United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

L.H., Appellant

and

FEDERAL DEPOSIT INSURANCE COMPANY, 

Arlington, VA, Employer

__________________________________________

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Docket No. 23-0481

Issued: October 11, 2023

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JAMES D. McGINLEY, Alternate Judge

JURISDICTION

On February 22, 2023 appellant, through counsel, filed a timely appeal from a February 1, 

2023 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 her burden of proof to establish an injury in the 

performance of duty on May 29, 2019, as alleged.

FACTUAL HISTORY

This case has previously been before the Board.3 The facts and circumstances as set forth 

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

are as follows. 

On July 8, 2019 appellant, then a 67-year-old supervisory program specialist, filed a 

traumatic injury claim (Form CA-1) alleging that on May 29, 2019 she sustained an injury to her 

right foot while in the performance of duty. She indicated that she was entering invoices on her 

computer when she reached for the trash can. Appellant next remembered that when she opened 

her eyes, she was lying on the floor with her head against a metal cabinet. She advised that she 

tried to get up, but fell back down to the floor. Appellant then noticed that her right foot was 

twisted. On the reverse side of the claim form, the employing establishment contended that 

appellant was not injured in the performance of duty; rather, she likely fainted when she got up 

from her chair and fell. Appellant stopped work on the date of the claimed injury.

An occupational health incident report dated May 29, 2019 indicated that appellant felt 

nauseated and then bent over to throw-up when she lost consciousness and fell on her right side 

and twisted her right ankle. The nurse, who was not identified, noted that appellant’s right ankle 

was visibly swollen and painful, she was alert and oriented, and there were no neurological deficits 

observed. 

Appellant was treated on June 14, 2019 by Dr. C. Clay Wellborn, a Board-certified 

orthopedic surgeon, for a fractured right ankle and underwent surgery on June 7, 2019. 

In a July 22, 2019 development letter, OWCP notified appellant of the deficiencies of her 

claim. It advised her of the type of factual and medical evidence needed and provided a 

questionnaire for her completion. OWCP afforded appellant 30 days to submit the necessary 

evidence. No response was received. 

By decision dated August 22, 2019, OWCP denied appellant’s claim, finding that the 

evidence of record was insufficient to establish that the injury occurred as alleged. It noted that 

she had not responded to the development questionnaire. OWCP concluded, therefore, that the 

requirements had not been met to establish an injury as defined by FECA.

OWCP subsequently received a May 31, 2019 report, wherein Dr. Wellborn noted his 

treatment of appellant for right ankle pain following a workplace injury. Dr. Wellborn noted 

symptoms of blurred vision, blacking out or fainting, and swelling including ankles or legs. He

diagnosed displaced bimalleolar fracture of the right lower leg, closed fracture, initial encounter, 

3 Docket No. 22-0449 (issued November 8, 2022); Order Dismissing Appeal, Docket No. 20-1454 (issued 

August 26, 2020).
3

and recommended surgical treatment. On June 7, 2019 Dr. Wellborn performed an open reduction 

internal fixation (ORIF) of right lateral malleolus for bimalleolar ankle fracture and diagnosed 

displaced right lateral malleolus fracture with interposed medial malleolar chip. He treated 

appellant on June 14, 2019 for postoperative ORIF of right lateral malleolar ankle fracture. In a 

duty status report (Form CA-17) dated July 9, 2019, Dr. Wellborn diagnosed fracture of right 

bimalleolar and advised that she could not work. 

OWCP received an August 5, 2019 witness statement from S.C., who arrived after the fall 

on May 29, 2019 and observed that appellant was on the floor behind her desk grimacing. S.C.

noticed that appellant’s office was unusually hot with little air circulation. A witness statement 

from an individual who was not identified noted arriving at appellant’s office after her fall and 

observing that she appeared alert and was responding to questions. Appellant explained that she 

began to feel unwell and reached for the trash can when she passed out and injured her foot. 

On August 28, 2019 appellant responded to the development letter and indicated that on 

May 29, 2019 while performing computer work, she rolled her chair over to use the trash can and 

the next thing she remembered she was lying on the floor. She opened her eyes and her head was 

resting against the file cabinet on the floor. Appellant reported hitting her head on the bottom 

drawer of the file cabinet stating, “I don’t know what really happened.” She indicated that her 

office was “extremely over heated” and that she had never before fainted. Appellant advised that 

her ankle was severely injured, and she also hit her head on the file cabinet, but she was more 

concerned about her foot, which was very painful. She only remembered reaching for the trash 

can while sitting in her office chair at her computer. 

On March 30, 2020 appellant, through counsel, requested reconsideration. 

By decision dated June 17, 2020, OWCP denied appellant’s claim, as modified. It accepted 

that the May 29, 2019 employment incident occurred as alleged and that there was a diagnosed 

closed right ankle fracture. However, OWCP found that appellant failed to establish that the 

alleged injury occurred while in the performance of duty. It found that her collapse and fall were 

due to an idiopathic incident, which was considered to be a personal nonoccupatio nal pathology 

without intervention or contribution by a factor of employment and, therefore, the injury was not 

considered compensable.

