United States Department of Labor

Employees’ Compensation Appeals Board

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D.T., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Pittsburgh, PA, Employer

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Docket No. 21-0091

Issued: May 21, 2021

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

PATRICIA H. FITZGERALD, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On October 19, 2020 appellant filed a timely appeal from a September 1, 2020 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 his burden of proof to establish a medical condition

causally related to the accepted July 20, 2018 employment incident.

 

1 5 U.S.C. § 8101 et seq.
2

FACTUAL HISTORY

This case has previously been before the Board.2 The facts and circumstances as set forth 

in the Board’s prior decision are incorporated herein by reference. The relevant facts are as 

follows.

On August 10, 2018 appellant, then a 22-year-old clerk, filed a traumatic injury claim 

(Form CA-1) alleging that on July 20, 2018 he sustained injuries to his head and knees, and a 

broken maxilla on the right side of his mouth, when he fell to the floor and hit his face while in the 

performance of duty. He stopped work on July 20, 2018 and returned to work on August 14, 2018. 

In an August 6, 2018 medical note, Dr. Marianna Vinokur, a resident physician, advised 

that appellant may return to work on August 7, 2018.

In an August 10, 2018 statement, appellant explained that on July 20, 2018 he fell and hit 

his head and face on the workroom floor. He related that he came out of the bathroom and did not 

remember how he injured his head and face or how the impact caused his tooth avulsion. The only 

thing appellant recalled was waking up in an ambulance on his way to the hospital after the 

incident.

C.S., a customer service manager, recounted in an August 22, 2018 statement that on 

July 20, 2018 appellant was involved in an incident at the employing establishment. He indicated 

that, according to appellant and witnesses, appellant was walking on the workroom floor when he 

“went into a seizure” and fell to the floor. The fall resulted in injuries to appellant’s face and 

mouth when his head hit the concrete floor. The paramedics were immediately called and he was 

transported to the hospital. 

In a letter of even date, the employing establishment controverted appellant’s claim, noting 

that appellant exited the bathroom and fell to the floor, landing on his face. It contended that he 

submitted no evidence to establish fact of injury or causal relationship. 

In an August 23, 2018 development letter, OWCP informed appellant of the deficiencies 

of his claim. It advised him of the type of factual and medical evidence necessary and provided a 

questionnaire for his completion. OWCP afforded him 30 days to submit the necessary evidence. 

In response, appellant submitted a September 12, 2018 statement in which he explained 

that on the date of the alleged employment incident he had just finished putting up the delivery 

point sequence and using the restroom. The last thing he remembered was leaving the restroom 

and later waking up in an ambulance outside of the work building. All appellant recalled was 

falling on his face and the impact of the fall causing him to lose a tooth and break a bone in his 

face near his right upper lip. He also stated that he had no other similar disabilities or symptoms 

prior to his injury. 

By decision dated October 3, 2018, OWCP denied appellant’s claim, finding that he had 

not submitted medical evidence containing a medical diagnosis in connection with his injury. It 

 

2 Docket No. 19-1486 (issued January 17, 2020).
3

concluded, therefore, that the requirements had not been met to establish an injury as defined under 

FECA. 

OWCP continued to receive evidence. In a September 26, 2018 attending physician’s 

report (Form CA-20), Dr. James Jones, Board-certified in family medicine, diagnosed a new onset 

seizure and a tooth avulsion in relation to the July 20, 2018 employment incident. When 

responding to the question of whether he believed appellant’s conditions were caused or 

aggravated by an employment activity, Dr. Jones noted that it was “not applicable.”

On November 1, 2018 appellant requested an oral hearing before a representative of 

OWCP’s Branch of Hearings and Review. 

Appellant submitted a July 20, 2018 after visit summary indicating that appellant was seen 

by Dr. Brent Rau, Board-certified in emergency medicine. The note diagnosed a seizure and a 

tooth avulsion and recommended that he follow up with his primary care physician, a dentist, and 

a neurologist for further evaluation.

Appellant submitted an August 13, 2018 after visit summary in which Dr. Jones saw 

appellant for a new onset of seizure and dental trauma. 

