United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

R.W., Appellant 

and 

DEPARTMENT OF THE AIR FORCE, 

MATERIEL COMMAND, TINKER AIR 

FORCE BASE, OK, Employer 

__________________________________________ 

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Docket No. 14-2059 

Issued: February 6, 2015 

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 HOWARD FITZGERALD, Judge 

ALEC J. KOROMILAS, Alternate Judge 

JURISDICTION 

On September 29, 2014 appellant filed a timely appeal from the May 29, 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 met his burden of proof to establish that he has more than 

an eight percent permanent impairment of his right arm, for which he received a schedule award. 

 1

 5 U.S.C. §§ 8101-8193. 
2

FACTUAL HISTORY 

OWCP accepted that on September 14, 2012 appellant, then a 54-year-old sheet metal 

mechanic, sustained a right biceps tear due to taking a heavy box from a rack and setting it down 

to the floor. He did not stop work at the time of his September 14, 2012 injury. 

In a September 21, 2012 report, Dr. Brian A. Levings, an attending osteopath, stated that 

appellant presented with a right shoulder injury sustained on September 14, 2012 when he felt a 

pop while trying to get something off of a high shelf at work. Dr. Levings diagnosed biceps 

tendon tear of the right arm. 

On September 27, 2012 Dr. Levings performed right shoulder surgery, including 

arthroscopy, subacromial decompression, distal clavicle excision, arthroscopic rotator cuff 

repair, biceps tenodesis, and extensive debridement of the biceps, rotator cuff, and labrum. The 

procedures were authorized by OWCP. 

In a March 25, 2013 report, Dr. Levings stated that appellant was seen six months status 

post right shoulder surgery. He reported that appellant was “doing well” with “[n]o complaints.” 

Dr. Levings indicated that no medications were noted and reported examination findings for the 

right shoulder, including full flexion and abduction, good strength with internal and external 

rotation, and negative empty can and O’Brien tests. He recommended that appellant continue 

with his home exercise and indicated that he could work full duty without restriction. 

OWCP requested that Dr. Levings provide an impairment rating for appellant’s right arm 

under the standards of the sixth edition of the American Medical Association, Guides to the 

Evaluation of Permanent Impairment (A.M.A., Guides) (6th ed. 2009). In a July 25, 2013 report, 

Dr. Levings stated that appellant presented on September 21, 2012 with a right shoulder injury 

sustained on September 14, 2012 when he felt a pop while trying to get something off of a high 

shelf at work. Appellant underwent a magnetic resonance imaging scan test on September 21, 

2012 which showed full-thickness tear of the supraspinatus and subscapularis and some biceps 

instability and he underwent a right shoulder arthroscopic biceps tenodesis, subscapularis repair, 

and rotator cuff repair on September 27, 2012. Dr. Levings noted that appellant “proceeded 

nicely” with his postoperative course and rehabilitation into maximum medical improvement and 

was released from care on March 25, 2013. He stated, “According to the [A.M.A., Guides] is 20 

percent [sic] for his right upper extremity.” 

On July 17, 2014 appellant filed a claim (Form CA-7) for a schedule award due to his 

accepted injury. 

On March 4, 2014 Dr. Henry Mobley, a Board-certified internist serving as an OWCP 

medical adviser, stated that he had reviewed Dr. Levings’ July 15, 2013 impairment evaluation. 

He indicated that the report did not meet the requirements of OWCP’s regulations for a probative 

schedule award determination because it was not clear how the impairment rating was derived 

from the standards of the sixth edition of the A.M.A., Guides. Dr. Mobley recommended that an 

impairment evaluation be obtained from a Board-certified specialist (preferably an orthopedic 

surgeon or physical medical and rehabilitation physician) who is familiar with the sixth edition of 

the A.M.A., Guides.
3

In March 2014, OWCP referred appellant and the case record to Dr. Shawn Smith, a 

Board-certified physical medical and rehabilitation physician, for examination and an opinion on 

his right arm impairment. In a report dated April 10, 2014, Dr. Smith detailed appellant’s medical 

history, including the nature of his September 14, 2012 work injury and subsequent treatment, and 

reported the findings of his examination on that date. He described appellant’s right arm surgery in 

