United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

L.J., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Oregon, OH, Employer

__________________________________________

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Docket No. 19-0046

Issued: April 17, 2019

Appearances: Case Submitted on the Record

Alan J. Shapiro, 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 October 8, 2018 appellant, through counsel, filed a timely appeal from an August 8, 

2018 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 her burden of proof to establish greater than one 

percent permanent impairment of her right upper extremity, for which she previously received 

schedule award compensation.

FACTUAL HISTORY

On September 26, 2012 appellant, then a 56-year-old modified window clerk, filed a 

traumatic injury claim (Form CA-1) alleging that, on August 2, 2012, she sustained an 

exacerbation of right epicondylitis while in the performance of duty. OWCP accepted the claim, 

assigned OWCP File No. xxxxxx235, for an aggravation of right lateral epicondylitis.3 Appellant 

stopped work on August 9, 2012 and did not return. OWCP paid her wage-loss compensation on 

the supplemental rolls beginning September 24, 2012, and on the periodic rolls beginning 

March 10, 2013. Appellant retired from the employing establishment and elected to receive OPM 

retirement benefits in lieu of workers’ compensation benefits, effective August 24, 2014.4

On November 24, 2015 appellant filed a claim for a schedule award (Form CA-7). 

In a development letter dated November 30, 2015, OWCP requested that appellant submit 

an impairment evaluation from her attending physician in accordance with the sixth edition of the 

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

Guides)

5

addressing the extent of her permanent impairment. It afforded her 30 days to submit the 

necessary evidence. No response was received.

By decision dated January 20, 2016, OWCP denied appellant’s claim for a schedule award. 

It found that she had not submitted evidence demonstrating permanent impairment of a scheduled 

member or function of the body.

On January 25, 2016 appellant, through counsel, requested a telephonic hearing before an 

OWCP hearing representative.

In a report dated June 21, 2016, based on an April 15, 2016 evaluation, Dr. Catherine 

Watkins Campbell, Board-certified in occupational and family medicine, discussed appellant’s 

history of employment-related bilateral lateral epicondylitis. On examination, she found a 

QuickDASH score of 58. Dr. Watkins Campbell measured range of motion (ROM) of the right 

 

3 Appellant had a prior claim for a December 9, 2002 employment injury. That claim, assigned OWCP File No. 

xxxxxx111, was accepted for right lateral epicondylitis. Appellant also had an August 14, 2003 occupational disease 

claim. That claim, assigned OWCP File No. xxxxxx230, was accepted for left lateral epicondylitis. OWCP has 

administratively combined OWCP File Nos. xxxxxx111, xxxxxx230, and xxxxxx235, with OWCP File No. 

xxxxxx111 serving as the master file. which had previously been accepted for right lateral epicondylitis due to a 

December 9, 2002 employment injury)

4 By decision dated November 20, 2014, OWCP reduced appellant’s wage-loss compensation, effective 

November 20, 2014, based on its finding that she had the capacity to earn wages as a receptionist. By decision dated

July 10, 2015, an OWCP hearing representative affirmed the November 18, 2014 decision.

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

upper extremity as negative 8, negative 9, and negative 10 degrees extension; 145, 150, and 150 

degrees of flexion; 78, 72, and 72 degrees of supination; and 98, 96, and 94 degrees of pronation. 

She found grade 4/5 strength in the right upper extremity, grip strength of 28 pounds on the right 

and 54 pounds on the left, a bilateral intention tremor, and variable tenderness of the right 

epicondyle. Dr. Watkins Campbell identified the diagnosis as lateral epicondylitis using the elbow 

regional grid set forth in Table 15-4 on page 399 of the A.M.A., Guides, which yielded a default 

impairment of one percent. She applied a grade modifier of two for functional history (GMFH) 

based on appellant’s QuickDASH score, a grade modifier of one for physical examination (GMPE)

findings of tenderness with palpation without observed abnormalities, and found that a grade 

modifier for clinical studies (GMCS) was not applicable. Dr. Watkins Campbell used the net 

adjustment formula, (GMFH-CDX) + (GMPE-CDX), or (2-1) + (1-1) = 1, to find a net adjustment 

of one and a right upper extremity impairment of two percent.

