United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

D.D., Appellant 

and 

DEPARTMENT OF THE NAVY, NAVAL 

MEDICAL CENTER, PORTSMOUTH 

NEURODEVELOPMENTAL PEDIATRICS 

CLINIC, Portsmouth, VA, Employer 

__________________________________________ 

) 

) 

) 

) 

) 

) 

) 

) 

) 

) 

Docket No. 15-1132 

Issued: March 21, 2016 

Appearances: Case Submitted on the Record

Appellant, pro se 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

PATRICIA H. FITZGERALD, Deputy Chief Judge 

ALEC J. KOROMILAS, Alternate Judge 

JAMES A. HAYNES, Alternate Judge 

JURISDICTION 

On April 20, 2015 appellant filed a timely appeal of an October 28, 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 this case. 

ISSUE 

The issue is whether appellant met her burden of proof to establish that she sustained an 

injury on April 11, 2014 in the performance of duty. 

 1

 5 U.S.C. § 8101 et seq. 
2

FACTUAL HISTORY 

On August 25, 2014 appellant, then a 54-year-old pediatric occupational therapist, filed a 

traumatic injury claim alleging that on April 11, 2014 she sustained severe and sudden onset of 

diarrhea and vomiting, dehydration, and fainting, which caused her to hit the right side of her 

head and face on the floor. Her symptoms were due to exposure to Sydney norovirus which she 

contracted from a pediatric patient who had the virus. The fainting caused chipped and fractured 

five front teeth and sutures for appellant’s right ear injury. On the back of the form, the 

employing establishment stated that it was “unable to determine if a specific incident or work 

event contributed to medical condition” as she was in a hotel on vacation when her illness 

occurred. 

In a September 8, 2014 letter, OWCP informed appellant that the evidence of record was 

insufficient to establish her claim. Appellant was advised as to the medical and factual evidence 

required and given 30 days to provide the requested information. 

On September 12, 2014 OWCP received April 11, 2014 New Hanover Regional Medical 

Center, Wilmington, NC reports noting that appellant was treated in the emergency room that 

day and released on April 12, 2014. Appellant was seen by Dr. Randall N. Willard, an 

examining Board-certified emergency room physician, who diagnosed syncope, acute 

gastroenteritis, closed head injury, right earlobe laceration, and right eyelid laceration. The 

injury was described as occurring due to her having a syncopal episode in which she passed out, 

fell forward, and hit her head in the bathroom. The report stated prior to the syncopal episode 

appellant had an episode of diarrhea and vomiting. 

In her September 12, 2014 statement, appellant detailed the chronology of her exposure 

to the norovirus until her injury on April 11, 2014. She stated that she was on a half-day of 

personal leave on April 11, 2014 when at approximately 5:00 p.m., she began to feel nauseous, 

and beginning at 6:00 p.m. she experienced significant diarrhea with subsequent episodes of 

vomiting and diarrhea. At approximately 7:15 p.m. appellant remembered getting up to go to the 

bathroom, lost consciousness, and woke up leaning against the bathroom counter with several 

broken teeth and a bleeding right eyebrow. She was taken to the emergency room by her 

fiancée. Initially, appellant was placed in a wheelchair, but due to her severe light-headedness 

and nausea she was placed on a stretcher. At the emergency room she was treated for severe 

dehydration and sutures were applied to her right eyebrow and right earlobe. Diagnoses included 

concussion/head injury, syncope, and acute gastroenteritis. Appellant related that she had been 

exposed to the norovirus due to her treatment of a toddler who had been diagnosed with it. She 

was contacted by the Naval Medical Center’s Infection Control Department and Occupational 

Health Department regarding her illness and contact with the patient and that four of her 

coworkers became symptomatic with similar gastrointestinal symptoms. 

In a September 17, 2014 report, Dr. Steven A. Carroll, a dentist, stated that on April 11, 

2014 that appellant fell and hit the right side of her head on the toilet and tile floor due to 

syncope caused by dehydration from vomiting and diarrhea. Appellant was seen by him for 

lingual fractures of teeth numbers 7, 8, 9, broken with no tracks of teeth numbers 25 and 26 and a 

broken MI angle for tooth number 7. Dr. Carroll recommended crowns for teeth numbers 25 and 
3

26 and a four surface filling for tooth number 7. He attributed these conditions to appellant’s 

falling and hitting her head. 

