United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

E.D., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Richmond, VA, Employer

__________________________________________

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Docket No. 21-1293

Issued: January 25, 2023

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

PATRICIA H. FITZGERALD, Deputy Chief Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On August 26, 2021 appellant filed a timely appeal from a May 6, 2021 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 May 6, 2021 decision and on appeal, 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 greater than seven 

percent permanent impairment of the left lower extremity, for which she previously received a 

schedule award.

FACTUAL HISTORY

On August 23, 2019 appellant, then a 55-year-old city carrier, filed a traumatic injury claim 

(Form CA-1) alleging that on August 12, 2019 she injured her left knee when she stepped down 

off a step and felt something pull in her left knee, while in the performance of duty. She stopped 

work on August 12, 2019 and returned to part-time modified work on December 7, 2020. OWCP 

accepted the claim for left knee sprain and tear of the left knee medial meniscus. It authorized a 

left knee medial meniscectomy, which appellant underwent on June 16, 2020. 

An August 12, 2019 x-ray of the left knee read by Dr. Salvador Trinidad, Jr., a Boardcertified diagnostic radiologist, revealed no fractures or dislocations, the knee joint was 

well-maintained, the articular surfaces were smooth, and no loose bodies were evident upon the 

joint space. He advised that appellant’s left knee was normal. 

An October 10, 2019 magnetic resonance imaging (MRI) scan of the left knee read by

Dr. Joseph McMonagle, Board-certified in diagnostic radiology, demonstrated medial meniscus 

posterior horn oblique tear, overlying. It also revealed a grade 1 medial collateral ligament 

abnormality, mild tricompartmental degenerative osteoarthropathy, no high-grade cartilage 

abnormality, small left knee joint effusion, intra-articular loose body within the posterior aspect of 

the intercondylar notch, approximately 3 millimeter (mm) in size, and superiorly extending 

Baker’s cyst. 

In a report dated January 21, 2021, Dr. Arthur W. Wardell, a Board-certified orthopedic 

surgeon, noted that appellant continued to have sharp left knee pain. He related that appellant’s 

physical examination indicated medial and lateral patellar facet tenderness and medial joint 

tenderness. Dr. Wardell also noted that appellant had 0 to 100 degrees of motion of the left knee, 

with good stability and valgus stress testing, with some patellofemoral grinding. He also noted 

that review of a January 21, 2021 x-ray demonstrated medial joint space narrowing and mild 

patellofemoral spurring. 

In a February 8, 2021 report, Dr. Wardell diagnosed primary left knee joint arthritis. He 

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

Permanent Impairment (A.M.A., Guides).3 Dr. Wardell referred to Table 16-3, page 511 of the 

A.M.A., Guides and noted that appellant had a Class 2 impairment for the class of diagnosis(CDX)

of primary joint arthritis, for a 2.2 mm cartilage interval. He referred to Table 16-6, page 516, 

finding a grade modifier for functional history (GMFH) of 2;Table 16-7, page 517,finding a grade 

modifier for physical examination (GMPE) of 2; and Table 16-8, page 519, finding a grade 

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

modifierfor clinical studies(GMCS) of 2. Dr. Wardell determined a net adjustment from a default 

grade of C and provided an impairment rating of 20 percent of the left lower extremity. 

A March 1, 2021 MRI scan of the left knee read by Dr. Srinesh Alle, Board-certified in 

neuroradiology, demonstrated medial meniscus tear, negative for a lateral meniscal tear, collateral 

ligament tear, and cruciate ligament tear. It also demonstrated moderate chondromalacia involving 

the medial compartment, and mild chondromalacia involving the lateral and patellofemoral 

compartment. Dr. Alle noted that there was a parameniscal cyst measuring 3 mm adjacent to the 

posterior and medial meniscus. 

On March 19, 2021 appellant filed a claim for compensation (Form CA-7) for a schedule 

award.

