Federal Disability Retirement: The mediocre medical report

One can, of course, obtain an “excellent” medical report — i.e., one that has full, unequivocal support in providing a clear diagnosis, description of symptoms, impact upon specific job functions, etc., with an unequivocal conclusion of disability beyond the specific elements of one’s job functions, etc. — and yet get denied by the U.S. Office of Personnel Management.

On the other hand, one can submit with a Federal Disability Retirement application a “mediocre” medical report — e.g., one that is generalized and non-specific, and shows scant reference to specific job functions, and provides barely a conclusion of disability, and yet get an approval at the First Stage of a Federal Disability Retirement application.

So, one may ask, where is the consistency shown by the U.S. Office of Personnel Management?  Is it all a matter of perspective — of a crap shoot as to who reviews a Federal Disability Retirement application at OPM?  The fact is, there is no “perfect” methodology that will guarantee that a well-prepared Federal Disability Retirement application will be approved at the First Stage of the OPM Disability Retirement process.

However, there are certainly “chance-enhancers” — those preparatory actions that exponentially increase the A 5-Step Pathway to Success at each stage of a Federal Disability Retirement process — that will help to ensure that, more likely than not (sort of like the legal standard itself — of a “preponderance of the evidence” — that is applied to a Federal Disability Retirement case), your Federal Disability Retirement application, whether you are under FERS, CSRS or CSRS Offset, will have a successful outcome with the U.S. Office of Personnel Management.

First and foremost, understand the critical structure of a Federal Disability Retirement application:  The foundation of every Federal Disability Retirement application is the medical report.  It is the foundation of a Federal Disability Retirement application (otherwise referred to as an “FDR”); from it, the legal arguments arise and the justifying Applicant’s Statement of Disability are together formulated.

Thus, just as a shaky building’s foundation will likely fail to withstand even a minor earthquake or a minimal subterranean tremor, so a mediocre medical report will often decrease the chances of a First Stage FDR approval.

Are there ways to counter such mediocrity?  Yes — by pointing out other critical elements of the case. And, of course, sometimes the choices are limited, where it is better to proceed even with a mediocre medical report than not at all, and to put the best case forward regardless of the insufficiency of a mediocre medical report.

Sincerely,

Robert R. McGill, Esquire

 

FERS & CSRS Disability Retirement from the Office of Personnel Management: SF 3112C

As a “government form” it purports to provide guidance in general terms, and it is doubtful that the lack of clarity as to its purpose or utility will assist the medical professional into writing an effective report.

The plain fact is that SF 3112C is a confusing form — confusing both to the doctor or Nurse Practitioner who is presented with it, as well as to the FERS Applicant who is attempting to prepare an effective OPM Disability Retirement application.  It refers to a “position description” being attached, but fails to provide the necessary explanatory nexus between the PD and the medical opinion sought.

What part of the position description should be focused upon?  Is it the entirety of the PD, portions of it, or just the “essential elements”?  Is it relevant whether a person can work part-time, full time, or an erratic combination of both depending upon the severity of symptoms that may arise periodically?  Is SF 3112C meant to confuse, or like so many “government forms”, is the language inevitably misleading because it is (A) meant to be that way, (B) unintentionally written in an unclear manner or (C) is meant to be wholly unhelpful because OPM doesn’t want to go out of its way to help the Federal Disability Retirement applicant?  Must the SF 3112C, the “Physician’s Statement”, be used at all?

If you are still working with the Federal Agency or on the rolls of the Postal Service, or at least not separated for more than thirty one (31) days, must the prepared physician’s statement be sent directly to your H.R. Office without first being reviewed and validated by the applicant?  The form itself certainly makes it appear so, but is that really the case?

In the end, the applicant who is preparing, formulating and filing a Federal Disability Retirement application, to be submitted to the U.S. Office of Personnel Management, whether the Federal or Postal employee is under FERS, CSRS or CSRS Offset, must make some initial and important determinations concerning the substance and content of the application itself.

Forms are tricky; the laws that oversee them, often vague; but if you are relying upon instructions written and formulated by the very government agency that will be making a determination on your application, you may want to first consult with an attorney who specializes in the very law that governs Federal Disability Retirement, before you begin “filling” out forms or having your doctor fill one out.

