United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

D.R., Appellant

and

DEPARTMENT OF VETERANS AFFAIRS, 

HUNTER HOLMES McGUIRE HOSPITAL, 

Richmond, VA, Employer

__________________________________________

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Docket No. 19-0954

Issued: October 25, 2019

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

PATRICIA H. FITZGERALD, Deputy Chief Judge

JANICE B. ASKIN, Judge

ALEC J. KOROMILAS, Alternate Judge

JURISDICTION

On April 1, 2019 appellant, through counsel, filed a timely appeal from a February 4, 2019 

merit decision of the Office of Workers’ Compensation Programs (OWCP). Pursuant to the 

Federal Employees’ Compensation Act2(FECA) and 20 C.F.R. §§ 501.2(c) and 501.3, the Board 

has jurisdiction over the merits of this case. 

 

1

In all cases in which a representative has been authorized in a matter before the Board, no claim for a fee for legal 

or other service performed on appeal before the Board is valid unless approved by the Board. 20 C.F.R. § 501.9(e). 

No contract for a stipulated fee or on a contingent fee basis will be approved by the Board. Id. An attorney or 

representative’s collection of a fee without the Board’s approval may constitute a misdemeanor, subject to fine or 

imprisonment for up to one year or both. Id.; see also 18 U.S.C. § 292. Demands for payment of fees to a 

representative, prior to approval by the Board, may be reported to appropriate authorities for investigation.

2

5 U.S.C. § 8101 et seq.
2

ISSUE

The issue is whether appellant has met his burden of proof to establish a right knee 

condition causally related to the accepted May 31, 2017 employment incident. 

FACTUAL HISTORY

On August 4, 2017 appellant, then a 56-year-old nursing assistant, filed a traumatic injury 

claim (Form CA-1) alleging that on May 31, 2017 he injured his right leg/knee while in the 

performance of duty. He indicated that he had been participating in cardiopulmonary resuscitation 

(CPR) training and then fainted and fell unconscious. On the reverse side of the claim form, the 

employing establishment indicated that the injury occurred while in the performance of duty. In a 

separate August 4, 2017 letter, it controverted appellant’s claim, noting that he had not provided 

any medical documentation.

OWCP received a handwritten August 3, 2017 employee health record by a provider with 

an illegible signature. It noted that appellant was seeking medical treatment for a “new injury”

that he sustained while he was completing his CPR training on May 31, 2017.

In an August 8, 2017 development letter, OWCP informed appellant that the evidence of 

record was insufficient to establish his claim. It advised him of the factual and medical evidence 

necessary to establish his claim and also provided a questionnaire for completion. OWCP afforded 

appellant 30 days to provide the necessary evidence. By separate letter of even date, it requested 

additional information from the employing establishment.

OWCP received a May 31, 2017 emergency room intake report indicated that appellant 

was completing CPR training when he became dizzy and had a one minute period of syncope. 

Appellant also complained of minor aching in his left leg related to how he fell on it. He was 

diagnosed with probable vasovagal syncope episode.

A July 31, 2017 right knee magnetic resonance imaging (MRI) scan report revealed a pes 

anserine bursa with underlying osseous venous congestion, small Baker’s cyst, moderate knee 

effusion, and attenuated size of the medial meniscus at junction of the body and posterior horn, 

consistent with meniscal tear. 

Appellant submitted progress notes by Dr. Paul Kiritsis, a Board-certified orthopedic 

surgeon, dated July 28 and August 4, 2017. In a July 28, 2017 progress note, Dr. Kiritsis indicated 

that he evaluated appellant for a right knee injury that occurred about one month ago when he 

passed out at work. He recounted appellant’s complaints of pain and associated swelling over the 

medial knee. Upon examination of appellant’s right knee, Dr. Kiritsis observed slight effusion and 

tenderness over the medial joint line. McMurray test was positive medially. Dr. Kiritsis diagnosed 

right knee pain and lytic lesion of bone. In an August 4, 2017 progress note, he indicated that a 

right knee MRI scan had showed a complex tear of appellant’s medial meniscus. 

In an August 14, 2017 report, Dr. Gregory F. Domson, a Board-certified orthopedic 

surgeon, recounted appellant’s complaints of right knee pain and right proximal tibial lesion. He 

described that appellant was participating in CPR training at work when he got lightheaded and 
3

passed out. Appellant indicated that he experienced acute onset of right knee pain. Dr. Domson 

reported that a subsequent right knee MRI scan showed that appellant had a medial meniscus tear 

and lesion in the proximal tibia medially. Upon examination of appellant’s right knee, he observed 

tenderness to palpation over the medial joint line especially posteriorly. Dr. Domson opined that 

appellant had a medial meniscal tear that was “most likely related to his injury.”

