Marilyn Keeton (97-882) 
mq: Marilyn Keeton (Docket No. 97-882) [1997] 


In the Matter of MARILYN KEETON and DEPARTMENT OF THE TREASURY, 
U.S. CUSTOMS SERVICE, Blaine, Wash. 

Docket No. 97-882; Submitted on the Record; 
Issued December 17, 1997 
____________ 

DECISION and ORDER 

Before GEORGE E. RIVERS, DAVID S. GERSON, 
A. PETER KANJORSKI 


The issue is whether appellant had any condition or disability after November 19, 1991 that was causally related to her September 23, 1991 exposure to chemical fumes. 

Appellant, then a 42-year-old lead customs agent, filed a claim on September 23, 1991 stating that on that date a contractor was spraying a sealant, White Roc 20, on the employing establishment building. The fumes came into the building forcing the evacuation of the building. Appellant subsequently had to reenter the building to secure and take out the money collected by the employing establishment that day. She claimed that the fumes caused breathing problems. The Office of Workers' Compensation Programs accepted appellant's claim for respiratory conditions due to chemical fumes and vapors. 1 The employing establishment submitted a copy of an analysis of the air in the building, finding no chemicals in sufficiently significant concentrations to cause problems. However, the report did note that the building's air system had problems in delivering a sufficient flow of fresh air throughout the building. 

In a November 12, 1991 report, Dr. Janet Seltzer, a Board-certified pulmonologist, described appellant's symptoms on the day of the exposure as dry mouth, flushed face, difficulty breathing, hoarseness, eye irritation, sinus congestion and a cough. She noted that appellant had trouble completing pulmonary functions tests. She diagnosed mucosal irritability due to exposure to the sealant at work. 

In a November 20, 1991 report, Dr. Joel Kaufman, a Board-certified internist and Board-certified in preventive medicine, specializing in occupational medicine, indicated that appellant described persistent nasal and upper respiratory irritation, wheezing at work and a burning sensation of her face after exposure to her workplace. He noted that appellant had a history of allergies as a child for which she received hyposensitization shots. He stated that it seemed reasonable to assume the majority of appellant's exposure agent was the aromatic solvent which included mineral spirits, isopropyl alcohol, 124-trimethylbenzene, aromatic 100 solvent and xylene. He indicated that this combination could be expected to be an acute respiratory irritant when inhaled in large concentrations. He related that an industrial hygienist who visited the employing establishment stated that the concentrations present on the night of September 23, 1991 would have been sufficient to produce the short-term health effect experienced by some of the workers. Dr. Kaufman stated that examination demonstrated erythematous nasal mucosa without other marked changes. He indicated that appellant had persistent symptoms after exposure to irritant hydrocarbons. Dr. Kaufman concluded, from the toxicity of the class of compounds to which appellant was exposed, that the acute toxicity should have resolved by the time of his examination. He noted that appellant's pulmonary functions tests had returned to normal . He stated that whatever acute inflammation that had been going on should have resolved or should be resolved within the next few weeks. He stated that it was important for appellant to go back to work. 

In a November 26, 1991 report, Dr. Peter M. Ambrose, Board-certified in emergency medicine, diagnosed possible exposure to solvents or other organic materials that may have caused sinusitis. He stated that investigation basically found that there might have been levels of organic high enough to produce short terms the night before the levels were measured. He indicated, however, that these effects would be short lived. In a December 3, 1991 report, Dr. Ambrose stated that the chemicals appellant was exposed to may cause an irritation to the respiratory mucosa . He expressed doubt that there would be any long-term effects from exposure to these items. He noted that benzene, to which appellant was exposed, was known to cause leukemia but indicated that the levels to which appellant was exposed should not cause a problem. 

In a July 13, 1993 report, Dr. Peter D.F. James, a Board-certified family practitioner discussed his treatment of appellant, stating that from the first treatment on September 24, 1991, appellant had symptoms of nasal congestion, sinus discomfort, recurrent bronchitis, occasional headaches and facial flushing. He stated that these symptoms had been very disabling to appellant, ongoing since her employment injury. He indicated that to his knowledge, since 1987, appellant had no significant sinus or bronchial problems other than an occasional upper respiratory infection which responded rapidly to conservative treatment. He commented that the facial flushing was not present prior to the employment injury. He concluded that appellant's symptoms were related to her exposure to fumes at work but indicated that he was unable to state why appellant's symptoms may have persisted for so long. 

