United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

W.D., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Bedford Park, IL, Employer 

__________________________________________ 

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Docket No. 15-1469 

Issued: October 7, 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 

COLLEEN DUFFY KIKO, Judge 

VALERIE D. EVANS-HARRELL, Alternate Judge 

JURISDICTION 

On June 29, 2015 appellant filed a timely appeal from a March 2, 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 more than a two percent permanent impairment of his 

right leg for which he received a schedule award. 

FACTUAL HISTORY 

On February 19, 2014 appellant, then a 56-year-old letter carrier, filed a traumatic injury 

claim (Form CA-1) alleging that on that same date he sustained a right leg hamstring strain when 

walking on a snowy/icy sidewalk and his right leg slipped forward and stretched awkwardly. He 

 1

 5 U.S.C. § 8101 et seq.
2

sought treatment that same date at Ingalls Memorial Hospital. In a February 19, 2014 medical 

report, Dr. Mark Weissman, Board-certified in emergency medicine, diagnosed right thigh strain. 

OWCP accepted the claim for sprain of right hip and thigh. Appellant stopped work on 

February 19, 2014 and received medical and wage-loss benefits. 

In a March 5, 2014 medical report, Dr. Joseph G. Thometz, a Board-certified orthopedic 

surgeon, reported that appellant slipped on ice while at work on February 19, 2014 and felt a pop 

on the posterior aspect of his right hip. A March 3, 2014 magnetic resonance imaging (MRI) 

scan revealed a large hematoma posteriorly and avulsion of the hamstring origin off the greater 

tuberosity. Dr. Thometz diagnosed complete hamstring avulsion and recommended surgery. On 

March 18, 2014 appellant underwent repair of the right proximal hamstring tear. The surgery 

was approved by OWCP. In a July 17, 2014 work status note, Dr. Thometz released appellant to 

regular-duty work on July 26, 2014. The record reflects that appellant returned to full duty on 

July 26, 2014. 

On September 26, 2014 appellant filed a claim for a schedule award (Form CA-7). 

By letter dated October 10, 2014, OWCP requested that appellant submit an impairment 

evaluation from his attending physician in accordance with the American Medical Association, 

Guides to the Evaluation of Permanent Impairment (A.M.A., Guides) (6th ed. 2009). It provided 

him 30 days to submit the requested impairment evaluation. 

In an October 30, 2014 report, Dr. Thometz reported that appellant had reached 

maximum medical improvement (MMI) regarding his hamstring tendon tear that required 

surgery on March 18, 2014. He explained that physical therapy had been completed and 

appellant was able to return to work. Dr. Thometz’ permanent impairment evaluation was based 

on the nature of the injury, the required surgery, and the scarring and disability related to the 

injury. 

Utilizing Table 16-4 of the A.M.A., Guides, he diagnosed ruptured tendon pertaining to 

appellant’s injury.2 Paul Pepich, a physical therapist, explained that mild palpatory findings 

(residual fascial tightness of the distal hamstrings from the bleeding at the time of the tear, 

tenderness, and fullness of the quadratus and proximal adductors) and the presence of mild 

residual weakness represented a class 1, one percent right lower extremity impairment. He 

determined appellant’s functional history grade modifier as 2 due to his lower extremity 

functional score (LEFS) of 44 percent, his physical examination grade modifier as 1 due to 

minimal palpatory findings, and his clinical studies grade modifier as 2 due to MRI scan and 

surgical findings. After modification, Mr. Pepich found that appellant had two percent right 

lower extremity impairment. 

OWCP properly routed Dr. Thometz’ report and the case file to Dr. Michael Hellman, an 

OWCP district medical adviser (DMA) and orthopedic surgeon, for review and a determination 

on whether appellant sustained a permanent partial impairment of the right leg and date of MMI. 

 2

 A.M.A., Guides 512 (2009). 
3

In a January 20, 2015 medical report, Dr. Hellman reported that he agreed with 

Dr. Thometz’ two percent right lower extremity impairment rating. In accordance with the sixth 

edition of the A.M.A., Guides, he utilized Table 16-4 to determine that appellant’s diagnosis of 

ruptured tendon was class 1, grade C diagnosis with a default value of one percent.3

 Using Table 

16-6, Dr. Hellman determined that appellant’s functional history (LEFS 45/80) resulted in a 

grade modifier 2.4

 Utilizing Table 16-7, appellant’s physical examination resulted in a grade 

modifier 1 due to mild pain to palpation.5

 Table 16-8 revealed a grade modifier 1 for clinical 

studies as the MRI scan of the hamstring showed a tear.6 Dr. Hellman applied the net adjustment 

formula which resulted in an adjustment of 1, moving appellant to grade D with an adjusted 

impairment rating of two percent for the right lower extremity.7 He opined that appellant 

reached MMI on July 26, 2014 as his treating physician released him back to work on that date. 

By decision dated March 2, 2015, OWCP granted appellant a schedule award for two 

percent permanent impairment of the right leg. It found that the impairment rating was based on 

Dr. Thometz’ October 30, 2014 report and the DMA’s January 20, 2015 report. The date of 

MMI was noted as July 26, 2014. The award covered a period of 5.76 weeks from July 26 to 

September 4, 2014. 

