R.B. and Department of Veterans Affairs, Edward Hines, Jr. VA Hospital (Board decision, May 30, 2025)

ECAB remand decision. The Board set aside OWCP's denial and remanded for a specialist opinion on whether the work incident caused the fracture. Compensation eligibility remains unresolved. A party may petition the Board for reconsideration within 30 days of issuance unless this order specifies another period, under 20 C.F.R. § 501.7(a). FECA compensation decisions are generally not subject to court review under 5 U.S.C. § 8128(b).

Plain-English summary

A VA medical support assistant reported slipping in water at work and later received a left-foot fracture diagnosis. OWCP denied her claim. The Board found her physician's explanation linking the inversion injury to the fracture was not enough to establish compensation on its own, but did require further medical development. It set aside the denial and ordered a specialist opinion and new decision.

Decision snapshot

• Authority: Federal Employees' Compensation Act, 5 U.S.C. § 8101 et seq.
• Outcome: Injury denial set aside; fracture claim remanded for specialist review.
• Key point: A supported medical explanation can require further development even before it proves causation.

Full text (ECAB public release)

United States Department of Labor
Employees’ Compensation Appeals Board

____________
)
R.B., Appellant
)
)
and ) Docket No. 25-0404
) Issued: May 30, 2025
DEPARTMENT OF VETERANS AFFAIRS,
)
EDWARD HINES, JR. VA HOSPITAL,
)
Hines, IL, Employer
)
)

Appearances: Case Submitted on the Record
Alan J. Shapiro, Esq., for the appellant1
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 March 21, 2025 appellant, through counsel, filed a timely appeal from a February 28, 2025 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.

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.
ISSUE

The issue is whether appellant has met her burden of proof to establish a left ankle condition causally related to the accepted July 11, 2024 employment incident.

FACTUAL HISTORY

On July 17, 2024 appellant, then a 53-year-old advanced medical support assistant, filed a traumatic injury claim (Form CA-1) alleging that on July 11, 2024 she sustained an ankle injury when she slipped on a puddle of water, while in the performance of duty.

OWCP received an after-visit summary dated July 18, 2024 wherein Dr. Rebecca Kasa, an osteopathic physician specializing in family medicine, provided appellant with instructions for the medical treatment of, inter alia, her left hip pain and acute left knee and left ankle pain.

In a July 22, 2024 letter, the employing establishment controverted appellant’s claim, contending that she had not submitted rationalized medical evidence supporting causal relationship.

In a development letter dated July 22, 2024, OWCP informed appellant of the deficiencies of her claim. It advised her of the type of additional factual and medical evidence needed and provided a questionnaire for completion. OWCP afforded appellant 60 days to submit the necessary evidence.

OWCP subsequently received an investigative statement wherein appellant’s supervisor responded to questions regarding appellant’s claimed injury. It also received an official position description for an advanced medical support assistant and an April 7, 2024 notice of personnel action (Standard Form (SF) 50) which indicated that appellant’s work performance was at an acceptable level of competence.

Additionally, OWCP received medical evidence. In an after-visit summary dated August 8, 2024, Dr. David Snow, a Board-certified emergency medicine specialist, indicated that appellant was treated in the emergency department for an ankle injury. He noted that x-rays of the left ankle, left foot, and left hip were performed. Dr. Snow diagnosed acute left ankle pain and left hip pain. Appellant was provided discharge instructions for foot fracture.

In an August 15, 2024 attending physician’s report (Form CA-20a), Dr. Adam Schiff, a Board-certified orthopedic surgeon, indicated that on July 11, 2024 appellant slipped at work and reinjured her foot on August 8, 2024. He noted objective findings of tenderness to palpation at the left base of the fifth metatarsal and weight-bearing x-rays performed on August 15, 2024 showed proximal base of fifth metatarsal fracture. Dr. Schiff diagnosed left foot base fifth metatarsal Jones fracture. He advised that it was difficult to know whether the diagnosed condition was caused or aggravated by an employment activity because there were two different injury dates, and no imaging studies were performed after appellant’s first injury at work. Dr. Schiff opined that she was totally disabled from work as of August 10, 2024 and could return to modified work on October 30, 2024.

2
In an August 15, 2024 letter, Talia Jaramillo, a certified physician assistant, requested that appellant be excused from work. She noted that appellant was scheduled to undergo surgery on August 19, 2024.

In a follow-up development letter dated August 22, 2024, OWCP advised appellant that it had conducted an interim review, and the evidence remained insufficient to establish her claim. It noted that she had 60 days from the July 22, 2024 letter to submit the requested necessary evidence. OWCP further advised that if the evidence was not received during this time, it would issue a decision based on the evidence contained in the record.

In an undated response to OWCP’s August 22, 2024 letter, appellant recounted that on July 11, 2024, she slipped on water at work causing her to twist/roll her left ankle, left knee, left hip and left back area, but did not fall. She noted that on August 8, 2024 she was walking and pain shot up her foot and leg, causing her to fall. During this event appellant heard a popping/cracking in her left foot. Following treatment in the emergency department she was diagnosed with having breaks in her left foot, which were surgically repaired on August 19, 2024 by Dr. Schiff. Appellant claimed that she did not sustain a second injury or a reinjury on August 8, 2024, rather her condition was a result of the July 11, 2024 incident.

