United States Department of Labor
Employees’ Compensation Appeals Board
__________________________________________
D.M., Appellant
and
U.S. POSTAL SERVICE, POST OFFICE,
Corpus Christi, TX, Employer
__________________________________________

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Appearances:
Appellant, pro se
Office of Solicitor, for the Director

Docket No. 17-1128
Issued: November 22, 2017

Case Submitted on the Record

DECISION AND ORDER
Before:
CHRISTOPHER J. GODFREY, Chief Judge
ALEC J. KOROMILAS, Alternate Judge
VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION
On April 21, 2017 appellant filed a timely appeal from a March 1, 2017 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 established permanent impairment of a scheduled
member entitling her to a schedule award.
FACTUAL HISTORY
On May 5, 2014 appellant, then a 35-year-old rural carrier, filed a traumatic injury claim
(Form CA-1) alleging that on May 2, 2014 she sustained a back injury while she was training an
employee when she leaned forward from the backseat of a vehicle while wearing a lap belt. She
1

5 U.S.C. § 8101 et seq.

stopped work on the date of injury and was released to full-time work with restrictions on
June 20, 2014.
By decision dated June 25, 2014, OWCP accepted the claim for sprain of back lumbar
region and sprain of neck. By decision dated November 19, 2014, it accepted the additional
conditions of displacement of cervical intervertebral disc without myelopathy, displacement of
lumbar intervertebral disc without myelopathy, and thoracic or lumbosacral neuritis or
radiculitis.
Following her injury, appellant sought treatment with Dr. Syed Hussain, a Board-certified
neurological surgeon.
In a June 22, 2015 medical report, Dr. Hussain reported that
neuromuscular examination revealed normal findings despite complaints of lower back pain
radiating into the legs. He diagnosed cervicalgia, cervical radiculopathy, lumbar radiculopathy,
and lumbago.
On August 14, 2015 appellant filed a claim for a schedule award (Form CA-7).
In support of her claim, appellant submitted a July 29, 2015 impairment rating report
from Dr. Louise Lamarre, Board-certified in anatomic pathology. Dr. Lamarre reported that
electromyography (EMG) testing revealed sensory deficit over the lower extremity L5-S1
radiculopathy and opined that maximum medical improvement (MMI) had been reached. In
accordance with the American Medical Association, Guides to the Evaluation of Permanent
Impairment (6th ed. 2009) (A.M.A., Guides),2 she calculated four percent permanent impairment
of the lower extremity for sciatic nerve mild-to-moderate sensory deficit.3
OWCP routed Dr. Lamarre’s report, a statement of accepted facts (SOAF), and the case
file to Dr. Michael M. Katz, a Board-certified orthopedic surgeon serving as an OWCP district
medical adviser (DMA), for review and a determination on whether appellant sustained a
permanent impairment and date of MMI.
In a September 3, 2015 report, Dr. Katz reported that Dr. Lamarre failed to specify
whether the four percent permanent impairment rating applied to the left or right lower
extremity. He further noted that use of the Lower Extremity Peripheral Nerve Impairment Grid,
Table 16-12, was not the preferred method for rating spinal nerve impairment.4 Dr. Katz
reported that a June 22, 2015 report from Dr. Hussain revealed normal physical examination
findings. As such, he found a conflict in medical opinion between Dr. Hussain and Dr. Lamarre.
On October 22, 2015 OWCP referred appellant, a series of questions, a SOAF, and the
medical record to Dr. James E. Butler, a Board-certified orthopedic surgeon, for a second
opinion examination and determination as to whether she sustained a permanent impairment of a
scheduled member and the date of MMI.

2

A.M.A., Guides (2009).

3

Id. at 535, Table 16-12.

4

Id. at 534.

2

In an October 22, 2015 report, Dr. Butler reported that appellant reached MMI on
July 29, 2015. He explained that The Guides Newsletter should be applied for rating spinal nerve
impairment. Dr. Butler noted that diagnostic testing did not correlate with appellant’s clinical
examination as EMG testing showed left-sided radiculopathy while she was reporting symptoms
on the right side. He further noted examination of the upper and lower extremities revealed
normal sensory findings, as well as normal lower extremity motor examination findings.
Therefore, Dr. Butler opined that appellant had zero percent permanent impairment of the upper
extremities and zero percent permanent impairment of the lower extremities due to the accepted
cervical and lumbar spine conditions.
On March 31, 2016 Dr. Katz, serving as OWCP’s DMA, reviewed Dr. Butler’s second
opinion evaluation and agreed with the physician, finding that appellant had zero percent
permanent impairment of the right and left upper extremities and zero percent permanent
impairment of the right and left lower extremities.
By decision dated April 4, 2016, OWCP denied appellant’s claim for a schedule award as
the evidence was insufficient to establish any permanent impairment to a scheduled member or
function of the body.
Following OWCP’s denial of her schedule award claim, appellant underwent new
diagnostic testing on June 23, 2016. In a June 23, 2016 diagnostic report, Dr. Rafath Quraishi, a
practicing radiologist, reported that a magnetic resonance imaging (MRI) scan of the lumbar
spine revealed interval improvement with decreased L4-5 and L5-S1 disc sizes. A cervical spine
MRI scan revealed minimal C4-5 disc bulge with otherwise normal findings.
On January 19, 2017 appellant filed a new Form CA-7 for a schedule award.
In support of her claim, appellant submitted a January 5, 2017 impairment rating from
Dr. Charles Kennedy, a Board-certified orthopedic surgeon. Dr. Kennedy reported that physical
examination of the cervical spine revealed full range of motion and negative compression, while
examination of the back revealed some mild tenderness with negative straight leg testing. He
diagnosed cervicalgia without radiculopathy and lumbago without radiculopathy. Dr. Kennedy
noted prior MRI scan testing of the lumbar and cervical spine on October 12, 2015 with repeat
testing performed on June 23, 2015. In accordance with Table 17-2 of the A.M.A., Guides,
Cervical Spine Regional Grid, he noted use of a diagnosis-based impairment (DBI) of
intervertebral herniation with no radiculopathy under class zero. However, as appellant’s
symptoms were more than moderate and moderately severe, Dr. Kennedy determined that this
resulted in class 1 seven percent whole person impairment of the cervical spine.5 With respect to
the lumbosacral spine, he noted no radiculopathy and no long tract signs or straight leg
abnormalities, moderate range. Utilizing Table 17-4, Lumbar Spine Regional Grid, Dr. Kennedy
determined a class 1 seven percent permanent impairment of the lumbosacral spine.6 He added
the cervical and lumbar spine impairment ratings (7 + 7), for a total 14 percent whole person

5

Id. at 564.

6

Id. at 570.

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permanent impairment. Dr. Kennedy concluded that MMI was reached on June 23, 2016, the
date of the last diagnostic testing.
OWCP routed Dr. Kennedy’s report, the SOAF, and case file to Dr. Katz, serving as
OWCP’s DMA, for review and a determination on whether appellant sustained a permanent
partial impairment and date of MMI.
In a February 27, 2017 report, Dr. Katz reviewed Dr. Kennedy’s report and disagreed
with the physician’s rating of seven percent permanent impairment of the cervical spine and
seven percent permanent impairment of the lumbar spine. He explained that FECA did not allow
a schedule award for the spine and therefore a diagnosed injury originating in the spine could
only be considered to the extent that it resulted in permanent impairment of the extremities,
generally reflected as spinal nerve impairment. Therefore, Dr. Kennedy’s impairment under
Table 17-2 and Table 17-4 could not be considered as spinal nerve injuries, which were best
determined by the method described in The Guides Newsletter. Dr. Katz further reported that
Dr. Kennedy found no motor/sensory deficits in any extremity which established no ratable
impairment of the accepted spinal conditions per FECA guidelines. He concluded that the date
of MMI was January 5, 2017 and found that appellant had zero percent permanent impairment of
the right and left upper extremities and zero percent permanent impairment of the right and left
lower extremities.
By decision dated March 1, 2017, OWCP denied appellant’s claim for a schedule award
as the evidence of record was insufficient to establish any permanent impairment to a scheduled
member or function of the body.
LEGAL PRECEDENT
The schedule award provision of FECA and its implementing regulations 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.7 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. The A.M.A., Guides has been adopted by the implementing regulations as the
appropriate standard for evaluating schedule losses.8 As of May 1, 2009, the sixth edition of the
A.M.A., Guides is used to calculate schedule awards.9

7

5 U.S.C. § 8107; 20 C.F.R. § 10.404.

8

K.H., Docket No. 09-0341 (issued December 30, 2011). For decisions issued after May 1, 2009, the sixth
edition will be applied. B.M., Docket No. 09-2231 (issued May 14, 2010).
9

Federal (FECA) Procedure Manual, Part 2 -- Claims, Schedule Awards and Permanent Disability Claims,
Chapter 2.808.5(a) (February 2013); id. Part 3 -- Medical, Schedule Awards, Chapter 3.700.2 and Exhibit 1
(January 2010).