A telephonic hearing was held on February 26, 2019.

Appellant submitted an unsigned July 20, 2018 diagnostic report where he underwent a 

computerized tomography (CT) scan of his facial bones that found a fracture at the maxilla along 

the alveolar ridge with loosening on the right canine tooth. 

In an August 8, 2018 diagnostic report, Dr. Troy Desai, a Board-certified neurologist, 

conducted an electroencephalogram (EEG), finding that it was normal. 

By decision dated April 8, 2019, OWCP affirmed the October 3, 2018 decision, as 

modified. It accepted that the July 20, 2018 incident occurred as alleged and that there was a

diagnosed seizure and tooth avulsion. However, OWCP found that appellant failed to establish 

that the alleged injury occurred while in the performance of duty. It found that appellant’s seizure 

and fall were due to an idiopathic incident, which was considered to be a personal nonoccupational 

pathology without intervention or contribution by a factor of employment and, therefore, the injury 

was not considered compensable. 

On July 1, 2019 appellant appealed to the Board. By decision dated January 17, 2020, the 

Board determined that the case was not in posture for decision and remanded the case to OWCP

for further development regarding whether appellant suffered an idiopathic fall or an unexplained 

fall. 

On June 17, 2020 OWCP referred appellant, with a statement of accepted facts (SOAF) 

and a copy of the medical record, to Dr. Charles Gennaula, a Board-certified neurologist, for a 

second opinion evaluation to determine whether he suffered a seizure, which caused him to fall 

and strike his face or whether the fall caused him to have the seizure. 
4

In his August 3, 2020 medical report, Dr. Gennaula reviewed the SOAF, history of injury 

and medical evidence of record, including that appellant’s fall resulted in damage to his tooth in 

the form of a tooth avulsion. He noted that appellant had no history of seizure or prior losses of 

consciousness and that the record seemed to indicate that he “simply fell and had a seizure.”

3

 

Dr. Gennaula provided that, based on review of the record provided, appellant’s description of the 

events and the witnesses available, that there was no clear evidence to suggest that there was any 

trip and fall event. He opined that it appeared as if appellant lost consciousness and fell to the 

ground and noted convulsive activity witnessed with the fall. Dr. Gennaula indicated that there 

did not appear to be any clear precipitated underlying event that the fall in regard to a trip and fall, 

a particular stressor at work or any potential causes for his sudden loss of consciousness. He 

reasoned that, based on the information available to him, the incident appeared to be a primary 

event not directly related to his work, explaining that appellant suffered a “fall/loss of 

consciousness with likely etiology being a seizure event that was unprovoked by any 

circumstances at his work.” Dr. Gennaula concluded that appellant suffered a seizure and fell to 

the floor and, based on FECA’s definition of causation, there did not appear to be any direct 

causation of the event based on the workplace.

By decision dated September 1, 2020, OWCP accepted that appellant fell on July 20, 2018 

while in the performance of duty as alleged. It found that “[t]here did not appear to be any clear 

underlying event that precipitated this event based on the records in regard to the trip and fall 

stressor or event that occurred in the workplace.” However, OWCP denied appellant’s traumatic 

injury claim, finding that the medical evidence of record was insufficient to establish that his 

diagnosed medical conditions were causally related to the July 20, 2018 employment incident. 

LEGAL PRECEDENT

An employee seeking benefits under FECA 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 period 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 has sustained a traumatic injury in the performance of duty, 

OWCP begins with an analysis of whether fact of injury has been established. Fact of injury 

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

 

3 Appellant also informed Dr. Gennaula that he may have tripped on something, although he did not know what he 

tripped on. 

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 L.S., Docket No. 19-1769 (issued July 10, 2020); Jacqueline M. Nixon-Steward, 52 ECAB 140 (2000).

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).
5

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

occurred.7 The second component is whether the employment incident caused a personal injury.8

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.9 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.10 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).11

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.12 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.13 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.14

ANALYSIS

The Board finds that appellant has met his burden of proof to establish a tooth avulsion and 

facial fracture causally related to the accepted July 20, 2018 unexplained fall.

