United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

L.L., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Clinton, IA, Employer

__________________________________________

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Docket No. 19-0855

Issued: September 24, 2019

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

PATRICIA H. FITZGERALD, Deputy Chief Judge

JANICE B. ASKIN, Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On March 15, 2019 appellant filed a timely appeal from a February 28, 2019 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 greater than 

17 percent permanent impairment of the right upper extremity, for which she received schedule 

award compensation.

FACTUAL HISTORY

On January 11, 2016 appellant, then a 54-year-old city carrier, filed a traumatic injury 

claim (Form CA-1) alleging that on that date she injured her right wrist while in the performance 

 

1 5 U.S.C. § 8101 et seq.
2

of duty. OWCP accepted the claim for unspecified fractures of the lower end of the right radius 

and right ulna. It subsequently expanded acceptance of appellant’s claim to include an incomplete 

rotator cuff tear or rupture of the right shoulder and unspecified complications of medical care. 

On January 28, 2016 appellant underwent a closed reduction and percutaneous pinning of 

her right distal radius fracture. On September 13, 2016 she underwent a right rotator cuff repair, 

subacromial decompression, and resection of the acromioclavicular (AC) joint. 

On May 23, 2017 appellant filed a claim for a schedule award (Form CA-7). 

In a development letter dated June 6, 2017, OWCP requested that appellant submit an 

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

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

Guides).2 

In a June 14, 2017 impairment evaluation, Dr. Tuvi Mendel, a Board-certified orthopedic 

surgeon, measured range of motion (ROM) of appellant’s bilateral shoulders and wrists. He found 

that she had 3 percent permanent impairment of the upper extremity due to her wrist fracture and 

12 percent impairment of the upper extremity due to her shoulder condition. Dr. Mendel rated 

appellant’s impairment using the fifth edition of the A.M.A., Guides.

3

 

On July 31, 2017 Dr. David J. Slutsky, a Board-certified orthopedic surgeon serving as a 

district medical adviser (DMA), reviewed the evidence and opined that appellant had two percent 

permanent impairment of the right upper extremity due to her nondisplaced distal radius fracture 

using the diagnosis-based impairment (DBI) method set forth in the sixth edition of the A.M.A., 

Guides. He further found 10 percent permanent impairment of the right upper extremity due to 

her right rotator cuff tear with AC joint resection using the DBI method.

By decision dated August 17, 2017, OWCP granted appellant a schedule award for 

12 percent permanent impairment of the right upper extremity. 

On September 1, 2017 appellant requested a telephonic hearing before a representative of 

OWCP’s Branch of Hearings and Review. 

Following a preliminary review, by decision dated December 15, 2017, OWCP’s hearing 

representative vacated the August 17, 2017 decision. He instructed OWCP to obtain a 

supplemental report from the DMA addressing the extent of appellant’s upper extremity 

impairment due to loss of ROM in accordance with FECA Bulletin No. 17-06.4

 

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

3 A.M.A., Guides (5th ed. 2001).

4 FECA Bulletin No. 17-06 (May 8, 2017).
3

On January 16, 2018 Dr. Slutsky advised that the ROM measurements obtained by

Dr. Mendel failed to conform to the provisions of the sixth edition of the A.M.A., Guides for 

assessing motion. 

On January 23, 2018 OWCP requested that appellant have her physician review the DMA’s 

January 17, 2018 report and indicate whether his ROM measurements conformed to the sixth 

edition of the A.M.A., Guides. It afforded her 30 days to submit the requested evidence.

In a February 1, 2018 response, appellant related that her physician only provided 

impairment ratings using the fifth edition of the A.M.A., Guides. 

On March 27, 2018 OWCP referred appellant to Dr. Farid Manshadi, a Board-certified 

physiatrist, for a second opinion examination. 

In a report dated April 26, 2018, Dr. Manshadi discussed appellant’s January 11, 2016 

employment injury. He measured ROM of the bilateral wrists and shoulders three times and 

obtained the average measurement. For the right wrist, Dr. Manshadi measured extension of 

54 degrees, flexion of 53 degrees, radial deviation of 22 degrees, and ulnar deviation of 30 degrees. 

He measured right shoulder forward flexion of 135 degrees, extension of 58 degrees, abduction of 

11 degrees, external rotation of 71 degrees, internal rotation of 68 degrees, and adduction of 

45 degrees. Dr. Manshadi further measured passive ROM of the right shoulder as 150 degrees 

flexion, 150 degrees abduction, and 65 degrees extension. Using Table 15-3 on page 396 of the 

A.M.A., Guides, he identified the diagnosis as a wrist fracture, which yielded a default value of 

three percent. Dr. Manshadi applied a grade modifier for functional history (GMFH) of two, a 

grade modifier for physical examination (GMPE) of one, and determined that a grade modifier for 

clinical studies (GMCS) was inapplicable. He applied the net adjustment formula to find four 

percent permanent impairment of the right upper extremity due to appellant’s wrist fracture. 

