United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

L.B., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Fremont, CA, Employer

__________________________________________

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Docket No. 23-0961

Issued: December 15, 2023

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

PATRICIA H. FITZGERALD, Deputy Chief Judge

JANICE B. ASKIN, Judge

JURISDICTION

On July 6, 2023 appellant, through counsel, filed a timely appeal from a February 17, 2023 

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.3

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.

3 The Board notes that following the February 17, 2023 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

ISSUE

The issue is whether appellant has met his burden of proof to establish a left lower 

extremity condition causally related to the accepted factors of his federal employment.

FACTUAL HISTORY

On March 2, 2022 appellant, then a 62-year-old city letter carrier, filed an occupational 

disease claim (Form CA-2) alleging that he developed left-sided insertional Achillestendinitis due 

to repetitive walking on his mail route. He indicated that he was able to work in the past as his 

left ankle pain was intermittent, but now the pain was constant. Appellant noted that he first 

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

December 29, 2021. He stopped work on March 2, 2022. 

In a March 23, 2022 development letter, OWCP informed appellant of the deficiencies of 

his claim. It advised him of the type of factual and medical evidence needed, provided a 

questionnaire for his completion, and afforded him 30 days to respond. 

In a March 1, 2022 statement, appellant asserted that for the past two years he experienced 

periodic discomfort in his left ankle walking and carrying a satchel while delivering mail. He 

approximated that he took 5,000 to 16,000 steps a day, 5 days a week. Appellant stated that 

initially an ankle brace helped to stabilize the pain and that he underwent physical therapy and 

treated with a chiropractor on a biweekly basis. In late December 2021, the pain worsened, and

he noticed a lump on his left heel. Appellant indicated that his podiatrist diagnosed a bone spur in 

his left heel and insertional Achilles tendinitis. He advised that he had restrictions relative to 

standing/walking, and wore a walking boot to stabilize his heel and ankle. 

In a February 20, 2022 progress note, Dr. Sara Karamloo, a Board-certified podiatric foot 

and ankle surgeon, reported that appellant, a mail carrier, recently had cardiac bypass surgery and 

was previously walking 12 miles a day in his job. Appellant returned to work with a new mail 

route that was not all walking. Dr. Karamloo provided examination findings and diagnosed left 

foot calcaneal spur, and Achilles tendinitis, left leg.

In a March 1, 2022 note and progress report, Dr. Karamloo indicated that appellant was 

initially seen in her office on December 29, 2021 due to left ankle and heel pain that he developed 

as a mail carrier. She noted results of x-rays and a February 25, 2022 magnetic resonance imaging 

(MRI) scan and diagnosed with a bone spur on the left heel coupled with plantar fasciitis. 

Dr. Karamloo placed appellant off work. In March 1, 21, and 23, and April 8, 2022 reports, she

continued to diagnose left leg Achilles tendinitis, and left foot calcaneal spur. Dr. Karamloo also 

continued to hold appellant off work. 

Physical therapy reports dated March 25 and April 26, 2022 were also received. 

In an April 27, 2022 note, Dr. Karamloo indicated that appellant had been under her care 

since December 29, 2021 for bone spur and multiple torn tendons in his left ankle. She noted 

appellantwas on doctor’s orders to include home rest, limited walking while wearing his controlled 

ankle movement (CAM) walker boot and physical therapy twice a week. 
3

By decision dated May 3, 2022, OWCP denied appellant’s occupational disease claim, 

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

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

On May 18, 2022 appellant requested reconsideration. 

In a May 4, 2022 report, Dr. Karamloo reported that appellant, a city mail carrier, had a 

route that consisted of walking approximately 12 miles per day, 5 days per week. She opined that 

as a result of that walking and overuse, he developed a calcaneal bone spur in his left ankle that 

became inflamed and caused multiple tears in his Achilles tendon. Dr. Karamloo noted that 

appellant continued to work, but the persistent condition had increased in pain and swelling, and 

in December it became too much for him to handle without additional medical treatment. She

indicated that he had been under her care for the past few months with the goal of returning him 

to work.

In a June 2, 2022 report, Dr. Karamloo noted appellant’s medical treatment for bone spur 

and multiple torn tendons in his left ankle. She indicated that two weeks ago, he twisted his left 

knee and calf while walking up the stairs at his home which re-aggravated his tendon injury and 

strained his left calf muscle which caused his current issue of being unable to put full weight on 

his left foot and trouble walking without limping.

