United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

P.H., Appellant 

and 

U.S. POSTAL SERVICE, BULK MAIL 

CENTER, Denver, CO, Employer 

__________________________________________ 

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Docket No. 15-0482 

Issued: August 4, 2015 

Appearances: Case Submitted on the Record

John S. Evangelisti, Esq., for the appellant 

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 December 30, 2014 appellant, through counsel, timely appealed the July 29, 2014 

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 the claim.2

ISSUE 

The issue is whether appellant sustained a consequential injury on March 24, 2000. 

 1

 5 U.S.C. §§ 8101-8193 (2006). 

2

 The case record provided to the Board includes evidence received after OWCP issued its July 29, 2014 decision. 

The Board is precluded from considering evidence that was not in the case record at the time OWCP rendered its 

final decision. 20 C.F.R. § 501.2(c)(1) (2014). 
2

FACTUAL HISTORY 

This case was previously before the Board. Appellant, a 60-year-old distribution clerk, 

has an accepted claim for post-traumatic stress disorder (PTSD) which arose on July 12, 1999 as 

a result of an altercation with her then supervisor.3 In October 1999 she resumed work at another 

facility with a different supervisor. 

On March 24, 2000 appellant asked Ed Loffredo, an attendance control supervisor, to 

sign a note she had written to remind herself which forms she needed to submit for her workers’ 

compensation claim.4

 He refused to sign the note. Appellant alleged that Mr. Loffredo yelled at 

her and waved his arms in a threatening manner and allegedly told appellant he did not care 

whether her paycheck was correct. She stated that she thought Mr. Loffredo was going to 

physically hurt her. Mr. Loffredo indicated that he kept his hands in his pockets and used a 

soothing voice as he explained to appellant why he would not sign her note. OWCP accepted 

that Mr. Loffredo refused to sign appellant’s personal note. However, appellant failed to 

establish that he waved his arms and yelled at her. 

A few hours after the March 24, 2000 incident, appellant was treated in the emergency 

room for acute anxiety reaction.5

 She did not report for work on March 25, 2000. Appellant 

filed various claims for wage-loss compensation beginning March 25, 2000. OWCP has 

adjudicated the March 24, 2000 incident as both a new traumatic injury and an occupational 

disease claim (xxxxxx296). Additionally, the claim has been adjudicated as a recurrence of 

appellant’s July 12, 1999 employment injury, and more recently, as a consequential injury of her 

employment-related PTSD.6

On two prior occasions, the Board addressed the issue of whether appellant sustained a 

consequential injury.7 When the Board last reviewed the merits in August 2012, it affirmed 

 3

 Appellant’s supervisor, Kristine L. Prusak, yelled at her, used profanity and was verbally abusive and 

threatening. OWCP accepted that on July 12, 1999 appellant had a heavy load of mail and she requested assistance 

from Ms. Prusak, who responded “Too bad.” Appellant later received some assistance, but she did not complete her 

assignment until after her lunch break. When Ms. Prusak returned, she yelled at appellant because appellant failed 

to advise her of the late dispatches. She also used profanity and verbally threatened appellant. Later that day, 

Ms. Prusak continued her verbal assault while appellant waited outside the operations manager’s office to report the 

earlier incident. Appellant contacted the postal service police. After taking statements, the police declined to 

intervene because they considered the incident an “administrative problem.” 

4

 Appellant’s March 24, 2000 note stated in relevant part: “I Daniel Kuenz ... along with Ed Lafreydo (sic) ... 

have instructed [appellant], she must fill out forms CA-7..., CA-20..., and CA-7a.... This will be done for each pay 

period of leave without pay for continuation of pay.” 

5

 The emergency room attending physician indicated that appellant’s condition was due to “a combination of not 

taking her medications ... and having an argument with her boss.” 

6

 The Board previously affirmed OWCP’s denial of appellant’s claimed recurrence of disability beginning 

March 25, 2000. Docket No. 04-1480 (issued December 30, 2005). At the time, counsel also argued that 

appellant’s work stoppage was the result of a March 24, 2000 consequential injury. However, OWCP had not yet 

issued a decision with respect to that particular issue. 

7

 Docket No. 08-1872 (issued June 2, 2009); Docket No. 11-1670 (issued August 16, 2012). 
3

OWCP’s May 16, 2011 decision denying compensation for a consequential injury. Counsel 

argued that the March 24, 2000 incident with Mr. Loffredo reawakened or triggered appellant’s 

memory of the July 12, 1999 altercation with her prior supervisor, and thus, aggravated her 

PTSD. However, the Board found that the medical evidence failed to establish a causal 

relationship between appellant’s original injury and the claimed consequential injury. The 

Board’s August 16, 2012 decision is incorporated herein by reference. 

