United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

L.R., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Chicago, IL, Employer

__________________________________________

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Docket No. 21-1312

Issued: March 6, 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 August 27, 2021 appellant filed a timely appeal from a May 26, 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

ISSUE

The issue is whether appellant has met her burden of proof to establish more than16 percent 

permanent impairment of the right upper extremity and more than 24 percent permanent 

1

5 U.S.C. § 8101 et seq.

2 The Board notes that appellant submitted additional evidence to OWCP following the May 26, 2021 decision. 

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

impairment of the left upper extremity, for which she has previously received schedule award 

compensation.

FACTUAL HISTORY

On March 3, 2018 appellant, then a 43-year-old letter carrier, filed an occupational disease 

claim (Form CA-2) alleging that she developed pain in her upper extremities due to factors of her 

federal employment which included sorting, casing, throwing, and delivering mail. She indicated 

that she first became aware of the condition on January 7, 2014 and realized that her conditionwas

caused or aggravated by her federal employment on January 26, 2017. Appellant did not stop 

work. OWCP assigned OWCP File No. xxxxxx053. 

By decision dated March 20, 2018, OWCP accepted the claim for synovitis and 

tenosynovitis of the shoulders; left elbow lateral epicondylitis; cervical disc displacement; joint 

derangement of the shoulders; and cervical disc disorder with radiculopathy, unspecified cervical 

region. Appellant had prior claims under OWCP File No. xxxxxx507, accepted for bilateral carpal 

tunnel syndrome, bilateral lesion of ulnar nerve, and right lateral epicondylitis, and OWCP File 

No. xxxxxx234, accepted for right shoulder sprain/strain. 

On March 6, 2015 OWCP granted appellant a schedule award for 10 percent permanent 

impairment of the right upper extremity and 8 percent permanent impairment of the left upper 

extremity under OWCP File No. xxxxxx507.

.

Appellant subsequently filed a claim for compensation (Form CA-7) for a schedule award 

on May 31, 2018 under OWCP File No. xxxxxx053. 

In a June 22, 2018 report, Dr. Samuel Chmell, a Board-certified orthopedic surgeon, noted 

appellant’s history of injury and treatment and utilized the sixth edition of the American Medical 

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

appellant’s permanent impairment.

3

 He examined her, provided findings and concluded that she

had 19 percent permanent impairment of the right upper extremity (7 percent for the right shoulder 

and 12 percent for cervical spine-related sensory and motor impairments); and 19 percent

permanent impairment of the left upper extremity (2 percent for lateral epicondylitis, 5 percent for 

the shoulder, and 12 percent for cervical spine-related sensory and motor impairments).

Dr. Chmell opined that appellant reached maximum medical improvement (MMI) on 

April 12, 2018.

On December 14, 2018 OWCP referred appellant to Dr. James Elmes, a Board-certified 

orthopedic surgeon, for a second opinion examination. 

In a February 7, 2019 report, Dr. Elmes reviewed appellant’s history of injury and medical 

treatment, as well as the statement of accepted facts (SOAF). He opined that she reached MMI on 

February 16, 2015. Dr. Elmes related appellant’s physical examination findings and explained 

thatshe had no objective spasm, atrophy, or neurological deficit, other than some mild right thenar 

atrophy. He utilized the diagnosis-based impairment (DBI) methodology for rating permanent 

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

impairment of the right upper extremity, and found that she had three percent permanent 

impairment for ulnar nerve entrapment of the wrist, and three percent permanent impairment for 

nerve entrapment of the elbow. Dr. Elmes also found that appellant had 6 percent permanent 

impairment of the shoulder, utilizing the range of motion (ROM) methodology, for a total of 12 

percent permanent impairment of the right upper extremity. He noted that she previously received 

an award of 10 percent and was entitled to an additional award of 2 percent for the right upper 

extremity. Dr. Elmes determined that,for the left upper extremity,utilizing the DBI methodology,

appellant had three percent permanent impairment for entrapment neuropathy at the wrist, three

percent permanent impairment for entrapment atthe elbow, and six percent permanent impairment. 

Utilizing the ROM methodology, appellant had six percent permanent impairment for the left 

shoulder. Dr. Elmes therefore concluded that she also had 12 percent permanent impairment of

the left upper extremity. He noted that appellant previously received an award of eight percent for 

the left upper extremity and was entitled to an additional award of four percent for the left upper 

extremity. 

