United States Department of Labor

Employees’ Compensation Appeals Board

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N.B., Appellant

and

DEPARTMENT OF HEALTH & HUMAN 

SERVICES, FOOD & DRUG 

ADMINISTRATION, Takoma, WA, Employer

__________________________________________

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Docket No. 22-1295

Issued: May 25, 2023

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

PATRICIA H. FITZGERALD, Deputy Chief Judge

JANICE B. ASKIN, Judge

JAMES D. McGINLEY, Alternate Judge

JURISDICTION

On September 2, 2022 appellant filed a timely appeal from an August 10, 2022 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.

ISSUE

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

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

schedule award.

1

5 U.S.C. § 8101 et seq.
2

FACTUAL HISTORY

On July 12, 2017 appellant, then a 54-year-old consumer safety officer, filed a traumatic 

injury claim (Form CA-1) alleging that on July 10, 2017 a dog attacked her when she walked along 

a driveway in the course of inspecting a property while in the performance of duty. She asserted 

that she sustained a full-mouth dog bite and bruising on her left buttock, three deep lacerations on 

her right calf, and additional puncture wounds and scrapes on her right leg. Appellant stopped 

work on the date of the claimed injury and returned to work on August 25, 2017 in a modifiedduty job without wage loss.

2

 OWCP accepted her claim for open dog bites of the left buttock and

right calf; and subsequently expanded the acceptance of her claim to include strain of muscle, 

fascia, and tendon of the left hip; traumatic shock; and chronic post-traumatic stress disorder. It 

paid appellant wage-loss compensation on the supplemental rolls, effective November 13, 2017.

A February 26, 2019 magnetic resonance imaging (MRI) scan of the left hip revealed 

partial tears of the distal left gluteus minimus tendon extending to the greater trochanteric insertion, 

bilateral hamstring tendons at the ischial tuberosity origins, and ligamentum teres at the foveal 

attachment. The MRI scan also showed mild bilateral greater trochanteric bursitis. 

In an August 6, 2019 report, Dr. Jason C. King, a Board-certified orthopedic surgeon, 

indicated that appellant was seen for the left hip conditions of trochanteric bursitis and partial tears

of the gluteus medius and gluteus minimus. He noted that she needed to undergo a rating for 

permanent impairment and advised her that she should avoid engaging in roundhouse kicks and 

quick abduction and internal rotation maneuvers as part of her home exercise regimen. 

On December 28, 2020 appellant filed a claim for compensation (Form CA-7) for a 

schedule award.

On January 22, 2021 OWCP referred appellant, along with the case record and a statement 

of accepted facts (SOAF), for a second opinion examination and evaluation with Dr. Richard 

White, a Board-certified orthopedic surgeon. It requested that Dr. White provide an opinion on 

appellant’s lower extremity permanent impairment under the standards of the sixth edition of the 

American Medical Association, Guides to the Evaluation of Permanent Impairment (A.M.A., 

Guides).3

In a February 26, 2021 report, Dr. White detailed appellant’s factual and medical history, 

and reported the findings of his physical examination. He noted that appellant had well-healed 

scars on the popliteal area of her right knee with the largest scar measuring approximately 1 

centimeter (cm) in width and 13 cm in length horizontally across the length of her popliteal fossa. 

In the same area, appellant also had a five-cm horizontal well-healed wound, other possible 

puncture wounds approximately one cm in length, and an additional scarring line which was five 

cm long. Dr. White indicated that these scars did not exhibit erythema, ecchymosis, or swelling. 

He advised that the left buttock area had no obvious scarring, although there could be possible 

2 The case record contains a July 10, 2017 report from an emergency room describing the suturing/stitching of 

wounds from the dog attack. 

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

light scarring when compared to the opposite buttock, and noted that there was no erythema, 

ecchymosis, or swelling in this area. Dr. White reported that both lower extremities had full 

confrontational strength without weakness or deficits, sensation was subjectively intact throughout 

both lower extremities, and that no abnormal lower extremity reflexes were observed. The right 

knee exhibited range of motion (ROM) from 0 degrees of extension to 140 degrees of flexion, and 

was stable to varus and valgus stress. Dr. White noted that active bilateral hip ROM was from 0 

degrees of extension to 100 degrees of flexion without deficits. He indicated that appellant 

subjectively continued to complain of pain at the greater trochanteric area of the left hip as well as 

the right popliteal fossa area of the right knee.

