United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

R.W., Appellant

and

U.S. POSTAL SERVICE, PROCSSING &

DISTRIBUTION CENTER, Philadelphia, PA, 

Employer

__________________________________________

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Docket No. 22-1017

Issued: December 30, 2022

Appearances: Case Submitted on the Record

Russell Uliase, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

JANICE B. ASKIN, Judge

JAMES D. McGINLEY, Alternate Judge

JURISDICTION

On June 24, 2022 appellant, through counsel, filed a timely appeal from a January 12, 2022 

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 left upper extremity and two percent permanent impairment 

of her right upper extremity, for which she previously received schedule award compensation.

FACTUAL HISTORY

On November 12, 2015 appellant, then a 58-year-old bulk mail technician, filed an 

occupational disease claim (Form CA-2) alleging that she developed bilateral carpal tunnel 

syndrome due to factors of her federal employment, including repetitive movement and use of her 

hands and wrists casing and bundling mail. She noted that she first became aware of her condition 

on June 30, 2015 and realized its relationship to her federal employment on August 18, 2015. By 

decision dated August 9, 2016, OWCP accepted appellant’s claim for other lesions of the bilateral 

median nerve, bilateral upper extremity strain injury, and bilateral osteoarthritis of the first 

carpometacarpal (CMC) joints.3 

On February 3, 2020 appellant filed a claim for compensation (Form CA-7) for a schedule 

award. 

Appellant submitted a December 2, 2019 impairment evaluation report by Dr. Nicholas 

Diamond, an osteopath specializing in pain medicine, who reviewed her medical records and 

recounted her current complaints of bilateral hand pain and stiffness. Dr. Diamond noted that an 

electromyography (EMG) report of the upper extremities dated September 22, 2015 revealed right 

median nerve impairment at the wrist level and left ulnar nerve impairment at the medial elbow 

level.4 Examination of appellant’s thumbs revealed no tenderness or swelling and full range of 

motion (ROM) testing. Dr. Diamond’s sensory examination revealed decreased sensation, left 

greater than right, in the hands. He diagnosed, in part, bilateral wrist strain and sprain, bilateral 

CMC joint arthrosis, bilateral brachial plexitis, left cubital tunnel syndrome, right carpal tunnel 

syndrome, and bilateral hand flexor tenosynovitis. 

Referencing the sixth edition of the American Medical Association, Guides to the 

Evaluation of Permanent Impairment (A.M.A., Guides),5 Dr. Diamond utilized the diagnosisbased impairment (DBI) rating method for appellant’s entrapment neuropathy of the bilateral 

median nerve at the wrist and found that, under Table 15-23 (Entrapment/Compression 

Neuropathy Impairment), page 449, she had a grade modifier for functional history (GMFH) of 3, 

a grade modifier for physical examination (GMPE) of 3, and a grade modifier for clinical studies 

(GMCS) of 1. He added these grade modifiers, which totaled 7, and then divided this figure by 3, 

which resulted in 2.3 or a grade modifier of 2. Dr. Diamond calculated that appellant had five 

percent permanent impairment of the bilateral upper extremity. He also determined that, under

3 Appellant retired from Federal Government, effective November 1, 2019. 

4 An EMG report dated September 22, 2015 revealed mild right median nerve impairment at the right wrist level, 

significant left ulnar nerve impairment at the left elbow, and bilateral brachial plexus. 

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

Table 15-2 (Digit Regional Grid), page 392, the class of diagnosis (CDX) for bilateral first finger

metacarpophalangeal (MCP) joint degenerative joint disease resulted in a class 1 impairment with 

a default value of six. Dr. Diamond assigned a GMPE of 0. He indicated that grade modifiers of 

GMCS and GMFH were not applicable. After applying the net adjustment formula, (GMPE -

CDX) = (0-1) = -1, Dr. Diamond calculated that appellant had five percent permanent impairment 

of the bilateral digit, which translated to two percent permanent impairment of the upper extremity. 

