United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

M.J.,

and

DEPARTMENT OF VETERANS AFFAIRS, 

ALEDA E. LUTZ VA MEDICAL CENTER, 

Saginaw, MI, Employer

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Docket No. 20-1264

Issued: February 16, 2021

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant1

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 10, 2020 appellant, through counsel, filed a timely appeal from an April 29, 2020 

merit decision of the Office of Workers’ Compensation Programs (OWCP). Pursuant to the 

Federal Employees’ Compensation Act2(FECA) and 20 C.F.R. §§ 501.2(c) and 501.3, the Board 

has jurisdiction over the merits of this case.

 

1

In all cases in which a representative has been authorized in a matter before the Board, no claim for a fee for legal 

or other service performed on appeal before the Board is valid unless approved by the Board. 20 C.F.R. § 501.9(e). 

No contract for a stipulated fee or on a contingent fee basis will be approved by the Board. Id. An attorney or 

representative’s collection of a fee without the Board’s approval may constitute a misdemeanor, subject to fine or 

imprisonment for up to one year or both. Id.; see also 18 U.S.C. § 292. Demands for payment of fees to a 

representative, prior to approval by the Board, may be reported to appropriate authorities for investigation.

2 5 U.S.C. § 8101 et seq.
2

ISSUE

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

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

schedule award.

FACTUAL HISTORY

On December 19, 2002 appellant, then a 44-year-old nursing assistant, filed a traumatic 

injury claim (Form CA-1) alleging that on December 18, 2002 he injured his right kneecap when 

he slipped on ice while in the performance of duty. By decision dated January 21, 2003, OWCP 

accepted the claim for right knee sprain.

3

 Appellant returned to full-time modified-duty work on 

February 11, 2003 and full-time regular-duty work on March 5, 2003.4

OWCP thereafter received an October 3, 2017 medical report by Dr. Catherine Watkins 

Campbell, Board-certified in occupational medicine. Dr. Watkins Campbell noted a history of the 

accepted December 18, 2002 employment injury.5 On physical examination appellant presented 

wearing braces bilaterally and ambulated with a mild-to-moderately antalgic gait. On general 

examination she found limited ability to squat, negative Trendelenburg sign bilaterally, and no 

laxity in the right knee. Dr. Watkins Campbell reported medial joint line tenderness of the right 

knee, mild patellar crepitance of the right knee, negative popliteal examination on the right, and 

normal strength. On range of motion (ROM) examination of the right knee, she reported three 

measurements of appellant’s right knee consisting of 120, 120, and 125 degrees of flexion, and -

14, -10, and -9 degrees of extension. She reported that appellant was at maximum medical 

improvement (MMI) on August 10, 2017, the date of the examination. 

Dr. Watkins Campbell referred to the sixth edition of the American Medical Association, 

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

6

and utilized the diagnosisbased impairment (DBI) rating method to find that, under Table 16-3 (Knee Regional Grid), page 

509, the class of diagnosis (CDX) for a knee strain resulted in a class 1 impairment for “mild 

motion deficits” with a default value of seven. Dr. Watkins Campbell assigned a grade modifier 

for functional history (GMFH) of 1, at page 516, based on appellant’s gait derangement consistent 

with “antalgic limp with asymmetric shortened stance, corrects with footwear modifications and/or 

orthotics.” She assigned a grade modifier for physical examination (GMPE) of 1, at page 517, 

based on minimal palpatory findings, consistently documented, without observed abnormalities. 

She further noted a GMPE of 1 as appellant’s range of motion revealed “mild or arthrodesis in 

position of function.” Dr. Watkins Campbell found that a grade modifier for clinical studies 

 

3 Appellant was paid continuation of pay from December 19, 2002 through February 1, 2003.

4 On December 11, 2009 OWCP indicated that there was no activity in the claim since 2003 and it was placed in a 

case-closed status. Appellant retired effective November 30, 2015.

5 Dr. Campbell referenced a 2014 work injury in which appellant tripped and fell while assisting a patient and 

reinjured his right knee and lower back. She noted having no documentation of the 2002 injury. She rated the right 

knee based on the assumption that a recognized injury occurred in 2002 and again in 2014.

