United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

K.R., Appellant

and

U.S. POSTAL SERVICE, DENVER 

COLORADO PROCESSING & DISTRIBUTION 

CENTER, Denver, CO, Employer

__________________________________________

)

)

)

)

)

)

)

)

)

Docket No. 20-1675

Issued: August 19, 2022

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 September 28, 2020 appellant filed a timely appeal from an August 12, 2020 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 12, 2020decision, appellant submitted additional 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 

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 five 

percent permanent impairment of his right upper extremity and two percent permanent impairment 

of his left upper extremity for which he previously received schedule award compensation.

FACTUAL HISTORY

On August 24, 2018 appellant, then a 59-year-old tractor trailer operator, filed an 

occupational disease claim (Form CA-2) alleging that he developed right rotator cuff syndrome

“tendinitis” due to factors of his federal employment, including the repetitive motions of his duties 

and tasks. He noted that he first became aware of his condition on July 23, 2018 and realized its 

relation to his federal employment on August 23, 2018. Appellant stopped work on 

August 23, 2018. On October 1, 2018 OWCP accepted his claim for right shoulder rotator cuff 

syndrome. It paid appellant wage-loss compensation on the supplemental rolls from February 25 

through March 26, 2019. 

A magnetic resonance imaging (MRI) scan of the right shoulder dated December 31, 2018 

demonstrated supraspinatus, infraspinatus,subscapularis tendinosis with partial thickness tear of 

the subscapularis from the lesser tuberosity, anterior, inferior, posterior inferior and posterior 

superior quadrant labral tear, and degenerative cartilage changes in the posterior superior quadrant 

of the glenoid.

On February 25, 2019 Dr.Cary Motz, a Board-certified orthopedist, performed an OWCPauthorized right shoulder arthroscopy with arthroscopic subscapularis repair, extensive

debridement of the glenohumeral joint, partial thickness subscapularis tear and subacromial space, 

and arthroscopic subacromial decompression.3 

On March 15, 2019 OWCP expanded the acceptance of appellant’s claim to include right 

shoulder rotator cuff/impingement syndrome and right shoulder partial thickness subscapularis 

tear.

Appellant underwent a functional capacity evaluation (FCE) on October 21, 2019, which 

demonstrated his ability to function in the very heavy physical demand category. 

On December 11, 2019 Dr. Jay Reinsma, a Board-certified family practitioner, prepared a 

duty status report (Form CA-17), diagnosed rotator cuff tear status post repair, and returned 

appellant to full-duty work as of December 11, 2019.

On February 21, 2020 appellant filed a claim for compensation (Form CA-7) for a schedule 

award.

3 An MRI scan of the rightshoulder dated June 26, 2019 revealed postoperative changes of an acromioplasty, mild 

edematous change and degenerative changes about the acromioclavicular (AC) joint slight progressed, fluid in the 

subacromial and subdeltoid bursa, tendinosis of the rota tor cuff but the cuff remains intact, stable osteoarthritic 

changes of the glenohumeral articulation, and joint effusion with synovitis change.
3

In support of his claim, appellant submitted a January 14, 2020 report from Dr. Amanda 

Cava, a family practitioner, who documented appellant’s right shoulder treatment following his 

right shoulder arthroscopy. Dr. Cava’s physical examination of appellant’s right shoulder revealed 

no biceps popeye deformity, the incision was clean, dry and intact, there was no tenderness, and 

palpation revealed no crepitus. She noted forward flexion of 165 degrees with pain, extension of 

50 degrees, abduction of 150 degrees with pain, adduction of 25 degrees with pain, internal rotation 

of 20 degrees with pain, and external rotation of 70 degrees with pain. Dr. Cava noted motor and 

sensation testing were intact. She examined appellant’s left shoulder, which did not indicate a 

biceps popeye deformity, there was no tenderness, and the appearance was normal. Dr. Cava noted 

forward flexion of 165 degrees with pain, extension of 50 degrees, abduction of 165 degrees with 

pain, adduction of 35 degrees with pain, internal rotation of 35 degrees with pain, and external 

rotation of 70 degrees with pain. Motor and sensation testing were intact. Dr. Cava diagnosed 

unspecified rotator cuff tear or rupture of the right shoulder, anterior to posterior tear of the 

superior glenoid labrum of the left shoulder, and status post arthroscopy of the right shoulder.

