Federal Employee Medical Retirement: Choosing the Medical Conditions

Often, in preparing, formulating and filing a Federal Disability Retirement application under FERS or CSRS, the question is asked as to which medical conditions should be included in a Federal Disability Retirement application.  The obvious answer, of course, is to identify the “most serious” of the medical conditions, with a secondary consideration being the ones which impact one’s ability to perform the essential elements of one’s job.

Whether to list “all of them” is a separate question, and then there are the subtleties which further delve into a more detailed analysis of the creation of an effective nexus between one’s medical conditions, the job description which one is supposed to be doing, and the provability of the medical conditions identified and described.

Inasmuch as a Federal Disability Retirement application under FERS or CSRS is a “paper presentation” to the Office of Personnel Management (and yes, the concept of a “paper presentation” still applies even if and when OPM converts entirely to the technological next-step of a paperless system; the Federal or Postal employee must still present a formatted application), the admixture of legal and medical issues will ultimately come about.

The conceptual distinction between the diagnosis and the symptomatologies; the extent of willingness of what a treating doctor will state; the concordance between the diagnosis, the symptoms described, and their impact upon the particular elements of one’s position description; the potential impact of being found “disabled” by the Office of Personnel Management based upon a “minor” medical condition which may resolve itself in the future, as opposed to a more serious-listed one; the nebulous areas of “syndromes” (as in Chronic Fatigue Syndrome) and the description of symptoms and making sure to relate the symptoms to a particular medical condition — these are all “subtleties” which involve an intersection between the legal standard of proof and the medical “facts”, in formulating a Federal Disability Retirement application under FERS or CSRS.  But that it were as easy as simply listing one’s medical conditions.  But, alas, OPM is a Federal bureaucracy, and the combination of “the law” and “a bureaucracy” can only lead to one result:  a conundrum.

Sincerely,

Robert R. McGill, Esquire

Medical Retirement for Federal Workers: Medical Conditions & OPM

Clearly, there are certain medical conditions which the Office of Personnel Management “dislikes” or has a negative, suspicious view towards, in a Federal Disability Retirement application under FERS or CSRS.  One may attempt to rationally comprehend the innate bias towards certain groupings of medical conditions, but to do so would expend energy which, ultimately, results in an act of futility.

In preparing, formulating and filing a Federal Disability Retirement application under FERS or CSRS, nowhere in the statute which provides for Federal Disability Retirement benefits is there notification or indication of a distinction between medical conditions.  As such, any pattern of hostility towards a particular medical condition, or a “type” of medical condition, must have evolved over time.  

The peculiar thing, of course, is the consistency in which all of the Claims Representatives at OPM have developed — of a similar pattern of reaction and behavior towards the “undesirable” medical conditions, as if they all work from a single template and have discussed, in conspiratorial hushed tones, a concerted effort to deny certain cases which are primarily based upon X medical conditions.  

That all said — and put aside as a note of interest but ultimately irrelevant — the way to rebut and overcome the inherent bias towards such medical conditions is to systematically reinforce the statutory requirements for eligibility, by explaining to the treating doctor(s) what is needed in order to overcome such bias.  Ignorance of the law is one thing; misapplication of the law is another.  Both must be overcome by guiding the treating doctor in how to meet the legal criteria, no matter what the medical condition.

Sincerely,

Robert R. McGill, Esquire

Federal Disability Retirement: Those Chronic Medical Conditions

Often, in preparing, formulating and filing a Federal Disability Retirement application under FERS or CSRS, there is the concern that because a particular medical condition has had a “chronic” nature to it (whatever the particular diagnosis is, to include Chronic Fatigue Syndrome, Failed Back Syndrome, Fibromyalgia, Chronic Pain, etc.), that somehow it will impact the chances of being approved for Federal Disability Retirement benefits under FERS or CSRS.  

The argument and concern goes somewhat as follows:  X Federal or Postal employee has been able to work for Y number of years for the Agency or the U.S. Postal Service; the medical condition has not prevented the Federal or Postal employee from performing the essential elements of the job all these years, because the Federal or Postal employee has simply endured the chronic nature of the pain; therefore, the medical condition (it is feared) cannot be cited as a basis for an approval from the Office of Personnel Management.  

