United States Department of Labor

Employees’ Compensation Appeals Board

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S.S., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Pittsburgh, PA, Employer

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Docket No. 17-1361

Issued: January 8, 2018

Appearances: Case Submitted on the Record

Jeffrey P. Zeelander, Esq., for the appellant1

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 June 2, 2017 appellant, through counsel, filed a timely appeal from a February 10, 

2017 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 more than five percent permanent impairment of his 

left upper extremity and three percent permanent impairment of his right upper extremity, for 

which he previously received schedule awards.

FACTUAL HISTORY

This case has previously been before the Board.3 The facts and circumstances as set forth 

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

follows:

On November 13, 2014 appellant, then a 56-year-old mail handler, filed an occupational 

disease claim (Form CA-2) alleging that he developed bilateral carpal tunnel syndrome due to 

factors of his federal employment. OWCP accepted the claim for bilateral carpal tunnel 

syndrome, tenosynovitis of the right hand and wrist, and synovitis and tenosynovitis of the left 

hand.

An electromyogram (EMG) and nerve conduction velocity (NCV) study performed on 

September 10, 2014 revealed moderately severe bilateral carpal tunnel syndrome especially on 

the right side. An October 22, 2014 EMG study revealed moderate bilateral carpal tunnel 

syndrome.

On April 23, 2015 appellant underwent authorized left carpal tunnel release and flexor 

tenosynovectomy and on June 25, 2015 he underwent authorized right carpal tunnel release and 

flexor tenosynovectomy. 

In an impairment evaluation dated December 17, 2015, Dr. Michael Platto, a Boardcertified physiatrist, measured range of motion of appellant’s wrists and found decreased twopoint discrimination of the left thumb, middle, and index fingers. Referencing the sixth edition 

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

(A.M.A., Guides),

4 he opined that appellant had three percent impairment due to tenosynovitis as 

a result of bilateral loss of wrist range of motion according to Table 15-32 on page 473. For the 

right side, using Table 15-23 on page 473, Dr. Platto applied a grade modifier of three due to test 

findings of axon loss, a grade modifier of one for normal physical findings with intermittent 

symptoms, and a grade modifier of one for physical examination, which rounded to a grade 

modifier of two. He found a grade modifier of zero based on a QuickDASH (Disabilities of the 

Arm, Shoulder, and Hand) score of 15.9. For the left side, Dr. Platto advised that he performed 

an NCV study due to appellant’s complaints of continued numbness, which revealed axon loss 

with “decreased motor median amplitude of less than [five]” and a delay in median sensory peak 

latency, for a grade modifier of three for test results. He applied a grade modifier of one for a 

history of mild intermittent symptoms and a grade modifier of two for physical findings of 

decreased two-point discrimination, for an average grade modifier of two, or four percent 

 

3 Docket No. 16-1101 (issued November 4, 2016).

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

impairment. Dr. Platto opined that appellant had three percent permanent impairment of each 

upper extremity due to tenosynovitis and four percent permanent impairment of each upper 

extremity due to carpal tunnel syndrome, for seven percent combined permanent impairment of 

each arm. 

Appellant, on January 8, 2016, filed a claim for a schedule award (Form CA-7).

On January 20, 2016 OWCP referred appellant to Dr. Shaka Walker, a Board-certified 

orthopedic surgeon, for a second opinion examination regarding the extent of any permanent 

impairment due to the accepted work injury. In an impairment evaluation dated February 1, 

2016, Dr. Walker reviewed his history of hand numbness and pain treated with carpal tunnel 

releases and flexor tenosynovectomies. On examination, he found no atrophy and a negative 

