United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

J.B., Appellant

and

DEPARTMENT OF HOMELAND SECURITY, 

CUSTOMS & BORDER PROTECTION, 

Calexico, CA, Employer

__________________________________________

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Docket No. 18-1509

Issued: May 2, 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

ALEC J. KOROMILAS, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On August 1, 2018 appellant filed a timely appeal from an April 20, 2018 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.2

ISSUE

The issue is whether appellant has met his burden of proof to establish more than 11 percent 

permanent impairment of his right upper extremity, for which he previously received schedule 

award compensation.

 

1 5 U.S.C. § 8101 et seq.

2 The Board notes that, following the April 20, 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.
2

FACTUAL HISTORY

On February 16, 2015 appellant, then a 54-year-old custom and border patrol officer, filed 

a traumatic injury claim (Form CA-1) alleging that he sustained right shoulder and thumb injuries

when he pushed a subject while in the performance of duty. He stopped work that day.3 On 

April 3, 2015 OWCP accepted the claim for closed fracture of the right metacarpal bone, sprain of 

the right shoulder, rotator cuff and upper arm, and other affections of the right shoulder.

On October 15, 2015 appellant underwent an OWCP-authorized right shoulder arthroscopy 

with superior labrum anterior and posterior repair and a sub acromial bursectomy, which was 

performed by Dr. Veerinder Anand, a Board-certified orthopedic surgeon.

4

On May 30, 2017 appellant filed a claim for a schedule award (Form CA-7).

In a May 15, 2017 permanent impairment evaluation, Dr. Anand discussed appellant’s 

employment injury and noted examination findings from August 30, 2016. He indicated that 

appellant had reached maximum medical improvement (MMI) on August 30, 2016. Using the 

sixth edition of the American Medical Association, Guides to the Evaluation of Permanent 

Impairment (A.M.A., Guides)

5

and the August 30, 2016 examination findings, Dr. Anand opined 

that appellant had 17 percent total right upper extremity permanent impairment. For the right 

wrist, he found a diagnosis-based impairment (DBI) rating for the de Quervain’s tenosynovitis 

without surgery equaled two percent permanent impairment of the right upper extremity. For the 

right shoulder, Dr. Anand opined that appellant’s right shoulder impingement syndrome, status 

post arthroscopic surgery resulted in five percent permanent impairment. He opined, however, 

that a DBI rating for the shoulder did not adequately reflect appellant’s functional limitations. 

Under the range of motion (ROM) method, Dr. Anand opined that appellant had 15 percent 

permanent impairment of the right shoulder. He cited to tables within the A.M.A., Guides and 

provided his impairment calculations.

In a June 13, 2017 letter, OWCP requested that Dr. Anand provide a detailed narrative 

medical report based on a recent examination, which included three independent ROM 

measurements for the right shoulder and wrist.

In a July 25, 2017 impairment evaluation report, Dr. Anand provided updated examination 

findings and three ROM measurements for the right shoulder and right wrist. He opined that 

appellant had reached MMI and had 17 percent total right upper extremity permanent impairment. 

Dr. Anand indicated his opinion had not changed and that appellant could be rated under the DBI 

methodology for the right wrist for the diagnosis of de Quervain’s tenosynovitis. He further noted 

that while he offered a right shoulder rating based on DBI methodology, it remained his opinion 

that the ROM methodology more accurately reflected appellant’s status. 

 

3 Under OWCP File No. xxxxxx960, appellant sustained a May 5, 2012 right shoulder injury while in the 

performance of duty. The case was never formally adjudicated. 

