United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

R.J., Appellant 

and 

DEPARTMENT OF THE AIR FORCE, 

WHITEMAN AIR FORCE BASE, MO, 

Employer 

__________________________________________ 

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Docket No. 16-1561 

Issued: January 9, 2017 

Appearances: 

Appellant, pro se 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

CHRISTOPHER J. GODFREY, Chief Judge 

PATRICIA H. FITZGERALD, Deputy Chief Judge 

COLLEEN DUFFY KIKO, Judge 

JURISDICTION 

On July 26, 2016 appellant filed a timely appeal from a June 22, 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 the case. 

ISSUE 

The issue is whether appellant has more than two percent permanent impairment of the 

left lower extremity for which he received a schedule award. 

FACTUAL HISTORY 

On July 18, 2012 appellant, then a 53-year-old aircraft overhaul leader, sustained a left 

knee injury when he missed a rung while descending an aircraft step ladder and fell. OWCP 

 1

 5 U.S.C. § 8101 et seq. 
2

accepted appellant’s claim for left knee sprain and expanded his claim to include tear of the 

medial meniscus of the left knee and synovitis. Appellant did not stop work but returned to light 

duty. Appellant underwent arthroscopic surgery on November 14, 2012. He was off work from 

November 12 to December 2, 2012 after undergoing surgery and returned to full duty on 

January 14, 2013. Appellant retired on June 8, 2015. 

Appellant was treated by Dr. Robert F. Greiner II, an osteopath, from July 31 to 

October 9, 2012, for the July 18, 2012 work-related left knee injury when he fell while 

descending a ladder. He diagnosed left knee pain and sprain and strain of the knee and leg. On 

November 14, 2012 the physician performed left knee arthroscopic surgery, partial medial 

meniscectomy and arthroscopic three compartment major synovectomy. Dr. Greiner diagnosed 

left knee meniscus tear. A left knee magnetic resonance imaging (MRI) scan on September 21, 

2012 revealed an intrasubstance signal of the posterior horn of the medial meniscus suspicious 

for a tear, a small subchondral lesion at the medial femoral condyle peripherally, probably 

degenerative, and a possible small nonacute subchondral fracture. 

On March 3, 2016 appellant filed a claim for a schedule award (Form CA-7). He 

submitted a July 28, 2015 report from Dr. Greiner who noted that appellant presented with 

radiating left knee pain and a limp. Left knee findings included crepitus in the patellofemoral 

region, intact anterior and posterior cruciate ligament, intact medial and lateral collateral 

ligaments, negative McMurray’s sign, and strength of 4/5. Dr. Greiner diagnosed left knee pain, 

internal derangement of the knee and sprain and strain of the medial collateral ligament of the 

knee. He noted that appellant had reached maximum medical improvement for the left knee. In 

an August 31, 2015 report, Dr. Greiner opined that based on appellant’s medical history, clinical 

findings and physical examination of July 28, 2015, he sustained 16 percent permanent 

impairment of the left knee in accordance with the sixth edition of the A.M.A., Guides2

 as a 

result of the work-related injury. He indicated that appellant’s work-related injury led to 

permanent loss of physical function. In a March 17, 2016 report, Dr. Greiner reiterated that, 

based on appellant’s medical history, clinical findings, and physical examination of July 28, 

2015, appellant had permanent impairment of 16 percent of the left knee in accordance with the 

A.M.A., Guides as a result of the work injury. He based his findings on range of motion of the 

knee from the prior examination and the related surgery. 

In a report dated April 14, 2016, an OWCP medical adviser reviewed Dr. Greiner’s report 

and disagreed with his findings. He indicated that Dr. Greiner referenced no tables or charts and 

provided no worksheets, narrative, or calculations to explain the method by which he arrived at 

his determination. Further, the medical adviser indicated that Dr. Greiner based his rating 

determination on range of motion findings. However, the examinations of July 7 and 28, 2015 

failed to document left knee range of motion measurements. He recommended appellant be 

referred to a second opinion physician for an impairment evaluation. 

On April 21, 2016 OWCP referred appellant for a second opinion to Dr. Kala 

Danushkodi, a Board-certified physiatrist, for a determination of whether he had permanent 

impairment attributable to his accepted conditions. In a report dated May 10, 2016, 

 2

 A.M.A., Guides (6th ed. 2009). 
3

Dr. Danushkodi noted a history of appellant’s work-related condition and subsequent treatment. 

