United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

M.C., Appellant

and

U.S. POSTAL SERVICE, VEHICLE 

MAINTENANCE FACILITY, Baltimore, MD, 

Employer

__________________________________________

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Docket No. 16-1645

Issued: May 3, 2018

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

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On August 9, 2016 appellant filed a timely appeal from a July 7, 2016 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 13 percent permanent impairment of her left 

upper extremity and 6 percent permanent impairment of her right upper extremity, for which she 

previously received schedule awards.

 

1 5 U.S.C. § 8101 et seq.
2

FACTUAL HISTORY

On March 4, 2013 appellant, a 59-year-old clerk, filed an occupational disease claim (Form 

CA-2) under OWCP File No. xxxxxx451, alleging that she developed bilateral carpal tunnel 

syndrome (CTS) causally related to factors of her federal employment. She indicated on the claim 

form that she first became aware of her condition and its relation to her federal employment on 

December 5, 2012.2

On December 23, 2013 OWCP received a bilateral upper extremity nerve conduction

velocity (NCV) study and a medical report from Dr. Margit L. Bleecker, a Board-certified 

neurologist. Dr. Bleecker diagnosed right neurogenic thoracic outlet syndrome (TOS), which she 

explained was supported by examination findings (positive Adson’s maneuver) and 

electrodiagnostic studies.3 She noted that appellant worked for the employing establishment since 

1986, and her duties as a general clerk involved frequent filing.4 Dr. Bleecker further noted that 

appellant frequently had to reach above her shoulder height for filing, and also the file drawers 

were extremely tight and required a lot of force to pull open. She explained that these were risk 

factors for right TOS, which diagnosis had been demonstrated on appellant’s physical examination 

and her NCV studies. Dr. Bleecker further explained that constant flexion and extension with 

filing put stress on the ulnar nerve in the cubital tunnel, which diagnosis was also demonstrated 

both by examination and NCV studies.5

On January 29, 2014 appellant filed a claim for a schedule award (Form CA-7) based on a 

partial loss of use of her left and right upper extremities. 

In a February 11, 2014 report, Dr. Bleecker advised that appellant had five percent left 

upper extremity impairment for left CTS and six percent right upper extremity impairment for 

right CTS under the sixth edition of the American Medical Association, Guides to the Evaluation 

 

2 Appellant has two other claims with OWCP. In File No. xxxxxx753, appellant filed a traumatic injury claim 

(Form CA-1) on January 11, 2012, alleging that she injured her left shoulder and neck while carrying heavy folders. 

OWCP accepted this claim for sprain of the shoulder and upper left arm (ICD-9 840.9), and sprain of the neck (ICD9 847.0). In File No. xxxxxx032, appellant filed an occupational disease claim (Form CA-2) on January 8, 2014 for 

a work-related right upper extremity injury that she allegedly sustained on or about December 23, 2013. She indicated 

that her employment duties included computer data input. Appellant also indicated that she had already been 

diagnosed with bilateral CTS, and that she recently experienced shocking nerve pain and swelling in her right forearm, 

elbow, and shoulder. File Nos. xxxxxx451. xxxxxx753, and xxxxxx032 have been administratively combined, with 

File No. xxxxxx451 serving as the master file.

3 Dr. Bleecker reported that the NCV study results revealed right ulnar neuropathy at the elbow, which supported 

the clinical presentation of right cubital tunnel syndrome. She also noted that a right brachial plexus lesion involving 

the lower roots supported a positive examination for right thoracic outlet syndrome. 

4 Appellant’s duties also included extensive keyboarding and use of a mouse. Dr. Bleecker explained that constant 

flexion and extension of the elbow and reaching above shoulder height had proved to be difficult for appellant. 

