Tag Archives: objective and subjective medical evidence

CSRS & FERS Medical Disability Retirement: Bureaucracy and the Objective Algorithm

On the one hand, objectivity can be viewed as a positive thing; for, with it, one is assured that all applications are treated equally, by the implementation of identical criteria across the board.  “Gut feelings”, personal beliefs, and that “sixth sense” is eliminated; and thus is fairness achieved by the equal treatment of all cases, and “exceptional circumstances” are not, and cannot be, considered.

What such an approach gains in large-scale application, however, may lose out in individual cases.  For, if experience and age accounts for anything, it should allow for decisions made outside of the mainstream of thought, based upon those very factors which make up the difference — wisdom from years of engaging in a particular endeavor.

The problem with the bureaucratization of a process is precisely that it fails to allow for exceptions; but concomitantly, it is precisely those unique circumstances which cry out for a carved-out exception.  In a Federal Disability Retirement application, submitted to the U.S. Office of Personnel Management, whether under FERS or CSRS, there are always cases where all of the facts and circumstances reveal eligibility; but in applying the mathematical (and thoughtless) algorithm of criteria-based analysis, there may be something missing.  Perhaps the doctor would not, or could not, say exactly X; or the test results revealed nothing particularly significant.

In some ways, the medical conditions identified as Fibromyalgia or Chronic Fatigue Syndrome represent such scenarios.  In those instances, it is important to descriptively convey the human narrative in a particularly poignant manner.

The administrative bureaucracy is here to remain among us; to rise above the level of thoughtless application of a criteria, however, one must creatively encourage the phoenix to rise from the ashes of boredom, and span its wings to include those others who deserve the benefits of Federal Disability Retirement.

Sincerely,

Robert R. McGill, Esquire

Federal Gov. and USPS Disability Retirement: Pain as a Reminder

Pain is a reminder that the physiological state of one’s body is in need of rest or repair; it is tantamount to an error message on the computer, with the analogy of our brain being the software component.  Chronic pain thus constitutes a system shutdown; continued non-response and delay will either result in systematic error messages or progressive deterioration where the entire system will begin to be impacted with reverberating consequences.

It is well that the largest organ of our body is our skin; for, as a concealing covering, it contains the inner workings — and malfunctions — of our other organs and systems.  But within the constellation of the composite of organs and systems functioning in coordinated fashion to keep us alive, the “software system” allows for error messages to be relayed to important information centers, of warnings meant to be heeded.

Pain is such an error message; chronic pain is the heightened alert system to keep us informed.

For the Federal or Postal worker who experiences such continuous and persistent relays of error messages, the failure to heed merely delays the necessity of responding to the system shutdown.  Federal Disability Retirement is meant to be a compensatory system whereby a restorative period of recuperation is allowed for, with the possibility of engaging in employment in a different capacity without losing one’s base annuity.  It is a long and involved administrative process.  Such preparations must be submitted through the U.S. Office of Personnel Management, whether you are under FERS or CSRS; further, if you are a separated Federal or Postal employee, you have only up until one (1) year to file from the date of separation.

Allowing the error message to be sent repetitively and ignored out of hand may constitute malpractice on the part of the recipient — the Federal or Postal Worker who does nothing but continue to be dedicated to one’s job, while ignoring the basic rule of life:  self preservation.

Sincerely,

Robert R. McGill, Esquire

Federal and Postal Disability Retirement: The Pain Problem

The problem with pain is that, quite simply put, there is only one person who “owns” it — the pain-feeler.  One can describe it, ascribe adjectives which somewhat make it come alive for the listener; and even attempt metaphors and analogies that expand upon the limited universe of words as opposed to the physical sensation which creates havoc and turmoil in a person’s life.

There are numerical designations (“she consistently feels pain on the scale of 7/10 daily”) and words like “chronic”, “intractable”, and “severe” capture a sense of what a person undergoes; but in the end, these are merely word-games in comparison to the agonizing physical trauma which the person experiencing the pain must endure.

In preparing a paper presentation to the U.S. Office of Personnel Management in the form of a Federal Disability Retirement packet, whether under FERS or CSRS, chronic pain and the extent of how such pain prevents one from performing one or more of the essential elements of one’s job, is often problematic for the Federal or Postal employee who is contemplating such a venture.

It presents a challenge for two primary reasons:  First, because of the difficulty in translating a physical sensation into a clear and effective conceptual modality; and Second, because the audience to whom such a descriptive analysis is conveyed is quite likely attuned to, and therefore somewhat indifferent to, thousands of such descriptions, and thus may have a somewhat calloused view of such statements.

