United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

O.V., Appellant

and

U.S. POSTAL SERVICE, GENERAL MAIL 

FACILITY Denver, CO, Employer

__________________________________________

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Docket No. 17-0619

Issued: February 26, 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

ALEC J. KOROMILAS, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On January 25, 2017 appellant filed a timely appeal from a November 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 over the merits of this case.

ISSUE

The issue is whether appellant has more than nine percent permanent impairment of the 

right upper extremity, for which he previously received a schedule award. 

FACTUAL HISTORY

On September 21, 2011 appellant, then a 59-year-old mail handler, filed an occupational 

disease claim (Form CA-2) alleging that he had developed carpal and cubital tunnel syndromes 

as a result of his federal employment. He indicated on the claim form that his job patching mail 

 

1 5 U.S.C. § 8101 et seq.
2

involved constant grasping and manipulating torn mail. In a report dated August 25, 2011,

Dr. Carleton Clinkscales, a Board-certified orthopedic surgeon, diagnosed right carpal tunnel and 

right cubital tunnel syndromes. He indicated right upper extremity surgery was scheduled.

OWCP accepted the claim on December 30, 2011 for right carpal tunnel syndrome and 

right ulnar nerve lesion.2 On July 9, 2012 appellant underwent right carpal tunnel release, and 

right ulnar nerve decompression, performed by Dr. Clinkscales. He underwent a right wrist 

extensor tenosynovectomy and right distal radius bone graft on November 19, 2012. Appellant 

received wage-loss compensation and returned to work at five hours per day on 

February 4, 2013.

On April 11, 2013 appellant filed a schedule award claim (Form CA-7). In a report dated 

March 27, 2013, Dr. Bennett Machanic, a Board-certified neurologist, provided results on 

examination. He opined that appellant had 18 percent permanent impairment under the sixth 

edition of the American Medical Association, Guides to the Evaluation of Permanent 

Impairment (A.M.A., Guides)

3 due to loss of wrist range of motion.

OWCP referred the case to an OWCP medical adviser for review. In a report dated 

April 25, 2013, the medical adviser opined that appellant had one percent right upper extremity 

permanent impairment for carpal tunnel syndrome, and one percent for cubital tunnel syndrome. 

As to any additional permanent impairment, the medical adviser asserted that Dr. Machanic had 

not provided adequate range of motion results and additional information was required.

In a report dated May 8, 2013, Dr. Machanic provided results on examination. For right 

wrist range of motion, he opined that appellant had 12 percent right upper extremity permanent 

impairment. Dr. Machanic also found an additional two percent for carpal tunnel and cubital 

tunnel syndromes.

An OWCP medical adviser reviewed the medical evidence and in a June 5, 2013 report 

opined that appellant had four percent right upper extremity permanent impairment. He again 

found one percent permanent impairment for carpal tunnel syndrome, and one percent for cubital 

tunnel syndrome. For a right wrist ganglion/bone cyst, the medical adviser opined the diagnosisbased impairment (DBI) was the preferred method. He found two percent right upper extremity 

permanent impairment based on the diagnosis of right wrist synovitis.

By decision dated June 10, 2013, OWCP issued a schedule award for four percent right 

upper extremity permanent impairment. The period of the award ran for 12.48 weeks from 

May 8, 2013.

On December 1, 2015 appellant submitted a September 16, 2015 report from

Dr. Christopher Ryan, a Board-certified physiatrist. Dr. Ryan opined that appellant had 28

percent right upper extremity permanent impairment. He found that appellant had 14 percent 

right upper extremity permanent impairment based on loss of wrist range of motion. Dr. Ryan

 

2 On August 16, 2012 OWCP indicated that it had accepted a right ganglion cyst.

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

also found eight percent permanent impairment for the median nerve, and eight percent for the 

ulnar nerve, under Table 15-23 of the A.M.A., Guides. The permanent impairments were 

combined for 28 percent right upper extremity permanent impairment.

The case was referred to another OWCP medical adviser for review. In a report dated 

December 18, 2015, an OWCP medical adviser opined that the report from Dr. Ryan was 

“problematic for several reasons.” He wrote that Dr. Clinkscales had indicated an excellent 

result following surgeries, and the subsequent decline in function was hard to explain. The 

medical adviser also indicated the ulnar nerve entrapment impairment should be reduced as a 

second entrapped nerve under Table 15-23.

OWCP referred appellant for a second opinion examination by Dr. Wallace Larson, a 

Board-certified orthopedic surgeon. Dr. Larson was asked to provide a permanent impairment 

rating under the A.M.A., Guides.

In a report dated July 12, 2016, Dr. Larson provided a history and results on examination. 

He opined that range of motion impairment would not be calculated, as this was from 

degenerative arthritis that was not employment related. Dr. Larson found that appellant had 

seven percent right upper extremity permanent impairment under Table 15-23. He indicated 

there was five percent permanent impairment for cubital tunnel syndrome, and four percent for 

carpal tunnel syndrome. The four percent permanent impairment was reduced by one half, 

resulting in seven percent right upper extremity permanent impairment.

The evidence was again referred to an OWCP medical adviser for review. In a report 

dated October 18, 2016, the medical adviser opined that appellant had seven percent right upper 

extremity permanent impairment under Table 15-23. According to him, the cubital nerve 

entrapment was five percent right upper extremity permanent impairment, and the median nerve 

entrapment impairment was two percent. The medical adviser combined the seven percent with 

two percent for other wrist conditions from the prior schedule award, for nine percent permanent 

impairment. He opined that appellant was entitled to an additional five percent, after deducting 

the prior schedule award of four percent. 

