United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

J.R., Appellant

and

DEPARTMENT OF HOMELAND SECURITY, 

CUSTOMS & BORDER PATROL, 

Falfurrias, TX, Employer

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Docket No. 21-1030

Issued: August 21, 2023

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, Deputy Chief Judge

JANICE B. ASKIN, Judge

JURISDICTION

On June 23, 2021 appellant filed a timely appeal from a May 27, 2021 merit decision and 

a June 4, 2021 nonmerit 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.

ISSUES

The issues are: (1) whether appellant has met his burden of proof to establish permanent 

impairment of the left upper extremity, warranting a schedule award; and (2) whether OWCP 

properly denied appellant’s request for reconsideration of the merits of his claim, pursuant to 

5 U.S.C. § 8128(a).

1

5 U.S.C. § 8101 et seq.
2

FACTUAL HISTORY

On March 16, 2020 appellant, then a 48-year-old supervisory border patrol agent, filed an 

occupational disease claim (Form CA-2) alleging that he experienced pain and numbness in his 

left arm, from his forearm to his fingers, due to typing on a daily basis for 24 years while in the 

performance of duty. OWCP accepted his claim for left upper limb carpal tunnel syndrome (CTS), 

left upper limb lesion of the ulnar nerve, and left elbow lateral epicondylitis. On July 13, 2020 

appellant underwent an OWCP-authorized left carpal tunnel release. 

On December 4, 2020 appellant filed a claim for a schedule award (Form CA-7). In support 

of his claim, he submitted a November 4, 2020 medical report and an amended November 4, 2020 

report from Dr. Rafath Quraishi, a pain medicine specialist. On physical examination of the left 

elbow, Dr. Quraishi found mild tenderness on palpation over the lateral epicondyle with full range 

of motion (ROM). He provided three sets of ROM measurements that included 140 degrees, 140

degrees, and 143 degrees of flexion; 0 degrees, 0 degrees, and 0 degrees of extension; 75 degrees,

70 degrees, and 70 degrees of supination; and 80 degrees, 90 degrees, and 90 degrees of pronation. 

There was no joint effusion or swelling when compared to the opposite elbow. Muscle strength in 

the elbow was graded at +5/5. Deep tendon reflexes were +2/4. Appellant had continued tingling 

and numbness in the left wrist into the thumb and index finger. Capillary refills were normal with 

no swelling or edema. On physical examination of the left wrist, Dr. Quraishi reported only mild 

tenderness on palpation with no swelling or joint crepitation. He provided ROM measurements 

that included 60 degrees of flexion, 60 degrees of extension, 20 degrees of ulnar deviation, and 

30 degrees of radial deviation. Tinel’s signs were positive and Phalen’s tests were positive for 

sensory changes and tingling and numbness in appellant’s thumb index and middle fingers. 

Muscle strength was 5/5 in flexion, extension, ulnar and radial deviation, and grip strength was

normal at 5/5. Appellant was right-hand dominant and had increased strength when comparing 

the right versus the left. Dr. Quraishi noted appellant’s difficulties with activities of daily living

(ADLs). He diagnosed the accepted conditions of left elbow lateral epicondylitis, left upper limb 

lesion of ulnar nerve/CTS, and left ulnar nerve lesion. Dr. Quarishi determined that appellant 

reached maximum medical improvement (MMI) on the date of his evaluation. He referred to the 

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

Impairment (A.M.A., Guides)

2 and utilized the diagnosis-based impairment (DBI) rating method 

to assign a Class of diagnosis (CDX) of 1 for left elbow lateral epicondylitis with a history of 

painful injury with residual symptoms, which represented a default value of one percent 

impairment under Table 15-4 (Elbow Regional Grid). Dr. Quraishi assigned a grade modifier for 

functional history (GMFH) of 2 based on painful symptoms with normal activity with or without 

medication to control symptoms and the ability to perform self-care activities with modifications. 

He assigned a grade modifier for physical examination (GMPE) of 1 due to appellant’s

QuickDASH score of 50 and normal examination. Dr. Quraishi did not assign a grade modifier 

for clinical studies (GMCS). He utilized the net adjustment formula (GMFH - CDX) + (GMPE -

CDX) = (2 - 1) + (0 - 1) = 0, which resulted in a grade C or one percent permanent impairment of 

the left elbow. Dr. Quraishi advised that ROM was within normal limits and resulted in no higher 

impairment rating under Section 15.7.

