United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

B.W., Appellant

and

U.S. POSTAL SERVICE, ROCKFORD 

CARRIER ANNEX, Rockford, MI, Employer

__________________________________________

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Docket No. 19-0370

Issued: October 10, 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 December 10, 2018 appellant filed a timely appeal from a November 15, 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 November 15, 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 seven 

percent permanent impairment of the left upper extremity, for which she previously received a 

schedule award. 

FACTUAL HISTORY

On January 17, 2017 appellant, then a 59-year-old sales, services and distribution associate, 

filed a traumatic injury claim (Form CA-1) alleging that she injured her left shoulder that morning 

when she slipped on ice in the employing establishment parking lot while in the performance of 

duty.

3

 She stopped work following the incident and returned to full-time, modified-duty 

employment on January 19, 2017. OWCP accepted appellant’s claim for left biceps tendon strain, 

left trapezius strain, and left rotator cuff tear. 

On June 25, 2018 appellant filed a claim for a schedule award (Form CA-7). 

Appellant submitted a June 12, 2018 impairment rating by Dr. Mark A. Seldes, a Boardcertified family practitioner. Dr. Seldes reviewed appellant’s medical records and related her 

complaints of continued daily left shoulder pain with significant limited range of motion. Upon 

examination of her left shoulder, he observed moderate tenderness to palpation over the anterior, 

lateral, and posterior aspects. Neer’s and Hawkin’s tests were positive. Dr. Seldes indicated that 

range of motion testing was completed after initial warm-up and performed three times. He 

explained that the findings were the same each time and reported 75 degrees flexion, 10 degrees 

extension, 65 degrees abduction, 10 degrees adduction, 30 degrees external rotation, and 0 degrees 

internal rotation. Dr. Seldes diagnosed internal derangement of the left shoulder joint, left shoulder 

impingement syndrome, and torn rotator cuff of the left shoulder joint. He noted a QuickDASH 

score of 73. Dr. Seldes opined that appellant had reached maximum medical improvement (MMI) 

as of June 12, 2018.

Referring to Table 15-5, Shoulder Regional Grid, of the sixth edition of the American 

Medical Association, Guides to the Evaluation of Permanent Impairment (A.M.A., Guides),4

Dr. Seldes selected a class 1 diagnosis-based impairment (DBI) for a rotator cuff tear. He 

explained that the maximum impairment rating under the DBI methodology is five percent 

permanent impairment. Dr. Seldes related that, as an alternative, a range of motion (ROM) 

impairment method may be assessed using section 15.7. Utilizing Table 15-34, Shoulder Range 

of Motion, he reported that appellant had nine percent permanent impairment for 75 degrees 

flexion, two percent permanent impairment for 10 degrees extension, six percent permanent 

impairment for 65 degrees abduction, one percent permanent impairment for 10 degrees adduction, 

two percent permanent impairment for 30 degrees external rotation, and four percent permanent 

impairment for 0 degrees internal rotation. Dr. Seldes calculated a combined 24 percent left upper 

extremity permanent impairment due to loss of ROM. He explained that, if more than one method 

was appropriate for rating the impairment, the method which produced the higher impairment 

 

3 Appellant lost her balance, but was able to avoid falling to the ground.

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

rating should be adopted. As the ROM method resulted in 24 percent permanent impairment and 

the DBI method resulted in a maximum of 5 percent permanent impairment, Dr. Seldes concluded 

that the higher impairment rating of 24 percent based on loss of ROM should be applied to 

appellant’s case.

In a development letter dated August 15, 2018, OWCP advised appellant of the type of 

evidence needed to establish her schedule award claim, including a statement from her attending 

physician that the accepted condition had reached MMI and an impairment rating utilizing the 

appropriate portions of the A.M.A., Guides. It afforded her 30 days to submit the necessary 

evidence. OWCP subsequently received another copy of Dr. Seldes’ June 12, 2018 impairment 

rating.

