United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

J.M., Appellant

and

U.S. POSTAL SERVICE, OAKLAND 

PROCESSING & DISTRIBUTION CENTER, 

Oakland, CA, Employer

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Docket No. 21-0787

Issued: June 21, 2022

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

JANICE B. ASKIN, Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On April 26, 2021 appellant filed a timely appeal from a November 19, 2020 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

ISSUE

The issue is whether appellant has met her burden of proof to establish greater than 25 

percent permanent impairment of the right lower extremity and greater than 25 percent permanent 

1

5 U.S.C. § 8101 et seq.

2 The Board notes that, following the November 19, 2020 decision and on appeal, OWCP received additional 

evidence. However, the Board’s Rules of Procedureprovides: “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

impairment of the left lower extremity for which she previously received schedule award

compensation.

FACTUAL HISTORY

On April 6, 1998 appellant, then a 47-year-old clerk, filed a traumatic injury claim (Form 

CA-1) alleging that she injured her right wrist and right lower extremity when she jumped from 

the back of a mail truck onto a loading dock while in the performance of duty.

OWCP accepted appellant’s claim forclosed fracture ofthe rightfibula shaft;tenosynovitis 

of the right hand and wrist; bilateral wrist sprain; tear of lateral meniscus of the left knee; bilateral

synovitis and tenosynovitis; right knee tear of the medial meniscus of the right knee; closed 

fracture of the right ankle; and bilateral osteoarthritis of the knees.

On May 22, 1998 appellant underwent an open reduction and internal fixation of the right 

tibia fracture. On January 19, 2000 she underwent a removal of hardware from the right proximal 

tibia. On December 19, 2001 appellant underwent a right knee meniscectomy of the medial and 

lateral menisci, synovectomy, and chondroplasty of the patellofemoral and lateral femoral 

compartments. On September 18, 2002 she underwent an additional excision of an osteophyte 

formation over the anterior right tibia, repair of a complex lateral meniscus tear, repair of a tear of 

the lateral collateral and fibular collateral ligaments, and proximal tibia ostectomy. On October 5, 

2005 appellant underwent a left knee arthroscopy and synovectomy for lateral meniscal tear. On 

September 12, 2007 she underwent a right total knee arthroplasty and correction of valgus. On 

October 9, 2018 appellant underwent a left total knee arthroplasty. 

By decision dated October 30, 2000, OWCP granted appellant a schedule award for three

percent permanent impairment of the right lower extremity. By decision dated May 7, 2013, it

granted her a schedule award for 9 percent permanent impairment of the right upper extremity and 

0 percent permanent impairment of the left upper extremity, 40 percent impairment of the right 

lower extremity (43 percent current, with 3 percent previously paid), and 7 percent permanent 

impairment of the left lower extremity. 

In July 11 and 23, 2019 reports, Dr. John H. Welborn, Jr., Board-certified in orthopedic 

surgery, noted that he saw appellant for follow up. He found that her knees were stable, with no 

tenderness and no swelling, that both had 120 degrees of active flexion and 0 degrees active 

extension. Dr. Welborn concluded that both knees had improved following total knee 

replacements. 

On September 13, 2019 appellant filed a claim for compensation (Form CA-7) for a 

schedule award.

In support of her claim, appellant submitted an October 7, 2019 report from Dr. Welborn. 

Dr. Welborn provided a history of her injury and medical treatment. He provided examination 

findings relating to appellant’s left knee, relating that appellant had 110 degrees of flexion and 0 

degrees of extension. Dr. Welborn noted that she had undergone a knee replacement on the left, 

and he found that she had left knee degenerative joint disease with limited motion and joint pain. 

He referred to the sixth edition of the American Medical Association, Guides to the Evaluation of 
3

Permanent Impairment (A.M.A., Guides),3 Table 16-3, page 511, Knee Regional Grid -- Lower 

Extremity Impairments, and opined that appellant had a fair result from her left total knee 

replacement, the class of diagnosis (CDX), which is the equivalent of a Class 3, 37 percent left 

lower extremity permanent impairment.

In a January 13, 2020 report, Dr. Welborn noted that appellant had undergone bilateral 

knee replacements, both of which were stable. He related that both knees had 120 degrees of

flexion. Dr. Welborn opined that appellant had attained maximum medical improvement (MMI) 

as of July 11, 2019. He referred to the fifth edition of the A.M.A., Guides,

4 Table 17-33, page 

547, and opined that she had a fair result for her left knee replacement with a 20 percent whole 

person impairment.

On June 22, 2020 OWCP advised appellant that her case was referred to a district medical 

adviser (DMA) for review of the medical evidence and the October 7, 2019 report from

Dr. Welborn. 

