United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

A.N., Appellant 

and 

DEPARTMENT OF HEALTH & HUMAN 

SERVICES, WOODROW WILSON KEEBLE 

MEMORIAL HEALTH CARE CENTER, 

Sisseton, SD, Employer 

__________________________________________ 

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Docket No. 15-1220 

Issued: September 27, 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 May 7, 2015 appellant filed a timely appeal from a December 17, 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 has met his burden of proof to establish an occupational 

disease due to factors of his federal employment. 

 1

 5 U.S.C. § 8101 et seq.
2

FACTUAL HISTORY 

On March 6, 2014 appellant, then a 63-year-old radiology supervisor, filed an 

occupational disease claim (Form CA-2) alleging that on January 30, 2014 he first became aware 

of his bad chest pain, dizziness, stomach problems, and loss of sleep. He alleged that on 

March 3, 2014 he first realized that his conditions were due to very high stress at work. 

Appellant stopped work on March 10, 2014. 

In a March 5, 2014 narrative statement, appellant stated that he began to experience chest 

pain on about January 30, 2014 and that his condition increased daily by mid-February 2014 

during his regular work hours. He contended that, during his first week of March 14, 2014, as a 

supervisor, a clinic administrator instructed him to suspend an employee. She also reminded 

appellant on several occasions about his probation status as a career conditional employee. 

Appellant contended that he was expected to meet reportable deadlines and to learn a difficult 

budget and contract policy. At that time, he noticed a link between his job stress and episodes of 

chest pain, dizziness, shortness of breath, weakness in his knees, indigestion, vomiting, 

headache, shaking, and, high blood pressure. Appellant also contended that the radiology 

department had been without a supervisor for two years and that as such, it had low employee 

morale and was a “mess.” For these reasons, he alleged that he experienced an extremely high 

level of stress as a supervisor in the radiology department. 

In discharge summary instructions dated March 7, 2014 from Sanford Health, Dr. Rawa 

Sarji, Board-certified in internal medicine and cardiovascular disease, indicated that appellant 

was admitted to the hospital on that same day for evaluation and released on March 8, 2014. She 

advised that he could resume his home diet and normal activity as tolerated and provided a 

discharge medication list. 

By letter dated March 18, 2014, OWCP advised appellant that the evidence submitted 

was insufficient to establish his claim. It requested that he submit factual and medical evidence 

to establish his claim. OWCP also requested that the employing establishment respond to 

appellant’s allegations and submit medical evidence, if he had been treated at its medical facility. 

Hospital records from Coteau des Prairies Hospital and Clinic included a report and an 

emergency note dated March 7, 2014 from Dr. Judy C. Beumer, a Board-certified family 

practitioner, who provided appellant’s history which included, among other things, episodes of 

angina that began in January 2014. She attributed his symptoms to work-related stress. 

Dr. Beumer reported examination findings and diagnosed, among other things, anxiety, stress, 

hypertension, elevated troponin-nonstemi, high cholesterol, family history of heart problems, and 

remote smoking history. 

In reports dated March 7, 2014, Dr. Sarah Malik, an internist, and Dr. Sarji provided 

appellant’s history which included experiencing chest pain during the third week of 

January 2014 he experienced chest pain while working as a supervisor at the employing 

establishment and his medical, social, and family background. Appellant told the physicians that 

in late February 2014 that he had a high level of stress at work and felt overwhelmed. 

Examination findings were noted. Appellant was assessed as presenting with chest pain that had 

been going on for the last two months, left-sided substernal radiating to the left armpit with jaw 
3

tightness, diaphoresis, and nausea precipitated by exertion and relieved with rest. He had no 

prior history of coronary artery disease (CAD) or cardiac workup and no aspirin use at home. 

Appellant had a family history of CAD, as his father died at 47 years old due to myocardial 

infarction. Dr. Sarji advised that his cardiac risk factors included his age, hypertension, 

hyperlipidemia, family history of heart disease, and obesity. Appellant’s TIMI score was 3 for 

CAD risk factors. He had severe anginal episodes, positive cardiac markers that included a 13 

percent risk during 14 days of his hospital stay, and acute coronary syndromes that required 

urgent revascularization. Appellant’s first troponin was elevated at 0.14. An electrocardiogram 

(EKG) did not reveal any ischemic changes. 

In another report dated March 7, 2014, Dr. Sarji noted that she personally interviewed 

and examined appellant. She agreed with Dr. Malik’s note. Dr. Sarji advised that appellant had 

experienced progressively worsening chest pain over the prior one to two months. Appellant 

was under a lot of stress at work. An EKG was unremarkable, but troponin was positive at 0.24. 

