When OWCP has accepted a psychiatric or psychological condition as caused or aggravated by work, it asks the treating physician or psychologist to assess work capacity on OWCP-5a. The form asks whether the employee can work 8 hours a day, if not how many and when that will increase, whether the usual job is possible, and which duties and work settings would suit them.
The treating psychiatrist, psychologist or physician answers every question and signs; the injured worker completes nothing on the form.
Download the current version from the source each time; forms change without notice.
Work Capacity Evaluation Psychiatric/Psychological Conditions
Evaluación de la capacidad de trabajo Condiciones psiquiátricas / psicológicas
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Yes. DOL posts a Spanish version, Evaluación de la capacidad de trabajo, condiciones psiquiátricas / psicológicas, alongside the English form on its FECA forms page. The questions on work hours, the usual job and suitable duties are the same.
Send it to OWCP when the claims office requests it, either by uploading through ECOMP or by mailing it to the address on the letterhead of the request. The form specifically says not to send it to the Paperwork Reduction Act address printed on page 2.
Item 4 asks the doctor to describe, in as much detail as possible, the duties or work environments suitable for the patient, since many employers can accommodate restrictions. Item 5 asks for other medical factors to consider, with an explanation of each.