United States Department of Labor

Employees’ Compensation Appeals Board

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B.H., Appellant

and

DEPARTMENT OF HOMELAND SECURITY, 

IMMIGRATION & CUSTOMS 

ENFORCEMENT, Laredo, TX, Employer

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Docket No. 21-1110

Issued: March 3, 2022

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

JANICE B. ASKIN, Judge

PATRICIA H. FITZGERALD, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On July 8, 2021 appellant filed a timely appeal from a June 30, 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.

ISSUE

The issue is whether appellant met his burden of proof to establish permanent impairment 

of a scheduled member or function of the body, warranting a schedule award.

FACTUAL HISTORY

On February 25, 2020 appellant, then a 40-year-old criminal investigator, filed a traumatic 

injury claim (Form CA-1) alleging that on January 29, 2020, he injured his right wrist when

1

5 U.S.C. § 8101 et seq.
2

attempting to perform a bridge maneuver during survival training while in the performance of duty. 

He asserted that he heard and felt something “pop” in his right wrist.

On May 14, 2020 OWCP accepted the claim for sprain of unspecified part of right wrist 

and hand, and other instability of the right wrist.

In a May 21, 2020 report, Dr. Michael Jones, a Board-certified orthopedic surgeon 

specializing in surgery of the hand, provided a history of injury and treatment. On examination of 

the right upper extremity, he noted mild subluxation of the ulna with manipulation with the forearm 

in full supination. Dr. Jones diagnosed a right wrist sprain. He recommended an MRI scan of the 

right wrist to assess whether the TFCC remained detached at the insertion of the ulnar fovea.

A June 3, 2020 MRI scan of the right wrist demonstrated a TFCC tear at its ulnar 

attachment with a small bony flake and fluid around the ulnar styloid, small central perforation of 

the TFCC with fluid in the distal radioulnar joint, tears of the ulnar collateral and radial collateral 

ligaments, thickening and mild intrasubstance increased thickening and mild intrasu bstance 

increased signal in the extensor carpi ulnaris tendon compatible with tendinosis, and a small 

amount of fluid in the carpometacarpal joint of the right thumb. 

In a June 17, 2020 report, Dr. Jones noted that appellant experienced intermittent slight 

soreness on the ulnar side of the right wrist, which appellant attributed to his return to full duty. 

On examination, he found no abnormalities of the right wrist. Dr. Jones returned appellant to fullduty work with no restrictions.

In a June 17, 2020 Form OWCP-5c, Dr. Jones diagnosed a right wrist sprain with 

instability. He returned appellant to full-duty work with no restrictions.

On June 17, 2020 Dr. Jones referred appellant for an impairment rating. On June 26, 2020

his office requested OWCP authorization for an impairment rating to be performed by Snowden 

Orthopedic and Occupational Rehabilitation. 

In a July 21, 2020 impairment rating, Thomas I. Washington, a physical therapist with 

Snowden Orthopedic and Occupational Rehabilitation, reviewed a history of injury and treatment. 

On examination of the right upper extremity, he observed right wrist flexion at 50 degrees, right 

wrist extension at 40 degrees, radial deviation at 15 degrees, ulnar deviation at 25 degrees, forearm 

supination at 75 degrees, and forearm pronation at 70 degrees. Appellant completed a QuickDASH 

questionnaire, scored at 18. Mr. Washington provided an impairment rating referring to the sixth 

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

(A.M.A., Guides),2 utilizing the diagnosis-based impairment (DBI) method, to find that, under

Table 15-3, page 396, the class of diagnosis (CDX) for TFCC injury with residual findings, 

resulted in a class 1 impairment with a default value of eight. He assigned a grade modifier for 

functional history (GMFH) of 1 according to Section 15.3a, page 406 of the A.M.A., Guides, based 

on his clinical observations and functional history, a grade modifier for physical examination 

(GMPE) of 1 according to Table 15-8, page 408, for minimal palpatory findings consistently 

documents, and a grade modifier for clinical studies of (GMCS) of 1 for June 3, 2020 MRI findings

2 A.M.A., Guides(6th ed. 2009). Table 15-3 is entitled “Wrist Regional Grid: Upper Extremity Impairments.”
3

according to Table 15-9, page 410. Applying the net adjustment formula, (GMFH - CDX) + 

(GMPE - CDX) + (GMCS - CDX), or (1-1) + (1-1) + (1-1) = 0, Mr. Washington calculated a net 

adjustment of zero. He therefore found an eight percent permanent impairment of the right upper 

extremity. 

