United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

C.S., Appellant

and

DEPARTMENT OF VETERANS AFFAIRS, 

EDITH NORSE ROGERS MEMORIAL

VETERANS HOSPITAL, Bedford, MA, 

Employer

__________________________________________

)

)

)

)

)

)

)

)

)

)

Docket No. 19-0769

Issued: March 15, 2022

Appearances: Case Submitted on the Record

Daniel B. Shapiro, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

JANICE B. ASKIN, Judge

PATRICIA H. FITZGERALD, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On February 22, 2019 appellant, through counsel, filed a timely appeal from an August 28, 

2018 merit decision of the Office of Workers’ Compensation Programs (OWCP).2 Pursuant to the 

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 Appellant timely requested oral argument before the Board. By order dated July 20, 2020, the Board exercised 

its discretion and denied the request as the matter could be adequately addressed based on a review of the case record. 

Order DenyingRequest for Oral Argument, Docket No. 19-0769 (issued July 20, 2020).
2

Federal Employees’ Compensation Act3(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 an injury in the 

performance of duty on October 1, 2015, as alleged.

FACTUAL HISTORY

On October 8, 2015 appellant, then a 61-year-old nurse, filed a traumatic injury claim 

(Form CA-1) alleging on October 1, 2015 that she fell to her knee and twisted her ankle while in 

the performance of duty. On the reverse side of the claim form, the employing establishment 

acknowledged that she was injured in the performance of duty. Appellant stopped work on the 

date of injury.

In support of her claim, appellant provided an October 1, 2015 note from Dr. Ryan A. 

Secan, a Board-certified internist, noting that she fell after her legs gave way for an unknown 

reason. Dr. Secan recounted that she did not walk well due to back issues and used a scooter to 

cover long distances. He reviewed x-rays and diagnosed a spiral fracture through the distal left 

fibula.

A note of even date from Linda Gaudet, a registered nurse, indicated that appellant was 

walking out of her office using her cane when her knees collapsed and she fell, landing on her right 

knee.

In an October 2, 2015 report, Dr. Brock Drapkin, a Board-certified internist, noted that 

appellant fell forward when walking home from work and was unable to get up due to severe left 

leg pain. He relayed that, over the past several months, she had experienced frequent falls for 

uncertain reasons. Dr. Drapkin related that appellant experienced a feeling of generalized

weakness when she fell, but no loss of consciousness, and was generally unable to get up by 

herself. He diagnosed preexisting morbid obesity, gout, hyperlipidemia, depression, neuropathy, 

and found that she had sustained a nondisplaced oblique distal fibular fracture on the left.

Dr. Drapkin found that appellant had experienced an unexplained fall without loss of 

consciousness which resulted in a distal left fibular fracture. He reported, “The mechanism of this 

and other recent recurrent falls is not clear.” 

On October 2, 2015 Dr. Eric Holstein, a Board-certified orthopedic surgeon, examined 

appellant and noted her history of morbid obesity and severe knee degenerative joint disease. He 

reported that she ambulated with a cane and that she sustained a syncopal episode at work. 

Dr. Holstein found that appellant did not slip, but fell after passing out. He noted that she was 

unclear as to why this occurred, and that she awoke with pain in her left leg. Dr. Holstein 

diagnosed nondisplaced distal fibula fracture.

3

5 U.S.C. § 8101 et seq.
3

On October 2, 2015 the employing establishment provided appellant with an authorization 

for examination and/or treatment (Form CA-16).

Dr. Jasper Ngomba, a Board-certified internist, examined appellant on October 3, 2015 and 

noted that she had fallen 20 times in the past six months. He found that she had been diagnosed 

with optic neuritis.

In an October 4, 2015 report, Dr. Stacie Perlman, a Board-certified surgeon, noted that, on 

October 2, 2015, appellant fell on the sidewalk while walking home from work and sustained a 

nondisplaced left fibular fracture.

On October 4, 2015 Dr. Jonathan Moray, a Board-certified neurologist, examined 

appellant due to her frequent falls. He noted that she reported falls beginning 23 years earlier. 

