United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

J.S., Appellant 

and 

DEPARTMENT OF DEFENSE, DEFENSE 

CONTRACT MANAGEMENT AGENCY, 

Pittsburgh, PA, Employer 

__________________________________________ 

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Docket No. 14-1878 

Issued: December 4, 2015 

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

CHRISTOPHER J. GODFREY, Chief Judge 

ALEC J. KOROMILAS, Alternate Judge 

JAMES A. HAYNES, Alternate Judge 

JURISDICTION 

On August 26, 2014 appellant, through counsel, filed a timely appeal from the July 16, 

2014 merit Office of Workers’ Compensation Programs (OWCP) decision. 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 established that he sustained a recurrence of disability 

on September 17, 2013 causally related to his August 2, 2010 injury. 

FACTUAL HISTORY 

On August 2, 2010 appellant, then a 57-year-old contract administrator, tripped over a 

computer cart and fell, hitting his head on a file cabinet. He stopped work on the date of injury. 

 1

 5 U.S.C. § 8101 et seq.
2

OWCP accepted the claim for a concussion with brief loss of consciousness, unspecified posttraumatic headache, and postconcussion syndrome. 

August 2, 2010 emergency room records diagnosed a fall with concussion and noted a 

history of a prior subdural hematoma. An August 2, 2010 computerized tomography (CT) scan 

of the brain revealed no acute intracranial injury. Initial reports beginning August 6, 2010 from 

appellant’s physician, Dr. W. Paul Slomiany, a family practitioner, noted treating appellant for 

headache after head trauma at work. He also noted conditions of diabetes, a previous subdural 

hematoma, depression, hypertension, and hyperlipidemia. Appellant returned to modified 

telework duty, four hours a day on October 18 and on December 20, 2010 he was released to 

regular, full-time duty. 

Appellant filed a claim for recurrence (Form CA-2a) on November 8, 2011 claiming that 

his headaches had generally subsided because of his pain medication, but that in October 2011 

the headaches began to return and the pain medication did not reduce the pain. He claimed that 

he had been working at his desk doing his work duties when his headaches became unbearable, 

he became dizzy, and was unable to concentrate. 

By decision dated January 11, 2012, OWCP accepted the recurrence claim and advised 

appellant to submit claims for any periods of disability and for any medical expenses associated 

with the recurrence. Appellant returned to work only four hours a day and was paid intermittent 

disability compensation from December 4, 2011 until his physician returned him to work full 

time on March 12, 2012 without restrictions. 

On September 17, 2013 appellant filed another claim for recurrence (Form CA-2a). In a 

September 17, 2013 statement, he indicated that, although he had been released to full duty on 

March 14, 2012, he continued to have headaches but they were controlled with pain but they 

were coming back again. Appellant was also losing concentration and was unable to 

comprehend what he was reading. He stated that he believed these were due to his continuing 

postconcussion syndrome. Appellant described the headaches as the same as those he had when 

he was first injured back on August 2, 2010. He denied any other injuries or illnesses.2

 

In a September 19, 2013 report, Dr. Slomiany recommended that appellant return to 

working only four hours a day. In a duty status report, also dated September 19, 2013, he 

described his clinical findings and noted a normal neurological examination. On September 20, 

2013 however, in an attending physician’s report, Dr. Slomiany diagnosed recurrent headaches, 

concentration impairment, and depression. He checked a box “yes” to indicate that the condition 

was employment related. Dr. Slomiany noted that the “headaches began after fall/head trauma at 

work on August, 21, 2010.” He also advised that appellant had trouble concentrating and 

significant depression. 

On September 19, 2013 appellant’s supervisor provided a timeline concerning appellant’s 

claim for recurrence. He noted that on September 16, 2013 appellant had submitted a post 

negotiation memorandum (PNM) for the supervisor’s review. The supervisor sent appellant an 

e-mail noting that the PNM was unsatisfactory and needed to be revised. (He noted that many 

 2

 Appellant also submitted CA-7 forms claiming wage-loss compensation. 
3

times leading up to and right after negotiations, which had been held on August 28, 2013, 

appellant had been reminded to complete the PNM prior to October 3, 2013 or the file would 

become overage and negatively impact the metrics.) Appellant was advised of the details of the 

deficiencies and was requested to have the revised PNM returned to the supervisor by close of 

business September 18, 2013. While he replied to the supervisor on September 17, 2013 that he 

understood and that he would correct the PNM, appellant filed his claim for recurrence on 

September 18, 2013 at 8:00 a.m. 

