United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

T.J., Appellant 

and 

U.S. POSTAL SERVICE, STOCKYARDS, 

Chicago, IL, Employer 

__________________________________________ 

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Docket No. 17-0736 

Issued: July 10, 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 February 14, 2017 appellant filed a timely appeal from a November 3, 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 met her burden of proof to establish more than 31 

percent permanent impairment of the right lower extremity, for which she previously received a 

schedule award. 

FACTUAL HISTORY 

On April 26, 2013 appellant, then a 46-year-old letter carrier, filed a traumatic injury 

claim (Form CA-1) alleging that on April 6, 2013 she experienced pain in her right leg when she 

 1

 5 U.S.C. § 8101 et seq. 
2

twisted it around in reaction to a dog’s bark while delivering mail at work. OWCP assigned the 

claim File No. xxxxxx587. 

On July 17, 2013 OWCP accepted the claim for sprain, other specified sites of the right 

hip and thigh. It authorized right total hip arthroplasty performed on September 23, 2014 by 

Dr. Scott Sporer, a Board-certified orthopedic surgeon. 

On November 26, 2013 appellant filed occupational disease claims (Form CA-2) alleging 

that she developed right osteoarthritis with internal derangement following her right leg sprain. 

OWCP assigned the claims File No. xxxxxx720. It accepted the claims for aggravation of right 

hip osteoarthritis, spondylolisthesis at L4-5 level, degenerative lumbar disc disease, and lumbar 

radiculopathy. OWCP combined File No. xxxxxx720 and File No. xxxxxx587. 

On April 7, 2015 appellant filed a claim for a schedule award (Form CA-7) (File No. 

xxxxxx587). She submitted a March 13, 2015 duty status report (Form CA-17) with an illegible 

signature. The report provided a diagnosis of right hip osteoarthritis due to appellant’s accepted 

April 6, 2013 employment injury. It indicated that she was released to return to full-duty work 

with no restrictions. In addition, the report noted that appellant had reached maximum medical 

improvement (MMI). 

By letter dated April 9, 2015, OWCP advised appellant that the evidence submitted was 

insufficient to establish her claim. It requested that she provide a medical report from her 

physician assessing her permanent impairment based on the sixth edition of the American 

Medical Association, Guides to the Evaluation of Permanent Impairment (A.M.A., Guides). 

Appellant was afforded 30 days to submit the requested evidence. She did not respond. 

In a June 6, 2016 decision, OWCP denied appellant’s claim for a schedule award, finding 

that she had not submitted the medical evidence necessary to establish permanent impairment of 

a scheduled member. 

On July 19, 2016 appellant requested reconsideration. She submitted a June 22, 2016 

report from Dr. Neil Allen, a Board-certified internist and neurologist. Dr. Allen noted a history 

of the April 6, 2013 injury and the September 23, 2014 right hip surgery. Appellant had 

complaints of intermittent right hip and thigh pain with right hip pain that ranged from 2 to 4 on 

a scale of 10 with reduced mobility and stiffness. She reported exacerbating factors that included 

standing more than 20 minutes, walking more than 15 minutes, walking her large dogs, kneeling 

while gardening, and working on cars. Relieving factors included rest, placing a pillow between 

the knees for sleeping, and medications. Appellant avoided riding her motorcycle. Dr. Allen 

advised that she had reached MMI. 

Regarding appellant’s functional history, Dr. Allen utilized Table 1-2, page 4 of the sixth 

edition of the A.M.A., Guides which listed activities of daily living (ADLs). He reported that 

she had no interference with self-care, personal hygiene, communication, sensory function, and 

nonspecialized hand activities. Appellant had moderate interference with physical activity, 

travel, and sleep. She experienced severe interference with sexual activity. Dr. Allen reported 

that appellant’s American Academy of Orthopedic Surgery (AAOS) Lower Limb Questionnaire 

score was 75. On examination of the right hip, he observed left-sided hip sway. The thigh 

measured at 35 centimeters (cm) bilaterally and 10 cm proximal to the superior pole of the 

patella. Appellant had a 10 cm well-healed surgical scar in the region of the greater trochanter of 
3

the femur. She also had a 4 cm well-healed surgical scar just posterior to the 10 cm scar. On 

palpation, global tenderness was mild. There was a mild increased tone through the gluteal 

musculature. 

On neurovascular examination, popliteal pulses were intact bilaterally. Sharp/dull and 

soft touch discrimination were intact in all regions bilaterally. Muscle strength was 5/5 for the 

hamstrings, quadriceps, abductors, adductions, hip flexor, internal rotators, and external rotators 

bilaterally. 

