United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

G.S., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Macon, GA, Employer 

__________________________________________ 

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Docket No. 14-1872 

Issued: January 15, 2015 

Appearances: Case Submitted on the Record

Appellant, pro se 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

CHRISTOPHER J. GODFREY, Chief Judge 

PATRICIA HOWARD FITZGERALD, Judge 

JAMES A. HAYNES, Alternate Judge 

JURISDICTION 

On August 25, 2014 appellant filed a timely appeal from a March 25, 2014 schedule 

award 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 has more than six percent impairment of her right arm and 

six percent impairment of her left arm, for which she received schedule awards. 

FACTUAL HISTORY 

On April 1, 2008 appellant, then a 46-year-old postal employee, filed an occupational 

disease claim (Form CA-2) alleging that she developed bilateral carpal tunnel syndrome (CTS) 

as a result of her federal employment duties. By decision dated June 3, 2008, OWCP accepted 

the claim for bilateral CTS. 

 1

 5 U.S.C. § 8101 et seq.
2

OWCP authorized carpal tunnel surgery for bilateral carpal tunnel release. On May 20, 

2009 appellant underwent left carpal tunnel release. On August 6, 2009 she underwent right 

carpal tunnel release. 

In a September 25, 2013 diagnostic report, Dr. Harry Hughes, a Board-certified 

neurologist, reported that an electromyography (EMG) and nerve conduction velocity (NCV) 

study of the upper extremities revealed moderately severe bilateral median nerve injuries at the 

wrists affecting motor and sensory components, right worse than left. He noted that these 

findings could be due to residual abnormalities after appellant’s prior carpal tunnel release. The 

study also revealed no evidence of ulnar nerve entrapment, mild chronic C5 and C6 motor 

radiculopathy on the right, and no evidence of acute right cervical motor radiculopathy. 

In a February 3, 2014 medical report, Dr. Robert Gambrell, Board-certified in family 

medicine, reported that appellant underwent bilateral carpal tunnel release with positive results, 

but began to experience recurrent symptoms due to her repetitive employment activities. He 

noted that a recent EMG/NCV study of the upper extremities revealed moderately severe 

changes of both sensory and motor conduction. Dr. Gambrell provided findings on physical 

examination and diagnosed bilateral CTS: mononeuritis of the upper limb and mononeuritis 

multiplex. He opined that maximum medical improvement (MMI) had been reached. 

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

Permanent Impairment (A.M.A., Guides),2

 Dr. Gambrell calculated nine percent bilateral upper 

extremity impairment based on Table 15-23 Entrapment/Compression Neuropathy Impairment,3

and the multiple simultaneous neuropathies section of the upper extremities chapter. According 

to Table 15-23 of the A.M.A., Guides, test findings were determined to be a grade modifier of 2 

as shown by the motor conduction block from the recent EMG/NCV study. History was 

processed as a grade modifier of 2 due to significant intermittent symptoms. Dr. Gambrell noted 

that physical findings were relatively normal which placed appellant at a grade modifier of 1. 

Using the instructions for the rating process on page 448, he added the corresponding grade 

modifier values (2 + 2 + 1) and took the average of the sum, rounding to the nearest integer, for a 

total of 2 as the final grade modifier. Using the QuickDASH (QD) score of 55, Dr. Gambrell 

determined that appellant placed in the moderate level of the functional scale, which increased 

her upper extremity impairment rating to six percent for the right arm and six percent for the left 

arm. He then noted that, based on the multiple simultaneous neuropathy section, the nerve 

qualifying for the smaller impairment was rated at 50 percent of the impairment listed in Table 

15-23, totaling an additional 3 percent impairment.4

 Dr. Gambrell added the two nerve 

impairments for a total nine percent bilateral upper extremity impairment.5

On March 14, 2014 appellant filed a claim for a schedule award (Form CA-7). 

 2

 A.M.A., Guides (2009). 

