United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

B.G., Appellant 

and 

DEPARTMENT OF VETERANS AFFAIRS, 

VETERANS ADMINISTRATION MEDICAL 

CENTER, Dublin, GA, Employer 

__________________________________________ 

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Docket No. 14-1582 

Issued: November 6, 2014 

Appearances: Case Submitted on the Record

Appellant, pro se 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

PATRICIA HOWARD FITZGERALD, Judge 

ALEC J. KOROMILAS, Alternate Judge 

JAMES A. HAYNES, Alternate Judge 

JURISDICTION 

On July 8, 2014 appellant filed a timely appeal from an April 25, 2014 merit decision of 

the Office of Workers’ Compensation Programs (OWCP) which denied 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 has a ratable impairment of the upper extremities. 

FACTUAL HISTORY 

Appellant, a 64-year-old former lead file clerk, has an accepted occupational disease 

claim for bilateral carpal tunnel syndrome (CTS), which arose on or about February 21, 2012.2

 

 1

 5 U.S.C. §§ 8101-8193. 

2

 Appellant has also been diagnosed with peripheral neuropathy and osteoarthritis of the hands, which OWCP has 

not accepted as employment related. 
2

She retired effective June 30, 2012. Appellant underwent a right carpal tunnel release on 

July 9, 2012, followed by a left carpal tunnel release on October 15, 2012. Dr. James D. Peters, 

a Board-certified orthopedic surgeon, performed both procedures, which OWCP authorized. 

On July 10, 2013 appellant filed a claim (Form CA-7) for a schedule award. Dr. Peters 

provided a March 2, 2013 impairment rating that referenced the fifth edition of the American 

Medical Association, Guides to the Evaluation of Permanent Impairment (2001). He diagnosed 

bilateral carpal tunnel syndrome and noted that appellant had undergone carpal tunnel releases 

on July 9 and October 15, 2012. Dr. Peters found three percent whole person impairment. He 

indicated that the rating was based on impairment of the left hand secondary to residual 

dysesthetic pain into the index finger. 

In a report dated July 12, 2013, Dr. Howard “H.P.” Hogshead, a Board-certified 

orthopedic surgeon and district medical adviser, found one percent bilateral upper extremity 

impairment based on residual dysesthesias. He diagnosed bilateral CTS and rated appellant 

under Table 15-23, Entrapment/Compression Neuropathy Impairment, A.M.A., Guides 449 

(6th ed. 2008). Dr. Hogshead opined that Dr. Peters’ March 2, 2013 impairment rating was 

incorrect. 

OWCP forwarded a copy of Dr. Hogshead’s July 12, 2013 report to Dr. Peters for his 

review. On July 31, 2013 Dr. Peters noted his disagreement, but did not otherwise explain why 

he disagreed with Dr. Hogshead’s assessment. 

OWCP declared a conflict in medical opinion and referred appellant for an impartial 

medical evaluation. 

Dr. Jeffrey C. Easom, a Board-certified orthopedic surgeon and impartial medical 

examiner, saw appellant on October 22, 2013. As part of his examination, he administered an 

upper extremity nerve conduction study (NCS), which was interpreted as normal and negative 

for bilateral CTS.3 Although the latest electrodiagnostic study was normal/negative, appellant’s 

 3

 The October 22, 2013 study did not include bilateral upper extremity needle electromyography. 
3

symptoms were noted to be consistent with carpal tunnel syndrome. Dr. Easom diagnosed 

bilateral CTS and found two percent bilateral upper extremity impairment under Table 15-23, 

A.M.A., Guides 449 (6th ed. 2008).4 

In a report dated November 26, 2013, a new district medical adviser, Dr. Guillermo M. 

Pujadas, a Board-certified orthopedic surgeon, questioned Dr. Easom’s October 22, 2013 

impairment rating based on entrapment neuropathy. He explained that an impairment rating 

under Table 15-23, A.M.A., Guides 449 (6th ed. 2008) must be premised on positive preoperative 

electrodiagnostic evidence of CTS. Dr. Pujadas noted that appellant’s February 2012 

preoperative NCS did not meet the criteria for rating impairment under Table 15-23.5 He 

recommended that OWCP obtain clarification from Dr. Easom regarding his interpretation of 

appellant’s electrodiagnostic studies. 

In a March 18, 2014 supplemental report, Dr. Easom noted that appellant’s preoperative 

electrodiagnostic study revealed normal nerve conduction. He reiterated his prior diagnosis of 

bilateral CTS. Because of appellant’s normal electrodiagnostic study, which were not available 

at the time of the initial evaluation, Dr. Easom found zero percent upper extremity impairment 

under Table 15-23, A.M.A., Guides 449 (6th ed. 2008). 

