United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

E.B., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Denver, CO, Employer

__________________________________________

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Docket No. 18-1211

Issued: February 27, 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

ALEC J. KOROMILAS, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On May 29, 2018 appellant filed for review of a May 8, 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 appellant submitted additional evidence on appeal. 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 his burden of proof to establish more than nine 

percent permanent impairment of his left lower extremity, for which he previously received a 

schedule award. 

FACTUAL HISTORY

On February 15, 2000 appellant, then a 45-year-old mail handler, filed a traumatic injury 

claim (Form CA-1) alleging that on that day he broke a bone in his left foot when a coworker ran 

an over the road (OTR) container over his foot. On April 12, 2001 OWCP accepted appellant’s 

claim for left foot strain.

3

On August 15, 2017 appellant filed a claim for a schedule award (Form CA-7).

By development letter dated September 14, 2017, OWCP requested that appellant submit 

an impairment evaluation from his attending physician in accordance with the sixth edition of the 

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

Guides).4 It afforded him 30 days to submit the necessary evidence.

In an August 7, 2017 medical note, Dr. James M. Falko, Board-certified in internal 

medicine, reported that appellant’s February 15, 2000 left foot injury had reached maximum 

medical improvement (MMI).

In support of his claim, appellant submitted a November 30, 2017 impairment rating from

Dr. Jack L. Rook, Board-certified in physical medicine and rehabilitation. Dr. Rook discussed 

appellant’s medical history, reviewed diagnostic testing, and provided findings on physical 

examination. He explained that on February 15, 2000 appellant’s left foot was injured when it was 

run over by an OTR container that was filled with mail weighing over 2,000 pounds. Dr. Rook

noted review of a February 15, 2000 x-ray that revealed suspicion for an avulsion-type fracture of 

the cuboid bone of the left foot which correlated clinically with examination findings. He noted 

that, while the claim had been accepted for left foot sprain, the medical records indicated that at 

the time of the left foot injury, appellant sustained a fracture of his left cuboid bone. As such,

Dr. Rook prepared impairment ratings for both noted diagnoses. Using Table 16-2, Foot and 

Ankle Regional Grid, of the sixth edition of the A.M.A., Guides,

5 he calculated two percent 

permanent impairment of the left lower extremity based on the diagnosis of left foot sprain.

Dr. Rook calculated seven percent permanent impairment of the left lower extremity based on the 

diagnosis of class 1 cuboid fracture with mild motion deficits.6 He assigned a grade modifier of 1 

 

3 The record reflects that appellant stopped working for the employing establishment effective August 3, 2000. By 

decision dated January 11, 2013, OWCP denied appellant’s claim for compensation for the period December 19, 1999

to July 6, 2000.

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

5

Id. at 501, Table 16-2.

6

Id. at 503.
3

for physical examination (GMPE),

7

a grade modifier of 1 for functional history (GMFH),

8

and no 

grade modifier for clinical studies (GMCS) because the diagnostic study had been used to assign 

the class. Dr. Rook reported that, following assignment of grade modifiers, application of the net 

adjustment formula resulted in no net change, amounting to seven percent permanent impairment 

of the left lower extremity. He then calculated two percent lower extremity permanent impairment 

rating “utilizing the accepted diagnosis of left foot sprain,” and seven percent permanent 

impairment rating “for the diagnosis of left cuboid fracture with residuals.” Dr. Rook reported 

that while either of these impairment ratings could be used, the greater seven percent permanent 

impairment seemed more appropriate based on review of the medical records and physical 

examination findings.

On February 1, 2018 OWCP routed Dr. Rook’s report, a statement of accepted facts 

(SOAF), and the case file to Dr. Jovito Estaris, Board-certified in occupational medicine serving 

as an OWCP district medical adviser (DMA), for review and determination regarding whether 

appellant sustained permanent impairment of the left foot and date of MMI in accordance with the 

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

In a February 7, 2018 report, Dr. Estaris reviewed the case file and Dr. Rook’s

November 30, 2017 report, finding that appellant had reached MMI on the date of his examination. 

