nodcerrl US. DEPARTMENT OF LABOR OFFICE OF COMP PROGRAMS PO BOX 0300 DISTRICT 14 SEA LONDON. KV 4074278300 Phone: (206) 470-3100 November 6. 2015 Date of injury: 08/11/2015 Employee: KEVIN ALBERT Dear Mr NOTICE OF DECISION Your claim for compensation is denied as the medical evidence does not demonstrate that the claimed medical condition is related to the established work-related eventts) as required tor coverage under the Federal Employees' Compensation Act (FECA). On 08/20/2015 you tiled a claim for Traumatic injury indicating you sustained an Injury or medical condition on 08/11/2015 as a result of your employment as a Combined Trades Supervisor with the Department of the Navy in Bremerton. WA Specifically. you stated that the inyury or condition occurred on 08/04/2015 as a result oi dust being expelled into the air during construction You indicated that you were walking from building 435 to building 550 when a gust otwind carrying dust. dirt. and debris filled the air causing you to cough. Along With your claim. you submitted a (DA-17 dated 08/19/2015. statement, SF-SO. medical report dated 08/19/2015. certificate of medical examination. and a position description, On 09/25/2015 this office advised you of the deficiencies in your claim and provided you the opportunity to submit additional evidence. Specifically. you were asked to submit evidence that you actually experienced the incident alleged to have caused your injury, a diagnosis of any condition resulting from your injury. a physician's opinion as to how your injury resulted in the condition diagnosed a narrative report describing the traumatic injury and objective findings explaining as to how your injury caused or contributed to the diagnosed condition. You were provided 30 days to submit the requested iniorrnalion, In response to our development letter. we received the following evidence: CAv7s. EFT form. CA-17 dated 09/25/2015. medical report dated 09/02/2015 trom Dr, Tanya Meyer. statement dated 10/21/2015. CA-17 dated 10/20/2015. medical report dated 10/20/2015, CA--17 dated 10/02/2015. email dated 04/16/2013. 06/06/2013. smoke test dated 05/23/2013. a non-nuclear critique report dated 04/19/2013. medlcal report dated 09/29/2014, and a (IA-17 dated 09/28/2015 in order for a clalm to no accepted under the Federal Employees' Compensation Act (FECA). the claim must meet 5 basic elements The claim must: (1) Be Timely Filed. If you have a disability (a substantially limiting physical or mental lmpa/rment), please coniact our ofiice/cleinrs examiner for information about the kinds Ollie/p available. such as communication assistance {alternate formats or sign language interpretation). accommodations and modifications. File Number: -- nodcr>>D-I (2) Be made by a Federal civil Emplo ee. (3) Establish Fact of ln'um. has both 3 (actual and medical component, Factually. the injury. accident or employment factor alleged must have actually occurred, Medically. a medical condition must be diagnosed in connection with the injury or event. (4) Establish P'erlormance oi Dut . The injury and/or medical condition must have arisen during the course of employment and within the scope of compensable work factors. (5) Establish Causal Relationship. which means the medical evidence establishes that the diagnosed condition is causally related to the injury or event. you have established that you are a Federal civilian employee who fiied a timely claim; that the injury, accident or employment factor occurred; that a medical condition has been diagnosed; and that you were within performance of duty. However. after a thorough review of all evidence. your claim is denied because the fifth basic element. Causal Relationship, has not been met. Specifically. your case is denied because the evidence is not sufficient to establish that the medical condition is causally related to the accepted work eventts). You indicated that you were injured when dust was expelled into the air on 08/04/2015, You were first treated on 09/05/2015. the day after your injury. by Dr. Kathleen Leppig. In the history of the report. she did not mention your injury or exposure to dust. There is no medical opinion discussing how your medical conditions were related or aggravated as a result of your traumatic work injury. A CA717 dated 09/25/2015 states you have respiratory problems under clinical findings and a diagnosis of congenital malformation 6187.89. A 0/1717 dated 08/19/2015. 09/25/2015 and 10/20/2015 reports your injury is due to exposure to various toxic/irritant fumes as waste water treatment worker including chlorine gas and cyanide. There are no objective findings or medical rationale to support that your medical conditions were related to your incident dated 08/04/2015. The medical reggae. ted 09/ 015fro a edicals ecialis nn Sumida.isnot rovid a sician nor does it discuss our work in'u a ravated our re-existln medical ee condl A medical report dated 09/02/2015 by Dr. Tanya Meyer failed to discuss any indication of your injury on 05/04/2015 or how it contributed to aggravated your medical conditions, You provided previous medical reports and statements from your employing agency that pertains to the case #146073315. As this case is a traumatic injury as a result of your work injury dated 08/04/2015. new medical was needed to support how your new injury aggravated or caused your medical conditionts). As such. your claim for traumatic injury is denied. In order for a medical condition to be covered underthe FECA. medical evidence must demonstrate that it is related to the accepted injury. Your physician must expla' how the work eventts,' caused or affected your condition. based upon an accurate factual and medical history. citing objective findings in support ofthe opinion. Based on these findings. your claim is denied on the fifth basic element. Causal Relationship. because the requirements have not been met for establishing that you sustained an injury and/or medical condition causally related to the accepted work event(s). Medical treatment is not authorized and prior authorization. if any. is terminated. Your employing agency will charge any previously paid Continuation of Pay to your sick and/or annual leave balance or declare it an overpayment. File Number nodcr--D-l you dlsagree with decision' you should carelully review lhe allached appeal rights, and pursue whichever avenue is appropriate to your silualion. mam Hany Tran Claims Examiner Enclosure: Appeal Rights DEPARTMENT OF THE NAW COMMANDER US PACIFIC FLEETASHIPYARDS HRO-NORTHWEST 1400 FARRAGUT AVENUE. BLDG 435, SR WA 98314 :3 6211 CE 1 I113 (Sc) 11 :i:r nu Date FRI 13:55 Name BMTC Tel. 3604760532 Phone 912067442756 Pages 4/4 Start Time 11-13 13:53 Elapsed Time 01'51" Mode G3 Result 0k