United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

M.O., Appellant 

and 

DEPARTMENT OF VETERANS AFFAIRS, 

KNOXVILLE COMMUNITY BASED 

OUTPATIENT CLINIC, Knoxville, TN, 

Employer 

__________________________________________ 

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Docket No. 16-0822 

Issued: August 29, 2016 

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant1

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

CHRISTOPHER J. GODFREY, Chief Judge 

COLLEEN DUFFY KIKO, Judge 

VALERIE D. EVANS-HARRELL, Alternate Judge 

JURISDICTION 

On March 15, 2016 appellant, through counsel, filed a timely appeal of a January 6, 2016 

merit decision of the Office of Workers’ Compensation Programs (OWCP). Pursuant to the 

Federal Employees’ Compensation Act2 (FECA) and 20 C.F.R. §§ 501.2(c) and 501.3, the Board 

has jurisdiction to consider the merits of the case. 

ISSUE 

The issue is whether appellant met her burden of proof to establish an injury on 

December 4, 2014 in the performance of duty. 

 1

 In all cases in which a representative has been authorized in a matter before the Board, no claim for a fee for 

legal or other service performed on appeal before the Board is valid unless approved by the Board. 20 C.F.R. 

§ 501.9(e). No contract for a stipulated fee or on a contingent fee basis will be approved by the Board. Id. An 

attorney or representative's collection of a fee without the Board's approval may constitute a misdemeanor, subject 

to fine or imprisonment for up to one year or both. Id.; see also 18 U.S.C. § 292. Demands for payment of fees to a 

representative, prior to approval by the Board, may be reported to appropriate authorities for investigation. 

2

 5 U.S.C. § 8101 et seq.
2

FACTUAL HISTORY 

On January 27, 2015 appellant, then a 45-year-old practical nurse, filed a traumatic injury 

claim (Form CA-1) alleging that on December 4, 2014 she sustained a laceration to her right 

lateral forehead, a concussion, and head trauma. She alleged that she was found on the floor at 

the employing establishment. Appellant noted that there was blood on the edge of the medical 

supply cart as well as on the floor where she was unconscious. On the reverse of the form, 

appellant’s supervisor disputed her allegation that there was blood on the supply cart. The 

supervisor contended that neither she nor the nurses that cleaned the room after the incident 

found blood on the supply cart. 

In a letter dated February 3, 2015, OWCP requested that appellant provide additional 

factual and medical evidence in support of her traumatic injury claim. It afforded her 30 days for 

her response. 

In a letter dated February 11, 2015, the employing establishment alleged that appellant 

had been complaining of chest pains on December 4, 2014 and that she was found on the floor 

totally unresponsive. When she awoke, appellant reported chest pain on the left. She described 

that she experienced dizziness in the restroom, which she believed had caused her to fall and 

strike her head on the floor. 

The employing establishment provided a description of the location of the bathroom and 

the supply cart, noting that the door covered one corner of the cart and that, after her fall, 

appellant’s head was positioned on the floor in the area near the middle of the cart. The distance 

from the door to the cart was approximately 30 inches. The employing establishment again 

noted that no blood was found on the supply cart and that based on the locations of appellant, the 

cart, and the door, she could not have hit her head on the cart. It claimed an idiopathic fall due to 

chest pains, dizziness, and loss of consciousness. The employing establishment further 

contended that there was no intervention or contribution by any hazard or special condition of 

employment such that appellant’s fall was considered to have occurred in the performance of 

duty. 

The employing establishment provided a hand-drawn diagram of appellant’s location 

after her fall relative to the bathroom door and the supply cart. This diagram suggested that 

appellant’s head was on the floor 6 to 12 inches from the side of the supply cart and short of the 

exposed corner of the cart. 

In an employing establishment accident report, Dr. Syria Heath, a family practitioner, 

who is also a coworker, noted that appellant had complained of chest pain earlier on December 4, 

2014 and that she advised appellant to seek medical attention. When she found appellant on the 

floor, with blood on her right temple, appellant was initially unresponsive. Appellant 

complained of chest pain to her left chest and she was transported to the emergency room. 

A coworker, B.S., a nurse, completed a statement on January 23, 2015 and described 

finding appellant on the floor on December 4, 2014. She alleged that appellant was located 

between the examination room and the cart with her feet just outside the restroom doorway. B.S. 

reported appellant’s blood sugar was taken and found to be 240. She reported that upon 

awakening appellant informed Dr. Health that she was coming from the bathroom, was feeling 

dizzy, and that she fell. B.S. reported that appellant also indicated that she had been 
3

experiencing chest pains all morning. A second coworker, P.S., also a nurse, completed a 

statement on January 28, 2015 relaying the same facts. She noted that appellant’s blood pressure 

was 225/110. P.S. also reported that she cleaned the room including an area of dried blood on 

the floor. 

