United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

C.Y., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Merrick, NY, Employer

__________________________________________

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Docket No. 23-0814

Issued: December 20, 2023

Appearances: Case Submitted on the Record

Paul Kalker, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

JANICE B. ASKIN, Judge

JAMES D. McGINLEY, Alternate Judge

JURISDICTION

On May 17, 2023 appellant, through counsel, filed a timely appeal from a March 15, 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 March 15, 2023 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

ISSUE

The issue is whether appellant has met her burden of proof to establish disability from work 

for the period June 24 through August 19, 2022 causally related to her accepted July 27, 2019 

employment injury.

FACTUAL HISTORY

On July 27, 2019 appellant, then a 31-year-old city carrier assistant, filed a traumatic injury 

claim (Form CA-1) alleging that on that date she injured her right wrist, right hip, and right ankle 

when she tripped and fell due to an “uneven sidewalk while walking mail” while in the 

performance of duty. She stopped work on July 28, 2019. OWCP accepted appellant’s claim for 

strains/sprain of the right hip, right ankle, and right wrist. It paid wage-loss compensation on the 

supplemental rolls, effective September 1, 2019. On September 18, 2021 appellant returned to 

full-duty work. By decision dated April 22, 2022, OWCP expanded the acceptance of her claim 

to include right trigger thumb and right hip articular cartilage disorder. 

In a report dated June 22, 2022, Dr. Thomas Youm, a Board-certified orthopedic surgeon, 

indicated that appellant was evaluated for continued pain in her right hip and right thumb after she 

fell down at work. He noted that she was working, but he would need to consider some time off. 

On physical examination of the right hip, Dr. Youm observed positive impingement and FABER 

signs. He opined that appellant’s injuries to her right hand and right thumb were a result of her 

fall at work. Dr. Youm diagnosed right hip other articular cartilage disorder and right trigger 

thumb. He noted “Yes” indicating that appellant was disabled and recommended surgery for 

appellant’s right hip and thumb.

On June 28, 2022 appellant underwent right hip arthroscopic surgery with labral repair, hip 

cam and pincer resection. The operative report noted diagnosis of right hip labral tear. Appellant 

submitted hospital records dated June 28, 2022.

In a report dated July 6, 2022, Dr. Youm noted a diagnosis of status post right hip 

arthroscopic labral repair with cam and pincer resection. He described a course of treatment for 

the next six months. 

On July 8, 2022 appellant filed a claim for compensation (Form CA-7) for disability from 

work for the period June 24 through July 8, 2022. On the reverse side of the claim form, an 

occupational health specialist for the employing establishment indicated that appellant was no 

longer employed by the employing establishment.

On July 27 and August 19, 2022 appellant filed additional Form CA-7 claims for disability 

from work for the period July 9 through August 19, 2022. 

In an August 23, 2022 development letter, OWCP informed appellant of the deficiencies 

of her claim for compensation commencing June 24, 2022. It advised her of the type of additional 

evidence needed and afforded her 30 days to provide the necessary evidence.

In a treatment note dated August 8, 2022, Dr. Youm indicated that appellant was evaluated 

for status post right hip arthroscopy with cam and pincer resection. On physical examination, he 

observed flexion of the hip to 90 degrees, internal and external rotation to 90 degrees, and flexion 

to 10 degrees. Impingement sign was mildly positive. Dr. Youm reported that appellant still 
3

complained of triggering of the right thumb with tenderness over the A1 pulley and locking. He 

noted “Yes” indicating that appellant was disabled. Dr. Youm diagnosed right hip articular 

cartilage disorder and right thumb trigger finger.

By decision dated September 30, 2022, OWCP denied appellant’s claim for disability from 

work for the period commencing June 24, 2022. It found that the medical evidence of record was 

insufficient to establish that she was unable to work during the claimed period due to her accepted 

July 27, 2019 employment injury.

On October 12, 2022 appellant, through counsel, requested a telephonic hearing before a 

representative of OWCP’s Branch of Hearings and Review.

In a report dated October 10, 2022, Dr. Youm indicated that appellant had right hip and 

right thumb pain since a July 27, 2019 employment injury. He reviewed appellant’s history of 

injury and provided examination findings. Dr. Youm reported that appellant was totally disabled 

since her right hip arthroscopic surgery on June 28, 2022. He noted that appellant had been out of 

work since June 24, 2022, and advised that she would be out of work until her next office visit. 

Dr. Youm explained that appellant could not work because she was still regaining range of motion 

and strength back since her right hip surgery. He diagnosed right trigger thumb and right hip other 

articular cartilage disorder. Dr. Youm responded “Yes” indicating that appellant was disabled and 

concluded that her diagnoses and conditions were a direct result of the July 27, 2019 employment 

injury. 

In an October 31, 2022 letter, appellant, through counsel, requested expansion of

appellant’s claim to include right hip labral tear.

By decision dated November 28, 2022, OWCP expanded the acceptance of appellant’s 

claim to include right hip labral tear.

By decision dated February 2, 2023, OWCP’s hearing representative set aside the 

September 30, 2022 decision, finding that OWCP must resolve whether appellant’s right hip 

surgery was medically necessary to treat appellant’s July 27, 2019 employment injury, before 

adjudicating appellant’s claim for wage-loss compensation. Appellant’s claim was remanded for 

further development of the medical evidence. 

OWCP subsequently referred appellant, along with the medical record, and a statement of 

accepted facts (SOAF), to Dr. Todd Fellars, a Board-certified orthopedic surgeon serving as the 

district medical adviser (DMA), to determine whether appellant’s right hip surgery on June 28, 

2022 was medically necessary, and causally related to appellant’s July 27, 2019 employment 

injury. In a February 17, 2023 report, Dr. Fellars noted that he had reviewed the medical evidence 

of record, and indicated that appellant’s claim was accepted for right hand and wrist sprain, right 

hip sprain and strain, and right ankle sprain and strain. He reported that the June 28, 2022 right 

hip arthroscopic surgery was causally related to appellant’s accepted right hip conditions. 