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It is the claimant’s burden of proof to establish that he or she has sustained a permanent
impairment of the scheduled member or function as a result of any employment injury.10 OWCP
procedures provide that, to support a schedule award, the file must contain competent medical
evidence which shows that the impairment has reached a permanent and fixed state and indicates
the date on which this occurred (date of MMI), describes the impairment in sufficient detail so
that it can be visualized on review, and computes the percentage of impairment in accordance
with the A.M.A., Guides.11
Although the A.M.A., Guides includes guidelines for estimating impairment due to
disorders of the spine, a schedule award is not payable under FECA for injury to the spine.12 In
1960, amendments to FECA modified the schedule award provisions to provide for an award for
permanent impairment to a member of the body covered by the schedule regardless of whether
the cause of the impairment originated in a scheduled or nonscheduled member. Therefore, as
the schedule award provisions of FECA include the extremities, a claimant may be entitled to a
schedule award for permanent impairment to an extremity even though the cause of the
impairment originated in the spine.13
The sixth edition of the A.M.A., Guides does not provide a separate mechanism for rating
spinal nerve injuries as extremity impairment.14 For peripheral nerve impairments to the upper
or lower extremities resulting from spinal injuries, OWCP procedures indicate that The Guides
Newsletter, Rating Spinal Nerve Extremity Impairment using the sixth edition
(July/August 2009) is to be applied.15 FECA approved methodology is premised on evidence of
radiculopathy affecting the upper and/or lower extremities.16
ANALYSIS
OWCP accepted appellant’s claim for sprain of back lumbar region, sprain of neck and
later expanded the claim to include, displacement of cervical intervertebral disc without
myelopathy, displacement of lumbar intervertebral disc without myelopathy, and thoracic or
lumbosacral neuritis or radiculitis. The Board notes that a schedule award is not payable under
FECA for injury to the spine17 or based on whole person impairment.18 However, a claimant
10

Tammy L. Meehan, 53 ECAB 229 (2001).

11

Supra note 9 at Chapter 2.808.5 (February 2013).

12

Pamela J. Darling, 49 ECAB 286 (1998).

13

Thomas J. Engelhart, 50 ECAB 319 (1999).

14

Supra note 9 at Chapter 3.700, Exhibit 4 (January 2010).

15

See G.N., Docket No. 10-0850 (issued November 12, 2010); see also FECA Procedure Manual at Part 3 -Medical, Schedule Awards, Chapter 3.700, Exhibit 1, note 9 (January 2010). The Guides Newsletter is included as
Exhibit 4.
16

Supra note 9 at Chapter at 2.808.5c(3) (February 2013).

17

Supra note 12.

18

N.M., 58 ECAB 273 (2007).

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may be entitled to a schedule award for permanent impairment to an extremity even though the
cause of the impairment originated in the spine.19
The Board finds that appellant failed to submit sufficient evidence to establish that, as a
result of her employment injury, she sustained any permanent impairment to a scheduled
member such that she would be entitled to a schedule award.20
In support of her claim, appellant submitted a January 5, 2017 impairment rating from
Dr. Kennedy who diagnosed cervicalgia without radiculopathy and lumbago without
radiculopathy. Dr. Kennedy found that she reached MMI as of June 23, 2016. However, he
determined that appellant sustained 7 percent permanent impairment of the cervical spine and 7
percent permanent impairment of the lumbar spine, for a total 14 percent whole percent
permanent impairment. The Board notes that Dr. Kennedy’s report did not provide support for a
ratable impairment warranting her a schedule award. There is no statutory basis for the payment
of a schedule award for whole body impairment under FECA.21
Moreover, the sixth edition of the A.M.A., Guides does not provide for a schedule award
for injury to the spine.22 However, impairment of a scheduled member of the upper or lower
extremities is payable under FECA, if it originates from the spine.23 The approach of rating
impairment of the upper or lower extremities caused by a spinal injury is provided in section
3.700 of OWCP procedures, which memorializes proposed tables as outlined in a
July/August 2009, The Guides Newsletter.24 The Board notes that Dr. Kennedy did not reference
or provide an evaluation in accordance with the July/August 2009, The Guides Newsletter.25
Dr. Kennedy did not rate appellant’s impairment pursuant to The Guides Newsletter, and his
rating is therefore insufficient to establish that she is entitled to a schedule award of the lower or
upper extremities due to the accepted lumbar and cervical injuries.26
OWCP appropriately forwarded the medical evidence and record to Dr. Katz, an OWCP
DMA, for review and a determination on whether appellant sustained a permanent impairment
and date of MMI. Dr. Katz reviewed Dr. Kennedy’s report and properly concluded that she had
no permanent impairment of the upper or lower extremities. The DMA explained that
Dr. Kennedy failed to use The Guides Newsletter for impairment of a spinal nerve injury.
Moreover, the findings of Dr. Kennedy’s January 5, 2017 evaluation failed to provide support for
a schedule award as his examination revealed no significant problems to the lower or upper
19

Supra note 13.

20

W.R., Docket No. 13-0492 (issued June 26, 2013).

21

K.S., Docket No. 15-1082 (issued April 18, 2017).

22

W.D., Docket No. 10-0274 (issued September 3, 2010).

23

K.H., supra note 8.

24

Supra note 15.

25

J.C., Docket No. 15-1780 (issued March 17, 2016).

26

E.D., Docket No. 10-0967 (issued January 7, 2011).

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extremities with normal sensory and motor findings.27 Dr. Katz provided a well-reasoned report
based on a proper factual and medical history and included detailed findings and rationale
supporting his opinion. As previously noted, FECA does not allow for permanent impairment
ratings of the spine without evidence of extremity impairment.28
Regarding the medical evidence of record submitted prior to the January 19, 2017
schedule award claim, the Board finds that Dr. Hussain and Dr. Quraishi offered no rating of
appellant’s alleged permanent impairment.29 Their reports are therefore of limited probative
value regarding appellant’s schedule award claim.
While Dr. Lamarre found that appellant had four percent permanent impairment of a
lower extremity, he did not specify which lower extremity sustained the permanent impairment.
Furthermore, he did not explain that his permanent impairment rating was conducted pursuant to
The Guides Newsletter.30 As such, Dr. Lamarre’s report is of limited probative value.
The other medical reports of record from Dr. Katz and Dr. Butler support the finding that
appellant has not established a permanent impairment of a scheduled member causally related to
the accepted injury.
Thus, the record does not provide any medical opinion finding that appellant sustained
permanent impairment of the upper or lower extremities as a result of her accepted lumbar and
cervical injuries.31 The Board finds that she failed to meet her burden of proof.32
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 employmentrelated condition resulting in permanent impairment or increased impairment.
CONCLUSION
The Board finds that appellant has not established a permanent impairment of a
scheduled member entitling her to a schedule award.

27

L.W., Docket No. 12-1613 (issued February 19, 2013).

28

Supra note 17.

29

See F.S., Docket No. 15-1884 (issued February 16, 2016) (appellant’s physician did not explain that appellant
had permanent impairment of a scheduled member as a result of the employment injury).
30

Supra note 15.

31

L.F., Docket No. 10-0343 (issued November 29, 2010); V.W., Docket No. 09-2026 (issued February 16, 2010).

32

It is appellant’s burden of proof to establish that she sustained a permanent impairment of a scheduled member
as a result of an employment injury. The medical evidence must include a description of any physical impairment in
sufficient detail so that the claims examiner and others reviewing the file would be able to clearly visualize the
impairment with its resulting restrictions and limitations. See A.L., Docket No. 08-1730 (issued March 16, 2009).

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ORDER
IT IS HEREBY ORDERED THAT the Office of Workers’ Compensation Programs’
decision dated March 1, 2017 is affirmed.
Issued: November 22, 2017
Washington, DC

Christopher J. Godfrey, Chief Judge
Employees’ Compensation Appeals Board

Alec J. Koromilas, Alternate Judge
Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge
Employees’ Compensation Appeals Board

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United States Department of Labor
Employees’ Compensation Appeals Board
__________________________________________
R.N., Appellant
and
U.S. POSTAL SERVICE, POST OFFICE,
Tulsa, OK, Employer
__________________________________________

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Appearances:
Alan J. Shapiro, Esq., for the appellant
Office of Solicitor, for the Director

Docket No. 12-1465
Issued: February 11, 2013

Case Submitted on the Record

DECISION AND ORDER
Before:
ALEC J. KOROMILAS, Alternate Judge
MICHAEL E. GROOM, Alternate Judge
JAMES A. HAYNES, Alternate Judge
JURISDICTION
On May 27, 2012 appellant, through his attorney, filed a timely appeal from an April 6,
2012 decision of the Office of Workers’ Compensation Programs (OWCP) regarding a schedule
award. 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 sustained more than a three percent impairment of the
right leg or a zero percent impairment of the left leg.
On appeal, counsel contends that OWCP’s April 6, 2012 decision is contrary to fact and
law.

