United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

D.B., Appellant 

and 

DEPARTMENT OF THE ARMY, ARMY 

NATIONAL GUARD, KANSAS NATIONAL 

GUARD -- JOINT FORCES HEADQUARTERS, 

Topeka, KS, Employer 

__________________________________________ 

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Docket No. 16-1219 

Issued: November 8, 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 

COLLEEN DUFFY KIKO, Judge 

VALERIE D. EVANS-HARRELL, Alternate Judge 

JURISDICTION 

On May 18, 2016 appellant filed a timely appeal from an April 14, 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 to 

consider the merits of the case. 

ISSUE 

The issue is whether appellant met his burden of proof to establish an injury causally 

related to an accepted August 8, 2013 employment incident. 

On appeal, appellant alleges that he was instructed to file a Form CA-1 for payment of 

his medical expenses instead of submitting the medical bills to his health insurance carrier. 

 1

 5 U.S.C. § 8101 et seq. 
2

FACTUAL HISTORY 

On August 8, 2013 a traumatic injury claim (Form-CA-1) was filed on behalf of 

appellant, then a 33-year-old facility plans and program management specialist, alleging that on 

that date he lost consciousness twice while trying to stand up after donating blood. He was 

transferred to a hospital for medical evaluation. Appellant returned to work on August 9, 2013. 

An August 8, 2013 patient care report signed by a paramedic and an emergency medical 

technician (EMT), revealed that appellant had a syncopal episode while donating blood. They 

related that, upon their arrival at the employing establishment, appellant was resting on a cot, and 

he showed some improvement enroute to the St. Francis emergency room. 

Appellant was seen at St. Francis Health Center by Dr. Rebecca Hierholzer, a physician 

Board-certified in emergency medicine, who noted her impression as vasovagal syncope. 

Dr. Hierholzer noted that appellant stated that he was okay when the needle was placed in his 

arm to draw blood, but when he pumped his arm he started feeling lightheaded and when he 

started to sit up he passed out. Appellant noted that he was given a drink and cookies, but he 

continued to feel lightheaded and dizzy. 

Appellant submitted x-ray reports of his right ankle, right knee, and lumbosacral spine 

taken on July 3, 2014 by Dr. Matthew S. Malmstrom, an osteopathic diagnostic radiologist. The 

x-rays of the right ankle and right knee were interpreted as revealing normal findings. The x-ray 

of the lumbosacral spine was interpreted as revealing mild L5-S1 disc degeneration. 

By letter to appellant dated March 14, 2016, OWCP 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, that the employing establishment did not controvert the claim, and that based on these 

criteria, the payment of a limited amount of medical expenses was approved. However, it noted 

as the medical bills now exceeded $1,500.00, further medical evidence was necessary to support 

his claim. Appellant was afforded 30 days to submit evidence including a rationalized medical 

report from a physician explaining how the employment incident caused a diagnosed condition. 

OWCP did not receive a response. 

By decision dated April 14, 2016, OWCP denied appellant’s claim as the medical 

evidence did not demonstrate that a medical condition was causally related to the accepted 

employment incident. 

LEGAL PRECEDENT 

An employee seeking benefits under FECA 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 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. These are the essential elements of each and every 
3

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

occupational disease.2

 

In order to determine whether an employee actually sustained an injury in the 

performance of duty, OWCP begins with an analysis of whether fact of injury has been 

established. Generally, fact of injury consists of two components, which must be considered in 

conjunction with one another. The first component to be established is that the employee 

actually experienced the employment incident or exposure, which is alleged to have occurred.3 

In order to meet his or her burden of proof to establish the fact that he or she sustained an injury 

in the performance of duty, an employee must submit sufficient evidence to establish that he or 

she actually experienced the employment injury or exposure at the time, place, and in the manner 

alleged.4

The second component is whether the employment incident caused a personal injury and 

generally can be established only by medical evidence.5

 The medical evidence required to 

establish causal relationship is usually rationalized medical evidence. Rationalized medical 

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

issue of whether there is a causal relationship between the claimant’s diagnosed condition and 

the implicated employment factors. 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.6

ANALYSIS 

There is no dispute that the incident occurred as alleged, i.e., that appellant donated blood 

on August 8, 2013, and that he has established a medical diagnosis, i.e., vasovagal syncope. He 

has also submitted x-ray evidence of mild L5-S1 disc degeneration. OWCP denied appellant’s 

claim as he failed to provide a rationalized medical opinion establishing causal relationship 

between the accepted employment incident and the medical diagnoses. 

