United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

L.B., Appellant 

and 

DEPARTMENT OF VETERANS AFFAIRS, 

VETERANS ADMINISTRATION MEDICAL 

CENTER -- JEFFERSON BARRACKS, 

St. Louis, MO, Employer 

__________________________________________ 

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Docket No. 15-1408 

Issued: November 5, 2015 

Appearances: Case Submitted on the Record

Appellant, pro se 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

COLLEEN DUFFY KIKO, Judge 

ALEC J. KOROMILAS, Alternate Judge 

VALERIE D. EVANS-HARRELL, Alternate Judge 

JURISDICTION 

On June 16, 2015 appellant, through counsel, filed a timely appeal from a June 4, 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. 

ISSUES 

The issues are: (1) whether appellant met his burden of proof to expand his claim to 

include additional conditions; and (2) whether he established permanent impairment to his right 

upper extremity impairment caused by the accepted April 25, 2014 employment injury, resulting 

in a schedule award. 

 1

 5 U.S.C. § 8101 et seq. 
2

FACTUAL HISTORY 

On April 28, 2014 appellant, then a 62-year-old motor vehicle operator, filed a traumatic 

injury claim (Form CA-1) alleging that on April 25, 2014 he was attacked and pushed into a 

glass frame by a volunteer while at work. He stated that this caused left shoulder pain and a 

contusion and abrasions to the left elbow. Appellant did not stop work. An employing 

establishment police investigation confirmed that the assault took place. 

In an emergency room report dated April 25, 2014, Dr. Wahied Gendi, a Board-certified 

internist, described the injury and appellant’s complaints of left shoulder pain and an abrasion of 

the left arm. Physical examination demonstrated a superficial elbow abrasion and no obvious 

shoulder deformity. Dr. Gendi diagnosed left shoulder pain and a superficial left arm abrasion. 

Appellant was discharged on pain medication. A left shoulder x-ray demonstrated mild 

degenerative arthritis and no acute traumatic injury of the bone or joint. On April 29, 2014 

Melissa E. Nixon, a nurse practitioner, described the injury and reported that appellant’s left 

shoulder had improved 70 percent but was still stiff and sore and that his left elbow abrasion had 

scabbed without infection.2 

On June 13, 2014 OWCP accepted left shoulder contusion and left elbow abrasion. The 

employing establishment indicated that appellant missed no days from work and was working 

full time. 

Appellant filed a schedule award claim (Form CA-7) on July 28, 2014. By letter dated 

August 11, 2014, OWCP informed him of the evidence needed to support a schedule award 

claim. This was to include, in accordance with the sixth edition of the American Medical 

Association, Guides to the Evaluation of Permanent Impairment (hereinafter A.M.A., Guides),3

an opinion that his condition had reached a permanent and fixed state (maximum medical 

improvement), a diagnosis on which the impairment was based, and an impairment rating 

specific to the conditions accepted by OWCP as work related. Appellant was given 30 days to 

provide the requested information. No additional information was provided. 

By decision dated September 11, 2014, OWCP denied appellant’s claim for a schedule 

award as appellant had not submitted the requested medical information. 

On April 20, 2015 appellant requested reconsideration and an expansion of his claim. In 

a February 3, 2015 treatment note, Melissa S. Stevens, a physician assistant, noted appellant’s 

complaints of left shoulder pain, clicking, and popping that had occurred since an assault on 

April 25, 2014. The shoulder was nontender to palpation on examination. Shoulder range of 

motion was diminished. Ms. Stevens diagnosed left shoulder impingement, possible rotator cuff 

tear, and ordered a magnetic resonance imaging (MRI) scan. A March 19, 2015 MRI scan of the 

left shoulder demonstrated an undersurface tear with possible pinhole full thickness component. 

 2

 The record also includes a May 8, 2014 x-ray of the right hand that demonstrated a healing fracture of the 

proximal phalanx of the second finger. This was from a February 6, 2014 nonemployment-related injury. 

3

 A.M.A., Guides (6th ed. 2nd prtg. 2009). 
3

By decision dated June 4, 2015, OWCP found that appellant had not met his burden of 

proof to expand his claim to include an additional medical condition caused, aggravated, or 

accelerated by the April 25, 2014 assault and that no permanent impairment had been 

established. 

LEGAL PRECEDENT -- ISSUE 1 

 Causal relationship is a medical issue and the medical evidence required to establish a 

causal relationship is rationalized medical evidence.4

 The opinion of the physician must be 

based on a complete factual and medical background of the claimant, must be one of reasonable 

medical certainty, and must be supported by medical rationale explaining the nature of the 

relationship between the diagnosed condition and the specific employment factors identified by 

the employee.5

 Neither the mere fact that a disease or condition manifests itself during a period 

of employment nor the belief that the disease or condition was caused or aggravated by 

employment factors or incidents is sufficient to establish causal relationship.6

ANALYSIS -- ISSUE 1 

The Board finds that appellant has not met his burden of proof to expand her claim to 

include any additional conditions related to the April 25, 2014 injury. The medical record is 

devoid or medical evidence from a physician who diagnosed an additional condition. 

