United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

R.R., Appellant

and

U.S. POSTAL SERVICE, JACKSONVILLE 

MAIN OFFICE WALK UP POST OFFICE, 

Jacksonville, FL, Employer

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Docket No. 22-0525

Issued: May 18, 2023

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

JANICE B. ASKIN, Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JAMES D. McGINLEY, Alternate Judge

JURISDICTION

On February 24, 2022 appellant filed a timely appeal from a September 17, 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 September 17, 2021 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 his burden of proof to establish greater than seven 

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

schedule award.

FACTUAL HISTORY

On November 11, 2019 appellant, then a 50-year-old tractor trailer operator, filed a 

traumatic injury claim (Form CA-1) alleging that on that date he injured his left knee when he 

stepped from the bottom step of his vehicle to the ground while in the performance of duty.

OWCP accepted the claim for left knee sprain, left knee meniscus tear, left knee effusion, 

and aggravation of left knee preexisting osteoarthritis. It paid appellant wage-loss compensation 

on the supplemental rolls as of December 27, 2019, and on the periodic rolls effective

March 29, 2020.

A December 11, 2019 magnetic resonance imaging (MRI) scan of appellant’s left knee 

read by Dr. Paul P. Byra, a Board-certified diagnostic radiologist, revealed a complex tear of the

left knee body and posterior horn of the medial meniscus, large volume joint effusion, and 

tricompartmental articular cartilage abnormalities. Regarding the articular cartilage, Dr. Byra

found a full-thickness cartilage defect along the central weight bearing surface of the medial 

femoral condyle measuring 13-11 millimeters; grade 1 chondromalacia along the lateral femoral 

condyle with superficial fissuring along the posterior weightbearing surface with a grade 1

chondromalacia along the lateral tibial plateau with focal deep fissuring posteriorly; a grade 4

chondromalacia lateral trochlear facet and central trochlea with grade 2 to 3 chondromalacia

medial trochlear facet; and deep fissuring and small delaminating component at the patellar apex 

extending toward the lateral facet, grade 1 chondromalacia patella.

On February 18, 2020 appellant underwent OWCP-authorized left knee arthroscopy with 

partial medial meniscectomy, removal of loose body, limited synovectomy, and abrasion 

chondroplasty. 

In a May 10, 2021 report, Dr. Aaron Bates, Board-certified in orthopedic sports medicine 

and orthopedic surgery, noted appellant’s history of left knee pain, worsening secondary to 

osteoarthritis, and that appellant had been involved in a motor vehicle accident in February 2021. 

He noted that appellant had increased pain in the knee after the accident, but the pain was now 

back to baseline. Dr. Bates also noted that appellant denied using medication or a brace for the 

knee and “denied keeping up with strengthening exercises.” On examination he found that 

appellant was tender over the anterolateral and lateral knee and had no instability and no 

crepitation, with a negative McMurray test. Dr. Bates provided one set of measurements for range 

of motion (ROM). He advised that appellant was status post left knee arthroscopy on February 18, 

2020, with partial medial meniscectomy and removal of loose body, and now had worsening pain 

secondary to osteoarthritis. Dr. Bates diagnosed pain in the left knee and osteoarthritis in the left 

knee joint. He opined that appellant had reached maximum medical improvement (MMI) and 

noted appellant’s permanent work restrictions.
3

On June 16, 2021 appellant filed a claim for compensation (Form CA-7) for a schedule 

award.

In a development letter dated June 24, 2021, OWCP advised appellant that additional 

medical evidence was necessary to support his schedule award claim. It requested that he submit 

a detailed narrative medical report from his treating physician based on a recent examination,

setting forth an opinion on the date of MMI and a rating of permanent impairment in accordance 

with the sixth edition of the American Medical Association, Guides to the Evaluation of Permanent 

Impairment (A.M.A., Guides).3

On June 24, 2021 OWCP routed the May 10, 2021 report from Dr. Bates, a statement of 

accepted facts (SOAF), and the case record to Dr. Jovito B. Estaris, a Board-certified internist 

serving as an OWCP district medical adviser (DMA), for review and rating of appellant’s left

lower extremity permanent impairment under the sixth edition of the A.M.A., Guides. OWCP 

asked Dr. Estaris to provide the date of appellant’s MMI.

