United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

E.M., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

PROCESSING & DISTRIBUTION CENTER, 

Palatine, IL, Employer 

__________________________________________ 

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Docket No. 14-795 

Issued: January 9, 2015 

Appearances: Case Submitted on the Record

Appellant, pro se 

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

COLLEEN DUFFY KIKO, Judge 

PATRICIA HOWARD FITZGERALD, Judge 

MICHAEL E. GROOM, Alternate Judge 

JURISDICTION 

On February 25, 2014 appellant filed a timely appeal from a September 13, 2013 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 the case. 

ISSUE 

The issue is whether appellant established more than three percent permanent impairment 

of the left upper extremity and four percent permanent impairment of the right upper extremity 

for which she received a schedule award. 

FACTUAL HISTORY 

On April 9, 2011 appellant, then a 52-year-old mail handler, filed an occupational disease 

claim asserting that work duties caused right and left upper extremity, neck, low back and left 

knee and ankle pain. She did not stop work. OWCP accepted tendinitis of the left shoulder, 

 1

 5 U.S.C. §§ 8101-8193. 
2

temporary aggravation of lumbar disc disease, temporary aggravation of cervical disc disease, 

bilateral carpal tunnel syndrome and sprain of right shoulder, upper arm, and rotator cuff. 

Appellant received intermittent compensation. She stopped work on February 27, 2012 and filed 

claims for compensation. Appellant returned to work on July 17, 2012.2

On May 14, 2013 appellant filed a schedule award claim and submitted an April 19, 2013 

report in which Dr. Anatoly Rozman, a Board-certified physiatrist, advised that she had been 

under his care since June 29, 2011. Dr. Rozman indicated that she reached maximum medical 

improvement on October 26, 2012. He advised that appellant had residuals of the accepted 

conditions, including loss of strength, pain and crepitation of both shoulders with grossly 

preserved range of motion and positive empty can and lift-off tests on the right; pain and spasm 

in the cervical and lumbar paraspinal muscles with a positive straight leg raising test and 

decreased sensation at the L4-5 level; decreased cervical spine range of motion with positive 

Spurling’s maneuver and Hoffman’s test; and positive Phalen’s and Tinel’s tests bilaterally with 

decreased sensation in the median nerve distribution. Dr. Rozman indicated that upper extremity 

electrodiagnostic testing on May 6, 2011 demonstrated cervical radiculopathy, ulnar nerve 

neuropathy and bilateral carpal tunnel syndrome and that lower extremity electrodiagnostic 

testing on May 20 and July 22, 2011 demonstrated L4-5 lumbar radiculopathy. He further noted 

that magnetic resonance imaging (MRI) scan studies of the cervical and lumbar spines on May 9, 

2011 and February 16, 2012 respectively, demonstrated disc disease and stenosis and that left 

and right shoulder MRI scan studies in May and August 2011 each demonstrated partial tears of 

the supraspinatus tendon. 

Dr. Rozman provided an impairment rating in accordance with the sixth edition of the 

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

Guides).3

 

Regarding the accepted left shoulder tendinitis, Dr. Rozman found that, under Table 15-5, 

Shoulder Regional Grid, appellant had a class 1 impairment with a default value of three percent. 

He found modifiers of one each for functional history and physical examination and a modifier 

of two for clinical studies. Dr. Rozman then applied the net adjustment formula, concluding that 

appellant had four percent impairment due to left shoulder tendinitis. 

Regarding the right upper extremity, Dr. Rozman found that under Table 15-5 she had a 

class 1 impairment for rotator cuff tendinitis with grade modifiers of two each for functional 

history and clinical studies and a modifier of one for physical examination. After applying the 

net adjustment formula, he concluded that appellant had seven percent impairment of the right 

upper extremity due to right shoulder tendinitis. 

Regarding bilateral carpal tunnel syndrome, Dr. Rozman indicated that, in accordance 

with Table 15-23, Entrapment/Compression Neuropathy Impairment, she had a modifier of one 

on test findings and modifiers of two each for history and physical examination findings. He 

 2

 On July 26, 2012 OWCP denied appellant’s claim for wage-loss compensation. On October 14, 2012 an OWCP 

hearing representative vacated the July 26, 2012 decision and directed an OWCP medical adviser to provide an 

opinion regarding the claimed disability. Based on a November 18, 2012 report from the medical adviser, appellant 

was paid wage-loss compensation for the period February 27 through July 13, 2012. 

