United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

M.F., Appellant

and

U.S. POSTAL SERVICE, BALTIMORE POST 

OFFICE, Baltimore, MD, Employer

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Docket No. 23-0881

Issued: December 6, 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 June 12, 2023 appellant filed a timely appeal from a May 18, 2023 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 greater than five 

percent permanent impairment of her left upper extremity or five percent permanent impairment 

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

FACTUAL HISTORY

On September 3, 1997 appellant, then a 44-year-old clerk, filed an occupational disease 

claim (Form CA-2) alleging that she developed pain, tingling, and stiffness in her fingers, hands, 

1

5 U.S.C. § 8101 et seq.
2

and wrists due to repetitive factors of her federal employment. She noted that she first became 

aware of her condition on May 8, 1997, and realized its relation to her federal employment on

May 22, 1997. OWCP accepted the claim for bilateral carpal tunnel syndrome (CTS). On June 8, 

2006 appellant underwent OWCP-authorized left carpal tunnel release surgery. On June 17, 2009 

she underwent OWCP-authorized right carpal tunnel release surgery. OWCP initially paid 

appellant wage-loss compensation on the supplemental rolls commencing June 8, 2006, and then 

on the periodic rolls commencing May 13, 2007.

On April 19, 2022 appellant filed a claim for compensation (Form CA-7) for a schedule 

award.

In an April 19, 2022 report, Dr. Kenneth R. Lippman, an orthopedic surgeon, examined 

appellant’s wrists and hands and found well-healed carpal tunnel incisions. He related that her 

hands were tender bilaterally and her grip was very weak and dysfunctional bilaterally. On 

examination, appellant experienced discomfort with Tinel’s testing and Phalen’s testing bilaterally;

her sensory testing revealed shooting pains that radiated through the fingers; and she reported 

tingling, numbness, and inability to hold or get a good grip. Dr. Lippman diagnosed 

entrapment/compression neuropathy and opined that this condition interfered with appellant’s

functional use of both hands and limited her vocational and activities of daily living abilities. He 

referred to “the AMA Guidelines” and opined that his diagnosis resulted in 35 percent impairment 

of the right upper extremity and 35 percent impairment of the left upper extremity. 

In a December 29, 2022 report, Dr. Nathan Hammel, a Board-certified orthopedic surgeon 

and district medical adviser (DMA), reviewed Dr. Lippman’s report. He noted the accepted 

condition of bilateral carpal tunnel syndrome and referred to the sixth edition of the A.M.A., 

Guides2 and noted that entrapment neuropathy is rated using Table 15-23, Entrapment/

Compression Neuropathy Impairment (at page 449). Dr. Hammel noted that the grade modifier 

for test findings/clinical studies (GMCS) was 1 for conduction delay, the grade modifier for 

functional history (GMFH) was 2 for significant intermediate symptoms, and the grade modifier 

for physical examination (GMPE) was 2 for decreased sensation. He explained that the average 

of the grade modifiers was 2, which resulted in 5 percent bilateral upper extremity impairment,

according to Table 15-23. In response to the request that he comment on Dr. Lippman’s report, 

Dr. Hammel indicated that it was “completely unclear” how Dr. Lippman opined that appellant 

had 35 percent bilateral upper extremity impairment, given that Table 15-23 only allows a 

maximum impairment rating of 9 percent. He opined that appellant reached maximum medical 

improvement (MMI) on April 19, 2022, the date of Dr. Lippman’s report.

In a February 7, 2023 report, Dr. Lippman noted that appellant agreed with his impairment 

rating of 35 percent and that appellant suggested that “we get a book to calculate the award.” He 

indicated that due to the discrepancy in the rating, it would be reasonable to obtain an independent 

third-party rating.

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

(6th ed. 2009).
3

On February 28, 2023 OWCP referred appellant for a second opinion examination with

Dr. Brian Lumsden, a Board-certified orthopedic surgeon. 

