United States Department of Labor 

Employees’ Compensation Appeals Board 

__________________________________________ 

S.D., Appellant 

and 

U.S. POSTAL SERVICE, POST OFFICE, 

Topeka, KS, Employer 

__________________________________________ 

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Docket No. 17-0078 

Issued: March 20, 2017 

Appearances: Case Submitted on the Record

Houston Ford, Jr., for the appellant1

Office of Solicitor, for the Director 

DECISION AND ORDER 

Before: 

CHRISTOPHER J. GODFREY, Chief Judge 

PATRICIA H. FITZGERALD, Deputy Chief Judge 

ALEC J. KOROMILAS, Alternate Judge 

JURISDICTION 

On October 17, 2016 appellant, through his representative, filed a timely appeal from a 

September 21, 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. 

 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

ISSUE 

The issue is whether appellant has met his burden of proof to establish more than six 

percent permanent impairment of the right upper extremity and two percent permanent 

impairment of the left upper extremity. 

FACTUAL HISTORY 

On August 28, 2012 appellant, then a 66-year-old line production operator, filed an 

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

to factors of his federal employment. He did not stop work. OWCP accepted the claim for 

bilateral carpal tunnel syndrome, a ganglion cyst of the synovium of the right third 

metacarpophalangeal (MCP) joint, and osteoarthrosis of the right third MCP joint.3

Appellant, on July 1, 2014, filed a claim for compensation (Form CA-7) requesting a 

schedule award. 

In a July 2, 2014 impairment evaluation, Dr. Lynn D. Ketchum, an attending Boardcertified plastic surgeon, diagnosed carpal tunnel syndrome bilaterally, osteoarthritis, and a 

ganglion cyst at the MCP joint of the third right finger. She attributed the conditions to 

appellant’s work duties. Referencing the fourth edition of the American Medical Association, 

Guides to the Evaluation of Permanent Impairment (hereinafter A.M.A., Guides), Dr. Ketchum 

found that appellant had 18 percent permanent impairment of the right upper extremity and 10 

percent permanent impairment of the left upper extremity. 

By letter dated July 17, 2014, OWCP advised appellant that the medical evidence from 

Dr. Ketchum was insufficient to support a schedule award as he did not provide objective 

findings or a detailed description of any impairment. It requested that appellant submit a report 

from his attending physician providing an impairment rating in accordance with the sixth edition 

of the A.M.A., Guides. 

Dr. Ketchum, in a July 22, 2014 report, noted that appellant had a right upper extremity 

permanent impairment of 18 percent and a left upper extremity permanent impairment of 10 

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

An OWCP medical adviser reviewed the evidence on February 12, 2015 and determined 

that Dr. Ketchum’s opinion was insufficient to support a finding of permanent impairment 

warranting a schedule award and noted that her determination was not compatible with the sixth 

edition of the A.M.A., Guides. 

OWCP, on March 2, 2015, referred appellant to Dr. Joseph W. Huston, a Board-certified 

orthopedic surgeon, for a second opinion evaluation. 

 3

 In decisions dated November 28, 2012 and April 29, 2013, OWCP denied appellant’s occupational disease 

claim. By decision dated October 4, 2013, it vacated its April 29, 2013 decision and accepted the claim. 
3

In a report dated March 27, 2015, Dr. Huston discussed appellant’s accepted conditions 

of bilateral carpal tunnel syndrome, a ganglion cyst of the right third MCP joint, and 

osteoarthrosis of the right third MCP joint. He advised that the ganglion was “a component of 

the arthritis of that joint and does not need a separate rating.” Dr. Huston reviewed appellant’s 

complaints of pain and swelling in the MCP joint and numbness and pain in his hands. He noted 

that appellant had elected against surgery. Dr. Huston diagnosed carpal tunnel syndrome 

bilaterally, more pronounced on the right, and arthrosis of the MCP joint with reduced motion 

and swelling. 

Dr. Huston obtained an electromyogram (EMG) and nerve conduction velocity (NCV) 

study on May 29, 2015. The diagnostic testing revealed moderate-to-severe right median 

neuropathy and mild left median neuropathy. 

