United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

S.S., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Pittsburgh, PA, Employer 

__________________________________________ 

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Docket No. 16-1101 

Issued: November 4, 2016 

Appearances: Case Submitted on the Record

Jeffrey P. Zeelander, Esq., for the appellant1

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

PATRICIA H. FITZGERALD, Deputy Chief Judge 

ALEC J. KOROMILAS, Alternate Judge 

VALERIE D. EVANS-HARRELL, Alternate Judge 

JURISDICTION 

On May 3, 2016 appellant, through counsel, filed a timely appeal from a March 23, 2016 

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 over the merits of this case. 

ISSUE 

The issue is whether appellant has more than two percent permanent impairment of each 

upper extremity, for which he received schedule awards. 

 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 November 13, 2014 appellant, then a 56-year-old mail handler, filed an occupational 

disease claim (Form CA-2) alleging that he sustained bilateral carpal tunnel syndrome due to 

factors of his federal employment. OWCP accepted the claim for bilateral carpal tunnel 

syndrome, tenosynovitis of the right hand and wrist, and synovitis and tenosynovitis of the left 

hand. 

A September 10, 2014 electromyogram (EMG) and nerve conduction velocity (NCV) 

study revealed moderately severe bilateral carpal tunnel syndrome especially on the right side. 

An EMG study performed on October 22, 2014 revealed moderate bilateral carpal tunnel 

syndrome. 

Appellant underwent a left carpal tunnel release and flexor tenosynovectomy on April 23, 

2015 and a right carpal tunnel release and flexor tenosynovectomy on June 25, 2015. OWCP 

authorized the surgeries. 

In an impairment evaluation dated December 17, 2015, Dr. Michael Platto, a Boardcertified physiatrist, reviewed appellant’s history of injury, the results of electrodiagnostic 

testing, and history of bilateral carpal tunnel releases. On examination he measured range of 

motion of the wrists and found decreased two-point discrimination of the left thumb, middle, and 

index fingers. Citing the sixth edition of the American Medical Association, Guides to the 

Evaluation of Permanent Impairment (A.M.A., Guides), Dr. Platto found that appellant had three 

percent permanent impairment due to tenosynovitis as a result of bilateral loss of wrist range of 

motion according to Table 15-32 on page 473. In rating impairment due to carpal tunnel 

syndrome, he referenced Table 15-23 on page 449. Utilizing the preoperative EMG study dated 

September 10, 2014, for the right side Dr. Platto applied a grade modifier of three due to test 

findings of axon loss, a grade modifier of one for normal physical findings with intermittent 

symptoms, and a grade modifier of one for physical examination, which rounded to a grade 

modifier of two. He found a grade modifier of zero based on a QuickDASH (Disabilities of the 

Arm, Shoulder, and Hand) score of 15.9. For the left side, Dr. Platto advised that he performed 

NCV studies due to appellant’s complaints of numbness not improved after surgery. He opined 

that the NCV studies revealed axon loss with “decreased motor median amplitude of less than 

[five]” and a delay in median sensory peak latency, which yielded a grade modifier of three for 

test results. Dr. Platto also applied a grade modifier of one for a history of mild intermittent 

symptoms and a grade modifier of two for physical findings of decreased two-point 

discrimination. He found an average grade modifier of two, or four percent impairment. 

Dr. Platto concluded that appellant had three percent impairment of each upper extremity due to 

tenosynovitis and four percent impairment of each upper extremity due to carpal tunnel 

syndrome, for a combined seven percent permanent impairment of each upper extremity. He 

opined that appellant had reached maximum medical improvement. 

On January 8, 2016 appellant filed a claim for a schedule award (Form CA-7). 