In a March 24, 2023 report, Dr. Lumsden noted appellant’s history of injury, medical 

course, and the diagnosis of bilateral carpal tunnel syndrome. He examined her and related that 

her shoulder, biceps, triceps, elbow, forearm, wrist, hand, grip, and manual dexterity motion were 

normal. Dr. Lumsden also noted appropriate composite fist flexors and extensors, grip was poor 

effort to 3+/5, and sensory was diminished to the thumb index and middle, moderately on the right 

and mildly on the left, with no cubital tunnel involvement. He noted that MMI was reached on 

April 19, 2022, per the DMA’s report. Dr. Lumsden referred to the A.M.A., Guides, Table 15-23, 

at pages 448-49, for entrapment compression neuropathy impairment. He assessed GMFH of 3,

and GMPE of 3, based on appellant’s constant symptoms and the objective examination findings 

of some thenar atrophy and weakness, and complaints of sensation. Dr. Lumsden noted that his 

assignment of 3 for GMFH and 3 for GMPE were a grade above what the DMA assessed. He did 

not provide a grade modifier for test findings, explaining that there were no updated clinical 

studies. Dr. Lumsden explained that his grade modifiers of 3 for GMFH and 3 for GMPE resulted 

in an average grade modifier of 3. He noted that in Table 15-23, the grade modifier of 3 

corresponds with an impairment range of seven to nine percent, with eight percent being the default 

value; however, he opined that, “realistically this claimant actually falls to a seven percent

impairment relative to the hands bilaterally.”

On April 10, 2023 OWCP requested that the DMA provide an addendum to his 

December 29, 2022 report.

In an April 18, 2023 report, Dr. Hammel noted that the range of motion (ROM)

methodology provided no impairment, as the ROM was full. With regard to the diagnosis-based 

impairment (DBI) methodology, the DMA noted that carpal tunnel syndrome is rated using Table 

15-23, page 499 of the A.M.A., Guides, for Entrapment/Compression Neuropathy Impairment. 

Dr. Hammel assigned a GMFH of 3, based on a history of functional limitations, and a GMPE of 

3 for physical findings, based on atrophy and decreased sensation. The DMA also assigned a

GMCS of 1 for test findings, based on the preoperative nerve conduction study, and noted that 

averaging the three grade modifiers yielded 2, which resulted in five percent bilateral upper 

extremity impairment.

On April 25 and May 3, 2023 OWCP requested that the DMA, Dr. Hammel, clarify his 

April 18, 2013 report. 

In a May 12, 2023 report, Dr. Hammel indicated that he reviewed Dr. Lumsden’s report 

and opined that Dr. Lumsden did not apply the A.M.A., Guides correctly. He explained that

Dr. Lumsden did not utilize the preoperative nerve conduction velocity study and did not provide 

a GMCS, which should have been 1. Dr. Hammel further explained excluding the GMCS elevated

the impairment rating. He explained that the A.M.A., Guides mandate use of a GMCS, which 

results in an average grade modifier of 2 and corresponds to five percent permanent impairment 

of the bilateral upper extremities, according to Table 15-23. Dr. Hammel concurred that MMI was 

reached on April 19, 2022. 
4

By decision dated May 18, 2023, OWCP granted appellant a schedule award for five 

percent permanent impairment of her right upper extremity (right arm) and five percent permanent 

impairment of her left upper extremity (left arm). The period of the award ran for 31.2 weeks from 

January 1 to August 7, 2023. 

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 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. 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 and the Board has concurred in such 

adoption.5 As of May 1, 2009, the sixth edition of the A.M.A., Guides, published in 2009, is used 

to calculate schedule awards.6

In determining impairment under the sixth edition of the A.M.A., Guides, an evaluator must 

identify the impairment class of diagnosis (CDX), which is then adjusted by GMFH, GMPE, and 

GMCS.7 The net adjustment formula is (GMFH - CDX) + (GMPE - CDX) + (GMCS - CDX).8 

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

diagnoses from regional grids, and calculations of modifier scores. 9 

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

15-23, Entrapment/Compression Neuropathy Impairment, and the accompanying relevant text.10 

In Table 15-23, grade modifiers levels (ranging from 0 to 4) are described for the categories clinical 

studies, functional history, and physical examination findings. The grade modifier levels are 

averaged to arrive at the appropriate overall grade modifier level and to identify a default rating 

3

5 U.S.C. § 8107.

4

20 C.F.R. § 10.404.

5

Id. at § 10.404(a); see R.M., Docket No. 20-1278 (issued May 4, 2022); see also Jacqueline S. Harris, 54 ECAB 

139 (2002).