OWCP forwarded Dr. Welborn’s July 23 and October 7, 2019 reports, the medical record, 

and statement of accepted facts (SOAF) to Dr. Michael M. Katz, a Board-certified orthopedic 

surgeon, serving as an OWCP DMA. 

In a June 26, 2020 report, Dr. Katz reviewed the SOAF and medical record. He noted that 

he was unable to locate Dr. Welborn’s October 7, 2019 report and parts of the July 23, 2019 report. 

In a July 6, 2020 report, Dr. Welborn noted that appellant had reached MMI on 

July 11, 2019. He explained that on October 7, 2019 he rated her left knee as a 37 percent lower 

extremity permanent impairment. However, appellant had not received a schedule award, despite 

that he had assessed her permanent impairment pursuant to the A.M.A., Guides. 

On July 21, 2020 OWCP provided Dr. Katz with the July 23 and October 7, 2019 reports

from Dr. Welborn. 

In a July 27, 2020 report, Dr. Katz reviewed the SOAF and medical record,referred to the 

sixth edition of the A.M.A., Guides, and applied the diagnosis-based impairment (DBI) method.

For the left lower extremity, the DMA referred to the Knee Regional Grid, Table 16-3, page 511, 

using the diagnostic key factor, CDX of a total knee replacement, good result (functional good 

position), and found Class 2, with default impairment value of 25 percent, with adjustment factors 

of CDX 2, grade modifier for functional history (GMFH) of 2, grade modifier for physical 

examination (GMPE) of 2, grade modifier for clinical studies (GMCS) not applicable, for a net 

adjustment of 0, and a 25 percent impairment rating. For the right lower extremity, Dr. Katz

referred to the Knee Regional Grid, Table 16-3, page 511, using the diagnostic key factor, CDX,

of a total knee replacement, good result (functional, good position), and again found Class 2, with 

default impairment value of 25 percent, with adjustment factors of CDX 2, GMFH 2, GMPE 2, 

and GMCS N/A, for a net adjustment of 0, and a 25 percent impairment rating. Regarding the 

range of motion (ROM) method, the DMA explained that the key diagnostic fac tors were not 

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

4 A.M.A., Guides(5th ed. 2001).
4

eligible for an alternative ROM impairment rating. Dr. Katz advised that MMI was reached on 

July 23, 2019 for the right lower extremity, and October 7, 2019 for the left lower extremity.

Dr. Katz indicated that he reviewed Dr. Welborn’s July 23 and October 7, 2019 reports. 

Regarding the October 7, 2019 report, he advised that Dr. Welborn’s “use of Class 3 impairment 

implying mild motion deficit or instability” was not supported, and that “Class 2 impairment is the 

appropriate choice.” The DMA explained that the documented ROM for the left lower extremity 

of 0 - 110 did not qualify under Table 16-23, page 549, for a mild motion deficit, and that

Dr. Welborn’s examination also indicated a “stable” knee. He also noted that the July 23, 2019 

report from Dr. Welborn did not include an impairment rating.

By decision dated November 19, 2020, OWCP granted appellant a schedule award for 25 

percent permanent impairment of the left lower extremity, less 7 percent previously awarded, for 

a total of 18 percent due, and 25 percent permanent impairment of the right lower extremity, less 

43 percent previously awarded, for a total of 0 percent due. The award ran for 51.84 weeks from 

October 7, 2019 through October 3, 2020. OWCP noted that the schedule award was based on the 

July 23, 2019 report of Dr. Welborn and the July 27, 2020 report from Dr. Katz, the DMA.

LEGAL PRECEDENT

The schedule award provisions of FECA5 and its implementing regulations6 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. FECA, however, does not 

specify the manner in which the percentage of loss of a member 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 and the Board has concurred in such 

adoption.7 As of May 1, 2009, the sixth edition of the A.M.A., Guides, published in 2009, is used 

to calculate schedule awards.8

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 position of the leg for the present case, reference 

is made to Table 16-3 (Knee Regional Grid) beginning on page 509.9 After 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 (GMFH5

5 U.S.C. § 8107.

6

20 C.F.R. § 10.404.

7

Id. See also M.F., Docket Nos. 21-0759 & 21-1037 (issued May 4, 2022); Ronald R. Kraynak, 53 ECAB 

130 (2001).

8 For decisions issued after May 1, 2009 the sixth edition of the A.M.A., Guidesis used. A.M.A., Guides(6th ed. 

2009); Federal (FECA) Procedure Manual, Part 2 -- Claims, Schedule Awards and Permanent Disability Claims,

Chapter 2.808.5a (March 2017); see also Chapter 3.700, Exhibit 1 (January 2010).

