 12, 2019 progress notes, Dr. Glaser advised that appellant presented with pain on 

the left side and was symptomatically unchanged. He noted that appellant complained of left midfoot pain related to an injury at work when, “A [wheel] rolled over her left foot.” Dr. Glaser 

assessed a closed nondisplaced fracture of second metatarsal bone of the left foot with routine 

healing, subsequent encounter, and indicated that appellant had a left second metatarsal base and 

medial cuneiform fractures healing. 

In his August 8, 2019 addendum to first report of injury, Dr. Brubaker noted that he was 

provided additional information after he was informed that his initial report was not sufficient to 

establish causal relationship. He noted, “Frankly, I think it is pretty clear, but I will lay out my 

medical reasoning.” Dr. Brubaker explained that on October 17, 2018, appellant along with two 

colleagues was transferring a patient from a bed to a gurney when the gurney rolled over her left 

foot causing pain and swelling. He noted that the average weight of a gurney was 100 pounds. 

Dr. Brubaker noted that appellant’s first medical appointment was on October 23, 2018, during 

which she had related a history that the rail of a bed hit the top of her foot and she kept working 

for two days following which the foot swelled. He also noted that while she had denied any trauma 

to her foot when she was seen on December 10, 2018 by a foot specialist, he opined that injured 

workers could easily be pressured to go outside the work comp system. Dr. Brubaker explained 

that he had reviewed the medical reports of record and the description of the incident and opined 

that “it was very probable and likely that [appellant] indeed injured her foot by a gurney rolling 

over it. The natural inclination to abruptly pull the foot out from under such weight could cause 

additional pain as well.” He concluded that a foot injury can cause enormous pain, depending on 

the severity of the damage. Excessive walking or other activities which required standing or 

moving could exacerbate the injured foot, and certain medical conditions such as diabetes or 

arthritis could compound the pain in an injured foot by decreasing blood circulation and healing 

time. 
5

By decision dated October 28, 2019, OWCP’s hearing representative affirmed the 

April 24, 2019 decision.

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,3that 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.4 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.5

To determine whether a federal employee has sustained a traumatic injury in the 

performance of duty it must first be determined whether fact of injury has been established.6 First, 

the employee must submit sufficient evidence to establish that she actually experienced the 

employment incident at the time and place, and in the manner alleged.7 Second, the employee 

must submit sufficient evidence to establish that the employment incident caused a personal 

injury.

8

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve.9 The opinion of the physician must be based on a complete factual and 

medical background, 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 incident identified by the claimant.10

 

3 See D.P., Docket No. 19-1596 (April 23, 2020); S.B., Docket No. 17-1779 (issued February 7, 2018); J.P., 59 

ECAB 178 (2007); Joe D. Cameron, 41 ECAB 153 (1989).

4 C.K., Docket No. 19-1549 (issued June 30, 2020); J.M., Docket No. 17-0284 (issued February 7, 2018); R.C., 59 

ECAB 427 (2008); James E. Chadden, Sr., 40 ECAB 312 (1988).

5 T.M., Docket No. 20-0767 (issued January 13, 2021); 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).

6 D.B., Docket No. 18-1348 (issued January 4, 2019); T.H., 59 ECAB 388, 393-94 (2008).

7 C.D., Docket No. 20-0762 (issued January 13, 2021); D.S., Docket No. 17-1422 (issued November 9, 2017); 

Elaine Pendleton, 40 ECAB 1143 (1989).

8 C.D., id.; B.M., Docket No. 17-0796 (issued July 5, 2018); John J. Carlone, 41 ECAB 354 (1989).

9 L.S., Docket No. 19-1769 (issued July 10, 2020); Jacqueline M. Nixon-Steward, 52 ECAB 140 (2000).

10 B.C., Docket No. 20-0221 (issued July 10, 2020); Leslie C. Moore, 52 ECAB 132 (2000).
6

ANALYSIS

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

condition causally related to the accepted October 17, 2018 employment incident.

OWCP initially received an October 23, 2018 report from Ms. Huipio, a physician 

assistant, which was subsequently countersigned by Dr. Linscheid Janzen.11 This report related a 

history that one week prior appellant was moving a patient and the rail of the bed hit the top of her 

foot, appellant continued working and after two days her foot developed swelling and pain. The 

Board notes that this differs from the accepted employment incident of appellant’s left foot being 

run over by a gurney. An inconsistent history of injury limits the probative value of a medical 

opinion.12 Regarding the diagnosis of calcaneal spur, the report did not offer any explanation as 

to how appellant could have developed a bone spur due to a gurney rolling over her foot, the 

accepted incident in this claim. The Board has held that medical evidence that does not offer an 

opinion regarding the cause of an employee’s condition is of no probative value regarding the issue 

of causal relationship.13

In a December 10, 2018 report, Dr. Oseni-Olalemi noted that appellant had denied any 

trauma to her left foot and he related appellant’s complaints of left foot pain. He provided a 

