OPM Disability Retirement: Office Notes (Continued…)

The Office of Personnel Management has every right to establish a consistency of medical treatment and opinions rendered on the part of the doctor, the specialist, the medical facility, etc.  One of the reasons why Federal Disability Retirement benefits are (in great part) determined by the opinion of the “treating doctor”, as opposed to a determination made by a medical doctor who makes such disability determinations but is not the applicant’s “treating doctor”, is that such a determination (in the eyes of Federal Disability Retirement laws, statutes, MSPB case laws, etc.) can best be rendered by a medical specialist who has a long-standing relationship with the patient/applicant, over a long period of time, to determine the extent, severity, chronicity, etc., of the medical condition claimed.  

With this in mind, there often arises a conflict of sorts:  On the one hand, most people who are attending to their medical needs, are not thinking in terms of “getting Federal Disability Retirement benefits” during the time of treatment.  The critical point of when the line becomes drawn, where treatment & chronicity begin to conflict; or where, despite every attempt by the doctor to prescribe treatment modalities, there appears to be a medical condition which is “intractable”, is often a difficult one to determine.  In most cases, the office/treatment notes will reveal the line, which may come about gradually.  At other times, one may have a doctor who thinks that he or she can successfully treat any and all conditions, and reflects such a “positive” outlook in every office notation.  This is often not helpful, when it comes time to filing for Federal Disability Retirement benefits under FERS or CSRS.  To counter this, a frank discussion with the doctor at some point may become necessary.

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

 

Disability Retirement Benefits for Federal & Postal Employees: Are all Doctors Necessary?

In a Federal Disability Retirement case under FERS or CSRS, is it necessary to obtain the medical opinion of each and every doctor for each and every medical condition listed on the Applicant’s Statement of Disability (SF 3112A)?  To put the question in another way, Must there be a one-to-one correspondence between the medical condition listed or described, and the doctor who is specifically treating the medical condition? 

Certainly, in today’s world of medicine, where specialization is the key to treatment because of the complexity of each field of medicine and the successful treatment of diseases and medical conditions, it has become a fact of life that patients are “referred out” to various specialists.  Thus, the Primary Care Physician is often merely the “gate-keeper” of referrals, coordinating the medical treatment of a patient by overseeing the referrals to various specialists who treat various medical conditions.

An applicant for Federal or Postal Disability Retirement benefits under FERS or CSRS who must prove, by a preponderance of the evidence, his or her eligibility for Federal OPM Disability Retirement benefits, must submit substantiating medical documentation to prove his or her entitlement. 

As with all such questions, the answer to the above question is, “It depends”.  A one-to-one correspondence is not necessarily required; where helpful, of course, the referral specialist’s medical opinion should be used.  However, one should never underestimate the importance and force of the coordinating physician — the Primary Care Physician himself/herself.

Sincerely,

Robert R. McGill, Esquire