United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

L.A., Appellant

and

U.S. POSTAL SERVICE, POST OFFICE, 

Lake Mary, FL, Employer

__________________________________________

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Docket No. 22-0839

Issued: April 21, 2023

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

PATRICIA H. FITZGERALD, Deputy Chief Judge

JANICE B. ASKIN, Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On May 2, 2022 appellant filed a timely appeal from an April 5, 2022 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.2

1 5 U.S.C. § 8101 et seq.

2 The Board notes that, following the April 5, 2022 decision, appellant submitted additional evidence to OWCP. 

However, the Board’s Rules of Procedure provides: “The Board’s review of a case is limited to the evidence in the 

case record that was before OWCP at the time of its final decision. Evidence not before OWCP will not be considered 

by the Board for the first time on appeal.” 20 C.F.R. § 501.2(c)(1). Thus, the Board is precluded from reviewing this 

additional evidence for the first time on appeal. Id.
2

ISSUE

The issue is whether appellant has met her burden of proof to establish greater than 15 

percent permanent impairment of the bilateral upper extremities for which she previously received 

schedule award compensation.

FACTUAL HISTORY

This case has previously been before the Board on a different issue.3 The facts and 

circumstances as set forth in the Board’s prior decision are incorporated herein by reference. The 

relevant facts are as follows.

On April 8, 2013 appellant, then a 55-year-old clerk, filed a traumatic injury claim (Form 

CA-1) alleging that, on that date, she sustained a head injury with visual disturbance when a metal 

container door unlatched and struck the left side of her head while in the performance of duty. 

OWCP accepted her claim for post-concussion syndrome, post-traumatic headache, and 

cervicocranial syndrome and subsequently expanded acceptance of her claim to include 

intervertebral disc disorder with myelopathy, and herniated discs at C3-4, C4-5, C5-6, and C6-7. 

In a March 11, 2016 report, Dr. Robert R. Reppy, an osteopathic physician specializing in 

family practice, recounted that physical therapy had reduced appellant’s chronic headaches and 

cervical spine pain. He diagnosed herniated discs with multilevel radiculopathy, cervical stenosis, 

and cephalgia secondary to cervical disc pathology.

On May 12, 2016 appellant filed a claim for compensation (Form CA-7) for a schedule 

award.4

In an August 25, 2017 report, Dr. Reppy reviewed medical records and opined that 

appellant had attained maximum medical improvement (MMI) on September 30, 2016, when her 

condition plateaued without subsequent improvement. He provided an impairment rating applying 

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

Impairment (A.M.A., Guides)

5

and The Guides Newsletter, Rating Spinal Nerve Extremity 

Impairment Using the Sixth Edition (July/August 2009) (The Guides Newsletter). Dr. Reppy

performed monofilament testing to determine sensory deficits. Strength testing demonstrated 4/5 

upper extremity strength against gravity with some resistance. Dr. Reppy noted that The Guides 

Newsletter did not allow for impairment ratings at the C3-4 level. Using the diagnosis-based 

impairment (DBI) method, he referred to The Guides Newsletter to find 2 percent impairment for 

moderate sensory deficit at the C5 nerve roots, 2 percent impairment for moderate sensory 

impairment at C7, and 9 percent impairment for moderate motor impairment at C7. Dr. Reppy

3 Docket No. 16-1420 (issued December 15, 2016).

4 An October 5, 2016 magnetic resonance imaging (MRI) scan of the cervical spine demonstrated a loss of cervical 

lordotic curvature, increased disc herniations at C3-4, and disc herniations at C4-5, C5-6, and C6-7. A February 8, 

2017 electromyography/nerve conduction velocity (EMG/NCV) study suggested left cubital entrapment syndrome 

and a possible right T1 anomaly.

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

found no permanent impairment at the C6 level. He assigned a grade modifier for functional 

history (GMFH) of 3 according to Table 15-7 (Functional History Adjustment: Upper Extremities)

of the A.M.A., Guides, based on a QuickDASH score of 75 for pain symptoms with less than 

normal activity, limited cervical spine motion in all axes, and 2+ spasm of the paracervical 

musculature bilaterally. Dr. Reppy assigned a grade modifier for clinical studies (GMCS) of 2 

according to Table 15-9 (Clinical Studies Adjustment: Upper Extremities) based on demonstrated 

moderate pathology. He assigned to the Class of diagnosis (CDX) of a class 1. Dr. Reppy utilized

the net adjustment formula, (GMFH - CDX) + (GMCS - CDX), or (3-1) + (2-1), to calculate a net 

adjustment of 3, which moved the default percentages of impairment two places to the right for 

each affected spinal level. He, therefore, found three percent impairment for C5 sensory loss, no 

impairment for C5 motor loss, three percent impairment for C7 sensory loss, and nine percent 

impairment for C7 motor loss. Using the Combined Values Chart on page 604 of the A.M.A., 

Guides, Dr. Reppy combined the 3 percent impairment at C5 and 12 percent impairment at C7 to 

determine a final rating of 15 percent permanent impairment of each upper extremity. 

