United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

B.E., Appellant 

and 

DEPARTMENT OF VETERANS AFFAIRS, 

ATLANTA VETERANS ADMINISTRATION 

MEDICAL CENTER, Decatur, GA, Employer 

__________________________________________ 

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Docket No. 15-0815 

Issued: October 5, 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 

PATRICIA H. FITZGERALD, Deputy Chief Judge 

COLLEEN DUFFY KIKO, Judge 

JURISDICTION 

On February 26, 2015 appellant timely appealed the December 22, 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. 

ISSUE 

The issue is whether appellant has met her burden of proof to establish that her 

respiratory condition is causally related to her federal employment. 

FACTUAL HISTORY 

On December 6, 2013 appellant, then a 55-year-old medical technician, filed an 

occupational disease claim (Form CA-2) for a respiratory condition that allegedly arose on or 

 1

 5 U.S.C. §§ 8101-8193. 
2

about November 1, 2013. She claimed to have been exposed to mold, mildew, and dust particles 

when a ceiling collapsed due to rain water damage. Appellant indicated that the workroom 

ceiling tiles had since been replaced, but nothing was done about the mold, mildew, odor, and 

dust. The alleged occupational exposure reportedly caused headaches and respiratory problems, 

which included nasal congestion, chest congestion, and throat irritation. Appellant did not 

submit any factual or medical evidence with her claim. 

In a January 17, 2014 development letter, OWCP outlined the five basic elements to 

establishing a claim under FECA, and advised appellant that her claim was deficient from both a 

factual and a medical standpoint. Appellant was afforded at least 30 days to submit the required 

evidence in support of her claim. 

In a March 10, 2014 decision, OWCP denied appellant’s occupational disease claim 

because she had not submitted any factual or medical evidence. It found that she failed to 

establish that the employment incident(s) occurred as alleged. Appellant also failed to submit 

medical evidence that contained a diagnosis in connection with her alleged occupational 

exposure. 

Appellant requested reconsideration on March 25, 2014, but again failed to submit any 

factual or medical evidence. Consequently, OWCP denied reconsideration by decision dated 

April 7, 2014. 

On April 23, 2014 OWCP received another request for reconsideration. Appellant 

provided factual information regarding her claimed exposure, which included various e-mails 

about the ceiling in her work area. OWCP also received various treatment records from the 

employing establishment’s occupational health unit. Additionally, it received February to 

April 2014 treatment records from Kaiser Permanente. 

On January 22, 2013, before the current claim, appellant had visited the employee health 

unit complaining of an upper respiratory infection, with nasal drainage, throat soreness, and a 

loss of appetite over the past five days. She reported having been exposed to dust and mold. 

Appellant’s self-medication had not improved her symptoms. Dr. Michael B. Miller, Boardcertified in family practice, who examined appellant, described her condition as “reaction to 

environmental allergen.” He referenced an unexplained June 4, 2012 incident where the 

employing establishment’s safety team and industrial hygienist had been called to investigate. 

Dr. Miller recommended that appellant be reassigned to another area until the safety team and 

industrial hygienist could reassess the situation. 

Appellant returned to the employee health unit on April 2, 2013 with continued 

complaints of upper respiratory symptoms while working. Dr. Miller reported that she attributed 

her symptoms to exposure to mold in the workplace. Appellant described an incident from 

May 2012 where an overhead pipe leaked water onto her desk and computer. Dr. Miller noted a 

prior history of allergies, with continued intermittent upper respiratory exacerbation. He 

provided a differential diagnosis (rule out) of mold vs. allergies. Appellant was advised to 

continue taking Claritin. 
3

On December 3, 2013 Dr. Miller saw appellant again for complaints of recurrent 

respiratory allergy from dust in the work environment. Appellant attributed her condition to a 

ceiling leak that was awaiting repair and replacement of the ceiling tiles. Her current symptoms 

reportedly began two weeks prior, with minimal relief from self-management. Appellant 

indicated that the laboratory area where she worked had been closed the previous evening, and 

when she returned to work the following day she experienced a runny nose, itchy eyes, sneezing, 

and headache. Dr. Miller’s assessment was respiratory allergy exacerbation secondary to 

environment. He recommended conservative treatment, which included medication and 

avoidance of the work area until construction was completed. 