1

5 U.S.C. § 8101 et seq.

FACTUAL HISTORY
OWCP accepted that on or before December 1, 2000 appellant, then a 42-year-old letter
carrier, sustained a displacement of a lumbar intervertebral disc without myelopathy. He had a
prior claim accepted under File No. xxxxxx688 for a November 28, 1997 left ankle sprain with
osteomyelitis and synovitis.
A September 15, 2003 magnetic resonance imaging (MRI) scan showed an L4-5 disc
bulge and L5-S1 disc protrusion indenting the thecal sac. A January 25, 2005 MRI scan showed
a broad posterior L5-S1 central spondylosis/protrusion with an osteophyte and a moderate
right-sided L4-5 protrusion with indentation of the thecal sac and intrathecal nerve root
displacement.
Based on this study, Dr. Allan Fielding, an attending Board-certified
neurosurgeon, opined on January 26, 2005 that appellant’s pain was due to degenerated L4-5 and
L5-S1 discs. On August 18, 2005 Dr. Christopher Boxell, an attending Board-certified
neurosurgeon, performed a lumbar discogram at L3-4, L4-5 and L5-S1. It revealed internal disc
derangement syndrome with midline disc protrusions at L4-5 and L5-S1 and a left-sided
paracentral protrusion at L5-S1. Lumbar x-rays of October 24, 2005 showed focal disc
degeneration with slight disc space narrowing at L5-S1.2
On August 13, 2008 OWCP issued a schedule award under File No. xxxxxx688 for 35
percent permanent impairment of the left leg due to weakness and restricted motion of the left
ankle and foot, ligamentous instability of the left ankle and a rocker bottom left foot.
February 20, 2009 nerve conduction velocity (NCV) studies showed chronic left L5
radiculopathy and mild right L5 radiculopathy. A June 26, 2009 MRI scan showed degenerative
disc disease and central annular disc bulges indenting the thecal sac at L4-5 and L5-S1.
On April 4, 2010 appellant claimed an additional schedule award. In a March 26, 2010
impairment rating from, Dr. M. Stephen Wilson, an attending orthopedic surgeon, referenced the
sixth edition of the American Medical Association, Guides to the Evaluation of Permanent
Impairment (A.M.A., Guides). He found a class 1 diagnosis-based impairment (CDX) for
sensory deficit of the L5 nerve, with a default value of 3 percent, a class 1 motor deficit of the L5
nerve, with a default value of 13 percent, based on appellant’s history of injury, chronic
neuropathy and moderate weakness as documented on current and prior examinations.
Dr. Wilson assessed a grade 1 modifier for Functional History (GMFH) secondary to an
American Association of Orthopedic Surgeons (AAOS) scale score of 2, according to Table
16-6.3 He found a grade 2 modifier for Clinical Studies (GMCS) according to Table 16-8.4
2

From December 2005 to August 2009, appellant was followed by Dr. David Fell, a Board-certified
neurosurgeon, Dr. Wohong Min, a Board-certified neurosurgeon, Dr. Jospeh Blough, a Board-certified family
practitioner, Dr. Richard D. Thomas, a Board-certified orthopedist, and Dr. C. Anthony Scott, an osteopathic
physician Board-certified in orthopedics.. Each physician diagnosed L4-5 and L5-S1 disc degeneration with
bilateral L5 radiculopathy. These physicians did not provide an impairment rating.
3

Table 16-6, page 516 of the sixth edition of the A.M.A., Guides is entitled “Functional History Adjustment -Lower Extremities.”
4

Table 16-8, page 519 of the sixth edition of the A.M.A., Guides is entitled “Clinical History Adjustment -Lower Extremities.”

2

Using the net adjustment formula of (GMFH - CDX) + (GMPE - CDX) + (GMCS - CDX) or
(1-1) + (2-1) resulted in a total modifier of +1, raising the default rating of C to D, equaling a
4 percent or moderate sensory deficit and a 13 percent or moderate motor deficit. Referring to
the Combined Values Chart at page 604, Dr. Wilson found a 16 percent impairment of the right
lower extremity due to L5 nerve deficits. He also found a 12 percent impairment of the right leg
due to sensory and motor deficits in the S1 dermatome. Dr. Wilson assessed a class
1 impairment for moderate sensory deficit of the S1 nerve with a default value of eight percent,
based on a history and current findings of neuropathy and weakness. He applied a grade 1
GMFH for an AAOS score of 2 according to Table 16-6 and a GMCS of 2 according to Table
16-8. Using the net adjustment formula of (1-1) + (2-1), Dr. Wilson found a +1 modifier, raising
the rating from C to D, equaling a three percent moderate sensory deficit and a nine percent
moderate motor deficit. Using the Combined Values Chart, he calculated a 12 percent
impairment of the right leg. Dr. Wilson combined the L5 and S1 nerve deficits to total a
28 percent impairment of the right leg above any prior rating.
Regarding the left lower extremity, Dr. Wilson found a class 1 CDX for moderate
sensory deficits in the L5 nerve distribution, with a default value of three percent and mild motor
deficits in the L5 dermatome, with a default value of five percent, due a documented history of
pain and weakness. He assigned a GMFH of 1 for an AAOS score of 2 according to Table 16-6
and a GMCS of 2 according to Table 16-8. Using the net adjustment formula of (1-1) + (2-1)
resulted in a +1 modifier, raising the impairment rating for C to D, equaling a four percent
moderate sensory deficit and seven percent mild motor deficit. Referring to the Combined
Values Chart, Dr. Wilson found an 11 percent impairment of the left leg. He also assessed a
class 1 impairment for S1 nerve root deficits, with a default value of two percent and class 1 mild
motor deficits with a default value of three percent based on neuropathy and weakness on current
and prior examinations. Dr. Wilson assigned a GMFH of 1 for an AAOS score of 2 according to
Table 16-6 and a GMCS of 2 according to Table 16-8. Using the net adjustment formula of (1-1)
+ (2-1) resulted in a total grade modifier of +1, raising the rating for C to D, equaling a three
percent moderate sensory deficit and a four percent mild motor deficit. Referring to the
Combined Values Chart, Dr. Wilson found a seven percent impairment of the left lower
extremity due to S1 nerve impairment. He combined all the impairments to equal 18 percent
“over and above any prior injury.”
On May 26, 2010 Dr. Michael M. Katz, an OWCP medical adviser, reviewed
Dr. Wilson’s March 26, 2010 report. He stated that there were insufficient objective findings of
nerve root compression to support Dr. Wilson’s impairment rating.
On August 23, 2010 OWCP obtained a second opinion from Dr. Timothy Pettingell, a
Board-certified physiatrist, regarding the issue of permanent impairment. Dr. Pettingell found
that appellant had reached maximum medical improvement. He diagnosed bilateral L5
radiculopathy and chronic lumbar pain due to degenerated L4-5 and L5-S1 discs. Dr. Pettingell
noted that the L5-S1 disc protrusion with bilateral neuroforaminal encroachment and right L4-5
narrowing visible on the June 6, 2009 MRI scan adequately correlated appellant’s bilateral L5
radiculopathy; therefore, the impairment rating should be based on bilateral L5 radiculopathy,

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using the peripheral nerve model. According to Table 16-12 of the A.M.A., Guides,5 common
peroneal nerve impairment for the right lower extremity equaled a class 1, default grade C or
three percent impairment of the leg. As appellant had atrophy of the extensor digitorum brevis
of the left foot, Dr. Pettingell assigned a class 2, default grade C or 16 percent lower extremity
impairment. He found a GMFH of zero and GMCS of zero. Dr. Pettingell therefore found a two
percent impairment of the left lower extremity and a 14 percent impairment of the right lower
extremity.
In an October 5, 2010 report, Dr. H. Mobley, an OWCP medical adviser, reviewed
Dr. Pettingell’s report and disagreed with the impairment ratings. Regarding the left leg, he
referenced Table 16-116 and Table 16-12 to assess 16 percent impairment due to class 2, grade C
moderate motor impairment of the common peroneal nerve. Dr. Mobley noted a GMCS and
GMFH of zero. Applying the net adjustment formula of (0-1) + (0-1), he found a net adjustment
of -2, lowering the default grade C to A, equaling a 14 percent impairment of the left lower
extremity. However, Dr. Mobley noted that as appellant had already received a schedule award
for a 35 percent impairment of the left leg under File No. xxxxxx688, he was not entitled to an
additional award. Regarding the right leg, he found a grade C, mild sensory impairment of the
common peroneal nerve. Using the same calculation as for the left lower extremity, he found a
modifier of -2, lowering the default grade of C to A, equaling a one percent impairment of the
right lower extremity.
By decision dated December 1, 2010, OWCP granted appellant a schedule award for one
percent impairment of the right leg. The period of the award ran from August 30 to
September 19, 2010.
On December 14, 2010 appellant, through counsel, requested a telephonic hearing, held
on April 13, 2011. At the hearing, he described difficulty with activities of daily living but
acknowledged that he was able to work full time as a letter carrier. Appellant used two to four
days of leave a month due to back and lower extremity pain. Dr. Wilson testified that his
impairment rating was supported by clinical findings. Following the hearing, appellant
submitted a March 15, 2011 impairment rating by Dr. John W. Ellis, an attending Board-certified
family practitioner, who opined that appellant had a combined 14 percent impairment of the right
lower extremity according to Table 16-12, 8 percent for L5 nerve root impairment and 7 percent
for S1 nerve root impairment. Regarding the left lower extremity, Dr. Ellis found three percent
impairment for S1 nerve root impairment according to Table 16-12.
By decision dated July 5, 2011, an OWCP hearing representative vacated the
December 1, 2010 schedule award and remanded the case for additional development. On
July 15, 2011 Dr. Mobley reviewed the impairment rating of Dr. Ellis and found unexplained
discrepancies between that report and Dr. Pettingell’s opinion.
The medical adviser
recommended a new impairment rating from a physiatrist.

