of impairment, the Office medical adviser may be asked to provide this information.
David E. Fishback, 38 ECAB 654 [1987].
An Office medical adviser's use of the Combined Values Chart of the A.M.A.
Guides to combine the impairment of the hand that was contributed by each digit
was not the method prescribed by the Guides. The Guides specify that the sum of
the values of the impairment of each digit represents the impairment of the hand.
Chester E. Menter, 38 ECAB 697 [1987].
Appellant's attending physician assigned appellant an "overall rating" of 25 per-
cent permanent partial impairment and indicated that this took into consideration
the impairment of appellant's back and right leg. This physician's conclusion was
not probative on the extent of the permanent impairment of appellant's leg, as the
physician provided no rationale explaining the method he used to assign the impair-
ment rating and stated that he did not utilize the A.M.A. Guides. Glen R. Clark, 38
ECAB 724 [1987].
Appellant did not have greater than a five percent permanent partial loss of use
of her left arm for which she received a schedule award. The Office medical adviser
properly measured the residual pain of appellant's left shoulder area by utilizing
Table 9, (Specific Unilateral Spinal Nerve Impairment Affecting the Upper Extremi-
ty) of the A.M.A. Guides. While the opinion of appellant's treating physician might
otherwise be accorded some greater weight as the opinion of an examining physi-
cian, he gave no explanation as to how he arrived at his rating of impairment. The
reports of a second treating physician, also failed to utilize the appropriate tables
under the A.M.A. Guides or otherwise explain his reasons for not doing so. As the
report of the Office medical adviser provided the only evaluation which properly
conformed with the A.M.A. Guides, it constituted the weight of the medical evi-
dence, and the Office acted properly in relying on it. Robin L. McClain, 38 ECAB
398 [1987].
The case was not in posture for decision and was remanded to the Office for fur-
ther development. On a prior appeal the Board remanded the case for consideration
of whether appellant had any impairment in addition to a 5 percent impairment of
the arm. On remand two Office medical advisers concluded that appellant had a 5
percent impairment due to pain. They stated, however, that appellant had no im-
pairment due to loss of motion because he had 130 degrees of flexion in both elbows.
This conclusion was contrary to the principles of consistency and uniformity which
necessitates the use of the A.M.A. Guides. The A.M.A. Guides indicate that the
range of flexion of the elbow is 150 degrees. In calculating a schedule award, all
claimants must be measured against this range of motion, even if an individual
claimant's normal range of motion may be greater or lesser than the range of
motion contained in the A.M.A. Guides. It is only by using this range of motion that
the Office can reach consistent results in schedule award determinations. Basing
schedule awards on the loss of the motion from a individual claimant's own range of
motion injects too much variability into the calculation of schedule awards and
would result in inconsistent awards, defeating the purpose of adopting uniform
standards. Frank Vara, Jr., 38 ECAB 434 [1987].
The FECA provides for payment of proper and equitable compensation not exceed-
ing $3,500.00 for serious disfigurement of the face, head or neck of a character likely
to handicap an individual in securing or maintaining employment. Matthew
Leonka, 38 ECAB 119 [1986].
The Board found that Office hearing representatives because of their experience,
are among the officials employed by the Office who are experts in evaluating disfi-
gurements for schedule award purposes so long as they have personally viewed the
disfigurement. Matthew Leonka, 38 ECAB 119 [1986].
FACTORS IN CALCULATING IMPAIRMENT
An appropriate method of evaluating the extent of any permanent impairment is
found in the A.M.A. Guides to the Evaluation of Permanent Impairment, the use of
which has been approved by the Board. Among the elements which may be consid-
ered in determining the extent of impairment are loss of motion, pain and weak-
ness. Chapter II of the A.M.A. Guides (second edition) "The Nervous System" pro-
vides a grading scheme and procedure for determining impairment of an affected
body part due to pain, discomfort, or loss of sensation. The element of pain may
serve as the sole basis for determining the degree of impairment for schedule award
purposes. Paul A. Toms, 38 ECAB 403 [1987]. Robin L. McClain, 38 ECAB 398 [1987].
Schedule awards are paid under the Act for a permanent impairment involving
the loss or loss of use of certain members of the body, without regard to whether in
fact there has been a resultant loss in wage-earning capacity. Glen R. Clark, 38
ECAB 724 [1987].
The Office referral orthopedic surgeon utilized the A.M.A. Guides in determining
appellant's range of motion with respect to the right fifth finger. The doctor added
that appellant had a 25 percent loss of sensation and a 35 percent loss of strength.
