United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

R.T., Appellant 

and 

U.S. POSTAL SERVICE, MAIN POST OFFICE, 

Indianapolis, IN, Employer 

__________________________________________ 

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Docket No. 15-1242 

Issued: September 18, 2015 

Appearances: Case Submitted on the Record

Appellant, pro se 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

PATRICIA H. FITZGERALD, Deputy Chief Judge 

ALEC J. KOROMILAS, Alternate Judge 

JAMES A. HAYNES, Alternate Judge 

JURISDICTION 

On May 12, 2015 appellant filed a timely appeal from an April 28, 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 established greater than a four percent impairment of 

the right upper extremity, for which he received a schedule award. 

FACTUAL HISTORY 

OWCP accepted that on or before April 17, 2002 appellant, then a 28-year-old mail 

handler, sustained right rotator cuff tendinopathy due to repetitive upper extremity motion and 

repetitive heavy lifting at work.2 Dr. Peter I. Sallay an attending Board-certified orthopedic 

 1

 5 U.S.C. § 8101 et seq. 

2

 OWCP denied appellant’s previous claim for a September 25, 2000 traumatic right shoulder injury. 
2

surgeon, performed a right shoulder acromioplasty on April 16, 2002. Appellant returned to 

modified-duty work on May 1, 2002. Dr. Sallay followed appellant for recurrent right shoulder 

pain and impingement. 

On December 5, 2002 OWCP obtained a second opinion from Dr. Richard A. Hutson, a 

Board-certified orthopedic surgeon, who opined that appellant could perform full-time modified 

work. Dr. Hutson submitted a July 30, 2003 addendum reiterating that appellant required 

permanent restrictions due to right shoulder impingement and crepitus. 

In a March 14, 2003 report, Dr. Sallay opined that appellant required permanent 

restrictions against lifting more than 10 pounds above shoulder level with the right arm, 

minimizing repetitive work above shoulder level, and no use of a flat sorter machine. He 

released appellant from care. 

On November 7, 2003 appellant claimed a schedule award. He submitted a 

November 19, 2003 report from Dr. Sallay, noting possible acromioclavicular joint dysfunction. 

In a March 15, 2004 report, Dr. Sallay opined that appellant had attained maximum medical 

improvement, with normal range of motion and strength in the right shoulder. He released 

appellant to modified duty. 

In an April 14, 2004 report, an OWCP medical adviser reviewed the medical record, and 

opined that appellant had no ratable impairment of the right upper extremity, as Dr. Sallay 

observed full range of motion with normal strength. 

By decision dated April 28, 2004, OWCP denied appellant’s schedule award claim as the 

medical evidence did not support a ratable impairment of the right upper extremity.3

 

Dr. Brian S. Jacobs, an attending Board-certified internist, diagnosed right shoulder pain. 

He provided work restrictions in reports from April 2006 through March 9, 2010.4 

Appellant submitted reports dated from March 1 to May 10, 2011 from Dr. Elizabeth T. 

Nolan, an attending Board-certified orthopedic surgeon. Dr. Nolan opined that his laboratory 

and imaging studies were unremarkable, and did not explain his persistent symptoms. She 

opined that appellant could perform full-time modified-duty work.5

 

 3

 By decision dated May 20, 2004, OWCP denied appellant’s April 2, 2004 claim for a left shoulder condition. It 

denied reconsideration by decision dated May 12, 2005. 

4

 Appellant was off work from March 12, 2009 to June 6, 2010 as the employing establishment had no work 

available within his restrictions. 

5

 OWCP conducted development regarding appellant’s work restrictions and wage-earning capacity. In an 

April 5, 2011 report, Dr. Louis J. Angelicchio, a Board-certified orthopedic surgeon and second opinion physician, 

opined that appellant could perform full-time sedentary work as a policy holder information clerk. By notice dated 

April 18, 2011 and finalized June 1, 2011, OWCP reduced appellant’s compensation effective June 5, 2011, based 

on his ability to earn $447.00 a week in the selected position of policy holder information clerk. In a July 9, 2012 

report, Dr. Paul K. Ho, an attending Board-certified orthopedic surgeon, found full motion of the right shoulder with 

no muscular atrophy or bony abnormalities. He diagnosed “[r]ight shoulder pain, cause uncertain.” On July 19, 

2012 OWCP obtained a second opinion from Dr. Norman Mindrebo, a Board-certified orthopedic surgeon, who 

decreased appellant’s work limitations. 
3

On January 11, 2013 appellant accepted a full-time position as a modified clerk at the 

employing establishment. By decision dated April 10, 2013, OWCP reduced his wage-loss 

compensation to zero effective January 9, 2013, as he returned to work with no loss of wageearning capacity. 