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

Regarding impairment to the left wrist, Dr. Quraishi utilized the DBI method in Table 

15-23 (Entrapment/Compression Neuropathy Impairment). He assigned a GMFH of 1 based on 

mild intermittent symptoms, a GMPE of 2 due to decreased sensation in the thumb and index and 

middle fingers and a QuickDASH score of 50, and a GMCS of 1 due to conduction sensory delay.

Dr. Quraishi found that appellant had one percent permanent impairment of the left wrist. He

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

On December 28, 2020 OWCP referred Dr. Quraishi’s November 4, 2020 report, the 

medical evidence, and a statement of accepted facts (SOAF) to Dr. David J. Slutsky, a Boardcertified orthopedic surgeon serving as a district medical adviser (DMA). 

In a March 7, 2021 report, the DMA found that appellant did not have permanent 

impairment as a result of his accepted diagnosis of left CTS. He noted that, according to the sixth 

edition of the A.M.A., Guides, page 489, the criteria for conduction delay in CTS included distal 

motor latencies longer than 4.5 milliseconds from an 8 centimeter study, a distal peak sensory 

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

nerve latency longer than 2.4 milliseconds for a mid-palmar study of 8 centimeters. The DMA 

further noted that the diagnosis of a focal neuropathy syndrome must be documented by 

electromyogram (EMG) and/or nerve conduction velocity (NCV) studies in order to be ratable as 

permanent impairment in accordance with appendix 15-B, page 445, of the A.M.A., Guides. He 

explained that, if the NCV testing is not performed or does not meet the diagnostic criteria, there 

is no permanent impairment for entrapment neuropathy in accordance with this section. The DMA 

applied page 446 of the A.M.A., Guides which noted that CTS could be rated in Section 15.2 DBI, 

page 395, Table 15-3 using the CDX of nonspecific wrist pain, a Class 1 impairment with a default 

grade of one percent. He determined that a GMFH was not applicable under Table 15-7, page 406, 

because there was no documented wrist pain with activity and there was a QuickDASH score of 

50. The DMA assigned a GMPE of 1 in accordance with Table 15-8, page 408, due to mild 

tenderness. He determined that a GMCS was not applicable as there were no electrodiagnostic 

studies. The DMA then applied the net adjustment formula (GMPE - CDX) = (1 - 1) = 0, resulting 

in a Class 1 grade C or one percent permanent impairment of the left wrist. He also utilized the 

DBI method in Table 15-4, page 399, and found that appellant’s left lateral epicondylitis fell under 

a Class 1 impairment with a default value of one percent. Using Table 15-7, page 406, the DMA

applied a GMFH of 2 based on difficulty with ADLs and a QuickDASH score of 50 for mild pain. 

Using Table 15-8, page 408, he applied a GMPE of 1 based on a completely normal physical 

examination. The DMA advised that a grade modifier for GMCS was not applicable as there were 

no relevant imaging studies. He applied the net adjustment formula (GMFH - CDX) + (GMPE -

CDX) = (2 - 1) + (0 - 1) = 0, resulting in a Class 1 grade C impairment, or one percent permanent 

impairment of the left elbow. 

The DMA noted that peripheral nerve compression could not be rated using the ROM 

impairment method as it was rated under Table 15-23. He also noted that Dr. Quraishi reported 

only one measurement for wrist ROM impairment with regard to flexion, extension, radial 

deviation, and ulnar deviation. The DMA advised that GMPE and GMFH under Table 15-36,

page 477, were not applicable. He concluded that an ROM impairment rating could not be 

calculated due to a lack of three validated ROM measurements.
4

The DMA utilized the ROM method to rate impairment to the left elbow. He found that 

140 degrees, 140 degrees, and 143 degrees of flexion represented 0 percent impairment;0 degrees, 

0 degrees, and 0 degrees of extension represented 0 percent impairment; 75 degrees, 70 degrees, 

and 70 degrees of supination represented 0 percent impairment; and 80 degrees, 90 degrees, and 

90 degrees of pronation represented 0 percent impairment, resulting in 0 percent permanent ROM 

impairment. The DMA again advised that GMPE and GMFH under Table 15-36, page 477, were

not applicable. He concluded that appellant had 0 percent permanent ROM impairment of the left 

elbow.

The DMA noted that the discrepancy between his and Dr. Quraishi’s impairment ratings 

was that Dr. Quraishi assigned a GMCS of 1 based on an apparent conduction delay in appellant’s 

left wrist when there were no electrodiagnostic studies or progress notesof record. Thus, the DMA

opined that there was no permanent impairment. He related that if electrodiagnostic studies 

became available then the impairment rating may change accordingly. The DMA determined that 

appellant reached MMI on November 4, 2020 the date of Dr. Quraishi’s impairment evaluation. 

