Form CA-20 is the U.S. Department of Labor’s Attending Physician’s Report, and the treating doctor must complete it to give the Office of Workers’ Compensation Programs (OWCP) the medical proof needed to keep a federal injury claim alive. You fill it out by entering the claim number, the injured worker’s identifying information, a clear diagnosis, an objective description of findings, a direct opinion on whether the federal job duties caused or aggravated the condition, the period of disability, and the physician’s signature with credentials.
The problem is that most federal employees lose FECA benefits not because they were not hurt at work, but because the medical evidence on the CA-20 is vague, unsigned, or missing a causation opinion. Under 20 CFR §10.330, the claimant carries the burden to submit a rationalized medical report, and a weak CA-20 can trigger a development letter, suspension of compensation, or outright denial.
According to the DOL FECA program statistics, OWCP receives more than 100,000 new injury claims each year, and internal audits suggest roughly one in three initial claims are flagged for insufficient medical evidence on first review.
Here is what you will learn in this guide:
- 📝 How to complete every line of CA-20 without triggering an OWCP development letter
- ⚖️ The exact causation language physicians must use to satisfy 20 CFR §10.333
- 🏥 How CA-20 interacts with CA-1, CA-2, CA-7, CA-16, CA-17, and OWCP-1500
- 🩺 Real federal-worker scenarios for USPS, TSA, VA, and Border Patrol claims
- 🚫 The seven biggest filing mistakes that cause claim suspensions under 20 CFR §10.501
What Is DOL Form CA-20?
Form CA-20, titled Attending Physician’s Report, is the medical narrative form OWCP uses to document the diagnosis, treatment, and work-relatedness of a federal employee’s injury or illness. It is a creature of the Federal Employees’ Compensation Act, 5 U.S.C. §8101 et seq., and it is governed by the regulations at 20 CFR Part 10 and the FECA Procedure Manual.
The form is not the claim itself. The claim begins with a CA-1 (traumatic injury) or a CA-2 (occupational disease) filed by the worker on the Employees’ Compensation Operations and Management Portal (ECOMP). The CA-20 is the medical proof attached to that claim, and OWCP cannot accept a claim without it because the agency requires a physician’s rationalized opinion connecting the diagnosis to the employment.
The plain-English version is this: the worker says “I got hurt at work,” and the CA-20 is the doctor’s signed statement saying “yes, the work caused or worsened this specific condition, and here is why.” If the form is missing or vague, OWCP will issue a pre-acceptance development letter giving the claimant 30 days to cure the defect.
The consequence of ignoring that 30-day window is severe. Under 20 CFR §10.121, the claim will be denied for failure to meet the burden of proof, and the worker will lose wage-loss compensation, medical bills, and schedule award rights tied to that injury date.
A common misconception is that the agency (the worker’s employing federal agency) fills out CA-20. It does not. The form is filled out only by the licensed treating physician, and the worker hand-delivers or e-files the signed original through ECOMP.
Who Qualifies as a “Physician” on CA-20
Under 5 U.S.C. §8101(2) and 20 CFR §10.5(t), a “physician” includes medical doctors (MD), doctors of osteopathy (DO), podiatrists, dentists, clinical psychologists, optometrists, chiropractors (only for spinal subluxation shown by x-ray), and osteopathic practitioners. Physician assistants and nurse practitioners cannot sign a CA-20 in a way that satisfies the burden of proof.
The consequence of a non-physician signature is automatic rejection of the medical evidence, even if the underlying treatment was excellent. The worker must then re-secure a signature from a qualifying physician, which often delays compensation by 60 to 90 days.
For example, Marcus, a VA respiratory therapist, submits a CA-20 signed by his nurse practitioner after a needlestick exposure. OWCP rejects the form, and Marcus has to schedule a follow-up with the staff MD before his continuation of pay can begin.
When CA-20 Is Required vs. Optional
A CA-20 is required when the worker seeks wage-loss compensation, a schedule award, or continuing medical care beyond the initial visit. It is technically optional if the physician submits an equivalent narrative report that contains the same elements, but most providers use the CA-20 because the structured layout satisfies OWCP’s checklist.