On April 1, 2019 OWCP determined that a conflict of medical opinion existed between

Dr. Chmell, appellant’s treating physician, and Dr. Elmes, the second opinion physician, regarding 

the impairment ratings for the right and left upper extremities, and that she be referred to an 

impartial medical examiner (IME). It referred her, along with the case record and a SOAF, to

Dr. Michael Grear, Board-certified in orthopedic surgery,serving as the IME.

In a June 27, 2019 report, Dr. Grear noted appellant’s history of injury and medical 

treatment. He provided her physical examination findings and related that she had no sensory 

deficits bilaterally, and motor function within normal limits. Dr. Grear also provided appellant’s 

ROM measurements. He utilized the DBI methodology for the diagnosis of shoulder tendinitis, 

under Table 15-5, page 402 of the A.M.A. Guides, and concurred with Dr. Chmell’s permanent

impairment rating of seven percent of each upper extremity. However, the IME found no basis for 

impairment related to the cervical spine. Dr. Grear noted that since appellant had received a 

schedule award for 10 percent permanent impairment of the right upper extremity and 8 percent 

permanent impairment of the left upper extremity, she had no additional permanent impairment. 

In a July 31, 2019 report, Dr. Michael Katz, Board-certified in orthopedic surgery and 

serving as the district medical adviser (DMA), noted that Dr. Grear provided separate findings for 

ROM and it was unclear why these findings were not utilized to rate appellant’s permanent

impairment. He requested that the IME be contacted and afforded the opportunity to clarify his 

opinion. 

In a letter dated August 29, 2019, OWCP requested that Dr. Grear clarify his opinion and 

confirm whether three independent ROM measurements had been made for each shoulder. It

requested clarification on March 2 and June 1 and 2, 2020 without response. OWCP then referred 

appellant to Dr. Michael Cohen, Board-certified in orthopedic surgery, for an impartial medical 

examination to be scheduled after May 18, 2020.

In a June 3, 2020 report, Dr. Cohen, serving as an IME, opined that appellant had five

percent permanent impairment of the right upper extremity based upon the diagnosis of rotator 

cuff, full thickness tear of the shoulder, under Table 15-5, page 403 of the A.M.A., Guides. He 

also found that, based on the diagnosis of tendinitis of the left shoulder, under Table 15-5, page 
4

402 of the A.M.A., Guides, appellant had three percent permanent impairment of the left upper 

extremity. 

By decision dated June 23, 2020, OWCP denied appellant’s claim for an increased 

schedule award. 

On July 15, 2020 appellant requested a hearing before a representative of OWCP’s Branch 

of Hearings and Review. 

Following a preliminary review, by decision dated September 1, 2020 an OWCP hearing 

representative found the case not in posture for decision. The hearing representative found that

Dr. Cohen’s report could not be utilized as the record did not contain any documentation to 

establish that Dr. Cohen was properly selected as the IME and that appellant had been properly 

advised of the examination. OWCP’s hearing representative explained that, if such documentation 

was not available, OWCP should take the proper steps to properly select an IME and advise 

appellant of the examination. The hearing representative also indicated that appellant’s other 

claims involving the upper extremities (OWCP Files No. xxxxxx507 and xxxxxx234) should be 

combined with the present claim and that the IME should provide ratings under both the ROM and

DBI methods. 

On September 15, 2020 OWCP notified appellant that it had administratively combined 

her other claims, OWCP File Nos. xxxxxx507 and xxxxxx234, with the present claim serving as 

the master file. It further notified her that a new impartial medical examination would be 

scheduled. 

On February 8, 2021 OWCP referred appellant, along with the case record and a SOAF, to

Dr. John Scott Player, Board-certified in orthopedic surgery, to resolve the conflict in medical 

opinion between Dr. Elmes, the second opinion physician, and Dr. Chmell, the treating physician. 

In a March 9, 2021 report, Dr. Player utilized the sixth edition of the A.M.A., Guides and 

rated appellant’s upper extremity permanent impairments. He examined her and provided physical 

findings. Dr. Player found that appellant had reached MMI on April 12, 2018. He opined that she

had 6 percent impairment of the right upper extremity and 16 percent impairment of the left upper 

extremity. Dr. Player provided both DBI and ROM based ratings for the right and left shoulders.

