United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

L.B., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Rincon, GA, Employer

__________________________________________

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Docket No. 21-0353

Issued: May 23, 2022

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

PATRICIA H. FITZGERALD, Deputy Chief Judge

JANICE B. ASKIN, Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On January 4, 2021 appellant filed a timely appeal from an October 15, 2020 merit decision 

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 establish a cardiac condition 

causally related to the accepted factors of her federal employment.

FACTUAL HISTORY

On April 21, 2020 appellant, then a 39-year-old rural carrier, filed an occupational disease 

claim (Form CA-2) alleging that she suffered a heart attack due to factors of her federal 

employment, including a stressful work environment over the past 12 years. She noted that she 

1

5 U.S.C. § 8101 et seq.
2

first became aware of her condition and its relationship to her federal employment on 

December 17, 2019. Appellant stopped work on December 18, 2019.

In a December 17, 2019 statement, appellant related that she arrived at work earlier that 

day around 8 a.m. and had a lot of parcels to case and deliver. She asserted that during a break, 

her postmaster pulled over another hamper full of parcels and asked her to deliver them, even 

though she notified him that they were not due to deliver until the next day. Appellant noted that 

she felt tired after casing additional parcels but that she continued to work. She noticed that she 

was having a harder time performing her usual duties, with her legs feeling more tired than usual. 

Appellant noted that she briefly thought of going back inside and notifying management that she 

needed to go home, but she continued working when she realized that no one was available to take 

over her route. She explained that she felt worse later that day after delivering more parcels. 

Appellant reported feeling nauseous and chest tightening, which was not too painful but made her 

arm feel “weird.” She initially suspected a heart attack but was not sure and continued working. 

Appellant asserted that after she finished her work and left the office around 6:30 p.m., her 

condition worsened by the time she went home. 

A December 18, 2019 echocardiogram revealed severely reduced left ventricular ejection 

fraction (LVEF) that was less than or equal to 25 percent.

In a December 19, 2019 operative report, Dr. Jeremy E. London, a Board-certifiedvascular 

surgeon, noted that appellant underwent several procedures including urgent coronary bypass 

grafting, endoscopic vein harvesting, and bilateral internal mammary artery harvesting. He 

diagnosed atherosclerotic coronary vascular disease, ST-segment elevation myocardial infarction, 

and ejection fraction. Dr. London noted reasonable hemostasis with a moderate coagulopathy.

In a December 20, 2019 procedure note, Dr. William F. Wallace, Board-certified in 

cardiovascular disease, noted that appellant was diagnosed with coronary artery disease (CAD) 

and congestive heart failure (CHF). He indicated that she underwent several procedures on her 

heart. 

In a December 24, 2019 discharge summary, Dr. Adarsh Shetty, an internal medicine 

specialist, noted that appellant was treated in the emergency department on December 17, 2019 

with evidence of an acute coronary syndrome. He indicated that she had significant three -vessel 

CAD with moderately depressed left ventricular systolic function. Dr. Shetty noted that appellant 

underwent coronary bypass grafting and had recovered well.

On January 16, 2020 appellant presented to Dr. Wallace for follow-up of her recent 

hospitalization and an initial cardiac evaluation. She relayed that she had no significant problems 

since her discharge and denied any chest pain. Dr. Wallace conducted a physical examination and 

found that appellant was doing well without symptoms suggestive of angina or CHF.

OWCP also received a February 27, 2020 cardiopulmonary report. 

On March 19, 2020 Dr. Wallace conducted a physical examination and reported no 

significant symptoms or exertional chest pain, pressure, or tightness.
3

In a March 24, 2020 form report, Dr. Wallace diagnosed CHF, CAD, coronary artery 

bypass graft (CABG), myopathy, and myocardial infarction. He noted that appellant might 

experience shortness of breath, chest pain or tightness, and fatigue, and that she was prone to 

cardiovascular disease stress.

In an April 20, 2020 report, Dr. Wallace opined that stress from appellant’s job “in all 

likelihood played a role, along with her other risk factors, for her premature development of 

coronary artery disease requiring coronary artery bypass grafting.”

In an April 23, 2020 report, the employing establishment controverted appellant’s claim. 

In an undated statement, appellant related that she had been employed by the employing 

establishment for 12 years as of April 2020. She contended that she dealt with difficult times at 

work. Appellant explained that she started out as a rural carrier associate and completed the 

required duties of a regular mail carrier. She asserted that she had to work even when she was sick 

or faced the possibility of reprimand or termination. Appellant alleged that her workload had been 

heavy on a daily basis for years but that she always pulled through and got the job done. She 

contended that by August 2019, management had lost five carriers within a few weeks due to

intimidation and poor treatment of its employees. Appellant asserted that they were extremely 

understaffed and needed help by the time the Christmas season approached. She contended that 

the lack of staff added unnecessary stress and created a hostile work environment. Appellant 

asserted that many carriers, including herself, were finding it difficult to work each day but 

continued to work because they feared reprimand or termination. She contended that management 

continued to intimidate employees, adding more stress to an already stressful situation. Appellant 

noted that management would normally dispatch someone to assist her route, but it did not in 2019, 

increasing her workload and resulting stress. She contended that this was the state of her work for 

the week leading up to December 17, 2019 when she had a heart attack at work. Appellant further 

noted that she worked 10 to 12 hours each day. 

