United States Department of Labor

Employees’ Compensation Appeals Board

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R.M., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Ontario, CA, Employer

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Docket No. 21-0752

Issued: January 5, 2022

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

JANICE B. ASKIN, Judge

PATRICIA H. FITZGERALD, Alternate Judge

JURISDICTION

On April 8, 2021 appellant filed a timely appeal from December 17, 2020 and February 12, 

2021 merit decisions of the Office of Workers’ Compensation Programs (OWCP). Pursuant to the 

Federal Employees’ Compensation Act1(FECA) and 20 C.F.R. §§ 501.2(c) and 501.3, the Board 

has jurisdiction over the merits of this case.2

ISSUE

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

causally related to the accepted factors of his federal employment.

1

5 U.S.C. § 8101 et seq.

2 The Board notes that, following the February 12, 2021 decision, appellant submitted additional evidence to 

OWCP. However, the Board’s Rules of Procedure provides: “The Board’s review of a case is limited to the evidence 

in the case record that was before OWCP at the time of its final decision. Evidence not before OWCP will not be 

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

reviewing this additional evidence for the first time on appeal. Id
2

FACTUAL HISTORY

This case has previously been before the Board.3 The facts and circumstances as set forth 

in the Board’s prior decision are incorporated herein by reference. The relevant facts are as 

follows. 

On March 1, 2017 appellant, then a 52-year-old rural route carrier, filed an occupational 

disease claim (Form CA-2) alleging that he developed a bilateral hip condition due to factors of 

his federal employment, including walking, standing, twisting, turning, pushing, pulling, and 

climbing in and out of his long-life vehicle (LLV). He noted that he first became aware of his 

claimed condition and realized its relationship to his federal employment on January 16, 2017. 

Appellant stopped work on August 10, 2016. On the reverse side of the claim form, D.B., a 

customer service supervisor for the employing establishment, indicated that appellant had been 

working limited duty since July 3, 2014 due to a prior work-related injury.4

In a March 3, 2017 letter, the employing establishment controverted appellant’s claim, 

alleging that he had submitted a false statement that contradicted actual events. It noted that 

appellant had not driven a postal vehicle in over two years since he began to work a limited-duty 

assignment that had no delivery duties. The employing establishment reported that appellant had 

not worked since August 10, 2016 under a separate claim and had no opportunity to aggravate this 

injury for over nine months. It attached a limited-duty job offer dated July 15, 2014. 

In a March 16, 2017 development letter, OWCP advised appellant of the deficiencies of 

his claim. It requested additional factual and medical evidence, and provided a questionnaire for 

his completion. OWCP afforded appellant 30 days to respond.

In an April 3, 2017 response, appellantrecounted that he performed his employment duties 

daily with the exception of climbing in and out of the postal vehicle, which he stopped performing 

on June 6, 2017 due to his current work restrictions under OWCP File No. xxxxxx667. He

estimated that, beginning September 1989, he spent 51⁄2 to 61⁄2 hours walking and standing, 2 to 3 

hours twisting, 2 or more hours turning, 30 to 60 minutes pushing, 30 or more minutes pulling, 

and 3 to 4 hours climbing in and out of postal vehicles. Appellant also clarified that he was 

claiming a new occupational disease claim that was not related to his previously accepted bilateral 

knee condition.

Appellant also submitted additional medical evidence. A January 17, 2017 right hip 

magnetic resonance imaging (MRI) scan demonstrated osteoarthritis and a complex tear of the 

superolateral labrum with an adjacent small-to-moderate-sized paralabral cyst. A left hip MRI 

scan report of even date also demonstrated a complex superolateral labral tear and moderate left 

hip effusion. 

