United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

M.T., Appellant 

and 

DEPARTMENT OF VETERANS AFFAIRS, 

VETERANS ADMINISTRATION, NORTHERN 

CALIFORNIA HEALTH CARE SYSTEM, 

Martinez, CA, Employer 

__________________________________________ 

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Docket No. 16-0296 

Issued: May 20, 2016 

Appearances: Case Submitted on the Record

Appellant, pro se 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

COLLEEN DUFFY KIKO, Judge 

ALEC J. KOROMILAS, Alternate Judge 

VALERIE D. EVANS-HARRELL, Alternate Judge 

JURISDICTION 

On December 4, 2015 appellant filed a timely appeal from a July 13, 2015 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 has met her burden of proof to establish more than 17 

percent permanent impairment of the right upper extremity and 11 percent permanent 

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

 

 1 5 U.S.C. § 8101 et seq.
2

FACTUAL HISTORY 

On April 14, 2005 appellant, then a 39-year-old medical support assistant, filed an 

occupational disease claim (Form CA-2) alleging that on March 10, 2005 she first realized that 

her strain, pain, swelling, and carpal tunnel of both wrists, worse on the left, were caused by her 

federal employment. In an undated letter, she attributed her wrist and hand conditions to her 

repetitive work duties. Medical reports dated March 10, 2005 provided findings on examination 

of appellant’s bilateral forearms, wrists, and hands and diagnosed bilateral forearm, hand, and 

wrist strain and pain. On July 8, 2005 OWCP accepted the claim for bilateral hand strain and 

sprain/strain of an unspecified site of the bilateral forearms. 

On August 29, 2005 appellant returned to her regular duties four hours a day. On 

September 2, 2005 the employing establishment offered her a full-time modified limited-duty job 

that she accepted on the same date. On November 8, 2005 appellant stopped work. 

On November 17, 29, and 30, 2005 appellant filed claims for compensation (Forms 

CA-7) for leave without pay from November 8 to December 29, 2005. In a January 31, 2006 

decision, OWCP denied her claim for a recurrence of disability commencing November 8, 2005. 

It found that the medical evidence established that appellant was capable of performing her 

regular duties eight hours a day with necessary ergonomic equipment.2

 

On February 14, 2006 OWCP received a January 13, 2006 report from Dr. Jeffrey L. 

Gao, an attending physician Board-certified in occupational medicine. Dr. Gao noted a history 

of injury and appellant’s medical treatment. He provided findings on physical examination 

which included range of motion measurements for the right wrist. Dr. Gao diagnosed mild right 

wrist carpal tunnel syndrome. He determined that appellant had 20 percent impairment of the 

right upper extremity and an additional 3 percent impairment for loss of grip strength and pain 

based on the fifth edition of the American Medical Association, Guides to the Evaluation of 

Permanent Impairment (A.M.A., Guides). Dr. Gao concluded that she had reached maximum 

medical improvement (MMI) on the date of his examination. 

On September 20, 2008 appellant filed a Form CA-7 for a schedule award. On the same 

date, OWCP referred the case to an OWCP medical adviser. A statement of accepted facts 

(SOAF) indicated that it had also accepted appellant’s claim for right carpal tunnel syndrome. 

In a September 20, 2008 report, an OWCP medical adviser applied the fifth edition of the 

A.M.A., Guides to Dr. Gao’s January 13, 2006 findings and determined that appellant had 17 

percent impairment of the right upper extremity and no impairment of the left upper extremity. 

He further determined that she was not entitled to additional impairment for loss of grip strength 

and pain. The medical adviser concluded that appellant reached MMI on January 13, 2006, the 

date of Dr. Gao’s evaluation. 

 2

 Appellant requested reconsideration of the January 31, 2006 denial of her recurrence claim. In a September 8, 

2006 decision, OWCP denied modification of the January 31, 2006 decision. It found that the medical evidence was 

insufficient to establish that appellant sustained a recurrence of total disability commencing November 8, 2005. 
3

By decision dated October 21, 2008, OWCP granted appellant a schedule award for 17 

percent permanent impairment of the right arm and found that she had no impairment of the left 

arm based on the opinion of its medical adviser. 

On January 28, 2011 appellant underwent authorized right open carpal tunnel release 

performed by Dr. Robert A. Gomez, an attending Board-certified orthopedic surgeon. On 

April 1, 2011 Dr. Gomez performed authorized left open carpal tunnel release. On October 7, 

2011 he performed authorized left elbow ulnar nerve release and medial epicondylectomy. 

