United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

D.D., claiming as widow of T.D., Appellant 

and 

TENNESSEE VALLEY AUTHORITY, 

HARTSVILLE NUCLEAR PLANT, 

Hartsville, TN, Employer 

__________________________________________ 

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Docket No. 13-1828 

Issued: March 19, 2014 

Appearances: Case Submitted on the Record

Appellant, pro se 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

COLLEEN DUFFY KIKO, Judge 

ALEC J. KOROMILAS, Alternate Judge 

JAMES A. HAYNES, Alternate Judge 

JURISDICTION 

On August 1, 2013 appellant timely appealed the March 27, 2013 merit decision and the 

June 18, 2013 nonmerit 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 the survivor’s claim.2

ISSUES 

The issues are: (1) whether appellant established that the employee’s death was causally 

related to his September 23, 1980 accepted lumbar injury; and (2) whether OWCP properly 

declined to reopen appellant’s case for merit review under 5 U.S.C. § 8128(a). 

 1

 5 U.S.C. §§ 8101-8193 (2006). 

2

 OWCP also granted posthumous schedule awards on March 12, 2012 and June 19, 2013, totaling 11 percent 

right lower extremity impairment. See 5 U.S.C. § 8109. Appellant has not appealed OWCP’s June 19, 2013 

schedule award decision. See 20 C.F.R. § 501.3(c) (2012). 
2

FACTUAL HISTORY 

The decedent-employee, a former ironworker, injured his lower back in the performance 

of duty on September 23, 1980.3

 OWCP accepted his claim for lumbosacral sprain, aggravation 

of spondylolisthesis and aggravation of displaced lumbar intervertebral disc. The employee 

underwent lumbar laminectomies with fusion in 1991 and 1999. He last worked in 

December 2003 as a correctional officer with the Tennessee Department of Corrections. In 

February 2004, the employee underwent an OWCP-approved surgical procedure to address 

complications that arose as a result of his prior lumbar surgery.4 

OWCP paid wage-loss compensation for temporary total disability (TTD) beginning 

December 11, 2003 and placed the employee on the periodic compensation rolls effective 

March 21, 2004. He filed a claim (Form CA-7) for a schedule award in October 2011. 

However, OWCP did not process the schedule award at that time because the employee was 

already receiving FECA wage-loss compensation. 

The employee passed away on December 14, 2011, at the age 58.5

 The death certificate 

identified the immediate cause of death as acute coronary syndrome due to coronary artery 

disease. Morbid obesity and chronic pain syndrome -- backache were listed as other significant 

conditions contributing to death, but were not the underlying cause. An autopsy was not 

performed. 

Just two days prior to his death, the employee was treated by Curry L. Dudley, a nurse 

practitioner with Tennessee Physical Medicine and Pain management. His chief complaint at the 

time was back pain. The December 12, 2011 pain management progress notes are specific to 

appellant’s lumbar complaints and do not mention a history of coronary artery disease or any 

other nonorthopedic conditions. 

On March 14, 2012 appellant, the decedent-employee’s widow, filed a survivor’s claim 

(Form CA-5). She attributed her husband’s death to his back injury and the multiple surgeries he 

had undergone as a result. Appellant also indicated that her husband participated in pain 

management and had been prescribed strong medications for a lengthy period. 

In a report dated March 14, 2012, Dr. Hanna C. Ilia, a Board-certified family practitioner, 

noted a history of back injury which caused chronic back pain.6

 He also noted that the employee 

had been treated with narcotic pain medication. Dr. Ilia listed acute coronary syndrome 

secondary to coronary artery disease as the direct cause of death. He further noted that the 

 3

 The employee slipped climbing steps, but avoided falling. 

4

 Appellant developed a pseudomeningocele at L5, which OWCP accepted as disorder of meninges (ICD-9 

No. 349.2). 

5

 The employee received compensation for TTD through December 14, 2011. Afterwards, OWCP paid appellant 

compensation based on a posthumous schedule award, which covered the period December 18, 2011 to July 27, 

2012 (31.68 weeks). 

6

 Dr. Ilia, who also signed the December 21, 2011 death certificate, is Board-certified in family medicine. 
3

employee’s chronic back pain prohibited him from certain activities. This resulted in significant 

weight gain, which put extra strain on his heart. Dr. Ilia explained that while the employee’s 

death was not directly caused by his back injury, chronic back pain contributed to his morbid 

obesity. Also, the employee’s use of large amounts of narcotics compromised his 

cardiopulmonary function. 

