United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

P.S., Appellant 

and 

DEPARTMENT OF VETERANS AFFAIRS, 

VETERANS ADMINISTRATION MEDICAL 

CENTER, Houston, TX, Employer 

__________________________________________ 

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Docket No. 15-0682 

Issued: July 14, 2015 

Appearances: Case Submitted on the Record

Debra Hauser, Esq., for the appellant 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

CHRISTOPHER J. GODFREY, Chief Judge 

COLLEEN DUFFY KIKO, Judge 

JAMES A. HAYNES, Alternate Judge 

JURISDICTION 

On February 10, 2015 appellant, through counsel, filed a timely appeal from a January 7, 

2015 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 sustained a ratable impairment of the lower extremities, 

bladder, and bowel due to her accepted January 10, 2008 employment injury entitling her to a 

schedule award. 

 1

 5 U.S.C. § 8101 et seq.
2

FACTUAL HISTORY 

On January 15, 2008 appellant, then a 49-year-old Veterans’ Affairs nurse, filed a 

traumatic injury claim alleging that on January 10, 2008 she sustained injuries to her hip and 

right ankle when she was struck by an engineering scooter as she crossed the pedestrian 

crosswalk. She stopped work. OWCP initially accepted appellant’s claim for right ankle sprain, 

hip contusion, and contusion of the right ankle. It further expanded her claim to include 

incontinence of feces, other urinary incontinence, neurogenic bladder, neurogenic bowel, urinary 

frequency, and retention of urine. OWCP paid wage-loss and medical compensation benefits. 

On May 18 and May 20, 2013 appellant, through counsel, requested a schedule award. 

She submitted a May 1, 2013 report by Dr. Robert A. Helsten, Board-certified in physical 

medicine and rehabilitation, who reviewed her history and accurately described the January 10, 

2008 injuries. Dr. Helsten noted that a May 10, 2010 electromyography and nerve conduction 

study examination demonstrated prolonged left pudendal terminal motor latency and absent right 

pudendal. He related that anal manometric studies, rectal sensation studies, rectoanal inhibitory 

reflex, and puborectalis muscle fiber recruitment revealed an abnormal study with multiple 

dysfunctions noted. Upon examination of appellant’s back and lower extremities, Dr. Helsten 

observed moderate lumbar tenderness, worse on the right extending into the right sacroiliac area. 

He found no tenderness to either hip or right ankle. Rectal examination demonstrated that 

appellant had no rectal tone even, when she tried to tighten her rectal muscles. Dr. Helsten 

reported diagnosed right ankle sprain, contusion of both hips and right ankle, incontinence of 

feces, neurogenic bladder, neurogenic bowel, urinary frequency, and urinary retention. 

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

of Permanent Impairment2

, Table 16-2, page 501, for right ankle sprain, and Table 16-4, page 

512, for hip contusion, Dr. Helsten determined that appellant was class 0 due to no residual pain 

which resulted in no permanent impairment of the lower extremities. 

Regarding appellant’s diagnoses of incontinence of feces and a neurogenic bowel, 

Dr. Helsten utilized Table 16-6, page 116, and determined that she had a class 4 impairment due 

to frequent severe or occasional extreme symptoms or signs of anal disease. He noted grade 

modifiers of significant Functional History (GMFH) with frequent fecal incontinence and 

explained that her American Academy of Orthopedic Surgeons score was 56, which was 

comparable to an grade E modifier. Dr. Helsten stated that appellant’s grade modifier for 

Physical Examination (GMPE) was significant for complete loss of sphincter tone, which 

equaled a 4 minus 4 or 1 grade modifier. He explained that he did not assign a grade modifier 

for Clinical Studies (GMCS) since they were used to make the diagnosis. Dr. Helsten calculated 

that appellant had a +1 grade modifier which changed her default grade C to a grade D for 28 

percent whole person impairment. 