He calculated that she had a total of seven percent permanent impairment each for the left and right 

upper extremity. Dr. Diamond reported that appellant reached maximum medical improvement 

(MMI) on December 2, 2019. 

On May 2, 2020 Dr. Morley Slutsky, a physician Board-certified in occupational medicine 

serving as a district medical adviser (DMA), reviewed a statement of accepted facts (SOAF) and 

the medical record, including Dr. Diamond’s December 2, 2019 impairment evaluation report. 

Regarding appellant’s left wrist, he utilized the DBI-rating method and indicated that the most 

impairing diagnosis was “nonspecific pain.” Dr. Slutsky reported that, under Table 15-3 (Wrist 

Regional Grid), she had one percent left upper extremity permanent impairment. He disagreed 

with Dr. Diamond’s impairment rating, and asserted that electrodiagnostic testing did not allow 

for use of Table 15-23. Regarding appellant’s right wrist, Dr. Slutsky referenced Table 15-23 

(Entrapment/Compression Neuropathy Impairment) and assigned a GMFH of 1, a GMPE of 1, and 

a GMCS of 1, which resulted in an average of 1. He noted that her QuickDASH score was mild, 

which increased her rating to two percent permanent impairment of the right upper extremity. 

Dr. Slutsky also reported that, based on Dr. Diamond’s wrist ROM measurements, appellant had 

no ratable permanent impairment utilizing the ROM rating method. Regarding her bilateral thumb 

arthritis, he explained that, because there were no objective clinical findings consistent with CMC 

arthrosis or any other medical conditions, there was no basis for a ratable impairment for her

bilateral CMC joint arthritis. Dr. Slutsky noted a date of MMI of December 2, 2019. 

By decision dated July 10, 2020, OWCP granted appellant a schedule award for two 

percent permanent impairment of the right upper extremity and one percent permanent impairment 

of the left upper extremity based on Dr. Slutsky’s May 2, 2020 report. The award ran for 9.36 

weeks from December 2, 2019 through February 5, 2020. 

Appellant subsequently submitted a June 25, 2020 addendum report by Dr. Diamond who 

indicated that he had reviewed Dr. Slutsky’s May 2, 2020 report. Dr. Diamond explained that he 

agreed with Dr. Slutsky that she did not exhibit entrapment neuropathy of the left median nerve 

wrist. Regarding permanent impairment for appellant’s right wrist, he indicated that he disagreed 

with Dr. Slutsky’s assignment of a GMFH of 1 and a GMPE of 1. Dr. Diamond further explained 

that he erroneously noted an impairment rating for appellant’s first MCP joint instead of the 

bilateral CMC joints. 

On July 14, 2020 appellant, through counsel, requested a hearing before a representative 

of OWCP’s Branch of Hearings and Review. 

By decision dated August 14, 2020, OWCP’s hearing representative found that a conflict 

in medical opinion existed between Dr. Diamond, appellant’s treating physician, and Dr. Slutsky, 

the DMA, regarding the extent of permanent impairment of her bilateral upper extremities. It 
4

remanded the case for referral to an impartial medical examiner (IME) to resolve the conflict in 

medical opinion evidence. 

OWCP subsequently referred appellant, along with a SOAF and the medical record, to

Dr. Andrew Collier, Jr., a Board-certified orthopedic surgeon, for an impartial medical 

examination to resolve the conflict in medical evidence regarding her permanent impairment for 

his bilateral wrist and thumb conditions. In an October 14, 2020 report, Dr. Collier noted her

history of injury and reviewed the medical record. He indicated that EMG and nerve conduction

velocity (NCV) studies on the left were normal and were slightly delayed on the right. On 

examination of appellant’s thumbs, Dr. Collier observed tenderness at the basal joint bilaterally at 

the CMC joint with no thenar or hypothenar atrophy. Examination of appellant’s bilateral wrists 

revealed mildly positive Tinel’s test bilaterally. Sensory examination was negative bilaterally. 

Dr. Collier provided three ROM measurements and noted normal ROM of both wrists. He 

reported that presently there were no objective findings of carpal tunnel syndrome on either hand. 

