United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

B.S., Appellant 

and 

DEPARTMENT OF THE AIR FORCE, ROBINS 

AIR FORCE BASE, GA, Employer 

__________________________________________ 

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Docket No. 13-2058 

Issued: March 11, 2014 

Appearances: Case Submitted on the Record

Appellant, pro se 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

COLLEEN DUFFY KIKO, Judge 

ALEC J. KOROMILAS, Alternate Judge 

MICHAEL E. GROOM, Alternate Judge 

JURISDICTION 

On September 9, 2013 appellant filed a timely appeal from a July 5, 2013 merit decision 

of the Office of Workers’ Compensation Programs (OWCP). Pursuant to the Federal 

Employees’ Compensation Appeals 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 more than 11 percent impairment of the left arm. 

On appeal, appellant contends that his physician made a mistake on his report in that his 

surgery was for Dupuytren’s release. 

 1

 5 U.S.C. § 8101 et seq.
2

FACTUAL HISTORY 

On May 3, 2000 appellant, then a 46-year-old sheet metal worker, sustained injury to his 

left hand while in the performance of duty. OWCP accepted his claim for a contusion of the left 

hand with Dupuytren’s contracture. On July 18, 2000 Dr. Guy D. Foulkes, a Board-certified 

orthopedic surgeon, performed a subtotal palmar fasciectomy on appellant’s left hand to treat his 

left Dupuytren’s disease. On December 11, 2001 OWCP accepted appellant’s claim for left 

contracted palmar fascia. 

On January 7, 2002 OWCP granted a schedule award for an 11 percent impairment to 

appellant’s left arm. This impairment rating was based on the fourth edition of the American 

Medical Association, Guides to the Evaluation of Permanent Impairment (1993) (A.M.A., 

Guides). OWCP denied appellant’s request for reconsideration on January 21, 2003. 

On September 9, 2010 Dr. Robert L. Howell, a Board-certified surgeon with additional 

Board-certifications in plastic surgery and surgery of the hand, performed an excision of 

Dupuytren’s disease on appellant’s left palm and long finger and palm and ring finger. 

On October 30, 2012 appellant filed a claim for an additional schedule award. He 

submitted a July 24, 2012 report from Dr. Carlos Giron, a treating physician in pain medicine, 

who indicated that appellant’s diagnosis was right hand de Quervain’s tenosynovitis for which 

he underwent a de Quervain’s tenosynovitis release by Dr. Howell. Dr. Giron found that 

appellant had a three percent impairment of his hand and a three percent impairment of his upper 

extremity. Applying Table 15-2 of the sixth edition of the A.M.A., Guides.2

 Dr. Giron noted 

that stenosing synovitis (de Quervain’s) listed an impairment class for the diagnosed condition 

(CDX) of one with mid-range default of six percent digit impairment (one percent hand, one 

percent upper extremity). He noted no grade modifiers for Clinical Studies (GMCS), a grade 2 

modifier for Functional History (GMFH) (decreased active range of motion and increased pain, 

unable to tolerate tool usage on a constant basis), and a grade 2 modifier for Physical 

Examination (GMPE) (decreased range of motion and strength resulting grade modifier of 2 

pursuant to Table 15-31). Dr. Giron calculated GMFH - CDX (2-1) equaled 1; GMPE - CDX 

(2-1) equaled 1, and that GMCS was nonapplicable or 0. Adding these figures together (1+1-0), 

he found that appellant had an adjustment of 2 to the right of default grade C, resulting in a grade 

E, which equaled an eight percent digit impairment, or a three percent impairment of the hand or 

a three percent impairment of the upper extremity. 

By letter dated November 13, 2012, OWCP informed appellant that Dr. Giron did not 

specify which hand was rated, but that it appeared it was the right hand. It noted that an injury to 

the right hand was not an accepted medical condition. Further, the diagnosis of de Quervain’s

tenosynovitis did not appear to be related to the accepted left contracted palmar fascia. OWCP 

requested that appellant submit additional medical evidence to establish greater impairment than 

the 11 percent previously compensated. 

In a November 22, 2012 response, Brian Tharpe, a physical therapist, noted that an error 

had been made and that Dr. Giron had addressed appellant’s left hand and upper extremity. 