9

See A.M.A., Guides(6th ed. 2009) 509-11.
5

CDX) + (GMPE-CDX) + (GMCS-CDX).10 Evaluators are directed to provide reasons for their 

impairment rating choices, including the choices of diagnosis from regional grids and calculations 

of modifier scores.11

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

should be routed through an OWCP medical adviser for an opinion concerning the nature and 

extent of impairment in accordance with the A.M.A., Guides, with an OWCP medical adviser 

providing rationale for the percentage of impairment specified.12

ANALYSIS

The Board finds that appellant has not met her burden of proof to establish greater than 25 

percent permanent impairment of the right lower extremity and a greater than 25 percent permanent 

impairment of the left lower extremity for which she previously received schedule award

compensation.

Appellant submitted several reports from Dr. Welborn, her treating physician. In his 

October 7, 2019 report, Dr. Welborn provided an impairment rating for the left lower extremity 

impairment. He referred to the A.M.A., Guides,

13Table 16-3, and found that appellant had a CDX

of left knee replacement with fair result, which equated to a Class 3, 37 percent left lower extremity 

impairment. However, Dr. Katz, the DMA, reviewed the October 7, 2019 report and advised that

Dr. Welborn incorrectly applied Table 16-3 of the A.M.A., Guides and that the “use of Class 3 

impairment implying mild motion deficit or instability” was not supported” based upon

Dr. Welborn’s examination findings. Dr. Katz explained that Dr. Welborn’s examination found a 

“stable” knee, which would comport with “Class 2 impairment,” and that Dr. Welborn’s left knee 

flexion finding of 110 degrees did not qualify under Table 16-3 for a mild motion deficit.

14

Dr. Welborn also provided a January 13, 2020 report wherein he found that appellant had 

120 degrees of flexion of both knees and a fair result following knee replacement. He opined that 

she had a 20 percent whole person impairment. The Board notes that this report is of limited 

probative value as FECA, does not allow schedule awards for impairment of the body as a whole. 15 

Accordingly, Dr. Welborn’s January 14, 2020 report does not comport with OWCP’s procedures 

and is insufficient to establish any ratable impairment.16

10 Id. at 515-22.

11 Id. at 23-28.

12 Supra note 9 at Chapter 2.808.6f (March 2017).

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

14 Id. at 511.

15 See D.K., Docket No. 21-0303 (issued July 8, 2021); M.M., Docket No. 17-0197 (issued May 1, 2018); J.G., 

Docket No. 12-0995 (issued October 22, 2012).

16 See M.M., id.
6

The Board finds that the DMA, Dr. Katz, in his February 10, 2020 report, properly utilized 

the medical evidence of record, including Dr. Welborn’s examination findings, and applied the 

appropriate provisions and grading schemes of the sixth edition of the A.M.A., Guides to 

determine that appellant had 25 percent permanent impairment of the left lower extremity and 25 

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

A.M.A., Guides, and the CDX of left knee total replacement, good result (functional good 

position), the DMA found Class 2, with default impairment value of 25 percent, with adjustment 

factors of CDX 2, GMFH 2, GMPE 2, and GMCS N/A, for a net adjustment of 0, and a 25 percent 

impairment rating for the left lower extremity. He reviewed Dr. Welborn’s January 13, 2020 

findings regarding the right knee, and also found that appellant had right lower extremity 

permanent impairment rating of 25 percent. The DMA noted that the A.M.A., Guides did not 

allow an impairment rating due to loss of ROM for the applicable diagnosis. In addition, he

disagreed with Dr. Welborn’s choice of Class 3, as noted, and indicated that Class 2 was the

appropriate impairment rating, based upon Dr. Welborn’s examination findings regarding retained 

flexion and “stable” knee. For these reasons, the Board finds that OWCP properly relied on the 

DMA’s opinion and 25 percent impairment ratings for the right and left lower extremities. 

There is no medical evidence in conformance with the A.M.A., Guides showing greater 

impairment. As there is no medical evidence in conformance with the A.M.A., Guides establishing 

that appellant has greater impairment than previously awarded, the Board finds that appellant has 

not met her burden of proof to establish that she is entitled to additional schedule award 

compensation.17

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 greater than 25 

percent permanent impairment of the right lower extremity and greater than 25 percent permanent 

impairment of the left lower extremity for which she previously received a schedule award.

17 M.H., Docket No. 20-1109 (issued September 27, 2021); R.H., Docket No. 20-1472(issued March 15, 2021); 

L.D., Docket No. 19-0495 (issued February 5, 2020).
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ORDER

IT IS HEREBY ORDERED THAT the November 19, 2020 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: June 21, 2022

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board