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

FERS & CSRS Disability Retirement for Federal and USPS Workers: Solutions

In preparing, formulating and filing for Federal Disability Retirement benefits from the U.S. Office of Personnel Management, it is important to focus upon the solutions to the multiple obstacles which necessarily accompany the preparation of a Federal Disability Retirement packet.

Part of the inherent problem for the Federal or Postal worker who is contemplating filing for the Federal Disability Retirement benefit, is of course the medical condition itself.  It is difficult enough to maneuver through the potholes, valleys and pitfalls of life which one must face on a daily basis; it is exponentially pronounced when one must do so with the hindrance of a physical, mental, or emotional (or often all three) medical condition.

Thus, if the problem at the outset is to secure the support of a doctor, because the doctor is unwilling to provide a medical narrative report, then the solution is to find another doctor.  This often happens if the originating injury occurred as a job-related incident and the doctor’s services were obtained through OWCP; or, sometimes, one’s own lifelong treating doctor simply becomes weary of all of the administrative paperwork which is entailed by the process itself.

To “find another doctor”, of course, is an easy enough statement to make; to actually do so may entail energy, effort and a level of focus which involves much beyond what one wants to expend.  But what choice does one have?  Repetitively reviewing one’s obstacles contributes little to the advancement of one’s cause; focus upon the solution, not the problem, for it is the former whichjavascript:; leads one on a path of recovery, not the latter.

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

Postal and Federal Disability Retirement: Supporting the Concept

In preparing, formulating and filing a FERS or CSRS Federal Disability Retirement application, the important first step in the “preparation” phase — or, one might even term it conceptually as the “pre-preparation phase” — is to engage the treating doctor with the conceptual framework of what Federal Disability Retirement entails and encompasses.  

As has been repeated many times previously in other blogs, doctors are not administrators, and ultimately detest the need to annotate, narrate, write reports, etc.  The legal system has forced doctors to keep records, if only for their self-protection in the event of a question of malpractice, and the requirement of keeping office records and notes has had the positive corollary effect of forcing doctors to “think through” the procedural steps of what it is that they are “doing”.  

Requesting the treating doctor to support a Federal Disability Retirement application has the identical positive result of forcing the doctor into an admission that one’s medical condition has come to a crossroads:  prior treatment modalities have not proven to be effective; the chronic and progressively deteriorating nature of the physical or psychiatric condition has shown to be “treatment-resistant”; the time has come to acknowledge that a different mind-set must be embraced — one which includes a period of rest, restorative time, and a stage of recuperation away from the activities which the Federal or Postal employee spends on average 40 – 50% of the time at:  one’s job.  

Speaking to the doctor about his or her support and role in preparing a Federal Disability Retirement application is the first, necessary, and vital step in the preparation, formulation and filing of a Federal Disability Retirement application under either FERS or CSRS.  How best to approach the doctor, the timing, the words and concepts to use, etc., are all part of that preparation.  

If it is time for the Federal or Postal worker to recognize that one’s medical conditions are preventing the Federal or Postal worker from performing one or more of the essential elements of one’s job, it is time to think about pre-preparing the treating doctor.

Sincerely,

Robert R. McGill, Esquire

OPM Disability Retirement: The Treating Doctor versus “Others”

Obtaining the support of one’s treating doctor is an essential element in preparing, formulating and filing a Federal Disability Retirement application under FERS or CSRS. The “treating doctor” is a unique animal, and one who possesses peculiar and particularized knowledge specifically relevant to a Federal Disability Retirement case.  

The treating doctor usually has a longstanding relationship with the potential Federal Disability Retirement applicant; through extensive and multiple clinical encounters, has formed a professional opinion about the overall health issues of his/her patient; has often spoken about other matters, including personal issues, and therefore has formed that puzzling emotional bond identified as a “relationship” with the potential Federal or Postal Disability Retirement applicant; has knowledge of the history of the Federal or Postal employee, including personal tidbits of information; and other important information.  

Aside from the fact that the Merit Systems Protection Board’s specific acknowledgement of the importance of the treating doctor (while not denigrating the ability of a referral doctor or disability specialist in also playing an important part in the determination of an OPM Disability Retirement application), it is precisely because of this knowledge that he/she possesses — based upon a thorough understanding grounded upon historical information gathered over a span of time; based upon intimate clinical encounters; based upon a professional observation of the chronicity, impact and progressive nature of a medical condition upon the abilities and capabilities of the Federal or Postal employee — that a special “place” of status and stature is granted to the Treating Doctor.  

This is important to know in preparing, formulating and filing a Federal Disability Retirement application under FERS or CSRS.

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

Disability Retirement for Federal Government Employees: Confirming the Relationship

After undergoing all of the those diagnostic tests; after allowing the doctor to clinically examine, prescribe multiple medications based merely upon the say-so of the doctor; after allowing for invasive surgery; sending you to physical therapy; if the time then comes to prepare and file a Federal Disability Retirement application under FERS or CSRS, it is important to confirm the real strength of that “patient-doctor” relationship that has apparently been ongoing and fostered for those many months, years, and sometimes, decades.

It is not enough to get a nebulous “pat-on-the-back-sure-I’ll-support-you” sort of response, and with that, you receive a thick packet from the medical office, you open it, and inside is merely a copy of your medical records.  No — “support” must be concrete and definitive. It must mean, specifically, that the doctor is willing to write an excellent medical report outlining his or her opinion in connecting your medical condition with you inability to perform one or more of the essential elements of your job.  If it is time to file for Federal Disability Retirement benefits, it is time to have a heart-to-heart talk with the treating doctor, and see how committed he or she really was and is to this “patient-doctor” relationship.

Sincerely, Robert R. McGill, Esquire