In a May 4, 2020 development letter, OWCP informed appellant of the deficiencies of her 

claim. It advised of the type of factual and medical evidence needed to establish her claim and 

provided a questionnaire for her completion. In a separate development letter of even date, OWCP 

requested that the employing establishment provide additional information including comments 

from a knowledgeable supervisor and an explanation of appellant’s work activities. It afforded 

both parties 30 days to respond. 

In another letter dated May 4, 2020, OWCPprovided Dr. Wallace with a copy of the recent 

statement of accepted fact (SOAF) that discussed all of the accepted factors of appellant’s 

employment and requested he submit a narrative report addressing whether the accepted factors of 

her employment caused or contributed to her heart condition.

Appellant submitted additional evidence, including a copy of a January 3, 2019 grievance 

form, in which she asserted that the employing establishment forced her to work her holiday on 

November 20, 2018.
4

In a December 17, 2019 form report, an unidentifiable healthcare provider noted that 

appellant presented with chest pain, dizziness, and nausea. The report related that she had been 

experiencing chest pain throughout the day but continued to work.

In a medical report of even date, Dr. Wallace noted that appellant presented to the 

emergency department with ongoing chest discomfort. He diagnosed CAD and recommended 

coronary bypass grafting. In a cardiac catheterization report of even date, Dr. Wallace noted that 

she had normal systemic blood pressure, moderately reduced LV systolic function, and severe 

three-vessel coronary artery disease. A chest x-ray of even date demonstrated “no acute process.”

In a December 18, 2019 cardiac catheterization report, Dr. William Crosland, a 

cardiologist, indicated that appellant underwent a catheterization of the right side of the heart.

A December 19, 2020 chest x-ray revealed status post median sternotomy but demonstrated 

“no acute process.”

OWCP also received a December 20, 2019 electrocardiography (ECG) report and a chest 

x-ray of even date, which revealed new moderate gastric gaseous distention, new focal 

consolidation, and slightly improved mild pulmonary interstitial edema. 

In a December 29, 2019 progress report, Dr. Ryan P. Behta, an internal medicine specialist, 

conducted a physical examination and diagnosed bilateral plural effusion.

In an undated letter, the employing establishment controverted appellant’s claim, asserting 

that she had been a smoker for many years and her heart’s blockages were not caused by workrelated factors. It acknowledged that due to staffing shortages, the workload during the holiday 

season increased but that appellant never notified management or requested any accommodation 

related to her heart-related issue. The employing establishment also provided a job description for 

a rural carrier.

In an undated statement, appellant’s coworker, M.P., contended that their supervisor 

constantly berated and harassed him, eventually causing him to quit his employment. He asserted 

that the same supervisor targeted four other employees who all quit before him.

A January 27, 2020 chest x-ray revealed previous CABG but no CHF. 

A January 29, 2020 computerized tomography (CT) scan of the chest demonstrated

significantly decreased bilateral pleural effusions since the December 27, 2019 CT scan, trace 

residual fluid in the bilateral pleural spaces, subsegmental atelectasis in the lung bases, calcified 

granuloma in the right lung, and CABG. An ultrasound report of the chest of even date noted a 

right-sided thoracentesis with removal of a liter of fluid.

In a February 3, 2020 medical report, Dr. London diagnosed cough, shortness of breath, 

and status post CABG.

Appellant submitted additional evidence including laboratory testing results, dated 

April 21, 2020, which showed the results of hematology testing.
5

In a May 9, 2020 response to OWCP’s development questionnaire, appellant contended 

that her December 17, 2019 injury resulted from added pressure to deliver more parcels, stress of 

meeting a deadline, as well as repetitive lifting, bending, pushing heavy equipment, and pulling 

equipment and parcels. She reiterated that on December 17, 2019 her postmaster demanded that 

she deliver more parcels after she already delivered many parcels. Appellant contended that this 

added more stress and pressure to her when she was already feeling overwhelmed. She noted that 

she also sorted, lifted, and delivered an excessive amount of mail and parcels earlier on 

