United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

F.G., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

St. Louis, MO, Employer

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Docket No. 19-0494

Issued: August 16, 2019

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

CHRISTOPHER J. GODFREY, Chief Judge

JANICE B. ASKIN, Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On January 8, 2019 appellant filed a timely appeal from an October 2, 2018 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.2

 

1 5 U.S.C. § 8101 et seq.

2 The Board notes that, following the October 2, 2018 decision, OWCP received additional evidence. However, 

the Board’s Rules of Procedure provides: “The Board’s review of a case is limited to the evidence in the case record 

that was before OWCP at the time of its final decision. Evidence not before OWCP will not be considered by the 

Board for the first time on appeal.” 20 C.F.R. § 501.2(c)(1). Thus, the Board is precluded from reviewing this 

additional evidence for the first time on appeal. Id.
2

ISSUE

The issue is whether appellant has met her burden of proof to establish more than 19 percent 

permanent impairment of her right upper extremity, for which she previously received schedule 

award compensation.

FACTUAL HISTORY

On March 7, 2014 appellant, then a 46-year-old letter carrier, filed a traumatic injury claim 

(Form CA-1) alleging that on that day she sustained right side upper extremity injuries when she 

slipped and fell on a sheet of ice while in the performance of duty. OWCP accepted the claim for 

right shoulder and upper arm contusions and right shoulder impingement syndrome. Appellant 

underwent OWCP-authorized right shoulder arthroscopies on December 26, 2016 and 

June 5, 2017.

In a December 26, 2017 report with a December 28, 2017 addendum, Dr. Donald Weimer, 

a Board-certified orthopedic surgeon, indicated that he had performed appellant’s June 5, 2017 

surgical procedure and opined that appellant had reached maximum medical improvement (MMI). 

He indicated that she could return to work on December 27, 2017 in a light-duty position.

On January 9, 2018 appellant filed a claim for a schedule award (Form CA-7).

In a January 18, 2018 development letter, OWCP requested that appellant provide a 

detailed narrative medical report from Dr. Weimer, based on a recent examination, which included 

impairment ratings under the sixth edition of the American Medical Association, Guides to the 

Evaluation of Permanent Impairment (A.M.A., Guides).3 It requested that Dr. Weimer 

independently calculate the impairment using both the diagnosis-based impairment (DBI) and 

range of motion (ROM) method, if allowed by the A.M.A., Guides, and identify the higher rating. 

OWCP afforded appellant 30 days to submit the required medical evidence.

In January 25 and February 14, 2018 letters, appellant informed OWCP that Dr. Weimer 

did not perform permanent impairment evaluations.

On March 20, 2018 OWCP referred appellant, a statement of accepted facts (SOAF), and 

a list of questions to Dr. Richard T. Katz, a Board-certified physiatrist, for a second opinion 

impairment evaluation. In his April 27, 2018 report, Dr. Katz noted appellant’s history of injury, 

reviewed the medical records and the SOAF, and provided examination findings. He indicated 

that she had multiple conditions of the right shoulder, which included impingement syndrome,

adhesive capsulitis, subacromial adhesions, subacromial impingement, partial tear of the long 

tendon of the biceps, contusion of shoulder and upper arm, right glenohumeral chondromalacia, 

partial thickness tear of supraspinatus and subscapularis tendon, and acromioclavicular arthritis. 

Dr. Katz opined that MMI was reached on December 26, 2017 when appellant had optimally 

recovered from surgery, completed extensive physical therapy, and completed a functional 

capacity evaluation. Since appellant had multiple shoulder diagnoses and impaired ROM, he 

indicated that the ROM methodology should be used to calculate her right upper extremity 

 

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

impairment. Dr. Katz indicated that three active ROM measurements were recorded after a warm 

up and that all measurements fell within 10 degrees of the mean. Under Table15-34, shoulder 

range of motion, he found 80 degrees flexion equaled 9 percent impairment, 50 degrees extension 

equaled 0 percent impairment, 60 degrees abduction equaled 6 percent impairment, 50 degrees 

adduction equaled 0 percent, external rotation 0 degrees equaled 4 percent impairment, and internal 

rotation 90 degrees equaled 0 percent impairment for 19 percent total permanent impairment. 

Under Table 15-36, functional history grade adjustment: range of motion, Dr. Katz assigned a 

grade modifier 2 and a grade modifier 4 based on appellant’s QuickDASH score of 4.