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

(GMCS) was not applicable as the clinical studies were used to establish the diagnosis and proper 

placement in the regional grid. She utilized the net adjustment formula (GMFH - CDX) + (GMPE 

- CDX) = (1 - 1) + (1 - 1) = 0, which resulted in a grade C or seven percent permanent impairment 

of the right lower extremity. Dr. Watkins Campbell did not provide a ROM impairment rating

pursuant to Table 16-23 (Knee Motion Impairments), page 549. She concluded that appellant had 

seven percent permanent impairment of the right lower extremity under the DBI rating method.

On June 7, 2019 OWCP routed Dr. Watkins Campbell’s October 3, 2017 report, a 

statement of accepted facts (SOAF), and the case file to Dr. Herbert White, Jr., a Board-certified 

orthopedic surgeon serving as a district medical adviser (DMA), for review and a determination 

of permanent impairment of the right lower extremity in accordance with the sixth edition of the 

A.M.A., Guides and the date of maximum medical improvement (MMI).

In a June 12, 2019 report, Dr. White reviewed the medical record, including the report of

Dr. Watkins Campbell. He found that the diagnosis of right knee sprain had been established. 

Using the DBI method with reference to appellant’s right knee condition, the DMA found that, 

under the sixth edition of the A.M.A., Guides, Table 16-3, page 509, the CDX for a knee strain 

resulted in a class 1 impairment for “palpatory findings” with a default value of two. Dr. White 

assigned a GMFH of 1 based on appellant’s abnormal gait. He assigned a GMPE of 1 based on 

tenderness. Dr. White found that a GMCS was not applicable as the clinical studies were used to 

establish the diagnosis and proper placement in the regional grid. He utilized the net adjustment 

formula (GMFH - CDX) + (GMPE - CDX) = (1 - 1) + (1 - 1) = 0, which resulted in a grade C or 

two percent permanent impairment of the right lower extremity. Dr. White referenced Dr. Watkins 

Campbell’s right knee ROM measurements for flexion 120, 120 and 125 degrees and for flexion 

contracture -14, -10, and -9 degrees and opined that pursuant to Table 16-23, Knee Motion 

Impairments, page 549, these ROM findings were normal. Dr. White addressed the discrepancy 

between his rating of two percent impairment and Dr. Watkins Campbell’s rating of seven percent 

impairment of the right lower extremity and explained that Dr. Watkins Campbell noted that 

appellant had decreased ROM of the right knee; however, upon application of her findings to Table 

16-23, ROM was found to be normal. He concurred that the date of MMI was August 10, 2017.

By decision dated November 19, 2019, OWCP granted appellant a schedule award for two 

percent permanent impairment of the right lower extremity. The period of the award ran for 5.76

weeks for the period August 10 to September 19, 2017, and was based on the opinion of the DMA.

On November 26, 2019 appellant, through counsel, requested a telephonic hearing before 

a representative of OWCP’s Branch of Hearings and Review and submitted a supplemental report 

from Dr. Watkins Campbell in which she addressed the discrepancy between her impairment 

findings and Dr. White’s. Referencing the A.M.A., Guides, Dr. Watkins Campbell asserted that

Dr. White erroneously applied the use of the stand-alone ROM method, which was permissible for 

some diagnoses primarily in the upper extremity ratings. She indicated that there was no asterisk 

by the knee strain diagnosis allowing for use of the ROM method. Dr. Watkins Campbell noted 

that the examiner was to use the greater of the two values using the DBI method and ROM method. 

She reiterated her prior opinion that appellant sustained seven percent impairment of the right 

lower extremity.
4

An oral hearing was held on March 11, 2020. By decision dated April 29, 2020 OWCP’s 

hearing representative affirmed the November 19, 2019 decision.

LEGAL PRECEDENT

The schedule award provisions of FECA7and its implementing regulations8set 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 to all claimants, good administrative practice necessitates the 

use of a single set of tables so that there may be uniform standards applicable to all claimants.

Through its implementing regulations, OWCP adopted the A.M.A., Guides as the appropriate 

standard for evaluating schedule losses.9 As of May 1, 2009, schedule awards are determined in 

accordance with the sixth edition of the A.M.A., Guides (2009).10 The Board has approved the 

use by OWCP of the A.M.A., Guides for the purpose of determining the percentage loss of use of 

a member of the body for schedule award purposes.11

The sixth edition of the A.M.A., Guides provides a DBI method of evaluation utilizing the 

World Health Organization’s International Classification of Functioning, Disability and Health 

(ICF).12 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 knee, the relevant portion of the leg for the present case, reference 

is made to Table 16-3 (Knee Regional Grid) beginning on page 509.13 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 (GMFH-CDX) + (GMPE-CDX) + (GMCS-CDX).14 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.15

 

7 5 U.S.C. § 8107.