In an August 23, 2018 report, Dr. Kevin Kuhn, a Board-certified orthopedic surgeon 

serving as a district medical adviser (DMA), reviewed the medical evidence of record and noted 

the accepted conditions of strain of the left arm biceps tendon, left shoulder strain, and left shoulder 

rotator cuff tear. He opined that the ROM method, as used by Dr. Seldes in his June 12, 2018 

impairment rating, was not applicable in this case because there was lack of evidence of three 

independent measurements and the greatest ROM measurement had not been identified. Dr. Kuhn 

noted June 12, 2018 as the date of MMI.

Dr. Kuhn indicated that according to the DBI method, under Table 15-5, Shoulder Regional 

Grid, appellant had sustained a class 1 impairment (default three percent) due to residual loss for 

partial-thickness rotator cuff tear. He reported a grade modifier for functional history (GMFH) 

of 3 (QuickDASH score of 73); a grade modifier for physical examination (GMPE) of 2 (moderate 

palpatory findings); and a grade modifier for clinical studies (GMCS) of 2 (moderate pathology). 

Applying the net adjustment formula, (3-1) + (2-1) + (2-1), resulted in a net modifier of plus 4, 

which raised the default three percent value to five percent permanent impairment of the left upper 

extremity permanent impairment. For the diagnosis of left shoulder strain, Dr. Kuhn noted that 

appellant had sustained a class 1 impairment (default value 1 percent). He reported GMFH 3 

(QuickDASH score); GMPE 2 (moderate palpatory findings); and GMCS 2 (moderate pathology). 

Applying the net adjustment formula, (3-1) + (2-1) + (2-1), resulted in a net modifier of plus 4, 

which raised the default one percent value to two percent permanent impairment of the left upper 

extremity impairment. Dr. Kuhn combined the two DBI-based impairment ratings for a total of 

seven percent left upper extremity permanent impairment. 

In a September 7, 2018 report, Dr. Seldes noted his disagreement with Dr. Kuhn’s 

August 23, 2018 report that the ROM method was not applicable. He explained that in his June 12, 

2018 report, he clearly explained that ROM testing had been completed after an initial warm-up 

and was performed three times as required by the A.M.A., Guides. Dr. Seldes further related that 

since both the DBI and ROM methods could be used to rate appellant’s impairment or condition, 

the A.M.A., Guides provides that the method which produced the higher rating must be used. He 

concluded that appellant should be awarded the higher impairment rating of 24 percent based on 

loss of ROM.

In an October 2, 2018 report, Dr. Kuhn reviewed Dr. Seldes’s September 7, 2018 

supplemental report and provided an impairment rating utilizing the ROM method based on

Dr. Seldes’s measurements. Utilizing Table 15-34, Shoulder Range of Motion, he calculated that 
4

appellant had 9 percent permanent impairment for 75 degrees with grade 1 modifier, 2 percent 

permanent impairment for 10 degrees extension with grade 0 modifier, 6 percent permanent 

impairment for 65 degrees abduction with grade 1 modifier, 2 percent permanent impairment for 

10 degrees adduction with grade 0 modifier, 8 percent permanent impairment for 0 degrees internal 

rotation with grade 0 modifier, and 9 percent permanent impairment for 30 degrees external 

rotation with grade 0 modifier, for a total left upper extremity impairment of 36 percent. Dr. Kuhn

further explained that since the ROM modifier and GMFH with the DBI method were both 3, there 

was no modification of appellant’s impairment rating and the impairment rating remained 

unchanged at seven percent permanent left upper extremity impairment under the DBI method. 

He contended that Dr. Seldes failed to convert the total ROM deficit into a ROM modifier and 

recommended that Dr. Seldes refer to example 15-25 on pages 477 and 478 of the A.M.A., Guides.

