United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

L.R., Appellant

and

U.S. POSTAL SERVICE, MOUNT McCOY 

POST OFFICE, Simi Valley, CA, Employer

__________________________________________

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Docket No. 20-0493

Issued: September 20, 2021

Appearances: Case Submitted on the Record

Appellant, pro se

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 January 2, 2020 appellant filed a timely appeal from a July 23, 2019 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.

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 September 16, 2012 appellant, then a 59-year-old letter carrier, filed an occupational 

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

(CTS), nerve impingement, and osteoarthritis of the hands due to factors of her federal 

 

1

5 U.S.C. § 8101 et seq.
2

employment, including repetitive gripping of the steering wheel, mail and full mail trays, and 

casing mail. She stopped work on September 15, 2012. 

On October 1, 2012 appellant underwent electrodiagnostic testing including 

electromyogram and nerve conduction velocity (EMG/NCV) studies, which revealed right median

nerve motor distal latency of 3.9 milliseconds and left median nerve motor distal latency of 2.6 

milliseconds. The diagnosis was bilateral moderate sensorimotor CTS. On November 15, 2012 

OWCP accepted appellant’s claim for bilateral CTS and bilateral tenosynovitis of the hands and 

wrists. It paid her wage-loss compensation on the periodic rolls, effective July 27, 2013.

On April 22, 2013 appellant underwent additional EMG/NCV studies. The right median 

nerve motor distal latency was 3.7 milliseconds while the left was 2.7 milliseconds. The diagnosis 

was bilateral moderate sensorimotor CTS, stable to mildly improved compared to the October 1, 

2012 EMG/NCV study.

On October 21, 2014 appellant accepted a light-duty position working four hours a day and 

lifting up to 10 pounds.

On February 2, 2015 appellant underwent NCV studies which demonstrated right median 

nerve motor distal latency of 3.7 milliseconds and left median nerve motor distal latency of 3.4 

milliseconds.

On February 29, 2016 appellant retired from the employing establishment. On June 3, 

2016 she elected to receive retirement benefits under the Civil Service Retirement Act rather than 

FECA compensation.

On August 22 and December 19, 2016 appellant filed claims for compensation (Form 

CA-7) for schedule awards. In a July 1, 2016 report, Dr. Charles Xeller, a Board-certified 

orthopedic surgeon, described appellant’s employment duties and performed a physical 

examination. He found significant pain in her thumbs, notable arthritis, and full range of motion 

of all fingers. Dr. Xeller found two-point discrimination was nine millimeters on digits one to 

three bilaterally, and five millimeters on digits four and five. He further found slight thumb 

abductor weakness which he attributed to both CTS and basilar joint arthritis. Dr. Xeller reviewed 

the electrodiagnostic studies and determined that appellant had moderate bilateral sensory and 

motor CTS. He diagnosed bilateral synovitis/tenosynovitis. Dr. Xeller determined that she had 

reached maximum medical improvement (MMI) on April 14, 2014. 

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

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

2 Dr. Xeller determined that appellant’s permanent 

impairment should be rated based on her CTS diagnosis, as it would result in greater impairment 

than the arthritis of the basilar joint of her thumb. He applied Table 15-23, page 449 of the A.M.A., 

Guides to his findings of grade modifier 2 for test findings due to motor and conduction delay, 

grade modifier 2 for history, functional scale grade modifier 2, and grade modifier 2 for physical 

findings of decreased sensation. Dr. Xeller also noted that appellant had slight weakness in thumb 

abductor which resulted in a grade modifier 3. He determined that in accordance with page 448 

 

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

of the A.M.A., Guides the average of these grade modifiers was 2.25 and that appellant had five

percent permanent impairment of each of her upper extremities due to her accepted bilateral CTS.

