United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

R.Q., Appellant 

and 

DEPARTMENT OF TRANSPORTATION, 

FEDERAL AVIATION ADMINISTRATION, 

Washington, DC, Employer 

__________________________________________ 

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Docket No. 17-0283 

Issued: February 21, 2017 

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 November 17, 2016 appellant filed a timely appeal from an October 12, 2016 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 his burden of proof to establish that he sustained a 

work-related hearing condition on August 30, 2016. 

FACTUAL HISTORY 

On August 31, 2016 appellant, then a 36-year-old air traffic controller, filed a traumatic 

injury claim (Form CA-1) alleging that he sustained injury in the form of left ear ringing, white 

noise, and discomfort when working as the controller-in-charge on August 30, 2016. He 

indicated that he heard white noise while using a wireless headset and had ringing in his left ear. 

 1

 5 U.S.C. § 8101 et seq. 
2

On the same form, appellant’s immediate supervisor checked a box marked “Yes” indicating that 

her knowledge of the facts of the claimed injury agreed with the statements of appellant.2 

Appellant stopped work on August 30, 2016.3

In a September 7, 2016 letter, OWCP advised appellant that the documentation it 

received to date was insufficient to support his claim for a work-related injury on 

August 30, 2016. It requested that he submit a report from an attending physician containing, 

inter alia, a detailed description of findings, diagnosis, and an opinion supported by a medical 

explanation as to how the reported work incident caused or aggravated a medical condition. 

Appellant submitted a form entitled “Authorization for Examination [and/or] Treatment” 

(Form CA-16), completed on September 2, 2016. In this form report, Dr. Jin S. Lim, an 

attending Board-certified otolaryngologist, indicated that appellant reported that on August 30, 

2016, due to wearing a left ear headset, he “began to have white noise, abnormal beeping after 

sounds, and headaches.” He noted “normal physical exam[ination]” in the portion of the report 

for findings. Dr. Lim also noted that an audiogram was pending. In the diagnosis section of the 

form report, he noted “hyperacusis” and “abn[ormal] auditory perceptions,” along with their 

corresponding ICD-10 codes (International Classification of Diseases, 10th revision), H93.232 

and H93.292, respectively.4

 Dr. Lim also included the ICD-10 diagnostic code for tinnitus, 

H93.12. He checked a box marked “Yes” indicating that the condition found was caused or 

aggravated by the employment activity described and noted, “Only because it started 

immediately after use of headset.” Additionally, Dr. Lim reported that appellant was totally 

disabled from September 2, 2016 until “pending.” 

By decision dated October 12, 2016, OWCP denied appellant’s claim for a work-related 

hearing condition arising on August 30, 2016. It found that he had established the existence of 

work factors on August 30, 2016, but that he did not submit medical evidence establishing causal 

relationship between the accepted work factors and a diagnosed medical condition. OWCP 

further noted that the Form CA-16 “contained an illegible diagnosis and illegible physician’s 

signature.” 

LEGAL PRECEDENT 

 An employee seeking benefits under FECA has the burden of proof to establish 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 timely filed within the applicable 

time limitation period of FECA, that an injury was sustained 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.5

 These are the essential elements of each 

 2

 Under a separate OWCP file number (xxxxxx364) for a claim not currently before the Board, OWCP accepted 

that on July 1, 2013 appellant sustained a traumatic right ear injury in the form of acoustic trauma (ICD-9 code 

388.11, International Classification of Diseases, 9th revision). 

3

 Appellant requested continuation of pay on the Form CA-1 completed on August 31, 2016. However, it is 

unclear from the record whether he received continuation of pay. 

4

 Hyperacusis is defined as exceptionally acute hearing, with an unusually low hearing threshold, which may or 

may not be accompanied by pain. See Dorland’s Illustrated Medical Dictionary, 878 (30th ed. 2003). 

5 C.S., Docket No. 08-1585 (issued March 3, 2009); Elaine Pendleton, 40 ECAB 1143 (1989). 
3

compensation claim regardless of whether the claim is predicated upon a traumatic injury or an 

occupational disease.6

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

performance of duty, it first must be determined whether the fact of injury has been established. 

There are two components involved in establishing the fact of injury. First, the employee must 

submit sufficient evidence to establish that he actually experienced the employment incident at 

the time, place, and in the manner alleged.7

 Second, the employee must submit evidence, in the 

form of medical evidence, to establish that the employment incident caused a personal injury.8

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

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

physician must be based on a complete factual and medical background of the claimant, 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 claimant.9

ANALYSIS 

Appellant filed a Form CA-1 alleging that on August 30, 2016 he sustained injury in the 

form of ringing, white noise, and discomfort while using a wireless headset at work. OWCP 

denied his claim because he failed to submit medical evidence sufficient to establish such a 

work-related hearing injury. 