September 2012 and indicated that he continued to have weakness in his right bicipital muscle as 

well as pain in his right shoulder at times.2

 Dr. Smith stated that appellant’s right shoulder showed 

fairly well-preserved range of motion with 60 degrees of adduction, 135 degrees of abduction, 155 

degrees of flexion, 60 degrees of extension, 90 degrees of internal rotation, and 45 degrees of 

external rotation. Appellant had a positive Popeye’s sign with dissection of the biceps proximally 

on the right with minimal weakness. Dr. Smith noted that he had tenderness in the right shoulder 

acromioclavicular joint and weakness in the supraspinatus muscle at 3 to 4/5, but that he otherwise 

had good strength throughout his right shoulder. Appellant had no focal numbness or weakness 

and no hyperhidrosis or contracture. Dr. Smith diagnosed right full thickness rotator cuff tear with 

mild residual impairment range of motion and pain, and right bicipital tendon tear status post repair 

with some residual weakness. He stated that Table 15-5 of the sixth edition of the A.M.A., Guides

provided for diagnosis-based impairments for these two injuries. Dr. Smith concluded that 

appellant had an eight percent permanent impairment of his right arm and stated: 

“The patient has a complete rotator cuff tear with residual loss which is a [c]lass 1 

impairment. Grade [m]odifier [a]djustments are 1 for [f]unctional [h]istory, 1 for 

[p]hysical [e]xam[ination], 1 for [c]linical [s]tudies with a QuickDASH score of 

28. This results in a Net Adjustment Score of 0 or a [g]rade C, which provides for 

five percent impairment according to the same table. 

“The bicipital tendon dislocation is a [c]lass 1 impairment with [g]rade [m]odifiers 

of 1 for [f]unctional [h]istory, 1 for [p]hysical [e]xam[ination], [and] 1 for [c]linical 

[s]tudies with the same QuickDASH score. This results in an additional Net 

Adjustment Score of 0 or [g]rade C [and] it provides for three percent. In this case, 

I think both should be provided to accurately reflect the injuries to the arm, elbow, 

and shoulder. This results in a total of eight percent partial permanent impairment 

for the right upper extremity.... 

“As a result, I concur with the date of maximum medical improvement of [July 15, 

2013] with a total of eight percent partial permanent impairment of the right 

shoulder....”3

In an April 30, 2014 report, Dr. Mobley, again serving as an OWCP medical adviser, 

stated that he had reviewed Dr. Smith’s April 10, 2014 impairment evaluation. He provided a 

summary of how Dr. Smith had rated appellant’s right arm impairment under Table 15-5 on 

pages 401 to 405 of the sixth edition of the A.M.A., Guides. Dr. Mobley noted that Dr. Smith’s 

 2

 Appellant reported a previous rotator cuff tear in his right shoulder in 2009 which had previously been repaired 

with no residual deficits. 

3

 Dr. Smith indicated that appellant’s right rotator cuff tear from 2009 did not appear to contribute any additional 

impairment. 
4

combination of rotator cuff and bicep impairments “better represents [appellant’s] impairment than 

one” and agreed with Dr. Smith’s assessment that appellant had an eight percent right arm 

impairment. 

In a May 29, 2014 decision, OWCP granted appellant a schedule award for an eight 

percent permanent impairment of his right arm. The award ran for 24.96 weeks from April 10 to 

October 1, 2014 and was based on the April 10, 2014 report of Dr. Smith and the April 30, 2014 

report of Dr. Mobley. 

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 

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

appropriate standard for evaluating schedule losses.6 For OWCP decisions issued on or after 

May 1, 2009, the sixth edition of the A.M.A., Guides (6th ed. 2009) is used for evaluating 

permanent impairment.7 

In determining impairment for the upper extremities under the sixth edition of the 

A.M.A., Guides, an evaluator must establish the appropriate diagnosis for each part of the upper 

extremity to be rated. With respect to the shoulder, the relevant portion of the arm for the 

present case, reference is made to Table 15-5 (Shoulder Regional Grid) beginning on page 401. 

After the Class of Diagnosis (CDX) is determined from the Shoulder Regional Grid (including 

identification of a default grade value), the net adjustment formula is applied using the grade 

modifier Functional History (GMFH), grade modifier Physical Examination (GMPE) and grade 

modifier Clinical Studies (GMCS). The net adjustment formula is (GMFH - CDX) + (GMPE - 

CDX) + (GMCS - CDX).8 It is well established that, in determining the amount of a schedule 

award for a member of the body that sustained an employment-related permanent impairment, 

 4

 5 U.S.C. § 8107. 

5

 20 C.F.R. § 10.404 (1999). 

6 Id. 

7

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

Chapter 2.808.5a (February 2013). 