On April 5, 2017 OWCP referred Dr. Xeller’s report and the medical evidence to

Dr. David J. Slutsky, a Board-certified orthopedic surgeon serving as a district medical adviser 

(DMA). In an April 19, 2017 report, Dr. Slutsky found that appellant did not have a ratable 

impairment as a result of her diagnosed bilateral CTS. He noted that the NCV testing in 2013 and 

2015 was within normal limits. The DMA determined that the criteria for conduction delay in 

CTS was found in Appendix 15-B, page 487 of the A.M.A., Guides, which included distal motor 

latencies longer the 4.5 millisecond from an 8 centimeter study and distal peak sensory latency 

longer than 4.0 milliseconds for a 14 centimeter distance and distal peak compound nerve latency 

of longer than 2.4 milliseconds for a transcarpal or midpalmar study of 8 centimeters. He further 

noted that the diagnosis of a focal neuropathy syndrome must be documented by sensory and motor 

NCV studies or EMG in order to be ratable as impairment in accordance with page 445 of the 

A.M.A., Guides. The DMA further explained that, if the NCV testing does not meet the diagnostic 

criteria, there is no ratable impairment for entrapment neuropathy in accordance with pages 432 

through 450 of the A.M.A., Guides. He found that appellant’s NCV testing for either upper 

extremity did not meet the diagnostic criteria. The DMA applied page 446 of the A.M.A., Guides

which noted that CTS could be rated in Section 15.2 Diagnosis-Based Impairment, page 395, Table 

15-3 using the class of diagnosis (CDX) of nonspecific wrist pain, a class 1 impairment with a 

default grade of 1. He determined that appellant’s grade modifier for functional history (GMFH) 

was 1 in accordance with Table 15-7, page 406 of the A.M.A., Guides, that her grade modifier for 

physical examination (GMPE) was 0 in accordance with Table 15-8, page 408 of the A.M.A., 

Guides, and that her grade modifier for clinical studies (GMCS) was 0 in accordance with Table 

15-9, page 410 of A.M.A., Guides. The DMA then applied the net adjustment formula to reach a

net adjustment of -2, which moves the grade two spaces to the left resulting in a Class 1 Grade A

or 0 percent permanent impairment of each upper extremity.

By decision dated July 23, 2018, OWCP denied appellant’s schedule award claim, finding 

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

impairment of a scheduled member as a result of her accepted employment injury. It found that 

the DMA’s report was entitled to the weight of the medical evidence. 

On November 17, 2018 appellant filed a request for reconsideration. In support of her 

reconsideration request, she submitted October 5, 2018 EMG and NCV studies from Dr. Omar 

Mora, a physical medicine specialist which demonstrated mild bilateral CTS affecting the motor 

components.

In a November 17, 2018 report, Dr. Xeller again diagnosed bilateral CTS and bilateral 

synovitis and tenosynovitis. He indicated that he was providing an impairment rating based on 

de Quervain’s syndrome and bilateral CTS. Dr. Xeller found that appellant had 2 percent 

impairment bilaterally due to de Quervain’s syndrome and 5 percent bilaterally due to CTS for a 

total of 14 percent permanent impairment of the upper extremities.

By decision dated February 5, 2019, OWCP denied modification of the July 23, 2018 

decision. 
4

On April 26, 2019 appellant requested reconsideration of the February 5, 2019 decision. 

In support of her request, she provided an April 13, 2019 report from Dr. Xeller. Dr. Xeller

reviewed appellant’s October 2018 EMG/ NCV studies and found no slowing of the conduction, 

but a decrease in the amplitude of the right median motor nerve, decreased velocity of the left 

median motor nerve and, therefore, evidence of bilateral CTS. He applied the A.M.A., Guides and 

found that in accordance with Table 15-23, page 449, conduction delay was a grade modifier 1 for 

test findings. Dr. Xeller also reported that appellant had very significant intermittent symptoms 

which woke her up at night, prevented her from opening jars, and required her to use her other 

hand for support. He reported that appellant was constantly dropping things, and that this history 

is consistent with grade modifier 2 for history in accordance with Table 15-23, page 449. 

