United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

J.T., Appellant

and

DEPARTMENT OF THE ARMY, TOOELE 

ARMY DEPOT, Tooele, UT, Employer

__________________________________________

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Docket No. 18-0176

Issued: August 21, 2019

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

ALEC J. KOROMILAS, Alternate Judge

JURISDICTION

On October 30, 2017 appellant filed a timely appeal from a June 22, 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 case.

ISSUE

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

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

award compensation.

FACTUAL HISTORY

On November 7, 2013 appellant, then a 41-year-old blocker bracer, filed an occupational 

disease claim (Form CA-2) alleging that he experienced aching and numbness in both hands and 

 

1 5 U.S.C. § 8101 et seq.
2

wrists as a result of his repetitive federal-employment duties. He noted that he first became aware 

of his condition on October 28, 2013 and realized its relation to his federal employment on 

November 6, 2013. Appellant did not stop work, but began modified duty on November 7, 2013.

OWCP accepted appellant’s claim for bilateral carpal tunnel syndrome, bilateral lesion of 

the ulnar nerve, and bilateral radial styloid tenosynovitis. Appellant continued to receive medical 

treatment. 

On June 5, 2014 appellant underwent authorized right carpal tunnel surgery performed by

Dr. Jennifer Nicole Jarrell, an orthopedic surgeon. He subsequently underwent authorized right 

cubital tunnel release surgery on July 31, 2014 by Dr. Angela A. Wang, a Board-certified 

orthopedic surgeon. Appellant stopped work and OWCP paid him wage-loss compensation for 

total disability until he returned to full-time modified-duty work on August 18, 2014.

Appellant subsequently underwent an authorized left cubital tunnel release surgery on 

September 25, 2014 and an authorized left carpal tunnel release on May 7, 2015 by Dr. Wang. He 

stopped work and returned to full duty on July 7, 2015.

OWCP received a June 20, 2016 impairment rating report by Dr. Michael M. Hess,

2

an 

orthopedic surgeon. Dr. Hess reviewed appellant’s history and noted that he underwent bilateral 

ulnar nerve release and bilateral carpal tunnel release surgeries. Upon physical examination of 

appellant’s right elbow, he observed positive Tinel’s sign over the right elbow and negative Tinel’s 

sign over the right wrist. Dr. Hess reported that sensory testing on the right demonstrated two 

point discrimination in the median and ulnar nerve distribution. Examination of appellant’s left 

elbow and wrist showed negative Tinel’s sign. Dr. Hess referenced Table 15-23 of the sixth edition 

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

(A.M.A., Guides)

3

and opined that appellant sustained five percent permanent impairment of the 

upper extremity for ulnar nerve impairment. He explained that according to page 450 of the 

A.M.A., Guides, involving multiple nerve entrapments, appellant’s ulnar nerve had the highest 

impairment value for all diagnosed conditions. Dr. Hess combined the 5 percent impairment with 

50 percent of appellant’s carpal tunnel impairment (3 percent permanent impairment), which 

resulted in 1.5 percent permanent impairment, for a combined 6.5 percent permanent impairment 

of each upper extremity.

On October 24, 2016 appellant filed a claim for a schedule award (Form CA-7). 

In a letter dated November 8, 2016, OWCP informed appellant that it had received an 

impairment rating report from his physician and would forward the report to an OWCP district 

medical adviser (DMA) for review. Appellant was afforded 30 days to submit additional 

documentation that he wanted reviewed in consideration of his schedule award claim.

 

2 The record reveals that Dr. Hess had previously examined appellant on December 8, 2014. In a report of the same 

date, Dr. Hess provided a history of appellant’s injury and physical examination findings. He related that it was too 

early to determine a date of maximum medical improvement (MMI) for appellant’s cubital tunnel symptoms because 

his surgery had occurred less than six months prior.

3 A.M.A., Guides (6th

ed. 2009).
3

On April 28, 2017 OWCP routed Dr. Hess’ June 20, 2016 report, a statement of accepted 

facts (SOAF), and the case file to Dr. Arthur S. Harris, a Board-certified orthopedic surgeon 

serving as a DMA, for review and determination regarding whether appellant sustained permanent

impairment of his bilateral upper extremities and the proper date of MMI. 

In an April 29, 2017 report, the DMA noted appellant’s accepted conditions and reviewed 

his history, noting appellant’s previous surgeries. He reviewed Dr. Hess’ June 20, 2016 report and 

noted that his physical examination findings revealed diminished sensation in the bilateral ulnar 

and median nerve distribution. The DMA agreed with Dr. Hess’ finding that appellant sustained 

6.5 percent permanent impairment of each upper extremity and provided a date of MMI of June 20, 

2016, the date of Dr. Hess’ examination.

Regarding appellant’s right upper extremity, the DMA referenced Table 15-23, page 449,

and indicated that appellant sustained five percent permanent impairment (grade modifier 2B) for 

residual problems with moderate cubital tunnel symptoms status post cubital tunnel surgery. He

opined that appellant sustained three percent permanent impairment (grade modifier 1D) for 

residual problems with mild carpal tunnel symptoms status post carpal tunnel release. The DMA

explained that in patients with multiple compression neuropathies, the second or smaller nerve 

impairment was rated at 50 percent of the impairment listed in Table 15-23, page 449. He assigned 

1.5 percent permanent impairment for appellant’s right carpal tunnel symptoms, which he rounded 

up to 2 percent permanent impairment. Utilizing the Combined Values Chart, the DMA calculated 

that appellant had a combined of seven percent permanent impairment of the right upper extremity. 