On July 11, 2012 the district medical adviser (DMA) reviewed the record and advised 

that the employee’s death was unrelated to his accepted orthopedic conditions. He noted that the 

employee died at home on December 14, 2011 due to acute coronary syndrome as a consequence 

of coronary artery disease, which was exacerbated by morbid obesity. The DMA stated that 

chronic pain syndrome/back pain was not causally related to acute coronary syndrome or 

coronary artery disease. 

OWCP referred the case for a second opinion evaluation. In a September 10, 2012 

report, Dr. Raye L. Bellinger, Board-certified in internal medicine with a subspecialty in 

cardiovascular disease, reviewed the employee’s medical records and found no causal 

relationship between his death and his accepted employment injury. He noted that the employee 

was last seen on December 12, 2011 for complaints of back pain. The employee’s pain was 

noted to be adequately controlled and his condition was unchanged. At the time, he was being 

treated with opioid therapy and his physical examination was unremarkable. Dr. Bellinger noted 

that there was no mention of chest discomfort or other cardiovascular-related symptoms during 

the December 12, 2011 examination. The employee had been advised to return in one month, 

but he expired two days later. Dr. Bellinger noted that the December 14, 2011 cause of death 

was identified as acute coronary syndrome/coronary artery disease. 

On the issue of causal relationship, Dr. Bellinger indicated that there was no evidence 

that the employee had recurrent chest discomfort or had been diagnosed with coronary artery 

disease. He also noted that the medical records revealed no evidence of any concomitant 

high-risk clinical features such as diabetes mellitus or hyperlipidemia. There was also no 

evidence that the employee had excessive weight gain, development of hypertension or 

worsening of underlying hyperlipidemia on the basis of his back pain. Moreover, medical 

records did not document any other significant risk factors for coronary artery disease. 

Dr. Bellinger indicated that the most likely etiology for the employee’s development of coronary 

disease was genetic predisposition. He stated that there was no evidence that the employee’s 

accepted injury caused, aggravated or contributed to the development of coronary artery disease 

given the lack of comorbid medical conditions. 

In a September 20, 2012 decision, OWCP denied appellant’s claim based on her failure to 

establish a causal relationship between the employee’s December 14, 2011 death due to acute 

coronary syndrome -- heart attack -- and his September 23, 1980 employment-related lumbar 

injury. 

Appellant requested an oral hearing. She also submitted her deceased husband’s medical 

records from Tennessee Heart & Vascular Institute and Hometown Healthcare, which covered 

the period March 2009 to December 2011. 
4

A March 2, 2009 cardiac computerized tomography angiogram (CTA) revealed 

potentially significant coronary disease with an 89 percent likelihood of a flow-limiting lesion. 

Cardiac catheterization was suggested. The CTA report also noted that the employee had 

excessive atherosclerosis which reportedly began 7 to 12 years prior. Without proper treatment, 

the 10-year risk of a serious event would reportedly increase from 22 to 85 percent. The 

employee’s plaque was predominantly soft (lipid laden), therefore, a more aggressive cholesterol 

lowering therapy was suggested. 

In reports dated July 28, 2009 and March 9, 2010, Dr. Jung H. Lee, Board-certified in 

cardiovascular disease, diagnosed moderate coronary artery disease, lipids and hypertension. 

Dr. Donald J. Russo, a Board-certified internist with a subspecialty in cardiovascular disease, 

examined the employee on November 30, 2010 and provided the same diagnoses as his 

colleague, Dr. Lee. However, he also diagnosed borderline diabetes mellitus. 

On February 4, 2011 the employee began a weight management program. At that time, 

he weighed 300.6 pounds. The treatment records also revealed a family history of coronary 

artery disease as wells as a cigarette smoking history. When the employee was seen on 

November 15, 2011, he reported smoking only one cigarette a week. His nonorthopedic 

diagnoses in the month preceding his death included hypertension, hypogonadisim, Vitamin D 

deficiency, subclinical hypothyroidism and hyperlipidemia. Also, the employee was 6’1” tall 

and weighed 303 pounds when examined on November 15, 2011. 

