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

OPM Disability Retirement: Professionals & Saving Time

In many areas of law, it is often the case that “professionals” prefer dealing with other professionals.  Thus, doctors will often encourage their patients to obtain the services of a lawyer when it has come time to consider medical retirement.  

In preparing, formulating and filing for Federal Disability Retirement benefits under FERS or CSRS, submitted to the Office of Personnel Management, there are multiple factors to consider when engaging in the preparatory stages of the administrative process.  The reason why doctors often prefer to deal with attorneys when the patient is compiling the “paperwork” for Federal Disability Retirement is that it saves time.  

Time is a commodity which is scarce and valuable.  Doctors do not want to have to engage in multiple revisions or rewriting of medical reports.  Doctors are professionals who believe that their time is best spent in treating patients — and while such “paperwork” is a necessary part of a doctor’s practice, and one which ultimately assists the patient in furthering his or her medical condition and future well-being; nevertheless, if an administrative issue needs to be addressed, doctors will often prefer to accomplish such administrative tasks in the most efficient, expeditious manner possible.  

The same concept holds true for the Federal or Postal worker who is filing for Federal Disability Retirement benefits under FERS or CSRS.  While there is never a guarantee that a “professional” will present a compelling enough case to the Office of Personnel Management such that an approval of one’s Federal Disability Retirement application will be a certainty; nevertheless, it is normally the most effective road to success.  

As time is a valuable and scarce commodity, so such scarcity and value should be considered at the beginning of the process of preparing, formulating and filing for Federal Disability Retirement benefits under FERS or CSRS.

Sincerely,

Robert R. McGill, Esquire

Medical Retirement for Federal Workers: Narrowing the Options

In preparing, formulating and filing for Federal Disability Retirement benefits under FERS or CSRS, clarification of the direction, purpose and choices/options available is often helpful in compiling an effective and compelling Federal Disability Retirement case.  

Often, there is hesitancy in preparing the application, and such hesitancy and pause are a sign that there is a part of the Federal or Postal worker who is hoping that the medical condition will either resolve itself, or that somehow — in some nebulous and obscure thought-processes — procrastination will result in resolution and continuation in the career one has chosen.  

Narrowing the options with a perspective of reality-based evaluation of one’s situation, however, is important in taking the initial steps.  “Preparation” constitutes thinking about the various options, including questioning the circumstances of one’s medical history, present reality, and future expectations.  

Thus, some questions might be:  Can I continue to work at this job until retirement?  If I continue to work at this job till retirement, will my health have been impacted so detrimentally that I will be in a debilitated state such that “retirement” would be a meaningless goal?  What is my doctor saying?  Will my doctor support me in an application for Federal Disability Retirement benefits?  How is my agency acting/reacting?  Will they continue to tolerate less than full performance and productivity?  What are my choices — work till retirement, file for Disability Retirement, or walk away without anything?  

Such narrowing of choices and options, through proper questioning, is the initial preparatory step in preparing, formulating and filing for Federal Disability Retirement benefits, whether under FERS or CSRS, from the Office of Personnel Management.  

Sincerely,

Robert R. McGill, Esquire

Disability Retirement for Federal Workers: The Unguided Doctor

In preparing, formulating and filing a Federal Disability Retirement application under FERS or CSRS, it is important to guide the doctor into properly preparing and formulating the medical narrative report.

This is not a matter of “telling what the doctor to say”.  The treating doctor is obviously aware of the types of medical conditions that the patient — the Federal worker who is filing for Federal or Postal Disability Retirement benefits — is suffering from.  The doctor’s professional integrity, as to what his or her medical opinions are, should always be preserved and be paramount.  

Further, it is merely a factual issue as to whether the doctor will be supportive of such an endeavor, and such support can only come about by having a direct and frank discussion about the requirements of one’s positional duties and how those positional duties are impacted by one’s medical conditions.  

Rather, the issue of guiding the doctor is one of informing him or her of the particular elements which are necessary and unique in a Federal Disability Retirement application, which must be addressed in a narrative report.  For, otherwise, the unguided doctor will simply issue a narrative report with a different focus and a different end.

Guidance is merely knowing what the goal of a particular activity requires, and unless the treating doctor understands the technical requirements of what is needed (the end-goal), that doctor will merely attempt to meander by accident in a formulation which may include elements which are more harmful, than helpful, in preparing, formulating, and filing for Federal Disability Retirement benefits under either FERS or CSRS.

Sincerely, Robert R. McGill, Esquire

OPM Disability Retirement: Quality & Quantity of Medical Report

In preparing, formulating and filing a Federal Disability Retirement application under FERS or CSRS, it is often asked as to the quantitative sufficiency of the medical documentation to be submitted.

