OWCP Sample Employee Statements

Provide your doctor with a copy of your employee statement at the time you request medical documentation.
Your doctor needs to have a comprehensive understanding of the history of your condition to write an effective narrative.

Employee statements must include the following information: (reference page four of form CA 2 -- upper left corner)

  • a) A detailed history of the disease or illness from the date it started.

  • b) Complete details of the conditions of employment which are believed to be responsible for the disease or illness.

  • c) A description of specific exposures to substances or stressful conditions causing the disease or illness, including locations where exposure or stress occurred, as well as the number of hours per day and days per week of such exposure or stress.

  • d) Identification of the part of the body affected. (If disability is due to a heart condition, give complete details of all activities for one week prior to the attack with particular attention to the final 24 hours of such period.)

  • e) A statement as to whether the employee ever suffered a similar condition. If so, provide full details of onset, history, and medical care received, along with names and addresses of physicians rendering treatment.

Remember the reviewing claims examiner in Cleveland is not a postal employee. S/he may not know anything about postal operations. You must paint a picture; explain exactly what your duties involve and how they contributed to (caused, aggravated) your condition.

  • Be overly descriptive, using words that literally describe your duties, including, but not limited to: grasp, pull, push, lift, squeeze, grip, stretch, reach, lift above shoulders, bend, stand, stoop, lean, twist etc.

  • Make sure you mention how often you perform these duties (ex. I lift 20 pound trays above my head at least 40 times per shift).

  • DO NOT USE SHORT CUTS WHEN DESCRIBING EQUIPMENT WITH WHICH YOU WORK. A claims examiner isn't going to know what a DBCS is ... or an APC ... or FSM. So, spell it out! Delivery Bar Code Sorter (DBCS) or All Purpose Container (APC), or Flat Sorter Machine (FSM). If it isn't obvious, make sure you explain what the equipment is for and how it is used.

  • Please remember you only have three years to file a claim. Try to keep facts about your condition as recent as possible. If you state your condition began more than three yrs ago, it's possible your claim could be denied for untimeliness. However, if your condition did indeed start more than three years ago, it may still be acceptable to state your symptoms began back then, but progressed over time to an intolerable level -- which then forced you to finally seek medical treatment. The date you initially sought medical treatment would be key in this situation.

The following are actual employee statements (I deleted names and sensitive material to protect our members). These statements are here to help you create a statement of your own; use them as a guide only:

 Back Pain Carpel Tunnel Doctor's Letter
Hip Pain