United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

K.M., Appellant

and

DEPARTMENT OF THE NAVY, NAVAL 

INTERMEDIATE MAINTENANCE FACILITY, 

Bangor, WA, Employer

__________________________________________

)

)

)

)

)

)

)

)

)

Docket No. 19-1526

Issued: January 22, 2020

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

ALEC J. KOROMILAS, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On July 10, 2019 appellant filed a timely appeal from a June 21, 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 his burden of proof to establish more than four 

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

schedule award.

 

1 5 U.S.C. § 8101 et seq.
2

FACTUAL HISTORY

On May 14, 2018 appellant, then a 31-year-old electrician helper, filed a traumatic injury 

claim (Form CA-1) alleging that on May 11, 2018 he injured his right foot while in the 

performance of duty.2 On June 13, 2018 OWCP accepted his claim for right foot displaced fracture 

of the second metatarsal bone, and on June 15, 2018 appellant underwent OWCP-approved right 

foot surgery.3 OWCP paid appellant wage-loss compensation through July 21, 2018. Appellant

returned to work in a limited-duty capacity on August 3, 2018. His surgeon released him to resume 

full-time, regular-duty work, effective November 15, 2018. In a January 29, 2019 work capacity 

evaluation (Form OWCP-5c), Dr. Kessinger advised that appellant had reached maximum medical 

improvement.

On March 4, 2019 Dr. Marc I. Suffis, Board-certified in emergency medicine, provided an 

impairment rating, pursuant to the sixth edition of the American Medical Association, Guides to 

the Evaluation of Permanent Impairment (A.M.A., Guides).4 He diagnosed right second TMT 

Lisfranc fracture/dislocation, status post ORIF. Pursuant to Table 16-2, Foot and Ankle Regional 

Grid, A.M.A., Guides 504, a Lisfranc injury (nondisplaced with minimal findings) represents a 

class 1 diagnosis (CDX), with a default rating (grade C) of three percent permanent impairment of 

the right lower extremity. Pursuant to Table 16-6, page 516 of the A.M.A., Guides, Dr. Suffis 

assigned a grade modifier of one for functional history (GMFH) based on a mild gait derangement. 

Pursuant to Table 16-7, page 517 of the A.M.A., Guides he also assigned a grade modifier of one 

for physical examination (GMPE) based on minimal palpatory findings. Lastly, pursuant to Table 

16-8, page 518 of the A.M.A., Guides, Dr. Suffis assigned a grade modifier of three for clinical 

studies (GMCS) based on severe problems due to fracture dislocation at the Lisfranc joint. He 

then found that appellant had four percent permanent impairment of the right lower extremity.

On May 1, 2019 appellant filed a claim for a schedule award (Form CA-7).

In a May 22, 2019 report, Dr. Ari Kaz, a Board-certified orthopedic surgeon and OWCP 

district medical adviser (DMA), noted that he concurred with Dr. Suffis’ finding of four percent 

permanent impairment of the right lower extremity. He agreed with the diagnosis of Lisfranc 

(fracture/dislocation) injury under Table 16-2, A.M.A., Guides 504. Dr. Kaz also concurred with

Dr. Suffis’ assigned grade modifiers, including the clinical studies grade modifier (GMCS 3) based 

on appellant’s computerized tomography (CT) scan. Applying the net adjustment formula, the 

DMA found that a +2 adjustment was appropriate, which resulted in four percent (grade D) 

 

2 Appellant reported that he was on a break walking to the smoke shack when he caught his foot on a pallet and 

tripped.

3 Dr. Stacee M. Kessinger, a Board-certified orthopedic surgeon, performed the June 15, 2018 surgical procedure, 

which included right foot Lisfranc second tarsometatarsal (TMT) fracture/dislocation with open reduction and internal 

fixation (ORIF).

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

permanent impairment of the right lower extremity.5 He further found that appellant reached MMI 

as of March 4, 2019, which corresponded with the date of Dr. Suffis’ examination.

By decision dated June 21, 2019, OWCP granted appellant a schedule award for four 

percent permanent impairment of the right lower extremity. The award covered an 11.52-week 

period from March 4 through May 23, 2019.

LEGAL PRECEDENT

The schedule award provisions of FECA,6and its implementing federal regulations,7set 

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.8 As of May 1, 2009, the 

sixth edition of the A.M.A., Guides is used to calculate schedule awards.9

In determining impairment for 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 foot/ankle, the relevant portion of the lower extremity for the 

present case, reference is made to Table 16-2, Foot and Ankle Regional Grid, beginning on page 

501.

10

 After the class of diagnosis (CDX) is determined from the Foot and Ankle Regional Grid 

(including identification of a default grade (“C”) value), the net adjustment formula is applied 

using the GMFH, GMPE, and GMCS. The net adjustment formula is (GMFH-CDX) + (GMPECDX) + (GMCS-CDX).11

 Under Chapter 2.3, evaluators are directed to provide reasons for their 

impairment rating choices, including choices of diagnoses from regional grids and calculations of 

modifier scores.12

OWCP’s procedures provide that, after obtaining all necessary medical evidence, the file 

should be routed to an OWCP DMA for an opinion concerning the nature and percentage of 

 

5 Net Adjustment (+2) = (GMFH 1 – CDX 1) + (GMPE 1 – CDX 1) + (GMCS 3 – CDX 1). A.M.A., Guides 521 

(6th ed. 2009).

6 5 U.S.C. § 8107.

7 20 C.F.R. § 10.404.

8

Id. at § 10.404(a).

9 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).

10 See A.M.A., Guides 501-08 (6th ed. 2009).

11 Id. at 521.

12 Id. at 23-28.
4

impairment in accordance with the A.M.A., Guides, with OWCP’s medical adviser providing 

rationale for the percentage of impairment specified.13

ANALYSIS

The Board finds that appellant has not met his burden of proof to establish greater than four 

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

schedule award.

Appellant submitted a March 4, 2019 impairment rating from Dr. Suffis who found four 

percent permanent impairment of the right lower extremity based on a diagnosis of Lisfranc 

fracture/dislocation under Table 16-2, A.M.A., Guides 504. Relying on his examination findings 

and a review of appellant’s medical records, Dr. Suffis assigned appropriate grade modifiers for 

GMFH 1, GMPE 1, and GMCS 3, and concluded that appellant had four percent permanent 

impairment of the right lower extremity. Although Dr. Suffis did not clearly explain his net 

adjustment calculation, the DMA, upon further review, adequately explained how the assigned 

grade modifiers represented a +2 net adjustment, with a corresponding right lower extremity 

impairment of four percent (grade D) pursuant to Table 16-2, A.M.A., Guides 504.14 

The Board finds that OWCP properly determined that the clinical findings and reports of

Dr. Suffis and the DMA constituted the weight of the medical evidence.15 There is no probative 

medical evidence of record demonstrating greater impairment than that previously awarded.16

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 four 

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

schedule award.

 

13 See M.J., Docket No. 17-1776 (issued December 19, 2018); P.R., Docket No. 18-0022 (issued April 9, 2018).

See Federal (FECA) Procedure Manual, supra note 9 at Chapter 2.808.5 (March 2017).

14 See supra note 5.

15 J.H., Docket No. 18-1207 (issued June 20, 2019); M.C., Docket No. 15-1757 (issued March 17, 2016).

16 See J.M., Docket No. 18-1334 (issued March 7, 2019).
5

ORDER

IT IS HEREBY ORDERED THAT the June 21, 2019 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: January 22, 2020

Washington, DC

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Alec J. Koromilas, Alternate Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board