United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

A.B., Appellant

and

DEPARTMENT OF THE AIR FORCE, 

ILLINOIS AIR NATIONAL GUARD, SCOTT 

AIR FORCE BASE, IL, Employer

__________________________________________

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Docket No. 22-1332

Issued: June 27, 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

VALERIE D. EVANS-HARRELL, Alternate Judge

JAMES D. McGINLEY, Alternate Judge

JURISDICTION

On September 20, 2022 appellant filed a timely appeal from a May 3, 2022 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

ISSUE

The issue is whether appellant has met his burden of proof to establish greater than 16

percent permanent impairment of his left upper extremity, and 23 percent permanent impairment 

of the right upper extremity for which he previously received schedule awa rd compensation.

1

5 U.S.C. § 8101 et seq.

2 The Board notes that, following the May 3, 2022 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

FACTUAL HISTORY

This case has previously been before the Board.

3

 The facts and circumstances as set forth 

in the Board’s prior decisions are incorporated herein by reference. The relevant facts are as 

follows.

On November 2, 2005 appellant, then a 34-year-old aircraft mechanic, filed an 

occupational disease claim (Form CA-2) alleging that he developed carpal tunnel syndrome 

causally related to factors of his federal employment. OWCP accepted the claim for bilateral 

carpal tunnel syndrome, bilateral cubital tunnel syndrome, and right lateral epicondylitis.

A September 16, 2005 electromyogram (EMG) and nerve conduction velocity study 

(NCV) revealed findings consistent with right more than left carpal tunnel syndrome, and mild 

bilateral ulnar neuropathy.

On February 10, 2006 appellant underwent right carpal tunnel and cubital tunnel releases. 

On March 2, 2006 he underwent left carpal tunnel and cubital tunnel releases. On October 2, 2006 

appellant had an ulnar nerve neurolysis and anterior subcutaneous transposition of the ulnar nerve 

due to recurrent right cubital tunnel syndrome. The procedures were approved by OWCP. 

Appellant, on January 4, 2007, filed a claim for compensation (Form CA-7) for a schedule 

award.

On May 10, 2007 Dr. Robert W. Wysocki, a Board-certified internist serving as a district 

medical adviser (DMA), found that appellant had 23 percent permanent impairment of the right 

upper extremity due to a sensory deficit in the right median and ulnar nerve distributions, and 16 

percent permanent impairment of the left upper extremity due to a sensory deficit in the left median 

nerve distribution. 

By decision dated July 3, 2007, OWCP granted appellant a schedule award for 16 percent4

permanent impairment of the left upper extremity and 23 percent permanent impairment of the 

right upper extremity pursuant to the fifth edition of the American Medical Association, Guides to 

the Evaluation of Permanent Impairment (A.M.A., Guides).

5 The period of the award ran for 

121.68 weeks from April 19, 2007 to August 16, 2009.6

On March 28, 2010 appellant filed a claim for an additional schedule award (Form CA-7).

3 Docket No. 08-1728 (issued April 10, 2009); Docket No. 16-0706 (issued February 15, 2018).

4 OWCP indicated that the award was for 16.5 percent permanent impairment of the left upper extremity; however, 

this appears to be a typographical error as the schedule award was partially based on 16 percent impairment of the left 

upper extremity. 

5 A.M.A., Guides (5th ed. 2001).

6 By decision dated April 10, 2009, the Board affirmed an April 2, 2008 decision finding that OWCP properly 

calculated appellant’s pay rate for compensation purposes. See Docket No. 08-1728 (issued April 10, 2009).
3

In an October 20, 2011 report, Dr. Michael E. Beatty, a Board-certified plastic surgeon, 

found that appellant had 46 percent bilateral upper extremity permanent impairment. 

On May 13, 2013 Dr. David H. Garelick, a Board-certified orthopedic surgeon serving as 

a DMA, opined that Dr. Beatty’s report was not in conformance with the sixth edition of the 

A.M.A., Guides.

7

 He found that appellant had eight percent permanent impairment of each upper 

extremity due to carpal and cubital tunnel syndrome pursuant to Table 15-23 on page 449 of the 

A.M.A., Guides.

By decision dated July 25, 2013, OWCP denied appellant’s claim for an increased schedule 

award.

On June 5, 2014 OWCP expanded its acceptance of the claim to include bilateral upper 

extremity residual paresthesia and bilateral surgically-treated compressive neuropathies involving 

the median and ulnar nerves.

