United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

T.S., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Colton, CA, Employer 

__________________________________________ 

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Docket No. 15-1022 

Issued: August 17, 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 

ALEC J. KOROMILAS, Alternate Judge 

JAMES A. HAYNES, Alternate Judge 

JURISDICTION 

On March 30, 2015 appellant filed a timely appeal from a March 10, 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 that he sustained more than 21 percent 

permanent impairment to his left lower extremity, for which he previously received a schedule 

award. 

On appeal appellant contends that the schedule award should be greater as he lost his job 

and mobility as a result of his injury. 

 1

 5 U.S.C. § 8101 et seq. 
2

FACTUAL HISTORY 

On October 4, 2004 appellant, then a 38-year-old letter carrier, filed a traumatic injury 

claim (Form CA-1) for a work-related injury to his left knee that occurred on August 25, 2004. 

He alleged that the injury occurred while pushing up with his legs from a crouched position and 

attaining standing position. OWCP accepted the conditions of old bucket handle tear of medial 

meniscus, bilateral; and Pica Syndrome and paid benefits. Surgeries appellant underwent 

include: July 22, 2008 left knee arthroscopy, debridement of the medial meniscus and lateral 

meniscus, chondroplasty of the medial femoral condyle; September 26, 2011 right knee 

arthroscopy with partial medial and lateral meniscectomy; and July 12, 2013 left knee 

arthroscopy and partial meniscectomy. Appellant has had intermittent periods of work and work 

stoppage. He has been temporarily totally disabled since the July 12, 2013 surgery. 

By decision dated June 29, 2006, OWCP awarded appellant eight percent impairment for 

loss of use of the left lower extremity. The award ran for 23.04 weeks for the period January 19, 

2005 to June 29, 2006. Appellant thereafter requested an increased award. By decision dated 

December 3, 2009, OWCP awarded an additional 12 percent impairment for loss of use of the 

left lower extremity, for a total impairment of 20 percent.2 The award ran for 34.56 weeks for 

the period February 19 to October 18, 2009. 

On February 22, 2012 appellant filed a schedule award claim for a new increased 

schedule award and submitted new medical evidence in support of the request. 

In a January 25, 2012 report, Dr. Ronny Ghazal, a Board-certified orthopedic surgeon, 

noted the history of injury and appellant’s physical examination findings. 

On August 3, 2012 OWCP referred appellant’s record to its medical adviser for an 

opinion regarding the degree of permanent impairment of appellant’s bilateral lower extremities. 

In a September 7, 2012 report, an OWCP medical adviser noted that appellant was status post 

partial medial and partial lateral meniscectomies, both right and left lower extremities. He noted 

that with the history of right knee arthroscopy on September 26, 2011, a date of maximum 

medical improvement (MMI) of January 25, 2012 would be reasonable, i.e., four months 

following the surgical procedure and agreed that the 10 percent right lower extremity impairment 

for status post partial medial and partial lateral meniscectomy was proper under the American 

Medical Association, Guides to the Evaluation of Permanent Impairment (A.M.A., Guides). The 

OWCP medical adviser further opined that the record did not document any additional left lower 

extremity impairment beyond the 20 percent awarded. 

Appellant continued to submit medical evidence from Dr. Ghazal regarding treatment of 

his knee conditions. In a June 13, 2013 progress report, Dr. Ghazal provided an impression of 

left knee medial meniscus retear with a seven millimeter osteochondral defect in the medial 

femoral condyle and recommended left knee arthroscopy, which appellant underwent on 

July 12, 2013. Appellant was temporarily totally disabled for a period following the surgery. On 

October 24, 2013 he was released to sedentary work. However, on October 24 and 

 2

 Twenty percent total impairment less eight percent impairment, previously awarded, equaled twelve percent 

impairment owed appellant. 
3

November 14, 2013, the employing establishment advised no work was available for appellant. 

Progress reports from Dr. Ghazal continued to report on appellant’s lower extremity condition 

and that he was capable of performing only modified, sedentary-duty work. 

In an April 14, 2014 report, Dr. Richard A. Bjama, an orthopedic surgeon, noted the 

history of injury, presented left knee examination findings, and diagnosed left knee posttraumatic osteoarthritis. Discussion was held with Dr. Ghazal regarding a left total knee 

arthroplasty and appellant was referred to a different total joint specialist. On April 14, 2014 

Dr. Bjama again diagnosed left knee traumatic osteoarthritis and recommended against a total 

knee replacement. 

In a June 10, 2014 report, Dr. Peter Elsissy, a Board-certified orthopedic surgeon, noted 

the history of injury, appellant’s medical course, and diagnosed left knee medial osteoarthritis, 

for which he recommended medial unicompartmental arthroplasty. He opined that appellant 

could only work modified, sedentary-duty work and appellant’s knee condition was industrial in 

nature. Appellant underwent a left medial compartment unicompartmental arthroplasty on 

August 6, 2014. 

