C.J. and Department of the Interior, National Park Service, Buffalo National River, Harrison, AR (Board decision, September 22, 2015)

ECAB final decision. The Board affirmed OWCP’s January 12, 2015 denial of C.J.’s occupational disease claim. Under 20 C.F.R. § 501.6(d), this Board decision becomes final 30 days after issuance unless the Board fixed a different period in it. A party may petition the Board for reconsideration within 30 days of issuance unless this decision specifies another period, under 20 C.F.R. § 501.7(a). FECA compensation decisions are generally not subject to court review under 5 U.S.C. § 8128(b).

Plain-English summary

C.J., a wildland fire radio operator, attributed a urinary tract infection to long shifts and limited hygiene facilities at a fire camp. Her employer acknowledged the camp conditions, and a physician diagnosed the infection. The Board found that the physician's statement that those conditions likely predisposed her to infection did not explain medically how they caused or aggravated it. A later report and laboratory tests did not supply that explanation. The Board affirmed the claim denial for lack of a reasoned medical link to work.

Decision snapshot

• Authority: Federal Employees’ Compensation Act, 5 U.S.C. § 8101 et seq.
• Outcome: Occupational disease claim denial affirmed.
• Key point: Established camp conditions and a diagnosis still required a reasoned medical opinion connecting the two.

Full text (ECAB public release)

United States Department of Labor
Employees’ Compensation Appeals Board

________
)
C.J., Appellant
)
)
and ) Docket No. 15-1115
) Issued: September 22, 2015
DEPARTMENT OF THE INTERIOR,
)
NATIONAL PARK SERVICE, BUFFALO
)
NATIONAL RIVER, Harrison, AR, Employer
)
__________ )

Appearances: Case Submitted on the Record
Appellant, pro se
Office of Solicitor, for the Director

DECISION AND ORDER

Before:
PATRICIA H. FITZGERALD, Deputy Chief Judge COLLEEN DUFFY KIKO, Judge
JAMES A. HAYNES, Alternate Judge

JURISDICTION

On April 21, 2015 appellant filed a timely appeal from a January 12, 2015 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 that she sustained a urinary tract infection in the performance of duty.

FACTUAL HISTORY

On August 27, 2014 appellant, then a 57-year-old wildland fire radio operator, filed an occupational disease claim alleging that her urinary tract infection of August 10, 2014 was due to 1 5 U.S.C. § 8101 et seq. factors of her federal employment. She cited the camp conditions, where workers had to use porta-potties, portable hand washing stations, endure high temperatures, and limited air conditioning. Appellant was required to sit during 14- to 16-hour work shifts. She alleged that these contributed to her condition. The employing establishment noted that appellant did not stop work, but worked while taking antibiotic medication.

Evidence submitted with the claim included: an August 15, 2014 urinalysis lab report and an August 18, 2014 microbiology report.

In an August 16, 2014 medical report, Dr. Geoff Richardson, a Board-certified family practitioner, noted the conditions in which appellant worked and diagnosed urinary tract infection. The provider opined that her work conditions on a more probable than not basis likely predisposed her to getting an infection.

In a September 8, 2014 report, Dr. Richardson noted that appellant was seen for evaluation of possible urinary infection and that she had been working as a radio operator at the fire camp and spent long days sitting. A urinary tract infection was diagnosed.

In a November 14, 2014 letter, OWCP advised appellant of the deficiencies in her claim and provided her the opportunity to submit additional factual and medical evidence. This included a physician’s rationalized opinion as to how her work factors resulted in the diagnosed condition. Appellant was accorded 30 days in which to provide such information.

In a December 4, 2014 statement, the employing establishment acknowledged that the conditions at the large fire camps were full of dirt and dust, had minimal hand washing and lavatory facilities, and showers for personal hygiene were only available once every three days. The employing establishment did not dispute that appellant contracted the reported illness while at fire camp. No other evidence was received.

By decision dated January 12, 2015, OWCP denied the claim finding that the medical evidence failed to establish that the diagnosed medical condition was causally related to the work conditions in the fire camp.

LEGAL PRECEDENT

An employee seeking benefits under FECA has the burden of proof to establish the essential elements of his claim, including the fact that the individual is an employee of the United States within the meaning of FECA, that the claim was filed within the applicable time limitation, that an injury was sustained while in the performance of duty as alleged and that any disability and/or specific condition for which compensation is claimed are causally related to the employment injury.2 These are the essential elements of each and every compensation claim regardless of whether the claim is predicated on a traumatic injury or an occupational disease.3

2
C.S., Docket No. 08-1585 (issued March 3, 2009); Bonnie A. Contreras, 57 ECAB 364 (2006).
3
S.P., 59 ECAB 184 (2007); Joe D. Cameron, 41 ECAB 153 (1989).

