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

OPM Disability Retirement: Pre-Conditional Preparatory Steps

In preparing, formulating and filing for Federal Disability Retirement benefits from the U.S. Office of Personnel Management, whether a Federal or Postal employee is under FERS or CSRS, there are steps to be taken — not only at each “stage” of the administrative process, but moreover, in the weeks and months prior to the actual formulation, compilation and submission of the Standard Forms, documentary support, writing of the Applicant’s Statement, etc.

As a “process”, one may bifurcate the necessary steps into the following:  the pre-conditional stage; the preparatory stage; the time of formulation & actualization; finally, the submission of the disability retirement packet.

In the “pre-conditional” time period, one should focus upon the single most important aspect of a Federal Disability Retirement case — that of garnering, concretizing and establishing the necessary physician-patient relationship, such that there is a clear understanding of what is required of the physician; what the physician expects of the patient; and, wherever and whenever possible, a continuing mutual respect and understanding between the doctor and the patient-applicant.

This is why the Merit Systems Protection Board has explicitly, through case after case, opined upon the preference for “treating” doctors of longstanding tenure.  For, in such a relationship of long-term doctor-patient relationships, a greater ability to assess and evaluate the capabilities and limitations of the patient’s physical, emotional and psychological capacities can best be achieved.

In every “rule”, of course, there are exceptions, and sometimes more “distant” methods of evaluations can be obtained — through OWCP doctors, referee opinions, independent examinations (indeed, one can make the argument that because it is “independent”, therefore it carries greater weight), functional capacity evaluations, etc.

For the most part, however, the cultivation of an excellent physician-patient relationship will be the key to a successful Federal Disability Retirement claim, and as such, the pre-conditional stage to the entire process should be focused upon establishing that solid foundation.

Sincerely,

Robert R. McGill, Esquire

Federal Worker Disability Retirement: Agencies & SF 3112C

Agencies have an amazing ability to be inquisitive, especially into those areas which really do not concern them.  Often, Agencies will insist that, despite all of the relevant, pertinent, and desired medical documentation already having been attached to a Federal Disability Retirement application under FERS or CSRS, the applicant/Federal employee “must” sign the Standard Form 3112C (“Physician’s Statement) , which becomes superfluous and irrelevant.  They insist that the Office of Personnel Management (OPM) “requires” the form, which is an erroneous statement.  OPM has never required a signed SF 3112C so long as the Federal Disability Retirement application is accompanied by sufficient medical documentation to support the application.  Sometimes, the insistence by the Agency is merely based upon ignorance; other times, it is based upon an administrative and bureaucratic inflexibility to longstanding “procedures” which the Human Resources personnel cannot adapt to, or change, because “this is the way we’ve been doing it for X number of years”.  Still, there is a suspicion that in some instances, the “requirement” of SF 3112C is because of a more nefarious reason:  The Agency wants full access to all medical records, notes, treatment notes, etc.

Sincerely,

Robert R. McGill, Esquire

OPM Disability Retirement: A Doctor’s Comfort Level

Doctors are funny creatures.  Administrative matters are often distasteful; yet, most doctors recognize that it is a necessary evil as part of the general practice of medicine.  Doctors often act arrogantly; yet, their arrogance is often in reaction to questions and statements which they deem to be irrelevant or insolent.  In filing for Federal Disability Retirement benefits under FERS & CSRS, it is obviously important to get the active, affirmative support of a treating doctor.  How does one go about doing this?  It is ultimately up the patient.  Remember — we are speaking about a “treating doctor” — not a stranger, but a person who, normally over the course of many years, has come to know, evaluate and treat the potential applicant who is filing for OPM Disability Retirement benefits.  Over the years, therefore, hopefully a relationship has grown to fruition.  Asking the treating doctor to support you in a Federal Disability Retirement application — or, if an attorney is hired, to let the doctor know that his or her legal representative will be requesting a medical report — should be the culmination of that special relationship which has developed:  the doctor-patient relationship, one which has grown over the many years of contact, discussion, conversation, and treatment.

Sincerely,

Robert R. McGill, Esquire

CSRS & FERS Disability Retirement: Summer Doldrums & the Physician’s Statement

I have often pointed out in past blogs and articles that I do not have my clients sign the Physicians Statement (SF 3112C), for multiple and various reasons, not the least of which is that it is a confusing form, and in smaller print than necessary, leaving the impression to the doctor that what is requested is far more complex than what is actually required.  In its place, for my clients, I write a 4 – 5 page letter outlining the type of medical narrative report which I need.  This is the summer months; everyone from OPM representatives to lawyers, to doctors and Federal and Postal employees, take time off to recover from the hard work throughout the rest of the year.  When doctors take off for some “summer fun”, it just means that they have less time to spend on administrative matters — such as writing up a medical narrative report for their patients.  Because of this, it is important to try and simplify the matter as much as possible, and a blanket submission of the SF 3112C without some explanatory guidance, is not the best course of action.  Doctors need guidance, and in this busy world, it is best to streamline the process for them as much as possible.

Sincerely,

Robert R. McGill