United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

M.L., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Portland, OR, Employer 

__________________________________________ 

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Docket No. 15-0858 

Issued: March 24, 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 

PATRICIA H. FITZGERALD, Deputy Chief Judge 

JAMES A. HAYNES, Alternate Judge 

JURISDICTION 

On March 3, 2015 appellant filed a timely appeal of a September 8, 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 to consider the merits of the case. 

ISSUE 

The issue is whether appellant has more than six percent impairment of his left upper 

extremity and three percent impairment of his right upper extremity, for which he received 

schedule awards. 

On appeal appellant argued that he was entitled to additional impairment as his hands 

were very large. 

 1

 5 U.S.C. § 8101 et seq.
2

FACTUAL HISTORY 

On February 28, 2013 appellant, then a 57-year-old letter carrier, filed an occupational 

disease claim (Form CA-2) alleging that he developed carpal tunnel syndrome due to his federal 

employment duties. He stated that he first became aware of his condition on February 4, 2013 

and first realized that it was related to his employment on February 8, 2013. 

In an accompanying narrative statement, appellant related that he began a mounted route 

in June 2011 with a change in the mechanics of his position. He stated that he had more delivery 

time and increased movement of his arms, wrists, and hands. Appellant reported approximately 

800 deliveries on his route. He described his duties of sorting flats of up to 920 pieces of 

magazine-sized mail, residential letters of 50 pieces of mail, and parcels of 30 pieces of mail. 

Appellant loaded his vehicle with this mail as well as an additional 2,700 letters. To deliver the 

mail, he had to finger each letter with his right hand to check for forwarded mail, holds, 

miss-sorted, and miss-spent mail. Appellant then placed the mail in the proper mailbox from his 

vehicle using his right hand. He noted that he delivered to locked mailboxes which required him 

to unlock and lock 23 boxes a day. Appellant stated that his route required work of 8 to 10 hours 

a day and that he also worked an additional 1 to 2 hours to perform delivery functions on a 

vacation route. He worked six days a week and averaged 56 hours a week. Appellant stated, 

“These thousands of daily fine manipulations by my hands, wrists, and arms has resulted in 

slowly over a period of time, numbness, tingling, swelling, and pain which has resulted in carpal 

tunnel in both my left and right hands and/or wrists.” 

In a report dated February 8, 2013, Dr. Conrad G. Hamilton, a surgeon, noted appellant’s 

history of injury and the gradual onset of his paresthesias, numbness, and tingling. He reviewed 

appellant’s electromyogram study and found that it demonstrated bilateral carpal tunnel 

syndrome worse on the right. Dr. Hamilton noted that appellant had thick muscular hands and 

wrists that limited his range of motion due to anatomy rather than pathology. He found no thenar 

or hyperthenar atrophy and noted that Tinel’s sign was negative. Dr. Hamilton reported that 

appellant’s right side two-point discrimination was in the six to seven millimeter range on the 

ulnar distribution and the seven to eight millimeter range on the median distribution. Appellant 

demonstrated eight millimeter or greater two-point discrimination on the radial and ulnar 

borders. On the left side he demonstrated six millimeter two-point discrimination in his small 

finger, six to seven millimeter discrimination on the remaining fingers with seven to eight 

millimeter two-point discrimination on his thumb. 

By decision dated May 2, 2013, OWCP accepted appellant’s claim for bilateral carpal 

tunnel syndrome. 

Dr. Hamilton performed an open median nerve decompression at the right carpal tunnel 

with thenar motor branch exploration on May 28, 2013. He performed an open median nerve 

decompression on the left carpal tunnel on July 9, 2013. Appellant returned to full duty on 

August 20, 2013. 

