United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

L.H., Appellant

and

U.S. POSTAL SERVICE, BUSSE PROCESSING 

& DISTRIBUTION CENTER, Elk Grove, IL, 

Employer

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Docket No. 22-0618

Issued: December 22, 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

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On March 20, 2022 appellant filed a timely appeal from a March 9, 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

ISSUE

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

percent permanent impairment of the left lower extremity and four percent permanent impairment 

of the right lower extremity, for which she previously received schedule award compensation. 

1

5 U.S.C. § 8101 et seq.

2 The Board notes that,following the March 9, 2022 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

FACTUAL HISTORY

On August 3, 2017 appellant, then a 48-year-old mail handler, filed an occupational disease 

claim (Form CA-2) alleging that she sustained a right knee condition due to factors of her federal 

employment which included walking, standing on her feet eight hours per day, five days per week,

lifting, pulling, twisting, and dumping of mail. She noted that she first became aware of her 

claimed condition on May 3, 2017, and realized its relation to her factors of federal employment 

on June 19, 2017. Appellant stopped work on August 3, 2017. OWCP initially accepted the claim 

for peripheral tear of medial meniscus, right knee. It subsequently expanded the acceptance of the 

claim to include chondromalacia patella, right knee; patellofemoral disorders, right knee; and 

aggravation of chondromalacia patellae, left knee. OWCP paid appellant wage-loss compensation 

for disability from work on the supplemental rolls, commencing October 26, 2017. 

Appellant underwent several OWCP-authorized surgeries. On October 26, 2017 she

underwentright knee arthroscopy with partial medial meniscectomy; chondroplasty of the trochlea 

patella and medial femoral condyle; lateral retinacula release; and arthroscopic debridement of 

lateral patellar spur. On January 25, 2019 appellant underwent left knee arthroscopy with abrasion 

chondroplasty of the medial femoral condyle; and abrasion chondroplasty of the patellofemoral 

joint, and lateral retinacular release. On May 20, 2019 she underwent posterior lateral arthrodesis 

at C4-5 and C5-6 with instrumentation and allograft. 

On May 31, 2019 appellant filed a claim for compensation (Form CA-7) for a schedule 

award. 

By decision dated October 16, 2019, OWCP granted appellant a schedule award for three 

percent permanent impairment of the left lower extremity. The award ran for 8.64 weeks from 

May 17 through July 16, 2019, and was based on the April 29, 2019 report of Dr. Eduard H. 

Sladek, a Board-certified orthopedic surgeon, and the September 20, 2019 report of Dr. Arthur S. 

Harris, a Board-certified orthopedic surgeon serving as OWCP’s district medical adviser (DMA). 

On November 9, 2019 appellant requested an oral hearing before a representative of 

OWCP’s Branch of Hearings and Review. 

OWCP received additional medical evidence, including a November 14, 2019 narrative 

report wherein Dr. Neil Allen, a Board-certifiedneurologist, noted the history of appellant’s workrelated injury and her medical treatment, and set forth findings from an October 29, 2019 physical 

examination. Dr. Allen opined that she had reached maximum medical improvement (MMI) on 

April 29, 2019 per Dr. Sladek. With regard to the right lower extremity, under the sixth edition of 

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

Guides),

3 he opined that appellant had 3 percent permanent impairment of the right lower extremity

based on the diagnosis-based impairment (DBI) methodology for “meniscal tear; partial medial 

meniscectomy” and 20 percent permanent impairment based on the range of motion (ROM) 

impairment methodology, which represented the greater impairment. Under Table 16-23, Knee 

Motion Impairments, Dr. Allen related that 109 degrees flexion equaled 10 percent lower 

extremity impairment, and negative 8 degrees extension equaled 10 percent lower extremity 

impairment, for a total of 20 percent right lower extremity impairment. Under Table 16-17, he 

noted that 20 percent lower extremity impairment was consistent with a grade modifier for 

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

functional history (GMFH) of 2. Under Table 16-6, Dr. Allen noted that appellant’s GMFH 

adjustment was 1. He thus opined that she had a total of 20 percent right lower extremity

permanent impairment. While Dr. Allen noted that appellant had three percent permanent 

impairment of the right lower extremity under the DBI methodology, he did not provide an 

explanation of his rating utilizing the A.M.A., Guides. 