8 20 C.F.R. § 10.404.

9

Id. See also Ronald R. Kraynak, 53 ECAB 130 (2001).

10 See Federal (FECA) Procedure Manual, Part 3 -- Medical, Schedule Awards, Chapter 3.700, Exhibit 1 

(January 2010); Federal Procedure Manual, Part 2 -- Claims, Schedule Awards and Permanent Disability Claims, 

Chapter 2.808.5a (March 2017).

11 P.R., Docket No. 19-0022 (issued April 9, 2018); Isidoro Rivera, 12 ECAB 348 (1961).

12 A.M.A., Guides, page 3, section 1.3, The International Classification of Functioning, Disability and Health (ICF): 

A Contemporary Model of Disablement.

13 See A.M.A., Guides 509, Table 16-3.

14 Id. at 515-22.

15 Id. at 23-28.
5

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

should be routed to a DMA for an opinion concerning the nature and percentage of impairment in 

accordance with the A.M.A., Guides, with the DMA providing rationale for the percentage of 

impairment specified.16

ANALYSIS

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

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

schedule award.

Appellant submitted an October 3, 2017 report from Dr. Watkins Campbell to support his 

claim for a schedule award. Dr. Watkins Campbell reviewed appellant’s history and conducted an 

examination. She reported a diagnosis of right knee strain. Utilizing the DBI methodology under 

Table 16-3, page 509 of the sixth edition of the A.M.A., Guides, Dr. Watkins Campbell found that 

appellant had a class 1, grade C impairment for “mild motion deficits” with a default value of 

seven. She assigned grade modifiers and applied the net adjustment formula to find a net 

adjustment of 0, which yielded seven percent right lower extremity permanent impairment.

OWCP properly referred the evidence of record to a DMA, Dr. White. In his June 12, 2019

report, the DMA disagreed with Dr. Watkins Campbell’s impairment rating of seven percent

because it was based on the (CDX) for a knee strain, class 1 impairment for “mild motion deficits.” 

He correctly explained that Dr. Watkins Campbell provided right knee ROM for flexion of 120, 

120 and 125 degrees and for flexion contracture of -14, -10, and -9 degrees. Pursuant to Table 16-

23, Knee Motion Impairments, these findings were normal and would not be appropriately rated 

as “mild motion deficits.” Rather, “palpatory findings” more accurately described appellant’s 

condition. The Board has held that, when an attending physician’s report gives an estimate of 

permanent impairment, but it is not based on proper application of the A.M.A., Guides, OWCP 

may follow the advice of the DMA if he or she has properly applied the A.M.A., Guides.

17

 In his 

June 12, 2019 report, the DMA properly applied the A.M.A., Guides to the physical examination 

findings of Dr. Watkins Campbell. He noted that the physical examination of record did not 

demonstrate mild motion deficits and correctly noted the CDX resulted in a class 1 impairment 

most consistent with “palpatory findings” with a default value of two. The DMA and Dr. Watkins 

Campbell both recommended the same grade modifiers and provided a calculation of the net 

adjustment formula. The Board finds that the DMA accurately summarized the relevant medical 

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

condition which comported with his findings, and with the appropriate provisions of the A.M.A., 

 

16 See supra note 10 at Chapter 2.808.6(f) (March 2017). See also P.W., Docket No. 19-1493 (issued August 12, 

2020); Frantz Ghassan, 57 ECAB 349 (2006).

17 See J.D., Docket No. 19-0414 (issued August 19, 2019); P.L., Docket No. 17-0355 (issued June 27, 2018); see 

also Ronald J. Pavlik, 33 ECAB 1596 (1982).
6

Guides.

18

 The DMA’s report therefore carries the weight of the medical evidence and establishes 

that appellant has two percent permanent impairment of his right lower extremity.19

On appeal counsel contends that OWCP failed to give due deference to the findings of 

appellant’s attending physician. The Board finds that this assertion is not meritorious. As 

explained above, appellant has not established greater than two percent permanent impairment of 

his right lower extremity.

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 two 

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

schedule award.

ORDER

IT IS HEREBY ORDERED THAT the April 29, 2020 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: February 16, 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

 

18 See J. M., Docket No. 18-1387 (issued February 1, 2019).

19 See F.T., Docket No. 16-1236 (issued March 12, 2018).