Appellant’s counsel subsequently requested reconsideration and submitted additional 

evidence including treatment notes from appellant’s therapist, Virginia H. Poor, a licensed 

clinical social worker (LCSW). OWCP also received transcripts of two recent depositions. By 

decision dated April 23, 2013, it denied further merit review on the basis that evidence submitted 

was cumulative. The Board disagreed.8

On reconsideration, counsel had submitted the November 21, 2012 deposition of 

Dr. Randolph W. Pock, a Board-certified psychiatrist and OWCP-referral physician, who 

previously examined appellant in April 2010. In his deposition, Dr. Pock indicated that 

appellant’s interaction with Mr. Loffredo triggered her March 24, 2000 panic attack, which was a 

symptom of PTSD. He explained that the incident with Mr. Loffredo evoked memories of 

appellant’s initial injury, and under this theory, she suffered a consequential injury. 

Counsel also submitted the December 7, 2012 deposition of Dr. Carole S. Kornreich, a 

psychiatrist, who first treated appellant in January 2006. Dr. Kornreich indicated that the 

incident with Mr. Loffredo was one of several workplace events that reminded appellant of her 

prior injury. She explained that, when appellant returned to work, her original injury had not 

optimally resolved, and was constantly aggravated to the point where appellant just 

decompensated profoundly. 

The Board found that the recent depositions of Dr. Pock and Dr. Kornreich were relevant 

and pertinent new evidence not previously considered by OWCP. Therefore, appellant was 

entitled to merit review pursuant to 20 C.F.R. § 10.608(a). Accordingly, the Board remanded the 

case to OWCP for merit review and a determination of whether modification of the May 16, 

2011 decision was warranted. The Board’s May 6, 2014 decision is incorporated herein by 

reference. 

In a July 29, 2014 decision, OWCP found the evidence insufficient to modify its May 16, 

2011 decision. The senior claims examiner determined that neither Dr. Pock nor Dr. Kornreich 

adequately explained how an ostensibly nonthreatening interaction with a supervisor on 

March 24, 2000 resembled or symbolized the July 12, 1999 incident, thus, aggravating 

appellant’s PTSD. 

LEGAL PRECEDENT 

When an injury arises in the course of employment, every natural consequence that flows 

from that injury likewise arises out of the employment, unless it is the result of an independent 

 8

 Docket No. 13-2183 (issued May 6, 2014). 
4

intervening cause attributable to claimant’s own intentional misconduct.9

 Thus, a subsequent 

injury, be it an aggravation of the original injury or a new and distinct injury, is compensable if it 

is the direct and natural result of a compensable primary injury.10 The Board has recognized 

PTSD as a compensable consequential injury under circumstances where a certain triggering 

event has been medically demonstrated to have caused a reawakening or exacerbation of PTSD 

symptoms.11

Certain healthcare providers such as physician assistants, nurse practitioners, physical 

therapists, and social workers are not considered “physician[s]” as defined under FECA.12 

Consequently, their medical findings and/or opinions will not suffice for purposes of establishing 

entitlement to FECA benefits.13 A clinical psychologist may serve as a treating physician for a 

work-related emotional condition.14

ANALYSIS 

On appeal, counsel seeks to relitigate many of the issues and arguments addressed in 

prior decisions. As noted by the senior claims examiner, counsel requested that OWCP reverse 

all prior decisions denying wage-loss benefits due to a recurrence or consequential or intervening 

injury. However, OWCP correctly limited its analysis to the scope of the May 16, 2011 merit 

decision and the Board’s May 6, 2014 instructions on remand. Accordingly, the only issue 

currently before the Board is whether the latest findings from Drs. Pock and Kornreich 

demonstrate that appellant sustained a consequential injury on March 24, 2000.15

At OWCP’s request, Dr. Pock examined appellant on April 23, 2010. At that time, he 

diagnosed PTSD and found appellant totally disabled. Based on the information provided, 

including the statement of accepted facts (SOAF), Dr. Pock stated that he “[could not] find 

grounds for a consequential injury.” He explained that appellant’s ongoing symptoms 

represented a continuation of her July 12, 1999 PTSD. Appellant’s counsel deposed Dr. Pock on 

July 21, 2010. During the deposition, Dr. Pock did not specifically address whether appellant 

sustained a consequential injury on March 24, 2000. He explained that the cumulative effect of 

various life stressors, including the incident with Mr. Loffredo, contributed to appellant’s 

 9 Mary Poller, 55 ECAB 483, 487 (2004); 1 Arthur Larson & Lex K. Larson, The Law of Workers’ 

Compensation, 10-1 (2006). 

10 Susanne W. Underwood (Randall L. Underwood), 53 ECAB 139, 141 n.7 (2001). 

11 Charlet Garrett Smith, 47 ECAB 562 (1996). 

12 5 U.S.C. § 8101(2); 20 C.F.R. § 10.5(t). 