By decision dated November 7, 2016, OWCP issued a schedule award for an additional 

five percent permanent impairment to the right upper extremity. The award ran for 15.60 weeks 

from July 12, 2016.

LEGAL PRECEDENT

Section 8149 of FECA delegates to the Secretary of Labor the authority to prescribe rules 

and regulations for the administration and enforcement of FECA. The Secretary of Labor has 

vested the authority to implement the FECA program with the Director of OWCP.

4

 Section 8107 

of FECA sets forth the number of weeks of compensation to be paid for the permanent loss of 

use of specified members, functions, and organs of the body.5 FECA, however, does not specify 

 

4 See 20 C.F.R. §§ 1.1-1.4.

5 For a complete loss of use of an arm, an employee shall receive 312 weeks’ compensation. 5 U.S.C. 

§ 8107(c)(1).
4

the manner by which the percentage loss of a member, function, or organ shall be determined. 

To ensure consistent results and equal justice under the law, good administrative practice 

requires the use of uniform standards applicable to all claimants. Through its implementing 

regulations, OWCP adopted the A.M.A., Guides as the appropriate standard for evaluating 

schedule losses.6 

The sixth edition of the A.M.A., Guides was first printed in 2008. Within months of the 

initial printing, the A.M.A. issued a 52-page document entitled “Clarifications and Corrections, 

Sixth Edition, Guides to the Evaluation of Permanent Impairment.” The document included 

various changes to the original text, intended to serve as an erratum/supplement to the first 

printing of the A.M.A., Guides. In April 2009, these changes were formally incorporated into 

the second printing of the sixth edition. 

As of May 1, 2009, schedule awards are determined in accordance with the sixth edition 

of the A.M.A., Guides (2009).7 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.8

ANALYSIS

The issue on appeal is whether appellant has more than nine percent right upper extremity 

permanent impairment, for which he previously received a schedule award. The accepted 

conditions include carpal tunnel syndrome, as well as right ulnar nerve lesion and right ganglion 

cyst. In the original schedule award decision dated June 10, 2013, OWCP’s medical adviser 

opined that the DBI method was appropriate for the right ulnar nerve and ganglion cyst 

conditions, rather than the ROM approach. Appellant submitted a September 16, 2015 report 

from Dr. Ryan, who opined that appellant had 28 percent permanent impairment to the right 

upper extremity. The A.M.A., Guides notes that, when impairment results strictly from a 

peripheral nerve lesion, no other rating method is applied to this section (15.4 Peripheral Nerve 

Impairments) to avoid duplication or unwarranted increases in the impairment estimation.9 

Dr. Ryan referred to the DBI method based on Table 15-3, but found that the ROM approach for 

loss of wrist range of motion was proper. 

With respect to the remainder of the upper extremity, the Board finds the case is not in 

posture for decision. 

 

6 20 C.F.R. § 10.404. See also Ronald R. Kraynak, 53 ECAB 130 (2001).

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

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

Claims, Chapter 2.808.5a (February 2013). 

8

Isidoro Rivera, 12 ECAB 348 (1961).

9 A.M.A., Guides 423 (note that peripheral nerve impairment may be combined with DBI at the upper extremity 

as long as the DBI does not encompass the nerve impairment. Id. at 419
5

To properly evaluate the medical evidence with respect to conditions other than carpal 

tunnel syndrome, OWCP must resolve the issues regarding the ROM and DBI methods of 

evaluating permanent impairment.

10

 The Board has found that OWCP inconsistently applied 

Chapter 15 of the sixth edition of the A.M.A., Guides when granting schedule awards for upper 

extremity claims. No consistent interpretation had been followed regarding the proper use of the 

DBI or the ROM methodology when assessing the extent of permanent impairment for schedule 

award purposes.11 The purpose of the use of uniform standards is to ensure consistent results and 

to ensure equal justice under the law to all claimants.12 In T.H., the Board concluded that OWCP 

physicians were at odds over the proper methodology for rating upper extremity impairment, 

having observed attending physicians, evaluating physicians, second opinion physicians, 

impartial medical examiners, and district medical advisers use both DBI and ROM 

methodologies interchangeably without any consistent basis. Furthermore, the Board observed 

that physicians interchangeably cited to language in the first printing or the second printing when 

justifying use of either the ROM or DBI methodology. Because OWCP’s own physicians were 

inconsistent in the application of the A.M.A., Guides, the Board found that OWCP could no 

longer ensure consistent results and equal justice under the law for all claimants.13 

In order to ensure a consistent result and equal justice under the law for cases involving 

upper extremity impairment, the Board will set aside the November 7, 2016 decision with respect 

to the upper extremity not including the condition of carpal tunnel syndrome. Utilizing a 

consistent method for calculating permanent impairment14 for upper extremities to be applied 

uniformly, and such other development as may be deemed necessary, OWCP shall issue a 

de novo decision on appellant’s claim for an upper extremity schedule award. 

CONCLUSION

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

 

10 Dr. Larson referred to loss of wrist motion but opined that wrist arthritis was not employment related, without 

further explanation.

11 T.H., Docket No. 14-0943 (issued November 25, 2016).

12 Ausbon N. Johnson, 50 ECAB 304, 311 (1999).

13 Supra note 9.

14 See FECA Bulletin No. 17-06 (May 8, 2017).
6

ORDER

IT IS HEREBY ORDERED THAT the decision of the Office of Workers’

Compensation Programs dated November 7, 2016 is set aside and the case remanded for further 

action consistent with this decision of the Board. 

Issued: February 26, 2018

Washington, DC

Christopher J. Godfrey, 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