United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

K.S., Appellant

and

U.S. POSTAL SERVICE, PROCESSING & 

DISTRIBUTION CENTER, Los Angeles, CA, 

Employer

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Docket No. 19-1588

Issued: March 10, 2020

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

CHRISTOPHER J. GODFREY, Deputy Chief Judge

JANICE B. ASKIN, Judge

PATRICIA H. FITZGERALD, Alternate Judge

JURISDICTION

On July 19, 2019 appellant filed a timely appeal from a June 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.2

 

1 5 U.S.C. § 8101 et seq.

2 The Board notes that, following the June 28, 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 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 11 percent 

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

award.

FACTUAL HISTORY

On August 4, 2015 appellant, then a 47-year-old mail handler, filed a traumatic injury claim 

(Form CA-1) alleging that she sustained a right shoulder injury when she pushed a mail container 

on July 29, 2015 while in the performance of duty. She stopped work on July 30, 2015.

OWCP accepted that appellant sustained right shoulder bursitis; strain of muscles, fascia, 

and tendons of the right shoulder/upper arm; and unspecified right rotator cuff tear or rupture, and 

it paid her appropriate wage-loss compensation benefits for periods of disability. On 

September 20, 2016 appellant underwent OWCP-authorized right shoulder surgery, including 

distal clavicle excision/resection, rotator cuff repair, acromioplasty, and subacromial 

decompression.

3

 She later filed a claim for a schedule award (Form CA-7) due to her accepted 

employment injuries. 

OWCP referred appellant to Dr. Jacob Rabinovich, a Board-certified orthopedic surgeon, 

for a second opinion examination. It requested that he provide an opinion on the nature and extent 

of her permanent impairment of her right upper extremity under the standards of the sixth edition 

of the American Medical Association, Guides to the Evaluation of Permanent Impairment 

(A.M.A., Guides).4 In a January 21, 2019 report, Dr. Rabinovich discussed appellant’s factual and 

medical history and reported the findings of the physical examination he conducted on that date. 

He noted that, for the right shoulder, she had passive range of motion (ROM) of 120 degrees for 

flexion, 25 degrees for extension, 100 degrees for abduction, 40 degrees for adduction, 50 degrees 

for internal rotation, and 90 degrees for external rotation. Dr. Rabinovich diagnosed status post 

right distal clavicle resection, rotator cuff repair, and subacromial decompression. 

Dr. Rabinovich provided an evaluation of the permanent impairment of appellant’s right 

upper extremity utilizing the diagnosis-based impairment (DBI) rating method of the sixth edition 

of the A.M.A., Guides. He indicated that, under Table 15-5 on page 403, her acromioclavicular 

(AC) joint disease/distal clavicle resection fell under Class 1 for the class of diagnosis (CDX), a 

designation which warranted a default value of 10 percent permanent impairment of the right upper 

extremity. Dr. Rabinovich referenced Table 15-6, Table 15-7, and Table 15-8 on pages 406 and 

408 and found that appellant had a grade modifier for functional history (GMFH) of 3 (based on a 

QuickDASH score of 68), a grade modifier for physical examination (GMPE) of 2 (based on 

limited ROM and right deltoid motor weakness), and a grade modifier for clinical studies (GMCS) 

of 2 (based on right rotator cuff tear seen on diagnostic testing). Application of the net adjustment 

formula resulted in movement two spaces to the right of the default value on Table 15-5 to the 

 

3 On March 6, 2017 appellant returned to work for the employing establishment as a consumer affairs agent, a 

position which involved answering calls and complaints from customers. 

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

value of 12 percent permanent impairment. Therefore, Dr. Rabinovich concluded that appellant 

had 12 percent permanent impairment of her right upper extremity under the DBI rating method.

5

Dr. Rabinovich then applied the ROM rating method to the right upper extremity under 

Table 15-34, Table 15-35, and Table 15-36 on pages 475 and 477. He indicated that appellant had 

three percent permanent impairment due to loss of flexion of the right shoulder, one percent due 

to loss of extension, three percent due to loss of abduction, and two percent due to loss of internal 

rotation. Dr. Rabinovich combined these values to equal 9 percent permanent impairment of the

right upper extremity, but noted that, under Table 15-36, appellant’s GMFH dictated that the final 

value for right upper extremity permanent impairment was 10 percent under the ROM rating 

method. He concluded that appellant had 12 percent permanent impairment of her right upper 

extremity given that she had a higher rating for permanent impairment under the DBI rating.