Qualitative sufficiency for Federal Disability Retirement applications, at least on a generic level, is an easy one to answer — the substance of the medical documentation must meet the legal standard of proof.  If the Office of Personnel Management or the Merit Systems Protection Board approves the Federal or Postal employee’s Federal Disability Retirement application under FERS or CSRS, then obviously both the quality and quantity of medical documentation met the standard of proof.  

But an answer based upon “after the fact” circumstances is rarely useful; the generic answer of, “Submit medical evidence such that it meets the legal burden of proof, of Preponderance of the Evidence”, might be well and good, but what does that mean?  

Ultimately, the reason why such questions as to sufficiency of medical documentary submission cannot be answered in a generic manner, is that each particular case is unique, and any imposition of a general rule is dangerous because, the moment the general rule is followed and violated (with a denial from the Office of Personnel Management), then the rule becomes obsolete and irrelevant.  

The quality of the medical documentation to be submitted must ultimately show to OPM that each of the legal criteria are met, and that there is a nexus between one’s medical conditions and the type of work that one performs.  

Quantity of medical documentation is ultimately determined by the quality of the medical narrative.  While generic in scope, the general approach is that one should submit only the extent of medical documentation sufficient to prove one’s case; and in each particular case, what that proof must consist of, is unique, particularized, and ultimately personalized to the individual Federal or Postal Worker who is 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

FERS & CSRS Disability Retirement for Federal and USPS Workers: Patient-Doctor Relationship II

Part of a patient-doctor relationship (and I intentionally placed the term “patient” before the hyphenation to “doctor”, because the primacy of the relationship should recognize the order of importance) should necessarily involve a commitment from the doctor.  That commitment should entail the desire to do that which is necessary, within reasonable bounds and within the law, as well as the integrity of the doctor’s medical opinions, in order to look after the best interests of the patient.  

It is always a puzzle and a disturbing bit of news to find that a doctor who has performed surgery, who has prescribed multitudes of pain or psychotropic medications, has prescribed multiple diagnostic tests and have the patient undergo test after test, physical therapy sessions, clinical evaluations, etc. — and at the end of it all, to have the “final straw” which severs the patient-doctor relationship to be a refusal to provide a medical narrative report in support of a Federal Disability Retirement application.  Think how preposterous that sounds.  Thus, it is not enough to get some vague support when the issue is first broached; no, what is needed is the same level of commitment from the doctor, as when he or she first said to you, “Yes, I am going to treat you for your medical condition…”

Sincerely,

Robert R. McGill, Esquire

OPM Disability Retirement for Federal and Postal Employees: Doctors Do Want to Help

It is rare that a treating doctor fails to help, or refuses to help.  Yes, “getting involved” in a “legal case” is not only a headache, but for a doctor, it is often an intimidating experience, and many doctors have become “gun shy” over the years because of the negative experiences which have befallen them when getting involved in the legal side of his or her medical practice.

Look at it from the doctor’s viewpoint.

While one may fully understand the distinction between Federal Disability Retirement issues under FERS or CSRS, and those “other” issues (i.e., OWCP/FECA Department of Labor cases, or personal injury cases, etc.), from the treating doctor’s viewpoint, they are all “legal” issues.  And, from the doctor’s perspective and prior negative experiences, once you stick your neck out on behalf of a patient and get involved in a case, one never knows what it may lead to — court, depositions, cross-examinations, etc.  But there is indeed a difference and a distinction between those “other cases” and filing for Federal Disability Retirement cases.

To soothe the feathers of a doctor is important; to take the time to explain the process is vital; to make the job of the doctor as efficient and non-threatening is the key to a successful Federal Disability Retirement application under FERS or CSRS.

Sincerely,

Robert R. McGill, Esquire

OPM Disability Retirement: Thank the Medical Professionals

If not for the doctors, disability retirement would obviously not be a possibility.  Of course, one may make the self-evident statement that being supportive of a Federal Disability Retirement application is simply part of a doctor’s job; and, to some extent, that would be true.  Doctors should indeed be willing to write up supportive medical narrative reports for their patients. 

Nevertheless, it is because of the doctor, the effort expended, the willingness to testify at a Merit Systems Protection Board Hearing, that the Office of Personnel Management even listens, or reverses a prior denial, and grants a disability retirement application.  Especially when a case gets denied twice by the Office of Personnel Management, it becomes crucial to have the cooperation of the treating doctor to testify in an MSPB Hearing.  This is normally done by telephone, thereby making it a minimal imposition upon the doctor’s time.  Indeed, I often only take a total of 30 minutes of the doctor’s time, including preparation and actual testimony, for an MSPB Hearing.  But the very fact that the doctor is willing to testify — to speak to the Administrative Judge directly to give his or her medical opinion — is often enough to convince OPM to change course, and grant the disability retirement benefits. 

Sincerely,

Robert R. McGill