On May 10, 2013 OWCP obtained an impairment rating from Dr. Ralph M. Bushbacher, 

a Board-certified physiatrist and second opinion physician. Dr. Bushbacher reviewed the 

medical record and a statement of accepted facts. On examination of the right upper extremity, 

he found full range of motion, no muscular atrophy, full strength, tenderness to palpation of the 

acromion and biceps tendon, mild discomfort with internal rotation, and moderate symptom 

aggravation with horizontal adduction. Dr. Bushbacher opined that appellant had reached 

maximum medical improvement. He diagnosed right shoulder pain. Referring to the sixth 

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

(hereinafter, A.M.A., Guides), Dr. Bushbacher found a class 1 diagnosis-based impairment Class 

of Diagnosis (CDX) according to Table 15-5.6

 He assessed a grade modifier for Functional 

History (GMFH) of 2, and a grade modifier for findings on Physical Examination (GMPE) of 3, 

and a grade modifier for Clinical Studies (GMCS) of 3. Dr. Bushbacher stated that this resulted in 

a “[g]rade E rating, which corresponds to 12 percent upper extremity rating.” 

In a June 1, 2013 addendum, Dr. Bushbacher explained that according to Table 15-5, 

appellant had a class 1 CDX for acromioclavicular joint injury or disease. He noted that he erred 

in his prior report regarding the GMPE, which was properly “1 instead of 3.” Dr. Bushbacher 

noted that according to Table 15-7,7 appellant had a GMFH of 2 for pain with normal activities, a 

GMPE of 1 according to Table 15-88

 for a mildly abnormal examination, and a GMCS of 

2 according to Table 15-9,9 as clinical studies, although not provided for review, confirmed “the 

lack of part of the bone of the distal acromion.” Applying the net adjustment formula (GMFHCDX) + (GMPE-CDX) + (GMCS-CDX), or (2-1) + (1-1) + (2-1), he found a net adjustment of 2, 

moving the default CDX from grade C to grade E which, “for a distal clavicular resection, 

corresponds to a 12 percent upper extremity rating.” 

On September 30, 2013 an OWCP medical adviser reviewed the medical record and 

statement of accepted facts. He noted that there was no operative report of record regarding 

appellant’s 2002 acromioplasty, and no mention of a distal clavicle resection. The medical 

adviser opined that appellant attained maximum medical improvement as of June 1, 2013, the 

date of Dr. Bushbacher’s impairment rating. He explained that the diagnosis-based rating 

method was the preferred means of assessing upper extremity impairment, as appellant’s most 

impairing diagnosis was acromioclavicular joint disease and not restricted motion. The medical 

 6

 Table 15-5, page 403 of the sixth edition of the A.M.A., Guides is entitled “Shoulder Regional Grid: Upper 

Extremity Impairments.” 

7

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

Upper Extremities.” 

8

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

Upper Extremities.” 

9

 Table 15-9, page 410 of the sixth edition of the A.M.A., Guides is entitled “Clinical Studies Adjustment: Upper 

Extremities.” 
4

adviser noted a CDX of 1, GMFH of 2, GMPE of 1, and GMCS of zero. Applying the net 

adjustment formula (GMFH-CDX) + (GMPE-CDX) + (GMCS-CDX), or (2-1) + (1-1) + (0-1), he 

found a net adjustment of zero, leaving the default CDX at grade C, equaling three percent 

impairment of the right upper extremity according to Table 15-5. 

By decision dated December 19, 2013, OWCP issued a schedule award for three percent 

impairment of the right upper extremity. The period of the award ran from May 10 to 

July 14, 2013. 

In a December 3, 2014 letter, appellant requested reconsideration. He contended that he 

was entitled to a 12 percent impairment rating as found by Dr. Bushbacher, under the facts 

described in the Board’s decision and order in A.G.,10 where an OWCP medical adviser 

concurred with an attending physician that the claimant’s “right shoulder open acromioplasty and 

repair was equally as impairing as a distal clavicle arthroplasty.” 