4 Appellant retired from the employing establishment on February 29, 2016.

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

Using the DBI methodology for the right wrist, Dr. Anand found, under Table 15-3 of the 

A.M.A., Guides, the wrist regional grid, that appellant’s right de Quervain’s tenosynovitis without 

surgery was class 1. He applied grade modifiers of 2 for functional history and physical 

examination and grade modifier of 1 for clinical studies, which yielded a net adjustment of 2 from 

the default value of 1, which resulted in class 1, grade E or two percent upper extremity 

impairment. Under the DBI methodology for the right shoulder, Dr. Anand diagnosed class one 

right shoulder impingement syndrome, a status post arthroscopic surgery, under Table 15-5 of the 

A.M.A., Guides, and the shoulder regional grid, which yielded a default impairment of three

percent. He applied grade modifiers of 2 for functional history, physical examination, and clinical 

studies, which yielded a net adjustment of 2 for a five percent permanent impairment. 

Under the ROM methodology, Dr. Anand noted that appellant’s ROM for the right 

shoulder was moderately decreased when compared to the opposite side. He explained that section 

15.7 of the A.M.A., Guides allowed impairment for wrist, elbow, and shoulder joints of 12 to 23 

percent upper extremity impairment when there was a moderate decrease of ROM from normal.

Dr. Anand indicated that appellant’s ROM was moderately decreased when compared to the 

opposite and again found 15 percent upper extremity permanent impairment. He combined the 

two impairments (2 percent for wrist and 15 percent for shoulder) and obtained a total right upper 

extremity permanent impairment rating of 17 percent.

In an October 29, 2017 report, Dr. Herbert White, Jr., an OWCP district medical adviser 

(DMA) and Board-certified internist, reviewed the medical evidence. He opined that appellant 

had reached MMI on July 25, 2017. Dr. White also opined that appellant had 5 percent permanent

impairment based on DBI for right labral lesion and 6 percent permanent impairment of the wrist 

based on ROM, for a total 11 percent right upper extremity permanent impairment. Using the DBI 

methodology, for the right shoulder, the DMA identified class 1 labral lesion under Table 15-5, 

page 404, which yielded a default impairment of three percent. Under Table 15-17, Table 15-8, 

and Table 15-9 found grade modifiers of one for functional history, 2 for physical examination, 

and 2 for clinical studies. Applying the net adjustment formula, the DMA calculated a net 

adjustment of 2, which resulted in a grade E or 5 percent permanent impairment rating. Using the 

ROM methodology for the shoulder, he calculated one percent upper extremity permanent

impairment. Under Table 15-34, page 475, the DMA compared the right and left sides and found 

a total impairment of one percent.6 Under Table 15.35, page 477, and Table 16-7, page 406, he 

found grade one modifiers for range of motion and functional history, respectively. The DMA

calculated that there was no functional history net modifier as the grade modifier functional history 

(1) minus grade modifier range of motion (1). Thus, he found a total upper extremity permanent

impairment of one percent for the shoulder. The DMA indicated that Dr. Anand had not compared

the motions with the unaffected left shoulder as indicated on page 451 of the A.M.A., Guides. He 

 

6 Under Table 15-34, page 475 of A.M.A, Guides Dr. White reported that flexion of 90 degrees (3 percent 

impairment) on right minus 170 degrees (3 percent impairment) on left equaled zero impairment. Extension 50 

degrees (0 percent impairment) on right minus 50 degrees (0 percent impairment) on left equaled zero impairment. 

Abduction 90 degrees (3 percent impairment) on right minus 120 degrees (3 percent impairment) equaled zero 

impairment. Adduction 50 degrees (0 percent impairment) on right minus 50 degrees (0 percent impairment) equaled 

1 percent impairment. Internal rotation 80 degrees (0 percent impairment) on right minus 80 degrees (0 percent 

impairment) on left equaled zero impairment. External rotation 80 degrees (0 percent impairment) on right minus 80 

degrees (0 percent impairment) on left equaled zero impairment. 
4

noted, however, that the higher rating was produced under the DBI method and concluded that 

appellant had five percent permanent impairment of the right shoulder. 