In emergency room records from December 4 through 6, 2014, appellant indicated that 

she fell to the ground and hit her head. She did not remember falling. Appellant reported that 

she had chest pain and drowsiness before falling. She demonstrated a superficial and clean 

abrasion over the right side of the forehead with no active bleeding. Appellant noted chest 

palpitations on December 4, 2014. Her blood pressure was 120/71 when she arrived at the 

hospital and her glucose level was 174 at 1:24 pm at the hospital. 

Dr. Jeffrey Robinson, an internist, described appellant’s history noting that she had felt 

poorly as of December 2, 2014. Appellant was tired and had some left upper chest pain 

described as squeezing and tightness. She related that while at work she went to the bathroom, 

washed her hands, threw her paper towel in the trash, and then had a syncopal episode hitting the 

floor sustaining a small laceration to her scalp. Appellant had just completed a 12-hour drive on 

December 1, 2014. She was experiencing left-sided weakness. Appellant’s preexisting 

conditions included diabetes mellitus, hypertension, hyperlipidemia, obstructive sleep apnea, 

kidney stones, anemia, anxiety, and depression. Dr. Robinson hospitalized her due to her 

syncope with left-sided weakness, chest pain, and low magnesium. 

Dr. Albert Robert Blacky, a Board-certified cardiologist, noted appellant’s history of 

malaise and occasional episodes of pain to the center of her chest. He related that on 

December 4, 2014 she was in the bathroom, washed her hands, and she went to throw the paper 

towel into the trash when she had a sudden episode of syncope. Appellant denied any 

precipitation chest discomfort, palpitations, dizziness, or light-headedness. Test results including 

cardiac enzymes revealed no evidence of acute myocardial infarction, ischemia, or arrhythmia. 

Appellant’s brain computerized tomography scan was negative. She had no evidence of lower 

extremity deep vein thrombosis, and her magnetic resonance imaging (MRI) scan of the brain 

also showed no acute infarction. Dr. Blacky diagnosed syncope, chest pain, diabetes, and 

hypertension. He concluded that the etiology of appellant’s syncopal episode was unclear and 

that her cardiac evaluation was unremarkable. Dr. Blacky also noted that her hypertension was 

under control with therapy as was her diabetes with oral medication. 

Appellant sought medical treatment on December 10, 22, and 27, 2014 from Dr. Dinu C. 

Nodit, a Board-certified neurologist. Dr. Nodit reported that the previous week she lost 

consciousness at work, falling face down on the floor. Appellant had a history of headaches and 

diabetes, but no loss of consciousness or seizures in the past. Dr. Nodit diagnosed left 

hemiparesis, syncope, neck pain, and numbness. 

Appellant experienced a second episode of dizziness on January 14, 2015. Dr. Douglas 

Holland, a physician Board-certified in emergency medicine, noted that she reported symptoms 

of light-headedness and weakness. He diagnosed muscle weakness and acute headache. 

Dr. Jonathan G. Martin, a Board-certified family practitioner, related appellant’s history of a 

headache on January 13, 2015 and left-sided weakness on January 14, 2015. He reviewed her 

history and found that after her fall at work on December 4, 2014 her tests results were normal. 
4

On February 2, 2015 Dr. Stephen Russell, a physician Board-certified in emergency 

medicine, examined appellant for an additional episode of syncope and indicated that this 

incident occurred at home. He diagnosed syncope and possible seizure. 

By decision dated March 6, 2015, OWCP denied appellant’s traumatic injury claim 

finding that she had not established that her injury occurred in the performance of duty. It found 

that she sustained an idiopathic fall, which was not considered to be a personal injury occurring 

while in the performance of duty. OWCP found that appellant had not established that she struck 

any object prior to falling to the floor. It, therefore, concluded that her injury was not sustained 

in the performance of duty. 

On March 18, 2015 appellant requested an oral hearing before an OWCP hearing 

representative. She provided a narrative statement. Appellant denied complaining of chest pains 

or dizziness. She asserted that her blood pressure and blood sugar were within normal range. 

Appellant contended that the medical supply cart extended approximately one quarter of the way 

in front of the bathroom entryway. She hypothesized that she tripped on the cart exiting the 

bathroom and hit her head on the cart causing the gash on her forehead. Appellant again asserted 

that blood was found on the corner of the supply cart and that she hit her head on the cart. She 

noted that she experienced ongoing migraines and seizures following her fall on 

December 4, 2014. 