She noted examination findings of no swelling or effusion, mild patellofemoral crepitus, mild 

tenderness of the right medial femoral condyle, negative anterior drawer signs, negative varus 

and valgus stress testing, normal knee range of motion, mild pain with knee hyperflexion, mildly 

antalgic gait, normal manual strength in the leg, and intact sensory examination. Dr. Danushkodi 

diagnosed left knee partial medial meniscectomy. She noted, pursuant to Table 16-3, page 511 

of the A.M.A., Guides, Knee Regional Grid, Medial Meniscus tear, status post partial 

meniscectomy, appellant was a class 1 impairment, grade C, with default impairment of two 

percent of the left leg. Dr. Danushkodi noted that pursuant to Table 16-6, the grade modifier for 

Functional History (GMFH) was 1 for antalgic limp; pursuant to Table 16-7, the grade modifier 

for Physical Examination (GMPE) was 1 for palpatory findings; and pursuant to Table 16-8, the 

grade modifier for Clinical Studies (GMCS) was not applicable as it was used in the diagnosis 

grid. She utilized the net adjustment formula to find a net adjustment of zero which would place 

appellant at grade C with two percent permanent left lower extremity impairment. 

In a May 26, 2016 report, the medical adviser agreed with Dr. Danushkodi’s impairment 

rating determination of two percent permanent impairment of the left lower extremity. 

In a decision dated June 22, 2016, OWCP granted appellant a schedule award for two 

percent permanent impairment of the left lower extremity. The period of the award was from 

May 10 to June 19, 2016. 

LEGAL PRECEDENT 

The schedule award provision of FECA3 and its implementing federal regulations,4 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 for all claimants, OWCP has adopted 

the A.M.A., Guides as the uniform standard applicable to all claimants.5 For decisions issued 

beginning May 1, 2009, the sixth edition of the A.M.A., Guides will be used.6

 

The sixth edition of 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).7

 Under the sixth edition, for lower extremity impairments the evaluator 

identifies the impairment Class of Diagnosis (CDX) condition, which is then adjusted by grade 

 3

 5 U.S.C. § 8107. 

4

 20 C.F.R. § 10.404. 

5 Id. at § 10.404(a). 

6

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

Chapter 2.808.5a (February 2013); see also Part 3 -- Medical, Schedule Awards, Chapter 3.700.2 and Exhibit 1 

(January 2010). 

7

 A.M.A., Guides, 3, section 1.3, The International Classification of Functioning, Disability and Health (ICF): A 

Contemporary Model of Disablement. 
4

modifiers based on functional history, physical examination, and clinical studies.8

 The net 

adjustment formula is (GMFH - CDX) + (GMPE - CDX) + (GMCS - CDX).9

 The grade 

modifiers are used on the net adjustment formula described above to calculate a net adjustment. 

The final impairment grade is determined by adjusting the grade up or down the default value C, 

by the calculated net adjustment.10 

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

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

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

adviser providing rationale for the percentage of impairment specified.11 

ANALYSIS 

OWCP accepted the claim for left knee sprain, left knee medial meniscus tear, and left 

knee synovitis. It authorized a left knee arthroscopic surgery which was performed on 

November 14, 2012. On June 22, 2016 appellant received a schedule award for two percent 

permanent impairment of his left lower extremity. The Board finds that appellant has not met his 

burden of proof to establish more than two percent permanent impairment. 

In support of his request appellant submitted a report from Dr. Greiner dated July 28, 

2015 who noted that his examination of the left knee revealed crepitus in the patellofemoral 

region, intact anterior and posterior cruciate ligament, intact medial and lateral collateral 

ligaments, and strength of 4/5. Dr. Greiner diagnosed left knee pain, internal derangement of the 

knee and sprain and strain of the medial collateral ligament of the knee. He noted that appellant 

reached maximum medical improvement for the left knee. In reports dated August 31, 2015 and 

March 17, 2016, Dr. Greiner opined that based on appellant’s medical history, clinical findings 

and physical examination of July 28, 2015, appellant had permanent impairment of 16 percent of 

the left knee under the A.M.A., Guides as a result of the work-related condition. On March 17, 