On September 9, 2020 appellant filed a claim for compensation (Form CA-7) for a schedule 

award. 

In a development letter dated September 16, 2020, OWCP advised appellant of the 

additional evidence needed to establish his schedule award claim. It noted that the impairment 

rating received was insufficient to support his claim as it had not been countersigned by a qualified

physician. OWCP requested that appellant submit his physician’s opinion as to whether appellant 

had attained maximum medical improvement (MMI), the date MMI had been reached, the clinical 

findings indicating that the employment condition had reached a fixed and stable state, a detailed 

description of all pertinent findings, and a final rating of permanent impairment according to the 

applicable criteria of the A.M.A., Guides. It afforded him 30 days to respond.

On October 14, 2020 Dr. Jones examined appellant, noted findings, and provided ROM 

measurements of the hand and wrist. He opined that appellant had attained MMI. Dr. Jones

reviewed the impairment rating performed by Mr. Washington and concurred with the rating. He

maintained appellant on full duty with no physical restrictions.

On November 10, 2020 OWCP referred the case record, along with a statement of accepted 

facts (SOAF) noting Mr. Washington’s July 21, 2020 impairment rating, to Dr. Arthur S. Harris, 

a Board-certified orthopedic surgeon serving as a District Medical Adviser (DMA), for a 

permanent impairment rating of the right upper extremity. 

Dr. Harris submitted a May 11, 2021 report in which he found that appellant had attained 

MMI as of the July 21, 2020 impairment evaluation. He reviewed Mr. Washington’s calculations 

and references to the A.M.A., Guides, and concurred with the methodology and calculations as 

presented. Dr. Harris found that appellant had eight percent permanent impairment of the right 

upper extremity utilizing the DBI method, based on the diagnosed right wrist TFCC tear. He

commented that the range of motion (ROM) rating method would have also resulted in an eight

percent permanent impairment of the right upper extremity. 

By decision dated June 30, 2021, OWCP denied appellant’s schedule award claim, finding 

that the medical evidence of record did not support permanent impairment of a scheduled member 

or function of the body. 

LEGAL PRECEDENT

The schedule award provisions of FECA3 and its implementing federal regulations,4 set 

forth the number of weeks of compensation payable to employees sustaining permanent 

3

Supra note 1.

4

20 C.F.R. § 10.404.
4

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 loss of a member shall be determined.

The method used in making such a 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 the claimant’s burden of proof to establish permanent impairment of a scheduled 

member or function of the body as a result of an employment injury.7 OWCP’s 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, 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.

8

In addressing upper extremity impairments, the sixth edition requires identification of the 

impairment CDX, which is then adjusted by GMFH, GMPE, and GMCS. 9 The net adjustment 

formula is (GMFH - CDX) + (GMPE - CDX) + (GMCS - CDX).10

The A.M.A., Guides also provide that ROM impairment methodology is to be used as a 

stand-alone rating for upper extremity impairments when other grids direct its use or when no other 

DBI sections are applicable.11 If ROM is used as a stand-alone approach, the total of motion 

impairment for all units of function must be calculated. All values for the joint are measured and 

added.12 Adjustments for functional history may be made if the evaluator determines that the 

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 2.808.5(a) (March 2017);see also id. at Chapter 3.700, Exhibit 1 (January 2010).

6

See K.J., Docket No. 19-1492 (issued February 26, 2020); P.R., Docket No. 19-0022 (issued April9, 2018);

Isidoro Rivera, 12 ECAB 348 (1961).

7

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).

8

See 5 U.S.C. § 8101(19); J.K., Docket Nos. 19-1420 and 19-1422 (issued August 12, 2020); FrancescoC. 

Veneziani, 48 ECAB 572 (1997).

9

Supra note 2 at 383-492.