For appellant’s diagnosis of neurogenic bladder and retention of urine, Dr. Helsten 

utilized Table 7-4, page 139, and stated that she had default class 3 impairment or 25 percent 

with little or no voluntary control of micturition. He reported that she had grade modifiers of +2 

 2

 A.M.A., Guides (6th ed. 2008). 
3

for functional history and 0 for physical examination. Thus, Dr. Helsten determined that 

appellant had 29 percent whole percent impairment. He referred to the Combined Values Chart 

and calculated that she had 49 percent impairment of the combined whole person impairment for 

bowel and bladder dysfunction. Dr. Helsten stated that appellant reached maximum medical 

improvement on January 11, 2013. 

On July 2, 2013 OWCP referred appellant’s schedule award claim, along with the 

medical record and statement of accepted facts, to an OWCP medical adviser to determine 

whether she sustained any permanent impairment due to her January 10, 2008 employment 

injuries. In a September 9, 2013 report, Dr. Ronald Blum, a Board-certified orthopedic surgeon 

and the medical adviser, related that he reviewed the record, including the statement of accepted 

facts, and noted appellant’s accepted conditions of right ankle sprain, hip and right ankle 

contusions, incontinence of feces, neurogenic bladder, neurogenic bowel, urinary frequency, and 

retention of urine. He reviewed Dr. Helsten’s May 1, 2013 report and agreed that appellant had 

zero percent impairment of the bilateral lower extremities as the conditions of right ankle 

sprain/contusion and bilateral hip contusion had resolved. Regarding appellant’s impairment 

based on abnormalities of the anus and bladder, Dr. Blum stated that anal disease (neurogenic 

bowel), bladder disease (neurogenic bladder) and whole person impairments were not considered 

scheduled members for purposes of determining schedule awards under OWCP regulations. 

Accordingly, he opined that he was unable to determine impairment for appellant’s accepted 

conditions of anal disease, bladder disease, or whole person. 

In an October 28, 2013 letter, counsel for appellant pointed out that 5 U.S.C. 

§ 8107(22) provided that: “For permanent loss or loss of use of any other important external or 

internal organ of the body as determined by the Secretary, proper and equitable compensation ... 

for each organ so determined shall be paid in addition to any other compensation payable under 

this schedule.” She contended that the bladder was certainly an “important internal organ” for 

which appellant sustained a permanent loss of function due to her January 10, 2008 employment 

injury. Furthermore, counsel alleged that a conflict in medical opinion existed between 

appellant’s physician and the medical adviser, which required referral for an impartial medical 

examination in order to resolve the conflict regarding her impairment rating. 

In a decision dated December 17, 2013, OWCP denied appellant’s schedule award claim 

finding that the medical evidence was insufficient to establish that she sustained a permanent 

impairment to a scheduled member due to her accepted conditions as defined by FECA. 

Following OWCP’s December 17, 2013 decision, appellant submitted various vouchers 

requesting reimbursements for travel and medical appointments and resubmitted Dr. Helsten’s 

May 1, 2013 report. 

On September 17, 2014 counsel requested reconsideration. She contended that a detailed 

review of appellant’s medical history demonstrated that appellant suffered far more conditions 

than reflected in her case file, most notably unspecified symptoms associated with female genital 

organs (ICD-9 Code 625.9) for the condition of pudendal nerve neuropathies. Counsel stated 

that if this code was properly included it would be the condition upon which to determine any 

permanent impairment according to the sixth edition of the A.M.A., Guides. She pointed out that 

appellant’s treating physicians and the medical adviser, Dr. Blum, agreed that there was a causal 
4

relationship between the January 10, 2008 employment injury and the development of pudendal 

nerve neuropathy which resulted in bowel and bladder malfunction. Counsel also cited 5 U.S.C. 

§ 8107(c); 20 C.F.R. § 10.404(b), and Federal (FECA) Procedure Manual, Part 3 -- Medical, 

Schedule Awards, Chapter 3.700.4(d)(2) (January 2010) which stated that the list of scheduled 

members granted under FECA was expanded to include the “breast, kidney, larynx, lungs, penis, 

testicle, ovary, uterus/cervix, and vulva/vagina and skin.” She alleged that appellant’s case file 

established that she had a permanent impairment of a scheduled member covered under FECA, 

specifically unspecified symptoms associated with female genital organs. 