Dr. Page completed a note on July 24, 2015 describing his observations on 

December 4, 2014. He noted that appellant was face down on the floor just inside the door. 

Dr. Page noted that he rolled her over and saw a bleeding laceration and contusion on her head. 

Appellant also submitted additional medical records addressing her ongoing conditions 

following her fall on December 4, 2014. 

At the oral hearing on October 15, 2015 before an OWCP hearing representative, 

appellant described her health prior to her December 4, 2014 incident noting that she was 

diagnosed with diabetes which was controlled. She described the events of December 4, 2014 as 

using the restroom to wash her hands, throwing the paper towels away, and turning to walk out 

of the bathroom. Appellant alleged that she tripped on the wheel of the supply cart which was 

sticking about half way out into the doorway of the bathroom, struck her head on the far edge of 

the cart and hit the floor landing in front of the closed examination room door. She noted that 

she visited the emergency room and received a cardiac examination and testing which was 

negative. Appellant believed that she had a concussion and sought further treatment from her 

primary care physician and a neurologist. She has currently been diagnosed with petit mal 

seizures and migraines. Appellant experienced eight more concussions, permanent nerve 

damage to her eyes, utilizes anti-seizure medication, and is no longer allowed to drive. She 

alleged that the employing establishment had informed her that there was blood on the cart. 

Appellant further asserted that she was not dizzy and did not experience chest pain on 

December 4, 2014 or any other day. She denied that her blood sugar was elevated. 

The employing establishment responded and disagreed with appellant’s description of 

events again denying that there was blood on the supply cart. It also asserted that the bathroom 

door covered the supply cart wheel such that she could not have tripped over it. The employing 

establishment reiterated that appellant had reported dizziness and chest pain prior to her fall on 

December 4, 2014. 
5

Appellant reviewed the admission notes from her December 4, 2014 hospitalization and 

disagreed with the facts as presented. Her spouse submitted a statement supporting appellant’s 

allegations. 

By decision dated January 6, 2016, OWCP’s hearing representative found that appellant 

had sustained an idiopathic fall, which was not considered to have arisen in the performance of 

duty. She found that appellant’s blood pressure and blood sugar levels were elevated following 

the event and that appellant had a preexisting diabetic condition. 

LEGAL PRECEDENT 

Congress, in providing for a compensation program for federal employees, did not 

contemplate an insurance program against any and every injury, illness, or mishap that might befall 

an employee contemporaneous or coincidental with her employment; liability does not attach 

merely upon the existence of any employee/employer relation.3

 FECA provides for the payment of 

compensation for disability or death of an employee resulting from personal injury sustained while 

in the performance of duty.4

 The term “in the performance of duty” has been interpreted to be the 

equivalent of the commonly found prerequisite in workers’ compensation law, “arising out of and 

in the course of employment.”5 “In the course of employment” deals with the work setting, the 

locale, and time of injury.6 In addressing this issue, the Board has stated: 

“In the compensation field, to occur in the course of employment, in general, an 

injury must occur-- 

(1) at a time when the employee may reasonably be [stated] to be engaged 

in her master’s business; (2) at a place where he may reasonably be 

expected to be in connection with the employment; and (3) while he was 

reasonably fulfilling the duties of his employment or engaged in doing 

something incidental thereto.”7

This alone is not sufficient to establish entitlement to benefits for compensability. The 

concomitant requirement of an injury “arising out of the employment” must be shown, and this 

encompasses not only the work setting but also a causal concept, the requirement being that the 

employment caused the injury in order for an injury to be considered as arising out of the 

employment, the facts of the case must show some substantial employer benefit is derived or an 

employment requirement gave rise to the injury.8

 3 Christine Lawrence, 36 ECAB 422, 423-24 (1985); Minnie N. Heubner (Robert A. Heubner), 2 ECAB 20, 

24 (1948). 

