United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

J.L., Appellant

and

DEPARTMENT OF VETERANS AFFAIRS, 

TENNESSEE VALLEY HEALTH CARE 

SYSTEM -- ALVIN C. YORK CAMPUS, 

Murfreesboro, TN, Employer

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Docket No. 20-0717

Issued: October 15, 2020

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

CHRISTOPHER J. GODFREY, Deputy Chief Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On February 12, 2020 appellant filed a timely appeal from an August 21, 2019 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 a head injury 

causally related to the accepted May 8, 2017 employment incident.

FACTUAL HISTORY

On August 31, 2017 appellant, then a 57-year-old nurse, filed a traumatic injury claim 

(Form CA-1) alleging that on May 8, 2017 she sustained a head injury when she fell to the floor 

while in the performance of duty. She reported that she became dizzy after standing up, fell, and 

 

1 5 U.S.C. § 8101 et seq.
2

hit the front of her head on the desk and the side and back of her head on the floor as she was 

falling down. Appellant was found lying on the floor unconscious by a coworker. She did not 

stop work. 

In a May 9, 2017 report, Rebecca Durbin, a certified physician assistant, recounted that 

appellant was treated “after passing out at work yesterday.” Appellant indicated that she was alone 

when she passed out and that she hit the right side of her head when she fell down to the floor. 

Ms. Durbin conducted an examination and noted a negative neurological examination. She 

diagnosed concussion with loss of consciousness of 30 minutes or less. 

A May 11, 2017 magnetic resonance imaging (MRI) scan of appellant’s brain revealed 

probable left globe enucleation, chronic left maxillary sinus disease, and otherwise negative MRI 

scan of the brain without evidence of acute intracranial abnormality. 

In a June 14, 2017 report, Mary Angela Smith, an advanced practice registered nurse, noted

that appellant was seen for complaints of headache and eye pressure. She indicated that appellant 

attributed her condition to looking at a computer screen every day. Ms. Smith diagnosed allergic 

contact dermatitis due to plants and headache. 

In a June 16, 2017 report, Dr. James Crager, a Board-certified internist specializing in 

cardiovascular disease, indicated that an echocardiogram revealed that appellant’s left ventricular 

systolic function was normal and that trace mitral valve regurgitation was present. 

Appellant continued to receive treatment from Ms. Smith. In reports dated August 3 to 

December 7, 2017, Ms. Smith noted appellant’s complaints of continued migraine headaches three 

to four times a week. Cardiovascular examination revealed regular rate and rhythm, and no edema 

or varicosities of the extremities. Ms. Smith diagnosed headache and migraine without aura. 

In an April 12, 2018 report, Staci Caudill, a registered nurse, recounted that appellant was 

treated for complaints of daily headaches that lasted hours to all day. She reviewed appellant’s 

history and reported examination findings. Ms. Caudill assessed migraine, chronic daily 

headaches, and left occipital neuralgia. 

In work status notes dated May 24 and 30, 2018, Ms. Smith indicated that appellant was 

seen in the office on those dates and requested that appellant be excused from work for the period 

May 22 to June 15, 2018 “for migraines.” 

Dr. Andrew Cook, a Board-certified anesthesiologist, in a June 7, 2018 report, noted that 

appellant was referred by neurology for consideration of occipital nerve ablation. He indicated 

that appellant reported a history of migraine headaches and daily headaches. Upon physical 

examination, Dr. Cook observed tenderness to palpation over the posterior occipital region on the 

left and pain in the posterior neck region. He diagnosed cervicogenic headache. 

In a June 13, 2018 report, Ms. Smith indicated that appellant was seen for complaints of a 

migraine. She conducted an examination and reported diagnoses of chronic migraines. 

In a June 25, 2018 development letter, OWCP informed appellant that her claim was 

initially accepted as a minor injury, but was now being formally considered because she had filed 

a claim for wage-loss compensation. It advised her of the factual and medical evidence necessary 

to establish her claim and also provided a questionnaire for completion. In a separate letter of even 
3

date, OWCP also requested additional information from the employing establishment. It afforded 

both parties 30 days to provide the requested factual and medical evidence. 

On July 2, 2018 appellant responded to OWCP’s development questionnaire. She 

described that on May 8, 2017 she got up from her desk to get a fax when she felt lightheaded. 

Appellant noted that, when she went to sit back down in her chair, it slid from underneath her and 

caused her to lose her balance and she fell to the ground hitting her head on the desk. She noted 

that the wheel on her office chair was broken. Appellant indicated that she had no history of 

fainting spells or a heart condition. She reported that she had experienced an increase in intensity 

in headaches since she hit her head. 

Appellant submitted a position description and witness statements from G.M. and L.M. 