In June 30 and July 19, 2022 reports, Dr. Karamloo advised that appellant should remain 

off work with continued physical therapy and increased daily walking. This would be followed 

by conservative return to duties with gradual increases in duties and workload to avoid re-injury. 

OWCP also continued to receive physical therapy notes.

By decision dated August 16, 2022, OWCP denied modification of May 3, 2022 decision. 

It found that the medical evidence of record was insufficient to establish causal relationship

between the diagnosed left lower extremity conditions and the accepted work factors.

OWCP continued to receive medical evidence. In an August 8, 2022 report, Dr. Karamloo 

released appellant to limited-duty workof threehours a day, every other day with lifting limitations

of up to 10 pounds with incremental increases in workload of casing and delivery of mail. 

Appellant returned to light-duty work. In August 22 and September 9, 2022 reports, Dr. Karamloo 

recommended that he increase to working two days in a row at three hours per day of limited-duty 

workload followed by a day of rest and physical therapy. 

A February 25, 2022 MRI scan of appellant’s left ankle demonstrated marked thickening 

of the distal Achilles tendon, edema within the calcaneus deep to the insertion, marked 

peritendinitis of the flexor pollicis longus tendon, and extensive subcutaneous edema medially and 

laterally. A September 14, 2022 left ankle MRI scan included findings consistent with plantar 

fasciitis, medium-sized calcaneal heel enthesophyte, severe Achilles tendinosis with near complete 

tear, and tenosynovitis of various tendons and partial tear of various ligaments. 

In an October 3, 2022 report, Dr. Spencer B. Tilley, Board-certified in family medicine, 

indicated that he was appellant’s primary care physician and that appellant continued under 

doctors’ orders for bone spur and multiple torn tendons in his left ankle. He discussed appellant’s 
4

MRI scan findings and referred appellant to an orthopedic surgeon as surgery would probably be 

necessary. Dr. Tilley opined that appellant may continue his limited work schedule and duties of 

two days on and one day off for four hours per day for the next week.

In an October 11, 2022 report, Dr. Joshua Van Gompel, a podiatric foot and ankle surgery 

specialist, indicated that the two MRI scans of appellant’s left ankle demonstrated multiple tears 

to the peroneal and Achilles tendons along with some bone spur formation. He recommended 

surgery as appellant’s peroneal tendon was close to rupturing (90 percent) and advised that 

appellant could not return to work before the scheduled surgery of November 1, 2022. 

On December 20, 2022 appellant, through his representative, requested reconsideration. 

In a December 16, 2022 report, Dr. Tilley opined that appellant’s work duties caused a 

calcaneal bone spur that became inflamed and caused multiple tears in his left Achilles tendon, 

which led to his November 1, 2022 surgery. He indicated that appellant’s postal duties included

walking 8 to 10 miles per workday delivering mail, heavy packages, catalogs, and seasonal 

advertisement pieces. Dr. Tilley stated that the repetitive walking combined with approximately 

15 pounds of satchel weight caused the development of appellant’s bone spur in his left heel which 

eventually led to multiple tears in his Achilles tendon. He explained the physiological process of 

how heel strike, pronation and mid-stance on the weight bearing (especially with additional 

weight) increased the longitudinal arch area which, in turn, caused pulling of the plantar fascia 

more at the calcaneal origin than its metatarsal insertion and associated pain. Dr. Tilley indicated 

that after appellant’s release in August to return to limited-duty capacity with incremental increases 

in hours and days, appellant’s pain became unbearable, and his limp grew more severe despite 

continued doctor visits, medical treatment and physical therapy. He stated that when he saw 

appellant in October, he ordered an MRI scan, which demonstrated a 94 percent torn tendon near 

rupture, which required surgery. Dr. Tilley also discussed appellant’s Parkinson’s disease and 

opined that the symptoms of that disease did not have any effect on how appellant’s bone spur 

developed that caused tears in his Achilles tendon. 

In a December 20, 2022 report, Dr. Charan K. Singh, Board-certified in neurology, opined 

that appellant’s Parkinson’s disease symptoms, which included rigidity of his left arm and hand 

tremors, did not contribute to his torn Achilles tendons. Dr. Singh noted that appellant’s 

medications and his city mail carrier duties helped in controlling his Parkinson’s disease

symptoms.