In a March 8, 2014 discharge summary report, Dr. Malik noted appellant’s medical 

treatment and provided examination findings along with laboratory and diagnostic test results. 

Appellant’s primary discharge diagnosis was non-ST segment elevation myocardial infarction 

(NSTEMI) and status post drug-eluting stents (DES) in right coronary artery (RCA). 

In a March 8, 2014 discharge summaries report, Dr. Sarji noted that she had personally 

interviewed and examined appellant. She reviewed and agreed with Dr. Malik’s note. 

Appellant’s discharge summary was NSTEMI, CAD status post percutaneous coronary 

intervention (PCI) of the proximal RCA with a 3.0 x 30 millimeters (mm) resolute DES, and 

acute on chronic kidney disease. 

In a March 7, 2014 progress note, Dr. Thomas A. Haldis, an internist with a subspecialty 

in cardiovascular disease, performed a left heart catheterization, stent to RCA with a 3.0 x 30 

mm resolute DES to treat appellant’s NSTEMI. Appellant’s postoperative condition was stable. 

In an after visit summary and work status report dated March 20, 2014, 

Dr. Pushpanjalie D. Wijeratne, a Board-certified family practitioner, provided examination 

findings and diagnosed essential hypertension, hyperlipidemia (high blood fats), CAD with the 

presence of a stent, angina pectoris (chest pain), and anxiety disorder. Appellant was placed off 

work through April, 19, 2014. Dr. Wijeratne noted that extended time off for more than one 

month would be decided by the cardiology department after its evaluation of appellant. 

In a March 31, 2014 letter, the employing establishment disagreed with appellant’s 

statements and allegations. On March 7, 2014 appellant informed his supervisor about his chest 

pains due to stress. His supervisor advised him to immediately go to the emergency department 

for evaluation, but he refused to do so. Instead, appellant returned to his office. Several hours 

later he left the facility without telling his supervisor. Prior to March 7, 2014, appellant never 

reported any stress or health-related concerns that he was having with his supervisor. The 

employing establishment stated that there were no aspects of his job perceived as stressful. The 

only established deadlines were for submitting monthly reports to the clinical director. 

Appellant’s only intense assignment was to address a disciplinary/adverse action handled by a 

prior supervisor. The employing establishment stated that he was allowed reasonable time to 
4

address this issue. Appellant did not request any accommodations and no stress or other healthrelated issues were discussed. He did not request an extension of deadlines. Upon appellant’s 

hiring, the radiology department was fully staffed and he was not required to cover any evening 

or weekend duties. He was temporarily relieved of his radiology duties until the stated 

disciplinary/adverse action was resolved. After resolving this issue, appellant refused to follow 

through with learning departmental procedures and, thus, was unable to assist with radiology 

duties. The employing establishment stated that his performance did not meet the expectations 

required of a supervisor and that he was also advised about his conduct issues. As a radiologist, 

appellant was required to spend at least 50 percent of his time performing radiology duties. 

However, he failed to perform the required duties and refused to learn processes to accomplish 

his tasks. Appellant was counseled by his supervisor on multiple occasions. 

The employing establishment submitted a description of appellant’s supervisory 

diagnostic radiologic technologist position. 

In an April 25, 2014 decision, OWCP denied appellant’s claim. It found that he had 

established compensable factors of employment, that he was expected to meet report deadlines 

and he had to learn a very difficult budget and contract policy. However, the medical evidence 

of record was insufficient to establish that appellant had a medical condition caused by the 

accepted employment factors. 

On May 19, 2014 appellant requested a review of the written record by an OWCP hearing 

representative. 

In a report dated May 6, 2014, Dr. Bahram Khadivi, an internist with a subspecialty in 

cardiovascular disease, provided appellant’s history and complaints of mild dyspnea on a 

treadmill and slight chest pain like he experienced on March 20, 2014 with NSTEMI. 

Examination findings were noted and appellant was assessed as having CAD with the presence 

of a stent, hyperlipidemia (high blood fats), essential hypertension, dyspnea, and chest pain. 

In a November 6, 2014 letter, the employing establishment stated that appellant had no 

intentions of returning to his position as he moved to San Diego, California. He resigned from 

his position, effective May 14, 2014. 

By decision dated December 17, 2014, an OWCP hearing representative affirmed the 

April 25, 2014 decision. She found that appellant had failed to submit rationalized medical 

evidence to establish that his diagnosed conditions were due to the accepted employment factors. 