In a September 8, 2014 report, Dr. David T. Easley, a Board-certified orthopedic surgeon 

and OWCP referral physician, reviewed a statement of accepted facts and appellant’s medical 

record. He noted examination findings and provided an impression of status post multiple 

arthroscopic left knee surgeries, status post left unicompartmental knee replacement, status post 

arthroscopic right knee surgery, and pes anserine bursitis left knee. Dr. Easley opined that 

appellant was temporarily totally disabled following his August 6, 2014 surgery, which was 

necessary due to residuals from the August 25, 2004 work injury. 

Physical therapy and progress reports were submitted regarding appellant’s condition. 

In a December 5, 2014 report, Dr. Elsissy noted the history of injury and set forth 

examination findings. An impression of status post left medial compartment unicompartmental 

arthroplasty was provided. Dr. Elsissy opined that appellant reached MMI and had permanent 

work restrictions. He opined that appellant’s current left knee condition was industrial in nature. 

Under the sixth edition of the A.M.A., Guides, Dr. Elsissy opined that appellant had 25 percent 

left lower extremity impairment. Under Table 16-3, page 511, appellant was assigned class 2. 

Dr. Elsissy accorded a functional history grade modifier 2, physical examination grade modifier 

0, and clinical testing grade modifier 0. He found a net adjustment of -4, which resulted in class 

2, grade C for 25 percent impairment. 

On February 9, 2015 appellant filed a claim for an increased schedule award. 

On February 18, 2015 OWCP referred appellant’s medical record to its medical adviser 

for review. In a February 24, 2015 report, an OWCP medical adviser reviewed the medical 

records of file, including Dr. Elsissy’s December 5, 2014 report. He advised that, under Table 

16-3, Knee Regional Grid -- Lower Extremity Impairment, a class 2 default rating for status post 

total knee replacement was 25 percent. A grade 2 modifier for functional history adjustment 

would result in 0 net adjustment and a physical examination adjustment with a grade modifier of 

0 would be a -2 net adjustment. Clinical studies adjustment was not applicable as it was utilized 
4

for class placement. The medical adviser opined that the total net adjustment was -2, not -4 as 

found by Dr. Elsissy, which would result in a class 2, category A or a 21 percent left lower 

extremity impairment. As this impairment is 1 percentage point higher than the previously 

assessed 20 percent, he opined that appellant was entitled to an additional 1 percent impairment 

of the left lower extremity. The medical adviser further opined that MMI was obtained 

December 5, 2014, approximately four months following the medial compartment 

hemiarthroplasty. 

By decision dated March 10, 2015, OWCP awarded appellant an additional 1 percent left 

lower extremity impairment of the left lower extremity, for a total impairment of 21 percent. 

The award ran for 2.88 weeks for the period December 5 to 25, 2014. It is from this latest 

decision which appellant has filed his appeal requesting an increased schedule award. 

LEGAL PRECEDENT 

The schedule award provision of FECA and its implementing regulations 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.3

 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 

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

appropriate standard for evaluating schedule losses.4 

A claimant may seek an increased schedule award if the evidence establishes that he or 

she sustained an increased impairment at a later date causally related to his or her employment 

injury.5

 Moreover, OWCP procedure provides that a claim for an increased schedule award may 

be based on an incorrect calculation of the original award or an increased impairment at a later 

date which is due to work-related factors. In such a situation, an increased schedule award may 

be payable if supported by the medical evidence.6

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). 

For upper and lower extremity impairments, the evaluator identifies the impairment Class of 

 3

 5 U.S.C. § 8107; 20 C.F.R. § 10.404. 

4 K.H., Docket No. 09-341 (issued December 30, 2011). For decisions issued after May 1, 2009, the sixth edition 

will be applied. B.M., Docket No. 09-2231 (issued May 14, 2010). 

5 Linda T. Brown, 51 ECAB 115, 116 (1999); Paul R. Reedy, 45 ECAB 488, 490 (1994). 

6

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

Chapter 2.808.9 (February 2013). In addition, OWCP procedures provide that a request for reconsideration of a 

schedule award based on a disagreement with the percentage awarded must be distinguished from a situation where 

a claimant who previously received an award is filing for an increased impairment due to a worsening of the 

claimant’s medical condition due to deterioration of his condition or increased exposure. Such a request for 

increased impairment is not subject to the one-year time limitation for reconsideration. Federal (FECA) Procedure 

Manual, Part 2 -- Claims, Reconsiderations, Chapter 2.1602.3 (October 2011); Paul R. Reedy, id. 
5

Diagnosis condition (CDX), 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).7 Evaluators are 

directed to provide reasons for their impairment rating choices, including the choices of 

diagnoses from regional grids and calculations of modifier scores.8 

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.