3

 A.M.A., Guides (6th ed. 2008). 
3

averaged these and found two percent bilateral upper extremity impairment and modified this by 

appellant’s QuickDASH score, concluding that appellant had a total three percent impairment of 

each upper extremity due to carpal tunnel syndrome. Dr. Rozman analyzed her cervical and 

lumbar conditions under Chapter 17, The Spine and Pelvis, finding 16 percent whole person 

impairment for lumbar disc disease and 15 percent whole person impairment for cervical disc 

disease. 

In a June 3, 2013 report, Dr. Christopher Gross, an orthopedic surgeon and an OWCP 

medical adviser, indicated that appellant had no impairment due to her cervical and lumbar spine 

conditions. Regarding bilateral carpal tunnel syndrome, he indicated that, under Table 15-23, 

she had a grade one modifier for testing because the electrodiagnostic study demonstrated 

bilateral mild to moderate carpal tunnel syndrome and a modifier of one for physical findings 

due to mild intermittent symptoms, for a total impairment rating of two percent for each upper 

extremity based on carpal tunnel syndrome. Dr. Gross found a class 1 impairment under Table 

15-5 for a left partial thickness rotator cuff tear with residual symptoms. He found a functional 

history modifier of one and physical examination and clinical studies modifiers of two each. 

After applying the net adjustment formula, Dr. Gross determined that appellant had two percent 

left shoulder impairment. He indicated that, because she had minimal pain and functional loss of 

the right shoulder, she had a class 0 right shoulder impairment. Dr. Gross concluded that 

appellant had a right upper extremity impairment of four percent and a left upper extremity of 

three percent and no impairment of the lower extremities, with maximum medical improvement 

reached on October 26, 2012, when Dr. Rozman saw a stabilization of her problems. 

On September 13, 2013 appellant was granted a schedule award for three percent 

impairment of the left upper extremity and four percent impairment on the right, for a total of 

21.84 weeks, to run from October 26, 2012 to March 27, 2013. 

LEGAL PRECEDENT 

The schedule award provision of FECA4 and its implementing federal regulations5 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.6

 For decisions after 

February 1, 2001, the fifth edition of the A.M.A., Guides was used to calculate schedule awards.7 

For decisions issued after May 1, 2009, the sixth edition is used.8

 4

 5 U.S.C. § 8107. 

5

 20 C.F.R. § 10.404. 

6 Id. at § 10.404(a). 

7

 Federal (FECA) Procedure Manual, Part 3 -- Medical, Schedule Awards, Chapter 3.700, Exhibit 4 (June 2003). 

8

 FECA Bulletin No. 09-03 (issued March 15, 2009). 
4

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 

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 

Section 15.2e of the A.M.A., Guides provides that the evaluator should select the most 

significant diagnosis regarding the shoulder and to rate only that diagnosis.12

Although the diagnosis-based approach is the preferred method of evaluating permanent 

impairment under the sixth edition of the A.M.A., Guides,

13 Table 15-5, Shoulder Regional Grid, 

provides that, if loss of motion is present, the impairment may alternatively be assessed under 

section 17-7, range of motion impairment.14 A range of motion impairment stands alone and is not 

combined with a diagnosis-based impairment.15

Although the A.M.A., Guides includes guidelines for estimating impairment due to 

disorders of the spine, a schedule award is not payable under FECA for injury to the spine.16 In 

1960, amendments to FECA modified the schedule award provisions to provide for an award for 

permanent impairment to a member of the body covered by the schedule regardless of whether 

the cause of the impairment originated in a scheduled or nonscheduled member. Therefore, as 

the schedule award provisions of FECA include the extremities, a claimant may be entitled to a 

schedule award for permanent impairment to an extremity even though the cause of the 

impairment originated in the spine.17 The sixth edition of the A.M.A., Guides does not provide a 

separate mechanism for rating spinal nerve injuries as extremity impairment. The A.M.A., 

Guides for decades has offered an alternative approach to rating spinal nerve impairments.18 

OWCP has adopted this approach for rating impairment of the upper or lower extremities caused 

by a spinal injury, as provided in section 3.700 of its procedures which memorializes proposed 

tables outlined in the July/August 2009 The Guides Newsletter.