Counsel further reported that the new medical evidence submitted demonstrated that 

appellant sustained bilateral pudendal neuropathies as a result of the January 10, 2008 

employment injury, which caused the neurogenic bladder and neurogenic bowel conditions. She 

cited various cases where a federal employee was granted a schedule award due to permanent 

impairment to the female genital organ and bladder and contended that appellant should have, at 

least, been referred to a Board-certified urologist, for an impartial medical examination. Counsel 

concluded that the Board should grant a schedule award for permanent impairment as stated in 

Dr. Helsten’s May 1, 2013 schedule award report or, at least, her case should be referred to an 

impartial Board-certified urologist to determine her permanent impairment. 

In a January 13, 2014 report, Dr. Mary E. Vanderlick, a neurologist, stated that appellant 

had bilateral pudendal neuropathies related to trauma with subsequent pelvic floor atrophy with 

bowel and bladder incontinence. She provided a detailed description of appellant’s extensive 

medical treatment for her urinary conditions. Dr. Vanderlick reported that despite appellant’s 

treatment she continued with significant disability including bladder and bowel incontinence and 

significant pain requiring narcotic medications. She also reported that appellant was not able to 

perform her duties as a registered nurse because bowel and bladder incontinence were 

unpredictable and would interfere with her ability to hold down a full-time job. Dr. Vanderlick 

diagnosed specified symptoms associated with female genital organs, neurogenic bladder, 

neurogenic bowel, and displacement of lumbar intervertebral disc without myelopathy. She 

noted that she did not expect appellant to make a full recovery and that her symptoms and 

disability would last at least a year, and throughout her lifetime. Dr. Vanderlick also noted that 

appellant was restricted in her ability to perform various physical abilities. 

Dr. Vanderlick reported in a letter dated August 11, 2014, that appellant had a diagnosis 

of pudendel nerve neuropathy and that it fell under code 625.9 for “unspecified symptoms 

associated with female genital organs.” She explained that pudendal neuropathy for appellant 

did not mean pelvic floor pain but instead meant atrophy of the pelvic floor muscles. 

Dr. Vanderlick opined that appellant’s pudendal nerves were injured in a traumatic way when 

appellant was a pedestrian in a motor vehicle accident in the employing establishment’s parking 

lot. 

In a September 11, 2014 report, Dr. Vanderlick examined appellant for follow-up 

regarding neuropathic pain, addendum neuropathy, neurogenic bowel, and bladder. She stated 

that appellant had bilateral pudendal neuropathies as a result of trauma with resultant pelvic floor 

atrophy and that this condition caused neurogenic bladder and neurogenic bowels. 

Dr. Vanderlick reviewed appellant’s medical treatment and provided findings on examination. 

She diagnosed unspecified symptoms associated with female genital organs, neurogenic bladder, 
5

neurogenic bowel, displacement of lumbar intervertebral disc without myelopathy, disturbance 

of skin sensation -- paresthesia, numbness, tingling, hypoesthesia, carpal tunnel syndrome, and 

joint pain. Dr. Vanderlick stated that most of appellant’s symptoms originated from the trauma 

she suffered several years ago resulting in bilateral pudendal neuropathy and pelvic floor 

atrophy. 

By decision dated January 7, 2015, OWCP denied modification of the December 17, 

2013 denial decision. 

