United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

S.C., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Westbury, NY, Employer 

__________________________________________ 

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Docket No. 16-0002 

Issued: November 25, 2015 

Appearances: Case Submitted on the Record

Appellant, pro se 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

CHRISTOPHER J. GODFREY, Chief Judge 

ALEC J. KOROMILAS, Alternate Judge 

VALERIE D. EVANS-HARRELL, Alternate Judge 

JURISDICTION 

On October 2, 2015 appellant timely appealed the September 21, 2015 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 this case. 

ISSUE 

The issue is whether appellant sustained an injury in the performance of duty on 

February 16, 2015. 

FACTUAL HISTORY 

On February 23, 2015 appellant, then a 69-year-old sales, services, and distribution 

associate, filed a traumatic injury claim (Form CA-1) for an unspecified injury. He claimed to 

have been injured while outside unloading a truck on the dock. Appellant described it as a “full 

and heavy load,” and also noted that it was very cold outdoors, “may be (sic) negative degrees.” 

 1

 5 U.S.C. § 8101 et seq. 
2

On the Form CA-1 the employing establishment indicated that appellant was unloading a truck in 

extreme cold weather when he began to feel faint. 

OWCP received a February 17, 2015 discharge notice indicating that appellant had been 

admitted the previous day. There was no additional information regarding a diagnosis and/or 

specific treatment received. Appellant also submitted two February 17, 2015 prescriptions. One 

prescription was for aspirin, and the other was for Simvastatin. 

On February 25, 2015 OWCP advised appellant that the evidence received thus far was 

insufficient to support his traumatic injury claim. It afforded him at least 30 days in which to 

submit additional factual information regarding the alleged employment incident, as well as 

additional medical evidence regarding his claimed condition(s). 

OWCP subsequently received emergency medical services (EMS) records, as well as 

hospital (Nassau University Medical Center -- NUMC) records regarding appellant’s 

February 16 to 17, 2015 admission. 

An EMS crew encountered appellant at 8:32 a.m. on February 16, 2015. Appellant’s 

chief complaint was “[syncope - I am dizzy]”. His symptoms included dizziness, general 

weakness, lightheadedness, fatigue, and syncope. When EMS arrived appellant was sitting in a 

chair complaining of dizziness and weakness of a few minutes duration. Appellant advised EMS 

that he had been outside in the cold lifting boxes. He denied having lost consciousness. 

Appellant also denied shortness of breath, chest pain, nausea/vomiting, and trauma. The EMS 

report further noted that appellant presented with cool and pale skin, bradycardia, and 

hypotension. Although the initial electrocardiogram results showed bradycardia, appellant’s 

heart rate soon returned to normal sinus rhythm. The EMS report also noted that he stated that 

he felt much better after having a bowel movement. Additionally, appellant denied any prior 

medical history, medications, or allergies. He was transported without incident. Appellant 

arrived at NUMC emergency department at 9:10 a.m. By then he had no complaints. 

Appellant’s diagnosis was presyncope. 

The NUMC treatment records noted that appellant had complained of dizziness and 

tingling in both hands. Appellant was identified as a 68-year-old male who had been at work 

unloading a mail truck. He reported that it was very cold and the boxes were heavy. Appellant 

began feeling numbness in both hands, and then dizziness. He reportedly went inside and laid 

down. EMS informed the hospital staff that when they first encountered appellant he was 

bradycardia in the forties and hypotensive in the sixties. Appellant then went to the bathroom 

and had a bowel movement, and afterwards appellant began to feel better. By the time he arrived 

at the hospital, he was asymptomatic. 

There was some question as to whether appellant lost consciousness. Appellant denied it, 

but his wife advised the hospital staff that appellant’s coworker stated that he may have lost 

consciousness. NUMC treatment records also noted that appellant advised that he does not have 

breakfast in the morning. Appellant also reported having previously experienced dizziness with 

exertion, but he did not seek medical attention at the time. Although asymptomatic, he was 

admitted to the hospital for continuous cardiac monitoring (telemetry) because of the possibility 
3

that he may have experienced a transient ischemic attack.2

 An echocardiogram was administered 

and appellant also had a neurological consultation with Dr. Nadeem Shabbir, a Board-certified 

neurologist. No neurological problems were noted. Dr. Shabbir surmised that appellant’s 

presyncope was probably due to bradycardia and hypothermia.3

 From a neurological standpoint, 

he cleared appellant for discharge. 

