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

Disability Retirement for Federal Workers: Causation Irrelevancy

Causation and the issue of causality involves the occurrence of X as a result of an action Y.  There are direct causes, intermediate causes, interceding causes, etc., which concern whether or not an immediate linkage can be established between the action Y and the effect X.

Thus, if the white billiard ball strikes the Number 7 ball, and the latter moves forward, we say that X (the white ball) caused Y (the Number 7 ball) to move.  On the other hand, if the rooster makes its traditional cry at 7 a.m. as the sun is rising, and does so only when the sun rises, we may informally say, in an imperfect sense of causation, that “because” the sun rose, the rooster crowed.  We rarely ascribe a direct cause between X and Y, however.

For OWCP/Department of Labor cases, causation is a relevant and significant aspect of proving a case — for, in a FECA case, one must prove, as one of the elements of eligibility, the fact that the injury was “caused” by the job, while on the job, while related to the job, etc.  A significant amount of time is thus expended in proving the issue of causality in a Department of Labor, Office of Workers’ Compensation claim.

For FERS & CSRS Disability Retirement cases, however, under the auspices of the U.S. Office of Personnel Management, causation is not an issue.  A Federal or Postal Worker can be injured while on vacation; he or she can have the injury while at work, and concurrently (or sequentially) file for OWCP benefits and OPM Disability Retirement benefits; or the injury or medical condition can simply “occur” during his or her tenure with the Federal government.

In any and all events, it is essentially an irrelevancy.  The issue is not “how” it occurred; rather, the point is to show that, once occurred, in what manner does it impact one’s ability to perform the essential elements of one’s job.

While causation in a FERS or CSRS Disability Retirement application may be of some historical interest, it should not be a central focus of any applicant’s statement of disability.  To do so would be to make a peripheral issue a central one, and conversely, to allow for the central issue to become less focused.

Sincerely,

Robert R. McGill, Esquire

Federal Disability Retirement: Dependent Contextual Information

The historical context of one’s medical condition is an issue which is mostly irrelevant for the First and Second Stages of a Federal Disability Retirement application, submitted to the U.S. Office of Personnel Management, whether under FERS or CSRS. This is because OPM is not interested — or, more accurately, the law does not recognize as relevant in analyzing the eligibility criteria applied in a Federal Disability Retirement application — of “how” or “why”.

While such contextual information may be relevant for OWCP/FECA cases because of the issue of causality and its importance in such cases, the overriding and determining factor in a Federal Disability Retirement application is whether a Federal or Postal employee has a medical condition; how that medical condition prevents one from performing one or more of the essential elements of one’s job; and whether the medical condition will last a minimum of 12 months.

Outside of that contextual information (actually, such information is more accurately identified as content-information), OPM in pragmatic terms has no patience for the historical background of such information.  Obviously, however, some contextual narrative should be included in any Applicant’s Statement of Disability, in order to make the statement meaningful.

One last point:  While historical context may not be relevant for the Initial Stage and the Reconsideration Stage, it may be very important if one finds oneself before an Administrative Judge at the U.S. Merit Systems Protection Board.

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

OPM Disability Retirement: The OWCP Intersection

Federal Disability Retirement benefits under FERS or CSRS is oblivious and unconcerned with whether or not a particular medical condition occurred “on-the-job” or not.  Rather, the focus is upon (A) the existence of a medical condition along with the symptomatologies and their manifestations, and (B) the impact of the medical condition(s) upon one’s ability/inability to perform all of the essential elements of one’s job.  

Thus, “causality” in all of its forms is an irrelevant issue — whether “how it happened”, “where it happened”, “what happened”, etc.  Causation is a legal/medical issue which may be interesting, and is certainly one which the Office of Worker’s Compensation Programs inquires about, but it is a “non-starter” for purposes of Federal Disability Retirement benefits under FERS or CSRS.  

As such, when a Federal or Postal employee who has been injured on the job, or who has incurred a medical condition from a worksite because of inherently hazardous medical triggers reasonably related to the particular occupation of an individual, an inordinate amount of focus is often paid as to the “causality” of a medical condition.  While this may be of historical interest — both to a doctor as well as to FECA/OWCP — it is an issue which should play a lesser role of importance in a Federal Disability Retirement application.  