By decision dated February 17, 2023, OWCP denied modification of its prior decision.

LEGAL PRECEDENT

An employee seeking benefits under FECA4 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 

4

Supra note 2.
5

limitation of FECA,5that 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.6 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.7

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.8

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

relationship is rationalized medical opinion evidence.9 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 relationship 

between the diagnosed condition and specific employment factors identified by the employee. 10

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.11

ANALYSIS

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

In his December 16, 2022 report, Dr. Tilley opined that appellant’s work duties contributed 

to his calcaneal bone spur that became inflamed and caused multiple tears in his left Achilles 

tendon. He detailed a history of appellant’s medical treatment for his calcaneal bone spur and 

5

J.W., Docket No. 18-0678 (issued March 3, 2020); S.B.,Docket No. 17-1779 (issued February 7, 2018); J.P., 59 

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

6

J.S.,Docket No.18-0657 (issued February 26, 2020); J.M., Docket No. 17-0284 (issued February 7, 2018);

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

7 L.J., Docket No. 19-1343 (issued February 26, 2020); R.R., Docket No.18-0914 (issued February 24, 2020);

Delores C. Ellyett, 41 ECAB 992 (1990).

8

S.C., Docket No. 18-1242 (issued March 13, 2019); R.H., 59 ECAB 382 (2008).

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

238 (1996).

10 R.G., Docket No. 18-0792 (issued March 11, 2020); D.J.,Docket No. 19-1301 (issued January 29, 2020); I.J., 59 

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

11 Federal (FECA) Procedure Manual, Part 2 --Claims, Causal Relationship, Chapter 2.805.3e (January 2013);see 

L.C., Docket No. 19-1301 (issued January 29, 2020); R.D., Docket No. 18-1551 (issued March 1, 2019).
6

multiple tears in his left Achilles tendon and provided the factual evolution of events from 

appellant’s full-duty postal work, to the May 2021 twisting of his left ankle and calf muscle while 

walking up the stairs at home, to his August 2022 release to work in a limited capacity with 

incremental increases in workload and days, and to his November 1, 2022 surgery. The Board has 

held that a medical opinion must explain how the implicated employment factors physiologically 

caused, contributed to, or aggravated the specific diagnosed conditions. 12 Dr. Tilley provided 

rationale explaining how, physiologically, the specific movements involved in repetitive walking 

and the additional weight of carrying a satchel caused the development and inflammation of a 

calcaneal bone spur which eventually led to multiple tears in the left Achilles tendon . He also 

noted that appellant’s preexisting Parkinson’s disease did not lead to the development of the bone 

spur that caused tears in his Achilles tendon. 

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

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

responsibility in the development of the evidence.13 OWCP has an obligation to see that justice is 

done.14 While Dr. Tilley’s opinion is insufficient to establish the claim, it is sufficient to require 

further development of the medical evidence.15 The case must therefore be remanded for further 

development. 

On remand, OWCP shall refer appellant to a specialist in an appropriate field of medicine, 

along with the case record and a statement of accepted facts. Its referral physician shall provide a 

well-rationalized opinion as to whether appellant’s diagnosed conditions as related by Dr. Tilley 

were causally related to or aggravated by factors of his federal employment, including repetitive 

walking and carrying weighted satchels. 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. Tilley. After this and other such further development of the case record as deemed 

necessary, OWCP shall issue a de novo decision.

CONCLUSION

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

12 S.C., Docket No. 20-0492 (issued May 6, 2021); R.S., Docket No. 19-1774 (issued April 3, 2020).

13 See id. See also A.P., Docket No. 17-0813 (issued January 3, 2018); Jimmy A. Hammons, 51 ECAB 219, 

223 (1999).

14 See B.C., Docket No. 15-1853 (issued January 19, 2016);E.J., Docket No. 09-1481 (issued February 19, 2010);

John J. Carlone, 41 ECAB 354 (1989).

15 John J. Carlone, id.
7

ORDER

IT IS HEREBY ORDERED THAT the February 17, 2023 decision of the Office of 

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

consistent with this decision of the Board.

Issued: December 15, 2023

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board