United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

J.S., Appellant

and

U.S. POSTAL SERVICE, ALBANY POST 

OFFICE, Albany, NY, Employer

__________________________________________

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Docket No. 23-0271

Issued: September 18, 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

VALERIE D. EVANS-HARRELL, Alternate Judge

JAMES D. McGINLEY, Alternate Judge

JURISDICTION

On December 12, 2022 appellant filed a timely appeal from an August 16, 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.2

1

5 U.S.C. § 8101 et seq.

2 The Board notes that,following the August 16, 2022 decision, appellant submittedadditional evidence to OWCP. 

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 

new 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 16 

percent permanent impairment of eachlower extremity, for which he previously received schedule 

award compensation.

FACTUAL HISTORY

On September 1, 2020 appellant, then a 42-year-old city carrier, filed an occupational 

disease claim (Form CA-2) alleging that he developed bilateral knee osteoarthritis due to factors 

of his federal employment. He noted that he first became aware of his condition and realized its

relation to his federal employment on August 18, 2020. OWCP accepted appellant’s claim for 

permanent aggravation of bilateral primary osteoarthritis of the knee. Appellant did not stop work.

On October 8, 2021 appellant filed a claim for compensation (Form CA-7) for a schedule 

award. In support of his claim, he submitted reports dated August 2 and 27, 2021 from Dr. David J. 

Barnes, an osteopath and Board-certified family medicine specialist.

In a development letter dated October 14, 2021, OWCP indicated that the August 2 and 27, 

2021 reports from Dr. Barnes were partially legible. It requested that appellant submit a permanent 

impairment evaluation from his attending physician in accordance with the standards of the sixth 

edition of the American Medical Association, Guides to the Evaluation of Permanent Impairment 

(A.M.A., Guides).3 OWCP afforded him 30 days to submit the requested evidence.

In medical reports dated August 2 and 27, 2021, Dr. Barnes noted that appellant previously 

sustained a torn meniscus in his right knee in 1999 and underwent arthroscopic surgery. 

Thereafter, appellant experienced right knee pain and swelling and underwent conservative 

treatment including a knee brace and synvisc injections. Dr. Barnes noted that, in 2013, appellant 

began working as a letter carrier, which required walking approximately 11 miles a day while 

regularly carrying 30 to 35 pounds in appellant’s satchel, and appellant reported experiencing

severe left knee pain that mirrored his right knee pain. In 2017 appellant began working as a motor 

vehicle trainer, which required standing all day on pavement. Dr. Barnes noted findings on 

physical examination of antalgic gait, pain in the medial and lateral portion of both knees, moderate 

tenderness upon palpation to the medial portion of the knees, decreased range of motion of the 

knees with flexion and extension, positive varus and valgus test bilaterally, and positive McMurray 

test bilaterally. He noted that x-rays revealed considerable narrowing of the medial joint line with 

only two millimeters (mm) of articular surface interval medially. Dr. Barnes diagnosed unilateral 

primary osteoarthritis of both knees and noted that appellant had reached maximum medical 

improvement (MMI) on August 2, 2021.

Dr. Barnes referred to the sixth edition of the A.M.A., Guides and utilized the diagnosisbased impairment (DBI) rating method to find that, under Table 16-3 (Knee Regional Grid), page 

511, the class of diagnosis (CDX) for appellant’s joint arthritis in each knee, which was measured 

at a two mm cartilage interval, resulted in a Class 2 impairment with a default value of 20 percent. 

He assigned a grade modifier for functional history (GMFH) of 2, a grade modifier for physical 

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

examination (GMPE) of 2, and a grade modifier for clinical studies (GMCS) of 2. Dr. Barnes 

utilized the net adjustment formula (GMFH - CDX) + (GMPE - CDX) + (GMCS - CDX) = (2-2) 

+ (2-2) + (2-2) = 0, which resulted in no movement from the 20 percent default value and therefore 

appellant had 20 percent permanent impairment of each lower extremity due to primary knee joint 

arthritis.