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

of Permanent Impairment (A.M.A., Guides),4 Dr. Cava initially calculated impairment based on 

the diagnosis-based impairment (DBI) rating method to find that under Table 15-5 (Shoulder 

Regional Grid), page 402, the class of diagnosis (CDX) for appellant’s partial thickness rotator 

cuff tear of the right shoulder resulted in a class 1 impairment with a default value of 3. She

assigned a grade modifier for functional history (GMFH) of 1 due to mild symptoms, a grade 

modifier for physical examination (GMPE) of 1 for mild problems. Dr. Cava found that a grade 

modifier for clinical studies (GMCS) was not applicable. She applied the net adjustment formula

(GMFH - CDX) + (GMPE - CDX) + (GMCS - CDX) = (1-1) + (1-1) + (2-1) = -4, which resulted 

in a grade A or one percent permanent impairment of the right upper extremity. 

Using the DBI rating method to rate the left shoulder under Table 15-5 (Shoulder Regional 

Grid), page 402, Dr. Cava identified the CDX for the diagnosis of shoulder impingement as a class 

1 impairment with a default value of 1. She assigned a GMFH of 1 for mild symptoms, a GMPE 

of 1 for mild findings, and a GMCS of 1. Dr. Cava applied the net adjustment formula (GMFH -

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

D or two percent permanent impairment of the left upper extremity.

Dr. Cava calculated impairment for the stand-alone range of motion (ROM) method and 

opined that appellant had 11 percent permanent impairment of the right upper extremity under 

Table 15-34 of the A.M.A., Guides.

5

 Using the ROM method to calculate impairment of the left 

upper extremity corresponded to eight percent permanent impairment of the left upper extremity. 

Dr. Cava documented only one motion per joint movement. She opined that appellant had reached 

maximum medical improvement (MMI) on January 14, 2020.

On July 7, 2020 OWCP further expanded the acceptance of appellant’s claim to include 

anterior to posterior tear of the superior glenoid labrum lesion of the left shoulder. 

4

5 U.S.C. § 8107.

5 A.M.A., Guides 475, Table 15-34.
4

OWCP referred appellant’s medical record, along with a statement of accepted facts 

(SOAF), for a schedule award impairment rating with Dr. Morley Slutsky, Board-certified in 

occupational medicine, serving as the district medical adviser (DMA). In a July 15, 2020 report,

Dr. Slutsky reviewed the SOAF and medical record. He noted that he was not provided with a 

copy of the February 25, 2019 right shoulder surgery report that he stated was key to rating the 

right shoulder. Dr. Slutsky utilized the DBI method to find that, under Table 15-5 (Shoulder 

Regional Grid), page 402, the CDX for the diagnosis of partial thickness rotator cuff tear with 

residual dysfunction resulted in a class 1 impairment with a default value of 3. He assigned a 

GMFH of 1, in accordance with Table 15-7, page 406, as appellant had no evidence of functional 

limitations as noted by Dr. Cava’s January 14, 2020 report. Dr. Slutsky assigned a GMPE of zero, 

in accordance with Table 15-8, page 408 as Dr. Cava documented only one motion per joint 

movement, which was inconsistent with the validity criteria in Section 15.7 page 464, for 

measuring ROM. Therefore, the ROM measurements were not valid for impairment calculations. 

Dr. Slutsky, therefore, disagreed with Dr. Cava’s assignment of a GMFH of 1. He noted that, a 

GMCS should be excluded, in accordance with Table 15-9, page 410, as an MRI scan was used 

for placement of the diagnosis within a specific class in the DBI grid. Dr. Slutsky calculated that 

appellant had a net adjustment of -1, resulting in movement from the default class of C to B and 

corresponding to two percent permanent impairment of the right upper extremity. 

