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

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

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

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 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