On October 23, 2017 OWCP referred appellant’s case, including a statement of accepted 

facts (SOAF), to Dr. Michael M. Katz, a Board-certified orthopedic surgeon and district medical 

adviser (DMA), to obtain an impairment rating. In an October 24, 2017 report, Dr. Katz noted that 

he reviewed the medical record and found that the range of motion (ROM) impairment method 

was inappropriate and concurred with Dr. Reppy’s use of the DBI method. Dr. Katz noted that 

while a 4/5 motor deficit was classified as a mild deficit, and not a moderate deficit as Dr. Reppy 

had found, this discrepancy did not alter the final percentage of impairment as the adjusted

impairment for both mild and moderate C7 motor deficits was nine percent. He therefore 

concurred with Dr. Reppy’s assessment of 15 percent permanent impairment of each upper 

extremity.

By decision dated November 1, 2017, OWCP granted appellant a schedule award for 15 

percent permanent impairment of the left upper extremity and 15 percent permanent impairment 

of the right upper extremity. The award ran for a 93.6-week period from August 25, 2017 through 

June 11, 2019.

In a July 20, 2021 report, Dr. Reppy diagnosed cervical disc disease with myelopathy and 

post-concussion syndrome. He opined that appellant had attained MMI as of July 16, 2021. 

Dr. Reppy noted that MRI scans had demonstrated disc herniations from C3 through C7,6and that 

a December 11, 2019 NCV study7established the presence of radiculopathy according to Proposed 

Table 1 of The Guides Newsletter. He determined a Class 1 impairment for the CDX of moderate 

degenerative disc disease based on imaging studies and appellant’s persistent symptoms during 

normal activity. Dr. Reppy noted a range of one to three percent impairment for moderate C5 

sensory deficit, eight to nine percent impairment for C5 motor deficit, two to five percent for C6 

6

In a November 6, 2018 report of an MRI scan of the cervical spine, Dr. W. Joseph Wall, a Board-certified 

radiologist, opined that the study demonstrated mild bilateral facet arthropathy at C2-3 and C3-4, a mild disc bulge at 

C4-5, severe left and mild right neuroforaminal narrowing at C5-6 with moderate central canal narrowing, and 

osteophyte formation creating mild central canal narrowing at C6-7. He also opined that the degenerative facet 

arthropathy had progressed at C5-6 and C6-7 compared to an October 5, 2016 MRI scan.

7 A December 11, 2019 EMG/NCV study demonstrated right median motor mononeuritis. A May 5, 2021 

EMG/NCV study demonstrated right radial entrapment neuropathy and a possible right C7 radiculopathy.
4

sensory deficit, nine percent for C6 motor deficit, one to three percent for C7 sensory deficit, and 

nine percent for C7 motor deficit. He assigned a GMFH of 2 for pain with normal activity, and a 

GMCS of 2 for a moderate problem. Dr. Reppy noted that there was no applicable grade modifier 

for physical examination findings (GMPE). He applied the net adjustment formula, (GMFH -

CDX) + (GMCS - CDX), or (2-1) + (2-1), to calculate a net adjustment of 2, moving the default 

Grade C upward to Grade D. Referring to Table 1 of The Guides Newsletter, Dr. Reppy found 

three percent impairment for C5 sensory deficit, nine percent impairment for C5 motor deficit, 

four percent impairment for C6 sensory deficit, nine percent impairment for C6 motor deficit, three

percent impairment for C7 sensory deficit, and nine percent impairment for C7 motor deficit. He 

added these percentages to equal 37 percent permanent impairment of each upper extremity.

On September 8, 2021 appellant filed a Form CA-7 claim for an increased schedule award.

On September 21, 2021 OWCP referred appellant’s case, including a SOAF, to Dr. Katz 

to obtain an impairment rating. In a September 27, 2021 report, Dr. Katz reviewed the medical 

record and SOAF. He opined that Dr. Reppy had not provided a sufficient description of the 

objective findings on which he based his July 20, 2021 impairment rating, and that Table 1 of The 

Guides Newsletter capped cervical spinal impairment at 37 percent for unilateral radiculopathy or 

56 for multilevel or bilateral radiculopathy. Dr. Katz recommended that OWCP refer appellant 

for a second opinion evaluation to obtain an impairment rating.