By decision dated March 27, 2013, the hearing representative affirmed OWCP’s 

September 20, 2012 decision. She found that Dr. Bellinger’s second opinion evaluation 

represented the weight of the evidence. 

On May 28, 2013 appellant requested reconsideration. She submitted medical literature 

about known side effects associated with her deceased husband’s prescribed medications.7

On June 18, 2013 OWCP denied appellant’s request for reconsideration without 

revisiting the merits of the survivor’s claim. 

LEGAL PRECEDENT 

FECA provides for the payment of compensation for the disability or death of an 

employee resulting from personal injury sustained while in the performance of duty.8

 Appellant 

has the burden of proving by the weight of the reliable, probative and substantial evidence that 

the employee’s death was causally related to his employment.9

 This burden includes the 

necessity of furnishing rationalized medical opinion evidence demonstrating a causal 

relationship.10 The physician’s opinion must be based on a complete factual and medical 

 7

 Appellant obtained the information from WebMD.com and the Mayo Clinic’s Web site. 

8

 5 U.S.C. §§ 8102(a) and 8133. 

9 L.R., 58 ECAB 369, 375 (2007). 

10 Id.
5

background, must be expressed in terms of a reasonable degree of medical certainty and must be 

supported by medical rationale explaining the relationship between the employee’s death and his 

previous employment.11

ANALYSIS 

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

Dr. Ilia, who signed the December 21, 2011 death certificate, mentioned morbid obesity 

and chronic pain syndrome -- backache. He indicated that the employee’s back pain contributed 

to his morbid obesity, which in turn placed strain on his heart. Dr. Ilia also indicated that large 

amounts of narcotic pain medication compromised the employee’s cardiopulmonary function. 

Both factors were part of the employee’s medical condition at the time of his death from acute 

coronary syndrome and coronary artery disease. 

Neither the death certificate nor Dr. Ilia’s March 14, 2012 report included specific 

information regarding injury-related weight gain, narcotic usage or even a prior history of 

coronary artery disease. An autopsy was not performed and Dr. Ilia otherwise failed to provide a 

basis for his findings. Under the circumstances, OWCP properly referred the case to the DMA 

and subsequently to Dr. Bellinger. 

The DMA and Dr. Bellinger both found that there was no relationship between the 

employee’s December 14, 2011 death from acute coronary syndrome/coronary artery disease and 

his September 23, 1980 employment-related lumbar condition. Dr. Bellinger’s September 10, 

2012 opinion noted the absence of medical documentation of coronary artery disease. He could 

not physically examine the employee and there were no autopsy findings. Dr. Bellinger, a 

cardiologist, relied on the evidence provided by OWCP on the accepted orthopedic condition. 

Since the time Dr. Bellinger reviewed the case record, appellant provided additional 

medical records regarding her deceased husband’s nonorthopedic conditions, which included 

coronary artery disease, hypertension and hyperlipidemia. Rather than refer the additional 

evidence to Dr. Bellinger for review, the hearing representative continued to rely on his 

September 10, 2012 opinion despite the existence of additional relevant evidence. 

The burden lies with appellant to establish her entitlement to benefits. Once OWCP 

undertakes development of the record, it must do a complete job in procuring medical evidence 

that will resolve the relevant issues in the case.12 Because there was additional potentially 

relevant evidence added to the records, OWCP should seek further information and clarification 

from Dr. Bellinger.13 Consequently, the case shall be remanded for further development. After 

OWCP has developed the record to the extent it deems necessary, a de novo decision shall be 

issued. 

 11 Id.

12 Richard F. Williams, 55 ECAB 343, 346 (2004). 

13 See Federal (FECA) Procedure Manual, Part 3 -- Medical, OWCP Directed Medical Examinations, Chapter 

3.500.3f(2)(a) (July 2011). 
6

CONCLUSION 

The case is not in posture for decision.14

ORDER 

IT IS HEREBY ORDERED THAT the June 18 and March 27, 2013 decisions of the 

Office of Workers’ Compensation Programs are set aside. The case is remanded for further 

action consistent with this decision of the Board. 

Issued: March 19, 2014 

Washington, DC 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board 

 

 James A. Haynes, Alternate Judge 

 Employees’ Compensation Appeals Board 

 14 Given the Board’s disposition of the merits of the survivor’s claim, the question of the propriety of OWCP’s 

June 18, 2013 nonmerit decision is moot.