Joyce Thompson, a doctor of nursing practice and family nurse practitioner, submitted a 

February 6, 2014 “report of employee’s emergency treatment.”2

 She noted that appellant visited 

employee health earlier that day complaining of a sore throat, cough, sinus headache, watery 

eyes, night cough, and sweats. Appellant also reported that her other acute illness was 

exacerbated with chest heaviness.3

 Ms. Thompson noted a February 4, 2014 onset of recurrent 

upper respiratory infection due to work environment construction. Appellant reported there was 

a dark stain on the ceiling near the sprinkler and a smell of mildew and that the safety team 

reportedly had visited the area earlier that day and an air quality assessment had been completed 

the day before. She reported that the staff was instructed to move until further notice. 

Ms. Thompson noted that appellant’s respiratory history was compromised with this 

environmental exposure. She recommended conservative treatment, which included medication 

and a humidifier. Ms. Thompson further advised that appellant should be removed from the area 

or taken off work for the remainder of the day if her condition did not improve. 

Appellant returned to the employee health unit on February 11, 2014 and Ms. Thompson 

submitted another “report of employee’s emergency treatment.” Ms. Thompson noted that 

appellant was seen for follow up of her respiratory illness after environmental exposure on 

February 4, 2014. Appellant reported some relief with medication, but her symptoms flared up 

earlier that morning while she continued to work at her current workstation. Ms. Thompson 

recommended that appellant be removed from her current work area until construction was 

completed. 

Dr. Neena D. Ghose, a Board-certified family practitioner, examined appellant on 

February 20, 2014 and diagnosed acute upper respiratory infection. The Kaiser Permanente 

treatment records noted a prior history of chronic type 2 diabetes (uncontrolled), screening for 

diabetic retinopathy, chronic hypertension, sciatica, and fibromyalgia. 

In a February 24, 2014 “report of employee’s emergency treatment,” Dr. Miller noted 

that he had a discussion with an industrial hygienist who recommended that appellant relocate 

while construction continued. 

Appellant returned to Kaiser Permanente on April 9, 2014, where she was seen by 

Dr. Marion E. Howard, a Board-certified internist with a subspecialty in geriatric medicine. She 

 2

 Ms. Thompson previously treated appellant on January 22, April 2, and December 3, 2013. 

3

 Appellant’s prior medical history included chronic hypertension and type 2 diabetes. 
4

received a diagnosis of allergic rhinitis (nose congestion), seasonal. Dr. Howard prescribed a 

nasal spray (Fluticasone) and referred appellant to an allergy clinic. 

With respect to her alleged occupational exposure, appellant identified several dates in 

November and December 2013 when the ceiling in her work area leaked. She also provided 

photographs. Additionally, appellant identified several other dates in March 2014 when the 

ceiling continued to leak and when ceiling tiles were replaced. She also submitted an April 2, 

2014 work completion report, which indicated that a ceiling light panel had been cleaned. 

In a February 5, 2014 note to appellant, the employing establishment advised her that 

engineering, infection control, and safety were all in the labs that morning to evaluate the water 

leak and ceiling conditions.4

 It further noted that they were currently working to control/stop the 

leak and also to ensure that the areas were dry. 

The record also includes a February 6, 2014 e-mail exchange between Ms. Thompson 

and Jeffery Jones, the employing establishment’s industrial hygiene program manager. The 

e-mail subject line was “environmental exposure.” Ms. Thompson advised that she had seen a 

total of four employees that day for respiratory complaints as a result of the February 4, 2014 

roof leakage and construction work in the laboratory area. She further noted that it was her 

understanding that safety visited the area to replace the wet ceiling tile. Ms. Thompson noted 

that one employee was still experiencing breathing difficulty and another employee experienced 

further complications from a prior medical history. 

In a separate February 6, 2014 e-mail to Mr. Jones, Ms. Thompson indicated that an 

employee reported to occupational health that day with complaints of an upper respiratory 

infection and headache due to construction on the roof that caused ceiling damage, such as 

leaking with moisture and mildew odor. She also noted that industrial hygiene and safety had 

reportedly visited the area. Ms. Thompson further indicated that other staff members were 

experiencing similar signs and symptoms. She commented that there was no current treatment 

for the location other than plastic to cover the ceilings. Ms. Thompson advised that the 

employee was treated with antibiotics, and due to the headache and difficulty breathing, she 

needed to relocate or take the day off. She asked for an evaluation of the air quality and 

requested that air purifiers be provided to improve ventilation. 