By decision dated July 28, 2016, OWCP’s hearing representative found that the case was 

not in posture for a hearing. He set aside the January 20, 2016 decision and remanded the case for 

OWCP to consider the impairment evaluation from Dr. Watkins Campbell.

On August 31, 2016 Dr. Jovito Estaris, Board-certified in occupational medicine serving 

as an OWCP district medical adviser (DMA), reviewed the impairment evaluation from

Dr. Watkins Campbell. Referencing Table 15-4, the elbow regional grid, he identified the 

diagnosis as class 1 lateral epicondylitis, which yielded a default value of one percent. Dr. Estaris 

applied GMFH of two and GMPE of one. He opined that a GMCS was not applicable. Dr. Estaris

found that the net adjustment formula (GMFH-CDX) + (GMPE-CDX) + (GMCS-CDX), or (2-1) 

+ (1-1) + (0-1) = 0, yielded a net adjustment of zero. He opined that appellant had one percent 

permanent impairment of the right upper extremity. 

By decision dated November 21, 2016, OWCP granted appellant a schedule award for one 

percent permanent impairment of the right upper extremity. The period of the award ran for 3.12 

weeks from April 15 to May 6, 2016.

Appellant, through counsel, subsequently requested a telephonic hearing before an OWCP 

hearing representative. 

During the telephonic hearing, held on June 14, 2017, counsel maintained that Dr. Watkins 

Campbell had properly calculated the permanent impairment rating. 

By decision dated August 28, 2017, OWCP’s hearing representative vacated the 

November 21, 2016 decision. She found that both Dr. Watkins Campbell and Dr. Estaris used the 

diagnosis-based impairment (DBI) method without explaining whether the ROM method for 

evaluating permanent impairment of the upper extremity would have yielded a higher impairment 

rating. The hearing representative remanded the case for the DMA to determine the extent of 

appellant’s permanent impairment based on ROM measurements of the right upper extremity in 

accordance with FECA Bulletin No. 17-06.6

 

6 FECA Bulletin No. 17-06 (May 8, 2017).
4

On December 5, 2017 Dr. Estaris applied the provisions of the A.M.A., Guides to the right 

elbow ROM measurements found by Dr. Watkins Campbell. He found that 150 degrees flexion, 

8 degree extension, 80 degrees supination, and 100 degrees of pronation yielded no impairment 

according to Table 15-33 on page 474 of the A.M.A., Guides. Dr. Estaris again found one percent 

right upper extremity permanent impairment using the DBI method.

By decision dated December 6, 2017, OWCP found that appellant had no more than the 

previously awarded one percent permanent impairment of the right upper extremity. 

Appellant, through counsel, again requested a telephonic hearing before an OWCP hearing 

representative. 

During the telephonic hearing, held on May 31, 2018, counsel questioned why the DMA 

had failed to find Dr. Watkins Campbell’s report sufficient to establish two percent permanent

impairment of the right upper extremity. 

By decision dated August 8, 2018, OWCP’s hearing representative affirmed the 

December 6, 2017 decision. 

LEGAL PRECEDENT

The schedule award provisions of FECA,7and its implementing federal regulations,

8

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.9 As of May 1, 2009, the 

sixth edition of the A.M.A., Guides is used to calculate schedule awards.10

In determining impairment for the upper extremities under the sixth edition of the A.M.A., 

Guides, an evaluator must establish the appropriate diagnosis for each part of the upper extremity 

to be rated. With respect to the elbow, reference is made to Table 15-4 (Elbow Regional Grid) 

beginning on page 398. After the class of diagnosis (CDX) is determined from the Elbow Regional 

Grid (including identification of a default grade value), the impairment class is then adjusted by 

grade modifiers including GMFH, GMPE, and GMCS.11 The net adjustment formula is (GMFHCDX) + (GMPE-CDX) + (GMCS-CDX). 

 

7 5 U.S.C. § 8107.

8 20 C.F.R. § 10.404.

9

Id. at § 10.404(a).

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

2.808.5(a) (March 2017); Federal (FECA) Procedure Manual, Part 3 -- Medical, Schedule Awards, Chapter 3.700.2 

and Exhibit 1 (January 2010). 

