United States Department of Labor

Employees’ Compensation Appeals Board

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T.W., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Houston, TX, Employer

__________________________________________

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Docket No. 18-0765

Issued: September 20, 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

PATRICIA H. FITZGERALD, Deputy Chief Judge

ALEC J. KOROMILAS, Alternate Judge

JURISDICTION

On February 26, 2018 appellant filed a timely appeal from a January 30, 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.

ISSUE

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

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

schedule award.

FACTUAL HISTORY

On August 29, 2009 appellant, then a 40-year-old city carrier, filed a traumatic injury claim 

(Form CA-1) alleging that on August 27, 2009 she sustained injuries to her “legs, hips, and knees”

 

1 5 U.S.C. § 8101 et seq.
2

when she tripped and fell on concrete as she avoided a lunging dog while in the performance of 

duty. OWCP initially accepted the claim for contusions of her right elbow and forearm and 

bilateral contusions of her knees and lower legs. It later expanded the claim to include a tear of 

the left medial meniscus. OWCP authorized left knee surgery, which was performed on 

December 10, 2009, and placed appellant on the periodic rolls effective January 17, 2010. 

Appellant returned to work on March 8, 2010. 

In a September 29, 2015 report, Dr. Robert S. Bell, a Board-certified orthopedic surgeon, 

opined that appellant, that day, was at maximum medical improvement (MMI) and had four 

percent permanent impairment of the left lower extremity based on the sixth edition of the 

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

Guides).2 He found on physical examination that there was a very slight amount of weakness of 

the left knee, full flexion, full extension, negative McMurray’s testing, and no effusion. Dr. Bell 

also noted that x-rays of both knees showed no evidence of changes or degenerative issues. He 

calculated that appellant had two percent permanent impairment of the left lower extremity finding 

a class of diagnosis (CDX) of 1 with a default impairment rating of two percent. Dr. Bell assigned 

a grade modifier of 2 for physical examination (GMPE), zero for clinical studies (GMCS), and 

zero for functional history (GMFH), equaling a net adjustment of +2, equating to four percent 

permanent impairment of the left lower extremity.3

Appellant filed a schedule award claim (Form CA-7) on October 18, 2016. 

On June 12, 2017 Dr. Arthur S. Harris, a Board-certified orthopedic surgeon serving as a 

district medical adviser (DMA), reviewed a statement of accepted facts (SOAF) and the medical 

evidence of record and determined that appellant’s date of MMI was September 29, 2015, the date 

of Dr. Bell’s impairment examination. He disagreed with the diagnosis Dr. Bell had used for 

calculating appellant’s permanent impairment rating, explaining that she had sustained impairment 

for having undergone a partial medial meniscectomy. Utilizing Table 16-3, page 509, of the 

A.M.A., Guides, the DMA determined that appellant had two percent permanent impairment of 

the left lower extremity based upon the diagnosis-based impairment (DBI) method. He noted that 

the range of motion (ROM) method was not an allowable rating method for the assigned diagnosis. 

In a letter dated June 20, 2017, OWCP requested a supplemental report from Dr. Bell 

regarding his permanent impairment rating and attached a copy of Dr. Harris’ June 12, 2017 report 

for his review. It did not receive a response from Dr. Bell. 

As Dr. Bell did not respond, OWCP referred appellant to Dr. James E. Butler, III, a Boardcertified orthopedic surgeon, for a second opinion evaluation to determine the nature and extent of 

her permanent impairment for her accepted employment-related conditions. In his October 27, 

2017 report, Dr. Butler reviewed the SOAF and the medical evidence of record and reported the 

findings of his physical examination. He found that appellant was status post left knee arthroscopic 

partial medial meniscectomy and continued to have some chronic pain, but that her symptoms 

were stable. Dr. Butler determined that appellant had reached MMI on October 27, 2017, the date 

 

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

3 Dr. Bell cited to page 526 of the A.M.A., Guides.
3

of his examination. He reported that appellant’s subjective complaints included aching pain in her 

left knee with prolonged standing/walking and heavy pushing. The objective findings upon 

examination included well-healed arthroscopic scars on the left knee, tenderness over left knee 

patellar region, nontender right knee and right elbow, full ROM of both knees and right elbow, 

mild left knee patellofemoral crepitation, normal sensation in both lower extremities, and 5/5 

strength in both lower extremities. Utilizing Table 16-3, page 506, of the A.M.A., Guides,

Dr. Butler calculated that appellant had a CDX of 1 for left knee contusion/medial meniscus tear 

status post partial medial meniscectomy. He assigned a GMFH of 1 and zero for both GMPE and

GMCS based on Table 16-6, Table 16-7, and Table 16-8 of the A.M.A., Guides. Using the net 

adjustment formula (GMFH - CDX) + (GMPE - CDX) + (GMCS - CDX), Dr. Butler calculated 

that appellant had a net adjustment of (1-1) + (1-1) + (0-1) = -1, equaling a grade B impairment. 

Based on these calculations, he concluded that appellant had two percent permanent impairment 

of her left lower extremity. Dr. Butler further found that appellant had zero percent impairment of 

the right lower extremity and the right upper extremity because there were no significant objective 

symptoms or abnormal findings on examination. 

