United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

R.S., Appellant

and

U.S. POSTAL SERVICE, LAKE OTIS 

STATION, Anchorage, AK

__________________________________________

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Docket No. 18-0023

Issued: July 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

PATRICIA H. FITZGERALD, Deputy Chief Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On October 2, 2017 appellant filed a timely appeal from an August 11, 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 this claim.

ISSUE

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

percent permanent impairment of each upper extremity, for which he previously received schedule 

awards.

FACTUAL HISTORY

On August 12, 2014 appellant, then a 53-year-old letter carrier, filed an occupational 

disease claim (Form CA-2) for a bilateral hand condition causally related to factors of his federal 

 

1 5 U.S.C. § 8101 et seq.
2

employment. He first became aware of his claimed condition on August 11, 2014 and he attributed 

it to repetitive movements required by his work. He claimed that his hands would close on their 

own accord. Appellant did not stop work. 

OWCP, by development letter dated August 14, 2014, informed appellant of the 

deficiencies in his claim and afforded him 30 days to submit additional factual and medical 

evidence.

In an August 11, 2014 medical report, Dr. Lisa A. Rabinowitz, Board-certified in 

emergency medicine, related that appellant presented with bilateral hand and wrist pain that began 

approximately one week prior. She noted his complaints and history of his medical and social 

background. Dr. Rabinowitz examined appellant and provided a final impression of carpal spasm.

By decision dated October 8, 2014, OWCP denied appellant’s occupational disease claim, 

finding that the medical evidence of record failed to establish a diagnosed condition causally 

related to the accepted employment factors.

On February 23, 2015 appellant requested reconsideration and submitted a January 28, 

2015 attending physician’s report (Form CA-20) from Dr. David Roberts, a neurosurgeon. 

Dr. Roberts noted that appellant complained about left wrist pain radiating up to his shoulder. He

also noted that in 2011 he underwent a left ulnar nerve transposition. Dr. Roberts reported that an 

electromyogram (EMG) confirmed left carpal tunnel syndrome. He diagnosed enthesopathy of 

the wrist and carpus, left carpal tunnel syndrome, and lesion on the left ulnar nerve. Dr. Roberts

checked a box marked “yes” that the diagnosed conditions were caused or aggravated by an 

employment activity, which he identified as repetitive motion. He advised appellant that he could 

resume light work with limitations as of the date of his examination.

The record contains a memorandum of conference, dated April 2, 2015, between an OWCP 

claims examiner and appellant. Appellant described his work duties at the employing 

establishment, which involved casing mail two to two and one-half hours a day and delivering 

mail five to five and one-half hours a day. He noted changes in his hands about one year ago. 

Appellant related that both of his hands would ball up after a hard day. He had no prior hand 

injuries. Appellant was not performing full-time, full-duty work due to a lifting restriction.

On April 6, 2015 OWCP prepared a statement of accepted facts (SOAF). 

By letter dated April 8, 2015, OWCP referred appellant to Dr. Thomas Gritzka, a Boardcertified orthopedic surgeon, for a second opinion examination to determine whether he had a 

bilateral arm or hand condition causally related to factors of his federal employment.

In a medical report dated May 19, 2015, Dr. Gritzka reviewed the SOAF and the medical 

record. He noted appellant’s medical and social background, provided a review of systems and 

findings on physical examination, and diagnosed bilateral carpal tunnel syndrome, left greater than 

right, related to appellant’s work activites. Dr. Gritzka advised that appellant had not yet reached 

maximum medical improvement (MMI). In an addendum to his August 21, 2015 report, he noted 

that EMG studies performed on August 6, 2015 revealed that appellant met the criteria for a left 

carpal tunnel release. Dr. Gritzka related, however, that the EMG studies of his right upper 

extremity were normal.
3

By decision dated September 3, 2015, OWCP vacated its October 8, 2014 decision and

accepted appellant’s claim for bilateral carpal tunnel based on Dr. Gritzka’s opinion.

On December 9, 2015 appellant underwent authorized left endoscopic carpal tunnel release 

performed by Dr. Owen Ala, an orthopedic surgeon. OWCP paid appellant wage-loss 

compensation benefits on the supplemental rolls as of the date of his surgery. On January 27, 2016

Dr. Ala performed authorized right endoscopic carpal tunnel release. OWCP paid appellant wageloss compensation on the supplemental rolls as of February 6, 2016. He returned to full-time, 

modified duty work on February 12, 2016.

In reports dated April 7, 2016, Jenifer Crawley, a certified physician assistant, examined 

appellant and assessed status post right endoscopic carpal tunnel release, healing well. She related 

that he was doing well and that he could return to work without restriction on April 8, 2016.

