United States Department of Labor

Employees’ Compensation Appeals Board

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A.T., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Langston, AL, Employer

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Docket No. 18-1717

Issued: May 10, 2019

Appearances: Case Submitted on the Record

Appellant, pro se

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 September 11, 2018 appellant filed a timely appeal from May 10 and August 9, 2018 

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. 

ISSUE

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

claim to include additional left hip conditions causally related to or consequential to the accepted 

June 19, 2017 employment injury. 

FACTUAL HISTORY

On June 21, 2017 appellant, then a 56-year-old rural carrier, filed a traumatic injury claim 

(Form CA-1) alleging that on June 19, 2017 she sustained a right foot injury when she slipped and 

 

1 5 U.S.C. § 8101 et seq.
2

fell down steps while in the performance of duty. OWCP accepted the claim for nondisplaced 

fracture of the fifth metatarsal bone, right foot, and closed fracture. It paid appellant wage-loss 

compensation on the supplemental rolls for the period August 5 to 28, 2017. 

In a June 21, 2017 report, Dr. Matthew J. De Orio, a Board-certified orthopedic surgeon, 

noted the history of appellant’s June 19, 2017 employment injury. He reported examination and 

x-ray findings and provided an assessment of right fifth metatarsal avulsion fracture, closed, mildly 

comminuted, and mildly displaced. Dr. De Orio recommended closed treatment of the injury with 

the use of a walking boot. He held appellant off work for six weeks. 

In an October 11, 2017 report, Dr. De Orio noted that appellant had returned to work three

to four days a week and had transitioned into a regular shoe from a postoperative shoe. He noted 

that she complained of hip pain from when she was wearing the walking boot. Dr. De Orio 

recommended follow-up with a specialist if appellant’s hip pain was not relieved. In a 

December 15, 2017 report, he indicated that x-rays of the right foot were essentially normal. An 

assessment of right healed fifth metatarsal base fracture and left hip flexor tendinitis were 

provided. With regard to the left hip, Dr. De Orio indicated that the x-rays of the left hip were 

normal and that there was no significant degenerative change. He also advised that it was difficult 

to determine whether or not the left hip tendinitis was caused by the same injury as appellant’s 

right foot. Physical therapy was recommended for appellant’s left hip condition. Copies of the 

December 15, 2017 x-rays of the right foot and left hip were provided. 

In a December 20, 2017 report, Dr. Brett Franklin, a Board-certified orthopedic surgeon, 

noted examination findings of the left hip and reviewed a left hip x-ray which showed no acute 

injuries, but degenerative changes at L5 and S1 with no significant impingement signs. An 

impression of left hip pain consistent with intra-articular pathology was provided. 

A December 26, 2017 left hip arthrogram revealed a partial thickness tear of the gluteus 

minimus tendon and a tear of the superior labrum. 

On January 29, 2018 appellant requested that the acceptance of her claim be expanded to 

include her left hip conditions. 

In a March 28, 2018 development letter, OWCP advised appellant that additional medical 

evidence was necessary to expand the acceptance of her claim to include additional left hip

conditions as consequential to her accepted injury. It afforded her 30 days to submit additional 

medical evidence. 

In response, OWCP received an April 9, 2018 treatment note from Dr. Franklin which 

diagnosed left hip pain and nontraumatic left hip labral tear. 

By decision dated May 10, 2018, OWCP denied appellant’s request for expansion of the 

acceptance of the claim “to include a consequential injury.” It found that the medical evidence of 

record was insufficient to establish that the left hip conditions were causally related to the accepted 

June 19, 2017 employment injury. 

On June 11, 2018 appellant requested reconsideration. In a June 7, 2018 letter, she advised 

that she experienced left hip pain during the time she was treated for her broken foot utilizing a 
3

walking boot and that the pain continued after she stopped its use. Appellant indicated that both 

her husband and her supervisor had noticed a change in her gait. 

In an June 8, 2018 statement, C.S., a coworker, indicated that appellant had favored her 

left side after she returned to work following her injury. She indicated that appellant had problems 

with her hip since the fall and that she had noticed a change in her gait. 

By decision dated August 9, 2018, OWCP denied modification of the May 10, 2018 

decision as the evidence submitted was insufficient to establish appellant’s claim. It found that

“the medical evidence does not demonstrate that the weakness or impairment caused by 

[appellant’s] accepted work-related injury or illness led to an aggravation of the original injury or 

to a new injury as required for coverage under FECA.”

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, that an injury was sustained in the performance of duty as alleged, 

and that any specific condition or disability for which compensation is claimed is causally related 

to the employment injury.2 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.3

Where 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.4

Causal relationship is a medical issue and the medical evidence generally 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 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.5

When an injury arises in the course of employment, every natural consequence that flows 

from that injury likewise arises out of the employment, unless it is the result of an independent 

 

2

J.B., Docket No. 18-0522 (issued January 16, 2019); see also J.T., Docket No. 17-0578 (issued 

December 6, 2017).

3 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).