He agreed with Dr. Rook’s diagnosis of left foot cuboid fracture resulting in a class 1 diagnosis

for mild motion deficit. Dr. Estaris also assigned a GMPE of 1 and no GMCS, but determined that

Dr. Rook should have assigned a GMFH of 2 due to appellant’s antalgic gait with use of a cane.9 

Application of the net adjustment formula amounted to one, resulting in grade D warranting 

movement one place to the right of the default value for eight percent permanent impairment of 

the left lower extremity. 

Dr. Estaris noted that while Dr. Rook had not submitted an impairment rating based on the 

range of motion (ROM) method, his examination findings provided three sets of ROM 

measurements such that impairment could be calculated. He noted that appellant’s range of motion 

was an appropriate alternative method for rating appellant’s permanent impairment, given 

appellant’s multiple diagnoses of left foot sprain and fracture. Utilizing Table 16-25, ROM ICF 

Classification, Dr. Estaris calculated nine percent permanent impairment of the left lower 

extremity based on measurements revealing decreased range of motion.

10

 He noted the range of 

motion measurements and determined that for the left foot, 10 degrees dorsiflexion yielded seven 

percent impairment, 40 degrees plantar flexion yielded zero percent impairment, 15 degrees 

inversion yielded two percent impairment, and 20 degrees eversion yielded zero percent 

impairment for a combined nine percent permanent impairment. Thus, Dr. Estaris concluded that 

appellant was entitled to the nine percent permanent impairment rating as permitted by the ROM 

method over the lesser rated diagnosis-based impairment (DBI) method.

 

7

Id. at 517, Table 16-7.

8

Id. at 516, Table 16-6.

9

Id.

10 Id. at 550, Table 16-25.
4

On March 1, 2018 OWCP expanded acceptance of the claim to include left tarsometatarsal 

ligament sprain.

By decision dated May 8, 2018, OWCP granted appellant a schedule award for nine percent 

permanent impairment of the left lower extremity. The date of MMI was found to be

November 30, 2017 and the award covered a period of 25.92 weeks from November 30, 2017 to 

May 30, 2018. The schedule award was paid at the 75 percent augmented rate for a qualifying 

dependent.

LEGAL PRECEDENT

The schedule award provision of FECA 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.11 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. 

Through its implementing regulations, OWCP adopted the American Medical Association, Guides 

to the Evaluation of Permanent Impairment as the appropriate standard for evaluating schedule 

losses.12 For schedule awards after May 1, 2009, the impairment is evaluated under the sixth 

edition of the A.M.A., Guides, published in 2009.13

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 (ICF).

14

 Under the sixth edition, the evaluator identifies the impairment class of 

diagnosis (CDX) condition, which is then adjusted by grade modifiers including GMFH, GMPE, 

and GMCS.15 The net adjustment formula is (GMFH-CDX) + (GMPE-CDX) + (GMCS-CDX). 

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

choices of diagnoses from regional grids and calculations of modifier scores.16

OWCP’s 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 permanent 

 

11 5 U.S.C. § 8107; 20 C.F.R. § 10.404.

12 20 C.F.R. § 10.404. See also Ronald R. Kraynak, 53 ECAB 130 (2001).

13 See D.T., Docket No. 12-0503 (issued August 21, 2012); Federal (FECA) Procedure Manual, Part 2 -- Claims, 

Schedule Awards and Permanent Disability Claims, Chapter 2.808.6.6a (March 2017); see also Part 3 -- Medical, 

Schedule Awards, Chapter 3.700.2 and Exhibit 1 (January 2010).

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

(ICF): A Contemporary Model of Disablement.

15 Id. at 494-531.

16 C.M., Docket No. 17-1692 (issued December 14, 2018). 
5

impairment in accordance with the A.M.A., Guides with a DMA providing rationale for the 

percentage of impairment specified.17

ANALYSIS

The Board finds that appellant has not met his burden of proof to establish more than nine

percent permanent impairment of the left lower extremity, for which he previously received a 

schedule award.

