CSRS & FERS Medical Disability Retirement: The Treating Doctor

There is efficacy and motivational bias.  Sometimes, unintended consequences result in the coalescence of both, but where the result is unaffected by the underlying reason for acting upon an event.

In OWCP cases, the motivational bias almost always includes the intent of the Department of Labor to try and save money, and to steer the injured worker to undergo treatment (if one can call it that) and oversight with one of “the company” doctors who can quickly declare a person to be healed and ready for return to full-time duty, despite protestations of pain, discomfort and limitation of movement, all to the contrary.

It is no accident that the ever-present Worker’s Comp Nurse who infringes upon the patient-doctor relationship by imposing her presence upon each visit, agrees whole-heartedly with any such assessment of full recovery, and ignores the pleas of the patient/OWCP benefit-recipient.

By contrast, those who are filing for Federal Disability Retirement benefits from the U.S. Office of Personnel Management, whether under FERS or CSRS, are encouraged to speak with their longstanding treating doctors, as opposed to merely going to a doctor whose motivational bias may stem from the source of one’s payment.

Treating doctors who have a long tenure of doctor-patient relationships have little underlying motivation to do anything but look out for the best interests of the patient.  If Disability Retirement is the best course, then that will be what the treating doctor will support.  It is ultimately the relationship that has been established over the many years, which makes for all the difference.  And that difference is worth its incalculable weight in gold.

Sincerely,

Robert R. McGill, Esquire

CSRS & FERS Medical Disability Retirement: Refinements, Redux

A “refined sense of taste”; refineries which take crude oil and extract and leave out the waste; perfecting and polishing that which is roughly hewn.  What always needs to be focused upon, first and foremost, however, is the foundation which allows for such refinements, and to ensure that the “base” is solidly built, upon which such “refinements” can be made.

Thus, in preparing, formulating and filing for Federal Disability Retirement benefits from the U.S. Office of Personnel Management, whether under FERS or CSRS, it is important to put one’s energies into building the proper foundation at the outset — and, in practical terms, that means obtaining an excellent medical report.

Federal and Postal workers inquiring about Federal Disability Retirement benefits often get sidetracked with agency and employment issues which, while having some corollary or peripheral relation to one’s medical conditions and work-related concerns which may have prompted an adverse action, or even perhaps discriminatory behavior on the part of the agency; nevertheless, the focus must be upon the foundation, with all else being recognized as secondary matters to be dealt with separately.

Thus, the story of the three piggies:  remember that it was the one with the solid foundation which survived the attacks.  By analogy and metaphor:  The agency is the Big Bad Wolf; the Federal or Postal employee is the piggy; the house to be built is the Federal Disability Retirement packet.  For that, a solid foundation must be created; window dressings can come later.

Sincerely,

Robert R. McGill, Esquire

Federal Employee Medical Retirement: The Supportive Physician

Physicians comprise a peculiar and unique breed of people; highly trained, the best physicians must be more than a technician, however, in order to effectively treat their patients.  The uniqueness of the profession itself requires a full panoply of skills, including intelligence of application; an acuity of judgment; analytical abilities in evaluating, assessing, diagnosing, and ultimately treating; a bedside manner which conveys confidence and compassion at the same time; and not least — an ability to listen and communicate.

For the Federal or Postal worker who is contemplating preparing, formulating and filing for Federal Disability Retirement benefits from the U.S. Office of Personnel Management, a physician who is supportive of the potential applicant’s endeavor is crucial to the successful outcome of the entire administrative process.  By “support” cannot merely be characterized by a smile and a pat on the back; it requires that the physician be willing to make the connection between one’s medical conditions (which the treating doctor should have a thorough knowledge and understanding of) and the essential elements of one’s job (of which the Federal or Postal employee should have a deep and detailed awareness).

Thus, as the partnership for healing comes together in the creation and fostering of a doctor-patient relationship, so the fruition of a successful Federal Disability Retirement application begins with the coalescent cooperation between the medical professional and the Federal or Postal employee who is preparing, formulating, and filing for Federal Disability Retirement benefits.  How that cooperation comes together, of course, makes all the difference, and the tell-tale sign is the willingness to provide a detailed narrative medical report.

Sincerely,

Robert R. McGill, Esquire

OPM Disability Retirement: Quality & Quantity of Medical Report

In preparing, formulating and filing a Federal Disability Retirement application under FERS or CSRS, it is often asked as to the quantitative sufficiency of the medical documentation to be submitted.

Qualitative sufficiency for Federal Disability Retirement applications, at least on a generic level, is an easy one to answer — the substance of the medical documentation must meet the legal standard of proof.  If the Office of Personnel Management or the Merit Systems Protection Board approves the Federal or Postal employee’s Federal Disability Retirement application under FERS or CSRS, then obviously both the quality and quantity of medical documentation met the standard of proof.  

But an answer based upon “after the fact” circumstances is rarely useful; the generic answer of, “Submit medical evidence such that it meets the legal burden of proof, of Preponderance of the Evidence”, might be well and good, but what does that mean?  