Dr. Moray noted that appellant had fallen recently and was experiencing increasing pain in her low 

back as well as weakness and numbness in the right leg. He indicated that she had chronic neck 

and back pain. Dr. Moray noted that appellant experienced frequent falling with an unknown 

etiology. He reported that she had a history of a possible central nervous system disease, that her 

examination was consistent with peripheral neuropathy or spinal stenosis, and questionable 

regarding lumbar radiculopathy with myelopathy. 

On October 5, 2015 appellant underwent a brain magnetic resonance imaging (MRI) scan 

which demonstrated minimal scattering of white matter signal abnormalities with bilateral frontal 

predominance differential including microangiopathic change, Lyme disease, the effects of 

hypertension or migraine, demyelinating disease, and other entities.

In a December 10, 2015 development letter, OWCP advised appellant of the deficiencies 

of her claim. It requested additional factual and medical evidence and provided a questionnaire 

for her completion. OWCP afforded appellant 30 days to respond.

In an October 1, 2015 note, Jessica G. Sprangers, a physician assistant, reported that 

appellant described appellant’s fall as resulting from a slip, and that she had no preceding 

symptoms. She recounted that appellant used a cane due to chronic back pain. Appellant denied 

feeling dizzy or weak just prior to falling. Ms. Sprangers noted that appellant was unsure of 

exactly what made her fall, but that appellant had asserted that her legs did not “give out.” She 

noted that appellant had experienced frequent falls in the past due to balance problems.

In a December 16, 2015 letter, appellant denied syncopal episodes. She asserted that on 

October 1, 2015 she was feeling well, did not have dizziness, and that her gait was steady. 

Appellant alleged that she informed her physicians that she did not know why she fell. She 

described the events surrounding her fall as walking toward the restroom at the employing 

establishment at approximately 3:55 p.m. and as she was walking in the corridor she suddenly had 

fallen onto the hard surface of the corridor. Appellant noted pain in her left foot and indicated that 

she sought medical treatment. She asserted that she did not strike any objects on the way down to 

the immediate supporting surface. Appellant denied any history of fainting. She noted that her 

back was arthritic. Appellant reported that she had experienced more falls as she had aged, but 

that the falls were not serious and usually caused by an uneven surface or due to objects, ice, or 
4

fluids on the floor. She did not notice any substance on the floor on October 1, 2015 and did not 

know what caused her fall.

In a December 24, 2015 note, Dr. Mythily Meda, an internist, reported that appellant had 

a history of dizziness, but no syncope. She recounted that appellant reported no syncopal episode 

at the time of her fall on October 1, 2015.

By decision dated January 14, 2016, OWCP denied appellant’s claim, finding that the 

factual evidence was insufficient to support that she actually experienced the alleged employment 

incident as a result of her work duties, as well as that the medical evidence did not substantiate 

that the diagnosis provided was caused or aggravated by a work injury. It noted that she reported 

that she did not know what caused her fall and did not strike any object as she was falling. OWCP 

also noted that Dr. Holstein reported that appellant had sustained a syncopal episode at work.

On February 5, 2016 appellant requested reconsideration of the January 14, 2016 decision. 

She provided a February 5, 2016 note from Dr. Holstein in which he reported that she used a cane 

or walker due to severe knee degenerative joint disease. Dr. Holstein reported that there had been 

a discrepancy between appellant’s history of injury, experiencing an mechanical fall, and his 

reports suggesting a syncopal episode. He noted that she reported no loss of consciousness and 

that medically there were no abnormalities. Dr. Holstein also reported that physicians had found 

no diagnosis of syncope in appellant’s medical history, and that therefore her history was 

“consistent with a mechanical fall at work.” He diagnosed closed fracture of the lateral malleolus.

In a March 10, 2016 narrative statement, appellant again asserted that she had not ever

experienced syncope including immediately prior to her fall on October 1, 2015. She noted that 

she did have a history of dizziness due to medications prior to October 1, 2015 and that this was 

addressed through dosage adjustment before her fall on October 1, 2015. Appellant surmised that 

she likely slipped on liquid left on the floor by a patient. She submitted nurses’ notes, as well as 

physical and occupational therapy notes.

By decision dated April 11, 2016, OWCP denied modification.

