United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

S.S., Appellant 

and 

DEPARTMENT OF JUSTICE, EXECUTIVE 

OFFICE FOR IMMIGRATION REVIEW, 

Falls Church, VA, Employer 

__________________________________________ 

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Docket No. 14-1610 

Issued: November 25, 2014 

Appearances: Case Submitted on the Record

Appellant, pro se 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

COLLEEN DUFFY KIKO, Judge 

PATRICIA HOWARD FITZGERALD, Judge 

MICHAEL E. GROOM, Alternate Judge 

JURISDICTION 

On July 14, 2014 appellant filed a timely appeal from a June 24, 2014 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 sustained permanent impairment of the left upper 

extremity. 

FACTUAL HISTORY 

On September 30, 2011 appellant, then a 56-year-old legal assistant, filed an occupational 

disease claim (Form CA-2) alleging that she developed a cyst on her left wrist as a result of her 

 1

 5 U.S.C. § 8101 et seq.
2

federal employment duties. On January 3, 2012 OWCP accepted the claim for aggravation of 

left wrist ganglion cyst. On November 13, 2013 appellant underwent a left wrist cyst excision 

which was approved by OWCP. 

In a February 28, 2014 treatment note, Dr. Erika Gantt, a Board-certified orthopedic 

surgeon, reported that appellant was doing well following her left wrist cyst excision despite 

complaints of tightness and scar discomfort. According to the North Carolina Industrial Rating 

Guide, she opined that appellant had two percent permanent partial impairment to the left wrist 

as a result of the work-related surgery. 

By letter dated April 21, 2014, counsel for appellant argued that Dr. Gantt’s 

February 28, 2014 report provided an impairment rating which established her claim for a 

schedule award. On May 9, 2014 appellant filed a claim for a schedule award (Form CA-7). 

By letter dated May 19, 2014, OWCP requested that appellant submit an impairment 

evaluation from her attending physician in accordance with the American Medical Association, 

Guides to the Evaluation of Permanent Impairment (6th ed. 2009) (A.M.A., Guides). It provided 

her 30 days to submit the requested impairment evaluation. No additional evidence was 

received. 

By decision dated June 24, 2014, OWCP denied appellant’s claim for a schedule award. 

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.2 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.3

It is the claimant’s burden to establish that he or she has sustained a permanent 

impairment of the scheduled member or function as a result of any employment injury.4

 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 maximum medical improvement), describes the 

 2 Id. at § 8107; 20 C.F.R. § 10.404. 

3 K.H., Docket No. 09-341 (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). 

4 Tammy L. Meehan, 53 ECAB 229 (2001). 
3

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.

5

ANALYSIS 

OWCP accepted appellant’s claim for left wrist ganglion and cyst of synovium, tendon 

and bursae. On May 9, 2014 appellant filed a claim for a schedule award. By decision dated 

June 24, 2014, OWCP denied her schedule award claim finding that she did not submit an 

impairment evaluation to establish a permanent impairment resulting from her work injury. 

The Board finds appellant has not submitted sufficient medical evidence to establish any 

permanent impairment to her left upper extremity due to her accepted condition.6

 In support of 

her claim, appellant submitted a February 28, 2014 report from Dr. Gantt, who opined that 

appellant had a two percent permanent impairment of the left upper extremity based on the North 

Carolina Industrial Rating Guide. 

The Board notes that OWCP procedures provide that maximum medical improvement 

(MMI) must be reached before a schedule award can be made.7 In this case, Dr. Gantt did not 

address whether appellant had reached MMI as a result of her accepted left wrist dorsal ganglion 

cyst following the November 13, 2013 surgery. Moreover, he failed to provide an impairment 

rating based on the sixth edition of the A.M.A., Guides.

8

 Dr. Gantt failed to provide findings 

from physical examination which could establish a ratable permanent impairment in accordance 

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

9

By letter dated May 19, 2014, OWCP informed appellant of the evidence necessary to 

establish her schedule award claim. It specifically requested that she submit an impairment 

evaluation from her attending physician in accordance with the sixth edition of the A.M.A., 

Guides. Appellant did not respond. 

It is appellant’s burden of proof to establish a permanent impairment of a scheduled 

member as a result of an employment injury.10 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 

 5

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

Chapter 2.808.5(b) (February 2013). 

6 T.V., Docket No. 13-533 (issued June 19, 2013). 

7

 FECA (FECA) Procedure Manual, Part 3 -- Medical, Schedule Awards, Chapter 3.700 (January 2010). 

8 Id.

9 V.L., Docket No. 11-2048 (issued June 11, 2012). 

10 See supra note 4. 
4

limitations.11 Appellant did not submit such evidence. The Board finds that OWCP properly 

denied her schedule award claim.12 

On appeal, appellant argues that OWCP’s June 24, 2014 schedule award decision was in 

error and resubmitted Dr. Gantt’s February 28, 2014 medical report.13 As noted, this evidence is 

insufficient to establish her permanent impairment. There is no probative medical evidence of 

record, in conformance with the sixth edition of the A.M.A., Guides, establishing that appellant 

sustained any permanent impairment of the left arm as a result of her employment injury.14

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 she is entitled to a schedule award. 

 11 See A.L., Docket No. 08-1730 (issued March 16, 2009). 

12 L.F., Docket No. 10-343 (issued November 29, 2010); V.W., Docket No. 09-2026 (issued February 16, 2010). 

13 The Board notes that on February 4, 2014 appellant retained and authorized James M. Snow as counsel to 

represent her with respect to her OWCP claim. Appellant’s appeal before the Board pertains to OWCP’s 

June 24, 2014 decision only as she has not appealed or provided argument in support of the other OWCP decisions 

issued in her claim. 

14 M.B., Docket No. 12-361 (issued September 10, 2012). 
5

ORDER 

IT IS HEREBY ORDERED THAT the Office of Workers’ Compensation Programs’ 

decision dated June 24, 2014 is affirmed. 

Issued: November 25, 2014 

Washington, DC 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 Patricia Howard Fitzgerald, Judge 

 Employees’ Compensation Appeals Board 

 

 Michael E. Groom, Alternate Judge 

 Employees’ Compensation Appeals Board