OWCP referred Dr. Wardell’s February 8, 2021 report to a district medical adviser (DMA) 

for review. In a report dated March 27, 2021, Dr. David J. Slutsky, a Board-certified orthopedic 

surgeon serving as a DMA, reviewed the medical evidence of record. He explained that an 

impairment rating could not be performed because the report from Dr. Wardell was largely 

illegible. Dr. Slutsky also noted that the rating was based upon the diagnosis of arthritis of the 

knee, but the August 12 and October 10, 2019 diagnostic tests did not show any joint space 

narrowing. The DMA recommended further documentation to include a detailed history of 

appellant’s current complaints, physical findings including palpation of the knee, and validated 

lower extremity range of motion (ROM), along with all imaging studies that documented 

osteoarthritis of the knees, including standing x-ray views. Dr. Slutsky advised that maximum 

medical improvement (MMI) would be determined after the additional information had been 

provided. 

On March 31, 2021 OWCP provided a copy of the March 27, 2021 reportfrom Dr. Slutsky, 

the DMA, and requested that Dr. Wardell, the treating physician, provide additional information. 

It afforded Dr. Wardell 30 days to respond. 

In an April 14, 2021 report, Dr. Wardell noted that he had reviewed the DMA’s findings 

and that he was enclosing his office notes. He related that, on multiple occasions, appellant had 

restricted ROM on examination, effusion, as well as joint line tenderness, and that his notes 

provided ample physical findings, including palpation of the knee and lower extremity ROM. 

Dr. Wardell noted that she had continued soreness and intermittent sharp pain over the medial knee 

and that she could not stand too long without being able to sit. He advised that appellant had 

undergone a functional capacity evaluation, which revealed significant limitations on activities

that stress the knee, including climbing, squatting, and carrying. Dr. Wardell noted that he had 

rereviewed x-rays from January 20, 2021, which showed a 2.2 mm cartilage interval in the medial 

compartment that was consistent with operative and MRI scan findings. 

On April 19, 2021 OWCP forwarded Dr. Wardell’s report to the DMA for a supplemental 

report. In an April 29, 2021 report, Dr. Slutsky, the DMA, selected primary knee arthritis as the 

diagnosis for the diagnosis-based impairment (DBI) rating and noted that under the knee regional 

grid, a three mm cartilage interval would fall into the midrange default, for seven percent 

permanent impairment of the left lower extremity, pursuant to Table 16-3, page 511. The DMA 

found that neither a GMFH nor a GMPE were applicable, and that for GMCS the October 10, 2019 
4

MRI scan revealed mild tri-compartmental degenerative osteoarthritis, pursuant to Table 16-8, 

page 519.4 He applied the net adjustment formula, which resulted in a net adjustment of 0, and 

found that appellant had a seven percent permanent impairment of the left lower extremity. The 

DMA also reviewed Dr. Wardell’s report and noted that Dr. Wardell did not discuss appellant’s 

subjective findings, physical examination and ROM findings, and did not document how he 

determined a 2.2 mm cartilage interval, which had a midrange lower extremity impairment of 20

percent. He noted that the October 10, 2019 MRI scan revealed mild tricompartmental arthritis,

but no measurement for the cartilage interval. The DMA also noted that the March 1, 2021 MRl 

scan revealed a collateral ligament tear and an anterior cruciate ligament tear, with moderate 

chondromalacia involving the medial compartment, and mild chondromalacia of the lateral 

patellofemoral compartment; however, there was no measurement of the cartilage interval. He

opined that, based upon the MRI scan reports, it was more appropriate for appellant to be assigned 

to a Class 1, which consisted of a mild problem, according to Table 15-8, which is defined as a 

cartilage interval of less than 25 percent loss compared to the opposite side, and Table 16-3, page 

511, for a 3 mm cartilage interval. The DMA noted that appellant reached MMI on February 8, 

2021 the date of Dr. Wardell’s evaluation. 

By decision dated May 6, 2021, OWCP granted appellant a schedule award for seven 

percent permanent impairment of the left lower extremity (leg). The award ran for 20.16 weeks 

for the period April 10 through August 29, 2021. 