On February 8, 2017 appellant, through counsel, requested reconsideration of the April 11, 

2016 decision. She submitted additional medical and factual evidence and asserted that OWCP 

had not established that her fall on October 1, 2015 was idiopathic,rather than an unexplained fall 

which would be considered to have occurred in the performance of duty.

In a February 7, 2017 affidavit, appellant asserted that the corridor where she fell on 

October 1, 2015 was busy and traveled by hundreds of people on a daily basis. She noted that 

there had been numerous floods and water leaks on the floor as well as water drips from people 

using the restrooms, spills of liquids including coffee and other beverages, and water tracks from 

inclement weather. Appellant alleged that there were cracks, grooves, depressions, and pits in the 

floor surface in which water or other liquids often collected. She repeated her statement that, on 

October 1, 2015, as she walked to the restroom, she was feeling well, her gait was steady and that 

she was not weak or dizzy in any way. Appellant suddenly slipped and fell on the floor. She did 

not know the cause of her slip, but asserted that it felt like she slipped due to water on the floor. 

In a January 16, 2017 report, Matthias J. Mulvey, a professional building safety and code 
5

consultant, noted that on November 4, 2016 he inspected the corridor where appellant fell on 

October 1, 2015. He found deep erosion marks, pitting, and water stains from heavy pedestrian 

traffic and water damage. Mr. Mulvey reported 20 feet of erosion marks and water staining 

running in a line from the bathroom exit toward appellant’s office door. He noted that the depth 

of the erosion and pitting was sufficient to allow for the pooling of liquid and that the existing 

surface marks were consistent with liquid historically collecting and pooling in the pits and 

depressions of the floor’s surface.

Appellant also resubmitted Ms. Sprangers’ October 1, 2015 note in which appellant 

described a fall at work which resulted from a slip. She also provided discharge notes in which

Dr. Meda diagnosed a fracture of the distal fibular shaft and noted that she had a fall at work. 

Appellantsubmitted Dr. Drapkin’s October 2, 2015 note describing her frequent falls for uncertain 

reasons.

In a January 17, 2017 report, Dr. George P. Whitelaw, a Board-certified orthopedic 

surgeon, reviewed appellant’s medical records and affidavit. He noted that syncope was a 

temporary loss of consciousness or fainting due to other medical conditions. Dr. Whitelaw found 

that there was no medical evidence that appellant had a diagnosis of a syncopal event and that

Dr. Meda explicitly denied that appellant had a history of syncope. He opined that appellant had 

experienced a mechanical fall as her incident was consistent with slipping.

By decision dated July 7, 2017, OWCP denied modification of its prior decisions.

On July 5, 2018 appellant, through counsel, requested reconsideration and submitted 

additional factual evidence.

In an October 1, 2015 incident report, the employing establishment described appellant’s 

fall as losing her balance while trying to exit the building, striking both knees on the floor, and 

complaining of left ankle pain.

Appellant’s husband completed a narrative statement on November 8, 2017 explaining that 

appellant fell on October 1, 2015 in the basement of a building on the employing establishment’s 

premises, approximately 25 feet from her office

K.H., the acting director of performance management at the employing establishment, 

completed a statement on November 14, 2017 and reported that on October 1, 2015 he was 

informed that appellant had fallen in a tunnel.

On November 24, 2017 K.S., patient safety officer at the employing establishment, 

reported on October 1, 2015 appellant informed her that she had fallen and did not know how or 

why. Appellant denied hitting her head or losing consciousness at any time. K.S. and K.H. helped 

appellant onto her scooter and directed her to urgent care.

In a November 30, 2017 statement, J.W., an employing establishment nurse, reported that 

she found appellant on her knees on October 1, 2015 outside her office and next to the exit door. 

Appellant indicated that she had injured her left leg and discussed seeking treatment at urgent care. 

J.W. noted that appellant did not fall on her face, but was on her knees in a sitting position holding 

on to a railing. 
6

On June 15, 2018 Dr. Whitelaw provided a correction to his January 17, 2017 report and 

again opined that appellant’s incident was consistent with slipping and suffering a mechanical fall. 

He noted that a review of the medical records established that she denied dizziness or weakness 

prior to the fall. Dr. Whitelaw concluded that there was no syncopal event involved in the 

October 1, 2015 fall.