Sincerely,

Robert R. McGill, Esquire

 

OPM Form SF 3112C and the Sufficiency of the Physician’s Statement

Confusing necessity and sufficiency is always a precarious matter. That which is necessary may not be sufficient for a given purpose, and failure in understanding such a fundamental distinction can be fatal to a Federal Disability Retirement claim.

SF 3112C requires that a physician complete and provide essential medical information in the pursuance of a Federal Disability Retirement application. The form itself — SF 3112C — is the vehicle by which the medical documentation is obtained. It is “necessary” in the sense that SF 3112C delineates a guideline of the type of information which is needed in order to become eligible for Federal Disability Retirement benefits.

The form itself — SF 3112C — however, is to a great extent irrelevant (although, the U.S. Office of Personnel Management has recently required that a signed SF 3112C be included in the final Federal Disability Retirement packet, despite SF 3112E clearly stating that an “equivalency” of the form would satisfy the lack thereof, as in the attachment of the medical documentation itself), and it is instead the medical documentation through which SF 3112C is obtained, which is what is important.

Regardless, while the OPM SF 3112C constitutes the vehicle, is necessary, but is ultimately irrelevant in and of itself, it is a necessary form to the extent that it mandates the delineation of what information is required for eligibility and entitlement to Federal Disability Retirement benefits.

Will following the guidelines in accordance with what SF 3112C states, result in a successful OPM Disability claim? That is the question of “sufficiency”, as opposed to “necessity”.

Over the years, case-law and statutory interpretation and expansion of Federal Disability Retirement laws have greatly altered the landscape of a Federal Disability Retirement claim. SF 3112C is the vehicle of necessity, although the form itself is an unnecessary one. The greater question is whether it is sufficient to meet the legal weight of preponderance of the evidence, and that question must ultimately be answered by questioning the efficacy of the form itself.

Sincerely,

Robert R. McGill, Esquire

SF 3112C

OPM Standard Form 3112C: Physician’s Statement:

Forms tend to intimidate; the more official the appearance, the greater heightening of anxiety in close encounters of this kind.  Beyond the alien look of some forms (for those who have already identified the two references to Steven Spielberg’s 1977 Science Fiction film, you have revealed what generation you are from), the size of the font, the extent of warnings issued (i.e., “Privacy Act and Public Burden Statements”, etc.), and most importantly, the cogency and clarity of understanding for a third-party being requested to provide valuable and necessary information on behalf of a patient — these are all important considerations to entertain.

In this busy world, where doctors must wear multiple hats — of administrative overloads, compliance with billing requirements in Medicare, Medicaid, and numerous other government portals, etc.; of earning sufficient income in order to pay staff, salaries and practice expenses; of ensuring privacy protections; and, finally, beyond all of the headaches associated with running a medical practice — of actually engaging in patient care becomes almost a secondary issue. Time is limited; time is a commodity of invaluable substance; time is a restrictive resource when the exhaustion of the modern world impinges upon the daily necessity of making a living.

And so the Federal or Postal Worker who is filing for Federal Disability Retirement benefits hands, sends, or faxes a government form, demanding that a doctor complete another issuance of what can only be kindly termed as a nuisance or a headache.  The normal response of the treating doctor is to procrastinate, ignore, or, worse yet, to put together a bundle of treatment records and send them off.

OPM Form 3112C, the so-called Physician’s Statement, is the crucial linchpin of a Federal Disability Retirement application; yet, the form itself is an intimidating venue which can predispose a Federal Disability Retirement application to a preview of failure. Are there alternatives? SF 3112C itself is put forth as if it is a necessary prerequisite in the entire process of filing for Federal Disability Retirement. The answer can be found in another form — SF 3112E — where it clearly states: Attach SF 3112C, Physician’s Statement (or its equivalent).

It is the equivalency which is the key to a successful Federal Disability Retirement application, for the Federal Employee on long-term sick leave (SL) or the injured Postal worker who is preparing, formulating and filing for Federal Disability Retirement benefits, whether one is under FERS or CSRS, through the U.S. Office of Personnel Management.