Regarding appellant’s left upper extremity, the DMA assigned the same impairment rating 

of five percent (grade modifier 2B) for residual problems with moderate cubital tunnel symptoms 

and three percent impairment (grade modifier 1D) for residual problems with mild carpal tunnel 

symptoms status post carpal tunnel release. He calculated that 50 percent of the smaller nerve 

impairment (3 percent) resulted in 1.5 percent permanent impairment, which he rounded up to 2 

percent, finding 7 percent permanent impairment of the left upper extremity. 

The DMA concluded that appellant had seven percent permanent impairment of each upper 

extremity. 

On June 22, 2017 OWCP granted appellant a schedule award of seven percent permanent 

impairment for each upper extremity. The period of the award ran for 43.68 weeks from June 20, 

2016 to April 21, 2017. OWCP found that the schedule award was based on Dr. Hess’ June 20, 

2016 report and the DMA’s April 29, 2017 report.

LEGAL PRECEDENT

The schedule award provisions of FECA4and its implementing regulations 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. FECA, however, does not 

specify the manner in which the percentage of 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 

 

4 Supra note 1.
4

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.5 For schedule awards after May 1, 2009, the impairment is evaluated 

under the sixth edition of the A.M.A., Guides, published in 2009.6

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

diagnosis condition (CDX), which is then adjusted by grade modifiers based on functional history 

(GMFH), physical examination (GMPE), and clinical studies (GMCS). The net adjustment 

formula is (GMFH - CDX) + (GMPE - CDX) + (GMCS - CDX).8 Evaluators are directed to 

provide reasons for their impairment rating choices, including the choices of diagnosis from 

regional grids and calculations of modifier scores.9

However, permanent impairment due to carpal tunnel and cubital tunnel syndrome is 

evaluated under the scheme found in Table 15-23 (Entrapment/Compression Neuropathy 

Impairment) and accompanying relevant text in section 15.4f of the A.M.A., Guides.

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 modifier levels are averaged to arrive at the 

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

value may be modified up or down based on functional scale, an assessment of impact on daily 

living activities.11 

OWCP’s procedures provide that, if a claimant’s physician provides an impairment rating, 

the case should be routed to a DMA for an opinion concerning the nature and percentage of 

impairment in accordance with the A.M.A., Guides with OWCP’s medical adviser providing 

rationale for the percentage of impairment specified.

12

 

5 20 C.F.R. § 10.404 (1999); see also Jacqueline S. Harris, 54 ECAB 139 (2002). 

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

2.806.6.6a (January 2010); Federal (FECA) Procedure Manual, Part 3 -- Medical, Schedule Awards, Chapter 3.700.2 

and Exhibit 1 (January 2010).

7 A.M.A., Guides 3, section 1.3 (6th ed. 2009).

8

Id. at 385-419.

9 See R.V., Docket No. 10-1827 (issued April 1, 2011).

10 Supra note 7 at 449.

11 Id. at 448-49.

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

Chapter 2.808.6(e) (February 2013); Tommy R. Martin, 56 ECAB 273 (2005).
5

ANALYSIS

The Board finds that appellant has not met his burden of proof to establish more than seven 

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

award compensation.

In support of his claim, appellant submitted a June 20, 2016 impairment rating report by

Dr. Hess in which he found a combined 6.5 percent permanent impairment of each upper 

extremity. Thereafter, OWCP properly routed the report of Dr. Hess to a DMA. In an April 29, 

2017 report, Dr. Harris, the DMA, reviewed Dr. Hess’ June 20, 2016 impairment report and agreed 

with his finding that appellant had 7 percent permanent impairment of both upper extremities. He 

noted a date of MMI of June 20, 2016, when appellant was examined by Dr. Hess. In calculating 

permanent impairment, the DMA utilized Table 15-23, page 449, of the A.M.A., Guides and 

indicated that appellant had five percent permanent impairment (grade modifier of 2B) for residual 

problems with moderate cubital tunnel symptoms status post cubital tunnel surgery. He assigned 

three percent permanent impairment (grade modifier of 1D) for residual problems with mild carpal 

tunnel symptoms status post carpal tunnel release. The DMA calculated that according to page 

450 of the A.M.A., Guides for multiple compression neuropathies, appellant had 1.5 percent 

impairment (50 percent of 3 percent impairment) for his carpal tunnel symptoms. Utilizing the 

Combined Values Chart, he calculated that appellant had a total of 6.5 percent, which he rounded 

to 7 percent permanent impairment of the right upper extremity. 

Regarding appellant’s left upper extremity, the DMA assigned the same impairment rating 

of five percent (grade modifier of 2B) for residual problems with moderate cubital tunnel 

symptoms and three percent impairment (grade modifier of 1D) for residual problems with mild 

carpal tunnel symptoms status post carpal tunnel release. He calculated that 50 percent of the 

smaller nerve impairment (3 percent) resulted in 1.5 percent permanent impairment, which he 

rounded to 2 percent. The DMA indicated that appellant had seven percent permanent impairment 

of the left upper extremity. 

OWCP granted appellant’s schedule award based on the opinions of his treating physician

Dr. Hess and the DMA. There is no current medical evidence of record, in conformance with the 

sixth edition of the A.M.A., Guides, showing a greater percentage of permanent impairment. As 

appellant bears the burden of proof to establishment entitlement to an additional schedule award, 

he was required to submit rationalized medical evidence on which an additional award could be 

based. He has not done so for his claim. Therefore, the Board finds that appellant has not met his 

burden of proof to establish more than seven percent permanent impairment of each upper 

extremity.

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 employment-related 

condition resulting in permanent impairment or increased impairment.
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CONCLUSION

The Board finds that appellant has not met his burden of proof to establish more than seven 

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

award compensation.

ORDER

IT IS HEREBY ORDERED THAT the June 22, 2017 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: August 21, 2019

Washington, DC

Christopher J. Godfrey, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Alec J. Koromilas, Alternate Judge

Employees’ Compensation Appeals Board