OWCP, in a March 9, 2021 letter, requested that Dr. Quraishi review the DMA’s March 8, 

2021 report and address the deficiencies raised in his report. It received a copy of Dr. Quraishi’s 

amended November 4, 2020 report. 

OWCP also received a November 20, 2019 EMG/NCV study regarding appellant’s upper 

extremities. The study provided an impression of mild-to-moderate compressive neuropathies of 

the bilateral median nerves at the wrists, i.e., significant bilateral CTS. The study also provided 

impressions of no evidence of cervical radiculopathy, brachial plexopathy, or more proximal 

entrapment neuropathy.

On April 6, 2021 OWCP requested that the DMA review a SOAF and the medical record, 

including the November 20, 2019 EMG/NCV study and provide a supplemental opinion regarding 

the extent of appellant’s permanent impairment. 

In a May 2, 2021 supplemental report, the DMA noted his review of the SOAF and the 

November 20, 2019 EMG/NCV study. He reiterated his prior impairment calculations based on 

the diagnoses of left CTS and left lateral epicondylitis, and concluded that appellant had one 

percent permanent impairment of the left upper extremity for each diagnosis. Additionally, the 

DMA opined that he had zero percent left upper extremity permanent impairment due to a

diagnosis of left elbow cubital tunnel syndrome. He found that the November 20, 2019 EMG/NCV 

study yielded normal findings. The DMA noted that the EMG/NCV study measured distal ulnar 

motor latencies of 3.9 milliseconds, distal ulnar sensory latencies of 1.9 milliseconds, and 

conduction velocity of 59 milliseconds from the AE to BE segments. The study was not silent 

regarding abductor digiti minimi/first dorsal interosseous. The DMA concluded that the test 

findings were zero, and thus, the diagnosis of left cubital tunnel syndrome was not ratable. The 

DMA again noted that the discrepancy between his and Dr. Quraishi’s impairment ratings was that

Dr. Quraishi did not provide an impairment rating for appellant’s left CTS. Regarding the 

diagnosis of cubital tunnel syndrome, he indicated that Dr. Quraishi assigned a GMCS of one

based on an apparent sensory conduction delay while the November 20, 2019 electrodiagnostic 

studies were normal, and thus, there was no ratable impairment. Additionally, the DMA indicated

that, while Dr. Quraishi reported decreased sensation in the thumb and index and middle fingers, 
5

this was the median nerve distribution and not the ulnar nerve distribution. He restated his prior 

opinion that MMI was reached on November 4, 2020. 

By decision dated May 27, 2021, OWCP denied appellant’s schedule award claim, finding 

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

upper extremity, warranting a schedule award. It explained that appellant was previously paid a 

schedule award for the left upper extremity and that the opinion of its DMA established that he 

had no greater left upper extremity permanent impairment.

On May 28, 2021 appellant requested reconsideration. He submitted copies of

Dr. Quraishi’s November 4, 2020 report and the November 20, 2019 EMG/NCV study. 

OWCP, by decision dated June 4, 2021, denied appellant’s request for reconsideration of 

the merits of his claim pursuant to 5 U.S.C. § 8128(a). 

LEGAL PRECEDENT -- ISSUE 1

It is the claimant’s burden of proof to establish permanent impairment of the left upper 

extremity, warranting a schedule award.

3

The schedule award provisions of FECA4 and its implementing federal regulations5 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.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 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

See T.H., Docket No. 19-1066 (issued January 29, 2020); D.F., Docket No. 18-1337 (issued February 11, 2019); 

Tammy L. Meehan, 53 ECAB 229 (2001).

4

5 U.S.C. § 8107.

5

20 C.F.R. § 10.404.

6

Id.

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

2.808.5a (March 2017); id. at Chapter 3.700.2 and Exhibit 1 (January 2010).

