United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

D.F., Appellant

and

U.S. POSTAL SERVICE, HICKORY HILL 

POST OFFICE, Memphis, TN, Employer

__________________________________________

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Docket No. 20-1286

Issued: June 17, 2021

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

PATRICIA H. FITZGERALD, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On June 8, 2020 appellant filed a timely appeal from December 12 and 13, 2019 merit 

decisions 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 

ISSUE

The issue is whether appellant has met her burden of proof to establish more than 12 percent 

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

award compensation.

 

1 5 U.S.C. § 8101 et seq.

2 The Board notes that, following the December 13, 2019 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 

evidence for the first time on appeal. Id. 
2

FACTUAL HISTORY

On January 17, 2009 appellant, then a 45-year-old carrier, filed a traumatic injury claim 

(Form CA-1) alleging that on January 14, 2009 she injured her right shoulder while in the 

performance of duty. In an attached statement, she explained that she was placing mail into a 

customer’s mailbox when a dog charged towards her. In an attempt to quickly drive away, she 

hyperextended her arm and hurt her shoulder when she pulled her hand from the mailbox. OWCP 

assigned the claim OWCP File No. xxxxxx702 and accepted it for a sprain of the right shoulder 

and upper arm supraspinatus and other affectations of the right shoulder region not elsewhere

classified. On May 14, 2009 appellant underwent an OWCP-authorized right shoulder 

arthroscopy, with debridement of an anterior labral tear, acromioplasty, and min-open rotator cuff 

repair.

On January 19, 2010 appellant filed a schedule award claim (Form CA-7).

In a January 14, 2010 report, Dr. Stephen Waggoner, Board-certified in orthopedic 

surgery, opined that appellant had reached maximum medical improvement (MMI). He noted his 

use of the diagnosis-based impairment (DBI) methodology of the sixth edition of the American 

Medical Association, Guides to the Evaluation of Permanent Impairment, (A.M.A., Guides),3to 

calculate that appellant sustained five percent permanent impairment of her right upper extremity

for a full-thickness rotator cuff tear.

On January 29, 2010 OWCP forwarded appellant’s medical records to a district medical 

adviser (DMA) for a schedule award review. In a January 29, 2010 report, Dr. James Dyer, a 

Board-certified orthopedic surgeon serving as OWCP’s DMA, indicated that he had reviewed 

appellant’s surgical and medical history and indicated that she had reached MMI on 

January 14, 2010. Using the A.M.A., Guides, he calculated that appellant sustained five percent 

permanent impairment of her right upper extremity.

By decision dated February 4, 2010, OWCP granted appellant a schedule award for five 

percent permanent impairment of her right upper extremity. The award ran for 15.6 weeks from 

January 14 to May 3, 2010.4

A September 30, 2010 operative report signed by Dr. Christopher Pokabla, a Boardcertified orthopedic surgeon, noted that appellant underwent arthroscopic right shoulder surgery 

with rotator cuff repair, subacromial decompression, distal clavicle excision, biceps tenodesis, and 

debridement of labral fraying and degenerative tearing.

On October 8, 2012 appellant filed a Form CA-7 claim for an increased schedule award.

In a development letter dated November 9, 2012, OWCP informed appellant that additional 

evidence was needed in support of her increased schedule award claim. It advised her of the 

 

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

4 On June 19, 2010 appellant filed a notice of recurrence (Form CA-2a) under OWCP File No. xxxxxx702, which 

OWCP converted to an occupational disease claim and assigned OWCP File No. xxxxxx699. Under OWCP File No. 

xxxxxx699, OWCP also accepted sprain of the right rotator cuff. OWCP’s files have been administratively combined, 

with OWCP File No. xxxxxx609 serving as the master file.
3

medical evidence necessary to establish her claim and provided 30 days for her to submit the 

requested evidence.

On December 10, 2012 OWCP referred appellant’s medical records to a DMA for review 

regarding appellant’s entitlement for an increased schedule award.

A December 11, 2012 report from the DMA, containing an illegible signature reviewed 

appellant’s surgical history and used the DBI methodology from the A.M.A., Guides to calculate 

that appellant sustained 10 percent permanent impairment of her right upper extremity. The DMA 

indicated that appellant should, therefore, be awarded a schedule award of an additional five 

percent permanent upper extremity impairment.

By decision dated December 18, 2012, OWCP granted appellant a schedule award for an 

additional five percent permanent impairment of her right upper extremity. The award ran for 15.6 

weeks from October 21, 2012 to February 7, 2013.

In a May 3, 2017 operative report, Dr. Robert Jones, a Board-certified orthopedic surgeon, 

indicated that appellant underwent authorized right shoulder arthroscopy with arthroscopic 

subacromial decompression, extension of the distal clavicle, and rotator cuff repair with 

coracoacromial ligament release.

On March 8, 2019 appellant filed a Form CA-7 claim for an increased schedule award.

In a development letter dated March 14, 2019, OWCP informed appellant that additional 

evidence was needed in support of her increased schedule award claim. It advised her of the 

medical evidence necessary to establish her claim and provided 30 days for her to submit the 

requested evidence. No evidence was submitted.