5

Table 16-12, page 535 of the sixth edition of the A.M.A., Guides is entitled “Peripheral Nerve Impairment -Lower Extremity Impairments.”
6

Table 16-11, page 533 of the sixth edition of the A.M.A., Guides is entitled “Sensory and Motor Severity.”

4

OWCP referred appellant to Dr. Michael Shawn Smith, a Board-certified physiatrist, for
an impairment evaluation. In an August 9, 2011 report, Dr. Smith reviewed the record and noted
examination findings. He diagnosed L5 radiculopathy of the right lower extremity and no
abnormality of the left lower extremity. Referring to an A.M.A., Guides newsletter for rating
spinal nerve impairment of the extremities, proposed table two, he assessed a class 1, moderate
sensory deficit in the right L5 dermatome, with a range of 2 to 5 percent impairment of the lower
extremity. Dr. Smith found a GMFH of 1 due to chronic symptoms, a GMCS of 1 for consistent
studies showing a right-sided L5-S1 disc bulge and a GMPE of zero. Using the net adjustment
formula of (1-1) + (1-1), equaling zero, he found a default impairment level of C, equaling three
percent impairment of the right lower extremity due to accepted lumbar disc disease. Dr. Smith
explained that, while appellant had intermittent left leg symptoms, sensory examination of the
left leg was not sufficiently changed to document any peripheral nerve injury.
On August 22, 2011 Dr. Ronald Blum, an OWCP medical adviser, concurred with
Dr. Smith’s rating of three percent impairment of the right lower extremity and no impairment of
the left lower extremity.
By decisions dated September 1, 2011, OWCP awarded appellant an additional two
percent impairment of the right lower extremity, for a total of three percent. It further found that
he had no ratable impairment of the left lower extremity.
In a September 8, 2011 letter, appellant, through counsel, requested a telephonic hearing,
held on February 8, 2012. At the hearing, counsel contended that OWCP should accord
Dr. Wilson the weight of the medical evidence. He submitted additional medical evidence.
An August 11, 2011 electromyography (EMG) of both lower extremities was negative for
sensory or motor loss, lumbar radiculopathy, peripheral polyneuropathy, sensory or motor axonal
loss. Dr. Wilson provided reports from September 30, 2011 to February 7, 2012 diagnosing
lumbar radiculopathy and delineating work restrictions.
By decision dated and finalized April 6, 2012, an OWCP hearing representative affirmed
September 1, 2011 decisions. He found that Dr. Smith’s report represented the weight of
medical opinion. The hearing representative found that Dr. Wilson’s reports were of diminished
value as he did not base his impairment ratings on sufficient objective neurodiagnostic findings.
LEGAL PRECEDENT
The schedule award provision of FECA7 and its implementing regulations8 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

7

5 U.S.C. § 8107.

8

20 C.F.R. § 10.404.

5

all claimants. The A.M.A., Guides has been adopted by the implementing regulations as the
appropriate standard for evaluating schedule losses.9
No schedule award is payable for a member, function, or organ of the body not specified
in FECA or in the regulations.10 Because neither FECA nor the regulations provide for the
payment of a schedule award for the permanent loss of use of the back,11 no claimant is entitled
to such an award.12 However, in 1966, amendments to FECA modified the schedule award
provision to provide for an award for permanent impairment to a member of the body covered by
the schedule regardless of whether the cause of the impairment originated in a scheduled or
nonscheduled member. As the schedule award provision of FECA includes the extremities, a
claimant may be entitled to a schedule award for permanent impairment to an extremity even
though the cause of the impairment originated in the spine.13
ANALYSIS
OWCP accepted that appellant sustained displacement of the L4-5 intervertebral disc
without myelopathy. He claimed a schedule award on April 4, 2010. Although FECA does not
provide for a schedule award for the back or spine, impairment of the extremities due to a spinal
injury may be compensable.14
Appellant submitted a March 26, 2010 impairment rating from Dr. Wilson, an attending
orthopedic surgeon. Utilizing the sixth edition of the A.M.A., Guides, Dr. Wilson found a
combined 28 percent impairment of the right lower extremity based on a 4 percent sensory and
13 percent motor impairment in the L5 dermatome and 12 percent for sensory and motor
impairments in the S1 nerve distribution. Regarding the left lower extremity, he found a
combined 18 percent impairment for L5 and S1 sensory and motor deficits. Dr. Wilson opined
that these impairments were supported by physical examination findings, an August 18, 2005
discogram and February 20, 2009 NCV studies. Dr. Katz, an OWCP medical adviser, found that
there were insufficient clinical studies to support Dr. Wilson’s ratings.
OWCP then obtained a second opinion from Dr. Pettingell, a Board-certified physiatrist,
who found a 14 percent impairment of the right leg and 2 percent impairment of the left leg
based on common peroneal nerve impairment. Dr. Mobley, an OWCP medical adviser, agreed
with Dr. Pettingell’s rating method, but found a one percent impairment of the right leg and no
impairment of the left leg. He stated that Dr. Pettingell misapplied the net adjustment formula.
On December 1, 2010 OWCP granted appellant a schedule award for one percent impairment of
9

Id.; Jacqueline S. Harris, 54 ECAB 139 (2002).

10

Henry B. Floyd, III, 52 ECAB 220 (2001).

11

FECA specifically excludes the back from the definition of “organ.” 5 U.S.C. § 8101(19).

12

Thomas Martinez, 54 ECAB 623 (2003).

13

See Thomas J. Engelhart, 50 ECAB 319 (1999).

14

See id.

6

the right lower extremity, with no impairment of the left lower extremity, based on
Dr. Pettingell’s opinion as reviewed by the medical adviser.
Appellant submitted a March 15, 2011 impairment rating from Dr. Ellis, a Boardcertified family practitioner, who found a 14 percent impairment of the right lower extremity due
to L5 and S1 nerve root impairments and a 3 percent impairment of the left lower extremity due
to S1 nerve root impairment.
On August 9, 2011 OWCP obtained a second opinion from Dr. Smith, a Board-certified
physiatrist, who found three percent impairment of the right leg for moderate impairment in the
L5 nerve distribution and no impairment of the left leg. Dr. Blum, an OWCP medical adviser,
concurred with the ratings by Dr. Smith. OWCP issued September 1, 2011 decisions granting an
additional two percent schedule award for the right lower extremity and finding that appellant
had no additional ratable impairment of the left lower extremity.
Appellant disagreed and requested a second hearing. He submitted reports from
Dr. Wilson diagnosing lumbar radiculopathy and an August 11, 2011 EMG study showing no
lumbar radiculopathy or other spinal nerve impairment affecting either lower extremity. By an
April 6, 2012 decision, OWCP affirmed its September 1, 2011 schedule award decisions.
The Board finds that Dr. Smith’s report properly applied the applicable portions of the
A.M.A., Guides to rate three percent impairment of the right leg and no impairment of the left
leg. Dr. Smith based his opinion on the complete medical record and a statement of accepted
facts. He correlated appellant’s clinical findings with imaging and diagnostic studies of record,
finding that radiographic studies documented L5 nerve root impingement competent to produce
her subjective symptoms. Dr. Smith clearly explained the cause and extent of appellant’s
occupationally-related impairments. In contrast, Dr. Wilson based his impairment rating on S1
nerve root impingement, but did not support his rating by addressing the objective imaging or
neurodiagnostic studies. Appellant did not provide adequate evidence of S1 nerve root
impingement. The Board notes that the August 11, 2011 EMG study was negative for sensory or
motor spinal nerve loss to either leg. OWCP properly accorded Dr. Smith’s opinion the weight
of the medical evidence. Its April 6, 2012 decision was proper under the facts and circumstances
of this case.
Appellant may request a schedule award or increased schedule award based on evidence
of a new exposure or medical evidence showing progression of an employment-related condition
resulting in permanent impairment or increased impairment.
CONCLUSION
The Board finds that appellant has not established that he sustained more than a three
percent impairment of the right lower extremity causally related to accepted lumbar conditions.
The Board further finds that he has not established that he sustained a ratable impairment of the
left lower extremity.