On October 6, 2014 OWCP received an undated statement by appellant’s supervisor, 

Commander R. Scott Akins, an osteopath and behavioral pediatrician of professorial rank, who 

concurred with appellant that her gastroenteritis illness was caused by her exposure to a pediatric 

patient with the virus, which is highly contagious. Commander Akins supported her claim that 

she contracted the norovirus due to exposure to a pediatric patient with the virus. He stated that 

appellant saw the patient on April 8 to 10, 2014 in the patent’s room and occupational therapy 

clinic and that she “provided hands on occupational therapy.” The patient had an onset of 

diarrhea beginning approximately April 7, 2014 and continuing to April 14, 2014. 

On October 7, 2014 OWCP received an undated report from, Dr. Mark Hammett, a 

reviewing Board-certified occupational medicine physician with the employing establishment. 

Based upon a review of the factual and medical evidence and medical history, Dr. Hammett 

opined that appellant’s injuries on April 11, 2014 were directly caused by her exposure to a 

pediatric patient with the norovirus which appellant contracted. He stated that the norovirus 

causes persistent vomiting and diarrhea which could result in dehydration and electrolyte 

imbalances without proper treatment. Dr. Hammett also stated that the norovirus is very 

contagious and appellant was in contact with a pediatric patient who was later determined to 

have the norovirus. He reiterated his opinion that she sustained an occupational injury due to her 

exposure to the norovirus on April 8 to 10, 2014 and her subsequent symptoms of gastroenteritis 

on April 11, 2014. 

By decision dated October 28, 2014, OWCP denied appellant’s claim as it found that she 

failed to establish causal relationship. It found that the record failed to contain a wellrationalized medical opinion explaining how the diagnosed conditions were causally related to 

the accepted employment incident/factor. 

LEGAL PRECEDENT 

An employee seeking benefits under FECA2 has the burden of establishing the essential 

elements of his or her claim, including the fact that the individual is an employee of the United 

States within the meaning of FECA; that the claim was filed within the applicable time 

limitation; that an injury was sustained while in the performance of duty as alleged and that any 

disability and/or specific condition for which compensation is claimed are causally related to the 

employment injury.3

 These are the essential elements of each and every compensation claim 

regardless of whether the claim is predicated on a traumatic injury or an occupational disease.4 

To determine whether a federal employee has sustained a traumatic injury in the 

performance of duty it must first be determined whether a fact of injury has been established.5 

 2 Id. 

3 C.S., Docket No. 08-1585 (issued March 3, 2009); Bonnie A. Contreras, 57 ECAB 364 (2006). 

4 S.P., 59 ECAB 184 (2007); Joe D. Cameron, 41 ECAB 153 (1989). 

5 B.F., Docket No. 09-60 (issued March 17, 2009); Bonnie A. Contreras, supra note 3. 
4

First, the employee must submit sufficient evidence to establish that he or she actually 

experienced the employment incident at the time, place, and in the manner alleged.6 Second, the 

employee must submit sufficient evidence, generally only in the form of medical evidence, to 

establish that the employment incident caused a personal injury.7

 

Causal relationship is a medical issue and the medical evidence generally required to 

establish causal relationship is rationalized medical opinion evidence.8

 Rationalized medical 

opinion evidence is medical evidence which includes a physician’s rationalized opinion on 

whether there is a causal relationship between the employee’s diagnosed condition and the 

compensable employment factors.9

 The opinion of the physician must be based on a complete 

factual and medical background of the employee, must be one of reasonable medical certainty, 

and must be supported by medical rationale explaining the nature of the relationship between the 

diagnosed condition and the specific employment factors identified by the employee.10 

Simple exposure to a workplace hazard, such as an infectious agent, does not constitute a 

work-related injury entitling an employee to medical treatment under FECA. The employing 

establishment therefore should not use a Form CA-16 to authorize medical testing for an 

employee who has merely been exposed to a workplace hazard, unless the employee has 

sustained an identifiable injury or medical condition as a result of that exposure.11

ANALYSIS 

OWCP accepted that appellant was in the performance of duty when she was exposed to 

a patient with norovirus. It denied her claim on the basis that the medical evidence failed to 

establish a causal relationship between the accepted work factor and her diagnosed medical 

conditions. The Board finds that appellant failed to meet her burden of proof in establishing her 

claim. 