On September 24, 2013 Dr. Slomiany explained that, due to continued headaches and 

depression, appellant required hospitalization. He requested that appellant be excused from 

work. 

By letter dated September 26, 2013, OWCP advised appellant that it had received his 

claim for recurrence and advised him of the evidence that would be needed to establish his 

disability claim, including factual and medical evidence to establish that the work stoppage was 

caused either by: (1) a spontaneous change in the medical condition which resulted from the 

previous injury without an intervening injury or new exposure to factors causing the original 

illness, or by (2) a withdrawal of a light-duty assignment. A questionnaire was forwarded to 

appellant to complete. 

Appellant subsequently submitted September 24, 2013 emergency department records 

which noted his treatment for headaches and suicidal ideation. The records noted that he had 

suffered a previous head injury at age five. 

In a September 26, 2013 report, Dr. Rami Ausi, a neurologist, noted that appellant was 

hospitalized for persistent headache, worsening depression, and trouble concentrating. He 

reported that appellant had suffered a subdural hematoma in 1991 following head trauma. 

Dr. Ausi noted that appellant had headaches after the hematoma was evacuated, but that they 

became less frequent over time till they occurred only about once a week. Appellant denied 

headaches before 1991. Dr. Ausi related that in the last two or three months, appellant’s 

headaches had become constant and regularly occurred around 2:00 p.m. He mentioned that 

appellant had stress at work. Dr. Ausi noted that the MRI scans taken over the years did not 

establish a cause for the headaches and that appellant’s current CT scan was also unrevealing. 

He opined that appellant’s examination was normal but diagnosed chronic, constant, daily 

headaches with probable superimposed, analgesic rebound headaches from taking large doses of 

Tylenol and Aleve. 

On October 7, 2013 appellant returned the completed questionnaire. He explained that 

his headaches never went away, but they were controlled by pain medication. Appellant stated 

that on September 17, 2013 he was trying to meet deadlines for projects he was assigned but 

could not comprehend or concentrate on what he was reading. It brought on a severe headache 

and blurry vision. Appellant stated that it was the same headache he had when he was injured in 

2010 and his symptoms had remained since the injury. He described his daily work and stated 

that his workload had increased because of a personnel shortage and work deadlines. Appellant 

claimed that Dr. Ausi had told him that the increase in job duties and deadlines triggered his 

headaches and his postconcussion syndrome because the symptoms were the same as those he 

had at the time of his 2010 injury. He stated that Dr. Ausi had placed him on limited duty on 
4

September 19, 2013, working four hours a day. Appellant noted that he had been hospitalized on 

September 24, 2013 and released on September 26, 2013. He stated that he had no other injuries 

and no activities outside of work that could have affected his condition. 

In an October 21, 2013 report, Dr. Slomiany again described appellant’s history of injury 

and treatment. Appellant had sustained a subdural hematoma in 2002 from which he had 

recovered and that he had recently been hospitalized on September 24, 2013 for severe 

depression, suicidal thoughts, and headaches. A CT scan of the brain taken at the hospital 

showed a prior left craniotomy. Dr. Slomiany noted that appellant had improved after his 

hospitalization. Regarding the relationship between appellant’s disability and the original injury, 

he stated: “his headaches began after the fall and head trauma at work on August 2, 2010 and ... 

have been recurrent since that time.” Dr. Slomiany further believed that appellant’s depression 

developed “because of a concern regarding his recurrent headaches.” 

On October 23, 2013 appellant requested that his claim be expanded to include 

depression. He claimed that his ongoing, post-traumatic headaches brought on depression, and 

suicidal thoughts. 

