United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

P.M., Appellant

and

U.S. POSTAL SERVICE, KEY WEST POST 

OFFICE, Key West, FL, Employer

__________________________________________

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Docket No. 22-0211

Issued: August 5, 2022

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

JANICE B. ASKIN, Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JAMES D. MCGINLEY, Alternate Judge

JURISDICTION

On November 23, 2021 appellant filed a timely appeal from June 15 and August 4, 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

ISSUES

The issues are: (1) whether appellant has met her burden of proof to establish disability 

from work for the period commencing January 2, 2021 causally related to her accepted 

employment injury; and (2) whether OWCP has met its burden of proof to terminate appellant’s 

1

5 U.S.C. § 8101 et seq.

2 The Board notes that, following the August 4, 2021 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 additional 

evidence for the first time on appeal. Id.
2

wage-loss compensation and medical benefits, effective August 4, 2021, as she no longer had 

disability or residuals due to her accepted employment injury.

FACTUAL HISTORY

On April 4, 2019 appellant, then a 44-year-old city carrier assistant, filed an occupational 

disease claim (Form CA-2) alleging that she developed inflammation in her feet due to factors of 

her federal employment. She noted that she first became aware of her condition and realized its 

relationship to her federal employment on March 12, 2019. Appellant stopped work on March 13, 

2019 and returned to work on April 1, 2019. OWCP accepted the claim for plantar fascial 

fibromatosis and paid her intermittent wage-loss compensation on the supplemental rolls from 

April 8, 2019 to January 1, 2021.

In an October 19, 2020 report, Dr. Michael R. Cook, a podiatrist Board-certified in foot 

surgery, noted that appellant presented for follow-up care secondary to pain in both feet associated 

with plantar fasciitis. He related that she was suffering from plantar fasciitis and continued to 

work, but was not at 100 percent, and was unable to carry or push a cart of more than 10 pounds 

or climb stairs. Dr. Cook noted that appellant was on her feet “quite a bit” and was wearing her 

orthotics, which had worn out, as well as supportive shoes, but that she complained of continued 

pain in both feet. He examined her and noted findings, which included remaining tenderness upon 

palpation of both plantar fascial insertions, pes cavus deformities bilaterally, intractable plantar 

keratosis underneath both fifth metatarsal heads, and tenderness upon palpation of the third 

interspace of the right foot with a positive Mulder’s sign. Dr. Cook also noted that appellant’s

range of motion (ROM) of the subtalar, ankle, and metatarsal phalangeal joints were adequate,

without pain or crepitation. He advised that previous x-rays confirmed accessory navicular bones, 

increase in calcaneal inclination angles bilateral, and heel spurs bilateral. Dr. Cook diagnosed 

plantar fasciitis, bilateral, as a result of working at the employing establishment; pes cavus

deformities, bilateral; and intractable plantar keratosis bilateral, with third interspace neuritis of 

the right foot. He advised that appellant was capable of working full time with restrictions of no 

carrying or pushing a cart of more than 10 pounds and no stair climbing. Dr. Cook also completed 

a duty status report (Form CA-17) on October 19, 2020, advising no work.

Appellant had various periods of intermittent work and work stoppage and remained off 

work as of February 5, 2021.

On February 22, 2021 OWCP referred appellant along with a statement of accepted facts 

(SOAF) for a second opinion evaluation with Dr. Clinton G. Bush, a Board-certified orthopedic 

surgeon, to determine the status of her accepted employment-related conditions. OWCP provided 

a SOAF indicating that it had accepted the claim for plantar fascial fibromatosis.

In a February 24, 2021 Form CA-17, Dr. Cook noted that appellant could perform limited 

duty with restrictions that included walking or standing for no more than 1 hour per day, lifting or 

carrying up to 10 pounds, pushing or pulling up to 10 pounds for 1 hour, no climbing, 25 minutes 

of kneeling or stooping, no more than 2 hours of twisting, no more than 7 hours of simple grasping 

and 3 hours of fine manipulation, 1 hour of reaching, and 4 hours driving a vehicle.
3

In a March 15, 2021 report, Dr. Bush noted appellant’s history of injury and medical

treatment. He examined appellant and found that she ambulated slowly, but without any specific 

abnormal gait pattern and that she did not use any supportive devices. Dr. Bush examined 

appellant’s feet and ankles and found that there was no evident abnormality in either ankle and 

there was full motion without crepitus or instability, the feet were symmetrical bilaterally, the 

arches revealed mild pes cavus, ROM in the hindfoot, midfoot, and forefoot joints was full and 

painless, there was mild prominence of the fifth metatarsal head laterally consistent with 

developmental bunionette deformities, but without any associated inflammatory changes, and no 

tenderness to palpation over the lateral aspect of the fifth metatarsal heads. He found moderate 

callus formation on the plantar surface of both fifth metatarsal heads and mild tenderness to 

palpation in these areas, no tenderness to palpation over the right third web space, no tenderness 

to palpation over the origin of the plantar fascia bilaterally, no evidence of swelling, warmth, 

discoloration, or other observable defect, the vascular supply was intact to all 10 toes, sensory 

function was intact and motor strength was 5/5 in all major muscle groups of the lower extremities, 

deep tendon reflexes were 2+ and symmetrical at the knees and ankles, and the radiographically 

evident traction osteophytes on the calcaneal tuberosities at the origin of the plantar fascia were

post-morbid artifacts and not contributory to potential symptoms.