Tinel’s sign and Phalen’s test. Dr. Walker measured range of motion of the wrists and 

performed pinch and grip strength testing. He measured normal wrist motion, for a grade 

modifier of zero. Dr. Walker found no impairment due to tenosynovitis as a result of reduced 

motion. Referencing Table 15-23 on page 449 of the A.M.A., Guides, for the right side he found 

that EMG findings in the September 10, 2014 study showed axonal loss, for a grade three 

modifier. Dr. Walker applied a grade modifier of zero for functional history and physical 

examination. He declined to use the QuickDASH score due to reliability issues. Dr. Walker 

found an average modifier of one and a final right arm impairment rating of one percent. For the 

left wrist, he determined that a postoperative EMG showed median motor amplitude of less than 

five, or axonal loss, for a grade three modifier. Dr. Walker applied a grade two modifier for 

decreased sensation and a grade modifier of three for history. He found an average grade 

modifier of three and a resulting seven percent permanent impairment of the left arm. 

An OWCP medical adviser reviewed the medical records on March 21, 2016. He advised 

that diagnostic testing performed September 10, 2014 did not show axonal loss and that grip and 

pinch strength were nonspecific findings. The medical adviser concurred with Dr. Walker’s 

finding of no impairment due to tenosynovitis. Using Table 15-23, he applied a grade modifier 

of one bilaterally due to electrodiagnostic testing. The medical adviser further applied a grade 

modifier of zero on the right and two on the left for physical findings of loss of two-point 

discrimination of the left hand and a grade modifier of zero for history on the right and one on 

the left. He found that the functional history was not applicable because of the unreliable 

QuickDASH score. The medical adviser opined that appellant had two percent permanent 

impairment of each upper extremity due to carpal tunnel syndrome.

By decision dated March 23, 2016, OWCP granted appellant schedule awards for two 

percent permanent impairment of each upper extremity. The period of the award ran for 12.48 

weeks from February 1 to April 28, 2016.

Appellant appealed to the Board. By decision dated November 4, 2016, the Board set 

aside the March 23, 2016 decision after finding a conflict in medical opinion between Dr. Platto 

and Dr. Walker regarding the extent of appellant’s permanent impairment of the upper 

extremities. It remanded the case for OWCP to refer appellant to an impartial medical examiner 

for resolution of the conflict.
4

On December 17, 2016 OWCP referred appellant to Dr. Victoria Langa, a Board-certified 

orthopedic surgeon, for an impartial medical examination. In a report dated January 23, 2017,

Dr. Langa reviewed the history of injury and the results of diagnostic testing. She discussed 

appellant’s complaints of numbness and tingling intermittently more on the left side and loss of 

strength bilaterally. On examination, Dr. Langa found no tenderness of the wrist or hands and a 

negative Tinel’s sign and Phalen’s test bilaterally. She measured range of motion of the wrists as 

symmetrical bilaterally with 44 degrees of palmar-flexion, 55 degrees of dorsiflexion, 30 degrees 

of ulnar deviation, and 20 degrees of radical deviation. Dr. Langa found no crepitation, thenar 

atrophy, or weakness, normal two-point discrimination on the right and borderline two-point 

discrimination on the left, and full range of motion of the digits without triggering. She

diagnosed status post left and right carpal tunnel releases with flexor tenosynovectomies and 

opined that appellant had reached maximum medical improvement. Dr. Langa found no 

evidence of residual digital flexor tenosynovitis and thus no impairment. She attributed 

appellant’s minimal loss of motion at the wrists to early arthritis rather than carpal tunnel 

syndrome. 

Referencing Table 15-23 on page 449 of the A.M.A., Guides, Dr. Langa found, for the 

right side, that he had a grade two modifier for preoperative test findings based on his motor 

conduction block, a grade one modifier for history due to mild intermittent symptoms, and a 

grade one modifier for physical findings of normal two-point discrimination and no atrophy or 

weakness, for a total of four. She divided the four by three as set forth on page 448 on the 

A.M.A., Guides to find a category one impairment, which she modified to three percent 

impairment based on the QuickDASH score of 50. For the left side, Dr. Langa applied a grade 

three modifier for test results showing axon loss, a grade modifier of one for history, and a grade 

modifier of two for altered sensation, which she added and divided by three to find category two 

impairment. She found no adjustment based on the QuickDASH score as the rating was already 

in category two, and concluded that appellant had five percent left upper extremity impairment.

