United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

C.F., Appellant

and

DEPARTMENT OF THE ARMY, U.S. ARMY 

AVIATION & MISSILE COMMAND, CORPUS 

CHRISTI ARMY DEPOT, Corpus Christi, TX, 

Employer

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Docket No. 22-1271

Issued: November 21, 2023

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

JANICE B. ASKIN, Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JAMES D. McGINLEY, Alternate Judge

JURISDICTION

On August 31, 2022 appellant filed a timely appeal from an April 21, 2022 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 to 

consider the merits of this case.

ISSUE

The issue is whether appellant has met his burden of proof to establish greater than two

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

schedule award.

1

5 U.S.C. § 8101 et seq.
2

FACTUAL HISTORY

On September 21, 2016 appellant, then a 40-year-old aircraft engineer repairer, filed an 

occupational disease claim (Form CA-2) alleging that he sustained pain in both hands as a result 

of repetitive factors of his federal employment, including using power tools and hand wrenches. 

On January 30, 2017 OWCP accepted the claim for bilateral carpal tunnel syndrome (CTS) and 

bilateral ulnar nerve lesions. It paid appellant wage-loss compensation on the periodic rolls 

beginning May 1, 2017. 

On March 3, 2017 appellant underwent electromyogram and nerve conduction velocity 

(EMG/NCV) studies which revealed prolonged median inter latency bilaterally and prolonged 

median-ulnar palm mixed nerve action potentials, bilaterally. The left median, radial and bilateral 

ulnar nerves demonstrated normal distal latencies and amplitudes. These studies demonstrated 

mild left and moderate right CTS.

On May 1, 2017 Dr. Ryan Thomas, a Board-certified orthopedic surgeon, performed an 

OWCP-authorized left ulnar nerve compression at the elbow, left medial condylectomy at the 

elbow, and left open carpal tunnel release. On July 10, 2017 he performed an OWCP-authorized

right ulnar nerve neuroplasty at the elbow, right open carpal tunnel release, and right medial 

condylectomy at the elbow. Appellant returned to modified full-duty position on 

September 20, 2017.

On August 15, 2019 Dr. Thomas performed an OWCP-authorized revised left ulnar nerve

transposition and lengthening of the common flexor origin of the medial elbow. On January 7, 

2020 he performed an OWCP-authorized revision of the right cubital tunnel with intramuscular 

placement of the ulnar nerve and lengthening of the common flexor origin, right elbow.

OWCP paid appellant wage-loss compensation on the periodic rolls beginning 

January 5, 2020. Appellant returned to work on January 30, 2020.

On May 4, 2020 appellant underwent postoperative EMG/NCV studies with normal 

findings except for mid-palmar stimulation bilaterally. These findings were diagnostic for mild 

residual bilateral CTS.

On July 27, 2020 appellant filed a claim for compensation (Form CA-7) requesting a 

schedule award.

In a report dated July 7, 2020, Dr. Thomas E. Martens, an osteopath, found that appellant 

had reached maximum medical improvement (MMI) with regard to his accepted upper extremity 

conditions of bilateral CTS and bilateral ulnar nerve lesions. He applied Table 15-23, 

(Entrapment/Compression Neuropathy Impairments) on page 449 of the American Medical 

Association, Guides to the Evaluation of Permanent Impairment (A.M.A., Guides)

2

to reach an 

impairment rating. Dr. Martens determined that the May 4, 2020 EMG/NCV study showed a 

grade modifier of one for test findings in regard to the bilateral ulnar nerves. He assigned a grade

modifier of one for a history of mild intermittent symptoms, and a grade modifier of three for

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

physical findings of weakness. Dr. Martens averaged the three grade modifiers to find a final 

rating category of grade modifier of one with a default impairment value of two percent permanent 

impairment. He then utilized appellant’s QuickDASH (Disabilities of the Arm, Shoulder, and 

Hand) score to find a grade modifier functional scale of one. Dr. Martens found two percent 

impairment of each upper extremity due to the ulnar nerve lesions. He noted that the rating for the 

second nerve on the same side was reduced by half in accordance with Multiple Simultaneous 

Neuropathies, page 448 of the A.M.A., Guides, and found that appellant, therefore, had an 

additional one percent impairment of the upper extremities bilaterally due to median nerve 

impairments, resulting in three percent permanent impairment of the upper extremities, bilaterally.

In an August 7, 2020 development letter, OWCP requested that appellant submit an 

impairment evaluation from his attending physician addressing whether he had reached MMI and, 

if so, the extent of any permanent impairment in accordance with the A.M.A., Guides. It afforded 

him 30 days to submit the necessary evidence.

