United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

T.P., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Greensboro, NC, Employer 

__________________________________________ 

) 

) 

) 

) 

) 

) 

) 

) 

Docket No. 15-1399 

Issued: July 22, 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 

JAMES A. HAYNES, Alternate Judge 

JURISDICTION 

On June 11, 2015 appellant filed a timely appeal from a December 15, 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 met his burden of proof to establish more than five percent 

permanent impairment of his left and right upper extremities for which he received a schedule 

award. 

FACTUAL HISTORY 

On July 2, 1992 appellant, then a 34-year-old letter carrier, filed an occupational disease 

claim (Form CA-2) alleging pain in his right hand, wrist, and shoulder due to his employment 

 1

 5 U.S.C. § 8101 et seq. 
2

duties as a mail carrier. By decision dated February 24, 1993 OWCP accepted bilateral carpal 

tunnel syndrome due to the performance of his repetitive work duties. Appellant returned to full 

duty, but symptoms increased. Electromyography (EMG) nerve conduction studies were 

conducted by Dr. David Siegel, an attending Board certified orthopedic surgeon, on March 25, 

1993 and found to be normal but, because of the numbness in his right hand when it was cold 

and the persistent pain, he requested and OWCP authorized a June 2, 1993 right carpal tunnel 

release surgery. Appellant returned to full duty effective December 13, 1993. 

Appellant continued to have pain in the right hand and the left hand became more 

symptomatic. As of November 8, 1994, EMG nerve conduction studies of the left hand were 

found to be normal by Dr. Anthony J. Defranzo, an attending Board-certified orthopedic 

surgeon. Appellant filed a claim for recurrence (Form CA-2a) and by decision dated February 2, 

1995 OWCP accepted a recurrence of disability. A medical report from Dr. Defranzo dated 

August 6, 1996 referenced continuing problems with the left hand and noted that appellant had 

“borderline nerve conduction studies on the left in the past.” On September 16, 1996 appellant 

underwent authorized left carpal tunnel release surgery. 

In 1999 appellant began to complain of problems with the right forearm but, in a 

September 21, 1999 report, Dr. Defranzo found no lateral epicondylitis. Appellant continued to 

work full time. 

In August 2009, Dr. Defranzo noted continued problems with lateral epicondylitis. He 

noted that, with appellant’s repetitive employment duties, he anticipated that appellant would 

continue to have intermittent problems with this condition. On October 15, 2009 Dr. Defranzo 

diagnosed bilateral chronic medial and lateral epicondylitis due to repetitive overuse of his arms 

with flexion and extension of the elbows. 

By decision dated October 26, 2009, OWCP expanded the accepted conditions to include 

bilateral lateral and medial epicondylitis. 

On March 25, 2011 appellant filed a claim for a schedule award (Form CA-7) due to his 

accepted work injuries. He provided a copy of a January 19, 2011 functional capacity evaluation 

report, which had been obtained by Dr. Defranzo, finding that appellant’s “injured area has 

returned to normal or near normal function.” Appellant also submitted a report of Dr. Defranzo 

dated February 17, 2011 in which he references the “excellent effort and valid results” of the 

functional capacity evaluation and finds five percent permanent impairment rating for bilateral 

carpal tunnel syndrome and two percent permanent impairment rating for bilateral medial and 

lateral epicondylitis. 

OWCP forwarded the medical record to Dr. Howard G. Hogshead, a Board-certified 

orthopedic surgeon serving as the OWCP medical adviser, for review. Dr. Hogshead found that 

appellant should be rated one percent bilaterally for lateral epicondylitis and two percent for 

bilateral carpal tunnel syndrome. By letter dated May 16, 2011, OWCP forwarded 

Dr. Hogshead’s report to Dr. Defranzo for a supplemental report. 

In his June 9, 2011 supplemental report, Dr. Defranzo noted that appellant complained of 

painful bilateral medial and lateral epicondylitis, but that appellant had not undergone surgery for 
3

this condition as he continued to work in the highly repetitive position with the employing 

establishment. He provided an impairment evaluation under the sixth edition of the American 

Medical Association, Guides to the Evaluation of Permanent Impairment (A.M.A., Guides).2 

Under Table 15-4 (Elbow Regional Grid) on page 399, Dr. Defranzo diagnosed lateral and 

medial epicondylitis under class 1. He claimed that appellant had a class 1 grade “C2” which 

equaled two percent permanent impairment of his left upper extremity and two percent 

permanent impairment of his right upper extremity. 

