United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

S.G., Appellant 

and 

U.S. POSTAL SERVICE, SOUTH ARLINGTON 

STATION, Akron, OH, Employer 

__________________________________________ 

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Docket No. 16-1882 

Issued: March 22, 2017 

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant1

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

CHRISTOPHER J. GODFREY, Chief Judge 

PATRICIA H. FITZGERALD, Deputy Chief Judge 

VALERIE D. EVANS-HARRELL, Alternate Judge 

JURISDICTION 

On September 23, 2016 appellant, through counsel, filed a timely appeal from an 

August 1, 2016 merit decision of the Office of Workers’ Compensation Programs (OWCP). 

Pursuant to the Federal Employees’ Compensation Act2

 (FECA) and 20 C.F.R. §§ 501.2(c) and 

501.3, the Board has jurisdiction to consider the merits of this case. 

ISSUE 

The issue is whether appellant has established more than five percent permanent 

impairment of the right lower extremity, for which she previously received a schedule award. 

 1

 In all cases in which a representative has been authorized in a matter before the Board, no claim for a fee for 

legal or other service performed on appeal before the Board is valid unless approved by the Board. 20 C.F.R. 

§ 501.9(e). No contract for a stipulated fee or on a contingent fee basis will be approved by the Board. Id. An 

attorney or representative’s collection of a fee without the Board’s approval may constitute a misdemeanor, subject 

to fine or imprisonment for up to one year or both. Id.; see also 18 U.S.C. § 292. Demands for payment of fees to a 

representative, prior to approval by the Board, may be reported to appropriate authorities for investigation. 

2

 5 U.S.C. § 8101 et seq. 
2

On appeal, counsel argues that the decision is contrary to fact and law. 

FACTUAL HISTORY 

On December 16, 2013 appellant, then a 40-year-old city carrier assistant, filed a 

traumatic injury claim (Form CA-1) alleging that on December 14, 2013 she sustained a right 

ankle fracture when she slipped and fell on a snowy day while delivering mail. She stopped 

work on the day of the injury. OWCP accepted the claim for right closed lateral malleolus ankle 

fracture and right distal tibiofibular ligament ankle sprain and authorized ankle surgery, which 

occurred on December 15, 2013. It paid appellant wage-loss compensation on the supplemental 

rolls for the period January to July 26, 2014. 

On June 9, 2014 appellant accepted a modified letter carrier job offer working for two 

and one-half hours per day. She returned to work on June 23, 2014, and to full-time full-duty 

work on July 28, 2014. 

In a December 19, 2014 note, Dr. Eric T. Miller, a treating Board-certified orthopedic 

surgeon, indicated that appellant reached maximum medical improvement (MMI) as of 

December 11, 2014. 

On January 6, 2015 appellant filed a claim for a schedule award (Form CA-7). 

In an April 9, 2015 report, Dr. Catherine Watkins Campbell, a physician Board-certified 

in family practice and occupational medicine, provided a permanent impairment rating using the 

sixth edition of the American Medical Association, Guides to the Evaluation of Permanent 

Impairment (hereinafter A.M.A., Guides).3

 She observed that: 

“Appellant ambulated with a moderately antalgic gait more pronounced without 

shoes. She was unable to toe walk on the left. There was mild swelling of the 

ankle but no temperature changes. The right ankle mortise measured 29.7 

centimeters (cm) and the left 27.5 cm. There was asymmetric mild lateral laxity 

of the right ankle. There was a 12 cm lateral scar that ran to the dorsum of the 

mid foot. There was mild diffuse extensor tendon tenderness across the dorsum 

of the foot and ankle. Normal strength noted. ‘Both calves measured 47.5 cm. 

Range of motion of the right ankle measured 40, 38, 32 degrees of dorsiflexion, 

24, 24, 24 degrees of plantar flexion, 14 122m 14 degrees of eversion, 20, 18.’ 

*** There was no significant varus or valgus deformity at the ankle.” 

Dr. Watkins Campbell assigned class 1 for mild motion deficits using Table 16-2. She assigned 

a grade modifier of two for functional history, one for physical examination modifier, and zero 

for clinical studies modifier. Using the net adjustment formula, Dr. Watkins Campbell 

determined that appellant had 10 percent right lower extremity permanent impairment. The date 

of MMI was determined to be December 12, 2014, based on Dr. Miller’s opinion. 