Dr. Martens responded in an August 25, 2020 report and repeated that appellant had 

reached MMI on July 7, 2020 and that he had three percent permanent impairment of each upper 

extremity due to his accepted bilateral CTS and ulnar nerve lesionsin accordance with the A.M.A., 

Guides. He noted that the diagnosis-based impairment (DBI) method was the correct method for 

evaluating appellant’s permanent impairment under the A.M.A., Guides and that the range of 

motion (ROM) method was not appropriate.

On June 8, 2021 OWCP referred appellant’s medical record, including Dr. Martens’ July 7 

and August 25, 2020 impairment ratings, a series of questions, and a statement of accepted facts 

(SOAF) to a district medical adviser (DMA) for a schedule award determination. It also asked 

him to assess appellant’s impairment and review and address any areas of disagreement with

Dr. Martens.

On June 15, 2021 Dr. David J. Slutsky, a Board-certified orthopedic surgeon, serving as a 

DMA, reviewed the SOAF and the medical record. Utilizing the sixth edition of the A.M.A., 

Guides, Entrapment Neuropathy, on pages 432 through 449, he noted that postoperative

EMG/NCV studies should not be utilized in the impairment rating unless the postoperative study 

is clearly worse. Dr. Slutsky found that there was insufficient medical evidence to determine 

appellant’s impairment rating and requested further development by OWCP.

In a July 7, 2021 development letter, OWCP requested additional medical evidence 

including all previous EMG/NCV studies and a further report from Dr. Martens.

On August 11, 2021 Dr. Charles Xeller, a physician specializing in orthopedic surgery,

diagnosed status postbilateral peripheral neuropathy surgery to address bilateral carpal and cubital 

tunnel syndromes. He reviewed appellant’s physical findings and advised that a preoperative 

EMG/NCV showed conduction showing of the median nerves. Dr. Xeller applied Table 15-23 on

page 449 of the A.M.A., Guides and found a grade modifier of one for test findings showing a 

slight delay of the bilateral ulnar nerves, a grade modifier of one for a history of mild intermittent 

symptoms, and a grade modifier of three for physical findings of weakness. He averaged the three 

grade modifiers and found that appellant fell under grade modifier one with a default value of two. 

Dr. Xeller applied a grade modifier of 1 for functional scale due to a QuickDASH score of 25
4

resulting in two percent impairment of the ulnar nerves, bilaterally. He found that the median 

nerves were within the same perimeters, but as the rating for the second nerve on the same side 

was half the value in accordance with page 448 of the A.M.A., Guides, appellant had three percent 

permanent impairment of each upper extremity.

In an August 26, 2021 report, Dr. Kyriakos Tsalamandris, Board-certified in emergency 

medicine, reviewed appellant’s preoperative EMG/NCV studies and foundevidence of conduction 

slowing of the median nerves, but normal ulnar nerve values. He found that appellant had two 

percent permanent impairment of each upper extremity for CTS and no rating for cubital tunnel 

syndrome based on the normal EMG/NCV studies results. 

On March 31, 2022 OWCP referred appellant’s medical record, including the additional 

reports from Drs. Xeller and Martens, a series of questions, and SOAF to the DMA for a schedule 

award determination.

On April 10, 2022 Dr. Slutsky, serving as a DMA, reviewed the SOAF and the medical 

record. Utilizing the sixth edition of the A.M.A., Guides, Entrapment Neuropathy, on pages 432 

through 449, he found that appellant had two percent permanent impairment of the right upper 

extremity due to CTS and no other ratable impairments. Dr. Slutsky noted that, in accordance with 

Appendix 15-B: Electrodiagnostic Evaluation of Entrapment Syndromes, on page 487 of the 

A.M.A., Guides, the criteria for CTS was distal motor latency longer than 4.5 milliseconds for an 

8 centimeter study, distal peak sensory latency longer than 4.0 milliseconds for 14 centimeter 

distances, and distal peak latency longer than 2.4 milliseconds for a transcarpal or midpalmar study 

of 8 centimeters. He found that the March 3, 2017 EMG/NCV tests met these requirements for 

the right median nerve resulting in a grade modifier of 1 for test findings according to Table 15-23 

(Entrapment/Compression Neuropathy Impairment), on page 449. The DMA also assigned a 

grade modifier of one for history, and a grade modifier of two for physical findings due to 

decreased sensation. Averaging the three grade modifiers resulted in a grade modifier of one on 

Table 15-23 with a default impairment value of two percent permanent impairment. The DMA

indicated that the QuickDASH score of 25 was grade modifier of 1 for functional scale, and 

therefore did not modify the rating from the default of two percent permanent impairment of the 

right upper extremity.