8 See A.M.A., Guides (6th ed. 2009) 401-11. Table 15-5 also provides that, if motion loss is present for a claimant 

who has undergone a shoulder arthroplasty, 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 

impairment. Id. at 405, 475-78. 
5

preexisting impairments of the body are to be included.9

 There is no basis for including 

subsequently acquired conditions.10

ANALYSIS 

OWCP accepted that on September 14, 2012 appellant sustained a right biceps tear due to 

taking a heavy box from a rack and setting it down to the floor. On September 27, 2012 

Dr. Levings, an attending osteopath, performed right shoulder surgery, including arthroscopy, 

subacromial decompression, distal clavicle excision, arthroscopic rotator cuff repair, biceps 

tenodesis, and extensive debridement of the biceps, rotator cuff, and labrum. The procedures 

were authorized by OWCP. Appellant filed a claim for a schedule award due to his accepted 

injury. On May 29, 2014 OWCP granted him a schedule award for an eight percent permanent 

impairment of his right arm based on the April 10, 2014 report of Dr. Smith, a Board-certified 

orthopedic surgeon serving as an OWCP referral physician, and the April 30, 2014 report of 

Dr. Mobley, a Board-certified internist serving as an OWCP medical adviser. 

The Board finds that appellant did not submit sufficient medical evidence to establish that 

he has more than an eight percent permanent impairment of his right arm, for which he received 

a schedule award. 

In a report dated April 10, 2014, Dr. Smith properly determined that appellant had an eight 

percent permanent impairment of his right arm under the standards of the sixth edition of the 

A.M.A., Guides. He detailed appellant’s medical history, including the nature of his 

September 14, 2012 work injury and subsequent treatment, and reported the findings of his 

examination on that date. Dr. Smith diagnosed right full thickness rotator cuff tear with mild 

residual impairment range of motion and pain, and right bicipital tendon tear status post repair with 

some residual weakness. He stated that Table 15-5 (Shoulder Regional Grid) of the sixth edition of 

the A.M.A., Guides11 provided for diagnosis-based impairments for these two injuries. Dr. Smith 

noted that appellant’s complete right rotator cuff tear with residual loss which was a class 1 

impairment and that the grade modifier adjustments were 1 for functional history, 1 for physical 

examination, and 1 for clinical studies with a QuickDASH score of 28. This resulted in a Net 

Adjustment Score of 0 or a grade C which provided for five percent right arm impairment 

according to the same table.12 Dr. Smith further indicated that appellant’s right bicipital tendon 

dislocation was a class 1 impairment with grade modifiers 1 for functional history, 1 for physical 

examination, and 1 for clinical studies with a QuickDASH score of 28. This resulted in a Net 

Adjustment Score of 0 or grade C and an additional right arm impairment of three percent. 

Dr. Smith properly indicated that combining the five percent impairment (rotator cuff tear) and the 

three percent impairment (biceps rupture) provided the best assessment of appellant’s right arm 

 9 D.F., 59 ECAB 288 (2007); Kenneth E. Leone, 46 ECAB 133 (1994). 

10 R.G., Docket No. 13-220 (issued May 9, 2013). 

11 A.M.A., Guides 401-05, Table 15-2. 

12 See supra note 8 for a description of the application of grade modifiers and the net adjustment formula. 
6

and shoulder.13 On April 30, 2014 Dr. Mobley produced a report in which he explained why he 

was in agreement with Dr. Smith’s impairment rating. 

On appeal, appellant asserted that his right arm impairment was represented by a 20 

percent impairment rating provided in a July 15, 2013 report of Dr. Levings. However, the 

July 15, 2013 report is of limited probative value on the extent of appellant’s right arm 

impairment because the impairment rating it provides is not derived in accordance with the 

standards adopted by OWCP and approved by the Board as appropriate for evaluating schedule 

losses.14 With respect to appellant’s right arm impairment, Dr. Levings merely stated, 

“According to the [A.M.A., Guides] is 20 percent [sic] for his right upper extremity.” He did not 

provide any explanation of how his impairment rating was derived under the specific standards 

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

For these reasons, appellant did not show that he has more than an eight percent 

permanent impairment of his right arm. He 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 meet his burden of proof to establish that he has 

more than an eight percent permanent impairment of his right arm, for which he received a 

schedule award. 

 13 The Board notes that Dr. Smith also considered appellant’s preexisting right shoulder condition, including an 

apparent 2009 rotator cuff tear, in arriving at his impairment rating. See supra note 9. 

14 See James Kennedy, Jr., 40 ECAB 620, 626 (1989) (finding that an opinion which is not based upon the 

standards adopted by OWCP and approved by the Board as appropriate for evaluating schedule losses is of little 

probative value in determining the extent of a claimant’s permanent impairment). 
7

ORDER 

IT IS HEREBY ORDERED THAT the May 29, 2014 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: February 6, 2015 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Patricia Howard Fitzgerald, Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board