United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

L.J., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Champaign, IL, Employer

__________________________________________

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Docket No. 17-1533

Issued: October 20, 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

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On July 5, 2017 appellant filed a timely appeal from a March 9, 2017 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 her burden of proof to establish permanent 

impairment of her left foot for schedule award purposes.

FACTUAL HISTORY

On July 26, 2012 appellant, then a 42-year-old letter carrier, filed an occupational disease 

claim (Form CA-2) alleging that she sustained plantar fasciitis of her left foot. She contended 

that the condition was caused by performing her repetitive work duties, including walking her 

mail delivery route on a daily basis. Appellant indicated that she first became aware of her 

 

1

5 U.S.C. § 8101 et seq.
2

claimed condition on February 1, 2012 and first realized on the same date that it was caused or 

aggravated by factors of her federal employment.

OWCP accepted left plantar fasciitis. Appellant stopped work on August 10, 2012 on 

which date Dr. Michael Muscatella, an attending podiatrist, performed OWCP-approved left foot 

endoscopic plantar fasciotomy with cascade injection.

2

There is no indication in the record that appellant continued to receive regular medical 

care for her left foot condition in the years immediately following her return to work in late2012. She continued to perform her regular duties on a full-time basis without restrictions. 

In a September 26, 2016 report, Dr. Eugene P. Lopez an attending Board-certified 

orthopedic surgeon, discussed appellant’s factual and medical history and reported findings on

physical examination.

3

 He indicated that appellant exhibited mild pes planovalgus in her left 

foot, but that there were no other lesions or masses. Dr. Lopez found that appellant had 

inferomedial tenderness of her left hindfoot. Range of motion was normal in all areas tested in 

appellant’s left foot, sensation was normal, and strength was 5/5 in all muscle groups tested. 

Dr. Lopez noted that appellant’s reflexes were normal and symmetric, and that her gait pattern 

was normal with no limp. Examination of the rest of appellant’s left lower extremity did not 

show any tenderness, deformity, or injury. Dr. Lopez found that there was no gross instability of 

the left lower extremity and that strength and tone were normal. He diagnosed “work-related left 

plantar fasciitis doing well [four] years status post left plantar fascial release at MMI [maximum 

medical improvement]” and indicated that he would order a functional capacity evaluation (FCE) 

for appellant. 

In an October 26, 2016 report, Dr. Lopez discussed appellant’s left foot condition and the 

medical treatment she had received for that condition. He referenced the plantar fasciotomy she

had undergone on August 10, 2012 and her return to full-duty work without restrictions. 

Dr. Lopez provided results on examination from September 26, 2016 which were similar to those 

of September 26, 2016. He further noted that appellant underwent an FCE on October 25, 2016.4 

Dr. Lopez provided a summary of appellant’s symptoms as reported in the October 25, 2016 

FCE noting that she reported that her left foot pain generally was very minimal. Appellant 

reported that, when she did get left foot pain, it was a sharp pain in the heel. This pain was 

aggravated by walking barefoot, wearing shoes without orthotics (i.e., heeled shoes, sandals), or

wearing worn-out shoes.5 Dr. Lopez noted that appellant reported that her current left foot 

symptoms ranged from 0 to 3 out of a scale of 10, with 10 being the worse.

 

2 Appellant received disability compensation on the daily roll beginning August 10, 2012.

3 Dr. Lopez’s September 26, 2016 report is the first medical report in the record since late-2012.

4 The record contains a copy of the October 25, 2016 FCE report which indicated that appellant was capable of 

performing light to medium work as classified under the U.S. Department of Labor’s Dictionary of Occupational 

Titles. 

5 Appellant further reported that she experienced jolts of sharp pain one to two times per week while carrying her 

mail route at work and that rest and taking weight off her left foot helped relieve the pain. She denied having 

numbness or tingling in her left foot.
3

Dr. Lopez provided a permanent impairment rating utilizing the American Medical 

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

He indicated that appellant’s left plantar fascial fibromatosis constituted a class 1 condition 

under the diagnosis-based impairment (DBI) rating method of Table 16-2 (Foot and Ankle 

Regional Grid) on page 501. Dr. Lopez noted that, therefore, appellant had a default value of 1 

percent for permanent impairment of her left lower extremity. He then calculated values for 

grade modifiers using Table 16-6 through Table 16-8 on pages 516 through 520. Dr. Lopez 

indicated that appellant had a functional history grade modifier of 1 due to her antalgic gait 

pattern corrected with footwear modifications. Appellant had a physical examination grade 

modifier of 1 due to minimal palpatory findings for her left foot, and a clinical studies modifier 

of 1 due to clinical studies confirming her diagnosis with mild pathology. Dr. Lopez found that 

application of the net adjustment formula on page 521 meant that there was no movement from 

the one percent default value on Table 16-2, which resulted in total permanent impairment of her 

left lower extremity of one percent. 