The March 19, 2015 MRI scan does not contain an opinion as to the cause of the 

diagnosed condition. Medical evidence that does not offer any opinion regarding the cause of an 

employee’s condition is of limited probative value on the issue of causal relationship.7 

The treatment note from Ms. Stevens dated February 3, 2015 is of no probative value. 

Section 8101(2) of FECA provides that “physician” includes surgeons, podiatrists, dentists, 

clinical psychologists, optometrists, chiropractors, and osteopathic practitioners within the scope 

of their practice as defined by State law.8

 Reports from a physician assistant are not considered 

medical evidence as a physician assistant is not considered a physician under FECA.9 

Appellant did not meet his burden of proof to establish an additional condition caused by 

the April 25, 2014 employment injury. 

Appellant may submit new evidence or argument with a written request for 

reconsideration to OWCP within one year of this merit decision, pursuant to 5 U.S.C. § 8128(a) 

and 20 C.F.R. §§ 10.605 through 10.607. 

 

 4 Jacqueline M. Nixon-Steward, 52 ECAB 140 (2000). 

 5 Leslie C. Moore, 52 ECAB 132 (2000). 

 6 Dennis M. Mascarenas, 49 ECAB 215 (1997). 

7 Willie M. Miller, 53 ECAB 697 (2002). 

8

 5 U.S.C. § 8101(2); see Roy L. Humphrey, 57 ECAB 238 (2005). 

9 Ricky S. Storms, 52 ECAB 349 (2001). 
4

LEGAL PRECEDENT -- ISSUE 2 

The schedule award provision of FECA10 and its implementing federal regulations11 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. However, 

FECA does not specify the manner in which the percentage of loss shall be determined. For 

consistent results and to ensure equal justice under the law for all claimants, OWCP has adopted 

the second printing of the sixth edition of the A.M.A., Guides as the uniform standard applicable 

to all claimants.12 For decisions after May 1, 2009, the sixth edition of the A.M.A., Guides will 

be used.13 

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).14 Under the sixth edition, for upper extremity impairments the evaluator 

identifies the impairment Class of Diagnosis (CDX) condition, which is then adjusted by grade 

modifiers based on Functional History (GMFH), Physical Examination (GMPE) and Clinical 

Studies (GMCS).15 The net adjustment formula is (GMFH-CDX) + (GMPE-CDX) + (GMCSCDX).16 

ANALYSIS -- ISSUE 2 

As noted above, the accepted conditions in this case are left shoulder contusion and left 

elbow abrasion. It is the claimant’s burden to establish that he sustained a permanent impairment 

of a scheduled member or function as a result of the accepted employment injury.17 OWCP 

procedures provide that to support a schedule award, the file must contain medical evidence 

which shows that the impairment has reached a permanent and fixed state and indicates the date 

on which this occurred, and describes the impairment in sufficient detail.18 The percentage of 

impairment should be computed in accordance with the sixth edition of the A.M.A., Guides. 

Appellant submitted no such evidence in this case. 

 10 5 U.S.C. § 8107. 

11 20 C.F.R. § 10.404. 

12 Id. at § 10.404(a). 

13 See Federal (FECA) Procedure Manual, Part 3 -- Medical, Schedule Awards, Chapter 3.700, Exhibit 1 

(January 2010); see also, Part 2 -- Claims, Schedule Awards & Permanent Disability Claims, Chapter 2.808.5a 

(February 2013). 

14 Supra note 3 at 3, section 1.3, “The International Classification of Functioning, Disability and Health (ICF): A 

Contemporary Model of Disablement.” 

15 Id. at 385-419. 

16 Id. at 411. 

17 D.F., Docket No. 09-1463 (issued August 12, 2010). 

18 Supra note 13 at Chapter 2.808.5b. 
5

There is no medical evidence of record that provides an impairment rating. On 

August 11, 2014 OWCP advised appellant of the type of medical evidence needed to support a 

claim for a schedule award. Appellant did not submit responsive evidence. Thus, there is no 

medical report of record containing an opinion supporting that appellant’s accepted conditions 

caused any permanent impairment to a scheduled member. Consequently, there is no medical 

basis to support entitlement to a schedule award.19

 Appellant may request a schedule award based on evidence of a new exposure or medical 

evidence showing progression of an employment-related condition resulting in permanent 

impairment. 

CONCLUSION 

The Board finds that appellant failed to meet his burden of proof to expand his claim to 

include additional medical conditions or to establish permanent impairment to his right upper 

extremity impairment caused by the accepted April 25, 2014 employment injury. 

ORDER 

IT IS HEREBY ORDERED THAT the June 4, 2015 decision of the Office of Workers’ 

Compensation Programs is affirmed. 

Issued: November 5, 2015 

Washington, DC 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board 

 

 Valerie D. Evans-Harrell, Alternate Judge 

 Employees’ Compensation Appeals Board 

 19 See H.G., Docket No. 09-88 (issued June 3, 2009).