For the right wrist, Dr. White concurred with Dr. Anand’s DBI rating of two percent 

impairment for the diagnosis of de Quervains. He noted that Dr. Anand had not rated the right 

wrist with the ROM method. Using the ROM methodology for the right wrist, utilizing Table 15-

32, page 473 of A.M.A., Guides, Dr. White found that flexion 40 degrees equaled three percent 

impairment, extension 40 degrees equaled three percent impairment, radial deviation 25 degrees 

equaled zero percent impairment, and ulnar deviation 20 degrees equaled zero percent impairment. 

Under Table 15-35, he assigned a grade 1 range of motion grade modifier and, under Table 15-7, 

he assigned a grade 2 functional history grade modifier to find a functional history net modifier of 

1. Under Table 15-36, page 477, a modifier adjustment of .3 (total ROM impairment times 5 

percent) was found, which yielded a total permanent impairment of 6.3 percent rounded down to 

6 percent. The DMA used the Combined Values Chart and found that 5 percent DBI impairment 

for labral lesion and 6 percent ROM impairment for wrist resulted in combined value of 11 percent 

total permanent impairment.

In a December 8, 2017 letter to Dr. Anand, OWCP provided a copy of the DMA’s 

October 29, 2017 impairment report and afforded him 30 days to identify specific findings with 

which he disagreed along with the basis of his disagreement.

On January 10, 2018 OWCP received a December 14, 2017 report from Dr. Anand. While

Dr. Anand indicated that he agreed with the 11 percent total right upper extremity permanent 

impairment rating, he disagreed with the 1 percent right upper extremity impairment under the 

ROM method for the right shoulder. He noted his calculations, but agreed that the DBI method 

should be used as it yielded the highest impairment rating for the shoulder at five percent.

By decision dated April 20, 2018, OWCP granted appellant a schedule award for 11 

percent right upper extremity permanent impairment. The period of the award ran for 34.32 weeks 

from July 25, 2017 to March 22, 2018.

LEGAL PRECEDENT

The schedule award provisions of FECA,7and its implementing federal regulations,8set 

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 

 

7 5 U.S.C. § 8107.

8 20 C.F.R. § 10.404.
5

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 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). The 

net adjustment formula is (GMFH - CDX) + (GMPE - CDX) + (GMCS - CDX).11 OWCP 

procedures provide that, after obtaining all necessary medical evidence, the file 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 the DMA providing rationale for the percentage of permanent 

impairment specified.12

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

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

diagnosis-based sections are applicable.13 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.14 Adjustments for functional history may be made if the evaluator 

determines that the resulting impairment does not adequately reflect functional loss and functional 

reports are determined to be reliable.15

Regarding the application of ROM or DBI methodologies in rating permanent impairment 

of the upper extremities, FECA Bulletin No. 17-06 provides: 

“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

 

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); see also Part 3 -- Medical, Schedule Awards, Chapter 3.700.2 and Exhibit 1 (January 2010).

11 A.M.A., Guides 411.

12 See P.R., Docket No. 18-0022 (issued April 9, 2018); Federal (FECA) Procedure Manual, Part 2 -- Claims, 

Schedule Awards and Permanent Disability Claims, Chapter 2.808.6f (March 2017).

13 A.M.A., Guides 461.

14 Id. at 473.

15 Id. at 474.
6

impairment rating for the diagnosis in question, the method producing the higher 

rating should be used.”

16 (Emphasis in the original.) 

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.17

ANALYSIS

The Board finds that appellant has established 13 percent permanent impairment of his 

right upper extremity.

Appellant provided May 15 and July 25, 2017 reports from Dr. Anand, who opined that 

appellant had 17 percent total right upper extremity permanent impairment under the A.M.A., 

Guides based on a DBI methodology for the wrist and ROM methodology for the shoulder. 

However, his May 15, 2017 report is of diminished probative value as Dr. Anand did not provide 

three ROM measurements as required by the A.M.A., Guides.

18

On October 29, 2017 the DMA utilized the findings provided by Dr. Anand in his July 25, 

2017 report and opined that appellant had 11 percent permanent impairment of the right upper 

extremity. He found that appellant had reached MMI on July 25, 2017. With regards to the right 

shoulder, the DMA concurred with Dr. Anand that appellant had five percent permanent 

impairment based on DBI, as the DBI methodology yielded the highest result. 