On May 13, 2015 appellant filed a claim for an additional schedule award (Form CA-7).

In a June 11, 2015 report, Dr. Michael Hellman, an orthopedic surgeon serving as a DMA, 

opined that appellant had three percent permanent impairment of each upper extremity due to 

cubital and carpal tunnel syndrome pursuant to Table 15-23 on page 449 of the A.M.A., Guides. 

He also found an additional one percent right upper extremity permanent impairment for lateral 

epicondylitis under Table 15-4 on page 399. Dr. Hellman advised that appellant had no more than 

the previously awarded 16 percent permanent impairment of the left upper extremity and 23 

percent permanent impairment of the right upper extremity. 

By decision dated June 23, 2015, OWCP denied appellant’s claim for an increased 

schedule award. 

On July 16, 2015 appellant requested reconsideration of the June 23, 2015 schedule award 

decision.

In a July 5, 2015 report, Dr. Robert H. Thompson, a Board-certified vascular surgeon, 

diagnosed bilateral thoracic outlet syndrome due to appellant’s employment duties. He opined 

that most of appellant’s symptoms were related to thoracic outlet syndrome instead of peripheral 

nerve compression syndromes.

By decision dated December 7, 2015, OWCP denied appellant’s request for an increased 

schedule award.8

On February 26, 2016 appellant appealed to the Board.

On June 2, 2016 OWCP expanded its acceptance of the claim to include thoracic outlet 

syndrome. 

7 A.M.A., Guides (6th ed. 2009).

8 On November 21, 2015 Dr. Hellman reiterated the findings from his June 11, 2015 report. 
4

By decision dated February 15, 2018, the Board set aside the December 7, 2015 schedule 

award decision. Citing T.H.,

9

it remanded the case for OWCP to develop a consistent method for 

calculating upper extremity impairments.

10

In a development letter dated March 23, 2018, OWCP requested that appellant submit an 

opinion from his physician addressing the extent of any permanent impairment in accordance with 

the sixth edition of the A.M.A., Guides. It afforded him 30 days to submit the required evidence. 

Appellant did not respond within the time allotted.

By decision dated May 3, 2018, OWCP denied appellant’s claim for an increased schedule 

award.

On July 17, 2018 appellant filed a Form CA-7 requesting an increased schedule award. 

In a development letter dated October 5, 2018, OWCP requested that appellant submit an 

opinion from his physician addressing the extent of any permanent impairment in accordance with 

the sixth edition of the A.M.A., Guides. It afforded him 30 days to submit the required evidence. 

In a December 27, 2018 memorandum of telephone call (Form CA-110), appellant advised 

that his physician would not perform an impairment rating without prior reimbursement. 

On January 14, 2021 OWCP referred appellant to Dr. Michael Mayron, a Board-certified 

neurologist, for a second opinion examination. 

In a report dated March 18, 2021, Dr. Mayron diagnosed a history of bilateral carpal and 

cubital tunnel syndromes treated with surgical releases and a history of neurogenic thoracic outlet 

syndrome treated with surgery on July 25, 2016. On examination he found full and symmetrical 

motor power and decreased sensation to pinprick in the bilateral upper extremities. Dr. Mayron 

opined that the diagnoses of carpal and cubital tunnel syndrome were minor conditions and 

attributed appellant’s symptoms to his thoracic outlet syndrome. He noted that his physical 

examination currently revealed “a sensory deficit to pinprick in the distribution of the lower 

brachial plexus bilaterally.” Dr. Mayron identified the class of diagnosis (CDX) as a Class 1 

brachial plexus impairment due to mild sensory and motor deficit, which yielded a default 

impairment of 13 percent according to Table 15-20 on page 434 of the A.M.A., Guides. He applied 

grade modifiers and found a net adjustment of negative one, or seven percent permanent 

impairment of each upper extremity.

On April 21, 2021 Dr. Michael M. Katz, a Board-certified orthopedic surgeon serving as a 

DMA, opined that Dr. Mayron failed to explain his rating for a mild motor deficit given his 

examination findings of full motor power bilaterally. He further found that Dr. Mayron’s finding 

of seven percent impairment due to a mild sensory and motor deficit did not correlate with Table 

15-20, and that he did not provide sufficient detail to confirm the diagnosis of a brachial plexus 

9 Docket No. 14-0943 (issued November 25, 2016).

10 Docket No. 16-0706 (issued February 15, 2018).
5

deficit. Dr. Katz recommended that OWCP refer appellant for another second opinion 

examination.