2
 To establish that an injury was sustained in the performance of duty in an occupational disease claim, a claimant must submit the following: (1) medical evidence establishing the presence or existence of the disease or condition for which compensation is claimed; (2) factual statement identifying employment factors alleged to have caused or contributed to the presence or occurrence of the disease or condition; and (3) medical evidence establishing that the employment factors identified by the claimant were the proximate cause of the condition for which compensation is claimed or, stated differently, medical evidence establishing that the diagnosed condition is causally related to the employment factors identified by the claimant. The medical evidence required to establish causal relationship is generally rationalized medical opinion evidence. Rationalized medical opinion evidence is medical evidence which includes a physician’s rationalized opinion on the issue of whether there is a causal relationship between the claimant’s diagnosed condition and the implicated employment factors. The opinion of the physician must be based on a complete factual and medical background of the claimant, 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 factors identified by the claimant.4

Causal relationship is a medical issue and the medical evidence generally required to establish causal relationship is rationalized medical opinion evidence.5 Rationalized medical opinion evidence is medical evidence which includes a physician’s rationalized opinion on whether there is a causal relationship between the employee’s diagnosed condition and the compensable employment factors.6 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 factors identified by the employee.7

ANALYSIS

OWCP denied appellant’s claim because the medical evidence did not establish that her urinary tract infection was caused or aggravated by her work conditions.

The determination of whether an employment injury is causally related to work factors is generally established by medical evidence.8 Thus, appellant’s statements pertaining to the cause of her condition before OWCP and on appeal have no probative value.

In the August 16, 2014 medical report, Dr. Richardson noted appellant’s working conditions she worked under at the fire camp and diagnosed a urinary tract infection. The

4
Solomon Polen, 51 ECAB 341 (2000).
5
Y.J., Docket No. 08-1167 (issued October 7, 2008); A.D., 58 ECAB 149 (2006); Michael S. Mina, 57 ECAB 379 (2006).
6
J.J., Docket No. 09-27 (issued February 10, 2009); Sedi L. Graham, 57 ECAB 494 (2006).
7
I.J., 59 ECAB 408 (2008); Victor J. Woodhams, 41 ECAB 345 (1989).
8
Lois E. Culver (Clair L. Culver), 53 ECAB 412 (2002).

3 provider opined that her work conditions on a more probable than not basis likely predisposed her to getting an infection. An opinion on causal relationship based on a more probable than not basis does not establish causal relationship because it is unsupported by medical rationale explaining how appellant’s work conditions actually caused the diagnosed conditions.9 As the medical provider failed to provide a rationalized opinion explaining how factors of her federal employment at the fire camp caused or aggravated her urinary tract condition, this report is insufficient to establish appellant’s claim.

In his September 8, 2014 report, Dr. Richardson noted that appellant was working as a radio operator at the fire camp and spent long days sitting. While he diagnosed a urinary tract infection, he offered no opinion on the causal relationship of the condition. The Board has held that medical evidence that does not offer any opinion regarding the cause of an employee’s condition is of limited probative value on the issue of causal relationship.10

The diagnostic testing provided is also insufficient to establish appellant’s claim because it does not address causation and thus is insufficient to establish the causal relationship between any diagnosed condition and the established work factors.11

Because appellant has not submitted rationalized medical evidence to support her allegation that her condition is causally related to her identified employment factors, she failed to meet her burden of proof to establish a claim.

On appeal, appellant asserts that the medical evidence submitted supports her claim. As noted, the evidence of record is insufficient to establish causal relationship. She has the burden to establish causal relationship through the submission of rationalized medical opinion evidence.12

Appellant may submit additional evidence, together with a written request for reconsideration, to OWCP within one year of the Board’s merit decision, pursuant to 5 U.S.C.
§ 8128(a) and 20 C.F.R. §§ 10.606 and 10.607.

CONCLUSION

The Board finds that appellant did not meet her burden of proof to establish that her urinary tract infection was due to factors of employment, as alleged.

9
See K.W., Docket No. 10-98 (issued September 10, 2010).
10
See C.B., Docket No. 09-2027 (issued May 12, 2010); S.E., Docket No. 08-2214 (issued May 6, 2009).
11
S.E., id.; Conard Hightower, 54 ECAB 796 (2003).
12
John J. Montoya, 54 ECAB 306 (2003).

4
 ORDER

IT IS HEREBY ORDERED THAT the January 12, 2015 decision of the Office of Workers’ Compensation Programs is affirmed.

Issued: September 22, 2015
Washington, DC

Patricia H. Fitzgerald, Deputy Chief Judge Employees’ Compensation Appeals Board

Colleen Duffy Kiko, Judge
Employees’ Compensation Appeals Board

James A. Haynes, Alternate Judge
Employees’ Compensation Appeals Board

5