The Office medical adviser reviewed the orthopedic surgeon's findings and conclu-
sions and estimated that appellant had a 34 percent impairment of the right fifth
finger. The medical adviser followed the instructions provided by the Guides for de-
termining the percentage of impairment of the right fifth finger regarding sensory
loss and loss of strength, and estimated that appellant had a two percent and three
percent impairment, respectively. The medical adviser applied the Combined Values
Chart of the Guides in estimating that appellant had a 34 percent impairment of
the right fifth finger. George A. Phillips, 38 ECAB 513 [1987].
An Office medical adviser's use of the Combined Values Chart of the A.M.A.
Guides to combine the impairment of the hand that was contributed by each digit
was not the method prescribed by the Guides. The Guides specify that the sum of
the values of the impairment of each digit represents the impairment of the hand.
Chester E. Menter, 38 ECAB 697 [1987].
The Board found that the case was not in posture for decision. The Office medical
consultant applied the Office's new standard for determining the extent of hearing
loss to the audiometric test results and determined that appellant had a 3.75 per-
cent monaural hearing loss in his right ear, a 46.88 percent monaural hearing loss
in his left ear which equaled an 11 percent binaural hearing loss. The Board noted,
however, that FECA Program memorandum No. 81 provides: "On occasion, the al-
lowances for loss of hearing in each ear, if computed separately, may be greater
than the combined value of bilateral hearing loss." In such cases, the employee
should be given the benefit of the more favorable allowance. Thus, the claimant
should be compensated in accordance with the scheduled allowance for the sum of
loss of hearing of each ear. Calculated separately appellant's schedule award using
the monaural hearing loss figures would result in 26.33 weeks of compensation
(46.88 percent multiplied by 52 weeks plus 3.75 percent multiplied by 52 weeks), as
opposed to 22 weeks of compensation for an 11 percent binaural hearing loss. The
case was remanded to the Office for issuance of a schedule award in accordance
with the Federal Employees' Compensation Act Program Memorandum No. 181.
Clarence L. Weeks, 38 ECAB 613 [1987].
The Office properly determined that appellant's loss of hearing was not sufficient
to entitle him to a schedule award under the Act. This determination was based on
an Office medical consultant's proper application of the Office standards to the only
audiogram in the case record which is in accordance with the Office's requirements
as set forth in its Procedure Manual to conclude that appellant had no ratable loss
of hearing. James L. Andrews, 38 ECAB 731 [1987].
The case was not in posture for decision based on a conflict in medical opinion
between appellant's treating physician and an Office referral physician. The former
reported chondromalacia with a small partial tear of the lateral meniscus, noted at-
rophy of the quadriceps muscle and, based on appellant's complaints of discomfort,
estimated that appellant had a five percent impairment of the left lower extremity.
The latter reported that appellant exhibited minimal atrophy with no loss of motion
of the left knee, minimal grade I subpatellar chrondromalacia present on both
knees and diagnosed a normal left knee with no impairment related to the employ-
ment injury. The Board instructed the Office to refer appellant to an impartial spe-
cialist for a report on the nature and extent of any impairment to the left knee
causally related to September 21, 1979 and to instruct the impartial specialist to uti-
lize the A.M.A. Guides, including Chapter II, if applicable. Paul A. Toms, 38 ECAB
403 [1987].
The Board found that the case was not in posture for decision. The Office referral
physician, described his findings on examination, noted appellant's subjective com-
plaints of pain and calculated a 20 percent permanent impairment of appellant's
left knee. The doctor did not indicate that he utilized the A.M.A. Guides in his cal-
culations. The Office medical adviser indicated he utilized Tables 37 and 38 of the
A.M.A. Guides and calculated a ten percent impairment of appellants left knee, the
maximum allowable for a meniscectomy. The Office medical adviser provided no im-
pairment rating for loss of motion or atrophy, stating no such figures were indicat-
ed. The referral physician's reports noted complaints of continued knee pain and
discomfort, but the Office medical adviser failed to utilize Table 4 on page 73 of the
A.M.A. Guides and assign an impairment rating for pain, discomfort or loss of sen-
sation. The Board directed the Office to request that the Office referral physician
provide an evaluation utilizing the A.M.A. Guides by reference to the appropriate
section, table and page. Ruth Randich, 38 ECAB 631 [1987].
The larynx is a member of the body for which a schedule award is payable under
the Act for 160 weeks for a total permanent impairment. Under the A.M.A. Guides,
impairment to the larynx is determined by impairment of claimant's ability to
speak, which is evaluated as to audibility, intelligibility, and functional efficiency.
Martin J. Epp, 38 ECAB 854 [1987].