In a report dated October 18, 2013, Dr. Hamilton noted appellant’s increasingly 

symptomatic bilateral long finger triggering. On October 28, 2013 he performed trigger digit 

injections. On November 21, 2013 Dr. Hamilton noted that appellant’s symptoms had worsened 

and that the injections had not helped. 
3

Appellant requested a schedule award on February 10, 2014. In a letter dated 

February 19, 2014, OWCP informed him that he was entitled to a schedule award when he 

reached maximum medical improvement (MMI) of his accepted condition of bilateral carpal 

tunnel syndrome. 

Dr. Hamilton completed a report following his February 3, 2014 examination, finding 

that appellant had experienced complete resolution of numbness and tingling bilaterally in his 

wrists, hands, and digits. Appellant continued to describe global achiness and pain in his hands 

with long days at work as well as intermittent symptoms of the left long finger triggering. 

Dr. Hamilton examined appellant’s wrists and found negative Tinel’s sign, with no thenar 

atrophy, normal strength in the abductor pollicis brevis, and abductor digiti quinti minimi. He 

reported appellant’s two-point discrimination as five millimeters on the radial and ulnar borders 

of all digits. Dr. Hamilton noted that no triggering was actively identified on the right long 

finger, but mild nodularity could be appreciated with deep palpation and tendon excursion. 

Appellant’s left long finger demonstrated intermittent trace triggering with deep palpation and 

associated nodularity was appreciated in the active range. Dr. Hamilton reported that appellant’s 

grip strength on the right side was 46 kilograms and on the left side 41 kilograms in position 

number two. He noted that appellant did not wish to undergo operative intervention for his left 

long finger trigger digit and was at MMI. 

By decision dated April 24, 2014, OWCP denied appellant’s claim for a schedule award 

finding that Dr. Hamilton did not provide an impairment rating in accordance with the A.M.A., 

Guides. 

In a report dated April 29, 2014, Dr. Paul S. Darby, a physician Board-certified in 

occupational medicine, examined appellant to rate his permanent impairment. He noted that 

appellant had not regained his preinjury strength, that he complained of pain in both hands that 

woke him from sleep, and that his grip strength was lessened. Dr. Darby found a positive Tinel’s 

sign at the left wrist, with no dermatomal sensory deficits in either hand. He observed, “His 

hands are quite massive. There is no obvious muscle atrophy of the thenar regions. He has 5/5 

strength of bilateral thumb opposition.... His gross grip strength is diminished bilaterally 

compared to what it should be based on his massive hand size.” Appellant’s QuickDASH score 

was 62. Dr. Darby noted that appellant required repeat electrodiagnostic studies prior to an 

impairment rating. 

Appellant underwent electrodiagnostic studies on May 20, 2014. These revealed that his 

distal motor latency on the right median nerve was 5.8 and on the left it was 5.9. Appellant’s 

right distal motor latency had improved while his left had worsened. Dr. Kevin J. Jamison, a 

Board-certified neurologist, diagnosed moderate bilateral carpal tunnel syndrome and 

recommended repeat carpal tunnel releases. 

In a report dated July 16, 2014, Dr. Darby applied the A.M.A., Guides to his 

electrodiagnostic studies and physical findings. He reported that appellant’s electrodiagnostic 

studies showed ongoing delayed distal motor latencies of the bilateral median nerves at the wrists 

and bilateral mixed median sensory responses, which were borderline to slightly delayed 

bilaterally. Dr. Darby referenced Table 15-232

 of the A.M.A., Guides and found that appellant’s 

 2

 A.M.A., Guides, 449, Table 15-23. 
4

test findings were grade modifier 1, that his constant bilateral symptoms were grade modifier 3 

for history, and based on bilateral weakness appellant had grade modifier 3 for physical findings. 

He noted, “The sum of the modifiers is 7 and the averages is 2.33, indicating [g]rade 2 is the 

final rating category. The QuickDASH score of 62 corresponds to [g]rade [m]odifier 3 on the 

functional scale. Therefore, the default upper extremity impairment of five percent is raised to 

six percent because the functional grade modifier is one level higher than the final rating 

category.” Dr. Darby concluded that appellant had six percent impairment of his upper 

extremities bilaterally. 