 2

 A.M.A., Guides 392. 
3

Although appellant received a previous impairment rating in 2002, he sustained a recurrent 

injury to his left hand, and that, “[t]he three [percent] impairment noted in the report should be 

considered an apportionment to his previous rating in 2002. Therefore, we stand by our rating of 

three [percent] left upper extremity impairment.” On December 20, 2012 OWCP received a 

corrected copy of Dr. Giron’s July 24, 2012 rating. Dr. Giron advised that appellant had left 

hand de Quervain’s tenosynovitis and noted that the impairment rating was for three percent of 

the left hand or three percent of the left upper extremity. 

On December 26, 2012 Dr. H.P. Hogshead, a medical adviser, reviewed the prior 11 

percent impairment rating. The claim was accepted for a Dupuytren’s contracture of the left 

hand for which surgery was performed and the 2002 schedule award was granted. Dr. Hogshead 

noted that appellant recently developed a de Quervain’s stenosing tenosynovitis of the first 

dorsal compartment of the left wrist extensors. He stated that appellant’s accepted condition did 

not include de Quervain’s tendinitis. Dr. Hogshead noted that de Quervain’s disease was an 

entirely different entity than Dupuytren’s contracture and had nothing in common. He concluded 

that no additional impairment rating was appropriate. 

By decision dated January 11, 2013, OWCP denied appellant’s claim for an additional 

schedule award. It found that the de Quervain’s tendinitis rated by Dr. Giron was not an 

accepted condition. 

In reports dated December 20, 2012 through May 15, 2013, Dr. Giron listed his 

impression as left hand contusion; left hand palmer contractures; and left upper extremity 

complex regional pain syndrome/reflex sympathetic dystrophy. He also noted Dupuytren’s 

contractures in both hands. In a September 22, 2010 note, Dr. Howell advised that appellant had 

Dupuytren’s disease in his left palm as well as Dupuytren’s disease with contracture to his left 

finger, for which he underwent surgery on September 9, 2010. On February 12, 2013 

Mr. Tharpe stated that his original report did not address the Dupuytren’s contracture or surgical 

releases. Based on appellant’s limited use of hands, the three percent impairment rating was 

considered an apportionment to the previous rating in 2002. 

On April 18, 2013 appellant requested reconsideration contending that there was a 

misunderstanding on his evaluation in that the examiner addressed the wrong surgery in the 

report. He stated that his surgery was for a Dupuytren’s release performed by Dr. Howell. 

On June 3, 2013 Dr. Hogshead reviewed the medical record and noted that the 

February 12, 2013 letter of Mr. Tharpe suggested a typographical error that referred to 

de Quervain’s rather than Dupuytren’s contracture. Dr. Hogshead stated that the therapist was 

confusing de Quervain’s with Dupuytren’s disease. He reiterated that de Quervain’s disease was 

an entirely different entity than a Dupuytren’s contracture and had nothing in common. As 

de Quervain’s was not an accepted condition an impairment rating for de Quervain’s was not 

related to the accepted Dupuytren’s disease. 

In a July 5, 2013 decision, OWCP denied modification of the January 11, 2013 decision. 
4

LEGAL PRECEDENT 

The schedule award provision of FECA and its implementing regulations3 set forth the 

number of weeks of compensation payable to employee’s sustaining permanent impairment from 

loss or loss of use, of scheduled members or functions of the body. FECA, however, does not 

specify the manner in which the percentage of loss shall be determined. The method used in 

making such a determination is a matter that rests within the sound discretion of OWCP.4 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.5

 As of May 1, 2009, the 

sixth edition of the A.M.A., Guides is used to calculate schedule awards.6

The sixth edition requires identifying the impairment class for the diagnosed condition 

(CDX), which is then adjusted by grade modifiers based on GMFH, GMPE and GMCS.7

 The 

net adjustment formula is (GMFH-CDX) + (GMPE-CDX) + (GMCS-CDX).8

 The sixth edition 

of the A.M.A., Guides also provides that range of motion may be selected as an alternative 

approach in rating impairment under certain circumstances. A rating that is calculated using 

range of motion may not be combined with a diagnosis-based impairment and stands alone as a 

rating.9

OWCP’s procedures provide that, after obtaining all necessary medical evidence, the file 

should be routed to an OWCP medical adviser for an opinion concerning the percentage of 

impairment using the A.M.A., Guides.