7

ORDER
IT IS HEREBY ORDERED THAT the April 6, 2012 decision of the Office of
Workers’ Compensation Programs is affirmed.
Issued: February 11, 2013
Washington, DC

Alec J. Koromilas, Alternate Judge
Employees’ Compensation Appeals Board

Michael E. Groom, Alternate Judge
Employees’ Compensation Appeals Board

James A. Haynes, Alternate Judge
Employees’ Compensation Appeals Board

8


United States Department of Labor
Employees’ Compensation Appeals Board
__________________________________________
A.R., Appellant
and
U.S. POSTAL SERVICE, POST OFFICE,
Jersey City, NJ, Employer
__________________________________________

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Appearances:
Thomas R. Uliase, Esq., for the appellant
Office of Solicitor, for the Director

Docket No. 08-1502
Issued: February 19, 2009

Case Submitted on the Record

DECISION AND ORDER
Before:
ALEC J. KOROMILAS, Chief Judge
COLLEEN DUFFY KIKO, Judge
JAMES A. HAYNES, Alternate Judge

JURISDICTION
On April 28, 2008 appellant, through her representative, filed a timely appeal from the
December 12, 2007 merit decision of the Office of Workers’ Compensation Programs’ hearing
representative, which denied a schedule award. Pursuant to 20 C.F.R. §§ 501.2(c) and 501.3, the
Board has jurisdiction to review the merits of the case.
ISSUE
The issue is whether appellant’s May 4, 2000 employment injury caused permanent
impairment to her right lower extremity.
FACTUAL HISTORY
On May 4, 2000 appellant, then a 55-year-old postal clerk, sustained an injury in the
performance of duty: “Right knee was hit by steel bar door magnet from top of administration
entrance upon entering.” A postal physician saw her that day and diagnosed a contusion of the
right inferior patellar ligament. A consulting orthopedic surgeon examined her five days later.
He noted that the incident caused no immediate pain, but the knee worsened over time. The

doctor diagnosed knee sprain.1 The Office accepted appellant’s claim for right knee sprain and
paid compensation for wage loss.
On October 17, 2005 appellant, through her representative, filed a claim for a schedule
award. She submitted in support thereof the July 25, 2005 report of Dr. David Weiss, an
osteopath, who related appellant’s history and current complaints. Dr. Weiss noted the following
findings on physical examination of the right knee:
“Examination of the right knee reveals no gross effusion is noted. Range of
motion is 0-140/140 degrees. There is tenderness noted along the undersurface of
the medial and lateral patellar facets. [Appellant] is nontender over the medial
and lateral joint lines. Patellofemoral compression produces pain but no crepitus.
Valgus and varus stress tests produce firm end points. Drawer and Lachman signs
are negative. Apley grind is negative. McMurray sign is negative.”
Dr. Weiss reported that a May 24, 2000 magnetic resonance imaging (MRI) scan was
found to be normal. He diagnosed, among other things, post-traumatic internal derangement of
the right knee, post-traumatic chondromalacia patella of the right knee and a derivative injury to
the right foot with plantar fasciitis and aggravation of preexisting quiescent calcaneal spur.
Dr. Weiss found that appellant had a 15 percent permanent impairment of her right lower
extremity due to IV/V motor strength deficit in right ankle dorsiflexion with a pain-related
impairment of 3 percent.
An Office medical adviser reviewed Dr. Weiss’ report and found no impairment due to
the accepted right knee sprain. He noted that appellant had a good examination under Dr. Weiss
with no focal knee deficits.
The Office found a conflict in medical opinion and referred the case to Dr. Robert
Dennis, a Board-certified orthopedic surgeon, for an impartial medical examination. On
December 27, 2006 Dr. Dennis related appellant’s history of injury and subsequent medical
treatment. He listed appellant’s current subjective complaints and his findings on physical
examination. Examination of both knees revealed the following:
“Both knees had a full active and passive extension to 180 degrees. Both knees
could flex in a symmetric fashion to 130 degrees. Both knees were checked for
effusion. They were normal. The right knee showed no evidence of maltracking.
We utilized osteophony of both knees on the focused on the patella. The amount
of crepitus, which was audible only through the stethoscope, was completely
equal on both sides and considered very mild. There was no hesitation on motion
of the right knee through its entire range and no particular difference or
abnormality in the amount of crepitus. There was no medial joint line tenderness
to the right knee or to the left. Quadriceps function and measurements were equal
bilaterally.”
1

There was no ecchymosis or effusion. Range of motion was from -10 degrees full extension to 100 degrees
flexion. There was lateral joint line tenderness, a positive McMurray test, patellar crepitus, pain with resisted
extension and a click with flexion-extension. X-rays were negative.

2

Summarizing the knee examination, Dr. Dennis reported that both knees showed
completely normal and healthy evaluation. There was no difference whatsoever between them.
Dr. Dennis remarked that the old contusions that might have occurred from the injury had
resolved. He noted that the tenderness Dr. Weiss reported along the undersurface of the medial
and lateral patella facets was no longer evident on multiple examinations of the area.
Reviewing objective studies, Dr. Dennis reported that the May 9, 2000 right knee x-rays
were completely normal and “pristine,” with no evidence of pathology, spurs or inflammation
under the patella. Joint spaces were well maintained. Dr. Dennis reported that the May 24, 2000
MRI scan was completely normal. The reports of the right knee were also normal, showing no
evidence of arthritis. Similarly, the x-ray was read as showing no evidence of arthritis. There
was no evidence of effusion “and these were done early on close to the time of injury.”
Dr. Dennis concluded that appellant had no impairment of her right lower extremity due
the accepted knee injury. Appellant’s physical examination was “extraordinarily benign” with
no positive clinical findings of the right knee, and there was no evidence of residual
chondromalacia of the patella or patellofemoral arthritis. “If it was present before,” Dr. Dennis
stated, “it was transient, well treated and has completely resolved without residual.”
In a decision dated April 5, 2007, the Office denied appellant’s claim for a schedule
award. It found that the medical evidence failed to demonstrate a measurable impairment.
On December 12, 2007 an Office hearing representative affirmed the denial of
appellant’s claim. The hearing representative found that the weight of the medical evidence
rested with the thorough, well-rationalized opinion of Dr. Dennis. The hearing representative
further found that the medical record did not support that appellant was entitled to a schedule
award for the right lower extremity as a result of her work-related injury.
LEGAL PRECEDENT
Section 8107 of the Federal Employees’ Compensation Act2 authorizes the payment of
schedule awards for the loss or loss of use of specified members, organs or functions of the body.
Such loss or loss of use is known as permanent impairment.3
A claimant seeking compensation under the Act has the burden of establishing the
essential elements of her claim by the weight of the reliable, probative and substantial evidence.4
A claimant seeking a schedule award, therefore, has the burden of establishing that her accepted

2

5 U.S.C. § 8107.

3

20 C.F.R. § 10.404 (1999).

4

Nathaniel Milton, 37 ECAB 712 (1986); Joseph M. Whelan, 20 ECAB 55 (1968) and cases cited therein.

3

employment injury caused permanent impairment of a scheduled member, organ or function of
the body.5
If there is disagreement between the physician making the examination for the United
States and the physician of the employee, the Secretary shall appoint a third physician who shall
make an examination.6 If medical reports that are equally well reasoned support inconsistent
determinations of an issue under consideration, the Office will direct the employee to undergo a
referee examination to resolve the issue.7
ANALYSIS
The Office accepted that appellant sprained her right knee in the performance of duty on
May 4, 2000. So when she filed her claim for a schedule award on October 17, 2005, it was her
burden to establish by the weight of the medical evidence that this sprain had caused a permanent
impairment to her right lower extremity.
To support her claim, appellant submitted a July 25, 2005 report from her osteopath,
Dr. Weiss, who found a 15 percent permanent impairment of the right lower extremity, but he
did not explain how this impairment arose from a sprained knee. The only positive findings he
made on physical examination of the right knee were tenderness along the undersurface of the
medial and lateral patellar facets and pain on patellofemoral compression. Dr. Weiss, again, did
not explain how either finding was connected to a sprain that occurred five years earlier. His
diagnoses of post-traumatic internal derangement of the right knee, post-traumatic
chondromalacia patella of the right knee and derivative injury to the right foot are wholly
unsupported by medical rationale.
Because Dr. Weiss offered no sound medical reasoning, the Board finds that his July 25,
2005 report is of little probative value in establishing that appellant’s May 4, 2000 right knee
sprain caused any permanent impairment to the right lower extremity.8 Not only did this
evidence not discharge appellant’s ultimate burden of proof to establish entitlement to a schedule
award, it lacked sufficient probative value to warrant the application of section 8123 of the Act.
The evidence was unrationalized. The Board therefore finds no true conflict in the medical
opinion evidence warranting further development under section 8123.9
For this reason, Dr. Dennis, the Board-certified orthopedic surgeon, does not hold the
status of an impartial medical specialist. His opinion does not carry the special weight normally
5

E.g., Russell E. Grove, 14 ECAB 288 (1963) (where medical reports from the attending physicians showed that
the only leg impairment was due to arthritis of the knees, which was not injury related, the claimant failed to meet
his burden of proof to establish entitlement to a schedule award).
6

5 U.S.C. § 8123(a).

7

20 C.F.R. § 10.502 (1999).

8

Ceferino L. Gonzales, 32 ECAB 1591 (1981); George Randolph Taylor, 6 ECAB 968 (1954) (medical
conclusions unsupported by rationale are of little probative value).
9

See text accompanying note 7 above. A true conflict requires reasoned medical reports.

