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U. S. DEPARTMENT OF LABOR

 

Employees’ Compensation Appeals Board

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In the Matter of JANET L. ADAMSON and DEPARTMENT OF DEFENSE,

DEFENSE SUPPLY CENTER, Columbus, OH

 

Docket No. 00-1771; Submitted on the Record;

Issued July 10, 2001

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DECISION and ORDER

 

Before   MICHAEL J. WALSH, WILLIE T.C. THOMAS,

MICHAEL E. GROOM

 

 

            The issue is whether appellant has more than a five percent permanent impairment of her right upper extremity, for which she received a schedule award.

            The Office of Workers’ Compensation Programs accepted that in February 1998 appellant, then a 39-year-old store checker, sustained carpal tunnel syndrome of her right wrist for which she underwent surgery on April 6, 1998.  Following the April 6, 1998 right wrist carpal tunnel release, appellant accepted and returned to light-duty work on December 10, 1999 as an identification checker.

            On July 6, 1999 appellant filed a Form CA-7 claim for a schedule award for permanent impairment of her right wrist.

            By report dated June 7, 1999, Dr. Kenneth B. Cobbs, a Board-certified orthopedic surgeon, noted that appellant had loss of range of motion of the right wrist and painful scarring.  He opined that appellant had a six percent permanent impairment of her right hand, equivalent to a five percent impairment of her right upper extremity.

            By report dated February 14, 2000, Dr. Cobbs stated that the date of appellant’s maximum medical improvement was October 10, 1999.  He listed active range of right wrist motion as follows:  8 degrees radial deviation; 12 degrees ulnar deviation; 15 degrees dorsi-flexion; 15 degrees palmar flexion; 10 degrees pronation; and 45 degrees supination.  Dr. Cobbs noted that there was no ankylosis, but that appellant had dysesthesias in the median nerve distribution.  However, no impairment rating estimate was given nor were the American Medical Association (A.M.A.), Guides to the Evaluation of Permanent Impairment specifically referenced.

            On February 18, 2000 an Office medical adviser questioned the accuracy of Dr. Cobbs’ range of motion values in relation to appellant’s carpal tunnel surgery.  He recommended a second opinion evaluation and noted that Table 16 of the fourth edition of the A.M.A., Guides was the usual rating reference.

            On February 24, 2000 a physical therapist reported that Dr. John E. Keiter, a Board-certified plastic surgeon, requested evaluation of appellant.  He listed findings on range of motion and findings for sensation and grip strength for both of appellant’s upper extremities.  However, no percentages of impairment were given and no date of maximum medical improvement was specified.[1]

            On March 3, 2000 the same Office medical adviser reviewed the February 24, 2000 physical therapist’s report.  He again questioned the accuracy of the range of motion values, noting the report was not from a physician and that only the range of motion measurements in the right wrist were ratable impairments for appellant’s carpal tunnel syndrome.  The Office medical adviser calculated that appellant had a seven percent permanent impairment of the right arm based on loss of range of motion and listed the date of maximum medical improvement as March 24, 2000.[2]  The Office medical adviser reiterated the need for a second opinion examination.

            An Office claims examiner reviewed the Office medical adviser’s March 3, 2000 report and characterized the Office medical adviser’s estimate of the date of maximum medical improvement as “futuristic.”  The claims examiner determined the date of maximum medical improvement by “split[ting] the difference” between Dr. Cobbs’ maximum medical improvement date of October 10, 1999 and the date of the physical therapist’s February 24, 2000 report.  In reviewing the report, the claims examiner noted that the 7 percent impairment estimated by the Office medical adviser was “well in line with 5 to 10 percent usually arrived at in most post carpal tunnel surgery claims” and saw no reason to delay issuance of a schedule award.

            In a March 3, 2000 report, received by the Office on March 20, 2000, Dr. Keiter stated:  “The specific perimeters of measurement of range of motion, strength, sensation and coordination share no specific permanent impairment, but because of her multiple surgeries with Raynaud’s phenomenon,[3] I am giving her a final disability rating estimate, as follows:  a five percent disability for her hand which translates to a five percent disability for the upper extremity….”  The date of maximum medical improvement was not addressed.

            On March 29, 2000 the Office granted appellant a schedule award for a five percent permanent impairment of her right arm for the period December 18, 1999 to April 6, 2000.  The date of maximum medical improvement was listed as December 18, 1999.

            The Board finds that this case is not in posture for decision.[4]

            The schedule award provision of the Federal Employees’ Compensation Act[5] and its implementing regulations[6] 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, the Act does not specify the manner in which the percentage of loss shall be determined.[7]  For consistent results and to ensure equal justice under the law to all claimants, 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 the implementing regulation as the appropriate standard for evaluating schedule losses.[8]

            Although the standards for evaluating the permanent impairment of an extremity under the A.M.A., Guides are based primarily on loss of range of motion, all factors that prevent a limb from functioning normally, including pain and loss of strength, should be considered, together with loss of motion, in evaluating the degree of permanent impairment.[9]  Chapter 3.1h of the A.M.A., Guides provides a grading scheme and procedure for determining impairment of the upper extremity due to pain, discomfort, loss of sensation, or loss of strength.[10]

            In this case, the Office claims examiner issued a schedule award for appellant’s right upper extremity despite the Office medical adviser’s repeated notations that he questioned the accuracy of the range of motion values of record and recommended further evaluation of appellant for schedule award purposes.[11]  In light of the Office medical adviser’s characterization of the medical evidence of record, the Board finds that the Office claims examiner issued the schedule award prematurely as the medical opinion evidence was not sufficiently developed to provide a reliable estimate of impairment for appellant’s right upper extremity.[12]  The medical evidence of record does not provide an accurate or reliable description of the residuals of appellant’s accepted condition such that the Board can clearly visualize the impairment with its resulting restrictions and limitations.[13]

            As the determination of the degree of appellant’s permanent impairment was not based on a proper application of the A.M.A., Guides, the schedule award will be set aside.  Further, as the date of maximum medical improvement was not based upon any specific medical evidence of record; it was improperly determined and should be further evaluated upon return of the case record.

            The case will be remanded to the Office for further development to determine appellant’s degree of permanent impairment and the date of maximum medical improvement.

            The decision of the Office of Workers’ Compensation Programs dated March 29, 2000 is hereby set aside and the case is remanded for further development in accordance with this decision of the Board.

Dated,  Washington, DC

            July 10, 2001

 

 

 

 

                                                                                                            Michael J. Walsh

                                                                                                            Chairman

 

 

 

 

                                                                                                            Willie T.C. Thomas

                                                                                                            Member

 

 

 

 

                                                                                                            Michael E. Groom

                                                                                                            Alternate Member