United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

G.J., Appellant

and

DEPARTMENT OF THE ARMY, WOMACK 

ARMY MEDICAL CENTER, Fort Bragg, NC, 

Employer

__________________________________________

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Docket Nos. 19-1651 & 20-0199

Issued: June 22, 2020

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

CHRISTOPHER J. GODFREY, Deputy Chief Judge

PATRICIA H. FITZGERALD, Alternate Judge

JURISDICTION

On July 31, 2019 appellant filed a timely appeal from a July 5, 2019 merit decision of the 

Office of Workers’ Compensation Programs (OWCP). This appeal was docketed as 19-1651. On 

November 4, 2019 appellant filed a timely appeal from an August 15, 2019 merit decision of 

OWCP. This appeal was docketed as 20-0199. 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 July 5 and August 15, 2019 decisions, OWCP received additional evidence. 

Appellant also submitted additional evidence with his appeal to the Board. 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

ISSUES

The issues are: (1) whether appellant has met his burden of proof to establish more than 

16 percent permanent impairment of the right upper extremity, for which he previously received a 

schedule award; and (2) whether appellant has met his burden of proof to establish more than six 

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

schedule award.

FACTUAL HISTORY

This case has previously been before the Board.3 The facts and circumstances as set forth 

in the Board’s prior decision are incorporated herein by reference. The relevant facts are as 

follows.

On April 26, 1994 appellant, then a 51-year-old nursing assistant, filed a traumatic injury 

claim (Form CA-1) alleging an injury on April 23, 1994 when he struck his right elbow against a 

piece of equipment while in the performance of duty. OWCP assigned OWCP File No. xxxxxx556

and accepted the claim for right elbow contusion. It authorized right lateral humeral tendon 

debridement with exploration, which occurred on February 21, 1995. Appellant returned to 

limited-duty work on April 15, 1995.

On July 20, 1995 appellant filed a Form CA-1 alleging that on July 13, 1995 he injured his 

right hip when he tripped and fell in the performance of duty. OWCP assigned this claim, OWCP 

File No. xxxxxx141, and accepted the claim for right hip contusion, right trochanteric bursitis, and 

right lateral epicondylitis. Appellant stopped work on the date of injury. OWCP paid appellant 

compensation on the supplemental rolls beginning August 28, 1995 and the periodic rolls

beginning June 16, 2002. OWCP File Nos. xxxxxx556 and xxxxxx141 have been administratively 

combined with the latter serving as the master file. 

By decision dated December 23, 1999, OWCP granted appellant a schedule award for 16 

percent permanent impairment of the right upper extremity, under OWCP File No. xxxxxx141.

On August 3, 2018 appellant filed a claim for an additional schedule award (Form CA-7). 

In a development letter dated October 9, 2018, OWCP advised appellant that additional 

medical evidence was necessary to establish his schedule award claim. Appellant was requested 

to submit a report from his treating physician which provided a permanent impairment rating 

pursuant to the sixth edition of the American Medical Association, Guides to the Evaluation of 

Permanent Impairment (A.M.A., Guides).4

Memorandum of telephone calls (Form CA-110) dated November 21 and December 21, 

2018 indicate that appellant informed OWCP that he could not obtain a rating report from his 

 

3 Docket No. 19-1103, Order Dismissing Appeal (issued May 28, 2019).

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

treating physician. Appellant requested that OWCP schedule a second opinion evaluation to assist

with the development of his schedule award claim.

On February 19, 2019 OWCP referred appellant for a second opinion evaluation with

Dr. Robert M. Moore, a Board-certified orthopedic surgeon, to determine the extent of his 

permanent impairment, if any, due to the accepted conditions.

In a March 12, 2019 report, Dr. Moore noted appellant’s history of injury and medical

treatment. He reported that examination of appellant’s right upper extremity revealed full active

range of motion (ROM) of his elbow, wrist, and hand. Dr. Moore related three ROM findings of 

appellant’s right elbow noting that appellant had flexion of 140 degrees, extension of 0 degrees, 

pronation of 80 degrees, and supination of 80 degrees. Appellant had no elbow swelling, no 

sensory deficit, no atrophy, intact right upper extremity motor strength, and exacerbated right 

elbow pain with restricted wrist extension. Dr. Moore applied the diagnosis-based impairment 

(DBI) rating methodology of the A.M.A., Guides. Using Table 15-4,5 he noted a default value for 

the accepted right lateral epicondylitis of five percent.