19 Specifically, it will address 

 9 Supra note 3 at 3, 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. 

12 Id. at 390. 

13 Id. at 461, section 15.7. 

14 Id. at 401-05. 

15 Id. at 405. 

16 Pamela J. Darling, 49 ECAB 286 (1998). 

17 Thomas J. Engelhart, 50 ECAB 319 (1999). 

18 Rozella L. Skinner, 37 ECAB 398 (1986). 

19 FECA Transmittal No. 10-04 (issued January 9, 2010); see supra note 7. 
5

lower extremity impairments originating in the spine through Table 16-11 and upper extremity 

impairment originating in the spine through Table 15-14.20 

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

15-23 (Entrapment/Compression Neuropathy Impairment) and accompanying relevant text.21 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.22 

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.23 In determining entitlement to a 

schedule award, preexisting impairment to the scheduled member is to be included.24

ANALYSIS 

The Board finds this case is not in posture for decision. The accepted conditions are 

bilateral carpal tunnel syndrome, temporary aggravation of cervical and lumbar disc disease, left 

shoulder tendinitis and right upper extremity sprains of the shoulder, upper arm and rotator cuff. 

Appellant was granted a schedule award on September 13, 2013 for a three percent left upper 

extremity impairment and a four percent impairment on the right. OWCP found the weight of 

the medical opinion evidence rested with the opinion of the medical adviser, Dr. Gross. 

As noted above, a schedule award is not payable under FECA for injury to the spine.25 A 

claimant, however, may be entitled to a schedule award for permanent impairment to an 

extremity even though the cause of the impairment originated in the spine.26 Dr. Rozman, the 

attending physiatrist, utilized Chapter 17, The Spine and Pelvis, of the A.M.A., Guides, rather 

than following section 3.700 of OWCP’s procedures, which memorializes proposed tables 

outlined in the July/August 2009 The Guides Newsletter in reaching his conclusion that appellant 

had 15 percent whole person impairment for aggravation of cervical disc disease.27 He did not 

indicate that she had upper extremity findings relative to the accepted temporary aggravation of 

 20 Supra note 3 at 533 and 425 respectively. 

21 Id. at 449. 

22 Id. at 448-50. 

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

Chapter 2.808.6(f) (February 2013). 

24 Peter C. Belkind, 56 ECAB 580 (2005). 

25 Supra note 16. 

26 Supra note 17. 

27 Supra notes 7 and 19. 
6

cervical disc disease. Dr. Rozman’s impairment ratings under Chapter 17 are of no probative 

value. Dr. Gross, the medical adviser, advised that, while appellant had radiculopathy as 

demonstrated electrodiagnostically, she had no dysfunction at C6 and therefore a class 0 

impairment. As he explained why appellant did not demonstrate a ratable impairment of C6 and 

as Dr. Rozman’s analysis of cervical radiculopathy did not comport with the A.M.A., Guides, the 

Board finds that appellant was not entitled to a schedule award for the accepted temporary 

aggravation of cervical disc disease. 

Regarding appellant’s impairment due to bilateral carpal tunnel syndrome, although both 

physicians utilized Table 15-23,28 their analyses differed. Impairment due to carpal tunnel 

syndrome is evaluated under the scheme found in Table 15-23 (Entrapment/Compression 

Neuropathy Impairment) and accompanying relevant text.29 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, e.g., by using the QuickDASH questionnaire.30

Dr. Rozman described physical findings in detail and indicated that, in accordance with 

Table 15-23, appellant had a test findings modifier of one and modifiers of two each for history 

and physical examination. He averaged these and concluded that appellant had two percent 

bilateral upper extremity impairment under Table 15-23. Dr. Rozman stated that he modified 

this by appellant’s QuickDASH score, finding a total three percent impairment of each upper 

extremity due to carpal tunnel syndrome. The record before the Board, however, does not 

include a completed QuickDASH questionnaire, and Dr. Rozman did not provide sufficient 

explanation to support his conclusion that by using the QuickDASH score, appellant’s 

impairment due to carpal tunnel syndrome was three percent bilaterally. There is therefore no 

basis on which to determine how the physician arrived at his conclusion.31

The Board also finds that the opinion of Dr. Gross, the medical adviser, is insufficient. 

Dr. Gross agreed that appellant had a grade one modifier for testing because the 

electrodiagnostic study demonstrated bilateral mild to moderate carpal tunnel syndrome. He, 

however, differed in his finding of a modifier for physical findings, stating appellant had mild 

intermittent symptoms. Dr. Gross did not include a modifier for history. As he did not 

sufficiently explain how he reached his conclusions under Table 15-23, his opinion is of 

insufficient rationale to establish appellant’s degree of impairment due to carpal tunnel 

syndrome. 