December 14 and 16, 2019. Appellant explained that when deadlines were not met, she faced the 

threat of discipline from her supervisor. She contended that the lack of leave replacement over the 

past 12 years put a big strain on her heart and body. Appellant indicated that she had previously 

filed a grievance regarding the denial of her Thanksgiving holiday leave. She asserted that she 

engaged in no strenuous hobbies or activities outside of her work. Appellant acknowledged that 

she previously smoked for roughly 21 years, almost 20 cigarettes a day, but that she stopped 

smoking. She indicated that she was never previously diagnosed with CAD. Appellant reiterated 

that on December 17, 2020 she worked through her shift despite feeling chest tightening and other 

symptoms and contended that she ultimately sustained a heart attack while working. She noted 

that she might not have been in the right frame of mind by the time she went home as she felt 

disoriented. Appellant indicated that her chest pain worsened and she called for medical assistance 

around 8:30 p.m. She asserted that she notified the employing establishment of her situation that 

evening via a text message. Appellant alleged that her postmaster told her not to worry about 

anything after her heart attack. 

In a May 14, 2020 statement, K.W., a coworker, alleged that the workload over the years 

significantly increased from the day she started working. She asserted that due to harassment and 

retaliation by management, there was more pressure added on carriers. K.W. indicated that the 

employees had previously filed “a class action” due to management’s improper behavior. She 

contended that there was a tremendous amount of stress and anxiety placed on carriers at work.

In a May 17, 2020 witness statement, another coworker, J.S., supported that appellant was 

stressed at work due to how the office was managed. She alleged that on the date of appellant’s 

heart attack, she saw their postmaster pushing a hamper full of parcels, which were due for delivery 

the next day, to appellant and asked her to deliver them. J.S., noted that appellant already had 

twice the normal volume. She also alleged that she had been previously overworked. J.S. further 

contended that leave requests were denied to some of her coworkers. 

In a May 21, 2020 report, Dr. Wallace noted that appellant presented to the emergency 

department on December 17, 2019 with evidence of acute coronary syndrome and complaints of 

ongoing chest discomfort, nausea, dizziness, and left arm discomfort after a day of heavy repetitive 

lifting, bending, pushing heavy equipment, as well as enduring the pressure to finish an excessive 

workload. He noted that her electrocardiogram (EKG) was abnormal with some ST-segment 

elevation in the anterolateral leads. Dr. Wallace indicated that appellant was diagnosed with 

anterior ST-segment elevation myocardial infarction and underwent both cardiac catheterization 

and other procedures including urgent coronary grafting. He noted that appellant continued to be 

treated for the following six months and received medication for CHF. Dr. Wallace opined that 

mental stress and anxiety as well as repetitive heavy lifting, pushing, and bending “could have 

contributed to” her heart attack and “could contribute to” the possibility of a future heart attack. 

He further concluded that, based on “her premature age of onset of cardiovascular disease,” work-
6

related stress was one of the contributing factors of appellant’s heart condition. Dr. Wallace found 

that appellant was totally incapacitated due to her heart condition.

On August 6, 2020 OWCP provided Dr. Wallace with a copy of the recent statement of 

accepted fact (SOAF) that discussed the accepted factors of appellant’s employment and requested 

that he submitted a narrative report addressing whether the accepted factors of her employment 

caused or contributed to her heart condition.

In an August 26, 2020 report, Dr. Wallace reiterated his findings and opinion in the 

May 21, 2020 report. He further diagnosed ischemic cardiomyopathy, CAD, and CABG, and 

myocardial infarction. Dr. Wallace again concluded that appellant was totally incapacitated. 

By decision dated October 15, 2020, OWCP denied appellant’s occupational disease claim, 

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

condition was causally related to the accepted factors of her federal employment.

LEGAL PRECEDENT

An employee seeking benefits under FECA2 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,3that 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.4 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.5

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.6 

2

Id.

3

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). 

4

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).

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

DeloresC.Ellyett, 41 ECAB 992 (1990).

6

S.C., Docket No. 18-1242 (issued March 13, 2019); R.H., 59 ECAB 382 (2008).
7

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

relationship is rationalized medical opinion evidence.7 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. 8

ANALYSIS

The Board finds that appellant has not met her burden of proof to establish a cardiac 

condition causally related to the accepted factors of her federal employment.

In an April 20, 2020 report, Dr. Wallace opined that stress from appellant’s federal 

employment “in all likelihood played a role, along with her other risk factors,” in premature 

development of her CAD. This report is speculative in nature. The Board has held that medical 

opinions that suggest that a condition was “likely” or “possibly” caused by work activities are 

speculative or equivocal in nature and have limited probative value.9 Thus, Dr. Wallace’s 

April 20, 2020 letter is of limited probative value and insufficient to meet appellant’s burden of 

proof.