On July 22, 2015 Dr. Huston completed impairment evaluation forms. For the right third 

MCP joint, he used Table 15-2 on page 392 the sixth edition of the A.M.A., Guides. Dr. Huston 

identified the diagnosis as class 1 post-traumatic degenerative joint disease, which yielded a 

default value of six percent of the digit. He applied a grade modifier of one for functional 

history, physical examination, and clinical studies, to find no adjustment from the default value 

of six percent of the digit, or one percent of the upper extremity. Dr. Huston rated appellant’s 

left carpal tunnel syndrome using Table 15-23 on page 449 of the A.M.A., Guides. He 

diagnosed grade one median nerve entrapment based on the May 24, 2015 electrodiagnostic 

testing, for a default value of two percent. Dr. Huston applied a grade modifier of one for 

clinical studies, functional history, and physical examination and found no adjustment from the 

default value. For the right carpal tunnel syndrome, he found grade two median nerve 

entrapment using Table 15-23. Applying grade modifiers of two for clinical studies, functional 

history, and physical examination yielded no adjustment from the default value of five percent. 

Dr. Huston combined the one percent right upper extremity impairment due to MCP joint 

arthritis and the five percent right upper extremity due to carpal tunnel syndrome to find six 

percent permanent impairment of the right upper extremity. He further found two percent 

permanent impairment of the left upper extremity due to carpal tunnel syndrome. Dr. Huston 

advised that appellant had reached maximum medical improvement. 

An OWCP medical adviser reviewed Dr. Huston’s report on September 17, 2015 and 

concurred with his impairment ratings. He noted that Dr. Huston should not have applied a 

grade modifier for clinical studies in rating the impairment of the MCP joint due to degenerative 

joint disease as it was used to identify the class, but found that excluding clinical studies yielded 

the same impairment value of the digit of six percent, or one percent permanent impairment of 

the upper extremity under Table 15-11 on page 420 of the A.M.A., Guides. The medical adviser 

combined the impairment ratings for the right upper extremity due to carpal tunnel syndrome and 

degenerative joint disease of the MCP joint using the Combined Values Chart on page 604 of the 

A.M.A., Guides to find six percent right upper extremity impairment. He further agreed with the 

two percent left upper extremity rating. 

In an October 26, 2015 decision, OWCP granted appellant a schedule award for six 

percent permanent impairment of the right arm and two percent permanent impairment of the left 

arm. The award ran for 23.52 weeks from March 27 to September 7, 2015. 
4

Appellant, through his representative, requested an oral hearing on November 18, 2015, 

arguing that OWCP did not properly consider Dr. Ketchum’s rating. 

At the hearing, held on July 7, 2016, appellant’s representative contended that Dr. Huston 

and OWCP did not consider appellant’s age and his arthritis in rating his impairment, and 

asserted that he should not be penalized because he did not have surgery. 

In a decision dated September 21, 2016, an OWCP hearing representative affirmed the 

October 26, 2015 decision. She found that appellant had not submitted evidence showing a 

greater impairment than that previously awarded by OWCP. 

On appeal appellant’s representative maintains that OWCP’s medical adviser and 

Dr. Huston did not sufficiently consider that appellant’s bilateral carpal tunnel syndrome was 

continuing to worsen, and asserted that his award should not be reduced because he did not 

undergo surgery. 

LEGAL PRECEDENT 

The schedule award provision of FECA,4 and its implementing federal regulation,5 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 As of May 1, 2009, the 

sixth edition of the A.M.A., Guides is used to calculate schedule awards.7

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

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

(GMFH), Physical Examination (GMPE) and Clinical Studies (GMCS).8 The net adjustment 

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

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

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

section 15.4f of the A.M.A., Guides.

9

 In Table 15-23, grade modifier levels (ranging from 0 to 

4) are described for the categories of test findings, history, and physical examination. The grade 

 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 2 -- Claims, Schedule Awards and Permanent Disability Claims, 

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

(January 2010). 

8

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

9 Id. at 433-50. 
5

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.10

ANALYSIS 

The Board finds that appellant has not met his burden of proof to establish more than six 

percent permanent impairment of the right upper extremity and two percent permanent 

impairment of the left upper extremity. 

OWCP accepted the claim for bilateral carpal tunnel syndrome, a ganglion cyst of the 

synovium of the right third MCP joint, and osteoarthrosis of the right third MCP joint. On 

July 1, 2014 appellant filed a claim for a schedule award. 