In an April 7, 2016 return to work Form CA-3 worksheet, the employing establishment 

notified OWCP that appellant had returned to full-time, regular-duty work with no restrictions.

On December 12, 2016 appellant filed a claim for a schedule award (Form CA-7). He did 

not submit any additional evidence.

By development letter dated December 30, 2016, OWCP requested that appellant submit 

additional factual and medical evidence in support of his schedule award claim, including an 

impairment rating, which applied the standards of the sixth edition of the American Medical 

Association, Guides to the Evaluation of Permanent Impairment (A.M.A., Guides).

2

 It afforded

appellant 30 days to submit the requested information. 

Appellant submitted an anesthesia record dated December 9, 2015 and a duplicate copy of

Ms. Crawley’s April 7, 2016 report.

On March 16, 2017 OWCP denied appellant’s claim for a schedule award. It found that 

the medical evidence submitted failed to establish that he sustained measurable impairment due to 

his accepted employment injury. 

On May 5, 2017 appellant requested reconsideration.

In an April 26, 2017 report, Dr. Sean D. Taylor, a Board-certified physiatrist, noted that

Dr. Ala had referred appellant for a permanent impairment evaluation. He related a history of the 

accepted employment injury and appellant’s medical, family, and social background. Dr. Taylor 

reviewed medical records. On physical examination he reported that appellant was resting 

comfortably in no acute distress. Dr. Taylor found that strength throughout the bilateral upper 

extremities was five out of five. There was no atrophy noted on visual inspection of the bilateral 

upper extremities. Normal muscle bulk was found in the bilateral abductor pollicis brevis. A 

sensory examination included monofilament testing at 3.61 millimeter (mm) in the left thumb and 

little finger, 4.31 mm in the left index, middle, and ring fingers, 2.83 mm in the little and ring 

fingers, and 4.31 mm in the right thumb, index, and middle fingers. An examination of the bilateral 

 

2 A.M.A., Guides (6th ed. 2009).
4

wrists and elbows revealed negative Tinel’s and Phalen’s tests. Dr. Taylor diagnosed bilateral 

carpal tunnel syndrome. He noted that appellant was status post bilateral carpal tunnel release. 

Dr. Taylor related that he was medically stable at the time Dr. Ala had referred him for a permanent 

impairment rating.

Utilizing Table 15-23 (Entrapment/Compression Neuropathy Impairment) on page 449 of 

the sixth edition of the A.M.A., Guides, for the right wrist, Dr. Taylor assigned a grade modifier 0 

for clinical studies (GMCS) based on the findings of a September 24, 2014 EMG and nerve 

conduction velocity (NCV) study.3 He assigned a grade modifier 2 for functional history (GMFH), 

which was remarkable for significant intermittent symptoms. Dr. Taylor assigned a grade modifier 

2 for physical examination (GMPE). He found an average modifier of 1.33. Dr. Taylor determined 

that the default grade modifier was one, resulting in a default upper extremity impairment of two 

percent. He related that appellant had a QuickDASH (Disabilities of the Arm, Shoulder, and Hand) 

score of 66 that was consistent with position three, which yielded three percent right upper 

extremity impairment. Dr. Taylor used Table 15-11 on page 420 to convert the three percent upper 

extremity impairment rating to a two percent whole person impairment rating. For the left wrist, 

he applied a grade modifier one for GMCS based on the September 24, 2014 EMG/NCV study 

results. Dr. Taylor applied a grade modifier two for GMFH, noting that appellant had significant 

intermittent symptoms. He applied a grade modifier two for GMPE. Dr. Taylor found an average 

modifier of 1.66, which represented a default grade modifier two and a default upper extremity 

impairment of five percent. He determined that a QuickDASH score of 66 was consistent with 

position three, which yielded six percent left upper extremity impairment. Utilizing Table 15-11,

Dr. Taylor converted the six percent upper extremity impairment rating to four percent whole 

person impairment rating. Using the combined values chart on page 604, he combined the two 

percent whole person impairment on the right and the four percent whole person impairment on 

the left to calculate six percent whole person impairment rating. Dr. Taylor summarized that 

appellant had sustained six percent whole person impairment as a result of his work-related injury.

On July 31, 2017 Dr. Michael M. Katz, an OWCP medical adviser and a Board-certified 

orthopedic surgeon, reviewed the April 6, 2015 SOAF and the medical record, including

Dr. Taylor’s April 26, 2017 findings. He found that Dr. Taylor’s report was problematic as the 

electrodiagnostics performed prior to appellant’s surgery did not confirm sufficient changes in the 

median nerve function to warrant use of Table 15-23 to calculate impairment for carpal tunnel 

syndrome (no median nerve abnormalities were reported in the September 24, 2014 study). 