10

ANALYSIS 

OWCP accepted appellant’s claim for a contusion of the left hand with Dupuytren’s 

contracture and left contracted palmar fascia. On July 18, 2000 Dr. Foulkes performed a subtotal 

palmar fasciectomy on appellant’s left hand to treat the left Dupuytren’s disease. On January 7, 

2002 OWCP granted appellant a schedule award for 11 percent impairment of his left arm. 

 3

 20 C.F.R. § 10.404. 

4 Linda R. Sherman, 56 ECAB 127 (2004); Daniel C. Goings, 37 ECAB 781 (1986). 

5 Ronald R. Kraynak, 53 ECAB 130 (2001). 

6

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

Chapter 2.808.6.6a (January 2010); see also Part 3 -- Medical, Schedule Awards, Chapter 3.700.2 and Exhibit 1 

(January 2010). 

7

 A.M.A., Guides 494-531. 

8 Id. at 521. 

9 L.B., Docket No. 12-910 (issued October 5, 2012). 

10 Federal (FECA) Procedure Manual, supra note 6 at Chapter 2.808.6(d) (August 2002). 
5

Appellant had additional surgery on September 9, 2010, when Dr. Howell performed an excision 

of Dupuytren’s disease in appellant’s palm and long finger and palm and right finger. 

Appellant requested an additional schedule award and submitted the July 24, 2012 report 

of Dr. Giron, who rated a three percent impairment of the hand and a three percent impairment of 

the upper extremity. The Board notes that the rating by Dr. Giron is of reduced probative value 

as the report listed appellant’s right hand but the accepted conditions pertain to appellant’s left 

hand. Furthermore, the rating was based on a diagnosis of de Quervain’s disease, not the 

accepted conditions which included left Dupuytren’s disease. When applying Table 15-2 of the 

A.M.A., Guides, Dr. Giron indicated that digital stenosing tenosynovitis, as listed in the A.M.A., 

Guides, was de Quervain’s, and he rated this diagnosis, but it is not an accepted condition, as 

noted by Dr. Hogshead, who advised that de Quervain’s was an entirely different entity than 

Dupuytren’s contracture and the two conditions had nothing in common. 

Dr. Giron subsequently provided a correction of the July 24, 2012 report and stated that 

the rating was for the left hand; however, the impairment rating was based on the diagnosis of de 

Quervain’s tenosynovitis. 

Mr. Tharpe stated that appellant actually had Dupuytren’s contracture and that the 

surgical releases were performed to correct this condition. He also stated that the three percent 

impairment rating should be considered as an apportionment to the 2002 rating. As this report is 

not countersigned by a physician, it does not constitute probative medical evidence.11 

The remaining evidence submitted on reconsideration is not probative on the issue of 

permanent impairment. Dr. Giron’s reports noted continued treatment of appellant. Dr. Howell 

indicated that he treated appellant’s Dupuytren’s disease. Neither physician addressed the issue 

of permanent impairment based on the conditions accepted in this case. 

The Board finds that appellant did not submit medical evidence to establish that he has 

greater than 11 percent impairment of his left arm. 

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 greater than 11 percent impairment of 

the left upper extremity, for which he received a schedule award. 

 11 Evidence submitted by Mr. Tharpe, a “certified functional capacity evaluator” for a physical therapy practice is 

of no probative medical evidence. The Board has held that such persons as physician’s assistants and physical 

therapists are not competent to render a medical opinion under FECA. See David P. Sawchuk, 57 ECAB 316 (2006) 

(lay individual such as physician’s assistants, nurses and physical therapists are not competent to render a medical 

opinion under FECA); 5 U.S.C. § 8101(2) (this subsection defines a “physician as surgeons, podiatrists, dentists, 

clinical psychologists, optometrists, chiropractors and osteopathic practitioners within the scope of their practice as 

defined by State law). 
6

ORDER 

IT IS HEREBY ORDERED THAT the July 5, 2013 decision of the Office of Workers’ 

Compensation Programs is affirmed. 

Issued: March 11, 2014 

Washington, DC 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board 

 

 Michael E. Groom, Alternate Judge 

 Employees’ Compensation Appeals Board