3 Docket No. 19-0543 (issued December 23, 2019).

4 Appellant has filed two previous occupational disease claims. Under OWCP File No. xxxxxx064, OWCP 

accepted appellant’s claim for bilateral femoral and ventral hernia in 2014. Under OWCP File No. xxxxxx667, it

accepted his claim for bilateral knee sprains, bilateral tears of the lateral and medial meniscus, and bilateral patellar 

chondromalacia in 2016. The cases have not been administratively combined.
3

In a February 23, 2017 report, Dr. Edward Mittleman, a family physician, recounted that 

appellant had been delivering his regular route for over 20 years without any limitation, but had 

not performed his mail delivery duties since June 2014. He provided a detailed, chronological 

description of appellant’s duties from when he arrived at the employing establishment until he 

completed his mail delivery route. Dr. Mittleman noted that appellant was continuously standing 

and repetitively bending, twisting, reaching, and grabbing mail, lifting up to 70 pounds, mounting 

and dismounting his LLV, and ascending and descending stairs on his delivery route. He reported 

that appellant had complained of sharp bilateral hip pain for approximately a year and a half that 

increased when walking, standing, twisting, turning, sitting upright while driving his LLV, and

climbing in and out of his LLV while walking. On examination of appellant’s bilateral hips

Dr. Mittleman observed greater pain on the left, compared to the right, with lateral pressure and 

greater pain on the left, compared to the right, on passive rotation of the hips. He also provided 

range of motion findings.

Dr. Mittleman diagnosed left hip labral tear, right hip labral tear, and acceleration of left 

and right hip osteoarthritis. He indicated that appellant had also developed femoracetabular 

impingement (FAI), which caused the ball and socket of appellant’s right hip joint to not fit 

together perfectly. Dr. Mittleman explained how this joint allowed for movement forwards and 

backwards, side to side, and internal and external rotation, which appellant performed as a rural 

route carrier. He noted that a patient usually began to experience symptoms of his FAI when a 

labral tear event would occur. Dr. Mittleman reported: 

“Once the labrum is torn, the protective effectiveness of the labrum to the articular 

cartilage is decreased, and articular cartilage damage occurs as it has occurred in 

[appellant’s] hips. Over time, this breakdown of articular cartilage leads to hip 

arthritis because without the protection of the articular cartilage there is now bone 

rubbing against bone as has occurred in [appellant’s] hips. Although the hip bones 

in [his] hips developed abnormally, it has been the repetitive weight-bearing forces 

sustained by [appellant’s] hips when performing his duties as a rural route carrier 

for the USPS for 27 years.” 

Dr. Mittleman further described in detail how appellant’s specific employment duties 

required him to be in a constant weight-bearing position and placed significant forces on his hips. 

He concluded that it was the “long-term repetitive pressure to Mr. Martin’s hips that has 

accelerated the femoroacetabular impingement in both of his hips.”

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

finding that he had not established that his diagnosed medical conditions were causally related to 

the accepted factors of his federal employment.

Appellant continued to request reconsideration and submit medical evidence.

In letters dated June 12 and October 19, 2017, Dr. Mittleman noted his disagreement with 

OWCP’s denial decision and reiterated his opinion that appellant’s daily weight-bearing activities 

as a letter carrier accelerated his bilateral degenerative hip condition(s). He noted that, while 

appellant had an underlying FAI condition, appellant’s employment duties also contributed to the 

development of his bilateral hip labral tears and bilateral hip osteoarthritis. 
4

Appellant also submitted a March 7, 2017 report by Dr. Charles Herring, a Board-certified 

orthopedic surgeon, who discussed appellant’s history of injury and employment history. On 

physical examination he observed that appellant ambulated with a slight bilateral antalgic gait. 

Dr. Herring reported that range of motion examination demonstrated limited flexion and external 

and internal rotation of both hips. He diagnosed bilateral hip osteoarthritis, bilateral hip labral 

tears, and bilateral FAI syndrome. Dr. Herring concluded that appellant’s work activities, 

including frequent entering and exiting of the LLV, walking, stooping, and lifting, superimposed 

upon his existing FAI condition, caused labral tears and hastened the osteoarthritic changes within 

his hip joints.

By decisions dated September 19, 2017 and August 8, 2018, OWCP denied appellant’s 

request for reconsideration of the merits of his claim pursuant to 5 U.S.C. § 8128(a).

Appellant filed an appeal to the Board. By decision dated December 23, 2019, the Board 

found that appellant had submitted pertinent and relevant new medical evidence not previously 

considered by OWCP. It set aside the August 8, 2018 OWCP decision and remanded the case for 

OWCP to conduct a merit review of appellant’s claim. 