Appellant submitted a note from the paramedic and EMT who responded on 

August 8, 2013. However, this report does not constitute medical evidence as neither a 

paramedic nor an EMT are qualified to provide a medical opinion under FECA.7

 

 2 Jussara L. Arcanjo, 55 ECAB 281, 283 (2004). 

3 See Federal (FECA) Procedure Manual, Part 2 -- Claims, Fact of Injury, Chapter 2.803(2)(a) (August 2012). 

4 Linda S. Jackson, 49 ECAB 486 (1998). 

5 John J. Carlone, 41 ECAB 354 (1989); Horace Langhorne, 29 ECAB 820 (1978). 

6 Judith A. Peot, 46 ECAB 1036 (1995); Ruby I. Fish, 46 ECAB 276 (1994). 

7

 5 U.S.C. § 8101(2) of FECA provides as follows: a physician includes surgeons, podiatrist, dentists, clinical 

psychologists, optometrist, chiropractors, and osteopathic practitioners within the scope of their practice as defined 

by State law. Lay individuals are not competent to render a medical opinion under FECA. See David P. Sawchuk, 

57 ECAB 316, 320 n.11 (2006). 
4

The August 8, 2013 report of Dr. Hierholzer noted the employment incident and related 

that appellant had a vasovagal syncope, but failed to provide a well-rationalized opinion 

explaining causal relationship between the accepted employment incident and the medical 

diagnosis.8

The July 3, 2014 x-rays from Dr. Malmstrom noted an impression of mild L5-S1 disc 

degenerative disease, but offered no medical opinion regarding the cause of this diagnosed 

condition. 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.9

 

In a similar case, Michael John Zenker,

10 the claimant fainted while donating blood and 

allegedly sustained tailbone and neck injuries. The Board found that the claimant had not met 

his burden of proof as he has not submitted a report containing a physician’s opinion, supported 

by medical rationale and based on a complete history, explaining how and why donating blood at 

work resulted in the fainting incident which led to his lower back injury. 

Similarly, in this case the record is without a well-rationalized medical opinion 

establishing that the diagnosed conditions of syncope were causally related to the accepted 

August 8, 2013 employment incident. OWCP advised appellant that it was his responsibility to 

provide a comprehensive medical report explaining how the diagnosed medical condition was 

caused by the accepted employment incident. Appellant failed to submit appropriate medical 

documentation in response to OWCP’s request.11 

The Board has held that the mere fact that a condition manifests itself during a period of 

employment does not raise an inference of causal relation.12 An award of compensation may not 

be based on surmise, conjecture, speculation, or upon appellant’s own belief that there was a 

causal relationship between his or her condition and his or her employment.13 Causal 

relationship must be based on rationalized medical opinion evidence.14 As appellant did not 

submit a rationalized medical opinion supporting that his medical conditions were causally 

related to the accepted August 8, 2013 employment incident, he did not meet his burden of proof 

to establish an employment-related traumatic injury. 

 8 Supra note 6. 

9 L.L., Docket No. 16-0896 (issued September 13, 2016). 

10 Docket No. 93-1363 (issued September 8, 1994). 

11 See T.H., Docket No. 15-0772 (issued May 12, 2016). 

12 L.D., Docket No. 09-1503 (issued April 15, 2010); D.I., 59 ECAB 158 (2007); Daniel O. Vasquez, 57 ECAB 

559 (2006). 

13 Patricia J. Glenn, 53 ECAB 159, 160 (2001). 

14 M.E., Docket No. 14-1064 (issued September 29, 2014). 
5

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 injury 

causally related to an accepted August 8, 2013 employment incident. 

ORDER 

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

Compensation Programs dated April 14, 2016 is affirmed. 

Issued: November 8, 2016 

Washington, DC 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 Valerie D. Evans-Harrell, Alternate Judge 

 Employees’ Compensation Appeals Board