On December 15, 2011 appellant filed a Form CA-7 for an additional schedule award. 

By letter dated December 29, 2011, OWCP requested a medical opinion from her 

physician assessing her permanent impairment based on the sixth edition of the A.M.A., Guides

and establishing that she had reached MMI. 

In a January 4, 2012 letter and treatment note, Dr. Gomez indicated that he was not 

familiar with the sixth edition of the A.M.A., Guides and that he used the fifth edition of the 

A.M.A., Guides, as required in California. He noted that in November 2011 he had injected the 

right radial tunnel and appellant had partial relief from forearm discomfort. Dr. Gomez advised 

that it was not a good time to have either extremity evaluated since she recently had left elbow 

surgery and was overusing her right upper extremity. He recommended an impairment 

evaluation by someone familiar with the sixth edition of the A.M.A. Guides after appellant’s left 

elbow settled down in three or four months. 

On February 2, 2012 OWCP advised appellant that it would refer her for a second 

opinion examination regarding permanent impairment due to her accepted work injury. In a 

SOAF prepared on January 30, 2012, it advised that it had accepted the claim for bilateral hand 

sprain, bilateral medial epicondylitis, bilateral forearm sprain, and bilateral carpal tunnel 

syndrome. 

By letter dated February 9, 2012, OWCP notified appellant that she was scheduled for a 

March 8, 2012 appointment for a second opinion with Dr. Mohinder S. Nijjar, a Board-certified 

orthopedic surgeon. 

In a March 15, 2012 report, Dr. Nijjar noted that he had evaluated appellant on 

March 8, 2012. He provided a history of injury and appellant’s medical and employment 

background and reviewed medical records. Dr. Nijjar provided examination findings and 

diagnosed left medial epicondylitis, status post medial epicondylectomy and decompression of 

the ulnar nerve, median nerve entrapment, and status post decompression at the right and left 

wrists. He found that appellant had 2 percent impairment of the right arm and 11 percent 

impairment of the left arm3

 based on the sixth edition of the A.M.A., Guides. Dr. Nijjar found 

that she reached MMI on the date of his examination. 

 3

 Dr. Nijjar found five percent impairment due to medial epicondylitis and six percent due to median and ulnar 

nerve impairment. 
4

On June 25, 2012 a second OWCP medical adviser reviewed the medical record, 

including Dr. Nijjar’s March 15, 2012 findings, and agreed that appellant had 2 percent 

impairment of the right upper extremity and 11 percent impairment of the left upper extremity 

under the sixth edition of the A.M.A., Guides. He found that she reached MMI on March 15, 

2012, the date of Dr. Nijjar’s report. 

In an August 21, 2012 decision, OWCP found that appellant had no more than the 

previously awarded 17 percent permanent impairment of the right upper extremity and granted 

her a schedule award for 11 percent permanent impairment of the left upper extremity based on 

the opinions of Dr. Nijjar and its second medical adviser. 

On December 27, 2013 Dr. Gomez performed authorized right elbow in situ ulnar nerve 

release. In a February 3, 2014 report, he noted that appellant’s numbness and pain had 

significantly improved following this surgery. Dr. Gomez advised appellant to perform 

desensitization and mobilization exercises since her scar was very tender. He concluded that 

appellant would remain off work until her next evaluation in one month. 

On January 5, 2015 appellant filed a Form CA-7 for an additional schedule award.4

By letter dated January 15, 2015, OWCP notified appellant of the deficiencies of her 

claim. It afforded her 30 days to submit additional evidence, including a medical report 

containing a detailed description of her permanent impairment based on the sixth edition of the 

A.M.A., Guides. 

Appellant did not respond. In a February 18, 2015 decision, OWCP denied her claim for 

an additional schedule award. 

On March 3, 2015 appellant requested reconsideration of the February 18, 2015 decision. 

In a March 11, 2015 letter, she requested a referral to a physician who utilized the sixth edition 

of the A.M.A., Guides as recommended by Dr. Gomez in his February 9, 2015 treatment note. 

By letter dated April 17, 2015, OWCP notified appellant that she was scheduled for a 

May 8, 2015 appointment for a second opinion with Dr. Bruce E. Thompson, a physician Boardcertified in occupational medicine. 

In a May 8, 2015 report, Dr. Thompson noted a history of appellant’s occupational, 

medical, social, and family background. He indicated that she had retired on July 2, 2006. 