Dr. Collier noted that appellant had degenerative arthritis of the first CMC joints bilaterally. 

Regarding appellant’s left upper extremity, Dr. Collier utilized Table 15-3 (Wrist Regional 

Grid) and determined that, for the diagnosis of nonspecific wrist pain, she had one percent 

permanent impairment. Regarding her right upper extremity, he utilized Table 15-23

(Entrapment/Compression Neuropathy Impairment) and noted that she was grade 1 with a default 

value of two. Dr. Collier assigned a GMPE of 0, a GMFH of 1, and GMCS of 1, which resulted 

in an average of .66 or +1. He explained that this moved the default rating to the right, resulting 

in three percent permanent impairment. Regarding appellant’s right thumb, Dr. Collier reported 

that ultrasound of her hand demonstrated that she had one percent permanent impairment for right 

CMC joint arthritis. He calculated that appellant had a total of four percent permanent impairment 

of the right upper extremity. Dr. Collier noted a date of MMI as of December 2, 2019. 

In a December 8, 2020 addendum report, Dr. Collier explained that his impairment rating 

was based on the physical examination at the time of his examination on October 14, 2020. He 

agreed with Dr. Slutsky’s impairment of one percent of the left upper extremity. Dr. Collier also 

clarified that his calculation of four percent permanent impairment of the right upper extremity 

was not in addition to the prior impairment rating. 

By decision dated December 15, 2020, OWCP granted appellant an additional two percent 

permanent impairment of the right upper extremity for a total of four percent permanent 

impairment of the right upper extremity. The award ran for 6.24 weeksfrom October 14 through

November 26, 2020. 

On December 29, 2020 appellant, through counsel, requested a hearing before a 

representative of OWCP’s Branch of Hearings and Review, which was held on April 5, 2021. 

By decision dated May 26, 2021, OWCP’s hearing representative vacated the 

December 15, 2020 OWCP decision and remanded the case for OWCP to obtain a supplemental 

report from Dr. Collier. On remand, it instructed him to review Dr. Diamond’s June 25, 2020 

addendum report and to properly apply the ROM-rating methodology to determine the extent of 

appellant’s bilateral upper extremity permanent impairment. 
5

In a June 7, 2021 report, Dr. Collier indicated that ROM measurements of appellant’s 

wrists were taken three times and noted measurements of 75 degrees extension on the right and 

left, 65 degrees volar flexion on the right and left, 20 degrees radial deviation on the right and left, 

35 degrees ulnar deviation on the right and left, 90 degrees pronation on the right and left, and 90 

degrees supination on the right and left. He also clarified that he had reviewed Dr. Diamond’s 

June 25, 2020 report and reiterated that he disagreed with Dr. Diamond’s impairment rating 

because she did not have any evidence of carpal tunnel syndrome. Dr. Collier reported that his 

original impairment rating remained unchanged. 

By de novo decision dated July 19, 2021, OWCP denied an increased schedule award for 

appellant’s bilateral upper extremities based on Dr. Collier’s October 14, 2020 and June 7, 2021 

reports. 

On July 27, 2021 appellant, through counsel, requested a hearing before a representative 

of OWCP’s Branch of Hearings and Review, which was held on November 8, 2021. 

By decision dated January 12, 2022, OWCP’s hearing representative affirmed the July 19, 

2021 decision. 

LEGAL PRECEDENT

The schedule award provisions of FECA6 and its implementing regulations7 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. 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 and the Board has concurred in such 

adoption.8 As of May 1, 2009, the sixth edition of the A.M.A., Guides, published in 2009, is used 

to calculate schedule awards.9

Impairment due to carpal tunnel syndrome is evaluated under the scheme found in Table 

15-23 (Entrapment/Compression Neuropathy Impairment) and accompanying relevant text. 10 In 

Table 15-23, grade modifiers 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 

6

5 U.S.C. § 8107.

7

20 C.F.R. § 10.404.

8

Id. at § 10.404(a); see also T.T., Docket No. 18-1622 (issued May 14, 2019); Jacqueline S. Harris, 54 ECAB 

139 (2002). 