On November 2, 2021 OWCP referred appellant to Dr. Omar David Hussamy, a Boardcertified orthopedic surgeon, for a second opinion evaluation. A copy of the case record, a SOAF, 

and a series of questions were provided for his review.

In a February 11, 2022 report, Dr. Hussamy reviewed the medical record and SOAF. On 

examination, he noted limited cervical range of motion in all axes, motor strength at 5/5 throughout

both upper extremities, and decreased sensation to light touch and pinprick in the C5, C6, and C7 

dermatomes bilaterally. Dr. Hussamy indicated that appellant had attained MMI as of that day. 

He referenced the A.M.A., Guides to find a Class 1 impairment for the CDX of herniated discs, a 

GMFH of 2, and a GMCS of 2. Dr. Hussamy utilized the impairment rating methodology set forth 

in The Guides Newsletter. Beginning at the C5 level, he applied the net adjustment formula, 

(GMFH - CDX) + (GMCS - CDX), (2-1) + (2-1), resulting in a net adjustment of 2, which raised

the default CDX class C upward to E, which resulted in three percent permanent impairment of 

the bilateral upper extremities for moderate motor deficit at C5. Utilizing the same formula,

Dr. Hussamy found bilateral upper extremity impairment of three percent for moderate sensory 

deficit at C5, five percent for moderate sensory deficit at C6, and three percent for moderate 

sensory deficit at C7. He added the impairment ratings to find a total of 11 percent permanent 

impairment of the left upper extremity and 11 percent permanent impairment of the right upper 

extremity.

On March 21, 2022 OWCP referred appellant’s case, including a SOAF, to Dr. Katz for 

another supplemental opinion. In a March 21, 2022 report, Dr. Katz concurred with

Dr. Hussamy’s February 11, 2022 rating of 11 percent permanent impairment of the right upper 

extremity and 11 percent permanent impairment of the left upper extremity. He noted that, as 

appellant had previously been granted a schedule award for 15 percent permanent impairment of 
5

each upper extremity, she had not established a greater percentage of impairment than that 

previously awarded.

By decision dated April 5, 2022, OWCP denied appellant’s claim for an increased schedule 

award. 

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.8 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. 

Through its implementing regulations, OWCP adopted the A.M.A., Guides as the appropriate 

standard for evaluating schedule losses.9 As of May 1, 2009, schedule awards are determined in 

accordance with the sixth edition of the A.M.A., Guides (2009).10 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.11

No schedule award is payable for a member, function, or organ of the body that is not 

specified in FECA or the implementing regulations.12 The list of scheduled members includes the 

eye, arm, hand, fingers, leg, foot, and toes.13 Additionally, FECA specifically provides for 

compensation for loss of hearing and loss of vision.14 Neither FECA nor its implementing 

regulations provide for a schedule award for impairment to the back or to the body as a whole.15 

Furthermore, the back is specifically excluded from the definition of organ under FECA.16 The 

sixth edition of the A.M.A., Guides does not provide a separate mechanism for rating spinal nerve 

injuries as impairments of the extremities. Recognizing that, FECA allows ratings for extremities 

8 5 U.S.C. § 8107; 20 C.F.R. § 10.404.

9

Id. at § 10.404. See also Ronald R. Kraynak, 53 ECAB 130 (2001).

10 See Federal (FECA) Procedure Manual, Part 3 -- Medical, Schedule Awards, Chapter 3.700, Exhibit 1 

(January 2010); id. at Chapter 2.808.5a (March 2017).

11 R.C., Docket No. 21-1332 (issued July 1, 2022); J.C., Docket No. 20-1071 (issued January 4, 2021); P.R., Docket 

No. 19-0022 (issued April 9, 2018); Isidoro Rivera, 12 ECAB 348 (1961).

12 D.L., Docket No. 20-0059 (issued July 8, 2020); W.C., 59 ECAB 374 (2008); Anna V. Burke, 57 ECAB 

521 (2006).

13 5 U.S.C. § 8107(c).

14 Id.

15 K.Y., Docket No. 18-0730 (issued August 21, 2019); L.L., Docket No. 19-0214 (issued May 23, 2019); N.D., 59 

ECAB 344 (2008); Tania R. Keka, 55 ECAB 354 (2004).