Dr. Thompson reviewed medical records and the SOAF. On examination of the arms, he found 

well-healed surgical scars at the cubital and carpal tunnel consistent with appellant’s past history 

of four surgeries. There was a slight decrease in sensation to simple monofilament. Deep tendon 

reflexes were brisk and equilateral at the bicep, triceps, and brachioradialis. A Jamar 

dynamometer revealed 65, 60, and 60 pounds on the left and 65, 70, and 65 pounds on the right. 

Range of motion of the shoulders, elbows, and wrists were equilaterally normal in all planes. 

 4

 Appellant previously filed a Form CA-7 on March 11, 2014 for an additional schedule award. By letter dated 

March 28, 2014, OWCP advised her that no action would be taken on her claim as Dr. Gomez’s February 3, 2014 

report indicated that she had not yet reached MMI. 
5

Motor strength in flexion, extension, supination, and pronation against resistance were equal on 

the left side to the right side at level 5/5. Circumferential measurements for the right and left 

mid-arm were each 11.5 inches and the right and left mid forearm were each 11.0 inches. Twopoint discrimination of 0.2 centimeters was over the palmer surface of all ten fingertips. Sensory 

deficit in the median and ulnar nerve distribution was mild to moderate as tested by 

monofilament and light brush and touch with preserved sharp and dull discrimination. Deep 

tendon reflexes were brisk and equilateral at the biceps, triceps, and brachioradialis. 

Finklestein’s test was negative. Dr. Thompson diagnosed bilateral carpal tunnel syndrome status 

postsurgical release and bilateral cubital tunnel syndrome status postsurgical release. He noted 

that, since appellant had retired, she continued to be able to perform all activities of daily living. 

Appellant generally had a good result from her four surgeries, noting the last surgery was in 

December 2013 to release compression of both ulnar and radial nerves. Dr. Thompson advised 

that appellant reached MMI in all four areas on December 1, 2014. 

In rating impairment under the sixth edition of the A.M.A., Guides, Dr. Thompson noted 

his diagnoses of bilateral cubital tunnel syndrome and bilateral carpal tunnel syndrome were 

essentially an identical manifestation without significant difference in the four nerves, as 

evaluated by functional history, physical examination, and clinical studies on both the left and 

right. He found that appellant’s functional history revealed mild intermittent parasthesias and 

mild ache and pain about the bilateral wrist and elbow and mild recurrent numbness in the 

median and ulnar nerve distribution. Examination showed bilateral full range of motion of the 

elbows, wrists, and hands and mild ulnar nerve decreased sensitivity in the distal dermatomes. 

Clinical Studies included a May 25, 2010 electromyogram/nerve conduction studies (EMG/NCS) 

which revealed right median nerve compression at the carpal tunnel. There was borderline 

slowing motor conduction of the left ulnar nerve across the carpal tunnel (cubital tunnel 

syndrome). There was also normal conduction velocity across the canal of the Guyon. 

Dr. Thompson indicated that all four nerves, right medial nerve, right ulnar nerve, left medial 

nerve, and left ulnar nerve, were rated in the same class and grade. He determined that appellant 

had two percent impairment of the right arm due to residual problems status post carpal tunnel 

release under Table 15-23 on page 449. Dr. Thompson noted that patients with multiple 

neuropathies the second or smaller nerve impairment was rated at 50 percent of the impairment 

listed in Table 15-23. He found that appellant had one percent impairment of the right arm due 

to residual problems, cubital tunnel symptoms status post cubital tunnel release under Table 15-4 

on page 399. Dr. Thompson added the two percent impairment rating for carpal tunnel 

syndrome and one percent impairment rating for cubital tunnel syndrome to calculate three 

percent impairment of the right arm. Regarding the left arm, he found that appellant had two 

percent impairment for carpal tunnel syndrome and one percent impairment for cubital tunnel 

syndrome. Dr. Thompson added these ratings to calculate three percent impairment of the left 

arm. He found that appellant had three percent impairment of each arm. 