For the right shoulder, Dr. Manshadi identified the CDX as an AC joint injury after a distal 

clavicle resection or AC joint separation using Table 15-5 on page 403, which yielded a default 

value of 10 percent. He found a GMFH of two, a GMPH of two, and that GMCS were inapplicable, 

which yielded a 12 percent permanent impairment of the right upper extremity due to appellant’s 

shoulder condition after applying the net adjustment formula. Dr. Manshadi opined that the DBI 

method was more appropriate than the ROM impairment method as her active ROM was not within 

10 degrees of her passive ROM.

On June 10, 2018 Dr. Slutsky concurred with Dr. Manshadi’s finding of four percent 

permanent impairment of the right upper extremity due to appellant’s wrist fracture and 12 percent 

permanent impairment of the right upper extremity due to her distal clavicle resection using the 

DBI method. He further found that, for the right wrist, 53 degrees of flexion yielded three percent 

impairment, 54 degrees extension yielded three percent impairment, 22 degrees radial deviation 

yielded no impairment, and 30 degrees ulnar deviation yielded no impairment, for a total ROM 

impairment of six percent.5 Dr. Slutsky applied a grade modifier of one which yielded no 

adjustment. For the right shoulder, he determined that 135 degrees flexion yielded three percent 

impairment, 58 degrees extension yielded no impairment, 111 degrees abduction yielded three 

 

5 A.M.A., Guides 473, Table 15-32.
4

percent impairment, 45 degrees adduction yielded no impairment, 68 degrees internal rotation 

yielded two percent impairment, and 71 degrees external rotation yielded no impairment, for a 

total impairment due to loss of ROM of eight percent.6 Dr. Slutsky found no adjustment after 

application of the grade modifier of one.

In a supplemental report dated December 8, 2018, Dr. Slutsky again advised that, for her 

right wrist, appellant had four percent permanent impairment of the upper extremity using the DBI 

method and six percent permanent impairment of the upper extremity using the ROM method. For 

the right shoulder, he found 12 percent permanent impairment of the upper extremity using the 

DBI method and 8 percent permanent impairment of the upper extremity using the ROM method. 

Dr. Slutsky combined the 6 percent impairment of the right upper extremity using the ROM 

method due to appellant’s wrist condition with the 12 percent impairment of the right upper 

extremity using the DBI method due to her shoulder condition to find 17 percent permanent 

impairment of the right upper extremity.

On February 3, 2019 Dr. Slutsky clarified that combining 6 percent impairment and 12 

percent yielded 17 percent permanent impairment as indicated in his prior report.7 He noted that 

he had used ROM method for the wrist and the DBI method for the shoulder as it yielded the 

greater impairment rating.

By decision dated February 28, 2019, OWCP granted appellant a schedule award for an 

additional 5 percent permanent impairment of the right upper extremity, for a total right upper 

extremity impairment of 17 percent. The period of the award ran for 15.6 weeks from March 4 to 

June 21, 2018.

LEGAL PRECEDENT

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

9

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 loss of a member shall be 

determined. The method used in making such a determination is a matter which rests in the 

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. 

OWCP evaluates the degree of permanent impairment according to the standards set forth in the 

specified edition of the A.M.A., Guides, published in 2009.10 The Board has approved the use by 

 

6

Id. at 475.

7

Id. at 419, 604.

8 Supra note 1.

9 20 C.F.R. § 10.404.

10 For decisions issued after May 1, 2009 the sixth edition of the A.M.A., Guides is used. A.M.A., Guides (6th ed. 

2009); Federal (FECA) Procedure Manual, Part 2 -- Claims, Schedule Award and Permanent Disability Claims, 

Chapter 2.808.6 (March 2017); see also Federal (FECA) Procedure Manual, Part 3 -- Medical, Schedule Awards, 

Chapter 3.700, Exhibit 1 (January 2010).
5

OWCP of the A.M.A., Guides for the purpose of determining the percentage loss of use of a 

member of the body for schedule award purposes.11

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).12 Under the sixth edition, the evaluator identifies the impairment class of 

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

GMCS.13 The net adjustment formula is (GMFH - CDX) + (GMPE - CDX) + (GMCS - CDX).14 

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

diagnoses from regional grids and calculations of modifier scores.15

The A.M.A., Guides also provide that the ROM impairment method is to be used as a 

stand-alone rating for upper extremity impairments when other grids direct its use or when no other 

diagnosis-based sections are applicable.16 If ROM is used as a stand-alone approach, the total of 

motion impairment for all units of function must be calculated. All values for the joint are 

measured and added.17 Adjustments for functional history may be made if the evaluator 

determines that the resulting impairment does not adequately reflect functional loss and functional 

reports are determined to be reliable.18

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 

 

11 P.R., Docket No. 19-0022 (issued April 9, 2018); Isidoro Rivera, 12 ECAB 348 (1961).

12 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.

13 Id. at 494-531.

14 Id. at 411.

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

16 A.M.A., Guides 461.

17 Id. at 473.

18 Id. at 474.
6

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

rating should be used.”