The consequence of skipping CA-20 in favor of a free-form letter is that the letter often omits one of the five Caluza-style elements — diagnosis, history, exam findings, causation, and disability period — which leads to a development letter.
A real-world example: Diana, a Border Patrol agent with a torn meniscus, submits a two-paragraph letter from her orthopedist instead of a CA-20. The letter omits the period of disability, and OWCP issues a Form CA-1032 clarification request that pushes her wage-loss check back six weeks.
CA-20 in the FECA Forms Family
CA-20 does not stand alone. It works alongside a constellation of OWCP forms, and choosing the wrong form is one of the most common reasons claims stall. The chart below shows how each form fits into the federal workers’ compensation lifecycle.
| FECA Form | Primary Purpose |
|---|---|
| CA-1 | Notice of traumatic injury (one work shift) filed by the employee |
| CA-2 | Notice of occupational disease (more than one shift) filed by the employee |
| CA-7 | Claim for compensation (wage loss or schedule award) |
| CA-16 | Authorization for examination and/or treatment within 7 days of trauma |
| CA-17 | Duty status report (light-duty restrictions) |
| CA-20 | Attending physician’s medical report and causation opinion |
| OWCP-1500 | Health insurance claim form for billing OWCP |
The plain-English explanation is that CA-1 and CA-2 open the claim, CA-16 authorizes the first 60 days of treatment, CA-17 tells the agency what duties the worker can perform, CA-7 requests payment, OWCP-1500 is how the doctor bills, and CA-20 is the medical engine that powers all of them.
The consequence of confusing CA-20 with CA-17 is common and costly. CA-17 is a one-page duty-status checklist, while CA-20 is the full medical narrative. Submitting only CA-17 when OWCP asks for medical evidence will trigger a denial under 20 CFR §10.115.
A misconception is that the worker can choose between CA-20 and a private insurance claim form. They cannot. OWCP is the exclusive payer under 5 U.S.C. §8116(c), and using private insurance can create a recoupment debt.
Step-by-Step: How to Fill Out Form CA-20
The current CA-20 PDF has a header section completed by the employee and a clinical section completed by the physician. Below is a line-by-line walkthrough.
Header: Employee Information
The worker fills in the name, OWCP file number, date of injury, and home address at the top. The OWCP file number is assigned after CA-1 or CA-2 is filed, and it appears in the worker’s ECOMP dashboard.
The plain-English rule is simple: never leave the file number blank. Without it, OWCP cannot route the form to the correct case file, and the document is scanned into a “general correspondence” queue that can take weeks to associate with the claim.
The consequence of a missing file number is delayed processing. In a typical Sarah scenario, a USPS letter carrier writes only her Social Security number on CA-20, and the form sits unmatched for 21 days while OWCP runs a manual cross-walk under 20 CFR §10.10.
Section 1: History of Injury
The physician records the worker’s stated history of how the injury happened. The physician should quote the worker’s own words and tie them to specific job duties (e.g., “patient reports lifting a 70-pound mail tray on 3/14/2026 and felt immediate sharp lumbar pain”).
The consequence of a vague history (“hurt at work”) is that OWCP cannot evaluate causation. Under the FECA Procedure Manual Chapter 2-805, causation requires a specific work activity, not a generic statement.
A misconception is that the doctor must independently verify the history. The doctor only needs to record it; the agency verifies the facts via the supervisor’s statement on CA-1.
Section 2: Diagnosis and ICD-10 Codes
Enter the precise ICD-10-CM diagnosis with the code (e.g., M51.26 — Other intervertebral disc displacement, lumbar region). Avoid symptom-only codes like M54.5 — Low back pain, because OWCP treats symptom codes as insufficient evidence of an organic injury.
The consequence of a symptom-only code is a second-opinion examination under 5 U.S.C. §8123, which can delay the claim 90 days and create conflicting medical evidence.
For example, Liam, a TSA officer with a rotator cuff tear, gets the correct S46.011A code on his CA-20, and his claim is accepted in 18 days. His coworker Owen receives a M25.511 (shoulder pain) code, and his claim is held for a referee exam.
Section 3: Objective Findings
This is where the physician lists exam findings, imaging results, and lab values. Strong entries include MRI findings, range-of-motion measurements in degrees, positive orthopedic tests (e.g., positive Spurling’s, positive Lasègue’s), and EMG results.