Appellant provided a copy of Dr. Sallay’s April 16, 2002 operative note. Dr. Sally 

described his arthroscopic evaluation of the glenohumeral joint, labrum, biceps tendon, and 

undersurface of the rotator cuff, arthroscopic debridement of the subacromial space, arthroscopic 

shaving of four to five millimeters of the anteroinferior bone at the acromion. He did not 

indicate that he removed bone from the distal clavicle. 

Appellant also submitted a December 1, 2014 report from Dr. Brian W. Case, an 

attending physician Board-certified in occupational medicine. He noted that according to A.G.,

11

“an acromioplasty is equally impairing to a distal clavicle resection.” On examination, Dr. Case 

noted surgical scars consistent with previous arthroscopic surgery. He related appellant’s 

complaints of chronic right shoulder pain, with a QuickDASH score of 59. On examination of 

the right shoulder, Dr. Case found mild tenderness to palpation, full range of motion, and normal 

muscle strength. He opined that, according to Table 15-5, appellant had a default 10 percent 

impairment of the right upper extremity. Dr. Case noted a GMFH of 2, GMPE of 1, and GMCS 

of 2, resulting in a net adjustment of +2, raising the default 10 percent CDX to 12 percent. He 

therefore found 12 percent impairment of the right arm. 

On March 10, 2015 an OWCP medical adviser reviewed Dr. Sallay’s operative note, 

Dr. Case’s December 1, 2014 report, and an updated statement of accepted facts. He opined that 

the new evidence indicated that appellant had GMCS of 1 as opposed to his prior finding of zero. 

Reapplying the net adjustment formula, or (2-1) + (1-1) + (1-1), the net adjustment of 1 raised 

the default CDX of C to D, equaling four percent impairment of the right upper extremity, 

greater than the three percent previously awarded. 

By decision dated April 28, 2015, OWCP issued appellant a schedule award for an 

additional one percent impairment of the right upper extremity, for a total of four percent. 

 

 10 Docket No. 07-0677 (issued June 21, 2007). 

11 Id. 
5

LEGAL PRECEDENT 

The schedule award provisions of FECA12 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.13 For schedule awards after May 1, 2009, the impairment is 

evaluated under the sixth edition of the A.M.A., Guides, published in 2008.14 

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

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

and Health (ICF).15 In addressing upper extremity impairments under the sixth edition, the 

evaluator identifies the impairment class for the diagnosed condition CDX, which is then 

adjusted by grade modifiers based on GMFH, GMPE, GMCS.16 The net adjustment formula is 

(GMFH-CDX) + (GMPE-CDX) + (GMCS-CDX).17

While section 15.2 of the sixth edition of the A.M.A., Guides provides that “[d]iagnosisbased impairment is the primary method of evaluation for the upper limb,” Table 15-5 also 

provides that, if motion loss is present for a claimant who has a rotator cuff injury, impairment 

may alternatively be assessed using section 15.7 (range of motion impairment). Such a range of 

motion impairment stands alone and is not combined with a diagnosis-based impairment.18 

Section 15.7 of the sixth edition of the A.M.A., Guides provides: 

“Range of motion should be measured after a ‘warm up,’ in which the individual 

moves the joint through its maximum range of motion at least [three] times. The 

range of motion examination is then performed by recording the active 

measurements from [three] separate range of motion efforts. Measurements 

should be rounded up or down to the nearest number ending in 0.... All 

measurements should fall within 10 [degrees] of the mean of these three 

 12 5 U.S.C. § 8107. 

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

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

Chapter 2.808.5(a) (February 2013); see also Part 3 -- Medical, Schedule Awards, Chapter 3.700.2 and Exhibit 1 

(January 2010). 

15 A.M.A., Guides (6th ed., 2008), page 3, section 1.3, “ICF: A Contemporary Model of Disablement.” 

16 Id at (6th ed., 2008), pp. 494-531. 

17 Id at 411. 

18 Id. at 387, 405, 475-78. 
6

measurements. The maximum observed measurement is used to determine the 

range of motion impairment....”19 

It is well established that in determining entitlement to a schedule award, preexisting 

impairment to the scheduled member is to be included.20 There is no basis for including 

subsequently acquired conditions. OWCP procedures provide: “Impairment ratings for schedule 

awards include those conditions accepted by OWCP as job-related and any preexisting 

permanent impairment of the same member or function.”21 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.