For the right shoulder DBI rating, Dr. Player referred to the Shoulder Regional Grid, and 

selected the class of diagnosis (CDX) of tendinitis, Table 15-5, page 402. He assigned a class 1 

impairment for residual loss, functional with normal motion, a default position of C for three

percent upper extremity impairment. For the functional history grade modifier (GMFH),

Dr. Player referred to Table 15-7, page 406, and noted that appellant had pain/symptoms with less 

than normal activity and required assistance with self-care activities, arriving at a QuickDASH

score of 75, resulting in a grade modifier of 3. For the physical examination grade modifier

(GMPE), he referred to Table 15-8, page 408, noting observed and palpable findings of tenderness, 

swelling or crepitus, resulting in a grade modifier of 1. Dr. Player referred to Table 15-9, page 

410, and noted that the grade modifier for clinical studies (GMCS) could not be utilized. He 

applied the net adjustment formula (GMFH - CDX) + (GMPE - CDX) + (GMCS - CDX) = (1- 1) 
5

+ (1 - 1) + (0 - 1) = 0. Dr. Player noted that there was no net adjustment from the default value of 

C and determined three percent impairment for the right upper extremity using the DBI method.

For the left shoulder, using the DBI method, Dr. Player again selected the CDX of 

tendinitis, and related the same findings and calculations as he had for the right shoulder. He 

therefore again concluded that appellant had three percent permanent impairment of the left 

shoulder.

Utilizing the ROM method, Dr. Player explained that he made three independent 

measurements of each motion with a goniometer, rounded each measurement to the nearest zeroending integer, determined each measurement within 10 degrees of the average of the three, and 

used the greatest measurement for the calculation of the ROM impairment rating.

For the right shoulder, Dr. Player used the ROM method and referred to Table 15-34, page 

475 of the A.M.A., Guides. From his chart containing the three independent measurements and 

his narrative summary, he noted that the highest rating for flexion of 90 degrees was three percent, 

extension of 80 degrees was zero percent, abduction of 90 degrees was three percent, adduction of 

40 degrees was zero percent, internal rotation of 80 degrees was zero percent, and external rotation 

of 70 degrees was zero percent. Dr. Player therefore found that appellant had six percent

permanent impairment of the right upper extremity using the ROM method.

For the left shoulder, Dr. Player used the ROM method and referred to Table 15-34, page 

475 of the A.M.A., Guides. From his chart containing the three independent measurements, he 

noted that the highest rating for flexion of 90 degrees was three percent, extension of 70 degrees 

was zero percent, abduction of 90 degrees was three percent, adduction of 30 degrees was one

percent, internal rotation of 70 degrees was two percent, and external rotation of 60 degrees was 

zero percent, resulting in nine percent impairment of the left upper extremity under the ROM 

method. Dr. Player noted from his narrative summary that the highest rating for flexion of 90 

degrees was three percent, extension of 80 degrees was zero percent, abduction of 90 degrees was 

three percent, adduction of 40 degrees was one percent, internal rotation of 80 degrees was two

percent, and external rotation of 70 degrees was zero percent, resulting in nine percent impairment 

of the left upper extremity under the ROM method.

Dr. Player also provided an impairment rating for the left elbow. For the DBI method, he

referred to the A.M.A., Guides, Table 15-4, page 399, Elbow Regional Grid, Table 15-7, page 406,

and Table 15-8, page 408. Dr. Player determined that appellant’s CDX of lateral or medial 

epicondylitis, was a class 1 impairment with a GMFH of 3, a GMPE of 1, and a GMCS of 0. After

applying the net adjustment formula, he concluded that she had one percent impairment forthe left 

elbow using the DBI method.

For the left elbow ROM, Dr. Player noted that the highest rating for flexion of 80 degrees 

was eight percent, extension of 0 degrees was zero percent, protraction of 90 degrees was zero

percent, and supination of 90 degrees was zero percent, resulting in eight percent impairment of 

the left elbow using the ROM method.

Dr. Player used the Combined Values Chart on page 604 of the A.M.A., Guides, and 

combined the 9 percent impairment for the left shoulder and the 8 percent impairment for the left 
6

elbow, resulting in 16 percent impairment for the left upper extremity. He also provided a whole 

person impairment of onepercent for the cervical spine, under Table 17-2, page 564 of the A.M.A., 

Guides. 

In a letter dated April 19, 2021, OWCP requested clarification from Dr. Player regarding 

whether his findings were in addition to appellant’s prior award. 