In a January 11, 2018 report, Dr. William Watson, a Board-certified neurologist, indicated 

that appellant was referred to the neurology clinic for complaints of headache occurring about four 

to five times per week. He noted a family history of migraines and that her initial onset of 

headaches occurred when she was a teenager, but that she had severe headaches occurring twice a 

week since June 2017. Dr. Watson also described that, in May 2017, appellant fell and hit her 

head at work and lost consciousness for an unknown amount of time. He reported that her

headaches increased in frequency, intensity, and duration post-head injury. Upon physical 

examination, Dr. Watson observed trigger and tender points in the left upper back, neck, and left 

occipital area. He assessed migraine without aura, chronic daily headaches, post-traumatic 

headache, concussion, occipital neuralgia of the left side, and myofascial pain syndrome. 

In a July 5, 2018 report, Dr. Richard M. Dartt, a family physician, noted appellant’s 

complaint of migraines and pain in the base of her neck. Upon physical examination, he reported 

normal psychiatric evaluation and musculoskeletal examination. Dr. Dartt diagnosed migraine 

without aura. He indicated that appellant had symptoms of migraines, blurry vision, and was very 

photo sensitive, which made it very difficult for her to work. 

In a July 9, 2018 report, Ms. Caudill indicated that appellant was seen at the clinic for 

follow-up of headaches. She noted that appellant reported having daily headaches and described 

the May 8, 2017 employment incident. Ms. Caudill conducted an examination and diagnosed 

migraine, chronic daily headaches, and left occipital neuralgia. 

In a July 12, 2018 report, Dr. Dartt recounted that appellant was seen that day for a 

narrative report needed for a workers’ compensation claim. Upon physical examination, he 

observed normal psychiatric and musculoskeletal examinations. Dr. Dartt diagnosed unspecified 

migraine, unspecified fall, and generalized anxiety disorder. He related that after the May 8, 2017 

fall appellant became lightheaded and went to sit down in a chair that rolled out from underneath

her at work. Dr. Dartt indicated that she hit her head on the desk and floor, lost consciousness, 

and had a concussion due to the fall. He reported that appellant has had migraines on a weekly 

basis since the fall. Dr. Dartt opined that she could not return to work. He noted that appellant 

was required to spend the day reading a computer screen, which exacerbated the headaches. 

Dr. Dartt recommended that she continue to follow-up with neurology. 

By decision dated August 3, 2018, OWCP denied appellant’s claim. It accepted that the 

May 8, 2017 incident occurred as alleged and that the incident was determined to be unexplained 

and as such, fell under the coverage of FECA. OWCP noted that the conditions of migraines, 
4

chronic daily headaches, post-traumatic headaches, concussion, and left-side occipital neuralgia 

had been diagnosed. However, it denied appellant’s claim finding that she had failed to establish 

causal relationship between the accepted employment incident and the diagnosed conditions. 

On September 6, 2018 appellant requested reconsideration.2 She alleged that the broken 

rolling office chair caused her to lose her balance, hit her head on her desk, and fall to the floor 

unconscious for an unknown period of time. Appellant also explained that a neurologist had 

diagnosed her with a concussion with TBI with migraines. 

In reports dated July 16 and August 14, 2018, Ms. Smith reviewed appellant’s history and 

conducted an examination. She reported that appellant had continued migraines since suffering a 

fall at work and hitting her head in 2017. Ms. Smith completed a work status note dated August 14, 

2018, which indicated that appellant could not return to work until she was seen by neurology on 

September 23, 2018. 

Appellant submitted an August 29, 2018 letter by Dr. Dartt, who explained that she was 

initially seen on May 9, 2017 following an incident at work in which she passed out and hit her 

head on a desk. Dr. Dartt reported that she had a history of headaches and that he continued to see 

her for continued headaches. He further reported that, since the incident at work that resulted in a 

direct blow to the head, appellant had increased frequency and severity of headaches. 

By decision dated December 3, 2018, OWCP denied modification of the August 3, 2018 

decision. 

On May 24, 2019 appellant requested reconsideration. She provided a timeline of the 

May 8, 2017 incident and reiterated that her head injury “would have never happened if the wheel 

of [appellant’] office chair had not broken off.” 

OWCP received additional medical evidence. In reports dated November 21 and 

December 10, 2018, Ms. Smith reviewed appellant’s history and noted examination findings. She 

diagnosed migraine without aura. Ms. Smith reported that appellant had failed multiple treatment 

modalities for appellant’s migraines, which had been a chronic and ongoing issue for quite some 

time. 

In a November 12, 2018 neurocognitive assessment report, Dr. Frederick Schmitt, a 

neuropsychologist, reviewed appellant’s history and reported her complaints of continued 

debilitating headaches two to three times per week. He conducted a neurobehavioral examination 

and assessed that she had major neurocognitive disorder, multiple etiologies, and mild severity 

with behavioral disturbance. Dr. Schmitt recommended a review of appellant’s headache 

medications, adjustment of psychotropic medications, and psychotherapy. 

Appellant also submitted medical records from a neurology institute dated September 19, 

2018 and February 27, 2019, which indicated that she was treated for a follow-up regarding her 

chronic migraine and post-concussive headache due to a May 2017 accident. 

