United States Department of Labor

Employees’ Compensation Appeals Board

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D.P., Appellant

and

DEPARTMENT OF DEFENSE, DEFENSE 

INTELLIGENCE AGENCY, Washington, DC, 

Employer

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Docket No. 18-1647

Issued: March 21, 2019

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

ALEC J. KOROMILAS, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On August 29, 2018 appellant filed a timely appeal from a March 5, 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 to 

consider the merits of the case.

ISSUE

The issue is whether appellant met her burden of proof to establish medical conditions 

causally related to the accepted factors of her federal employment. 

FACTUAL HISTORY

On December 22, 2014 appellant, then a 36-year-old intelligence analyst, filed an 

occupational disease claim (Form CA-2) alleging that, while in the performance of duty, she 

 

1 5 U.S.C. § 8101 et seq.
2

suffered from Gulf War Illness/Chronic Multisymptom Illness. She alleged that she was exposed 

to burn pits while deployed to Iraq in 2009, causing, contributing to, or aggravating the following 

symptoms of widespread chronic pain, sleep disturbances including insomnia and sleep paralysis, 

chronic fatigue and exhaustion, shortness of breath, numbness and tingling, dysesthesia, cognitive 

difficulties, difficulties with memory, poor concentration tremulousness, orthostatic intolerance 

which includes fainting when standing for longer than an 10-minute period, rapid heart rate, high 

blood pressure, visual disturbances, palpitations, and chest pain, sensitivity to light and sounds, 

muscle weakness and cramping, gastrointestinal issues including gastroparesis, bloating, nausea 

and vomiting, frequent urination and incontinence, constipation, dry eyes, night sweats, recurring 

skin rashes and flushing of the skin, recurring infections, and an exacerbation of migraine 

headaches and symptoms of Raynaud’s disease. Appellant noted that she first became aware of 

her condition on September 7, 2009 and related it to her federal employment on April 8, 2014. 

She did not stop work.

By development letter dated February 3, 2015, OWCP acknowledged receipt of a medical 

report from Dr. Benjamin Natelson, a Board-certified neurology specialist, dated December 1, 

2014 and a medical report from Dr. Ruben Cintron, a Board-certified neurology specialist, dated 

November 19, 2014.2 It informed appellant that additional evidence was needed to establish her

occupational disease claim. OWCP advised her of the type of factual and medical evidence needed 

and provided a questionnaire for her completion. It afforded appellant 30 days to submit additional 

evidence.

In a separate development letter of even date, OWCP asked the employing establishment 

to submit information concerning appellant’s claim. No response was received.

On February 4, 2015 OWCP received various diagnostic test results and medical reports 

dated between 2009 and 2014. Appellant noted a November 10, 2009 visit with Dr. Shalini 

Kaneriya, a Board-certified internal medicine specialist, was one of her first appointments with 

her primary care physician after she began experiencing symptoms upon her return from 

deployment. Dr. Kaneriya indicated that appellant complained of chronic low back pain. 

In a November 24, 2009, Dr. Cintron noted a portion of appellant’s symptoms, including 

severe headaches, paresthesias in the lower extremities and back, and arthalgias, some of the 

treatments attempted, and some of the examinations performed or planned that could shed light on 

the situation. 

By statement dated March 1, 2015, appellant indicated that she began to suffer from 

symptoms a week after she left Iraq in September 2009, although she was unaware of the cause. 

It was not until Dr. Natelson diagnosed “Gulf War Illness” after a November 26, 2014 appointment 

that she believed her illness related to her exposure to environmental toxins during her deployment 

to Iraq. 

OWCP received a Department of the Air Force memorandum, dated December 20, 2006, 

documenting the burn pit at Balad Air Base as “a health concern” based upon after action reports. 

