United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

J.F., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE,

Flowery Branch, GA, Employer

__________________________________________

)

)

)

)

)

)

)

)

Docket No. 17-1726

Issued: March 12, 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 August 7, 2017 appellant filed a timely appeal from the July 14, 2017 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 the claim.

ISSUE

The issue is whether appellant has established greater than 18 percent permanent 

impairment of her right upper extremity, for which she previously received a schedule award.

 

1 5 U.S.C. § 8101 et seq.
2

FACTUAL HISTORY

This case has previously been before the Board.2 The facts and circumstances set forth in 

the Board’s prior decision are incorporated herein by reference. The relevant facts are as 

follows.

OWCP accepted that on May 23, 2013 appellant, then a 56-year-old lead customer 

service clerk, sustained reflex sympathetic dystrophy (RSD) of the right upper limb and an 

acromioclavicular sprain of the right shoulder and upper arm while in the performance of duty. 

It paid appropriate compensation benefits and authorized surgery performed by Dr. Jesse E. 

Seidman, an attending Board-certified orthopedic surgeon on December 18, 2013.

3

 Appellant 

returned to light-duty work on August 14, 2014 and Dr. Seidman then released her to return to 

full-duty work on January 12, 2015. 

On January 21, 2015 appellant filed a claim for a schedule award (Form CA-7). In a 

January 12, 2015 report, Dr. Seidman noted active abduction and forward flexion of the right 

shoulder at 140 degrees, external rotation at 40 degrees, internal rotation at 30 degrees, and 

extension at 50 degrees. He found good motion of the right wrist, slight atrophy in the right 

hand, and range of motion (ROM) of the proximal interphalangeal (PIP) and 

metacarpophalangeal (MCP) joints limited to 90 degrees. 

An OWCP medical adviser reviewed the evidence of record on February 4, 2015. He 

found that appellant had attained maximum medical improvement (MMI) as of December 18, 

2014, one year after arthroscopic right shoulder surgery. Referring to Table 15-34 in the sixth 

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

Impairment (hereinafter, A.M.A., Guides),4the medical adviser found, utilizing ROM 

methodology, three percent impairment of the right upper extremity due to forward elevation 

limited to 140 degrees, three percent impairment due to shoulder abduction limited to 140 

degrees, four percent impairment due to internal rotation limited to 30 degrees, and two percent 

impairment for external rotation limited to 40 degrees. He combined these percentages to equal 

12 percent permanent impairment of the right upper extremity. 

In a March 2, 2015 letter, Dr. Seidman found that appellant had attained MMI as of 

January 12, 2015. He opined that she had 18 percent permanent impairment of the right upper 

extremity according to unspecified portions of the A.M.A., Guides.

An OWCP medical adviser reviewed Dr. Seidman’s report on April 10, 2015 and 

concurred that appellant had 18 percent permanent impairment of the right upper extremity due 

to limited right shoulder and finger motion. He noted that Dr. Seidman indicated that she had 

complex regional pain syndrome postoperation with resultant motion deficit of right shoulder as 

well as finger motion which equaled a total 18 percent right upper extremity impairment. The 

 

2 Docket No. 16-1462 (issued April 11, 2017). 

3 Dr. Seidman performed arthroscopic debridement of the subscapularis, arthroscopic subacromial 

decompression, biceps tenotomy, arthroscopic Mumford procedure, and arthroscopic double row rotator cuff repair.

4 Table 15-34 (Shoulder Range of Motion), p. 475, A.M.A., Guides (6th ed. 2009).
3

medical adviser found that it was appropriate to use the ROM rating method as opposed to a 

diagnosis-based impairment (DBI) methodology, because appellant’s RSD syndrome manifested 

itself primarily through limited shoulder and hand motion. 

By decision dated May 5, 2015, OWCP granted appellant a schedule award for 18 

percent permanent impairment of the right upper extremity. The period of the award ran from 

January 12, 2015 to February 9, 2016. 

In a May 18, 2015 letter, appellant requested a telephonic oral hearing, which was held 

before an OWCP hearing representative on December 17, 2015. At the hearing, she described 

continued limited motion in her right hand and shoulder. Appellant’s husband presented 

information and quoted newspaper articles about RSD syndrome. Appellant submitted 

photographs illustrating her limited hand motion, including the inability to make a fist with her 

right hand. Following the hearing, she submitted physical therapy notes. 

By decision dated March 2, 2016, OWCP’s hearing representative affirmed OWCP’s 

May 5, 2015 schedule award determination, finding that the additional evidence submitted did 

not establish that appellant sustained greater than 18 percent permanent impairment of the right 

upper extremity. 

Appellant appealed to the Board on July 1, 2016. By decision dated April 11, 2017, the 

Board set aside the March 2, 2016 decision.5 The Board found that OWCP had inconsistently 

applied Chapter 15 of the A.M.A., Guides regarding the proper use either the DBI or ROM 

methodology in assessing the extent of permanent impairment. The Board remanded the case for 

OWCP to issue a de novo decision after development of a consistent method for calculating 

permanent impairment of the upper extremities. 