For appellant’s bilateral carpal tunnel syndrome, Dr. Defranzo referenced Table 15-23 on 

page 449 and concluded that he had five percent permanent impairment bilaterally due to this 

condition. He referenced nerve conduction studies that had been conducted in 1994 and in 1995 

which reflected 4.3 on the right and 4.5 on the left.3

 Based on these nerve conduction studies, 

which Dr. Defranzo found as “mildly abnormal motor conduction blocks,” he placed appellant 

under grade modifier 2 for five percent permanent impairment bilaterally due to the carpal tunnel 

syndrome. 

OWCP again forwarded the record to Dr. Hogshead for review. In his June 22, 2011 

report, Dr. Hogshead found that Dr. Defranzo’s assessment of appellant’s impairment due to 

epicondylitis was reasonable, but that he disagreed with the assessment of appellant’s 

impairment due to carpal tunnel syndrome. He noted that, in Dr. Defranzo’s earlier November 8, 

1994 report, he had found that electrodiagnostic testing studies and physical examinations were 

normal. Dr. Hogshead noted that Dr. Defranzo had repeatedly referred to motor conduction 

“blocks” rather than motor conduction “delays” and commented that this was a significant 

distinction in determining whether appellant fell under class 1 or class 2 under Table 15-23 on 

page 449. He noted that Dr. Defranzo did not provide the physical examination findings or the 

Semmes-Weinstein graduation of sensory loss. Dr. Hogshead determined that appellant should 

be rated at three percent, which was the higher end of class 1, rather than five percent, which was 

the default rating for class 2. He determined that was “a reasonable compromise.” Adding the 

two percent impairment due to epicondylitis in each upper extremity to the three percent 

impairment due to carpal tunnel syndrome in each upper extremity meant that appellant had five 

percent impairment of each upper extremity. 

In a July 1, 2011 decision, OWCP granted appellant a schedule award for five percent 

permanent impairment of each upper extremity. The award ran for 31.2 weeks and was based on 

the June 22, 2011 opinion of Dr. Hogshead. 

In a June 21, 2012 letter, appellant requested reconsideration of his schedule award claim. 

He argued that OWCP had not adequately considered the severity of his carpal tunnel test results 

as found by Dr. Defranzo. Appellant submitted an August 18, 1999 letter from Dr. Defranzo 

noting that he believed appellant had five percent permanent disability due to his bilateral carpal 

tunnel syndrome and a December 8, 2011 report from Dr. Defranzo referencing ongoing 

symptoms with bilateral medial epicondylitis. 

 2

 A.M.A., Guides (6th ed. 2009). 

3

 These reports are not in the record. 
4

In an August 7, 2012 decision, OWCP affirmed its July 1, 2011 decision, noting that 

appellant had submitted insufficient evidence to establish more than five percent permanent 

impairment of each arm. 

In a July 26, 2013 letter, appellant again requested reconsideration of his claim. He 

argued that OWCP had not adequately considered the severity of his carpal tunnel test results. 

On October 23, 2013 Dr. Hogshead again reviewed the record and reiterated that 

appellant had five percent permanent impairment of each upper extremity. 

In an October 28, 2013 decision, OWCP affirmed its August 7, 2012 schedule award 

decision, finding that appellant had not established more than five percent permanent impairment 

of each upper extremity. 

In a September 5, 2014 decision,4

 the Board set aside OWCP’s October 28, 2013 decision 

and remanded the case to OWCP for further development. The Board found that Dr. Hogshead 

had not adequately explained how his impairment rating of five percent permanent impairment 

of each arm comported with the relevant standards of the sixth edition of the A.M.A., Guides. 

The Board noted that Dr. Hogshead found that Dr. Defranzo’s assessment of appellant’s 

impairment due to epicondylitis was reasonable and adopted the position that appellant had two 

percent impairment to each upper extremity due to this condition. The Board noted, however, 

that Dr. Hogshead had not adequately explained how he had reached this conclusion. The Board 

further found that, with respect to appellant’s upper extremity impairment due to bilateral carpal 

tunnel syndrome, Dr. Hogshead had also not provided an adequate explanation of his conclusion. 