4 See supra note 2.

5 James E. Chadden, Sr., 40 ECAB 312, 314 (1988). 

6 Denis F. Rafferty, 16 ECAB 413, 414 (1965). 

7 Carmen B. Gutierrez, 7 ECAB 58, 59 (1954). 

8 See Eugene G. Chin, 39 ECAB 598, 602 (1988). 
6

It is a well-settled principle of workers’ compensation law, and the Board has so held, 

that an injury resulting from an idiopathic fall -- where a personal, nonoccupational pathology 

causes an employee to collapse and to suffer injury upon striking the immediate supporting 

surface, and there is no intervention or contribution by any hazard or special condition of 

employment -- is not within coverage of FECA.9

 Such an injury does not arise out of a risk 

connected with the employment and is, therefore, not compensable. The Board has made equally 

clear, the fact that the cause of a particular fall cannot be ascertained or that the reason it 

occurred cannot be explained, does not establish that it was due to an idiopathic condition. This 

follows from the general rule that an injury occurring on the industrial premises during working 

hours is compensable unless the injury is established to be within an exception to such general 

rule.10 If the record does not establish that the particular fall was due to an idiopathic condition, 

it must be considered as merely an unexplained fall, one which is distinguishable from a fall in 

which it is definitely proved that a physical condition preexisted and caused the fall.11

To properly apply the idiopathic fall doctrine, there must be two elements present: a fall 

resulting from a personal, nonoccupational pathology, and no contribution from the 

employment.12 If the record does not establish the fall was due to an idiopathic condition, it 

must be considered as merely an unexplained fall, which is covered under FECA. 

ANALYSIS 

Appellant alleged that she fell at work on December 4, 2014 after washing her hands. 

OWCP denied the claim after finding that she had a preexisting condition of diabetes. 

As noted, an injury resulting from an idiopathic fall is not compensable.13 If appellant’s 

injury was due to an idiopathic condition, the injury would not arise out of her employment. 

OWCP has the burden of proof to submit medical evidence showing the existence of a personal, 

nonoccupational pathology if it chooses to make a finding that a given fall is idiopathic in nature. 

The fact that the cause of a particular fall cannot be determined does not establish that it was due 

to an idiopathic condition and if the record does not establish a particular fall was due to an 

idiopathic condition, it must be considered as merely an unexplained fall, which is covered under 

FECA.14 

Appellant has alleged that she sustained an employment incident on December 4, 2014 

and she believes that she tripped and fell striking her head on a medical supply cart. The factual 

evidence establishes that she, through some mechanism, was found on the floor on 

December 4, 2014. There was no medical evidence in the record at the time that appellant’s 

 9 See Carol A. Lyles, 57 ECAB 265 (2005). 

10 Dora J. Ward, 43 ECAB 767, 769 (1992); Fay Leiter, 35 ECAB 176, 182 (1983). 

11 John R. Black, 49 ECAB 624 (1998); Judy Bryant, 40 ECAB 207 (1988); Martha G. List, 26 ECAB 

200 (1974). 

12 E.C., Docket No. 15-0823 (issued February 2, 2016). 

13 R.C., 59 ECAB 427 (2008). 

14 H.B., Docket No. 12-840 (issued November 20, 2012); M.M., Docket No. 08-1510 (issued November 25, 

2008); Jennifer Atkerson, 55 ECAB 317 (2004).
7

employment incident on December 4, 2014 was due to an idiopathic condition. Dr. Blacky 

concluded that the etiology of her syncopal episode was unclear and that it was not related to her 

cardiac condition. OWCP’s hearing representative appears to rely on the findings of appellant’s 

coworkers, nurses, who reported a blood sugar level of 240 shortly after her fall. Healthcare 

providers such as nurses, acupuncturists, physicians assistants, and physical therapist are not 

considered physicians under FECA and their reports and opinions do not constitute competent 

medical evidence to establish a medical condition, disability or causal relationship.15 As these 

statements from Nurses B.S. and P.S. do not constitute medical evidence, these statements 

cannot establish that appellant’s fall was idiopathic. The medical records do not provide a cause 

for the event of December 4, 2014. Based on the medical evidence of record, the Board finds 

that appellant’s fall on December 4, 2014 was an unexplained fall. As an unexplained fall while 

appellant was engaged in activities incidental to her employment duties, an injury resulting from 

this fall is compensable. 

The case, therefore, will be remanded for OWCP to determine if appellant sustained an 

injury due to her fall on December 4, 2014. 

CONCLUSION 

The Board finds that the case is not in posture for a decision. Following any further 

necessary development, it shall issue a de novo decision. 

 15 5 U.S.C. § 8101(2); see also G.G., 58 ECAB 389 (2007); Jerre R. Rinehart, 45 ECAB 518 (1994); Barbara J. 

Williams, 40 ECAB 649 (1989); Jan A. White, 34 ECAB 515 (1983). 
8

ORDER 

IT IS HEREBY ORDERED THAT the January 6, 2016 decision of the Office of 

Workers’ Compensation Programs is set aside and remanded for further proceedings consistent 

with this opinion of the Board. 

Issued: August 29, 2016 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 Valerie D. Evans-Harrell, Alternate Judge 

 Employees’ Compensation Appeals Board