Appellant provided medical evidence from Dr. Jones and Dr. Rau who consistently

diagnosed a tooth avulsion and dental trauma. He also submitted a July 20, 2018 diagnostic report 

 

7 B.P., Docket No. 16-1549 (issued January 18, 2017); Elaine Pendleton, 40 ECAB 1143 (1989).

8 M.H., Docket No. 18-1737 (issued March 13, 2019); John J. Carlone, 41 ECAB 354 (1989).

9 T.H., 59 ECAB 388, 393 (2008); Robert G. Morris, 48 ECAB 238 (1996).

10 M.V., Docket No. 18-0884 (issued December 28, 2018).

11 B.C., Docket No. 20-0221 (issued July 10, 2020); Leslie C. Moore, 52 ECAB 132 (2000).

12 D.R., Docket No. 19-0954 (issued October 25, 2019); H.B., Docket No. 18-0278 (issued June 20, 2018); see 

Carol A. Lyles, 57 ECAB 265 (2005).

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

14 H.B., supra note 12; John R. Black, 49 ECAB 624 (1998); Judy Bryant, 40 ECAB 207 (1988); Martha G. List, 26 

ECAB 200 (1974).
6

where he underwent a computerized tomography (CT) scan of his facial bones that found a fracture 

at the maxilla along the alveolar ridge with loosening on the right canine tooth. This medical 

evidence was supported by Dr. Gennaula in his August 3, 2020 second opinion evaluation in which 

he noted appellant’s July 20, 2018 fall resulted in damage to his tooth in the form of a tooth 

avulsion. In clear-cut traumatic injury claims, where the fact of injury is established and is clearly 

competent to cause the condition described (for instance, a worker falls from a scaffold and breaks 

an arm), a fully-rationalized medical opinion is not needed. The physician’s diagnosis and an 

affirmative statement are sufficient to accept the claim.15 The Board finds, therefore, that this 

evidence is sufficient to establish that appellant sustained a tooth avulsion and facial fracture on 

July 20, 2018. The case will, therefore, be remanded for payment of medical expenses and any 

attendant disability. 

The Board further finds, however, that this case is not in posture for decision as to whether 

the medical evidence of record is sufficient to establish that appellant’sseizure was causally related

to his accepted July 20, 2018 injury. 

Section 8124(a) of FECA provides that OWCP shall determine and make a finding of fact 

and make an award for or against payment of compensation.16 Its regulations at 20 C.F.R. § 10.126

provide that the decision of the Director of OWCP shall contain findings of fact and a statement 

of reasons.17 As well, OWCP’s procedures provide that the reasoning behind its evaluation should 

be clear enough for the reader to understand the precise defect of the claim and the kind of evidence 

which would overcome it.18

The Board finds that OWCP failed to properly explain the findings with respect to the issue 

presented so that appellant could understand the basis for the decision, i.e., whether appellant’s 

seizure was causally related to the accepted July 20, 2018 fall. The Board will, therefore, set aside 

OWCP’s September 1, 2020 decision and remand the case for findings of fact and a statement of 

reasons, to be followed by a de novo decision.

CONCLUSION

The Board finds that appellant has met his burden of proof to establish a tooth avulsion and 

facial fracture causally related to the accepted July 20, 2018 unexplained fall. The Board further 

finds that the case is not in posture for decision as to whether appellant’s seizure was causally 

related to the accepted injury.

 

15 Federal (FECA) Procedure Manual, Part 2 -- Claims, Causal Relationship, Chapter 2.805.3.d(1) (January 2013).

16 5 U.S.C. § 8124(a).

17 20 C.F.R. § 10.126.

18 Supra note 15 at Part 2 -- Claims, Disallowances, Chapter 2.1400.5 (February 2013).
7

ORDER

IT IS HEREBY ORDERED THAT the September 1, 2020 decision of the Office of 

Workers’ Compensation Programs is reversed in part and set aside in part. The case is remanded 

for further proceedings consistent with this decision of the Board.

Issued: May 21, 2021

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Alternate Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board