Dr. Ketchum, on July 2, 2014, diagnosed bilateral carpal tunnel syndrome and 

osteoarthritis and a ganglion cyst of the right third middle finger at the MCP joint. She opined 

that appellant had 18 percent permanent impairment of the right upper extremity and 10 percent 

impairment of the left upper extremity under the fourth edition of the A.M.A., Guides. OWCP, 

however, currently uses the sixth edition of the A.M.A., Guides to calculate schedule awards.11 

A medical opinion based on an outdated edition of the A.M.A., Guides is of diminished 

probative value in determining the extent of permanent impairment.12

On July 22, 2014 Dr. Ketchum opined that under the sixth edition of the A.M.A., Guides

appellant had 18 percent permanent impairment of the right arm and 10 percent permanent 

impairment of the left arm. He did not, however, reference any tables and pages of the A.M.A., 

Guides in reaching his impairment evaluation or provide any findings on examination supporting 

his conclusions. As Dr. Ketchum did not explain the protocols used in making the impairment 

determination or provide the clinical findings used to evaluate the impairment, his opinion is 

insufficient to establish permanent impairment.13

OWCP referred appellant to Dr. Huston for an impairment evaluation. On March 27, 

2015, the physician diagnosed bilateral carpal tunnel syndrome more severe on the right side and 

MCP joint arthrosis with loss of motion and swelling. Diagnostic studies obtained by Dr. Huston 

on May 29, 2015 revealed moderate to severe median neuropathy on the right and mild median 

neuropathy on the left. On July 22, 2015 he applied the sixth edition of the A.M.A., Guides to 

his examination findings and the results of objective testing. Dr. Huston used the diagnosis of 

class one post-traumatic degenerative joint disease set forth in Table 15-2 on page 392 of the 

A.M.A., Guides in rating appellant’s impairment due to arthrosis of the MCP joint of the right 

third finger. The physician applied grade modifiers of one for functional history, physical 

 10 Id. at 448-50. 

11 See supra note 7. 

12 See P.O., Docket No. 15-1631 (issued June 2, 2016); Fritz A. Klein, 53 ECAB 642 (2002). 

13 See Carl J. Cleary, 57 ECAB 563 (2006); Patricia J. Penney-Guzman, 55 ECAB 757 (2004). 
6

examination, and clinical studies, which did not yield an adjustment from the default value of six 

percent of the digit, or one percent of the upper extremity.14 

In evaluating the impairment due to bilateral carpal tunnel syndrome, Dr. Huston used 

Table 15-23 on page 449 of the A.M.A., Guides. On the left side he found that appellant had 

class one median nerve entrapment based on the diagnostic studies, for a default value of two 

percent. Dr. Huston applied a grade modifier of one for clinical studies, functional history, and 

physical examination, which did not alter the default value.15 For the right side, he used the 

diagnosis of class two median nerve entrapment, which yielded a default value of five percent. 

Applying grade modifiers of two for clinical studies, history, and physical examination did not 

alter the default value.16 Dr. Huston combined the right upper extremity impairment of one 

percent for arthrosis of the right third finger and five percent for carpal tunnel syndrome to find 

six percent permanent impairment of the right upper extremity. He further concluded that 

appellant had two percent impairment of the left upper extremity due to carpal tunnel syndrome. 

An OWCP medical adviser reviewed Dr. Huston’s opinion and concurred with his 

impairment evaluation.17 There is no evidence conforming to the sixth edition of the A.M.A., 

Guides showing greater impairment than that previously awarded. 

On appeal appellant’s representative argues that appellant should not be penalized for 

failing to undergo surgery. However, his choosing not to undergo surgery was not a factor 

considered in rating the extent of his permanent impairment. Appellant’s representative further 

maintains that OWCP and Dr. Huston did not consider that appellant’s bilateral carpal tunnel 

syndrome would worsen in the future. He may, however, 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 his burden of proof to establish more than six 

percent permanent impairment of the right upper extremity and two percent permanent 

impairment of the left upper extremity. 

 14 Utilizing the net adjustment formula discussed above, (GMFH-CDX) + (GMPE-CDX) + (GMCS-CDX), or (1-

1) + (1-1) + (1-1) = 0, yielded a zero adjustment. 

15 (1-1) + (1-1) + (1-1) = 0, yielded a zero adjustment. 

16 (2-2) + 2-2) + (2-2) = 0, yielded a zero adjustment. 

17 OWCP’s medical adviser noted that Dr. Huston should not have used clinical studies as a grade modifier in 

evaluating appellant’s MCP joint impairment as it was used to identify class; however, this did not alter the extent of 

the impairment. 
7

ORDER 

IT IS HEREBY ORDERED THAT the September 21, 2016 decision of the Office of 

Workers’ Compensation Programs is affirmed. 

Issued: March 20, 2017 

Washington, DC 

 

 Christopher J. Godfrey, Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Patricia H. Fitzgerald, Deputy Chief Judge 

 Employees’ Compensation Appeals Board 

 

 Alec J. Koromilas, Alternate Judge 

 Employees’ Compensation Appeals Board