However, Dr. Fellars also opined that the surgery was not medically necessary to treat appellant’s 

employmentinjury. He noted that appellant’s initial hip examination showed full range of motion,

and diagnostic imaging demonstrated no evidence of a cam deformity and small punctate labral 

lesions. Dr. Fellars reported that the surgery would not be considered medically necessary because 

the punctate labral tears would unlikely be clinically significant, and unlikely to contribute to any 

type of pain.
4

By de novo decision dated March 15, 2023, OWCP denied appellant’s claim for disability 

commencing June 24, 2022 and continuing. It noted that Dr. Fellars, the DMA, had determined 

that the June 28, 2022 right hip surgery was not medically necessary to treat appellant’s July 27, 

2019 employment injury. Thus, OWCP determined that the medical evidence of record was 

insufficient to establish that appellant was unable to work during the claimed period due to her 

accepted July 27, 2019 employment injury.

LEGAL PRECEDENT

An employee seeking benefits under FECA4 has the burden of proof to establish the 

essential elements of his or her claim, including the fact that any disability or specific condition 

for which compensation is claimed is causally related to the employment injury. 5 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.6 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.7 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 evidence. 8 

The medical evidence required to establish causal relationship between a claimed period 

of disability and an employment injury 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 claimed disability and the specific employment factors 

identified by the claimant.9

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.10

4

Supra note 2.

5 C.B., Docket No. 20-0629 (issued May 26, 2021); D.S., Docket No. 20-0638 (issued November 17, 2020); S.W., 

Docket No. 18-1529 (issued April19, 2019); Elaine Pendleton, 40 ECAB 1143 (1989); see also Nathaniel Milton, 37 

ECAB 712 (1986).

6

20 C.F.R. § 10.5(f); S.T., Docket No. 18-412 (issued October 22, 2018); Cheryl L. Decavitch, 50 ECAB 

397 (1999).

7 K.C., Docket No. 17-1612 (issued October 16, 2018); William A. Archer, 55 ECAB 674 (2004).

8

S.G., Docket No. 18-1076 (issued April 11, 2019); Fereidoon Kharabi, 52 ECAB 291, 292 (2001).

9 K.H., Docket No. 19-1635 (issued March 5, 2020); V.A., Docket No. 19-1123 (issued October 29, 2019).

10 K.A., Docket No. 19-1564 (issued June 3, 2020); J.B., Docket No. 19-0715 (issued September 12, 2019); 

William A. Archer, supra note 7.
5

ANALYSIS

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

OWCP referred appellant, along with the medical record and a SOAF, to Dr. Fellars, 

serving as the DMA, to determine whether appellant’s right hip surgery was medically necessary 

or causally related to appellant’s July 27, 2019 employment injury. In a February 17, 2023 report,

Dr. Fellars noted in response to OWCP’s question that the right hip arthroscopic surgery was 

causally related to the accepted conditions of right hip strain. He also reported that the right hip 

surgery was not medically necessary to treat appellant’s employment injury, as appellant’s initial 

hip examination and diagnostic imaging were clinically insignificant. 

The Board finds that OWCP failed to properly develop appellant’s claim for compensation 

for disability during the period June 24 through August 19, 2022. When OWCP referred the case 

to a DMA, it should have also inquired as to whether appellant’s disability from work for the 

period June 24 through August 19, 2022 was causally related to any employment-related 

conditions.11 In addition, while Dr. Fellars noted appellant’s accepted conditions for right hand 

and wrist sprain, right hip sprain, and right ankle sprain, he did not report the accepted condition 

of right hip labral tear even though it was noted on the SOAF. OWCP’s procedures dictate that 

when an OWCP medical adviser, second opinion specialist, or referee physician 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.12 In this case, it is unclear whether Dr. Fellars was aware that appellant’s 

condition was accepted for right hip labral tear, which was the basis for the June 28, 2022 right 

hip surgery and subsequent alleged disability. 

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 Thus, the Board will remand the case to OWCP for further development of the medical 

evidence in order to determine whether appellant’s disability from work for the period June 24 

through August 19, 2022 was causally related to her accepted July 27, 2019 employment injury. 

On remand, OWCP shall request a supplement report from Dr. Fellars specifically addressing

whether appellant’s disability from work for the period June 24 through August 19, 2022 was 

causally related to any employment-related conditions. Following this, and any other further 

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

11 See V.K., Docket No. 20-0989 (issued January 25, 2022).

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

(October 1990); see also R.P., Docket No. 18-0900 (issued February 5, 2019).

13 See e.g., M.G., Docket No. 18-1310 (issued April16, 2019); Walter A. Fundinger, Jr., 37 ECAB 200, 204 (1985); 

Michael Gallo, 29 ECAB 159, 161 (1978); WilliamN. Saathoff, 8 ECAB 769, 770-71; Dorothy L. Sidwell, 36 ECAB 

699, 707 (1985).

14 See A.J., Docket No. 18-0905 (issued December 10, 2018); WilliamJ. Cantrell, 34 ECAB 1233, 1237 (1983); 

Gertrude E. Evans, 26 ECAB 195 (1974).
6

CONCLUSION

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

ORDER

IT IS HEREBY ORDERED THAT the March 15, 2023 decision of the Office of 

Workers’ Compensation Programs is set aside, and the case is remanded to OWCP for further 

proceedings consistent with this decision of the Board.

Issued: December 20, 2023

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

James D. McGinley, Alternate Judge

Employees’ Compensation Appeals Board