United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

D.T., Appellant 

and 

DEPARTMENT OF HOMELAND SECURITY, 

IMMIGRATION & CUSTOMS 

ENFORCEMENT SAC, San Antonio, TX, 

Employer 

__________________________________________ 

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Docket No. 17-0102 

Issued: April 13, 2017 

Appearances: Case Submitted on the Record

Appellant, pro se 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

CHRISTOPHER J. GODFREY, Chief Judge 

COLLEEN DUFFY KIKO, Judge 

ALEC J. KOROMILAS, Alternate Judge 

JURISDICTION 

On October 21, 2016 appellant filed a timely appeal from a September 26, 2016 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 is entitled to a schedule award for 

permanent impairment of the right lower extremity sufficient to warrant a schedule award. 

 1

 5 U.S.C. § 8101 et seq.
2

FACTUAL HISTORY 

On February 26, 2015 appellant, then a 48-year-old special agent, filed a traumatic injury 

claim (Form CA-1) alleging that on February 24, 2015 he sustained a right knee condition when 

the vehicle he was driving was struck from behind, causing him to hit his knee on the steering 

column. He stopped work on April 9, 2015 and returned on April 27, 2015. By decision dated 

April 22, 2015, OWCP accepted the claim for right collateral ligament knee sprain. 

Following the accepted employment incident, appellant sought treatment with 

Dr. Geoffrey Glidden, a Board-certified orthopedic surgeon. In a March 19, 2016 medical 

report, Dr. Glidden reported that appellant complained of transient pain in his right knee, made 

worse with prolonged sitting or standing. He provided findings on physical examination and 

diagnosed right knee sprain/strain and prepatellar contusion. Dr. Glidden reported that appellant 

had returned to work without restrictions for approximately six months and competently 

performed his job duties without difficulty. He noted that appellant wished to be discharged 

from medical treatment. Dr. Glidden found this to be appropriate and informed appellant to 

follow up when necessary. 

On April 1, 2016 appellant filed a claim for a schedule award (Form CA-7). 

By letter dated April 20, 2016, OWCP requested that appellant submit a report from his 

attending physician addressing his work-related condition, the date of maximum medical 

improvement (MMI), objective findings, subjective complaints, and an impairment rating 

rendered according to the American Medical Association, Guides to the Evaluation of 

Permanent Impairment (6th ed. 2009) (A.M.A., Guides).2

 Appellant was advised that, if his 

physician was unable or unwilling to provide the required report, he should advise OWCP in 

writing. He was afforded 30 days to provide the requested information. Appellant did not 

respond. 

By decision dated September 26, 2016, OWCP denied appellant’s claim for a schedule 

award as the evidence was insufficient to establish any permanent impairment to a scheduled 

member or function of the body. 

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 

 2

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

3

 5 U.S.C. § 8107; 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.4

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

the scheduled member or function as a result of any employment injury.5

 OWCP procedures 

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

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

on which this occurred (date of MMI), 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.

6

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 (ICF). 

For lower 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).7

 The net adjustment 

formula is (GMFH - CDX) + (GMPE - CDX) + (GMCS - CDX).8 Evaluators are directed to 

provide reasons for their impairment rating choices, including choices of diagnoses from 

regional grids and calculations of modifier scores.9

ANALYSIS 

OWCP accepted appellant’s claim for right collateral ligament knee sprain. On April 1, 

2016 appellant filed a claim for a schedule award. By decision dated September 26, 2016, 

OWCP denied his schedule award claim finding that he had failed to submit an impairment 

evaluation to establish a permanent impairment resulting from his work injury. 

The Board finds that appellant has failed to submit evidence of permanent impairment to 

a scheduled member warranting a schedule award. By letter dated April 20, 2016, OWCP 

informed him of the type of evidence necessary to establish his schedule award claim and 

specifically requested that he submit an impairment evaluation from his attending physician in 

accordance with the sixth edition of the A.M.A., Guides. It afforded 30 days. 

Appellant did not respond to OWCP’s development letter. The only recent medical 

report of record was Dr. Glidden’s March 19, 2016 report which noted complaints of continued 

 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

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

6

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

Chapter 2.808.5 (February 2013). 

7 Supra note 2 at 493-531. 

8 Id. at 521. 

9 R.V., Docket No. 10-1827 (issued April 1, 2011). 
4

knee pain and discharged appellant from medical treatment. The Board finds that Dr. Glidden’s 

report is insufficient to establish any permanent impairment. OWCP procedures provide that 

MMI must be reached before a schedule award can be made.10 Dr. Glidden failed to address 

whether MMI had been reached and provided no impairment rating for the right lower 

extremity.11 His report is therefore insufficient to establish permanent impairment of his right 

knee. 

It is appellant’s burden of proof to establish a permanent impairment of a scheduled 

member.12 The medical evidence must include a description of any physical impairment in 

sufficient detail so that the claims examiner and others reviewing the file would be able to clearly 

visualize the impairment with its resulting restrictions and limitations.13 Appellant did not 

submit such evidence and thus, OWCP properly denied his schedule award claim.14 

On appeal, appellant argues that his right knee injury entitles him to a schedule award, 

but his physician failed to provide him an MMI date or an impairment rating.15

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 met his burden of proof to establish entitlement to 

a schedule award for permanent impairment. 

 10 Supra note 6 at Part 3 -- Medical, Schedule Awards, Chapter 3.700.3(a)(1) (January 2010). 

11 E.D., Docket No. 10-967 (issued January 7, 2011). 

12 Supra note 5. 

13 See A.L., Docket No. 08-1730 (issued March 16, 2009). 

14 V.W., Docket No. 09-2026 (issued February 16, 2010); L.F., Docket No. 10-343 (issued November 29, 2010). 

15 On appeal, appellant requested an evaluation from a Department of Labor physician. Any requests pertaining 

to his treatment should be made in writing to OWCP. 
5

ORDER 

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

decision dated September 26, 2016 is affirmed. 

Issued: April 13, 2017 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board