United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

P.S., Appellant 

and 

DEPARTMENT OF HOMELAND SECURITY, 

IMMIGRATION & CUSTOMS 

ENFORCEMENT, Cleveland, OH, Employer 

__________________________________________ 

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Docket No. 15-310 

Issued: April 6, 2015 

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

PATRICIA H. FITZGERALD, Deputy Chief Judge 

ALEC J. KOROMILAS, Alternate Judge 

JAMES A. HAYNES, Alternate Judge 

JURISDICTION 

On November 24, 2014 appellant, through counsel, filed a timely appeal from the 

October 17, 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 to review the merits of this case. 

ISSUE 

The issue is whether appellant’s December 22, 2013 heart attack was causally related to 

running on a treadmill in the course of his employment. 

FACTUAL HISTORY 

On December 30, 2013 appellant, a 53-year-old deportation officer, filed a traumatic 

injury claim alleging that he suffered a heart attack in the performance of duty on December 22, 

 1

 5 U.S.C. § 8101 et seq.
2

2013 while running on a treadmill in the fitness room. He went to the emergency room, where 

he had a coronary angiography and successful stenting of an occluded distal circumflex. 

Appellant was diagnosed with coronary atherosclerosis and a posterior wall myocardial 

infarction due to an occluded circumflex. 

In a decision dated February 18, 2014, OWCP denied appellant’s traumatic injury claim. 

It found that the work incident occurred as alleged and that appellant was in the course of 

employment. OWCP also found, however, that the medical evidence failed to provide a 

reasoned medical opinion on how appellant’s cardiac condition was causally related to the 

December 22, 2013 work incident. On February 24, 2014 appellant requested an oral hearing. 

Appellant submitted additional diagnostic test reports and progress notes. Dr. Ashoka 

Nautiyal, a Board-certified internist specializing in cardiovascular disease and interventional 

cardiology, addressed the issue of causal relationship stating: 

“The patient has filed a workman’s compensation claim, and wishes a statement 

as to whether the exercise that was required in the performance of his duties 

contributed to or caused his heart attack. My opinion is that he had, as is true in 

most cases with heart attacks, preexisting coronary artery disease. Whether his 

physical activity on the day of his heart attack caused the myocardial infarction is 

impossible to state for certainty. While it is true that many heart attacks occur 

under conditions that do not involve physical effort, it is also true that in some 

cases vigorous exercise may precipitate acute coronary insufficiency.” 

In a decision dated October 17, 2014, an OWCP hearing representative affirmed the 

denial of appellant’s traumatic injury claim. Although appellant had established that he was 

running on a treadmill on December 22, 2013 in the course of his employment, and although he 

had established the diagnoses of coronary atherosclerosis and myocardial infarction, appellant 

failed to establish the element of causal relationship. The hearing representative found that 

Dr. Nautiyal’s opinion was not provided with a reasonable degree of medical certainty. 

Dr. Nautiyal’s opinion was instead equivocal, as equal credence was given to the fact that heart 

attacks occur without any physical exertion, and appellant provided no other medical opinion on 

the issue of causal relationship. 

LEGAL PRECEDENT 

FECA provides compensation for the disability of an employee resulting from personal 

injury sustained while in the performance of duty.2

 An employee seeking benefits under FECA 

has the burden of proof to establish the essential elements of his or her claim. When an 

employee claims that he or she sustained an injury in the performance of duty, he or she must 

submit sufficient evidence to establish that he or she experienced a specific event, incident, or 

exposure occurring at the time, place, and in the manner alleged. He or she must also establish 

that such event, incident, or exposure caused an injury.3

 2

 5 U.S.C. § 8102(a). 

3 John J. Carlone, 41 ECAB 354 (1989). 
3

Causal relationship is a medical issue,4 and the medical evidence generally required to 

establish causal relationship is rationalized medical opinion evidence. The opinion of the 

physician must be based on a complete factual and medical background of the claimant,5

 must be 

one of reasonable medical certainty,6

 and must be supported by medical rationale explaining the 

nature of the relationship between the diagnosed condition and the established incident or factor 

of employment.7

ANALYSIS 

OWCP accepted that appellant was running on a treadmill in the fitness room on 

December 22, 2013 while in the course of his employment as a deportation officer. Appellant 

has, therefore, met his burden to establish that he experienced a specific event, incident, or 

exposure occurring at the time, place, and in the manner alleged. The question that remains is 

whether this incident caused or contributed to his heart attack. 

To support his claim, appellant submitted the opinion of Dr. Nautiyal, a specialist in 

cardiovascular disease, who explained that, while it was true that many heart attacks occur under 

conditions that do not involve physical effort, it was also true that in some cases vigorous 

exercise may precipitate acute coronary insufficiency. 

Dr. Nautiyal’s opinion was thus equivocal. He did not state with any degree of medical 

certainty whether running on a treadmill on December 22, 2013 caused or contributed to 

appellant’s heart attack. At best, Dr. Nautiyal opined that it was possible, as in some cases that 

vigorous exercise may precipitate acute coronary insufficiency. However, the question that 

needs to be answered in appellant’s case is more specific. 

Dr. Nautiyal observed that it was impossible to state with certainty whether there was a 

causal relationship. However, it is not necessary that the evidence be so conclusive as to suggest 

causal connection beyond all possible doubt. The evidence required is only that necessary to 

convince the adjudicator that the conclusion drawn is rational, sound, and logical.8

Because Dr. Nautiyal’s opinion on causal relationship was equivocal, the Board finds that 

it has little or no evidentiary value.9

 The Board, therefore, finds that appellant has not met his 

 4 Mary J. Briggs, 37 ECAB 578 (1986). 

5 William Nimitz, Jr., 30 ECAB 567, 570 (1979). 

6 See Morris Scanlon, 11 ECAB 384, 385 (1960). 

7 See William E. Enright, 31 ECAB 426, 430 (1980). 

8 Kenneth J. Deerman, 34 ECAB 641, 645 (1983) and cases cited therein at note 1. 

9 Philip J. Deroo, 39 ECAB 1294 (1988) (although the medical opinion of a physician supporting causal relationship 

does not have to reduce the cause or etiology of a disease or condition to an absolute medical certainty, neither can such 

opinion be speculative or equivocal); Jennifer Beville, 33 ECAB 1970 (1982) (statement of a Board-certified internist 

that the employee’s complaints “could have been” related to her work injury was speculative and of limited probative 

value). 
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burden to establish the critical element of causal relationship. The Board will affirm OWCP’s 

October 17, 2014 decision. 

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 his burden to establish that his December 22, 

2013 heart attack was causally related to running on a treadmill in the course of his employment. 

ORDER 

IT IS HEREBY ORDERED THAT the October 17, 2014 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: April 6, 2015 

Washington, DC 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board 

 

 James A. Haynes, Alternate Judge 

 Employees’ Compensation Appeals Board