OWCP received additional evidence. On May 29, 2019 appellant was treated in the 

emergency room by Dr. Teresa M. Ross, a Board-certified emergency medicine physician. In a 

history and physical examination, appellant reported a prior medical history of myocardial 

infarction in 2013, diabetes mellitus, one episode of acute syncope with associated nausea prior to 

syncope, and right ankle pain. She related that, while speaking to her sister on the telephone, she 

felt intensely nauseated and reached for the trash can and woke up on the floor. Appellant reported 

that her office was hot, and she felt nauseated after eating “bad eggs and sausage.” She reported 

a recent six-day steroid course regimen that ended three days prior. Appellant also stated that her 

physician increased her blood pressure medicine two weeks prior. Dr. Ross opined that the workup suggested multifactorial syncope, including vasovagal from heat and nausea in the context of 

low baseline blood pressure with increased medication two weeks prior due to transient 

hypertension. She diagnosed syncope and collapse, nausea induced, likely due to overmedication 

of hypertension medication, with a betablocker recently prescribed due to high blood pressure. 
4

Dr. Ross suspected that appellant was overmedicated, which likely exacerbated her syncope in the 

context of nausea, heat, and dehydration. 

By decision dated November 29, 2021, OWCP denied modification of the June 17, 2020 

decision.

On February 1, 2022 appellant appealed to the Board. By decision dated November 8, 

2022, the Board affirmed the November 29, 2021 decision finding that she did not meet her burden 

of proof to establish an injury in the performance of duty on May 29, 2019, as alleged.

4

On November 11, 2022 appellant requested reconsideration.

A January 27, 2022 report from Dr. Ghazala S. Shah, an internist and general surgeon, 

noted that appellant had an injury at work on May 29, 2019. She indicated that appellant had been 

on blood pressure medication, cholesterol, and diabetes medicine for years and there was no 

problem with her medicines that would cause dizziness or cause her to pass out.

By decision dated February 1, 2023, OWCP denied modification of the November 29, 2021 

decision.

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,5that 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.6 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.7

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 

component is whether the employee experienced the employment incident at the time and place, 

4 Docket No. 22-0449 (issued November 8, 2022).

5

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

153 (1989).

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

7 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).
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and in the manner alleged.8 The second component is whether the employment incident caused a 

personal injury.9

Causal relationship is a medical question that requires rationalized medical opinion 

evidence to resolve the issue.10 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.11 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).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. 14 

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.15 OWCP has the burden of proof to submit medical evidence showing the existence 

of a personal nonoccupational pathology if it chooses to make a finding that a given fall is 

idiopathic in nature.16 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 

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

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

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

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

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

13 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).

14 Id.

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

16 A.B., Docket No. 17-1689 (issued December 4, 2018); P.P., Docket No. 15-0522 (issued June1, 2016);see also 

Jennifer Atkerson, 55 ECAB 317 (2004).
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distinguishable from a fall in which it is definitely proved that a physical condition preexisted and 

caused the fall.17

ANALYSIS

The Board finds that appellant has not met her burden of proof to establish an injury in the 

performance of duty on May 29, 2019, as alleged.

Initially, the Board notes that it is unnecessary to consider the evidence appellant submitted 

prior to the issuance of OWCP’s November 29, 2021decision, which was considered by the Board 

in its November 8, 2022 decision. Findings made in prior Board decisions are res judicata absent 

further merit review by OWCP under section 8128 of FECA. 18

In determining whether appellant’s injury occurred in the performance of duty, the Board 

must first consider factors to determine whether the May 29, 2019 employment incident was 

caused by an idiopathic fall. Factors to be considered include whether there is evidence of a 

predisposed condition that caused her to collapse, whether there were any intervening 

circumstances or conditions that contributed to her fall, and whether she struck any part of her 

body against a wall, piece of equipment, furniture, or similar object as she fell.19

In its prior decision dated November 8, 2022, the Board found that a May 29, 2019 report 

of Dr. Ross demonstrated that appellant’s May 29, 2019 fall was caused by a personal, 

nonoccupational pathology, including hypertension, without employment contribution.20 After the 

issuance of the November 29, 2021 OWCP decision affirmed by the Board, appellant submitted a

January 27, 2022 report from Dr. Shah who noted that she had been on blood pressure medication, 

cholesterol, and diabetes medicine for years and there was no problem with her medicines that 

would cause dizziness or cause her to pass out on May 29, 2019. While Dr. Shah generally 

indicated that appellant had no problem with her blood pressure, cholesterol, and diabetes medicine 

that would cause dizziness, she did not specifically address whether appellant’s fall was 

unexplained, thereby rendering it compensable.

21

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

she sustained an injury in the performance of duty on November 8, 2022, as alleged.22

17 H.B., supra note 13; JohnR. Black, 49 ECAB 624 (1998); Judy Bryant, 40 ECAB 207 (1988); Martha G. List, 

26 ECAB 200 (1974).

18 C.M., Docket No. 19-1211 (issued August 5, 2020); Clinton E. Anthony, Jr., 49 ECAB 476, 479 (1998).

19 D.T., Docket No. 19-1486 (issued January 17, 2020);A.B., Docket No. 17-1689 (issued December 4, 2018); P.P., 

Docket No. 15-0522 (issued June 1, 2016); see also Jennifer Atkerson, 55 ECAB 317 (2004).

20 In its November 8, 2022 decision, the Board found that appellant had not established that intervening 

circumstances or conditions contributed to her fall, or that she struck any part of her body against a wall, piece of 

equipment, furniture, or similar object as she fell.

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

22 P.N., Docket No. 17-1283 (issued April 5, 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 an injury in the 

performance of duty on May 29, 2019, as alleged.

ORDER

IT IS HEREBY ORDERED THAT the February 1, 2023 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: October 11, 2023

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board

James D. McGinley, Alternate Judge

Employees’ Compensation Appeals Board