6

 Dr. Moore then assigned a grade modifier 

for functional history (GMFH) of 2, a grade modifier for physical examination (GMPE) of 0, and 

a grade modifier for clinical studies (GMCS) of 0.

7

 Application of the net adjustment formula8

resulted in movement one space to the left of the default value on Table 15-4 to the value of four 

percent permanent impairment. Therefore, Dr. Moore concluded that appellant had four percent 

permanent impairment of the right upper extremity due to the accepted condition of right lateral 

epicondylitis.

Regarding the right hip, Dr. Moore indicated that appellant’s examination revealed right 

trochanteric tenderness, no visible swelling or atrophy. He conducted right hip ROM examinations 

three times and found the maximum ROM to be 10 degrees of flexion contracture, 90 degrees 

flexion, 20 degrees internal rotation, 30 degrees external rotation, 30 degrees abduction, and 10 

degrees adduction. Appellant reported right lumbar pain at the end ranges of right hip motion. A 

review of appellant’s right hip x-ray showed no abnormality and no evidence of dislocation, joint 

cartilage space narrowing, fracture, soft tissue calcification, osteophyte formation or lytic lesion. 

Dr. Moore applied the DBI method for rating permanent impairment as it provided a greater 

impairment rating than using ROM. Using Table 16-4,9 he noted a default value for the accepted 

right hip trochanteric bursitis with document chronically abnormal gait of seven percent.

Dr. Moore then assigned a grade modifier for GMPE of 1 and a grade modifier for GMCE of 0.10 

He found GMFH was not applicable because gait abnormality was used for primary placement in 

 

5

Id. at 399, Table 15-4.

6

Id.

7

Id. at 406, Table 15-7; 408, Table 15-8; 410, Table 15-9.

8

Id. at 411.

9

Id. at 512.

10 Id. at 516, Table 16-7; 519, Table 16-8.
4

the regional grid and, thus was not used in adjusting impairment.

11

 Application of the net 

adjustment formula12 resulted in movement one space to the left of the default value on Table 16-

4 to the value of six percent permanent impairment. Therefore, Dr. Moore concluded that appellant 

had six percent permanent impairment of the right lower extremity due to the accepted condition 

of right hip trochanteric bursitis.

13

On April 17, 2019 OWCP referred the claim to a district medical adviser (DMA) for a 

review of the medical evidence of record and an opinion regarding the extent of appellant’s 

permanent impairment.

On April 20, 2019 Dr. Arthur S. Harris, a Board-certified orthopedic surgeon serving as a

DMA, reviewed the medical evidence of record and concluded that appellant had four percent 

permanent impairment of the right upper extremity and six percent permanent impairment of the 

right lower extremity. He found, using the ROM methodology for rating permanent impairment 

of the right upper extremity, that appellant had zero percent permanent impairment as he had full 

range of motion. The DMA concurred with Dr. Moore’s application of the A.M.A., Guides in 

determining appellant’s permanent impairment pursuant to the DBI methodology and affirmed 

that appellant had four percent permanent impairment of the right upper extremity. Regarding 

permanent impairment of appellant’s right lower extremity, the DMA noted that the ROM method 

for rating permanent impairment could only be used as a stand-alone rating when the impairment 

could not be rated under the DBI method or if a severe injury resulted in a passive ROM or 

amputation. However, appellant’s permanent impairment could be rated using the DBI method. 

He concurred that appellant had six percent permanent impairment of the right lower extremity

pursuant to Table 16-4, page 512 of the A.M.A., Guides for the diagnosis of trochanteric bursitis.

On May 21, 2019 OWCP requested that the DMA clarify whether appellant’s current 

4 percent permanent impairment of the right upper extremity was in addition to the 16 percent 

permanent impairment, for which he had previously received a schedule award. In a report dated 

May 25, 2019, the DMA clarified that appellant’s current four percent permanent impairment 

rating was not an additional impairment.