On February 17, 2015 appellant was discharged by Dr. Roman Zeltser, a Board-certified 

internist with a subspecialty in cardiovascular disease, with a principal diagnosis of near 

syncope, “secondary to low temperature outside.” He was advised to avoid dehydration, stay 

warm, wear protective clothing outdoors, and to follow-up with his primary care physician. 

In an April 7, 2015 decision, OWCP acknowledged receiving “hospital treatment notes 

dated [February 16, 20015].” It denied appellant’s claim because he did not provide additional 

information regarding the alleged February 16, 2015 employment incident. OWCP found that 

the events of February 16, 2015 remained unclear, and therefore, he failed to establish the factual 

component of his claim. It also noted that, although the hospital treatment records included a 

final diagnosis of near syncope, there was no rationalized medical opinion explaining how the 

reported findings were either caused or aggravated by appellant’s February 16, 2015 

employment exposure. 

OWCP subsequently received appellant’s March 23, 2015 statement. Appellant 

explained that on February 16, 2015 at approximately 8:30 a.m., he was unloading a truck with 

heavy mail containers like cages, flat sequencing system (F.S.S.) casters, and postal containers 

(Postcons). He further indicated that, with great difficulty, he and the driver were able to get a 

few items from the truck to the lift, then to the dock, and then inside. Appellant also noted that 

his fingers got numb and his body got weak, and he could not do anything more. He indicated 

that he went inside and told the postmaster and leaned against the postcon. Appellant did not 

recall what happened afterwards. He indicated that by the time he realized it, EMS, the police, 

and the postmaster were next to him. Appellant was placed on a stretcher, taken to the hospital, 

and discharged the following day. He indicated that he saw his personal physician on 

February 20, 2015, and per his doctor’s instructions, appellant reported for duty on February 23, 

2015, at which time the postmaster filled out Form CA-1. 

OWCP also received a one-page, NUMC discharge plan with a final diagnosis of syncope 

and collapse. The February 17, 2015 discharge instructions indicated that appellant could 

resume normal activity. Appellant was also instructed to continue his medications, avoid 

dehydration, wear protective clothes to go outside, and to follow-up with his primary care 

physician. 

On February 20, 2015 appellant had a follow-up appointment with Dr. Daniel M. 

Appelbaum, a Board-certified internist with a subspecialty in cardiovascular disease. 

 2

 The preliminary admitting diagnoses included syncope, prediabetes, pulmonary atelectasis, atelectasis, 

hyperglycemia, and near syncope. A February 16, 2015 chest x-ray revealed a liner density/opacity at the left base 

that was thought to represent either a consolidation or atelectasis. 

3

 Appellant’s body temperature upon arrival in the emergency department was 95 degrees Fahrenheit. 
4

Dr. Appelbaum noted that appellant was a postal worker who was recently admitted to NUMC. 

He reported that appellant had been working outdoors in extremely cold weather when his hands 

felt numb and he felt dizzy. Dr. Appelbaum further noted that appellant was taken by ambulance 

to the hospital and was admitted overnight. The results of an echocardiogram revealed normal 

left ventricle, enlarged right ventricle, dilated right atrium, mild mitral insufficiency, mild-tomoderate mitral annular calcifications, mild aortic regurgitation, and mildly elevated pulmonary 

artery pressure. Dr. Appelbaum explained that the work-up and laboratory results were 

unremarkable, and appellant was discharged to home. Since then there were no recurring 

symptoms. Dr. Appelbaum opined that appellant’s dizziness was most likely related to doing 

heavy work in the extreme cold. Because appellant’s condition improved and had not recurred, 

there was no need for further work-up. Dr. Appelbaum noted additional problems of mild mitral 

and aortic insufficiency, as demonstrated by appellant’s recent echocardiogram. 

On July 20, 2015 appellant requested reconsideration of the April 7, 2015 decision. 

By decision dated September 21, 2015, OWCP reviewed the merits, but continued to 

deny appellant’s traumatic injury claim. It modified the April 7, 2015 decision to reflect that he 

satisfied the factual component of the claim based on his March 23, 2015 statement. However, 

OWCP found that the medical evidence failed to establish a causal relationship between 

appellant’s accepted occupational exposure and the diagnosed condition(s). It explained that his 

physician did not provide an opinion supported by medical rationale which explained how 

unloading a truck in cold weather caused, aggravated, or contributed to the diagnosed 

condition(s). 