16 See 5 U.S.C. § 8101(19); see also G.S., Docket No. 18-0827 (issued May 1, 2019); Francesco C. Veneziani, 48 

ECAB 572 (1997).
6

and precludes ratings for the spine, The Guides Newsletter offers an approach to rating spinal nerve 

impairments consistent with sixth edition methodology. For peripheral nerve impairments to the 

upper or lower extremities resulting from spinal injuries, OWCP’s procedures indicate that The

Guides Newsletter is to be applied.17 The Board has recognized the adoption of this methodology 

for rating extremity impairment, including the use of The Guides Newsletter, as proper in order to 

provide a uniform standard applicable to each claimant for a schedule award for extremity 

impairment originating in the spine.18

The claimant has the burden of proof to establish that the condition for which a schedule 

award is sought is causally related to his or her employment.19

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

should be routed through an OWCP medical adviser for an opinion concerning the nature and 

percentage of impairment in accordance with the A.M.A., Guides, with an OWCP medical adviser 

providing rationale for the percentage of impairment specified.20

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 impartial medical specialist) who shall 

make an examination.21 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.22 When there exist opposing medical 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.23

ANALYSIS

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

In support of her schedule award claim, appellant submitted a July 20, 2021 report from 

her treating physician, Dr. Reppy, who determined that, under The Guides Newsletter, appellant 

had a default value of one percent moderate sensory deficit at C5, eight percent motor deficit at 

17 Supra note 10 at Chapter 3.700 (January 2010). The Guides Newsletter is included as Exhibit 4.

18 R.C., supra note 13; J.C., supra note 13; E.D., Docket No. 13-2024 (issued April 24, 2014); D.S., Docket No. 

13-2011 (issued February 18, 2014).

19 See G.S., Docket No. 18-0827 (issued May 1, 2019).

20 Supra note 10 at Chapter 2.808.6(f)(March 2017).

21 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).

22 20 C.F.R. § 10.321.

23 Darlene R. Kennedy, 57 ECAB 414 (2006); Gloria J. Godfrey, 52 ECAB 486 (2001).
7

C5, two percent sensory deficit at C6, nine percent motor deficit at C6, one percent sensory deficit 

at C7, and nine percent motor deficit at C7. Dr. Reppy assigned a GMFH of 2 for pain with normal 

activity, and assigned a GMCS of 2 for a moderate problem. He applied the net adjustment formula 

to find a net grade modifier of 2, resulting in three percent C5 sensory deficit, nine percent C5 

motor deficit, four percent C6 sensory deficit, nine percent C6 motor deficit, three percent C7 

sensory deficit, and nine percent C7 motor deficit. Dr. Reppy concluded that appellant had a final 

impairment rating of 27 percent permanent impairment of each upper extremity.

In a February 11, 2022 report, Dr. Hussamy, an OWCP second opinion physician, also 

assigned a GMFH of 2 and GMCS of 2. He applied the net adjustment formula to find three

percent moderate C5 motor deficit, three percent moderate C5 sensory deficit, six percent moderate 

C6 sensory deficit, and three percent moderate sensory deficit at C7. Dr. Hussamy added these 

percentages to determine a final 11 percent permanent impairment of each upper extremity.

As Dr. Reppy, appellant’s attending physician, and Dr. Hussamy, a second opinion 

physician, disagree regarding the nature and extent of appellant’s bilateral upper extremity 

permanent impairment, the Board finds that a conflict in medical opinion exists.24 While both 

physicians properly utilized the A.M.A., Guides and The Guides Newsletter, they differed on the

severity of motor deficit at C5 and the presence of motor deficits at C6 and C7. As noted above, 

if there is a disagreement between the employee’s physician and an OWCP physician, OWCP shall 

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

make an examination.25 Because the reports of Dr. Reppy and Dr. Hussamy are of equal weight, 

appellant must be referred to an impartial medical specialist to resolve the existing conflict in the 

medical opinion evidence regarding the nature and extent of the permanent impairment of the

bilateral upper extremities.

26

On remand, OWCP shall refer appellant, along with the case record and SOAF, to a 

specialist in the appropriate field of medicine for an impartial medical evaluation to resolve the 

conflict in the medical opinion evidence. After this and other such further development as deemed 

necessary, OWCP shall issue a de novo decision.

CONCLUSION

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

24 V.S., Docket No. 21-1300 (issued April 25, 2022); see L.E., Docket No. 20-1505 (issued June 7, 2021); see also 

C.B., Docket No. 20-0258 (issued November 2, 2020).

25 Supra note 21.

26 C.P., Docket No. 21-1363 (issued May 3, 2022); V.S., supra note 24; D.W., Docket No. 21-840 (issued 

November 30, 2021); M.M., Docket No. 18-0235 (issued September 10, 2019).
8

ORDER

IT IS HEREBY ORDERED THAT the April 5, 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: April 21, 2023

Washington, DC

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board