In a June 29, 2021 report, the DMA noted that appellant reached MMI on May 10, 2021,

the date of the evaluation by Dr. Bates. He noted that appellant had findings of tenderness over 

the anterolateral and lateral knee, ROM from 5 to 120 degrees, no instability, no crepitation, and 

a negative McMurray test. Dr. Estaris also noted that the MRI scan of appellant’sleft knee showed 

a medial meniscus tear and full-thickness cartilage defect at the medial femoral condyle. The 

DMA referred to the A.M.A., Guides, Table 16-3, Knee Regional Grid -- Lower Extremity 

Impairments, at page 511, for the class of diagnosis (CDX) of left knee medial meniscus tear with 

primary osteoarthritis, and found a Class 1 impairment, with a default value of 7 for a full-thickness 

articular cartilage defect. Dr. Estaris referred to Table 16-6, Functional History Adjustment --

Lower Extremities, at page 516, and selected a grade modifier for functional history (GMFH) of 

1, for left knee pain with difficulty with kneeling and squatting. He referred to Table 16-7, Physical 

Examination Adjustment -- Lower Extremities, at page 517, and selected a grade modifier for 

physical examination (GMPE) of 1 for mild limitation of ROM of the left knee. The DMA noted 

the grade modifier for clinical studies (GMCS) was not used because the MRI scan showing a fullthickness cartilage defect was used in selecting the CDX. Dr. Estaris applied the Net Adjustment 

Formula and found (GMFH - CDX) + (GMPE - CDX) = (1 - 1) + (1 - 1) = 0, which resulted in no 

net adjustment. The DMA determined that appellant had a Class 1, grade C, impairment of his left 

knee which resulted in seven percent permanent impairment of the left lower extremity, according 

to the diagnosis-based impairment (DBI) method. Dr. Estaris also explained that he could not 

provide an impairment rating under the ROM method because Dr. Bates did not provide three

independent sets of ROM measurements.

In an August 3, 2021 memorandum, OWCP related that a second opinion examination was 

needed and noted that, “if the Guides allow for the use of both the diagnosis-based impairment 

(DBI) and range of motion (ROM) methods to calculate an impairment rating for the diagnosis in 

question, the method producing the higher rating shall be used.” It also noted that, “if it is clear to 

the evaluator evaluating loss of ROM that a restricted ROM has an organic basis, three (3)

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

independent measurements should be documented/recorded and the greatest ROM should be used 

for determination of the impairment.”

On August 19, 2021 OWCP requested that Dr. Bates provide three sets of ROM 

measurements for the left knee. 

In an August 27, 2021 memorandum of telephone call (Form CA-110), appellant advised 

OWCP that ROM measurements were “already done” and that he would resubmit the paperwork. 

OWCP received a copy of the measurements contained in the May 10, 2021 report from Dr. Bates.

On August 31, 2021 OWCP requested clarification from Dr. Estaris, the DMA.

OWCP received a September 3, 2021 report from Dr. Michael M. Katz, a Board-certified 

orthopedic surgeon and DMA, who practiced in the same medical office as Dr. Estaris. Dr. Katz

explained that the case was forwarded to him as Dr. Estaris was no longer available for reviews. 

He explained that the DBI method was the preferred method for evaluating lower extremity 

impairments and that the ROM method was to be used as a stand-alone method for upper extremity 

impairments if grids referred to this section of the A.M.A., Guides, or for lower extremity 

impairments if no diagnosis was applicable for rating the condition. Dr. Katz further explained 

that appellant’s loss of ROM of the left knee might justify a GMPE of 1 as a mild motion 

impairment under Table 16-7, however the point was moot as the objective findings on appellant’s 

physical examination findings of tenderness over the anterolateral and lateral knee would also 

qualify under Table 16-7 as a GMPE of 1. He thereafter opined that another probative ROM 

measurement was not required to complete the impairment evaluation. Dr. Katz concurred with

Dr. Estaris prior rating of seven percent permanent impairment of the left lower extremity. 

By decision dated September 17, 2021, OWCP granted appellant a schedule award for 

seven percent permanent left lower extremity impairment(left leg), based on the impairment rating 

from Dr. Estaris, the DMA. The award ran for 20.16 weeks, from May 10 to September 28, 2021. 

LEGAL PRECEDENT

The schedule award provision of FECA and its implementing regulations 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. 4 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.5 As of May 1, 2009, schedule awards are determined in 

4

5 U.S.C. § 8107; 20 C.F.R. § 10.404.

5

20 C.F.R. § 10.404; see J.H., Docket No. 21-1215 (issued May 5, 2022);see also Ronald R. Kraynak, 53 ECAB 

130 (2001).
5

accordance with the sixth edition of the A.M.A., Guides(2009).6 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 purpose.7

Chapter 16 of the sixth edition of the A.M.A., Guides, pertaining to the lower extremities, 

provides that diagnosis-based impairment is the primary method of calculation for the lower limb 

and that most impairments are based on the DBI methodology where impairment class is 

determined by the diagnosis and specific criteria as adjusted by the grade modifiers for functional 

history, physical examination, and clinical studies. It further provides that alternative approaches 

are also provided for calculating impairment for peripheral nerve deficits, complex regional pain 

syndrome, amputation, and range of motion. ROM is primarily used as a physical examination 

adjustment factor.8 The A.M.A., Guides, however, also explain that some of the diagnosis-based 

grids refer to the ROM section when that is the most appropriate mechanism for grading the 

impairment. This section is to be used as a stand-alone rating when other grids refer to this section 

or no other diagnosis-based sections of the chapter are applicable for impairment rating of a 

condition.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 knee, the relevant portion of the leg for the present case, reference 

is made to Table 16-3, the Knee Regional Grid, beginning on page 509.10 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).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 through an OWCP medical adviser for an opinion concerning the nature and 

6

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

(January2010); id. at Part 2 -- Claims, Schedule Awards and Permanent Disability Claims, Chapter 2.808.5a 

(March 2017).