In his February 6, 2014 reply, Mr. Jones noted that an indoor air quality (IAQ) survey 

had been performed the day before. He further noted that the vendor who performed the IAQ 

survey did not indicate that there was “anything major going on.” Mr. Jones stated that, while 

the odor was unpleasant, it was not hazardous. He explained that the odor was created by the 

rain water passing through the roofing material and ceiling tiles, neither of which caused a 

hazardous fume or odor. Lastly, Mr. Jones advised Ms. Thompson that he would provide the 

IAQ survey results so that she could include this information in the employees’ medical folders. 

In a July 3, 2014 merit decision, OWCP found that, while appellant established that she 

was exposed to “mold or construction” in the workplace, she failed to establish a link between 

her breathing or upper respiratory condition and the work exposure. It noted that no physician of 

 4

 In at least one report, Dr. Miller identified Mr. Ugbo as appellant’s supervisor. 
5

record explained how “wet ceiling tiles in the workplace” led to the development of a medical 

condition. Consequently, OWCP continued to deny appellant’s occupational disease claim, 

albeit for a different reason. 

On September 17, 2014 appellant again requested reconsideration. She submitted 

September 8, 2014 treatment records from the Atlanta Allergy and Asthma Clinic. Dr. Na 

Kyoung Judy Nam, a Board-certified internist, noted that appellant’s list of active problems 

included chronic rhinitis, wheezing, type 2 diabetes mellitus, and unspecified essential 

hypertension.5

 Aeroallergen testing was negative. Appellant’s spirometry revealed a mild 

restriction, but the results were noted to be limited by technique. The treatment records also 

noted possible persistent asthma vs. nasal symptoms. Additionally, Dr. Nam considered a 

possible cardiac etiology, and noted that appellant was scheduled to see a cardiologist in 

October 2014. 

Appellant also submitted a September 16, 2014 “Report of Employee’s Emergency 

Treatment” from Dr. Miller. Dr. Miller noted she was formally diagnosed with asthma and was 

on multiple medications to control her symptoms. He noted that appellant’s condition was 

aggravated by fumes, chemicals, perfumes, and particulate matter present in her workspace. 

Dr. Miller further noted that her workplace had been aggravating her condition since 2010, when 

she began treatment for recurrent respiratory problems. Although appellant was able to work 

and perform her duties, he recommended that she be relocated in order to minimize contact with 

airborne irritants. 

By decision dated December 22, 2014, OWCP found that, while the medical evidence 

revealed a history of asthma and chronic rhinitis, the record was insufficient to establish a causal 

relationship between the diagnosed conditions and appellant’s exposure to “mold and 

construction” in the workplace. 

LEGAL PRECEDENT 

A claimant seeking benefits under FECA has the burden of proof to establish 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.6

To establish that an injury was sustained in the performance of duty, a claimant must 

submit: (1) medical evidence establishing the presence or existence of the disease or condition 

 5

 Dr. Nam is also certified by the American Board of Allergy and Immunology. 

6

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

medical question, which 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 factors 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 

factors. Id. 
6

for which compensation is claimed; (2) a factual statement identifying employment factors 

alleged to have caused or contributed to the presence or occurrence of the disease or condition; 

and (3) medical evidence establishing that the diagnosed condition is causally related to the 

identified employment factors.7

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

therapists, and social workers are not considered “physician[s]” as defined under FECA.8

 

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

entitlement to FECA benefits.9

 A report from a physician assistant or certified nurse practitioner 

will be considered medical evidence if countersigned by a qualified physician.10

ANALYSIS 

OWCP has accepted that appellant was exposed to wet ceiling tiles, mold, and 

construction while performing her duties as a medical technician. Appellant’s employee health 

records reveal a history of allergies and recurrent upper respiratory infections. Her Kaiser 

Permanente treatment records similarly include a diagnosis of acute upper respiratory infection, 

as well as allergic rhinitis. Additionally, Dr. Nam noted that appellant’s active problems 

included chronic rhinitis and wheezing. While she also mentioned the possibility of persistent 

asthma, she did not provide a definitive diagnosis of asthma. Lastly, Dr. Miller recently reported 

that appellant had been formally diagnosed with asthma, which he believed was aggravated by 

her workplace exposure. 

