United States Department of Labor

Employees’ Compensation Appeals Board

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T.M., Appellant

and

DEPARTMENT OF THE NAVY, ASSISTANT 

FOR ADMINISTRATION, Washington, DC, 

Employer

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Docket No. 18-0182

Issued: July 26, 2018

Appearances: Case Submitted on the Record

Appellant, pro se

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 November 1, 2017 appellant filed for review from an August 22, 2017 merit decision 

of the Office of Workers’ Compensation Programs (OWCP).1 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 established more than 32 percent permanent impairment 

of her left upper extremity, for which she previously received schedule awards

 

1 Appellant timely requested oral argument in this case. By order dated April 5, 2018, the Board exercised its 

discretion and denied her request as oral argument would further delay issuance of a Board decision and not serve a 

useful purpose. Order Denying Request for Oral Argument, Docket No. 18-0182 (issued April 5, 2018).

2 5 U.S.C. § 8101 et seq.
2

FACTUAL HISTORY

On November 1, 2011 appellant, then a 50-year-old administrative support technician, filed 

a traumatic injury claim (Form CA-1) alleging that on September 26, 2011 she fractured her left 

wrist when she was trying to put a box in the backseat of her car while in the performance of her 

federal duties. She explained that the box caught on the seat and started to fall. As appellant

grabbed the box, her left wrist struck the car door. By decision dated December 7, 2011, OWCP 

accepted the claim for left closed fracture of lower end of radius with ulna. On January 6, 2015 it

expanded acceptance of the claim to include left nonunion fracture. 

Following her injury, appellant sought treatment with Dr. Marc Suffis, Board-certified in 

emergency medicine, for her left wrist fracture. On February 16 and September 13, 2012 she

underwent OWCP-approved left wrist surgery. 

On May 7, 2015 appellant filed a claim for a schedule award (Form CA-7). 

By decision dated June 12, 2015, OWCP denied appellant’s claim for a schedule award as 

the evidence of record was insufficient to establish permanent impairment of a scheduled member 

or function of the body.

On July 21, 2015 appellant filed a subsequent claim for a schedule award. 

In support of her claim appellant submitted a September 9, 2015 impairment evaluation 

from Dr. Suffis. Dr. Suffis diagnosed left wrist navicular fracture with resultant nonunion, 

avascular necrosis, and carpal collapse. He further diagnosed left wrist triangular fibrocartilage 

complex ligamental disruption and determined that appellant had reached maximum medical 

improvement (MMI). Utilizing the American Medical Association, Guides to the Evaluation of 

Permanent Impairment (A.M.A., Guides),

3 Dr. Suffis reported that her diagnosis-based 

impairment (DBI) was best characterized by Table 15-3, Wrist Regional Grid, wrist sprain history 

of dislocation including severe carpal instability, which would place her in class 2 with a default 

grade C value of 24 percent.4 He reported that, following assignment of grade modifiers, 

application of the net adjustment formula resulted in no net change, amounting to 24 percent 

permanent impairment of the left upper extremity. 

In an October 8, 2015 medical report, Dr. L. Jean Weaver, serving as an OWCP district 

medical adviser (DMA), reviewed the case file and Dr. Suffis’ September 9, 2015 report, finding 

that appellant had reached MMI on the date of his examination. He agreed with Dr. Suffis’

impairment rating, noting that the injury was best identified as a left wrist injury/sprain with severe 

instability since her arthrodesis had not resulted in a successful fusion and she had carpal instability 

with pain on minimal everyday activity.5 Dr. Weaver reported that this resulted in class 2 with a 

default grade C impairment rating of 24 percent. Application of the net adjustment formula 

 

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

4

Id. at 396, Table 15-3.

5

Id.
3

resulted in zero, warranting no movement from the default grade C value, resulting in 24 percent 

permanent impairment of the left upper extremity. 