An OWCP medical adviser reviewed the reports of Drs. Hamilton and Darby on 

August 14, 2014. He agreed with Dr. Darby’s method of impairment rating, but stated that he 

disagreed with the grade modifier for physical examination which, he noted, affected the final 

rating for the right side, but not the left. The medical adviser found that, in accordance with the 

A.M.A., Guides, appellant’s grade modifier for test findings was 1, that his grade modifier for 

history was 3, bilaterally. He then found that, as appellant had a normal physical examination on 

the right, the grade modifier for physical examination was 0 on the right. On the left the medical 

adviser found a grade modifier 1 for physical examination based on appellant’s positive Tinel’s 

sign. He found a functional scale grade modifier 3 bilaterally. The medical adviser concluded 

that on the right appellant’s average grade modifier was 1 for an impairment rating of two 

percent, while on the left appellant’s average grade modifier was 2 for an impairment rating of 

five percent. He further explained, “Dr. Darby used a grade modifier for physical examination of 

3 on both sides based on his perception of grip strength weakness, however, he reported 5/5 

strength of individual muscles and no atrophy and he did not measure grip strength. 

Dr. Hamilton had previously documented that grip strength was 46 kilograms (101 pounds) on 

the right and 41 kilograms (90 pounds) left, which would be considered to be normal.” The 

medical adviser noted that, as the functional scale was greater on both sides than the average 

grade modifier, the default impairment rating was increased by one percent on both sides. 

Therefore, he concluded that appellant had three percent impairment of the right upper extremity 

for residuals of median neuropathy carpal tunnel syndrome and six percent impairment of the left 

upper extremity. The medical adviser used April 29, 2014 as the date of MMI based on 

Dr. Darby’s examination. 

By decision dated September 8, 2014, OWCP granted appellant schedule awards for six 

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

extremity. The award ran 28.08 weeks for the period April 29, 2014 MMI to 

November 11, 2014. 

LEGAL PRECEDENT 

The schedule award provision of FECA3

 and its implementing regulations4 set forth the 

number of weeks of compensation payable to employees sustaining permanent impairment for 

loss or loss of use, of scheduled members or functions of the body. FECA, however, does not 

specify the manner in which the percentage loss of a member shall be determined. The method 

used in making such determination is a matter which rests in the discretion of OWCP. For 

 3

 5 U.S.C. §§ 8101-8193, 8107. 

4

 20 C.F.R. § 10.404. 
5

consistent results and to ensure equal justice, the Board has authorized the use of a single set of 

tables so that there may be uniform standards applicable to all claimants. OWCP evaluates the 

degree of permanent impairment according to the standards set forth in the specified edition of 

the A.M.A., Guides.

5

 

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

15-23 (Entrapment/Compression Neuropathy Impairment) and accompanying relevant text.6

 In 

Table 15-23, grade modifiers 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.7

ANALYSIS 

Appellant submitted medical evidence from Dr. Hamilton and Dr. Darby regarding the 

extent of his permanent impairment for his accepted bilateral carpal tunnel condition. The 

medical adviser reviewed these reports and generally agreed with Dr. Darby’s findings and 

ratings. Dr. Darby applied the methodology of Table 15-23 of the A.M.A., Guides8

 and 

reviewed appellant’s electrodiagnostic studies to reach grade modifier 1 based on a sensory or 

motor conduction delay. The medical adviser agreed with this rating. Dr. Darby then opined 

that appellant had constant bilateral symptoms which resulted in grade modifier 3 for history. 

The medical adviser agreed. Both Dr. Darby and the medical adviser agreed that appellant’s 

functional scale or QuickDASH score was grade modifier 3 and resulted in an increase in one 

percent of the determined impairment ratings. 