 

2 The Board notes that these reports do not appear in the record prior to the February 3, 2015 development letter in 

which OWCP acknowledges receiving them.
3

Lt. Col. D.C., a bioenvironmental engineering flight commander with the U.S. Air Force 

Biomedical Sciences Corps, reported that contaminants resulting from open burning of solid waste 

that exceeded the Military Exposure Guides had not yet been quantified, but noted that smoke 

hazards are associated with burning plastics, Styrofoam, paper, wood, rubber, POL products, 

nonmedical waste, some metals, some chemicals, such as paints and solvents, and incomplete 

combustion by-products. Possible contaminants included acetaldehyde, acrolein, arsenic, 

benzene, carbon dioxide, carbon monoxide, dichlorfluoromethane, ethylbenzene, formaldehyde, 

hydrogen cyanide, hydrogen chloride, hydrogen fluoride, various metals, nitrogen dioxide, 

phosgene, sulfuric acid, sulfur dioxide, toluene, trichloroethane, trochloropropane, and xylene.

By decision dated April 7, 2015, OWCP denied appellant’s claim, finding that the factual 

evidence of record was insufficient to establish that she was exposed to burn pits as alleged. It 

noted that her documentation lacked specificity regarding frequency or intensity of her alleged 

exposure. OWCP further noted that the Air Force memorandum characterizing the burn pit as a 

health concern was dated several years prior to her deployment. 

On April 7, 2016 appellant requested reconsideration. In support of this request, she

submitted U.S. Army Public Health Command Screening Health Risk Assessments May 11 to 

June 19, 2009. They detailed the findings of ambient air samples in the vicinity of the Balad burn 

pit, determining that polychclic aromatic hydrocarbons (PAHs), dioxins/furans, particulate matter 

(PM) PM10 and PM2.5 and associated metals were present in the ambient air in amounts greater 

than established guidelines. 

On April 13, 2016 OWCP received a report dated March 31, 2016 from Deborah Norris, 

Ph.D., a neurotoxicologist, who reviewed appellant’s history and the Army air sample reports.

Dr. Norris provided toxicological profiles and permissible occupational exposure limits for several 

observed substances. She concluded that appellant’s exposure to N-Hexane, Acetone, PM10 and 

PM2.5 from the burn pit caused her illnesses. 

By decision dated July 6, 2016, OWCP modified the April 7, 2015 decision, finding that 

the Army report was sufficient to establish moderate exposure to PAHs, dioxins/furans, PM10 and 

PM2.5, and associated metals greater than established guidelines, and therefore establishing fact of 

injury. However, the claim remained denied because there was insufficient medical opinion 

evidence to establish causal relationship between appellant’s diagnosed conditions and the 

accepted occupational exposure. 

On January 3, 2017 appellant requested reconsideration. In support of her request, she 

referenced two medical reports that she stated she previously submitted, but that claims examiners 

did not discuss in their decisions: Dr. Natelson’s December 1, 2014 report and Dr. Cintron’s 

November 19, 2014 report. Appellant indicated that she enclosed a copy of each report with her 

request for reconsideration.3

 

3 The Board notes that the record reflects only Dr. Natelson’s December 1, 2014 report was received with the 

request for reconsideration. This is the first instance of this report appearing in the record. Dr. Cintron’s 

November 19, 2014 report previously appeared in the record on December 14, 2017.
4

By decision dated April 3, 2017, OWCP denied modification of its July 6, 2016 decision. 

It found that Dr. Natelson’s December 1, 2014 report, which had not been previously considered, 

was insufficient to establish a diagnosed condition causally related to the accepted exposure 

because the report lacked a definitive opinion regarding causation. Further, OWCP noted that the 

report did not detail a well-rationalized medically certain opinion as to the specific relationship 

between appellant’s diagnosis and her employment. 

