United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

K.G., Appellant 

and 

DEPARTMENT OF THE NAVY, NAVAL 

SUPPLY SYSTEMS COMMAND, Norfolk, VA, 

Employer 

__________________________________________ 

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Docket No. 15-0669 

Issued: April 8, 2016 

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 

ALEC J. KOROMILAS, Alternate Judge 

JURISDICTION 

On February 9, 2015 appellant filed a timely appeal from an August 11, 2014 merit 

decision of the Office of Workers’ Compensation Programs (OWCP).1

 Pursuant to the Federal 

Employees’ Compensation Act2

 (FECA) and 20 C.F.R. §§ 501.2(c) and 501.3, the Board has 

jurisdiction over the merits of this case.3

 

                                                             1

 The Board notes that, following the issuance of the August 11, 2014 OWCP decision, appellant submitted new 

evidence. The Board, however, is precluded from reviewing evidence which was not before OWCP at the time it 

issued its final decision. See 20 C.F.R. § 501.2(c)(1). 

2

 5 U.S.C. § 8101 et seq. 

3

 Together with her appeal request, appellant submitted a timely request for oral argument pursuant to 20 C.F.R. 

§ 501.5(b). By order dated December 9, 2015, the Board exercised its discretion and denied the request as 

appellant’s arguments on appeal could be adequately addressed in a decision based on a review of the case as 

submitted on the record. Order Denying Request for Oral Argument, Docket No. 15-0669 (issued 

December 9, 2015). 
2 

ISSUE 

The issue is whether appellant met her burden of proof to establish a recurrence of her 

medical condition causally related to her September 20, 2012 employment injury. 

On appeal, appellant contends that there were a vast number of actions overlooked or 

delayed during her case, including a medical bill for a pulmonary function test performed on 

June 27, 2014 that was not paid by OWCP. 

FACTUAL HISTORY 

On October 18, 2012 appellant, a 60-year-old supervisory inventory management 

specialist, filed a traumatic injury claim (Form CA-1), alleging that she was injured on 

September 20, 2012 as a result of being exposed to gas fumes in the performance of duty. She 

did not stop work. 

In an e-mail message dated November 19, 2012, the employing establishment indicated 

that appellant was exposed to fuel fumes at work on September 20, 2012. 

Appellant submitted reports dated October 31 and November 29, 2012 from Dr. Vanessa 

Duncombe, a Board-certified family practitioner, who asserted that appellant inhaled diesel and 

jet fuel fumes on September 20, 2012 as she went to pick up papers at a military fuel station in 

the performance of duty. She stated that the fumes hit her immediately and then she left 

immediately back out. Before the end of the day, appellant noticed her eyes were affected and 

she had a headache. The next day, she saw an eye doctor who prescribed eye drops. Appellant 

complained of headaches, nausea, nervousness, neck pain, bilateral earache, mucus, chest pain, 

chest tightness, irritated throat, pain in back of head, abdominal pain, pain in arms, numbness in 

fingers and hands, elevated blood pressure, inability to taste foods, diarrhea, pain and irritation in 

the left eye, and bilateral eye pressure. Dr. Duncombe conducted a physical examination and 

found both eyes with conjunctival injection, mild lymphoid plaquing with erythema, no exudate, 

supple neck, and a clear chest. She diagnosed exposure and allergic rhinitis. Dr. Duncombe 

diagnosed optic track exposure and allergic rhinitis. She opined that appellant’s exposure did not 

affect her blood pressure directly and noted that “her anxiety about the whole thing [was] more 

of the problem.” 

By decision dated December 26, 2012, OWCP accepted the claim for allergic rhinitis due 

to other allergen, bilateral. It indicated that when appellant’s claim was received it appeared to 

be a minor injury that resulted in minimal or no lost time from work and, based on these criteria 

and because the employing establishment did not controvert continuation of pay (COP) or 

challenge the case, payment of a limited amount of medical expenses was administratively 

approved. OWCP stated that it had reopened the claim for consideration because the medical 

bills had exceeded $1,500.00. 

In a letter dated August 20, 2013, OWCP requested a medical opinion from 

Dr. Duncombe regarding the nature and extent of appellant’s accepted condition and afforded her 

30 days to respond. Dr. Duncombe did not respond. 
3 

In a letter dated October 25, 2013, OWCP again requested a medical opinion from 

Dr. Duncombe regarding the nature and extent of appellant’s accepted condition and afforded her 

30 days to respond. 