11 A.M.A., Guides 494-531.
5

FECA Bulletin No. 17-06 provides guidance in applying ROM or DBI methodologies in 

rating permanent impairment of the upper extremities.12 Regarding the application of ROM or 

DBI impairment methodologies in rating permanent impairment of the upper extremities, FECA 

Bulletin No. 17-06 provides in pertinent part:

“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).

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

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 the original.)

13

ANALYSIS

The Board finds that appellant has met her burden of proof to establish two percent 

permanent impairment of the right upper extremity. 

In support of her claim for a schedule award appellant submitted a June 21, 2016 

impairment evaluation from Dr. Watkins Campbell. In the report Dr. Watkins Campbell measured 

ROM of the right upper extremity as negative 8, negative 9, and negative 10 degrees extension;

145, 150, and 150 degrees of flexion; 78, 72, and 72 degrees of supination; and 98, 96, and 94 

degrees of pronation. She found strength of 4/5 on the right, grip strength of 28 pounds on the 

right, and variably right epicondyle tenderness. Dr. Watkins Campbell, using Table 15-4 on page 

399 of the A.M.A., Guides, identified the CDX of 1 for lateral epicondylitis, which yielded a 

default one percent impairment. She found a GMFH of two due to appellant’s QuickDASH score 

of 58, a GMPE of one for physical findings of tenderness to palpation, and determined that a 

GMCS was inapplicable. Dr. Watkins Campbell used the net adjustment formula, (GMFH-CDX) 

+ (GMPE-CDX) or (2-1) + (1-1) = 1, to find a net adjustment of one and a total of two percent 

right upper extremity impairment.

Dr. Estaris, a DMA, properly found that an alternative impairment rating for loss of ROM 

could not be used in this case as Dr. Watkins Campbell had measured normal ROM of the right 

elbow.14 He concurred with her finding of a CDX of 1 for epicondylitis, which yielded one percent 

impairment under Table 15-4, the elbow regional grid. Dr. Estaris further concurred with

 

12 Supra note 4.

13 Id.

14 See generally C.M., Docket No. 17-1732 (issued August 3, 2018). 
6

Dr. Watkins Campbell’s finding of a GMFH of two and GMPE of one for examination findings, 

and that a GMCS was inapplicable. When applying the net adjustment formula, however, he did 

not omit the GMCS, as instructed by the A.M.A., Guides. Instead, Dr. Estaris found that applying 

the net adjustment formula (GMFH-CDX) + (GMPE-CDX) + (GMCS-CDX), or (2-1) + (1-1) + 

(0-1) = 0, yielded a net adjustment of zero. He opined that appellant therefore had one percent 

permanent impairment of the right upper extremity. As Dr. Estaris found that clinical studies were 

inapplicable, however, he should not have included clinical studies as part of the net adjustment 

formula.15 Consequently, the formula should be (GMFH-CDX) + (GMPE-CDX), or (2-1) + (1-1) 

= 1, for a net adjustment of 1 and thus 2 percent permanent impairment. 

The Board finds that appellant has met her burden of proof to establish that she sustained 

two percent permanent impairment based on the opinion of Dr. Watkins Campbell, who properly 

applied the provisions of the A.M.A., Guides to her findings on examination. There is no current 

medical evidence of record conforming to the A.M.A., Guides which supports a greater 

impairment.16

Appellant may request a schedule award or an increased schedule award at any time based 

on evidence of a new exposure or medical evidence showing a progression of an employmentrelated condition resulting in permanent impairment or increased impairment.

CONCLUSION

The Board finds that appellant has met her burden of proof to establish two percent 

permanent impairment of her right upper extremity.

 

15 See generally A.M.A., Guides 411, which provides, “If a grade modifier is found to be unreliable or inconsistent, 

it should be disregarded and eliminated from the calculation.” See also A.M.A., Guides 414, Example 15-3; L.W., 

Docket No. 14-0503 (issued June 20, 2014).

16 See S.H., Docket No. 18-1297 (issued January 3, 2019).
7

ORDER

IT IS HEREBY ORDERED THAT the August 8, 2018 decision of the Office of 

Workers’ Compensation Programs is affirmed, as modified.

Issued: April 17, 2019

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