4

accorded such. Dr. Dennis is, instead, a second-opinion physician. He examined appellant on
December 27, 2006, about a year and a half after Dr. Weiss and reported a completely normal
and healthy evaluation. Dr. Dennis stated that the old contusions that might have occurred had
resolved and appellant no longer had any trace of the tenderness Dr. Weiss reported. Given
appellant’s extraordinarily benign physical examination and normal diagnostic studies,
Dr. Dennis concluded that appellant had no impairment of her right lower extremity due the
accepted knee injury.
The Board finds that Dr. Dennis’ opinion carries the weight of the medical opinion
evidence on whether appellant’s May 4, 2000 knee sprain caused permanent impairment to her
right lower extremity. This evidence appears more consistent, logical and well reasoned than the
evidence given by Dr. Weiss and it only further weakens appellant’s claim. To be clear, even
without Dr. Dennis’ opinion, appellant has not met her burden of proof. On these grounds, then,
the Board will affirm the Office hearing representative’s December 12, 2007 denial of a schedule
award.
CONCLUSION
The Board finds that appellant has not met her burden to establish that the May 4, 2000
employment injury caused permanent impairment to her right lower extremity.
ORDER
IT IS HEREBY ORDERED THAT the December 12, 2007 decision of the Office of
Workers’ Compensation Programs is affirmed.
Issued: February 19, 2009
Washington, DC

Alec J. Koromilas, Chief Judge
Employees’ Compensation Appeals Board

Colleen Duffy Kiko, Judge
Employees’ Compensation Appeals Board

James A. Haynes, Alternate Judge
Employees’ Compensation Appeals Board

5


United States Department of Labor
Employees’ Compensation Appeals Board
__________________________________________
L.C., Appellant
and
U.S. POSTAL SERVICE, POST OFFICE,
LaPlace, LA, Employer
__________________________________________

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Appearances:
Martin Kaplan, Esq., for the appellant
Office of Solicitor, for the Director

Docket No. 14-402
Issued: July 8, 2014

Case Submitted on the Record

DECISION AND ORDER
Before:
PATRICIA HOWARD FITZGERALD, Acting Chief Judge
COLLEEN DUFFY KIKO, Judge
JAMES A. HAYNES, Alternate Judge

JURISDICTION
On December 13, 2013 appellant, through his attorney, filed a timely appeal from an
October 1, 2013 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 was disabled, for purposes of leave buyback and wage
loss, commencing December 21, 2010 due to his December 16, 2010 employment injury.
On appeal, counsel contends that a December 26, 2012 medical report from
Dr. Michael P. Zeringue, an attending Board-certified family practitioner and physiatrist,
establishes that appellant sustained a recurrence of disability due to his employment-related
injury.

1

5 U.S.C. § 8101 et seq.

FACTUAL HISTORY
OWCP accepted that on December 16, 2010, appellant, then a 53-year-old letter carrier,
sustained thoracic or lumbosacral neuritis or radiculitis not otherwise specified when he picked
up mail that he had dropped on the ground.
On October 17, 2011 appellant filed claims (Form CA-7) requesting leave buyback
commencing December 21, 2010 and leave without pay (LWOP) commencing
February 24, 2011. He stopped work on January 12, 2011.
A December 20, 2010 prescription with an illegible signature recommended that
appellant rest through December 30, 2010 and requested that he be excused.
In a January 5, 2011 prescription, Dr. Kiran G. Zaveri, a Board-certified internist, advised
that appellant had low back pain and sciatica. He recommended a desk job for three weeks and
advised that appellant could resume full-duty work on February 1, 2011. In a January 12, 2011
prescription, Dr. Zaveri noted that appellant had low back pain and recommended rest through
January 19, 2011. He advised that he could resume full-duty work on January 20, 2011.
In a January 24, 2011 note, a physician whose signature is illegible stated that appellant
could return to work on January 29, 2011.
A January 31, 2011 report cosigned by Dr. Zeringue and Dr. Charles G. Haddad, Jr., a
Board-certified orthopedic surgeon, stated that appellant could not return to work until after he
underwent a magnetic resonance imaging (MRI) scan. In a February 8, 2011 report,
Dr. Zeringue advised that appellant was unable to work until further notice. In reports dated
January 31 through July 21, 2011, he listed findings on physical and psychiatric examination.
Dr. Zeringue assessed spinal stenosis, chronic pain syndrome, long-term pain medicine, lumbar
radiculitis and disc degeneration. On June 13, 2011 he reported that appellant could immediately
resume light-duty work.
A May 5, 2011 report from a physician whose signature is illegible stated that appellant
could resume light duties.
By letter dated October 24, 2011, OWCP informed appellant that the medical evidence
submitted was insufficient to support partial disability during the claimed period. It requested
additional factual and medical evidence. OWCP also requested that the employing establishment
submit factual evidence regarding appellant’s claim for leave buyback.
A January 24, 2011 hospital record contained the printed name of Dr. Cynthia L. Swart, a
Board-certified family practitioner, which stated that appellant’s symptoms may be due to low
back pain. Appellant was given instructions which included quiet rest at home for the next two
to three days.
An October 17, 2011 report which contained an illegible signature stated that appellant
was absent from work on that date due to diagnostic testing.

2

In an October 21, 2011 report, Dr. Everett G. Robert, Jr., a neurosurgeon, listed a history
of the December 16, 2010 employment injury and appellant’s medical treatment, social and
family background. He provided findings on physical examination and reviewed x-ray results.
Dr. Robert stated that his clinical suspicion was that appellant suffered from spinal stenosis and
needed a decompression, but he would wait until he reviewed flexion and extension views of the
lumbar spine and a copy of appellant’s MRI scan before making a determination. In another
report dated October 21, 2011, he advised that a February 2, 2011 lumbar MRI scan showed a
disc bulge with mild disc degradation at L4-5 with disc osteophyte complex contacting the left
L4 nerve root within the compromised neuroforamen. There was a less prominent bone spur in
the left foramen at L5-S1 contacting the undersurface of the ipsilateral nerve root, but to a lesser
extent. Dr. Robert stated that the MRI scan, which was nine months old, did not fit appellant’s
complaints of bilateral lower extremity, severe back pain and neurogenic claudication. He
wanted to obtain flexion and extension films and to repeat the lumbar MRI scan. Dr. Robert
stated that if there was no change on the MRI scan, then appellant would more than likely not
have any surgical indications. However, he related that if it showed increased degeneration in
the L4-5 disc, then appellant may have discogenic-like pain along with L4 nerve root
compression.
An October 31, 2011 diagnostic report that, contained the printed name of Dr. John N.
Joslyn, a Board-certified radiologist, stated that x-rays of the lumbar spine showed minimal
scoliosis of unknown significance and etiology and age-appropriate spondylosis. Another report
dated October 31, 2011 that contained Dr. Joslyn’s printed name stated that a lumbar MRI scan
showed a left lateral L4-5 bulging disc, L4-Sl facet arthropathy and mild L4-5 neural foraminal
narrowing.
On November 3, 2011 Dr. Zaveri reported that he evaluated appellant on December 20,
2010 for lower back pain and pain radiating into his leg which was suggestive of lumbar
radiculopathy. At that time appellant was unable to work and was advised to take time off work.
Dr. Zaveri noted that on January 2, 2011 appellant was seen again for radiculopathy, put on
steroids and advised to take further time off work. On January 24, 2011 appellant’s pain
continued and Dr. Zaveri added an anti-inflammatory medicine. Dr. Zaveri concluded that
appellant was unable to return to work as a letter carrier from December 20, 2010 to February 1,
2011 due to lumbar radiculopathy with severe pain.
Also, on November 3, 2011 Dr. Zeringue reported that appellant was unable to work
from January 31 to March 30, 2011 secondary to pain. He released appellant to limited-duty
work that involved mostly sitting on March 30, 2011. Appellant advised Dr. Zeringue that he
was unable to walk secondary to pain and therefore could not work, but after receiving a second
epidural steroid injection he was able to walk some without severe pain. Dr. Zeringue reiterated
his prior diagnoses of neurogenic claudication, spinal stenosis, chronic pain syndrome and
long-term pain medicine. In a December 8, 2011 note, he indicated that appellant had a right
L3 to 5 and S1 medial branch/dorsal ramus block on December 7, 2011. Appellant advised
Dr. Zeringue that afterward he had over 60 percent pain relief and better range of motion with his
back. He was scheduled for radiofrequency ablation of the right L3 to 5 and S1 medial
branch/dorsal ramus nerves on December 9, 2011.

3

In a November 9, 2011 report, Dr. Robert noted the October 31, 2011 lumbar MRI scan
and x-ray results. He stated that appellant had abnormal motion. Dr. Robert advised that, in
general, the imaging results did not fit appellant’s complaints. He concluded that appellant was
not a surgical candidate and sent him back to Dr. Zeringue for further treatment.
By decision dated December 27, 2011, OWCP denied appellant’s claims for leave
buyback commencing December 21, 2010 and wage-loss compensation commencing
February 24, 2011. The medical evidence was not sufficiently rationalized to establish that he
was disabled during the claimed periods due to his December 16, 2010 employment injury.
By letter dated December 26, 2012, appellant, through his attorney, requested
reconsideration of the December 27, 2011 decision and submitted medical evidence. In a
December 20, 2012 report, Dr. Zeringue assessed appellant as having neuritis/neuralgia. Also,
appellant still had a possibility of a component of plantar fasciitis. Dr. Zeringue advised that
appellant could continue performing light-duty work. In a December 26, 2012 report, he advised
that appellant was unable to perform his work duties from January 31 to February 8, 2011
because he had severe symptoms of lumbar radiculitis, which were confirmed by an MRI scan
that showed severe neuroforaminal stenosis at L4, left greater than right at the L5 nerve root.
Dr. Zeringue stated that in any case of sciatica, the type of job appellant had, which included
prolonged walking, stooping, bending and carrying loads for an extended period of time, could
aggravate his condition. Appellant stated that it was in his best interest to get an epidural
injection or other conservative treatment such as, rest and anti-inflammatories before going back
to work because his work could provoke his condition. In reports dated October 10, 2010 to
March 14, 2013, Dr. Zeringue advised that appellant had plantar fasciitis, lumbosacral radiculitis,
claudication and lumbar facet disease. In a March 21, 2012 report, he noted appellant’s
improved back pain due to his radiofrequency ablation and complaint of pain from his knee to
his ankle. Dr. Zeringue listed findings on physical examination and assessed claudication versus
neurogenic claudication. He ordered diagnostic testing and gave appellant a note excusing him
from work during the prior week and a couple of weeks after the radiofrequency ablation
procedure. On May 9, 2012 Dr. Zeringue noted that appellant only drove while delivering mail
and he had a burning sensation in his heels. He listed physical examination findings and
reiterated his prior diagnoses of chronic pain syndrome and long-term use of medicines.
Dr. Zeringue assessed perhaps compartmental syndrome of the lower extremities, but stated that
since appellant was driving this was not an issue. He also assessed plantar fasciitis.
Dr. Zeringue gave appellant a note to allow him to continue driving instead of walking to deliver
mail.
A February 20, 2012 report which contained the printed name of Dr. Lehman K. Preis,
Jr., a Board-certified internist, stated that an electrocardiogram was normal.
In an October 1, 2013 decision, OWCP denied modification of the December 27, 2011
decision. It found that the medical evidence submitted was not sufficiently rationalized to
establish appellant’s entitlement to leave buyback commencing December 21, 2010 and wageloss compensation commencing February 24, 2011 causally related to his accepted December 16,
2010 employment injury.