For the right lower extremity, Dr. White referred to the sixth edition of the A.M.A., Guides

and utilized the diagnosis-based impairment (DBI) rating method to find that, under Table 16-3

(Knee Regional Grid), page 509, the class of diagnosis (CDX) for appellant’s accepted right leg 

bite met the criteria for a soft tissue lesion which fell under class 1 with a default value of 1. He 

assigned a grade modifier for functional history (GMFH) of 1, a grade modifier for physical 

examination (GMPE) of 0, and a grade modifier for clinical studies (GMCS) of 0. Dr. White

utilized the net adjustment formula, (GMFH - CDX) + (GMPE - CDX) + (GMCS - CDX) = (1 -

1) + (0 - 1) + (0 - 1) = -2, which resulted in a grade A or zero percent permanent impairment of 

the right lower extremity. For the left lower extremity, he analyzed two separate accepted left 

lower extremity conditions. First, Dr. White utilized the DBI rating method to find that, under 

Table 16-4 (Hip Regional Grid) on page 512, appellant’s accepted left buttock bite met the criteria 

for a soft tissue lesion which fell under class 1 with a default value of 1. He assigned a GMFH of 

1, a GMPE of 0, and a GMCS of 0. Dr. White utilized the net adjustment formula, (GMFH -CDX) 

+ (GMPE - CDX) + (GMCS - CDX) = (1 - 1) + (0 - 1) + (0 - 1) = -2, which resulted in a grade A 

or zero percent permanent impairment of the left lower extremity. Second, he utilized the DBI 

rating method to find that, under Table 16-4 on page 512, the CDX for appellant’s left hip tendon 

strain resulted in a class 1 impairment with a default value of 1. Dr. White assigned a GMFH of 

1, a GMPE of 0, and a GMCS of 1. He utilized the net adjustment formula, (GMFH - CDX) + 

(GMPE - CDX) + (GMCS - CDX) = (1 - 1) + (0 - 1) + (1 - 1) = -1, which resulted in a grade B or 

one percent permanent impairment of the left lower extremity.4 Dr. White noted that appellant’s 

lower extremity conditions did not meet the criteria for applying the ROM impairment rating 

method. Therefore, he concluded that appellant’s only documented permanent impairment of a 

lower extremity was the one percent permanent impairment of the left lower extremity.

On April 1, 2021 OWCP referred appellant’s case to Dr. Arthur S. Harris, a Board-certified

orthopedic surgeon serving as an OWCP district medical adviser (DMA), and requested that he 

provide an opinion regarding Dr. White’s permanent impairment rating. In an April 20, 2021 

report, Dr. Harris provided an assessment of appellant’s lower extremity permanent impairment 

which was in accordance with that of Dr. White. He concluded that appellant had zero percent 

permanent impairment of the right lower extremity and one percent permanent impairment of the 

left lower extremity.

4 Dr. White found that appellant had reached maximum medical improvement (MMI) by February 26, 2021, the 

date of his examination.
4

By decision dated May 13, 2021, OWCP granted appellant a schedule award for one 

percent permanent impairment of the left lower extremity. The award ran for 2.88 weeks from 

February 26 through March 18, 2021 and was based on the February 26, 2021 report of Dr. White 

and the April 20, 2021 report of Dr. Harris. 

On May 12, 2022 appellant requested reconsideration of OWCP’s May 13, 2021 decision. 

She resubmitted several reports from healthcare providers, including Dr. King, which were dated 

between July 10, 2017 and June 4, 2019. Appellant also submitted photographs of her injuries 

taken on an unspecified date or dates.

By decision dated August 10, 2022, OWCP denied modification of its May 13, 2021 

decision.

LEGAL PRECEDENT

The schedule award provisions of FECA5 and its implementing federal 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 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 is used 

to calculate schedule awards.8

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 diagnosis-based impairment where impairment class 

is determined by the diagnosis and specific criteria as adjusted by the GMFH, GMPE, and GMCS. 

It further provides that alternative approaches are also provided for calculating impairment for 

peripheral nerve deficits, complex regional pain syndrome, amputation, and ROM. ROM is 

primarily used as a physical examination adjustment factor.9 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 

5

5 U.S.C. § 8107.

6

20 C.F.R. § 10.404.

7

Id.; see V.J., Docket No. 1789 (issued April 8, 2020); Jacqueline S. Harris, 54 ECAB 139 (2002).

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

2.808.5a (March 2017); Federal (FECA) Procedure Manual, Part 3 --Medical, Schedule Awards, Chapter 3.700.2 and 

Exhibit 1 (January 2010).

9 A.M.A., Guides (6th ed. 2009) 497, section 16.2.
5

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.10

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 knees and hips, reference is made to Table 16-3 (Knee Regional 

Grid) and Table 16-4 (Hip Regional Grid), respectively.

11

 Under each table, after the CDX is 

determined and a default grade value is identified, the net adjustment formula is applied using the 

GMFH, GMPE, and GMCS. The net adjustment formula is (GMFH - CDX) + (GMPE - CDX) + 

(GMCS - CDX).12 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.13

ANALYSIS

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

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

schedule award.

