CSRS & FERS Medical Disability Retirement: The Treating Doctor

There is efficacy and motivational bias.  Sometimes, unintended consequences result in the coalescence of both, but where the result is unaffected by the underlying reason for acting upon an event.

In OWCP cases, the motivational bias almost always includes the intent of the Department of Labor to try and save money, and to steer the injured worker to undergo treatment (if one can call it that) and oversight with one of “the company” doctors who can quickly declare a person to be healed and ready for return to full-time duty, despite protestations of pain, discomfort and limitation of movement, all to the contrary.

It is no accident that the ever-present Worker’s Comp Nurse who infringes upon the patient-doctor relationship by imposing her presence upon each visit, agrees whole-heartedly with any such assessment of full recovery, and ignores the pleas of the patient/OWCP benefit-recipient.

By contrast, those who are filing for Federal Disability Retirement benefits from the U.S. Office of Personnel Management, whether under FERS or CSRS, are encouraged to speak with their longstanding treating doctors, as opposed to merely going to a doctor whose motivational bias may stem from the source of one’s payment.

Treating doctors who have a long tenure of doctor-patient relationships have little underlying motivation to do anything but look out for the best interests of the patient.  If Disability Retirement is the best course, then that will be what the treating doctor will support.  It is ultimately the relationship that has been established over the many years, which makes for all the difference.  And that difference is worth its incalculable weight in gold.

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

CSRS & FERS Medical Disability Retirement: Unequivocal Statements

Unequivocal statements can go either way:  They can either show the force of authority, or unravel a lack of knowledge.  In a Federal Disability Retirement case, where a Federal or Postal Worker is attempting to obtain Federal Disability Retirement benefits under FERS or CSRS, such statements of “unequivocal” authority can be seen at any stage of the process.  An unequivocal statement of disability can be made by a treating doctor.  An unequivocal statement of denial of a Federal Disability Retirement application can be made by an OPM Representative.  

What is the distinction and difference between the two?  For the former, the medical doctor who makes an unequivocal statement of disability is based upon the history, clinical examinations, experience, possible diagnostic testing, and other criteria applied in coming to a medical conclusion.  There accompanies it the force of the doctor’s credentials.  The latter is an opinion based upon (hopefully) a comparison of the documentation submitted by the Federal or Postal worker, and the “letter of the law”.  But that assumes that the OPM Representative understands and correctly applies the law.  Such an assumption is often erroneous, inasmuch as the OPM Representative is not a lawyer — and that is just the first of many reasons.  

Don’t be fooled by unequivocal statements; authority of such statements must have a force of rational basis and credentials, and not just because a person “says so”.

Sincerely,

Robert R. McGill, Esquire

Medical Retirement Benefits for Federal & Postal Employees: OPM’s Arsenal

The names have been changed to protect the innocent.  Or, perhaps those who are impliedly involved herein are not so innocent after all.  Nevertheless, the names must be changed to protect confidentiality of sources, etc.  Every now and then, the Office of Personnel Management discloses their arsenal of weapons.  For instance, such an arsenal might be that a denial of a Federal Disability Retirement application was based upon a review by a retired contract doctor.  Now, let us analyze such an arsenal.  First, the term “retired” reveals an interesting concept.  It means that the individual no longer sees hundreds of patients on a daily basis, nor is actively practicing medicine.  Next, on a superficial level, we take the word “contract” — meaning thereby that the individual is paid to review the paper submissions — not to examine the applicant who is filing for Federal Disability Retirement benefits.  And, finally, the concept of a “doctor” — let us be certain as to the two preceding words, “retired” and “contract”, and that is the extent which one needs to understand in accepting the definition of the word “doctor”.  As opposed to:  the treating doctor of an applicant for Federal Disability Retirement.  Who would you choose to treat you?

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

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