United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

D.C., Appellant

and

DEPARTMENT OF JUSTICE, FEDERAL 

BUREAU OF INVESTIGATION, New York, NY, 

Employer

__________________________________________

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Docket No. 18-1358

Issued: June 13, 2019

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 July 2, 2018 appellant filed a timely appeal from an April 18, 2018 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 her burden of proof to establish that her diagnosed

medical conditions were causally related to the accepted April 12, 2018 employment incident. 

FACTUAL HISTORY

On May 4, 2017 appellant, then a 40-year-old investigative specialist, filed a traumatic 

injury claim (Form CA-1) alleging that on April 12, 2017 she sustained a bilateral vertebral 

 

1 5 U.S.C. § 8101 et seq.
2

dissection and cerebral stroke when driving her employing establishment vehicle during 

surveillance activity while in the performance of duty. She explained that, when she turned her 

head rapidly to check the traffic movement behind her, she sustained a “dissection of the left and 

right [vertebral] arteries which [caused] a blood clot, and then a cerebral stroke.”

On the reverse side of the claim form appellant’s supervisor indicated that appellant was 

injured in performance of duty. She noted that appellant was driving her assigned vehicle when 

she “turned her head rapidly.” The supervisor did not indicate a date when appellant stopped work.

In a development letter dated May 12, 2017, OWCP informed appellant that additional 

factual and medical evidence was necessary to establish her claim. It also requested that she 

complete a factual questionnaire regarding the injury. OWCP afforded appellant 30 days to submit 

the requested evidence. 

OWCP subsequently received an April 12, 2017 report from an emergency medical 

technician, an April 12, 2017 sinus bradycardia test report, and an April 17, 2017 admission and 

patient discharge instructions from Mount Sinai Hospital.

An April 12, 2017 computerized tomography (CT) scan of the head read by Dr. Marvin 

Weingarten, a Board-certified diagnostic radiologist, was found to be within normal limits.

OWCP also received April 12, 2017 treatment notes in which Dr. Robin S. Kim, an 

emergency medicine specialist, diagnosed a nonintractable headache, unspecified, and chronicity 

pattern, unspecified.

In an April 12, 2017 report, Dr. Purushottam Tiwari, a family medicine specialist, 

diagnosed dizziness, possible stroke.

An April 17, 2017 magnetic resonance imaging (MRI) scan of the brain read by

Dr. Stephen Greenberg, a Board-certified diagnostic radiologist, revealed acute/subacute infarct 

of the posteromedial left cerebellar hemisphere with restricted diffusion, and no mass effect on the 

fourth ventricle or hydrocephalus.

An April 17, 2017 magnetic resonance intracranial angiogram (MRA) read by

Dr. Greenberg revealed fetal origin of right posterior cerebral artery from the right internal carotid 

artery, aplastic A1 segment of the right anterior cerebral artery with normal caliber A2 segmented 

cross-filled from the left anterior cerebral artery by way of a patent anterior communicating artery, 

and patent superior cerebellar arteries bilaterally. 

An April 18, 2017 MRA read by Dr. Greenberg revealed focal dissection of the left 

vertebral artery as it exited the left transverse foramen at the C1 level, extending over a length of 

approximately three centimeters, with intramural hematoma over the proximal one centimeter, and 

patent false lumen over the distal two centimeter.

OWCP received an April 19, 2017 report from Dr. Gabriella Tantino, a neurologist, who 

indicated that appellant was seen for a stroke and follow up of left cerebellar stroke and bilateral 

vertebral dissection. Dr. Tantino advised appellant to avoid sudden neck movements, vigorous 

exercise, heavy lifting, chiropractic manipulation, and yoga.
3

In a May 8, 2017 report, Dr. Deborah Horowitz, Board-certified in internal medicine, noted 

that appellant was under her care for treatment of bilateral vertebral artery dissection and a left 

cerebellar infarction. She explained that appellant had no residual deficits and her prognosis was 

excellent. Dr. Horowitz advised that appellant could not do any heavy lifting, but she was able to 

drive. She diagnosed cerebral stroke and bilateral vertebral artery dissection and indicated that 

appellant could work with restrictions.

By decision dated June 19, 2017, OWCP denied appellant’s claim, finding that she had not 

met her burden of proof to establish causal relationship between her diagnosed medical conditions

and the accepted April 12, 2017 employment incident.

2

On July 17, 2017 appellant requested reconsideration.

In an April 12, 2017 report, Dr. Chantal Gabriel, an emergency medicine physician

explained that, while driving, appellant’s vision began to change and it seemed like it “rotated,” 

appellant had difficulty steering due to upper extremity weakness, and could not focus on the road. 