 3

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

On May 22, 2015 OWCP’s medical adviser reviewed Dr. Watkins Campbell’s 

impairment rating and determined that appellant had five percent right lower extremity 

permanent impairment. He observed that the findings of 40 degrees right ankle dorsiflexion 

appeared to be a typographical error as 20 degrees was the maximum for dorsiflexion. The 

medical adviser also noted the two numbers for right ankle eversion probably were attributable to 

right ankle inversion. He recommended that OWCP obtain clarification from Dr. Watkins 

Campbell on the range of motion as a key factor. In reaching his impairment rating, the medical 

adviser assigned class 1 for the diagnosis of bi-malleolar fracture with range of motion within 

normal ranges. He assigned a grade modifier of one for functional history using Table 16-6, 

page 516 and a grade modifier of one for physical examination using Table 16-7, page 517. 

Using Table 16-6, page 516, the medical adviser explained that he assigned a grade modifier of 

one instead of two for functional history adjustment as there was no documentation of an 

antalgic gait requiring the use of a cane, crutch, or external orthotic device, or positive 

Trendelenburg test. He assigned a grade modifier of one for physical examination findings of 

mild swelling using Table 16-7, page 517. The medical adviser noted that no modifier was 

assigned for clinical studies using Table 16-8, page 519. Using the net adjustment formula, he 

found the final grade to be C with a permanent impairment rating of five percent. 

On July 9, 2015 OWCP requested that Dr. Watkins Campbell clarify her report. In a 

letter dated July 20, 2015, counsel informed OWCP that there would be no response forthcoming 

from Dr. Watkins Campbell. 

By decision dated September 10, 2015, OWCP granted appellant a schedule award for 

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

January 23 to May 3, 2015. 

In a letter dated September 21, 2015, counsel requested a telephonic hearing before an 

OWCP hearing representative. The hearing was held on May 17, 2016. 

By decision dated August 1, 2016, OWCP’s hearing representative affirmed the 

September 10, 2015 schedule award determination. She found OWCP’s medical adviser 

constituted the weight of the evidence as he properly applied the A.M.A., Guides when 

determining permanent impairment. 

LEGAL PRECEDENT 

Under section 8107 of FECA4

 and section 10.404 of the implementing federal 

regulations,5 schedule awards are payable for permanent impairment of specified body members, 

functions, or organs. FECA, however, does not specify the manner in which the percentage of 

impairment shall be determined. For consistent results and to ensure equal justice under the law 

for 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 

 4

 5 U.S.C. § 8107. 

5

 20 C.F.R. § 10.404 
4

adopted by the implementing regulations as the appropriate standard for evaluating schedule 

losses.6 

The sixth edition of the A.M.A., Guides provides a diagnosis-based impairment method 

of evaluation utilizing the World Health Organization’s International Classification of 

Functioning, Disability and Health (ICF).7

 Under the sixth edition, 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).8 The net adjustment formula is (GMFH-CDX) + (GMPE-CDX) + (GMCS-CDX).9

In determining impairment for the lower extremities, an evaluator must establish the 

appropriate diagnosis for each part of the lower extremity to be rated. With respect to the ankle, 

the relevant portion of the leg (foot) for the present case, reference is made to Table 16-2 (Foot 

and Ankle Regional Grid) beginning on page 501.10 After the class of diagnosis is determined 

from the Foot and Ankle Regional Grid (including identification of a default grade value), the net 

adjustment formula is applied using the grade modifier for functional history, grade modifier for 

physical examination, and grade modifier for clinical studies.11

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

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

extent of impairment in accordance with the A.M.A., Guides, with an OWCP medical adviser 

providing rationale for the percentage of impairment specified.12

ANALYSIS 

OWCP accepted the claim for right closed lateral malleolus ankle fracture and right distal 

tibiofibular ligament ankle sprain. It authorized ankle surgery, which occurred on 

December 15, 2013. Appellant filed a claim for a schedule award on January 6, 2015. By 

decision dated September 10, 2015, OWCP granted her a schedule award for five percent right 

lower extremity permanent impairment, which was affirmed by an OWCP hearing representative 

by decision dated August 1, 2016. 