On December 17, 2021 OWCP routed Dr. Barnes’ reports, a statement of accepted facts 

(SOAF), and the case file to Dr. James W. Butler, a Board-certified occupational medicine 

physician serving as an OWCP district medical adviser (DMA). It requested that the DMA provide 

an evaluation of appellant’s permanent impairment under the sixth edition of the A.M.A., Guides.

In a January 16, 2022 report, Dr. Butler indicated that he had reviewed the SOAF and the 

medical record, includingDr. Barnes’August 2 and 27, 2022 reports. He noted that he was unable 

to assign an impairment rating at the time. Dr. Butler indicated that he had no actual cartilage 

interval measurements from x-rays which were necessary to determine a rating for arthritis and 

referenced section 16.3c on page 518 of the sixth edition of the A.M.A., Guides. He further noted 

that the findings from the full examination performed by Dr. Barnes would be useful to determine 

the impairment rating. Dr. Butler requested the additional information prior to completing his 

report.

OWCP received February 9, 2022 x-ray reports of appellant’s knees. The report indicated 

a film of weightbearing with a sunrise view, that revealed bilateral medial tibiofemoral joint 

interval narrowing, patellofemoral joint interval narrowing, and lateral joint interval narrowing. 

The right knee had 1.85 mm of medial joint interval, 3.8 mm of lateral joint interval, and 1 mm of 

patellofemoral joint interval. The left knee had 2 mm of medial joint interval, 4 mm of lateral joint 

interval, and 1.15 mm of patellofemoral joint interval. There was evidence of bilateral advanced 

osteophytes and the impression was aggressive arthritic changes.

On March 16, 2022 OWCP referred appellant and the case file, including a SOAF, to

Dr. Kevin L. Scott, a Board-certified orthopedic surgeon, for a second opinion examination and 

evaluation regarding appellant’s permanent impairment under the sixth edition of the A.M.A., 

Guides.

In a report dated April 14, 2022, Dr. Scott provided a history of clinical presentation and 

described the accepted employment conditions, as well as appellant’s medical treatment. On 

examination of the right knee, he noted that appellant wore braces, ambulated with a limp, and had

bilateral medial and lateral joint tenderness to palpation. Dr. Scott recorded 90 degrees of flexion 

for the right knee, 90 degrees of flexion for the left knee, 0 degrees of extension for the right knee, 

and 0 degrees of extension for the left knee. He diagnosed osteoarthritis of the knees and opined 

that appellant had reached MMI. Dr. Scott indicated that x-ray findings of the right knee revealed 

1.85 mm of medial joint interval, 3.8 mm of lateral joint interval, and 1 mm of patellofemoral joint

interval. In the left knee, x-rays revealed 2 mm of medial joint interval, 4 mm of lateral joint 

interval, and 1.15 mm of patellofemoral joint interval. 

Dr. Scott referred to the sixth edition of the A.M.A., Guides and utilized the DBI rating 

method to calculate appellant’s right lower extremity impairment, noting that, under Table 16-3, 

page 511, the CDX for appellant’s 1 mm of right patellofemoral joint interval resulted in a Class 
4

3 impairment. He assigned a GMFH of 1 and a GMPE of 1. Dr. Scott found that GMCS was not 

applicable. He utilized the net adjustment formula,(GMFH - CDX) + (GMPE - CDX) = (1 - 3) + 

(1 - 3) = -4, which resulted in grade A or 26 percent permanent impairment of the right lower 

extremity. For the left lower extremity, Dr. Scott utilized the DBI rating method to find that, under 

Table 16-3, page 511, the CDX for appellant’s 2 mm interval of the left medial joint resulted in a

Class 2 impairment with a default value of 20. He assigned a GMFH of 1 and a GMPE of 1.

Dr. Scott found that the GMCS was not applicable. He utilized the net adjustment formula, 

(GMFH - CDX) + (GMPE - CDX) = (1 - 2) + (1 - 2) = -2, which resulted in grade A or 16 percent 

permanent impairment of the left lower extremity.