On June 16, 2017 OWCP requested that its medical adviser review Dr. Seidman’s 

March 2, 2015 impairment rating of 18 percent permanent impairment of the right upper 

extremity and explain how the impairment calculation was determined under the reprinted 2009 

sixth edition A.M.A., Guides. In pertinent part, it indicated that the medical adviser must 

reference all pertinent objective and subjective findings, identify the methodology used by the 

rating physician, and advise whether the applicable tables in the A.M.A., Guides identify a 

diagnosis that can alternatively be rated by ROM. If the A.M.A., Guides allows 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. If the rating physician provided an 

assessment using the ROM method and the A.M.A., Guides allows for use of ROM diagnosis in 

question, the medical adviser was to independently calculate the impairment using both the ROM 

and DBI methods and identify the higher rating. He noted that if it was clear to the evaluator 

evaluating loss of ROM that a restricted ROM had an organic basis, three (3) independent 

measurements should be documented/recorded and the greatest ROM should be used for the 

determination of impairment. If the medical evidence of record was not sufficient to render a 

rating based on ROM where allowed, the medical adviser was advised to note the medical 

evidence necessary to complete the ROM rating and render an impairment rating using the DBI 

method, if possible, given the available evidence. OWCP noted that appellant had previously 

 

5 Supra note 2.
4

been awarded 18 percent permanent impairment of the right upper extremity and requested that 

its medical adviser opine whether an additional impairment had been incurred. 

On June 19, 2017 Dr. Nathan Hammel, a Board-certified orthopedic surgeon serving as

an OWCP medical adviser, reviewed the evidence of record. He noted that appellant had 

received 18 percent permanent partial impairment of the right upper extremity, but the 

calculation of additional impairment was not possible as the examination findings of March 2, 

2015 were not provided. Dr. Hammel noted that, under the DBI method, she had 10 percent 

permanent impairment for class 1 distal clavical excision under Table 15-5, page 403 of A.M.A., 

Guides. 

The medical adviser indicated that the most recent clinical examination of January 12, 

2015 showed mild continued shoulder and wrist pain with moderate ROM loss in the right 

shoulder. The ROM in the digits limited to 90 PIP and MCP index through small finger. The 

PIP joint had 10 degree flexion contracture. The shoulder showed mild limitation in ROM with 

no crepitus. The wrist was limited to 40 degrees of extension with full motion in all other planes. 

Utilizing the DBI method, the medical adviser indicated under Table 15-5, page 403, a 

distal clavicle excision, class 1 default C had 10 percent impairment. A grade 1 was provided for 

history modifier for mild continued symptoms and a grade 1 was provided for examination 

modifier for mild ROM loss. A clinical studies modifier was not applicable as it was used to 

select DBI. Applying the net adjustment formula, the medical adviser concluded that appellant 

had 10 percent upper extremity impairment under the DBI method.

Utilizing the ROM method, the medial adviser found a total impairment of seven percent 

for the hand/wrist. Under Table 15-32, wrist extension of 40 degrees was given three percent 

impairment with all other planes noted as normal. Under Table 15-31, 90 degrees flexion 

equaled six percent digit impairment; 10 flexion contracture equaled three percent digit 

impairment. Four fingers equated nine percent digit impairment, which, when converted under 

Table 15-11, equaled four percent total right hand impairment, consisting of one percent 

impairment for each of the index, long, ring and small fingers. No specific findings ROM were 

noted for the shoulder impairment or an analysis under ROM for shoulder.

The medical adviser combined the DBI (10 percent distal clavicle resection) and ROM 

(7 percent wrist/digit) impairment for a total 17 percent right upper extremity permanent 

impairment. He indicated that, March 2, 2015, the date of the award examination, was the date 

MMI was reached. The medical adviser stated that the 17 percent upper extremity impairment 

was not additive to the previously awarded 18 percent. He also stated that, based on his 

calculations above, the previous impairment calculation seemed reasonable. 

By decision dated July 14, 2017, OWCP denied appellant’s claim as the medical 

evidence did not support an increase in the impairment already compensated. It noted that the 

medical adviser had applied the DBI and ROM methodologies to the examination findings

provided by the treating physician and had indicated that the calculation seemed reasonable. 
5

LEGAL PRECEDENT

The schedule award provisions of FECA6 provide for compensation to employees 

sustaining impairment from loss or loss of use of specified members of the body. It, 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 sound discretion of 

OWCP. For 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. The 

A.M.A., Guides has been adopted by OWCP as a standard for evaluation of schedule losses and 

the Board has concurred in such adoption.7 For schedule awards after May 1, 2009, the 

impairment is evaluated under the sixth edition of the A.M.A., Guides.

8

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

should be routed to an OWCP medical adviser for an opinion concerning the percentage of 

impairment using the A.M.A., Guides.