In a February 26, 2021 report, Dr. White, an OWCP referral physician, provided an 

evaluation of the permanent impairment of the lower extremities. For the right lower extremity, 

he referred to the sixth edition of the A.M.A., Guides and utilized the DBI rating method to find 

that, under Table 16-3 (Knee Regional Grid) on page 509, the CDX for appellant’s accepted right 

leg bite met the criteria for a soft tissue lesion, which fell under class 1 with a default value of 1. 

Dr. White assigned a GMFH of 1, a GMPE of 0, and a GMCS of 0. He utilized the net adjustment 

formula, (GMFH - CDX) + (GMPE - CDX) + (GMCS - CDX) = (1 - 1) + (0 - 1) + (0 - 1) = -2, 

which resulted in a grade A or zero percent permanent impairment of the right lower extremity. 

For the left lower extremity, Dr. White analyzed two separate accepted left lower extremity 

conditions. First, he utilized the DBI rating method to find that, under Table 16-4 (Hip Regional 

Grid) on page 512, appellant’s accepted left buttock bite met the criteria for a soft tissue lesion,

which fell under class 1 with a default value of 1. Dr. White assigned a GMFH of 1, a GMPE of 

0, and a GMCS of 0. He utilized the net adjustment formula, (GMFH - CDX) + (GMPE - CDX) 

+ (GMCS - CDX) = (1 - 1) + (0 - 1) + (0 - 1) = -2, which resulted in a grade A or zero percent 

permanent impairment of the left lower extremity. Second, Dr. White utilized the DBI rating 

method to find that, under Table 16-4 on page 512, the CDX for appellant’s left hip strain resulted 

in a class 1 impairment with a default value of 1. He assigned a GMFH of 1, a GMPE of 0, and a 

GMCS of 1. Dr. White utilized the net adjustment formula, (GMFH - CDX) + (GMPE - CDX) + 

(GMCS - CDX) = (1 - 1) + (0 - 1) + (1 - 1) = -1, which resulted in a grade B or one percent 

10 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).

11 A.M.A., Guides 509-15.

12 Id at 515-22.

13 Id. at 23-28.
6

permanent impairment of the left lower extremity.14 He noted that appellant’s lower extremity 

conditions did not meet the criteria for applying the ROM impairment rating method.15 Therefore,

Dr. White concluded that appellant’s only documented permanent impairment of a lower extremity 

was this one percent permanent impairment of the left lower extremity.

In an April 20, 2021 report, Dr. Harris, the DMA, provided an assessment of appellant’s 

lower extremity permanent impairment which was in accordance with that of Dr. White. He

concluded that appellant had zero percent permanent impairment of the right lower extremity and 

one percent permanent impairment of the left lower extremity. 

The Board finds that the well-rationalized reports of Dr. White and Dr. Harris provide an 

opinion on appellant’s lower extremity permanent impairment which were derived in accordance 

with the standards of the sixth edition of the A.M.A., Guides and therefore are entitled to the weight 

of the evidence.16 Their calculations, including the derivation of grade modifiers and the 

application of the net adjustment formula, properly applied the relevant standards to the physical 

examination and diagnostic testing results.

After OWCP granted appellant a schedule award on May 13, 2021, she resubmitted several 

reports from healthcare providers, including Dr. King, which were dated between July 10, 2017 

and June 4, 2019. She also submitted photographs of her injuries taken on an unspecified date or 

dates. However, these documents do not contain a permanent impairment rating conducted under 

the standards of the sixth edition of the A.M.A., Guides and are of no probative value regarding 

appellant’s permanent impairment.17 

As there is no rationalized medical report providing a rating of permanent impairment 

greater than that provided by Dr. White and Dr. Harris, the Board finds that appellant had not met 

her burden of proof to establish greater than one percent permanent impairment of her left lower 

extremity, for which she received a schedule award.

18

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.

14 Dr. White found that appellant had reached MMI by February 26, 2021, the date of his examination.

15 Table 16-3 and Table 16-4 do not provide for use of the ROM method to rate a claimant’s lower extremity 

impairment. See A.M.A., Guides 509-15. See also supra notes 9 and 10.

16 See Y.S., Docket No. 19-0218 (issued May 15, 2020); R.D., Docket No. 17-0334 (issued June 19, 2018).

17 See N.A., Docket No. 19-0248 (issued May 17, 2019).

18 M.G., Docket No. 19-0823 (issued September 17, 2019); I.T., Docket No. 18-1049 (issued December 31, 2018).
7

CONCLUSION

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

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

schedule award.

ORDER

IT IS HEREBY ORDERED THAT the August 10, 2022 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: May 25, 2023

Washington, DC

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

James D. McGinley, Alternate Judge

Employees’ Compensation Appeals Board