In regard to the left median nerve, Dr. Slutsky noted that, as the distal median motor latency 

did not meet the criteria of Appendix 15-B, page 487 of the A.M.A., Guides, there was no ratable 

impairment for CTS. He thus rated appellant’s left CTS using Table 15-3, the wrist regional grid, 

on page 395. Dr. Slutsky identified the class of diagnosis (CDX) for wrist pain resulted in a Class 

1 impairment, which yielded a default value of one percent. He applied a grade modifier for 

functional history (GMFH) of zero for no documented wrist pain, a grade modifier for ph ysical 

examination (GMPE) of zero for no palpatory findings, and found that a grade modifier for clinical 

studies (GMCS) was not applicable. Applying the net adjustment formula yielded a net adjustment 

of negative two and no impairment due to wrist pain. 

Addressing the accepted bilateral ulnar nerve injuries, Dr. Slutsky found that the March 3, 

2017 EMG/NCV findings were not ratable in accordance with Appendix 15-B, page 487 through 

488 of the A.M.A., Guides. He thus rated the cubital tunnel syndrome using Table 15-4, the elbow 

regional grid, on page 398 of the A.M.A., Guides. Dr. Slutsky identified the CDX for elbow 
5

sprain/strain as a Class 1 impairment, which yielded a default value of one percent. He applied a 

GMFH of zero for no documented elbow pain, a GMPE of zero for no palpatory findings, and

determined that a GMCS was not applicable. Utilizing the net adjustment formula, Dr. Slutsky 

found a net adjustment of minus two, which yielded no impairment due to elbow sprain/strain. 

By decision dated April 21, 2022, OWCP granted appellant a schedule award for two 

percent permanent impairment of the right upper extremity (right wrist). The award ran for 6.24

weeks during the period August 26 through October 8, 2021.

LEGAL PRECEDENT

The schedule award provisions of FECA3 and its implementing regulations4 set forth the 

number of weeks of compensation payable to employees sustaining permanent impairment for loss 

or loss of use, of scheduled members or functions of the body. FECA, however, does not specify 

the manner in which the percentage loss of a member shall be determined. The method used in 

making such determination is a matter, which rests in the discretion of OWCP. For consistent 

results and to ensure equal justice, the Board has authorized the use of a single set of tables so that 

there may be uniform standards applicable to all claimants. OWCP evaluates the degree of 

permanent impairment according to the standards set forth in the specified edition of the A.M.A., 

Guides, published in 2009.5 The Board has approved the use by OWCP of the A.M.A., Guides for 

the purpose of determining the percentage loss of use of a member of the body for schedule award 

purposes.6 It is well established that in determining the amount of a schedule award for a member 

of the body that sustained an employment-related impairment, preexisting impairments are to be 

included.7

Impairment due to CTS is evaluated under the scheme found in Table 15-23 

(Entrapment/Compression Neuropathy Impairment) and accompanying relevant text. 8 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 value may 

3

Supra note 1.

4

20 C.F.R. § 10.404.

5 For decisions issued after May 1, 2009, the sixth edition of the A.M.A., Guidesis used. A.M.A., Guides (6th ed. 

2009); Federal (FECA) Procedure Manual, Part 2 -- Claims, Schedule Awards and Permanent Disability Claims, 

Chapter 2.808.5a (March 2017); see also id. at Part 3 -- Medical, Schedule Awards, Chapter 3.700, Exhibit 1 

(January 2010).

6 M.B., Docket No. 22-0157 (issued August 26, 2022); G.L., Docket No. 22-0166 (issued August 24, 2022); V.C., 

Docket No. 21-1228 (issued April7, 2022); P.R., Docket No. 19-0022 (issued April9, 2018); Isidoro Rivera, 12 

ECAB 348 (1961).

7 G.L.; P.R., id.; Carol A. Smart, 57 ECAB 340 (2006).

8 A.M.A., Guides, 448, Table 15-23; 449; Appendix 15-B, 487-488. See also M.B.,supra note 6; G.L.,id.; L.G., 

Docket No. 18-0065 (issued June 11, 2018).
6

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

living activities.9

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.10

ANALYSIS

The Board finds that appellant has not met his burden of proof to establish greater than two 

percent permanent impairment of the right upper extremity for which he previously received a 

schedule award.