With regard to the left lower extremity, Dr. Allen opined that appellant had 9 percent 

permanent impairment based on DBI methodology for “knee sprain/strain; mild motion deficits”

and 10 percent total permanent impairment based on ROMmethodology. He opined that the ROM 

methodology represented the greater impairment value. Under Table 16-23, Dr. Allen found that 

109 degrees flexion represented 10 percent lower extremity impairment and negative 8 degrees 

extension represented 10 percent lower extremity impairment, for a total 20 percent left lower 

extremity impairment. Under Table 16-17, he found that the 20 percent lower extremity 

impairment was consistent with a net GMFH of 2 and, under Table 16-6, appellant had a GMFH

of 1. Dr. Allen thus opined that appellant had a total of 10 percent left lower extremity permanent 

impairment. He concluded that she had nine percent permanent impairment under the DBI 

methodology, but did not provide an explanation of his rating utilizing the A.M.A., Guides. 

Following a preliminary review, by decision dated February 7, 2020, OWCP’s hearing 

representative vacated the October 16, 2019 decision and remanded the case to OWCP for further 

development. The hearing representative directed OWCP to refer Dr. Allen’s November 14, 2019 

report to its DMA to determine the degree of permanent impairment for the left and right lower 

extremities under the A.M.A., Guides and to issue a de novo decision on the issue of schedule 

award entitlement.

OWCP issued a February 13, 2020 statement of accepted facts (SOAF) and requested that 

its DMA provide an opinion on permanent impairment of appellant’s lower extremities based on 

the sixth edition of the A.M.A., Guides. 

In a report dated February 25, 2020, Dr. Harris, OWCP’s DMA, related that appellant’s 

diagnosed conditions did not meet the criteria to be calculated by the ROM method. He concluded 

that, utilizing the DBI methodology under the A.M.A., Guides, she had four percent permanent 

impairment of the right lower extremity for patella chondromalacia with osteochondral defect with 

a Class 1, grade D impairment, per Table 16-3, page 511. Dr. Harris also related that appellant 

had three percent permanent impairment of the left lower extremity, under the DBI methodology

for patella chondromalacia with osteochondral defect with a Class 1, grade C impairment. 

In a supplemental report, responding to OWCP’s request for further review, in a report

dated August 31, 2020, Dr. Harris responded “N/A [not applicable]” to questions regarding use of 

the ROM methodology to rate appellant’s permanent impairment, and the date of MMI. In a 

comment, he noted that OWCP’s memorandum of March 18, 2020 stated that she had previously 

been granted a schedule award for three percent permanent impairment of the left lower extremity, 

and a February 18, 2020 memorandum related that she had previously been granted a schedule 

award for eight percent permanent impairment of the right lower extremity, and three percent 

permanent impairment of the left lower extremity. Dr. Harris concluded that there was no increase 

in the degree of appellant’s permanent impairments. 

On November 16, 2020 OWCP requested that Dr. Harris provide a supplemental report. 

Dr. Harris was asked to confirm that appellant’s right lower extremity permanent impairment was 
4

four percent, the date of MMI, and to review and address the impairment rating provided by

Dr. Allen in his report dated October 29, 2019. 

In a report dated November 18, 2020, Dr. Harris responded “N/A” to the questions 

regarding date of MMI, and review of Dr. Allen’s report. He commented that appellant’s right 

lower extremity permanent impairment had increased to a total of four percent permanent 

impairment, and that her left lower extremity impairment had increased to a total of three percent 

permanent impairment, which represented an increase of three percent. 

By decision dated December 14, 2020, OWCP granted appellant a schedule award for four 

percent permanent impairment of the right lower extremity. The award ran for 11.52 weeks from 

October 29, 2019 through January 17, 2020 and was based upon the opinion of Dr. Harris, serving 

as the DMA. 

On December 20, 2020 appellant requested an oral hearing before a representative of 

OWCP’s Branch of Hearings and Review. New medical evidence, including a January 5, 2021 

report from Dr. Allen and a June 22, 2020 progress report from Dr. Sladek were received. 

Dr. Allen opined that the ROM impairment methodology represented the more accurate rating of 

appellant’s lower limb permanent impairment. He related that the A.M.A., Guides stated on page 

543 that, “In very rare cases, severe injuries may result in a passive [ROM] losses qualifying for 

[C]lass 3 or 4 impairment.” Therefore, Dr. Allen concluded that the ROM method reflected a more 

accurate impairment than the DBI method. 