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.8 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.9

The A.M.A., Guides provide a diagnosis-based method of evaluation utilizing the World 

Health Organization’s International Classification of Functioning, Disability and Health. For 

lower extremity impairments, the evaluator identifies the impairment Class of Diagnosis (CDX), 

which is then adjusted by grade modifiers based on Functional History (GMFH), Physical 

 3 Id.

4 Id. at 516. 

5 Id. at 517. 

6 Id. at 519. 

7 Supra note 2. 

8

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

9 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). 
4

Examination (GMPE), and Clinical Studies (GMCS).10 The net adjustment formula is (GMFH - 

CDX) + (GMPE - CDX) + (GMCS - CDX).11 Evaluators are directed to provide reasons for 

their impairment rating choices, including choices of diagnoses from regional grids and 

calculations of modifier scores.12

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 nature and 

percentage of impairment in accordance with the A.M.A., Guides, with the medical adviser 

providing rationale for the percentage of impairment specified.13

ANALYSIS 

OWCP accepted appellant’s claim for sprain of right hip and thigh. On March 18, 2014 

appellant underwent repair of the right proximal hamstring tendon tear which was approved by 

OWCP. The issue is whether he has more than two percent permanent impairment of the right 

leg for which he received a schedule award. The Board finds that appellant has not met his 

burden of proof to establish more than the two percent permanent impairment of the right leg 

already awarded.14

Diagnosis-based impairment is the primary method for evaluating impairment to the 

lower limb. Impairment is determined first by identifying the relevant diagnosis, then by 

selecting the class of the impairment: no objective problem, mild problem, moderate problem, 

severe problem, very severe problem approaching total function loss. This provides a default 

impairment rating, which can be adjusted slightly up or down using grade modifiers or nonkey 

factors, such as functional history, physical examination, and clinical studies.15

In an October 30, 2014 report, Dr. Thometz, appellant’s treating physician, determined 

that appellant has two percent permanent impairment of the right lower extremity based on his 

surgery, physical examination findings, and review of diagnostic testing. He indicated that 

according to the Hip Regional Grid, Table 16-4 on page 512, appellant’s injury fell under the 

diagnosis-based category of ruptured tendon which had a default value of one percent under class 

1 based on mild palpatory findings and residual weakness.16 Dr. Thometz further found that, 

under the grade modifier scheme, appellant’s condition meant that his impairment rating moved 

 10 Supra note at 493-531. 

11 Id. at 521. 

12 R.V., Docket No. 10-1827 (issued April 1, 2011). 

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

Chapter 2.808.6(d) (February 2013). 

14 W.R., Docket No. 13-492 (issued June 26, 2013). 

15 Supra note 2 at 497. 

16 Supra note 2. 
5

to the right of the default value on Table 16-4 which equaled a two percent impairment of the 

right leg. 

OWCP properly routed Dr. Thometz’ October 30, 2014 report to Dr. Hellman, an OWCP 

DMA, for review and a determination on whether appellant sustained a permanent impairment 

and date of MMI. Dr. Hellman reviewed Dr. Thometz’ report and agreed with his assessment 

that appellant sustained two percent impairment of the right leg. He explained that appellant had 

a grade modifier 2 for functional history, a grade modifier 1 for physical examination, and a 

grade modifier 1 for clinical studies. Applying the net adjustment formula, the DMA properly 

subtracted 1, the numerical value of the class, from the numerical value of the grade modifier for 

each applicable component (functional history, physical examination, and clinical studies) and 

then added those values, resulting in a net adjustment of 1 ((2-1) + (1-1) + (1-1)).17 Application 

of the net adjustment formula meant that movement was warranted one place to the right of class 

1 default value grade C to grade D based on Table 16-4. Therefore, the diagnosis-based 

impairment rating for appellant’s right hip ruptured tendon, yielded a two percent permanent 

impairment of the right lower extremity.18 

The Board notes that Dr. Thometz stated that appellant was currently at MMI regarding 

his hamstring tendon tear, yet did not specify a date. Dr. Thometz noted that, after the March 18, 

2014 surgery, appellant completed physical therapy and returned to his normal work duties on 

July 26, 2014, not having missed a day of work due to this problem since that time. Based on 

this, Dr. Hellman determined that appellant had reached MMI on July 26, 2014 the date he was 

released to work full duty by his treating physician. As Dr. Thometz failed to identify a date of 

MMI and Dr. Hellman provided rationale with his determination, the Board finds that 

Dr. Hellman properly selected the date of MMI as July 26, 2014.19 

Thus, the Board finds that Dr. Hellman, serving as OWCP DMA, properly reviewed 

Dr. Thometz’ report and applied the appropriate tables and grading schemes of the A.M.A., 

Guides in determining that appellant had no more than two percent permanent impairment of the 

right lower extremity for which he received a schedule award.20 As both physicians agreed on 

the impairment rating, appellant has not submitted sufficient evidence to establish that he has 

more than two percent impairment to the right lower extremity.21

On appeal, appellant argues that he suffered great hardship as a result of his injury and 

requested review of his award but that belief, however sincerely held, does not constitute the 

medical evidence necessary to establish greater impairment. As set forth above, he did not 

submit probative medical evidence supporting greater percentages of impairment than those 

awarded. 

 17 Supra note 11. 

18 Supra note 2. 

19 The determination of the date of MMI ultimately rests with the medical evidence. L.H., 58 ECAB 561 (2007). 

20 W.M., Docket No. 11-1156 (issued January 27, 2012). 

21 B.L., Docket No. 12-1240 (issued December 18, 2012). 
6

Appellant may request an 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 has more than a two percent 

permanent impairment of the right leg for which he received a schedule award. 

ORDER 

IT IS HEREBY ORDERED THAT the Office of Workers’ Compensation Programs 

decision dated March 2, 2015 is affirmed. 

Issued: October 7, 2015 

Washington, DC 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 Valerie D. Evans-Harrell, Alternate Judge 

 Employees’ Compensation Appeals Board