On April 24, 2014 another district medical adviser, Dr. James W. Dyer, a Board-certified 

orthopedic surgeon, reviewed the case file and commented that Dr. Easom’s October 22, 2013 

report was thorough, detailed and reflected the correct use of the A.M.A., Guides (6th ed. 2008). 

According to him, the October 22, 2013 report provided an “accurate [schedule award] for both 

[upper extremities] due to [bilateral] CTS.” Dr. Dyer did not specifically mention Dr. Easom’s 

March 18, 2014 supplemental report. 

By decision dated April 25, 2014, OWCP denied appellant’s claim for a schedule award. 

According to OWCP, the “DMA stated that the corrected report by Dr. Easom dated [March 18, 

2014] is a thorough detailed report that reflects the correct use of the [AMA, Guides]....” 

LEGAL PRECEDENT 

Section 8107 of FECA sets forth the number of weeks of compensation to be paid for the 

permanent loss of use of specified members, functions and organs of the body.6

 FECA, 

however, does not specify the manner by which the percentage loss of a member, function or 

organ shall be determined. To ensure consistent results and equal justice under the law, good 

administrative practice requires the use of uniform standards applicable to all claimants. The 

 4

 Dr. Easom assigned a grade modifier of 1 for test findings and a grade modifier of 2 for both history and 

physical findings. Additionally, he assigned a grade modifier of 1 for functional scale based on a reported 

QuickDASH score of 25. Dr. Easom then added the four above-noted grade modifiers (1+2+2+1=6) and divided 

by 4, resulting in an average grade modifier of 1.5, which he then rounded down to grade 1. Under Table 15-23, 

A.M.A., Guides 449 (6th ed. 2008), the default upper extremity rating for a grade 1 impairment is two percent. As 

discussed infra, Dr. Easom’s October 22, 2013 impairment rating is deficient for several reasons. 

5

 The previous DMA, Dr. Hogshead, noted in his July 12, 2013 report that appellant’s February 29, 2012 

electrodiagnostic study was completely normal. Based on the current record, the February 2012 study appears to 

have been the last upper extremity NCS administered prior to appellant’s July 9 and October 15, 2012 surgeries. 

6

 For total loss of use of an arm, an employee shall receive 312 weeks’ compensation. 5 U.S.C. § 8107(c)(1). 
4

implementing regulations have adopted the A.M.A., Guides as the appropriate standard for 

evaluating schedule losses.7 Effective May 1, 2009, schedule awards are determined in 

accordance with the sixth edition of the A.M.A., Guides (2008).8

When determining entitlement to a schedule award, preexisting impairment to the 

scheduled member should be included.9 Impairment ratings for schedule awards include those 

conditions accepted by OWCP as job related and any preexisting permanent impairment of the 

same member or function.10 If the work-related injury has affected any residual usefulness in 

whole or in part, a schedule award may be appropriate.11 There are no provisions for 

apportionment under FECA.12 When the prior impairment is due to a previous work-related 

injury and a schedule award has been granted for such prior impairment, the percentage already 

paid is subtracted from the total percentage of impairment.13

If there is disagreement between the physician making the examination for OWCP and 

the employee’s physician, OWCP shall appoint a third physician who shall make an 

examination.14 For a conflict to arise the opposing physicians’ viewpoints must be of “virtually 

equal weight and rationale.”15 Where OWCP has referred the employee to an impartial medical 

examiner to resolve a conflict in the medical evidence, the opinion of such a specialist, if 

sufficiently well rationalized and based upon a proper factual background, must be given special 

weight.16

ANALYSIS 

The Board finds that the case is not in posture for decision. 

OWCP declared a conflict in medical opinion based on differing impairment ratings 

between Dr. Peters, appellant’s physician, and Dr. Hogshead, one of several district medical 

adviser’s involved in the case. For a conflict to arise the opposing physicians’ viewpoints must 

 7

 20 C.F.R. § 10.404. 

8 See Federal (FECA) Procedure Manual, Part 3 -- Medical, Schedule Awards, Chapter 3.700, Exhibit 1 

(January 2010); id. at Part 2 -- Claims, Schedule Awards and Permanent Disability Claims, Chapter 2.808.6a 

(February 2013). 

9 Carol A. Smart, 57 ECAB 340, 343 (2006); Michael C. Milner, 53 ECAB 446, 450 (2002). 

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

Chapter 2.808.5d (February 2013). 

11 Id.

12 Id.

13 Id. at Chapter 2.808.7a(1); 20 C.F.R. § 10.404(c). 

14 5 U.S.C. § 8123(a); see 20 C.F.R. § 10.321; Shirley L. Steib, 46 ECAB 309, 317 (1994). The district medical 

adviser acting on behalf of OWCP may create a conflict in medical opinion. 20 C.F.R. § 10.321(b). 

