Did Booze or Enlarged Heart Cause Army Employee’s Death?

Federal Focus

After a drunken, fully clothed splash in the pool and passing out in his hotel room, a federal worker died overnight, leaving medical questions about what his cause of death was. Simply Research subscribers have access to the full text of the decision.

Case

J.F. and Dep't of the Army, No. 23-0871 (ECAB 03/17/25)

What Happened?

The employee’s widow filed a claim for compensation (Form CA-5), alleging that that the employee died due to an employment-related cardiac arrhythmia, cardiomegaly, and left ventricular hypertrophy.

How did the employee die? The employee, a 48-year-old management and program analyst, was on temporary-duty travel status when he was found deceased in his hotel room on May 9, 2019. On May 8, the employee and his coworkers returned to the hotel after a work-related training session and then dining together at a nearby restaurant. During dinner, the employee consumed alcohol.

Upon returning to the hotel, the employee and his coworkers spent time by the pool and continued to consume alcohol. Sworn statements indicated that the employee entered the pool fully clothed and his coworkers decided to help him back to his room as he appeared inebriated. A coworker stayed with the employee in his hotel room and managed to get him into bed, still fully clothed. The employee vomited in bed, and the coworker cleaned it up. The coworker then placed a clean towel under the employee's head and pillows behind the employee's back to prevent him from rolling and placed the door bolt in such a position so the employee could be checked on.

The next morning, the coworker found the employee in the same position, unresponsive.

While the forensic pathologist conducting the autopsy opined that the immediate cause of the employee's death was a cardiac arrythmia, the Office of Worker's Compensation Program's district medical adviser disagreed, opining that there was no was objective way to demonstrate that the employee's death was due to cardiac arrhythmia because the employee's body was in complete and fixed rigor mortis at the time of the autopsy. This doctor opined that the more likely cause of death was due to coma and respiratory depression caused by acute alcohol poisoning unrelated to his employment.

OWCP denied the widow's survivor benefits claim, finding that the employee's death was not caused, precipitated, or aggravated by factors of his federal employment. On reconsideration, OWCP modified its decision and found that the employee had deviated from his assigned duties and engaged in personal conduct that was not incidental to his work and that was the proximate cause of his death.

After OWCP denied another requested for reconsideration, the county coroner issued a letter indicating that the employee was in heart failure from his "alleged walk" from the pool to his hotel room and that "competent observers" should have called 911 for assistance. He also noted that blood alcohol levels do not decrease post-mortem regardless of when an autopsy is conducted.

Based on the coroner's report and additional evidence, OWCP declared a conflict in medical opinion and referred the employee's medical record to an impartial medical examiner.

The IME opined that the employee's heart was nearly double the size for an adult male and that the alcohol level in the employee's blood was not sufficient to ascribe the death solely as alcohol intoxication, and so his conclusion was that the employee's death was due to irregular rhythm of the heart due to a significantly enlarged heart.

OWCP denied modification of its prior decision and found that regardless of whether the employee was in the performance of duty at the time of his death, there was no evidence to establish that his death was causally related to factors of his employment.

Rule of Law

Under the Federal Employees' Compensation Act, a causal relationship between the employee’s death and an employment injury or factors of his federal employment is a medical issue and can be established only by medical evidence. has held that it is not necessary that there is a significant contribution of employment factors to establish causal relationship. If the employment contributed to the employee’s death, then causal relationship is established.

What ECAB Said

ECAB found that the case wasn't ready for a decision based on the evidence OWCP had before it from the IME.

ECAB noted that OWCP referred the issue of cause of death to the IME because it found a conflict in the medical record and, because of this referral, shared a responsibility in the development of evidence.

"It has an obligation to see that justice is done," ECAB wrote of OWCP. "Once it undertakes development of the record, it must do a complete job in procuring medical evidence that will resolve the relevant issues in the case."

According to ECAB, as OWCP undertook the development of evidence by referring to the IME, it had a duty to secure a sufficiently rationalized report to resolve the relevant issue.

Verdict: ECAB remanded the case to OWCP for referral to the IME for a supplemental opinion regarding whether the employee's death was causally related to the accepted factors of his federal employment. If the IME ended up being unable or unwilling to clarify his opinion or if his requested supplemental report were lacking rationale, OWCP would then have to refer the case to a new IME for the purpose of obtaining a rationalized medical opinion.

Takeaway

In a situation where OWCP secures an opinion from an IME for the purpose of resolving a conflict in the medical evidence and the opinion from the examiner requires clarification or elaboration, it has the responsibility to secure a supplemental report from the examiner for the purpose of correcting the defect in the original opinion.

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