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. However, FECA 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 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 has adopted the A.M.A., Guides as the 

appropriate standard for evaluating schedule losses.7 As of May 1, 2009, schedule awards are 

determined in accordance with the sixth edition of the A.M.A., Guides (2009).8 The Board has 

4 Dr. Slutsky indicated that functional history and physical examination adjustments were not applicable as there 

were no documented findings.

5

5 U.S.C. § 8107.

6

20 C.F.R. § 10.404.

7

Id.; see D.C., Docket No. 20-0916 (issued September 14, 2021); see also RonaldR. Kraynak, 53 ECAB 

130 (2001).

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

2.808.5a (March 2017); see also id.Chapter 3.700.2 and Exhibit 1 (January 2010).
5

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. 9

The sixth edition of the A.M.A., Guides provides a diagnosis-based method of evaluation 

utilizing the World Health Organization’s International Classification of Functioning, Disability 

and Health.

10

 In evaluating lower extremity impairment, the sixth edition requires identifying the 

impairment CDX, which is then adjusted by GMFH, GMPE, and GMCS.11 The net adjustment 

formula is (GMFH - CDX) + (GMPE - CDX) + (GMCS - CDX). Evaluators are directed to provide 

reasons for their impairment rating choices, including the choices of diagnoses from regional grids 

and calculations of modifier scores.12

ANALYSIS

The Board finds that this case is not in posture for decision.

In support of her claim for a schedule award, appellant submitted February 8 and April 14, 

2021 reports from Dr. Wardell. In his February 8, 2021 report, Dr. Wardell diagnosed primary 

knee joint arthritis of the left knee, the CDX, and indicated that appellant had a Class 2 impairment 

based upon a 2.2, mm cartilage interval. In his April 14, 2021 report, Dr. Wardell indicated that 

he was enclosing his office notes. However, the Board finds that the record does not contain

Dr. Wardell’s notes. Dr. Wardell indicated that he had rereviewed January 20, 2021 x-rays which 

revealed a 2.2 mm cartilage interval; however, the Board notes that the record does not contain the 

January 20, 2021 x-rays. The March 27, 2021 report from the DMA recommended that further 

documentation be obtained from Dr. Wardell, including a detailed history of appellant’s current 

complaints, physical findings including palpation of the knee, validated lower extremity ROM 

measurements, and all imaging studies that documented osteoarthritis of the knees, including 

standing x-ray views. If the DMA believes that the impairment has not been correctly described 

by the claimant’s physician, the DMA should specify the missing information so that it can be 

requested and routed back to the DMA. If the missing information cannot be secured, a new or 

supplemental evaluation should be obtained.13 As OWCP requested additional information and 

the treating physician did not provide the requested information, OWCP should have referred 

appellant for a second opinion examination. This is especially important as the schedule award 

was based on loss of cartilage interval and the record does not include the January 21, 2021 x-rays. 

Once OWCP undertakes to develop the medical evidence, it has the responsibility to do so in a 

manner that will resolve the relevant issues in the case.14

9 P.R., Docket No. 19-0022 (issued April9, 2018); Isidoro Rivera, 12 ECAB 348 (1961).

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

11 Id. at 494-531.

12 See M.P., Docket No. 18-1298 (issued April12, 2019); R.V., Docket No. 10-1827 (issued April1, 2011).

13 Federal (FECA) Procedure Manual, Chapter 2.808,supra note 8.

14 See M.B., Docket No. 21-0060 (issued March 17, 2022); D.S., Docket No. 19-0292 (issued June21, 2019).
6

Accordingly, the Board finds that the case must be remanded to OWCP. On remand,

OWCP shall refer the medical record, including an updated SOAF and Dr. Wardell’s complete 

report of April 14, 2021, to the DMA for clarification regarding appellant’s left lower extremity 

permanent impairment. Following this and other such further development as deemed necessary, 

OWCP shall issue a de novo decision.

CONCLUSION

The Board finds that this case is not in posture for decision.

ORDER

IT IS HEREBY ORDERED THAT the May 6, 2021 decision of the Office of Workers’

Compensation Programs is set aside and the case is remanded for further proceedings consistent 

with this decision of the Board.

Issued: January 25, 2023

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board