By decision dated July 5, 2019, OWCP denied appellant’s request for an additional 

schedule finding that the medical evidence did not warrant an increase from the prior schedule 

award. It noted that he was previously awarded 16 percent permanent impairment of the right 

upper extremity. OWCP found that the medical evidence of record was insufficient to establish 

that he was entitled to an additional schedule award as a result of his accepted lateral epicondylitis.

By decision dated August 15, 2019, OWCP granted appellant a schedule award for six 

percent permanent impairment of the right lower extremity. The award ran for 17.28 weeks for 

the period March 12 to July 10, 2019.

 

11 Id. at 512, 516.

12 Supra note 8.

13 Dr. Moore determined that the date of maximum medical improvement (MMI) was March 12, 2019 the date of 

the physical examination he conducted.
5

LEGAL PRECEDENT -- ISSUE 1

The schedule award provisions of FECA,14 and its implementing regulations,15 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.16 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.17 As of May 1, 2009, the sixth edition of the 

A.M.A., Guides is used to calculate schedule awards.18 The sixth edition requires identifying the 

class of diagnosis (CDX), which is then adjusted by grade modifiers GMFH, GMPE, and GMCS. 

The net adjustment formula is (GMFH - CDX) + (GMPE - CDX) + (GMCS - CDX).19

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.)

* * *

“If the rating physician provided an assessment using the DBI method and the 

[A.M.A.,] Guides allow for use of ROM for the diagnosis in question, the DMA 

 

14 5 U.S.C. § 8107.

15 20 C.F.R. § 10.404.

16 Id.

17 Federal (FECA) Procedure Manual, Part 2 -- Claims, Schedule Award 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).

18 Id.

19 Supra note 4 at 411.
6

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.”

20

ANALYSIS -- ISSUE 1

The Board finds that appellant has not met his burden of proof to establish more than 16 

percent permanent impairment of the right upper extremity, for which he previously received a 

schedule award.

Regarding appellant’s right upper extremity, has OWCP accepted that appellant sustained 

the conditions of right elbow contusion and right lateral epicondylitis. OWCP authorized right 

lateral tendon debridement with exploration, which was performed on February 21, 1995.

OWCP referred appellant for a second opinion evaluation with Dr. Moore and in his 

March 12, 2019 report, he found that appellant had reached MMI due to his accepted conditions.

He determined that, under the DBI method for rating permanent impairment, utilizing Table 15-

4,21 appellant had a default value of five percent for the accepted right lateral epicondylitis.22 

Dr. Moore then assigned a GMFH of 2, a GMPE of 0, and a GMCS of 0.

23

 After applying the net 

adjustment formula,

24 he concluded, that the net adjustment value would move one space to the 

left of the default value on Table 15-4, resulting in a permanent impairment finding of four percent.

He also provided three ROM measurements of appellant’s right elbow, which did not record any 

loss of ROM.

In accordance with its procedures, OWCP properly referred the evidence of record to

Dr. Harris, a DMA, who reviewed the clinical findings of Dr. Moore on April 20, 2019 and 

determined that appellant had four percent permanent impairment of the right upper extremity 

based upon Dr. Moore’s report and the A.M.A., Guides. Dr. Harris explained that appellant had 

no permanent impairment based upon his ROM findings and therefore his permanent impairment 

was rated utilizing the DBI method. He found that appellant had reached MMI as of March 12, 

2019, the date of Dr. Moore’s report. 

 

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

21 Id. at 399, Table 15-4.

22 Id.

23 Id. at 406, Table 15-7; 408, Table 15-8; 410, Table 15-9.

24 Id. at 411.
7

The Board finds that the DMA discussed how he arrived at his conclusion by listing 

specific tables and pages in the A.M.A., Guides. He accurately summarized the relevant medical 

evidence, provided detailed findings on examination, and reached conclusions about appellant’s 

conditions which comported with his findings.25 The DMA properly utilized the DBI method and 

ROM method to rate appellant’s right shoulder condition pursuant to FECA Bulletin No. 17-06. 

The Board finds that the DMA’s report is detailed, well rationalized, and based on a proper factual 

background.

