United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

M.C., Appellant

and

U.S. POSTAL SERVICE, ROMEOVILLE POST 

OFFICE, ROMEOVILLE, IL, Employer

__________________________________________

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Docket No. 20-1234

Issued: January 27, 2022

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

ALEC J. KOROMILAS, Chief Judge

PATRICIA H. FITZGERALD, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On June 1, 2020 appellant, through counsel, filed a timely appeal from an April 20, 2020 

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 permanent 

impairment of a scheduled member or function of the body, warranting a schedule award.

FACTUAL HISTORY

On July 5, 2016 appellant, then a 37-year-old rural carrier, filed an occupational disease 

claim (Form CA-2) alleging that she developed carpal tunnel syndrome due to factors of her federal 

employment. She noted that she first became aware of her condition and its relationship to her 

federal employment on April 27, 2016. Appellant stopped work on June 29, 2016. On 

September 9, 2015 OWCP accepted her claim for carpal tunnel syndrome of the left upper limb. 

It paid appellant wage-loss compensation on the supplemental rolls beginning 

September 17, 2016.

Appellant underwent OWCP-authorized left carpal tunnel release on October 17, 2016.

Appellant returned to full-duty work on March 4, 2017.

On August 28, 2017 appellant filed a claim for compensation (Form CA-7) a schedule 

award.

In a March 16, 2018 report, Dr. Neil Allen, a Board-certified internist and neurologist, 

reviewed appellant’s medical history and provided findings on physical examination. He noted 

that she experienced numbness and tingling in her left hand and opined that she had reached 

maximum medical improvement (MMI). Dr. Allen found that appellant had full muscle strength 

in her left and right hands. He provided a permanent impairment rating for the left wrist utilizing 

Table 15-23 (Entrapment/Compression Neuropathy Impairment) on page 449 of the sixth edition 

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

(A.M.A., Guides).3 Dr. Allen determined that appellant’s condition fell under grade modifier 1 

for test findings, grade modifier 3 for history, and grade modifier 2 for physical findings. He 

reported a QuickDASH score of 59 for the functional scale portion of Table 15-23 and concluded 

that she had a total of five percent permanent impairment of the left upper extremity.

On July 13, 2018 OWCP referred appellant’s case, along with a statement of accepted facts 

(SOAF), for a schedule award impairment rating with Dr. David Slutsky, a Board-certified 

orthopedic surgeon serving as the district medical adviser (DMA). In a July 29, 2018 report,

Dr. Slutsky reviewed the medical record and SOAF. He disagreed with Dr. Allen’s March 16, 

2018 impairment rating report, noting that appellant’s electromyography (EMG) and nerve 

conduction velocity (NCV) study findings did not meet the criteria for carpal tunnel syndrome 

impairment under the A.M.A., Guides. Accordingly, Dr. Slutsky utilized the diagnosis-based 

impairment (DBI) method of the A.M.A., Guides. He identified the class of diagnosis (CDX) as 

a class one impairment for the diagnosis of wrist sprain/strain under Table 15-3, page 395. 

Dr. Slutsky found that a grade modifier for functional history (GMFH) was not applicable , in 

accordance with Table 15-7, page 406, as appellant had no documented wrist pain. He assigned a 

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

grade modifier for physical examination (GMPE) of zero, in accordance with Table 15 -8, page 

408, as she had no palpatory findings. Dr. Slutsky reported a grade modifier for clinical studies 

(GMCS) of zero in accordance with Table 15-9, page 410, as there were no imaging studies. He 

calculated that appellant had a net adjustment of -1, resulting in movement from the default value 

of C to B and corresponding to zero percent upper extremity impairment. Dr. Slutsky noted that a 

rating under the range of motion (ROM) methodology could not be calculated as validated upper 

extremity measurements of the wrist were not performed. He opined that appellant reached MMI 

on March 16, 2018.

On August 8, 2018 appellant was referred for a second opinion examination with Dr. Allan 

Brecher, a Board-certified orthopedic surgeon. In a September 7, 2018 report, Dr. Brecher 

reviewed the medical record and SOAF. He examined appellant and noted wrist dorsiflexion of 

72 degrees, palmar flexion of 82 degrees, radial deviation of 20 degrees, and ulnar deviation of 31 

degrees on the left compared to 74, 82, 24, and 38 degrees respectively on the right. Utilizing the 

DBI method of the A.M.A., Guides, Dr. Brecher identified the CDX as a class one impairment for 

the diagnosis of nonspecific wrist pain under Table 15-3. He noted that a GMFH was not 

applicable, in accordance with Table 15-7, page 406, as appellant had no documented wrist pain. 