On November 28, 2016 appellant filed a claim for compensation (Form CA-7) claiming a 

schedule award due to her accepted employment injury, left plantar fasciitis. 

In February 2017 OWCP referred appellant’s case to Dr. Jovito Estaris, a Board-certified 

occupational medicine physician serving as an OWCP medical adviser, to evaluate the extent of 

her permanent impairment under the standards of the sixth edition of the A.M.A., Guides.

In his February 21, 2017 report, Dr. Estaris reviewed the evidence of record, discussed 

appellant’s left foot condition and course of treatment, including the left plantar fasciotomy 

performed on August 10, 2012, and noted that her left foot condition had reached MMI on 

October 26, 2016, the date of Dr. Lopez’ evaluation. Dr. Estaris provided an impairment rating 

for appellant’s left lower extremity under the standards of the sixth edition of the A.M.A., 

Guides. Under Table 16-2 on page 501, he applied the DBI rating method noting that appellant’s 

left plantar fibromatosis fell under class 1 due to her significant palpatory findings on 

examination with a default value of one percent permanent impairment of her left lower 

extremity. Dr. Estaris calculated values for grade modifiers using Table 16-6 through Table 16-8 

on pages 516 through 520. He noted that appellant had a functional history grade modifier of 0 

because she had no antalgic gait, her left foot condition caused no interference with her daily 

activities, and she was performing her regular work. Appellant had a physical examination grade 

modifier of 1 due to findings of mild tenderness over her left hindfoot, and she had a clinical 

studies modifier of 0 because there was no clinical study supporting the diagnosis of plantar 

fibromatosis. Applying the net adjustment formula on page 521 resulted in movement two 

spaces to the left of the one percent default value on Table 16-2, which resulted in appellant 

having zero percent total permanent impairment of her left lower extremity. Dr. Estaris

explained that his impairment rating differed from Dr. Lopez’ calculation of one percent

permanent impairment of the left lower extremity because Dr. Lopez had not evaluated the 

functional history and clinical studies grade modifiers in accordance with the standards of the 

sixth edition of the A.M.A., Guides and therefore used improper values in the net adjustment 

formula. He noted that Dr. Lopez found a functional history grade modifier of 1, but indicated 

that this finding was inappropriate under Table 16-6 because Dr. Lopez clearly reported that 

appellant had a normal gait pattern with no limp. Dr. Estaris further indicated that Dr. Lopez 

found a clinical studies modifier of 1 but advised that this was not correct because there was no 
4

clinical study in the evidence of record, let alone one that supported a diagnosis of plantar 

fibromatosis/fasciitis.

In a March 9, 2017 decision, OWCP denied appellant’s schedule award claim noting that 

she had not met her burden of proof to establish permanent impairment due to her accepted left 

foot condition. It found the weight of the medical evidence to rest with Dr. Estaris which found

that appellant had no permanent impairment of her left lower extremity under the standards of 

the sixth edition of the A.M.A., Guides. OWCP noted that Dr. Estaris explained why Dr. Lopez’ 

October 26, 2016 rating calculation, finding one percent permanent of the left lower extremity, 

was not carried out in accordance with those standards.

LEGAL PRECEDENT

The schedule award provision of the FECA6and its implementing regulations

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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. The effective date of the sixth edition of the 

A.M.A., Guides is May 1, 2009.8

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

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

extremity to be rated. With respect to the foot, the relevant portion of the leg for the present case, 

reference is made to Table 16-2 (Foot and Ankle Regional Grid) beginning on page 501.9 After 

the Class of Diagnosis (CDX) 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 (GMFH), grade modifier for Physical Examination (GMPE), and 

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

(GMPE - CDX) + (GMCS - CDX).10 Under Chapter 2.3, evaluators are directed to provide 

reasons for their impairment rating choices, including choices of diagnoses from regional grids 

and calculations of modifier scores.11

 

6

5 U.S.C. § 8107.

7

20 C.F.R. § 10.404 (1999).

8

See Federal (FECA) Procedure Manual, Part 3 -- Medical, Schedule Awards, Chapter 3.700, Exhibit 1 

(January 2010); Federal (FECA) Procedure Manual, Part 2 -- Claims, Schedule Awards and Permanent Disability 

Claims, Chapter 2.808.5a (February 2013).