2016 he indicated that he based his findings on range of motion of the knee from the prior 

examination and the related surgery. However upon review of Dr. Greiner’s reports dated July 7 

and 28, 2015, he fails to document range of motion figures for the left knee and did not otherwise 

explain how he arrived at his impairment rating pursuant to specific provisions of the A.M.A., 

Guides. Dr. Greiner failed to cite tables or charts in the A.M.A., Guides to support his 

impairment rating or provide his calculations in support of his determination. It is well 

established that when an attending physician’s report provides an estimate of impairment but 

 8 Id. at 494-531. 

9 Id. at 521. 

10 A.M.A., Guides 497. 

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

Chapter 2.808.6(f) (February 2013). 
5

does not address how the rating was made under the A.M.A., Guides, it is of little probative 

value.12 

OWCP referred appellant for a second opinion evaluation to Dr. Danushkodi. In a 

May 10, 2016 report, Dr. Danushkodi diagnosed left knee post partial medial meniscectomy. 

She properly noted that, under Table 16-3, page 511 of the A.M.A., Guides, Knee Regional Grid, 

Medial Meniscus Tear status post partial meniscectomy, appellant was a class 1 impairment, 

grade C, with a default impairment rating of two percent. Dr. Danushkodi noted pursuant to 

Table 16-6, page 516, the grade modifier for functional history was 1 for appellant’s antalgic 

limp; pursuant to Table 16-7, page 517, the grade modifier for physical examination was 1 for 

positive palpatory findings; and pursuant to Table 16-8, the grade modifier for clinical studies 

was not applicable as it was used in the diagnosis grid. She properly utilized the net adjustment 

formula to find a net adjustment of zero which would place appellant at grade C for two percent 

of the left leg. Dr. Danushkodi opined that appellant had two percent permanent impairment of 

the left leg. 

In a May 26, 2016 report, OWCP’s medical adviser reviewed Dr. Danushkodi’s May 10, 

2016 report. He agreed with the diagnosis and class of diagnosis used by Dr. Danushkodi. The 

medical adviser also agreed that appellant’s functional history grade modifier, GMFH, was 1; 

that his physical examination grade modifier (GMPH) was 1, and that GMCS was not applicable. 

Using the net adjustment formula the medical adviser concurred with a net adjustment of zero for 

a final grade of C which yields two percent impairment of the left lower extremity. 

The Board finds that OWCP’s medical adviser and Dr. Danushkodi properly calculated 

permanent impairment under the A.M.A., Guides. There is no current medical evidence in 

accordance with the A.M.A., Guides which supports that appellant sustained more than two 

percent permanent impairment for the left leg for which he previously received a schedule 

award. 

On appeal appellant asserts that Dr. Greiner performed an impairment evaluation under 

the A.M.A., Guides on August 31, 2015 and determined that he had 16 percent permanent 

impairment of the left lower extremity. Appellant advised that he also submitted a March 17, 

2016 report from Dr. Greiner who attached his office notes and operative report. He asserts that 

Dr. Greiner’s report supports that he has 16 percent permanent impairment. However, as noted 

above, Dr. Greiner’s report failed to clearly explain how he arrived at 16 percent left lower 

extremity impairment rating under the A.M.A., Guides. Appellant also contended that the 

second opinion physician examined him for seven minutes, that she was not thorough, and that 

she failed to mention his pain in her report. The Board found that Dr. Danushkodi’s report was 

sufficiently rationalized and properly based on the sixth edition of the A.M.A., Guides. 

Appellant has offered no evidence to support his contentions. 

Appellant may request a schedule award or increased schedule award at any time based 

on evidence of a new exposure or medical evidence showing progression of an employmentrelated condition resulting in permanent impairment or increased impairment. 

 12 See Paul R. Evans, Jr., 44 ECAB 646 (1993); John Constantin, 39 ECAB 1090 (1988) (medical report not 

explaining how the A.M.A., Guides are utilized is of little probative value). 
6

CONCLUSION 

The Board finds that appellant has not established that he has more than two percent 

permanent impairment of the left lower extremity. 

ORDER 

IT IS HEREBY ORDERED THAT the June 22, 2016 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: January 9, 2017 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board