On December 22, 2017 the DMA concurred with Dr. Butler’s impairment rating of 

two percent permanent impairment left lower extremity. He determined that appellant had reached 

MMI as of October 27, 2017, the date of Dr. Butler’s second opinion evaluation. 

By decision dated January 30, 2018, OWCP granted appellant a schedule award for two 

percent permanent impairment of the left lower extremity (left knee), giving the weight of the 

medical evidence to Dr. Butler’s October 27, 2017 report and the DMA’s December 22, 2017 

report. The award ran for 5.76 weeks for the period October 27 to December 6, 2017. 

LEGAL PRECEDENT

The schedule award provisions of FECA,4and its implementing federal regulations,5set 

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.6 As of May 1, 2009, the 

sixth edition of the A.M.A., Guides is used to calculate schedule awards.7

 

4 5 U.S.C. § 8107.

5 20 C.F.R. § 10.404.

6

Id. at § 10.404(a).

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

2.808.5(a) (March 2017); see also Part 3 -- Medical, Schedule Awards, Chapter 3.700.2 and Exhibit 1 (January 2010).
4

With respect to the knee, the relevant portion of the leg for the present case, reference is 

made to Table 16-3 (Knee Regional Grid) beginning on page 509.8 After the CDX is determined 

from the Knee Regional Grid (including identification of a default grade value), the net adjustment 

formula is applied using the GMFH, GMPE, and GMCS. The net adjustment formula is (GMFHCDX) + (GMPE-CDX) + (GMCS-CDX).9

 Under Chapter 2.3, the evaluators are directed to 

provide reasons for their impairment rating choices, including the choices of diagnoses from 

regional grids and calculations of modifier scores.10

ANALYSIS

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

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

schedule award. 

In his September 29, 2015 report, Dr. Bell opined that appellant had four percent 

permanent impairment of the left lower extremity based on the A.M.A., Guides. He determined 

that appellant had reached MMI and calculated that she had two percent permanent impairment of 

the left lower extremity based upon a CDX of 1, with a default impairment of two percent. Dr. Bell

assigned a GMPE of 2 and zero for both GMCS and GMFH, equaling a net adjustment of +2, 

equating to a total four percent permanent impairment of the left lower extremity.

In accordance with its procedures, OWCP properly referred the medical record to a DMA,

Dr. Harris, who reviewed the clinical findings of Dr. Bell on September 29, 2015 and determined 

that appellant had two percent permanent impairment of the left lower extremity based upon

Dr. Bell’s objective findings. However, the DMA disagreed with Dr. Bell’s impairment rating and 

explained that appellant’s permanent impairment was based upon having undergone a partial 

medial meniscectomy. Utilizing Table 16-3, page 509, of the A.M.A., Guides, he determined that 

appellant had two percent permanent impairment of the left lower extremity.

After Dr. Bell did not respond to a request for a supplemental report, OWCP referred 

appellant to Dr. Butler for a second opinion evaluation to determine the nature and extent of her 

permanent impairment for the accepted employment-related conditions. In his October 27, 2017 

report, Dr. Butler found that appellant was status post left knee arthroscopic partial medial 

meniscectomy and continued to have some chronic pain, but with stable symptoms. He determined 

that appellant had reached MMI and reported that her subjective complaints, included aching pain 

in her left knee with prolonged standing/walking and heavy pushing. Dr. Butler provided objective 

examination findings upon which he based his impairment rating. Utilizing Table 16-3, page 506, 

of the A.M.A., Guides, he calculated that appellant had a CDX of 1 for a left knee contusion/medial 

meniscus tear status post partial medial meniscectomy. Dr. Butler assigned grade modifiers based 

on Table 16-6, Table 16-7, and Table 16-8 of the A.M.A., Guides. Using the net adjustment 

formula, he calculated a net adjustment of -1, equaling a grade B impairment. Based on these 

 

8 See A.M.A., Guides 509-11 (6th ed. 2009).

9

Id. at 515-22.

10 Id. at 23-28.
5

calculations, Dr. Butler concluded that appellant had two percent permanent impairment of the left 

lower extremity. 

On December 22, 2017 the DMA reviewed the medical record and concurred with

Dr. Butler’s impairment rating of two percent permanent impairment left lower extremity. He

discussed how Dr. Butler had arrived at his impairment ratings by listing specific tables and pages 

in the A.M.A., Guides and he also properly interpreted the sixth edition of the A.M.A., Guides to 

find that appellant had two percent permanent impairment of the left lower extremity. The Board 

finds that the DMA properly applied the standards of the A.M.A., Guides and therefore his opinion 

carries the weight of medical evidence and supports that appellant does not have greater than the 

two percent left lower extremity impairment previously awarded.

The Board finds that there is no current medical evidence of record, in conformance with 

the sixth edition of the A.M.A., Guides, establishing greater than two percent permanent 

impairment of the left lower extremity. Accordingly, appellant has not met her burden of proof to 

establish entitlement to a schedule award greater than that previously awarded.

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 two 

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

schedule award.
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ORDER

IT IS HEREBY ORDERED THAT the January 30, 2018 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: September 20, 2019

Washington, DC

Christopher J. Godfrey, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Alec J. Koromilas, Alternate Judge

Employees’ Compensation Appeals Board