lumbar myelogram. Dr. Millheiser's report indicates that he only performed x-rays at the time of his examination of appellant." If it is Dr. Millheiser's opinion that the medical evidence of record does not show evidence of disc herniation at anytime and that the Office erroneously accepted this condition, then Dr. Millheiser's opinion is in conflict with the opinion of appellant's physician, Dr. Sheffel, who interpreted the January 28, 1985 CT scan as showing "midline disc herniation at L4-S1, L4-L5 and L3-4," and Dr. Millheiser's opinion is also in conflict with the opinion of Dr. Hinenburg, the first Office referral physician, and upon whose report the Office accepted the condition of multiple ruptured discs. Accordingly, for Dr. Millheiser's opinion to carry any weight he may not simply state that there is no evidence of disc herniation. Dr. Millheiser must explain why he believes Drs. Sheffel and Hinenburg erroneously diagnosed disc herniation. Other than stating that he found no evidence of objective orthopedic problems or evidence of disc herniation, Dr. Millheiser offered no medical rationale for his opinion that appellant is not permanently disabled or for his implied opinion that appellant has no disability due to, or due to the residuals of, the several conditions for which the Office accepted appellant's claim. The Board notes that Dr. Hinenburg, upon whose examination and report the Office accepted several conditions as causally related to appellant's September 4, 1984 employment injury, has maintained on several occasions subsequent to his initial examination of appellant that appellant remains disabled due to residuals of his September 4, 1984 employment injury. To discharge its burden of proof, it is not sufficient for the Office to simply produce a physician's opinion negating causal relationship. As with the case when the burden of proof is upon a claimant, the Office must support its position on causal relationship with a physician's opinion which is based upon a proper factual and medical background and which is supported by medical rationale explaining why there no longer is, or never was, a causal relationship. The opinion of Dr. Millheiser is not sufficiently rationalized and, therefore, does not constitute the weight of the medical evidence and is inadequate to discharge the Office's burden of proof. Appellant's case is therefore remanded to the Office for reinstatement of benefits. *See Patsy L. Rubio, 37 ECAB 179, 185 (1985). The decision of the Office of Workers' Compensation Programs dated June 15, 1988 is hereby reversed and the case is remanded for action consistent with this decision of the Board. In the Matter of EDWARD V. JUARE and DEPARTMENT OF THE ARMY, PUEBLO DEPOT ACTIVITY, Pueblo, Colo. Docket No. 89-1006; Submitted on the Record; Before GEORGE E. RIVERS, DAVID S. GERSON, The issue is whether appellant has met his burden of proof in establishing that his fall at work on May 24, 1988 was sustained in the performance of duty within the meaning of the Federal Employees' Compensation Act. Appellant, then a 43-year-old integrated electronic systems mechanic, filed a claim for compensation on account of traumatic injury (Form CA-1). He noted on his claim form that he could not recall the alleged work incident as it "caused temporary memory loss." A witness statement on the claim form stated: "On May 24, 1988 at 11:30 a.m. Ed and I went for our daily jog. He is a faster runner than I am therefore he completed the run about one-eighth mile ahead of me. We were running around one and one-half miles at a pace of about 12 minutes per mile as I rounded building No. 716. At the end of our run I saw Ed lying on the ground it appeared as if he had fainted, tripped, or fallen down. As I talked to him he stood up and tried to walk. He was disoriented and was walking like he was dizzy. I told our boss about the incident and we took Ed to the dispensary." Appellant stopped work on May 24, 1988, returning on May 31, 1988. Appellant's supervisor noted on the claim form that appellant was injured in the performance of duty as "Employer has paid lunch 11:30 a.m. to 12:00 p.m." By letter dated June 24, 1988 the Office of Workers' Compensation Programs requested that the employing establishment submit information as to whether appellant's alleged injury while jogging during a paid lunch was "in the performance of duty." By letter of that same date the Office requested that appellant submit a description of the nature of his injury and how it happened. The Office also noted that it had received no medical evidence regarding his claim. In response to the Office's request for additional information appellant submitted a July 7, 1988 medical report from Dr. Jarvis D. Ryals, a Board-certified neurologist. Dr. Ryals stated that he admitted appellant to Parkview Hospital on May 24, 1988 after receiving a call from Dr. Timothy Fogel, a Board-certified surgeon of the employing establishment dispensary. He noted that appellant received appropriate care. By letter decision dated July 14, 1988 the Office rejected appellant's claim for compensation finding that he had not met his burden of proof. The Office stated that appellant did not submit factual information necessary for adjudication of his claim, nor furnish medical evidence needed to support his claim. By letter dated July 12, 1988 appellant described his alleged employment injury stating: "At 11:30 a.m. on May 24, 1988 I was jogging, upon completion of my run it is still unclear to me what exactly happened. I either tripped or fainted. I was immediately taken to the dispensary by my co-workers and my boss. . . . The thing that still has me confused is the memory loss that occurred during the time immediately following the incident, and the following morning. Here at the Pueblo Depot Activity they were conducting various tests for the burning of Rocket Motors involved with the recently signed I.N.F. treaty. People involved in the project have told me that on the