Medical Retirement (for US Federal Employees): Administering Treatment versus Administrative Functions

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.

Sincerely,

Robert R. McGill, Esquire

Federal Disability Retirement: Doctors and the Peculiarities of Treatment

Efficacy of treatment is the goal for a doctor; and upon information that such efficacy has failed to render improvement or incremental signs of progress, many doctors lose interest, or become suspicious.

Social Security Disability, of course, requires a higher standard of proof — one of essentially “total disability”, where one is no longer able to engage in “substantially gainful activity” — and, as such, is an implicit admission of medical failure.

FERS & CSRS Disability Retirement, however, is merely an acknowledgement that there are certain medical conditions which, limited in their scope and impact, prevent a person from performing one or more of the essential elements of a particular kind of job.  Such a person who goes out on Federal Disability Retirement benefits can still remain productive in the work-world, by pursuing another, different kind of vocation.

As such, from a medical point of view, conveying the distinction between the two is like the difference between identifying a hill as opposed to a mountain:  both may have some elevation, but the extent and scope between the two goes well beyond a linguistic peculiarity.

Sincerely,

Robert R. McGill, Esquire

Federal Employee Medical Retirement: The Verification Process

The process for verifying information is a procedural matter which is applied with a systematic methodology.  Verification is essentially a comparative analysis — comparing what is said in one sector of information, with claims made in another.  Consistency of information and claims is therefore what is crucial.  This general overview is applicable in nearly all areas — of law, of marketing, of scholarly endeavors, etc.  

In preparing, formulating and filing for Federal Disability Retirement benefits from the U.S. Office of Personnel Management, whether under FERS or CSRS, it is important to maintain a consistency of claims and assertions.  Thus, there should be a logical and sequential order in the approach of putting together a Federal Disability Retirement application.  What is so surprising is how many Federal and Postal employees filing for Federal Disability Retirement benefits will prepare and submit an Applicant’s Statement of Disability independent of a written medical report from one’s treating doctor.  

Assumptions and presumptions should be avoided at all costs (yes, and the cost of assuming or presuming can be high, indeed, with the consequence of a denial from OPM).  Of course, consistency and verification of information is applicable not only in the preparation of a Federal Disability Retirement application — the same methodology of verification should be applied as to claims by those who represent Federal and Postal employees.  

There is a lot of information “out there”, but whether and to what extent such information is accurate, useable, or even relevant, is a question to be asked and answered by the Federal or Postal employee preparing a Federal Disability Retirement application.

Sincerely,

Robert R. McGill, Esquire

Postal and Federal Disability Retirement: The Positive/Negative Approaches

The inverse of a thing can often be just as effective as the original matter; the ultimate endpoint may be the same, but stated in a different way.

Thus, in preparing, formulating, and filing for Federal Disability Retirement benefits from the U.S. Office of Personnel Management, whether under FERS or CSRS, the preferred approach is the “positive” one, where one’s treating medical doctor will affirmatively connect the dots, create the nexus between one’s medical conditions and the positional duties of one’s Federal or Postal job, and thereby providing the foundational basis of a Federal Disability Retirement application.

However, there are instances where the “inverse” approach, or the Negative entrance into the bureaucratic nightmare called Federal Disability Retirement, might have to be entertained.  Such an approach is a more complex process, within the context of an unwilling doctor.  It takes a thorough review of the doctor’s statements which should include, “Patient X is unable to do X, Y and Z” or “Patient A has limitations in the following areas…”

Thereafter, of course, it is the Applicant for the Federal OPM Disability Retirement who must (or his or her FERS Disability attorney, obviously) take the position description and argue the 1-to-1 correspondence between the medical condition, the limitations expressed by the treating doctor, and the positional elements which are applicable.

In the end, if the doorway to success is achieved through either means, the efficacy of the effort is what matters, and not the pathway in getting there.

Sincerely,

Robert R. McGill, Esquire

 

Federal Disability Retirement: The Supportive Physician

Perspectives vary; varying perspectives often lead to conflict; and conflict represents the divergent paths which pursue different directions, or follow a parallel route.

