The Physicians and the Substance of a Federal Disability Retirement Case

Ultimately, the essence of any claim, endeavor, vocation or activity possesses a characteristic “essence” of a matter — that which defines itself, reveals its core value, and manifests the substantive content of what X “is” as opposed to the accidental and peripheral appearances which can throw one off from the central enigma of that which we seek to unravel.

That is the defining history of Western Philosophy; it is what Plato began in inquiring about the differences between Forms and appearances; what Aristotle did in rolling his sleeves up and getting down to the serious work of scientifically approaching the world through observation and keen perspective; and in more modern times, it is encapsulated by the work of Heidegger, who viewed every being as an encounter to unmask in the experiential sequel learned from his master, Edmund Husserl and the school of phenomenology.

The History of Philosophy has since been one of loss of stature, as all of the subsciences have taken on their prominent roles and fractured apart from the umbrella of philosophy.  Psychology, Anthropology, Physics, Theology — they have all found and formed their own mouthpieces.

Medicine and the physicians who represent the discipline of the medical community have a unique and enduring perspective; it has now become defined by an approach of pharmacology and surgery, prompting alternative movements of holistic endeavors. But until a time in a distant future which accepts “other” approaches, it is the physician with an “M.D.”, “D.O.”, or other such designation, which will be necessary in the acceptable community of opinions and judgments. Yes, Chiropractic care, Physical Therapists, Nurse Practitioners, Psychologists and LCSWs can help to prove a case; but the central focus of authoritative acceptance still comes primarily from that guy or girl who went to “medical school”.

For the Federal and Postal employee who seeks to obtain Federal Disability Retirement benefits from the U.S. Office of Personnel Management, whether under FERS or CSRS, the core of one’s case must be based upon a view towards the examiner, reviewer, or “Administrative Specialist” as designated by OPM, and what that individual will accept as the authoritative basis of a viable Federal Disability Retirement case.  This is a world where the word of the physician is paramount; and those in the communities of subsets can certainly lend authoritative support; but it is always a mistake to confuse the outpost for the headquarters.

In a viable OPM Disability Retirement application, it is important to obtain the opinion and support of that which will provide the essence of authoritative support, to the greatest extent possible. What opinion to seek; how the narrative opinion is characterized; who provides it; and what the substantive content will state — all will make a difference in preparing and formulating a Federal Disability Retirement application, and its proper presentation to the authorities at the U.S. Office of Personnel Management.

While the “enemy” may attack and destroy the perimeters and outposts, until the neurological center of an organism is defeated, all such efforts are destined to fail.

Sincerely,

Robert R. McGill, Esquire

 

Disability Retirement for Federal Government Employees: Random Decisions

Waiting is indeed a requirement in the entire administrative process of preparing, formulating, then filing for Federal Disability Retirement Benefits, whether under FERS or CSRS, from the U.S. Office of Personnel Management.

As this author has repeatedly noted previously, if patience is a virtue, then it necessarily follows that Federal and Postal employees must be the most virtuous of individuals, for the very act of waiting for a decision from the U.S. Office of Personnel Management mandates such a virtuous response from the Federal or Postal Worker who has filed for Federal Disability Retirement benefits.

Is there a systematic and logical basis in the sequence and order of the decisions which are being made?  Perhaps.  Stories always abound, of course, of specific instances where a Federal Disability Retirement application was approved within a very short timeframe, but without knowledge of the specifics, including whether the facts included exigent circumstances beyond everyday occurrences, one cannot make a determination as to why an “exception” to the sequence of decision-making was made, if at all.

From an outsider perspective, it appears that the sequence of decisions made by OPM is rather random.  Yes, there is somewhat of a pattern of first-in, first-out, but of course that depends upon whether or not such a pattern is based upon the assignment of a CSA number from Boyers, PA or at the entry point of being assigned to a case worker in Washington, D.C.

The randomness can be troubling; waiting is a frustrating part of the process; but beyond that, virtue can be tested beyond the limits of reasonableness.

Sincerely,

Robert R. McGill, Esquire

FERS & CSRS Disability Retirement: The Doctor

Out of all of the elements comprising a Federal Disability Retirement application — the various aspects, including medical, personal, impact-statement, statement of disability, Supervisor’s Statement, etc. —  the essence of it all must be coordinated around the core of the case:  the medical narrative report.