10 Id. at 411.

11 Id. at 461.

12 Id. at 473.
5

resulting impairment does not adequately reflect functional loss and functional reports are 

determined to be reliable.13

OWCP issued FECA Bulletin No. 17-06 to explain the use of the DBI methodology versus

the ROM methodology for rating of upper extremity impairments.14 Regarding the application of 

ROM or DBI impairment methodologies in rating permanent impairment of the upper extremities, 

FECA Bulletin No. 17-06 provides in pertinent part:

“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.,] 

Guidesidentify a diagnosis that can alternatively be rated by ROM. If the [A.M.A.,] 

Guides allow for the use of both the DBI and ROM methods to calculate an 

impairment rating for the diagnosis in question, the method producing the higher 

rating should be used.” (Emphasis in the original.)

15

The Bulletin further advises:

“If the rating physician provided an assessment using the ROM method and the 

[A.M.A.,] Guides allow for use of ROM for the diagnosis in question, the DMA 

should independently calculate impairment using both the ROM and DBI methods 

and identify the higher rating for the CE.”

16

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

should be routed to a 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.17

ANALYSIS

The Board finds that appellant has established that he sustained eight percent permanent 

impairment of the right upper extremity, warranting a schedule award.

The record establishes that on June 26, 2020, Dr. Jones, a Board-certified orthopedic 

surgeon specializing in surgery of the hand, referred appellant for an impairment rating by 

Snowden Orthopedic and Occupational Rehabilitation which was performed by Mr. Washington, 

a physical therapist, on July 21, 2020. On October 14, 2020 Dr. Jones examined appellant, noted 

13 Id. at 474.

14 FECABulletin No. 17-06 (May 8, 2017).

15 Id.

16 Id.;see also H.H., Docket No. 19-1530 (issued June26, 2020);A.G., Docket No. 18-0329 (issued July 26, 2018).

17 Supra note 5 at Chapter 2.808.6(f); J.M., Docket No. 20-0602 (issued October 8, 2021); P.W., Docket No. 

19-1493 (issued August 12, 2020).
6

findings, and provided ROM measurements of the hand and wrist. He opined that appellant had 

attained MMI. Dr. Jones reviewed the impairment rating performed by Mr. Washington and 

concurred with the rating.

18

Consistent with its procedures, OWCP properly referred the case record to Dr. Harris, 

serving as DMA, for an opinion regarding appellant’s permanent impairment in accordance with 

the sixth edition of the A.M.A., Guides.

19

 In his May 11, 2021 report, Dr. Harris agreed that 

appellant had sustained an eight percent permanent impairment of the right upper extremity based 

on the diagnosed TFCC tear.

The Board finds that the DMA, Dr. Harris, properly considered the findings contained in 

the July 21, 2020 impairment evaluation, as reviewed and approved by Dr. Jones, and explained 

that appellant’s current impairment was eight percent total permanent impairment of the right 

upper extremity based on the diagnosed right wrist TFCC tear. In addition, the DMA properly 

utilized the DBI method and considered the ROM method to rate appellant’s accepted upper 

extremity condition pursuant to FECA Bulletin No. 17-06. 

Therefore, the Board finds that appellant has established eight percent permanent 

impairment of the right upper extremity, based upon the reports of Dr. Jones and DMA Dr. Harris. 

Consequently, OWCP’s June 30, 2021 decision must be reversed, and the case returned to OWCP 

for payment of the schedule award for an eight percent permanent impairment of the right upper 

extremity.

CONCLUSION

The Board finds that appellant has established that he sustained eight percent permanent 

impairment of the right upper extremity, warranting a schedule award.

18 The Board has held that a report may be considered as probative medical evidence when either signed or reviewed 

by a qualified physician. MertonJ. Sills, 39 ECAB 572, 575 (1988); see also D.J., Docket No. 21-0414 (issued 

October 14, 2021); R.H., Docket No. 20-1684 (issued August 27, 2021); M.W., Docket No. 19-1667 (issued 

June 29, 2020).

19 P.T., Docket No. 21-0138 (issued June14, 2021); see S.C., Docket No. 20-0769 (issued January 12, 2021).
7

ORDER

IT IS HEREBY ORDERED THAT the June 30, 2021 decision of the Office of Workers’

Compensation Programs is reversed.

Issued: March 3, 2022

Washington, DC

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Patricia H. Fitzgerald, Alternate Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board