Norman E. Underwood (43 ECAB 719)

mq: Norman E. Underwood (43 ECAB 719) [1992] 43ECAB719 Docket No. 91-1 720

In the Matter of NORMAN E. UNDERWOOD and U.S. AIR FORCE, RICKENBACKER AIR NATIONAL GUARD BASE, Ohio

Docket No. 91-1 720; Submitted on the Record;

Issued April 28, 1992

Before MICHAEL J. WALSH, DAVID S. GERSON,

WILLIE T.C. THOMAS

The issue is whether appellant has met his burden of proof to establish that his hives condition was caused by factors of his federal employment.

On July 12, 1990 appellant, then a 57-year-old aircraft mechanic, filed a claim alleging that beginning in November 1989, and continuing he experienced hives which were caused by chemical exposure in the course of his federal employment. The record indicates that appellant stopped work on July 5, 1990.

In a supplemental statement, appellant explained that he was exposed to aircraft lube grease, oil dry lubricants, cleaning solvents, and aircraft wash soap as a result of performing his federal duties. Appellant also stated that his physician advised him on July 5, 1990 to stop work for four weeks, that his physician thereafter advised him to remain at home another two weeks, that during this period of time his condition cleared up, however, after his return to work within three days the hives returned.

In support of his claim, appellant submitted employing establishment health clinic records. A notation dated December 3, 1989 indicated that appellant had a red cellulitis from the right wrist halfway up the forearm. The notation dated April 11:1990 stated: "[appellant] presents today with large areas of hives on abdomen and upper back. Complains of severe itching. States he has had this off and on for approximately six months." Hives were also noted on progress notes dated May 29, and 31, 1990. A rash was noted on June 4, 5, 6, 7, 11, 12, 29, and July 2, 1990.

On January 13, 1990 Dr. Ralph Gebhart, Board-certified in family practice, stated, "[appellant] has allergies and should avoid chemicals at work."

On March 27, 1990 Dr. T.A. Keifer reported:

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"I saw [appellant] in allergy consultation on March 27, 1990. As you know he is a 57-year-old man with a six-month history of recurrent hives. They occur almost daily and are generalized. They are often accompanied by swelling of the hands. There are no obvious triggers for the hives and they generally resolve spontaneously. He has been receiving an injection in your office and the name of which he could not recall. He does state that this helps. He has no other associated allergies such as hay fever or asthma. He currently works in an aircraft maintenance shop and is concerned about his exposure to the different chemicals. He is otherwise healthy and is on no other medications. On physical exam[ination] today his ENT [ear, nose, throat] and lungs were clear. Examination of the skin showed several hives and demonstrated marked dermographism. Skin testing today showed completely negative reactions to all common inhalations and foods. It is my impression that his chronic urticaria is most likely secondary to his demographic skin. As you know minor trauma to the skin will produce the hives. Unfortunately, there is no way to either prove or disprove an association with the chemicals that he works with. My only recommendations were to treat the urticarial episodes with the daily administration of Hismanal. He may require intermittent administration of corticosteroids for control."

On May 29, 1990 Dr. Gebhart reported that appellant had allergies due to an unknown cause. To see whether the condition was work related, the doctor stated he would stop his Hismanal for three to four days and remove him from his environment to see if the allergy recurred. If it did recur, it was probably not work related and if he did have hives of any significant extent he should go back on Hismanal.

On June 13, 1990 Dr. Gebhart reported:

"This man has been seen here since January 19, 1990 with rather severe hives. These are large welts causing marked itching, swelling of his hands and feet, difficulty walking and have failed to respond to any medication or treatment. These hives seem worse when he is exposed to diesel fuels and oils, gasolines, etc. which he is in intermittent contact with at work daily. We have been unable to find any other cause for these hives and I now feel that this is probably due to exposure at work to hydrocarbon fuels. He was seen again today with a large amount of hives over most of his body with rather

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marked itching and discomfort. Diagnosis: giant hives and urticaria. He has had steroids, cortisone antihistamines with no relief. Because of this, I feel that he should not be exposed to these compounds for some length of time to see if this, indeed, causes the allergy. If his hives appear when he comes in contact with these chemicals then I feel that this must be the cause. However, this will take up to one month. I do n[o]t feel that he could get this allergen completely out of his system in a week. I feel that he should be completely unexposed to any fuels, oils, greases, etc. for a period of one month."

On September 14, 1990 Dr. Gebhart reported:

'This man was first seen in the office on January 19, 1990. He had rather severe hives at that time. He had large welts with itching and he felt it was due to exposure to diesel fuels, oils, gasolines, etc. at work. He had received intermittent injections of Depo-Medrol which is a cortisone preparation and antihistamines of various types with only temporary relief. It was felt that back in June he should discontinue work and all exposure to these possibly allergic compounds and see if he would improve. He was seen in consultation, with a Dr. Keifer, an allergist, who could not prove or disprove the etiology of his hives.

"He was last seen on August 1, 1990 at which time he was still having some hives and felt he had not been out of contact completely from the hydrocarbons long enough to be sure that it was not due to them. He has not been seen since that time. If this is really due to hydrocarbon exposure, it may be difficult to prove and he will then need to be continuously prohibited from contact with oils, grease, gasoline, and etc."

By compensation order dated November 26, 1990, the Office of Workers' Compensation Programs denied appellant's claim, finding that the evidence of record failed to demonstrate a causal relationship between the factors of employment and the condition claimed as causing the disability.

On January 8, 1991 appellant requested reconsideration. In support of his request for reconsideration, appellant submitted an October 13, 1990 report from an Air Force Reserve physician, 1 and a December 27, 1990 report from Dr. Gebhart. The air force medical progress note stated:

1 The physician's signature is illegible.

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"Meticulously documented case of urticaria/giant hives related to if not clearly caused by exposure to grease from work on aircraft. Has been back on job during the week for past month without great difficulty and without use of medications.