By decision dated July 2, 2019, OWCP denied appellant’s claim for an increased schedule 

award, finding that the evidence of record was insufficient to establish an increased permanent

impairment.

In an August 28, 2019 report, Dr. Jones indicated that appellant presented with right 

shoulder pain, swelling, and limited range of motion. He reviewed appellant’s history of injury, 

medical history, and medical records. Dr. Jones conducted a physical examination of appellant’s 

right shoulder, revealing an active range of motion of: flexion of 130, 130, and 130 degrees;

abduction of 140, 140, and 135 degrees; external rotation of 90, 90, and 90 degrees; internal 

rotation of 70, 70, and 70 degrees; a passive range of motion of flexion and abduction of 180 

degrees; external rotation of 45 degrees; internal rotation of T4-T8, and an additional range of 

motion of extension of 30, 30, and 40 degrees; and abduction of 40 degrees. The examination 

additionally revealed a palpable exostosis in the superior distal clavicle and tenderness upon 

palpation in the acromioclavicular joint. Dr. Jones diagnosed a strain of the muscles and tendons 

of the rotator cuff of the right shoulder and listed associated diagnoses as osteoarthritis, 

supraspinatus tear, and shoulder impingement.

Utilizing the range of motion (ROM) methodology of the A.M.A., Guides, Dr. Jones 

opined that appellant’s flexion of 130 degrees resulted in three percent permanent impairment, 

extension of 40 degrees resulted in one percent permanent impairment, abduction of 140 degrees 

resulted in three percent impairment, adduction of 40 degrees resulted in zero percent impairment, 
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internal rotation of 70 degrees resulted in two percent impairment, and external rotation of 90 

degrees resulted in zero percent impairment. He concluded that appellant, therefore, sustained 

nine percent total upper extremity permanent impairment. Dr. Jones indicated that, since

Dr. Waggoner’s five percent impairment rating of appellant’s right upper extremity was based on 

appellant’s rotator cuff repair, his own DBI rating would be based on appellant’s excision of the 

distal clavicle. Using the DBI methodology of the A.M.A., Guides, Dr. Jones calculated that she 

sustained 10 percent permanent impairment of her upper extremity. He referenced appendix A of 

the Combined Values Chart on page 604 of the A.M.A., Guides, and stated that, since appellant 

had separate surgeries for her rotator cuff and her distal clavicle, his impairment rating should be 

added onto Dr. Waggoner’s impairment rating, totaling 15 percent permanent impairment of her 

right upper extremity.

On September 16, 2019 appellant requested reconsideration.

On September 25, 2019 OWCP referred appellant’s medical records to Dr. Herbert White, 

Board-certified in preventive medicine and DMA, for a schedule award evaluation. In an 

October 2, 2019 report, Dr. White, indicated that OWCP had not referred a SOAF for him to 

review. Dr. Jones noted appellant’s accepted diagnoses of right shoulder and upper arm 

supraspinatus sprain and right shoulder affection, and he indicated that appellant previously 

received a right upper extremity award of five percent. 

Using the DBI method, Dr. White indicated that appellant’s diagnosis was right shoulder 

acromioclavicular joint injury or disease on the DBI Regional Grid, page 403, and assigned a class 

of diagnosis (CDX) of one for this diagnosis. He assigned a grade modifier for functional history

(GMFH) of 2 due to appellant’s pain with normal activity, and he assigned a grade modifier for 

physical examination (GMPE) of 1 due to appellant’s mild range of motion deficits. Dr. White 

assigned a grade modifier for clinical studies (GMCS) of 4 due to her rotator cuff and labral tears. 

He calculated a total of 12 percent right upper extremity impairment. Using the ROM 

methodology, Dr. White utilized Table 15-34 on page 475 and indicated that appellant’s flexion 

of 130 degrees equaled three percent impairment, her extension of 40 degrees equaled one percent 

impairment, her abduction of 140 degrees equaled three percent impairment, her adduction of 40 

degrees equaled zero percent impairment, her internal rotation of 70 degrees equaled two percent 

impairment, and her external rotation of 90 degrees equaled zero percent impairment. He assigned 

a ROM grade modifier of 1, a functional history grade modifier of 2 due to pain with normal 

activity, and calculated a functional history net modifier of 1. Dr. White calculated that appellant 

sustained a total 9 percent permanent impairment of the right upper extremity, according to the 

ROM methodology, and concluded that, as appellant’s impairment percentage was higher using 

the DBI method, appellant, therefore, sustained 12 percent permanent impairment of her right 

upper extremity.

Dr. White stated that he had reviewed Dr. Jones’ impairment evaluation, and he reported 

that Dr. Jones did not indicate the grade modifiers that he used when he calculated appellant’s 

permanent impairment according to the DBI method. He stated that he disagreed with Dr. Jones’

addition of appellant’s permanent impairment of the distal clavicle to the previously calculated 

rotator cuff impairment because the A.M.A., Guides indicated that, if there was more than one 

diagnosis in a region, the specific diagnosis that provides the most clinically accurate causally

related impairment should be utilized. Dr. White opined that the impairment calculation based on

appellant’s distal clavicle should be used because it yielded a larger impairment than the 

impairment calculation based on the rotator cuff. He additionally stated that, while Dr. Jones 
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added appellant’s distal clavicle impairment rating to her previous rotator cuff impairment rating 

because appellant had multiple surgeries, the A.M.A., Guides, did not rate impairments based on 

that metric. Dr. White further reported that appellant reached MMI on August 28, 2019.