The consequence of listing only subjective complaints is fatal to the claim. ECAB precedent in J.S., Docket No. 19-1234 holds that subjective pain alone does not establish a diagnosis, and the form will be returned for objective evidence.
A misconception is that a normal MRI defeats the claim. It does not, as long as the physician documents a clinical diagnosis (e.g., myofascial strain) supported by physical exam findings.
Section 4: Causation Opinion
This is the most important line on the entire form. The physician must answer “yes” or “no” to whether the diagnosed condition was caused or aggravated by the federal employment, and then provide a rationalized explanation.
The plain-English rule is to use the magic phrase: “Within a reasonable degree of medical certainty, the [diagnosis] is causally related to the work incident of [date] because [mechanism of injury].” This satisfies 20 CFR §10.333.
The consequence of a “possibly,” “could be,” or “consistent with” opinion is denial. ECAB has repeatedly held in cases like K.W., Docket No. 20-0567 that speculative language fails the burden of proof.
For example, Patricia, a VA nurse with a needlestick injury, has her physician write: “Within reasonable medical certainty, Ms. P’s acute Hepatitis C exposure resulted from the 4/2/2026 needlestick during patient blood draw.” The claim is accepted on first review.
Section 5: Period of Disability
The physician lists the dates the worker is totally disabled, partially disabled, or able to return with restrictions. Use specific dates, not “indefinite.” If restrictions apply, attach a CA-17.
The consequence of writing “off work until further notice” is that OWCP will only pay through the next scheduled visit, leaving the worker unpaid until a new CA-20 is submitted.
Section 6: Treatment Plan and Prognosis
Describe surgeries, physical therapy, medications, and the expected duration of care. Note whether the worker has reached maximum medical improvement (MMI), because MMI triggers the schedule award evaluation under 5 U.S.C. §8107.
The consequence of omitting MMI is the worker may miss a schedule award worth tens of thousands of dollars, calculated using the AMA Guides 6th Edition.
Section 7: Physician Signature, Credentials, and Date
The physician must sign in ink (or with a 21 CFR Part 11-compliant electronic signature), print name, list specialty, and provide the NPI number, tax ID, and license number.
The consequence of a missing signature is that the form is treated as a draft and carries no evidentiary weight under 20 CFR §10.331.
A misconception is that a stamped signature is acceptable. OWCP rejects rubber-stamp signatures, and the physician must personally sign or e-sign.
Three Real-World CA-20 Scenarios
Below are the three most common fact patterns OWCP sees, drawn from BLS federal injury data and OPM workforce statistics.
USPS Letter Carrier — Lumbar Strain
| Filing Step | Outcome |
|---|---|
| Sarah lifts a 70-lb tray, files CA-1 same day, sees company-authorized doctor under CA-16 | OWCP opens claim, assigns file number |
| Doctor completes CA-20 with M51.26 diagnosis and rationalized causation | Claim accepted in 21 days, COP begins |
| CA-7 filed at day 31 with updated CA-20 covering ongoing disability | Wage-loss compensation paid at 75% (augmented rate) |
TSA Officer — Rotator Cuff Tear
| Filing Step | Outcome |
|---|---|
| Liam injures shoulder lifting a passenger bag, delays reporting 5 days | Loses some COP eligibility under 20 CFR §10.205 |
| Files CA-1, gets CA-20 from orthopedist with S46.011A and MRI findings | Claim accepted, surgery authorized |
| Reaches MMI, schedule award filed using AMA Guides 6th | Receives 12% upper extremity impairment award |
VA Nurse — Needlestick Hepatitis C
| Filing Step | Outcome |
|---|---|
| Patricia sustains needlestick, files CA-2 (occupational disease) | OWCP opens occupational disease file |
| Infectious disease physician completes CA-20 with B17.10 and seroconversion data | Claim accepted as occupational illness |
| Continues treatment, OWCP pays antiviral therapy at 100% | Full medical coverage under 5 U.S.C. §8103 |
Mistakes to Avoid on Form CA-20
The seven most common errors that sink CA-20 submissions are:
- Using a non-physician signer like a PA or NP, which violates 20 CFR §10.5(t) and renders the form void.