22 

ANALYSIS 

OWCP accepted that appellant sustained right rotator cuff tendinopathy, necessitating 

arthroscopic acromioplasty on April 16, 2002. On November 7, 2003 appellant claimed a 

schedule award. OWCP denied the schedule award claim on April 28, 2004, finding that 

Dr. Sallay, an attending Board-certified orthopedic surgeon, indicated that appellant did not have 

a permanent impairment of the right upper extremity. 

OWCP obtained an impairment rating from Dr. Bushbacher, a Board-certified physiatrist 

and second opinion physician. In May 10 and June 1, 2013 reports, Dr. Bushbacher found that 

appellant attained maximum medical improvement, and calculated a 12 percent impairment 

rating under the diagnosis-based method of Table 15-5, based on a distal clavicle resection. 

However, an OWCP medical adviser found that Dr. Bushbacher erred as the 2002 arthroscopy 

did not include a distal clavicle resection. The medical adviser noted a class 1 diagnosis-based 

impairment CDX for acromioclavicular joint disease, a grade 2 modifier for GMFH, a grade 1 

modifier for findings on GMPE, and no applicable modifier for GMCS. He calculated a net 

adjustment of zero, leaving the default CDX at grade C, equaling three percent impairment of the 

right upper extremity according to Table 15-5. Based on the medical adviser’s review, OWCP 

issued a schedule award on December 19, 2003 for three percent impairment of the right upper 

extremity. 

Appellant requested reconsideration. He provided Dr. Sallay’s April 16, 2002 operative 

note, which did not indicate that he performed any procedure involving the distal clavicle. 

Appellant also submitted a December 1, 2014 report from Dr. Case, an attending physician 

Board-certified in occupational medicine, who opined that appellant had 12 percent impairment 

of the right arm. He cited to the Board’s decision in A.G.,

23 where physicians found that an 

acromioplasty was “equally impairing to a distal clavicle resection.” However, Dr. Case did not 

 19 Id. at 464. 

20 R.G., Docket No. 13-220 (issued May 9, 2013); Peter C. Belkind, 56 ECAB 580 (2005); Raymond E Gwynn, 35 

ECAB 247 (1983). 

21 Supra note 14 at Chapter 2.806.5(d) (February 2013). 

22 Id. at, Chapter 2.808.6(f); see also L.R., Docket No. 14-674 (issued August 13, 2014); D.H., Docket No. 

12-1857 (issued February 26, 2013). 

23 Supra note 10. 
7

explain which aspects of appellant’s clinical presentation supported such impairment, 

considering his findings of full strength and motion of the right shoulder. An OWCP medical 

adviser reviewed the new evidence, and opined that it supported a GMCS of 1, an increase from 

the prior rating of zero. Applying the net adjustment formula resulted in a net modifier of +1, 

raising the default CDX from three to four percent. OWCP therefore issued the April 28, 2015 

decision, granting appellant a schedule award for an additional one percent impairment of the 

right upper extremity. 

The Board finds that an OWCP medical adviser applied the appropriate tables and 

grading schemes to the clinical findings observed by Dr. Bushbacher. The medical adviser 

provided a detailed explanation and supporting calculations for his finding of four percent 

impairment of the right upper extremity. There is no probative medical evidence of record 

indicating a greater percentage of impairment. Accordingly, OWCP’s April 28, 2015 decision 

finding that appellant had four percent impairment of the right upper extremity is appropriate 

under the law and facts of the case. 

On appeal, appellant reiterated his argument that he sustained 12 percent impairment of 

the right arm under the Board’s holding in A.G.24 As his arthroscopic surgery was equally 

disabling to an open distal clavicle resection, appellant contends that OWCP should not have 

reduced his rating based on the diagnosis-based method applicable to acromioclavicular joint 

disease. The medical opinions found in A.G., were offered under the standards of the fifth 

edition of the A.M.A., Guides, not the sixth edition currently in use.25 Furthermore, as stated 

above, there is no probative medical opinion of record indicating that the 2002 arthroscopic 

surgery caused upper extremity impairment equivalent to an open distal clavicle resection. 

Dr. Case found normal strength and range of motion of the right shoulder. 

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 that he sustained more than a four 

percent impairment of the right upper extremity, for which he received schedule awards. 

 24 Docket No. 07-0677 (issued June 21, 2007). 

25 Supra note 14. 
8

ORDER 

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

Compensation Programs dated April 28, 2015 is affirmed. 

Issued: September 18, 2015 

Washington, DC 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board 

 

 James A. Haynes, Alternate Judge 

 Employees’ Compensation Appeals Board