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

2.808.5(a) (March 2017); see also id. atChapter 3.700.2 and Exhibit 1 (January 2010).

10 Supra note 5 at 449.
6

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

daily living activities.11

In addressing upper extremity impairments, the sixth edition requires identification of the 

impairment CDX condition, which is then adjusted by GMFH, GMPE, and GMCS. 12 The net 

adjustment formula is (GMFH - CDX) + (GMPE - CDX) + (GMCS - CDX).13

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.)14

The Bulletin further advises:

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

[A.M.A.,] Guides allows 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 [claims examiner]. If the medical evidence 

of record is [in]sufficient for the DMA to render a rating on ROM where allowed, 

the DMA should advise as to the medical evidence necessary to complete the rating. 

However, the DMA should still render an impairment rating using the DBI method, 

if possible, given the available evidence.”

15

Section 8123(a) of FECA provides that if there is a disagreement between the physician 

making the examination for the United States and the physician of an employee, the Secretary shall 

appoint a third physician (known as a referee physician or IME) who shall make an examination. 16 

This is called an impartial medical examination and OWCP will select a physician who is qualified 

in the appropriate specialty and who has no prior connection with the case. 17 When a case is 

referred to an IME for the purpose of resolving the conflict, the opinion of such specialist, if 

11 Id. at 448-49.

12 Id. at 383-492.

13 Id. at 411.

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

15 Id. 

16 5 U.S.C. § 8123(a); see R.S., Docket No. 10-1704 (issued May 13, 2011); S.T., Docket No. 08-1675 (issued 

May 4, 2009).

17 20 C.F.R. § 10.321.
7

sufficiently well-rationalized and based upon a proper factual background, must be given special 

weight.18

ANALYSIS

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

OWCP properly determined that there was a conflict in the medical opinion evidence 

between Dr. Diamond, appellant’s treating physician, and Dr. Slutsky, an OWCP district medical 

examiner, regarding the extent of permanent impairment of her bilateral upper extremities due to 

her accepted bilateral wrist and thumb conditions. In order to resolve the conflict, it properly

referred her, pursuant to 5 U.S.C. § 8123(a), to Dr. Collier for an impartial medical examination. 

The Board finds that Dr. Collier properly provided a rating in accordance with the A.M.A., 

Guides for appellant’s right wrist injury. In an October 14, 2020 report, Dr. Collier indicated that 

EMG/NCV studies were slightly delayed on the right. He utilized Table 15-23 and noted that 

appellant was grade 1 with a default value of two. Dr. Collier assigned a GMPE of 0, a GMFH of 

1, and GMCS of 1, which resulted in an average of .66 or +1. He explained that this moved the 

default rating to the right, resulting in three percent permanent impairment. The Board finds that

Dr. Collier correctly applied the appropriate table and standards of the A.MA., Guides in 

calculating that appellant has three percent permanent impairment of the right upper extremity due 

to her right wrist injury. As OWCP denied increased schedule award, the Board finds that 

appellantis entitled to an additional one percent permanent impairment of the right upper extremity 

based on his opinion.

The Board further finds, however, that Dr. Collier’s reports are not well rationalized 

regarding the extent of appellant’s permanent impairment due to her accepted left wrist and 

bilateral thumb injuries as he does not properly apply the standards of the A.M.A., Guides.

In October 14, 2020 and June 7, 2021 reports, Dr. Collier reviewed appellant’s medical 

history and provided examination findings. Regarding her left wrist, he utilized the DBI-rating 

method to determine that, under Table 15-3, she had one percent permanent impairment for the 

diagnosis of nonspecific wrist pain. Dr. Collier fails, however, to adequately explain how he 

arrived at his finding of one percent permanent impairment. 19 While Dr. Collier noted ROM 

measurements for her left wrist, he does not provide calculations or an impairment rating using the 

ROM methodology under Table 15-32 even though the diagnosis of wrist pain allows for the 

alternate method of rating impairment under the ROM method.