Dr. Allen reported right hip range of motion as “l00 degrees (90 degrees, 100 degrees) 

flexion, -13 degrees (-10 degrees, -10 degrees) extension, 50 degrees (40 degrees, 45 degrees) 

external rotation, 25 degrees (20 degrees, 25 degrees) internal rotation, 50 degrees (50 degrees, 

50 degrees) abduction, 35 degrees (25 degrees, 30 degrees) abduction, 25 degrees (20 degrees, 

25 degrees) adduction on the right, 120 degrees flexion, -10 degrees extension, 50 degrees 

external rotation, 40 degrees internal rotation, 25 degrees abduction, and 40 degrees adduction on 

the left.” Clinical studies included a September 6, 2013 magnetic resonance imaging (MRI) scan 

of the pelvis and right hip which revealed severe asymmetric right hip osteoarthritis with femoral 

head and acetabular remodeling and small joint effusion. There was also relatively extensive 

bone marrow edema like signal involving the proximal right femur. A September 6, 2013 right 

hip x-ray showed asymmetric severe right hip arthropathy that was better seen by the MRI scan. 

Dr. Allen utilized the diagnosis-based impairment rating method of the sixth edition of 

the A.M.A., Guides to calculate appellant’s right hip impairment. He found that, under Table 

16-4,2

 page 515, Hip Regional Grid, the medical records and physical examination findings of a 

mild motion deficit in flexion represented a class three impairment with a default value of 37 

percent leg impairment. Dr. Allen adjusted this impairment rating based on functional history 

and physical examination findings. He assigned a grade modifier 3 for Functional History 

(GMFH) under Table 16-6, page 516 based on appellant’s AAOS Lower Limb Questionnaire 

score of 75. Dr. Allen assigned a grade modifier 1 for Physical Examination (GMPE) under 

Table 16-7, page 517 based on consistently documented mild palpatory findings without 

observed abnormalities, stability, no alteration in alignment/deformity compared to unaffected 

side, and no muscle atrophy. He assigned a grade modifier 4 for Clinical Studies (GMCS) under 

Table 16-8, page 519 based on the MRI scan and x-ray results. Using the net adjustment formula 

of (GMFH - CDX) + (GMPE - CDX) + (GMCS - CDX), Dr. Allen found that (3-3) + (1-3) + (4-

3) resulted in a net grade modifier of -1, equaling 37 percent permanent impairment, grade C, 

which he reduced to grade B or 34 percent permanent impairment of the right lower extremity. 

On October 23, 2016 Dr. Eric M. Orenstein, an OWCP district medical adviser (DMA) 

and Board-certified orthopedic surgeon, reviewed the medical record, including Dr. Allen’s 

June 22, 2016 findings. He agreed with the methodology used by Dr. Allen to calculate his 

impairment rating, but disagreed with his assessment of the functional history and clinical studies 

adjustments. Dr. Orenstein used Table 16-4, Hip Regional Grid, page 515, with a key factor of 

total hip replacement. He determined that appellant had class 3 impairment with a default grade 

C or 37 percent permanent impairment. Dr. Orenstein noted Dr. Allen’s finding that appellant 

 2

 It appears to the Board that Dr. Allen inadvertently indicated that he utilized Table 16-3 on page 515 rather than 

Table 16-4 on page 515 as his findings correspond to the values listed in Table 16-4 on page 515 for a partial or total 

hip replacement. 
4

had an AAOS Lower Limb Inventory Score of 75. According to the American Board of 

Independent Medical Examiners (ABIME) training he received on using the sixth edition of the 

A.M.A., Guides to determine an impairment rating, an AAOS Lower Limb questionnaire score 

of 75 equated to a grade 1 modifier for GMFH. Dr. Orenstein assigned a grade 1 modifier for 

GMPE based on minimal palpatory findings without observed abnormalities. He related that a 

grade modifier for GMCS was not warranted as there were no current x-rays of appellant’s right 

total hip replacement. Dr. Orenstein calculated a net adjustment of two positions to the left 

resulting in a final 31 percent permanent impairment rating for the right leg. He found that 

appellant had reached MMI on June 22, 2016, the date of Dr. Allen’s evaluation. 

In a November 2, 2016 decision, OWCP vacated the June 6, 2016 decision. It found that 

the medical evidence of record was sufficient to establish that appellant sustained a permanent 

impairment to a scheduled member due to her accepted April 6, 2013 work injuries. 

By decision dated November 3, 2016, OWCP granted appellant a schedule award for 31 

percent permanent impairment of the right lower extremity. 

LEGAL PRECEDENT 

The schedule award provision of FECA3

 and its implementing federal regulations4 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 As of May 1, 2009, the 

sixth edition of the A.M.A., Guides is used to rate permanent impairment.6

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

evaluating permanent impairment.7 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, physical examination, and clinical studies.8

 The net adjustment 

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

 Under Chapter 2.3 of the A.M.A., 

 3

 5 U.S.C. § 8107. 

4

 20 C.F.R. § 10.404. 

5 Id. at § 10.404(a). 

6 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). 

