United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

M.P., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Richmond, CA, Employer 

__________________________________________ 

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Docket No. 14-1602 

Issued: January 13, 2015 

Appearances: Case Submitted on the Record

Hank Royal, for the appellant 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

CHRISTOPHER J. GODFREY, Chief Judge 

COLLEEN DUFFY KIKO, Judge 

JAMES A. HAYNES, Alternate Judge 

JURISDICTION 

On July 14, 2014 appellant, through her representative, filed a timely appeal from a 

January 16, 2014 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 established greater than two percent impairment of the 

left upper extremity and seven percent impairment of the right upper extremity, for which she 

received a schedule award. 

FACTUAL HISTORY 

 OWCP accepted that on or before November 22, 1995 appellant, then a 41-year-old 

distribution clerk, sustained bilateral shoulder and elbow sprains, neck sprains, and back sprain 

 1

 5 U.S.C. § 8101 et seq. 
2

due to repetitive upper extremity motion in the performance of duty. Appellant remained under 

medical treatment through 1998. OWCP accepted a recurrence of disability commencing on or 

about February 8, 1999.2 Appellant filed a claim for schedule award on March 25, 2010. 

 On April 2, 2010 OWCP requested that Dr. Fred Blackwell, an attending Board-certified 

orthopedic surgeon, provide an impairment rating. By report dated June 7, 2010, Dr. Blackwell 

opined that appellant had attained maximum medical improvement in approximately 

March 1999. He diagnosed bilateral elbow, forearm and cervical sprains, and a thoracic strain 

and sprain. On examination, Dr. Blackwell noted limited cervical motion, with left lateral 

rotation at 60 degrees, and forward flexion at two inches above the chest. He also found bilateral 

tenderness over the lateral epicondyle, a bilaterally positive Finkelstein’s test, reduced grip 

strength on the right, an equivocally positive impingement sign in both shoulders, and a possible 

tear of the common extensor tendon in the right elbow. Referring generally to the sixth edition 

of the American Medical Association, Guides to the Evaluation of Permanent Impairment 

(hereinafter, “A.M.A., Guide”), Dr. Blackwell found 20 percent impairment of the right upper 

extremity for the right shoulder, and seven percent impairment of the left upper extremity related 

to the elbow. His medical notes on page four states that the permanent impairment worksheet 

provided by the claims examiner had been completed and was enclosed. However, the rating 

sheet was not received and is not in evidence. 

OWCP advised appellant on December 14, 2010 that the schedule award claim could not 

be processed because appellant was receiving compensation for total disability. 

On August 26, 2010 OWCP obtained a second opinion from Dr. Ramon Jimenez, a 

Board-certified orthopedic surgeon, who opined that appellant had active injury-related residuals 

but could perform full-time light-duty work. Following a vocational rehabilitation program and 

job placement effort, OWCP issued a May 10, 2013 notice, finalized on July 6, 2012, reducing 

appellant’s compensation based on her ability to earn wages in the selected position of 

surveillance system monitor. 

 Following a December 17, 2012 request from appellant’s representative to move forward 

on the schedule award. OWCP forwarded the case record to an OWCP medical adviser for an 

impairment rating consistent with the A.M.A., Guides, sixth edition. 

In a February 24, 2013 report, OWCP medical adviser reviewed the medical record and 

statement of accepted facts. She concurred with Dr. Blackwell that appellant had reached 

maximum medical improvement by June 7, 2010. Regarding the right shoulder, the medical 

adviser found a Class of Diagnosis impairment (CDX) for tendinitis according to Table 15-5,3

with a default grade of C, equaling three percent impairment of the right upper extremity. She 

explained that there was no applicable modifier for Clinical Studies (GMCS). The medical 

adviser assessed a grade modifier of 2 for findings on Physical Examination (GMPE) according 

 2

 Appellant again stopped work in August 2009 and February 26, 2010 during which she received wage-loss 

compensation. 