LEGAL PRECEDENT 

A claimant has the burden of establishing by the weight of the reliable, probative, and 

substantial evidence that the condition for which he or she claims compensation was caused or 

adversely affected by factors of his or her federal employment.2

 To establish that he or she 

sustained an emotional condition in the performance of duty, a claimant must submit: (1) factual 

evidence identifying employment factors or incidents alleged to have caused or contributed to an 

emotional condition; (2) medical evidence establishing an emotional or psychiatric disorder; 

 2 Pamela R. Rice, 38 ECAB 838 (1987). 
5

and (3) rationalized medical opinion evidence establishing that the identified compensable 

employment factors are causally related to the emotional condition.3

Workers’ compensation law does not apply to each and every injury or illness that is 

somehow related to an employee’s employment. There are situations where an injury or an 

illness has some connection with the employment, but nevertheless does not come within the 

concept or coverage of workers’ compensation. Where the disability results from an employee’s 

emotional reaction to his or her regular or specially assigned duties or to a requirement imposed 

by the employment, the disability comes within the coverage of FECA.4 On the other hand, the 

disability is not covered where it results from such factors as an employee’s fear of a 

reduction-in-force or his or her frustration from not being permitted to work in a particular 

environment or to hold a particular position.5

Administrative and personnel matters, although generally related to the employee’s 

employment, are administrative functions of the employing establishment rather than the regular 

or specially assigned work duties of the employee and are not covered under FECA6

 However, 

the Board has held that where the evidence establishes error or abuse on the part of the 

employing establishment in what would otherwise be an administrative matter, coverage will be 

afforded.7 In determining whether the employing establishment has erred or acted abusively, the 

Board will examine the factual evidence of record to determine whether the employing 

establishment acted reasonably.8 

In cases involving emotional conditions, the Board has held that, when working 

conditions are alleged as factors in causing a condition or disability, OWCP, as part of its 

adjudicatory function, must make findings of fact regarding which working conditions are 

deemed compensable factors of employment and are to be considered by a physician when 

providing an opinion on causal relationship and which working conditions are not deemed 

factors of employment and may not be considered.9 If a claimant does implicate a factor of 

employment, OWCP should then determine whether the evidence of record substantiates that 

factor. When the matter asserted is a compensable factor of employment and the evidence of 

record establishes the truth of the matter asserted, OWCP must base its decision on an analysis of 

the medical evidence.10

 3 See Donna Faye Cardwell, 41 ECAB 730 (1990). 

4

 5 U.S.C. §§ 8101-8193; Trudy A. Scott, 52 ECAB 309 (2001); Lillian Cutler, 28 ECAB 125 (1976). 

5 Gregorio E. Conde, 52 ECAB 410 (2001). 

6 See Matilda R. Wyatt, 52 ECAB 421 (2001); Thomas D. McEuen, 41 ECAB 387 (1990); reaff’d on recon., 42 

ECAB 556 (1991). 

7 See William H. Fortner, 49 ECAB 324 (1998). 

8 Ruth S. Johnson, 46 ECAB 237 (1994). 

9 Dennis J. Balogh, 52 ECAB 232 (2001). 

10 Id.
6

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

establish causal relationship is rationalized medical opinion evidence.11 The opinion of the 

physician must be based on a complete factual and medical background of the claimant12 and 

must be one of reasonable medical certainty13 explaining the nature of the relationship between 

the diagnosed condition and the specific employment factors identified by the claimant.14

ANALYSIS 

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

occupational disease causally related to factors of his federal employment. 

OWCP accepted as compensable factors of employment that appellant was expected to 

meet report deadlines and to learn a very difficult budget and contract policy. The Board has 

held that emotional reactions to situations in which an employee is trying to meet his or her 

position requirements are compensable.15 Further, the employing establishment confirmed that 

appellant did in fact have set deadlines for submitting monthly reports to the clinical director. 

Consequently, appellant has established as compensable factors of employment an expectation to 

meet report deadlines and to learn a very difficult budget and contract policy during the 

performance of his regularly assigned work duties. 

Appellant generally asserted that he worked in a stressful environment due to the fact that 

the radiology department was “a mess” and had low morale because it was without a supervisor 

for nearly two years. This allegation is insufficient to substantiate any work factor as factual. In 

order to establish his claim, appellant must submit factual evidence identifying specific 

employment factors or incidents as having caused or contributed to his condition.16 His 

allegation is nonspecific and there are no statements by any coworkers to substantiate his 

stressful work environment. Thus, the Board finds that appellant has not established an 

additional compensable employment factor with regard to this allegation. 