5 Dr. Bleecker also submitted narrative reports dated September 10, November 14, and December 19, 2013. These 

reports pertained to appellant’s December 5, 2012 injury. Dr. Bleecker diagnosed neck sprain, left shoulder sprain, 

bilateral CTS, and left brachial plexus lesions/TOS.
3

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

6

 With regard to the left upper extremity, she arrived 

at her five percent impairment rating by relying on Table 15-23 at page 449.7 Dr. Bleecker found 

that under the heading of “Test Findings” appellant had a grade modifier of 2, for conduction delay 

and motor conduction block; under the heading of “History,” she rated a grade modifier of 2, based 

on significant intermittent symptoms; and under the heading of “Physical Findings” she found that 

appellant’s physical examination yielded a grade modifier of 2 for decreased sensation. Pursuant 

to the rating process set forth at page 448,8 Dr. Bleecker determined that the average value for 

these modifiers, based on adding 2 plus 2 plus 2, divided by 3, equaled 2, which produced a midrange impairment of 5 under Table 15-23. Given that appellant’s QuickDASH (Disabilities of the 

Arm, Shoulder, and Hand) test score was 50, she found that this yielded a mild grade modifier of 

2, which produced five percent impairment rating for left carpal tunnel syndrome. 

Dr. Bleecker utilized the identical findings and analysis to render her six percent right upper 

extremity impairment for right-sided CTS, except with regard to the QuickDASH score of 68. She 

found that this was a severe problem which yielded a grade modifier of 2, producing six percent 

permanent impairment rating for right carpal tunnel syndrome. 

Dr. Bleecker also found that appellant had four percent left upper extremity impairment for 

tendinitis of the left shoulder; and four percent left upper extremity impairment for left neurogenic 

thoracic outlet syndrome.

In a statement of accepted facts dated February 28, 2014, OWCP advised that it had 

accepted the conditions of sprain of the shoulder and upper left arm (ICD-9 840.9), sprain of the 

neck (ICD-9 847.0), bilateral CTS (ICD-9 354.0), and left brachial plexus (ICD-9 353.0).

In a March 23, 2014 report, Dr. Arnold T. Berman, a Board-certified orthopedic surgeon 

and district medical adviser (DMA), found that appellant had 10 percent permanent impairment of 

the left upper extremity impairment and 6 percent permanent impairment of the right upper 

extremity. He found that appellant had 1 percent permanent impairment of the left upper extremity 

for the left shoulder; 5 percent permanent impairment of the left upper extremity based on leftsided carpal tunnel syndrome, and 1 percent permanent impairment for cervical spine discogenic 

disease, for a combined total of 10 percent left upper extremity permanent impairment. 

Dr. Berman further found that appellant had six percent right upper extremity permanent 

impairment based on right-sided CTS. 

In addition, Dr. Berman reviewed a February 11, 20149report of Dr. Bleecker, who rated 

permanent impairment of the bilateral upper extremities based in part on a diagnosis of TOS. He

advised that TOS was not an accepted condition, and there was no clinical evidence to support that

 

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

7

Id. at 449.

8

Id. at 448.

9 The Board notes that DMA Dr. Berman referred to a February, 11, 2012 report of Dr. Bleecker. However, this 

appears to have been a typographical error as Dr. Bleecker’s initial impairment rating report was dated 

February 11, 2014. 
4

diagnosis. Dr. Berman calculated 16 percent permanent impairment of the bilateral upper 

extremities.

By decision dated April 4, 2014, OWCP granted appellant a schedule award for 10 percent 

permanent impairment of her left upper extremity and 6 percent permanent impairment of her right 

upper extremity. The award ran for 6.24 weeks, covering the period February 11, 2014 to

January 26, 2015. It based this award on the Dr. Berman’s March 23, 2014 impairment rating.10

On April 17, 2014 appellant requested reconsideration of the April 4, 2014 schedule award 

decision. 

On March 26, 2015 appellant filed a claim for an additional schedule award (Form CA-7)

based on a partial loss of use of her left and right upper extremities. 

In a May 4, 2015 report, OWCP’s medical adviser, Dr. Berman, amended his March 23, 

2014 report and substituted four percent impairment for left-sided TOS, a condition which he had 

not rated in his previous report, for the one percent impairment for cervical spine disease. This 

amendment resulted in an additional three percent permanent impairment rating for the left upper 

extremity. 