8 A.M.A., Guides 449, Table 15-23.
6

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

ADLs.9

In determining impairment for the upper extremities under the sixth edition of the A.M.A., 

Guides, an evaluator must identify the CDX, which is then adjusted by a GMFH, GMPE, and/or

GMCS.10 The net adjustment formula is (GMFH - CDX) + (GMPE - CDX) + (GMCS - CDX).11 

Evaluators are directed to provide reasons for their impairment choices, including the choices of 

diagnoses from regional grids, and calculations of modifier scores. 12

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.13

ANALYSIS -- ISSUE 1

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

In denying appellant’s schedule award claim, OWCP incorrectly found that the DMA’s 

reports established that appellant had no greater permanent impairment of his left upper extremity, 

as he had previously received schedule award compensation for permanent impairment of his left 

upper extremity. The case record indicates that appellant previously received schedule award 

compensation for 7 percent permanent impairment of the right lower extremity, 3 percent 

permanent impairment of the right upper extremity, and 24 percent permanent impairment of the 

left lower extremity. The case record does not establish that he previously received a schedule 

award for permanent impairment of his left upper extremity. The Board therefore finds that 

appellant is entitled to a schedule award for his left upper extremity, based upon the medical 

evidence of record. 

Appellant submitted reports dated November 4, 2020 from Dr. Quraishi who opined that 

appellant had two percent permanent impairment of the left upper extremity in accordance with 

the sixth edition of the A.M.A., Guides based on the DBI methodology for the elbow and wrist. 

However, his one percent impairment rating for the left wrist is of diminished probative value as

Dr. Quraishi assigned a GMCS of 1 due to conduction sensory delay when the record did not 

contain electrodiagnostic studies at the time of his impairment evaluation. 

On March 7, 2021 Dr. Slutsky, the DMA, utilized the findings provided by Dr. Quraishi in 

his November 4, 2020 report to calculate appellant’s impairment under the DBI method and found 

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.

10 Id. at 383-492; see M.P., Docket No. 13-2087 (issued April 8, 2014).

11 Id. at 411.

12 See R.R., Docket No. 17-1947 (issued December 19, 2018);R.V., Docket No. 10-1827 (issued April 1, 2011).

13 Supra note 7 at Chapter 2.808.6(f) (March 2017); see S.H., Docket No. 20-0253 (issued June 17, 2020).
7

one percent permanent impairment of the left wrist and one percent permanent impairment of the 

left elbow. Further he properly found that peripheral nerve compression could not be rated using 

the ROM impairment method as it was rated under the DBI method in Table 15-23. The DMA 

properly found that Dr. Quraishi did not provide three sets of ROM measurements as required by 

the A.M.A., Guides. Additionally, he used the ROM method and opined that appellant had zero 

percent permanent impairment of the left elbow. The DMA explained that the difference between 

his and Dr. Quraishi’s impairment ratings was that Dr. Quraishi assigned a grade modifier of 1 for 

GMCS due to an apparent conduction delay in rating appellant’s left wrist impairment when there 

were no electrodiagnostic studies of record. He related, however, that his left wrist impairment 

rating could change if electrodiagnostic studies became available. The DMA determined that 

appellant’s date of MMI was November 4, 2020. 

In a May 2, 2021 response to OWCP’s April 6, 2021 request to review the November 20, 

2019 EMG/NCV study, the DMA properly reported the EMG/NCV study provided normal results

and opined that appellant had zero percent permanent impairment of the left wrist based on a 

diagnosis of left cubital tunnel syndrome. He also reiterated his prior impairment calculations

based on the diagnoses of left CTS and left lateral epicondylitis and opinion that appellant had one 

percent permanent impairment of the left upper extremity for each diagnosis.

The Board finds that the DMA, properly applied the A.M.A., Guides and provided rationale 

to explain his opinion that appellant had one percent permanent impairment of the left upper 

extremity due to permanent impairment of his elbow for the diagnosis of left lateral epicondylitis 

and one percent permanent impairment of the left upper extremity due to permanent impairment 

of his wrist based on the diagnosis of CTS. However, the effects of multiple impairments are 

accounted for by use of the Combined Values Chart of the A.M.A., Guides at page 604,.14 The 

DMA did not indicate that he utilized the Combined Values Chart on page 604 to combine the two 

impairment values for the left upper extremity.15 This case will therefore be remanded for OWCP 

to obtain a supplemental opinion from the DMA, which explains how appellant’s left upper 

extremity values are to be combined. 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.

16

 

14 See the A.M.A., Guides 22-23 and 604.

15 P.J., Docket No. 20-0549 (issued December 18, 2020).

16 In light of the Board’s disposition of Issue 1, Issue 2 is rendered moot.
8

ORDER

IT IS HEREBY ORDERED THAT the June 4 and May 27, 2021 decisions of the Office 

of Workers’ Compensation Programs are set aside and remanded for additional development 

consistent with this decision.

Issued: August 21, 2023

Washington, DC

Alec J. Koromilas, Chief Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Janice B. Askin, Judge

Employees’ Compensation Appeals Board