20

 Accordingly, his opinion does 

not conform to the A.M.A., Guides and is of diminished probative value regarding the degree of 

permanent impairment due to appellant’s left wrist injury. 

18 K.D., Docket No. 19-0281 (issued June 30, 2020); J.W., Docket No. 19-1271 (issued February 14, 2020); 

Darlene R. Kennedy, 57 ECAB 414 (2006); GloriaJ. Godfrey, 52 ECAB 486 (2001).

19 See D.O., Docket No. 19-1729 (issued November 3, 2020); F.B., Docket No. 18-0903 (issued December 7, 2018).

20 See H.C., Docket No. 21-0761 (issued May 5, 2022); V.G., Docket No. 20-0455 (issued June 17, 2021).
8

Regarding appellant’s bilateral thumb injury, Dr. Collier referenced Table 15-3 and 

calculated that she had one percent permanent impairment for her right CMC joint arthritis. The 

Board finds that he does not properly apply the methodology for rating digit impairment for her

accepted bilateral thumb CMC injury. With regard to digit impairment, the A.M.A., Guides 

provides a regional grid at Table 15-2.21 Dr. Collier, however, does not reference this table in 

rating appellant’s permanent impairment for her accepted bilateral thumb injury.22 Furthermore, 

Table 15-2 of the A.M.A., Guides allows an alternate rating for degenerative joint disease under 

the ROM impairment methodology, but he fails to provide valid thumb ROM measurements or 

utilize the ROM-method for rating her permanent impairment due to her accepted bilateral thumb 

condition. As Dr. Collier does not provide an impairment rating in accordance with the A.M.A., 

Guides, his opinion is insufficient to carry the special weight of the medical evidence regarding 

the nature and extent of appellant’s permanent impairment due to her accepted bilateral thumb 

injury.

23

When OWCP obtains an opinion from an impartial medical specialist for the purpose of 

resolving a conflict in medical evidence and the specialist’s opinion requires clarification or 

elaboration, OWCP must secure a supplemental report from the specialist to correct the defect in 

the original report.24 However, when the impartial specialist is unable to clarify or elaborate on 

the original report or if a supplemental report is also vague, speculative or lacking in rationale, 

OWCP must submit the case record and a detailed SOAF to a second impartial specialist for the 

purpose of obtaining a rationalized medical opinion on the issue. 25 In this case, the Board finds 

that Dr. Collier, serving as the IME, fails to provide an opinion that conforms to the A.M.A., 

Guides, and, is therefore insufficient to carry the special weight of the medical evidence regarding 

the nature and extent of appellant’s permanent impairment.26 On remand, OWCP shall refer 

appellant back to Dr. Collier for another supplemental report for clarification, or to a new IME in 

the appropriate field of medicine. After this and other such further development as deemed 

necessary, itshall issue a de novo decision.

CONCLUSION

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

permanent impairment of her right upper extremity due to her accepted right wrist injury. The 

21 Supra note 5 at 391-94. 

22 C.T., Docket No. 20-0043 (issued April30, 2021).

23 See K.W., Docket No. 22-0320 (issued July 28, 2022); see also id.

24 RaymondA. Fondots, 53 ECAB 637, 641 (2002); Nancy Lackner (Jack D. Lackner), 40 ECAB 232 (1988); 

Ramon K. Ferrin, Jr., 39 ECAB 736 (1988).

25 Nancy Keenan, 56 ECAB 687 (2005); Roger W. Griffith, 51 ECAB 491 (2000); Talmadge Miller, 47 ECAB 

673 (1996).

26 H.C., supra note 20; see also L.Y., Docket No. 20-0398 (issued February 9, 2021); PaulR. Evans, Jr., 44 ECAB 

646, 651 (1993).
9

Board also finds that this case is not in posture for decision regarding the extent of permanent 

impairment causally related to her accepted left wrist and bilateral thumb injuries. 

ORDER

IT IS HEREBY ORDERED THAT the January 12, 2022 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: December 30, 2022

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

James D. McGinley, Alternate Judge

Employees’ Compensation Appeals Board