On September 1, 2015 appellant again filed a Form CA-7 claim for an additional schedule 

award under File No. xxxxxx451 based on a partial loss of use of her left and right upper 

extremities. 

By decision dated October 29, 2015, OWCP awarded appellant a schedule award for an 

additional three percent permanent impairment of the left upper extremity for 6.24 weeks, covering 

the period January 27 to April 2, 2015. 

On November 4, 2015 OWCP accepted the condition of brachial plexus disorders. It 

indicated that it had originally accepted a condition for left brachial plexus lesions under ICD-9 

353.0 and noted that the condition was also commonly referred to as TOS (left), which had been 

added under ICD-10, G540. 

In a November 23, 2015 report, Dr. Bleecker found, using the Combined Values Chart,

that appellant had 13 percent left upper extremity permanent impairment and 3 percent right upper 

extremity permanent impairment. She derived this rating by calculating three percent impairment 

for the left and right upper extremities based on three percent impairment for bilateral CTS; five 

 

10 By decision dated April 11, 2014, under OWCP File No. xxxxxx032, OWCP denied appellant’s request to expand 

the accepted conditions to include right TOS. OWCP determined that Dr. Bleecker’s December 23, 2013 narrative 

report was insufficient to establish that appellant’s TOS was causally related to the accepted work conditions. OWCP 

further noted that TOS had already been rejected under appellant’s prior claim in File No. xxxxxx451, and that File 

No. xxxxxx032 was just an attempt to add a medical condition that had already been reviewed and ruled out. On 

March 17, 2015 appellant requested reconsideration of the April 11, 2014 decision. By decision dated June 11, 2015, 

OWCP denied appellant’s request for reconsideration, finding that the evidence submitted was insufficient to warrant 

review of its April 11, 2014 merit decision. Appellant subsequently appealed the June 11, 2015 decision to the Board. 

By decision dated October 22, 2015, the Board set aside OWCP’s June 11, 2015 decision and remanded the case for 

further development as File Nos. xxxxxx451 and xxxxxx032 had not at that time been administratively combined. 

Docket No. 15-1706 (issued October 22, 2015). 
5

percent impairment for left thoracic outlet syndrome; and five percent impairment for left shoulder 

tendinitis. 

OWCP subsequently referred appellant to Dr. Robert A. Smith, a Board-certified 

orthopedic surgeon, for a second opinion examination and impairment rating. In a January 8, 2016 

report, he found that appellant had five percent left upper extremity impairment for left CTS and 

five percent right upper extremity rating for right CTS under the A.M.A., Guides. Dr. Smith found 

on examination that the upper extremities revealed no dystrophic findings, focal muscle atrophy, 

engorgement, dependent rubor or increased collateralization. He noted no muscle atrophy in the 

arm, forearm or hand, with mild loss of sensation in the tips of the index and middle fingers,

negative Tinel’s signs at the elbows and equivocal Tinel’s signs at the volar wrists, mildly positive 

Phalen’s maneuvers, bilaterally, normal motor strength in gripping, pinch and opposition, 

bilaterally, dynamometer testing showing equal grip strength of 20 pounds on average, bilaterally,

and normal finger abduction and adduction strength.

Dr. Smith calculated five percent permanent impairment of the right and left upper 

extremities due to bilateral CTS, utilizing Table 15-23 at page 449 of the A.M.A., Guides.

11

 He

found pursuant to the heading of “Test Findings” that appellant had a grade modifier of 2, for 

sensory delay and motor conduction block, pursuant to the heading of “History,” he rated a grade 

modifier of 2, based on significant intermittent symptoms, and pursuant to the heading of “Physical 

Findings” he found that appellant’s physical examination yielded a grade modifier of 2, for 

decreased sensation. Utilizing the rating process at page 448,12 Dr. Smith added 2 plus 2 plus 2, 

divided by 3, which equaled 2, yielding a mid-range impairment of 5 under Table 15-23. Given 

that appellant’s QuickDASH test score was 55, he found that this yielded a mild grade modifier of 

2, which produced a five percent permanent impairment rating for bilateral CTS. 