That alone has multiple, inherently complicating factors:  Why won’t the surgeon write the report?  Why is it that the Pain Management doctor, or the Internal Medicine doctor, or the Family Physician is the one often most cooperative and willing?  Is the Chiropractor’s opinion sufficient?  Is it helpful?  How detailed must the report be?  How long must you be a patient in order to establish the threshold of having a “longstanding doctor-patient relationship“?  Are medical records in and of themselves sometimes sufficient to obtain Federal Disability Retirement benefits?  Is it sufficient to get a Therapist to do the report, without the Psychiatrist?  Can a therapist alone win a case? Must I undergo a Functional Capacity Evaluation?  Can I use reports from an OWCP Second Opinion doctor?  If my Psychiatrist only sees me for five minutes each time and prescribes the medication, is it necessary for him/her to write a report?  How detailed must the report be?  Is the doctor going to understand, let alone actually read, the SF 3112C?  These are just some of the questions which one is immediately confronted with, in beginning the process of putting together a Federal Disability Retirement application under FERS or CSRS.  It is a complex, overwhelming process.

Sincerely,

Robert R. McGill, Esquire

FERS & CSRS Disability Retirement: The Family Doctor and the Surgeon

I am often asked whether or not a medical report from the “specialist” will have a greater impact than a family doctor.  Implied in such a question, of course, is a perspective which tends to see the family doctor as somehow “less qualified”, sort of like comparing the technical deficiencies of a “country doctor” as opposed to a “real doctor” — one who works in an emergency room in a large metropolitan hospital.  Perspectives and prejudices have a way of defining judgments, and assumptions, presumptions and long-held beliefs, whether valid or not, often rule our lives. 

How can I answer such questions?  In the course of a Hearing before an Administrative Judge at the Merit Systems Protection Board, I have had family doctors testify who were unbeatable, and certainly overwhelming in his or her expertise and medical knowledge.  The years of experience in having to deal with thousands of patients, and confronting and treating medical conditions of every imaginable sort — and making decisions (including referring patients to “specialists” for concurring or confirming diagnoses and opinions) involving the “whole” patient’s medical condition and treatment — came through with such persuasive force and overwhelming confidence, that it was indeed the “family doctor” or the “country doctor” who ruled the day. 

Similarly, I have had the “specialist” testify in cases, who barely were able to coherently describe the connection between the medical condition and the essential elements of the job.  And, of course, sometimes the opposite is true — good surgeon, mediocre family doctor; mediocre specialist, great country doctor.  As in all things, in Federal Disability Retirement applications under FERS or CSRS, it is not so much that the credentials matter, as the character, experience, and “heart” of the doctor who treats the patient.

Sincerely,

Robert R. McGill, Esquire

CSRS & FERS Disability Retirement: Use of Medical Reports

People often ask me whether or not a certain type of medical report should or should not be used.  As with almost all such questions, the answer is, “It depends”.  On what?  On the content; in the manner it is written; and by whom.

This latter basis is often a determinative one.  For instance, should a medical report from a Chiropractor be used in an CSRS & FERS Disability Retirement case?  Let me answer this question in a circuitous manner — I handled an MSPB case years ago where I had no “medical” doctors testify, but I had two chiropractors testify (I needed both of them, not because two makes better than one, but merely because they treated my client in sequence over the relevant period of time).  To the great consternation of the OPM representative, we won the case.

Thus, chiropractors can provide valid medical opinions, and the MSPB has accepted the testimony of chiropractors — as well as therapists — standing alone, without the primary support of a medical doctor.  However, my customary approach in the utilization of therapists and chiropractors, as well as physicians’ assistants, nurses, etc., is that they are most effective as secondary support to a primary medical narrative from a medical doctor.

This will often present an interesting conundrum in that, often, chiropractors and therapists will write the more detailed, substantive, and interesting report than the medical doctor.  That is okay.  To use such reports as a piggy-back upon the short, concise and straightforward medical report is often the best way to use such valuable resources.

Sincerely,

Robert R. McGill, Esquire

FERS & CSRS Disability Retirement: Remember the Details

At each state of attempting to get a Federal disability retirement application approved, it is important to “remember the details”. For example, at the Merit Systems Protection Board level, in conducting a Hearing, remember that if the best medical evidence/testimony you are able to provide is through a health professional other than an “M.D.” (e.g., a therapist, a Nurse Practitioner, a Chiropractor, etc.), always point out the unique credentials of the provider, to include whether in the particular state in which he/she practices, if greater latitude and responsibilities are given to the practitioner.

Thus, it may be that in one state a Nurse Practitioner can exam, diagnose, and prescribe a medication regimen without the direct oversight of a medical doctor, whereas in other states such latitude may not be allowed. This should be pointed out to the Judge, to emphasize greater credibility of the testimony of the practitioner. Further, remember that in Vanieken-Ryals v. OPM (U.S. Court of Appeals for the Federal Circuit, November, 2007), the Court therein reiterated that the medical documentation/evidence required must come from a ‘licensed physician or other appropriate practitioner’, and so long as that medical practitioner utilizes “established diagnostic criteria” and that which is “consistent with generally accepted professional standards”, the testimony cannot be undermined. Use the strengths of the case you have, and emphasize the little details that matter.

Sincerely,

Robert R. McGill, Esquire