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

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 Employee Medical Retirement: The Reluctant Doctor

In preparing, formulating, and filing a Federal Disability Retirement application under FERS or CSRS, the linchpin (sometimes spelled “lynchpin”) is comprised of a supportive doctor who is willing to provide substantive medical evidence, by a preponderance of the evidence, that a Federal or Postal employee is no longer able to perform one or more of the essential elements of one’s job, and that the medical condition will last a minimum of 12 months.  

Originally, a linchpin referred to a metal fastener which prevented a wheel from becoming separated or dislodged from the axle.  Similar to the conceptual analogy of the “weakest link” in a chain, the idea of viewing a Federal Disability Retirement application in such terms and perspective is to recognize the centrality of a foundation, and how everything else is supported by that foundation.  If the foundation itself is weak, then the chain may snap, and the wheel may fall off the wagon, and everything which is supported by the foundation may come tumbling down.

Such a weak linchpin may be characterized by “The Reluctant Doctor.”   For, ultimately, it will be the treating doctor’s opinion which will provide the primary basis of a Federal Disability Retirement application under FERS or CSRS.  To presume the support of one’s treating doctor may reveal an unfounded sense of confidence.  To declare that, “Of course my doctor will support me.  He’s been my doctor for X number of years,” is to be naive about the psychology of doctors.

Doctors enjoy engaging in the practice of medicine; they abhor the administrative necessities of supporting their patients in preparing a Federal Disability Retirement application.  The Reluctant Doctor is fairly widespread; it is up to the potential applicant, or his/her attorney, to explain the process, beginning with a simple request for an assurance of support from the patient — the applicant who will be filing for Federal Disability Retirement benefits under FERS or CSRS.

Sincerely,

Robert R. McGill, Esquire

FERS & CSRS Disability Retirement for Federal and USPS Workers: Patient-Doctor Relationship II

Part of a patient-doctor relationship (and I intentionally placed the term “patient” before the hyphenation to “doctor”, because the primacy of the relationship should recognize the order of importance) should necessarily involve a commitment from the doctor.  That commitment should entail the desire to do that which is necessary, within reasonable bounds and within the law, as well as the integrity of the doctor’s medical opinions, in order to look after the best interests of the patient.  

It is always a puzzle and a disturbing bit of news to find that a doctor who has performed surgery, who has prescribed multitudes of pain or psychotropic medications, has prescribed multiple diagnostic tests and have the patient undergo test after test, physical therapy sessions, clinical evaluations, etc. — and at the end of it all, to have the “final straw” which severs the patient-doctor relationship to be a refusal to provide a medical narrative report in support of a Federal Disability Retirement application.  Think how preposterous that sounds.  Thus, it is not enough to get some vague support when the issue is first broached; no, what is needed is the same level of commitment from the doctor, as when he or she first said to you, “Yes, I am going to treat you for your medical condition…”

Sincerely,

Robert R. McGill, Esquire

Medical Retirement Benefits for US Government employees: Consistency

Consistency, in addition to coherence, is an important element which must always be recognized and reviewed in filing an application for Federal Disability Retirement under FERS or CSRS.  Coherence of an application has to do with the element of “fitting all the pieces” together so that everything coheres in a rational, logical, and often sequential manner.  Coherence often has more to do with form, than with substance.  Consistency has to do with the substantive issues — the actually claims and statements made by a doctor; the opinions rendered in relation to the knowledge obtained; and whether everything “agrees” with everything else, in the very substance of the statements and claims made.

Inconsistencies are precisely what the Office of Personnel Management aggressively searches for, in determining the validity of a Federal Disability Retirement application.  Coherence can often be ignored; indeed, in many Federal Disability Retirement applications filed without an OPM Disability Attorney at the First Stage of the process, I have often found that, when it has been denied and people come to me at the Second, Reconsideration Stage, that the application prepared by the applicant is almost entirely incoherent.

The narrative prepared is often illogical; the doctor’s report often takes a “shotgun” approach, without the coherence of a methodology of addressing the essential issues which OPM is looking for.  Either by form or by substance, it is always better to have problems with form, rather than substance.  But if you ask me, it would be “best” (good, better, best) if both form and substance are carefully prepared — meaning, that a Federal Disability Retirement application is both coherent and consistent.

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

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 willingIs 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 benefitsIs 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

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

OPM Disability Retirement: Thank the Medical Professionals

If not for the doctors, disability retirement would obviously not be a possibility.  Of course, one may make the self-evident statement that being supportive of a Federal Disability Retirement application is simply part of a doctor’s job; and, to some extent, that would be true.  Doctors should indeed be willing to write up supportive medical narrative reports for their patients. 

Nevertheless, it is because of the doctor, the effort expended, the willingness to testify at a Merit Systems Protection Board Hearing, that the Office of Personnel Management even listens, or reverses a prior denial, and grants a disability retirement application.  Especially when a case gets denied twice by the Office of Personnel Management, it becomes crucial to have the cooperation of the treating doctor to testify in an MSPB Hearing.  This is normally done by telephone, thereby making it a minimal imposition upon the doctor’s time.  Indeed, I often only take a total of 30 minutes of the doctor’s time, including preparation and actual testimony, for an MSPB Hearing.  But the very fact that the doctor is willing to testify — to speak to the Administrative Judge directly to give his or her medical opinion — is often enough to convince OPM to change course, and grant the disability retirement benefits. 

Sincerely,

Robert R. McGill