In an October 30, 2013 decision, OWCP denied appellant’s claim for a recurrence. It 

found the medical evidence insufficient to establish that disability or the need for current medical 

treatment was due to a material change/worsening of his accepted work-related conditions. 

Appellant requested a telephonic hearing, which was held on May 13, 2014.3

 OWCP 

received medical evidence dating from 1993 related to his service-connected injuries. A July 23, 

2002 Veterans Affairs (VA) rating decision denied appellant’s claim for a service-connected 

subdural hematoma. OWCP indicated that he had served in the army from 1972 to 1974 and 

from 1976 to 1994. The decision noted that appellant had been treated by the VA for headaches, 

muscle weakness, and change in mental status from February 13, 1996 to June 17, 2002 and that 

he had been hospitalized for an acute subdural hematoma which had been found on an April 11, 

2002 CT scan. 

Dr. Slomiany referred appellant to Dr. Mark Hospodar, a neurologist. In his February 13, 

2014 report, Dr. Hospodar noted that appellant had post-traumatic headache. He indicated that 

appellant had sustained a significant concussion during military service, with memory loss, 

slowing of speech, and disrupted sleep. Dr. Hospodar advised that appellant’s concussion was 

not recent but was fairly significant. He examined appellant and determined that his condition 

was likely service connected but that would be difficult to prove. Dr. Hospodar related that 

appellant did not report his head injury when it occurred because he had been in combat 

commanding troops. He explained that appellant had a significant brain hemorrhage and a 

subdural hematoma for which he later had surgery. Dr. Hospodar noted that appellant’s 

February 13, 2014 examination did not reveal focality so he was not going to be referring 

 3

 At the hearing, appellant confirmed that he retired on January 31, 2014. He indicated that he did not know the 

origin of the 2002 subdural hematoma from which he recovered. Appellant attributed his depression to headaches 

that would not stop. He stated that he was suicidal, and was hospitalized on September 24, 2013 but all tests were 

negative. Since that time, appellant’s symptoms remained the same. He denied having a head injury when he was 

five years old. 
5

appellant for imaging, but he did recommend an electroencephalogram and cognitive testing and 

would use that to dictate further care. 

Dr. Hospodar, in a follow-up report dated March 21, 2014 found that appellant’s 

cognitive testing was clearly abnormal, with severe difficulty with memory, symbol fluency, and 

executive function was borderline. Overall, he found the probability of mild cognitive 

impairment to be 70 to 79 percent which he found quite significant. Dr. Hospodar prescribed 

medication and sent his report to Dr. Slomiany. 

Records from appellant’s September 2013 hospitalization for depression included a 

September 25, 2013 report from Dr. Jeanann McAllister, a Board-certified psychiatrist, who 

noted that appellant completed many military tours and had some brain damage with short-term 

memory loss. Dr. McAllister concluded that appellant had a subdural hematoma in 2001 with 

some short-term memory loss but was able to return to work and have a full career. 

Dr. McAllister diagnosed severe recurrent major depressive disorder, secondary to 

headache. In a September 26, 2013 discharge summary, she noted that appellant had been 

referred to the hospital by his primary physician because the physician believed appellant was 

suicidal. Dr. McAllister advised, however, that he denied any suicidal ideation and that he had 

just made some vague reference to “what’s the point of going on.” He stated that he would not 

ever say things so flippantly ever again. Appellant looked forward to going home. 

Dr. McAllister diagnosed mood dysthymia, and noted a Vietnam era injury with a history of a 

left craniotomy. She mentioned short-term memory problems, but found nothing acute. 

In a September 25, 2013 report, Dr. Slomiany noted that appellant had a history of 

hypertension, diabetes mellitus. He identified head trauma from the Gulf War, with a subdural 

hematoma in 1991. Appellant also had a head trauma at work, about three years earlier, when he 

hit his head on a file cabinet and developed postconcussive syndrome and recurrent headaches. 

Dr. Slomiany noted that appellant had been improved but recently began having increased 

headaches, difficulty concentrating. Appellant complained of feeling foggy, some blurry vision, 

having difficulty completing tasks, and suicidal thoughts. In reports dated October 8 and 31, 

2013, Dr. Slomiany diagnosed markedly improved depression and headaches. He stated that 

appellant could return to full-time work on November 4, 2013. 

