File Number: 14-320904
reconmoddenied-D-RECO

U.S. DEPARTMENT OF LABOR
EMPLOYMENT STANDARDS ADMINISTRATION 
OFFICE OF WORKERS' COMP PROGRAMS 
PO BOX 8300 DISTRICT 14 SEA 
LONDON, KY 40742-8300 
Phone: (206) 398-8100

April 11, 2006

Date of Injury: 02/25/1993
Employee: ROBERT F. FARMER

ROBERT F FARMER
411 PINEWOOD DR NE
BREMERTON, WA 98310

Dear Mr. FARMER:

Enclosed is a decision on your request for reconsideration, explaining the basis for the determination.

We have not modified our prior decision. However, we have evaluated the evidence you submitted and have reviewed the merits of your case.

If you disagree with this decision read and follow the enclosed instructions carefully.

Sincerely,

Minnie E. Bain

Senior Claims Examiner

Enclosure(s): Appeal Rights, Notice of Decision

DEPARTMENT OF THE NAVY
NAVAL SEA SYSTEMS COMMAND/SHIPYARDS
CODE 1113-1 PUGET SOUND SHIPYARD
1400 FARRAGUT AVENUE
BREMERTON, WA 98314

File Number: 140320904
nod-D

NOTICE OF DECISION

DATE: April 12 2006

CASE NUMBER: 140320904

CLAIMANT NAME: ROBERT F. FARMER

ISSUE: The issue for determination is whether the claimant has submitted sufficient medical evidence to support a causal relationship between his diagnosed condition and the accepted work exposures.

REQUIREMENTS OF ENTITLEMENT: Under 20 CFR 10.606(b)(2), the application for reconsideration, including all supporting documents, must set forth arguments and contain evidence that either the office erroneously applied or interpreted a specific point of law, by advancing a relevant legal argument not previously considered by the office, or by submitting relevant and pertinent evidence not previously considered by the office. Section 10.608(b) provides that where the request is timely, but fails to meet at least one of the standards described in 10.606(b)(2) or the request is untimely and fails to present any clear evidence of error, the office will deny the application for reconsideration without reopening the case for a review of the merits.

To establish causal relationship a claimant must submit 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 a causal relationship, generally, is 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.

BACKGROUND: The history of this claim has been well documented in previous decisions and will not be repeated in its entirety. On 01/23/2002, after a merit review of the claim, a decision was issued to modify the initial denial and deny the claim because causal relationship had not been established. The claimant did not agree with this decision and requested a reconsideration on 01/17/2003. 

On 03/19/2003, following a merit review of the claim, the Office denied modification of the earlier decision. The claimant did not agree with this decision and on 03/19/2004, the claimant requested a reconsideration. With his request for reconsideration, the claimant provided an occupational history record dated 09/05/1979.

On 05/04/2004, the Office declined the reconsideration request without review of its merits stating that the reconsideration request was untimely and that the claimant had not demonstrated a clear evidence of error on the part of the Office. The claimant disagreed with this decision and requested a review by the Employee's Compensation Appeal Board (ECAB) on 05/04/2005.

On 02/02/2006, the ECAB remanded the claim back to the Office as they found the reconsideration request to be timely filed. In their decision, the ECAB ordered that the Office review the timely request for reconsideration under the appropriate standard of review.

The appropriate standard of review would then be to consider all evidence received with the 03/19/2004 request for reconsideration as well as any evidence received by the Office since that date. The evidence will be evaluated to determine whether it meets the criteria established under 20 CFR 10.606(b)(2)

With his request for reconsideration, the claimant submitted an Occupational History Record dated 09/05/1979.

Subsequent to the 03/19/2003 decision, the Office received the following documents:

* 02/19/2004 letter requesting copies of several files under FOIA.
* 03/19/2004 congressional inquiry into the concerns of the claimant.
* 06/28/2004 congressional inquiry into the concerns of the claimant. This 8 page transmittal includes a letter from Dr. Dabe dated 02/16/2004 (a copy of the medical evidence has been split from the congressional and now stands alone in the claim file for easier review).
* 05/01/2005 letter requesting copies of all records under FOIA.
* 05/04/2005 letter advising the Office of the ECAB appeal
* Hearing Conservation Records from the employing agency (DD Form 2216) A dispensary permit from 10/05/1989 regarding hearing loss
* Medical Care records from the PSNS Branch Dispensary 
* A DD214 - Report of Transfer or Discharge Armed Forces of the US
* 01/16/2006 letter requesting clarification of a telephone conversation with ECAB
* 04/05/2006 letter requesting status of the remand decision.
* 04/07/2006 congressional inquiry into the concerns of the claimant.