An August 23, 2017 right knee MRI scan report showed a mass lesion along the medial 

aspect of the tibia compatible with a pes anserine bursa, complex tearing of the posterior horn 

medial meniscus, and small focal areas of the avascular necrosis. 

In an August 25, 2017 report, Dr. Domson indicated that he did not think that the cystic 

lesion on the most recent MRI scan was anything new and that it did not contribute to appellant’s 

medial meniscal tear that he sustained at work. 

In a September 7, 2017 note, Dr. Kiritsis reported that appellant would be out of work from 

July 27 to September 29, 2017 due to his knee condition. 

By decision dated September 12, 2017, OWCP denied appellant’s claim. It accepted that 

the May 31, 2017 incident occurred as alleged and that a right knee condition had been diagnosed. 

However, OWCP found that appellant failed to establish that the alleged injury occurred while in 

the performance of duty. It noted that he had not responded to the questionnaire and had not 

provided a statement clarifying the circumstances of the May 31, 2017 employment injury.

On September 20, 2017 appellant, through counsel, requested a telephonic hearing before 

a representative of OWCP’s Branch of Hearings and Review and submitted additional medical 

evidence.

In a June 7, 2017 report, Dr. Eric Haacke-Golden, a Board-certified family physician, 

indicated that appellant had passed out at work during CPR training. Dr. Haacke-Golden related 

that appellant received medical treatment in the emergency room. 

In a September 14, 2017 progress note, Dr. Kiritsis recounted that appellant’s right knee 

symptoms remained persistent. Examination of his right knee demonstrated medial joint line 

tenderness and effusion. Dr. Kiritsis diagnosed right medial meniscus tear. 

On September 20, 2017 appellant underwent right knee arthroscopy surgery with medial 

meniscectomy.

In a September 28, 2017 postoperative report, Dr. Kiritsis noted right knee examination 

findings of slight effusion and stable and balanced range of motion. He diagnosed right acute 

medial meniscus tear.

A hearing was held on February 6, 2018. By decision dated March 22, 2018, OWCP’s

hearing representative set aside the September 12, 2017 decision and remanded the case for OWCP 

to request a statement from the employing establishment concerning the circumstances of the 

May 31, 2017 incident in order to determine whether appellant’s fall was due to an idiopathic 

condition. The hearing representative also instructed OWCP to request a medical opinion from

Dr. Haacke-Golden regarding the cause of appellant’s right leg condition. 
4

After further developing the evidence, OWCP received an April 24, 2018 letter by

Dr. Haacke-Golden. Dr. Haacke-Golden reported that he had not seen appellant since he had a 

syncopal event on the job last year related to CPR training. He explained that he continued to 

believe that this incident was a vasovagal event and also opined that appellant’s meniscal tear was 

related to the fall he had during the syncopal event of May 31, 2017. Dr. Eric Haacke-Golden

reported that he did not evaluate appellant’s knee, but had orthopedic notes available.

In an April 25, 2018 letter, a workers’ compensation case manager indicated that the room 

where the CPR certification occurred on May 31, 2017 was warm according to the nurse manager. 

By decision dated June 7, 2018, OWCP denied appellant’s claim. It accepted that the 

May 31, 2017 employment incident occurred while in the performance of duty as alleged, but it 

denied appellant’s claim finding that the medical evidence submitted was insufficient to establish 

that his right leg condition was causally related to the accepted May 31, 2017 employment 

incident. 

On June 14, 2018 appellant, through counsel, requested a hearing before a representative 

of OWCP’s Branch of Hearings and Review and submitted additional evidence. 

In an October 6, 2018 letter, Dr. Haacke-Golden indicated that he was providing more 

information to show causal relationship. He described that performing CPR required performing 

chest compressions on models on the floor. Dr. Haacke-Golden recounted that when appellant’s 

floor training was complete, he stood up, felt light headed, and fainted. He quoted the definition 

of a vasovagal syncope from the Cleveland Clinic website and noted that it was caused by a sudden 

drop in blood pressure, which caused a drop in blood flow to the brain. Dr. Haacke-Golden 

reported that in appellant’s case, when he stood up after giving compressions, he had a drop in 

blood pressure to his brain and to compensate for that, he fell to his knees and then to the floor, 

passing out. He opined that he also felt that this trauma caused the meniscal tear that he had been 

treated for by orthopedics and that there was a “cause and effect relationship between these 

events.” Dr. Haacke-Golden concluded that performing compressions on the CPR model, a workrelated activity, and the subsequent getting up off the ground after this exertion lead to a syncopal 

event that resulted in appellant falling to the floor, traumatizing his knee. 