With regard to the additional accepted conditions, Dr. Smith opined that, based on 

appellant’s current clinical findings, the conditions of cervical sprain, left shoulder/arm sprain, and 

left brachial plexus had objectively resolved without discernible residuals. He noted on 

examination that the cervical spine was functional, with no finding of spasm, atrophy, trigger 

points, or deformity. Dr. Smith reported that appellant had satisfactory cervical range of motion 

and no muscle spasm or rigidity during excursion, with no deformity, atrophy, or scapular winging. 

He found that appellant had essentially full range of motion of her left shoulder, with findings of 

180 degrees adduction, 170 degrees abduction, 50 degrees abduction, 50 degrees extension, 80 

degrees internal rotation and 60 degrees external rotation. There were no signs of instability, 

crepitation or impingement and negative Tinel’s signs at the thoracic outlets. Dr. Smith advised 

that degenerative disease of the cervical spine and left shoulder were not accepted conditions for 

this claim either by direct causation or aggravation; therefore, the only ratable condition for this 

claim was bilateral carpal tunnel syndrome.

In a May 28, 2016 report, Dr. Michael M. Katz, a Board-certified orthopedic surgeon 

serving as a DMA, reviewed Dr. Smith’s January 8, 2016 report and concurred with his five 

percent bilateral upper extremity impairment rating for bilateral CTS. He opined that his report 

 

11 Supra note 5.

12 Id. at 448.
6

was in conformance with the protocols of A.M.A., Guides. OWCP’s medical adviser found that, 

because Dr. Smith’s rating did not exceed the prior award for five percent left upper extremity 

impairment and six percent right upper extremity impairment for bilateral CTS, appellant was not 

entitled to an additional schedule award. 

By decision dated July 7, 2016, OWCP denied appellant’s claim for an additional schedule 

award. It found that she had not established more than the 13 percent permanent impairment of

her left upper extremity and 6 percent permanent impairment of her right upper extremity, for 

which she had previously received schedule awards.

LEGAL PRECEDENT

The schedule award provisions of FECA13 and its implementing regulations14 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 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. The 

A.M.A., Guides has been adopted by the implementing regulations as the appropriate standard for 

evaluating schedule losses.15 The claimant has the burden of proving that the condition for which 

a schedule award is sought is causally related to her employment.16

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).17 Under the sixth edition, for upper extremity impairments the evaluator 

identifies the impairment of the Class of Diagnosis (CDX) condition, which is then adjusted by 

grade modifiers based on Functional History (GMFH), Physical Examination (GMPE), and 

Clinical Studies (GMCS.18 The net adjustment formula is (GMFH-CDX) + (GMPE-CDX) + 

(GMCS-CDX).19

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

15-23 (Entrapment/Compression Neuropathy Impairment) and accompanying relevant text.20 In 

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

 

13 5 U.S.C. § 8107.

14 20 C.F.R. § 10.404. 

15 Id.

16 Veronica Williams, 56 ECAB 367, 370 (2005). 

17 Supra note 5 at 3, section 1.3, The International Classification of Functioning, Disability and Health (ICF): A 

Contemporary Model of Disablement.

18 Id. at 385-419.

19 Id. at 411.

20 Id. at 449.
7

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.21

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

should be routed to OWCP’s medical adviser for an opinion concerning the nature and percentage 

of impairment in accordance with the A.M.A., Guides, with OWCP’s medical adviser providing 

rationale for the percentage of impairment specified.22

ANALYSIS

OWCP accepted the conditions of bilateral CTS, left brachial plexus lesions/left thoracic 

outlet syndrome, sprain of left shoulder and upper arm, and cervical sprain. In its April 4, 2014 

decision, OWCP awarded appellant 10 percent left upper extremity impairment, for 1 percent 

impairment of the left shoulder, 5 percent impairment for left-sided CTS, and 1 percent impairment 

for cervical spine discogenic disease, and 6 percent impairment of the right upper extremity, for 

right-sided CTS. Appellant subsequently requested reconsideration and filed a claim for an 

additional schedule award. OWCP awarded an additional three percent left upper extremity 

permanent impairment for left-sided TOS in an October 29, 2015 decision. 