Physicians who have been practicing medicine for a number of years quite often see the therapeutic benefit of employment, and the negative impact of being identified as “disabled”, with progressive physical manifestations of deterioration, and psychological destruction of futility and hopelessness.  It is not mere coincidence that the high rate of mortality is correlated to two primary life events:  birth (where the infant’s susceptibility to being exposed to an expansive and threatening environment brings with it inherent dangers), and retirement (where the propelling teleological motivation of man suddenly comes to an end).

In preparing, formulating and filing for Federal Disability Retirement benefits from the U.S. Office of Personnel Management, whether under FERS or CSRS, it is obvious that one must have supportive medical documentation in order to prove, by a preponderance of the evidence, that the Federal or Postal employee is eligible for Federal Disability Retirement benefits.  Part of that medical evidence should include a narrative report from one’s treating doctor, or a doctor who can properly and thoroughly assess, evaluate, and conclude that the Federal or Postal employee  can no longer perform one or more of the essential elements of one’s job.

What constitutes “support”, however, can sometimes lead to divergent paths.  Doctors are trained to treat patients, not to perform administrative duties.  The divergence which potentially leads to conflict often involves the differing perspective of what will “help” the patient.  Federal Disability Retirement is a benefits which allows the Federal or Postal employee to remain productive in the workforce, by encouraging the Federal or Postal employee to seek outside employment.  This is the key component and concept which often lends persuasive effect upon a suspicious and cautious medical practitioner.

Explaining the process will hopefully allow for parallel paths, and not a route which results in different directions.

Sincerely,

Robert R. McGill, Esquire

Disability Retirement for Federal Workers: The “Nice” Doctor

In preparing, formulating and filing a Federal Disability Retirement application under FERS or CSRS, it is first and foremost important to have the support of one’s treating doctor.  By “support” is meant that the treating doctor must be willing to spend the time and effort needed to prepare and present a medical narrative which will not only narrate and delineate the diagnoses and symptoms — but beyond that, to take the time to explain the “why” of the nexus between the patient’s medical conditions and the essential elements of one’s job.  

To this extent, of course, the Federal or Postal Worker’s attorney should be of the utmost assistance — to guide the doctor in order to meet the legal criteria for qualifying for Federal Disability Retirement benefits under FERS or CSRS.  It is never an issue of telling the doctor “what to say” — the integrity of the medical opinion of the doctor should never be violated.  Rather, it is an issue of explaining the elements and legal criteria which need to be addressed.  

In ascertaining the level of support which a doctor is willing to provide, it is simply not enough to establish the factual foundation that the doctor is very “nice”.  Nice doctors aside — whether in conversation, table manners or a general sense that he or she is genuinely an all-around nice person — the question is, Will the doctor spend the time and effort (and yes, it is proper for the doctor to be reasonably compensated for his time and effort) in preparing a narrative report which addresses the legal elements in order to present a case of medical disability to the Office of Personnel Management?  

It is nice to have a nice doctor; it is even nicer to have a nice doctor who will support one’s Federal Disability Retirement application under FERS or CSRS.

Sincerely,

Robert R. McGill, Esquire

Federal and Postal Disability Retirement: Is the Doctor in, Please?

In preparing, formulating and filing an OPM Disability Retirement application under Federal employee retirement system (FERS), the support of one’s treating doctor is essential in putting together an effective presentation to the Office of Personnel Management.  Sometimes, even doctors have to be reminded of his or her “obligation” to a patient.  When, how, and in what manner of approaching the doctor, is a discretionary element of the process best left up to the patient.  

The reason why the “treating doctor”, as delineated by cases and opinions rendered by Administrative Judges at the Merit Systems Protection Board and by Judges at the U.S. Court of Appeals for the Federal Circuit, is the best one to provide a clinical assessment and evaluation of one’s ability or inability, and the extent thereof, of performing one or more of the essential elements of one’s job, is that the long-term relationship that has been (or should have been) established over these many years of treatment, is a foundational basis of being able to ascertain the abilities, capabilities, and limitations of the patient’s physical, emotional and mental condition. 

If a treating doctor hides behind the excuse of saying that he or she is not “equipped” to make a disability determination, or that there are doctors “out there” who specialize in disability determinations, and he/she is not one of them, an explanatory discussion should be engaged in with the doctor, which should include at least the following three (3) elements:  (1)  A reminder of the history of the doctor-patient relationship, (2) that your particular doctor is the one who knows the intimate details of your medical conditions and the history of treatment engaged in, and (3) that such administrative headaches resulting in obtaining Federal Disability Retirement benefits from the Office of Personnel Management is a vital part of the long and recuperative process that the doctor has been trying to attain.  