In a March 9, 1994 report, Dr. Mark Doherty, a Board-certified dermatologist, diagnosed appellant's face condition as an erythematous- telangiectatic type of rosacea which he doubted was related to appellant's exposure to hydrocarbons in the past. He stated that he saw no correlation with the September 1991 exposure and appellant's current clinical presentation. 

The Office referred appellant to Dr. W. David Jones, a Board- certified internist, for an examination and second opinion. In an April 11, 1994 report, Dr. Jones concluded that appellant had mucosal irritability since exposure to the sealant which seemed to be subsiding slightly. He stated that the hyperemia, rhinorrhea and resultant nasal obstruction made appellant prone to frequent upper respiratory infections and possibly sinusitis. He commented that appellant also had a bit of bronchorrhea in a reflexive nature when her upper airways were stimulated. He concluded that this was a direct result of appellant's previous exposure. He reported that a challenge test showed that appellant had very little, if any, reactive airway disease. He stated that appellant's prognosis should be better and seemed to be. He noted that appellant was gradually becoming less sensitive and had fewer respiratory infections in the past year than she had in the first year after exposure. He commented that he did not feel appellant's condition was a post-traumatic stress disorder. 

In a May 3, 1994 report, Dr. Ambrose, in response to questions from the Office, indicated that he had not seen appellant since he examined her on December 3, 1991. He stated that appellant had no evidence of reactive airway disease or allergic symptoms. He commented that appellant's mucosal irritation should be a limited problem, not an ongoing problem. He indicated that he did not subscribe to the multiple chemical sensitivity syndrome. He stated that appellant could have had some irritation for a brief period of time but that it should have passed with the resultant decrease in levels of toxins. He noted that the studies done on toxic levels in appellant's employing establishment failed to show any elevated levels. He concluded that appellant had mucosal and sinus irritation possibly related to chemical irritation. He stated appellant should have no ongoing restrictions. 

In a February 23, 1994 report, Dr. R. Emil Hecht stated that appellant had symptoms of ears plugging, especially on the right, sinus drainage and burning, recurrent bronchitis and particular exquisite sensitivity to strong fumes and odors. He diagnosed rhinitis, rhinosinusitis and hypopharyngitis probably related to sinus irritability and recurrent upper respiratory sensitivity directly related to her previous toxic exposure of September 23, 1991. 

In an October 6, 1994 decision, the Office rejected appellant's claim for compensation for the period January 6, 1992 through January 24, 1994 on grounds that appellant had not met her burden of proof. The Office noted that appellant used 417 hours of leave in 1992 and 115 hours of leave in 1993. 

Appellant requested a hearing before an Office hearing representative . At the hearing she submitted statements from coworkers that her reaction to the fumes at work had been severe. The coworkers indicated that the employing establishment had problems with diesel fumes being sucked into the employing establishment's air-conditioning system. Appellant and the coworkers indicated that the employing establishment had an ongoing problem with poor air quality. 

In a June 13, 1994 decision, the Office hearing representative set aside the Office's October 6, 1994 decision, finding that the case was not in posture for decision. He stated that there was no firm description of the condition accepted as injury related, noting that several physicians had given different diagnoses of her condition. He noted that Dr. Jones, in his second opinion examination, had related appellant's condition to the September 23, 1991 exposure. He remanded the case for referral of appellant for an examination to determine a firm diagnosis of appellant's condition, whether the condition had resolved and whether the subsequent periods of disability were related to the underlying condition or continued exposure to diesel fumes, car exhausts and other such fumes in the work environment. He stated that if it was determined that appellant's continued symptoms were related to new factors, appellant should be advised to file a new claim. He noted that only one report, from Dr. James, supported disability and that only for the period December 17, 1993 to January 8, 1994. He stated that there was no other medical evidence of record that supported any other specific periods with supporting documentation. 