13 K.W., 59 ECAB 271, 279 (2007); David P. Sawchuk, 57 ECAB 316, 320 n.11 (2006). 

14 See 20 C.F.R. § 10.312; Federal (FECA) Procedure Manual, Part 2 -- Claims, Causal Relationship, Chapter 

2.805.3a(2) (January 2013). 

15 As noted, the Board previously affirmed OWCP’s May 16, 2011 decision based on the record as it existed at 

the time. Appellant’s counsel has not presented any compelling reasons for revisiting the Board’s prior findings as 

set forth in its August 16, 2012 decision. 
5

March 24, 2000 panic attack.16 However, Dr. Pock did not single out the March 24, 2000 

incident with Mr. Loffredo. He indicated that appellant’s adverse reaction to the incident with 

Mr. Loffredo was caused by her PTSD; however, the specific incident itself was not sufficient to 

cause her PTSD. When counsel deposed him for a second time on November 21, 2012, Dr. Pock 

indicated that appellant’s interaction with Mr. Loffredo triggered her March 24, 2000 panic 

attack, which was a symptom of PTSD. He noted that the incident with Mr. Loffredo evoked 

memories of appellant’s initial injury, and thus, she suffered a consequential injury. 

As noted, Dr. Pock had not previously singled out the incident with Mr. Loffredo as a 

triggering event of either appellant’s PTSD or her March 24, 2000 panic attack. He previously 

included the incident with Mr. Loffredo as one among several life stressors that cumulatively 

contributed to appellant’s March 24, 2000 panic attack. The November 21, 2012 deposition does 

not clearly explain the evolution of Dr. Pock’s opinion regarding the impact of the March 24, 

2000 incident with Mr. Loffredo. Dr. Pock did not explain how Mr. Loffredo’s refusal to sign 

appellant’s note evoked memories of her initial injury of July 12, 1999. 

Dr. Kornreich similarly failed to explain how the March 24, 2000 incident with 

Mr. Loffredo triggered and reminded appellant of her prior injury. It is not readily apparent how 

the March 24, 2000 incident was purportedly a triggering event of appellant’s PTSD. 

Consequently, the Board finds that Drs. Pock and Kornreich have not adequately explained the 

basis for their respective opinions on causal relationship.17 

The Board further notes that the August 2012 through April 2014 treatment records from 

appellant’s therapist, Virginia Poor, are insufficient to support her claim for FECA benefits. 

Ms. Poor is a LCSW, not a physician or psychologist.18

 16 Dr. Pock referred to various incidents/events identified in the April 1, 2010 SOAF that OWCP found were not 

directly related to appellant’s duties, and therefore, noncompensable. OWCP identified the July 12, 1999 incident 

with Ms. Prusak as the sole event considered to be related to appellant’s employment duties. As to the March 24, 

2000 incident with Mr. Loffredo, the SOAF indicated that he “refused to sign [appellant’s] personal note used as a 

reminder ... of steps required to file FECA forms....” This latter incident fell under the heading of events “NOT” 

considered to be directly related to the employee’s duties. According to the SOAF, appellant failed to establish that 

Mr. Loffredo “waved his arms and yelled at her when she persistently pursued his signature on personal notes.” 

Other noncompensable events included appellant having felt pressure to return to work on October 25, 1999, stress 

from completing and filing required OWCP forms, supervisors having lost or failed to submit her timecards, having 

been shorted on four paychecks between October 1999 and January 2000, the agency failing to process her 

continuation of pay and claims for compensation, inadequate training for new assignments, and management 

changing appellant’s work schedule. 

17 Causal relationship is a medical question that generally requires rationalized medical opinion evidence to 

resolve the issue. See Robert G. Morris, 48 ECAB 238 (1996). A physician’s opinion on whether there is a causal 

relationship between the diagnosed condition and the implicated employment factor(s) must be based on a complete 

factual and medical background. Victor J. Woodhams, 41 ECAB 345, 352 (1989). Additionally, the physician’s 

opinion must be expressed in terms of a reasonable degree of medical certainty, and must be supported by medical 

rationale, explaining the nature of the relationship between the diagnosed condition and appellant’s specific 

employment factor(s). Id.

18 See supra notes 13 and 14. 
6

Appellant bears the burden of establishing a causal relationship between her original 

injury and her claimed consequential injury, which she has failed to satisfy.19 Accordingly, the 

Board finds that OWCP properly denied modification of the May 16, 2011 decision. 

CONCLUSION 

Appellant failed to establish that she sustained a consequential injury on March 24, 2000, 

causally related to her July 12, 1999 employment injury. Therefore, her claimed disability 

beginning March 25, 2000 is not compensable. 

ORDER 

IT IS HEREBY ORDERED THAT the July 29, 2014 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: August 4, 2015 

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 

 19 Federal (FECA) Procedure Manual, Part 2 -- Claims, Causal Relationship, Chapter 2.805.7a (January 2013).