On December 14, 2017 appellant requested reconsideration. In support of her request, she 

submitted a copy of Dr. Cintron’s November 19, 2014 report, which she indicated had been 

previously submitted, but overlooked in OWCP decisions to date.4In this report, Dr. Cintron noted 

appellant’s exposure to burn pits during her deployment to Iraq in 2009 and symptoms that began 

less than a week after her return to the United States. Detailing appellant’s “wide range of multisystem issues” and visits and examinations she had with various physicians, he opined “with 

reasonable medical certainty that [appellant] was exposed to an environmental toxin during her 

deployment which resulted in her illness.” Dr. Cintron diagnosed Gulf War Illness/Chronic 

Multisymptom Illness.

By decision dated March 5, 2018, OWCP denied modification of its April 3, 2017 decision. 

It found that Dr. Cintron’s December 1, 2014 report, which had not been previously considered, 

was insufficient to establish a diagnosed condition causally related to the accepted exposure. 

OWCP found that the report lacked discussion of the specific hazardous or infectious agents 

appellant was exposed to, the duration and rate of frequency of exposure, and well-rationalized 

medical explanation cited by clinical findings explaining how exposure caused, aggravated, or 

exacerbated any diagnosed condition. 

LEGAL PRECEDENT

An employee seeking benefits under FECA5 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 filed within the applicable time 

limitation, that an injury was sustained while in the performance of duty as alleged, and that any 

disability or specific condition for which compensation is claimed is causally related to the 

employment injury.6 These are the essential elements of each and every compensation claim 

regardless of whether the claim is predicated on a traumatic injury or an occupational disease.7

In an occupational disease claim, appellant’s burden requires submission of the following: 

(1) a factual statement identifying employment factors alleged to have caused or contributed to the 

presence or occurrence of the disease or condition; (2) medical evidence establishing the presence 

or existence of the disease or condition for which compensation is claimed; and (3) medical 

 

4 The Board notes this is the first instance in which Dr. Cintron’s November 19, 2014 report appears in the record.

5 Supra note 1.

6 See J.I., Docket No. 18-0286 (issued September 17, 2018); Elaine Pendleton, 40 ECAB 1143 (1989).

7 See R.B., Docket No. 18-0416 (issued September 14, 2018); Ellen L. Noble, 55 ECAB 530 (2004).
5

evidence establishing that the diagnosed condition is causally related to the employment factors 

identified by the employee.8

The medical evidence 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 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.9

ANALYSIS

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

conditions causally related to the accepted factors of her federal employment.

Appellant alleged that she developed Gulf War Illness/Chronic Multisymptom Illness as a 

result of exposure to burn pits and associated airborne hazards while deployed to Iraq in 2009. 

OWCP accepted her occupational exposure, as well as a medical diagnosis. However, it denied 

the claim because the medical evidence submitted failed to establish a causal relationship between 

appellant’s diagnosed Gulf War Illness/Chronic Multisymptom Illness and the accepted 

occupational exposure. 

In the November 19, 2014 report, Dr. Cintron noted appellant’s exposure to burn pits 

during her deployment to Iraq in 2009 and symptoms that began less than a week after her return 

to the United States. Detailing appellant’s “wide range of multi-system issues” and visits and 

examinations she had with various physicians, he opined “with reasonable medical certainty that 

[appellant] was exposed to an environmental toxin during her deployment which resulted in her 

illness.” Dr. Cintron diagnosed Gulf War Illness/Chronic Multisymptom Illness. However, he did 

not provide a probative, rationalized opinion regarding how the accepted federal employment 

exposure caused the diagnosed condition.10

While this report addresses appellant’s diagnosis and an opinion concerning its cause, the 

report falls short of the requisite rationalized medical opinion evidence FECA requires. In this 

report, Dr. Cintron only generally noted her exposure to burn pits and neurotoxins. He did not 

sufficiently explain why, medically, appellant would have sustained Gulf War Illness/Chronic 

Multisymptom Illness due to her exposure.