Dr. Bush noted that appellant had slightly high arches described by the podiatrist as pes 

cavus and explained that this phenomenon was developmental and not work related. He also noted 

that she had mild bunionette deformities bilaterally, not mentioned by the podiatrist, with lateral 

prominence of the fifth metatarsal head, and opined that this was developmental and not workrelated. Dr. Bush indicated that no additional diagnostic testing was performed, and the only 

imaging studies reported were plain radiographic studies of both feet revealed to be normal except 

for calcaneal osteophytes consistent with traction at the origin of the plantar fascia. He advised 

that the most significant finding on physical examination was the objectively noted callosities on 

the plantar surface of the fifth metatarsal heads, which correlates with the descriptions in the

various podiatry notes reviewed for his report. Dr. Bush noted that he found some tenderness to 

palpation associated with these callosities; however, no tenderness whatsoever on firm palpation 

of the origin of the plantar fascia and no symptoms elicited in the third web space of the right foot 

related to the alleged interdigital neuroma diagnosed by the podiatrist. He indicated there were no 

other significant findings on physical examination of appellant’s feet.

Dr. Bush opined there was no evidence of any plantar fibromas. He noted that, in the 

podiatry clinic notes, there was no mention of plantar fibromas, and the podiatrist had not 

diagnosed plantar fibromatosis. Dr. Bush explained that there appeared to be confusion with the 

diagnosis by the podiatrist of plantar fasciitis. He opined that the diagnoses of plantar fasciitis and 

interdigital neuroma were not active and were either resolved or possibly misdiagnosed. Dr. Bush 

explained that plantar keratoses, bunionette, and pes cavus were developmental issues and not 

work related. He opined that appellant was capable of returning to her date-of-injury job as a city 

carrier assistant, completed a work capacity evaluation (Form OWCP-5c), and indicated that 

appellant could perform her usual duties without restrictions.

On April 15, 2021 appellant filed a claim for compensation (Form CA-7) for disability

from work for the period January 2 through April 9, 2021.
4

In a development letter dated April 22, 2021, OWCP indicated that it was in receipt of 

appellant’s Form CA-7, that it appeared that she was claiming disability due to a material change 

or worsening of her accepted work-related conditions, and that she stopped work on January 2, 

2021, and had not returned. It explained that the October 19, 2020 report from her treating 

physician, Dr. Cook, did not support disability from work and his October 19, 2020 work 

restriction was not supported by a narrative report. OWCP also noted that the second opinion 

physician, Dr. Bush, found that she was able to perform full-duty work. It advised appellant of 

the type of evidence required to establish her claim and afforded her 30 days to provide the 

necessary evidence.

Appellant continued to file CA-7 forms claiming disability from work through 

May 14, 2021.

In a May 11, 2021 report, Dr. Cook noted that appellant had experienced pain in both feet

for more than two years associated with chronic plantar fasciitis. He explained that, when she 

attempted to return to work, she had continued pain in both feet, she was on her feet quite a bit as 

a postal worker, and she had been wearing her prescription orthotics, although they had since worn 

out, and also wearing her supportive shoes. Dr. Cook opined that “standing or walking for more 

than one hour creates disability.” He noted that appellant’s objective findings demonstrated 

remaining tenderness and effusion upon palpation of both plantar fascial insertions, and that 

previous x-rays revealed bilateral heel spurs. Dr. Cook recommended new prescription orthotics, 

since her old orthotics had worn out and were medically necessary. He opined that appellant was 

able to work with restrictions including no extensive walking or standing, no carrying or pushing 

a cart of more than 10 pounds, and no stair climbing. Dr. Cook reiterated his opinion that 

appellant’s bilateral foot pain was due to extensive walking and standing and her condition was 

the result of her work at the employing establishment. He further opined that, short of surgical 

intervention, her condition was chronic and not expected to improve, and that a sedentary position 

would be more suitable to accommodate her foot problems. Dr. Cook completed a Form OWCP5c advising that appellant could not perform her usual duties, but could work with restrictions to 

include only one hour of walking, one hour of standing, and eight hours of sitting.