In a report dated January 24, 2017, Dr. Platto provided findings on examination and 

determined that appellant had a QuickDASH score of 34. He concluded that appellant had three 

percent permanent impairment of each upper extremity due to tenosynovitis of the wrists, and 

four percent permanent impairment of each upper extremity for carpal tunnel syndrome, for a 

combined seven percent permanent impairment of each upper extremity.

By decision dated February 10, 2017, OWCP granted appellant a schedule award for an 

additional three percent left upper extremity permanent impairment and an additional one percent 

right upper extremity permanent impairment. It noted that he had previously received a schedule 

award for two percent permanent impairment of each upper extremity. The period of the award 

ran for 12.48 weeks from May 1 to July 27, 2016.

On appeal counsel contends that Dr. Langa did not adequately document her range of 

motion measurements, in contrast to the detailed findings by Dr. Platto. He notes that she 

attributed the motion loss to a condition other than carpal tunnel syndrome and asserts that 

preexisting and subsequently-acquired conditions are included in schedule awards. Counsel 

questions why Dr. Langa used the test results on the right side that were obtained prior to surgery 

and failed to rate the conditions of tenosynovitis and synovitis.
5

LEGAL PRECEDENT

The schedule award provisions of FECA,5and its implementing federal regulation,6set 

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.7 As of May 1, 2009, the 

sixth edition of the A.M.A., Guides is used to calculate schedule awards.8

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).

9

 The net adjustment formula is 

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

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

15-23 (Entrapment/Compression Neuropathy Impairment) and accompanying relevant text.10 In 

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

test findings, history, and physical findings. The grade modifiers are averaged to arrive at the 

appropriate overall grade modifier level and to identify a default rating value. 

When there exist opposing medical reports of virtually equal weight and rationale and the 

case is referred to an impartial medical specialist for the purpose of resolving the conflict, the 

opinion of such specialist, if sufficiently well rationalized and based upon a proper factual 

background, must be given special weight.11

ANALYSIS

On prior appeal, the Board found a conflict in medical opinion between Dr. Platto and

Dr. Walker regarding the extent of appellant’s permanent impairment of the upper extremities. 

On remand OWCP referred him to Dr. Langa, a Board-certified orthopedic surgeon, for an 

impartial medical examination.

 

5 5 U.S.C. § 8107.

6 20 C.F.R. § 10.404.

7

Id. at § 10.404(a).

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

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

(January 2010). 

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

10 Id. at 449, Table 15-23.

11 David W. Pickett, 54 ECAB 272 (2002); Barry Neutuch, 54 ECAB 313 (2003).
6

Where there exist opposing medical reports of virtually equal weight and rationale and 

the case is referred to an impartial medical examiner for the purpose of resolving the conflict, the 

opinion of such specialist, if sufficiently well rationalized and based upon a proper factual 

background, must be given special weight.12 On January 23, 2017 Dr. Langa discussed the 

history of injury and considered the results of diagnostic testing. She found no wrist tenderness, 

crepitation, thenar atrophy, or weakness, a negative Tinel’s sign and Phalen’s test bilaterally, and 

no triggering or loss of motion of the digits. Dr. Langa measured minimal loss of wrist motion 

bilaterally with the loss of only five degrees of dorsiflexion, which she attributed to early 

arthritis. She found no evidence of tenosynovitis based on appellant’s finger range of motion 

and lack of triggering, and thus no ratable impairment. Regarding impairment due to carpal 

tunnel syndrome, Dr. Langa applied the provisions Table 15-23 on page 449 of the A.M.A., 

