United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

S.J., Appellant

and

DEPARTMENT OF THE NAVY, U.S. NAVAL 

HOSPITAL, Patuxent River, MD, Employer

__________________________________________

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Docket No. 18-0966

Issued: September 20, 2019

Appearances: Case Submitted on the Record

Alan J. Shapiro, Esq., for the appellant1

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

CHRISTOPHER J. GODFREY, Chief Judge

PATRICIA H. FITZGERALD, Deputy Chief Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On April 10, 2018 appellant, through counsel, filed a timely appeal from a February 1, 

2018 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 more than eight 

percent permanent impairment of the left wrist, for which she previously received a schedule 

award.

FACTUAL HISTORY

On September 17, 1992 appellant, then a 42-year-old medical records clerk, filed a 

traumatic injury claim (Form CA-1) alleging a left wrist injury on September 16, 1992 as a result 

of “pull[ing] out about four or five medical records with left hand” while in the performance of 

duty. OWCP accepted the claim for left ganglion cyst of synovium, tendon, and bursae; other 

tenosynovitis of left hand and wrist; and other synovitis and tenosynovitis, left. On September 14, 

1996 it accepted appellant’s claim for a recurrence of disability and OWCP expanded the accepted 

conditions to include trigger finger (acquired), left.3 OWCP later authorized an October 12, 2009 

left wrist arthroscopy and left carpal tunnel surgery and then expanded the claim to include carpal 

tunnel syndrome, left upper limb.

On April 11, 2013 appellant filed a claim for a schedule award (Form CA-7). 

In support of her claim, appellant submitted a May 1, 2013 report by Dr. Stuart J. 

Goodman, a Board-certified psychiatrist and neurologist, who diagnosed left ganglion cyst of 

synovium tendon and bursa, left trigger finger, left other tenosynovitis of hand and wrist, and left 

other synovitis and tenosynovitis. Dr. Goodman conducted a physical examination and found that 

appellant had “tenderness of the left hand and wrist aggravated by movement.” Appellant was 

otherwise alert, oriented, and coherent. Motor examination revealed strength to essentially be 

equal and normal throughout with tenderness due to pain and limitation of motion on the hand and 

wrist, left side. Dr. Goodman found that appellant continued to have left hand and wrist problems 

as related to her September 16, 1992 work injury and determined that she had reached maximum 

medical improvement (MMI). He opined that she had residual issues and was working in a lightduty status. Utilizing the sixth edition of the American Medical Association, Guides to the 

Evaluation of Permanent Impairment (A.M.A., Guides),

4 Table 15-3, page 395 (Wrist Regional 

Grid), Dr. Goodman calculated that appellant had a class 0 diagnosis and assigned a grade modifier 

of 1 for both the functional history and physical examination. He concluded that appellant had a 

net adjustment of 2 and a grade E impairment, equaling five percent permanent impairment of the 

left upper extremity.

 

3 OWCP accepted that on September 12, 2005 appellant was injured at work while reaching for a pen on her desk 

and her chair flipped. It assigned OWCP File No. xxxxxx002 and accepted the condition of left elbow sprain. OWCP 

granted appellant a schedule award for one percent permanent impairment of the left upper extremity for this condition. 

Under OWCP File No. xxxxxx828, OWCP accepted that on September 21, 2004 appellant was injured at work when 

she lost her balance stepping off the sidewalk and fell down onto her left wrist. It accepted a left wrist fracture and 

contusion due to the September 21, 2004 work injury and granted a schedule award for eight percent permanent 

impairment of the left upper extremity. Therefore the Board notes that appellant previously received nine percent 

permanent impairment of her left upper extremity.

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

On September 12, 2015 the report of Dr. Goodman was sent to a district medical adviser 

(DMA) for review. No response was received.