An August 15, 2024 left foot x-ray report provided a date of injury as August 8, 2024 and an impression of early healing proximal metaphysis fracture left fifth metatarsal with good expected anatomic alignment satisfactory for further healing, based on a comparison with an August 8, 2024 x-ray.

In an August 19, 2024 operative report, Dr. Schiff performed an open treatment of the left fifth metatarsal fracture on appellant and provided preoperative and postoperative diagnoses of left proximal fifth metatarsal fracture. In an employing establishment work capacity evaluation dated September 17, 2024, he indicated that appellant was temporarily totally disabled from work.

Ms. Jaramillo, in an August 29, 2024 letter, indicated that appellant was unable to return to work. She noted that appellant was recovering from her August 19, 2024 surgery and as a result she was unable to bear weight. In an after-visit summary of even date, Ms. Jaramillo noted that appellant presented for a postoperative evaluation of her August 19, 2024 left foot nondisplaced fracture of fifth metatarsal bone surgery. She related, inter alia, that appellant was restricted from weight bearing on the left lower extremity and unable to work at that time.

A September 13, 2024 left foot x-ray report provided an impression of interval screw fixation of transverse fracture at the base of the left fifth metatarsal with noted healing changes , based on a comparison with the August 15, 2024 x-ray.

By decision dated September 27, 2024, OWCP denied appellant’s traumatic injury claim, finding that the medical evidence of record was insufficient to establish causal relationship between her diagnosed left foot condition and the accepted July 11, 2024 employment incident.

On October 22, 2024 appellant, through counsel, requested an oral hearing before a representative of OWCP’s Branch of Hearings and Review. On October 25, 2024, OWCP converted the request to one for a review of the written record.

3
Appellant submitted an October 1, 2024 note, wherein Dr. Schiff recounted a history of the accepted July 11, 2024 employment incident and appellant’s medical treatment. Dr. Schiff noted that she continued to experience pain over the base of her fifth metatarsal and, on August 8, 2024, she was evaluated in the emergency department where she was diagnosed with having a left proximal fifth metatarsal fracture which resulted in an open reduction and internal fixation of left proximal fifth metatarsal.

Appellant also submitted an undated narrative from Dr. Farah Chaus, a Board-certified family practitioner. Dr. Chaus noted a history that on July 11, 2024 appellant slipped on a puddle of water. Initially, the injury appeared to be soft-tissue related and appellant’s symptoms were managed with pain medication. Dr. Chaus also noted a history that on August 8, 2024 appellant presented to the emergency department after experiencing sharp pain and a “crack” sound in her left foot while descending stairs. She indicated that diagnostic imaging revealed a minimally-distracted oblique bicortical fracture of the left fifth metatarsal diaphysis. Appellant was placed in a controlled ankle motion boot and later evaluated by Dr. Schiff on August 15, 2024, who diagnosed a Jones fracture and successfully performed surgery on August 19, 2024. Dr. Chaus maintained that the denial of appellant’s claim due to a lack of causal relationship between her July 11, 2024 work injury and subsequent fracture on August 8, 2024 did not fully consider the continuity of symptoms and the likely exacerbation of the initial injury. She noted that it was medically plausible that the initial trauma weakened the structural integrity of the left foot, making it more susceptible to further injury during routine activities, such as what occurred on August 8, 2024. Based on her longitudinal care of appellant as her primary care physician, she believed that the initial injury was a significant contributing factor to the eventual fracture, even if the fracture itself was not immediately apparent. Dr. Chaus concluded that appellant’s pain and limited function never fully resolved between the two incidents.

Following a hearing held on December 18, 2024 OWCP received additional medical evidence. In a progress note dated July 18, 2024, Dr. Kasa noted that appellant was seen on that date and she slipped and sustained an injury at work. She reported examination findings following a magnetic resonance imaging (MRI) scan of the brain for concerns of vision changes, leg weakness, and balance problems. Dr. Kasa provided an assessment of partially empty sella. However, she noted that appellant was unable to further describe the condition without dedicated pituitary imaging. Dr. Kasa noted that appellant was able to ambulate and had no injuries to the head.

On July 23, 2024 Dr. Chaus indicated on Dr. Kasa’s July 18, 2024 progress note that she had reviewed the progress note and agreed with her findings.

In an undated narrative, Dr. Chaus reiterated her prior opinion that appellant’s July 11, 2024 work-related incident caused her August 8, 2024 left foot fracture diagnosis. She noted that the mechanism of injury involved a sudden inversion of the foot, which exerted significant force on the lateral structures of the foot, including the fifth metatarsal bone. Dr. Chaus further noted that ankle inversion injuries commonly cause fractures when the force applied surpasses the bone’s ability to withstand stress. She maintained that in this specific case, the biomechanics of the rolling motion likely created torsional and bending forces on the metatarsal shaft. These forces would have concentrated at the weakest point of the bone, leading to the development of an oblique bicortical fracture. Dr. Chaus related that although soft-tissue injuries are often seen

4 in ankle inversion events, fractures can occur when there is a combination of rapid force transmission and improper load distribution across the foot. She concluded that the subsequent crack heard by appellant, as described during her emergency department visit, was consistent with an acute bone injury rather than soft-tissue damage alone.