LEGAL PRECEDENT 

The schedule award provision of FECA3 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. FECA, however, does not 

specify the manner in which the percentage of loss of a member shall be determined. The 

method used in making such determination is a matter which rests in the sound discretion of 

OWCP. For consistent results and to ensure equal justice, the Board has authorized 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 OWCP as the appropriate standards for evaluating schedule 

losses.4

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.5 Under the sixth edition, the evaluator identifies the impairment class for the Class 

of Diagnosis (CDX), which is then adjusted by grade modifiers based on GMFH, GMPE, and 

GMCS. The Net Adjustment Formula is (GMFH - CDX) + (GMPE - CDX) + (GMCS - CDX).6 

Evaluators are directed to provide reasons for their impairment rating choices, including the 

choices of diagnoses from regional grids and calculations of modifier scores.7

No schedule award is payable for a member, function or organ of the body not specified 

in FECA or in the implementing regulations.8 FECA identifies members such as the arm, leg, 

hand, foot, thumb, finger, and toes. It also specifies loss of hearing and vision, the loss of an eye 

and serious disfigurement of the face, head, or neck.9

 Section 8107(c)(22) of FECA provides for 

the payment of compensation for permanent loss of any other important external or internal 

 3

 5 U.S.C. §§ 8101-8193. 

4

 20 C.F.R. § 10.404 (1999); see also Jacqueline S. Harris, 54 ECAB 139 (2002). 

5

 A.M.A., Guides (6th ed. 2009), p. 3, section 1.3. 

6 Id. at 494-531. 

7 See R.V., Docket No. 10-1827 (issued April 1, 2011). 

8 See J.W., 59 ECAB 308 (2008); Paul A. Zoltek, 56 ECAB 325 (2005); Leroy M. Terska, 53 ECAB 247 (2001). 

9

 5 U.S.C. § 8107. 
6

organ of the body as determined by the Secretary of Labor.10 The Secretary of Labor has made 

such a determination, and pursuant to the authority granted in section 8107(c)(22), added the 

breast, kidney, larynx, lung, penis, testicle, tongue, ovary, uterus/cervix, vulva/vagina, and skin 

to the compensation schedule.11 There is no statutory basis for payment of a schedule award for 

impairment to the bladder, colon, or rectum under FECA or in the regulations.12

ANALYSIS 

OWCP accepted that appellant sustained multiple injuries to her lower extremities and 

bladder as a result of the January 10, 2008 employment incident. Appellant filed a schedule 

award claim. In decisions dated December 17, 2013 and January 7, 2015, OWCP denied her 

schedule award claim finding that she failed to establish that she sustained a permanent 

impairment to a scheduled member under FECA. 

Appellant submitted a May 1, 2013 report from Dr. Helsten, who observed no tenderness 

to either hip or right ankle upon physical examination. Dr. Helsten referenced Table 16-2, page 

501, of the sixth edition of the A.M.A., Guides, for right ankle sprain and determined that she 

had zero percent impairment due to no residual pain. He noted that according to Table 16-4, 

page 512, appellant had zero percent impairment to her hips because she had no complaints of 

hip pain. Dr. Blum, an OWCP medical adviser, reviewed Dr. Helsten’s May 1, 2013 report and 

agreed that appellant had no remaining symptoms of her right ankle sprain and contusion and 

bilateral hip contusions. He concluded that appellant had not sustained any permanent 

impairment from her accepted right ankle sprain and contusion and bilateral hip contusion. 

Based on the opinions of both appellant’s treating physician and the medical adviser, the Board 

finds that appellant has not established a schedule award claim for bilateral lower extremities. 

In the same report, Dr. Helsten referred to Table 7-4, page 139, for bladder disease and 

determined that appellant had 29 percent whole person impairment for neurogenic bladder and 

retention of urine. He used Table 6-6, page 116, and opined that she had 28 whole percent 

impairment for incontinence of feces and neurogenic bowel. Dr. Helsten applied the Combined 

Values Chart and concluded that appellant had combined 49 percent whole person impairment 

for bowel and bladder dysfunction. 

Dr. Blum reviewed Dr. Helsten’s May 1, 2013 report and also noted that, while 

Dr. Helsten’s calculations might have been correct, but OWCP regulations provided a schedule 

award only for impairments to scheduled members of the body. He stated that anal disease 

(neurogenic bowel), bladder disease (neurogenic bladder) and “whole person” were not 

scheduled members under FECA. Accordingly, Dr. Blum concluded that he was unable to 

recommend any impairment for appellant based on an impairment of anal disease, bladder 

disease, or “whole person.” 