By decision dated October 5, 2015, OWCP denied appellant’s schedule award claim 

finding that the medical evidence of record did not establish permanent impairment of a scheduled 

member or function of the body. It noted that, although Dr. Goodman opined that appellant’s 

impairment was related to the accepted September 16, 1992 employment injury, he had not 

described the injury. He also indicated that her current symptoms were caused by “use and 

overuse.” OWCP, therefore, found that appellant could have developed an occupational disease 

caused by work activities over more than one workday or shift, which may have caused her 

impairment. It indicated that it had requested additional factual evidence from appellant to clarify 

this issue, but had not received a response.

On October 14, 2015 appellant, through counsel, requested an oral hearing before a 

representative of OWCP’s Branch of Hearings and Review. 

In a September 23, 2015 narrative statement, received by OWCP on October 20, 2015, 

appellant indicated that on September 16, 1992 she had developed swelling and pain in her left 

hand and wrist due to pulling records from shelves that were not easy to pull because they were 

stored tightly. 

By decision dated April 18, 2016, an OWCP hearing representative conducted a 

preliminary review of the case and determined that the case was not in posture for a hearing. He 

found that OWCP’s prior decision should be vacated and remanded for appellant’s claims to be 

administratively combined with common claims to be followed by a de novo decision regarding 

entitlement to schedule award benefits.

OWCP administratively combined appellant’s claims and referred appellant to Dr. Willie 

Thompson, a Board-certified orthopedic surgeon, for a second opinion evaluation to determine the 

nature and extent of her accepted employment-related conditions. In his September 15, 2016 

report, Dr. Thompson reviewed a statement of accepted facts, history of the injury, and the medical 

evidence of record. He conducted a physical examination and found that there was mild limitation 

of motion at the wrist and there was some tenderness present. Grip strength was graded at 4+/5. 

There was minimal decreased sensation over the median nerve distribution to the left hand. The 

radial pulse was 3+ and regular. Appellant had intact skin. The Tinel’s sign was negative with 

percussion over the median nerve. Dr. Thompson diagnosed status post left carpal tunnel release 

on October 12, 2009 with debridement of the scapholunate ligament. He also found that appellant 

suffered a fracture to the left wrist on September 21, 2004, resulting in surgery to repair the 

fracture. Dr. Thompson determined that appellant had reached MMI. Utilizing Table 15-23 of the 

A.M.A., Guides, he found that appellant’s most impairing diagnosis was median nerve entrapment, 

a CDX of 1. Dr. Thompson assigned a grade modifier for clinical studies (GMCS) of 1 due to a 

conduction delay on an electromyography and nerve conduction velocity (EMG/NCV) studies, a 

grade modifier for functional history (GMFH) of 1 due to intermittent symptoms, and a grade 

modifier for physical examination (GMPE) of 2 due to physical findings. He concluded that 

appellant had a net adjustment of 4, equaling two percent permanent impairment of the left upper 

extremity. 
4

On March 22, 2017 Dr. Michael M. Katz, a Board-certified orthopedic surgeon serving as 

a DMA, reviewed the medical evidence of record and found that Dr. Goodman’s impairment 

evaluation could not be considered probative for the purpose of establishing a schedule award 

under FECA because it lacked sufficient detail to permit assignment of an impairment rating on 

the basis of a records review due to lack of physical examination findings. Using the findings 

provided by Dr. Thompson’s second opinion report, the DMA concurred that appellant’s most 

impairing diagnosis was median nerve entrapment under Table 15-23, page 449, of the A.M.A.

Guides. He also concurred with the GMCS of 1 due to electrodiagnostic studies with delay, a 

GMPE of 2 due to decreased sensation, and a GMFH of 1 due to mild intermittent symptoms. 

Using the net adjustment formula (GMFH-CDX) + (GMPE-CDX) + (GMCS-CDX), the DMA

calculated that appellant had a net adjustment of (1-1) + (2-1) + (1-1) = 1, equaling a default 

grade C. Based on these calculations, he concluded that appellant had two percent permanent 

impairment of her left upper extremity. 