On April 28, 2022 OWCP routed the second opinion report to Dr. Barnes for review and 

requested that he address whether he agreed with Dr. Scott’s impairment rating. In a May 5, 2022 

report, Dr. Barnes indicated that he concurred with Dr. Scott’s impairment rating. 

On May 11, 2022 OWCP routed Dr. Scott’s report, a SOAF, and the case file to Dr. Butler, 

in his role as DMA, for review and a determination of appellant’s permanent impairment.

In a May 27, 2022 report, Dr. Butler indicated that he had reviewed the SOAF and medical 

record. Discussing Dr. Scott’s April 14, 2022 findings, he determined that application of the DBI 

rating method under Table 16-3 on page 511 of the sixth edition of the A.M.A., Guides to the right 

lower extremity meant that appellant’s right knee joint arthritis of the patellofemoral cartilage (1 

mm cartilage interval) fell under a CDX of Class 2 with a default value of 20 percent. Dr. Butler

assigned a GMFH of 1 and a GMPE of 1 (due to decreased range of motion with palpable findings). 

He noted that the GMCS was not applicable. Dr. Butler noted that, after applying a net adjustment, 

appellant had 16 percent permanent impairment of the right lower extremity. He indicated that 

there was a discrepancy between his right lower extremity rating and that of Dr. Scott as Dr. Scott 

assigned a rating for patellofemoral arthritis in the right knee of Class 3, whereas pursuant to the 

sixth edition of the A.M.A., Guides patellofemoral arthritis of 1 mm cartilage interval was rated in 

Class 2 with a maximum impairment rating of 17 percent.

With respect to the left lower extremity, Dr. Butler found appellant’s left knee joint arthritis 

of the medial compartment (2 mm cartilage interval) fell under a CDX of Class 2 with a default 

value of 20 percent. He assigned a GMFH of 1 and a GMPE of 1 (due to decreased range of 

motion). Dr. Butler found that the GMCS was not applicable. He calculated a net adjustment of 

-2, for 16 percent permanent impairment of the left lower extremity. Dr. Butler indicated that 

appellant’s date of MMI was April 14, 2022.

On July 5, 2022 OWCP routed the case record, including Dr. Butler’s report, to Dr. Scott 

for review and requested that he address whether he agreed with Dr. Butler’s impairment rating. 

In a July 25, 2022 report, Dr. Scott concurred with Dr. Butler’s impairment rating. 

By decision dated August 16, 2022, OWCP granted appellant a schedule award for 16

percent permanent impairment of each lower extremity. The award ran for 92.16 weeks from 

August 27, 2021 through June 3, 2023 and was based on the opinions of Dr. Scott, OWCP’s 

referral physician, and Dr. Butler, the DMA.
5

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, 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.6 As of May 1, 2009, schedule awards are determined in 

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

The sixth edition of the A.M.A., Guides provides for a DBI method of evaluation utilizing 

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

Health.

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 (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 to a DMA for an opinion concerning the nature and percentage of impairment in 

4

5 U.S.C. § 8107.

5

20 C.F.R. § 10.404.

6

Id. See also Ronald R. Kraynak, 53 ECAB 130 (2001).

7

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

(January 2010); id. at Chapter 2.808.5a (March 2017).

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

9 A.M.A., Guides, page 3, section 1.3.

10 See A.M.A., Guides 509, Table 16-3.

11 Id. at 515-22.

12 Id. at 23-28.
6

accordance with the A.M.A., Guides, with the DMA 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 16 

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

schedule award.

On April 14, 2022 Dr. Scott, OWCP’s referral physician, conducted an evaluation of the 

extent of permanent impairment of appellant’s right lower extremity using the DBI rating method 

described in Table 16-3 of the sixth edition of the A.M.A., Guides. He found that, utilizing Table 

16-3, the patellofemoral arthritis of appellant’s right knee had a CDX of Class 3. Dr. Scott

assigned a GMFH of 1 and a GMPE of 1. He found that a GMCS was not applicable. Dr. Scott

calculated a net adjustment of -4, yielding an impairment rating of 26 percent permanent 

impairment for the right lower extremity. 