The Board remanded the case to OWCP for further development of the medical evidence with 

respect to appellant’s permanent impairment and the issuance of an appropriate decision 

regarding appellant’s permanent impairment of his upper extremities. 

On remand OWCP again referred the case to Dr. Hogshead for a supplemental report. 

On December 12, 2014 Dr. Hogshead applied the standards of Table 15-23 on page 449 

of the sixth edition of the A.M.A., Guides with respect to appellant’s carpal tunnel syndrome. 

He indicated that the electrodiagnostic studies were important and referred to the report of 

Dr. Defranzo, dated November 8, 1994, in which he noted that EMG and nerve conduction 

velocity (NCV) findings were normal bilaterally. Dr. Hogshead reiterated that the three percent 

impairment rating for carpal tunnel syndrome in this case was “a reasonable compromise 

because the electrodiagnostic study reveals a motor delay, not a motor block. This is a major 

difference.” 

As to epicondylitis, Dr. Hogshead noted that he used Table 15-4 on page 399 of the 

A.M.A., Guides to assign class 1, grade D, for epicondylitis in each upper extremity. 

Dr. Hogshead indicated that no surgery had been performed. 

In a December 15, 2014 decision, OWCP found that appellant had not established more 

than five percent permanent impairment of his left upper extremity or more than five percent 

 4

 Docket No. 14-1200 (issued September 5, 2014). 
5

permanent impairment of his right upper extremity, for which he received a schedule award. It 

found that Dr. Hogshead’s supplemental report provided a rationalized explanation of why the 

evidence had not established additional impairment. 

LEGAL PRECEDENT 

A claimant seeking compensation under FECA has the burden of proof to establish the 

essential elements of his or her claim.5

 With respect to a schedule award, it is appellant’s burden 

of proof to establish permanent impairment.6 A claimant may seek an increased schedule award 

if the evidence establishes that he or she sustained an increased impairment causally related to an 

employment injury.7 The medical evidence must include a detailed description of the permanent 

impairment.8

The schedule award provision of FECA9

 and its implementing regulations10 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.11 For schedule awards after May 1, 2009, 

the impairment is evaluated under the sixth edition of the A.M.A., Guides.12

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

15-23 (Entrapment/Compression Neuropathy Impairment) and accompanying relevant text.13 In 

Table 15-23, grade modifier levels (ranging from zero to four) 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 

 5 John W. Montoya, 54 ECAB 306 (2003). 

6 Edward W. Spohr, 54 ECAB 806, 810 (2003). 

7

 See Rose V. Ford, 55 ECAB 449 (2004). 

8 See Vanessa Young, 55 ECAB 575 (2004). 

9

 5 U.S.C. § 8107. 

10 20 C.F.R. § 10.404 (1999). 

11 K.H., Docket No. 09-341 (issued December 30, 2009). For OWCP decisions issued after May 1, 2009, the 

sixth edition of the A.M.A., Guides is used. B.M., Docket No. 09-2231 (issued May 14, 2010). 

12 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). 

13 Supra note 3 at 449, Table 15-3 
6

rating value may be modified up or down by one percent based on Functional Scale, an 

assessment of impact on daily living activities.14

In determining impairment for the upper extremities under the sixth edition of the 

A.M.A., Guides, an evaluator must establish the appropriate diagnosis for each part of the upper 

extremity to be rated. With respect to the elbow, the relevant portion of the upper extremity for 

the present case, reference is made to Table 15-4 (Elbow Regional Grid) beginning on page 398. 

After the Class of Diagnosis (CDX) is determined from the Elbow Regional Grid (including 

identification of a default grade value), the net adjustment formula is applied using the grade 

modifier for Functional History (GMFH), grade modifier for Physical Examination (GMPE) and 

grade modifier for Clinical Studies (GMCS). The net adjustment formula is (GMFH - CDX) + 

(GMPE - CDX) + (GMCS - CDX).15

ANALYSIS 

On February 24, 1993 OWCP accepted that appellant, then a 34-year-old letter carrier, 

sustained bilateral carpal tunnel syndrome due to the performance of his repetitive work duties.16 

It upgraded his accepted conditions to include lateral and medial epicondylitis of both elbows. In 

a July 1, 2011 decision, OWCP granted appellant a schedule award for five percent permanent 

impairment to each upper extremity. The awards were based on the June 22, 2011 opinion of 

Dr. Hogshead, the Board-certified orthopedic surgeon serving as the medical adviser. 

