United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

S.B., Appellant

and

U.S. POSTAL SERVICE, CAROL STREAM 

PROCESSING & DISTRIBUTION CENTER, 

Carol Stream, IL, Employer

__________________________________________

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Docket No. 22-0148

Issued: March 24, 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

VALERIE D. EVANS-HARRELL, Alternate Judge

JAMES D. McGINLEY, Alternate Judge

JURISDICTION

On November 8, 2021 appellant filed a timely appeal from a November 3, 2021 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.2

1

5 U.S.C. § 8101 et seq.

2 The Board notes that, following the November 3, 2021 decision, OWCP received additional evidence. 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 two

percent permanent impairment of her left upper extremity and two percent permanent impairment 

of her right upper extremity, for which she previously received schedule award compensation.

FACTUAL HISTORY

On November 14, 2017 appellant, then a 53-year-old postage due clerk, filed an 

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

syndrome (CTS) and left cubital tunnel syndrome as a result of factors of her federal employment, 

including repetitive movements of her upper extremity.

3

 She noted that she first became aware of 

her condition on September 14, 2017 and realized its relation to her federal employment on 

November 14, 2017. Appellant stopped work on November 17, 2017.

By decision dated January 10, 2018, OWCP accepted appellant’s claim for bilateral CTS

and left cubital tunnel syndrome, which was later expanded to also include a lesion of left ulnar 

nerve and other synovitis and tenosynovitis of the right hand. OWCP paid her wage-loss 

compensation on the supplemental rolls commencing March 16, 2018, and on the periodic rolls 

commencing July 22, 2018.

Dr. Eugene Lopez, Jr., a Board-certified orthopedic surgeon and sports medicine specialist,

performed surgery including microscopic decompression of the median nerve, flexor 

tenosynovectomy, and median internal epineurolysis of appellant’s left wrist on March 16, 2018,

and of her right wrist on August 28, 2018.

On December 11, 2019 Dr. Lopez completed a functional capacity evaluation (FCE) and 

found that appellant could perform work at the light physical demand level, with occasional 

squatting, overhead reaching, and use of the hands for simple grasping, pushing, pulling, and fine 

manipulation.

On January 14, 2020 appellant filed a claim for compensation (Form CA-7) for a schedule 

award. In support of her claim, she submitted a report of even date by Dr. Lopez, who discussed 

the surgeries to her wrists, and indicated that his last physical examination of her wrists on 

November 13, 2019 revealed no swelling, deformity, effusion or tenderness, and that her strength 

was intact. Dr. Lopez opined that she had reached maximum medical improvement (MMI) as of 

November 13, 2019, and also noted that the symptoms she reported during the December 11, 2019

FCE included varying degrees of throbbing and pulsing pain in the right palm, wrist, forearm, and 

pinky finger. He utilized Table 15-23, Entrapment/Compression Neuropathy Impairment, of the 

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

Impairment (A.M.A., Guides)

4 and assigned a grade modifier for clinical studies (GMCS) of 1, a 

3 Appellant previously filed a Form CA-2 on January 3, 2013 alleging bilateral carpal tunnel syndrome due to 

repetitive work duties. OWCP assigned File No. xxxxxx156 and denied the claimby decision dated March 15, 2013.

OWCP has not administratively combined these claims.

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

grade modifier for functional history (GMFH) of 2, and a grade modifier for physical examination 

(GMPE) of 1 for both wrists, which yielded a default upper extremity impairment rating of 2 

percent of the left upper extremity and 2 percent of the right upper extremity due to CTS.

Dr. Lopez noted appellant’s QuickDASH scores were 34.09 bilaterally, which he indicated 

warranted no further modification to the impairment ratings. Dr. Lopez did not find any ratable 

deficits associated with left ulnar neuropathy/cubital tunnel syndrome.

In a letter dated August 19, 2020, Dr. Lopez noted that he last examined appellant on 

June 22, 2020, at which time she related complaints of worsening weakness, aching, throbbing, 

and shooting pains from her wrist to her left elbow. His examination revealed reduced strength,

but improving range of motion and no swelling or deformity in the wrists. Examination of the left 

ulnar nerve at the elbow revealed tenderness to palpation, reduced strength and range of motion, 

and a positive Tinel’s sign. Dr. Lopez reiterated that appellant had reached MMI and was able to 

work with restrictions consistent with the December 11, 2019 FCE.