With regard to the left upper extremity, Dr. Slutsky utilized the DBI method to find that, 

under Table 15-5 (Shoulder Regional Grid), page 404, the CDX for the diagnosis of left shoulder 

labral tear was a class 1 impairment with a default value of 3. He assigned a GMFH of 1 for mild 

symptoms, in accordance with Table 15-7, page 406. Dr. Slutsky assigned a GMPE of zero, in 

accordance with Table 15-8, page 408, as Dr. Cava documented only one motion per joint 

movement, which was inconsistent with the validity criteria in Section 15.7 page 464, for 

measuring ROM. He, therefore, disagreed with Dr. Cava’s assignment of a GMPE of 1. 

Dr. Slutsky noted that a GMCS should be excluded in accordance with Table 15-9, page 410, as 

an MRI scan was used for placement of the diagnosis within a specific class in the DBI grid. He

calculated that appellant had a net adjustment of -1, resulting in movement from the default class 

of C to B and corresponding to two percent permanent impairment of the left upper extremity.

Dr. Slutsky opined that appellant had reached MMI on January 14, 2020.

On July 21, 2020 OWCP requested clarification from Dr. Slutsky regarding his impairment 

rating. It provided Dr. Slutsky with the February 25, 2019 right shoulder operative report and 

requested he reevaluate his upper extremity impairment calculations.

In a supplemental report dated August 1, 2020, Dr. Slutsky reviewed the February 25, 2019 

right shoulder operative report. He utilized the DBI rating method to find that, under Table 15-5 

(Shoulder Regional Grid), page 402, the CDX for the diagnosis of partial thickness rotator cuff 

tear with residual dysfunction resulted in a class 1 impairment with a default value of 3.

Dr. Slutsky assigned a GMFH of 1, in accordance with Table 15-7, page 406, as appellant had no 

evidence of functional limitations. He assigned a GMPE of zero, in accordance with Table 15-8, 

page 408 as Dr. Cava documented only one motion per joint movement, which was inconsistent 

with the validity criteria in Section 15.7 page 464, for measuring ROM. Dr. Slutsky found a 

GMCS of 4 in accordance with Table 15-9, page 410, based on the right shoulder MRI scan dated 

December 31, 2018. Applying the net adjustment formula, he calculated that appellant had a net 

adjustment of +2, resulting in movement from the default class of C to E, corresponding to five
5

percent permanent impairment of the right upper extremity. Dr. Slutsky disagreed with Dr. Cava’s 

calculation of the net adjustment formula for the right shoulder and indicated that the GMFH of 1

and GMPE of 1 was zero and not -2 as assigned by Dr. Cava. He noted no change from his July 15, 

2020 report to the impairment rating for the left upper extremity. 

By decision dated August 12, 2020, OWCP granted appellant a schedule award for five 

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

of the left upper extremity. The award ran for 21.84 weeks from January 14 through June 14, 2020 

and was based on the January 14, 2020 report of Dr. Cava and the August 1, 2020 report of

Dr. Slutsky, the DMA. 

LEGAL PRECEDENT

The schedule award provisions of FECA,6 and its implementing federal regulations,7 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.8 As of May 1, 2009, the 

sixth edition of the A.M.A., Guidesis used to calculate schedule awards.9 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.10

In determining impairment for the upper extremities under the sixth edition of the A.M.A., 

Guides, an evaluator must establish the appropriate diagnosis for each part of the upper extremity 

to be rated. With respect to the shoulder, the relevant portion of the arm for the present case, 

reference is made to Table 15-5 (Shoulder Regional Grid) beginning on page 401. After the CDX 

is determined from the Shoulder 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 

6

5 U.S.C. § 8107.

7

20 C.F.R. § 10.404.

8

Id. at § 10.404(a).

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

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

10 See S.C., Docket No. 20-0769 (issued January 12, 2021); P.R., Docket No. 19-0022 (issued April 9, 2018);

Isidoro Rivera, 12 ECAB 348 (1961).