Furthermore, Dr. Katz indicated that ulnar nerve lesion of the left upper extremity was not an 

accepted condition under the claim. He related that, according to the A.M.A., Guides, pages 445 

and 446, the diagnosis of focal neuropathy syndrome must be documented by sensory and motor 

nerve conduction studies and/or needle EMG in order to be ratable as an impairment and that 

normal electrodiagnostic tests failed to meet the definitions necessary to permit a diagnosis of focal 

nerve compromise for the purpose of rating impairment. Dr. Katz further related that, under these 

circumstances, the A.M.A., Guides, pages 445 and 446, required the wrists to be rated as 

nonspecific wrist pain.4 He determined that, under Table 15-3, Wrist Regional Grid, on page 395, 

using the diagnosis of wrist pain, nonspecific, residual symptoms, appellant had a class of 

 

3 The September 24, 2014 EMG/NCV study provided an impression of left cubital tunnel syndrome.

4 A.M.A., Guides 445-46.
5

diagnosis 1 (CDX 1) impairment, which represented one percent impairment default value. 

Dr. Katz assigned a grade modifier 1 for GMPE and advised that Dr. Taylor’s grade modifier three

for GMFH and a GMCS were not applicable. Using the net adjustment formula of (GMPE - CDX) 

or (1-1), he found that the net adjustment was zero, resulting in one percent permanent impairment, 

grade C. Dr. Katz noted that the QuickDASH score of 66 was not applicable in his determination 

because the functional history was unreliable. Citing the A.M.A., Guides on page 406, he noted 

that, if functional history differed by two or more grades from the clinical studies or physical 

examination findings, it should be assumed to be unreliable. Dr. Katz also noted that, if the 

functional history was unreliable or inconsistent with other documentation, it was excluded from 

the grading process. He concluded that appellant had one percent impairment of each upper 

extremity. Dr. Katz determined that appellant had reached MMI on April 26, 2016, the date of

Dr. Taylor’s examination.

In an August 7, 2017 decision, OWCP vacated its March 16, 2016 decision, finding that 

appellant had sustained permanent impairment of a scheduled member due to his accepted 

employment injury. It noted that a decision addressing his claim for a schedule award would be 

issued under separate cover. 

By decision dated August 11, 2017, OWCP granted appellant a schedule award for one 

percent permanent impairment of each upper extremity. The period of the award, equivalent to 

6.24 weeks, ran from April 26 to June 8, 2017. OWCP based its determination on Dr. Katz’s 

July 31, 2017 report, which evaluated the April 26, 2017 findings of Dr. Taylor.

LEGAL PRECEDENT

The schedule award provisions of FECA5and its implementing federal regulations6set 

forth the number of weeks of compensation payable to employees sustaining permanent 

impairment from loss or loss of use, of scheduled members, functions, and organs of the body. 

FECA, however, does not specify the manner by which the percentage loss of a member, function, 

or organ shall be determined. To ensure consistent results and equal justice for all claimants under 

the law, good administrative practice requires the use of uniform standards applicable to all 

claimants.7 The A.M.A., Guides has been adopted by the implementing regulations as the 

appropriate standard for evaluating schedule losses.8 As of May 1, 2009, schedule awards are 

determined in accordance with the sixth edition of the A.M.A., Guides (2009).9 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.10 It is well established that in 

 

5 5 U.S.C. § 8107.

6 20 C.F.R. § 10.404.

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

8

Id.

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

2.808.5a (February 2013); Part 3 -- Medical, Schedule Awards, Chapter 3.700, Exhibit 1 (March 2017).

10 Isidoro Rivera, 12 ECAB 348 (1961).
6

determining the amount of a schedule award for a member of the body that sustained an 

employment-related permanent impairment, preexisting impairments are to be included.11

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).12 Under the sixth edition, the evaluator identifies the impairment class for the