OWCP on January 20, 2016 referred appellant to Dr. Shaka Walker, a Board-certified 

orthopedic surgeon, for a second opinion examination. In an impairment evaluation dated 

February 1, 2016, Dr. Walker reviewed appellant’s history of hand numbness and pain treated 
3

with carpal tunnel releases and flexor tenosynovectomies. On examination, he found no atrophy 

and a negative Tinel’s sign and Phalen’s test. Dr. Walker measured range of motion of the wrists 

and performed pinch and grip strength testing. He opined that appellant had reached maximum 

medical improvement. Dr. Walker advised that he had normal range of motion findings for the 

wrists for a grade modifier of zero. He noted that appellant had a QuickDASH score of 47.7, 

which was a significant increase from the prior score of 15.9 and “concerning for some element 

of symptom magnification....” Dr. Walker concluded that he had no impairment due to 

tenosynovitis due to reduced motion. Using Table 15-23 on page 449 of the A.M.A., Guides, for 

the right side he found that EMG findings on the right in the September 10, 2014 study showed 

axonal loss, for a grade three modifier. Dr. Walker applied a grade modifier of zero for 

functional history and physical examination. He opined that he would not use the QuickDASH 

due to reliability issues. Dr. Walker found an average modifier of one and a final right upper 

extremity permanent impairment rating of one percent. 

For the left wrist, Dr. Walker found that a postoperative EMG showed median motor 

amplitude of less than five, or axonal loss, for a grade three modifier. He applied a grade two 

modifier for decreased sensation and a grade modifier of three for history. Dr. Walker found an 

average grade modifier of three, for seven percent permanent impairment of the left upper 

extremity. 

An OWCP medical adviser reviewed the evidence on March 21, 2016. He advised that 

diagnostic testing performed September 10, 2014 did not show axonal loss and that grip and 

pinch strength were nonspecific findings. The medical adviser also noted that Dr. Walker did 

not perform sensory testing. He concurred with Dr. Walker’s finding of no impairment due to 

tenosynovitis. Using Table 15-23, the medical adviser applied a grade modifier of one bilaterally 

due to electrodiagnostic testing. He further applied a grade modifier of zero on the right and two 

on the left for physical findings of loss of two-point discrimination of the left hand and a grade 

modifier of zero for history on the right and one on the left. The medical adviser found that the 

functional history was not applicable because of the unreliable QuickDASH score. He opined 

that appellant had two percent permanent impairment of each upper extremity due to carpal 

tunnel syndrome. 

By decision dated March 23, 2016, OWCP granted appellant a schedule award for two 

percent permanent impairment of each upper extremity. The period of the award ran for 12.48 

weeks from February 1 to April 28, 2016. 

On appeal counsel contends that the opinions of Dr. Platto and Dr. Walker are entitled to 

more weight than the opinion of OWCP’s medical adviser because they performed physical 

examinations. 

LEGAL PRECEDENT 

The schedule award provision of FECA,3

 and its implementing federal regulations,4 set 

forth the number of weeks of compensation payable to employees sustaining permanent 

 3

 5 U.S.C. § 8107. 

4

 20 C.F.R. § 10.404. 
4

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.5

 As of May 1, 2009, the 

sixth edition of the A.M.A., Guides is used to calculate schedule awards.6

The sixth edition requires identifying the impairment Class of Diagnosis (CDX) 

condition, which is then adjusted by grade modifiers based on Functional History (GMFH), 

Physical Examination (GMPE), and Clinical Studies (GMCS).7 The net adjustment formula is 

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

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

15-23 (Entrapment/Compression Neuropathy Impairment) and accompanying relevant text.8

 In 

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

test findings, history, and physical findings. The grade modifiers are averaged to arrive at the 

appropriate overall grade modifier level and to identify a default rating value. 

Section 8123(a) provides that, if there is disagreement between the physician making the 

examination for the United States and the physician of the employee, the Secretary shall appoint 

a third physician who shall make an examination.9

 The implementing regulations states that, if a 

conflict exists between the medical opinion of the employee’s physician and the medical opinion 

of either a second opinion physician or an OWCP medical adviser, OWCP shall appoint a third 

physician to make an examination. This is called a referee examination and OWCP will select a 

physician who is qualified in the appropriate specialty and who has no prior connection with the 

case.10

ANALYSIS 

OWCP accepted that appellant sustained bilateral carpal tunnel syndrome, tenosynovitis 

of the right wrist and hand, and synovitis and tenosynovitis of the left hand causally related to 

factors of his federal employment. A September 10, 2014 EMG and NCV studies showed 

moderately severe bilateral carpal tunnel syndrome, greater on the right side. Appellant 

underwent a left carpal tunnel release and flexor tenosynovectomy on April 23, 2015 and a right 

carpal tunnel release and flexor tenosynovectomy on June 25, 2015. On January 8, 2016 he filed 

a claim for a schedule award. 

