United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

E.M., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Byram, MS, Employer 

__________________________________________ 

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Docket No. 15-1633 

Issued: October 27, 2015 

Appearances: Case Submitted on the Record

Appellant, pro se 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

CHRISTOPHER J. GODFREY, Chief Judge 

PATRICIA H. FITZGERALD, Deputy Chief Judge 

ALEC J. KOROMILAS, Alternate Judge 

JURISDICTION 

On August 17, 2014 appellant filed a timely appeal from the July 8, 2015 merit decision 

of the Office of Workers’ Compensation Programs (OWCP). Pursuant to the Federal 

Employees’ Compensation Act1

 (FECA) and 20 C.F.R. §§ 501.2(c) and 501.3, the Board has 

jurisdiction over the merits of this case. 

ISSUE 

The issue is whether appellant has more than 24 percent impairment of his right upper 

extremity. 

FACTUAL HISTORY 

On May 11, 2006 appellant, a 52-year-old postal driver, sustained a traumatic injury in 

the performance of duty while forcefully pulling the stuck door of a general purpose container. 

OWCP accepted his claim for bilateral complete rotator cuff rupture. Appellant received a 

 1

 5 U.S.C. § 8101 et seq.
2

schedule award for 16 percent impairment of his right upper extremity and 9 percent impairment 

of his left upper extremity. 

On June 11, 2013 appellant underwent a right reverse total shoulder arthroplasty and 

tenodesis of the biceps tendon. On February 6, 2014 Dr. Daniel P. Dare, the attending Boardcertified orthopedic surgeon, reported that the arthroplasty was “doing actually quite well.” 

Range of motion was approximately 65 to 70 percent of normal. Pain was in the functional 

range with average strength. Appellant filed a claim for an increased schedule award. 

In a decision dated November 19, 2014, OWCP denied an additional schedule award. It 

noted that Dr. Dare did not respond to a request for an impairment rating. Appellant 

acknowledged that his physician was not responding to the request for an impairment rating on 

his total right shoulder replacement. He therefore requested that OWCP refer him for a second 

opinion or to the district medical adviser. 

OWCP referred appellant’s case to a medical adviser, who noted that the results of the 

June 11, 2013 surgery were satisfactory. Referring to Table 15-5, page 405, of the American 

Medical Association, Guides to the Evaluation of Permanent Impairment (6th ed. 2009), the 

medical adviser noted that appellant’s right shoulder arthroplasty represented 24 percent 

permanent impairment of the upper extremity. As appellant had already received a schedule 

award for 16 percent impairment of his right upper extremity, he was entitled to an award for an 

additional 8 percent. 

In March 2015 OWCP received a report from Dr. Dare, who apologized for the long 

delay, explaining the chart and associated documents were misplaced. Dr. Dare reviewed 

appellant’s history and found that he had done reasonably well following the arthroplasty. It was 

his opinion that appellant’s impairment was 24 percent of the right upper extremity. 

Given the opinions of OWCP’s medical adviser and Dr. Dare, an OWCP hearing 

representative, reversed the November 19, 2014 denial of an increased schedule award and 

directed OWCP to pay additional benefits. 

In a decision dated July 8, 2015, OWCP issued a schedule award for an additional eight 

percent impairment of appellant’s right upper extremity. 

LEGAL PRECEDENT 

The schedule award provision of FECA2

 and the implementing regulations3 set forth the 

number of weeks of compensation payable to employees sustaining permanent impairment from 

loss or loss of use of scheduled members or functions of the body. FECA, however, does not 

specify the manner in which the percentage of loss shall be determined. The method used in 

making such a determination is a matter that rests within the sound discretion of OWCP.4

 2

 5 U.S.C. § 8107. 

3

 20 C.F.R. § 10.404. 

4 Linda R. Sherman, 56 ECAB 127 (2004); Danniel C. Goings, 37 ECAB 781 (1986). 
3

For consistent results and to ensure equal justice under the law to all claimants, good 

administrative practice necessitates the use of a single set of tables so that there may be uniform 

standards applicable to all claimants. OWCP has adopted the A.M.A., Guides as the appropriate 

standard for evaluating schedule losses.5

 As of May 1, 2009, the sixth edition of the A.M.A., 

Guides is used to calculate schedule awards.6

ANALYSIS 

Under the A.M.A., Guides, diagnosis-based impairment is the primary method of 

evaluation for the upper extremities. The first step is to choose the diagnosis that is most 

applicable for the region being assessed.7 Specific criteria for that diagnosis determine which 

class is appropriate: no objective problem, mild problem, moderate problem, severe problem, 

very severe problem approaching total function loss. The A.M.A., Guides assigns a default 

impairment rating for each diagnosis by class. This default impairment rating may then be 

adjusted using such grade modifiers as functional history, physical examination and clinical 

studies.8

Table 15-5, page 405, of the A.M.A., Guides shows that a shoulder arthroplasty implant 

represents a moderate impairment of the upper extremity ranging from 20 to 25 percent. The 

default impairment rating is 24 percent. Procedures require that the grade modifiers associated 

with functional history, physical examination, and clinical studies will be used to calculate a net 

adjustment that permits modification of the default value.9 In other words, once the impairment 

class is determined according to diagnostic criteria, the final impairment grade within a particular 

class is determined by the grade modifiers.10

Both, Dr. Dare, the attending surgeon, and OWCP’s medical adviser ignored appellant’s 

functional history, physical examination, and clinical findings. They simply found the default 

impairment value for a shoulder arthroplasty implant and stopped there. They did not follow the 

procedures for determining appellant’s final impairment. 

The Board will therefore set aside OWCP’s July 8, 2014 decision and remand the case for 

further development of the medical evidence. OWCP shall obtain a supplemental report from its 

medical adviser that follows the impairment calculation methodology set forth in the A.M.A., 

Guides. The medical adviser shall address each grade modifier and identify the findings that 

justify each modification of grade. After such further development of the evidence as may 

 5

 20 C.F.R. § 10.404; Ronald R. Kraynak, 53 ECAB 130 (2001). 

6

 Federal (FECA) Procedure Manual, Part 2 -- Claims, Schedule Awards and Permanent Disability Claims, 

Chapter 2.808.6.6a (January 2010). 

7

 A.M.A., Guides 387, 389 (6th ed. 2009). 

8 Id. at 497. 

9 Id. at 405. 

10 Id. at 409. 
4

become necessary, OWCP shall issue a de novo decision on appellant’s claim for an additional 

schedule award. 

CONCLUSION 

The Board finds that this case is not in posture for decision. Further development of the 

medical evidence is warranted. The A.M.A., Guides requires the proper consideration of grade 

modifiers to determine appellant’s final impairment. 

ORDER 

IT IS HEREBY ORDERED THAT the July 8, 2014 decision of the Office of Workers’ 

Compensation Programs is set aside and the case remanded for further action. 

Issued: October 27, 2015 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board