United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

R.R., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Gainesville, GA, Employer 

__________________________________________ 

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Docket No. 15-1444 

Issued: August 11, 2016 

Appearances: Case Submitted on the Record

Lenin V. Perez, for the appellant1

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

PATRICIA H. FITZGERALD, Deputy Chief Judge 

COLLEEN DUFFY KIKO, Judge 

JAMES A. HAYNES, Alternate Judge 

JURISDICTION 

On June 23, 2015 appellant, through his representative, filed a timely appeal of a 

March 20, 2015 merit decision of the Office of Workers’ Compensation Programs (OWCP). 

Pursuant to the Federal Employees’ Compensation Act2

 (FECA) and 20 C.F.R. §§ 501.2(c) and 

501.3, the Board has jurisdiction to consider the merits of this case. 

ISSUE 

The issue is whether appellant has established more than two percent permanent 

impairment of his right arm. 

 1

 In all cases in which a representative has been authorized in a matter before the Board, no claim for a fee for 

legal or other service performed on appeal before the Board is valid unless approved by the Board. 

20 C.F.R. § 501.9(e). No contract for a stipulated fee or on a contingent fee basis will be approved by the Board. 

Id. An attorney or representative’s collection of a fee without the Board’s approval may constitute a misdemeanor, 

subject to fine or imprisonment for up to one year or both. Id.; see also 18 U.S.C. § 292. Demands for payment of 

fees to a representative, prior to approval by the Board, may be reported to appropriate authorities for investigation. 

2

 5 U.S.C. § 8101 et seq. 
2

FACTUAL HISTORY 

On October 31, 2012 appellant, a 57-year-old letter carrier, filed an occupational disease 

claim (Form CA-2), alleging bilateral carpal tunnel syndrome causally related to his employment 

factors. On December 4, 2012 OWCP accepted bilateral carpal tunnel syndrome. Appellant 

stopped work on September 16, 2012 and returned to limited-duty work on September 17, 2012. 

In a December 5, 2012 report, Dr. Benjamin N. Puckett, Board-certified in orthopedic 

surgery, stated that appellant was experiencing persistent bilateral hand pain, that the pain was 

causing him difficulty with lifting, grasping, and pinching, and that it was aggravated by any 

movement. He noted that the results of electromyelogram (EMG) and nerve conduction velocity 

(NCV) tests showed moderate-to-severe compression of the left cubital tunnel in addition to 

moderate compression of bilateral carpal tunnel syndrome. Dr. Puckett diagnosed moderate 

bilateral carpal tunnel syndrome. 

The claim was expanded on December 19, 2012 to include lesion of left ulnar 

nerve/cubital tunnel. 

Dr. Puckett performed a left ulnar nerve transposition procedure at the elbow and left 

carpal tunnel release on January 31, 2013. Appellant received wage-loss compensation benefits 

from January 26 to March 8, 2013. On April 2, 2013 appellant was placed on the periodic rolls, 

effective March 9, 2013. 

Appellant filed a Form CA-7 claim for a schedule award on December 15, 2014 based on 

a partial loss of use of his left and right upper extremities.3

 

Dr. Samy F. Bishai, a specialist in orthopedic surgery, stated in an October 15, 2014 

report that appellant had 31 percent permanent impairment of the right upper extremity under the 

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

Guides) sixth edition. He based this rating on the combined rating for 24 percent impairment for 

the right shoulder and 9 percent impairment for his right carpal tunnel syndrome, the only 

condition OWCP had accepted for the right upper extremity, in this claim. Dr. Bishai advised 

that on examination of the right wrist, hand, and forearm appellant had diminished sensation in 

the distribution of the median nerve with diminished sensation in the right thumb, index and 

middle fingers of the right hand. Appellant had a positive Tinel’s sign and Phalen’s test on the 

right side, with weakness in his right hand grip. Dr. Bishai stated that the results of an NCV 

study of the upper extremities appellant underwent on October 13, 2014 reflected right-sided 

carpal tunnel syndrome affecting the sensory components of the median nerve. 

Dr. Bishai calculated the impairment rating for the accepted diagnosis of right carpal 

tunnel syndrome by relying on Table 15-23 at page 449.4

 He found that under the heading of 

 3

 The Board notes that the issue of permanent impairment from appellant’s accepted left carpal tunnel and lesion 

of left ulnar nerve/cubital tunnel conditions was adjudicated by OWCP in a separate claim under case number 

xxxxxx365. The record also reflects that appellant has received prior schedule awards for right upper extremity 

impairments from shoulder impairments, totaling 15 percent. However, he has not previously received a schedule 

award for right carpal tunnel syndrome. 

4

 A.M.A., Guides 449. 
3

“Test Findings” appellant had a grade modifier 2, for motor conduction block, under the heading 

of “History,” he rated a grade modifier 3, based on constant symptoms, and under the heading of 

“Physical Findings,” he found a grade modifier 3 for atrophy or weakness. Pursuant to the rating 

process set forth at page 448,5

 Dr. Bishai determined that the average value for these modifiers, 

based on adding 2 plus 3 plus 3, divided by 3, equaled 2.66, which he rounded off to 3. This 

produced a mid-range impairment of 5 under Table 15-23. Given that appellant’s QuickDASH 

test score was 90, Dr. Bishai found that this yielded a mild grade modifier of 3, which produced 

nine percent impairment rating for right carpal tunnel syndrome. 