In a May 9, 2017 addendum report, the DMA noted that appellant’s date of MMI was 

September 15, 2016, the date of Dr. Thompson’s second opinion examination and explained that 

since the present impairment of two percent was less than a prior overlapping award of eight

percent permanent impairment of the left upper extremity on the basis of carpal tunnel syndrome, 

there was no basis for an increased schedule award.

By decision dated May 11, 2017, OWCP denied appellant’s claim for an increased 

schedule award finding that the medical evidence of record was insufficient to establish greater

permanent impairment than eight percent of the left upper extremity that which was previously 

awarded. 

On May 22, 2017 appellant, through counsel, requested an oral hearing before a 

representative of OWCP’s Branch of Hearings and Review. 

A telephonic hearing was held on November 17, 2017. Appellant provided testimony and 

the hearing representative held the case record open for 30 days for the submission of additional 

evidence. OWCP did not receive additional evidence.

By decision dated February 1, 2018, OWCP’s hearing representative affirmed the May 11, 

2017 schedule award decision.

LEGAL PRECEDENT

The schedule award provisions 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.5 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. The 

A.M.A., Guides has been adopted by the implementing regulations as the appropriate standard for 

 

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

evaluating schedule losses.6 As of May 1, 2009, the sixth edition of the A.M.A., Guides is used to 

calculate schedule awards.7

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).8 Under the sixth edition, the evaluator identifies the impairment for the CDX 

condition, which is then adjusted by grade modifiers based on GMFH, GMPE, and GMCS. The 

net adjustment formula is (GMFH-CDX) + (GMPE-CDX) + (GMCS-CDX).9 Evaluators are 

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

from regional grids and calculations of modifier scores.10

The A.M.A., Guides specifically indicates that, if multiple simultaneous neuropathies 

occur in the same limb, both impairments may be rated, and the nerve qualifying for the larger 

impairment is given the full impairment while the nerve qualifying for the smaller impairment is 

rated at 50 percent.11 The A.M.A., Guides further indicate that Table 15-23 is to be used for rating 

focal nerve compromise,12 and Appendix 15-B provides further guidance regarding 

electrodiagnostic evaluation of entrapment syndromes.13

ANALYSIS

The Board finds that appellant has not met her burden of proof to establish more than eight 

percent permanent impairment of her left wrist, for which she previously received a schedule 

award.

In support of her claim appellant submitted a May 17, 2013 report by Dr. Goodman. 

Utilizing the sixth edition of the A.M.A., Guides, Table 15-3 (Wrist Regional Grid), page 395,

Dr. Goodman calculated that appellant had a CDX of 0 and assigned a GMFH and GMPE of 1. 

He concluded that appellant had a net adjustment of 2 and a grade E impairment, equaling five 

percent permanent impairment of the left upper extremity.

 

6 K.H., Docket No. 09-341 (issued December 30, 2011). For decisions issued after May 1, 2009, the sixth edition 

will be applied. B.M., Docket No. 09-2231 (issued May 14, 2010). 

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

2.808.6 (March 2017); see also Part 3 -- Medical, Schedule Awards, Chapter 3.700.2 and Exhibit 1 (January 2010).

8 A.M.A., Guides (6th ed. 2009) at 3, section 1.3, The International Classification of Functioning, Disability and 

Health (ICF): A Contemporary Model of Disablement.

9

Id. at 411.

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

11 Supra note 10 at 448.

12 Id.

13 Id. at 487-90.
6

In his September 15, 2016 report, Dr. Thompson provided physical examination findings 

and noted her prior history as set forth in the medical record, including the report of Dr. Goodman.

He diagnosed status post left carpal tunnel release on October 12, 2009 with debridement of the 

scapholunate ligament and found that appellant suffered a fracture to the left wrist on 

September 21, 2004, resulting in surgery to repair the fracture. Utilizing Table 15-23 of the 

A.M.A., Guides, Dr. Thompson found that appellant’s most impairing diagnosis was median nerve 

entrapment with a CDX of 1. He assigned a GMCS of 1 due to a conduction delay on 

electrodiagnostic studies, a GMFH of 1 due to intermittent symptoms, and a GMPE of 2 due to 

physical findings. Dr. Thompson concluded that appellant had a net adjustment of 4, equaling two

percent permanent impairment of the left upper extremity.