Dr. Brecher assigned a GMPE of zero as she had no palpatory findings. He reported a GMCS of 

zero as there were no imaging studies. Dr. Brecher indicated that appellant’s QuickDASH score 

was 66 and found that appellant had a grade B, zero percent upper extremity impairment. He 

opined that she reached MMI on March 16, 2018. Dr. Brecher noted that a rating under the ROM 

methodology would also be zero percent. He agreed with Dr. Slutsky’s assessment that appellant 

did not meet the criteria for carpal tunnel syndrome impairment under the A.M.A., Guides based 

on her EMG study. Dr. Brecher opined that Dr. Allen’s March 16, 2018 impairment report was 

not reliable as he did not perform a ROM rating or use two-point discrimination.

OWCP subsequently referred appellant’s case, along with a SOAF and the medical record, 

to Dr. John Kung, a Board-certified orthopedic surgeon, for an impartial medical examination in 

order to resolve the conflict in medical evidence between Drs. Allen and Brecher regarding her

permanent impairment of the left upper extremity. In a March 28, 2019 report, Dr. Kung reviewed 

the medical record and SOAF. He examined appellant and noted wrist dorsiflexion of 65 degrees, 

wrist flexion of 60 degrees, ulnar deviation of 35 degrees, and radial deviation of 20 degrees on 

the left compared to 65, 65, 35, and 25 degrees respectively on the right. Dr. Kung agreed with 

Drs. Brecher and Slutsky that she did not meet the criteria for carpal tunnel syndrome impairment 

under the A.M.A., Guides based on her EMG/NCV study findings. He therefore disagreed with

Dr. Allen’s determination of five percent permanent upper extremity impairment. Utilizing the 

DBI method of the A.M.A., Guides, Dr. Kung identified the CDX as a class one impairment for 

the diagnosis of nonspecific wrist pain under Table 15-3. He found a GMFH of zero as appellant 

had no functional issues. Dr. Kung assigned a GMPE of zero as she had no abnormal physical 

findings and normal ROM. He reported a GMCS of zero as there were no clinical studies. 

Dr. Kung calculated that appellant had a net adjustment of -3, resulting in movement from the 

default value of C to A and corresponding to a zero percent upper extremity impairment rating. 

He noted that a ROM impairment rating could not be used as her ROM was normal. Dr. Kung 

concurred with Dr. Brecher’s assessment that appellant had a zero percent upper extremity 

impairment rating.
4

By decision dated July 30, 2019, OWCP denied appellant’s schedule award claim, finding 

that the medical evidence of record was insufficient to establish permanent impairment of a 

scheduled member or function of the body. It noted that the special weight of the medical evidence 

rested with Dr. Kung, serving as the impartial medical examiner.

On August 7, 2019 appellant, through counsel, requested a telephonic hearing before a 

representative of OWCP’s Branch of Hearings and Review.

In a letter dated November 4, 2019, appellant through counsel, requested a review of the 

written record in lieu of an oral hearing.

By decision dated December 12, 2019, OWCP’s hearing representative affirmed the

July 30, 2019 decision.

OWCP subsequently received a December 10, 2019 addendum from Dr. Allen, who

reviewed the impairment rating reports from Drs. Slutsky and Brecher. Dr. Allen noted that, after 

further review of appellant’s EMG findings, she did not qualify for impairment under the 

entrapment/compression neuropathy method of the A.M.A., Guides. Utilizing the DBI method of 

the A.M.A., Guides, he identified the CDX as a class one impairment for the diagnosis of left wrist 

pain under Table 15-3, page 395. Dr. Allen found that a GMFH was not applicable, in accordance 

with Table 15-7, page 406, as it varied by two or more from the GMCS. He assigned a GMPE of

2, in accordance with Table 15-8, page 408, as appellant had moderate palpatory findings and mild 

thenar atrophy. Dr. Allen reported a GMCS of zero in accordance with Table 15-9, page 410, as 

the EMG/NCV findings did not qualify for a diagnosis of carpal tunnel syndrome. He calculated 

that appellant had a net adjustment of zero, resulting in no movement from the default value of C 

and corresponding to a one percent left upper extremity impairment.