In a report dated August 11, 2021, Dr. Xeller calculated appellant’s impairment of the 

median and ulnar nerves as three percent of his upper extremities, bilaterally. On August 26, 2021

Dr. Tsalamandris reviewed the postoperative EMG/NCV studies and opined that appellant had 

two percent permanent impairment of each upper extremity for CTS and no impairment due to 

cubital tunnel syndrome. 

In accordance with its procedures, OWCP forwarded these reports to Dr. Slutsky, serving 

as the DMA, for review. In a report dated April 10, 2022, Dr. Slutsky noted the accepted 

conditions and reviewed the medical records, including the March 3, 2017 EMG/NCV studies 

testing. Referring to the sixth edition of the A.M.A., Guides, the DMA found that appellant had 

two percent permanent impairment of the right upper extremity due to CTS and no other ratable 

impairments. He applied the requirements of Appendix 15-B: Electrodiagnostic Evaluation of 

Entrapment Syndromes, on page 487 of the A.M.A., Guides, to the March 3, 2017 EMG/NCV test

results and found that these requirements were met only for the right median nerve. Dr. Slutsky

then applied Table 15-23 (Entrapment/Compression Neuropathy Impairment), on page 449 of the 

sixth edition of the A.M.A., Guides, to the findings regarding the right median nerve to reach two

percent permanent impairment of the right upper extremity. He found that appellant had no 

impairment due to left CTS as the distal median motor latency failed to meet the criteria of 

Appendix 15-B on page 487. Dr. Slutsky thus applied Table 15-3 on page 395 and found a CDX 

for left wrist sprain resulted in a Class 1 impairment, which yielded a default value of one percent.11 

He applied a GMFH and a GMPE of zero and found a GMCS was not applicable, which after 

applying the net adjustment formula yielded no ratable impairment due to left wrist pain.12

9

Id. at 448-49.

10 See supra note 5 at Chapter 2.808.6d (March 2017).

11 Dr. Slutsky indicated that he was rating the impairment due to left wrist pain, but applied the diagnosis of left 

wrist sprain; however, both diagnoses yielded the same results under Table 15-3.

12 Applying the net adjustment formula, (GMFH - CDX) + (GMPE - CDX), or (0-1) + (0-1) = -2, yielded an 

adjustment downward of two.
7

Dr. Slutsky further determined that the findings of the EMG/NCV studies for the bilateral

ulnar nerve did not show a ratable impairment. He consequently applied Table 15-4 on page 398 

and found a CDX for elbow sprain/strain resulted in a Class 1 impairment, which yielded a default 

value of one percent.13 Dr. Slutsky found a GMFH and a GMPE of zero and that a GMCS was 

not applicable, which after applying the net adjustment formula resulted in no ratable impairment 

due to elbow strain.14

The Board finds that Dr. Slutsky, serving as DMA, adequately explained how he arrived 

at his rating of permanent impairment by listing specific tables and pages in the A.M.A., Guides

and explained why his rating differed from that of Drs. Xeller and Tsalamandris. Dr. Slutsky 

properly interpreted and applied the standards of the sixth edition of the A.M.A., Guides to 

conclude that appellant had no greater than two percent permanent impairment of his right upper 

extremity, and that he had no ratable impairments of his left upper extremity or right ulnar nerve.15 

The Board finds that there is no current medical evidence of record, in conformance with 

the sixth edition of the A.M.A., Guides, establishing that appellant has more than two percent 

permanent impairment of the right upper extremity. Accordingly, appellant has not established 

entitlement to a schedule award greater than that previously awarded. 16

Appellant may request a schedule award or increased schedule award at any time based on 

evidence of new exposure, or medical evidence showing a progression of an employment-related 

condition resulting in permanent impairment or increased permanent impairment.

CONCLUSION

The Board finds that appellant has not met his burden of proof to establish greater than two 

percent of the right upper extremity for which he previously received a schedule award.

13 Dr. Slutsky advised that he was rating the impairment due to left elbow pain, but identified the CDX as an elbow 

sprain; however, both diagnoses yielded the same results under Table 15-4.

14 Supra note 12.

15 See J.L., Docket No. 22-1299 (issued May 17, 2023); P.S., Docket No. 22-1051 (issued May 4, 2023); N.M., 

Docket No. 19-1925 (issued June 3, 2020).

16 P.S., id.; M.H., Docket No. 20-1109 (issued September 27, 2021); R.H., Docket No. 20-1472(issued March 15, 

2021); L.D., Docket No. 19-0495 (issued February 5, 2020).
8

ORDER

IT IS HEREBY ORDERED THAT the April 21, 2022 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: November 21, 2023

Washington, DC

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board

James D. McGinley, Alternate Judge

Employees’ Compensation Appeals Board