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

sustained a work-related hearing condition on August 30, 2016. 

In denying appellant’s claim, OWCP accepted that he experienced work factors in the 

form of being exposed to noise from a headset while conducting air traffic controller duties on 

August 30, 2016. The Board also finds that appellant was exposed to such work factors on 

August 30, 2016. In finding that appellant had not submitted medical evidence establishing a 

causal relationship between work factors and a diagnosed condition, OWCP indicated that he 

submitted a Form CA-16, which had been completed on September 2, 2016, but that the form 

report contained an illegible diagnosis and illegible physician’s signature. The Board finds that 

the Form CA-16 is identifiable as having been completed by Dr. Lim, an attending physician, 

and that Dr. Lim provided the specific diagnoses of hyperacusis, other abnormal auditory 

perceptions, and tinnitus. 

 6 S.P., 59 ECAB 184 (2007); Victor J. Woodhams, 41 ECAB 345 (1989). A traumatic injury refers to injury 

caused by a specific event or incident or series of incidents occurring within a single workday or work shift whereas an 

occupational disease refers to an injury produced by employment factors which occur or are present over a period 

longer than a single workday or work shift. 20 C.F.R. § 10.5 (q), (ee); Brady L. Fowler, 44 ECAB 343, 351 (1992). 

7 Julie B. Hawkins, 38 ECAB 393 (1987). 

8 John J. Carlone, 41 ECAB 354 (1989). 

9 See I.J., 59 ECAB 408 (2008); Donna Faye Cardwell, 41 ECAB 730 (1990). 
4

The September 2, 2016 form report of Dr. Lim is the only medical evidence submitted by 

appellant and the Board finds that this report does not establish that appellant sustained a workrelated hearing condition on August 30, 2016. In this form report, Dr. Lim indicated that 

appellant reported that on August 30, 2016, due to wearing a left ear headset, he “began to have 

white noise, abnormal beeping after sounds, and headaches.” Dr. Lim noted “normal physical 

exam[ination]” and checked a box marked “Yes” indicating that the diagnosed conditions of 

hyperacusis, other abnormal auditory perceptions, and tinnitus were caused or aggravated by the 

employment activity described. 

The Board finds that Dr. Lim’s report is of limited probative value on the relevant issue 

of this case because he did not provide a rationalized medical report relating the observed 

conditions to the accepted work factors that appellant experienced on August 30, 2016.10 The 

Board has held that when a physician’s opinion on causal relationship consists only of checking a 

box marked “Yes” to a form question, without the addition of adequate medical rationale, that 

opinion has little probative value and is insufficient to establish causal relationship.11 Appellant’s 

burden includes the necessity of furnishing an affirmative opinion from a physician who supports 

his or her conclusion with sound medical reasoning.12 

Dr. Lim indicated that he checked the box marked “Yes” denoting work-related causation 

only because appellant’s reported symptoms “started immediately after use of headset.” 

However, the Board has held that the fact that a condition manifests itself or worsens during a 

period of employment13 or that work activities produce symptoms revelatory of an underlying 

condition14 does not raise an inference of causal relationship between a claimed condition and 

employment factors. Temporal relationship alone will not suffice.15 Dr. Lim did not describe the 

accepted work factors in any detail or explain the medical process through which appellant’s use of 

a left ear headset could have caused the diagnosed conditions. As Dr. Lim did little more than 

check a box marked “Yes” to a form question, his opinion on causal relationship is of little 

probative value and is insufficient to discharge appellant’s burden of proof for a work-related 

hearing condition.16

 10 See supra note 9. 

11 See D.D., 57 ECAB 734, 739 (2006); Deborah L. Beatty, 54 ECAB 340, 341 (2003). 

12 Lillian M. Jones, 34 ECAB 379, 381 (1982). 

13 William Nimitz, Jr., 30 ECAB 567, 570 (1979). 

14 Richard B. Cissel, 32 ECAB 1910, 1917 (1981). 

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

16 The Board notes that where an employing establishment properly executes a Form CA-16 which authorizes 

medical treatment as a result of an employee’s claim for an employment-related injury, the Form CA-16 creates a 

contractual obligation, which does not involve the employee directly, to pay for the cost of the examination or 

treatment regardless of the action taken on the claim. See Tracy P. Spillane, 54 ECAB 608 (2003). The period for 

which treatment is authorized by a Form CA-16 is limited to 60 days from the date of issuance, unless OWCP 

terminates the authorization sooner. See 20 C.F.R. § 10.300(c). The record is silent as to whether OWCP paid for 

the cost of appellant’s examination or treatment for the period noted on the form. 
5

CONCLUSION 

The Board finds that appellant did not meet his burden of proof to establish that he 

sustained a work-related hearing condition on August 30, 2016. 

ORDER 

IT IS HEREBY ORDERED THAT the October 12, 2016 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: February 21, 2017 

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