In his June 22, 2020 report, Dr. Sladek diagnosed left knee chondromalacia and opined that 

appellant could return to work with her normal restrictions. 

A hearing was held on April 7, 2021. 

By decision dated June 10, 2021, OWCP’s hearing representative set aside OWCP’s 

December 14, 2020 decision and remanded the case for further development. The hearing 

representative requested that OWCP seek clarification from Dr. Allen as to who examined 

appellant for her permanent impairment rating. OWCP was then directed to provide the DMA 

with such clarification, to be followed by a de novo decision. 

In a June 22, 2021 report, Dr. Allen verified that appellant’s permanent impairment 

examination was actually completed by Dr. Ashley Daliege, a chiropractor. He related that he had 

reviewed and supervised appellant’s “medical records, patient history of illness, aggravating 

factors and relieving factors and results of the impairment examination.” 

OWCP issued an updated SOAF dated January 6, 2022 and referred appellant’s medical 

record, along with a series of questions, to Dr. Harris, OWCP’s DMA. 

In a February 17, 2022 report, usingthe DBI methodology for patella chondromalacia with 

osteochondral defect under Table 16-3, page 511 of the A.M.A., Guides, Dr. Harris again found 

that appellant had four percent permanent impairment of the right lower extremity and three 

percent permanent impairment of the left lower extremity, for which she had previously received 

schedule award compensation. He indicated that section 16.7, page 543 of the A.M.A., Guides

allowed for the ROM methodology to be used as a standalone rating where there are either no 

diagnosed-based sections applicable or, in very rare cases, where a severe injury results in a passive 

ROM loss, qualifying for Class 3 or 4 impairment or for amputation ratings. Dr. Harris advised 
5

that the DBI methodology allowed for appropriate impairment ratings of appellant’s diagnosed 

conditions and that her diagnosed conditions did not meet any of the criteria discussed to allow for 

an impairment calculation under the ROM methodology. He explained that Dr. Allen had 

erroneously calculated appellant’s impairment based on the ROM methodology in his October 29, 

2019 impairment evaluation. Dr. Harris indicated that her diagnosed conditions did not meet any 

of the criteria discussed under section 16.7 page 543 of the A.M.A., Guidesto allow for impairment 

to be calculated under the ROM methodology as there was an appropriate rating under the DBI 

methodology. He further explained that, regarding the right lower extremity, appellant’s diagnosis

of patella chondromalacia with osteochondral defect condition was a Class 1, grade D impairment.

Dr. Harris further explained that, while Dr. Allen indicated that the ROM impairment 

methodology produced a higher rating than that, of the DBI impairment methodology, the ROM 

impairment methodology was not consistent with the A.M.A., Guides as she only had a Class 1 

impairment of the bilateral lower extremities and, thus, her impairment cannot be calculated under 

ROM impairment methodology. 

By decision dated March 9, 2022, OWCP determined that appellant had not met her burden 

of proof to establish greater than three percent permanent impairment of the left lower extremity 

and four percent permanent impairment of the right lower extremity for which she previously 

received schedule award compensation. 

LEGAL PRECEDENT

The schedule award provisions of FECA,4 and its implementing federal regulations,

5 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.6 As of May 1, 2009, the 

sixth edition of the A.M.A., Guides is used to calculate schedule awards.7

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

provides that DBI is the primary method of calculation for the lower limb and that most 

impairments are based on the DBI where impairment class is determined by the diagnosis and 

specific criteria as adjusted by the GMFH, grade modifier for physical examination (GMPE), and 

grade modifier for clinical studies (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.8 

4

5 U.S.C. § 8107.

5

20 C.F.R. § 10.404.

6

Id. See also T.T., Docket No. 18-1622 (issued May 14, 2019).

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

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

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

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, reference is made to Table 16-3 (Knee Regional Grid) 

beginning on page 509.9 After the class of diagnosis(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).10 Evaluators are directed to provide reasons for their impairment 

choices, including the choices of diagnoses from regional grids and calculations of modifier 

scores.11

The A.M.A., Guides, however, also explain that some of the DBI 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. 12 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.13 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.14

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 

percentage of impairment in accordance with the A.M.A., Guides, with an OWCP medical adviser 

providing rationale for the percentage of impairment specified. 15

ANALYSIS

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

three percent permanent impairment of the left lower extremity and four percent permanent 

impairment of the right lower extremity, for which she previously received schedule award 

compensation.