26

 Therefore, his opinion is afforded the weight of the medical evidence and supports 

that appellant does not have a greater right upper extremity impairment than the 16 percent 

previously awarded.27

There is no current medical evidence of record, in conformance with the sixth edition of 

the A.M.A., Guides, establishing that appellant has greater than the 16 percent permanent 

impairment of the right upper extremity previously awarded. Accordingly, appellant has not met 

his burden of proof to establish that he is entitled to an additional schedule award.

LEGAL PRECEDENT -- ISSUE 2

In determining permanent impairment of the lower extremities under the sixth edition of 

the A.M.A., Guides, an evaluator must establish the appropriate diagnosis for each part of the 

lower extremity to be rated. With respect to the hip, the relevant portion of the leg for the present 

case, reference is made to Table 16-4 (Hip Regional Grid) beginning on page 512.28 After the 

CDX is determined from the Hip 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 (GMFH - CDX) + (GMPE - CDX) + (GMCS - CDX).29

ANALYSIS -- ISSUE 2

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

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

schedule award.

As noted above, OWCP referred appellant for a second opinion evaluation with Dr. Moore 

to determine the degree of appellant’s permanent impairment for schedule award purposes. 

Dr. Moore applied the DBI method for rating permanent impairment, as it provided a greater rating 

of permanent impairment than the ROM method. Using Table 16-4,30 he noted a default value for 

the accepted right hip trochanteric bursitis with documented chronically abnormal gait of seven 

 

25 M.D., Docket No. 20-0007 (issued May 13, 2020).

26 M.S., Docket No. 19-1011 (issued October 29, 2019).

27 R.R., Docket No. 17-1947 (issued December 19, 2018).

28 Supra note 4 at 509-11.

29 Id. at 515-22.

30 Id. at 512.
8

percent. Dr. Moore then assigned a GMPE of 1 and a GMCE of 0.31 He found that a GMFH was 

not applicable because gait abnormality was used for primary placement in the regional grid and, 

thus was not to be used in adjusting impairment.32 Application of the net adjustment formula33

resulted in movement one space to the left of the default value on Table 16-4 to the value of six 

percent permanent impairment. Thus, Dr. Moore concluded that appellant had six percent 

permanent impairment of the right lower extremity due to the accepted condition of right hip 

trochanteric bursitis. 

In accordance with its procedures, OWCP referred the evidence of record to a DMA,

Dr. Harris, who reviewed the clinical findings of Dr. Moore and determined appellant had six 

percent permanent impairment of the right lower extremity. He further determined that appellant’s 

date of MMI was March 12, 2019, the date of Dr. Moore’s examination upon which his impairment 

rating was based. Dr. Harris concurred with Dr. Moore that appellant’s most impairing diagnosis

was chronic trochanteric bursitis. He also explained that the A.M.A., Guides did not allow a ROM 

stand-alone rating if an appropriate DBI could be rated, and the injury was not severe and did not 

result in amputation. Therefore appellant’s permanent impairment was rated under the DBI 

method. The Board finds that as the DMA’s report is detailed, well rationalized, and based on a 

proper factual background, his opinion represents the weight of the medical evidence.34 Thus, the 

Board finds that appellant has not met his burden of proof to establish greater right lower extremity 

permanent impairment.

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 that appellant has more than six percent 

permanent impairment of the right lower extremity. Accordingly, appellant has not met his 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 his burden of proof to establish more than 16 

percent permanent impairment of his right upper extremity, for which he previously received a 

schedule award. The Board further finds that he has not met his burden of proof to establish more 

than six percent permanent impairment of his right lower extremity, for which he previously 

received a schedule award.

 

31 Id. at 516, Table 16-7; 519, Table 16-8.

32 Id. at 512, 516.

33 Supra note 8.

34 Supra note 26. 
9

ORDER

IT IS HEREBY ORDERED THAT the August 15 and July 5, 2019 decisions of the 

Office of Workers’ Compensation Programs are affirmed.

Issued: June 22, 2020

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Christopher J. Godfrey, Deputy Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Alternate Judge

Employees’ Compensation Appeals Board