18

 

In support of his schedule award claim, appellant submitted a November 30, 2017 report 

from Dr. Rook who determined that review of the medical record and physical examination 

findings established a work-related fracture of appellant’s left cuboid bone as a result of his

February 15, 2000 employment injury. Dr. Rook calculated seven percent permanent impairment 

of the left lower extremity using the DBI methodology based on a class 1 diagnosis of left cuboid 

fracture with mild motion deficits. 

The case file and Dr. Rook’s report was routed to Dr. Estaris, serving as an OWCP DMA,

who determined that appellant had reached MMI on November 30, 2017. Dr. Estaris noted 

appellant’s diagnosis of left foot strain and agreed with Dr. Rook’s diagnosis of left foot cuboid 

fracture resulting in class 1 for mild motion deficit. He also assigned a GMPE of 1 and no GMCS, 

but determined that Dr. Rook should have assigned a GMFH of 2 due to appellant’s antalgic gait 

with use of a cane.19 Dr. Estaris properly explained that application of the net adjustment formula

for a class 1 cuboid fracture with mild motion deficits resulted in eight percent permanent 

impairment of the left lower extremity.

20

 

The A.M.A., Guides explain that if there are multiple diagnoses of a lower extremity 

impairment at the time of MMI, the evaluating physician must determine which method best 

describes the impairment of a specific individual based on patient history and physical 

examination.21 When uncertain about which method to use (e.g., DBI or ROM), the evaluator 

should calculate the impairment using both alternatives and choose the method or combination of 

methods that gives the most clinically accurate permanent impairment rating.22 The evaluating 

physician must explain, in writing, the rationale for the rating methodology used.23

 

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

Chapter 2.808.6(f) (March 2017).

18 W.R., Docket No. 13-0492 (issued June 26, 2013).

19 Supra note 7.

20 R.V., Docket No. 17-0731 (issued June 7, 2017).

21 A.M.A., Guides 529. 

22 Id.; see also T.T., Docket No. 09-1379 (issued March 10, 2010). 

23 Id. 
6

The Board notes that Dr. Estaris explained that the ROM methodology provided the most 

accurate impairment evaluation, given appellant’s left foot diagnosis.24 Dr. Estaris also correctly 

noted that appellant’s impairment rating could be calculated using the ROM method as Dr. Rook’s

examination findings provided three sets of range of motion measurements.25 The DMA identified

the range of motion measurements determining that for the left foot, 10 degrees dorsiflexion 

yielded seven percent impairment, 40 degrees plantar flexion yielded zero percent impairment, 15 

degrees inversion yielded two percent impairment, and 20 degrees eversion yielded zero percent 

impairment for a combined nine percent permanent impairment of the left lower extremity.

26

 

Appellant has not established that he has more than nine percent permanent impairment of 

the left lower extremity as the record does not contain a medical report in which a greater rating 

of permanent impairment has been provided. Accordingly, he has failed to meet his burden of 

proof.

On appeal appellant arguesthat he was entitled to continuing compensation for his accepted 

disability as he had been unable to return to any type of work since his left foot was crushed on 

February 15, 2000. The Board notes that its jurisdiction is limited to reviewing the issue before it 

from OWCP’s May 8, 2018 schedule award decision. Appellant further argues that he had a child 

who was in college and he had filed the requisite forms establishing dependency. The Board notes 

OWCP’s May 8, 2018 decision reflected that his award was paid at the 75 percent augmented 

compensation rate for qualifying dependents. 

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 his burden of proof to establish more than nine

percent permanent impairment of the left lower extremity, for which he previously received a 

schedule award. 

 

24 Supra note 22.

25 D.W., Docket No. 17-1092 (issued October 22, 2018).

26 Supra note 3 at 549.
7

ORDER

IT IS HEREBY ORDERED THAT the May 8, 2018 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: February 27, 2019

Washington, DC

Christopher J. Godfrey, Chief Judge

Employees’ Compensation Appeals Board

Alec J. Koromilas, Alternate Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board