On January 8, 2020 appellant, through counsel, requested reconsideration.

On February 28, 2020 OWCP referred appellant’s case to Dr. Slutsky, the DMA, for 

review of the newly submitted medical evidence. In an April 4, 2020 report, Dr. Slutsky reviewed 

the SOAF and medical record, including Dr. Allen’s December 10, 2019 addendum. He noted 

that Dr. Allen assigned a GMPE of 2 as he found that appellant had tenderness through the distal 

third of the forearm. However, Dr. Slutsky disagreed with Dr. Allen’s determination as he did not 

palpate her wrist or perform an adequate wrist examination which would document specific sites 

of palpatory tenderness. He noted that Dr. Allen did not perform a Finkelstein’s test, a Watson’s 

test, or a lunotriquetral ballottement test. Dr. Slutsky therefore concluded that Dr. Allen’s 

impairment rating was not supportable under the A.M.A., Guides. He indicated that, if physical 

examination findings were determined to be unreliable or inconsistent, they were to be ex cluded 

from the grading process under section 15.3b, page 407. Accordingly, Dr. Slutsky found that 

appellant had zero percent upper extremity impairment for the diagnosis of left carpal tunnel 

syndrome which was rated as nonspecific wrist pain.

By decision dated April 20, 2020, OWCP again denied appellant’s schedule award claim, 

finding that the medical evidence of record was insufficient to establish permanent impairment of 

a scheduled member or function of the body. It based its determination on the opinion of the 

DMA.
5

LEGAL PRECEDENT

The schedule award provisions of FECA,4 and its implementing federal regulations,5 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 b e 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.6 As of May 1, 2009, the 

sixth edition of the A.M.A., Guides is used to calculate schedule awards.7

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

15-23 (Entrapment/Compression Neuropathy Impairment) and accompanying relevant text.8 In 

Table 15-23, grade modifiers levels (ranging from 0 to 4) are described for the categories 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.9

The sixth edition of the A.M.A., Guides provides a DBI method of evaluation utilizing the 

World Health Organization’s International Classification of Functioning Disability and Health 

(ICF): A Contemporary Model of Disablement.

10

 Under the sixth edition, the evaluator identifies 

the CDX, which is then adjusted by the GMFH, GMPE, and GMCS.11 The net adjustment formula 

is (GMFH - CDX) + (GMPE - CDX) + (GMCS - CDX).12 Evaluators are directed to provide 

reasons for their impairment rating, including the choice of diagnoses from regional grids and the 

calculation of the modifier score.13

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

physician making the examination for the United States and the physician of the employee, OWCP 

4

5 U.S.C. § 8107.

5

20 C.F.R. § 10.404.

6

Id. at § 10.404(a).

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

2.808.5.a.(March2017); see alsoChapter 3.700.2 and Exhibit 1 (January2010).

8 A.M.A., Guides 449.

9 A survey completed by a given claimant, known by the name QuickDASH, may be used to determine the 

functional scale score. Id. at 448-49; see also J.H., Docket No. 19-0395 (issued August 10, 2020).

10 A.M.A., Guides 3, section 1.3(a).

11 Id. at 493-556.

12 Id. at 521.

13 E.W., Docket No. 19-1720 (issued November 25, 2020); R.R., Docket No. 17-1947 (issued December 19, 2018); 

R.V., Docket No. 10-1827 (issued April1, 2011).
6

shall appoint a third physician (known as a referee physician or impartial medical specialist) who 

shall make an examination.14 This is called a referee examination and OWCP will select a 

physician who is qualified in the appropriate specialty and who has no prior connection with the 

case.15 When there exists opposing reports of virtually equal weight and rationale and the case is 

referred to an impartial medical specialist for the purpose of resolving the conflict, the opinion of 

such specialist, if sufficiently well rationalized and based upon a proper factual background, must 

be given special weight.16

OWCP’s 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 permanent 

impairment in accordance with the A.M.A., Guides, with the DMA providing rationale for the 

percentage of impairment specified.17

ANALYSIS

The Board finds that appellant has not met her burden of proof to establish permanent 

impairment of a scheduled member or function of the body, warranting a schedule award.

OWCP properly determined that a conflict in the medical opinion evidence existed between

Dr. Allen, appellant’s attending physician, and Dr. Brecher, OWCP’s referral physician, on the 

issue of whether appellant had permanent impairment of a scheduled member due to her accepted 

left carpal tunnel syndrome. It properly referred her case to Dr. Kung pursuant to 5 U.S.C. 

