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

Disability Retirement for Federal Workers: From the Doctor’s Perspective

In attempting to understand others, it is important to gain a perspective from which the third party views the world.  Understanding the third party perspective is a way to formulating an effective way of persuading a change in that person, if that is the goal. Or, perhaps understanding X merely in order to accept the behavior or actions of the individual, is enough of a reason.

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 often important to understand the perspective of one’s treating doctor in order to obtain the necessary support and administrative initiation of the medical provider.

From the doctor’s viewpoint, it is normally counter-productive in terms of treatment and therapy to declare, ascertain and deem that the patient is “totally disabled“.  Work is therapeutic; it allows for a teleological motivation which compels continuation in recuperative and rehabilitative terms.

Further, when this “fact” is combined with the general exposure of most doctors to other forms of disability benefits — state or federal OWCP benefits; Social Security Disability benefits; private disability insurance benefits — and rarely an encounter with FERS or CSRS disability retirement issues, it becomes apparent why doctors often become reluctant and resistant to getting involved with the administrative process.  OWCP benefits require an assertion of causality-to-employment; SSDI necessitates a declaration of “total disability”; private disability policies can often lead to depositions and legal responses.

Thus, everything that is counterintuitive to a doctor’s perspective of what is therapeutically beneficial to the patient, is potentially there when presented with a request for support in a disability retirement case.

Explanation is the key to understanding; effective explanation should persuade and alter a perspective founded upon a misinformed foundation.  It is often necessary to explain the differences between FERS & CSRS disability retirement benefits and the “others” which have previously polluted the waters of a pristine stream of thought.

Sincerely,

Robert R. McGill, Esquire

Federal Disability Retirement: The Supportive Physician

Perspectives vary; varying perspectives often lead to conflict; and conflict represents the divergent paths which pursue different directions, or follow a parallel route.

Physicians who have been practicing medicine for a number of years quite often see the therapeutic benefit of employment, and the negative impact of being identified as “disabled”, with progressive physical manifestations of deterioration, and psychological destruction of futility and hopelessness.  It is not mere coincidence that the high rate of mortality is correlated to two primary life events:  birth (where the infant’s susceptibility to being exposed to an expansive and threatening environment brings with it inherent dangers), and retirement (where the propelling teleological motivation of man suddenly comes to an end).

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 obvious that one must have supportive medical documentation in order to prove, by a preponderance of the evidence, that the Federal or Postal employee is eligible for Federal Disability Retirement benefits.  Part of that medical evidence should include a narrative report from one’s treating doctor, or a doctor who can properly and thoroughly assess, evaluate, and conclude that the Federal or Postal employee  can no longer perform one or more of the essential elements of one’s job.

What constitutes “support”, however, can sometimes lead to divergent paths.  Doctors are trained to treat patients, not to perform administrative duties.  The divergence which potentially leads to conflict often involves the differing perspective of what will “help” the patient.  Federal Disability Retirement is a benefits which allows the Federal or Postal employee to remain productive in the workforce, by encouraging the Federal or Postal employee to seek outside employment.  This is the key component and concept which often lends persuasive effect upon a suspicious and cautious medical practitioner.

Explaining the process will hopefully allow for parallel paths, and not a route which results in different directions.

Sincerely,

Robert R. McGill, Esquire

OPM Disability Retirement: Professionals & Saving Time

In many areas of law, it is often the case that “professionals” prefer dealing with other professionals.  Thus, doctors will often encourage their patients to obtain the services of a lawyer when it has come time to consider medical retirement.  

In preparing, formulating and filing for Federal Disability Retirement benefits under FERS or CSRS, submitted to the Office of Personnel Management, there are multiple factors to consider when engaging in the preparatory stages of the administrative process.  The reason why doctors often prefer to deal with attorneys when the patient is compiling the “paperwork” for Federal Disability Retirement is that it saves time.  

Time is a commodity which is scarce and valuable.  Doctors do not want to have to engage in multiple revisions or rewriting of medical reports.  Doctors are professionals who believe that their time is best spent in treating patients — and while such “paperwork” is a necessary part of a doctor’s practice, and one which ultimately assists the patient in furthering his or her medical condition and future well-being; nevertheless, if an administrative issue needs to be addressed, doctors will often prefer to accomplish such administrative tasks in the most efficient, expeditious manner possible.  