The physicians also disagreed in their analysis of appellant’s shoulder impairments. 

Regarding the accepted left shoulder tendinitis, Dr. Rozman, who described physical findings for 

 28 Supra note 3 at 449. 

29 Id. 

30 Id. at 448-50. 

31 D.N., 59 ECAB 576 (2008). 
7

both shoulders, found that, under Table 15-5,32 she had a class 1 impairment with a default value 

of three percent. He found modifiers of one each for functional history and physical examination 

and a modifier of two for clinical studies but did not explain his rationale for his modifier 

findings. Dr. Rozman then applied the net adjustment formula, concluding that appellant had 

four percent impairment due to left shoulder tendinitis. 

Regarding the right upper extremity, Dr. Rozman found that under Table 15-5 appellant 

had a class 1 impairment for right shoulder sprain and rotator cuff tendinitis for a five percent 

impairment with grade modifiers of two each for functional history and clinical studies and a 

modifier of one for physical examination. After applying the net adjustment formula, he 

concluded that appellant had seven percent impairment of the right upper extremity due to right 

shoulder tendinitis.33 Dr. Rozman did not explain which diagnosis he used and why he chose a 

five percent default value, and again he did not explain how he reached his modifier findings. 

Dr. Gross, the medical adviser, however, found a class 1 impairment under Table 15-5 for 

a left partial thickness left rotator cuff tear with residual symptoms. He found a functional 

history modifier of one and physical examination and clinical studies modifiers of two each. 

After applying the net adjustment formula, Dr. Gross determined that appellant had two percent 

left shoulder impairment. It is unclear on what basis he chose to use a diagnosis of left rotator 

cuff tear. Regarding the right shoulder, Dr. Gross indicated that, because she had minimal pain 

and minimal functional loss of the right shoulder, she had no right shoulder impairment.34

The Board finds that neither physician sufficiently explained why a particular diagnosis 

was chosen on which to base appellant’s bilateral shoulder impairments. The accepted 

conditions are tendinitis of the left shoulder, and sprain of the right shoulder, upper arm, and 

rotator cuff. Although appellant had MRI scan findings of partial supraspinatus tears bilaterally, 

these conditions had not been accepted. It is well established that in determining entitlement to a 

schedule award, preexisting impairment to the scheduled member is to be included yet neither 

physician indicated that he took this under consideration.35 

For these reasons, the Board will set aside the September 13, 2013 decision and remand 

the case for OWCP to return the record to the medical adviser for a supplementary opinion with 

sufficient rationale regarding appellant’s upper extremity impairments. After such further 

development as it deems necessary, OWCP shall issue a de novo schedule award decision. 

In regard to a schedule award for the accepted cervical condition, appellant may request a 

schedule award or increased schedule award based on evidence of a new exposure or medical 

 32 A.M.A., Guides, supra note 3 at 403. 

33 The Board notes that the maximum allowed for class 1 tendinitis under Table 15-5 is five percent. Id. 

34 The conclusion of the medical adviser’s report states that appellant has four percent right arm impairment and 

three percent left arm impairment. However, within his report, he states that appellant has two percent impairment 

of each arm due to carpal tunnel syndrome and two percent left arm impairment due to a partial thickness left rotator 

cuff tear. This would yield four percent left arm impairment and two percent right arm impairment. The medical 

adviser did not explain this discrepancy. 

35 Supra note 24. 
8

evidence showing progression of an employment-related condition resulting in permanent 

impairment or increased impairment to a scheduled member. 

CONCLUSION 

The Board finds this case is not in posture for decision regarding the degree of 

appellant’s bilateral upper extremity impairments.36

ORDER 

IT IS HEREBY ORDERED THAT the September 13, 2013 decision of the Office of 

Workers’ Compensation Programs is affirmed in part and set aside in part and the case remanded 

to OWCP for proceedings consistent with this opinion of the Board. 

Issued: January 9, 2015 

Washington, DC 

 

 Colleen Duffy Kiko, Judge 

 Employees’ Compensation Appeals Board 

 

 Patricia Howard Fitzgerald, Judge 

 Employees’ Compensation Appeals Board 

 

 Michael E. Groom, Alternate Judge 

 Employees’ Compensation Appeals Board 

 36 The Board also notes that appellant submitted evidence with her appeal to the Board. The Board cannot 

consider this evidence, however, as its review of the case is limited to the evidence that was before OWCP at the 

time it rendered its final decision. 20 C.F.R. § 501.2(c)(1) (2009).