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LEGAL PRECEDENT
In situations where compensation is claimed for periods when leave was used, OWCP has
the authority and the responsibility to determine whether the employee was disabled during the
period for which compensation is claimed.2 It determines whether the medical evidence
establishes that an employee is disabled by an employment-related condition during the period
claimed for leave buyback, after which the employing establishment will determine whether it
will allow the employee to buy back the leave used.3
Under FECA, the term disability means the incapacity, because of an employment injury,
to earn the wages that the employee was receiving at the time of injury. Disability is thus not
synonymous with physical impairment, which may or may not result in an incapacity to earn
wages. An employee who has a physical impairment causally related to a federal employment
injury, but who nevertheless has the capacity to earn the wages he or she was receiving at the
time of injury, has no disability as that term is used in FECA.4 Whether a particular injury
causes an employee to be disabled for employment and the duration of that disability are medical
issues which must be proved by a preponderance of the reliable, probative and substantial
medical evidence.5 The medical evidence required to establish a period of employment-related
disability is rationalized medical evidence.6 Rationalized medical evidence is medical evidence
based on a complete factual and medical background of the claimant, of reasonable medical
certainty, with an opinion supported by medical rationale.7 When the medical evidence
establishes that the residuals of an employment injury are such that, from a medical standpoint,
they prevent the employee from continuing in the employment held when injured, the employee
is entitled to compensation for any loss of wage-earning capacity resulting from such incapacity.8
The Board will not require OWCP to pay compensation for disability in the absence of
any medical evidence directly addressing the specific dates of disability for which compensation
is claimed. To do so would essentially allow employees to self-certify their disability and
entitlement to compensation. For each period of disability claimed, the employee has the burden
of establishing that he or she was disabled for work as a result of the accepted employment
injury.9

2

See Glen M. Lusco, 55 ECAB 148 (2003).

3

Id.

4

See 20 C.F.R. § 10.5(f); Cheryl L. Decavitch, 50 ECAB 397 (1999).

5

Fereidoon Kharabi, 52 ECAB 291 (2001).

6

Jacqueline M. Nixon-Steward, 52 ECAB 140 (2000).

7

Leslie C. Moore, 52 ECAB 132 (2000).

8

S.D., Docket No. 10-1820 (issued March 18, 2011).

9

Sandra D. Pruitt, 57 ECAB 126 (2005).

5

ANALYSIS
OWCP accepted that appellant sustained a thoracic or lumbosacral neuritis or radiculitis
not otherwise specified on December 16, 2010 while working as a letter carrier. Appellant
claimed compensation for leave buyback commencing December 21, 2010 and LWOP
commencing February 24, 2011. OWCP denied his claim on the grounds that the evidence was
insufficient to establish that the claimed disability was due to his accepted employment injury.
Appellant has the burden of establishing by the weight of the substantial, reliable and probative
evidence, a causal relationship between his claimed disability and the accepted condition.10 The
Board finds that he did not submit sufficient medical evidence to establish employment-related
disability for the periods claimed due to his accepted injury.
Dr. Zaveri’s January 5 and 12, 2011 examination found that appellant had low back pain
and sciatica. He initially recommended light-duty work for three weeks and subsequently
recommended rest from January 12 to 19, 2011 with a return to full-duty work on
January 20, 2011. The Board notes that OWCP has not accepted appellant’s claim for sciatica.
For conditions not accepted by OWCP as being employment related, it is the employee’s burden
to provide rationalized medical evidence sufficient to establish causal relation, not OWCP’s
burden to disprove such relationship.11 Dr. Zaveri did not provide a medical opinion addressing
whether appellant’s diagnosed conditions and resultant disability were causally related to the
accepted December 16, 2010 employment-related injury. The Board has held that a physician’s
opinion, which does not address causal relationship, is of diminished probative value.12 In his
November 3, 2011 report, Dr. Zaveri placed appellant off work from December 20, 2010 to
February 1, 2011 due to lumbar radiculopathy with severe pain, but failed to provide any medical
rationale explaining how the accepted employment injury caused his disability. Medical
opinions which contain no rationale or explanation are of little probative value.13 For the stated
reasons, the Board finds that Dr. Zaveri’s reports are insufficient to establish appellant’s claim.
Dr. Zeringue’s reports are also insufficient to establish appellant’s claim. In the
December 26, 2012 report, he found that appellant was unable to work from January 31 to
February 8, 2011 due to severe symptoms of lumbar radiculitis. Dr. Zeringue advised that
appellant’s job, which included prolonged walking, stooping, bending and carrying loads for an
extended period of time, could aggravate his condition. He did not explain how the accepted
employment injury caused appellant’s disability during the stated period.14 Dr. Zeringue’s
reports dated October 10, 2010 to March 14, 2013 found that appellant had neurogenic
10

Alfredo Rodriguez, 47 ECAB 437 (1996).

11

G.A., Docket No. 09-2153 (issued June 10, 2010); Jaja K. Asaramo, 55 ECAB 200 (2004); Alice J. Tysinger,
51 ECAB 638 (2000).
12

See A.D., 58 ECAB 149 (2006) (medical evidence which does not offer any opinion regarding the cause of an
employee’s condition is of limited probative value on the issue of causal relationship).
13

F.T., Docket No. 09-919 (issued December 7, 2009) (medical opinions not fortified by rationale are of
diminished probative value); Sedi L. Graham, 57 ECAB 494 (2006) (medical form reports and narrative statements
merely asserting causal relationship generally do not discharge a claimant’s burden of proof).
14

Id.

6

claudication, spinal stenosis, chronic pain syndrome, lumbar radiculitis, lumbar facet disease and
long-term use of pain medicine. He further found that appellant could not work from January 31
to March 30, 2011 and a week prior to and several weeks after his December 9, 2011
radiofrequency ablation procedure. The Board notes that OWCP has not accepted the conditions
of neurogenic claudication, spinal stenosis, chronic pain syndrome and Dr. Zeringue did not
provide any medical rationale explaining how appellant’s conditions and resultant disability were
caused by the December 16, 2010 employment injury.15 In the December 20, 2012 report,
Dr. Zeringue found that appellant had neuritis/neuralgia and possibly a component of plantar
fasciitis. He advised that appellant could continue performing light-duty work. Dr. Zeringue’s
diagnosis that appellant had “possibly” a component of plantar fasciitis is speculative in nature.16
Moreover, he did not provide an opinion explaining whether appellant had any disability causally
related to the accepted injury.17 The remaining reports from Dr. Zeringue did not address
whether appellant had any employment-related disability during the claimed period. For the
stated reasons, the Board finds that his reports are insufficient to establish appellant’s claim.
Dr. Robert’s reports found that the October 31, 2011 lumbar MRI scan and x-ray results
did not fit appellant’s complaints of bilateral lower extremity and severe back pain and
neurogenic claudication and, thus, he was not a surgical candidate. He did not opine that
appellant had any condition or disability during the claimed period causally related to the
accepted employment injury.18 The Board finds therefore that Dr. Robert’s reports are
insufficient to establish appellant’s claim.
The December 20, 2010 prescription, January 24, 2011 note and May 5 and October 17,
2011 reports which contained illegible signatures, the January 24 and October 31, 2011 and
February 20, 2012 reports which contained the printed names of Drs. Swart, Joslyn and Preis
have no probative value in establishing that appellant had any employment-related disability
during the claimed period. It is well established that medical evidence lacking proper
identification is of no probative medical value.19
In the absence of rationalized medical evidence, appellant failed to meet his burden of
proof to establish entitlement to leave buyback and wage-loss compensation commencing
December 21, 2010 due to his December 16, 2010 employment injury.
On appeal, appellant’s attorney contended that Dr. Zeringue’s December 26, 2012
medical report established that appellant sustained a recurrence of disability due to his
employment-related injury. As stated, Dr. Zeringue failed to provide a rationalized medical
15

See cases cited supra note 11.

16

Medical opinions that are speculative or equivocal in character are of little probative value. See Kathy A.
Kelley, 55 ECAB 206 (2004).
17

See A.D., supra note 12.