In a January 14, 2019 letter, Dr. Kiritsis recounted that appellant was initially seen in his 

office on July 27, 2017 for a right knee injury that occurred after he passed out at work on 

May 31, 2017. He indicated that appellant began experiencing immediate right knee discomfort 

that was diagnosed as a medial meniscal tear and subsequently underwent an arthroscopic 

procedure where the medial meniscal tear was debrided. Dr. Kiritsis opined that appellant’s injury 

was directly caused by his accident at work and necessitated the arthroscopic surgery.

A hearing was held on November 28, 2018. By decision dated February 4, 2019, OWCP’s

hearing representative affirmed the June 7, 2018 decision. He found that medical evidence of 

record was insufficient to establish that appellant’s right knee condition was causally related to the 

accepted May 31, 2017 employment incident or due to an idiopathic condition. Therefore, the 

hearing representative found that the fall was considered unexplained and to have occurred in the 

performance of duty.
5

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

In order to determine whether a federal employee has sustained a traumatic injury in the 

performance of duty, OWCP must first determine whether fact of injury has been established. 7 

There are two components involved in establishing fact of injury. First, the employee must submit 

sufficient evidence to establish that he or she actually experienced the employment incident at the 

time, place, and in the manner alleged.8 Second, the employee must submit evidence, generally 

only in the form of probative medical evidence, to establish that the employment incident caused 

a personal injury.9

To establish causal relationship between the condition, as well as any attendant disability 

claimed and the employment event or incident, the employee must submit rationalized medical 

opinion evidence.10 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 factor(s) identified by the employee.11 The weight of the medical 

 

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); 

DeloresC.Ellyett, 41 ECAB 992 (1990).

7 D.B., Docket No. 18-1348 (issued January 4, 2019); S.P., 59 ECAB 184 (2007).

8 D.S., Docket No. 17-1422 (issued November 9, 2017); Bonnie A. Contreras, 57 ECAB 364 (2006).

9 B.M., Docket No. 17-0796 (issued July 5, 2018); David Apgar, 57 ECAB 137 (2005); John J. Carlone, 41 ECAB 

354 (1989).

10 See S.A., Docket No. 18-0399 (issued October 16, 2018); see also RobertG. Morris, 48 ECAB 238 (1996).

11 M.V., Docket No. 18-0884 (issued December 28, 2018); I.J., 59 ECAB 408 (2008); Victor J. Woodhams, 41 

ECAB 345 (1989).
6

evidence is determined by its reliability, its probative value, its convincing quality, the care of 

analysis manifested, and the medical rationale expressed in support of the physician’s opinion.12

It is a well-settled principle of workers’ compensation law, and the Board has so held, that 

an injury resulting from an idiopathic fall -- where a personal, nonoccupational pathology causes 

an employee to collapse and to suffer injury upon striking the immediate supporting surface, and 

there is no intervention or contribution by any hazard or special condition of employment -- is not 

within coverage of FECA.13 Such an injury does not arise out of a risk connected with the 

employment and is, therefore, not compensable. The Board has made equally clear, the fact that 

the cause of a particular fall cannot be ascertained or that the reason it occurred cannot be 

explained, does not establish that it was due to an idiopathic condition.

This follows from the general rule that an injury occurring on the industrial premises during 

working hours is compensable unless the injury is established to be within an exception to such 

general rule.14 If the record does not establish that the particular fall was due to an idiopathic 

condition, it must be considered as merely an unexplained fall, one which is distinguishable from 

a fall in which it is definitely proved that a physical condition preexisted and caused the fall. 15

ANALYSIS

The Board finds that appellant has not met his burden of proof to establish a right knee 

condition causally related to the accepted May 31, 2017 employment incident. 

Appellant submitted a series of reports from Dr. Kiritsis dated July 28, 2017 through 

January 14, 2019. In his initial examination report, Dr. Kiritsis described the May 31, 2017 

employment incident and noted right knee examination findings of slight effusion and tenderness 

over the medial joint line. He diagnosed right knee pain, lytic lesion of the bone, and tear of the 

medial meniscus. In a January 14, 2019 letter, Dr. Kiritsis opined that appellant’s injury was 

directly caused by his accident at work. He did not, however, provide any rationale or explanation 

for how appellant’s right knee condition was causally related to the accepted employment incident. 