The issue currently before the Board is whether any of the above-noted conditions have 

been proven to be causally related to appellant’s accepted occupational exposure. As a 

preliminary matter, the Board finds that Ms. Thompson’s February 6 and 11, 2014 reports will 

not suffice for purposes of establishing causal relationship. Nurse practitioners are not 

considered physician as defined under FECA.11

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

medical opinion evidence to resolve the issue.12 A physician’s opinion on causal relationship 

must be based on a complete factual and medical background.13 The mere fact that a condition 

manifests itself during a period of employment is insufficient to establish causal relationship.14 

 7 Victor J. Woodhams, id. 

8

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

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

10 Federal (FECA) Procedure Manual, Part 2 -- Claims, Causal Relationship, Chapter 2.805.3a(1) (January 2013). 

11 See supra note 8. 

12 Robert G. Morris, supra note 6. 

13 Victor J. Woodhams, supra note 6. 

14 20 C.F.R. § 10.115(e). 
7

Temporal relationship alone will not suffice.15 Furthermore, appellant’s personal belief that her 

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

establish causal relationship.16

The February and April 2014 Kaiser Permanente records do not specifically address 

appellant’s accepted occupational exposure. Similarly, Dr. Nam’s September 8, 2014 report 

does not mention occupational exposure as a causative factor. Consequently, this evidence is 

insufficient to establish that appellant’s rhinitis and acute upper respiratory infection are 

employment related. 

The remaining medical evidence was provided by Dr. Miller, from the employing 

establishment’s occupational health unit. When he saw appellant on January 22, 2013 she 

complained of an upper respiratory infection, with nasal drainage, throat soreness, and a loss of 

appetite. Appellant claimed to have been exposed to dust and mold. Dr. Miller described her 

condition as “reaction to environmental allergen.” He referenced a June 4, 2012 incident, but did 

not otherwise explain the particular incident. Based on the information provided, it is unclear 

how Dr. Miller was able to attribute appellant’s upper respiratory infection to an “environmental 

allergen.” 

Appellant returned to the occupational health unit on April 2, 2013. She complained of 

upper respiratory symptoms, which she attributed to mold exposure. Appellant described a 

May 2012 incident where an overhead pipe leaked water onto her desk and computer. Dr. Miller 

noted that she had a prior history of allergies, with continued intermittent upper respiratory 

exacerbation. He provided a differential (rule out) diagnosis of mold vs. allergies. At the time, 

Dr. Miller was apparently unsure of the cause of appellant’s condition. Consequently, his 

April 2, 2013 report fails to establish a causal relationship between her respiratory condition and 

her accepted occupational exposure. 

On December 3, 2013 Dr. Miller provided an assessment of respiratory allergy 

exacerbation secondary to environment. Appellant reported that the ceiling in the lab where she 

worked had been leaking and was awaiting repair and replacement of the ceiling tiles. Her 

symptoms had reportedly begun two weeks prior. However, appellant noted that the laboratory 

was closed the previous evening, and when she returned to work she experienced a runny nose, 

itchy eyes, sneezing, and headache. Dr. Miller recommended that she avoid her work area until 

construction was completed. Although there is an apparent temporal relationship between 

appellant’s increased symptoms and her reported occupational exposure, he nonetheless failed to 

explain how her respiratory allergy was exacerbated by the work environment on or about 

December 3, 2013. 

Lastly, Dr. Miller’s September 16, 2014 report incorrectly noted that appellant had been 

formally diagnosed with asthma. He did not identify the source of the diagnosis. Appellant had 

recently visited the Atlanta Allergy and Asthma Clinic, but as previously noted Dr. Nam did not 

provide a definitive diagnosis of asthma. Assuming arguendo that appellant has asthma, 

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

16 20 C.F.R. § 10.115(e); Phillip L. Barnes, 55 ECAB 426, 440 (2004). 
8

Dr. Miller’s September 16, 2014 report is still insufficient to establish causal relationship. He 

indicated that appellant’s asthma was aggravated by fumes, chemicals, perfumes, and particulate 

matter present in her workspace. However, Dr. Miller’s description of appellant’s workplace 

exposure was inconsistent with her accepted occupational exposure -- wet ceiling tiles, mold, and 

construction. A physician’s opinion on causal relationship must be based on a complete and 

correct factual and medical background.17 Dr. Miller’s September 16, 2014 report is insufficient 

to establish a diagnosis of employment-related asthma. 

The Board finds that the medical evidence of record fails to establish that appellant’s 

claimed respiratory condition is causally related to her accepted employment exposure. 

Accordingly, OWCP properly denied appellant’s occupational disease claim. 

CONCLUSION 

The Board finds that appellant has not met her burden of proof to establish that her 

respiratory condition is causally related to her federal employment. 

ORDER 

IT IS HEREBY ORDERED THAT the December 22, 2014 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: October 5, 2015 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 17 Victor J. Woodhams, supra note 6.