United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

D.G., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Greensboro, NC, Employer 

__________________________________________ 

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Docket No. 16-0221 

Issued: March 25, 2016 

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 November 16, 2015 appellant filed an appeal of a May 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(e), the Board has jurisdiction 

to consider the merits of this case. 

ISSUE 

The issue is whether appellant has established more than five percent permanent 

impairment of her left upper extremity. 

FACTUAL HISTORY 

Appellant, a 55-year-old mail carrier, filed an occupational disease claim (Form CA-2) on 

September 13, 2013 alleging that she developed a left shoulder condition causally related to 

 1

 5 U.S.C. § 8101 et seq. 
2

employment factors. OWCP accepted the claim for disorder of bursae and tendons in the left 

shoulder. 

On November 1, 2013 appellant underwent arthroscopic surgery on her left shoulder to 

ameliorate the following conditions: impingement with high grade partial thickness or possibly 

full-thickness damage to the supraspinatus and biceps tendinopathy; and full thickness 

supraspinatus tear at the tuberosity. The procedure was performed by Dr. Donald A. Campbell, 

Board-certified in orthopedic surgery. 

On December 8, 2014 appellant filed a claim for a schedule award (Form CA-7) based on 

a partial loss of use of her left upper extremity. 

In a December 3, 2014 report, Dr. Campbell related findings from a functional capacity 

evaluation. He thereafter concluded that appellant had 10 percent permanent of the left shoulder 

and left arm. Dr. Campbell offered no explanation as to how he calculated appellant’s degree of 

permanent impairment. He did not indicate that this rating was made in conformance with the 

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

edition) (A.M.A., Guides).2

In an April 3, 2015 report, an OWCP medical adviser reviewed Dr. Campbell’s 

November 1, 2013 surgical report and December 3, 2014 report and found that appellant had a 

five percent left upper extremity impairment under the A.M.A., Guides. He calculated this rating 

by finding that she had a class 1 impairment for rotator cuff injury, full thickness tear at Table 15-

5, page 403 of the A.M.A., Guides,

3

 the shoulder regional grid for rating upper extremity 

impairments. The medical adviser found that appellant had a grade C impairment which 

corresponded to five percent permanent impairment, for residual loss, functional with normal 

motion. 

By decision dated May 28, 2015, OWCP granted appellant a schedule award for five 

percent permanent impairment of the left upper extremity for the period December 13, 2014 to 

April 1, 2015, for a total of 15.6 weeks of compensation. 

LEGAL PRECEDENT 

The schedule award provision of FECA4

 and its implementing regulations5 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 to all claimants, good administrative practice 

necessitates the use of a single set of tables so that there may be uniform standards applicable to 

 2

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

3

 A.M.A., Guides at 403. 

4

 5 U.S.C. § 8107. 

5

 20 C.F.R. § 10.404. 
3

all claimants. The A.M.A., Guides has been adopted by the implementing regulations as the 

appropriate standard for evaluating schedule losses.6 Effective May 1, 2009, the Office began 

using the A.M.A., Guides (6th ed. 2009).7

It is the claimant’s burden to establish that she has sustained a permanent impairment of 

the scheduled member or function as a result of any employment injury.8 Before an award may 

be made, it must be medically determined that no further improvement can be anticipated and the 

impairment must reach a fixed and permanent state, which is known as maximum medical 

improvement.9 OWCP procedures provide that, to support a schedule award, the file must 

contain competent medical evidence which describes the impairment in sufficient detail so that it 

can be visualized on review, and computes the percentage of impairment in accordance with the 

A.M.A., Guides.

10

The sixth edition of the A.M.A., Guides requires identifying the impairment class for the 

Class of Diagnosis (CDX) condition, which is then adjusted by grade modifiers based on 

Functional History (GMFH), Physical Examination (GMPE), and Clinical Studies (GMCS). The 

net adjustment formula is (GMFH-CDX) + (GMPE-CDX) + (GMCS-CDX).11 

ANALYSIS 

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

should be routed to OWCP medical adviser for an opinion concerning the nature and percent of 

impairment in accordance with the A.M.A., Guides, with the medical adviser providing rationale 

for the percentage of impairment specified.12

OWCP accepted appellant’s September 13, 2013 occupational disease claim for disorder 

of bursae and tendons of the left shoulder and authorized surgery for full-thickness supraspinatus 

tear. Dr. Campbell, appellant’s treating physician, rated 10 percent permanent impairment of 

appellant’s left arm and left shoulder. He, however, did not render this rating in accordance with 

the A.M.A., Guides, and OWCP procedures. Dr. Campbell’s report did not provide sufficient 

objective medical findings which would allow the visualization of appellant’s permanent 

 6 Id.

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

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

(February 2013). 

8 Tammy L. Meehan, 53 ECAB 229 (2001). 

9 Supra note 7 at Part 3 -- Medical, Schedule Awards, Chapter 3.700.3(a)(1) (January 2010). 

10 Id. at Part 2 -- Claims, Schedule Awards and Permanent Disability Claims, Chapter 2.808.7 (February 2013). 

See A.A., Docket No. 16-0041 (issued February 11, 2016). 

11 Supra note 2 at 411. 

12 See supra note 7 at Part 2 -- Claims, Schedule Awards and Permanent Disability Claims, Chapter 2.808.6(f) 

February 2013). 
4

impairment.13 Furthermore, he offered no explanation as to how he rated appellant’s impairment 

under the A.M.A., Guides. 

OWCP’s medical adviser calculated a five percent upper extremity impairment for the left 

shoulder by relying on Table 15-5 on page 403 of the A.M.A., Guides. He found that appellant 

had a class 1 impairment for rotator cuff injury, full thickness tear at Table 15-5, page 403 of the 

A.M.A., Guides. The medical adviser found that appellant had a grade C impairment which 

corresponded to a five percent impairment rating, for residual loss, functional with normal motion. 

The Board finds that the April 3, 2015 impairment rating of OWCP’s medical adviser was 

rendered in conformance with the sixth edition of the A.M.A., Guides. Accordingly, as OWCP’s 

medical adviser provided the only impairment rating of record rendered in accordance with the 

applicable protocols and tables of the A.M.A., Guides, OWCP properly found that appellant was 

not entitled to a schedule award greater than five percent impairment in its May 28, 2015 

decision. 

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 she has more than five percent 

permanent impairment of her left upper extremity. 

 13 Id.
5

ORDER 

IT IS HEREBY ORDERED THAT the May 28, 2015 decision of the Office of 

Workers’ Compensation Programs be affirmed. 

Issued: March 25, 2016 

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