3 Id. at 449. 

4 Id. at 448. 

5 Supra note 3. 
3

OWCP properly referred the case record to a district medical adviser (DMA) for review 

and a determination of whether appellant sustained a permanent partial impairment and the date 

of MMI. In his March 17, 2014 report, the DMA reported that appellant reached MMI on 

February 3, 2014, the date of Dr. Gambrell’s evaluation. Utilizing Table 15-23 of the sixth 

edition of the A.M.A., Guides, the DMA noted that the grade modifiers for test findings, history, 

and physical findings totaled six, resulting in an average of two for the final grade modifier 

rating.6

 The grade 2 modifier yielded a five percent impairment default value. After adjusting 

for a QD score of 55, the final impairment rating resulted in the higher value of six percent upper 

extremity impairment. The DMA noted that he agreed with Dr. Gambrell’s final impairment 

rating for six percent upper extremity impairment of the right arm and six percent upper 

extremity impairment for the left arm. 

By decision dated March 25, 2014, OWCP granted appellant a schedule award claim for 

six percent permanent impairment of the right arm and six percent permanent impairment of the 

left arm. The date of MMI was noted as February 3, 2014. The award covered a period of 37.44 

weeks from February 3 to March 2, 2014. OWCP noted that the DMA agreed with 

Dr. Gambrell’s six percent bilateral impairment calculation. 

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.7 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 scheduled losses.8

The A.M.A., Guides provide a diagnosis-based method of evaluation utilizing the World 

Health Organization’s International Classification of Functioning, Disability and Health (ICF).9 

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).10 The net 

adjustment formula is (GMFH-CDX) + (GMPE-CDX) + (GMCS-CDX).11

 6 Id. 

7

 5 U.S.C. § 8107; 20 C.F.R. § 10.404. 

8 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). 

9

 A.M.A., Guides, supra note 2, section 1.3, The International Classification of Functioning, Disability and Health 

(ICF): A Contemporary Model of Disablement. 

10 Id. at 385-419. 

11 Id. at 411. 
4

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

Table 15-23 (Entrapment/Compression Neuropathy Impairment) and accompanying relevant 

text.12 In Table 15-23, grade modifier levels (ranging from 0 to 4) are described for the 

categories 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.13

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 nature and 

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

providing rationale for the percentage of impairment specified.14

ANALYSIS 

OWCP accepted appellant’s claim for bilateral CTS. The issue is whether appellant 

sustained more than six percent permanent impairment of the left arm and six percent permanent 

impairment of the right arm for which she received schedule awards. The Board finds that 

appellant has not met her burden of proof to establish that she has impairment of the right arm 

greater than six percent and impairment of the left arm greater than the six percent already 

awarded. 

In a February 3, 2014 medical report, Dr. Gambrell reported that appellant’s bilateral 

CTS had reached MMI. Using Table 15-23 of the A.M.A., Guides, he assigned a grade modifier 

of 2 for motor conduction block test findings, a grade modifier of 2 for history due to significant 

intermittent symptoms, and a grade modifier of 1 for relatively normal physical findings. The 

average of the three grade modifiers totaled 2 which was adjusted one value higher due to the 

moderate QD score of 55 on the functional scale. This resulted in six percent upper extremity 

impairment for the right arm and six percent upper extremity impairment for the left. 

Dr. Gambrell then utilized the multiple simultaneous neuropathy section to calculate an 

additional 3 percent impairment, noting that the nerve qualifying for the smaller impairment was 

rated at 50 percent of the impairment listed in Table 15-23.15 Adding the six percent larger 

impairment value with the three percent smaller impairment value resulted in nine percent 

impairment of the upper extremity for the left and right. 

The DMA reviewed Dr. Gambrell’s report and averaged test findings, history, and 

physical findings as grade 2 for the final rating category. Using the 55 QD score16 under the 

functional scale, the DMA adjusted the default impairment rating of five percent to six percent 

 12 Id. at 449. 

13 Id. at 448-50. 

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

Chapter 2.808.6(f) (February 2013). 