7

Isidoro Rivera, 12 ECAB 348 (1961).

8 A.M.A., Guides 497, Section 16.2.

9

Id. at 543; see also M.D., Docket No. 16-0207 (issued June 3, 2016); D.F., Docket No. 15-0664 (issued 

January 8, 2016).

10 Id. at 509-11.

11 Id. at 515-22.

12 Id. at 23-28.
6

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

seven percent permanent impairment of his left lower extremity, for which he previously received 

a schedule award.

In support of his claim for a schedule award, appellant submitted a May 10, 2021 report 

from Dr. Bates who noted appellant’s history of left knee arthroscopy, and his physical 

examination findings. Dr. Bates diagnosed left knee pain and osteoarthritis of the left knee joint. 

He opined that appellant had reached MMI and provided permanent work restrictions. However,

Dr. Bates did not provide a permanent impairment rating and, therefore, OWCP properly referred 

his report to the DMA for an impairment rating.

In a June 29, 2021 report, Dr. Estaris provided an impairment rating using the DBI method 

under the A.M.A., Guides. He noted appellant’s diagnosis of left knee medial meniscus tear with 

primary osteoarthritis, referred to Table 16-3, the Knee Regional Grid, at page 511, and placed 

appellant in Class 1, with a default value of 7, for a full-thickness articular cartilage defect. 

Dr. Estaris also applied the grade modifiers, and found a GMFH of 1, underTable 16-6, Functional 

History Adjustment -- Lower Extremities, at page 516, for left knee pain with difficulty kneeling 

and squatting, and a GMPE of 1, under Table 16-7, Physical Examination Adjustment -- Lower 

Extremities, at page 517, for mild limitation of ROM of the left knee. He explained that the GMCS 

was not used because the MRI scan showing a full-thickness cartilage defect was used to determine 

the CDX. Dr. Estaris applied the Net Adjustment Formula and calculated, (GMFH - CDX) + 

(GMPE - CDX) = (1 - 1) + (1 - 1) = 0, which resulted in no net adjustment. As a result, appellant 

remained in Class 1, grade C, for seven percent permanent impairment of the left lower extremity. 

Dr. Estaris explained that he could not provide an impairment rating under the ROM method 

because the report from Dr. Bates did not contain three independent sets of ROM measurements.

On August 31, 2021 OWCP requested clarification from DMA Dr. Estaris with regard to 

the absence of a rating under the ROM method.

OWCP received a September 3, 2021 report from DMA Dr. Katz, as Dr. Estaris was no 

longer available. Dr. Katz properly explained that pursuant to the A.M.A., Guides, at page 497, a 

rating based on the ROM method was not required because ROM was not a stand-alone rating 

method for the lower extremities, unless no diagnosis was available for the rating. He also noted 

that appellant’s loss of ROM would result in the same grade modifier as his other physical 

examination findings under Table 16-7 for the physical examination adjustment. Dr. Katz noted 

that Dr. Estaris assigned a GMPE of 1 under Table 16-7, based on minimal palpatory findings, 

consistently documented, without observable abnormalities, and therefore a ROM measurement 

13 Supra note 6 at Chapter 2.808.6f (March 2017).
7

was not required to complete the impairment recommendation.

14

 He concurred with Dr. Estaris 

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

The Board finds that Dr. Estaris and Dr. Katz, both serving as a DMA, explained with 

rationale how the A.M.A., Guides were applied to Dr. Bates’ evaluation findings to determine that 

appellant sustained seven percent permanent impairment of the left lower extremity.

As the record contains no other probative, rationalized medical opinion that supports 

greater impairment of the left lower extremity based upon the A.M.A., Guides, the Board finds 

that appellant has not met his burden of proof.

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 permanent impairment.

CONCLUSION

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

seven percent permanent impairment of his left lower extremity, for which he previously received 

a schedule award.

14 A.M.A., Guides 497. The Board notes that section 16-2 of Chapter 16 of the A.M.A., Guides, pertaining to the 

lower extremities, provides that, “Range of motion is primarily used as a physical examination adjustment factor and 

is only used to determine actual impairment values when it is not possible to otherwise define impairment.”
8

ORDER

IT IS HEREBY ORDERED THAT the September 17, 2021 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: May 18, 2023

Washington, DC

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board

James D. McGinley, Alternate Judge

Employees’ Compensation Appeals Board