 6 D.J., 59 ECAB 620 (2008); Bernard A. Babcock, Jr., 52 ECAB 143 (2000). 

7

 A.M.A., Guides 3 (6th ed. 2009), section 1.3, The International Classification of Functioning, Disability and 

Health (ICF): A Contemporary Model of Disablement. 

8

 A.M.A., Guides 494-99 (6th ed. 2009). 

9 Id. at 497. 

10 Id. at 501-07. 

11 Id. at 515-22. 

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

Chapter 2.808.6(f) (February 2013). See C.K., Docket No. 09-2371 (issued August 18, 2010); Frantz Ghassan, 57 

ECAB 349 (2006).
5

In support of her claim for an additional schedule award, appellant submitted an April 9, 

2015 impairment rating by Dr. Watkins Campbell. Dr. Watkins Campbell reviewed medical 

records and the history of the employment injury. She provided examination findings and 

diagnosed right ankle closed lateral malleolus fracture and right ankle sprain distal tibiofibular 

ligament. Dr. Watkins Campbell noted that Dr. Miller found that appellant had reached MMI on 

December 12, 2014. She referenced Table 16-2 of the A.M.A., Guides and classified appellant’s 

impairment as a class 1 for mild right ankle motion deficits. Dr. Watkins Campbell assigned a 

grade modifier of 2 for functional history, 1 for physical examination, and 0 for clinical studies. 

Applying the net adjustment formula, she calculated an adjustment of 0, which resulted in a 

permanent impairment rating of 10 percent for the right lower extremity. 

OWCP’s medical adviser reviewed Dr. Watkins Campbell’s impairment rating and 

disagreed with her assessment. He explained that the record did not support Dr. Watkins 

Campbell’s assigning a grade modifier of 2 for functional history. According to Table 16-6, 

page 516 a grade modifier of 2 is warranted for moderate problems based on the documentation 

of an antalgic gait requiring a cane or crutch, no external orthotic device was required and there 

was no positive Trendelenburg test. On July 9, 2015 OWCP requested that Dr. Watkins 

Campbell clarify her report, but on July 20, 2015 counsel advised that no further report would be 

provided. 

OWCP’s medical adviser reviewed the medical record and opined that appellant had five 

percent permanent impairment of her right lower extremity. He utilized Table 16-2, page 503, 

and assigned class 1 impairment for bi-malleolar fracture with range of motion within normal 

ranges, with a default value of five percent for grade C. The medical adviser reported a grade 

modifier of 1 for functional history due to continued ankle symptoms. He also assigned grade 

modifiers of 1 for physical examination due to mild swelling and 0 for clinical studies. After 

applying these grade modifiers to the net adjustment formula, the medical adviser concluded that 

appellant had five percent right lower extremity permanent impairment. 

The Board finds that the weight of the medical evidence rests with the opinion of 

OWCP’s medical adviser as he provided the only impairment rating that properly applied the 

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

13 The Board notes that the medical adviser properly 

reviewed the medical record and evaluated appellant’s right lower extremity in accordance with 

the A.M.A., Guides. The medical adviser appropriately applied the sixth edition of the A.M.A., 

Guides in determining that appellant had five percent permanent impairment of the right lower 

extremity. Dr. Watkins Campbell’s impairment rating failed to establish that appellant sustained 

permanent impairment greater than five percent for the right lower extremity.14 The record does 

not contain any other current medical evidence in conformance with the A.M.A., Guides that 

shows greater impairment. 

 13 M.C., Docket No. 15-1757 (issued March 17, 2016). The only medical evidence that demonstrated a proper 

application of the A.M.A., Guides was the report of the medical adviser). 

14 A.M.A., Guides 516. 
6

On appeal, counsel contends that OWCP’s decision was contrary to fact and law. Based 

on the findings and reasons stated above, the Board finds that counsel’s arguments are not 

substantiated.

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. 

CONCLUSION 

The Board finds that appellant failed to establish more than five percent permanent 

impairment of the right lower extremity, for which she previously received a schedule award. 

ORDER 

IT IS HEREBY ORDERED THAT the decision of the Office of Workers’ 

Compensation Programs dated August 1, 2016 is affirmed. 

Issued: March 22, 2017 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Valerie D. Evans-Harrell, Alternate Judge 

 Employees’ Compensation Appeals Board