In a November 14, 2019 report, Dr. Allen opined that appellant had 3 percent permanent 

impairment of the right lower extremity based on DBI methodology for “meniscal tear; partial 

medial meniscectomy” and 20 percent permanent impairment based on the ROM impairment 

methodology. With regard to the left lower extremity, he opined that she had 9 percent permanent 

9

Id. at 509-11.

10 Id. at 515-22.

11 R.R., Docket No. 17-1947 (issued December 19, 2018); R.V., Docket No. 10-1827 (issued April 1, 2011).

12 A.M.A., Guides 543; see also J.W., Docket No. 22-0223 (issued August 23, 2022); M.D., Docket No. 16-0207 

(issued June 3, 2016); D.F., Docket No. 15-0664 (issued January 8, 2016).

13 Id. at 473.

14 Id. at 474.

15 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).
7

impairment based on DBI methodology for “knee sprain/strain; mild motion deficits” and 10 

percent total permanent impairment based on ROM methodology. While Dr. Allen noted that 

appellant had three percent permanent impairment of the right lower extremity under the DBI 

methodology, and nine percent permanent impairment of the left lower extremity under the DBI 

methodology, he did not provide an explanation of his rating utilizing the A.M.A., Guides. As he

did not provide an impairment rating in accordance with the tables of the A.M.A., Guides, his

opinion is of diminished probative value.16

OWCP thereafter issued an updated SOAF dated January 6, 2022 and referred appellant’s 

medical record, including Dr. Allen’s November 14, 2019, and January 5 and June 22, 2021

reports, along with a series of questions, to Dr. Harris, OWCP’s DMA, in accordance with its 

procedures.17 Dr. Harris, serving as the DMA, concluded that the medical evidence of record did 

not demonstrate a permanent, measurable, scheduled impairment greater than that already paid. 

He explained that, under section 16.7, page 543 of the A.M.A., Guides, that the ROM impairment 

methodology was not applicable as appellant’s diagnosed condition did not meet any of the criteria, 

i.e., there was an appropriate rating under the DBI methodology. Dr. Harris further explained that,

while Dr. Allen opined that the ROM methodology should be used because appellant’s permanent 

impairment was severe, Dr. Harris explained that her diagnosed conditions of patella 

chondromalacia with osteochondral defect condition only fell into a Class 1 impairment, not a

Class 3 or 4 impairment. 

In a report dated February 25, 2020, Dr. Harris properly concluded that, utilizing the DBI 

methodology under the A.M.A., Guides, appellant had four percent permanent impairment of the 

right lower extremity for patella chondromalacia with osteochondral defect with a Class 1, grade 

D impairment, per Table 16-3, page 511. He also related that she had three percent permanent 

impairment of the left lower extremity, under the DBI methodology for patella chondromalacia

with osteochondral defect with a Class 1, grade C impairment. The Board finds that the DMA 

accurately summarized the relevant medical evidence, provided detailed findings on examination, 

and reached conclusions which comported with his findings and the appropriate provisions of the 

A.M.A., Guides.

18

 The DMA’s report therefore constitutes the weight of the medical evidence.

As there is no current medical evidence of record, in conformance with the A.M.A., 

Guides, establishing a greater permanent impairment than the three percent permanent impairment 

of the left lower extremity and four percent permanent impairment of the right lower extremity 

previously awarded, the Board finds that appellant has not met her burden of proof to establish

entitlement to additional schedule award compensation.19

16 L.Y., Docket No. 20-0398 (issued February 9, 2021).

17 OWCP 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 accordance with the A.M.A., Guides, 

with the DMA providing rationale for the percentage of impairment specified. 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).

18 See K.P., Docket No. 23-0041 (issued November 20, 2023); A.G., Docket No. 22-0582 (issued October 4, 2022);

J.M., Docket No. 18-1387 (issued February 1, 2019).

19 See A.R., Docket No. 21-0346 (issued August17, 2022); see K.H., Docket No. 20-1198 (issued February 8, 2021).
8

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 her burden of proof to establish greater than 

three percent permanent impairment of the left lower extremity and four percent permanent 

impairment of the right lower extremity, for which she previously received schedule award 

compensation.

ORDER

IT IS HEREBY ORDERED THAT the March 9, 2022 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: December 22, 2023

Washington, DC

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board