Following the Board’s decision, OWCP received an April 15, 2020 letter from

Dr. Mittleman, who asserted that appellant’s preexisting FAI condition did not negate contribution 

of appellant’s work factors to his bilateral hip osteoarthritis and labral tears. He reiterated his 

opinion that appellant’s job duties as a letter carrier caused permanent aggravation of his bilateral 

hip osteoarthritis. Dr. Mittleman provided a detailed list of appellant’s job duties and noted that 

appellant had performed these duties for 20 years without restrictions and continued to work with 

restrictions after a bilateral knee injury and a hernia.

In a de novo decision dated May 14, 2020, OWCP denied appellant’s occupational disease 

claim, finding that the medical evidence of record was insufficient to establish that his diagnosed 

medical conditions were causally related to the accepted factors of his federal employment. 

On September 24, 2020 appellant requested reconsideration. 

In an April 23, 2020 progress note, Dr. Mittleman recounted appellant’s complaints of 

bilateral hip sensations of sharpness, shooting, stabbing, and aching. He provided examination 

findings and diagnosed aggravation of bilateral hip osteoarthritis and released appellant to 

modified-duty work.

In a letter dated July 6, 2020, Dr. Basimah Khulusi, Board-certified in physical medicine 

and rehabilitation, noted her disagreement with OWCP’s denial decision. She explained that 

appellant was born with deformed hips, which made him more vulnerable to suffer more damage 

from wear and tear because the distribution of forces going through the femoral head into the 

acetabulum was abnormally distributed. Dr. Khulusi described how appellant suffered “excessive 

stresses into his hip joints all through all the years that he worked for the post office. ” She 

requested that appellant’s claim be accepted for acceleration of degeneration of the bilateral hip 

joints, bilateral labral tears, and permanent aggravation of degeneration of the hip joint.

By decision dated December 17, 2020, OWCP denied modification of its prior decision. 
5

On February 8, 2021 appellant requested reconsideration.

In a January 25, 2021 letter, Dr. Khulusi again noted her disagreement with OWCP’s denial 

decision and alleged that she had provided sufficient medical rationale explaining how appellant’s 

osteoarthritis developed “from progressive wear and tear on the job.” She further explained:

“[w]hen the femoral head is aspherical, that causes abnormal pressure to go into some particular 

spots and not to be distributed equally over the whole area of the sphere. That causes abnormal 

stresses in these particular spots and causes these excessive pressures and stre sses to tear the 

labrum.” Dr. Khulusi requested that appellant’s claim be accepted for a bilateral hip condition. 

By decision dated February 12, 2021, OWCP denied modification of its prior decision.

LEGAL PRECEDENT

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

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

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

limitation 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: (1) a factual statement identifying employment factors 

alleged to have caused or contributed to the presence or occurrence of the disease or condition; 

(2) medical evidence establishing the presence or existence of the disease or condition for which 

compensation is claimed; and (3) medical evidence establishing that the diagnosed condition is 

causally related to the employment factors identified by the claimant.9 

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

relationship is rationalized medical opinion evidence.10 The opinion of the physician must be 

based on a complete factual and medical background of the employee, must be one of reasonable 

medical certainty, and must be supported by medical rationale explaining the nature of the 

5

Id.

6 L.C., Docket No. 19-0724 (issued September 5, 2019); S.B., Docket No. 17-1779 (issued February 7, 2018); J.P., 

59 ECAB 178 (2007); JoeD. Cameron, 41 ECAB 153 (1989). 

7 D.W., Docket No. 18-1139 (issued May 21, 2019); 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 D.W., id.; K.M., Docket No. 15-1660 (issued September 16, 2016); L.M., Docket No. 13-1402 (issued February 7, 

2014); DeloresC.Ellyett, 41 ECAB 992 (1990). 

9

S.C., Docket No. 18-1242 (issued March13, 2019); R.H., 59 ECAB 382 (2008).