Guides. For the right side, she applied a modifier of two due to a motor conduction block, a 

grade modifier of one for a history of mild intermittent symptoms and a grade modifier of one 

for physical findings of normal two-point discrimination with no atrophy or weakness, for a class 

one impairment and an impairment range of one to three percent. Dr. Langa found three percent 

right arm impairment based on appellant’s QuickDASH score of 50. For the left side, she

applied a grade modifier of three for test results showing axon loss, a grade modifier of one 

based on his history, and a grade modifier of two for physical findings of altered sensation, 

which yielded class 2 impairment under Table 15-23 and an impairment range of four to six 

percent. Dr. Langa found five percent permanent impairment due to the QuickDASH score of 

50.

The Board has carefully reviewed Dr. Langa’s report and finds that it is based on a proper 

factual background and supported by rationale. Dr. Langa further explained how her impairment 

rating comported with the standards of the sixth edition of the A.M.A., Guides. Consequently,

her report is entitled to the special weight of the evidence as the impartial medical specialist and 

establishes that appellant has no more than five percent permanent impairment of the left upper 

extremity and three percent permanent impairment of the right upper extremity.13 

In a report dated January 24, 2017, Dr. Platto opined that appellant had three percent 

permanent impairment of each upper extremity due to tenosynovitis of the wrists, and four 

percent permanent impairment of each upper extremity for carpal tunnel syndrome, for a 

combined seven percent permanent impairment of each upper extremity. He, however, was on 

one side of the conflict resolved by Dr. Langa. A medical report from a physician on one side of 

a conflict resolved by an impartial medical examiner is generally insufficient to overcome the 

special weight accorded the report of an impartial medical examiner or to create a new conflict.14 

Dr. Platto’s report is thus insufficient to overcome the special weight accorded to Dr. Langa’s 

opinion or to create a new conflict in medical opinion.15

 

12 See N.D., Docket No. 15-1392 (issued December 9, 2015); Gloria J. Godfrey, 52 ECAB 486 (2001).

13 See G.W., Docket No. 16-0525 (issued August 2, 2017).

14 See Jaja K. Asaramo, 55 ECAB 200 (2004); Michael Hughes, 52 ECAB 387 (2001).

15 See K.R., Docket No. 16-0542 (issued December 21, 2016).
7

On appeal counsel asserts that Dr. Langa did not sufficiently describe her measurements 

for range of motion and attributed motion loss to a nonemployment-related condition. He

maintains that preexisting and subsequently acquired conditions were included in calculating a 

schedule award. Dr. Langa, however, found minimal motion loss of the wrists, which she related 

to mild arthritis. She properly rated appellant’s wrist impairment using the provisions of 

Table 15-23, applicable to rating entrapment/compression neuropathy, the accepted condition. 

The A.M.A., Guides, provide that entrapment neuropathy is determined using the standards set 

forth in section 15.4f, which includes Table 15-23, and that additional impairment is “not 

permitted for decreased grip strength, loss of motion, or pain.”

16

Counsel questions why Dr. Langa used the test results on the right side that were obtained 

prior to surgery and failed to rate the conditions of tenosynovitis and synovitis. Dr. Langa

specifically found, however, no impairment due to tenosynovitis and provided appellant with a 

grade two modifier for his preoperative motor conduction block for test findings. As discussed,

her report is detailed and reasoned and thus entitled to the special weight of the evidence.17

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 employmentrelated condition resulting in permanent impairment or increased impairment.

CONCLUSION

The Board finds that appellant has no more than five percent permanent impairment of 

his left upper extremity and three percent permanent impairment of his right upper extremity 

impairment, for which he received schedule awards.

 

16 A.M.A., Guides 433.

17 Furthermore, the A.M.A., Guides, advise that in most situations preoperative electrodiagnostic testing should 

be used in impairment ratings under Table 15-23. Id. at 448.
8

ORDER

IT IS HEREBY ORDERED THAT the February 10, 2017 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: January 8, 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