In a May 15, 2014 attending physician’s report, Dr. Hospodar noted a history of injury 

which included a head injury in 2005 and a fall at work in 2010. He noted findings that included 

abnormal cognitive testing and poor memory. Dr. Hospodar opined, “clearly he has brain 

damage for multiple head traumas and is disabled now.” He diagnosed postconcussive syndrome 

and checked a box “yes” to indicate that appellant’s condition was employment related. 

In a May 16, 2014 mental health assessment, Dr. Howard Friday, a psychologist, 

diagnosed major depressive disorder, recurrent, unspecified. 

In a May 19, 2014 statement, appellant indicated that he was concerned about 

Dr. McAllister’s report, because he had not been serving in Vietnam in 1991. He served in the 

Gulf War in 1991. Appellant denied any head trauma in the Gulf War and also denied having a 

subdural hematoma in 1991. He denied Dr. McAllister’s statement that he had on-going 
6

headaches after 1991, and stated that his on-going headaches began only after his August 2, 2010 

work injury. Appellant explained that he had made an error in saying that he had not filed a VA 

claim. He looked through his records and remembered that he had filed a VA claim for an 

April 29, 2002 subdual hematoma but the claim was denied. Appellant noted that he returned to 

work after a month of recuperation from his subdural hematoma. He asserted that 

Dr. McAllister’s records and report were incorrect. 

In a June 3, 2014 attending physician’s report, Dr. Slomiany noted that appellant had a 

preexisting history of head trauma with craniotomy, head trauma in 2010, recurrent headaches 

and a history of depression. He stated that appellant’s headaches began after his fall at work in 

2010. Dr. Slomiany found that appellant had memory loss and trouble completing tasks which 

caused his job performance to suffer. Appellant decided to retire on January 31, 2014. 

Dr. Slomiany found that appellant was partially disabled from September 19 to 

November 3, 2013. 

In a June 18, 2014 report, Dr. Hospodar noted that medication did not help appellant very 

much. He stated that he believed appellant was still waiting for a decision on whether his head 

trauma was related to his military service. Dr. Hospodar reduced appellant’s medication and 

noted that appellant would continue to see Dr. Friday for psychological treatment of his 

depressive symptoms. 

By decision dated July 16, 2014, OWCP affirmed the October 30, 2013 decision denying 

the claimed recurrence beginning September 17, 2013. OWCP’s hearing representative also 

found that appellant did not establish that his depression was due to the accepted injury. 

LEGAL PRECEDENT 

Section 10.5(x) of OWCP’s regulations provide that a recurrence of disability means an 

inability to work after an employee has returned to work, caused by a spontaneous change in a 

medical condition which had resulted from a previous injury or illness without an intervening 

injury or new exposure to the work environment that caused the illness.4 

An individual who claims a recurrence of disability resulting from an accepted 

employment injury has the burden of establishing that the disability is related to the accepted 

injury. This burden requires furnishing medical evidence from a physician who, on the basis of a 

complete and accurate factual and medical history, concludes that the disabling condition is 

causally related to the employment injury and who supports that conclusion with sound medical 

reasoning.5 

Appellant has the burden of establishing that he sustained a recurrence of a medical 

condition6

 that is causally related to his accepted employment injury. To meet his burden, he 

must furnish medical evidence from a physician who, on the basis of a complete and accurate 

 4

 20 C.F.R. § 10.5(x); see Theresa L. Andrews, 55 ECAB 719 (2004). 

5 Dennis E. Twardzik, 34 ECAB 536 (1983); Max Grossman, 8 ECAB 508 (1956); 20 C.F.R. § 10.104. 

6

 20 C.F.R. § 10.5(y). 
7

factual and medical history, concludes that the condition is causally related to the employment 

injury and supports that conclusion with sound medical rationale.7 Where no such rationale is 

present, the medical evidence is of diminished probative value.8 

The general rule respecting consequential injuries is that, when the primary injury is 

shown to have arisen out of and in the course of employment, every natural occurrence that 

flows from the injury is deemed to arise out of the employment, unless it is the result of an 

independent intervening cause, which is attributable to the employee’s own intentional conduct.9 

