OPM Disability Retirement: OWCP Doctors, and Others, Etc.

Can a doctor with whom one has been treating, but one which was obtained through the Federal Employees’ Compensation Act, Department of Labor (FECA/DOL), Office of Workers’ Compensation Program (OWCP), be an effective advocate for one’s Disability Retirement application?  Of course.

Often, however, there is a complaint that the “OWCP doctor” is not very responsive to a Federal or Postal employee’s attempt to approach the question of filing for Federal Disability Retirement benefits from the U.S. Office of Personnel Management, whether under FERS or CSRS.  As FERS & CSRS Disability Retirement is based upon proving by a preponderance of the evidence one’s medical inability to perform one or more of the essential elements of one’s job, it is crucial that the Federal or Postal employee contemplating filing for Federal Disability Retirement benefits have a supportive doctor.

While the Merit Systems Protection Board’s expanding case-law holdings continue to reinforce the idea that the most effective advocate in a Federal Disability Retirement case is a “treating doctor”, as such, medical reports obtained through 2nd opinion or “referee” consultations, or via filing for Social Security Disability benefits, may have some limitations on their usage; nevertheless, the weapons of arguing that an “independent” source of medical review also found that one could not perform one or more of the essential elements of one’s job, can be an effective substantive argument.

As for the OWCP-treating doctor, sometimes those forms completed by such a doctor will be enough to meet the eligibility requirements for OPM Disability Retirement — but that is an individual assessment based upon the uniqueness of each case.

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

OPM Disability Retirement: Office Notes (Continued…)

The Office of Personnel Management has every right to establish a consistency of medical treatment and opinions rendered on the part of the doctor, the specialist, the medical facility, etc.  One of the reasons why Federal Disability Retirement benefits are (in great part) determined by the opinion of the “treating doctor”, as opposed to a determination made by a medical doctor who makes such disability determinations but is not the applicant’s “treating doctor”, is that such a determination (in the eyes of Federal Disability Retirement laws, statutes, MSPB case laws, etc.) can best be rendered by a medical specialist who has a long-standing relationship with the patient/applicant, over a long period of time, to determine the extent, severity, chronicity, etc., of the medical condition claimed.  

With this in mind, there often arises a conflict of sorts:  On the one hand, most people who are attending to their medical needs, are not thinking in terms of “getting Federal Disability Retirement benefits” during the time of treatment.  The critical point of when the line becomes drawn, where treatment & chronicity begin to conflict; or where, despite every attempt by the doctor to prescribe treatment modalities, there appears to be a medical condition which is “intractable”, is often a difficult one to determine.  In most cases, the office/treatment notes will reveal the line, which may come about gradually.  At other times, one may have a doctor who thinks that he or she can successfully treat any and all conditions, and reflects such a “positive” outlook in every office notation.  This is often not helpful, when it comes time to filing for Federal Disability Retirement benefits under FERS or CSRS.  To counter this, a frank discussion with the doctor at some point may become necessary.

Sincerely,

Robert R. McGill, Esquire

FERS & CSRS Disability Retirement for Federal and USPS Workers: Patient-Doctor Relationship II

Part of a patient-doctor relationship (and I intentionally placed the term “patient” before the hyphenation to “doctor”, because the primacy of the relationship should recognize the order of importance) should necessarily involve a commitment from the doctor.  That commitment should entail the desire to do that which is necessary, within reasonable bounds and within the law, as well as the integrity of the doctor’s medical opinions, in order to look after the best interests of the patient.  

It is always a puzzle and a disturbing bit of news to find that a doctor who has performed surgery, who has prescribed multitudes of pain or psychotropic medications, has prescribed multiple diagnostic tests and have the patient undergo test after test, physical therapy sessions, clinical evaluations, etc. — and at the end of it all, to have the “final straw” which severs the patient-doctor relationship to be a refusal to provide a medical narrative report in support of a Federal Disability Retirement application.  Think how preposterous that sounds.  Thus, it is not enough to get some vague support when the issue is first broached; no, what is needed is the same level of commitment from the doctor, as when he or she first said to you, “Yes, I am going to treat you for your medical condition…”

Sincerely,

Robert R. McGill, Esquire

FERS & CSRS Disability Retirement for Federal and USPS Workers: Patient-Doctor Relationship

In filing a Federal Disability Retirement application with the Office of Personnel Management, it is always preferable (though not an absolute mandate) to have medical reports and records from a “treating” doctor of some tenure.  What constitutes a “treating doctor” is fairly uncontroversial — it means that the report rendering an opinion concerning one’s physical or mental ability to perform all of the essential elements of your job should be prepared by a doctor who has provided medical treatment, and generally has a patient-doctor relationship.  The duration of the tenure which then creates such a “patient-doctor” relationship does not necessarily put a specific time frame upon a doctor.  It can mean anywhere from a month to a decade, in my view.

From the applicant’s perspective, it is important to understand that the person who is considering filing for Federal Disability Retirement benefits has been establishing and fostering that relationship, and this is important to see.  Those many years of going to the doctor, speaking to him or her about the most personal of problems — one’s medical conditions — is part of what creates that special bond identified as a “patient doctor relationship”.  It is a relationship which has been created and fostered through interactive needs, and that relationship should be strong enough to ask the doctor, when the time and need comes to fruition, for a medical report in support of one’s Federal Disability Retirement application.  So, at this point in the issue, as one is contemplating Federal Disability Retirement, does your interaction with your treating doctor constitute a “relationship”, or is it merely an economic exchange of goods and services?