By decision dated October 20, 2015, OWCP granted appellant a schedule award for 24 

percent permanent impairment of her left upper extremity. The date of MMI was reported as 

September 9, 2015 and the award covered a period of 74.88 weeks from September 10 through 

October 17, 2015.6 

On May 19, 2016 appellant underwent an OWCP-approved surgery for excision of left 

scaphoid bone surgery. 

On February 17, 2017 appellant again filed a claim for a schedule award. 

By letter dated April 4, 2017, OWCP requested that appellant submit an impairment 

evaluation from her attending physician in accordance with the sixth edition of the A.M.A., 

Guides.

In support of her claim, appellant submitted an April 26, 2017 impairment evaluation from

Dr. Suffis. Dr. Suffis discussed her medical history, examination findings, and diagnostic reports. 

He reported that on September 9, 2015 he performed a rating examination finding 24 percent 

permanent impairment of her left upper extremity as a result of carpal instability. Dr. Suffis noted 

that on May 19, 2016 appellant underwent excision of the left scaphoid bone and was released to 

full duty on June 17, 2016. He diagnosed left fracture of navicular with secondary avascular 

necrosis and carpal instability with resultant scaphoidectomy and left wrist fusion, development 

of post-traumatic osteoarthritis in the scaphotrapeziod-trapezial joint, and post-traumatic carpal 

tunnel syndrome. Dr. Suffis determined that appellant had reached MMI. Utilizing Table 15-3 of 

the A.M.A., Guides, he provided a diagnosis of wrist arthrodesis, class 3 with a grade C default 

rating of 30 percent with functional position.7 Dr. Suffis assigned a grade modifier of 3 for 

functional history,8a grade modifier of 4 for physical examination due to severe decrease from 

normal range of motion (ROM) as a result of her fusion,9and a grade modifier of 3 for clinical 

studies for the arthritis showing joint space narrowing.10 Applying the net adjustment formula,

Dr. Suffis subtracted 3, the numerical value of the class, from the numerical value of the grade 

modifier for each applicable component (functional history, physical examination, and clinical 

studies) and then added those values, resulting in a net adjustment of 1 ((3-3) + (4-3) + (3-3)).11 

Application of the net adjustment formula meant that movement was warranted one place to the 

 

6 OWCP reported that, as appellant received wage-loss compensation through September 9, 2015, the schedule 

award was adjusted to September 10, 2015. It noted that a schedule award was not payable concurrently with an

award for wage loss of the same injury.

7 Supra note 4 at 397.

8

Id. at 406, Table 15-7.

9

Id. at 408, Table 15-8.

10 Id. at 410, Table 15-9.

11 Id. at 411.
4

right of class 3 default value grade C to grade D based on Table 15-3.12 Therefore, the DBI for 

appellant’s left wrist arthrodesis amounted to 32 percent permanent impairment of the left upper 

extremity.13 Dr. Suffis noted that, as appellant had previously received an award for 24 percent 

left upper extremity permanent impairment, this would result in an increase of 8 percent permanent 

impairment of the left upper extremity. 

On July 14, 2017 OWCP routed Dr. Suffis’ report, a statement of accepted facts, and the 

case file to Dr. Michael M. Katz, a Board-certified orthopedic surgeon serving as an OWCP DMA, 

for review and determination regarding whether appellant sustained a permanent impairment and 

date of MMI in accordance with the sixth edition of the A.M.A., Guides. 

In a July 15, 2017 report, Dr. Katz reviewed the case file and Dr. Suffis’ July 14, 2017 

report and found that appellant had reached MMI. He agreed with Dr. Suffis’ impairment rating 

and findings, determining that she sustained 32 percent permanent impairment of the left upper 

extremity for a class 3 left wrist arthrodesis.14 Dr. Katz explained that as appellant had previously 

received an award for 24 percent permanent impairment of the left upper extremity, the net 

additional award now due would be determined by subtracting the prior overlapping 24 percent 

from the present impairment of 32 percent, resulting in a net additional award of 8 percent 

permanent impairment of the left upper extremity. He also noted that Table 15-5 permitted an 

alternative ROM calculation for her diagnostic factor of wrist fusion; however, this information 

was not provided by Dr. Suffis, nor could it be obtained through review of the record therefore 

only a DBI rating was provided. 