Equivalencies matter, and what constitutes such “equal-ness” in acceptable form, is the key to a successful Federal Disability Retirement application.

Sincerely,

Robert R. McGill, Esquire

 

Disability Retirement for Federal Workers: How and What

In preparing, formulating and filing for Federal Disability Retirement benefits from the U.S. Office of Personnel Management, whether under FERS or CSRS, “how” one states something is often just as important as the “what” one says.

The latter is relevant for obvious reasons:  the subject of the statement is the “identifier” for purposes of directing the reader (in this case, the person who is handling your Federal Disability Retirement benefit application at the U.S. Office of Personnel Management) to focus upon a particular matter; but just as importantly, “how” it is said — i.e., the tone, tenor and context of the “what”.

How a medical report is stated will often determine the success of a Federal Disability Retirement application, more than what is expected to be said.  For, from the perspective of the Office of Personnel Management, the generic “what” (the subject matter of the application) will almost always contain the obvious:  that there is a medical condition; that the medical condition prevents one from performing one or more of the essential elements of one’s job; that the Federal or Postal worker will make statements and claims of an inability to perform certain key elements of one’s job because of one’s medical conditions, etc.

On the other hand, how it is stated:  Is it persuasive?  Does the doctor follow from a reasonable explanation to an unequivocal conclusion?  Is the doctor convincing?  While the “what” of a Federal Disability Retirement application, whether under FERS or CSRS, may be a necessary condition of a Federal Disability Retirement application, it may not be sufficient; sufficiency may be determined by how a Federal Disability Retirement application is prepared, formulated, and ultimately filed.

Sincerely,

Robert R. McGill, Esquire

FERS & CSRS Disability Retirement: The Doctor

Out of all of the elements comprising a Federal Disability Retirement application — the various aspects, including medical, personal, impact-statement, statement of disability, Supervisor’s Statement, etc. —  the essence of it all must be coordinated around the core of the case:  the medical narrative report.

That alone has multiple, inherently complicating factors:  Why won’t the surgeon write the report?  Why is it that the Pain Management doctor, or the Internal Medicine doctor, or the Family Physician is the one often most cooperative and willing?  Is the Chiropractor’s opinion sufficient?  Is it helpful?  How detailed must the report be?  How long must you be a patient in order to establish the threshold of having a “longstanding doctor-patient relationship“?  Are medical records in and of themselves sometimes sufficient to obtain Federal Disability Retirement benefits?  Is it sufficient to get a Therapist to do the report, without the Psychiatrist?  Can a therapist alone win a case? Must I undergo a Functional Capacity Evaluation?  Can I use reports from an OWCP Second Opinion doctor?  If my Psychiatrist only sees me for five minutes each time and prescribes the medication, is it necessary for him/her to write a report?  How detailed must the report be?  Is the doctor going to understand, let alone actually read, the SF 3112C?  These are just some of the questions which one is immediately confronted with, in beginning the process of putting together a Federal Disability Retirement application under FERS or CSRS.  It is a complex, overwhelming process.

Sincerely,

Robert R. McGill, Esquire

FERS & CSRS Disability Retirement: The Family Doctor and the Surgeon

I am often asked whether or not a medical report from the “specialist” will have a greater impact than a family doctor.  Implied in such a question, of course, is a perspective which tends to see the family doctor as somehow “less qualified”, sort of like comparing the technical deficiencies of a “country doctor” as opposed to a “real doctor” — one who works in an emergency room in a large metropolitan hospital.  Perspectives and prejudices have a way of defining judgments, and assumptions, presumptions and long-held beliefs, whether valid or not, often rule our lives. 

How can I answer such questions?  In the course of a Hearing before an Administrative Judge at the Merit Systems Protection Board, I have had family doctors testify who were unbeatable, and certainly overwhelming in his or her expertise and medical knowledge.  The years of experience in having to deal with thousands of patients, and confronting and treating medical conditions of every imaginable sort — and making decisions (including referring patients to “specialists” for concurring or confirming diagnoses and opinions) involving the “whole” patient’s medical condition and treatment — came through with such persuasive force and overwhelming confidence, that it was indeed the “family doctor” or the “country doctor” who ruled the day. 