morning of May 24 a balloon containing some type of gas was expelled into the air, causing the cancellation of the burn scheduled for that day. Just recently the E.P.A. was investigating high concentrations of chlorine gas, in the proximity of the area where I was jogging... "" Appellant submitted medical evidence in support of his claim including May 24, 1988 notes from Dr. Fogel at the employing establishment dispensary and May 24 and 25, 1988 hospital reports from Dr. Ryals. Dr. Fogel stated that appellant "fainted" outside from jogging at lunch and complained of dizziness and disorientation. He noted that appellant has a history of high blood pressure, and that he sustained memory loss on that date, but related no evidence of head trauma. He referred appellant to Dr. Ryals at the hospital. Dr. Ryals admitted appellant to the hospital on May 24, 1988 describing the employment incident. He indicated that appellant has a serious illness-elevated blood pressure which was first found about 10 years ago when he had a "black out spell." Dr. Ryals reported his findings upon examination, admitted appellant for testing, and stated an impression of "Apparent syncope, rule out seizure, rule out intracranial lesion, rule out fall with concussion, rule out other intracranial lesion." Medical testing revealed an abnormal brain stem auditory evoked response due to delay in conduction through the left side of the brain stem, the nature of such was uncertain. Dr. Ryals stated that "It is possible it could be related to concussion or head trauma," and recommended repeat testing in two to three months. All other objective testing including EEG (electroencephalogram), CAT (computerized axial tomography) scan of the skull and brain, and x-rays of the chest were normal. By letter dated July 28, 1988 the Office advised appellant that the medical reports submitted in support of his claim fail to explain the etiology of his condition. The Office also noted that the employing establishment had not responded to its "performance of duty letter." The Office advised appellant that he should submit additional medical evidence in support of his claim and obtain the necessary factual evidence from his employer, in conjunction with a formal request for reconsideration of his case. By letter dated September 2, 1988 appellant requested reconsideration of his claim submitting in his support an August 4, 1988 report from Dr. Ryals, application for leave slips, slips from Dr. Ryals indicating that appellant was hospitalized from May 24 to May 25, 1988 and was advised to stay off work until May 31, 1988, and that appellant was seen for testing on July 28, 1988, and a September 2, 1988 letter from the employing establishment. Dr. Ryals stated in his August 4, 1988 report that appellant sustained "an unexplained episode of unconsciousness" on May 24, 1988. He described the alleged employment incident, reporting the findings upon hospitalization and objective testing. Dr. Ryals stated that he was uncertain as to the cause of appellant's spell, finding no evidence of a serious condition after work-up. He indicated that a one night hospitalization stay was certainly appropriate as he felt there was no doubt that appellant had a condition that needed to be worked up. The employing establishment's September 2, 1988 letter stated that appellant was in a paid status during lunch and/or any break periods during his tour of duty. It stated that it had "no policy against physical activity (i.e., jogging)," that the "employee is not required to participate in this activity (i.e., jogging), however, the agency does not discourage this type [of] activity," and that "no specific benefit to the organization is identified, other than the health of the individual and reduced sick leave usage because of health." The employing establishment noted that appellant's injury "did occur on agency premise and during paid work shift." By letter decision dated March 28, 1989 the Office reviewed appellant's claim on its merits and denied modification of its prior decision. The Office, however, modified its decision to show that denial of the claim was based on appellant's "failure to establish causal relationship between the injury and factors of federal employment." The Office stated: "The case was denied on July 14, 1988 because you had failed to submit any medical evidence and had failed to identify what injury had been sustained. These shortcomings have been rectified with medical reports containing history and findings (test results). It was reported to us that you suffered a decrease in brain function. . . . The medical evidence, however, does not demonstrate any causal relationship between your impairment and factors of your federal employment. The medical reports describe the findings to be of unknown etiology." The Board finds that this case is not in posture for decision and must be remanded for further evidentiary development. In Gertrude E. Evans (Wesley W. Evans),1 and Martha G. List (Joseph G. List), the Board stated that an injury resulting from an idiopathic fall is not within the coverage of the Federal Employees' Compensation Act. The Board defined an idiopathic fall as a fall "where a personal, nonoccupational pathology causes an employee to collapse and to suffer injury upon striking the immediate supporting surface, and there is no intervention or contribution by any hazard or special condition of employment. . . ."3 The Board indicated that such an injury was not compensable because it did not arise out of a risk connected with the employment. The Board, however, went on to point out that the mere fact that the cause of a particular fall cannot be ascertained, or the reason why it occurred cannot be explained, does not establish that it was due to an idiopathic condition. The Board indicated that this followed the 126 ECAB 195 (1974). #26 ECAB 200 (1974). 'Gertrude E. Evans (Wesley W. Evans), supra note 1 at 204. See also Albert E. Hermann, Jr., 35 ECAB 167, 171 (1983). |