United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

E.P., Appellant 

and 

DEPARTMENT OF JUSTICE, BUREAU OF 

PRISONS, Anthony, TX, Employer 

__________________________________________ 

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Docket No. 16-0582 

Issued: July 20, 2016 

Appearances: Case Submitted on the Record

Appellant, pro se 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

CHRISTOPHER J. GODFREY, Chief Judge 

COLLEEN DUFFY KIKO, Judge 

ALEC J. KOROMILAS, Alternate Judge 

JURISDICTION 

On February 8, 2016 appellant filed a timely appeal from a January 15, 2016 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 OWCP properly determined that appellant had no more than 12 

percent permanent impairment of the right upper extremity and 4 percent permanent impairment 

of the left upper extremity, for which he received schedule awards. 

FACTUAL HISTORY 

OWCP accepted that on or before February 26, 2013 appellant, then a 49-year-old drug 

treatment specialist, sustained bilateral carpal tunnel syndrome and bilateral tenosynovitis of the 

 1

 5 U.S.C. § 8101 et seq. 
2

hand and wrist due to repetitive keyboarding and clerical tasks. It had accepted right elbow and 

forearm sprain under a prior claim (File No. xxxxxx776) on August 2, 2006. 

By decision dated September 29, 2010 under File No. xxxxxx776, OWCP granted 

appellant a schedule award for six percent impairment of the right upper extremity. 

On July 18, 2013 appellant underwent surgery to remove a spur and sutures from the 

right triceps tendon at the elbow. He returned to restricted duty on September 1, 2013 and to full 

duty on December 4, 2013. 

Dr. Robert R. Bell, an attending Board-certified orthopedic surgeon, performed a right 

carpal tunnel release on March 3, 2014, authorized by OWCP. He received compensation for 

work absences. 

By decision dated April 2, 2014 under File No. xxxxxx776, OWCP issued a schedule 

award for an additional two percent impairment of the right upper extremity. 

Dr. Bell performed a left carpal tunnel release on August 4, 2014 authorized by OWCP. 

He received wage-loss compensation from August 4 to September 14, 2014. 

On September 15, 2014 appellant filed a claimed for a schedule award (Form CA-7). In 

an October 15, 2014 letter, OWCP advised him to submit a report from his attending physician 

establishing that the accepted bilateral carpal tunnel syndrome and tenosynovitis had reached 

maximum medical improvement. The physician was also to provide an impairment rating 

according to the sixth edition of the American Medical Association, Guides to the Evaluation of 

Permanent Impairment (hereinafter, the A.M.A., Guides) and to establish that the accepted 

conditions had reached maximum medical improvement. Appellant was afforded 30 days to 

submit such evidence. 

In response, appellant submitted a January 19, 2015 report from Dr. Andrew Palafox, an 

attending Board-certified orthopedic surgeon. Dr. Palafox reviewed the history of injury 

and treatment, and opined that appellant had reached maximum medical improvement as of 

January 19, 2015. Appellant completed a QuickDASH questionnaire with a score of 40. 

Dr. Palafox related appellant’s complaints of intermittent numbness and tingling in both hands. 

Appellant stated that he did not experience difficulties with activities of daily living. On 

examination, Dr. Palafox noted slightly reduced normal two-point discrimination in both hands. 

Referring to Table 15-23 of the A.M.A., Guides,

2

 he noted a class 1 diagnosis-based impairment 

(DBI) Class of Diagnosis (CDX) of bilateral carpal tunnel syndrome, with a default grade 5. For 

the right hand, Dr. Palafox found a grade 1 modifier for Clinical Studies (GMCS) for a 

conduction delay on electromyography studies. He also found a grade 2 modifier for Functional 

History (GMFH) for significant intermittent paresthesias and a grade 2 modifier for findings on 

Physical Examination (GMPE) for slightly diminished two-point discrimination. Dr. Palafox 

calculated that according to the net adjustment formula of (GMFH - CDX) + (GMPE - CDX) + 

(GMCS - CDX), or “1+2+2,” appellant had an average modifier of 2.25, rounded downward to 

 2

 Table 15-23, page 449 of the sixth edition of the A.M.A., Guides is entitled “Entrapment/Compression 

Neuropathy Impairment.” 
3

2, which left the default CDX of 5 unchanged. He opined that the QuickDASH score of 40 

raised the default five percent to six percent on the right. Dr. Palafox used the same method to 

calculate five percent impairment of the left hand, as the QuickDASH score was not included for 

the second extremity, so as not to use the grade modifier twice. Using the Combined Values 

Chart, 6 percent for the right combined with 5 percent for the left provided a total upper 

extremity impairment of 11 percent. 