In a May 6, 2021 follow-up report, Dr. Player noted that appellant was previously awarded 

10 percent permanent impairment for the right upper extremity and 8 percent for the left upper 

extremity. He explained that the present claim involved bilateral shoulder tendinitis and left elbow 

epicondylitis, whereas the prior claim involved bilateral carpal tunnel, bilateral ulnar nerves, and 

right lateral epicondylitis, and as such the prior impairment ratings were for different anatomical 

areas from the present claim. Dr. Player opined that therefore, the 6 percent right upper extremity 

and 16 percent left upper extremity ratings were in addition to the prior awards. 

By decision dated May 26, 2021, OWCP granted appellant a schedule award for 6 percent 

permanent impairment of the right upper extremity and 16 percent permanent impairment of the 

left upper extremity. The period of the award ran for 68.64 weeks from April 12, 2018, through

August 5, 2019.

LEGAL PRECEDENT

The schedule award provisions of FECA4 and its implementing regulations5 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 shall be determined. For consistent results and 

to ensure equal justice under the law to all claimants, OWCP has adopted the A.M.A., Guides as 

the uniform standard applicable to all claimants.6 As of May 1, 2009, the sixth edition of the 

A.M.A., Guides is used to calculate schedule awards.7 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.8

4

5 U.S.C. § 8107.

5

20 C.F.R. § 10.404.

6

Id. See A.D., Docket No. 20-0553 (issued April 19, 2021); see also T.T., Docket No. 18-1622 (issued 

May 14, 2019).

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

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

8

See D.C., Docket No. 20-1655 (issued August9, 2021); P.R., Docket No. 19-0022 (issued April9, 2018); Isidoro 

Rivera, 12 ECAB 348 (1961).
7

In addressing upper extremity impairments, the sixth edition requires that the evaluator 

identify the impairment CDX, which is then adjusted by a GMFH, GMPE, and GMCS. 9 The net 

adjustment formula is (GMFH - CDX) + (GMPE - CDX) + (GMCS - CDX).10

The A.M.A., Guides also provide that ROM impairment methodology is to be used as a 

stand-alone rating for upper extremity impairments when other grids direct its use or when no other 

DBI sections are applicable.11 If ROM is used as a stand-alone approach, the total of motion 

impairment for all units of function must be calculated. All values for the joint are measured and 

added.12 Adjustments for functional history may be made if the evaluator determines that the 

resulting impairment does not adequately reflect functional loss and functional reports are 

determined to be reliable.13

OWCP issued FECA Bulletin No. 17-06 to explain the use of the DBI methodology versus 

the ROM methodology for rating of upper extremity impairments.14 Regarding the application of 

ROM or DBI impairment methodologies in rating permanent impairment of the upper extremities, 

FECA Bulletin No. 17-06 provides in pertinent part:

“Upon initial review of a referral for upper extremity impairment evaluation, the 

DMA should identify: (1) the methodology used by the rating physician (i.e., DBI 

or ROM); and (2) whether the applicable tables in Chapter 15 of the [A.M.A.,] 

Guides identify a diagnosis that can alternatively be rated by ROM. If the 

[A.M.A.,] Guides allow for the use of both the DBI and ROM methods to calculate 

an impairment rating for the diagnosis in question, the method producing the higher 

rating should be used.”

15

The Bulletin further advises: “If the rating physician provided an assessment using the 

ROM method and the [A.M.A.,] Guides allow for use of ROM for the diagnosis in question, the 

DMA should independently calculate impairment using both the ROM and DBI methods and 

identify the higher rating for the [claims examiner].”

16

9 A.M.A., Guides 383-492.

10 Id. at 411.

11 Id. at 461.

12 Id. at 473.

13 Id. at 474.

14 FECA Bulletin No. 17-06 (issued May 8, 2017).

15 A.M.A., Guides 477.

16 FECA Bulletin No. 17-06 (issued May8, 2017); V.L., Docket No. 18-0760 (issued November 13, 2018); A.G., 

Docket No. 18-0329 (issued July 26, 2018).
8

Neither FECA nor its implementing regulations provide for the payment of a schedule 

award for the permanent loss of use of the back/spine or the body as a whole. 17 However, a 

schedule award is permissible where the employment-related spinal condition affects the upper 

and/or lower extremities.18 The sixth edition of the A.M.A., Guides (2009) provides a specific 

methodology for rating spinal nerve extremity impairment in The Guides Newsletter, Rating Spinal 

Nerve Extremity Impairment Using the Sixth Edition (July/August 2009) (The Guides Newsletter), 

which is a supplemental publication of the sixth edition of the A.M.A., Guides. It was designed 

for situations where a particular jurisdiction, such as FECA, mandated ratings for extremities and 

precluded ratings for the spine. The FECA-approved methodology is premised on evidence of 

radiculopathy affecting the upper and/or lower extremities. The appropriate tables for rating spinal 

nerve extremity impairment are incorporated in the Federal (FECA) Procedure Manual. 19