9

 In some instances, an OWCP medical adviser’s opinion 

can constitute the weight of the medical evidence. This occurs in schedule award cases where an 

attending physician indicates that the MMI has been reached and described the permanent 

impairment of the affected member, but does not offer an impairment rating. In this instance, a 

detailed opinion by an OWCP medical adviser, who gives a percentage based on reported 

findings and the A.M.A., Guides, may constitute the weight of the medical evidence.10

OWCP procedures state that any previous impairment to the member under consideration 

is included in calculating the percentage of loss, except when the prior impairment is due to a 

previous work-related injury, in which case the percentage already paid is subtracted from the 

total percentage of impairment.11

Regarding the application of ROM or DBI impairment methodologies in rating 

permanent impairment of the upper extremities, FECA Bulletin No. 17-06 provides:

“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).

 

6 5 U.S.C. § 8107.

7 Bernard A. Babcock, Jr., 52 ECAB 143 (2000).

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

Chapter 2.808.5a (February 2013); see also Federal (FECA) Procedure Manual, Part 3 -- Medical, Schedule Awards,

Chapter 3.700.2 and Exhibit 1 (January 2010).

9

Id. at Chapter 2.808.6(f) (February 2013); see also L.R., Docket No. 14-0674 (issued August 13, 2014); D.H.,

Docket No. 12-1857 (issued February 26, 2013).

10 See Federal (FECA) Procedure Manual, id. at Chapter 2.810.8(i) (September 2010).

11 Id. at Chapter 2.808.8.b (February 2013).
6

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

[district medical adviser] (DMA) should identify (1) the methodology used by the 

rating physician (i.e., DBI 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 original).

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.”

ANALYSIS

On prior appeal, the Board remanded the case for OWCP to reevaluate the extent of 

appellant’s permanent impairment of her right upper extremity after it determined a consistent 

method for rating upper extremity impairments under the A.M.A., Guides. On remand the 

medical adviser, Dr. Hammel, reviewed the evidence and found that she had 17 percent right 

upper extremity permanent impairment after combining DBI (10 percent distal clavicle 

resection) and ROM (7 percent wrist/digit) impairment. On July 14, 2017 OWCP denied an 

increased schedule award as the medical evidence of record did not support an increase in the 

permanent impairment previously awarded. The Board finds that this case is not in posture for 

decision.

In his March 2, 2015 report, Dr. Seidman opined that appellant had 18 percent right upper 

extremity impairment. He also indicated that she had attained MMI as of January 12, 2015. 

However, Dr. Seidman neither referenced a specific edition of the A.M.A., Guides, nor provided 

any calculations or examination findings explaining his 18 percent permanent impairment rating. 

As he did not provide an impairment calculation referring to specific elements of the A.M.A., 

Guides, his impairment rating is of diminished probative value.

12

 

OWCP’s medial adviser, Dr. Hammel, found that appellant had reached MMI as of 

March 2, 2015. He used Dr. Seidman’s January 12, 2015 examination findings to calculate her

impairment as there were no examination findings of March 2, 2015. For the DBI impairment, 

 

12 See Shalanya Ellison, 56 ECAB 150, 154 (2004) (an estimate of permanent impairment is irrelevant and of 

diminished probative value where it is not based on the A.M.A., Guides).
7

OWCP’s medical adviser indicated that appellant had 10 percent right upper extremity 

impairment due to distal clavicle resection. There is no indication that Dr. Seidman obtained 

three ROM measurements and that the ROM had an organic basis. In its June 16, 2017 

instructions, OWCP specifically informed its medical adviser that “if it was clear to the evaluator 

evaluating loss of ROM that a restricted ROM had an organic basis, three (3) independent 

measurements should be documented/recorded and the greatest ROM should be used for the 

determination of impairment.” It further instructed that “If the medical evidence of record was 

not sufficient to render a rating based on ROM where allowed, the medical adviser was advised 

to note the medical evidence necessary to complete the ROM rating.” The medical adviser failed 

to follow OWCP’s instructions as he did not indicate what medical evidence was used to 

complete the ROM rating. Furthermore, the prior schedule award was for ROM deficits in the 

shoulder and wrist/digits. The medical adviser failed to include Dr. Seidman’s ROM shoulder 

findings in his ROM impairment calculation. Due to the above-noted deficiencies, OWCP’s 

medical adviser’s impairment report is of diminished probative value.13

Pursuant to its procedures, OWCP shall further develop the claim to obtain the three 

independent ROM measurements required under FECA Bulletin 17-06 (issued My 8, 2017). 

Following this and other such development as it deemed necessary, OWCP shall issue a de novo 

decision regarding appellant’s claim for an increased right upper extremity schedule award.14

CONCLUSION

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

 

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

14 Id.
8

ORDER

IT IS HEREBY ORDERED THAT the July 14, 2017 decision of the Office of 

Workers’ Compensation Programs is set aside and the case is remanded for further action 

consistent with this decision of the Board. 

Issued: March 12, 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