19 (Emphasis in the original.)

ANALYSIS

The Board finds that appellant has not met her burden of proof to establish greater than 17 

percent permanent impairment of the right upper extremity, for which she received schedule award 

compensation.

In an impairment evaluation dated June 14, 2017, Dr. Mendel opined that appellant had 12 

percent permanent impairment of the right upper extremity due to her shoulder condition and 3

percent permanent impairment due to her wrist fracture. However, he utilized the fifth edition of 

the A.M.A., Guides in reaching his impairment rating, and thus his opinion is of diminished 

probative value.20

OWCP referred appellant to Dr. Manshadi for a second opinion examination. In an 

April 26, 2018 impairment evaluation, Dr. Manshadi measured ROM of the right wrist and 

shoulder three separate times. For the right wrist, he identified the CDX as a wrist fracture using 

Table 15-3 on page 396 of the A.M.A., Guides, for a default value of three percent. Dr. Manshadi 

found a GMFH of two, a GMPE of one, and that a GMCS was not applicable. He applied the net 

adjustment formula and found four percent permanent impairment of appellant’s right upper 

extremity due to her right wrist fracture.21 For the right shoulder, Dr. Manshadi identified the 

CDX as an AC joint injury after a distal clavicle resection or AC joint separation using Table 15-

5 on page 403, which yielded a default value of 10 percent. He applied a GMFH of two, a GMPH 

of two, and determined that GMCS were inapplicable, which yielded an adjustment of two after 

using the net adjustment formula and 12 percent permanent impairment of the right upper 

extremity due to appellant’s shoulder condition.22 Dr. Manshadi opined that the ROM was not 

appropriate as her active ROM was not within 10 degrees of passive ROM.

On June 10, 2018 Dr. Slutsky, the DMA, concurred with Dr. Manshadi’s finding of 4

percent permanent impairment of the right upper extremity due to appellant’s right wrist fracture 

right wrist and 12 percent permanent impairment of the right upper extremity due to her AC joint 

injury using the DBI method. He used Dr. Manshadi’s average ROM measurements to find that, 

for the right shoulder, 135 degrees flexion yielded three percent impairment, 58 degrees extension 

yielded no impairment, 111 degrees abduction yielded three percent impairment, 45 degrees 

adduction yielded no impairment, 68 degrees internal rotation yielded two percent impairment, 

and 71 degrees external rotation yielded no impairment, which he added to find a total impairment 

 

19 V.L., Docket No. 18-0760 (issued November 13, 2018); supra note 4.

20 S.J., Docket No. 16-1162 (issued February 8, 2017) (a medical opinion not based on the appropriate edition of 

the A.M.A., Guides is of diminished probative value in determining the extent of permanent impairment).

21 Utilizing the net adjustment formula discussed above, (GMFH-CDX) + (GMPE-CDX), or (2-1) + (1-1) = 1, 

yielded an adjustment of one.

22 GMFH-CDX) + (GMPE-CDX), or (2-1) + (2-1) = 2, yielded an adjustment of two.
7

due to loss of ROM of eight percent.23 For the right wrist, Dr. Slutsky found that 53 degrees of 

flexion yielded three percent impairment, 54 degrees extension yielded three percent impairment, 

22 degrees radial deviation yielded no impairment, and 30 degrees ulnar deviation yielded no 

impairment, for a total ROM impairment of six percent.24

On December 8, 2018 Dr. Slutsky opined that appellant had four percent permanent 

impairment of the right upper extremity using the DBI method and six percent permanent 

impairment of the upper extremity using the ROM method due to her right wrist condition. He 

further found 12 percent permanent impairment of the upper extremity using the DBI method and 

8 percent permanent impairment of the upper extremity using the ROM method for her right 

shoulder condition. Dr. Slutsky used the DBI method to rate appellant’s right shoulder impairment 

and the ROM method to rate her right wrist impairment as those methods yielded the higher 

permanent impairment rating.25 He combined the 12 percent permanent impairment of the right 

upper extremity due to her shoulder condition using the DBI method with the 6 percent permanent 

impairment of the right upper extremity due to her wrist condition using the ROM method to find 

17 percent permanent impairment of the right upper extremity.

As there is no current medical evidence of record conforming to the sixth edition of the 

A.M.A., Guides demonstrating greater than 17 percent permanent impairment of the right upper 

extremity, appellant has not met her burden of proof to establish entitlement to a greater schedule 

award.26

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 greater than 

17 percent permanent impairment of the right upper extremity, for which she received schedule 

award compensation.

 

23 A.M.A., Guides 475.

24 Id. at 473, Table 15-32.

25 Supra note 4; N.A., Docket No. 19-0248 (issued May 17, 2019).

26 See J.F., Docket No. 19-0166 (issued July 29, 2019).
8

ORDER

IT IS HEREBY ORDERED THAT the February 28, 2019 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: September 24, 2019

Washington, DC

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board