The subsequent injury is compensable if it is the direct and natural result of a compensable 

primary injury.10 With respect to consequential injuries, the Board has stated that, where an 

injury is sustained as a consequence of an impairment residual to an employment injury, the new 

or second injury, even though nonemployment related, is deemed, because of the chain of 

causation, to arise out of and in the course of employment and is compensable.11 A claimant 

bears the burden of proof to establish the claim for consequential injury.12 

ANALYSIS 

OWCP accepted appellant’s claim for concussion with brief loss of consciousness, posttraumatic headaches, and postconcussion syndrome. Appellant first returned to regular duty on 

December 20, 2010. OWCP later accepted his claim for an October 17, 2011 recurrence. 

Appellant was released to full duty on March 12, 2012. He subsequently claimed a recurrence of 

disability beginning September 17, 2013, noting that he could no longer perform his full-time 

duties because of his accepted conditions. 

The Board finds that appellant has failed to establish a recurrence of disability as of 

September 17, 2013. No medical opinion has been submitted containing a rationalized 

explanation as to how appellant’s disability on September 17, 2013 was directly related to 

his August 2, 2010 fall at work. The need for a rationalized opinion on causal connection 

is crucial in this case because of appellant’s serious preexisting head injury. 

In support of his claim, appellant submitted reports from Dr. Slomiany. On 

September 19, 2013 Dr. Slomiany opined that appellant should work only four hours a day due 

to worsening headaches and a previous head injury. However, he noted a normal neurological 

examination. This report fails to clearly establish the recurrence due to the 2010 accepted work 

injury. 

 7 Ronald A. Eldridge, 53 ECAB 218 (2001). 

8 Mary A. Ceglia, 55 ECAB 626 (2004); Albert C. Brown, 52 ECAB 152 (2000). 

9 Albert F. Ranieri, 55 ECAB 598 (2004). 

10 Id.; Carlos A. Marrero, 50 ECAB 117 (1998); A. Larson, the Law of Workers’ Compensation § 10.01 (2005). 

11 Kathy A. Kelley, 55 ECAB 206 (2004); see also C.S., Docket No. 11-1875 (issued August 27, 2012). 

12 S.P., Docket No. 14-900 (issued August 8, 2014). 
8

In a September 20, 2013 attending physician’s report, Dr. Slomiany diagnosed recurrent 

headaches, concentration impairment, and depression. He checked a box “yes” to show that he 

believed the condition was employment related noting that the “headaches began after fall/head 

trauma at work on August 21, 2010.” The Board has held, however, that the checking of a box 

“yes” in a form report, without additional explanation or rationale, is not sufficient to establish 

causal relationship.13 

Dr. Slomiany did not explain how the diagnosed symptoms were related to the accepted 

work injury rather than to appellant’s preexisting conditions. In his September 24 and 25, 2013 

reports, he advised that appellant could not work because of continued headaches and 

depression. However, Dr. Slomiany did not explain how the August 2, 2010 work injury was the 

cause of these conditions. The Board has long held that medical opinions not containing 

rationale on causal relation are entitled to little probative value and are generally insufficient to 

meet appellant’s burden of proof.14 

In his October 21, 2013 report, Dr. Slomiany described appellant’s history, which 

included a subdural hematoma in 2002 from which appellant had recovered. He opined that 

appellant’s deteriorating condition was due to the work incident because his headaches did not 

begin until after his fall at work, and had continued thereafter. Dr. Slomiany further found that 

appellant’s depression developed as a result of the recurrent headaches. The Board has held that 

the mere fact that a condition manifests itself during a period of employment does not raise an 

inference that there is a causal relationship between the two.15 Dr. Slomiany provided no 

medical rationale to explain why appellant had a spontaneous change in his accepted conditions 

on September 17, 2013 and how that change in his condition resulted from the August 2, 2010 

injury. 