In accordance with its procedures, OWCP properly referred the evidence of record to its 

DMA, Dr. Katz, who, in his reports dated March 22 and May 9, 2017, reviewed the evidence and 

determined that appellant’s date of MMI was September 15, 2016, the date of Dr. Thompson’s 

second opinion examination. Using the findings provided by Dr. Thompson’s second opinion 

report, the DMA concurred that appellant’s most impairing diagnosis was median nerve 

entrapment under Table 15-23, page 449, of the A.M.A., Guides. He also concurred with the 

GMCS of 1 due to electrodiagnostic studies with delay, a GMPE of 2 due to decreased sensation, 

and a GMFH of 1 due to mild intermittent symptoms. Using the net adjustment formula (GMFHCDX) + (GMPE-CDX) + (GMCS-CDX), the DMA calculated that appellant had a net adjustment 

of (1-1) + (2-1) + (1-1) = 1, equaling a default grade C. Based on these calculations, the DMA 

concluded that appellant had two percent permanent impairment left upper extremity. He

explained that since the present impairment was less than a prior overlapping award of eight 

percent permanent impairment of the left upper extremity.

The Board finds that the DMA applied the appropriate tables and grading schemes of the 

sixth edition of the A.M.A., Guides to Dr. Thompson’s clinical findings. The DMA’s calculations 

were mathematically accurate. There is no medical evidence of record utilizing the appropriate 

tables of the sixth edition of the A.M.A., Guides demonstrating a greater percentage of permanent 

impairment. The DMA reviewed the medical evidence of record and explained that

Dr. Goodman’s impairment evaluation could not be considered probative for the purpose of 

recommending a schedule award under FECA because it lacked sufficient detail to permit 

assignment of an impairment rating on the basis of a records review. The Board has held that 

when the attending physician fails to provide an estimate of impairment conforming to the A.M.A., 

Guides, or does not discuss how he or she arrives at the degree of impairment based on physical 

findings, his or her opinion is of diminished probative value in establishing the degree of 

impairment such that OWCP may rely on the opinion of the DMA to apply the A.M.A., Guides to 

the findings reported by the attending physician.14 The Board finds that OWCP’s DMA in this 

case properly applied the standards of the A.M.A., Guides. The DMA’s opinion represents the 

weight of medical evidence and OWCP properly relied on his assessment of two percent 

permanent impairment of the left upper extremity.15

 

14 See L.M., Docket No. 12-0868 (issued September 4, 2012); John L. McClanic, 48 ECAB 552 (1997).

15 See M.T., Docket No. 11-1244 (issued January 3, 2012).
7

OWCP’s procedures provide that previous impairment to the member under consideration 

is included in calculating the percentage of loss, except when the prior impairment is due to a 

previous work-related injury, in which case the percentage already paid is subtracted from the total 

percentage of impairment.16 Appellant previously received schedule award compensation for one

percent permanent impairment of the left upper extremity under OWCP File No. xxxxxx002 and 

eight percent permanent impairment of the left upper extremity under File No. xxxxxx828. Thus, 

the Board finds that OWCP properly denied an increased schedule award.

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 more than eight 

percent permanent impairment of the left wrist, for which she previously received a schedule 

award.

ORDER

IT IS HEREBY ORDERED THAT the February 1, 2018 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: September 20, 2019

Washington, DC

Christopher J. Godfrey, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board

 

16 Supra note 8 at Part 2 -- Claims, Schedule Awards and Permanent Disability Claims, Chapter 2.808.7.a(1)(a) 

(February 2013). See W.M., Docket No. 14-0953 (issued August 13, 2014).