4 F.L., Docket No. 17-1613 (issued August 15, 2018).

5

J.B., supra note 2; I.J., 59 ECAB 408 (2008).
4

intervening cause attributable to the claimant’s own conduct.6 Thus, a subsequent injury, be it an 

aggravation of the original injury or a new and distinct injury, is compensable if it is the direct and 

natural result of a compensable primary injury.7 A claimant bears the burden of proof to establish 

a claim for a consequential injury. As part of this burden, the claimant must present rationalized 

medical opinion evidence.8

ANALYSIS

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

of her claim to include additional left hip conditions causally related or consequential to the 

accepted June 19, 2017 employment injury. 

Following her June 19, 2017 employment injury, appellant began treating with Dr. De Orio

for her right foot condition, on June 21, 2017 he recommended use of a walking boot. In his 

October 11, 2017 report, Dr. De Orio related that she complained of left hip pain which she 

associated with wearing the walking boot. Pain and/or discomfort is only considered a symptom, 

not a medical diagnosis.9 In a December 15, 2017 report, Dr. De Orio reported that the left hip xray was essentially normal. While he provided an assessment of left hip flexor tendinitis, he failed 

to offer a specific opinion as to whether the diagnosed condition was caused by or consequential 

to the accepted right foot condition and the walking boot he had prescribed. Rather, Dr. De Orio

opined that it was difficult to determine whether or not the left hip tendinitis was caused by the 

same injury as appellant’s right foot. The Board has held that medical evidence which does not 

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

issue of causal relationship.10

Dr. Franklin treated appellant’s left hip conditions, but was not aware of the history of her 

June 19, 2017 employment injury or of the fact that she wore a walking boot for treatment of her 

right foot condition. In a December 20, 2017 report, he reported a left hip x-ray which showed 

degenerative changes at L5 and S1 with no acute injuries or significant impingement signs. In his 

April 9, 2018 treatment note, Dr. Franklin diagnosed left hip pain and nontraumatic left hip labral 

tear. Despite the fact he was not aware of the June 19, 2017 employment injury, he indicated that 

the left hip labral tear was nontraumatic in nature, thus essentially negating a causal relationship. 

 

6 A.M., Docket No. 18-0685 (issued October 26, 2018); Mary Poller, 55 ECAB 483, 487 (2004); 1 Arthur Larson 

& Lex K. Larson, The Law of Workers’ Compensation 10-1 (2006).

7

J.B.,supra note 2; Susanne W. Underwood (Randall L. Underwood), 53 ECAB 139, 141 n.7 (2001).

8 F.L., supra note 4; Charles W. Downey, 54 ECAB 421 (2003).

9 Findings of pain or discomfort alone do not satisfy the medical aspect of the fact of injury medical determination. 

Federal (FECA) Procedure Manual, Part 2 -- Claims, Fact of Injury, Chapter 2.803.4a(6) (August 2012); see A.C., 

Docket No. 16-1587 (issued December 27, 2016).

10 See L.B., Docket No. 18-0533 (issued August 27, 2018); D.K., Docket No. 17-1549 (issued July 6, 2018).
5

As Dr. Franklin’s medical reports lacked both a proper history and a rationalized opinion 

supporting causal relationship, these reports were of limited probative value.11

OWCP also received a December 15, 2017 x-ray of the left hip and a December 26, 2017 

left hip arthrogram. However, diagnostic studies are of lack probative value as they do not address 

whether the employment injury caused the diagnosed conditions.12

Appellant’s statements as well as the statement of her coworker pertaining to her left hip 

pain and altered gait are insufficient to establish causal relationship as lay persons are not 

competent to render medical opinions.13 As noted, causal relationship is a medical question that 

requires rationalized medical opinion evidence to resolve the issue.14 Appellant’s personal belief 

that her prescribed walking boot either caused or contributed to her condition is insufficient, by 

itself, to establish causal relationship.15 

The Board finds that appellant has not met her burden of proof because the medical opinion 

evidence of record is insufficient to establish the critical element of causal relationship between 

appellant’s additional diagnosed conditions and the accepted employment injury.16

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 expand the acceptance 

of her claim to include additional left hip conditions causally related or consequential to the 

accepted June 19, 2017 employment injury.

 

11 See S.G., Docket No. 18-1373 (issued February 12, 2019). 

12 See K.S., Docket No. 18-1781 (issued April 8, 2019); G.S., Docket No. 18-1696 (issued March 26, 2019). 

13 See J.A., Docket No. 18-0882 (issued December 31, 2018); James A. Long, 10 ECAB 538 (1989).

14 Supra note 5. 

15 M.B., Docket No. 18-0906 (issued November 21, 2018); Phillip L. Barnes, 55 ECAB 426, 440 (2004).

16 See J.A., supra note 13; T.F., Docket No. 17-0645 (issued August 15, 2018); G.M., Docket No. 16-1764 (issued 

March 16, 2018).
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ORDER

IT IS HEREBY ORDERED THAT the August 9 and May 10, 2018 decisions of the 

Office of Workers’ Compensation Programs are affirmed.

Issued: May 10, 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