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Medical evidence and the OWCP principle of “Performance
of Duty”
If you are seeking benefits under OWCP you have the
burden of proving the essential elements of your claim.
One of those essential elements that you must prove to
OWCP is that your injury or illness was sustained in the
performance of your duties with the USPS. In order to
establish that your claim meets the performance of duty
principle you must provide the following documentation:
• Medical evidence that clearly establishes the
existence of the medical condition for which you are
cleaning compensation.
• A factual statement that identifies the work factors
or incidents that you believe have caused or contributed
to your medical condition.
• Medical evidence that states clearly and to a medical
certainty that the job factors or incidents that you
have identified are indeed the proximate cause of your
claimed medical condition.
• Stated in another way, you must provide OWCP medical
evidence that establishes clearly and to a medical
certainly that the diagnosed medical condition is
causally related to (caused by) the job factors or
incidents that you have identified.
• All medical evidence must be through and rationalized.
Rationalized medical evidence means that your physician
must provide in writing logical explanations regarding
his/her opinions, reasons, and beliefs concerning the
casual relationship between the diagnosed medical
condition and the job factors or incidents that you have
identified as having caused your injury or illness.
• Medical statements must be written in a manner that
demonstrates that your physician’s opinion is based on
your complete factual and medical background and is
supported by a full understanding of the workplace
factors that directly caused your claimed medical
condition.
An employee who files a claim has the burden of prove
and MUST furnish essential medical evidence to
substantiate an employment-related medical condition
and/or disability. The best kind of evidence is a
medical report that includes:
• Dates of examination and treatment.
• Relevant medical histoty.
• Description of the work that was being performed when
this injury occurred.
• Detailed description of physical findings, results of
all diagnostic tests, and course of treatment.
• Diagnosis with full medical terminology.
• Physician’s opinion and supporting medical rationale
as to the relationship of the disability or disease to
the work injury or factors of employment believed to be
the cause. The physician should explain the
physiological mechanism by which the condition has
resulted and give the specific circumstances and
objective objective evidence which support casual
relationship.
• Medical opinion with documentation regarding the
precise extent and duration of total or partial
disability, and prognosis for recovery.
NOTE: A narrative report with employee’s history and the
physician’s opinion with medical rationale are
essential. A mere check of “yes” on a form in answer to
a question about casual relationship does not normally
constitute sufficient medical evidence for a claim to be
accepted by OWCP. Also, if hospitalized, the employee
should contact the medical record department of the
hospital and arrange for the hospital record to be sent
to the OWCP. These records should include: consultant
reports: x-rays and laboratory studies; surgical report;
and discharge summary.
INFORMATION WHICH YOUR PHYSICIAN SHOULD INCLUDE IN A
FULL NARRATIVE MEDICAL REPORT ESPECIALLY IF IT IS IN
SUPPORT OF A MORE COMPLEX OWCP CLAIM
• Patient’s name and address and OWCP file number.
• Reference to the injury and to the employment
conditions involved (brief description of both the
patient’s medical and employment history)
• Definitive diagnosis (no impressions), prognosis and
future medical care.
• Date of latest examination and/or treatment.
• Nature and type of treatment since last medical
report.
• Statement describing any apparent concurrent medical
conditions even if Unrelated to the work injury or
occupational disease.
• Nature of disability and the extent of disability,
that is, specify whether the disability was total or
partial. If partial describe the specific work
limitations (medical restrictions).
The work limitations should describe the limitation on
walking, standing, sitting, lifting, etc, and include
the number of hours allowed for each day (refer to Form
CA-17, “Duty Status Report”). The limitations should
also include any disability from an apparent concurrent
medical condition unrelated to the work injury or
occupational disease.
• Expected duration of the period of disability.
• If the medical condition causing disability was an
underlying or pre-existing (non-work-related) condition
aggravated by the work incident, is the aggravation
continuing and is it a permanent or temporary
aggravation? Provide clear medical rationale.
• Statement concerning whether maximum medical
improvement (MMI) has been reached. If the patient is at
MMI, are there permanent medical restrictions?
* Signature of physician (show specialty / Board
certification, and date).
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