Section 8123(a) of FECA provides that, if there is a disagreement between the physician 

making the examination for the United States and the physician of an employee, the Secretary shall 

appoint a third physician (known as a referee physician or IME) who shall make an examination.20 

This is called an impartial medical examination and when there exist opposing medical reports of 

virtually equal weight and rationale and the case is referred to an IME for the purpose of resolving 

the conflict, the opinion of such specialist, if sufficiently wellrationalized and based upon a proper 

factual background, must be given special weight.21

ANALYSIS

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

On February 8, 2021 OWCP properly referred appellant for an impartial medical 

examination, pursuant to 5 U.S.C. § 8123(a), with Dr. Player serving as the IME, to resolve the 

conflict between Dr. Elmes, the second opinion physician, and Dr. Chmell, the treating physician.

In his March 9, 2021 report, Dr. Player provided an impairment rating of 6 percent to the 

right upper extremity and 16 percent to the left upper extremity. He provided impairment ratings 

using both the DBI and ROM methods and he rated both shoulders and the left elbow. However, 

the Board notes that the ROM measurements Dr. Player provided in the chart for the left shoulder 

were inconsistent with the ROM measurements he provided in the narrative summary for the left 

shoulder. The Board finds, therefore, that clarification is required as to which left shoulder ROM 

measurements are accurate. 

17 5 U.S.C. § 8107(c); 20 C.F.R. § 10.404(a) and (b); see A.G., Docket No. 18-0815 (issued January 24, 2019);

Jay K. Tomokiyo, 51 ECAB 361, 367 (2000).

18 Supra note 7 at Chapter 2.808.5c(3) (March 2017).

19 Id., at Chapter 3.700, Exhibit 4 (January 2010).

20 5 U.S.C. § 8123(a); see T.C., Docket No. 20-1170 (issued January 29, 2021); see R.S., Docket No. 10-1704 

(issued May 13, 2011); S.T., Docket No. 08-1675 (issued May 4, 2009).

21 See T.C., id.; Darlene R. Kennedy, 57 ECAB 414 (2006); GloriaJ. Godfrey, 52 ECAB 486 (2001).
9

The Board further notes that Dr. Player concluded that appellant had one percent 

permanent impairment of the whole person due to her cervical condition. As previously noted, a 

schedule award cannot be granted for permanent loss of use of the spine or body as a whole.22 The 

rating must be based on evidence of radiculopathy affecting sensory and motor deficits of the 

extremities.23 However, Dr. Player did not provide a rating pursuant to The Guides Newsletter for 

spinal nerve impairment affecting the upper extremities. 

The Board has held that, when OWCP obtains an opinion from an IME for the purpose of 

resolving a conflict in the medical evidence and the IME’s opinion requires clarification or 

elaboration, OWCP must secure a supplemental report from the IME to correct the defect in his 

original report.24 If the IME is unable to clarify or elaborate on the original report, or if the 

supplemental report is also vague, speculative, or lacking in rationale, OWCP must submit the case 

record and a detailed SOAF to another IME for the purpose of obtaining a rationalized medical 

opinion on the issue.25

For the above-described reasons, the opinion of the IME, Dr. Player, requires clarification.

Therefore, in order to address the unresolved conflict in the medical opinion evidence, the case 

will be remanded to OWCP for referral to Dr. Player for a supplemental opinion regarding the 

above-noted inconsistencies. If Dr. Player is unable to clarify his opinion, or if his requested 

supplemental report is lacking rationale, OWCP shall refer appellant to a new IME for the purpose 

of obtaining a rationalized medical opinion regarding any employment-related impairment.

26

 

Following this and other such further development as deemed necessary, OWCP shall issue a 

de novo decision on her schedule award claim.

CONCLUSION

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

22 Supra note 19.

23 Id.

24 See F.H., Docket No. 17-1924 (issued January 25,2019); Talmadge Miller, 47 ECAB 673 (1996); Harold Travis, 

30 ECAB 1071, 1078 (1979); see alsosupra note 7 at Chapter 2.810.11e(September 2010).

25 Id.

26 M.D., Docket No. 19-0510 (issued August6, 2019); Harold Travis, supra note 24.
10

ORDER

IT IS HEREBY ORDERED THAT the May 26, 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: March 6, 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