On February 7, 2019 OWCP requested that Dr. James W. Butler, Board-certified in 

occupational medicine and serving as a district medical adviser (DMA), review the case record, 

including Dr. Rabinovich’s January 21, 2019 report, and provide an opinion as to the nature and 

extent of appellant’s permanent impairment of her right upper extremity under the sixth edition of 

the A.M.A., Guides.

In a March 28, 2019 report, the DMA indicated that he was unable to provide a complete 

assessment of the permanent impairment of appellant’s right upper extremity because he could not 

perform the calculations under the ROM rating method due to the fact that the A.M.A., Guides

requires an evaluation of active ROM findings and Dr. Rabinovich only provided passive ROM 

findings for appellant’s right shoulder. The DMA advised that he could not provide a permanent 

impairment rating due to this circumstance. 

OWCP referred the case back to Dr. Rabinovich and requested that he provide clarification 

regarding the ROM findings for appellant’s right shoulder. In a supplemental report dated May 7, 

2019, Dr. Rabinovich clarified that the reference to passive ROM findings for her right shoulder 

in his January 21, 2019 report was a typographical error and that the ROM findings described in 

the report actually were active ROM findings. He indicated that, as explained in his January 21, 

2019 report, appellant had 12 percent permanent impairment of her right upper extremity. 

OWCP requested that the DMA provide a supplemental report regarding the permanent

impairment of appellant’s right upper extremity. In a report dated June 21, 2019, the DMA 

indicated that he had reviewed Dr. Rabinovich’s supplemental report and he then evaluated the 

permanent impairment of her right upper extremity under the DBI rating method of the sixth 

edition of the A.M.A., Guides. He noted that, under Table 15-5, appellant’s right distal clavicle 

condition fell under Class 1 for the CDX, a designation which warranted a default value of 10 

percent permanent impairment of the right upper extremity. The DMA referenced Table 15-6, 

Table 15-7, and Table 15-8 and determined that she had a GMPE of 1 (limited ROM of the right 

shoulder) and a GMCS of 2 (based on right rotator cuff tear seen on diagnostic testing). He found 

that the GMFH was unreliable and should be excluded, noting that appellant fell under Class 1 for 

CDX, but had a GMFH of 3 which was two grades higher (based on a QuickDASH score of 68). 

 

5 Dr. Rabinovich noted that appellant reached maximum medical improvement (MMI) on January 21, 2019, the 

date of his examination.
4

Application of the net adjustment formula resulted in movement one space to the right of the 

default value on Table 15-5 to the value of 11 percent permanent impairment. Therefore, the DMA

concluded that appellant had 11 percent permanent impairment of her right upper extremity under 

the DBI rating method.

The DMA then applied the ROM rating method to the right upper extremity under Table

15-34, Table 15-35, and Table 15-36. He noted that appellant had three percent permanent 

impairment due to loss of flexion of the right shoulder, one percent due to loss of extension, three 

percent due to loss of abduction, and two percent due to loss of internal rotation. The DMA 

combined these values and concluded that she had nine percent permanent impairment of her right 

upper extremity under the ROM rating method. Because appellant had a higher rating for

permanent impairment under the DBI rating method (11 percent) than under the ROM rating 

method (9 percent), the DMA concluded that she had 11 percent permanent impairment of her 

right upper extremity.6

By decision dated June 28, 2019, OWCP granted appellant a schedule award for 11 percent 

permanent impairment of her right upper extremity. The award ran for 34.32 weeks from 

January 21 to September 18, 2019 and was based on the permanent impairment evaluation of the 

DMA. 