For eligibility in filing a Federal Disability Retirement application under FERS or CSRS, where something happened, what happened, or when it happened, is far less important than how much of an impact a medical condition has, and for how long, upon one’s ability/inability to perform the essential elements of one’s Federal or Postal job.

Sincerely,

Robert R. McGill, Esquire

CSRS & FERS Medical Disability Retirement: Psychiatric Disabilities — Origin versus Situational (Continued…)

The “origin” of a medical disability, from the perspective of a Claims Representative at the Office of Personnel Management, may be relevant for purposes of adjudicating a Federal Disability Retirement application under FERS or CSRS.  Note that physical disabilities rarely become an issue in the context of the origination of the medical disability, precisely because it is irrelevant whether or not a medical disability occurred on the job or not.

The origin of a psychiatric disability, however, is potentially relevant from OPM’s perspective, because it may give rise to the argument that it is a “situational” disability — one that is contained, limited, and ultimately circumscribed within the situation of the particular office of the specific agency in which the Federal or Postal Worker works.  

Thus, from this argument, the logical extrapolation is that while the Federal or Postal worker is unable to work in the specific office or location, he or she is nevertheless able to perform all of the essential elements of the particular job — but in another agency, another office, another location, etc.  Thus, the concept of “situational disability” arises, with the consequential argument that one is in fact NOT prevented from performing one or more of the essential elements of one’s job — but rather, it is the “situation” which is at fault. This is why the citation of correlative EEOC complaints, hostile work environment accusations, etc., are dangerous to make in the context of filing for Federal Disability Retirement benefits under FERS or CSRS.

Sincerely,

Robert R. McGill, Esquire

Disability Retirement for U.S. Federal Government Employees: Context, Sequence & Connections

Often, a potential applicant for Federal Disability Retirement will insist that the origin of the medical condition or injury is important to annotate, for one reason or another.  Unlike OWCP issues, origin and causation is usually of little or no significance in a Federal Disability Retirement application, whether under FERS or CSRS.  Thus, for OWCP Disability, it may be of importance to show that X injury was caused by occupational hazard Y; or that, while on the job on a certain date, the applicant slipped and fell, etc.  In proving OWCP Disability, such “incident-specific” facts are important in establishing causation, in order to determine eligibility and entitlement to OWCP Disability benefits.

For purposes of OPM Disability, however, the Federal or Postal worker who is seeking Federal Disability Retirement benefits from the Office of Personnel Management, does not have to establish such incident-specific facts.  Rather, the focus shifts upon the medical condition, the symptoms, and the impact upon those medical medical conditions and symptoms upon one’s inability to perform one or more of the essential elements of one’s job, within the last year.  While it may be that some factual context is significant by way of showing a sequence of events from the past, in order to show how the medical condition worsened over time, OPM normally does not care about such historical facts.  While the history of X is interesting, what occurs in the recent-to-present timeframe is what interests OPM.

Sincerely,

Robert R. McGill, Esquire

CSRS & FERS Disability Retirement: The (non) Problem of Causality & Causation

In a Worker’s Comp (DOL/OWCP/FECA) case, causation and causality often loom as significant issues, and doctors often have to walk a difficult line in making unequivocal statements, or somewhat equivocating statements, as to the “cause” of a medical condition or injury.

Such statements can sometimes be the singular focus as to the success or failure of an OWCP case.  Why?  Because OWCP compensable injuries and medical conditions must be related to the job — either as something caused by an accident while on the job, or in some way occupationally related.

In Federal Disability Retirement cases under FERS or CSRS, one can be on a skiing vacation and incur a medical condition or disability, and so long as that person is unable to, because of the medical condition, perform one or more of the essential elements of one’s job, one is thereby eligible for Federal Disability Retirement benefits under FERS & CSRS.

Sometimes, however, the issue of causation comes into the picture, but can work in a detrimental way, but need not.  Let me clarify:  In a chemical sensitivity case, or a psychiatric condition which finds its originating “causation” from the workplace, the doctor may want to relate the “cause” of the medical condition directly to the workplace.

This is fine, so far as it goes — and, ironically, most doctors (because they have no idea about FERS or CSRS Disability Retirement) think they are doing their patients a favor by relating it as “causally related” to the workplace.  More often than not, however, it can open up a “can of worms” — of being characterized by the Office of Personnel Management as a “situational disability”, which must be avoided like the plague.

Sincerely,

Robert R. McGill, Esquire