On October 17, 2019 OWCP informed appellant that it was submitting the DMA’s 

October 2, 2019 report to Dr. Jones for review.

A November 1, 2019 e-mail from appellant to Dr. Jones’ office indicated that she did not 

agree with the DMA’s permanent impairment rating. She related that Dr. Jones did not note that 

her rotator cuff was a 90 percent or greater tear and did not mention the deformity that developed 

on her distal clavicle. Appellant requested that Dr. Jones send her August 28, 2019 x-ray report 

to OWCP. She also mentioned that the DMA failed to mention the five percent permanent 

impairment rating that was provided to her by Dr. Pokabla. Appellant asked if her permanent 

impairment rating should be the sum of Dr. Pokabla’s permanent impairment rating,

Dr. Waggoner’s impairment rating, and Dr. Jones’ impairment rating.

In November 4 and December 4, 2019 letters, Dr. Jones indicated that he agreed with

Dr. White’s permanent impairment rating.

By decisions dated December 12, and 13, 2019, OWCP granted appellant a schedule award 

for an additional 2 percent permanent impairment of her right upper extremity, for a total award 

of 12 percent permanent impairment of the right upper extremity. The award ran for 6.24 weeks, 

from August 28 to October 10, 2019.

LEGAL PRECEDENT

The schedule award provisions of FECA,5and its implementing regulations,6set 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.7 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.8 As of May 1, 2009, the sixth edition of the 

A.M.A., Guides is used to calculate schedule awards.9 The sixth edition requires identifying the 

CDX, which is then adjusted by GMFH, GMPE, and GMCS. The net adjustment formula is 

(GMFH - CDX) + (GMPE - CDX) + (GMCS - CDX).10 Regarding the upper extremities, the 

A.M.A., Guides, provide the following: “[i]f more than 1 diagnosis can be used, the highest 

 

5 5 U.S.C. § 8107.

6 20 C.F.R. § 10.404.

7

Id.

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

Id.

10 Id.
6

causally related impairment rating should be used, this generally will be the more specific 

diagnosis.”

11

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 

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.,] 

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.) 

ANALYSIS

The Board finds that this case is not in posture for decision.

OWCP indicated that on September 25, 2019 it sent appellant’s medical records to a DMA 

for a schedule award evaluation; however, the DMA, Dr. White, related in his October 2, 2019 

report that no SOAF was provided from OWCP for him to review. Dr. White additionally stated 

that appellant had previously received a right upper extremity award of five percent. 

It is OWCP’s responsibility to provide a complete and proper frame of reference for a 

physician by preparing a SOAF. OWCP’s procedures dictate that, when an OWCP medical 

adviser, second opinion specialist, or referee physician renders a medical opinion based on a SOAF 

which is incomplete or inaccurate or does not use the SOAF as the framework in forming his or 

her opinion, the probative value of the opinion is seriously diminished or negated altogether.12 

Dr. White related that appellant’s accepted conditions were right shoulder/upper arm supraspinatus 

sprain and right shoulder affection; however, he did not note the right shoulder rotator cuff 

conditions accepted under OWCP File No. xxxxxx699. He also did not note that appellant had, in 

fact, previously received a schedule award for 10 percent permanent impairment of the right upper 

extremity. As OWCP did not provide a SOAF to Dr. White, the Board finds that his opinion is of

diminished probative value. 

It is well established that proceedings under FECA are not adversarial in nature, nor is 

OWCP a disinterested arbiter. While the claimant has the burden of proof to establish entitlement 

to compensation, OWCP shares the responsibility in the development of the evidence to see that 

 

11 Supra note 3 at 389. 

12 C.C., Docket No. 19-1948 (issued January 8, 2021). 
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justice is done.13 Once it undertakes development of the record, it must do a complete job in 

procuring medical evidence that will resolve the relevant issues in the case.14 Accordingly, the 

Board finds that the case must be remanded to OWCP.15

On remand OWCP shall provide Dr. White with an updated complete SOAF and case 

record, including the December 11, 2012 DMA medical report containing an illegible signature,

for a reasoned opinion regarding the extent of appellant’s permanent impairment of her right upper 

extremity. Following this and any such further development as deemed necessary, OWCP shall 

issue a de novo decision.

CONCLUSION

The Board finds that this case is not in posture for decision.

ORDER

IT IS HEREBY ORDERED THAT the December 12 and 13, 2019 decisions of the 

Office of Workers’ Compensation Programs are set aside and the case is remanded for further 

proceedings consistent with this decision of the Board.

Issued: June 17, 2021

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Alternate Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board

 

13 See L.F., Docket No. 20-0549 (issued January 27, 2021), 

14 Id.

15 Id.