The Board has held that reports are of limited probative value regarding causal relationship if it 

does not contain medical rationale explaining how a given medical condition/disability was related 

to employment factors.16 Dr. Kiritsis’ opinion, therefore, is insufficient to establish the claim.17

 

12 James Mack, 43 ECAB 321 (1991).

13 H.B., Docket No. 18-0278 (issued June20, 2018); see Carol A. Lyles, 57 ECAB 265 (2005).

14 H.B.; id.; Dora J. Ward, 43 ECAB 767, 769 (1992); Fay Leiter, 35 ECAB 176, 182 (1983).

15 H.B.; id.; JohnR. Black, 49 ECAB 624 (1998); Judy Bryant, 40 ECAB 207 (1988); Martha G. List, 26 ECAB 

200 (1974).

16 See Y.D., Docket No. 16-1896 (issued February 10, 2017); T.M., Docket No. 08-975 (February 6, 2009); S.E., 

Docket No. 08-2214 (issued May 6, 2009).

17 T.R., Docket No. 18-1272 (issued February 15, 2019); K.T., Docket No. 15-1758 (issued May 24, 2016).
7

Appellant also received medical treatment from Dr. Domson dated August 24 through 

25, 2017. Dr. Domson recounted that appellant experienced acute onset of right knee pain after 

he passed out while participating in a CPR training class at work. He provided examination 

findings and noted that a right knee MRI scan showed that appellant had a medial meniscus tear 

and lesion in the proximal tibia. Dr. Domson opined that appellant’s medial meniscus tear was 

“most likely related” to his injury. The Board has held that medical opinions that are speculative 

or equivocal in character are of diminished probative value.18 Dr. Domson’s reports, therefore, 

are insufficient to establish appellant’s claim.19 

OWCP also received several letters from Dr. Haacke-Golden dated April 24 and 

October 6, 2018. Dr. Haacke-Golden described the May 31, 2017 employment incident and also 

opined that appellant’s meniscal tear was related to that syncopal event. He further explained that 

appellant fell to the floor and landed first on his knees. Dr. Haacke-Golden opined that this trauma 

caused appellant’s meniscal tear. Although he attributed appellant’s right meniscal tear to the 

May 31, 2017 employment incident, the Board finds that his report does not contain sufficient 

explanation, based on medical rationale, of how falling on his knees caused or contributed to his 

right knee condition.20 Dr. Haacke-Golden did not explain the pathophysiological process of how 

falling onto his knees would have caused his right knee condition.21 His opinion, therefore, is 

insufficient to establish his claim.

The diagnostic testing, including the July 31 and August 23, 2017 right knee MRI scan 

reports also fail to establish appellant’s claim as they did not provide an opinion on the cause of 

appellant’s conditions. 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 incident 

and a diagnosed condition.22

On appeal counsel argues that OWCP failed to adjudicate the claim in accordance with the 

proper standard of causation and failed to give due deference to the findings of the attending 

physician. He did not, however, provide any evidence to support his arguments. In order to obtain 

benefits under FECA, an employee has the burden of proof to establish the essential elements of 

his or her claim by the weight of the reliable, probative, and substantial evidence.23 Because 

appellant has not provided such evidence, he has not met his burden of proof to establish his 

traumatic injury claim. 

 

18 D.B., Docket No. 18-1359 (issued May 14, 2019); 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).

19 See P.D., Docket No. 18-1461 (issued July 2, 2019).

20 See I.S., Docket No. 18-0606 (issued August 2, 2019); S.S., Docket No. 16-1760 (issued January 23, 2018).

21 See R.G., Docket No. 19-0233 (issued July 16, 2019); B.T., Docket No. 13-0138 (issued March 20, 2013).

22 T.H., Docket No. 18-1736 (issued March 13, 2019); A.B., Docket No. 17-0301 (issued May 19, 2017).

23 Supra note 5.
8

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 a right knee 

condition causally related to the accepted May 31, 2017 employment incident. 

ORDER

IT IS HEREBY ORDERED THAT the February 4, 2019 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: October 25, 2019

Washington, DC

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Alec J. Koromilas, Alternate Judge

Employees’ Compensation Appeals Board