 5 Id. at § 10.404(a). 

6

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

Chapter 2.808.5 (February 2013); see also Part 3 -- Medical, Schedule Awards, Chapter 3.700.2 and Exhibit 1 

(January 2010). 

7

 A.M.A., Guides 494-531. 

8 Id. at 449, Table 15-23. 

9

 5 U.S.C. § 8123(a). 

10 20 C.F.R. § 10.321. 
5

The Board finds that the case is not in posture for decision due to a conflict in medical 

opinion. In a December 17, 2015 impairment evaluation, Dr. Platto, an attending physician, 

identified the diagnosis as carpal tunnel syndrome and advised that, under Table 15-23, appellant 

had a grade modifier of three on the right side due to axon loss as shown by test results, a grade 

modifier of one for a history of intermittent symptoms, a grade modifier of one for physical 

examination, and no grade modifier for the functional scale based on the QuickDASH results. 

He found an average grade modifier of two and four percent right upper extremity impairment. 

For the left side, Dr. Platto applied a grade modifier of three for test findings of axon loss, a 

grade modifier of one for a history of mild intermittent symptoms, and a grade modifier of two 

for physical findings of decreased two-point discrimination, for an average modifier of two and 

four percent impairment due to carpal tunnel syndrome. He further determined that appellant 

had three percent impairment due to reduced wrist motion as a result of tenosynovitis, for seven 

percent total upper extremity impairment bilaterally. 

OWCP referred appellant to Dr. Walker for a second opinion examination. On 

February 1, 2016 Dr. Walker found that he had no impairment due to tenosynovitis, seven 

percent left upper extremity impairment due to carpal tunnel syndrome, and one percent right 

upper extremity impairment due to carpal tunnel syndrome. He opined that electrodiagnostic 

testing showed axonal loss on the right and left side. 

An OWCP medical adviser, on March 21, 2016, determined that the September 10, 2014 

EMG and NCV studies did not show axonal loss. Utilizing Table 15-23, for the left side he 

applied grade modifiers of one for test results, two for physical findings of loss of two-point 

discrimination, and one for history, which he found yielded a grade modifier of one. For the 

right side, the medical adviser applied a grade modifier of one for test results and history and 

zero for physical findings, for an average modifier of one. He found that the QuickDASH results 

were not reliable. The medical adviser determined that appellant had two percent permanent 

impairment of each upper extremity due to carpal tunnel syndrome and no impairment due to 

tenosynovitis. 

The Board finds that a conflict exists between Dr. Platto, appellant’s physician, and 

Dr. Walker, the second opinion physician, regarding the interpretation of the electrodiagnostic 

test results and the extent of his permanent impairment of the upper extremities. Section 8123(a) 

provides that, if there is disagreement between the physician making the examination for the 

United States and the physician of the employee, the Secretary shall appoint a third physician 

who shall make an examination.11 On remand, OWCP shall refer the case to an impartial 

medical specialist to resolve the conflict in medical opinion. After such further development as 

deemed necessary, it should issue a de novo decision regarding appellant’s schedule award 

claim. 

CONCLUSION 

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

 11 5 U.S.C. § 8123(a); see also A.E., Docket No. 15-0496 (issued May 23, 2016). 
6

ORDER 

IT IS HEREBY ORDERED THAT the March 23, 2016 decision of the Office of 

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

consistent with this opinion of the Board. 

Issued: November 4, 2016 

Washington, DC 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board 

 

 Valerie D. Evans-Harrell, Alternate Judge 

 Employees’ Compensation Appeals Board