On June 11, 2021 OWCP referred appellant to Dr. Michael H. Ralph, a Board-certified 

orthopedic surgeon, for a second opinion examination. It provided a statement of accepted facts 

(SOAF), describing the accepted conditions and appellant’s work history in private employment 

as a teacher beginning in August 2017.

In a report dated July 8, 2021, Dr. Ralph reviewed the accepted conditions and appellant’s 

surgical history. On examination he found vigorous grip strength bilaterally, a negative Phalen’s 

test, no thenar or hypothenar atrophy, a negative Tinel’s sign at the elbow, and no atrophy of the 

upper extremities. Dr. Ralph measured range of motion (ROM) of the wrists, elbows, and 

shoulders, three times each, which he found yielded normal findings. He further found a negative 

impingement test bilaterally, and noted that appellant’s only subjective complaint was occasional 

arm pain. Dr. Ralph advised that appellant had no pain over the lateral epicondyle and no fatigue 

on the right after his thoracic outlet surgery. He indicated that appellant’s left side was “not that 

problematic for him....” Dr. Ralph found that he had no impairment due to resolved lateral 

epicondylitis, no findings of either right or left carpal tunnel syndrome, and no impairment due to 

cubital tunnel syndrome. He indicated that postsurgical diagnostic tests were normal. Dr. Ralph

found that appellant had no impairment due to the lesions of his brachial plexus, or bilateral

thoracic outlet syndrome. He asserted that the surgery for thoracic outlet syndrome would not 

cause any impairment. Dr. Ralph noted that the release of the pectoralis minor might cause 

weakness, but that he had not found weakness on examination. He indicated that the lateral 

epicondylitis had resolved after bilateral releases. Dr. Ralph advised that he believed that appellant 

had only experienced mild carpal tunnel syndrome. He concluded that appellant had no 

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

On October 15, 2021 Dr. Katz concurred with Dr. Ralph’s conclusion that appellant had 

no ratable impairment. He noted that, under Table 15-23, preoperative studies should be used to 

document median and ulnar nerve delays. Dr. Katz indicated that he used the results from the 

2005 study which showed medial and ulnar nerve delays. For the conditions of bilateral medial 

and ulnar nerve entrapment, he applied a grade modifier of one due to the test findings showing 

electrodiagnostic delay, a grade modifier of zero for physical findings, and a grade modifier of 

zero for history, which he averaged to find a zero percent impairment according to Table 15-23 on 

page 449 of the A.M.A., Guides. Dr. Katz further found that appellant had no impairment due to 

right epicondylitis using Table 15-4 on page 399, or a bilateral brachial plexus impairment using 

Table 15-20 on page 434, as he had no objective abnormal findings as of the date of maximum 

medical improvement (MMI). He noted that Dr. Ralph had measured normal motion, and thus 

there was no impairment due to loss of ROM. Dr. Katz determined that appellant had reached 

MMI on July 7, 2021, the date of Dr. Ralph’s examination.

By decision dated October 22, 2021, OWCP denied appellant’s claim for an increased 

schedule award. 

On November 2, 2021 appellant requested an oral hearing before a representative of 

OWCP’s Branch of Hearings and Review. 
6

A telephonic hearing was held on February 16, 2022. Appellant described his impairment 

evaluations, and noted that Dr. Ralph found that he did not have thoracic outlet syndrome even 

though he was discharged from the military due to the condition. 

By decision dated May 3, 2022, OWCP’s hearing representative affirmed the October 22, 

2021 decision. 

LEGAL PRECEDENT

The schedule award provision of FECA,11 and its implementing federal regulation,12 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 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 2009.13 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.14

The sixth edition of the A.M.A., Guides provides a diagnosis-based method of evaluation 

utilizing the World Health Organization’s International Classification of Functioning Disability 

and Health (ICF): A Contemporary Model of Disablement.