In response, Dr. Duncombe submitted a report dated September 3, 2013 in which she 

opined that appellant’s allergic rhinitis had resolved. She asserted that appellant reported no 

further conditions related to her September 20, 2012 employment injury and had not required 

any further treatment related to her accepted condition. Dr. Duncombe concluded that appellant 

had reached maximum medical improvement. 

On June 16, 2014 appellant filed a notice of recurrence (Form CA-2a) requesting 

authorization for medical treatment. She indicated that she continued to suffer residuals of her 

employment injury and never received approval from OWCP for her pulmonary function test. 

Appellant did not stop work. 

In a July 2, 2014 letter, OWCP advised appellant of the deficiencies of her recurrence 

claim. It requested additional evidence in support of the claim and afforded appellant 30 days to 

respond to its inquiries. 

Subsequently, appellant submitted an April 2, 2013 report from Dr. Jennifer Rippon, a 

Board-certified internist, who diagnosed shortness of breath and scant hemoptysis. Dr. Rippon 

noted that appellant had no history of smoking or any personal history of cancer. Appellant also 

had no systemic symptoms, but given that the hemoptysis was still present, Dr. Rippon opined 

that this was indicated. She noted appellant’s occupational exposure to noxious chemicals in 

September 2012 after which her respiratory symptoms started, and she explained that this would 

be very consistent with a diagnosis of reactive airway dysfunction syndrome (RADS). 

Dr. Rippon prescribed an inhaler and ordered pulmonary function tests. 

In a July 30, 2014 narrative statement, appellant indicated that she was referred to 

Dr. Rippon who was required to register with OWCP before she could have a pulmonary 

function test performed, but Dr. Rippon was unable to get registered because she would not be 

practicing out of the office and would be moving into the Garden Park Hospital as a 

pulmonologist during the month of June 2013. She submitted a copy of a pulmonary function 

test performed on June 27, 2014. 

Appellant further submitted a July 29, 2013 bone density x-ray for an evaluation of 

osteoporosis and a November 11, 2013 oximetry report. 

By decision dated August 11, 2014, OWCP denied appellant’s recurrence claim as the 

medical evidence of record was insufficient to establish that she sustained a recurrence of her 

medical condition, causally related to her September 20, 2012 employment injury. 

LEGAL PRECEDENT 

Where appellant claims a recurrence of disability due to an accepted employment-related 

injury, she has the burden of proof to establish by the weight of reliable, probative, and 
4 

substantial evidence that the recurrence of disability is causally related to the original injury.4 

This burden includes the necessity of furnishing evidence from a qualified physician who, on the 

basis of a complete and accurate factual and medical history, concludes that the condition is 

causally related to the employment injury.5

 Moreover, the physician’s conclusion must be 

supported by sound medical reasoning.6

 

The medical evidence must demonstrate that the claimed recurrence was caused, 

precipitated, accelerated, or aggravated by the accepted injury.7

 In this regard, medical evidence 

of bridging symptoms between the recurrence and the accepted injury must support the 

physician’s conclusion of a causal relationship.8

 While the opinion of a physician supporting 

causal relationship need not be one of absolute medical certainty, the opinion must not be 

speculative or equivocal. The opinion should be expressed in terms of a reasonable degree of 

medical certainty.9

 

ANALYSIS 

OWCP accepted that appellant sustained allergic rhinitis as a result of inhaling fuel fumes 

at work on September 20, 2012. However, the medical record lacks a well-reasoned narrative 

from appellant’s physicians relating her claimed recurrent conditions to her accepted 

employment injury. 

In her reports, Dr. Duncombe noted appellant’s complaints, but only diagnosed exposure 

and allergic rhinitis. She found bilateral eyes with conjunctival injection and mild lymphoid 

plaquing with erythema upon examination, but provided no other medical diagnoses causally 

related to the September 20, 2012 employment incident. Dr. Duncombe opined that appellant’s 

exposure did not affect her blood pressure directly and noted that “her anxiety about the whole 

thing [was] more of the problem.” The Board finds that Dr. Duncombe failed to provide 

sufficient medical rationale explaining how appellant’s symptoms were causally related to the 

September 20, 2012 employment injury, without an intervening injury or new exposure. 