Sincerely,

Robert R. McGill, Esquire

Go to:  Patient-Doctor Relationship (Part II)

Federal Disability Retirement Benefits for Federal & Postal Employees: The Doctor and the FCE

For whatever reason, the treating doctor — unless he or she is a specialist (i.e., an Orthopaedic Surgeon, a Rheumatologist, a Pain Management Specialist, etc.) — is often uncomfortable and feels a sense of inadequacy in making a determination as to whether a Federal or Postal employee is unable to perform one or more of the essential elements of his or her job.  Under such circumstances, it may be fruitful for physical medical conditions, to undergo a Functional Capacity Evaluation (an “FCE”).  An FCE provides — in addition to “objective” diagnostic test results — an independent basis upon which to rely upon, in formulating a medical opinion.  The FCE provides, for the treating doctor, a “test” upon which the doctor can formulate an opinion, based upon reasonable medical certainty, as to the physical limits, endurance, and capabilities of an individual.  Further, the Office of Personnel Management is often impressed with an FCE.  Ultimately, the medical opinion of the treating doctor, based upon a long history of clinical examinations, diagnoses based upon generally accepted criteria within the medical profession, diagnostic testing, and an attempt at reasonable treatment modalities:  all together, comprise a valid basis for formulating and rendering a medical opinion in a Federal Disability Retirement case.  Nevertheless, if an FCE makes the treating doctor that much more comfortable in coming to a medical opinion, then by all means, go through with the FCE.  It can only make your OPM disability case stronger.

Sincerely,

Robert R. McGill, Esquire

Medical Retirement Benefits for Federal & Postal Employees: The Treating Doctor

In a Federal Disability Retirement application under FERS & CSRS, what distinguishes the entire process of proving, by a preponderance of the evidence, that a Federal or Postal employee is unable to perform one or more of the essential elements of one’s job — from other processes, such as Social Security and OWCP — is that the evidentiary weight is placed upon a treating doctor.  There are “other” types of doctors other than treating doctors:  specialists who are referred to for consultative purposes; doctors who specialize in determining functional capacity & evaluate the functional limits of an individual; occupational specialists, etc.  Why a “treating” doctor?  Because we are talking about workers who, over time, find that he or she is no longer able to perform the essential elements of a job and, over that same time, it makes sense that a doctor would be treating that individual.  Disability Retirement is not normally filed as a result of a traumatic accident (although that can happen, also); rather, a Federal or Postal employee normally files a Federal Disability Retirement application because of a condition which develops over time.  That is why the “treating” doctor would be the best source of knowledge and information:  because, through clinical examinations, long-term doctor-patient relationship, the treating doctor can make a long-term assessment based upon all of the facts and circumstances of the patient.

Sincerely,

Robert R. McGill, Esquire

Medical Retirement Benefits for Federal & Postal Employees: OPM’s Arsenal

The names have been changed to protect the innocent.  Or, perhaps those who are impliedly involved herein are not so innocent after all.  Nevertheless, the names must be changed to protect confidentiality of sources, etc.  Every now and then, the Office of Personnel Management discloses their arsenal of weapons.  For instance, such an arsenal might be that a denial of a Federal Disability Retirement application was based upon a review by a retired contract doctor.  Now, let us analyze such an arsenal.  First, the term “retired” reveals an interesting concept.  It means that the individual no longer sees hundreds of patients on a daily basis, nor is actively practicing medicine.  Next, on a superficial level, we take the word “contract” — meaning thereby that the individual is paid to review the paper submissions — not to examine the applicant who is filing for Federal Disability Retirement benefits.  And, finally, the concept of a “doctor” — let us be certain as to the two preceding words, “retired” and “contract”, and that is the extent which one needs to understand in accepting the definition of the word “doctor”.  As opposed to:  the treating doctor of an applicant for Federal Disability Retirement.  Who would you choose to treat you?

Sincerely,

Robert R. McGill, Esquire

OPM Disability Retirement: Thank the Medical Professionals

If not for the doctors, disability retirement would obviously not be a possibility.  Of course, one may make the self-evident statement that being supportive of a Federal Disability Retirement application is simply part of a doctor’s job; and, to some extent, that would be true.  Doctors should indeed be willing to write up supportive medical narrative reports for their patients. 

Nevertheless, it is because of the doctor, the effort expended, the willingness to testify at a Merit Systems Protection Board Hearing, that the Office of Personnel Management even listens, or reverses a prior denial, and grants a disability retirement application.  Especially when a case gets denied twice by the Office of Personnel Management, it becomes crucial to have the cooperation of the treating doctor to testify in an MSPB Hearing.  This is normally done by telephone, thereby making it a minimal imposition upon the doctor’s time.  Indeed, I often only take a total of 30 minutes of the doctor’s time, including preparation and actual testimony, for an MSPB Hearing.  But the very fact that the doctor is willing to testify — to speak to the Administrative Judge directly to give his or her medical opinion — is often enough to convince OPM to change course, and grant the disability retirement benefits. 

Sincerely,

Robert R. McGill

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