How to Fill Out the USPS Medical Restrictions Form (CA-17)

The USPS medical restrictions form, the CA-17 Duty Status Report, is a two-sided Department of Labor form: your supervisor completes Side A describing what your regular job physically demands, and your treating physician completes Side B translating your condition into specific, numeric work restrictions the Postal Service can act on. The doctor is expected to return the completed form within two days so your pay and assignment aren’t interrupted.¹

One thing to confirm before you start. The CA-17 is the form used for on-the-job injuries covered by the Office of Workers’ Compensation Programs and for limited-duty placement under ELM Section 546.² If your condition is not work-related, you’re on the light-duty track under Article 13 of your collective bargaining agreement, and that request goes to your installation head in writing rather than on a CA-17.³ The rest of this article assumes you’re on the OWCP/limited-duty track and need the CA-17 completed correctly.

Who Starts the Form and Where to Get It

Your supervisor should hand you a CA-17 with Side A already filled in. You are entitled to have the form completed for any compensable on-the-job injury, so if your supervisor hasn’t started it, ask directly. A blank version is also available as a PDF from the Department of Labor’s OWCP compliance page if you need to print one.

Side A: The Supervisor’s Section

Side A is where the supervisor describes the physical requirements of your regular position: what the job actually demands on a normal day. Item 7 is the important one. It tells your physician what your duties look like in practice, and the doctor uses that description to decide what you can and cannot safely do.¹

Read Side A before you take the form to your appointment. If the description of your regular duties is thin or wrong, ask your supervisor to correct it. A vague Side A produces vague restrictions on Side B, and vague restrictions give management little to work with when building a modified assignment.

Side B: The Physician’s Section

Side B is the heart of the form and the part that gets rejected most often when it’s done poorly. Your doctor works through an activity-restrictions table and, for each row, marks whether the activity can be performed continuously or intermittently, notes the weight in pounds where relevant, and specifies hours per day. The rows cover:¹

Lifting and carrying
Sitting, standing, and walking
Climbing, kneeling, bending, stooping, and twisting
Pulling and pushing
Simple grasping and fine manipulation, including keyboarding
Reaching above the shoulder
Driving a vehicle and operating machinery
Environmental exposures: temperature extremes, humidity, chemicals, fumes, dust, and noise levels

Below the table, the physician must also answer whether you can perform the regular work described on Side A, whether you should return to work and on what date, and whether any neuropsychiatric condition affects your interpersonal relations on the job. The form asks for the date of your next appointment, the physician’s specialty, and a signature certifying the statements are true and complete.¹

Numbers, Not Adjectives

The single most common reason a CA-17 gets sent back is that the physician wrote in general language instead of specific values. “No heavy lifting” is not usable. “Lifting no more than 10 pounds intermittently, 2 hours per day” is. “Limited standing” is not usable. A pound figure, a duration in hours, and a continuous/intermittent designation on every applicable row are what the agency needs.

If your physician isn’t familiar with the CA-17, walk through the activity table with them before the appointment starts and be clear that every row needs a concrete value. A doctor who writes “standing” without hours per day, or checks a box without a weight, has given management an incomplete form, and you’ll be the one waiting while it gets corrected.

The Two-Day Return Deadline

The instructions on the form direct the physician to complete and return it within two days to prevent interruption of your income.¹ Make sure the office you’re visiting understands that timeline. If your doctor’s staff routinely takes a week to complete forms, tell them at the front desk that this one has a two-day turnaround built in.

What Happens After You Submit It

Once the completed CA-17 goes back to your supervisor, the restrictions on Side B drive the limited-duty placement search under ELM Section 546. The Postal Service must try to assign you work consistent with your medically defined limitations. The search follows a set priority: first, work within your craft at your regular facility during your normal hours; then other work at the same facility; then work outside your regular schedule; and finally, if nothing is available locally, an assignment at another facility.²

If management cannot accommodate your restrictions at all, you must be given a written copy of Postal Service Headquarters’ concurrence with the refusal, along with notification of your right to appeal to the Merit Systems Protection Board.²

Pair the CA-17 With PS Form 3971

The CA-17 documents your medical restrictions. It does not, on its own, cover an absence. Every absence at the Postal Service runs through PS Form 3971, Request for or Notification of Absence, and when the absence is medically related, the 3971 is what ties the leave to your medical paperwork.

For foreseeable FMLA-covered leave, submit PS Form 3971 with the supporting medical certification to the FMLA coordinator or your supervisor at least 30 days before the absence begins. For unexpected illness or injury, submit the 3971 with the applicable medical documentation upon returning to duty. If the documentation isn’t adequate, the supervisor can disapprove the leave, and the absence may be recorded as annual leave, leave without pay, or AWOL.⁴ Keep copies of everything you turn in. If a dispute comes up later about whether an absence was properly documented, your copies are your best defense.

Updating the CA-17 When Your Restrictions Change

A CA-17 is not a one-time submission. Management can request updated medical information when there’s a legitimate reason to believe your condition has changed, and if your restrictions have a defined end date, you’ll need a fresh form when they run out.

Ask your physician to specify a clear duration on the form, such as restrictions that apply for a set number of months with a specific reassessment date. Open-ended or undated restrictions invite more frequent requests for updates, which means more appointments and more paperwork on both sides. A defined timeline gives you and your supervisor a predictable schedule.

Mistakes That Get the Form Rejected

The three failure modes to watch for:

Adjectives instead of numbers on Side B. Every applicable row in the activity table needs a weight in pounds where relevant, hours per day, and a continuous or intermittent designation. General phrases like “limited lifting” or “no prolonged standing” don’t meet the standard.
A Side A description that doesn’t match your actual job. If your supervisor’s description is thin, your doctor’s restrictions will be thin. Fix Side A before the appointment, not after.
Submitting the CA-17 without a PS Form 3971 for the absence itself. The medical form proves the condition; the 3971 is the leave record. Without both, the absence can be charged against annual leave or marked AWOL even when the medical reason was legitimate.⁴

If the doctor’s office hands you a form with generic language, push back before you turn it in. A rejected CA-17 means starting over, and your placement or pay can sit in limbo until a corrected version arrives.

1
U.S. Department of Labor. Office of Workers’ Compensation Programs – Duty Status Report CA-17
2
United States Postal Service. Employee and Labor Relations Manual – 546 Reassignment or Reemployment of Employees Injured on Duty
3
United States Postal Service. Employee and Labor Relations Manual – 355 Light Duty Assignments
4
United States Postal Service. Policies, Procedures, and Forms Updates