The Office referred appellant, together with the statement of accepted facts and the case record, to Dr. Dorsett D. Smith, a Board- certified pulmonologist and Dr. J.P. Lynch, an otolaryngologist, for examinations and a second opinion on appellant's condition and its relationship to her employment. In a November 1, 1995 report, Dr. Smith stated that x-rays of appellant's hands showed some cystic areas of the metacarpal and the phalanges consistent with bony sarcoid. He noted that examination of the chest showed hilar adenopathy and a mediastinal azygos node enlargement consistent with pulmonary sarcoid. He diagnosed a history of upper respiratory symptoms following organic solvent exposure, pulmonary sarcoidosis, probable lupus pernio, multiple chemical sensitivities syndrome and bony changes, arthritis and mild restrictive ventilatory defect, all due to sarcoidosis. He noted that appellant never had documented asthma and the pulmonary functions studies performed had either been normal or had shown a restrictive pattern. He concluded that appellant perhaps had a mild restrictive lung disease, which would go along with her pulmonary sarcoidosis. He stated that there was no evidence of permanent obstructive ventilatory defect that would be due to an inhalation gas injury and there was no evidence on any of the pulmonary function studies of airway obstruction due to asthma. He indicated that the data, therefore, did not document any evidence of airflow obstruction that would be consistent with sensitization or aggravation of preexisting asthma due to an inhalation injury. He stated that organic solvents were predominantly neurotoxins but they do not cause lung injury and were not responsible for airway injury. Dr. Smith noted appellant had a preexisting allergic history and commented that she may have allergic rhinitis, which was aggravated by the fumes, causing increasing nasal stuffiness and congestion. He indicated that lower respiratory tract symptoms always have occurred a day or two after the onset of upper respiratory tract symptoms, indicating that the primary problem was a chemical reaction in the upper airway or nose that probably causes mucosal edema and a sinus infection, followed by lower respiratory tract symptoms due to a postnasal drip and the coughing up of thick purulent secretions ingested from the sinuses. He stated that he found appellant's airway looked quite normal and found her symptoms more consistent with multiple chemical sensitivity syndrome which was of unknown etiology, most likely related to a psychosocial disorder. He indicated that patients with this syndrome had complaints of sensitivity to any strong chemical, which tended to produce a variety of symptoms. Dr. Smith commented that appellant's facial flushing and other constitutional symptoms when exposed to chemical could not be explained on a physiologic basis. He indicated that the malar-type redness that appellant exhibited could be seen in either systemic lupus erythematous or in lupus pernio which was a condition that was also related to appellant's sarcoidosis. He stated that he knew of no evidence that appellant's sarcoidosis would be related to the type of inhalation exposure present in appellant's case. He concluded that her condition was not causally related to her work in any way. He stated that appellant had recovered completely from the effects of the exposure on September 23, 1991 and no further medical treatment was needed. He indicated that appellant probably had allergic rhinitis which was not work related. He commented that it was quite possible that the strong fumes could have aggravated appellant's allergic rhinitis on the two days of exposure of September 23 and 24, 1991 and the exposure may have been sufficient to cause an acute sinus infection which would be work related. He added, however, that he did not find evidence that any subsequent symptoms and problems were work related. He concluded that appellant did not have any permanent respiratory impairment related to the exposure on September 23, 1991 but only had a mild restrictive pulmonary impairment which was related to her sarcoid and not to any occupational exposure. 

In a separate November 1, 1995 report, Dr. Lynch diagnosed abnormal reactive airway since exposure to the sealant. He stated that the description of the sealant demonstrated its toxicity. He stated that, assuming the veracity of appellant's statements, it was perfectly reasonable to expect that appellant had a long-lasting change in reactivity of her upper airway mucosa. He noted that she denied any problems in this area preceding exposure. He related appellant's noted gradual improvement of her symptoms. He commented that historically, based on appellant's statement, her condition appeared to be a work- related disability that was slowly improving. He indicated that he was unaware of any testing procedures that would unequivocally support that statement but based on the facts at hand, it certainly appeared logical. In a November 15, 1995 addendum to his report, Dr. Lynch commented that Dr. Smith's comments appeared to be appropriate and acceptable. He stated that the diagnosis was hyperreactive airway, precipitated by exposure to the sealant. He indicated that this sensitivity had increased appellant's reactants to a variety of other stimuli. He reported that this was expected to be temporary and appellant felt that the problems may be improving. He noted that multiple chemical sensitivities, mentioned by Dr. Smith, may be a possibility. Dr. Lynch stated that the symptoms described by appellant as coming on immediately after the exposure may certainly be related to the toxicity but he added that these symptoms should not have continued on to the time of his examination. He therefore concluded that appellant's current symptoms were not associated with the toxic exposure. He stated that normal findings on November 19, 1991 after the employment injury effectively ruled out any possibility of chronic problems arising from the exposure. He concluded that any abnormalities after November 19, 1991 were not related to the toxic exposure. He indicated that appellant should have recovered completely from the immediate effects of the toxic exposure by the time of his examination. He stated that, to his knowledge, there were no definitive studies suggesting that such toxic exposures lead to permanent disability on the basis of airway changes. He commented that appellant could clearly continue to have symptoms related to allergic abnormalities which existed prior to the toxic exposure. He concluded that appellant, on a more probable than not basis, did not have a permanent partial disability secondary to the toxic exposure. 