15 Supra note 4. 

16 Id. at 449. 
5

impairment of the upper extremity on the right and six percent impairment of the upper extremity 

on the left. The Board notes that the DMA properly reviewed Dr. Gambrell’s report and agreed 

with his impairment rating of six percent right and six percent left impairment of the arms. The 

DMA, however, did not provide an additional three percent rating for multiple simultaneous 

neuropathies. 

The A.M.A., Guides explain that, when multiple, concurrent neuropathies are diagnosed 

in the same limb; both impairments may be rated under Table 15-23.17 The nerve qualifying for 

the smaller impairment is rated at 50 percent of the impairment listed in Table 15-23, and then 

combined with the larger impairment rating. Nerve conduction testing of the upper limbs can 

clarify the role of the generalized peripheral nerve disease.18

Dr. Gambrell determined that 50 percent of the smaller impairment rating totaled 3 

percent, which he added to the larger 6 percent impairment rating for a 9 percent total arm 

impairment. While he stated that appellant sustained multiple simultaneous neuropathies, he 

failed to specifically state what these other neuropathies were, nor did he provide any details on 

how he reached his impairment rating for the smaller impairment. Moreover, the most recent 

September 25, 2013 EMG/NCV study does not provide support for multiple simultaneous 

neuropathies as the study revealed moderately severe bilateral median nerve injuries at the wrists 

affecting motor and sensory components, no evidence of ulnar nerve entrapment, mild chronic 

C5 and C6 motor radiculopathy on the right, and no evidence of acute right cervical motor 

radiculopathy. Board precedent is well settled that when an attending physician’s report gives an 

estimate of impairment but does not address how the estimate is based upon the A.M.A., Guides, 

OWCP may follow the advice of its DMA where he or she has properly applied the A.M.A., 

Guides.19 In this instance, Dr. Gambrell failed to adequately explain why appellant was entitled 

to an additional three percent impairment as a result of simultaneous neuropathies. 

Accordingly, the Board finds that the DMA correctly applied the A.M.A., Guides in 

determining that appellant had a six percent permanent impairment of the right arm and six 

percent impairment of the left arm, for which she received a schedule award.20 

On appeal, appellant argues that Dr. Gambrell established that she was entitled to nine 

percent impairment of the bilateral upper extremities. The Board notes that it is appellant’s 

burden of proof to establish that she sustained a permanent impairment of a scheduled member 

as a result of an employment injury.21 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 limitations.22 

 17 Id. at 448. 

18 Id. 

19 See Ronald J. Pavlik, 33 ECAB 1596 (1982); Robert R. Snow, 33 ECAB 656 (1982); Quincy E. Malone, 31 

ECAB 846 (1980). 

20 J.S., Docket No. 12-1170 (issued November 9, 2012); J.J., Docket No. 10-839 (issued December 23, 2010). 

21 Tammy L. Meehan, 53 ECAB 229 (2001). 

22 See A.L., Docket No. 08-1730 (issued March 16, 2009). 
6

Appellant has not submitted sufficient evidence to establish that she has more than six percent 

impairment for each of her arms and therefore OWCP properly awarded her six percent 

impairment for each arm.23 

Appellant may submit new evidence or argument with a written request for 

reconsideration to OWCP within one year of this merit decision, pursuant to 5 U.S.C. § 8128(a) 

and 20 C.F.R. §§ 10.605 through 10.607. 

CONCLUSION 

The Board finds that appellant did not meet her burden of proof to establish that she has 

more than six percent permanent impairment of her right arm and six percent permanent 

impairment of her left arm, for which she received a schedule award. 

ORDER 

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

decision dated March 25, 2014 is affirmed. 

Issued: January 15, 2015 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Patricia Howard Fitzgerald, Judge 

 Employees’ Compensation Appeals Board 

 

 James A. Haynes, Alternate Judge 

 Employees’ Compensation Appeals Board 

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