By decision dated August 22, 2017, OWCP granted appellant a schedule award for an 

additional 8 percent permanent impairment of the left upper extremity based on a total 32 percent 

permanent impairment rating, less the previously paid 24 percent awarded. It noted the date of 

MMI as May 25, 2017 and the award covered a period of 174.72 days from May 25 through 

August 19, 2017.

LEGAL PRECEDENT

The schedule award provisions of FECA and its implementing regulations 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.15 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. 

Through its implementing regulations, OWCP adopted the A.M.A., Guides as the appropriate 

 

12 Supra note 7.

13 Id.

14 Id.

15 5 U.S.C. § 8107; 20 C.F.R. § 10.404.
5

standard for evaluating schedule losses.16 As of May 1, 2009, schedule awards are determined in 

accordance with the sixth edition of the A.M.A., Guides (2009).17 The Board has approved the 

use by OWCP of the A.M.A., Guides for the purpose of determining the percentage loss of use of 

a member of the body for schedule award purposes.18

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).19 The net adjustment formula is (GMFH -

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

The A.M.A., Guides also provide that the ROM impairment method is to be used as a 

stand-alone rating for upper extremity impairments when other grids direct its use or when no other 

diagnosis-based sections are applicable.20 If ROM is used as a stand-alone approach, the total of 

motion impairment for all units of function must be calculated. All values for the joint are 

measured and added.21 Adjustments for functional history may be made if the evaluator 

determines that the resulting impairment does not adequately reflect functional loss and functional 

reports are determined to be reliable.22

OWCP issued FECA Bulletin No. 17-06 to explain the use of the DBI methodology versus

the ROM methodology basis for rating of upper extremity impairments.23 Regarding the 

application of ROM or DBI impairment methodologies in rating permanent impairment of the 

upper extremities, FECA Bulletin No. 17-06 provides in pertinent part: 

“As the [A.M.A.,] Guides caution that if it is clear to the evaluator evaluating loss 

of ROM that a restricted ROM has an organic basis, three independent 

measurements should be obtained and the greatest ROM should be used for the 

determination of impairment, the CE [claims examiner] should provide this 

information (via the updated instructions noted above) to the rating physician(s). 

“Upon initial review of a referral for upper extremity impairment evaluation, the 

DMA should identify (1) the methodology used by the rating physician (i.e., DBI 

 

16 Id. at § 10.404. See also, Ronald R. Kraynak, 53 ECAB 130 (2001).

17 See Federal (FECA) Procedure Manual, Part 3 -- Medical, Schedule Awards, Chapter 3.700, Exhibit 1 

(January 2010); Federal Procedure Manual, Part 2 -- Claims, Schedule Awards & Permanent Disability Claims, 

Chapter 2.808.6a (March 2017). 

18 Isidoro Rivera, 12 ECAB 348 (1961).

19 A.M.A., Guides 401-19.

20 Id. at 461.

21 Id. at 473.

22 Id. at 474.

23 FECA Bulletin No. 17-06 (issued May 8, 2017).
6

or ROM) and (2) whether the applicable tables in Chapter 15 of the [A.M.A.,] 

Guides identify a diagnosis that can alternatively be rated by ROM. If the 

[A.M.A.,] Guides allow for the use of both the DBI and ROM methods to calculate 

an impairment rating for the diagnosis in question, the method producing the higher 

rating should be used.” (Emphasis in the original).

24

The Bulletin further advises: 

“If the medical evidence of record is not sufficient for the DMA to render a rating 

on ROM where allowed, the DMA should advise as to the medical evidence 

necessary to complete the rating. However, the DMA should still render an 

impairment rating using the DBI method, if possible, given the available evidence. 