The OWCP medical adviser reviewed Dr. Bishai’s report and found that appellant had a 

total of two percent permanent impairment of his right upper extremity pursuant to the sixth 

edition of the A.M.A., Guides. He stated that appellant had tingling, numbness, and pain in 

hands and noted that EMG studies confirmed bilateral carpal tunnel syndrome of moderate 

severity, which yielded grade 2 impairment. Based on Table 15-23, page 449 of the A.M.A., 

Guides,

6

 OWCP’s medical adviser found that his impairment yielded a grade modifier of 1 for 

test findings, applied with a default of two percent right upper extremity impairment. 

By decision dated March 20, 2015, OWCP awarded appellant a schedule award for two 

percent permanent impairment of the right arm. The award ran for 6.24 weeks, covering the 

period March 9 to April 21, 2013. 

LEGAL PRECEDENT 

The schedule award provision of FECA7

 and its implementing regulations8 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. 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.9

 The claimant has the burden of proving 

that the condition for which a schedule award is sought is causally related to his or her 

employment.10

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 

 5 Id. at 448. 

6 Id. at 449. 

7

 5 U.S.C. § 8107. 

8

 20 C.F.R. § 10.404. Effective May 1, 2009, OWCP began using the A.M.A., Guides (6th ed. 2009). 

9 Id.

10 Veronica Williams, 56 ECAB 367, 370 (2005). 
4

and Health (ICF).11 Under the sixth edition for upper extremity impairments, the evaluator 

identifies the impairment Class of Diagnosis (CDX), which is then adjusted by grade modifiers 

based on Functional History (GMFH), Physical Examination (GMPE), and Clinical Studies 

(GMCS).12 The net adjustment formula is (GMFH - CDX) + (GMPE - CDX) + (GMCS - 

CDX).13

Impairment due to carpal tunnel syndrome is evaluated under the scheme found in Table 

15-23 (Entrapment/Compression Neuropathy Impairment) and accompanying relevant text.14 In 

Table 15-23, grade modifiers levels (ranging from zero to four) are described for the categories 

of Test Findings, History, and Physical Findings. The grade modifier levels are averaged to 

arrive at the appropriate overall grade modifier level and to identify a default rating value. The 

default rating value may be modified up or down by one percent based on functional scale, an 

assessment of impact on daily living activities.15

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

should be routed to OWCP’s medical adviser for an opinion concerning the nature and 

percentage of impairment in accordance with the A.M.A., Guides, with OWCP’s medical adviser 

providing rationale for the percentage of impairment specified.16

ANALYSIS 

In this case, OWCP accepted the conditions of bilateral carpal tunnel syndrome and 

lesion of left ulnar nerve/cubital tunnel. Appellant filed a claim for a schedule award and OWCP 

evaluated the claim for permanent impairment pertaining to the accepted right carpal tunnel 

syndrome condition. The record reflects that permanent impairment for the left upper extremity 

impairment has been adjudicated under a separate OWCP file number xxxxxx365. 

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

As noted above, impairment due to carpal tunnel syndrome is evaluated pursuant to Table 

15-23, which sets forth grade modifier levels for Test Findings, History, and Physical Findings. 

These grade modifier levels are averaged to arrive at the appropriate overall grade modifier level 

and to identify a default rating value.17 Dr. Bishai, in his October 15, 2014 report, evaluated 

appellant’s impairment under the categories of Test Findings, History, and Physical Findings, as 

 11 A.M.A., Guides, supra note 4 at 3, section 1.3, the ICF: A Contemporary Model of Disablement. 

12 Id. at 385-419 

13 Id. at 411. 

14 Id. at 449. 

15 Id. at 448-50. 

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

Chapter 2.808.6(f) (February 2013). 

17 Supra note 15. 
5

required by Table 15-23. He concluded that appellant had nine percent permanent impairment of 

the right upper extremity due to his right carpal tunnel condition. Pursuant to its procedures, 

OWCP then referred Dr. Bishai’s report to its medical adviser for review. 

In its March 20, 2015 decision, OWCP based its schedule award on the December 29, 

2014 report of its medical adviser, who rated two percent permanent impairment for right carpal 

tunnel syndrome. However, OWCP’s medical adviser only calculated a grade modifier for test 

findings based on an EMG study showing moderate carpal tunnel and failed to evaluate the 

categories of history and physical findings. Thus, his impairment rating was not rendered in 

conformance with the procedures outlined above. 

Proceedings under FECA are not adversarial in nature and OWCP is not a disinterested 

arbiter. While the claimant has the burden to establish entitlement to compensation, OWCP 

shares responsibility to see that justice is done. Once OWCP undertakes to develop the medical 

evidence it has the responsibility to do so in a proper manner.18 

The Board sets aside OWCP’s March 20, 2015 decision and remands the case for 

clarification from the medical adviser as to whether appellant had additional impairment of his 

right upper extremity related to his right carpal tunnel syndrome, as indicated by Dr. Bishai’s 

December 29, 2014 report, pursuant to the appropriate guidelines. On remand, OWCP should 

instruct its medical adviser to clearly indicate how he reached his ratings. After such further 

development of the record as it deems necessary, OWCP shall issue a de novo decision. 

On appeal appellant’s representative contends that a conflict exists in the medical opinion 

evidence regarding the degree of permanent impairment to appellant’s right upper extremity 

requiring referral to an impartial medical examiner. The Board however concludes that the case 

is not in posture for decision as the medical evidence of record has not been fully developed. 

CONCLUSION 

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

 18 See L.S., Docket No. 14-1460 (issued January 2, 2015). 
6

ORDER 

IT IS HEREBY ORDERED THAT the March 20, 2015 decision of the Office of 

Workers’ Compensation Programs be set aside and the case is remanded to OWCP for further 

action consistent with this decision of the Board. 

Issued: August 11, 2016 

Washington, DC 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 James A. Haynes, Alternate Judge 

 Employees’ Compensation Appeals Board