ELLIS CLINICOCCUPATIONAL & LEGAL MEDICINEOklahoma City, Oklahoma
OWCP · THE MEDICAL SIDE OF THE CLAIM

Medical Evidence Center

A diagnosis alone does not answer every FECA medical question. Strong medical evidence gives OWCP a clear, medically reasoned path from the work event or exposure to the diagnosed condition—and, when applicable, to disability, work restrictions, treatment, or permanent impairment.

THE MEDICAL FRAMEWORKCLAIM ROADMAP
LWECRecurrence vs. New InjuryReturn to WorkSecond Opinion / RefereeDecisions & AppealsDisability & Wage LossCA-35 Evidence CenterFrameworkMedical ReportsCausal RelationshipDisabilityReport ChecklistAppointments
OWCP RESOURCE SYSTEMResource CenterClaim RoadmapMedical EvidenceCA-35 EvidenceDisability & Wage LossReturn to WorkRecurrence vs. New InjurySecond Opinion / RefereeLWECDecisions & AppealsOverpayments
ELLIS CLINIC MEDICAL FRAMEWORK

Make the Medical Reasoning Easy to Follow

OWCP's current procedure manual emphasizes history, diagnosis, examination or diagnostic findings, causal relationship with medical reasoning, and the nature and extent of injury-related disability. The medical record becomes stronger when those elements tell one consistent story.

01Accurate HistoryThe physician understands the actual work event, mechanism, duties, or exposure.
02Objective FindingsExamination, imaging, laboratory, electrodiagnostic, or other pertinent findings.
03DiagnosisA specific medical condition supported by the history and findings.
04CausationA physician explains medically how work caused, contributed to, or aggravated the condition.
05Disability / RestrictionsWhat work cannot be performed, or what limitations are medically required.
06Course / PrognosisTreatment, expected recovery, MMI, or permanent impairment when relevant.

The Form Is Not the Medical Opinion

FECA medical evidence can be submitted on OWCP forms or in a physician's narrative report. DOL's procedure manual specifically notes that a narrative report may be required when disability continues, complex issues such as pre-existing conditions are present, and in almost all occupational disease cases.

CHOOSE THE RIGHT MEDICAL DOCUMENT

Forms Organize Different Parts of the Medical Record

INITIAL CARE

CA-16

Initial treatment authorization in qualifying traumatic injury claims. The medical portion can also provide early findings and disability information.

CA-16 GUIDE →
ATTENDING PHYSICIAN

CA-20

Diagnosis, objective findings, causal relationship, disability status, restrictions, and physician certification.

CA-20 GUIDE →
DUTY STATUS

CA-17

Focuses on current work capacity and restrictions. DOL generally treats it as supplemental because it may not address all medical issues.

CA-17 GUIDE →
WORK CAPACITY

OWCP-5c

More detailed functional work-capacity information for musculoskeletal conditions.

OWCP-5c GUIDE →
COMPLEX / CONTINUING CASES

Narrative Report

Useful when the physician must fully explain chronology, mechanism, findings, causation, disability, treatment course, prognosis, or competing explanations.

REPORT CHECKLIST →
PERMANENT LOSS

Impairment Evaluation

When an accepted condition has reached MMI and permanent impairment is claimed, the medical evidence must address the applicable Schedule Award requirements.

SCHEDULE AWARDS →
CAUSAL RELATIONSHIP

“Related to Work” Needs Medical Reasoning

DOL describes causal relationship as the medical link between the work exposure or injury and the condition found on examination. Current FECA guidance emphasizes rationalized medical evidence—not simply an unsupported causation conclusion.

WEAKER MEDICAL SUPPORT

A Conclusion Without the Bridge

A report becomes less persuasive when it gives the answer but does not explain the medicine behind the answer.

  • History does not match the established work event.
  • Diagnosis is unclear or unsupported by findings.
  • Causation is asserted without explaining the mechanism.
  • Language is speculative rather than medically definite.
  • Disability is stated without explaining why the condition prevents the work.
RATIONALIZED MEDICAL SUPPORT

Show the Medical Bridge

The physician connects the established facts to the medical conclusion in a logical sequence.

  • Accurate factual and medical history.
  • Specific diagnosis supported by pertinent findings.
  • Explanation of the physiological or medical mechanism.
  • Consideration of pre-existing or competing conditions when relevant.
  • Reasoned explanation of disability, restrictions, or aggravation.

Aggravation Is a Medical Question Too

When a pre-existing condition is involved, OWCP may need the physician to distinguish direct causation from aggravation and, if aggravated, whether the aggravation is temporary or permanent. A temporary aggravation may also require an opinion about when the condition returned or is expected to return to baseline.

DISABILITY IS MORE THAN A DIAGNOSIS

Connect the Condition to the Work the Employee Cannot Perform

A medical condition can exist without causing total disability. When wage loss is claimed, the medical evidence should address why the accepted work-related condition prevented the employee from performing the relevant duties during the period claimed.

CA-7 GUIDEWORK RESTRICTIONS
01CONDITIONIdentify the diagnosed work-related condition.
02JOB DEMANDSUnderstand the duties the employee is expected to perform.
03MEDICAL LIMITATIONExplain how objective findings and symptoms limit those duties.
04PERIOD / CAPACITYState the duration of total disability or the specific restrictions for partial capacity.
PHYSICIAN REPORT CHECKLIST

What a Comprehensive Medical Report Usually Needs

DOL's procedure manual lists the information usually required regardless of whether the report is on a standard OWCP form or physician letterhead.

1
DatesDates of examination and treatment.
2
Clinical HistoryThe history given to the physician, consistent with the established work facts.
3
Physical FindingsDetailed pertinent examination findings.
4
Diagnostic ResultsRelevant imaging, laboratory, electrodiagnostic, or other testing.
5
DiagnosisSpecific diagnosed medical condition or conditions.
6
PrognosisExpected course and recovery when it can be reasonably addressed.
7
ImpairmentDescription of impairment when applicable.
8
Work LimitationsSpecific functional restrictions when work capacity is at issue.
9
Treatment CourseClinical course and treatment followed or recommended.
10
Reasoned Causation OpinionThe physician's medical explanation connecting the diagnosed condition to factors of federal employment.
HOW THIS FITS THE CLAIM

Medical Evidence Changes as the Claim Changes

Initial Acceptance

Focus on accurate history, fact of injury, diagnosis, and causal relationship.

CLAIM ROADMAP

Continuing Benefits

Focus on current findings, treatment course, disability, restrictions, and whether continuing problems remain related to the accepted condition.

DISABILITY / CA-7

Permanent Impairment

After MMI, the medical focus may shift toward permanent anatomical or functional loss for a Schedule Award.

SCHEDULE AWARDS
Educational Resource: This page explains general FECA medical-evidence concepts. The evidence needed in an individual case depends on the claimed condition, accepted conditions, factual history, benefits being requested, and issues identified by OWCP. Current OWCP instructions and decisions control the individual claim.
Next useful paths:   Second Opinion / Referee →OWCP Resource Center →