Likewise, in his May 21, 2020 report, Dr. Wallace noted that appellant presented to the 

emergency department on December 17, 2019 with evidence of acute coronary syndrome after a 

day of heavy repetitive lifting, bending, pushing heavy equipment, as well as enduring the pressure 

to finish an excessive workload. He diagnosed anterior ST-segment elevation myocardial 

infarction and CHF. Dr. Wallace opined that mental stress and anxiety as well as repetitive heavy 

lifting, pushing, and bending “could have contributed to” her heart attack and “could contribute 

to” the possibility of a future heart attack. He concluded that work-related stress was one of the 

contributing factors of appellant’s heart condition based on her premature age of onset of 

cardiovascular disease. Similarly, in his August 26, 2020 report, Dr. Wallace reiterated his 

findings and opinion and further diagnosed cardiomyopathy, CAD, CABG, and myocardial 

infarction. As previously noted, the Board has held that medical opinions that are speculative or 

equivocal are of diminished probative value.10 Moreover, the Board has held that generalized 

statements do not establish causal relationship as they are unsupported by adequate medical 

rationale explaining the pathophysiologic mechanism by which the accepted employment duties 

caused, aggravated, or accelerated the employee’s diagnosed medical conditions.11 As such,

Dr. Wallace’s May 21 and August 26, 2020 reports are insufficient to establish appellant’s claim.

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

238 (1996).

8 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).

9

J.R., Docket No. 20-0903 (issued April22, 2021); J.W., Docket No. 18-0678 (issued March 3, 2020).

10 Id. 

11 See S.O., Docket No. 21-0002 (issued April29, 2021); A.P., Docket No. 19-0224 (issued July 11, 2019).
8

In December 17 and 20, 2019 and March 24, 2020 reports, Dr. Wallace provided multiple 

diagnoses including CHF, CAD, CABG, myopathy, and myocardial infarction, and indicated that 

appellant underwent several surgical procedures. However, he did not provide an opinion on 

causation. Similarly, Dr. London, in his December 19, 2019 and February 3, 2020 reports, 

diagnosed atherosclerotic coronary vascular disease, ST-segment elevation myocardial infarction, 

ejection fraction, and status post CABG. However, he also did not address the cause of her 

diagnosed conditions. Likewise, a December 24, 2019 discharge summary and a December 29, 

2019 progress report, Drs. Shetty and Behta diagnosed three-vessel CAD and bilateral plural

effusion. However, they did not provide an opinion on causation. The Board has held that medical 

evidence that does not offer an opinion regarding the cause of an employee’s condition is of no 

probative value on the issue of causal relationship.12 Therefore, this evidence is insufficient to 

meet appellant’s burden of proof. 

In a December 18, 2019 report, Dr. Crosland noted that appellant underwent right heart 

catheterization. However, he did not provide a medical diagnosis or reference the accepted 

employment factors in this report. Similarly, in his January 16 and March 19, 2020 reports,

Dr. Wallace noted that appellant presented for routine follow-up to her last hospitalization and 

cardiac evaluation but failed to provide a medical diagnosis or reference the accepted employment 

factors. The Board has held that medical reports which do not provide a firm diagnosis or fail to 

render an opinion on causal relationship are of no probative value and are insufficient to establish 

the claim.13 Thus, these reports are insufficient to establish appellant’s claim.

Appellant also submitted multiple diagnostic studies. The Board has held that diagnostic 

studies, standing alone, lack probative value on the issue of causal relationship, as they do not 

provide an opinion as to whether the employment incident caused any of the diagnosed 

conditions.14 Accordingly, these diagnostic studies are insufficient to establish appellant’s claim.

Lastly, appellant submitted a December 17, 2019 form report from an unidentifiable 

healthcare provider. The Board has held that reports that are unsigned or bear an illegible signature 

lack proper identification and cannot be considered probative medical evidence as the author 

cannot be identified as a physician.15 Therefore, this report is also insufficient to establish the 

claim.

As there is no rationalized medical evidence of record explaining how appellant’s accepted 

factors of her employment caused or aggravated her cardiac condition, the Board finds that she has 

not met her burden of proof.

12 R.I., Docket No. 21-0033 (issued May 18, 2021); E.G., Docket No. 20-1191 (issued April5, 2021); L.B., Docket 

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

13 C.D., Docket No. 20-0858 (issued November 30, 2020); A.K., Docket No. 20-0003 (issued June 2, 2020).

14 See K.C., Docket No. 20-1325 (issued May 5, 2021); C.B., Docket No. 20-0464 (issued July 21, 2020).

15 T.D., Docket No. 20-0835 (issued February 2, 2021); R.C., Docket No. 19-0376 (issued July 15, 2019); L.B., 

Docket No. 18-0533 (issued August27, 2018); Merton J. Sills, 39 ECAB 572, 575 (1988).
9

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 establish a cardiac 

condition causally related to the accepted factors of her federal employment.

ORDER

IT IS HEREBY ORDERED THAT the October 15, 2020 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: May 23, 2022

Washington, DC

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board