“Upon receipt of such a report, and if the impairment evaluation was provided from 

the claimant’s physician, the CE should write to the claimant advising of the 

medical evidence necessary to complete the impairment assessment and provide 30 

days for submission. Any evidence received in response should then be routed back 

to the DMA for a final determination. Should no evidence be received within 30 

days of the date of the CE’s letter, the CE should proceed with a referral for a second 

opinion medical evaluation to obtain the medical evidence necessary to complete 

the rating. After receipt of the second opinion physician’s evaluation, the CE 

should route that report to the DMA for a final determination.”

25

ANALYSIS

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

OWCP accepted appellant’s claim for left closed fracture of lower end of radius with ulna 

and left nonunion fracture, and approved the requisite left wrist surgeries. The Board notes that 

on October 20, 2015, she was previously awarded 24 percent permanent impairment of the left 

upper extremity for her accepted left wrist condition based on Dr. Suffis’ September 9, 2015 

medical report and the October 8, 2015 DMA report.

Appellant thereafter underwent a surgical procedure on May 19, 2016 for excision of the 

left scaphoid bone. Dr. Suffis prepared a new permanent impairment evaluation report on 

April 16, 2017. Dr. Katz, serving as OWCP DMA, reviewed Dr. Suffis’ findings from his 

April 26, 2017 report and agreed with his impairment rating based upon DBI. He noted that, since 

ROM findings were not of record, it was not possible to evaluate appellant’s permanent 

impairment utilizing the ROM methodology. Pursuant to Bulletin 17-06, Dr. Katz proceeded to 

evaluate appellant’s impairment using the DBI methodology. Both Dr. Suffis and Dr. Katz 

properly utilized the sixth edition of the A.M.A., Guides in determining that appellant had 32 

percent permanent impairment of the left upper extremity based upon the diagnosis of her left wrist 

arthrodesis. Both physiciansreferred to Table 15-3 and explained the basis for a class 3 assignment 

 

24 Id.

25 Id.
7

of wrist arthrodesis, as well as findings supporting assignment of the grade modifiers for functional 

history, physical examination, and clinical studies. Utilizing the net adjustment formula resulted 

in a net adjustment of 1 ((3-3) + (4-3) + (3-3)),

26 meaning that movement was warranted one place 

to the right of class 3 default value grade C to grade D, yielding a 32 percent permanent impairment 

of the left upper extremity.27 

However, as noted by Dr. Katz, while Table 15-5 of the A.M.A., Guides allowed an

alternative ROM calculation for appellant’s diagnosis, ROM findings were not of record. Pursuant 

to FECA Bulletin 17-06, if ROM rating is allowed, after review of the DBI rating, the DMA should 

advise as to the medical evidence necessary to complete the ROM rating if the medical evidence 

of record is insufficient to rate appellant’s impairment using ROM. If the claimant’s treating 

physician has provided an impairment rating, the claims examiner should then write to the treating 

physician advising of the medical evidence necessary to complete the rating. If the necessary 

evidence is not received within 30 days, OWCP is to refer appellant for a second opinion 

evaluation. In the present case, it did not follow the procedures outlined in Bulletin 17-06 after

Dr. Katz advised that the necessary evidence was not of record to rate appellant’s permanent 

impairment utilizing the ROM methodology. For this reason, this case must be remanded for 

OWCP to complete the proper procedures outlined in FECA Bulletin 17-06 to rate appellant’s 

upper extremity permanent impairment. After such further development as necessary, OWCP 

shall issue a de novo decision. 

CONCLUSION

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

 

26 Supra note 11.

27 Supra note 7.
8

ORDER

IT IS HEREBY ORDERED THAT the Office of Workers’ Compensation Programs’

decision dated August 22, 2017 is set aside and this case is remanded for further proceedings 

consistent with this opinion. 

Issued: July 26, 2018

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