United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

M.D., Appellant 

and 

DEPARTMENT OF HOMELAND SECURITY, 

CUSTOMS & BORDER PROTECTION, 

Tucson, AZ, Employer 

__________________________________________ 

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Docket No. 16-1450 

Issued: March 28, 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 

VALERIE D. EVANS-HARRELL, Alternate Judge 

JURISDICTION 

On July 6, 2016 appellant filed a timely appeal from a May 10, 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 an injury causally 

related to a January 30, 2016 employment incident. 

FACTUAL HISTORY 

On February 15, 2016 appellant, a 32-year-old border patrol agent, filed a traumatic 

injury claim (Form CA-1), alleging that he suffered from heat exhaustion on January 30, 2016 

 1

 5 U.S.C. § 8101 et seq. 
2

while in the performance of duty. He stated that he sustained a heat-related injury resulting in 

vomiting and cramping. The employing establishment did not indicate that appellant stopped 

work. 

Appellant submitted a January 30, 2016 ambulance bill from Ajo Ambulance, Inc. in the 

amount of $1,733.89. 

The employing establishment submitted an undated statement indicating that appellant 

was seen and assessed by an ambulance, but was not transported, and was currently on full-duty 

status. 

In an April 7, 2016 letter, 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 and, based on 

these criteria and because the employing establishment did not controvert continuation of pay or 

challenge the case, payment of a limited amount of medical expenses was administratively 

approved. It stated that it had reopened the claim for consideration because the medical bills had 

exceeded $1,500.00. OWCP requested additional evidence from appellant within 30 days to 

respond to its inquiries. 

In response, appellant submitted an April 16, 2016 narrative statement indicating that on 

January 30, 2016 he experienced symptoms of dehydration after hours of hiking through rugged 

terrain while tracking a group of drug smugglers. A coworker notified a helicopter pilot that 

appellant was in need of medical attention and that he was unable to hike out of the canyon to the 

nearest means of transportation. The pilot was able to land nearby and transport appellant to the 

Ajo Border Station. Once the helicopter landed at the station two paramedics, employed by Ajo 

Ambulance, Inc., were waiting to assist appellant. They assessed his condition and determined 

that, although he needed intravenous therapy to replace the fluids and electrolytes he had lost 

throughout the day, a trip to the emergency room was not required. Appellant opted out of riding 

in the ambulance to the emergency room and chose to stay at the station and received 

intravenous therapy from another coworker who was also a certified emergency medical 

technician. He did not receive any other medical treatment. Appellant stated that he obtained 

the paramedics report and was unable to provide further medical evidence from a physician 

because he did not visit or consult a doctor. He indicated that the only medical bill for which he 

was seeking compensation was the bill from Ajo Ambulance, Inc., for services rendered on 

January 30, 2016 in the amount of $1,733.89. 

By decision dated May 10, 2016, OWCP denied appellant’s claim because the medical 

evidence of record failed to establish a diagnosed condition causally related to the January 30, 

2016 employment incident. 

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 
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time limitation period of FECA, that an injury2

 was sustained in the performance of duty, as 

alleged, and that any disability or medical condition for which compensation is claimed is 

causally related to the employment injury.3

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. A 

fact of injury determination is based on two elements. 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. 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. 

An employee may establish that the employment incident occurred as alleged but fail to show 

that his or her condition relates to the employment incident.4

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 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.5

ANALYSIS 

OWCP has accepted that the employment incident of January 30, 2016 occurred at the 

time, place, and in the manner alleged. The issue is whether appellant sustained an injury as a 

result. 

The Board finds that appellant did not submit any medical evidence from a physician 

which provided a firm diagnosis and a reasoned explanation as to how the accepted incident 

caused an injury. Appellant therefore failed to meet his burden of proof to establish that he has a 

medical condition resulting from the January 30, 2016 employment incident. 

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. 

Finally, it is undisputed that an ambulance was called and assessed appellant’s condition 

at Ajo Border Station shortly after the January 30, 2016 employment incident. Ordinarily, the 

employing establishment will authorize treatment of a job-related injury by providing the 

 2

 OWCP regulations define a traumatic injury as a condition of the body caused by a specific event or incident, or 

series of events or incidents, within a single workday or shift. Such condition must be caused by external force, 

including stress or strain, which is identifiable as to time and place of occurrence and member or function of the 

body affected. 20 C.F.R. § 10.5(ee). 

3 See T.H., 59 ECAB 388 (2008). 

4 Id.

5 Id.
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employee a properly executed Form CA-16 within four hours.6

 However, under 5 U.S.C. 

§ 8103, OWCP has broad discretionary authority to approve unauthorized medical care which it 

finds necessary and reasonable in cases of emergency or other unusual circumstances.7

 Upon 

return of the case record, OWCP shall determine whether appellant’s ambulance transportation 

should be authorized pursuant to 20 C.F.R. § 10.304, which provides that in cases involving 

emergencies or unusual circumstances, OWCP may authorize treatment in a manner other than 

as stated in this subpart.8

CONCLUSION 

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

causally related to a January 30, 2016 employment incident. On return of the record, OWCP 

should consider the ambulance bill issued in this case. 

 6 See 20 C.F.R. § 10.300; Val D. Wynn, 40 ECAB 666 (1989); a Form CA-16, authorization of medical care was 

not issued in this case. 

7 See M.A., Docket No. 14-1071 (issued October 3, 2014) (where the Board found that the employee failed to 

establish that he had a medical condition resulting from a December 14, 2013 work incident, but returned the case to 

OWCP to determine whether his ambulance transportation and initial medical care in the hospital emergency room 

should be authorized). 

8 See J.D., Docket No. 14-936 (issued August 8, 2014); L.B., Docket No. 10-469 (issued June 2, 2010). 
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ORDER 

IT IS HEREBY ORDERED THAT the May 10, 2016 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: March 28, 2017 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Valerie D. Evans-Harrell, Alternate Judge 

 Employees’ Compensation Appeals Board