In support of her claim appellant submitted a report from Dr. Hammett, a September 17, 

2014 report by Dr. Carroll, a dentist, and April 11, 2014 emergency department records from 

New Hanover Regional Medical Center where she was treated by Dr. Willard. Dr. Willard 

provided examination findings, a history of the injury and diagnosed syncope, acute 

gastroenteritis, closed head injury, right earlobe laceration, and right eyelid laceration. He 

related that appellant reported falling and hitting her head due to syncopal episode brought on by 

vomiting and diarrhea. Dr. Willard did not, however, provide an opinion as to the cause of the 

 6 D.B., 58 ECAB 464 (2007); David Apgar, 57 ECAB 137 (2005). 

7 C.B., Docket No. 08-1583 (issued December 9, 2008); D.G., 59 ECAB 734 (2008); Bonnie A. Contreras, supra

note 3. 

8 Y.J., Docket No. 08-1167 (issued October 7, 2008); A.D., 58 ECAB 149 (2006); D’Wayne Avila, 57 ECAB 

642 (2006). 

9 J.J., Docket No. 09-27 (issued February 10, 2009); Michael S. Mina, 57 ECAB 379 (2006). 

10 I.J., 59 ECAB 408 (2008); Victor J. Woodhams, 41 ECAB 345, 352 (1989). 

11 20 C.F.R. § 10.303(a). 
5

gastroenteritis. Dr. Carroll diagnosed teeth fractures as the result of appellant falling and hitting 

the right side of her head on the toilet and tile floor due to syncope. He offered no opinion as to 

the cause of the vomiting and diarrhea which was the cause of her dehydration and resulting 

syncope. Medical evidence which does not offer any opinion regarding the cause of an 

employee’s condition is of limited probative value.12 Thus, the reports from Drs. Willard and 

Carroll are insufficient to support a causal relationship between the diagnosed conditions and the 

accepted employment factor of exposure to norovirus. 

The record also contains an undated report from Dr. Hammett which concluded that there 

was a relationship between appellant’s diagnosed April 11, 2014 injuries and her exposure to a 

pediatric patient with norovirus. On October 7, 2014 OWCP received an undated report from 

Dr. Hammett in which he noted that the norovirus causes persistent vomiting and diarrhea which 

could result in dehydration and electrolyte imbalances without proper treatment. Dr. Hammett 

also stated that the norovirus is very contagious and appellant was in contact with a pediatric 

patient who was later determined to have contracted the norovirus. Based on his review of the 

medical and factual evidence and medical history, he opined that her gastroenteritis and 

subsequent injuries were a direct result of her exposure to the norovirus, which he observed was 

very contagious. Dr. Hammett has not provided any rationale explaining how appellant’s 

diagnosed medical conditions had been caused or aggravated by the accepted work exposure. 

While he opined that the diagnosed condition was caused by appellant’s exposure to norovirus, 

he failed to adequately explain how the accepted work exposure caused or contributed to the 

diagnosed condition other than offering a generalized opinion that norovirus is very contagious. 

As he failed to provide a sufficient explanation as to the mechanism of injury, Dr. Hammett’s 

general statement that appellant sustained a work-related injury is of limited probative value.13 

In addition, he did not physically examine appellant and his conclusion is based solely on his 

review of the medical history and medical and available factual evidence. Thus, Dr. Hammett’s 

reports are insufficient to support appellant’s burden of proof. 

The Board finds that there is insufficient rationalized medical evidence of record to 

establish that appellant sustained severe and sudden onset of diarrhea and vomiting, dehydration, 

and fainting, which caused her to hit the right side of her head and face on the floor due to 

exposure to Sydney norovirus related to the accepted work exposure. Appellant did not meet her 

burden of proof. 

On appeal appellant argues that she has established her claim by the submission of 

reports from Dr. Hammett. As discussed above, the reports from Dr. Hammett are insufficiently 

rationalized to establish that the injuries she sustained were causally related to the accepted work 

factor. 

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. 

 12 C.B., Docket No. 09-2027 (issued May 12, 2010); A.F., 59 ECAB 714 (12, 2008); Michael E. Smith, 50 ECAB 

313 (1999). 

13 S.W., Docket 08-2538 (issued May 21, 2009); Cecelia M. Corley, 56 ECAB 662 (2005). 
6

CONCLUSION 

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

sustained an injury on April 11, 2014 in the performance of duty. 

ORDER 

IT IS HEREBY ORDERED THAT the decision of the Office of Workers’ 

Compensation Programs dated October 28, 2014 is affirmed.14

Issued: March 21, 2016 

Washington, DC 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board 

 14 James A. Haynes, Alternate Judge, participated in the preparation of this decision but was no longer a member 

of the Board effective November 16, 2015.