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

FERS & CSRS Disability Retirement for Federal and USPS Workers: Solutions

In preparing, formulating and filing for Federal Disability Retirement benefits from the U.S. Office of Personnel Management, it is important to focus upon the solutions to the multiple obstacles which necessarily accompany the preparation of a Federal Disability Retirement packet.

Part of the inherent problem for the Federal or Postal worker who is contemplating filing for the Federal Disability Retirement benefit, is of course the medical condition itself.  It is difficult enough to maneuver through the potholes, valleys and pitfalls of life which one must face on a daily basis; it is exponentially pronounced when one must do so with the hindrance of a physical, mental, or emotional (or often all three) medical condition.

Thus, if the problem at the outset is to secure the support of a doctor, because the doctor is unwilling to provide a medical narrative report, then the solution is to find another doctor.  This often happens if the originating injury occurred as a job-related incident and the doctor’s services were obtained through OWCP; or, sometimes, one’s own lifelong treating doctor simply becomes weary of all of the administrative paperwork which is entailed by the process itself.

To “find another doctor”, of course, is an easy enough statement to make; to actually do so may entail energy, effort and a level of focus which involves much beyond what one wants to expend.  But what choice does one have?  Repetitively reviewing one’s obstacles contributes little to the advancement of one’s cause; focus upon the solution, not the problem, for it is the former whichjavascript:; leads one on a path of recovery, not the latter.

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 Employee Medical Retirement: Medical Records Alone

Medical records can provide valuable information, and as a tool in getting a Federal Disability Retirement application under FERS or CSRS approved, it should be selectively submitted.  Can it replace a medical narrative report from a treating doctor?  Normally, a narrative report from one’s treating doctor — whether a specialist, a family doctor, a psychiatrist, etc. — is invaluable in preparing, formulating, and submitting a Federal Disability Retirement application under FERS or CSRS.  The combination of the two, of course, is unequivocally the best-case scenario:  of a medical narrative report supported by, and in consonance with, the office notes, surgical notes, treatment notes, etc.

However, it is not impossible to get a Federal Disability Retirement application under FERS or CSRS approved based upon medical records alone.  If that is the only course of action left — with the alternative choices being of walking away without filing for Disability Retirement benefits — then a Federal Disability Retirement application based upon one’s medical records alone can be successfully argued, but it must be done with meticulous care, and squeezing every notation and attribution of annotations to their fullest relevance, extent and extrapolating significance.

Sincerely,

Robert R. McGill, Esquire

CSRS & FERS Medical Disability Retirement: Don’t Assume

We are all familiar with the acronym-like adage which can be extracted from the word “assume”.  In preparing a Federal Disability Retirement application under FERS or CSRS, the first question that one must ask of one’s self is:  “Do I have a supportive doctor?”  If the answer is an unequivocal “No”, then entertaining even the thought of proceeding forward with the process is a virtual act of futility.  

Now, to all unqualified statements, there are exceptions to the rule.  There are, indeed, medical conditions where the mere treatment records, office notes, etc., reveal irrefutably of a medical condition of such severity that there is no question as to its impact upon one’s ability/inability to perform the essential elements of one’s job.  But that is rare.  If the answer to the original question is:  “He may be…”  “I assume he is supportive…”  “He seems supportive because…”   While these are niceties in one’s figment of one’s imagination, and foster a sense of security and a warmth for a doctor-patient relationship, such answers all have an undercurrent of an assumption.  Don’t assume, if you are planning to go forward with a Federal Disability Retirement application.  Instead, make an appointment with your doctor and have a frank and open discussion.

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

Federal and Postal Disability Retirement: Disarming the Doctor

To some extent, there is indeed a “difference” and a “distinction” between an Administrative process of law, and a “legal” or “courtroom” (i.e., “adversarial”) process of law.  Doctors are, by either personal & professional direct experience, or from hearing or reading about others, keenly aware of the horrors of the “legal” process.  Malpractice lawsuits, personal injury lawsuits, subpoenas, depositions, being cross-examined by a defense attorney (or the Plaintiff’s attorney, whichever may be the case) on the stand — these are all intimidating factors that are deliberately avoided. 

Because of such negative experiences, perspectives, memories or viewpoints about the legal process, it is often an unfortunate fact that doctors “run for cover” whenever there is even a hint that one is being asked to involve him or herself in such a “legal process”.  Doctors will outright refuse to write a medical report; one may be dropped as a patient suddenly and without warning; there may be considerable delays and obfuscation in responding to a request for a written narrative report.  These are merely some of the underlying reasons why an SF 3112C should never be used — because it does not properly explain what it means to “get involved” in the administrative process.  To this extent, it is important to have an attorney who will carefully, and with great tact, explain the process of obtaining Federal Disability Retirement benefits — and thereby “disarm” the doctor from being intimidated.

Sincerely,

Robert R. McGill, Esquire