Ultimately, the reason why such questions as to sufficiency of medical documentary submission cannot be answered in a generic manner, is that each particular case is unique, and any imposition of a general rule is dangerous because, the moment the general rule is followed and violated (with a denial from the Office of Personnel Management), then the rule becomes obsolete and irrelevant.  

The quality of the medical documentation to be submitted must ultimately show to OPM that each of the legal criteria are met, and that there is a nexus between one’s medical conditions and the type of work that one performs.  

Quantity of medical documentation is ultimately determined by the quality of the medical narrative.  While generic in scope, the general approach is that one should submit only the extent of medical documentation sufficient to prove one’s case; and in each particular case, what that proof must consist of, is unique, particularized, and ultimately personalized to the individual Federal or Postal Worker who is preparing, formulating and filing a Federal Disability Retirement application under FERS or CSRS.

Sincerely,

Robert R. McGill, Esquire

OPM Disability Retirement: The Treating Doctor versus “Others”

Obtaining the support of one’s treating doctor is an essential element in preparing, formulating and filing a Federal Disability Retirement application under FERS or CSRS. The “treating doctor” is a unique animal, and one who possesses peculiar and particularized knowledge specifically relevant to a Federal Disability Retirement case.  

The treating doctor usually has a longstanding relationship with the potential Federal Disability Retirement applicant; through extensive and multiple clinical encounters, has formed a professional opinion about the overall health issues of his/her patient; has often spoken about other matters, including personal issues, and therefore has formed that puzzling emotional bond identified as a “relationship” with the potential Federal or Postal Disability Retirement applicant; has knowledge of the history of the Federal or Postal employee, including personal tidbits of information; and other important information.  

Aside from the fact that the Merit Systems Protection Board’s specific acknowledgement of the importance of the treating doctor (while not denigrating the ability of a referral doctor or disability specialist in also playing an important part in the determination of an OPM Disability Retirement application), it is precisely because of this knowledge that he/she possesses — based upon a thorough understanding grounded upon historical information gathered over a span of time; based upon intimate clinical encounters; based upon a professional observation of the chronicity, impact and progressive nature of a medical condition upon the abilities and capabilities of the Federal or Postal employee — that a special “place” of status and stature is granted to the Treating Doctor.  

This is important to know in preparing, formulating and filing a Federal Disability Retirement application under FERS or CSRS.

Sincerely,

Robert R. McGill, Esquire

Federal and Postal Disability Retirement: Is the Doctor in, Please?

In preparing, formulating and filing a Federal Disability Retirement application under FERS or CSRS, 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

Federal and Postal Disability Retirement: Sufficiency of Medical Evidence

In meeting the eligibility criteria for Federal Disability Retirement benefits under FERS or CSRS, one must obtain the proper medical documentation, meeting a “preponderance of the evidence” burden of proof, such that it is more likely than not that you are entitled to Federal Disability Retirement benefits under FERS or CSRS.  

Whether a medical report and supporting documentation satisfies the eligibility criteria is based upon the subjective interpretation of the evidence presented.  By “subjective” is meant the following:  The reviewing Claims Representative at the Office of Personnel Management, while allegedly applying a 7-part legal criteria in making a determination of eligibility for each FERS or CSRS Federal Disability Retirement application, must nevertheless make an interpretive determination based upon the sufficiency of the medical evidence, and taking into account all other evidence.  

Indeed, often the interpretation of the statutory meaning which governs all Federal Disability Retirement applications is misunderstood and misinterpreted by OPM.  That being the case, how can one expect that OPM will “get it right” when reviewing and interpreting complex medical documentation?  For example, OPM will often cite as necessary that the medical evidence was not “compelling” enough; or, that the medical evidence presented did not show that it warranted the applicant’s “total exclusion from the workplace” — despite the fact that neither of these standards are required by law.  

The sufficiency of the medical documentation is the linchpin of a Federal Disability Retirement application.  As such, it must be prepared by the treating doctor by pulling together a compendium of multiple factors.  While it need not be compelling, one thing is for certain:  quantity versus quality will not meet the sufficiency test, and it is always better to have one excellent medical report, than numerous mediocre ones.

Sincerely,

Robert R. McGill, Esquire

Federal Disability Retirement: Formulating an Effective SF 3112A

The “heart of it all” is…   The medical report will provide the substantive basis; a supervisor’s statement may or may not be helpful or useful at all; legal arguments will certainly place the viability of the application for Federal Disability Retirement into its proper context and arguments which touch upon the legal basis will inevitably have their weight, impact and effect upon whether one has met by a preponderance of the evidence the legal criteria required to be eligible and entitled.  All of that aside, the SF 3112A — the Applicant’s Statement of Disability — is where the heart of the matter resides in preparing, formulating, and filing a Federal Disability Retirement application under FERS or CSRS. 

If a Federal or Postal employee is unsure of what to state, how to state it, or how much to reveal and state, that becomes a problem.  For, ultimately, the proper balance must be stricken — between that which is relevant as opposed to superfluous; between that which is substantive as opposed to self-defeating; and between that which is informational, as opposed to compelling.  Formulation takes thought and reflection.  Yes, the SF 3112A — the Applicant’s Statement of Disability — is the heart of it all.

Sincerely,

Robert R. McGill, Esquire