Dr. Kuhn determined that according to Table 15-5, Shoulder Regional Grid, appellant had a 

combined seven percent permanent impairment of the left upper extremity due to diagnoses of left 

shoulder rotator cuff tear and left shoulder strain. 

By decision dated November 15, 2018, OWCP granted appellant a schedule award for 

seven percent permanent impairment of the left upper extremity, based on the DMA’s October 2, 

2018 report. The period of the award ran for 21.84 weeks from June 12 to November 11, 2018. 

LEGAL PRECEDENT

The schedule award provisions of FECA,5 and its implementing federal regulations,6 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.7 As of May 1, 2009, the 

sixth edition of the A.M.A., Guides is used to calculate schedule awards.8

In determining impairment for the upper extremities under the sixth edition of the A.M.A., 

Guides, an evaluator must establish the appropriate diagnosis for each part of the upper extremity 

to be rated. With respect to the shoulder, reference is made to Table 15-5 (Shoulder Regional 

Grid).9 After the class of diagnosis (CDX) is determined from the Shoulder Regional Grid 

(including identification of a default grade value), the impairment class is then adjusted by grade 

 

5

5 U.S.C. § 8107.

6

20 C.F.R. § 10.404.

7

Id. at § 10.404(a).

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

2.808.5(a) (March 2017); Federal (FECA) Procedure Manual, Part 3 -- Medical, Schedule Awards, Chapter 3.700.2 

and Exhibit 1 (January 2010).

9 A.M.A., Guides 401-05.
5

modifiers of functional history, physical examination, and clinical studies.

10

 The net adjustment 

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

FECA Bulletin No. 17-0612 provides guidance in applying ROM or DBI methodologies in 

rating permanent impairment of the upper extremities.13 Regarding the application of ROM or 

DBI 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 

determination of impairment, the CE [claims examiner] 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.,] 

Guidesidentify 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.”

14 (Emphasis in the original.)

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. 

“If the medical evidence of record is not sufficient for the DMA to render a rating 

on ROM where allowed, the DMA should advise as to the medical evidence 

necessary to complete the rating. However, the DMA should still render an 

impairment rating using the DBI method, if possible, given the available 

evidence.”

15

 

10 Id. at 383-492.

11 Id. at 411.

12 The FECA Bulletin No. 17-06 advises that, if the A.M.A., Guides allows 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 claims examiner. See FECA Bulletin No. 17-06 (issued May8, 2017); see also D.F.,Docket 

No. 17-1474 (issued January 26, 2018).

13 J.M., Docket No. 18-1387 (issued February 1, 2019).

14 V.L., Docket No. 18-0760 (issued November 13, 2018); FECA Bulletin No. 17-06 (May 8, 2018). 

15 Id.
6

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 impairment in 

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

impairment specified.

ANALYSIS

The Board finds that appellant has established that she has 24 percent permanent 

impairment of the left upper extremity. 

OWCP accepted appellant’s claim for left biceps tendon strain, left trapezius strain, and 

left rotator cuff tear as causally related to a January 17, 2017 employment injury. On 

November 15, 2018 it granted her a schedule award for seven percent permanent impairment of 

the left upper extremity based on the DMA’s October 2, 2018 report. In his October 2, 2018 

supplemental report, the DMA calculated 36 percent upper extremity permanent impairment under 

Table 15-34 based on Dr. Seldes’ June 12, 2018 left shoulder ROM measurements.16 Instead of 

providing a stand-alone rating based on appellant’s left shoulder ROM deficits, he treated 

appellant’s ROM deficit as a GMFH of 3, which he noted was equal to the previous grade modifier 

assigned (3) based on appellant’s QuickDASH score. As such, the DMA concluded that there was 

no basis to modify his prior DBI rating of seven percent left upper extremity impairment due to 

appellant’s shoulder strain and partial rotator cuff tear.