Appellant subsequently submitted Dr. Bleecker’s November 23, 2015 report. She found 

that appellant had 10 percent left upper extremity permanent impairment and 6 percent right upper 

extremity permanent impairment based on 3 percent impairment for bilateral CTS, 5 percent 

impairment for left TOS, and 5 percent impairment for left shoulder tendinitis. Dr. Smith, 

OWCP’s referral physician, reported findings on examination, reviewed the medical history and 

statement of accepted facts and found that appellant had no ratable impairment from her accepted 

cervical sprain, left shoulder/arm sprain, and left brachial plexus conditions. He opined that these 

conditions had objectively resolved without discernible residuals. Dr. Smith reported that she had 

a normal cervical spine examination and normal left shoulder examination, with essentially normal 

range of motion. He further found that there were no signs of instability, crepitation or 

impingement and negative Tinel’s signs at the thoracic outlets. Dr. Smith advised that 

degenerative disease of the cervical spine and left shoulder were not accepted conditions for this 

claim either by direct causation or aggravation. He therefore concluded that the only ratable 

condition for this claim was bilateral CTS.23 

As noted above, impairment due to CTS is evaluated pursuant to Table 15-23 of the 

A.M.A., Guides, which sets forth grade modifier levels for test findings, history, and physical 

 

21 Id. at 448-450.

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

Chapter 2.808.6(d) (August 2002).

23 The Board notes that appellant had already received a schedule award for one percent impairment of the left 

upper extremity for the left shoulder and four percent left upper extremity impairment for left-sided TOS.
8

findings; these grade modifier levels are averaged to arrive at the appropriate overall grade 

modifier level and to identify a default rating value.24 

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

13 percent permanent impairment of her left upper extremity and 6 percent permanent impairment 

of her right upper extremity previously awarded.

In his January 8, 2016 second opinion report, Dr. Smith, a Board-certified orthopedic 

surgeon, calculated five percent bilateral permanent impairment of the upper extremities from the 

accepted bilateral CTS under the A.M.A., Guides using the formula set forth above. He found that 

her other accepted upper extremity conditions had resolved and did not warrant an additional 

impairment rating.

Dr. Smith provided clinical findings and explained how those objective elements warranted 

the percentages assessed. OWCP medical adviser, Dr. Katz, concurred with Dr. Smith’s 5 percent 

bilateral permanent impairment rating and methodology. OWCP then issued the July 7, 2016 

decision finding that appellant was not entitled to an additional impairment for her accepted 

bilateral CTS, or any other accepted condition, as the impairment calculated by Dr. Smith did not 

exceed the impairment for which she had already received a schedule award.

The Board finds that OWCP properly accorded Dr. Smith’s impairment rating the weight 

of the medical evidence. Dr. Smith’s opinion was based on a statement of accepted facts and the 

complete medical record. He provided a thorough impairment rating, utilizing the appropriate 

portions of the A.M.A., Guides. Dr. Smith described how the objective clinical findings, 

intermittent symptoms, and physical examination warranted the specified percentage of 

impairment. There is no probative medical evidence of record demonstrating that appellant 

sustained more than the 13 percent permanent impairment of her left upper extremity and 6 percent 

permanent impairment of her right upper extremity previously awarded due to her accepted upper 

extremity conditions. Thus, appellant has not met her burden of proof.

Appellant may request a schedule award or increased schedule award at any time, 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 13 

percent permanent impairment of her left upper extremity and 6 percent permanent impairment of

her right upper extremity, for which she previously received schedule awards.

 

24 Supra note 5 at 448-50.
9

ORDER

IT IS HEREBY ORDERED THAT the July 7, 2016 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: May 3, 2018

Washington, DC

Christopher J. Godfrey, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board