United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

J.S., Appellant 

and

U.S. POSTAL SERVICE, POST OFFICE, 

Bellingham, MA, Employer

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Docket No. 18-1635

Issued: May 15, 2019

Appearances: Case Submitted on the Record

William Bothwell, for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

CHRISTOPHER J. GODFREY, Chief Judge

ALEC J. KOROMILAS, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On August 28, 2018 appellant, through his representative, filed a timely appeal from an

August 17, 2018 merit decision of the Office of Workers’ Compensation Programs (OWCP). 

 

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

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.3

ISSUE

The issue is whether appellant has met his burden of proof to establish more than 10 percent 

permanent impairment of his left hand, for which he previously received a schedule award. 

FACTUAL HISTORY

On March 12, 2012 appellant, then a 43-year-old letter carrier, filed an occupational 

disease claim (Form CA-2) alleging that he developed left thumb pain as a result of 30 years of 

repetitive casing and sorting mail as a part of his employment duties. By decision dated March 22, 

2012, OWCP accepted the claim for left thumb osteoarthritis. 

Appellant sought treatment with Dr. Philip Blazar, a Board-certified orthopedic surgeon. 

On June 11, 2012 Dr. Blazar performed an authorized left thumb carpometacarpal arthroplasty 

with interposition.

In a July 26, 2017 report, Dr. Frank A. Graf, a Board-certified orthopedic surgeon, 

evaluated appellant and provided findings pertaining to his left thumb. With respect to the left 

thumb, he diagnosed left thumb basilar degenerative osteoarthritis with diminished pinch and grasp 

status post arthroplasty and soft tissue procedure basilar joint of the left thumb. Dr. Graf opined 

that appellant’s left thumb carpometacarpal joint had reached maximum medical improvement 

(MMI), Dr. Graf determined that there were permanent changes at the left basilar joint of the 

thumb. Utilizing Table 15-2, Digit Regional Grid, of the sixth edition of the American Medical 

Association, Guides to the Evaluation of Permanent Impairment (A.M.A., Guides),4 he determined 

that carpometacarpal joint instability warranted the default value of 15 percent permanent 

impairment of the left thumb.

5

On September 12, 2017 appellant filed a claim for a schedule award (Form CA-7).

On September 27, 2017 OWCP routed Dr. Graf’s report and the case file to Dr. Herbert 

White Jr., an OWCP district medical adviser (DMA) Board-certified in occupational medicine, for 

review and a determination as to whether appellant sustained permanent impairment of his left 

thumb and the date of MMI.

 

2 5 U.S.C. § 8101 et seq.

3 The Board notes that following the August 17, 2018 decision, OWCP received additional evidence. However, the 

Board’s Rules of Procedure provides: “The Board’s review of a case is limited to the evidence in the case record that 

was before OWCP at the time of its final decision. Evidence not before OWCP will not be considered by the Board 

for the first time on appeal.” 20 C.F.R. § 501.2(c)(1). Thus, the Board is precluded from reviewing this additional 

evidence for the first time on appeal. Id.

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

5

Id. at 393, Table 15-2.
3

In an October 1, 2017 report, the DMA discussed findings in the medical records pertaining 

to appellant’s left thumb and noted that x-rays dated February 14, 2013 revealed postsurgical 

changes of the left thumb carpometacarpal joint. Utilizing Table 15-2, Digit Regional Grid, of the 

A.M.A., Guides, he provided a diagnosis-based impairment (DBI) rating based upon a thumb

carpometacarpal arthroplasty.

6

 The DMA utilized the net adjustment formula to calculate 26 

percent permanent impairment of the left thumb.7 He reported that because the joint involved the 

hand, the digit impairment would be converted to a hand impairment. In accordance with Table 

15-12, the DMA converted the 26 percent digit impairment to 10 percent permanent impairment 

of the left hand.8 He further reported that he was unable to render a rating based on the range of 

motion (ROM) method because no thumb ROM findings were provided in the medical records. 

The DMA explained that Dr. Graf obtained a left digit impairment of 15 percent using the 

DBI method with the diagnosis of thumb carpometacarpal instability while he calculated 26 

percent impairment using the diagnosis of carpometacarpal arthroplasty. He reported that the 

A.M.A., Guides provide that if there is more than one method to rate a particular impairment, the 

method producing the higher rating should be used. In this instance, the carpometacarpal

arthroplasty diagnosis produced the higher rating. He concluded that appellant sustained 10 

percent permanent impairment of the left hand and that MMI was reached on July 26, 2017, the 

date of Dr. Graf’s examination.

On February 6, 2018 OWCP routed the DMA’s October 1, 2017 report to Dr. Graf for 

comment pertaining to his left thumb impairment rating. By letter dated April 24, 2018, Dr. Graf 

noted review of the DMA’s report and indicated that he had no problems with his calculations.

On June 21, 2018 OWCP routed the case file and referred appellant to Dr. Christopher 

Geary, a Board-certified orthopedic surgeon, for a second opinion evaluation and impairment 

evaluation of the left thumb using both ROM and DBI methods for evaluating permanent 

impairment.

In his July 11, 2018 report, Dr. Geary provided three measurements pertaining to thumb

ROM. He measured interphalangeal flexion at 60 degrees for one percent impairment, extension 

at 20 degrees for zero percent impairment, metacarpophalangeal joint flexion at 40 degrees for two 

percent impairment, metacarpophalangeal joint extension at 10 degrees for zero percent

impairment, carpometacarpal joint adduction at three centimeters for four percent impairment, 

carpometacarpal joint abduction at 40 degrees for two percent impairment, and 

metacarpophalangeal opposition at four centimeters for nine percent impairment. This combined 

to equal 18 percent permanent impairment based on the ROM method.