15 Darlene R. Kennedy, 57 ECAB 414, 416 (2006). 

16 Gary R. Sieber, 46 ECAB 215, 225 (1994). 
5

be of “virtually equal weight and rationale.”17 In his March 2, 2013 report, Dr. Peters applied an 

outdated version of the A.M.A., Guides and offered no explanation for his three percent whole 

person impairment rating.18 Dr. Hogshead on the other hand applied the latest edition of the 

A.M.A., Guides (6th ed. 2008). He criticized Dr. Peters for not explaining his impairment rating, 

but the district medical adviser similarly failed to provide an explanation for his July 12, 2013 

rating under Table 15-23, A.M.A., Guides 449 (6th ed. 2008). Also, Dr. Hogshead specifically 

noted that appellant’s February 29, 2012 electrodiagnostic studies were “completely normal,” 

which, as discussed infra, precludes a rating under Table 15-23. On July 31, 2013 Dr. Peters 

noted his disagreement with Dr. Hogshead’s rating, but again offered no explanation. Thus, 

neither him nor Dr. Hogshead provided a rationalized opinion regarding the nature and extent of 

any upper extremity impairment under the A.M.A., Guides (6th ed. 2008). Absent a true conflict 

in medical opinion, Dr. Easom’s October 22, 2013 OWCP-directed examination is relegated to 

second opinion status. 

Dr. Easom initially found two percent bilateral upper extremity impairment under 

Table 15-23, A.M.A., Guides 449 (6th ed. 2008). However, his October 22, 2013 rating was 

deficient for several reasons. First, Dr. Easom calculated an average grade modifier of 1.5, 

which he then rounded-down to grade 1.19 Assuming the 1.5 calculation was correct, he should 

have rounded up to grade 2 impairment rather than down to grade 1.20 Dr. Easom also erred by 

including functional scale when determining the average grade modifier.21 The functional scale 

grade modifier is taken into account only after the average graded modifier is determined based 

on test findings, history and physical findings.22 Lastly, Dr. Easom’s October 22, 2013 rating 

under Table 15-23 was incorrect because appellant’s preoperative electrodiagnostic study was 

normal.23 In cases where surgical decompression has been performed and the preoperative study 

fails to meet the specified criteria -- abnormal result(s), then Table 15-23 cannot be used to rate 

upper extremity impairment.24 On March 18, 2014 Dr. Easom amended his October 22, 2013 

rating to reflect zero percent bilateral upper extremity impairment because of appellant’s normal 

preoperative electrodiagnostic study, but where Table 15-23 is inapplicable, such cases may still 

be rated under Section 15.2, Diagnosis-Based Impairment, using the appropriate class for 

nonspecific hand/wrist pain.25 

 17 Supra note 15. 

18 Neither FECA nor the regulations provide for the payment of a schedule award for the permanent loss of use of 

the back/spine or the body as a whole. 5 U.S.C. § 8107(c); 20 C.F.R. § 10.404; see Jay K. Tomokiyo, 51 ECAB 361, 

367 (2000). 

19 See supra note 4. 

20 Federal (FECA) Procedure Manual, Part 3 -- Medical, Schedule Awards, Chapter 3.700.3b (June 2003). 

21 See A.M.A., Guides 448-49 (6th ed. 2008). 

22 Id. The Board notes that Dr. Hogshead’s July 12, 2013 impairment rating was similarly flawed. 

23 See Section 15.4f, Entrapment Neuropathy, A.M.A., Guides 445-46, 448-49 (6th ed. 2008). “Test findings are 

the ‘key factor’ for determining impairment in this section.” Id. at 446. 

24 Id. at 449. 

25 Id. at 446. 
6

Once OWCP undertakes development of the record it must do a complete job in 

procuring medical evidence that resolves the relevant issues in the case.26 The question of 

whether appellant has any upper extremity impairment remains unresolved. While it is evident 

she has no ratable impairment under Table 15-23, A.M.A., Guides 449 (6th ed. 2008), in this 

instance neither Dr. Easom nor the district medical adviser addressed alternative methods of 

determining the extent of appellant’s upper extremity impairment. Consequently, OWCP’s 

April 25, 2014 decision shall be set aside and the case remanded for further medical 

development. After OWCP has developed the record to the extent it deems necessary, a de novo

decision shall be issued. 

CONCLUSION 

The case is not in posture for decision. 

ORDER 

IT IS HEREBY ORDERED THAT the April 25, 2014 decision of the Office of 

Workers’ Compensation Programs is set aside and the case is remanded for further action 

consistent with this decision. 

Issued: November 6, 2014 

Washington, DC 

 

 Patricia Howard Fitzgerald, Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board 

 

 James A. Haynes, Alternate Judge 

 Employees’ Compensation Appeals Board 

 26 Richard F. Williams, 55 ECAB 343, 346 (2004).