By decision dated August 28, 2018, OWCP denied appellant’s claim, finding that the 

evidence of record established that she sustained an idiopathic fall outside of the performance of 

duty. It found that the medical record was consistent in reporting that she had a long history of 

falling with a recent increase in frequency of falls, difficulty ambulating, and balance problems. 

OWCP concluded that the mere fact that the etiology of appellant’s falls both past and present 

remained undiagnosed does not make the fall sustained at work on October 1, 2015 unexplained.

It determined that both the medical and factual evidence clearly established that a physical 

condition preexisted and resulted in the fall on October 1, 2015. OWCPconcluded that appellant’s 

fall on October 1, 2015 was explained as it was one of a series of 20 falls sustained over the 

preceding 6-month period resulting from preexisting pathology and must therefore be considered 

as idiopathic.

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

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.7 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 

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 M.R., Docket No. 19-0341 (issued July 10, 2019); H.B.,Docket No. 18-0278 (issued June 20, 2018); see CarolA. 

Lyles, 57 ECAB 265 (2005).
7

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.8

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.9 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.10 If the record does not establish that the particular fall was due to an 

idiopathic condition, it must be considered as merely an unexplained f all, one which is 

distinguishable from a fall in which it is definitely proved that a physical condition preexisted and 

caused the fall.11

ANALYSIS

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

performance of duty on October 1, 2015, as alleged.

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

must first consider factors to determine whether the October 1, 2015 incident was caused by an 

idiopathic fall. Factors to be considered include whether there is evidence of a predisposed 

condition that caused appellant to collapse, whether there were any intervening circumstances or 

conditions that contributed to her fall, and whether appellant struck any part of her body against a 

wall, piece of equipment, furniture, or similar object as she fell.12

The Board finds that the medical evidence establishes that appellant’s fall on October 1, 

2015 was due to a personal, nonoccupational pathology without employment contribution. On 

October 1, 2015 Dr. Secan reported that appellant did not walk well due to back issues. 

Dr. Ngomba examined appellant on October 3, 2015 noting that she had fallen 20 times in the past 

six months, and she had been diagnosed with optic neuritis. On October 2, 2015 Dr. Holstein 

reported that appellant used a cane or walker due to severe knee degenerative joint disease. 

Dr. Moray found on October 4, 2015 that her examination was consistent with peripheral 

neuropathy or spinal stenosis. The Board, therefore, finds that the evidence of record is sufficient 

to establish that appellant’s fall was caused by appellant’s preexisting conditions and thus, was

idiopathic.

8 M.R. and H.B., id.

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

10 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).

11 M.R., supra note 7; P.N., Docket No. 17-1283 (issued April5, 2018); JohnR. Black, 49 ECAB 624 (1998); Judy 

Bryant, 40 ECAB 207 (1988); Martha G. List, 26 ECAB 200 (1974).

12 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).
8

Further, the Board finds that the evidence of record is insufficient to show that appellant 

experienced an intervention or contribution by any hazard or special condition of employment. 

Appellant did not allege that she struck any object related to her employment when she fell to the 

ground.13 The Board, therefore, finds that appellant’s fall on October 1, 2015, without any further 

intervention or contribution by the employing establishment, is considered idiopathic and is

therefore noncompensable.14

Accordingly, appellant has not met her burden of proof to establish that she sustained an 

injury in the performance of duty on October 1, 2015, as alleged.

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 October 1, 2015, as alleged.

15

13 P.N., supra note 11.

14 Id.

15 The Board notes that where an employing establishment properly executes a Form CA-16 authorizing medical 

treatment related to a claim for a work injury, the form creates a contractual obligation, which does not involve the 

employee directly, to pay for the cost of the examination/treatment regardless of the action taken on the claim. 

Tracy P. Spillane, 54 ECAB 608 (2003). The period for which treatment is authorized by a Form CA-16 is limited to 

60 days from the date of issuance, unless terminated earlier by OWCP. See 20 C.F.R. § 10.300(c).
9

ORDER

IT IS HEREBY ORDERED THAT the August 28, 2018 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: March 15, 2022

Washington, DC

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Alternate Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board