"Now requests return to military duty. Would favor change of job to cut overall exposure to grease and oil. [I] would recommend use of impervious rubber gloves and rubber apron, . . . donning and doffing gloves and clothes." 2

In the report dated December 27, 1990, Dr. Gebhart stated:

"The above named has been seen in this office for the last 11 months for hives, welts and rash. Injections, medication and testing by an allergist were to no avail. The patient was off work for six weeks, at which time , . . . he started back to work, the hives, welts and rash returned as before. It would be my opinion that this problem is work related."

By compensation order dated March 13, 1991, the Office denied appellant's application for review, finding that the evidence submitted in support of the application was cumulative in nature, of a repetitious nature, and was not sufficient to warrant review of the prior decision.

The Board finds that appellant has not met his burden of proof to establish that his hives condition was caused by factors of his federal employment.

An award of compensation may not be based on surmise, conjecture, speculation, or upon appellant's belief that his condition is employment related. The mere fact that a condition develops or progresses during a period of federal employment is in and of itself insufficient to entitle an employee to benefits under the Federal Employees' Compensation Act. 3 Additionally, the fact that work activities may produce symptoms revelatory of an underlying condition does not raise an inference of causal relationship between the condition and the employment. 4 Causal relationship may not be inferred but must be established by rationalized medical opinion evidence. Appellant failed to submit such evidence and, therefore, the Office properly denied his claim for compensation.

In the present case, appellant has alleged that his exposure to aircraft grease, lubricants, cleaning solvents, soaps, oils and gases, during the course of his federal employment, has caused his hives

2 Some words in this handwritten statement are illegible.

3 Wilbur D, Starks, 23 ECAB 85 (1971).

4 Primo T. Salta, 34 ECAB 1033 (1983).

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condition. In support of his claim, appellant submitted employing establishment health clinic notes, a number of reports from Dr. Gebhart, and a report from Dr. Keller. The employing establishment health progress notes record appellant's symptoms, however, offer no opinion regarding the cause of the condition. These notes therefore are of limited probative value in establishing causal relationship between appellant's employment factors and his condition.

Dr. Gebhart's reports are also insufficient to establish causal relationship. On May 29, 1990 Dr. Gebhart reported that appellant had allergies due to an unknown cause. The physician also stated that to determine whether the condition was work related he would stop appellant's medication and remove him from his work environment. Thereafter on June 13, 1990 Dr. Gebhart reported "we have been unable to find any other cause for these hives and I now feel that this is probably due to exposure at work to hydrocarbon fuels." Dr. Gebhart suggested that appellant not be exposed to the alleged compounds for one month to see if these compounds indeed caused the allergy. On September 14, 1990 Dr. Gebhart reported that appellant was seen on August 1, 1990 at which time he was still having hives. Dr. Gebhart concluded, "If this is really due to hydrocarbon exposure, it may be difficult to prove." While the opinion of a physician supporting causal relationship need not be one of absolute medical certainty, neither can such opinion be speculative or equivocal. 5 The opinion should be one of reasonable medical certainty. Dr. Gebhart, by removing appellant from his working environment, attempted to find some basis upon which to offer an opinion regarding causal relationship. However, in order to provide a well-rationalized opinion supporting causal relationship, Dr. Gebhart would have to provide medical rationale to explain how physiologically appellant's employment factors caused the condition. By removing appellant from the employment Dr. Gebhart was attempting to provide a factual basis for an opinion regarding causal relationship. The Board notes that the mere fact that a condition manifests itself during a period of employment does not raise an inference that there is causal relationship between the two. 6 Moreover, by September 14, 1990, his efforts to remove appellant from the working environment had not improved appellant's condition. Thus, Dr. Gebhart had no basis on which to offer an opinion regarding causal relationship and his statement on causal relationship did not indicate reasonable medical certainty.

5 See Philip J. Deroo, 39 ECAB 1294 (1988).

6 Edward E. Olsen, 35 ECAB 1099 (1984).

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The Board also notes that in a report dated March 27, 1990, Dr. Keifer stated that he saw appellant for an allergy consultation and that skin testing was negative for all common inhalants and foods. Dr. Keifer concluded that "unfortunately, there is no way to either prove or disprove an association with the chemicals that he works with." Dr. Keifer's report does not provide the necessary causal relationship to establish appellant's claim. The Office thus properly denied appellant's claim on November 26, 1990.

On January 8, 1991 appellant requested that the Office reconsider his case and in support submitted a medical progress note from an Air Force Reserve physician dated October 13, 1990, and a December 27, 1990 report from Dr. Gebhart. These reports, however, do not offer any rationale on causal relationship. The medical note dated October 13, 1990 offers no rationale regarding causal relationship. The December 27, 1990 report from Dr. Gebhart is generally supportive of appellant's claim, however, it also offers no medical rationale to explain how the alleged allergens ( chemicals) to which appellant was exposed during his federal employment would have caused his condition. This report merely repeats the opinion that appellant's work activities produced symptoms revelatory of the condition. As noted above, the mere fact that a condition develops or progresses during a period of federal employment is not sufficient to establish causal relationship.

Thus as these additional medical reports did not provide the type of new evidence necessary to establish appellant's claim, and offered no new legal arguments, and did not show that the Office erroneously applied or interpreted a point of law; the Office did not abuse its discretion by denying appellant's application for review.

The decisions of the Office of Workers' Compensation Programs dated November 26, 1990 and March 13, 1991 are hereby affirmed.

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