18

Id.

19

Thomas L. Agee, 56 ECAB 465 (2005); Richard F. Williams, 55 ECAB 343 (2004); Merton J. Sills, 39 ECAB
572 (1988).

7

opinion explaining how the accepted employment-related lumbar radiculitis caused appellant’s
claimed disability.
Appellant may submit new evidence or argument with a written request for
reconsideration to OWCP within one year of this merit decision, pursuant to 5 U.S.C. § 8128(a)
and 20 C.F.R. §§ 10.605 through 10.607.
CONCLUSION
The Board finds that appellant has failed to establish that he was disabled for purposes of
leave buyback and wage loss commencing December 21, 2010 due to his December 16, 2010
employment injury.
ORDER
IT IS HEREBY ORDERED THAT the October 1, 2013 decision of the Office of
Workers’ Compensation Programs is affirmed.
Issued: July 8, 2014
Washington, DC

Patricia Howard Fitzgerald, Acting Chief Judge
Employees’ Compensation Appeals Board

Colleen Duffy Kiko, Judge
Employees’ Compensation Appeals Board

James A. Haynes, Alternate Judge
Employees’ Compensation Appeals Board

8


United States Department of Labor
Employees’ Compensation Appeals Board
__________________________________________
D.C., Appellant
and
DEPARTMENT OF LABOR, OCCUPATIONAL
HEALTH & SAFETY ADMINISTRATION,
Boston, MA, Employer
__________________________________________

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Appearances:
Appellant, pro se
Office of Solicitor, for the Director

Docket No. 12-1038
Issued: October 3, 2012

Case Submitted on the Record

DECISION AND ORDER
Before:
ALEC J. KOROMILAS, Alternate Judge
MICHAEL E. GROOM, Alternate Judge
JAMES A. HAYNES, Alternate Judge

JURISDICTION
On April 17, 2012 appellant filed a timely appeal from a November 9, 2011 nonmerit
decision of the Office of Workers’ Compensation Programs (OWCP) denying her request for
reconsideration. As OWCP did not issue a merit decision within 180 days of the filing of this
appeal, the Board lacks jurisdiction to review the merits of this case pursuant to the Federal
Employees’ Compensation Act1 (FECA) and 20 C.F.R. §§ 501.2(c) and 501.3.
ISSUE
The issue is whether OWCP properly denied appellant’s request to reopen her case for
further review of the merits under 5 U.S.C. § 8128.
FACTUAL HISTORY
This case has previously been before the Board. In a decision dated November 10, 2010,
the Board affirmed October 1 and November 20, 2009 OWCP decisions denying appellant’s
1

5 U.S.C. § 8101 et seq.

traumatic injury claim.2 It found that she had not submitted rationalized medical evidence to
establish that kneeling on April 3, 2008 caused either a new injury or an aggravation of a
preexisting condition. The facts and circumstances as set forth in the prior decision are hereby
incorporated by reference.
On December 18, 2010 appellant requested reconsideration. She asserted that OWCP did
not consider the June 17, 2008 report of Dr. Robert G. Davis, a Board-certified orthopedic
surgeon. Appellant resubmitted Dr. Davis’ June 17, 2008 form report. He diagnosed
posttraumatic osteoarthritis and recommended surgery on the left knee and a magnetic resonance
imaging (MRI) scan study of the right knee. Dr. Davis listed the history of injury as a direct
injury to the left knee on the floor, a meniscal tear, degenerative joint disease and right knee
secondary pain. He checked “yes” that the condition of both knees was caused or aggravated by
employment and found that appellant was partially disabled beginning April 3, 2008.
In a decision dated February 16, 2011, OWCP denied appellant’s request for
reconsideration on the grounds that it was not timely and did not establish clear evidence of
error.
Appellant appealed to the Board. In an order dated October 26, 2011, the Board found
that she had timely requested reconsideration as a right to reconsideration within one year
accompanied any merit decision on the issues, including a decision by the Board.3 It remanded
the case for OWCP to consider appellant’s request for reconsideration under the standard for
timely reconsideration requests.
By decision dated November 9, 2011, OWCP denied appellant’s request for
reconsideration after finding that she had not submitted evidence or raised argument sufficient to
warrant reopening her case for further merit review under 5 U.S.C. § 8128. It noted that the
June 17, 2008 report from Dr. Davis was already of record.
On appeal appellant argues that she submitted a June 17, 2008 letter from Dr. Davis. She
noted that she was beginning to experience problems with her right hip.
LEGAL PRECEDENT
To require OWCP to reopen a case for merit review under section 8128(a) of FECA,4 its
regulations provide that a claimant must: (1) show that OWCP erroneously applied or
interpreted a specific point of law; (2) advance a relevant legal argument not previously
considered by OWCP; or (3) constitute relevant and pertinent new evidence not previously
considered by OWCP.5 To be entitled to a merit review of an OWCP decision denying or
2

Docket No. 10-567 (issued November 10, 2010). On April 16, 2008 appellant, then a 51-year-old program
assistant, filed a traumatic injury claim alleging that she injured her knees on April 3, 2008 while kneeling on the
floor looking for a cable outlet.
3

Order Remanding Case, Docket No. 11-920 (issued October 26, 2011).

4

5 U.S.C. § 8101 et seq. Section 8128(a) of FECA provides that “[t]he Secretary of Labor may review an award
for or against payment of compensation at any time on her own motion or on application.”
5

20 C.F.R. § 10.606(b)(2).

2

terminating a benefit, a claimant also must file his or her application for review within one year
of the date of that decision.6 When a claimant fails to meet one of the above standards, OWCP
will deny the application for reconsideration without reopening the case for review on the
merits.7
The Board has held that the submission of evidence which repeats or duplicates evidence
already in the case record does not constitute a basis for reopening a case.8 The Board also has
held that the submission of evidence which does not address the particular issue involved does
not constitute a basis for reopening a case.9 While the reopening of a case may be predicated
solely on a legal premise not previously considered, such reopening is not required where the
legal contention does not have a reasonable color of validity.10
ANALYSIS
By decisions dated October 1 and November 20, 2009, OWCP denied modification of its
finding that the medical evidence was insufficient to establish that appellant sustained an injury
on April 3, 2008. On November 10, 2010 the Board affirmed the October 1 and November 20,
2009 decisions. On December 18, 2010 appellant requested reconsideration.
The issue presented on appeal is whether appellant met any of the requirements of 20
C.F.R. § 10.606(b)(2), requiring OWCP to reopen the case for review of the merits of the claim.
In her December 18, 2010 request for reconsideration, appellant did not show that OWCP
erroneously applied or interpreted a specific point of law. She did not identify a specific point of
law or show that it was erroneously applied or interpreted. Appellant did not advance a new and
relevant legal argument. A claimant may be entitled to a merit review by submitting pertinent
new and relevant evidence, but she did not submit any pertinent new and relevant medical
evidence in this case. In support of her request for reconsideration, appellant submitted a
June 17, 2008 form report from Dr. Davis. However, the June 17, 2008 form report from
Dr. Davis was previously considered by OWCP in its September 16, 2008 decision and by the
Board in its decision dated November 10, 2010. Evidence which repeats or duplicates evidence
already in the case record has no evidentiary value and does not constitute a basis for reopening a
case.11
On appeal appellant argues that she submitted a June 17, 2008 letter from Dr. Davis and
noted that she was beginning to have right hip problems. As discussed, however, the report from
Dr. Davis duplicated evidence already of record and thus did not warrant reopening her case for
further merit review.12 Additionally, the issue of whether appellant has a right hip problem
6

Id. at § 10.607(a).

7

Id. at § 10.608(b).

8

F.R., 58 ECAB 607 (2007); Arlesa Gibbs, 53 ECAB 204 (2001).

9

P.C., 58 ECAB 405 (2007); Ronald A. Eldridge, 53 ECAB 218 (2001); Alan G. Williams, 52 ECAB 180 (2000).

10

Vincent Holmes, 53 ECAB 468 (2002); Robert P. Mitchell, 52 ECAB 116 (2000).

11

See J.P., 58 ECAB 289 (2007); Richard Yadron, 57 ECAB 207 (2005).

12

Id.

3

related to employment is medical in nature and must be resolved through the submission of
probative medical evidence.13
The Board finds that appellant did not meet any of the requirements of 20 C.F.R.
§ 10.606(b)(2). Appellant did not show that OWCP erroneously applied or interpreted a specific
point of law, advance a relevant legal argument not previously considered by OWCP, or
constitute relevant and pertinent new evidence not previously considered. Pursuant to 20 C.F.R.
§ 10.608, OWCP properly denied merit review.
CONCLUSION
The Board finds that OWCP properly denied appellant’s request to reopen her case for
further review of the merits under section 8128.
ORDER
IT IS HEREBY ORDERED THAT the November 9, 2011 decision of the Office of
Workers’ Compensation Programs is affirmed.
Issued: October 3, 2012
Washington, DC

Alec J. Koromilas, Alternate Judge
Employees’ Compensation Appeals Board

Michael E. Groom, Alternate Judge
Employees’ Compensation Appeals Board

James A. Haynes, Alternate Judge
Employees’ Compensation Appeals Board

13

See L.G., Docket No. 09-1517 (issued March 3, 2010); Gloria J. McPherson, 51 ECAB 441 (2000).

4