CDX, which is then adjusted by grade modifiers based on GMFH, GMPE, and GMCS.13 The net 

adjustment formula is (GMFH - CDX) + (GMPE - CDX) + (GMCS - CDX).14

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 nature and percentage 

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

rationale for the percentage of impairment specified.15

ANALYSIS

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

OWCP accepted appellant’s claim for bilateral carpal tunnel syndrome. It authorized left 

endoscopic carpal tunnel release performed on December 9, 2015 and right endoscopic carpal 

tunnel release performed on January 27, 2016. Dr. Ala performed the surgeries. Appellant 

claimed a schedule award on December 12, 2016. By decision dated August 11, 2017, OWCP 

granted him a schedule award for one percent permanent impairment of each upper extremity. It 

is appellant’s burden of proof to submit sufficient evidence to establish the extent of permanent 

impairment.16

Appellant submitted an April 26, 2017 report from Dr. Taylor who diagnosed bilateral 

carpal tunnel syndrome. Utilizing the sixth edition of the A.M.A., Guides, Dr. Taylor found that 

appellant had six percent permanent impairment of the whole person due to the accepted 

employment injury. The overall rating included three percent permanent impairment of the right 

upper extremity due to appellant’s entrapment compression neuropathy, which Dr. Taylor 

converted to a two percent whole person impairment rating and six percent permanent impairment 

of the left upper extremity due to the same nerve condition which he converted to a four percent 

 

11 See Dale B. Larson, 41 ECAB 481, 490 (1990); supra note 8 at Part 3 -- Medical, Schedule Awards, Chapter 

3.700.3.a.3 (January 2010). This portion of OWCP procedures provides that the impairment rating of a given 

scheduled member should include any preexisting permanent impairment of the same member or function.

12 A.M.A., Guides (6th ed. 2009), page 3, section 1.3, The International Classification of Functioning, Disability 

and Health (ICF): A Contemporary Model of Disablement.

13 Id. at 494-531.

14 Id. at 521.

15 See Federal (FECA) Procedure Manual, supra note 8 at Chapter 2.808.6(f) (February 2013).

16 Tania R. Keka, 55 ECAB 354 (2004).
7

whole person impairment rating.17 Dr. Taylor combined the two percent whole person impairment

rating for the right upper extremity and the four percent whole person impairment rating for the 

left upper extremity to calculate a six percent whole person impairment rating.

18

 He concluded

that appellant had sustained six percent whole person impairment as a result of his work-related 

injury. The Board notes however that there is no statutory basis for the payment of a schedule 

award for whole body impairment under FECA.19

In accordance with its procedures, OWCP properly referred the evidence of record to its 

OWCP medical adviser, Dr. Katz. In his July 31, 2017 report, Dr. Katz reviewed the medical 

evidence of record, including Dr. Taylor’s April 26, 2017 findings, and determined that appellant 

had one percent permanent impairment of each upper extremity due to bilateral wrist nonspecific 

pain. As noted, however, appellant’s claim was accepted for bilateral carpal tunnel syndrome. In 

addition, the Board notes that the SOAF provided to Dr. Katz did not include the accepted 

condition, as it was prepared prior to the acceptance of any medical conditions in this claim and 

was not updated. Thus, Dr. Katz did not provide an impairment rating based on the accepted 

bilateral carpal tunnel syndrome condition.

OWCP procedures indicate that accepted conditions must be included in a SOAF and 

further provides that, when an OWCP medical adviser renders a medical opinion based on a SOAF

which is incomplete or inaccurate or does not use the SOAF as the framework in forming his or 

her opinion, the probative value of the opinion is diminished.20 In this case, Dr. Katz did not have 

a complete SOAF for review. Since he rendered his medical opinion based on an incomplete 

factual statement omitting appellant’s accepted condition of bilateral carpal tunnel syndrome, the 

probative value of his report is diminished. The Board finds, therefore, that the case must be 

remanded to OWCP for further development.

21

 

On remand OWCP should prepare an updated SOAF which includes all accepted 

conditions. The case shall then be forwarded to Dr. Katz for a supplemental opinion addressing 

whether appellant has permanent impairment in accordance with the sixth edition of the A.M.A., 

Guides. Following this and such further development deemed necessary, OWCP shall issue a 

de novo decision on appellant’s schedule award claim. 

CONCLUSION

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

 

17 A.M.A., Guides 449, 420, Tables 15-23, 15-11, respectively.

18 Id. at 604, Combined Values Chart.

19 5 U.S.C. § 8107(c); 20 C.F.R. § 10.404(a) and (b); K.S., Docket No. 15-1082 (issued April 18, 2017); Jay K. 

Tomokiyo, 51 ECAB 361, 367 (2000).

20 Federal (FECA) Procedure Manual, Part 3 -- Medical, Requirements for Medical Reports, Chapter 3.600.3 

(October 1990).

21 A.R., Docket No. 10-0515 (issued November 16, 2010).
8

ORDER

IT IS HEREBY ORDERED THAT the August 11, 2017 decision of the Office of 

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

consistent with this decision of the Board.

Issued: July 26, 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