The Board finds, however, that the DMA erred in at least two respects. First, it was 

improper to combine impairments based on two separate diagnoses within the same shoulder 

regional grid.17 Second, the DMA’s October 2, 2018 impairment rating is inconsistent with FECA 

Bulletin No. 17-06, which provides in pertinent part that 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.18 Because the DMA did not provide an 

impairment rating consistent with the A.M.A., Guides based upon ROM or DBI methodology, his 

opinion is of diminished probative value.19

In support of her schedule award claim, appellant submitted a June 12, 2018 impairment 

rating report by Dr. Seldes. Dr. Seldes reviewed appellant’s history and conducted an examination 

of appellant’s left shoulder. He indicated that ROM testing was completed after initial warm-up 

and performed three times. Dr. Seldes noted that appellant had reached MMI as of June 12, 2018. 

Referring to Table 15-5, Shoulder Regional Grid, of the A.M.A., Guides, he selected a class 1 DBI

for a rotator cuff tear. He explained that the maximum impairment rating under the DBI 

methodology is five percent permanent impairment. Dr. Seldes related that, as an alternative, a 

 

16 A.M.A., Guides 475 (6th ed. 2009).

17 Dr. Seldes provided a DBI rating based on a diagnosis of rotator cuff tear, whereas the DMA incorrectly rated 

appellant for both rotator cuff tear and shoulder strain.

18 Supra note 12.

19 M.D., Docket No. 19-0510 (issued August 6, 2019); G.S., Docket No. 13-1649 (issued December 24, 2013); 

Mary L. Henninger, 52 ECAB 408 (2001).
7

ROM impairment method may be assessed using Section 15.7. Utilizing Table 15-34, Shoulder 

Range of Motion, he reported that appellant had 9 percent permanent impairment for 75 degrees 

flexion, 2 percent permanent impairment for 10 degrees extension, 6 percent permanent 

impairment for 65 degrees abduction, 1 percent permanent impairment for 10 degrees adduction, 

2 percent permanent impairment for 30 degrees external rotation, and 4 percent permanent 

impairment for 0 degrees internal rotation for a combined 24 percent left upper extremity 

permanent impairment due to loss of ROM. 

The Board finds that Dr. Seldes properly utilized the A.M.A., Guides in determining that 

appellant had 24 percent permanent impairment of the left upper extremity. Dr. Seldes correctly 

referenced Table 15-5 and determined that, under the DBI methodology for a rotator cuff tear, the 

maximum impairment rating is 5 percent. He also correctly assessed that, as an alternative, a ROM 

impairment may be used. The Board notes that Dr. Seldes performed three ROM tests, explained 

his calculations for loss of ROM under Table 15-34, and properly determined that appellant had 

24 percent left upper extremity impairment due to loss of ROM. Dr. Seldes explained that as the 

ROM method provided the higher impairment rating, appellant was entitled to a schedule award 

for 24 percent left upper extremity permanent impairment. The Board finds that he properly 

applied the standards of the A.M.A., Guides and his opinion is sufficiently well rationalized and 

based upon a proper factual and medical background. As he properly calculated that appellant had 

24 percent left upper extremity impairment under the ROM method, the Board finds that appellant 

is entitled to an additional award of 17 percent.20 Accordingly, the November 15, 2018 schedule 

award shall be modified to reflect entitlement to an additional 17 percent permanent impairment 

of the left upper extremity, for a total permanent impairment of 24 percent. 

CONCLUSION

The Board finds that appellant has established that she has 24 percent permanent 

impairment of the left upper extremity. OWCP previously awarded 7 percent permanent 

impairment, and therefore, appellant is entitled to an additional schedule award for 17 percent 

permanent impairment for her left upper extremity.

 

20 See Federal (FECA) Procedure Manual,supra note 8at Chapter 2.808.5 (March 2017).
8

ORDER

IT IS HEREBY ORDERED THAT the November 15, 2018 decision of the Office of 

Workers’ Compensation Programs is affirmed as modified.

Issued: October 10, 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