Under the ROM methodology for the shoulder, Dr. Anand opined that appellant had 15 

percent permanent impairment. The DMA, however, properly noted that Dr. Anand had not 

compared the motions with the unaffected left shoulder as required on page 461 of the A.M.A., 

Guides.

19

 He calculated one percent permanent impairment of the upper extremity. In his 

December 14, 2017 report, Dr. Anand disagreed with the DMA’s calculation and provided his own 

calculations. 

With regard to the right wrist, both Dr. Anand and the DMA opined, under the DBI 

methodology, that appellant had two percent right upper extremity permanent impairment. Under 

Table 15-3, page 395, of the A.M.A., Guides, appellant’s right de Quervain’s tenosynovitis without 

surgery was class 1. Dr. Anand applied grade modifiers of 2 for functional history and physical 

examination and grade modifier of 1 for clinical studies, which yield a net adjustment of 2 from 

the default value of 1, which resulted in class 1, grade E or 2 percent upper extremity permanent 

impairment. While the DMA concurred with Dr. Anand’s DBI rating of two percent impairment 

 

16 FECA Bulletin No. 17-06 (May 8, 2017); A.G., Docket No. 18-0329 (issued July 26, 2018).

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

Chapter 2.808.6(d) (March 2017).

18 A.M.A., Guides 464.

19 See K.P., Docket No. 13-2079 (issued February 18, 2014).
7

for the diagnosis of deQuervains, he noted that Dr. Anand had not rated the right wrist under the 

ROM method. 

Using the ROM methodology for the right wrist, the DMA found six percent permanent 

impairment. The Board finds however that Dr. White improperly calculated under Table 15-32, 

page 473 that 20 degrees ulnar deviation equaled zero percent impairment, as it in fact equals two

percent impairment.20 However, under Table 15-32, page 473, flexion 40 degrees equaled three 

percent impairment; extension 40 degrees equaled three percent impairment; radial deviation 25 

degrees equaled zero percent impairment; and ulnar deviation 20 degrees equaled two percent 

impairment, for a combined value of upper extremity permanent impairment of eight percent. 

Thus this changes the total percentage of six percent to eight percent impairment under Table 15-

32, page 473. The DMA assigned, under Table 15-35, a grade 1 range of motion grade modifier 

and a grade 2 functional history grade modifier, under Table 15-7, which yielded a functional 

history net modifier of 1. Under Table 15-36, page 477, a modifier adjustment of .4 results, (total 

ROM impairment (8) times 5 percent), which yields a total impairment of 8.4 percent, which 

rounds down to 8 percent. The eight percent permanent impairment based on loss of range of 

motion is higher than two percent DBI assigned impairment.

Under the Combined Values Chart on page 604 of the A.M.A., Guides, 5 percent 

permanent impairment for labral lesion and 8 percent permanent impairment for wrist results in a 

combined value of 13 percent permanent impairment. As appellant received a schedule award for 

11 percent permanent impairment of his right upper extremity, the Board finds that he shall be 

compensated for an additional 2 percent permanent impairment of his right upper extremity.21

On appeal appellant contends that, due to his current symptoms, he should be entitled to a

greater impairment than that awarded. As discussed above, there is no probative medical evidence 

of record, in conformance with the sixth edition of the A.M.A., Guides, establishing that appellant 

has more than 13 percent permanent impairment of the right 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.

CONCLUSION

The Board finds that appellant has established 13 percent permanent impairment of his 

right upper extremity.

 

20 See supra note 6. 

21 See J.C., Docket No. 15-0534 (issued May 12, 2016).
8

ORDER

IT IS HEREBY ORDERED THAT the April 20, 2018 decision of the Office of Workers’

Compensation Programs is affirmed as modified.

Issued: May 2, 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