United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

B.B., Appellant 

and 

DEPARTMENT OF THE AIR FORCE, 

NELLIS AIR FORCE BASE, NV, Employer 

__________________________________________ 

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Docket No. 16-0139 

Issued: March 1, 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 

ALEC J. KOROMILAS, Alternate Judge 

JURISDICTION 

On November 2, 2015 appellant filed a timely appeal of an October 14, 2015 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 the case. 

ISSUE 

The issue is whether appellant has met his burden of proof to establish a traumatic injury 

in the performance of duty. 

FACTUAL HISTORY 

On April 22, 2015 appellant then a 36-year-old aircraft overhaul leader, filed a traumatic 

injury claim (Form CA-1) alleging that on April 21, 2015, while performing aircraft 

maintenance, he began to feel lightheaded and vomited several times. He did not stop work. 

 

 1 5 U.S.C. § 8101 et seq. 
2

By letter dated April 28, 2015, OWCP advised appellant of the type of evidence needed 

to establish his claim, particularly requesting that he submit a physician’s reasoned opinion 

addressing the relationship of his claimed condition and specific employment factors. 

On April 21, 2015 appellant was treated by Dr. David L. Watson, Board-certified in 

emergency medicine, who diagnosed dehydration. Dr. Watson provided discharge instructions 

for an upper respiratory infection, diarrhea, allergy, and sinus. He recommended that appellant 

stay hydrated and drink frequent sips of clear liquid and follow up with his primary care 

physician. Also submitted was a position description and core personnel document for an 

aircraft overhaul leader.2

In a decision dated June 5, 2015, OWCP denied appellant’s claim for a traumatic injury 

finding that he had failed to establish an injury or medical condition causally related to the 

accepted work events. 

In an appeal request form dated June 17, 2015, appellant requested reconsideration. In an 

undated statement he referenced attached documentation in support of his claim which he 

believed would clear up any causal relationship issues. Appellant submitted an Air Force patient 

care report dated April 21, 2015, prepared by an emergency medical technician, who treated 

appellant for abdominal and gastrointestinal issues, nausea/vomiting and syncope/fainting. He 

reported working on a jet when he started feeling dizzy and lightheaded and sat down and 

vomited. The technician noted that appellant began to vomit in the ambulance as he was 

transported to the hospital. 

Appellant submitted emergency department provider order sheets dated April 21, 2015 

from Dr. Watson who prescribed internal venous fluids and blood work. In an emergency 

physician record dated April 21, 2015, Dr. Watson noted that appellant reported vomiting from 

consuming spoiled food the previous night. Appellant noted experiencing cramping, abdominal 

pain, nausea/vomiting with syncope. Dr. Watson diagnosed volume depletion, vomiting and 

dehydration and discharged appellant. In an emergency care and treatment record dated 

April 21, 2015, he noted appellant’s complaints of nausea and vomiting. Dr. Watson diagnosed 

nausea/vomiting, syncope and dehydration. In emergency department nursing and data report, a 

nurse noted treating appellant for nausea, vomiting, and possible syncope. She noted that 

appellant was discharged home. 

In a decision dated October 14, 2015, OWCP denied modification of the decision dated 

June 5, 2015. 

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 filed within the applicable time limitation 

 2

 The record contains an authorization for examination or treatment (Form CA-16) dated April 21, 2015. The 

employing establishment advised that appellant reported experiencing severe light headiness and nausea while 

working and vomited several times. The attending physician’s section of the CA-16 form was not completed. 
3

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 compensation claim 

regardless of whether the claim is predicated upon a traumatic injury or an occupational disease.3

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

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

There are two components involved in establishing 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. Second, the employee must submit medical evidence 

to establish that the employment incident caused a personal injury.4

Rationalized medical opinion evidence is generally required to establish causal 

relationship. The opinion of the physician must be based on a complete factual and medical 

background, 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.5

ANALYSIS 

It is not disputed that on April 21, 2015 appellant was performing aircraft maintenance 

duties. It is also not disputed that he was diagnosed with nausea/vomiting, syncope and 

dehydration. However, appellant has not submitted sufficient medical evidence to establish that 

his diagnosed conditions were caused or aggravated by the April 21, 2015 incident. 

The medical reports from Dr. Watson noted that appellant reported vomiting from 

consuming spoiled food the previous night. Appellant noted experiencing cramping, abdominal 

pain, nausea/vomiting with syncope. Dr. Watson diagnosed volume depletion, vomiting and 

dehydration, and discharged appellant from his care. These reports are insufficient to establish 

the claim as Dr. Watson did not provide a history of the April 21, 2015 work incident or reflect 

knowledge of appellant’s work duties that day,6

 or specifically address how his employment 

activities had caused or aggravated a diagnosed medical condition.7

 Rather, Dr. Watson noted 

that appellant reported the diagnosed nausea and vomiting were caused by eating spoiled food 

the previous night. 

Appellant submitted emergency department nursing notes dated April 21, 2015. 

However, the Board has held that treatment notes signed by a nurse are not considered medical 

 3 Gary J. Watling, 52 ECAB 357 (2001). 

4

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

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

6 Frank Luis Rembisz, 52 ECAB 147 (2000) (medical opinions based on an incomplete history or which are 

speculative or equivocal in character have little probative value). 

7 A.D., 58 ECAB 149 (2006) (medical evidence which does not offer any opinion regarding the cause of an 

employee’s condition is of limited probative value on the issue of causal relationship). 
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evidence under FECA.8

 Similarly, appellant submitted a report dated April 21, 2015, prepared 

by an emergency medical technician who treated appellant for abdominal and gastrointestinal 

issues, nausea/vomiting and syncope/fainting. As there is no evidence that the document was 

prepared by a physician, it also is not considered medical evidence.9

 

An award of compensation may not be based on surmise, conjecture or speculation. 

Neither the fact that appellant’s condition became apparent during a period of employment nor 

the belief that her condition was caused, precipitated, or aggravated by her employment is 

sufficient to establish causal relationship. Causal relationships must be established by 

rationalized medical opinion evidence.10 Appellant failed to submit such evidence, and OWCP 

therefore properly denied appellant’s claim for compensation. 

On appeal appellant asserts that OWCP had improperly denied his claim and believed he 

submitted sufficient evidence to establish that his diagnosed nausea, vomiting and dehydration 

were causally related to his employment. He has not submitted a physician’s report, based on an 

accurate history, which describes how work activities on April 21, 2015 caused or aggravated his 

diagnosed conditions of nausea, vomiting and dehydration. 

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 did not meet his burden of proof to establish that his 

claimed conditions were causally related to his employment. 

 8 See David P. Sawchuk, 57 ECAB 316 (2006) (lay individuals such as physician assistants, nurses and physical 

therapists are not competent to render amedical opinion under the FECA); 5 U.S.C. § 8101(2) (this subsection 

defines a “physician” as surgeons, podiatrists, dentists, clinical psychologists, optometrists, chiropractors, and 

osteopathic practitioners within the scope of their practice as defined by State law). 

9 Id. 

10 See Dennis M. Mascarenas, 49 ECAB 215 (1997). 
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ORDER 

IT IS HEREBY ORDERED THAT the October 14, 2015 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: March 1, 2016 

Washington, DC 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board