Moreover, the September 3, 2013 report from Dr. Duncombe did not specifically address causal 

relationship between appellant’s accepted condition and her claimed recurrence of disability or 

conditions. Rather, Dr. Duncombe concluded that appellant had reached maximum medical 

                                                             4 See Robert H. St. Onge, 43 ECAB 1169 (1992). 

5

 Section 10.104(a)(b) of the Code of Federal Regulations provides that when an employee has received medical 

care as a result of the recurrence, she should arrange for the attending physician to submit a detailed medical report. 

The report should include the physician’s opinion with medical reasons regarding the causal relationship between 

the employee’s condition and the original injury, any work limitations or restrictions, and the prognosis. 20 C.F.R. 

§ 10.104. 

6 See supra note 4. 

7

 Federal (FECA) Procedure Manual, Part 2 -- Claims, Causal Relationship, Chapter 2.805.2 (January 2013); see 

supra note 4. 

8

 For the importance of bridging information in establishing a claim for a recurrence of disability, see Shirloyn J. 

Holmes, 39 ECAB 938 (1988); Richard McBride, 37 ECAB 748 (1986). 

9 See Ricky S. Storms, 52 ECAB 349 (2001); Morris Scanlon, 11 ECAB 384, 385 (1960). 
5 

improvement and her accepted allergic rhinitis condition had resolved. Thus, the Board finds 

that Dr. Duncombe’s reports are insufficient to establish that appellant sustained a recurrence of 

her accepted medical condition. 

In her April 2, 2013 report, Dr. Rippon diagnosed shortness of breath and scant 

hemoptysis. She noted appellant’s occupational exposure to noxious chemicals in 

September 2012 after which her respiratory symptoms began and she explained that this would 

be very consistent with a diagnosis of RADS. Dr. Rippon’s report is insufficient to establish that 

appellant sustained a recurrence of her accepted medical condition. She failed to provide 

sufficient medical rationale explaining how appellant’s symptoms were causally related to the 

September 20, 2012 employment injury. Moreover, OWCP has not accepted shortness of breath, 

hemoptysis, or RADS in this case. The Board thus finds that the report from Dr. Rippon is 

insufficient to establish a new intervening traumatic injury or a consequential injury which was 

caused or aggravated by factors of appellant’s federal employment. Therefore, this medical 

evidence is insufficient to expand appellant’s list of accepted conditions or establish her claim 

for a recurrence.10 

The July 29, 2013 bone density x-ray, the November 11, 2013 oximetry report, and the 

June 27, 2014 pulmonary function test are of limited probative medical value as they do not 

specifically address whether appellant’s claimed recurrent conditions are attributable to her 

accepted work injury.11 

On appeal, appellant contends that there were a vast number of actions overlooked or 

delayed during her case, including a medical bill for a pulmonary function test performed on 

June 27, 2014 that was not paid by OWCP. The Board finds that the evidence submitted by 

appellant lacks adequate rationale to establish a causal connection between the alleged 

recurrence of her medical condition and the accepted employment injury. Appellant had the 

burden of submitting sufficient medical evidence to document the need for further medical 

treatment for her accepted employment-related condition. She did not submit such evidence as 

required and failed to establish a need for continuing medical treatment.12

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. 

                                                             10 See Amanda Johnson, Docket No. 04-849 (issued July 22, 2004) (where OWCP accepted that the employee 

experienced paint fume inhalation at work, but the Board denied her claim for a recurrence because the medical 

evidence lacked a well-reasoned narrative from her physicians relating her claimed recurrent condition to her 

accepted employment injury). 

11 See K.W., 59 ECAB 271 (2007); A.D., 58 ECAB 149 (2006); Linda I. Sprague, 48 ECAB 386 (1997) (medical 

evidence that does not offer any opinion regarding the cause of an employee’s condition is of limited probative 

value on the issue of causal relationship). 

12 See J.F., 58 ECAB 331 (2006). 
6 

CONCLUSION 

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

of her medical condition causally related to her September 20, 2012 employment injury. 

ORDER 

IT IS HEREBY ORDERED THAT the August 11, 2014 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: April 8, 2016 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board