Medical Retirement for Federal Workers: Preexisting Conditions

The concept of a “preexisting condition” necessarily entails a date before which something was in existence; thus, that condition X preexisted date-certain Y, such that X preexisted Y.  Such a condition — whatever the nature of “it” — is normally ascertainable by doctor’s notes, treatment records, etc.

The relevance of whether a certain medical condition “preexisted” a certain date, however, depends upon the issue and the forum.  For Federal OWCP cases administered under the Department of Labor, such an issue is often relevant in determining coverage, precisely because an on-the-job injury will entail causation not only regarding “how” and “where” the injury occurred, but further, encompassing whether a Federal or Postal Worker is making a claim based upon a new and heretofore unknown injury or medical condition, or is merely suffering from a condition which “preexisted” a particular date — either the date of employment, the date of claimed injury, etc.

In a Federal Disability Retirement case, whether under FERS or CSRS, filed through the U.S. Office of Personnel Management, the issue of a “preexisting medical condition” is rarely of any relevance, either on the issue of “when” or certainly not on the “how” or “where”.  OPM will often attempt to make an argument on the basis that one’s medical condition “preexisted” one’s inception date of Federal employment, but presumably the Federal or Postal employee who may have suffered from the condition was able to adequately perform the essential elements of one’s job anyway, but at some point the preexisting medical condition came to a point of progressive deterioration such that it began to impact one’s ability to perform one’s job — in which case it matters not anyway.

In a Federal Disability Retirement application, one should never be fearful of divulging the history of one’s medical condition; rather, it is the here and now which is of relevance: How the medical condition impacts one’s ability to perform the essential elements here in one’s present job, and how it now impacts such job performance.

Sincerely,

Robert R. McGill, Esquire

USPS and Federal Disability Claims: Medical Conditions which Predate Federal or Postal Employment

Often, there is a concern about medical conditions which one suffers from, which “predate” employment in the Federal Sector, or with the U.S. Postal Service.  Such conditions are often identified as “preexisting medical conditions” — meaning, thereby, that they exist prior to an event.

In the context of OWCP (Federal Worker’s Compensation), under the aegis of the Department of Labor, such an issue normally involves the assertion and allegation (by the Department of Labor, Office of Worker’s Compensation Programs) that a Medical Condition-X already existed prior to Event-Y — the latter normally constituting the “on-the-job” accident or occurrence, or an occupational disease, etc.  Because causation — the “what caused the injury” issue — is important in OWCP/DOL cases, the concern of preexisting conditions is normally a point of contention between the Federal worker and the Federal Government/Department of Labor.

However, in OPM Disability Retirement cases, because causation is not an “issue” of concern (the “how” or “where” it happened is not a relevant legal criteria of proof), it rarely becomes a point of conflict between the Office of Personnel Management and the Federal or Postal employee.

It can become of interest, however, for the Office of Personnel Management, in a Federal Disability Retirement application, if a Federal or Postal worker has been hired and working in a particular job, with a specific medical condition for many years, successfully, but then files for Federal Disability Retirement benefits.  The reason it may become of some interest, however, is not as to the “causation” issue (of the “how” or “where” it happened), but rather, to the question:  Why is it that the Federal or Postal employee who has had a Medical Condition-X all of these years can now claim not to be able to perform Essential Elements Y & Z now?

That is the point where a medical condition existing prior to one’s Federal or Postal employment may be of some interest to the U.S. Office of Personnel Management.  It is, however, easily addressed; it just needs to be discussed in the right way.

Sincerely,

Robert R. McGill, Esquire

Medical Retirement Benefits for US Government Employees: Preexisting Conditions

In OWCP/Department of Labor cases, often the focal point of contention (among other issues) involves whether or not a medical condition “pre-existed” the on-the-job injury which is the basis of the claim for compensation.  

In a FERS or CSRS Federal Disability Retirement application, such an issue is usually irrelevant, precisely because the laws governing Federal Disability Retirement is unconcerned with the “where” of a medical condition, as in, “Where did the event take place, which resulted in the medical injury or condition — on the job or not?”  However, the term “preexisting condition” can involve a different conceptual paradigm, encapsulating not the situs of the occurrence, but whether the Federal or Postal employee was hired with the medical condition, and thus was able to accomplish and perform the essential elements of one’s job despite having the medical condition.  

The Office of Personnel Management will sometimes argue this point — that the Federal or Postal employee who has filed for Federal Disability Retirement benefits under FERS or CSRS has a “preexisting condition”; but such an argument actually goes to the issue NOT of whether or not such a preexisting condition is a basis for a denial (it is not), but rather, as to why a Federal or Postal employee would be eligible with such a preexisting condition since that Federal or Postal employee was able to successfully perform his or her job for many years even with the medical condition upon which the Federal Disability Retirement application is based upon.  

Thus, the question in such an instance is not really a preexisting medical condition issue; rather, it is an issue about exacerbation and whether such a preexisting medical condition has progressively worsened to impact one’s ability/inability to perform one or more of the essential elements of one’s job.  How one formulates the issue is very important; OPM does not necessarily understand the proper formulation of a legal issue; as such, it is often the job of the applicant for Federal Disability Retirement benefits to re-formulate the issue in its proper context.