At some point, while driving, appellant felt like she was going to pass out, but stated that “she was 

trying to fight it off.” When she got home, she went to an urgent care center for evaluation. While 

there appellant began to experience pain in the back of her eyes. She also reported associated 

symptoms of feeling “shaky,” diaphoresis, and weakness in both extremities (more on her right 

side), nausea, vomiting, and a headache and dizziness. Dr. Gabriel opined that her impression/

differential diagnosis was hyperglycemia, but that a final diagnosis was pending.

OWCP received an unsigned and undated statement from the employing which confirmed 

that no accident occurred, no police report was filled, and no investigation was conducted.

OWCP received appellant’s undated responses to OWCP’s questionnaire on 

August 1, 2017. Appellant denied having any similar disability or symptoms prior to the 

employment incident. She explained that immediately after she made a quick turn of her head, she 

felt pain in her neck, her vision was affected, and she began to suffer other symptoms.

In a May 8, 2017 report, Dr. Horowitz noted that appellant was under his care for bilateral 

vertebral artery dissection and a left cerebellar infarction. She recommended that appellant not 

perform heavy lifting, and indicated that she was unable to drive.

By decision dated October 12, 2017, OWCP denied appellant’s request for reconsideration,

finding that the evidence submitted was insufficient to warrant a merit review.

On December 5, 2017 appellant again requested reconsideration. She indicated that she 

was submitting additional evidence from her physician, Dr. Horowitz.

 

2 OWCP also noted that appellant had two prior claims involving motor vehicle accidents. The prior claims included 

a June 1, 2011 traumatic injury under File No. xxxxxx977, and a July 21, 2016 traumatic injury under File No. 

xxxxxx241, for a head injury. OWCP explained that it was unclear whether there was a correlation between her mini 

stroke symptoms and the two previous motor vehicle accidents in 2010 and 2016, or if there were any other similar 

injuries she might have sustained prior to April 12, 2017.
4

In a September 19, 2017 report, Dr. Horowitz advised that appellant was under her care 

from April 17 to 19, 2017. She noted the employment incident and explained that appellant’s MRI 

scan revealed a cerebellar stroke and bilateral vertebral artery dissections. Dr. Horowitz opined: 

“[h]ead turning while driving can be a cause of vertebral dissections; this may have been related 

to the development of the dissections in this case. The stroke resulted from the dissections. 

Concussions in the past are unlikely to be related.”

OWCP also received hospital records from Mount Sinai Hospital dating from 

April 17, 2017. The records included nursing notes, laboratory reports, nursing assessments, and 

discharge instructions. Dr. Indira Gowda, an emergency medicine physician, diagnosed vertebral 

artery dissection and cerebellar infarction.

In a letter dated April 11, 2018, appellant advised OWCP that she had not received a 

response to her request for reconsideration.

By decision dated April 18, 2018, OWCP denied modification of the June 19, 2017 

decision finding that the medical evidence of record was insufficient to establish that her diagnosed 

conditions were causally related to the accepted work incident. 

LEGAL PRECEDENT

An employee seeking benefits under FECA3 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 of FECA,4that an injury 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.5 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.6

To determine if an employee sustained a traumatic injury in the performance of duty, 

OWCP begins with an analysis of whether fact of injury has been established.7 Generally, fact of 

injury consists of two components that must be considered in conjunction with one another. The 

first component is whether the employee actually experienced the employment incident that 

allegedly occurred.8 The second component is whether the employment incident caused a personal 

 

3

Id.

4 S.B., Docket No. 17-1779 (issued February 7, 2018); J.P., 59 ECAB 178 (2007); Joe D. Cameron, 41 ECAB 

153 (1989).

5

J.M., Docket No. 17-0284 (issued February 7, 2018); R.C., 59 ECAB 427 (2008); James E. Chadden, Sr., 40 

ECAB 312 (1988).

6 K.M., Docket No. 15-1660 (issued September 16, 2016); L.M., Docket No. 13-1402 (issued February 7, 2014); 

Delores C. Ellyett, 41 ECAB 992 (1990).

7 D.B., Docket No. 18-1348 (issued January 4, 2019); T.H., 59 ECAB 388, 393-94 (2008).

8 D.S., Docket No. 17-1422 (issued November 9, 2017); Elaine Pendleton, 40 ECAB 1143 (1989).
5

injury.9 An employee may establish that an injury occurred in the performance of duty as alleged, 

but fail to establish that the disability or specific condition for which compensation is being 

claimed is causally related to the injury.10

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.11 A physician’s opinion on whether there is causal relationship 

between the diagnosed condition and the implicated employment factor(s) must be based on a 

complete factual and medical background.12 Additionally, the physician’s opinion must be 

expressed in terms of a reasonable degree of medical certainty and must be supported by medical 

rationale, explaining the nature of the relationship between the diagnosed condition and appellant’s 

specific employment factor(s).13

ANALYSIS

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

diagnosed medical conditions were causally related to the accepted April 12, 2017 employment 

incident.

