Medical Retirement for Federal Workers: Preexisting Conditions

The concept of a “preexisting condition” necessarily entails a date before which something was in existence; thus, that condition X preexisted date-certain Y, such that X preexisted Y.  Such a condition — whatever the nature of “it” — is normally ascertainable by doctor’s notes, treatment records, etc.

The relevance of whether a certain medical condition “preexisted” a certain date, however, depends upon the issue and the forum.  For Federal OWCP cases administered under the Department of Labor, such an issue is often relevant in determining coverage, precisely because an on-the-job injury will entail causation not only regarding “how” and “where” the injury occurred, but further, encompassing whether a Federal or Postal Worker is making a claim based upon a new and heretofore unknown injury or medical condition, or is merely suffering from a condition which “preexisted” a particular date — either the date of employment, the date of claimed injury, etc.

In a Federal Disability Retirement case, whether under FERS or CSRS, filed through the U.S. Office of Personnel Management, the issue of a “preexisting medical condition” is rarely of any relevance, either on the issue of “when” or certainly not on the “how” or “where”.  OPM will often attempt to make an argument on the basis that one’s medical condition “preexisted” one’s inception date of Federal employment, but presumably the Federal or Postal employee who may have suffered from the condition was able to adequately perform the essential elements of one’s job anyway, but at some point the preexisting medical condition came to a point of progressive deterioration such that it began to impact one’s ability to perform one’s job — in which case it matters not anyway.

In a Federal Disability Retirement application, one should never be fearful of divulging the history of one’s medical condition; rather, it is the here and now which is of relevance: How the medical condition impacts one’s ability to perform the essential elements here in one’s present job, and how it now impacts such job performance.

Sincerely,

Robert R. McGill, Esquire

Medical Retirement Benefits for US Government Employees: Preexisting Conditions

In OWCP/Department of Labor cases, often the focal point of contention (among other issues) involves whether or not a medical condition “pre-existed” the on-the-job injury which is the basis of the claim for compensation.  

In a FERS or CSRS Federal Disability Retirement application, such an issue is usually irrelevant, precisely because the laws governing Federal Disability Retirement is unconcerned with the “where” of a medical condition, as in, “Where did the event take place, which resulted in the medical injury or condition — on the job or not?”  However, the term “preexisting condition” can involve a different conceptual paradigm, encapsulating not the situs of the occurrence, but whether the Federal or Postal employee was hired with the medical condition, and thus was able to accomplish and perform the essential elements of one’s job despite having the medical condition.  

The Office of Personnel Management will sometimes argue this point — that the Federal or Postal employee who has filed for Federal Disability Retirement benefits under FERS or CSRS has a “preexisting condition”; but such an argument actually goes to the issue NOT of whether or not such a preexisting condition is a basis for a denial (it is not), but rather, as to why a Federal or Postal employee would be eligible with such a preexisting condition since that Federal or Postal employee was able to successfully perform his or her job for many years even with the medical condition upon which the Federal Disability Retirement application is based upon.  

Thus, the question in such an instance is not really a preexisting medical condition issue; rather, it is an issue about exacerbation and whether such a preexisting medical condition has progressively worsened to impact one’s ability/inability to perform one or more of the essential elements of one’s job.  How one formulates the issue is very important; OPM does not necessarily understand the proper formulation of a legal issue; as such, it is often the job of the applicant for Federal Disability Retirement benefits to re-formulate the issue in its proper context.

Sincerely,

Robert R. McGill, Esquire

Federal Worker Disability Retirement: Is the Concept of “Preexisting Condition” Ever an Issue?

Sometimes, the Office of Personnel Management will refer to a medical condition which “preexisted” — and it is often confusing as to what they are referring to.  The term “preexisting medical condition” must necessarily imply the question, “Preexisting to what”?  

For health insurance coverage, the issue is obviously one of a medical condition which existed prior to the start of medical coverage, and thus the question becomes whether or not the insurance company has an obligation to pay for medical bills incurred for treatment which existed and began prior to the terms of the policy.  

For purposes of Federal Disability Retirement, however, the question of a preexisting medical condition often encapsulates an admixture of multiple issues, based upon confusing a variety of concepts.  In a denial issued by the Office of Personnel Management, some cases will be denied based upon the assertion that a particular medical condition upon which a Federal Disability Retirement application is based, preexisted the time of Federal Service, and the Federal or Postal employee — despite the existence of the medical condition — was able to perform the essential elements of the duties of the Federal or Postal position.

Thus, a person with a confirmed Veteran’s Administration rating enters into the Federal government and is able to perform the job duties as required (for example).  Such an argument (or lack thereof) by the Office of Personnel Management is thus mixing a couple of issues, and conceptually identifying it as “preexisting condition”:  that the Federal or Postal employee has a medical condition which was identified prior to entering the Federal Service; that he or she was able to successfully perform the essential elements of the job; that the same medical condition is now the basis (or at least one of them) for a Federal Disability Retirement application.  But the issue is not really one of “preexisting condition” — for, whether the medical condition existed prior to or during one’s Federal Service is really an irrelevant issue — but rather, whether or not the medical condition as such became worse such that it now prevents a Federal or Postal employee to perform one or more of the essential elements of one’s job.  

Sometimes, people get the notion that by utilizing certain language, shouting certain sophisticated-sounding catch-phrases, or referring to concepts which seem intelligible, that it actually “means” something.  The concept of “preexisting conditions” is without meaning in a Federal Disability Retirement application, precisely because the law is neutral concerning that issue.  It may sound serious, but this is not OWCP or some other legal forum which applies a criteria regarding “preexisting conditions”.

Sincerely,

Robert R. McGill, Esquire

Federal Employee Medical Retirement: Preexisting Conditions

The Office of Personnel Management will sometimes make the following fallacious argument:  “Because your medical condition appears to have preexisted the time of your Federal Service, and you have been able to perform your job, you are not entitled to Federal Disability Retirement benefits.”  

This argument may take on various forms, with embellishments on the language used, but the argument as quoted represents the essence of what OPM will often state.  While the argument itself makes one scratch one’s head, there are implicit sub-arguments which, if extracted, extrapolated and projected/assumed, may bring one to a better understanding of what OPM is trying to say, and thereby be able to rebut and address such an argument.  The expanded version of the argument goes as follows:  “You had a diagnosed medical condition X prior to beginning your career with the Federal Service (often evidenced by a VA disability rating, or an MRI showing such).  You were placed in job Y, which you were able to do all of these many years.  From the time of your Federal Service to the present, there has been no defining moment or event which reveals that your condition worsened; only that you now state that you cannot perform your job.”  

This expanded version is what OPM is often attempting to argue.  Inasmuch as “pre-existing conditions” are not supposed to be a factor in Federal Disability Retirement cases (as opposed to being one in FECA cases), how does one address it?  By pointing out to the progressively deteriorating nature of the medical condition; by having a discussion with the treating doctor that, over time, a chronic condition can progressively deteriorate the human body, through fatigue, longevity, and chronicity of pain (or a chronic nature of Major Depression, Anxiety, stress, etc.), and such progressive deterioration often arrives at a critical point where, once passed, there is a sudden decline in the ability of a Federal or Postal worker to continue to perform a certain type of work.  

The key to an argument is to reframe the argument, so that one may understand and address it.  Only upon understanding the argument, can one begin to address it.

Sincerely,

Robert R. McGill, Esquire