Appellant’s remaining allegations, that a clinic administrator instructed him to suspend an 

employee and harassed him on several occasions about being on probation as a career condition 

employee, pertain to administrative actions. As stated, an administrative or personnel matter will 

be considered to be an employment factor only where the evidence discloses error or abuse on 

the part of the employing establishment.17 The method, by which managers perform their 

supervisory duties generally fall outside the coverage of FECA absent evidence of error or 

 11 John J. Montoya, 54 ECAB 306 (2003). 

12 Tomas Martinez, 54 ECAB 623 (2003); Gary J. Watling, 52 ECAB 278 (2001). 

13 Supra note 11. 

14 Judy C. Rogers, 54 ECAB 693 (2003). 

15 Trudy A. Scott, 52 ECAB 309 (2001). 

16 Leslie C. Moore, 52 ECAB 132 (2000). 

17 See supra notes 6 and 7. 
7

abuse.18 The Board finds that appellant’s allegations regarding the assignment of work19 and his 

employment status pertain to administrative functions. The Board also finds that the employing 

establishment’s counseling sessions also pertain to administrative functions.20 Appellant has not 

submitted evidence showing that the employing establishment committed error or abuse with 

regard to these matters. While the employing establishment stated that his only intense 

assignment was to address the disciplinary/adverse action against an employee that was handled 

by a prior supervisor, it provided him with a reasonable amount of time to handle this situation. 

Regarding appellant’s work performance, the employing establishment explained that he 

failed to spend at least 50 percent of his time performing radiology duties, as required. It stated 

that he was not required to cover any evening or weekend duties as his department was fully 

staffed. The employing establishment further stated that appellant refused to learn the processes 

necessary to accomplish his tasks. It related that he was counseled on multiple times by his 

supervisor for refusing to assist his staff and to participate in monthly staff meetings, taking 

extended lunch breaks, and leaving his tour of duty early. The employing establishment’s 

statements establish that it did not act unreasonably or err in handling the above-stated 

administrative matters. The Board finds therefore that appellant has not established an additional 

compensable employment factor with regard to these allegations. 

The Board finds that the medical evidence of record must be analyzed to address the two 

compensable factors of employment, namely that he was expected to meet reportable deadlines 

and that he had to learn a very difficult budget and contract policy.21 

Dr. Beumer’s March 7, 2014 reports found that appellant had, among other things, 

anxiety, stress, hypertension, elevated troponin-nonstemi, and high cholesterol based on 

examination findings and laboratory test results. Appellant told Dr. Beumer that his symptoms 

were attributable to work-related stress. His belief that his stress condition was caused or 

aggravated by an employment factor is insufficient to establish causal relationship.22 

Dr. Beumer did not offer her own opinion regarding the cause of appellant’s diagnosed 

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

employee’s condition is of limited probative value.23 Therefore, the Board finds that 

Dr. Beumer’s reports are insufficient to meet appellant’s burden of proof. 

The remaining reports and progress notes from Drs. Sarji, Malik, Haldis, Wijeratne, and 

Khadivi, and the laboratory reports are similarly insufficient to establish causal relationship. 

These reports provided diagnoses based on their examinations and addressed appellant’s medical 

treatment and work capacity, but none of the physicians provided an opinion addressing whether 

 18 See Janet I. Jones, 47 ECAB 345, 347 (1996); Jimmy Gilbreath, 44 ECAB 555, 558 (1993). 

19 C.E., Docket No. 13-1860 (issued January 17, 2014). 

20 Andrew Wolfgang-Masters, 56 ECAB 411 (2005). 

21 See Robert Breeden, 57 ECAB 622 (2006). 

22 See Gary J. Watling, supra note 12. 

23 See K.W., 59 ECAB 271 (2007). 
8

his diagnosed conditions, medical treatment, and disability for work were caused by the accepted 

compensable employment factors.24 While Dr. Sarji, in her March 7, 2014 report, noted his 

worsening chest pain and stated that he was under a lot of stress at work, he did not specifically 

opine whether his chest condition was causally related to the established employment factors. 

The Board finds that the reports from Drs. Sarji, Malik, Haldis, Wijeratne, and Khadivi, and the 

laboratory reports are insufficient to establish appellant’s claim. 

The Board therefore finds that appellant has not submitted sufficient medical evidence to 

establish an occupational disease causally related to the compensable work factors. 

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 

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

occupational disease casually related to factors of his federal employment. 

ORDER 

IT IS HEREBY ORDERED THAT the December 17, 2014 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: September 27, 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 

 24 Id.