The same concept holds true for the Federal or Postal worker who is filing for Federal Disability Retirement benefits under FERS or CSRS.  While there is never a guarantee that a “professional” will present a compelling enough case to the Office of Personnel Management such that an approval of one’s Federal Disability Retirement application will be a certainty; nevertheless, it is normally the most effective road to success.  

As time is a valuable and scarce commodity, so such scarcity and value should be considered at the beginning of the process of preparing, formulating and filing for Federal Disability Retirement benefits under FERS or CSRS.

Sincerely,

Robert R. McGill, Esquire

Medical Retirement for Federal Workers: Responsibility of the Applicant

In preparing, formulating and filing a Federal Disability Retirement application under FERS or CSRS, the importance of adequately conveying persuasive information to the Claims Representative at the Office of Personnel Management must be a primary goal of the Federal or Postal employee.  

Rarely does a doctor, without guidance and some “prodding”, execute an administrative duty such as preparing a medical narrative report for a patient, in a sufficiently excellent manner.  The work product of a doctor is normally defined by patient care, clinical examination, and prescribing an effective course of treatment.  It is up to the patient or his/her Federal Disability Attorney to remind the doctor as to “why” it is important to provide a medical narrative report in a Federal Disability Retirement application.  

Often, it is merely that the doctor does not understand the necessity of preparing a narrative report; or, as confusing as the entire administrative process of preparing a Federal Disability Retirement application is to the Federal or Postal employee, it is exponentially more confusing to the doctor, who is normally not part of the Federal workforce (unless he or she happens to be a doctor for the Department of Veterans Affairs, or is part of the Veterans Health Care System).  

It is ultimately the responsibility of the Federal or Postal employee to convey persuasive evidence and argumentation to the Office of Personnel Management, in order to meet that burden of proof, of showing that by a preponderance of the evidence the Federal or Postal employee has proven that he or she is eligible for Federal Disability Retirement benefits. While medical records, treatment notes, office notes, etc., can often be persuasive on their own, the applicant must be able to formulate a statement and refer to “the law” in order to convince the OPM Representative that his or her case meets that burden of proof.

Sincerely, Robert R. McGill, Esquire

Federal Employee Medical Retirement: The Family Doctor

One characteristic that people normally do not observe in medical doctors, is one of lack of confidence.  For, confidence, knowledge, direction, advice and assertiveness — those are the “bedside manners” which we expect from a medical doctor to whom we approach for treatment of our maladies.  

Yet, in preparing, formulating and filing a Federal Disability Retirement application under FERS or CSRS, often the “Family Doctor”, or otherwise identified as the Primary Care Physician or General Practitioner, will declare that he or she cannot make a disability determination because of being either ill-equipped, or because they do not possess the “speciality” of knowledge in making such a determination.  

Often, the doctor will rely upon a Functional Capacity Evaluation, and will insist that such an evaluation be performed prior to rendering his or her medical opinion on the matter of one’s capability, capacity, and ability to perform all of the essential elements of one’s job in preparing and formulating a medical narrative report for a Federal Disability Retirement application.  This, despite the obvious advantages already obtained in the course of many years of treatment of the Federal or Postal employee, the most important of which:  an intimate knowledge, gained through clinical examination and contact over the years, of the medical conditions of the patient, including the extent, severity and chronicity of the medical condition(s); as well as the consistency of complaints and review of radiological reports, the direct clinical contact with the patient, etc.  

Often, such lack of confidence is merely one of not understanding what a FERS or CSRS Disability Retirement application requires — and it is the job of either the patient or, if represented, with the assistance of the federal attorney, to clearly and concisely explain the process, the requirements, and why the family doctor is best qualified to provide a detailed medical narrative report explaining why the Federal or Postal employee is unable to perform one or more of the essential elements of one’s job.  

Marcus Welby, M.D. aside, the general practitioner is still the best source of information and proof in meeting the legal criteria in preparing, formulating and filing a Federal Disability Retirement application under either FERS or CSRS (and if you failed to understand the reference, you are much younger than the writer of this blog).