LEGAL PRECEDENT 

A claimant seeking benefits under FECA has the burden of establishing the essential 

elements of his or her claim by the weight of the reliable, probative, and substantial evidence, 

including that an injury was sustained in the performance of duty as alleged and that any specific 

condition or disability claimed is causally related to the employment injury.4

To determine if an employee sustained a traumatic injury in the performance of duty, 

OWCP begins with an analysis of whether “fact of injury” has been established. Generally, fact 

of injury consists of two components that must be considered in conjunction with one another. 

The first component is whether the employee actually experienced the employment incident that 

allegedly occurred.5 The second component is whether the employment incident caused a 

personal injury.6

 An employee may establish that an injury occurred in the performance of duty 

 4

 20 C.F.R. § 10.115(e), (f); see Jacquelyn L. Oliver, 48 ECAB 232, 235-36 (1996). 

5 Elaine Pendleton, 40 ECAB 1143 (1989). 

6 John J. Carlone, 41 ECAB 354 (1989). 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.
5

as alleged, but fail to establish that the disability or specific condition for which compensation is 

being claimed is causally related to the injury.7

ANALYSIS 

OWCP accepted that the February 16, 2015 employment incident occurred as alleged. 

Appellant was outdoors unloading a truck in what he described as very cold, possibly sub-zero 

conditions. He reported feeling numbness and tingling in his bilateral upper extremities, as well 

as dizziness. Appellant was transported via ambulance to the NUMC emergency department, 

and was subsequently admitted for observation. The following day he was discharged with a 

diagnosis of near syncope. Appellant’s condition and/or symptoms appeared to have resolved 

without residuals. The issue currently before the Board is whether the medical evidence 

establishes a causal relationship between appellant’s pre-syncope episode and his accepted 

February 16, 2015 occupational exposure. 

As noted, causal relationship is a medical question that generally requires rationalized 

medical opinion evidence to resolve the issue.8

 A physician’s opinion on causal relationship 

must be based on a complete factual and medical background.9

 The mere fact that a condition 

manifests itself during a period of employment is not sufficient to establish causal relationship.10 

Temporal relationship alone will not suffice.11 Furthermore, appellant’s personal belief that his 

employment activities either caused or contributed to his condition is insufficient, by itself, to 

establish causal relationship.12

Dr. Shabbir, a neurologist, who examined appellant during his February 16 to 17, 2015 

hospitalization, found no neurological problems and surmised that appellant’s pre-syncope was 

probably due to bradycardia and hypothermia. However, he provided no explanation of how 

appellant’s employment exposure was sufficient to either cause or contribute to his transient 

bradycardia and/or low body temperature and resultant pre-syncope. 

Dr. Zeltser, the NUMC cardiologist, provided a discharge diagnosis of syncope 

“secondary to low temperature outside.” Also, Dr. Appelbaum, appellant’s cardiologist, opined 

that his dizziness was most likely related to doing heavy work in the extreme cold. However, 

neither physician offered an explanation for their respective opinions on causal relationship. 

A 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 

 7 Shirley A. Temple, 48 ECAB 404, 407 (1997). 

8 Robert G. Morris, supra note 6. 

9 Victor J. Woodhams, supra note 6. 

10 20 C.F.R. § 10.115(e). 

11 See D.I., 59 ECAB 158, 162 (2007). 

12 Id.; Phillip L. Barnes, 55 ECAB 426, 440 (2004). 
6

between the diagnosed condition and appellant’s specific employment factor(s).13 In this 

instance, the above-referenced reports do not adequately explain how appellant’s specific duties 

on February 16, 2015 either caused or contributed to the pre-syncope episode he experienced at 

work that morning. 

The Board finds that the medical evidence of record fails to establish that appellant’s presyncope episode was causally related to his February 16, 2015 accepted employment exposure. 

Accordingly, appellant has failed to meet his burden of proof. 

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 

Appellant failed to establish that he sustained an injury in the performance of duty on 

February 16, 2015. 

ORDER 

IT IS HEREBY ORDERED THAT the September 21, 2015 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: November 25, 2015 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board 

 

 Valerie D. Evans-Harrell, Alternate Judge 

 Employees’ Compensation Appeals Board 

 13 Victor J. Woodhams, supra note 6.