Dr. Xeller found weakness in thumb abductor pollicis brevis, slight alteration in sensation, which 

resulted in grade modifier 2 for physical findings. He averaged the three grade modifiers and 

found grade 2 upper extremity impairment in accordance with Table 15-23, page 449, or five 

percent permanent impairment of each upper extremity.

By decision dated July 23, 2019, OWCP denied modification of its prior decisions.

LEGAL PRECEDENT

The schedule award provisions of FECA3 and its implementing federal regulations

4 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 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.5 As of May 1, 2009, the 

sixth edition of the A.M.A., Guides is used to calculate schedule awards.6

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

15-23 (Entrapment/Compression Neuropathy Impairment) and accompanying relevant text.7 In 

Table 15-23, grade modifier 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 

 

3

5 U.S.C. § 8107.

4

20 C.F.R. § 10.404.

5

Id.

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

2.808.5a (March 2017); Federal (FECA) Procedure Manual, Part 3 --Medical, Schedule Awards, Chapter 3.700.2 and 

Exhibit 1 (January 2010).

7 A.M.A.,Guides 449, Table 15-23.
5

value may be modified up or down by one percent based on functional scale, an assessment of 

impact on daily living activities.

8

OWCP’s procedures provide that, after obtaining all necessary medical evidence, the file 

should be routed to OWCP’s 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.9

ANALYSIS

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

OWCP accepted that appellant developed bilateral CTS and bilateral tenosynovitis of the 

hands and wrists due to factors of her federal employment. In support of her schedule award 

claims, she initially submitted a July 1, 2016 report from Dr. Xeller finding that she had five 

percent permanent impairment of each of her upper extremities due to bilateral CTS. However, in 

April 19, 2017, OWCP’s DMA reviewed Dr. Xeller’s July 1, 2016 report and disagreed with the 

application of the A.M.A., Guides based on the findings on electrodiagnostic studies.

On October 5, 2018 appellant underwent additional electrodiagnostic studies which 

demonstrated mild bilateral CTS. In an April 13, 2019 report, Dr. Xeller reviewed appellant’s 

October 2018 EMG/NCV studies and found no slowing of the conduction, but a decrease in the 

amplitude of the right median motor nerve, decreased velocity of the left median motor nerve and,

therefore, appropriate electrodiagnostic evidence of bilateral CTS. He provided an additional 

impairment rating based on this new diagnostic study and an application of the sixth edition of the 

A.M.A., Guides, finding again that appellant had five percent permanent impairment of each upper 

extremity.

As Dr. Xeller provided an impairment rating based on his November 17, 2018 examination

using the sixth edition of the A.M.A., Guides, pursuant to its procedures, OWCP should have 

routed the case record, including the additional electrodiagnostic studies and the additional report

of Dr. Xeller, 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 

impairment specified, if any.

10

 As this was not done, the case must be remanded for referral to a 

DMA.11

 

8 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.

9

Supra note 6 at Chapter 2.808.6(e) and (f)(1) (March 2017).

10 L.S., Docket No. 19-0092 (issued June12, 2019); N.I., Docket No. 16-1027 (issued January 11, 2017); Tommy R. 

Martin, 56 ECAB 273 (2005); supra note 6at Chapter 2.808.6(f) (March 2017). (If the claimant’s physician provides 

an impairment report the case should be referred to the DMA for review.)

11 L.S., id.; R.H., Docket No. 17-1017 (issued December 4, 2018).
6

On remand, OWCP shall further develop the medical evidence of record by obtaining an 

opinion from a DMA regarding the nature and extent of appellant’s permanent impairment, if any, 

for her accepted condition. Following this and other such further development as deemed 

necessary, it shall issue a de novo decision regarding appellant’s schedule award claim.

CONCLUSION

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

ORDER

IT IS HEREBY ORDERED THAT the July 23, 2019 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: September 20, 2021

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