 10 Id. at § 8122(c)(22). 

11 20 C.F.R. § 10.404(a); Marilyn S. Freeland, 57 ECAB 607 (2006). 

12 Supra note 9; D.J., Docket No. 11-1359 (issued February 24, 2012). 
7

As previously stated neither FECA nor OWCP’s implementing regulations provide for a 

schedule award for the bladder or the bowel.13 A schedule award is not payable for a member, 

function or organ of the body not specified in FECA or in the implementing regulations.14 

FECA does not allow OWCP to add organs or functions to the compensation schedule on a caseby-case basis and the Board lacks authority to enlarge the provisions of the statute or 

regulations.15 The Board finds, therefore, that appellant is not entitled to a schedule award for 

permanent impairment to the bowel or bladder.16 

On appeal, counsel argued that Dr. Helsten’s reports did meet the requirements for a 

schedule award. She asserted that the medical evidence demonstrated that appellant suffered 

more medical conditions than had been accepted, including pudendal nerve neuropathies. 

Counsel maintained that, if OWCP had accepted these conditions, appellant would have received 

a schedule award based on the designation of “unspecified symptoms associated with female 

genital organs.” She contended that appellant suffered from both bladder and bowel disease as a 

consequence of this diagnosis. The Board notes that to be eligible for a schedule award an 

employee must establish that the claimed impairment is causally related to the accepted work 

injury.17 To the extent that OWCP has not accepted that appellant sustained pudendal nerve 

condition as a result of the January 10, 2008 employment incident, she is not entitled to a 

schedule award for impairment related to this condition. 

Counsel further cited S.S. v. U.S. Postal Service18 and B.C. v. U.S. Postal Service19 as 

evidence that OWCP had granted schedule awards for permanent impairment due to a 

combination of bladder and other conditions. The Board in both cases pointed out that FECA 

and its implementing regulations do not allow a schedule award for the bladder. Accordingly, 

the employees in both cases did not receive a schedule award for bladder conditions but for their 

other accepted conditions that were scheduled members under FECA. 

In the alternative counsel argued that a conflict in medical opinion existed between 

Dr. Helsten, appellant’s treating physician, and Dr. Blum, the medical adviser, regarding whether 

appellant sustained a permanent impairment and that her claim should be referred to a Boardcertified urologist to resolve the conflict. The Board finds that a medical conflict does not exist 

which would warrant referral to an impartial medical specialist. The Board notes that Dr. Blum 

agreed with Dr. Helsten’s calculations regarding permanent impairment. However, the issue is 

not medical in nature, rather it is legal because neither FECA nor OWCP’s implementing 

regulations provide for a schedule award for the bladder or the bowel. Thus, regardless of 

 13 Supra note 12.

14 A.M.A., Guides 494-531; see also L.W., Docket No. 13-715 (issued June 14, 2013). 

15 Janet C. Anderson, 54 ECAB 394 (2003). 

16 See D.K., Docket No. 12-1190 (issued June 17, 2013). 

17 R.A., Docket No. 8-1301 (issued March 5, 2009). 

18 Docket No. 14-272 (issued July 8, 2014). 

19 Docket No. 13-1855 (issued July 22, 2014). 
8

whether Dr. Helsten properly calculated appellant’s impairment for her accepted bladder and 

bowel conditions, FECA does not authorized for a schedule award for these conditions. 

CONCLUSION 

The Board finds that appellant has not sustained a ratable impairment of the lower 

extremities, bladder, and bowel due to her accepted January 10, 2008 employment injury 

entitling her to a schedule award. 

ORDER 

IT IS HEREBY ORDERED THAT the January 7, 2015 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: July 14, 2015 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 James A. Haynes, Alternate Judge 

 Employees’ Compensation Appeals Board