January 8, 2019 report in which he diagnosed contusion of fifth toe, left foot; however, he again 

related that appellant had denied any trauma to the left foot. As Dr. Oseni-Olalemi did not provide 

an opinion that appellant’s diagnosed condition was causally related to the accepted employment 

incident, these reports are of no probative value on the issue of causal relationship and are 

insufficient to establish appellant’s claim.14

In a report dated March 14, 2019, Dr. Brubaker diagnosed left foot pain and a calcaneal 

spur of the left foot. In his August 8, 2019 addendum, Dr. Brubaker opined that “it was very 

probable and likely that she indeed injured her foot by a gurney rolling over it. The natural 

inclination to abruptly pull the foot out from under such weight could cause additional pain as 

well.” The Board has held that medical opinions that are speculative or equivocal are of 

diminished probative value.15 Consequently, Dr. Brubaker’s opinion is insufficient to meet 

appellant’s burden of proof to establish her claim.

OWCP received April 3, 2019 progress notes from Dr. Glaser noted that appellant’s left 

foot had been run over by a gurney in October 2013. Dr. Glaser reviewed appellant’s x-ray and 

 

11 A report from a physician assistant or certified nurse practitioner will be considered medical evidence if 

countersigned by a qualified physician. Federal (FECA) Procedure Manual, Part 2 -- Claims, Causal Relationship, 

Chapter 2.805.3a(1) (January 2013).

12 R.H., Docket No. 18-0021 (issued March 22, 2018); see S.L., Docket No. 16-0222 (issued August 11, 2016). 

13 B.W., Docket No. 20-1032 (issued November 17, 2020); S.J., Docket No. 19-0696 (issued August 23, 2019); 

M.C., Docket No. 18-0951 (issued January 7, 2019); L.B., Docket No. 18-0533 (issued August 27, 2018); D.K., Docket 

No. 17-1549 (issued July 6, 2018).

14 L.B., Docket No. 19-1907 (issued August 14, 2020).

15 D.S., Docket No. 20-0384 (issued October 8, 2020); H.A., Docket No. 18-1455 (issued August 23, 2019).
7

MRI scan of the left foot and noted that the x-ray did not show evidence of a resolving or resolved 

fracture. He then diagnosed “left mid foot pain, etiology undefined” and opined “[t]his may in 

fact represent a bone contusion or even arthritis.” In April 12, 2019 progress notes, Dr. Glaser 

noted that “A [wheel] rolled over [appellant’s] left foot” and he diagnosed a closed nondisplaced 

fracture of second metatarsal bone of the left foot with routine healing, subsequent encounter, and 

left second metatarsal base and medial cuneiform fractures healing. While Dr. Glaser noted 

appellant’s history regarding the employment incident, he did not offer an opinion regarding causal 

relationship. The Board has held that 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 Thus, 

this report is also insufficient to establish the claim.

OWCP also received an October 23, 2018 x-ray and a January 3, 2019 MRI scan of the left 

foot. The Board has held that diagnostic studies, standing alone, lack probative value on the issue 

of causal relationship, as they do not provide an opinion as to whether the employment incident 

caused any of the diagnosed conditions.17 This evidence is therefore insufficient to establish 

appellant’s claim.

Appellant also submitted a January 28, 2019 work status report with an illegible signature. 

The Board has held that reports that are unsigned or bear an illegible signature cannot be 

considered probative medical evidence as the author cannot be identified as a physician.18 

Therefore, this report has no probative value and is insufficient to establish the claim.

As the medical evidence of record does not contain a rationalized opinion establishing 

causal relationship between appellant’s diagnosed conditions and the accepted October 17, 2018 

employment incident, the Board finds that she has not met her burden of proof.

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 foot 

condition causally related to the accepted October 17, 2018 employment incident.

 

16 B.W., Docket No. 20-1032 (issued November 17, 2020); S.J., Docket No. 19-0696 (issued August 23, 2019); 

M.C., Docket No. 18-0951 (issued January 7, 2019); L.B., Docket No. 18-0533 (issued August 27, 2018); D.K., Docket 

No. 17-1549 (issued July 6, 2018).

17 See C.B., Docket No. 20-0464 (issued July 21, 2020).

18 C.S., Docket No. 20-1354 (issued January 29, 2021); D.T., Docket No. 20-0685 (issued October 8, 2020); 

Merton J. Sills, 39 ECAB 572, 575 (1988).
8

ORDER

IT IS HEREBY ORDERED THAT the October 28, 2019 merit decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: March 4, 2021

Washington, DC

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Alternate Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board