15

 Under the sixth edition, the evaluator 

identifies the impairment CDX, which is then adjusted by grade modifiers based on functional 

history (GMFH), physical examination (GMPE) and clinical studies (GMCS). 16 The net 

adjustment formula is (GMFH - CDX) + (GMPE - CDX) + (GMCS - CDX).17 Evaluators are 

directed to provide reasons for their impairment choices, including the choices of diagnoses from 

regional grids and calculations of modifier scores.18

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

15-23 (Entrapment/Compression Neuropathy Impairment) and accompanying relevant text.19 In 

11 Supra note 1.

12 20 C.F.R. § 10.404.

13 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 2.808.6 (March2017); see alsoPart 3 --Medical, Schedule Awards, Chapter 3.700, Exhibit 1 (January 2010).

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

15 A.M.A., Guides (6th ed. 2009), p.3, section 1.3.

16 Id. at 494-531.

17 Id. at 411.

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

19 A.M.A., Guides 449, Table 15-23; 449; see also L.G., Docket No. 18-0065 (issued June 11, 2018).
7

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

impact on daily living activities.20

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

should be routed to a DMA for an opinion concerning the percentage of permanent impairment 

using the A.M.A., Guides.

21

ANALYSIS

The Board finds that appellant has not met his burden of proof to establish greater than 16 

percent permanent impairment of his left upper extremity and 23 percent permanent impairment 

of the right upper extremity for which he previously received schedule award compensation.

In a report dated July 8, 2021, Dr. Ralph, an OWCP referral physician, noted that appellant 

complained of occasional pain in his arms. On examination he found good grip strength bilaterally, 

a negative Phalen’s test, no atrophy, no impingement, and a negative Tinel’s sign at the elbow. 

Dr. Ralph obtained three ROM measurements of both wrists, elbows, and shoulders, which he 

found yielded normal findings. He noted that appellant had no pain with dorsiflexion of the wrist 

or pain over the lateral epicondyle. Dr. Ralph further indicated that appellant had improved on the 

right side since his thoracic outlet surgery and that his left side was not significantly problematic. 

He opined that appellant had no impairment due to lateral epicondylitis, bilateral thoracic outlet 

syndrome, lesions of the brachial plexus, bilateral carpal tunnel syndrome, and bilateral cubital 

tunnel syndrome. Dr. Ralph noted that electrodiagnostic testing obtained after surgery were 

normal. He opined that appellant had no impairment under the A.M.A., Guides. While Dr. Ralph 

indicated his belief that appellant had only experienced carpal tunnel syndrome, he considered all 

the accepted conditions in determining that he had no ratable permanent impairment of either upper 

extremity. 

On October 15, 2021 Dr. Katz reviewed Dr. Ralph’s findings. He advised that Table 15-

23 of the A.M.A., Guides, relevant to determining impairment due to entrapment/compression 

neuropathy, provided that the evaluator should use preoperative studies to determine median and 

ulnar nerve delays. Dr. Katz found that electrodiagnostic testing from 2005 showed medial and 

ulnar nerve delays. Using Table 15-23, he found a grade modifier of one due to the test findings 

showing electrodiagnostic delay, a grade modifier of zero for physical findings, and a grade 

modifier of zero for history, which he averaged to find zero percent impairment. Dr. Katz further 

determined that appellant had no impairment due to right epicondylitis using Table 15-4 on page 

399, or a bilateral brachial plexus impairment using Table 15-20 on page 434, based on the lack 

of objective abnormal findings. He additionally found that as the ROM measurements obtained 

by Dr. Ralph were normal, appellant had no impairment using the ROM method. Dr. Katz 

concluded that he had no impairment of either the right or left upper extremities. There is no 

medical evidence of record, in conformance with the sixth edition of the A.M.A., Guides, 

20 Id. at 448-49.

21 Supra note 13 at Chapter 2.808.6(f) (March 2017); B.B., Docket No. 18-0782 (issued January 11, 2019).
8

establishing that appellant has more than 16 percent permanent impairment of his left upper 

extremity, and 23 percent permanent impairment of the right upper extremity. Accordingly, 

appellant has not established entitlement to schedule award compensation greater than that 

previously awarded.

Appellant may request a schedule award or increase 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 his burden of proof to establish greater than 16 

percent permanent impairment of his left upper extremity and 23 percent permanent imp airment 

of the right upper extremity for which he previously received schedule award compensation.

ORDER

IT IS HEREBY ORDERED THAT the May 3, 2022 decision of the Office of Workers’

Compensation Programs is affirmed.

Issued: June 27, 2023

Washington, DC

Alec J. Koromilas, 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