Ultimately, it is the treating doctor who is the best one to render an opinion as to whether a Federal or Postal employee whom the doctor is treating, can continue to perform all of the essential elements of one’s particular job.  The question then is, Is the doctor in?  Meaning:  Is the doctor still going to “be there” when it really counts?

Sincerely,

Robert R. McGill, Esquire

FERS & CSRS Disability Retirement for Federal and USPS Workers: The Reluctant Doctor II

Dealing with the Reluctant Doctor — one who presumably has been treating the potential applicant for Federal Disability Retirement benefits for at least several months, but often for several years — is a rather “touchy” subject.  

On the one hand, the build-up of confidence, confidentiality, and security developed over many years of having a doctor-patient relationship is at stake; on the other hand, the Federal or Postal employee has come to a critical point in his or her future, career and professional life, where the support of the treating doctor in the preparation, formulation and filing of a Federal Disability Retirement application has become necessary.  

Doctors, by nature dislike the administrative aspects of preparing lengthy medical narrative reports.  Yet, most doctors recognize the necessity of that aspect of their practice, and are willing to perform the service as part of their duty to their patients.  A diplomatic, sensitive balance must be struck, but one that is honest and placed within the appropriate context of one’s health and future well-being.  

In essence, the doctor must be asked about his or her support in preparing a Federal Disability Retirement application under FERS or CSRS, but in the context of a larger discussion concerning one’s health, treatment modalities, permanency and chronicity of disabling medical conditions, and future treatment.  In essence, the “reluctant doctor” must be persuaded to disrobe his or her reluctance, for the sake of the patient’s health.

Sincerely,

Robert R. McGill, Esquire

Federal and Postal Disability Retirement: The Necessary Doctor

Ultimately, the doctor who is necessary is the one who will be supportive.  Whenever the question is asked of me whether it is “necessary” to have the support of this or that doctor, my answer is generic in nature:  It is better to have one excellent narrative report in support of one’s Disability Retirement Application, than to have 5 mediocre or lukewarm reports.  Excellence in a Federal Disability Retirement application is encapsulated by the level of passion and support by the treating doctor.  The character and texture of a medical report is not just a set of factual listings of medical conditions and a dry statement of an opinion; rather, the underlying sense of a doctor’s firm and passionate belief in a patient is often evident in the intangible underpinnings of a good report.  There are simply some reports written by a doctor where one knows that it is improbable that the Office of Personnel Management will want to entangle themselves in; the unequivocal voice, tone and tenor of such a report can make the difference between getting an initial approval of an Application for Federal Disability Retirement under FERS or CSRS, or a denial, resulting in the necessity of going to another stage of the process.

Sincerely,

Robert R. McGill, Esquire

Disability Retirement Benefits for Federal & Postal Employees: Are all Doctors Necessary?

In a Federal Disability Retirement case under FERS or CSRS, is it necessary to obtain the medical opinion of each and every doctor for each and every medical condition listed on the Applicant’s Statement of Disability (SF 3112A)?  To put the question in another way, Must there be a one-to-one correspondence between the medical condition listed or described, and the doctor who is specifically treating the medical condition? 

Certainly, in today’s world of medicine, where specialization is the key to treatment because of the complexity of each field of medicine and the successful treatment of diseases and medical conditions, it has become a fact of life that patients are “referred out” to various specialists.  Thus, the Primary Care Physician is often merely the “gate-keeper” of referrals, coordinating the medical treatment of a patient by overseeing the referrals to various specialists who treat various medical conditions.

An applicant for Federal or Postal Disability Retirement benefits under FERS or CSRS who must prove, by a preponderance of the evidence, his or her eligibility for Federal OPM Disability Retirement benefits, must submit substantiating medical documentation to prove his or her entitlement. 

As with all such questions, the answer to the above question is, “It depends”.  A one-to-one correspondence is not necessarily required; where helpful, of course, the referral specialist’s medical opinion should be used.  However, one should never underestimate the importance and force of the coordinating physician — the Primary Care Physician himself/herself.

Sincerely,

Robert R. McGill, Esquire