7

 A.M.A., Guides 493-531. 

8 Id. 

9

 Id. at 521. 
5

Guides, evaluators are directed to provide reasons for their impairment rating choices, including 

choices of diagnoses from regional grids and calculations of modifier scores.10

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.11

ANALYSIS 

The Board finds that the case is not in posture for decision. 

OWCP accepted appellant’s claim for right hip and thigh sprain, aggravation of right hip 

osteoarthritis, spondylolisthesis at L4-5 level, degenerative lumbar disc disease, and lumbar 

radiculopathy. It authorized right total hip arthroplasty performed on September 23, 2014. 

OWCP granted appellant a schedule award for 31 percent permanent impairment of her 

right leg. In his June 22, 2016 report, Dr. Allen, appellant’s treating physician, opined that 

appellant had 34 percent permanent impairment of the right lower extremity. In his October 23, 

2016 report, Dr. Orenstein, serving as OWCP’s DMA, found that appellant had 31 percent 

permanent impairment of the right lower extremity for a total hip replacement. 

With respect to assigning values for grade modifiers, both Dr. Allen and Dr. Orenstein 

agreed that appellant had a grade modifier 1 for GMPE based on minimal or mild palpatory 

findings without observed abnormalities. However, the physicians disagreed on the value of the 

grade modifier for GMFH. Dr. Allen found that under Table 16-6, page 516, a grade modifier 

for GMFH of 3 for the right leg was justified by appellant’s AAOS Lower Limb Questionnaire 

score of 75 (Appendix 16A of the sixth edition of the A.M.A., Guides). Dr. Orenstein disagreed 

with Dr. Allen’s assessment and determined that based on his ABIME training regarding the use 

of the sixth edition of the A.M.A., Guides to rate impairment, appellant’s AAOS score of 75 

represented a grade modifier 1 for GMFH. The Board notes, however, that reference to Table 

16-6 and accompanying text regarding calculation of the grade modifier for functional history 

reveals that the Lower Limb Questionnaire is only meant to serve as an optional supplemental 

source for deriving the grade modifier for functional history and not as a sole source.12 Both 

Dr. Allen and Dr. Orenstein failed to apply the primary source of Table 16-6 for evaluating the 

grade modifier for functional history, i.e., the gait derangement portion of Table 16-6 which 

places individuals in various grades based on whether gait derangement exists and, if so, the 

level of such derangement.13 

 10 Id. at 23-28. 

11 See supra note 6 at Chapter 2.808.6(f) (February 2013). 

12 Section 16.3a of the sixth edition provides, “The evaluating physician may use outcome instruments and 

inventories as part of the process of evaluating functional symptoms.” “The [AAOS] Lower Limb Instrument is 1 

inventory that may be used.” “An inventory is used only to assist the examiner in defining the grade for functional 

history and does not serve as a basis for defining further impairment nor does the score reflect an impairment 

percentage.” See supra note 7 at 516. 

13 P.R., Docket No. 15-1782 (issued August 12, 2016). 
6

Drs. Allen and Orenstein also disagreed regarding the grade modifier value for clinical 

studies. Dr. Allen assigned a grade modifier 4 for clinical studies under Table 16-8, page 519 

based on the September 6, 2013 right hip MRI scan and x-ray results. However, he did not 

sufficiently explain how he calculated his assessment as Table 16-8 does not provide any criteria 

for a grade 4 modifier with regard to the hip. Dr. Orenstein disagreed with Dr. Allen’s 

assessment and noted that a clinical studies grade modifier was not applicable as there were no 

current x-rays of appellant’s right total hip replacement. 

The Board finds that neither Dr. Allen nor Dr. Orenstein sufficiently explained how the 

impairment was determined under the criteria of the sixth edition of the A.M.A., Guides. 

Accordingly, the Board will set aside OWCP’s February 14, 2017 decision and will remand the 

case to OWCP for such further medical development as it deems necessary and the issuance of a 

de novo decision on the extent of appellant’s right lower extremity impairment. 

On appeal appellant contends that she is entitled to a greater schedule award. As set forth 

above, the case will be remanded to OWCP for additional medical development on the extent of 

appellant’s right lower extremity impairment. 

CONCLUSION 

The Board finds that the case is not posture for decision. 

ORDER 

IT IS HEREBY ORDERED THAT the November 3, 2016 decision of the Office of 

Workers’ Compensation Programs is set aside and the case is remanded for further proceedings 

consistent with this decision of the Board. 

Issued: July 10, 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