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

2.808.5.a (March 2017); id. at Part 3 --Medical, Schedule Awards, Chapter 3.700.2 and Exhibit 1 (January 2010).

7 A.M.A., Guides 383-492; see M.P., Docket No. 13-2087 (issued April 8, 2014).

8

Id. at 411.

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

10 A.M.A., Guides 448-49; see J.L., Docket No. 22-1299 (issued May 17, 2023); S.B., Docket No. 22-0148 (issued 

March 24, 2023).
5

value. The default rating value is modified up or down based on the Functional Scale section of 

Table 15-23, using a QuickDASH score as an assessment of impact on daily living activities.11

ANALYSIS

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

OWCP referred appellant for a second opinion examination with Dr. Lumsden and in a 

March 24, 2023 report, he also applied Table 15-23 of the A.M.A., Guides for entrapment 

compression neuropathy impairment. Dr. Lumsden calculated an average grade modifier of 3, 

using grade modifiers of 3 for GMFH and GMPE, based on constant symptoms, atrophy, and 

weakness, and noting that he did not include a GMCS because there were no recent clinical studies. 

He computed an average grade modifier of 3, and opined that appellant had seven percent bilateral 

upper extremity impairment. Dr. Lumsden noted that the grade modifier of 3 corresponded to an 

impairment rating range of seven to nine percent, with a default value of 8, and explained that he 

chose seven percent because, “realistically this claimant actually falls to a [seven percent]

impairment relative to the hands bilaterally.” However, the Board notes that A.M.A., Guides at 

page 448 provide that preoperative clinical studies should be used unless postoperative studies

were performed for failure to improve with surgery and the postoperative studies clearly show a 

worsening of the condition. Dr. Lumsden also did not discuss the Functional Scale section of Table 

15-23 and did not provide a QuickDASH score. As such, the Board finds that his report fails to 

comply with the A.M.A., Guides and lacks probative value.12

It is well established that proceedings under FECA are not adversarial in nature, and while 

the employee has the burden of proof to establish entitlement to compensation, OWCP shares 

responsibility in the development of the evidence.13 Once OWCP undertook development of the 

evidence by referring appellant’s case file to a second opinion physician and an OWCP medical 

adviser, it had an obligation to do a complete job and obtain a proper evaluation and report that 

would resolve the issue in this case.14 

This case must, therefore, be remanded to OWCP for referral of the case record and a 

SOAF to Dr. Lumsden, the second opinion physician, to address appellant’s bilateral upper 

extremity permanent impairment rating based on all of appellant’s findings, including her 

preoperative clinical studies, the Functional Scale and QuickDash score. After this and such other 

further development as deemed necessary, OWCP shall issue a de novo decision on appellant’s 

schedule award claim.

11 Id. at 448-49.

12 Id.

13 See B.W., Docket No. 20-1441 (issued July 30, 2021); see W.W., Docket No. 18-0093 (issued October 9, 2018);

Donald R. Gervasi, 57 ECAB 281, 286 (2005); William J. Cantrell, 34 ECAB 1233, 1237 (1983).

14 See G.M., Docket No. 19-1931 (issued May 28, 2020); PeterC. Belkind, 56 ECAB 580 (2005); Ayanle A. Hashi, 

56 ECAB 234 (2004).
6

CONCLUSION

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

ORDER

IT IS HEREBY ORDERED THAT the May 18, 2023 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: December 6, 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