Overcoming the roadblocks and gaining the attention of an OPM case worker requires more than the mere meeting of the law; it demands overcoming the problem of pain — both medically, and administratively.

Sincerely, Robert R. McGill, Esquire

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: Manufactured Legal Criteria

Even assuming good faith, the application of a manufactured legal criteria can lead to a harm which can be irreversible.  The consequence of a Federal or Postal employee relying upon a mis-stated, non-existent legal criteria can potentially result in simply raising one’s hands in frustration, as a sign of futility, and giving up on the process of attempting to pursue a Federal Disability Retirement application under FERS or CSRS.  

David Hume’s philosophical argument concerning causality and the fact that, because there is no “necessary connection” between two objects which meet, which result in one object “causing” the movement or sequential effect of the second object, may be a technically ingenious analysis of an intellectual discourse.  In the “real world”, however, when two objects collide, there are causal consequences.  

Similarly, in a Federal Disability Retirement application under FERS or CSRS, when the Office of Personnel Management requires that one submit “objective evidence” to justify the medical doctor’s conclusions of disability, what the Office of Personnel Management is requiring is a “necessary connection” which does not exist in “the law”.  Years of clinical examinations; notations of progressive deterioration; limited flexion and mobility; consistent complaints of pain; the aggregate of such complaints in and of itself constitutes evidence — but of course OPM ignores such evidence as being merely “subjective“.  

Just as Hume’s requirement of a necessary connection violates the pragmatic standards applicable in the “real world”, so OPM’s requirement of “objective medical evidence” betrays the legal criteria in a Federal Disability Retirement application. Fighting the misapplication of a non-existent legal criteria is like denying a negative, however; it can be done, but you must use the law as a sword, and not merely as a shield.

Sincerely,

Robert R. McGill, Esquire

OPM Disability Retirement: In a Perfect World

Becoming distracted from the essential focus of an activity is a problem which we all face. In preparing, formulating and filing for Federal Disability Retirement benefits from the Office of Personnel Management, it is easy to become overly focused upon what the Agency is doing, will do, or potentially might engage in, which could somehow (it is thought) impact one’s Federal Disability Retirement application under FERS or CSRS.  

In a perfect world, the administrative process would proceed in a sequential, logical and methodological manner.  However, this is not a perfect world, and at each step of the long, administrative process, there are always glitches and temporary hold-ups.  The Agency often takes its time; the supervisor may make some statements which appear contrary to facts; OPM may require additional medical evidence, despite everything that needs to be filed for an approval having been submitted, etc.  

The Office of Personnel Management is a paradigm of an imperfect world.  It is an agency which has the power to be the sole arbiter of a Federal Disability Retirement application, for all Federal and Postal employees, and that power is indeed one which can determine the economic future of thousands of Federal and Postal employees.  

Making the distinction between peripheral and ancillary issues, and separating them from the essential components of what constitutes the important aspects of preparing, formulating and filing for Federal Disability Retirement benefits under FERS or CSRS will help in the process.  Recognizing that this is far from a perfect world will help to ease the strain of the process.

Sincerely,

Robert R. McGill, Esquire

CSRS & FERS Medical Disability Retirement: The Fallacy of Objective Medical Evidence

The Federal Circuit Court of Appeals has already addressed the issue of the Office of Personnel Management’s unjustified adherence to making a distinction between “objective medical evidence” as opposed to what they deem and declare to be “subjective” evidence.

The distinction has no statutory basis or authority, but OPM continues to make the same, repetitive and tiring arguments concerning such a distinction.  Of course, when there exists a plenitude of “objective” evidence, then OPM will often sidestep such evidence and argue that it wasn’t “compelling” enough.  

The fallacy of “objective” versus “subjective” becomes most apparent, of course, when it addresses the issue of “pain”.  Pain is by definition a subjective state of experiential encounter.  If there is any “objective” evidence of pain, it is a misunderstanding of what constitutes such evidence.  Thus, for instance, one might point to an MRI showing a multi-level disc degeneration from L3-L4, L4-L5, etc., and state, “There, we have objective evidence of pain.”

Not quite.  What you merely have, if one stops and considers it, is simply a parallel set of observable facts:  A:  an image which reveals an abnormality of the spine, combined with B, which has an individual who conveys a sensation of pain.  However, inasmuch as there are many people who have similar or worse states of “A” (multi-level disc degeneration), but go through life without any apparent pain, one cannot therefore argue that A is “objective” evidence of “B”.  There may be a parallel correlation to be made, but no causal connection.  