The physicians who examined appellant did not give any evaluation of appellant's
speech in terms of audibility, intelligibility, and functional efficiency, the criteria
specified in the A.M.A. Guides. As their reports showed that appellant had a condi-
tion that may permanently affect his ability to speak, the case was remanded for
further development, including an examination by another appropriate physician in
accordance with the A.M.A. Guides. Martin J. Epp, 38 ECAB 854 [1987].
Appellant had no more than a 19 percent permanent impairment of the left leg.
An Office medical consultant used the combined values chart of the A.M.A. Guides
to arrive at a 19 percent permanent impairment of the left leg based on the impair-
ment reported by appellant's attending physician. He properly applied the A.M.A.
Guides in reaching this percentage. There was no medical evidence of a greater loss
of use of the left leg. Ted R. Soares, 38 ECAB 480 [1987].
The reports of the attending physician were not complete in their description of
appellant's left lower extremity impairment and did not express the loss in degrees
of motion or other pertinent impairment of the member. To obtain this information,
appellant was referred by the Office to a Board-certified orthopedic surgeon, who
provided his findings and concluded that appellant had a 25 percent disability of the
whole man. The report was subsequently reviewed by an Office medical adviser who
noted that the whole man estimate of impairment was not in accordance with the
procedures provided by the A.M.A. Guides and concluded that appellant had a four
percent impairment of the left lower extremity due to sensory deficit, pain and dis-
comfort. In reaching his impairment estimate, the Office medical adviser described
his application of the A.M.A. Guides. The Board found however, that the Office
medical adviser's determination did not include any findings based on loss of
strength as was found by the referral specialist. The Board directed the Office to
issue a de novo decision following further development. David E. Fishback, 38 ECAB
654 [1987].
The medical reports failed to provide a full description of the residual impairment
of appellant's right ankle due to the employment injury or describe the nature and
extent of subjective factors, such as pain and weakness, to the legs due to the ac-
cepted phlebitis. The "whole man" impairment ratings provided by the physicians
are not provided for under the Act and were not responsive to the Office's request
for an evaluation in accordance with the A.M.A Guides. The case was remanded to
the Office to refer appellant for examination by a Board-certified orthopedic surgeon
for a full description of the nature and extent of residual impairment and an eval-
uation of impairment to the lower extremities due to appellant's thrombophlebitis.
In this regard, the specialist was requested to determine the extent of impairment
for loss of motion, pain or weakness in accordance with Chapter II of the A.M.A.
Guides. Gary L. Loser, 38 ECAB 673 [1987].
A schedule award is not payable for the loss or loss of use of a part of the body
not specifically enumerated in the FECA. In the William Edwin Muir decision the
Board held that this principle applied equally to body members which were not in
the schedule provision as it read before the 1974 amendments and to organs which
are not enumerated in the regulations promulgated pursuant to the 1974 amend-
ments. The back is specifically excluded from the definition of "organ" and neither
the Act nor the regulations provide for payment of a schedule award for loss or loss
of use of the back. Robert E. Wingate, 38 ECAB 361 [1987]; Glen R. Clark, 38 ECAB
724 [1987].
An appropriate method of evaluating the extent of any permanent impairment is
found in the A.M.A. Guides to the Evaluation of Permanent Impairment, the use of
which has been approved by the Board. Among the elements which may be consid-
ered in determining the extent of impairment are loss of motion, pain and weak-
ness. Chapter II of the A.M.A. Guides (second edition) "The Nervous System" pro-
vides a grading scheme and procedure for determining impairment of an affected
body part due to pain, discomfort, or loss of sensation. The element of pain may
serve as the sole basis for determining the degree of impairment for schedule award
purposes. Paul A. Toms, 38 ECAB 403 [1987].
SHOCK ABSORPTION DUE TO MENISCECTOMY
Though appellant was found to have a six percent impairment of the right leg for
a partial meniscectomy, the case was set aside and remanded as not in posture for
decision where none of the physicians examining him addressed whether he sus-
tained a loss of shock absorption as a result thereof. Under the A.M.A. Guides if
appellant has a loss of shock absorption in the joint as a result of a meniscectomy
he is considered to have at least a ten percent permanent impairment of his leg due
to this factor but if he does not have a loss of shock absorption the Office need not
consider this factor in determining the amount of the schedule award for the leg.
Charles P. Shinn, 38 ECAB 266 [1986].
The Board found that appellant had a 100 percent permanent impairment of the
right fifth toe. The orthopedic surgeon who operated on appellant, reported that he
removed the distal and middle phalanges of appellant's right fifth toe due to the
gangrene that developed secondary to the employment injury. The Office medical
adviser utilized the A.M.A. Guides and concluded that removal of these two pha-
langes, constituted an 80 percent impairment of the toe. The Office, however, failed
to apply section 8107(c)(15) of the FECA which provides that "compensation for loss
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