Dr. Hogshead reviewed the physical findings and impairment ratings of Dr. Defranzo, the 

treating physician and Board-certified orthopedic surgeon.17 

Appellant filed a claim for more than five percent permanent impairment in each upper 

extremity and, in August 7, 2012 and October 28, 2013 decisions, OWCP found that he had not 

met his burden of proof to establish additional impairment. In a September 5, 2014 decision, the 

Board set aside the October 28, 2013 decision and remanded the case to OWCP for further 

development of the medical evidence. On remand OWCP referred appellant’s case to 

Dr. Hogshead for a supplemental report addressing the matters delineated in the Board’s 

September 5, 2014 decision. Dr. Hogshead provided a supplemental report dated December 12, 

2014 clarifying his findings and, in a December 15, 2014 decision, OWCP affirmed its prior 

schedule award decisions finding that appellant had not met his burden of proof to establish more 

than five percent permanent impairment in each upper extremity. 

 The Board finds that both the treating physician and the OWCP physician agree that 

appellant has two percent permanent impairment of the upper extremity relating to the accepted 

 14 A survey completed by a given claimant, known by the name QuickDASH, may be used to determine the 

Functional Scale score. Id. at 448-49. 

15 Id. at 398-400, 405-11. 

16 On June 2, 1993 appellant underwent right carpal tunnel release surgery. On September 16, 1996 he underwent 

left carpal tunnel release surgery. The procedures were authorized by OWCP. 

17 Dr. Defranzo found that appellant had a seven percent permanent impairment of his left upper extremity and a 

seven percent permanent impairment of his right upper extremity. 
7

condition of bilateral lateral and medial epicondylitis. As to the accepted condition of bilateral 

carpal tunnel syndrome, appellant argues that Dr. Defranzo’s report should be the weight of the 

medical evidence, warranting an increased impairment to seven percent. Dr. Defranzo 

references, in his June 9, 2011 report, nerve conduction studies which had been conducted in 

1994 and in 1995 reflecting 4.3 on the right and 4.5 on the left.18 Based on these nerve 

conduction studies, utilizing Table 15-23 on page 449 of the A.M.A., Guides, he placed appellant 

into the category of grade modifier 2 for five percent permanent impairment bilaterally due to the 

carpal tunnel syndrome. This category is described as motor conduction block, significant 

intermittent symptoms, and decreased sensation. 

Dr. Hogshead disagreed with this finding as the 1994 and 1995 nerve conduction studies 

referenced by Dr. Defranzo were not in the record, and conflicted with a previous November 8, 

1994 report of Dr. Defranzo in which he noted that “[Appellant] has normal EMG nerve 

conduction studies.” Dr. Hogshead reviewed the existing medical records and the physical 

examination findings in the case and determined that appellant fell within the range under grade 

modifier 1, which was described as conduction delay, mild intermittent symptoms, and normal 

physical findings. The range under grade modifier 1 was between one and three. Dr. Hogshead 

determined that a “reasonable compromise” was at the high end of grade modifier 1 or three 

percent impairment bilaterally for the carpal tunnel syndrome, rendering a total impairment for 

the upper extremities at five percent. 

The Board finds that OWCP properly relied on the report of Dr. Hogshead to find that 

appellant had failed to establish more than five percent permanent of the upper extremities. 

Dr. Hogshead based his report on the medical evidence in the record, was based on an accurate 

review of the A.M.A., Guides, and was well rationalized. The Board finds that appellant has not 

established more than five percent permanent impairment of the right upper extremities. 

Appellant may request an increased schedule award at any time based on the submission 

of new and relevant evidence showing progression of an employment-related condition resulting 

in increased impairment. 

CONCLUSION 

The Board finds that appellant has failed to establish more than five percent permanent 

impairment of the right upper extremities. 

 18 These reports are not in the record. 
8

ORDER 

IT IS HEREBY ORDERED THAT the decision of the Office of Workers’ 

Compensation Programs dated December 15, 2014 is affirmed. 

Issued: July 22, 2016 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 Valerie D. Evans-Harrell, Alternate Judge 

 Employees’ Compensation Appeals Board