By decision dated February 28, 2025, OWCP’s hearing representative affirmed the September 27, 2024 decision.

LEGAL PRECEDENT

An employee seeking benefits under FECA 3 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, 4 that 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. 5 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. 6

To determine whether a federal employee has sustained a traumatic injury in the performance of duty, it first must be determined whether fact of injury has been established. There are two components involved in establishing fact of injury. The first component is that the employee must submit sufficient evidence to establish that he or she actually experienced the employment incident at the time and place, and in the manner alleged. The second component is whether the employment incident caused an injury. 7

The medical evidence required to establish causal relationship between a claimed specific condition and an employment incident is rationalized medical opinion evidence. 8 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 incident. 9 Neither the mere fact that a disease or condition manifests itself during a 3 Supra note 1.
4
E.K., Docket No. 22-1130 (issued December 30, 2022); F.H., Docket No. 18-0869 (issued January 29, 2020);
J.P., Docket No. 19-0129 (issued April 26, 2019); Joe D. Cameron, 41 ECAB 153 (1989). 5 L.C., Docket No. 19-1301 (issued January 29, 2020); J.H., Docket No. 18-1637 (issued January 29, 2020); R.C., 59 ECAB 427 (2008); James E. Chadden, Sr., 40 ECAB 312 (1988). 6 P.A., Docket No. 18-0559 (issued January 29, 2020); K.M., Docket No. 15-1660 (issued September 16, 2016); Delores C. Ellyett, 41 ECAB 992 (1990). 7 T.H., Docket No. 19-0599 (issued January 28, 2020); K.L., Docket No. 18-1029 (issued January 9, 2019); John J. Carlone, 41 ECAB 354 (1989). 8 S.S., Docket No. 19-0688 (issued January 24, 2020); A.M., Docket No. 18-1748 (issued April 24, 2019); Robert G. Morris, 48 ECAB 238 (1996). 9 F.S., Docket No. 23-0112 (issued April 26, 2023); T.L., Docket No. 18-0778 (issued January 22, 2020);
Y.S., Docket No. 18-0366 (issued January 22, 2020); Victor J. Woodhams, 41 ECAB 345, 352 (1989).

5 period of employment, nor the belief that the disease or condition was caused or aggravated by employment factors or incidents is sufficient to establish causal relationship. 10

ANALYSIS

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

In an undated narrative, Dr. Chaus reiterated her prior opinion that appellant’s July 11, 2024 work-related incident caused her August 8, 2024 left foot fracture diagnosis. She noted that the mechanism of injury involved a sudden inversion of the foot, which exerted significant force on the lateral structures of the foot, including the fifth metatarsal bone. Dr. Chaus further noted that ankle inversion injuries commonly cause fractures when the force applied surpasses the bone’s ability to withstand stress. She maintained that in this specific case, the biomechanics of the rolling motion likely created torsional and bending forces on the metatarsal shaft. These forces would have concentrated at the weakest point of the bone, leading to the development of an oblique bicortical fracture. Dr. Chaus related that although soft-tissue injuries are often seen in ankle inversion events, fractures can occur when there is a combination of rapid force transmission and improper load distribution across the foot. She concluded that the subsequent crack heard by appellant, as described during her emergency department visit, was consistent with an acute bone injury rather than soft-tissue damage alone.

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 for the development of the evidence and to see that justice is done. 11

While the Board finds that Dr. Chaus’ opinion is insufficient to establish the claim, it is sufficient to require further development of the medical evidence. 12

The case shall therefore be remanded for further development of the medical evidence.
On remand, OWCP shall refer appellant, along with the case record, and a statement of accepted facts, to a specialist in the appropriate field of medicine for an opinion regarding causal relationship. If the physician opines that appellant’s conditions are not causally related to the accepted employment incident, he or she must provide a rationalized explanation as to why their opinion differs from those articulated by Dr. Chaus. After this and other such further development as deemed necessary, OWCP shall issue a de novo decision.

10
L.W., Docket No. 24-0947 (issued January 31, 2025); T.H., Docket No. 18-1736 (issued March 13, 2019); Dennis M. Mascarenas, 49 ECAB 215 (1997). 11 See A.K., Docket No. 20-1426 (issued March 8, 2021); 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). 12 See A.G., Docket No. 20-0454 (issued October 29, 2020); see A.K., id.; C.G., Docket No. 20-1121 (issued February 11, 2021); J.D., Docket No. 18-0279 (issued January 6, 2020); K.P., Docket No. 18-0041 (issued May 24, 2019); M.K., Docket No. 17-1140 (issued October 18, 2017); G.C., Docket No. 16-0666 (issued March 17, 2017); John J. Carlone, id.; Horace Langhorne, 29 ECAB 280 (1978).

6
CONCLUSION

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

ORDER

IT IS HEREBY ORDERED THAT the February 28, 2025 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: May 30, 2025
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

7