11

 The Board has held that medical evidence which 

does not offer a clear opinion explaining the physiological cause of an employee’s condition is of 

limited probative value on the issue of causal relationship.12 The Board has also held that a mere 

 

8 See P.D., Docket No. 17-1885 (issued September 17, 2018).

9 See J.R., Docket No. 17-1781 (issued January 16, 2018); I.J., 59 ECAB 408 (2008).

10 M.G., Docket No. 18-0654 (issued October 17, 2018); see George Randolph Taylor, 6 ECAB 986, 988 (1954) 

(where the Board found that a medical opinion not fortified by medical rationale is of little probative value).

11 Id.

12 L.J., Docket No. 17-1993 (issued March 13, 2018); see R.B., Docket No. 16-1700 (issued September 25, 2017).
6

conclusion without the necessary rationale explaining how appellant’s specific accepted work 

duties could result in the diagnosed condition is insufficient for her to meet her burden of proof.13

As well, Dr. Cintron failed to provide a detailed history of the neurotoxin exposure, only 

generally noting that appellant was exposed on a daily basis to burn pits and unspecified “materials 

that have been known to cause chronic health issues similar to hers.” Without an understanding 

of the exposure, any opinion on causal relationship is of limited probative value as the physician 

is unable to describe how the incident caused her condition.

14

 Dr. Cintron’s report lacks the 

specificity and detail needed to establish appellant’s claim.15 Medical conclusions unsupported by 

rationale are of limited probative value.16 Thus, the Board finds that Dr. Cintron’s report is 

insufficient to meet appellant’s burden of proof.

Appellant also emphasizes Dr. Natelson’s report dated December 1, 2014. The Board 

notes that he did not definitively relate her diagnosed medical conditions to the accepted exposure. 

Dr. Natelson indicated that the temporal relation between appellant’s return to the U.S. from Iraq 

and the onset of her symptoms make it “highly likely” that her deployment caused her illness. His

opinion on causation is speculative and couched in equivocal terms. To be of probative value, a 

physician’s opinion on causal relationship should be one of reasonable medical certainty.17 

Dr. Natelson’s opinion therefore lacks the specificity and detail needed to establish appellant’s 

claim.18

Appellant contends that the causation element of her claim is demonstrated in part by

Dr. Norris’ report, but there is no indication that Dr. Norris, a Ph.D., is a physician under FECA.19 

Her opinion is of no probative value because lay individuals are not competent to render a medical 

opinion under FECA.20

The Board finds that the medical evidence of record is insufficient to establish appellant’s 

claim that her medical conditions are causally related to the accepted factors of her federal 

employment.

21

 

13 M.G., supra note 10; see J.S., Docket No. 18-0477 (issued August 28, 2018).

14 See L.M., Docket No. 14-0973 (issued August 25, 2014); R.G., Docket No. 14-0113 (issued April 25, 2014); 

K.M., Docket No. 13-1459 (issued December 5, 2013); A.J., Docket No. 12-0548 (issued November 16, 2012).

15 P.O., Docket No. 14-1675 (issued December 3, 2015); S.R., Docket No. 12-1098 (issued September 19, 2012).

16 See T.A., Docket No. 18-0431 (issued November 7, 2018).

17 See Beverly R. Jones, 55 ECAB 411 (2004).

18 P.O., Docket No. 14-1675 (issued December 3, 2015); S.R., Docket No. 12-1098 (issued September 19, 2012).

19 See D.W., Docket No. 16-0226 (issued March 28, 2016); 5 U.S.C. § 8101(2) (“‘physician’ includes surgeons, 

podiatrists, dentists, clinical psychologists, optometrists, chiropractors, and osteopathic practitioners within the scope 

of their practice as defined by State law”).

20 See A.P., Docket No. 18-0238 (issued July 20, 2018); David P. Sawchuk, 57 ECAB 316, 320 n.11 (2006).

21 T.O., Docket No. 18-0139 (issued May 24, 2018).
7

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 her burden of proof to establish diagnosed 

medical conditions causally related to the accepted factors of her federal employment.

ORDER

IT IS HEREBY ORDERED THAT the March 5, 2018 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: March 21, 2019

Washington, DC

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Alec J. Koromilas, Alternate Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board