Likewise, Dr. Slomiany’s June 3, 2014 attending physician’s report stated that appellant’s 

headaches began after the fall at work on August 2, 2010. He did not provide medical reasoning 

explaining the specific connection between the period of disability beginning September 17, 

2013 and the August 2, 2010 injury other than noting that headaches began after that fall. Other 

reports from Dr. Slomiany are also insufficient to establish the claim because they fail to discuss 

in detail causal relationship. 

In a May 15, 2014 attending physician’s report, Dr. Hospodar checked a box “yes” to 

support causal relationship and opined that: “clearly he has brain damage for multiple head 

traumas and is disabled now.” However, checking the box “yes” in a form report, without 

additional explanation or rationale, is not sufficient to establish causal relationship.16 The other 

reports from Dr. Hospodar do not clearly establish that appellant’s disability on and after 

September 17, 2013 was a spontaneous change in his previously accepted conditions. 

 13 See Barbara J. Williams, 40 ECAB 649, 656 (1989). 

14 Carolyn F. Allen, 47 ECAB 240 (1995). 

15 See Joe T. Williams, 44 ECAB 518, 521 (1993). 

16 Supra note 14. 
9

While Dr. McAllister treated appellant for depression and headaches, she did not offer an 

opinion on causal relationship between the recurrence of disability and the August 2, 2010 

injury. Likewise, Dr. Ausi’s September 26, 2013 report noted appellant’s history and findings 

but failed to discuss causal relationship. 

Accordingly, the Board finds that appellant has failed to meet his burden of proof to 

establish a recurrence of disability beginning September 17, 2013. 

The Board further finds that appellant has not submitted sufficient medical evidence to 

establish depression as a consequence of his accepted conditions. Appellant has also failed to 

submit reasoned medical evidence establishing the connection between the August 2, 2010 

employment injury and his depression. His medical record reflects a preexisting history of 

depression.17 

In his September 20, 2013 report, Dr. Slomiany diagnosed several conditions, to include 

depression, and checked a box “yes” to indicate that the condition was employment related. 

This, without additional explanation or rationale, is not sufficient to establish causal 

relationship.18 

In his October 21, 2013 report, Dr. Slomiany concluded that appellant’s diagnosed 

depression developed from his concern over his recurrent headaches. He did not provide 

medical reasoning to explain how depression was a consequence of the accepted 2010 work 

injury. Other reports from Dr. Slomiany either did not address the cause of appellant’s 

depression or likewise did not provide medical reasoning to explain its relationship to the 2010 

employment injury. 

Dr. McAllister in her September 25, 2013 report noted that appellant had a subdural 

hematoma in 2001 with some short-term memory loss, but she found him able to work and have 

a full career. She diagnosed depressive disorder secondary to headache. Although she attributed 

appellant’s depression to headaches, Dr. McAllister failed to explain with any specificity how 

appellant’s depression was a consequence of the accepted August 2, 2010 work incident. Her 

September 26, 2013 discharge summary did not address whether the work injury caused or 

contributed to his depression. 

Other medical evidence of record is also insufficient to establish depression as a 

consequence of the August 2, 2010 work injury because these reports do not contain a 

physician’s opinion clearly supporting that the work injury contributed to appellant’s diagnosed 

depression.19

 17 Although appellant asserted that he had no prior history of depression, Dr. Slomiany’s initial reports, beginning 

August 6, 2011, indicated that appellant had been treated for depression which he did not find to be work related. 

18 Supra note 14. 

19 See Jaja K. Asaramo, 55 ECAB 200 (2004) (medical evidence that does not offer any opinion regarding the 

cause of an employee’s condition is of diminished probative value on the issue of causal relationship). 
10

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 established that he sustained a recurrence of 

disability on September 17, 2008 causally related to his August 2, 2010 injury. 

ORDER 

IT IS HEREBY ORDERED THAT the July 16, 2014 decision of the Office of 

Workers’ Compensation Programs is affirmed.20 

Issued: December 4, 2015 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Boar 

 20 James A. Haynes, Alternate Judge, participated in the original decision but was no longer a member of the 

Board effective November 16, 2015.