 

2 OWCP received an August 7, 2018 letter by appellant wherein she requested a status update on her workers’

compensation claim. Appellant reported that she had missed almost seven months of work. She indicated that her 

neurologist and primary care physician had labeled the injury concussion and traumatic brain injury (TBI) with 

migraines related from hitting her head on the desk and floor. 
5

By decision dated August 21, 2019, OWCP denied modification of the December 3, 2018 

decision. 

LEGAL PRECEDENT

An employee seeking benefits under FECA3has 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, 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); 

Delores C. 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 Robert G. 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

In a case in which a preexisting condition involving the same part of the body is present 

and the issue of causal relationship therefore involves aggravation, acceleration, or precipitation, 

the physician must provide a rationalized medical opinion that differentiates between the effects 

of the work-related injury or disease and the preexisting condition.13

ANALYSIS

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

causally related to the accepted May 8, 2017 employment incident.

In a January 11, 2018 report, Dr. Watson recounted that appellant had a history of 

headaches since she was teenager and indicated that the headaches increased in frequency and 

intensity following the May 2017 employment incident. He conducted an examination and 

assessed migraine without aura, chronic daily headaches, post-traumatic headache, concussion, 

occipital neuralgia of the left side, and myofascial pain syndrome. Dr. Watson, however, did not 

offer an opinion on the cause of appellant’s diagnosed conditions. The Board has held that medical 

evidence that does not offer an opinion regarding the cause of an employee’s condition or disability 

is of no probative value on the issue of causal relationship.14 This report is therefore insufficient 

to establish appellant’s claim.

Likewise, Dr. Crager’s June 16, 2017 report, Dr. Dartt’s July 5, 12 and August 29, 2018

reports, Dr. Cook’s June 7, 2018 report, and Dr. Schmitt’s November 12, 2018 report are also 

insufficient to establish that appellant’s diagnosed conditions are causally related to the accepted 

May 8, 2017 employment incident as none of the physicians opined on the cause of her diagnosed 

conditions.15 As such, the Board finds that these reports are also insufficient to establish her claim.

Appellant also submitted reports dated June 14, 2017 to December 10, 2018 by Ms. Smith

and reports dated April 12 and July 9, 2018 by Ms. Caudill. The Board has held, however, that 

medical reports signed solely by a nurse are of no probative value, as nurses are not considered 

physicians as defined under FECA, and therefore are not competent to provide a medical opinion.16 

 

12 James Mack, 43 ECAB 321 (1991).

13 Federal (FECA) Procedure Manual, Part 2 -- Claims, Causal Relationship, Chapter 2.805.3e (January 2013).

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

15 See J.H., Docket No. 19-0838 (issued October 1, 2019); S.G., Docket No. 19-0041 (issued May 2, 2019).

16 Section 8102(2) of FECA provides as follows: (2) physician includes surgeons, podiatrists, dentists, clinical 

psychologists, optometrists, chiropractors, and osteopathic practitioners within the scope of their practice as defined 

by State law. 5 U.S.C. § 8101(2); 20 C.F.R. § 10.5(t). See also Federal (FECA) Procedure Manual, Part 2 -- Claims, 

Causal Relationship, Chapter 2.805.3a(1) (January 2013); David P. Sawchuk, 57 ECAB 316, 320 n.11 (2006) (lay 

individuals such as physician assistants, nurses, and physical therapists are not competent to render a medical opinion 

under FECA). 
7

For this same reason, Ms. Durbin’s May 9, 2017 report is also of no probative value because a 

physician assistant is not considered a physician under FECA.17

Appellant further submitted medical records from a neurology institute dated 

September 19, 2018 and February 27, 2019, which indicated that she was treated for a follow-up 

regarding her chronic migraine and post-concussive headache due to a May 2017 accident. The 

Board has found that medical evidence lacking proper identification is of no probative medical 

value.18 Accordingly, these reports are insufficient to establish appellant’s claim.

The May 9, 2017 MRI scan report is also insufficient to establish appellant’s claim. The 

Board has held that reports of diagnostic tests, standing alone, lack probative value on the issue of 

causal relationship as they do not provide an opinion on causal relationship between her

employment duties and the diagnosed conditions.19 

On appeal appellant alleges that she would not have hit her head on the desk and floor, 

which led to her TBI and headaches, if not for her broken office chair rolling out from underneath 

her. However, she has not submitted the rationalized medical evidence which is necessary to 

establish that her head injury is causally related to the accepted May 8, 2017 employment incident

in which she fell to the floor and hit her head. Thus, the Board finds that appellant 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.

CONCLUSION

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

causally related to the accepted May 8, 2017 employment incident.

 

17 Id.; see also R.L., Docket No. 19-0440 (issued July 8, 2019) (nurse practitioners are not considered physicians as 

defined under FECA); George H. Clark, 56 ECAB 162 (2004).

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

19 G.S., Docket No. 18-1696 (issued March 26, 2019); A.B., Docket No. 17-0301 (issued May 19, 2017).
8

ORDER

IT IS HEREBY ORDERED THAT the August 21, 2019 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: October 15, 2020

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Christopher J. Godfrey, Deputy Chief Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board