On July 14, 2021 OWCP routed Dr. Lopez’January 14, 2020 report, along with a statement 

of accepted facts (SOAF) and the case record, to Dr. Morley Slutsky, a physician Board-certified 

in occupational medicine, serving as OWCP’s district medical adviser (DMA), for review and 

evaluation of appellant’s permanent impairment pursuant to the A.M.A., Guides.

5

In a July 28, 2021 report, Dr. Slutsky indicated that he had reviewed the SOAF and

Dr. Lopez’ January 14, 2020 report and that appellant had reached MMI on November 13, 2019. 

He noted that the A.M.A., Guides did not allow for an impairment rating under the range of motion

(ROM) method for CTS and concurred with Dr. Lopez’ rating that she had two percent permanent 

impairment for the right upper extremity under Table 15-23 for residual problems with mild CTS 

(grade modifier 1).

For the left upper extremity, Dr. Slutsky also concurred with Dr. Lopez that appellant had 

two percent impairment of the left upper extremity under Table 15-23 for residual problems with 

mild CTS (grade modifier 1). He noted that the A.M.A., Guides did not allow an impairment 

rating under the ROM methodology for CTS. For the left elbow, Dr. Slutsky referenced page 488

of the sixth edition of the A.M.A., Guides and related that her electrodiagnostic studies were 

normal. He noted that the electromyogram and nerve conduction velocity (EMG/NCV) studies 

did not yield findings in the ulnar nerves sufficient to meet the criteria set forth in the A.M.A., 

Guides at Appendix 15-B on page 449 for rating an impairment due to entrapment/compression 

neuropathy. Dr. Slutsky further noted that Dr. Lopez did not find any ratable deficits associated 

with cubital tunnel syndrome.

By decision dated November 3, 2021, OWCP granted appellant a schedule award for two 

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

of the right upper extremity. The date of MMI was found to be November 13, 2019. The award 

covered a period of 12.48 weeks and ran for the period from October 10, 2021 to January 5, 2022. 

OWCP noted that the weight of the medical evidence rested with Dr. Slutsky as the DMA, who 

applied the A.M.A., Guides to Dr. Lopez’ findings.

5

Id.
4

LEGAL PRECEDENT

The schedule award provisions of FECA6 and its implementing regulations7 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. FECA, however, does not 

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

used in making such determination is a matter which rests in the sound discretion of OWCP. For 

consistent results and to ensure equal justice, 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 OWCP as a standard for evaluation of schedule losses and 

the Board has concurred in such adoption.8 For schedule awards after May 1, 2009, the impairment 

is evaluated under the sixth edition of the A.M.A., Guides, published in 2009.9

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

member or function of the body as a result of an employment injury.10 OWCP procedures provide 

that, to support a schedule award, the file must contain competent medical evidence which shows 

that the impairment has reached a permanent and fixed state and indicates the date on which this 

occurred (date of MMI), describes the impairment in sufficient detail so that it can be visualized 

on review, and computes the percentage of impairment in accordance with the A.M.A., Guides.

11

 

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

Guides, an evaluator must establish the appropriate diagnosis for each part of the upper extremity 

to be rated.12 After a class of diagnosis (CDX) is determined (including identification of a default 

grade value), the impairment class is then adjusted by grade modifiers based on GMFH, GMPE, 

and GMCS.13 The net adjustment formula is (GMFH - CDX) + (GMPE - CDX) + (GMCS -

CDX).14

6

Supra note 1.

7

20 C.F.R. § 10.404.

8

Id.; see also Jacqueline S. Harris, 54 ECAB 139 (2002).

9 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).

10 E.D., Docket No. 19-1562 (issued March 3, 2020); Edward Spohr, 54 ECAB 806, 810 (2003); TammyL. Meehan, 

53 ECAB 229 (2001).

11 Supra note 9 at Chapter 2.808.5 (March 2017).

12 M.D., Docket No. 20-0007 (issued May 13, 2020); T.T., Docket No. 18-1622 (issued May14, 2019).

13 A.M.A., Guides 383-492; see M.P., Docket No. 13-2087 (issued April8, 2014).

14 Id. at 411.
5

Regarding the application of ROM or diagnosis-based impairment (DBI) methodologies in 

rating permanent impairment of the upper extremities, FECA Bulletin No. 17-06 provides:

“As the [A.M.A.,] Guides caution that if it is clear to the evaluator evaluating loss 

of ROM that a restricted ROM has an organic basis, three independent 

measurements should be obtained and the greatest ROM should be used for the 

determination of impairment, the CE [claims examiner] should provide this 

information (via the updated instructions noted above) to the rating physician(s).”