3

 Table 15-5, page 401 of the sixth edition of the A.M.A., Guides is entitled “Shoulder Regional Grid: Upper 

Extremity Impairments.” 
3

to Table 15-8.4

 She also found a grade modifier for Functional History (GMFH) of 2 according 

to Table 15-7.5

 Applying the net adjustment formula of (GMFH-CDX) + (GMPE-CDX) + 

(GMCS-CDX), or (2-1) + (2-1), resulted in a net adjustment of +2, moving the default CDX 

grade from C to E, equaling an additional two percent impairment of the right shoulder, for a 

total of five percent. The medical adviser referred to Table 15-5 to provide identical impairment 

ratings for both elbows for epicondylitis without surgery, finding a class 1 CDX with a default 

grade of C, equaling one percent arm impairment. She found a GMCS of 1 according to Table 

15-9, a GMPE of 2 according to Table 15-8, and a GMFH of 2, according to Table 15-7. 

Applying the net adjustment formula of (2-1) + (2-1) + (1-1) resulted in a modification factor of 

+2, moving the default position from C to D, equaling two percent impairment of each elbow. 

For the right arm, the medical adviser combined the five percent impairment for shoulder 

tendinitis to the two percent impairment for the elbow epicondylitis to equal seven percent 

impairment. 

OWCP medical adviser found two percent impairment of the left elbow due to 

epicondylitis. The medical adviser noted that Dr. Blackwell did not provide rationale supporting 

the percentages of impairment he offered, and that it was not clear, from the physical findings he 

reported, how Dr. Blackwell arrived at those percentages. 

 By decision dated July 11, 2013, OWCP granted appellant a schedule award for seven 

percent impairment of the right arm and two percent impairment of the left arm, based on the 

medical adviser’s interpretation of Dr. Blackwell’s findings. 

In an August 9, 2013 letter, appellant’s representative requested a hearing, which was 

later changed to request a review of the written record. Appellant submitted periodic reports 

from Dr. Blackwell dated from July 12 to October 18, 2013 noting continued upper extremity 

symptoms and restricted motion of the cervical spine. No additional impairment rating from 

Dr. Blackwell was received or supplemented. 

 By decision dated January 16, 2014, an OWCP hearing representative affirmed the 

July 11, 2013 schedule award, finding that OWCP medical adviser’s February 24, 2013 

impairment rating continued to represent the weight of the medical evidence. The hearing 

representative found that Dr. Blackwell had not explained how he derived the offered 

percentages of impairment nor referred to specific tables or grading schemes of the A.M.A., 

Guides. OWCP therefore properly referred Dr. Blackwell’s reports to an OWCP medical adviser 

to obtain an impairment rating. The hearing representative found that OWCP medical adviser 

provided clear medical reasoning supporting her impairment calculations, referencing the 

appropriate portions of the A.M.A., Guides. 

 4

 A.M.A., Guides 408, Table 15-8 of the sixth edition is entitled “Physical Examination Adjustment: Upper 

Extremities.” 

5

 A.M.A., Guides 406, Table 15-7 of the sixth edition is entitled “Functional History Adjustment: Upper 

Extremities.” 
4

LEGAL PRECEDENT 

 The schedule award provisions of FECA6 provide for compensation to employees 

sustaining impairment from loss or loss of use of specified members of the body. FECA, however, 

does not specify the manner in which the percentage loss of a member shall be determined. The 

method used in making such determination is a matter which rests in the sound discretion of 

OWCP. For consistent results and to ensure equal justice, the Board has authorized the use of a 

single set of tables so that there may be uniform standards applicable to all claimants. The A.M.A., 

Guides has been adopted by OWCP as a standard for evaluation of schedule losses and the Board 

has concurred in such adoption.7 As of May 1, 2009 all impairment ratings are calculated using the 

sixth edition of the A.M.A., Guides.

8

The sixth edition of the A.M.A., Guides provide a diagnosis-based method of evaluation 

utilizing the World Health Organization’s International Classification of Functioning, Disability 

and Health (ICF).9 Under the sixth edition, the evaluator identifies the impairment class for the 

diagnosis, which is then adjusted by grade modifiers based on functional history, physical 

examination, and clinical studies.10 Under the sixth edition, the evaluator identifies the 

impairment class for the diagnosed condition, which is then adjusted by grade modifiers based 

on functional history, physical examination, and clinical studies. The net adjustment formula is 

(GMFH-CDX) + (GMPE-CDX) + (GMCS-CDX). 