9

 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 

attending physician indicates that the MMI has been reached and described the permanent 

impairment of the affected member, but does not offer an impairment rating. In this instance, a 

detailed opinion by an OWCP medical adviser, who gives a percentage based on reported 

findings and the A.M.A., Guides, may constitute the weight of the medical evidence.10 

OWCP procedures state that any previous impairment to the member under consideration 

is included in calculating the percentage of loss, except when the prior impairment is due to a 

previous work-related injury, in which case the percentage already paid is subtracted from the 

total percentage of impairment.11 

ANALYSIS 

OWCP accepted that appellant sustained conditions of old bucket handle tear of medial 

meniscus, bilateral; and Pica Syndrome and paid benefits. In a decision dated December 3, 

2009, it awarded a total impairment of 20 percent for loss of use of the left lower extremity. 

Appellant subsequently requested an increased schedule award on February 22, 2012 related to 

his right lower extremity12 and February 9, 2015 related to his left lower extremity. By decision 

dated March 10, 2015, OWCP awarded appellant an additional 1 percent left lower extremity 

impairment, for a total impairment of 21 percent. 

The Board finds that appellant has not established a schedule award greater than 21 

percent for the left lower extremity. Both Dr. Elsissy and the medical adviser opined that 

appellant reached MMI on December 5, 2014, approximately four months following the medial 

compartment hemiarthroplasty. Dr. Elsissy opined that appellant had 25 percent impairment to 

 7 R.Z., Docket No. 10-1915 (issued May 19, 2011). 

8 J.W., Docket No. 11-289 (issued September 12, 2011). 

9

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

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). 

10 See Federal (FECA) Procedure Manual, id. at Chapter 2.810.8(i) (September 2010). 

11 Id. at Chapter 2.808.8.b (February 2013). 

12 OWCP has not issued a final decision regarding impairment to the right lower extremity. 
6

the left lower extremity, while OWCP’s medical adviser opined that he had 21 percent 

impairment to the left lower extremity. 

The Board finds that OWCP properly relied on its medical adviser’s impairment rating. 

The medical adviser’s opinion was based on the complete record. He properly applied the 

appropriate portions of the A.M.A., Guides to Dr. Elsissy’s clinical findings in determining 

impairment to the left lower extremity. Both Dr. Elsissy and the medical adviser properly noted 

that under Table 16-3, page 511, appellant had class 2, default 25 impairment as a result of total 

knee replacement. Dr. Elsissy found that appellant had functional history grade modifier 2, 

physical examination grade modifier 0, and clinical testing grade modifier 0. He found a net 

adjustment of -4, which resulted in class 2, grade C for 25 percent impairment, while the medical 

adviser found a net adjustment of -2, which resulted in class 2, grade A for 21 percent 

impairment. 

The medical adviser provided proper rationale for the percentage of the left lower 

extremity.13 He properly identified the default value as 25 percent for class 2, total knee 

replacement. The medical adviser agreed with Dr. Elsissy that appellant had grade modifiers of 

2 for functional history and 0 for physical examination. However, he disagreed that appellant 

had a modifier of 0 for clinical studies, noting that the objective study was used to place 

appellant into the correct diagnostic class and thus was not applicable. This is in accordance 

with section 16.3c and Table 16-8 of the A.M.A., Guides, and thus could not be used as a clinical 

studies modifier and was therefore not applicable.14

As noted the default impairment for total knee replacement under class 2 is 25 percent 

impairment. Utilizing the net adjustment formula to the modifiers provided (GMFH-CDX) + 

(GMPE-CDX) + (GMCS-CDX) or (2-2) + (0-2) equals -2. As the net adjustment is -2, the result 

is a class 2, category A or a 21 percent left lower extremity impairment as the medical adviser 

found. As appellant was previously awarded 20 percent impairment and is entitled to 21 percent 

impairment, OWCP properly awarded him an additional 1 percent impairment of the left lower 

extremity. 

On appeal appellant contends that the schedule award should be greater as he lost his job 

and mobility as a result of his injury. There is a distinction between the concept of disability and 

that of permanent impairment. Schedule awards are included under FECA to indemnify for the 

loss of or loss of use of specific members or functions of the body without regard to loss of 

wage-earning capacity.15 Furthermore, there is no rationalized medical evidence of record 

supporting a greater permanent impairment of the left lower extremity impairment than 21 

percent. 

 13 See Federal (FECA) Procedure Manual, supra note 9. 

14 A.M.A., Guides 518. 

15 See Lorraine B. Ford, 10 ECAB 232 (1958); see also R.L., Docket No. 09-1948 (issued June 29, 2010). 
7

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 did not sustain greater than 21 percent impairment to the 

left lower extremity, for which he received a schedule award. 

ORDER 

IT IS HEREBY ORDERED THAT the March 10, 2015 decision of the Office of 

Workers’ Compensation Programs is affirmed.16 

Issued: August 17, 2016 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board 

 16 James A. Haynes, Alternate Judge, participated in the original decision but was longer a member of the Board 

effective November 16, 2015.