Sincerely,

Robert R. McGill, Esquire

Disability Retirement for Federal Workers: The “Nice” Doctor

In preparing, formulating and filing a Federal Disability Retirement application under FERS or CSRS, it is first and foremost important to have the support of one’s treating doctor.  By “support” is meant that the treating doctor must be willing to spend the time and effort needed to prepare and present a medical narrative which will not only narrate and delineate the diagnoses and symptoms — but beyond that, to take the time to explain the “why” of the nexus between the patient’s medical conditions and the essential elements of one’s job.  

To this extent, of course, the Federal or Postal Worker’s attorney should be of the utmost assistance — to guide the doctor in order to meet the legal criteria for qualifying for Federal Disability Retirement benefits under FERS or CSRS.  It is never an issue of telling the doctor “what to say” — the integrity of the medical opinion of the doctor should never be violated.  Rather, it is an issue of explaining the elements and legal criteria which need to be addressed.  

In ascertaining the level of support which a doctor is willing to provide, it is simply not enough to establish the factual foundation that the doctor is very “nice”.  Nice doctors aside — whether in conversation, table manners or a general sense that he or she is genuinely an all-around nice person — the question is, Will the doctor spend the time and effort (and yes, it is proper for the doctor to be reasonably compensated for his time and effort) in preparing a narrative report which addresses the legal elements in order to present a case of medical disability to the Office of Personnel Management?  

It is nice to have a nice doctor; it is even nicer to have a nice doctor who will support one’s 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 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

Federal Employee Medical Retirement: The Reluctant Doctor

In preparing, formulating, and filing a Federal Disability Retirement application under FERS or CSRS, the linchpin (sometimes spelled “lynchpin”) is comprised of a supportive doctor who is willing to provide substantive medical evidence, by a preponderance of the evidence, that a Federal or Postal employee is no longer able to perform one or more of the essential elements of one’s job, and that the medical condition will last a minimum of 12 months.  

Originally, a linchpin referred to a metal fastener which prevented a wheel from becoming separated or dislodged from the axle.  Similar to the conceptual analogy of the “weakest link” in a chain, the idea of viewing a Federal Disability Retirement application in such terms and perspective is to recognize the centrality of a foundation, and how everything else is supported by that foundation.  If the foundation itself is weak, then the chain may snap, and the wheel may fall off the wagon, and everything which is supported by the foundation may come tumbling down.

Such a weak linchpin may be characterized by “The Reluctant Doctor.”   For, ultimately, it will be the treating doctor’s opinion which will provide the primary basis of a Federal Disability Retirement application under FERS or CSRS.  To presume the support of one’s treating doctor may reveal an unfounded sense of confidence.  To declare that, “Of course my doctor will support me.  He’s been my doctor for X number of years,” is to be naive about the psychology of doctors.

Doctors enjoy engaging in the practice of medicine; they abhor the administrative necessities of supporting their patients in preparing a Federal Disability Retirement application.  The Reluctant Doctor is fairly widespread; it is up to the potential applicant, or his/her attorney, to explain the process, beginning with a simple request for an assurance of support from the patient — the applicant who will be filing for Federal Disability Retirement benefits under FERS or CSRS.

Sincerely,

Robert R. McGill, Esquire

Federal Disability Retirement: Speaking with the Doctor

Communication is the key to a successful outcome:  such a trite truism is certainly applicable in a Federal Disability Retirement application under FERS & CSRS.  The primary focus when a Federal or Postal employee has a medical condition which is impacting his or her ability to perform all of the essential elements of his or her job, is to take care of the medical condition — i.e., to have the necessary treatments, to undergo the proper prescriptive treatment modalities, including surgery, medication regimens, pain management treatments, psychotherapeutic intervention, etc.

Beyond such treatment modalities, however, there may come a point in the life of a Federal or Postal employee when it is becoming apparent that the medical condition is simply “incompatible” with the useful and efficient retention in the Federal or Postal Service.  Such a determination is best made by the Federal or Postal employee, if possible, as opposed to having the Federal Agency or the U.S. Postal Service suddenly and unceremoniously make such a determination — in the form of a proposed removal based upon one’s failure to maintain a regular work schedule; or because of taking “excessive leave“; or putting a Federal or Postal employee upon a Performance Improvement Plan.  Such a determination may best be made by the Federal or Postal employee by communicating one’s concerns to the treating doctor, and asking some incisive questions.  Another trite truism:  The only stupid question is the one not asked.

Sincerely,

Robert R. McGill, Esquire