By decision dated June 15, 2021, OWCP denied appellant’s claim for disability for the 

period from January 2through May 14, 2021. It found that the evidence did not establish that 

appellant was disabled from work due to the accepted work-related condition as she had not 

established that her wage loss was due to her inability to perform her regular job duties, or limitedduty assignment, or due to the employing establishment’s inability to accommodate her work 

restrictions.

On June 28, 2021 OWCP proposed to terminate appellant’s wage-loss compensation and 

medical benefits, as the evidence of record established that she no longer had employment-related 

residuals or disability due to her accepted work-related conditions. It afforded her 30 days to 

submit additional evidence or argument if she disagreed with the proposed termination of benefits.

No additional evidence was received.

By decision dated August 4, 2021, OWCP terminated appellant’s wage-loss compensation 

and medical benefits, effective August 4, 2021. It found that the weight of the medical evidence 
5

rested with the second opinion physician, Dr. Bush, and established that appellant no longer had 

any disability or residuals of the medical condition resulting from the work injury.

LEGAL PRECEDENT -- ISSUE 1

An employee seeking benefits under FECA3 has the burden of proof to establish the 

essential elements of his or her claim, including that any disability or specific condition for which 

compensation is claimed is causally related to the employment injury. 4 For each period of 

disability claimed, the employee has the burden of proof to establish that he or she was disabled 

from work as a result of the accepted employment injury.5 Whether a particular injury causes an 

employee to become disabled from work, and the duration of that disability, are medical issues 

that must be proven by a preponderance of the reliable, probative, and substantial medical opinion 

evidence.6 Findings on examination are generally needed to support a physician’s opinion that an 

employee is disabled from work.7

The term “disability” is defined as the incapacity, because of an employment injury, to earn 

the wages the employee was receiving at the time of the injury. 8 Disability is, thus, not 

synonymous with physical impairment, which may or may not result in an incapacity to earn 

wages.9 An employee who has a physical impairment causally related to a federal employment 

injury, but who nevertheless has the capacity to earn the wages he or she was receiving at the time 

of injury, has no disability as that term is used in FECA.10

The Board will not require OWCP to pay compensation for disability in the absence of 

medical evidence directly addressing the specific dates of disability for which compensation is 

claimed. To do so, would essentially allow an employee to self-certify his or her disability and 

entitlement to compensation.11

3

Supra note 1.

4

See M.T., Docket No. 21-0783 (December 27, 2021); L.S., Docket No. 18-0264 (issued January 28, 2020); B.O., 

Docket No. 19-0392 (issued July 12, 2019); Kathryn Haggerty, 45 ECAB 383 (1994); Elaine Pendleton, 40 ECAB 

1143 (1989).

5 T.W., Docket No. 19-1286 (issued January 13, 2020).

6

S.G., Docket No. 18-1076 (issued April11, 2019); V.H., Docket No. 18-1282 (issued April2, 2019); Fereidoon 

Kharabi, 52 ECAB 291 (2001).

7 C.S., Docket No. 20-1621 (issued June28, 2021); DeanE. Pierce, 40 ECAB 1249 (1989).

8

20 C.F.R. § 10.5(f); J.S., Docket No. 19-1035 (issued January 24, 2020); S.T., Docket No. 18-0412 (issued 

October 22, 2018); Cheryl L. Decavitch, 50 ECAB 397 (1999).

9 G.T., Docket No. 18-1369 (issued March 13, 2019); Robert L. Kaaumoana, 54 ECAB 150 (2002).

10 See 20 C.F.R. § 10.5(f); N.M., Docket No. 18-0939 (issued December 6, 2018).

11 See M.J., Docket No. 19-1287 (issued January 13, 2020); C.S., Docket No. 17-1686 (issued February 5, 2019); 

WilliamA. Archer, 55 ECAB 674 (2004).
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ANALYSIS -- ISSUE 1

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

work from January 2 through May 14, 2021, causally related to her accepted employment injury.

Dr. Cook provided a Form CA-17, dated February 24, 2021, with limited-duty restrictions,

and, in a May 11, 2021 report, Dr. Cook opined that the pain in both feet was due to extensive 

walking and standing, and was the result of working for the employing establishment. However, 

the Board has held that pain is a description of a symptom, not a diagnosis of a medical condition.12 

A medical report lacking a firm diagnosis is of no probative value.13 While Dr. Cook noted that 

appellant had suffered for more than two years from pain in both feet associated with chronic 

plantar fasciitis, her accepted condition was plantar fascial fibromatosis. The Board, therefore,

finds that appellant has not met her burden to establish that she was disabled from work during the 

claimed period as a result of the accepted employment condition.

Because appellant has not submitted rationalized medical opinion evidence to establish 

employment-related disability from January 2, 2021, as a result of her accepted plantar fascial 

fibromatosis, the Board finds that she has not met her burden of proof to establish her claim.