10 A.M., Docket No. 18-1748 (issued April24, 2019); T.H., 59 ECAB 388, 393 (2008); Robert G. Morris, 48 ECAB 

238 (1996).
6

relationship between the diagnosed condition and specific employment factors identified by the 

employee.11

In any case where a preexisting condition involving the same part of the body is present 

and the issue of causal relationship therefore involves aggravation, acceleration or precipitation, 

the physician must provide a rationalized medical opinion that differentiates between the effects 

of the work-related injury or disease and the preexisting condition.12

ANALYSIS

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

In support of her claim, appellant submitted a series of reports dated February 3, 2017 

through April 23, 2020 from Dr. Mittleman. Dr. Mittleman described appellant’s employment 

duties as a letter carrier and noted that appellant had not performed mail delivery since June 2014. 

He noted that appellant was continuously standing and repetitively bending, twisting, reaching, 

and grabbing mail, lifting up to 70 pounds, mounting and dismounting his LLV, and ascending 

and descending stairs on his delivery route. Dr. Mittleman provided examination findings and 

diagnosed left hip labral tear, right hip labral tear, and acceleration of left and right hip 

osteoarthritis. He also noted that appellant had developed FAI and explained how the joint allowed 

for movement, which appellant performed at his job. Dr. Mittleman reported that, although 

appellant’s hip bones had developed abnormally, “it has been the repetitive weight bearing forces 

sustained by [appellant’s] hips when performing his duties as a rural route carrier” that contributed 

to his arthritic condition. He further described in detail how appellant’s specific employment 

duties required him to be in a constant weight bearing position and placed significant forces on his 

hips. Dr. Mittleman concluded that appellant’s repetitive employment duties, along with his 

underlying FAI condition, had permanently aggravated appellant’s bilateral hip condition.

The Board finds that Dr. Mittleman provided a factual history confirming the accepted 

employment factors, and accurately noted appellant’s history of injury and an affirmative opinion 

on causal relationship,. The Board finds that, while Dr. Mittleman’s reports are not fully 

rationalized, they are consistent in indicating that he sustained a medical condition due to the 

accepted factors of federal employment and are sufficient to require OWCP to further develop the 

medical evidence and the case record.13 As such, his reports constitute substantial uncontradicted 

evidence in support of appellant’s claim, and they also provide sufficient rationale to require 

further development of the record.14

11 M.L., Docket No. 18-1605 (issued February 26, 2019); M.V., Docket No. 18-0884 (issued December 28, 2018); 

I.J., 59 ECAB 408 (2008); Victor J. Woodhams, 41 ECAB 345, 352 (1989).

12 Federal (FECA) Procedure Manual, Part 2 --Claims, Causal Relationship, Chapter 2.805.3e (January 2013).

13 E.P., Docket No. 19-1703 (issued April16, 2021); G.M., Docket No. 19-0657 (issued September 13, 2019); see 

also John J. Carlone, 41 ECAB 354 (1989); Horace Langhorne, 29 ECAB 820 (1978).

14 R.A., Docket No. 19-0650 (issued January 15, 2020); B.M., Docket No. 18-0448 (issued January 2, 2020);E.G., 

Docket No. 19-1296 (issued December 18, 2019).
7

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

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

responsibility in the development of the evidence to see that justice is done. 15 

The Board will, therefore, remand the case to OWCP for further development of the 

medical evidence. On remand OWCP shall refer appellant, a statement of accepted facts and the 

medical evidence of record to an appropriate Board-certified physician. The physician shall 

provide a rationalized opinion on whether the diagnosed conditions are causally related to the 

accepted employment incident. If the referral physician opines that the diagnosed conditions are

not causally related to the accepted employment factors, he or she must explain with rationale how 

or why their opinion differs from that of appellant’s treating physicians. Following this and any

further development as deemed necessary, OWCP shall issue a de novo decision.

CONCLUSION

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

15C.W., Docket No. 19-0322 (issued July18, 2019); S.W., Docket No. 18-0119 (issued October 5, 2018); WilliamJ. 

Cantrell, 34 ECAB 1233 (1993).
8

ORDER

IT IS HEREBY ORDERED THAT the December 17, 2020 and February 12, 2021 merit 

decisions of the Office of Workers’Compensation Programs are set aside and the case is remanded 

for further proceedings consistent with this decision of the Board.

Issued: January 5, 2022

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Alternate Judge

Employees’ Compensation Appeals Board