§ 8123(a) for an impartial medical examination in order to resolve the conflict in medical 

opinion.18

In a March 28, 2019 report, Dr. Kung noted that appellant did not meet the criteria for 

carpal tunnel syndrome impairment under the A.M.A., Guides based on her EMG/NCV study 

findings. He disagreed with Dr. Allen’s determination of five percent permanent upper extremity 

impairment. Utilizing the DBI method of the A.M.A., Guides, Dr. Kung identified the CDX as a 

class one impairment for the diagnosis of nonspecific wrist pain under Table 15-3. He found a 

GMFH of zero as appellant had no functional issues. Dr. Kung assigned a GMPE of zero as 

appellant had no abnormal physical findings and normal ROM. He reported a GMCS of zero as 

there were no clinical studies. Dr. Kung calculated that appellant had a net adjustment of -3, 

resulting in movement from the default value of C to A and corresponding to zero percent upper 

extremity impairment rating.

Dr. Kung’s opinion was based on a proper factual and medical history and on the 

appropriate tables and grading schemes of the A.M.A., Guides. Accordingly, OWCP properly 

14 5 U.S.C. § 8123(a); L.S., Docket No. 19-1730 (issued August26, 2020); M.S., 58 ECAB 328 (2007).

15 20 C.F.R. § 10.321; see also R.C., 58 ECAB 238 (2006).

16 P.B., Docket No. 20-0984 (issued November 25, 2020); Darlene R. Kennedy, 57 ECAB 414 (2006); Gloria J. 

Godfrey, 52 ECAB 486 (2001).

17 See supra note 7 at Chapter 2.808.6(f) (March 2017).

18 See J.B., Docket No. 18-0116 (issued October 2, 2020).
7

accorded the special weight of the medical evidence to Dr. Kung’s March 28, 2019 report and 

denied appellant’s schedule award claim.19

Appellant subsequently submitted a December 10, 2019 addendum report from Dr. Allen. 

Utilizing the DBI method of the A.M.A., Guides, Dr. Allen identified the CDX as a class one 

impairment for the diagnosis of left wrist pain under Table 15-3, page 395. He found that a GMFH 

was not applicable, in accordance with Table 15-7, page 406, as it varied by two or more from the 

GMCS. Dr. Allen assigned a GMPE of2, in accordance with Table 15-8, page 408, as appellant 

had moderate palpatory findings and mild thenar atrophy. He reported a GMCS of zero in 

accordance with Table 15-9, page 410, as the EMG/NCV findings did not qualify for a diagnosis 

of carpal tunnel syndrome. Dr. Allen calculated that appellant had a net adjustment of zero, 

resulting in no movement from the default value of C and corresponding to a one percent left upper 

extremity impairment.

In an April 4, 2020 report, the DMA, Dr. Slutsky, found that Dr. Allen’s impairment 

evaluation was in error as he assigned a GMPE of 2 and disagreed with the physical examination 

findings of Drs. Brecher and Kung. The DMA explained that Dr. Allen failed to palpate 

appellant’s wrist or perform an adequate wrist examination which would document specific sites 

of palpatory tenderness. He noted that Dr. Allen did not perform a Finkelstein’s test, a Watson’s 

test, or a lunotriquetral ballottement test. The DMA properly concluded that Dr. Allen’s 

impairment rating was not supportable under the A.M.A., Guides as physical examination findings 

should be excluded from the grading process if they were determined to be unreliable or 

inconsistent under section 15.3b, page 407.20 The Board finds that the DMA properly explained 

that Dr. Allen’s addendum was insufficient to establish permanent impairment of a scheduled 

member or function of the body.21

Appellant has submitted no other medical evidence in conformance with the A.M.A., 

Guides establishing permanent impairment of a scheduled member or function of the body. The 

Board therefore finds that she has not met her burden of proof to establish her schedule award 

claim.

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 not met her burden of proof to establish permanent 

impairment of a scheduled member or function of the body, warranting a schedule award.

19 See V.G., Docket No. 19-1728 (issued September 2, 2020).

20 See A.M.A., Guides 407; J.H., supra note 9.

21 See N.T., Docket No. 20-0667 (issued November 25, 2020).
8

ORDER

IT IS HEREBY ORDERED THAT the April 20, 2020 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: January 27, 2022

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Alternate Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board