Doctors rarely have any problems with administering treatment based upon clinical encounters and subjective narratives from their patients; yet, when it comes to providing a medical report and performing similar administrative functions, the sudden pause, hesitation, and sometimes outright refusal, is rather puzzling, if not disconcerting.
Such trepidation from the doctor can obviously result in a difficult wall for purposes of preparing, formulating and filing for Federal Disability Retirement benefits from the U.S. Office of Personnel Management, whether under FERS or CSRS.
For, much of medical evaluation, diagnosis, prognosis and prescribing of treatment encompasses receipt of subjective responses from the patient: where the pain is present; the nature and extent of the pain; the history and chronicity of manifested symptoms; even functional capacity evaluations must necessarily be an observation of the subjective actions & reactions of the participant. Of course, there are often distinguishable “objective” factors — swelling; carcinogenic versus benign tumors; broken bones, etc.
On the other hand, even MRIs and other diagnostic tools reveal only that X exists — not that X results in symptom Y. An example would be a bulging disc — while the abnormality itself may show up on an MRI, whether the individual experiences any pain from the abnormality may differ from subject to subject.
This is why, despite the willingness of a doctor to treat based upon most factors being “subjective” in nature, it becomes a puzzle why the same doctor shows an unwillingness to write a report stating that, because of the medical conditions for which patient M is being treated, one must necessarily conclude that he or she cannot perform essential elements X, Y and Z of his or her job.
It is the jump from treatment-to-disability-determination which is often problematic for the treating doctor. All of a sudden, the excuses flow: ”I am not trained to make such determinations”; “There is no objective basis for your pain” (then why have you been treating me for over a decade and prescribing high levels of narcotic pain medications?); “I can’t say whether you can or cannot do your job”; and many other excuses.
The switch from administering treatment, to treating administrative matters, is one fraught with potential obstacles. How one approaches the treating doctor will often determine whether such obstacles can be overcome — and whether one’s Federal Disability Retirement application can be successfully formulated.
Robert R. McGill, Esquire
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