OWCP procedures provide that, after obtaining all necessary medical evidence, the file 

should be routed to an OWCP medical adviser for an opinion concerning the percentage of 

impairment using the A.M.A., Guides.11 In some instances, an OWCP medical adviser’s opinion 

can constitute the weight of the medical evidence. This occurs in schedule award cases where an 

opinion on the percentage of permanent impairment and a description of physical findings is on 

file from an examining physician, but the percentage estimate by this physician is not based on 

the A.M.A., Guides. In this instance, a detailed opinion by OWCP medical adviser which gives 

a percentage based on reported findings and the A.M.A., Guides may constitute the weight of the 

medical evidence.12

 6

 5 U.S.C. § 8107. 

7 Bernard A. Babcock, Jr., 52 ECAB 143 (2000). 

8

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

Chapter 2.808.5(a) (February 2013). 

9

 A.M.A., Guides 3, (6th ed., 2008), Section 1.3, “The International Classification of Functioning, Disability and 

Health (ICF): A Contemporary Model of Disablement.” 

10 A.M.A., Guides 494-531 (6th ed. 2008). 

11 Supra note 8 at Chapter 2.808.6(f) (February 2013); see also L.R., Docket No. 14-674 (issued August 13, 

2014); D.H., Docket No. 12-1857 (issued February 26, 2013). 

12 Supra note 8 at Chapter 2.810.8(j) (September 2010). 
5

ANALYSIS 

OWCP accepted that appellant sustained a bilateral shoulder sprain, bilateral elbow 

sprain, neck sprain, and a back sprain. Appellant claimed a schedule award. Dr. Blackwell, an 

attending Board-certified orthopedic surgeon, provided a June 7, 2010 impairment rating. He 

opined that appellant attained maximum medical improvement regarding diagnosed bilateral 

epicondylitis of the elbow and right shoulder tendinitis. Dr. Blackwell referred generally to the 

sixth edition of the A.M.A., Guides, finding 20 percent impairment of the right arm for the right 

shoulder, and seven percent impairment of the left arm related to the elbow. 

As Dr. Blackwell was not shown to apply the rating criteria of the A.M.A., Guides, 

OWCP properly relied on the medical adviser’s February 24, 2013 report. The medical adviser 

applied the appropriate sections of the sixth edition of the A.M.A., Guides to Dr. Blackwell’s 

clinical findings. She found five percent impairment for right shoulder tendinitis according to 

Table 15-5. The medical adviser assessed grade modifiers for findings on examination and 

functional history. Applying the net adjustment formula of (GMFH-CDX) + (GMPE-CDX) + 

(GMCS-CDX), or (2-1) + (2-1), resulted in a net adjustment of the default diagnosis-based 

impairment upward for C to E, equaling five percent impairment of the right upper extremity. 

The medical adviser found identical impairments of both elbows due to epicondylitis. 

Application of the net adjustment formula to the diagnosis-based impairment resulted in two 

percent impairment of each elbow. The medical adviser therefore found a total of seven percent 

impairment of the right arm and two percent impairment of the left arm. She provided a detailed 

discussion of how each element of the rating scheme related to the clinical findings observed by 

Dr. Blackwell. 

The Board finds that OWCP properly relied on the medical adviser’s February 7, 2014 

impairment rating. The medical adviser properly applied the appropriate portions of the A.M.A., 

Guides to Dr. Blackwell’s clinical findings.13 She provided detailed explanations and 

calculations for each rating element. Therefore, OWCP’s January 16, 2014 decision affirming 

the July 11, 2013 schedule award for seven percent impairment of the right arm and two percent 

impairment of the left arm, was proper under the facts and circumstances of this case. There is 

no probative medical evidence establishing a greater percentage of impairment. 

Appellant may request a schedule award or increased schedule award based on evidence 

of a new exposure or medical evidence showing progression of an employment-related condition 

resulting in permanent impairment or increased impairment. 

CONCLUSION 

The Board finds that appellant has not established greater than two percent impairment of 

the left arm and seven percent impairment of the right arm, for which she received a schedule 

award. 

 13 Id.
6

ORDER 

IT IS HEREBY ORDERED THAT the decision of the Office of Workers’ 

Compensation Programs dated January 16, 2014 is affirmed. 

Issued: January 13, 2015 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 James A. Haynes, Alternate Judge 

 Employees’ Compensation Appeals Board