However, the mere rationale that a particular medical condition is chronic, inherently or otherwise, is not a basis for being concerned about a denial.  The fact is that a particular Federal or Postal employee was able to perform the essential elements of his or particular job for many years; the chronicity of the medical condition is often the case; but at some point, the constant, chronic pain comes to a point where the Federal or Postal employee is no longer able to physically, emotionally or mentally tolerate the extent, duration and severity of the pain.  At such a critical point, it is time to file for Federal Disability Retirement benefits under FERS or CSRS.

Sincerely,

Robert R. McGill, Esquire

Disability Retirement for Federal Government Employees: Beyond the Diagnosis

The diagnosis of the medical condition in a Federal Disability Retirement case, either under FERS or CSRS, is merely the beginning point in preparing a case. As the Office of Personnel Management in Washington, D.C., is fond of repetitively pointing out, “The mere existence of a medical condition is not a basis for approval under Federal Disability Retirement laws.” While there may be some exceptions for certain severe medical conditions, the statement itself contains a truism which needs to be kept in mind throughout the process.  

Ultimately, in preparing a Federal Disability Retirement case, one must approach the entire process (a process, by the way, which is taking longer and longer to complete, as the backlog at the Office of Personnel Management is increasingly extending the wait-time) with a view towards bridging the two critical elements in any successful filing:  (A) the medical condition and (B) its impact upon one or more of the essential elements of one’s job.  

It is that “connective tissue” between the two which must be the focus, and that is why the symptoms which manifest themselves from the origin (the diagnosis) is what must be discussed.  For, ultimately, while the diagnosis of a medical condition provides the basis for which a medical specialist may begin treatment on a patient, it is the symptoms/symptomatologies which provide the answer to the question in all Federal Disability Retirement applications under FERS or CSRS:  In what way does one’s medical condition prevent a Federal or Postal Employee from performing the essential elements of one’s job?

That is the critical question which must be answered, in order to have a chance at having one’s Federal Disability Retirement application approved by the Office of Personnel Management.

Sincerely,

Robert R. McGill, Esquire

Medical Retirement Benefits for Federal & Postal Employees: How to Handle those “Second-Class” Medical Conditions

Attitudes toward various medical conditions change over time.  This has certainly been the case with psychiatric medical conditions:  Major Depression, Anxiety, panic attacks, Bipolar Disorder, Agoraphobia, PTSD, OCD, etc.  At one time in our society, the heavy stigma placed upon such medical conditions essentially made them unacceptable.  Over time, however, as greater numbers of such conditions came to the forefront, and greater success at treatment of such conditions became evident, the validity and acceptance of such conditions have resulted in other medical conditions taking their place.

Thus, certain conditions such as Fibromyalgia, Chronic Fatigue Syndrome, Chronic Pain, Chemical Sensitivity cases, etc., have become the psychiatric conditions of a prior age.  Perhaps it is because the medical profession treats such conditions as afterthoughts — where, through a process of elimination of saying that the medical condition is not X, Y or Z, therefore it is A.

Whatever the reasons, in a Federal Disability Retirement application under FERS, a Federal or Postal employee who is applying for such benefits who is suffering from any of the Second-Class medical conditions must formulate and compile his or her case in a thoughtful, deliberate and forceful manner.  Such a FERS Disability Application must include adequate medical support; a clear and concise bridge between the symptomatologies experienced and the type of job which one must perform; and legal arguments which support the basis for an approval.

To some extent, this approach is no different than with any other medical condition; it is merely a reminder that one must cross all “T’s” and dot all “I’s” with that much more care.

Sincerely,

Robert R. McGill, Esquire
FERS Disability Retirement Attorney

 

Federal and Postal Disability Retirement: Those “Second-Class” Medical Conditions

We all know what the “Second-Class” medical conditions are:  Fibromyalgia, Chronic Fatigue Syndrome, Diffuse Pain, Chemical Sensitivity issues, etc.  To some extent, such medical conditions have always been a paradigm of a society — at one time, one could argue that all psychiatric conditions were treated in a similar manner:  accepted at some level as a medical condition, but stigmatized as somehow being less than legitimate.