With regard to the left lower extremity, Dr. Scott rated appellant’s primary knee using the 

diagnosis as joint arthritis and found that a 2 mm medial joint interval warranted a CDX of Class 

2. He assigned a GMFH of 1 and GMPE of 1. Dr. Scott found that GMCS was not applicable. 

He concluded that appellant had a net adjustment of -2, for an impairment rating of 16 percent for 

the left lower extremity. 

On May 27, 2022 Dr. Butler, the DMA, evaluated the April 14, 2022 impairment rating of

Dr. Scott. With respect to the left lower extremity, he properly applied the DBI rating method 

under Table 16-3 on page 511 of the sixth edition of the A.M.A., Guides to find that appellant’s 

left primary knee joint arthritis in the form of medial compartment arthritis (2 mm cartilage 

interval) fell under a CDX of Class 2 with a default value of 20 percent.14 Dr. Butler assigned a 

GMFH of 1 and a GMPE of 1, and found that GMCS did not apply.

15

 He utilized the net 

adjustment, which resulted in a final calculation of 16 percent permanent impairment of the left

lower extremity. The Board finds that Dr. Butler properly applied the A.M.A., Guides to find that 

appellant had 16 percent permanent impairment of the left lower extremity, for which appellant

previously received a schedule award, and thus properly found that he was not entitled to additional 

schedule award compensation for the left lower extremity.

With respect to the right lower extremity, Dr. Butler referred to the sixth edition of the 

A.M.A., Guides, and utilized the DBI rating method to find that, under Table 16-3, page 511, the 

CDX for appellant’s right knee patellofemoral arthritis(1 mm cartilage interval) resulted in a Class 

2 impairmentwith a default value of 20 percent. He disagreed with Dr. Scott who assigned a rating 

for patellofemoral arthritis in the right knee of Class 3, asserting that this rating was inconsistent 

13 See supra note 7 at Chapter 2.808.6f (March 2017). See also P.W.,Docket No. 19-1493 (issued August 12, 

2020); Frantz Ghassan, 57 ECAB 349 (2006).

14 See A.M.A., Guides 511, Table 16-3.

15 It is noted that it was proper for Dr.Butler to not find a GMCS applicable for either lower extremity as clinical 

studies were used to determine the CDX. See id. at 515-22.
7

with the sixth edition of the A.M.A., Guides on page 511 as patellofemoral arthritis of 1 mm

cartilage interval was rated in Class 2. Dr. Butler assigned a GMFH of 1 and a GMPE of 1, and 

found that the GMCS was not applicable. He utilized the net adjustment, which resulted in 16 

percent permanent impairment of the right lower extremity.

The Board notes that Dr. Butler properly determined that Dr. Scott erred when he rated 

appellant’s right patellofemoral arthritis under a CDX of Class 3. Dr. Butler also properly noted 

that this patellofemoral arthritis fell under Class 2, assigned grade modifiers, and calculated a net 

adjustment. He assigned a 20 percent default value for right patellofemoral arthritis, but the Board 

notes that Table 16-3 actually dictates assignment of 15 percent impairment default value for this 

condition, which in turn would yield 14 percent permanent impairment of the right lower extremity 

upon application of the net adjustment of -2. The Board finds that, given appellant has already 

received a schedule award for 16 percent permanent impairment of the right lower extremity, he 

would not be entitled to additional schedule award compensation for that extremity.

As appellant has not established greater than 16 percent permanent impairment of each 

lower extremity, for which he previously received schedule award compensation, the Board finds 

that he 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 16 

percent permanent impairment of eachlower extremity, for which he previously received schedule 

award compensation.
8

ORDER

IT IS HEREBY ORDERED THAT the August 16, 2022 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: September 18, 2023

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board

James D. McGinley, Alternate Judge

Employees’ Compensation Appeals Board