On July 8, 2015 a third OWCP medical adviser reviewed Dr. Thompson’s May 8, 2015 

findings and agreed that appellant had three percent impairment of each upper extremity based 

on the sixth edition of the A.M.A., Guides. She noted that impairment due to bilateral carpal 

tunnel syndrome was determined by Table 15-23 on page 449. The medical adviser assigned a 

grade modifier of 1 each for history, physical findings, and test findings. She determined that the 

average grade modifier was 1. Using the functional scale value of 1, mild, as a modifier, resulted 

in two percent upper extremity impairment. The medical adviser noted that impairment due to 
6

bilateral cubital tunnel syndrome was also determined by Table 15-23. She assigned a grade 

modifier of 1 each for history, physical findings, and test findings. The average grade modifier 

was 1. Using the functional scale value of 1, mild, as a modifier, the medical adviser determined 

that the upper extremity impairment was two percent. She noted that the second entrapment 

neuropathy was taken at one-half the value or one percent. The medical adviser found that 

appellant had a total three percent impairment of each arm. There was no additional impairment 

for either arm. The medical adviser concluded that appellant had reached MMI on May 8, 2015, 

the date of Dr. Thompson’s examination. 

In a July 13, 2015 decision, OWCP denied modification of the February 18, 2015 

decision. It found that the weight of the medical evidence rested with the opinions of 

Dr. Thompson and its medical adviser who determined that appellant had no greater impairment 

of either upper extremity than previously awarded. 

LEGAL PRECEDENT 

The schedule award provision of FECA5 and its implementing federal regulations6 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 for all claimants, OWCP has adopted 

the A.M.A., Guides as the uniform standard applicable to all claimants.7 As of May 1, 2009, the 

sixth edition of the A.M.A., Guides is used to rate permanent impairment.8

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). 

For upper and lower extremity impairments, the evaluator identifies the impairment class for the 

Class of Diagnosis (CDX), which is then adjusted by grade modifiers based on Functional 

History (GMFH), Physical Examination (GMPE), and Clinical Studies (GMCS). The net 

adjustment formula is (GMFH - CDX) + (GMPE - CDX) + (GMCS - CDX).9

 Evaluators are 

directed to provide reasons for their impairment rating choices, including the choices of 

diagnoses from regional grids and calculations of modifier scores.10

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

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

 5

 5 U.S.C. § 8107. 

6

 20 C.F.R. § 10.404. 

7 Id. at § 10.404(a). 

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

Chapter 2.808.5a (February 2013); see also Part 3 -- Medical, Schedule Awards, Chapter 3.700, Exhibit 1 

(January 2010). 

9 R.Z., Docket No. 10-1915 (issued May 19, 2011). 

10 J.W., Docket No. 11-289 (issued September 12, 2011). 
7

section 15.4f of the A.M.A., Guides.

11 In Table 15-23, grade modifier levels (ranging from 0 to 

4) 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.12

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

should be routed to the 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.13

OWCP procedures state that any previous impairment to the member under consideration 

is included in calculating the percentage of loss, except when the prior impairment is due to a 

previous work-related injury, in which case the percentage already paid is subtracted from the 

total percentage of impairment.14 

ANALYSIS 

The Board finds that appellant has not met her burden of proof to establish more than 17 

percent permanent impairment of the right arm and 11 percent impairment of the left arm. 

OWCP accepted appellant’s claim for bilateral hand sprain, bilateral medial epicondylitis, 

bilateral forearm sprain, and bilateral carpal tunnel syndrome. Appellant underwent authorized 

right open carpal tunnel release on January 28, 2011, left open carpal tunnel release on April 1, 

2011, left elbow ulnar nerve release and medial epicondylectomy on October 7, 2011, and right 

elbow in situ ulnar nerve release on December 27, 2013. 

On October 21, 2008 OWCP granted appellant a schedule award for 17 percent 

impairment of the right upper extremity. On August 21, 2012 it granted her a schedule award for 

11 percent impairment of the left upper extremity. On July 13, 2015 OWCP denied modification 

of its February 18, 2015 denial of appellant’s claim for an additional schedule award based on 

the May 8, 2015 medical opinion of Dr. Thompson, a second opinion physician. 