In an April 12, 2017 report, Dr. Gabriel opined that her impression/differential diagnosis 

was hyperglycemia, but that a final diagnosis had not been established. As she did not provide a 

firm diagnosis causally related to the accepted employment incident, the Board finds this report is 

of limited probative value.14

Dr. Horowitz saw appellant on April 17 and May 8 and 19, 2017 and diagnosed cerebral 

stroke and bilateral vertebral artery dissection. In a September 19, 2017 report, she opined:

“[h]ead turning while driving can be a cause of vertebral dissections; this may have been related 

to the development of the dissections in this case. The stroke resulted from the dissections. 

Concussions in the past are unlikely to be related.” This opinion on causal relationship was 

speculative as she indicated that head turning while driving “can” be a cause of vertebral 

dissections and “may” be related to the development of dissections. The Board has held that 

speculative and equivocal medical opinions regarding causal relationship have no probative 

value.15 The physician’s opinion must be expressed in terms of a reasonable degree of medical 

 

9 B.M., Docket No. 17-0796 (issued July 5, 2018); John J. Carlone, 41 ECAB 354 (1989). 

10 D.D., Docket No. 18-0648 (issued October 15, 2018); Shirley A. Temple, 48 ECAB 404, 407 (1997).

11 T.H., supra note 7 at 388, 393; Robert G. Morris, 48 ECAB 238 (1996).

12 M.V., Docket No. 18-0884 (issued December 28, 2018); Victor J. Woodhams, 41 ECAB 345, 352 (1989).

13 Id.

14 J.P., Docket No. 14-87 (issued March 14, 2014).

15 Ricky S. Storms, 52 ECAB 349 (2001) (while the opinion of a physician supporting causal relationship need not 

be one of absolute medical certainty, the opinion must not be speculative or equivocal. The opinion should be 

expressed in terms of a reasonable degree of medical certainty). 
6

certainty and must be supported by medical rationale, explaining the nature of the relationship 

between the diagnosed condition and appellant’s specific employment factor(s).16

Although Dr. Kim, Dr. Gowda, Dr. Tiwari, and Dr. Tantino also provided firm diagnoses, 

they offered no opinion regarding the cause of the diagnosed conditions. The Board has held that 

medical evidence that does not offer an opinion regarding the cause of an employee’s condition is 

of no probative value on the issue of causal relationship.17

The record contains April 12, 2017 hospital admissions records, discharge instructions, and 

an April 12, 2017 report from an emergency medical technician. These forms were not signed or 

reviewed by a physician. Medical opinions, in general, can only be given by a qualified 

physician.18 A report that is unsigned or bears an illegible signature lacks proper identification 

and cannot be considered probative medical evidence.19

OWCP also received nursing notes dated April 12, 2017. These notes lack probative value 

as healthcare providers such as physician assistants, physical therapists, or nurse practitioners are 

not considered physicians as defined under FECA.20 Therefore, these reports are also of no 

probative value regarding causal relationship. 

The diagnostic reports of record dated April 12 to 18, 2017 are also insufficient to establish 

appellant’s claim. The Board has held that reports of diagnostic tests lack probative value as they 

do not provide an opinion on causal relationship between appellant’s employment duties and the 

diagnosed conditions.21

As appellant submitted insufficient evidence to establish an injury caused by her accepted 

employment incident, the Board finds that she has not met her burden of proof to establish her 

claim. 

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. 

 

16 See supra note 13.

17 See L.B., Docket No. 18-0533 (issued August 27, 2018); D.K., Docket No. 17-1549 (issued July 6, 2018). 

18 E.K., Docket No. 09-1827 (issued April 21, 2010); see 5 U.S.C. § 8101(2) (defines the term physician to include 

surgeons, podiatrists, dentists, clinical psychologists, optometrists, chiropractors, and osteopathic practitioners within 

the scope of their practice as defined by state law). 

19 Thomas L. Agee, 56 ECAB 465 (2005); Richard F. Williams, 55 ECAB 343 (2004). 

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

therapists are not competent to render a medical opinion under FECA). See also M.M., Docket No. 16-1617 (issued 

January 24, 2017). 

21 See L.M., Docket No. 18-0473 (issued October 22, 2018). 
7

CONCLUSION

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

diagnosed medical conditions were causally related to the accepted April 12, 2017 employment 

incident. 

ORDER

IT IS HEREBY ORDERED THAT the April 18, 2018 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: June 13, 2019

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