In a March 30, 2015 report, an OWCP medical adviser reviewed Dr. Palafox’s report and 

concurred with his assessment of five percent impairment of the left upper extremity. He agreed 

with Dr. Palafox that the grade modifiers established five percent impairment of the right upper 

extremity, but differed in concluding that the QuickDASH score would not raise the total 

impairment to six percent. The medical adviser noted that the QuickDASH of 40 resulted in a 

modifier of 1 and that Dr. Palafox apparently misread Table 15-23. Therefore, appellant had five 

percent impairment of the right arm. As to the left, the medical adviser found a default value of 

five percent and noted that Dr. Palafox did not use the functional modifier, but as this is not the 

same extremity he could have. 

On June 1, 2015 the medical adviser provided an updated report noting errors in his prior 

report and inclusion of the schedule awards under File No. xxxxxx776. He opined that appellant 

had four percent impairment of each upper extremity, as the QuickDASH score of 40 reduced the 

default five percent CDX to four percent. No rationale was provided for using the modifier of 

the QuickDASH to reduce the right upper extremity rating. The medical adviser did note that it 

was his opinion that it is permissible to use the functional modifier more than one in determining 

impairment based on entrapment neuropathy. He noted that appellant had received a schedule 

award for eight percent impairment of the right arm under File No. xxxxxx776. Combining the 

prior 8 percent with the current 4 percent for carpal tunnel syndrome under the present claim 

resulted in 12 percent impairment of the right upper extremity. Subtracting the eight percent 

previously awarded resulted in an additional four percent right arm impairment due to accepted 

carpal syndrome and tendinitis. 

By decision dated July 24, 2015, OWCP awarded appellant four percent permanent 

impairment of the left upper extremity and an additional four percent permanent impairment of 

the right upper extremity. It noted that he had previously been granted a schedule award for an 8 

percent permanent impairment of the right upper extremity due to a bicep tendon tear and 

olecranon bursitis under File No. xxxxxx776, which corresponds to a total right upper extremity 

of 12 percent. 

Appellant disagreed and in an August 6, 2015 letter requested a review of the written 

record. He contended that he had not received prior schedule awards for his right upper 

extremity. Appellant submitted November 17 and 25, 2015 reports from Dr. Bell, an attending 

Board-certified orthopedic surgeon, who diagnosed bilateral carpal tunnel syndrome and 

prescribed compression gloves. Dr. Bell did not address the issue of permanent impairment. 

By decision dated January 15, 2016, an OWCP hearing representative affirmed OWCP’s 

July 24, 2015 decision, finding that properly applied the appropriate portions of the A.M.A., 

Guides to Dr. Palafox’s clinical findings. 
4

LEGAL PRECEDENT 

The schedule award provisions of FECA3 provide for compensation to employees 

sustaining impairment from loss or loss of use of specified members of the body. It, however, does 

not specify the manner in which the percentage loss of a member shall be determined. The method 

used in making such determination is a mater which rests in the sound discretion of OWCP. For 

consistent results and to ensure equal justice, the Board has authorized 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 OWCP as a standard for evaluation of schedule losses and the Board has 

concurred in such adoption.4 For schedule awards after May 1, 2009, the impairment is evaluated 

under the sixth edition of the A.M.A., Guides, published in 2008.5

The sixth edition of the A.M.A., Guides provides a diagnosis-based method of evaluation 

utilizing the World Health Organization’s International Classification of Functioning, Disability 

and Health (ICF).6

 Under the sixth edition, the evaluator identifies the impairment class for the 

diagnosed condition, 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). 

In addressing upper extremity impairments, the sixth edition requires identifying the 

impairment class for the diagnosed condition, which is then adjusted by grade modifiers based 

on GMFH, GMPE, and GMCS.8 The net adjustment formula is (GMFH - CDX) + (GMPE - 

CDX) + (GMCS - CDX).9

The adjustment grid for functional history notes that this grade modifier should be applied 

only to the single, highest DBI. Specific jurisdictions may modify the process such that functional 

history adjustment is considered for each DBI or not considered at all as a modifier.10 The 

evaluating physician may use the QuickDASH functional assessment outcome questionnaire as 

part of the process of evaluating functional symptoms.... The inventory is used only to assist the 

 3

 5 U.S.C. § 8107. 

4 Bernard A. Babcock, Jr., 52 ECAB 143 (2000). 

5

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

Chapter 2.808.5(a) (February 2013); Federal (FECA) Procedure Manual, Part 3 -- Medical, Schedule Awards, 

Chapter 3.700.2 and Exhibit 1 (January 2010). 