The disagreement between Dr. Darby and the medical adviser was based on a difference 

in determination of appellant’s physical findings. Dr. Darby found that appellant had a grade 

modifier 3 based on atrophy of weakness. In his initial report he noted that appellant’s hands 

were massive and that his gross grip strength was diminished bilaterally compared to what it 

should be based on his massive hand size. However, Dr. Darby did not provide any additional 

grip strength measurements and noted that appellant had no obvious muscle atrophy of the thenar 

regions. In further defining physical findings, the A.M.A., Guides provide: “To qualify for class 

3 by physical findings, there should be constant numbness (history), and no protective 

sensation.... There must also be grade 3 or less motor function, or a history of surgical tendon 

transfer to restore function. This is almost never seen in peripheral nerve entrapment.”9

 5

 For new decisions issued after May 1, 2009 OWCP began using the sixth edition of the A.M.A., Guides. 

A.M.A., Guides, 6th ed. (2009); Federal (FECA) Procedure Manual, Part 2 -- Claims, Schedule Award and 

Permanent Disability Claims, Chapter 2.808.5a (February 2013); see also Part 3 -- Medical, Schedule Awards, 

Chapter 3.700, Exhibit 1 (January 2010). 

6

 A.M.A., Guides 449, Table 15-23. 

7

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

function scale score. Id. at 448-49. 

8 Id. at 449, Table 15-23. 

9 Id. at 446. 
6

The medical adviser disagreed with Dr. Darby’s selection of grade modifier 3 for 

physical findings and explained, “Dr. Darby used a grade modifier for physical examination of 3 

on both sides based on his perception of grip strength weakness, however, he reported 5/5 

strength of individual muscles and no atrophy and he did not measure grip strength. 

Dr. Hamilton had previously documented that grip strength was 46 kilograms (101 pounds) on 

the right and 41 kilograms (90 pounds) left, which would be considered to be normal.” 

It is well established that, when the attending physician fails to provide an estimate of 

impairment conforming to the A.M.A., Guides, his or her opinion is of diminished probative 

value in establishing the degree of permanent impairment and OWCP may rely on the opinion of 

its medical adviser to apply the A.M.A., Guides to the findings of the attending physician.10 The 

Board finds that Dr. Darby did not provide sufficient findings or reasoning to support his 

selection of grade modifier 3 for physical findings under Table 15-23 of the A.M.A., Guides. 

The medical adviser offered his agreement with the majority of Dr. Darby’s findings and 

provided a detailed explanation of why he did not believe that the physical findings grade 

modifier was appropriate. He concluded that appellant had grade modifier 2 for physical 

findings on the left based on a positive Tinel’s sign and grade modifier 1 for physical findings on 

the right due to normal physical findings. 

After averaging the grade modifiers for test findings, history, and physical findings, the 

medical adviser concluded that on the right appellant’s average grade modifier was 1 for an 

impairment rating of two percent, while on the left appellant’s average grade modifier was 2 for 

an impairment rating of five percent. He concluded that, as the functional scale was greater on 

both sides than the average grade modifier, the default impairment rating was increased by one 

percent on both sides, to three on the right and to six on the left. 

The Board finds that appellant has no more than three percent impairment of his right 

upper extremity and no more than six percent impairment of his left upper extremity for which 

he received schedule awards. 

On appeal, appellant alleges that as his grip strength was diminished and because of his 

large hand-size, he should have received six percent impairment of each upper extremity. For 

the reasons set forth above, the Board finds that appellant’s medical evidence is insufficient to 

establish this greater impairment rating. 

Appellant may request a schedule award or 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 no more than three percent impairment of his right 

upper extremity and six percent impairment of his left upper extremity for which he received 

schedule awards. 

 10 Linda Beale, 57 ECAB 429 (2006). 
7

ORDER 

IT IS HEREBY ORDERED THAT September 8, 2014 decision of the Office of 

Workers’ Compensation Programs is affirmed.11

Issued: March 24, 2016 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 11 James A. Haynes, Alternate Judge, participated in the original decision but was no longer a member of the 

Board effective November 16, 2015.