4

 He then 

increased her 19 percent impairment rating by multiplying the 19 percent total ROM impairment 

by 10 percent and concluded that she had a final right upper extremity ROM permanent impairment 

of 20.9 percent, which rounded up to 21 percent.

On July 29, 2018 Dr. James W. Butler, a Board-certified occupational medicine specialist 

serving as the district medical adviser (DMA), reviewed the medical evidence of record along with

Dr. Katz’s impairment report. He indicated that MMI was reached on April 27, 2018, the date

Dr. Katz performed appellant’s impairment evaluation. For appellant’s right upper extremity 

conditions, the DMA indicated that the A.M.A., Guides provided impairments based on either 

ROM or DBI methodology and that the schedule award should be based on the higher of the two 

impairment calculations. He provided calculations under both methodologies and opined that 

appellant had 19 percent right upper extremity impairment under the ROM methodology, which 

yielded the higher rating of permanent impairment. 

Under the DBI methodology, the DMA determined that appellant had acromioclavicular 

(AC) joint injury or disease status post distal clavicle resection or AC separation type III (complete 

disruption AC joint capsule and coracoclavicular ligaments)5class 1, grade E or 12 percent final 

right upper extremity impairment. He determined the grade modifier for functional history 

(GMFH) was not applicable as it was two classes above the assigned class. The DMA assigned 

grade modifiers 2 for physical examination (GMPE) and clinical studies (GMCS) and applied the 

net adjustment formula (GMFH-CDX)(n/a) + (GMPE-CDX)(2-1) + (GMCS-CDX)(2-1) to find 

+2 net adjustment, which moved the default grade C to grade E or 12 percent. He provided his 

calculations and cited to appropriate Tables within the A.M.A., Guides.

The DMA also determined that Dr. Katz provided valid ROM measurements. He agreed 

that Dr. Katz’s impairment measurements resulted in 19 percent total upper extremity impairment,

but disagreed with the final ROM impairment rating of 21 percent. The DMA indicated that

Dr. Katz inappropriately utilized the GMFH under Table 15-36 in his ROM calculation. He 

explained that, as appellant’s GMFH of 4 differed 2 or more grades from that described by physical 

examination or clinical studies, pursuant to section 15.3a of the A.M.A., Guides, the functional 

history findings should be determined to be inconsistent or unreliable with other documentation 

 

4 Table 15-36, page 477 of the sixth edition of the A.M.A., Guides is entitled, Functional History Grade Adjustment: 

Range of Motion.

5

Id. at 402, Table 15-5.
4

and should be excluded from the grading process.

6

 Thus, the DMA found that appellant’s total 

right upper extremity permanent impairment under the ROM methodology was 19 percent.

By decision dated September 26, 2018, OWCP granted appellant a schedule award for 19 

percent permanent impairment of her right upper extremity. The award ran for 59.28 weeks for

the period April 27 to June 15, 2018. By decision dated October 2, 2018, OWCP issued an 

amended award letter adjusting the period of the schedule award for 19 percent upper extremity 

permanent impairment to reflect that the period of the award was from April 27 to 

September 15, 2018.

LEGAL PRECEDENT

The schedule award provisions of FECA,7and its implementing federal regulations,8set 

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.9 As of May 1, 2009, the 

sixth edition of the A.M.A., Guides is used to calculate schedule awards.10

In addressing upper extremity impairments, the sixth edition requires identification of the 

impairment class of diagnosis (CDX) condition, which is then adjusted by GMFH, GMPE, and 

GMCS. The net adjustment formula is (GMFH - CDX) + (GMPE - CDX) + (GMCS - CDX).11 

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

choices of diagnoses from regional grids and calculations of modifier scores.12

Regarding the application of ROM or DBI impairment methodologies in rating permanent 

impairment of the upper extremities, FECA Bulletin No. 17-06 provides: 

“As the A.M.A., Guides caution that, if it is clear to the evaluator evaluating loss 

of ROM that a restricted ROM has an organic basis, three independent 

measurements should be obtained and the greatest ROM should be used for the 

 

6 Section 15-3a, page 406 of the sixth edition of the A.M.A., Guides is entitled, Adjustment Grid: Functional 

History. 

7 5 U.S.C. § 8107.

8 20 C.F.R. § 10.404.

9

Id. at § 10.404(a).

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

2.808.6(a) (March 2017); see also Part 3 -- Medical, Schedule Awards, Chapter 3.700.2 and Exhibit 1 (January 2010).