In a May 8, 2015 report, Dr. Thompson, using the sixth edition of the A.M.A., Guides,

found three percent impairment of each upper extremity due to appellant’s bilateral carpal tunnel 

syndrome status postsurgical release and bilateral cubital tunnel syndrome status postsurgical 

release. In calculating impairment for appellant’s bilateral carpal tunnel syndrome, he properly 

referenced Table 15-23, Entrapment/Compression Neuropathy Impairment, page 449 of the 

A.M.A., Guides. Dr. Thompaon noted that appellant’s functional history indicated mild 

intermittent parasthesias and mild ache and pain about the bilateral wrist and elbow and mild 

 11 A.M.A., Guides 433-50. 

12 Id. at 448-50. 

13 See Federal (FECA) Procedure Manual, supra note 8 at Chapter 2.808.6(f) (February 2013). 

14 Id. at Chapter 2.808.7.a(2) (February 2013). 
8

recurrent numbness in the median and ulnar nerve distribution. His examination revealed 

bilateral full range of motion of the elbows, wrists, and hands and mild ulnar nerve decreased 

sensitivity in the distal dermatomes. Clinical studies included a May 25, 2010 EMG/NCS which 

demonstrated right median nerve compression at the carpal tunnel, borderline slowing motor 

conduction of the left ulnar nerve across the carpal tunnel (cubital tunnel syndrome), and normal 

conduction velocity across the canal of the Guyon. Dr. Thompson related that all four nerves, 

right medial nerve, right ulnar nerve, left medial nerve, and left ulnar nerve, were rated in the 

same class and grade. He properly calculated that appellant had two percent impairment of the 

right arm for residual problems status post carpal tunnel release under Table 15-23. 

Dr. Thompson noted that patients with multiple neuropathies the second or smaller nerve 

impairment was rated at 50 percent of the impairment listed in Table 15-23. He found that 

appellant had one percent impairment of the right arm due to residual problems, cubital tunnel 

symptoms status post cubital tunnel release, under Table 15-4 on page 399. Dr. Thompson 

added the two percent impairment rating for bilateral carpal tunnel syndrome and one percent 

impairment rating for bilateral cubital tunnel syndrome to calculate three percent impairment of 

the right arm. Regarding the left arm, he also properly found that appellant had two percent 

impairment for carpal tunnel syndrome and one percent impairment for cubital tunnel syndrome. 

Dr. Thompson accurately added these impairment ratings to calculate three percent impairment 

of the left arm. He concluded that appellant had three percent impairment of each arm. 

In accordance with its procedures,15 OWCP properly referred the file to its medical 

adviser. On July 8, 2015 she advised that the date of MMI was May 8, 2015, the date of 

Dr. Thompson’s evaluation. The medical adviser agreed with Dr. Thompson’s assessment that 

appellant had three percent impairment of each arm. For bilateral carpal tunnel syndrome, she 

determined under Table 15-23 that appellant had grade modifiers of 1 each for test findings, 

history, and physical findings, which she added and averaged, finding a grade modifier of 1. The 

medical adviser noted that there was no adjustment based on functional scale, as she found that 

the functional scale also equaled a grade modifier of 1 (mild), and therefore appellant had two 

percent impairment. Regarding appellant’s bilateral cubital tunnel syndrome, the medical 

adviser found under Table 15-23 that appellant had grade modifiers of 1 each for test findings, 

history, and physical findings, which she added and averaged, finding a grade modifier of 1. She 

found that the functional scale value was also a grade 1 modifier (mild) resulting in two percent 

impairment. The medical adviser noted that the second entrapment neuropathy was awarded at 

50 percent of the impairment value or one percent.16 She properly concluded that appellant had a 

total three percent impairment of each arm. 

The Board finds that OWCP medical adviser’s opinion, which is based on 

Dr. Thompson’s findings, represents the weight of the evidence and establishes that appellant has 

no more than 17 percent impairment of the right upper extremity and 11 percent impairment of 

the left upper extremity that were previously awarded. She properly applied the appropriate 

provisions of the A.M.A., Guides to the clinical findings of record.17 There is no current medical 

 15 See supra note 13. 

16 See Example 15-19, page 450, of the sixth edition of the A.M.A., Guides entitled Multiple Entrapments. 

17 W.M., Docket No. 11-1156 (issued January 27, 2012). 
9

evidence of record, in conformance with the sixth edition of the A.M.A., Guides, showing any 

greater impairment. 

Appellant may request an increased schedule award based on evidence of a new exposure 

or medical evidence showing progression of an employment-related condition resulting in 

permanent impairment or increased impairment. 

CONCLUSION 

The Board finds that appellant has not met her burden of proof to establish more than 17 

percent impairment of the right upper extremity and 11 percent impairment of the left upper 

extremity, for which she received schedule awards. 

ORDER 

IT IS HEREBY ORDERED THAT the July 13, 2015 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: May 20, 2016 

Washington, DC 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board 

 

 Valerie D. Evans-Harrell, Alternate Judge 

 Employees’ Compensation Appeals Board