11 A.M.A., Guides 405-12. Table 15-5 also provides that, if motion loss is present for a claimant with certain 

diagnosed conditions, permanent impairment may alternatively be assessed using section 15.7 (ROM impairment). 

Such a ROM rating stands alone and is not combined with a DBI rating. Id. at 401-05, 475-78.
6

are directed to provide reasons for their impairment rating choices, including choices of diagnoses 

from regional grids and calculations of modifier scores.12

The A.M.A., Guides also provide that the 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.13 If ROM is used as a standalone approach, the total of motion 

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

added.14 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.15

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.16 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.,] 

Guidesidentify 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.” (Emphasis in the original.)17

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 CE [claims examiner].”

18

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 

12 Id. at 23-28.

13 Id. at 461.

14 Id. at 473.

15 Id. at 474.

16 FECABulletin No. 17-06 (issued May 8, 2017).

17 Id.

18 Id.;see also H.H., Docket No. 19-1530 (issued June26, 2020);A.G., Docket No. 18-0329 (issued July 26, 2018).
7

accordance with the A.M.A., Guides, with the DMA providing rationale for the percentage of 

impairment specified.19

ANALYSIS

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

In her January 14, 2020 report, Dr. Cava calculated impairment utilizing the ROM method 

and opined that appellant had 11 percent permanent impairment of the right upper extremity under 

Table 15-34 of the A.M.A., Guides.

20

 Using the ROM method to calculate impairment of the left 

upper extremity corresponded to eight percent permanent impairment of the left upper extremity. 

However, Dr. Cava documented only one motion per joint movement. 

OWCP referred Dr. Cava’s report to Dr. Slutsky, its DMA, who opined that appellant had 

two percent permanent impairment of the left upper extremity for left shoulder labral tear and five

percent permanent impairment of the right upper extremity for partial thickness rotator cuff tear 

with residual dysfunction under the DBI methodology. Dr. Slutsky advised that Dr. Cava’s report 

did not contain complete ROM measurements and documented only one motion per joint 

movement, which was inconsistent with the validity criteria in Section 15.7, page 464, for 

measuring ROM. Therefore, the ROM measurements were not valid for impairment calculations. 

OWCP did not ask Dr. Cava to clarify whether appellant had a loss of ROM of the 

shoulders and, if so, to provide three measurements of appellant’s right and left shoulder ROM. 

Because Dr. Cava documented only one motion per joint movement, the DMA declared her ROM 

measurements invalid and then rated appellant’s permanent impairment on July 15 and August 1, 

2020 under the DBI methodology.

Pursuant to FECA Bulletin No. 17-06, if the ROM method of rating permanent impairment 

is allowed, after review of the DBI rating, and the ROM findings are incomplete, the DMA should 

advise as to the medical evidence necessary to complete the ROM method of rating if the medical 

evidence of record is insufficient to rate appellant’s impairment using ROM.21

The Board finds that OWCP did not follow the procedures outlined in FECA Bulletin No. 

17-06 after the DMA advised that the measurements for the bilateral shoulders were incomplete 

to rate appellant’s permanent impairment utilizing the ROM methodology.22 

19 Supra note 9 at Chapter 2.808.6f;P.W., Docket No. 19-1493 (issued August 12, 2020).

20 A.M.A., Guides 475, Table 15-34.

21 Supra note 16; R.L., Docket No. 19-1793 (issued August 7, 2020); E.P., Docket No. 19-1708 (issued 

April 15, 2020).

22 R.L., id.; C.T., Docket No. 18-1716 (issued May 16, 2019).
8

On remand, OWCP shall obtain the necessary evidence as required under FECA Bulletin 

No. 17-06.23 Following this and other such further development as deemed necessary, itshall issue 

a de novo decision.24

CONCLUSION

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

ORDER

IT IS HEREBY ORDERED THAT the August 12, 2020 decision of the Office of 

Workers’ Compensation Programs is set aside and the case is remanded for further development 

consistent with this decision of the Board.

Issued: August 19, 2022

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

23 J.S., Docket No. 19-0483 (issued October 10, 2019).

24 J.F., Docket No. 17-1726 (issued March 12, 2018).