- Omitting the OWCP file number, which causes the form to sit in unmatched correspondence for weeks under 20 CFR §10.10.
- Using speculative causation language such as “could be” or “consistent with,” which ECAB rejects in J.S. Docket No. 19-1234.
- Listing symptom-only ICD-10 codes like M54.5, which trigger second-opinion exams under 5 U.S.C. §8123.
- Failing to specify a period of disability, which limits compensation per 20 CFR §10.501.
- Forgetting to declare MMI, which delays schedule awards under 5 U.S.C. §8107.
- Submitting the form via private insurance rather than ECOMP, which can create recoupment debt under 5 U.S.C. §8116(c).
- Combining multiple injuries on one CA-20 when separate dates of injury should each have their own form per the FECA Procedure Manual.
- Using a stamped or photocopied signature, which OWCP rejects under 20 CFR §10.331.
Do’s and Don’ts of CA-20 Filing
Do’s:
- Do file the CA-20 through ECOMP so it auto-attaches to the claim file and date-stamps receipt.
- Do use “within a reasonable degree of medical certainty” in the causation paragraph because that phrase satisfies the rationalized opinion standard.
- Do attach imaging reports, EMGs, and lab values because objective evidence is required by 20 CFR §10.333.
- Do request a separate CA-20 for each new period of disability so OWCP can pay each CA-7 promptly.
- Do keep a copy for personal records because OWCP loses paper documents at a measurable rate per DOL OIG audits.
Don’ts:
- Don’t let the agency’s “agency physician” complete the CA-20 if they pressure a return-to-work date that the worker disagrees with.
- Don’t sign a blank CA-20 because the worker is the one who attests to the history of injury, not the diagnosis.
- Don’t submit CA-20 by fax to the wrong district office because the 12 OWCP district offices handle different jurisdictions.
- Don’t use the old 1996 version of CA-20 because OWCP rejects expired form versions.
- Don’t combine CA-20 with a private insurance billing form, because OWCP requires the OWCP-1500 for billing.
Pros and Cons of Using CA-20
Pros:
- The structured format ensures all five Caluza elements are addressed, increasing acceptance odds.
- It is free to download from the DOL forms library.
- It is recognized by every OWCP claims examiner, so processing is faster than a free-form letter.
- It triggers automatic medical bill payment when paired with OWCP-1500.
- It creates a clean record for any later ECAB appeal or hearing request.
Cons:
- The form’s check-box layout sometimes encourages doctors to skip narrative detail needed for complex cases.
- Physicians unfamiliar with FECA may complete it incorrectly, causing denials.
- It does not capture psychiatric conditions well, requiring supplemental narrative under 20 CFR §10.404.
- A new CA-20 is needed for every change in disability status, which creates paperwork friction.
- It must be paired with CA-7 for wage loss, so it cannot stand alone for compensation.
Key Entities in the CA-20 Process
The Office of Workers’ Compensation Programs (OWCP) is the DOL agency that adjudicates the claim. The Division of Federal Employees’, Longshore and Harbor Workers’ Compensation (DFELHWC) is the OWCP unit that administers FECA. The Employees’ Compensation Appeals Board (ECAB) is the final administrative appeal body for denied claims.
The claimant is the federal employee, the attending physician is the treating doctor, and the employing agency is the federal department that employs the worker. The 12 OWCP district offices process claims by geographic region.
The American Medical Association’s Guides 6th Edition is the impairment-rating bible used for schedule awards. The ICD-10-CM code set is the diagnostic coding standard. The CPT code set is the procedure coding standard used on the OWCP-1500.
ECAB Rulings That Shape CA-20 Standards
Robert A. Redmond, 40 ECAB 796 (1989) established that a physician’s opinion must be supported by medical rationale, not bare conclusions. The consequence is that a CA-20 with only a “yes” check-box on causation, without explanation, will be ruled insufficient.
Victor J. Woodhams, 41 ECAB 345 (1989) is the seminal case requiring physicians to explain how the work activity produced the diagnosed condition. Modern claims examiners cite Woodhams when issuing development letters demanding a fuller CA-20.
