Appellant subsequently submitted the March 26, 1987 report of Dr. Ochoa who stated in relevant part as follows: “*** This patient is known to have a plantar fascitis with the formation of os calcis spur on both sides. Knowing that he works as a mailman, delivering mail, this requires several miles of walking with a mailbag. It is difficult for this man to carry out his normal duties in a normal manner due to the complaints of the feet. He is advised that the only way to be engaged in a gainful activity is to change employment.*** "Diagnoses: (1) chronic bursitis, left shoulder; (2) plantar fascitis, both feet; (3) bilateral hip complaints; and (4) lumbosacral strain." By letter dated April 6, 1987, the Office informed appellant that Dr. Ochoa advised that he was not totally disabled for all work and further stated as follows: "Also, since your physician has indicated that the reason for your disability is your foot condition, it is your responsibility to prove that your current foot condition is still related to factors of your employment. We have accepted an aggravation of bilateral plantar fascitis as related to your job. Since you are no longer working, you must prove that the aggravation still exists." In a September 8, 1987 work restriction evaluation form, Dr. Ochoa set forth appellant's work tolerance limitations and advised that appellant was capable of working four hours a day. On May 6, 1988, appellant filed a claim for an additional schedule award. In support of his claim, appellant submitted with his claim the May 3, 1988 narrative report and May 5, 1988 attending physician's report of Dr. Ochoa. In both reports, Dr. Ochoa advised that appellant's condition "has continued to be about the same with no changes of his medical condition" submitted the same diagnoses as set forth in his March 26, 1987 report and further stated as follows: "This patient is entitled to a permanent medical impairment of the back up to 10 percent and in the left upper extremity, five percent, and the lower extremity, 10 percent each." Dr. Ochoa did not indicate the basis of his impairment ratings. By letter dated May 23, 1988, the Office advised Dr. Ochoa of appellant's accepted employment conditions and further advised that schedule awards were not payable for the back. The Office again requested that Dr. Ochoa determine appellant's impairment ratings in accordance with the A.M.A. Guides. In a report dated August 15, 1988, Dr. Ochoa reported findings on examination as follows: "Examination shows the left shoulder motion is complete with mild discomfort and pain at the extremes of motion. Neurological examination of the upper extremities is normal; good sensation; good strength. Regarding the lumbosacral spine, the patient complains of pain at the level of the lumbar area; mild to moderate; aggravated by prolonged sitting position, forward flexion and lifting. There are no neurological complaints with the lower extremities. The raising leg test is negative. Regarding the heels, bilaterally, the patient complains of pain at the level of the plantar aspect of both heels; aggravated by walking and standing. Palpation of this area also produces severe pain. "Diagnoses: (1) chronic bursitis, left shoulder; (2) plantar fascitis, both feet; (3) bilateral hip complaints; and (4) lumbosacral strain." In a November 15, 1988 report, Dr. Ochoa stated that examination revealed full range of motion of the left shoulder with slight pain at the extremes of motion, that neurological examination of the left upper extremity was normal and that there was mild tenderness to palpation over the lumbar paravertebral muscles of the back but that motion of the back was complete with slight complaints of pain at the extremes of motion. On February 12, 1989, an Office medical adviser reviewed the medical evidence of record and determined, that based on the recent reports of Dr. Ochoa and the A.M.A. Guides, appellant's current impairment ratings were: three percent of the left upper extremity; three percent of the right lower extremity and three percent of the left lower extremity. The Office medical adviser explained his calculations as follows: "Left Upper Extremity: Pain: axillary nerve; maximum [percentage of impairment] equals five percent. [Applicable A.M.A. tables] Class 3, Table 4, p. 73 equals 60 percent. Sixty percent of five percent equals three percent PPI [permanent partial impairment] of the LUE [left upper extremity]. "A previous Office medical adviser (April 27, 1986) had calculated an award of 13 percent; however eight percent of that was attributed to limitation of range of motion of the shoulder. Dr. Ochoa now says that the range of motion of the left shoulder is normal. Dr. Ochoa currently describes the pain in the shoulder as mild; whereas, previously it was awarded a value of five percent. I believe that the three percent is more accurate in view of the recent description. "Right Lower Extremity: Pain: sural nerve. [Applicable A.M.A. tables] Class 3, Table 4, p. 73 equals 60 percent. Sixty percent of five percent equals three percent PPI of the RLE [right lower extremity]. "Left Lower Extremity: Pain: sural nerve. [Applicable A.M.A. tables] Class 3, Table 4, p. 73 equals 60 percent. Sixty percent of five percent equals three percent PPI of the LLE [left lower extremity]." By letter decision dated February 27, 1989, the Office denied appellant's May 6, 1988 claim for an additional schedule award on the ground that the medical evidence failed to establish that he had sustained additional impairment since his June 20, 1986 schedule award. The Office stated in relevant part as follows: "You have received a schedule award for three percent permanent impairment to your