Regardless, the Federal Circuit Court has already declared OPM to be in error for making such a distinction.  However, despite the law, OPM continues to deny Federal Disability Retirement applications under FERS & CSRS by adhering to the false distinction.  Imagine that.

Sincerely,

Robert R. McGill, Esquire

CSRS & FERS Medical Disability Retirement: The Proper Balance

The Office of Personnel Management has sent out a number of denials in recent weeks, and the undersigned attorney has had multiple opportunities to review many of the cases which have been submitted at the Initial Stage of the process, by Federal and Postal workers who are or were unrepresented by an attorney.  

The spectrum of the quality of the applications vary; some have obviously engaged in some research, and attempted to put together a Federal Disability Retirement application by following some guidelines which have been put forth.  But in most cases, there is still the problem of an “imbalance” — of not reaching the correct median between the subjective and the objective; of an inability to stay away from the workplace issues, of harassment, of complaints about the Agency, etc.  

Remember that this is first and foremost a medical disability retirement application, and the operative term which should always be focused upon and emphasized is the “medical” aspect of the formulation.  While there is ultimately no formulaic Federal Disability Retirement packet (precisely because the particular medical condition which is unique to each individual resists any such attempt to package a Federal Disability Retirement application in a generic sort of way), nevertheless, there are certain key points which should be addressed and emphasized, while other “non-key points” should be avoided.  

Put in a different way, in proving that a medical condition prevents a Federal or Postal employee from performing one or more of the essential elements of one’s job, one must include multiple “essential elements” in meeting the burden of proof.

Sincerely,

Robert R. McGill, Esquire

Federal Employee Medical Retirement: Objectivity

In filing a Federal Disability Retirement application under FERS or CSRS, a level of objectivity in making one’s case is a goal which must always be in the purview of formulating an application.  If a Federal or Postal Worker is attempting to formulate and prepare a FERS or CSRS disability retirement application without the assistance or representation of an OPM Disability Attorney, this becomes a difficult task — for the identity of the person making the affirmative argument for approval of a Federal Disability Retirement application is the same person who is describing the medical condition, the impact upon one’s Federal or Postal job, and the legal reasons why such an application under FERS or CSRS should be approved.  

There are methods to avoid the appearance of “self-promotion” — a term which may not seem applicable to formulating a FERS or CSRS disability retirement application, but one which simply cannot be avoided completely. For, representation and being a proponent for one’s “cause” — however valid, and however arguably sustainable — nevertheless necessarily may imply a self-interest which engenders self-promotion.  If a Federal or Postal employee insists upon formulating, preparing and submitting an application for Federal Disability Retirement benefits under FERS or CSRS without proper representation, then one’s focus should be upon an “objective” basis — what the medical reports, narratives, diagnostic tests, psychological tests, etc., reveal, and to attempt to discuss such medical documentation in an objective, independent and dispassionate manner.

Sincerely,

Robert R. McGill, Esquire

Federal and Postal Disability Retirement: Psychiatric Disabilities

Perhaps there will always be a suspicion that a distinction is made by a governmental entity/bureaucracy, between physical medical conditions and those which are deemed “psychological“.  For Federal and Postal workers who are considering filing for Federal Disability Retirement benefits under FERS or CSRS, there are ample legal tools to point out to the Office of Personnel Management that such a distinction is not only improper, but moreover, contrary to the “law of the land“.  

The Federal Circuit Court has pointed out clearly and unequivocally that the law does not allow for OPM to make a distinction between that which is “objective” medical evidence and that which is “subjective“.  Further, beyond the conceptual distinction applying to the medical evidence, this means that the categories encompassing the two should not be distinguishable when applying the laws governing Federal Disability Retirement.  Thus, rational conclusions based upon clinical examinations, a long history with the patient, consistent symptoms as related to by the patient to the doctor — all are valid, and “as valid”, as the “objective” medical evidence purportedly revealed by an MRI or other diagnostic tools.  

Thus, the credence and credibility of Major Depression, Anxiety, Panic Disorder, Obsessive-Compulsive Disorder, Bipolar Disorder, Generalized Anxiety Disorder, and a host of other psychiatric disabilities, hold an equal level of legal validity as the long list of physical disabilities.  Don’t ever let OPM go down an argumentation route where no law exists to support it; they may often try, but it is up to the Federal or Postal Worker who is filing for Federal Disability Retirement benefits under FERS or CSRS to meet them at every juncture of such sophistry.

Sincerely, Robert R. McGill, Esquire