Dr. Geary reported that utilizing the DBI method, he would rate the diagnosis of left thumb

carpometacarpal arthritis with subsequent arthroplasty.

9

 Application of the net adjustment formula 

 

6

Id. at 394, Table 15-2.

7

Id. at 411.

8

Id. at 421, Table 15-12.

9 Supra note 5.
4

resulted in 26 percent digit impairment. Dr. Geary explained that the DBI method should be used 

since it provided a higher rating than the ROM method. He converted the 26 percent left thumb 

impairment to 10 percent permanent impairment of the left hand. Dr. Geary concluded that 

appellant had reached MMI on the date of Dr. Graf’s examination, July 26, 2017.

By decision dated August 17, 2017, OWCP granted appellant a schedule award for 10 

percent permanent impairment of the left hand. The date of MMI was July 26, 2017. The award 

covered a period of 24.4 weeks from July 26, 2017 to January 12, 2018. 

LEGAL PRECEDENT

The schedule award provision of FECA and 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.10 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 to all claimants, good administrative practice necessitates the 

use of a single set of tables so that there may be uniform standards applicable to all claimants. 

Through its implementing regulations, OWCP adopted the American Medical Association, Guides 

to the Evaluation of Permanent Impairment as the appropriate standard for evaluating schedule 

losses.11 As of May 1, 2009, schedule awards are determined in accordance with the sixth edition 

of the A.M.A., Guides (2009).12 

In addressing upper extremity impairments, the sixth edition requires identification of 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).13 The 

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

The A.M.A., Guides also provide that ROM impairment methodology is to be used as a 

stand-alone rating for upper extremity impairments when other grids direct its use or when no other 

DBI sections are applicable.15 If ROM is used as a stand-alone approach, the total of motion 

impairment for all units of function must be calculated. All values for the joint are measured and 

added.16 Adjustments for functional history may be made if the evaluator determines that the 

 

10 5 U.S.C. § 8107; 20 C.F.R. § 10.404.

11 20 C.F.R. § 10.404; L.T., Docket No. 18-1031 (issued March 5, 2019); see also Ronald R. Kraynak, 53 ECAB 

130 (2001).

12 See Federal (FECA) Procedure Manual, Part 3 -- Medical, Schedule Awards, Chapter 3.700, Exhibit 1 

(January 2010); Federal Procedure Manual, Part 2 -- Claims, Schedule Awards and Permanent Disability Claims, 

Chapter 2.808.5 (March 2017). 

13 A.M.A., Guides 383-492.

14 Id. at 411.

15 Id. at 461.

16 Id. at 473.
5

resulting impairment does not adequately reflect functional loss and functional reports are 

determined to be reliable.17

OWCP issued FECA Bulletin No. 17-06 to explain the use of the DBI methodology versus

the ROM methodology for rating of upper extremity impairments.18 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:

“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.)19

The Bulletin further advises:

“If the rating physician provided an assessment using the ROM method and the 

[A.M.A.,] Guides allow for use of ROM for the diagnosis in question, the DMA 

should independently calculate impairment using both the ROM and DBI methods

and identify the higher rating for the CE.”

20

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 OWCP’s medical adviser providing 

rationale for the percentage of impairment specified.21

ANALYSIS

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

Following Dr. Graf’s July 26, 2017 impairment rating, OWCP routed the case file to

Dr. White, serving as a DMA, for an opinion regarding appellant’s permanent impairment of the 

left thumb. In his October 1, 2017 report, the DMA related that appellant’s impairment should be 

 

17 Id. at 474.

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

19 A.M.A., Guides 477.

20 FECA Bulletin No. 17-06 (May 8, 2017); V.L., Docket No. 18-0760 (issued November 13, 2018); A.G., Docket 

No. 18-0329 (issued July 26, 2018).

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

Chapter 2.808.6(f) (March 2017).
6

rated for the diagnosis for carpometacarpal arthroplasty.

22

 He thereafter explained his rating and 

concluded that appellant had 26 percent permanent impairment of the left thumb, which converted 

to 10 percent impairment of the left hand.23 The DMA properly noted, however, that ROM 

findings were not provided to ascertain a ROM rating. 

OWCP referred appellant to Dr. Geary for a second opinion evaluation and impairment 

rating utilizing both DBI and ROM methods for rating permanent impairment. In his July 11, 2018 

report, Dr. Geary properly provided three range of motion measurements in accordance with the 

A.M.A., Guides and found that the ROM method would result in 18 percent permanent impairment 

of the left digit. He also utilized the DBI rating method and found that appellant sustained 26 

percent impairment to the left digit based on the DBI method. Dr. Geary’s report was sufficient 

to warrant referral to an OWCP DMA to determine the extent of permanent impairment of

appellant’s left thumb. After obtaining the permanent impairment rating from second opinion 

physician, Dr. Geary, based on both ROM and DBI assessments, OWCP should have referred the 

case record back to a DMA for his review and findings relative to impairment.24 OWCP 

procedures provide that the DMA should verify the calculations of the rating physician and 

determine the percentage of impairment according to the sixth edition of the A.M.A., Guides.

25

Consequently, the Board finds that further development of the medical evidence is required 

to determine the extent of appellant’s permanent impairment for schedule award purposes. The 

case will be remanded for Dr. Geary’s report to be routed to the DMA for further development in 

accordance with OWCP procedures. After such further development as deemed necessary, it shall 

issue a de novo merit decision. 

CONCLUSION

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

 

22 Supra note 6.

23 A.M.A., Guides 421, Table 15-12.

24 Supra note 21.

25 See supra note 21; see also J.M., Docket No. 16-0224 (issued May 20, 2016).
7

ORDER

IT IS HEREBY ORDERED THAT the August 17, 2018 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: May 15, 2019

Washington, DC

Christopher J. Godfrey, 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