Sincerely,

Robert R. McGill, Esquire

Federal Worker Disability Retirement: Is the Concept of “Preexisting Condition” Ever an Issue?

Sometimes, the Office of Personnel Management will refer to a medical condition which “preexisted” — and it is often confusing as to what they are referring to.  The term “preexisting medical condition” must necessarily imply the question, “Preexisting to what”?  

For health insurance coverage, the issue is obviously one of a medical condition which existed prior to the start of medical coverage, and thus the question becomes whether or not the insurance company has an obligation to pay for medical bills incurred for treatment which existed and began prior to the terms of the policy.  

For purposes of Federal Disability Retirement, however, the question of a preexisting medical condition often encapsulates an admixture of multiple issues, based upon confusing a variety of concepts.  In a denial issued by the Office of Personnel Management, some cases will be denied based upon the assertion that a particular medical condition upon which a Federal Disability Retirement application is based, preexisted the time of Federal Service, and the Federal or Postal employee — despite the existence of the medical condition — was able to perform the essential elements of the duties of the Federal or Postal position.

Thus, a person with a confirmed Veteran’s Administration rating enters into the Federal government and is able to perform the job duties as required (for example).  Such an argument (or lack thereof) by the Office of Personnel Management is thus mixing a couple of issues, and conceptually identifying it as “preexisting condition”:  that the Federal or Postal employee has a medical condition which was identified prior to entering the Federal Service; that he or she was able to successfully perform the essential elements of the job; that the same medical condition is now the basis (or at least one of them) for a Federal Disability Retirement application.  But the issue is not really one of “preexisting condition” — for, whether the medical condition existed prior to or during one’s Federal Service is really an irrelevant issue — but rather, whether or not the medical condition as such became worse such that it now prevents a Federal or Postal employee to perform one or more of the essential elements of one’s job.  

Sometimes, people get the notion that by utilizing certain language, shouting certain sophisticated-sounding catch-phrases, or referring to concepts which seem intelligible, that it actually “means” something.  The concept of “preexisting conditions” is without meaning in a Federal Disability Retirement application, precisely because the law is neutral concerning that issue.  It may sound serious, but this is not OWCP or some other legal forum which applies a criteria regarding “preexisting conditions”.

Sincerely,

Robert R. McGill, Esquire

OPM Disability Retirement: The OWCP Intersection

Federal Disability Retirement benefits under FERS or CSRS is oblivious and unconcerned with whether or not a particular medical condition occurred “on-the-job” or not.  Rather, the focus is upon (A) the existence of a medical condition along with the symptomatologies and their manifestations, and (B) the impact of the medical condition(s) upon one’s ability/inability to perform all of the essential elements of one’s job.  

Thus, “causality” in all of its forms is an irrelevant issue — whether “how it happened”, “where it happened”, “what happened”, etc.  Causation is a legal/medical issue which may be interesting, and is certainly one which the Office of Worker’s Compensation Programs inquires about, but it is a “non-starter” for purposes of Federal Disability Retirement benefits under FERS or CSRS.  

As such, when a Federal or Postal employee who has been injured on the job, or who has incurred a medical condition from a worksite because of inherently hazardous medical triggers reasonably related to the particular occupation of an individual, an inordinate amount of focus is often paid as to the “causality” of a medical condition.  While this may be of historical interest — both to a doctor as well as to FECA/OWCP — it is an issue which should play a lesser role of importance in a Federal Disability Retirement application.  

For eligibility in filing a Federal Disability Retirement application under FERS or CSRS, where something happened, what happened, or when it happened, is far less important than how much of an impact a medical condition has, and for how long, upon one’s ability/inability to perform the essential elements of one’s Federal or Postal job.

Sincerely,

Robert R. McGill, Esquire

CSRS & FERS Disability Retirement: The (non) Problem of Causality & Causation

In a Worker’s Comp (DOL/OWCP/FECA) case, causation and causality often loom as significant issues, and doctors often have to walk a difficult line in making unequivocal statements, or somewhat equivocating statements, as to the “cause” of a medical condition or injury.  Such statements can sometimes be the singular focus as to the success or failure of an OWCP case.  Why?  Because OWCP compensable injuries and medical conditions must be related to the job — either as something caused by an accident while on the job, or in some way occupationally related. 

In Federal Disability Retirement cases under FERS or CSRS, one can be on a skiing vacation and incur a medical condition or disability, and so long as that person is unable to, because of the medical condition, perform one or more of the essential elements of one’s job, one is thereby eligible for Federal Disability Retirement benefits under FERS & CSRS. 

Sometimes, however, the issue of causation comes into the picture, but can work in a detrimental way, but need not.  Let me clarify:  In a chemical sensitivity case, or a psychiatric condition which finds its originating “causation” from the workplace, the doctor may want to relate the “cause” of the medical condition directly to the workplace.  This is fine, so far as it goes — and, ironically, most doctors (because they have no idea about FERS or CSRS disability retirement) think they are doing their patients a favor by relating it as “causally related” to the workplace.  More often than not, however, it can open up a “can of worms” — of being characterized by the Office of Personnel Management as a “situational disability”, which must be avoided like the plague.

Sincerely, Robert R. McGill, Esquire