LEGAL PRECEDENT

The schedule award provision of FECA,7and its implementing federal regulations,

8

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.9 As of May 1, 2009, the 

sixth edition of the A.M.A., Guides is used to calculate schedule awards.10

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, the relevant portion of the arm for the present case, 

reference is made to Table 15-5 (Shoulder Regional Grid) beginning on page 401. After the CDX 

is determined from the Shoulder Regional Grid (including identification of a default grade value), 

the net adjustment formula is applied using the GMFH, GMPE, and GMCS. The net adjustment 

 

6 The DMA indicated that appellant reached MMI on January 21, 2019, the date of Dr. Rabinovich’s examination.

7 5 U.S.C. § 8107.

8 20 C.F.R. § 10.404.

9

Id.

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

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

Exhibit 1 (January 2010).
5

formula is (GMFH - CDX) + (GMPE - CDX) + (GMCS - CDX).11 Table 15-5 also provides that, 

if motion loss is present for a claimant with certain diagnosed conditions, including AC joint 

disease, permanent impairment may alternatively be assessed using section 15.7 (ROM 

impairment). Such a ROM rating stands alone and is not combined with a DBI rating.12

The A.M.A., Guides provides that, when the GMFH differs by two or more grades from 

that described by the GMPE or GMCS, it should be assumed to be unreliable. If the functional 

history is determined to be unreliable or inconsistent with other documentation, it is excluded from 

the grading process.13

The A.M.A., Guides provides that, when two methods of impairment evaluation are 

appropriate, the method which yields the highest impairment rating should be used.14 Moreover, 

FECA Bulletin No. 17-06 provides that if the A.M.A., Guides allows 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.15

ANALYSIS

The Board finds that appellant has not met her burden of proof to establish more than 11 

percent permanent impairment of her right upper extremity, for which she previously received a 

schedule award.

The Board notes that OWCP properly relied on the opinion of the DMA in granting 

appellant a schedule award for 11 percent permanent impairment of her right upper extremity.

In a report dated June 21, 2019, the DMA properly found that appellant had 11 percent 

permanent impairment of her right upper extremity under the sixth edition of the A.M.A., Guides. 

He evaluated her permanent impairment under the DBI rating method and noted that, under Table 

15-5, her right distal clavicle condition fell under Class 1 for the CDX, with a default value of 10 

percent permanent impairment. The DMA correctly evaluated the medical evidence, including the 

findings of Dr. Rabinovich, OWCP’s referral physician, to find that appellant had a GMPE of 1 

(limited ROM of the right shoulder) and a GMCS of 2 (based on right rotator cuff tear seen on 

diagnostic testing). He properly found that the GMFH was unreliable and should be excluded as

she fell under Class 1 for CDX with a GMPE of 1, and the provisional GMFH of 3 was two grades 

higher per her QuickDASH score of 68.

16

 Application of the net adjustment formula resulted in 

movement one space to the right of the default value on Table 15-5 to the value of 11 percent 

permanent impairment. The DMA then applied the ROM rating method to find that appellant had 

 

11 See A.M.A., Guides (6th ed. 2009) 405-12. 

12 Id. at 401-05, 475-78.

13 Id. at 406-07.

14 Id. at 526-27.

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

16 See supra note 13.
6

nine percent permanent impairment of her right upper extremity under this method.

17

 He properly

found that, because she had a higher rating for permanent impairment under the DBI rating method 

(11 percent) than under the ROM rating method (9 percent), that she had 11 percent permanent 

impairment of her right upper extremity.

18

Appellant has not submitted medical evidence to establish entitlement to additional 

schedule award compensation and OWCP properly found that she had not established more than 

11 percent permanent impairment of her right upper extremity, for which she previously received 

a schedule award.

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 11 

percent permanent impairment of her right upper extremity, for which she previously received a 

schedule award.

 

17 Due to the DMA’s finding that the GMFH should be excluded, the standards of Table 15-36 provide that there 

would be no modification of the nine percent rating. A.M.A., Guides 477, Table 15-36. 

18 The DMA complied with the appropriate standards, including those described in FECA Bulletin No. 17-06, by 

conducting both DBI and ROM ratings and choosing the method which yielded the higher permanent impairment 

rating. See supra notes 12, 14, and 15.
7

ORDER

IT IS HEREBY ORDERED THAT the June 28, 2019 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: March 10, 2020

Washington, DC

Christopher J. Godfrey, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Alternate Judge

Employees’ Compensation Appeals Board