In a Federal Disability Retirement application under FERS or CSRS, it is patently obvious that the Office of Personnel Management treats certain medical conditions as “second-class” conditions.  They often deny such cases at the initial stage of the process, and unless you point out a compendium of established case-law authorities, OPM will often get away with their groundless assertions.

Words matter, and which words and arguments are chosen to rebut the Office of Personnel Management matters much in a Federal Disability Retirement case.  Such medical conditions are not second-class medical conditions, and OPM should not be allowed to treat them as such.

Sincerely,

Robert R. McGill, Esquire

Federal and Postal Disability Retirement: Medical Conditions

In filing for Federal Disability Retirement benefits under FERS or CSRS, it is important to note that the Office of Personnel Management will often argue that the mere fact that a person suffers from a medical condition is not in and of itself a basis for granting disability retirement benefits.  So far as such a statement goes, the Office of Personnel Management is correct on the laws governing the eligibility criteria for Federal Disability Retirements (which is rare in and of itself).  Having a medical condition is not a sufficient cause in granting a Disability Retirement benefit.  As it is often argued in the world of philosophy, it is a necessary cause, but not a sufficient one.  In other words, one must indeed suffer from a medical condition (it is thus a “necessary cause”); however, suffering from a medical condition is not sufficient in and of itself to qualify for Federal Disability Retirement benefits under FERS or CSRS (it is not a “sufficient cause”).  One must, beyond having a necessary cause, prove that the medical condition is also the source and impact upon one’s inability to perform one’s job.  Thus, to the limited extent of its truth, suffering from a medical condition is indeed insufficient to obtain an approval from the Office of Personnel Management; it is not “proof enough” in and of itself.

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

Federal and Postal Disability Retirement: Listing Specific Medical Conditions

Because the essence of an OPM Disability Retirement Application under FERS or CSRS goes to the symptomatologies and their impact upon one’s ability or inability to perform one or more of the essential elements of one’s job, it is therefore important to weave throughout the narrative of one’s Statement of Disability the symptoms, the impact, the descriptive events, which impact one’s ability/inability to perform the job.  Thus, while listing specific diagnosed medical conditions shoulder certainly be a part of any such application, the narrative itself should include the description of multiple symptoms resulting from the diagnosis.  Further, while the applicant is disallowed from “adding” any new medical conditions once it has been received by the Office of Personnel Management and assigned a CSA number, nevertheless, the applicant is not a medical doctor, and if a medical condition which later develops or becomes clarified during the process of review needs to be supplemented with an additional medical report or results of a diagnostic test, if the medical condition can be reasonably related to a described symptomatology or description in the original statement of disability, then in all likelihood, it will be allowed in for review.

Sincerely,

Robert R. McGill, Esquire

Medical Retirement Benefits for Federal & Postal Employees: Listing the Medical Conditions (Continued…)

If an individual who has filed for Federal Disability Retirement benefits under FERS or CSRS later finds, during the process of waiting for a decision or, between the time of an initial denial and during the Reconsideration Stage or an appeal to the Merit Systems Protection Board — that a previously unlisted medical condition has worsened, can he “add” that medical condition to his Federal Disability Retirement Application?  Can he file an “amended” SF 3112A, Applicant’s Statement of Disability?  The general answer is, “No”. 

However, one can certainly submit a medical report concerning such “previously-unlisted” medical condition if one can reasonably argue that the previously-unlisted medical condition was in fact listed, right there for everyone (i.e., the Office of Personnel Management) to see.  This issue comes up often enough to be of concern, especially because of the valuable time lost in being forced to “withdraw” an application for OPM Disability Retirement and to start all over again in order to add a “new” medical condition.  To safeguard against such a potential event, it is wise to read through the multiple medical conditions when putting together an OPM Disability Retirement packet, and decide which primary diagnoses to include, and at the same time, to “weave” into the narrative of the description of medical conditions, symptoms and areas of pain which can be reasonably interpreted to encapsulate potentially underlying medical diagnoses which may later become prominent and require greater focal emphasis.

Sincerely,

Robert R. McGill, Esquire