6

 A.M.A., Guides, at 3, section 1.3, “The International Classification of Functioning, Disability and Health (ICF): 

A Contemporary Model of Disablement” (6th ed. 2009). 

7

 Id. at 494-531 (6th ed. 2008). 

8 Id. at 385-419, see M.P., Docket No. 13-2087 (issued April 8, 2014). 

9 Id. at 411. 

10 Supra note 2, section 15.3a Adjustment Grid: Functional History, at 406. 
5

examiner in defining the grade modifier for functional history and does not serve as a basis for 

defining further impairment, nor does the score reflect an impairment percentage.11 

ANALYSIS 

OWCP accepted that appellant sustained bilateral carpal tunnel syndrome and bilateral 

tenosynovitis of the hand and wrist. Appellant underwent right carpal tunnel release on March 3, 

2014 and left carpal tunnel release on August 4, 2014, authorized by OWCP. He claimed a 

schedule award on September 15, 2014. In support of his claim, appellant submitted a 

January 19, 2015 report from Dr. Palafox, an attending Board-certified orthopedic surgeon. 

Dr. Palafox opined that appellant had five percent impairment of the left upper extremity 

and six percent impairment of the left upper extremity due to carpal tunnel syndrome. Referring 

to Table 15-23 of the A.M.A., Guides, he found a class 1 DBI of bilateral carpal tunnel 

syndrome, with a default grade 5. For each hand, Dr. Palafox found a grade 1 modifier for 

GMCS due to a conduction delay on electrodiagnostic studies, a grade 2 modifier for GMFH for 

paresthesias, and a grade 2 modifier for findings on GMPE for slightly diminished two-point 

discrimination. As the modifiers did not result in a net adjustment, Dr. Palafox found five 

percent impairment of each arm, increased to six percent on the right due to the QuickDASH 

score. 

In March 30 and June 1, 2015 reports, an OWCP medical adviser explained that 

Dr. Palafox misunderstood the interrelationship of Table 15-23 and the QuickDASH score. He 

opined that based on Dr. Palafox’s clinical findings, appellant had four percent impairment of 

each arm due to carpal tunnel syndrome and tenosynovitis. OWCP then issued the July 24, 2015 

schedule award for four percent impairment of the right arm and four percent impairment of the 

left arm. It noted that this was in addition to the eight percent impairment for the right arm 

previously awarded under File No. xxxxxx776. 

The Board finds that this case is not in posture for a decision. Once OWCP undertakes 

development of the record, it must do a complete job in procuring medical evidence that will 

resolve the relevant issues in the case.12 The Board finds that neither the January 19, 2015 report 

of Dr. Palafox nor the March 30 and June 1, 2015 reports of the OWCP medical adviser provide 

sufficient medical rationale as to the extent of appellant’s permanent impairment of his bilateral 

upper extremities. Neither physician provided an explanation as to the proper use of the 

QuickDASH score in the calculation of permanent impairment. There is np explanation as to 

why the QuickDASH was used by Dr. Palafox only on the right upper extremity and not on the 

left. There is also no explanation from the medical adviser to explain why the QuickDASH score 

should be used to reduce the extent of impairment from the default value of five percent to four 

percent for both upper extremities. Accordingly, the case will be remanded to OWCP for further 

development of the medical evidence as to the extent of bilateral upper extremity impairment. 

On remand, OWCP should further develop the medical evidence by preparing a statement of 

accepted facts and referring appellant for a second opinion examination in accordance with its 

 11 Id. 

12 See B.C., Docket No. 15-1853 (issued January 2016). 
6

procedures.13 After such further development, as it deems necessary, it should issue a de novo

decision. 

On appeal, appellant contends that the medical adviser improperly reduced his 

impairment rating to four percent of each upper extremity because he mistakenly believed that 

appellant received prior schedule awards for an eight percent right upper extremity impairment 

under File No. xxxxxx776. He also contends that he did not receive prior schedule awards for 

right upper extremity impairment. The Board notes, however, that this case is not currently in 

posture for decision. 

CONCLUSION 

The Board finds that this matter is not in posture for a decision. 

ORDER 

IT IS HEREBY ORDERED THAT the January 15, 2016 decision of the Office of 

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

consistent with this decision. 

Issued: July 20, 2016 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board 

 13 OWCP’s procedures provide that, if a medical adviser provides an opinion which is not strong enough to 

constitute a conflict with the opinion of the treating physician, but is of sufficient value to warrant additional action, 

OWCP may refer the claim for a second opinion examination. See Federal (FECA) Procedure Manual, Part 2 -- 

Claims, Developing and Evaluation Medical Evidence, Chapter 2.810.8(h) (September 2010).