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.

LEGAL PRECEDENT-- ISSUE 2

Once OWCP accepts a claim and pays compensation, it has the burden of proof to justify 

termination or modification of an employee’s benefits.14 It may not terminate compensation 

without establishing that the disability had ceased or that it was no longer related to the 

employment.15 OWCP’s burden of proof includes the necessity of furnishing rationalized medical 

opinion evidence based on a proper factual and medical background.16

The right to medical benefits for an accepted condition is not limited to the period of 

entitlement for disability compensation.17 To terminate authorization for medical treatment, 

12 See A.T., Docket No. 21-0985 (issued April27, 2022); C.S., supra note 8; D.R., Docket No. 18-1408 (issued 

March 1, 2019); D.A., Docket No. 18-0783 (issued November 8, 2018).

13 A.T., id, C.S., id; J.P., Docket No. 20-0381 (issued July 28, 2020); R.L., Docket No. 20-0284 (issued 

June 30, 2020).

14 J.T., Docket No. 20-1470 (issued October 8, 2021); C.C., Docket No. 19-1062 (issued February 5, 2020); S.F., 

59 ECAB 642 (2008); KellyY. Simpson, 57 ECAB 197 (2005); Paul L. Stewart, 54 ECAB 824 (2003).

15 See T.M., Docket No. 19-1058 (issued March 30, 2021); G.T., supra note 10; A.G., Docket No. 18-0749 (issued 

November 7, 2018); ElsieL. Price, 54 ECAB 734 (2003).

16 R.R., Docket No. 19-0173 (issued May 2, 2019); Del K. Rykert, 40 ECAB 284 (1988).

17 L.W., Docket No. 18-1372 (issued February 27, 2019); KathrynE. Demarsh, 56 ECAB 677 (2005).
7

OWCP must establish that appellant no longer has residuals of an employment-related condition, 

which require further medical treatment.18

ANALYSIS -- ISSUE 2

The Board finds that OWCP has not met its burden of proof to terminate appellant’s wageloss compensation and medical benefits, effective August 4, 2021.

OWCP referred appellant for a second opinion examination with Dr. Bush. It provided a 

SOAF indicating that it had accepted the claim for plantar fascial fibromatosis. In a March 15, 

2021 report, Dr. Bush noted that appellant’s claim was accepted for plantar fascial fibromatosis

and opined that this diagnosis was incorrect, as there was no evidence of plantar fibromas, and the 

prior diagnosis seemed to be a confusion with plantar fasciitis.

However, Dr. Bush’s opinion is inconsistent with the SOAF. OWCP accepted that 

appellant sustained plantar fascial fibromatosis due to the accepted employment injury. When 

OWCP has accepted an employment condition as occurring in the performance of duty, the 

physician must base his opinion on the accepted conditions. 19 OWCP procedures and Board 

precedent dictate that, when an OWCP medical adviser, second opinion specialist, or impartial 

medical specialist renders a medical opinion based on a SOAF, which is incomplete or inaccurate,

or does not use the SOAF as the framework in forming his or her opinion, the probative value of 

the opinion is seriously diminished or negated altogether.20

In this case, Dr. Bush did not rely on the SOAF as a framework in reaching his opinion. 

The Board, thus, finds that Dr. Bush’s report is of diminished probative value.21 Accordingly, 

OWCP failed to meet its burden of proof to terminate appellant’s wage-loss compensation and 

medical benefits effective August 4, 2021.

CONCLUSION

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

commencing January 2, 2021, causally related to her accepted employment injury. The Board 

further finds that OWCP has not met its burden of proof to terminate appellant’s wage-loss 

compensation and medical benefits, effective August 4, 2021.

18 See T.M., supra note 16; A.M., Docket No. 18-1243 (issued October 7, 2019); R.P., Docket No. 17-1133 (issued 

January 18, 2018); A.P., Docket No. 08-1822 (issued August 5, 2009).

19 See D.T., Docket No. 21-1168 (issued April6, 2022) G.B., Docket No. 20-0750 (issued October 27, 2020); T.P., 

58 ECAB 524 (2007).

20 Federal (FECA) Procedure Manual, Part 3 -- Medical, Requirements for Medical Reports, Chapter 3.600.3 

(October 1990). See also D.C., Docket No. 21-0780 (issued December 22, 2021); Paul King, 54 ECAB 356 (2003).

21 Id.
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ORDER

IT IS HEREBY ORDERED THAT the June 15, 2021 decision of the Office of Workers’

Compensation Programs is affirmed. The August 4, 2021 decision of the Office of Workers’

Compensation Programs is reversed. 

Issued: August 5, 2022

Washington, DC

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board

James D. McGinley, Alternate Judge

Employees’ Compensation Appeals Board