11 A.M.A., Guides 411.

12 R.R., Docket No. 17-1947 (issued December 19, 2018); R.V., Docket No. 10-1827 (issued April 1, 2011).
5

determination of impairment, the claims examiner (CE) should provide this 

information (via the updated instructions noted above) to the rating physician(s). 

“Upon initial review of a referral for upper extremity impairment evaluation, the 

DMA should identify: (1) the methodology used by the rating physician (i.e., DBI 

or ROM); and (2) whether the applicable tables in Chapter 15 of the A.M.A., 

Guides identify a diagnosis that can alternatively be rated by ROM. If the A.M.A., 

Guides allow for the use of both the DBI and ROM methods to calculate an 

impairment rating for the diagnosis in question, the method producing the higher 

rating should be used.” (Emphasis in the original).

13

The Bulletin further advises: 

“If the rating physician provided an assessment using the ROM method and the 

A.M.A., Guides allow for use of ROM for the diagnosis in question, the DMA 

should independently calculate impairment using both the ROM and DBI methods 

and identify the higher rating for the CE.”

14

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

should be routed to a DMA for an opinion concerning the nature and percentage of impairment in 

accordance with the A.M.A., Guides, with the DMA providing rationale for the percentage of 

permanent impairment specified.15

ANALYSIS

The Board finds that appellant has not met her burden of proof to establish more than 19 

percent permanent impairment of her right upper extremity, for which she previously received 

schedule award compensation.

As appellant’s treating physician did not perform impairment evaluations, OWCP referred 

appellant for a second opinion evaluation with Dr. Katz. In his April 27, 2018 report, Dr. Katz 

found that appellant had reached MMI due to her accepted conditions and had 21 permanent 

impairment based on ROM methodology. ROM measurements were provided after three 

measurements for appellant’s right shoulder were taken consistent with the requirements set forth 

in the A.M.A., Guides and FECA Bulletin No. 17-06.

In accordance with its procedures, OWCP properly referred the evidence of record to its 

DMA, who reviewed the clinical findings of Dr. Katz. In his July 29, 2018 report, the DMA found 

that appellant reached MMI as of April 27, 2018, the date of Dr. Katz’s impairment evaluation. 

He calculated appellant’s permanent impairment using both DBI and ROM methodology and 

found that the ROM methodology resulted in the higher impairment rating. The DMA determined 

 

13 FECA Bulletin No. 17-06 (May 8, 2017).

14 Id.

15 See P.R., Docket No. 18-0022 (issued April 9, 2018); Federal (FECA) Procedure Manual, Part 2 -- Claims, 

Schedule Awards and Permanent Disability Claims, Chapter 2.808.6f (March 2017).
6

that appellant had 19 percent permanent impairment of the right upper extremity based upon

Dr. Katz’s valid ROM measurements. 

The DMA explained in his report that Dr. Katz inappropriately utilized the GMFH under 

Table 15-36 in his ROM calculation as the functional history of 4 differed by two or more grades 

from the GMPE or 2 and the GMCS of 2. Thus, he found that appellant’s total right upper 

extremity permanent impairment under the ROM methodology was 19 percent. 

The Board finds that the DMA applied the appropriate tables and grading schemes of the 

sixth edition of the A.M.A., Guides to Dr. Katz’s clinical findings and his calculations were 

mathematically accurate.16 The DMA also discussed how he arrived at his conclusion in finding 

that appellant had 19 percent permanent impairment of her right upper extremity based on the 

highest impairment methodology.

17

 Therefore, the Board finds that his opinion is given the weight 

of the medical evidence and supports that appellant does not have greater than the 19 percent 

permanent impairment of the right upper extremity.18

Accordingly, appellant has not met her burden of proof to establish that she is entitled to 

an additional schedule award.

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 employment-related 

condition resulting in permanent impairment or increased impairment. 

CONCLUSION

The Board finds that appellant has not met her burden of proof to establish more than 19 

percent permanent impairment of her right upper extremity, for which she previously received 

schedule award compensation.

 

16 See R.N., Docket No. 17-1123 (issued May 25, 2018).

17 Id. 

18 See D.T., Docket No. 18-1773 (issued April 22, 2019).
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ORDER

IT IS HEREBY ORDERED THAT the October 2, 2018 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: August 16, 2019

Washington, DC

Christopher J. Godfrey, Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board