In this instance, the evidence submitted is sufficient to warrant a merit review of the claim.

DISCUSSION OF EVIDENCE: The congressional inquiry dated 06/28/2004 contained a letter dated 06/11/2004 from RN Kay McManemy forwarding a report from Dr. Dabe which had been written in 02/2004 but not sent to the Office.

The medical opinion contained in the 02/16/2004 letter is basically a restatement of the opinion previously considered by the Office in his 01/21/2003 report. In the 02/16/2004 letter, Dr. Dabe has stated that the claimant's chronic myelocytic leukemia was aggravated or precipitated by the work history of exposures to the listed agents in an attached record, however, the attachment was not included with the copy provided to the Office. Dr. Dabe's opinion is not clearly rationalized and is equivocal. Dr. Dabe states that the claimant's condition was aggravated OR precipitated by work exposures provided by the claimant. The physician's opinion is diminished when he does not make a definite finding. Dr. Dabe does not discuss how the pre-existing condition was aggravated or precipitated by the claimant's limited exposure from 03/21/1993 - 02/19/1994 to vehicle exhaust fumes. A statement without medical rationale explaining the basis for the finding has little probative value. Furthermore, Dr. Dabe has stated that the claimant provided him a list of "agents° that he had been exposed to during many years of employment and that is why he has a reasonable medical certainty of the causal relationship to his illness. This claim covers the period 03/21/1993 through 02/19/1994 and the Office has accepted that the claimant experienced limited exposure to vehicle exhaust fumes. The physician continues to relate the claimant's current condition to exposures to various agents over a period of many years. The claimant has not established that he was exposed to multiple agents, only vehicle exhaust fumes. Without a clear and accurate history of injury, the medical opinion is not well rationalized. Dr. Dabe's letter concludes by discussing the treatments that have been provided to the claimant. 

The medical records from the employing agency are not considered relevant to this claim. The hearing conservation tests and other dispensary permits, etc. do not appear to address any exposures related to this claim nor is there any mention of the current condition. The records are of diminished value and offer no evidence of a causal relationship.

The question of causal relationship is a medical issue which usually requires reasoned medical opinion for resolution. For this reason, the congressional inquiries and the claimant's multiple letters to the Office and/or appellant board do not have relevance to the issue under reconsideration.

BASIS FOR DECISION: "While the medical opinion of a physician supporting causal relationship does not have to reduce the cause or etiology of a disease or condition to an absolute medical certainty, neither can such opinion be speculative or equivocal. The opinion of a physician supporting causal relationship must be one of reasonable medical certainty that the condition for which compensation is claimed is causally related to the employee's federal employment and such opinion on causal relationship must be supported with affirmative evidence, be explained by medical rationale and be based on a complete and accurate medical and factual background." Phillip J. Deroo, 39 ECAB - (1988)

The medical evidence of record does not meet the criteria to establish a causal relationship between the claimant's current condition and his limited exposure to vehicle exhaust fumes for the period of 03/21/1993 - 02/19/1994.

A person claiming benefits has the burden of establishing by the weight of the reliable, probative, and substantial evidence that his or her condition was caused or adversely affected by the employment. As part of this burden he or she must present rationalized medical opinion evidence, based on a complete factual and medical background, showing causal relation. The mere fact that a disease manifests itself during a period of employment does not raise an inference that there is a causal relationship between the two. Neither the fact that the disease became apparent during a period of employment, nor the belief of the employee that the disease was caused by the employment, is sufficient to establish causal relationship. (Meadows, 28 ECAB 290)

CONCLUSION: Following a review of the case on its merits under 5 USC 8128, I find that modification of the 03/19/2003 decision should be disallowed as the evidence on file does not support that a medical connection between the accepted exposure and the diagnosed condition.

Minnie E. Bain

Senior Claims Examiner


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