Similarly, I have had the “specialist” testify in cases, who barely were able to coherently describe the connection between the medical condition and the essential elements of the job.  And, of course, sometimes the opposite is true — good surgeon, mediocre family doctor; mediocre specialist, great country doctor.  As in all things, in Federal Disability Retirement applications under FERS or CSRS, it is not so much that the credentials matter, as the character, experience, and “heart” of the doctor who treats the patient.

Sincerely,

Robert R. McGill, Esquire

CSRS & FERS Disability Retirement: SF 3112C

Standard Form 3112C, the Physician’s Statement, is often an ineffective way of getting one’s treating doctor to prepare and write an effective medical report for a disability retirement application, to be submitted and reviewed by the Office of Personnel Management.  Because it is a standard form — with standard language and guidelines provided in generic form –doctor’s generally dislike taking such “instructional forms” and trying to decipher what is needed, how to properly and effectively interpret the generic instructions, and be the most effective medical advocate on behalf of a patient.

This is where an attorney’s guidance can be most effective and invaluable; for, ultimately, OPM’s review of eligibility for Federal Disability Retirement benefits under FERS or CSRS is not merely medical, but legal.  Because there are legal standards to be met, eligibility is ultimately determined not solely upon a medical basis, but upon a mixture of medical documentation which must satisfy a legal standard.  That is why the guidance of an attorney is crucial in a Federal Disability Retirement application under FERS & CSRS.

Sincerely,

Robert R. McGill, Esquire

OPM SF 3112 Schedule C Form: The Doctor’s Statements

The lack of cooperation from a treating doctor, who is asked to provide a medical narrative report for a Federal Disability Retirement application under FERS or CSRS, may be based upon one of several factors.

It may be that the doctor merely refuses to engage in any type of administrative support for his patients; it may be that the doctor has private suspicions that, to openly admit that his/her patient must file for Federal Disability Retirement means that his/her treatments have failed, and thus, the patient/disability retirement applicant is considering filing a malpractice action, and asking him/her to write a supportive medical narrative is merely a ploy to set the groundwork for a later malpractice action; it may just be bad bedside manners; or it may be that the doctor does not understand the Federal Disability Retirement process, and how it differs for Social Security Disability, or Worker’s Comp.

If it is the latter reason, then it is the job of the attorney to make sure and explain, delineate, and inform the doctor of the nature, extent, and context of Federal Disability Retirement — and to show how an approval for disability retirement benefits will be the best thing for his/her patient.  This is where an attorney representing an applicant for Federal Disability Retirement benefits under FERS or CSRS becomes a crucial component in the preparation of such an application.

Sincerely,

Robert R. McGill, Esquire

 

Federal & Postal Service Disability Retirement: Differing Legal Criteria

Similar benefits, at the State, Local, Private levels, and at the Federal level, each contain differing legal criteria for eligibility. Thus, for instance, Social Security Disability benefits require one set of standards of eligibility; private disability insurance policies require a different set of standards; and state disability benefits often differ from state to state.  This is of course true of Federal Disability Retirement benefits under FERS and CSRS — where the legal standard of eligibility is different from Social Security, Worker’s Comp, and State or private disability criteria.

Often, a question is asked whether a medical narrative report which is prepared for submission to the Office of Personnel Management can be used for submission for other “similar” benefits.  The short answer is, “It all depends”, but the long answer is that, in most cases, one must be very cautious.  When I represent a Federal or Postal employee under FERS or CSRS, one of the first steps in preparing a viable case is to request of the treating doctors a detailed medical narrative report.  One must understand that the treating doctor has, generally speaking, next to no idea as to the legal criteria that must be met under FERS or CSRS.  Furthermore, the treating doctor has no legal knowledge as to the differences between private disability insurance policies, State, Social Security, OWCP or FERS & CSRS.  It is the job of the Attorney to make sure and guide the treating doctors as to the criteria which must be met as to the particular and specialized field for which the medical narrative is being prepared.  This must be done with care, and with detailed guidance.

Sincerely,

Robert R. McGill, Esquire