right foot, three percent to your left foot, and 13 percent impairment to your left arm. This totals 370.02 days of compensation. On May 6, 1988 you filed a claim for an additional schedule award. Current medical evidence establishes a three percent impairment to your right leg, three percent to your left leg, and three percent impairment to your left arm; this current rating is equivalent to 186.40 days of compensation, you have no further entitlement at this time." By letter received by the Office July 6, 1989, appellant requested reconsideration of his May 6, 1988 claim for an additional schedule award on the basis that his physician, Dr. Ochoa, had stated that appellant's percentage of disability had increased since appellant's retirement. In support of his claim, appellant submitted the May 15, 1989 report of Dr. Ochoa who submitted his examination findings and conclusion as follows: "Regarding the left shoulder, complaints are minimal. Regarding the feet, the patient continues to complain of pain at the level of the plantar aspect of both heels; aggravated by prolonged standing position and prolonged walking. Examination of the patient's back reveals tenderness over the lumbar area. Motion of the back is complete in all directions; although, accompanied with complaints of pain at the extremes of motion. There is no evidence of muscle spasm. The raising test produces back pain with no radicular component. The neurological examination of the lower extremities is normal. Regarding examination of both heels, there is tenderness to palpation over the plantar aspect of both heels and the shoes have been modified to see if that will give some relief on ambulation. "Diagnoses: (1) chronic bursitis, left shoulder; (2) plantar fascitis, both feet; (3) bilateral hip complaints; and (4) lumbosacral strain. 66# ** It is still my opinion that this patient is entitled to a permanent medical impairment of his back up to 10 percent, five percent for the left upper extremity and 10 percent of each lower extremity, based on the presence of the os calcis spur and persistency of the painful symptoms and ambulation.* * *99 By compensation order dated July 17, 1989, the Office denied appellant's application for review on the ground that the evidence submitted was cumulative in nature and, therefore, insufficient to warrant a merit review. In the accompanying memorandum, the Office stated as follows: "In the instant case, the evidence submitted consisting of Dr. Ochoa's May 15, 1989 report is considered to be cumulative in nature because the doctor simply restated his position that the claimant should be entitled to a permanent medical impairment of 10 percent of the back; five percent of the left upper extremity; and 10 percent of each lower extremity. He does not state that he correlated his findings to the A.M.A. Guides to arrive at a recommended percentage of permanent impairment. Apparently, the doctor's percentage of impairment is based solely on subjective complaints of pain. He gave no objective findings of loss of range of motion to support objectively any permanent impairment. The opinion expressed is the same as the opinion expressed on May 15, 1988 which was also not correlated to the A.M.A. Guides.* *99 By letter dated August 18, 1989, appellant requested reconsideration and, in support of this request, submitted the August 7, 1989 report of Dr. Ochoa who stated in relevant part as follows: "The patient showed me a letter where he was explained that no benefits were given to him because the range of motion the patient has in his lower extremities, left upper extremity and back is within normal range. However, according to where they obtained these values for the impairment of this patient, the A.M.A., does not count anything for pain the patient has when he is executing motion. For this patient, the disabling factor is the pain, not the range of motion." By compensation order dated September 11, 1989, the Office denied appellant's application for review on the ground that the evidence submitted was insufficient to warrant merit review of his claim. In the accompanying memorandum, the Office stated as follows: "Dr. Ochoa states in his report that the A.M.A. Guides do not take pain into account when determining the percentage of impairment. He does not provide any rationalization for restating his previous opinion that the claimant is restricted by his subjective complaints of pain. The fact that he stated that the A.M.A. Guides were not used in making his determination on disability strengthens the findings of the District Medical Adviser. [The District Medical Adviser] used the reports of Dr. Ochoa to make his determination and provided a well rationalized report in support of his findings. The report from Dr. Ochoa is an accumulation of material contained in his previous reports. It is found to be repetition in nature and not sufficient to warrant a review of the case file." The Board finds that the medical evidence currently of record fails to establish that appellant is entitled to an additional schedule award. The schedule award provision of the Federal Employees' Compensation Act 3 and its implementing regulation, set forth the number of weeks of compensation to be paid for permanent loss, or loss of use, of members or functions of the body listed in the schedule. However, neither the Act nor its regulations specify the manner in which the percentage loss of a member shall be determined. For consistent results and to ensure equal justice to all claimants, the Board has authorized the use of a single set of tables in evaluating schedule losses so that there may be uniform stand '5 U.S.C. §§ 8101 et seq, see 5 U.S.C. § 8107(c). 20 C.F.R. § 10.304. |