In an October 25, 1995 report, Dr. James stated that, following the inhalation of the sealant, appellant had persistent problems with bronchitis, asthma and sinusitis and recurrent upper respiratory infections. He indicated that appellant had seen several respiratory specialists who concluded that appellant's problems were related to inhalation of the sealant. He concluded, within reasonable medical certainty, that the clinical features following inhalation of the sealant caused appellant significant ill health and time loss from work. 

In a November 27, 1995 decision, the Office found that the evidence of record did not establish that appellant was entitled to compensation because the weight of the medical evidence revealed that she had recovered from the effects of the work-related condition by November 19, 1991. 

Appellant requested a hearing before an Office hearing representative which was held on August 8, 1996. In an October 10, 1996 decision, the Office hearing representative found that the weight of the medical evidence, represented by the reports of Dr. Smith and Dr. Lynch, established that appellant recovered from the effects of her employment- related exposure by November 19, 1991. He found that the physicians who had supported appellant's claim had not given any rationale to state why her continued problems were causally related to the work injury other than to note the lack of problems before her exposure on September 23, 1991 and the continuous problems after that time. He stated that such rationale was not acceptable. 

The Board finds that the weight of the medical evidence establishes that appellant did not have any employment-related disability after November 20, 1991 causally related to her September 23, 1991 exposure to chemical fumes from a sealant. 

A person who claims benefits under the Federal Employees' Compensation Act 2 has the burden of establishing the essential elements of her claim. Appellant has the burden of establishing by reliable, probative and substantial evidence that her medical condition was causally related to a specific employment incident or to specific conditions of employment. 3 As part of such burden of proof, rationalized medical opinion evidence showing causal relation must be submitted. 4 The mere fact that a condition manifests itself or worsens during a period of employment does not raise an inference of causal relationship between the condition and the employment. 5 Such a relationship must be shown by rationalized medical evidence of causal relation based upon a specific and accurate history of employment incidents or conditions which are alleged to have caused or exacerbated a disability. 6 

The initial reports from Dr. Kaufman and Dr. Ambrose indicated that appellant's exposure to chemical fumes at work would cause only a short- term reaction. Dr. Kaufman stated that appellant's symptoms had resolved by the time of his November 20, 1991 report or should resolve within a few weeks. Dr. James and Dr. Hecht stated that appellant had mucosa and airway irritation and irritability which they related to appellant's exposure to the sealant. Neither physician, however, gave any rationale to explain how the exposure to the sealant would cause appellant's symptoms two to four years after the exposure. Similarly, Dr. Jones, a physician selected by the Office for a second opinion evaluation, did not give any rationale in support of his conclusion that appellant's exposure to the sealant was related to her mucosal irritation three years later. Dr. Smith, in an extensive, well-rationalized report, indicated that appellant had sarcoidosis which was unrelated to her exposure to fumes at work. He related appellant's mild restrictive pulmonary disease to the sarcoidosis. He stated that there was no evidence of any permanent obstructive ventilatory defect that would be due to an inhalation gas injury. He stated appellant's symptoms were more consistent with multiple chemical sensitivity syndrome which had an unknown etiology. He concluded that appellant had recovered from her exposure to chemical fumes. Dr. Lynch pointed out that appellant's examination was normal by November 19, 1991. The record does not contain any report of a November 19, 1991 examination but does contain Dr. Kaufman's November 20, 1991 report. Dr. Lynch concluded that appellant's current symptoms were not related to her exposure to chemical fumes, would not have continued and would have completely resolved. The reports of Dr. Smith and Dr. Lynch are well rationalized and are from specialists. These reports therefore constitute the weight of the medical evidence and establish that the effects of appellant's exposure to the sealant ceased by November 20, 1991. 

The decision of the Office of Workers' Compensation Programs dated October 10, 1996 is hereby affirmed. 

Dated, Washington, D.C. 
December 17, 1997 




George E. Rivers 
Member 




David S. Gerson 
Member 




A. Peter Kanjorski 
Alternate Member 


1 Appellant has filed a separate claim for continued exposure to diesel and gasoline fumes at the employing establishment. The Office has not issued a final decision on this claim. 
2 5 USC §§ 8101-8193. 
3 Margaret A. Donnelly, 15 ECAB 40, 43 (1963). 
4 Daniel R. Hickman, 34 ECAB 1220, 1223 (1983). 
5 Juanita Rogers, 34 ECAB 544, 546 (1983). 
6 Edgar L. Colley, 34 ECAB 1691, 1696 (1983). 





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