15

The FECA Bulletin further advises:

“Upon initial review of a referral for upper extremity impairment evaluation, the 

DMA should identify: (1) the methodology used by the rating physician (i.e., DBI 

or ROM); and (2) whether the applicable tables in Chapter 15 of the [A.M.A.,] 

Guides identify a diagnosis that can alternatively be rated by ROM.”

16

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

(Entrapment/Compression Neuropathy Impairment) and accompanying relevant text.17 In Table

15-23, grade modifier levels (ranging from zero to four) are described for the categories of 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 be modified up or down based on functional scale, an assessment of impact on daily 

living activities (QuickDASH).18

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

should be routed to OWCP’s 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.19

ANALYSIS

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

percent permanent impairment of her left upper extremity and a two percent permanent impairment 

of her right upper extremity, for which she previously received schedule award compensation.

In his January 14, 2020 report, Dr. Lopez opined that appellant had reached MMI as of his 

last evaluation on November 13, 2019. Based upon his examination findings and the results of a 

December 11, 2019 FCE, he opined that she had two percent permanent impairment to her left and 

15 FECA Bulletin No. 17-06 (issued May 8, 2017); V.L., Docket No. 18-0760 (issued November 13, 2018).

16 Id.

17 A.M.A., Guides 449.

18 Id. at 448-49.

19 See supra note 8 at Chapter 2.808.6f)(February2013). See alsoJ.T., Docket No. 17-1465 (issued September 25, 

2019); C.K., Docket No. 09-2371 (issued August18, 2010); Frantz Ghassan, 57 ECAB 349 (2006).
6

right upper extremities based on her bilateral CTS diagnosis. Utilizing the DBI methodology,

Dr. Lopez explained that, according to Table 15-23 of the A.M.A., Guides appellant had a GMCS 

of 1, a GMFH of 2, and a GMPE of 1, which yielded a default upper extremity impairment rating 

of two percent in each upper extremity due to CTS. He noted that her QuickDASH score did not 

result in any modification to the impairment rating, and also that he did not find any ratable deficits

associated with left cubital tunnel syndrome.

Dr. Slutsky, OWCP’s DMA, reviewed and concurred with Dr. Lopez’ two percent 

impairment rating for each of the upper extremities based on the diagnosis of CTS. He noted that 

the A.M.A., Guides do not allow an impairment rating under the ROM method for CTS.

Dr. Slutsky further noted that the EMG/NCV studies did not yield findings in the ulnar nerves 

sufficient to meet the criteria for rating an impairment due to entrapment/compression neuropathy,

and opined that there was no evidence of a ratable deficit associated with left cubital tunnel

syndrome. 

The Board finds that the DMA, Dr. Slutsky, properly applied the A.M.A., Guides to the 

findings of Dr. Lopez, and explained that appellant’s current impairment was two percent left 

upper extremity permanent impairment based on left CTS, and two percent right upper extremity 

impairment based on right CTS. Dr. Slutsky accurately summarized the relevant medical 

evidence, and reached conclusions about her condition which comported with the findings

therein.

20

 In addition, the DMA properly utilized the DBI method to rate appellant’s accepted 

upper extremity conditions. As the DMA’s report is detailed, well rationalized, and based on a 

proper factual background, his opinion represents the weight of the medical evidence.21 Thus, the 

Board finds that appellant has not met her burden of proof to establish greater right or left upper 

extremity permanent impairment than that which was previously awarded.

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 permanent impairment.

CONCLUSION

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

percent permanent impairment of her left upper extremity, and two percent permanent impairment 

of her right upper extremity, for which she previously received schedule award compensation.

20 See M.D., Docket No. 20-0007 (issued May 13, 2020); M.S., Docket No. 19-1011 (issued October 29, 2019); 

W.H., Docket No. 19-0102 (issued June 21, 2019); J.M., Docket No. 18-1387 (issued February 1, 2019).

21 See B.B., Docket No. 2-1187 (issued November 18, 2021);see alsoM.D., id., D.S., Docket No. 18-1816 (issued 

June 20, 2019).
7

ORDER

IT IS HEREBY ORDERED THAT the November 3, 2021 decision of the Office of 

Workers’ Compensation Programs is affirmed.

Issued: March 24, 2023

Washington, DC

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board

James D. McGinley, Alternate Judge

Employees’ Compensation Appeals Board