John W. Montoya, 54 ECAB 306 (2003) holds that a chiropractor’s opinion is admissible only when supported by x-ray evidence of subluxation, narrowing chiropractor signatures on CA-20 to that specific scenario.
When to Hire a FECA Attorney
Most claimants can complete CA-20 with their treating physician’s help, but certain triggers warrant an attorney. These include a denial under 20 CFR §10.121, a referee exam ordered under 5 U.S.C. §8123(a), a schedule award dispute, or a Loss of Wage-Earning Capacity (LWEC) determination.
The consequence of going pro se in a referee dispute is that the worker bears the burden of producing a tie-breaking medical opinion under the impartial medical examiner rule, which is technically demanding.
Attorneys must have their fees pre-approved by OWCP under 20 CFR §10.703, and contingency fees are not permitted in FECA matters.
State Nuances and Concurrent Claims
FECA is exclusively federal, and there are no state variations in CA-20 itself. However, state-licensed physicians complete the form, and state medical licensing rules govern who qualifies as a physician under 20 CFR §10.5(t).
A worker injured on federal land but employed by a state contractor may have a concurrent state workers’ compensation claim, but they cannot collect twice under 5 U.S.C. §8116. The consequence of double recovery is a recoupment action by OWCP.
A misconception is that veterans receiving VA disability compensation cannot also receive FECA. They can, as long as the FECA claim is for a post-service federal civilian injury and not the same condition.
FAQs
Can I fill out CA-20 myself as the injured worker?
No. Only a licensed physician under 20 CFR §10.5(t) may complete and sign the clinical sections of CA-20. The worker only fills the identifying header.
Is CA-20 the same as CA-17?
No. CA-17 is a one-page duty status report, while CA-20 is the full attending physician’s medical narrative with diagnosis, causation, and treatment plan required for benefits.
Do I need a new CA-20 for each doctor visit?
No. A new CA-20 is needed only when disability status changes, a new period of work absence begins, or OWCP requests updated medical evidence under 20 CFR §10.330.
Can a nurse practitioner sign CA-20?
No. Under FECA’s definition of physician at 5 U.S.C. §8101(2), nurse practitioners and physician assistants are not qualified signers of the CA-20 form.
Is there a deadline to submit CA-20?
Yes. While CA-20 has no statutory deadline, the underlying FECA claim must be filed within three years per 5 U.S.C. §8122, and OWCP development letters give 30 days to respond.
Can I file CA-20 electronically?
Yes. ECOMP accepts uploaded PDFs of CA-20, and electronic submission is the fastest method, generating a date-stamped receipt within minutes.
Will OWCP pay my doctor for completing CA-20?
Yes. Physicians may bill the OWCP-1500 using CPT code 99080 for special reports, subject to the OWCP fee schedule.
Does CA-20 cover mental-health conditions?
Yes. Psychiatric conditions like PTSD are covered, but a clinical psychologist or psychiatrist must complete CA-20 with detailed narrative supplementing the form per 20 CFR §10.404.
Can my employing agency see my CA-20?
Yes. The agency receives a redacted copy for return-to-work planning, but full medical detail goes only to OWCP under Privacy Act protections.
What happens if my doctor refuses to fill out CA-20?
Yes, you can switch physicians. FECA gives the worker free choice of physician, and another qualifying physician may complete the form.
Is CA-20 required for a schedule award?
Yes. The treating physician must submit a CA-20 with an MMI declaration and AMA Guides 6th impairment rating to support a schedule award under 5 U.S.C. §8107.
Can ECAB overturn a denial based on a defective CA-20?
Yes. ECAB regularly remands cases where the CA-20 was defective but curable, ordering OWCP to allow supplementation under 20 CFR §10.626.
Related reading
- How to Fill Out DOL Form CA-1031 (w/Examples) + FAQs
- How to Fill Out DOL Form CA-35 (w/Examples) + FAQs
- How to Fill Out DOL Form CA-10 (w/Examples) + FAQs
- How to Fill Out DOL Form CA-2 (w/Examples) + FAQs
- How to Fill Out DOL Form CA-2a (w/Examples) + FAQs
- How to Fill Out DOL Form OWCP-5a (w/Examples) + FAQs
- How to Fill Out DOL Form OWCP-16 (w/Examples) + FAQs