9

See A.M.A., Guides (6th ed. 2009) 509-11.

10 Id. at 501-08.

11 Id. at 23-28.
5

ANALYSIS

OWCP accepted that appellant sustained left plantar fasciitis and, on August 10, 2012, 

she underwent OWCP-approved left foot endoscopic plantar fasciotomy. On December 4, 2012 

she returned to performing her regular duties for eight hours per day without restrictions. On 

November 28, 2016 appellant filed a claim for a schedule award due to her accepted employment 

injury. In a March 9, 2017 decision, OWCP denied appellant’s schedule award claim noting that 

she had not established permanent impairment due to her accepted left foot condition. It found 

that its determination was supported by the impairment rating of Dr. Estaris, an OWCP medical 

adviser who utilized the examination findings of Dr. Lopez, an attending physician.

The Board finds that appellant failed to meet her burden of proof to establish permanent 

impairment due to her left foot condition.

The Board finds that Dr. Estaris properly determined that appellant did not have 

permanent impairment of her left lower extremity under the standards of the sixth edition of the 

A.M.A., Guides. Dr. Estaris indicated that he had reviewed the evidence of record and provided 

an impairment rating based on the physical examination findings of Dr. Lopez.12 He found that, 

under Table 16-2, application of the diagnosis-based impairment rating method meant that 

appellant’s left plantar fibromatosis fell under class 1 (significant palpatory findings on 

examination) with a default value of one percent permanent impairment.13 Dr. Estaris correctly 

calculated values for grade modifiers using Table 16-6 through Table 16-8. He noted that 

appellant had a functional history grade modifier of 0 because she had no antalgic gait, her left 

foot condition caused no interference with her daily activities, and she was performing her 

regular work. Appellant had a physical examination grade modifier of 1 due to findings of mild 

tenderness over her left hindfoot and she had a clinical studies modifier of 0 because there was 

no clinical study supporting the diagnosis of plantar fibromatosis.14 Dr. Estaris found that 

application of the net adjustment formula meant that there would be movement two spaces to the 

left of the one percent default value on Table 16-2, which resulted in zero percent permanent 

impairment of her left lower extremity.

15

The Board finds that Dr. Estaris, in his February 21, 2017 report, properly explained why

Dr. Lopez’ October 26, 2016 rating calculation, finding one percent permanent impairment of the 

left lower extremity, was not carried out in accordance with the standards of the sixth edition of 

the A.M.A., Guides and therefore was of limited probative value. The Board has held that an 

opinion on permanent impairment is of limited probative value if it is not derived in accordance 

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

 

12 Dr. Estaris noted that appellant’s left foot condition reached MMI on October 26, 2016, the date of Dr. Lopez’

evaluation.

13 See A.M.A., Guides 501-08, Table 16-2.

14 See id. at 516-20, Table 16-6 through Table 16-8.

15 See supra note 10.
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schedule losses.16 Dr. Estaris explained that his impairment rating differed from that of

Dr. Lopez because Dr. Lopez did not calculate the functional history and clinical studies grade 

modifiers in accordance with the standards of the sixth edition of the A.M.A., Guides. He noted 

that Dr. Lopez found a functional history grade modifier of 1, but indicated that this finding was 

not appropriate under Table 16-6 because Dr. Lopez clearly reported that appellant had a normal 

gait pattern with no limp.17 Dr. Estaris further indicated that Dr. Lopez found a clinical studies 

modifier of 1, but advised that this was not correct because there was no clinical study in the 

evidence of record to support the diagnosis of appellant’s left foot condition.

18

 

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 did not meet her burden of proof to establish permanent 

impairment of her left foot for schedule award purposes.

 

16 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).

17 Dr. Lopez had indicated that appellant had a functional history grade modifier of 1 due to an antalgic gait 

pattern corrected with footwear modifications. The Board notes, however, that there is no evidence of record 

supporting that appellant had an antalgic gait pattern that was corrected in such a manner.

18 The Board notes that the record does not contain any diagnostic testing of appellant’s left foot.
7

ORDER

IT IS HEREBY ORDERED THAT the March 9, 2017 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: October 20, 2017

Washington, DC

Christopher J. Godfrey, Chief Judge

Employees’ Compensation Appeals Board

Colleen Duffy Kiko, Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board