By Robert McGill
Whether or not a Federal or Postal employee is eligible for Federal Disability Retirement benefits under FERS (Federal Employee's Retirement System) or CSRS (the Civil Service Retirement System or, in the parlance of many, the "old" system), is ultimately determined by both the quality and the quantity of the medical documentation presented and submitted to the Office of Personnel Management. Such medical documentation should include, at a minimum, a medical narrative report prepared by one's treating doctor; office and/or treatment notes of the treating doctor, for up to 18 months prior to the filing of the Federal Disability Retirement application; any diagnostic testing, including X-ray results, MRIs, EMGs, etc.; and any recent records on hospitalization and surgeries, if available.
Whether qualitative sufficiency of a medical report is met (the "substance" of a doctor's medical narrative report), or whether quantitative weight of the evidence is enough (the amount, or number of pages of the medical documentation amassed) is probably a false choice; qualitative sufficiency is never determined by the amount of medical documentation; and quantitative compilation - the sheer volume of "how much" medical information should be gathered and submitted - should always be guided and based upon the quality of the submission. In some cases, a few pages of a well-crafted, detail-delineated medical report, along with diagnostic test results, will be sufficient to meet the burden of proof for a Federal Disability Retirement application, whether under FERS or CSRS. In other instances, a voluminous compendium of medical records may be required. Thus, while the legal criteria applicable in determining the eligibility of a Federal or Postal employee in filing for, and obtaining an approval of, a Federal Disability Retirement application may be uniform for purposes of statutory compliance, ultimately the evidence compiled for each particular case must be tailored in accordance with the unique features of the individualized case.
The legal burden of proof which is applicable in Federal Disability Retirement cases is what is known as the "preponderance of the evidence." By the conceptual term, "preponderance", however, is not meant to refer merely to the weight or volume of evidence presented. While the concept of "preponderance" does indeed encapsulate the idea of "more" as opposed to "equal" or "less", as in, "more likely the case than not" (thus obviously entailing the idea that a greater showing of evidentiary value is what is needed in order to meet the burden of proof); nevertheless, to think that one will necessarily meet the burden of proof by simply attaching one's medical records to an application for Federal Disability Retirement benefits would be a mistake.
Furthermore, the problem (and failure) with many Federal Disability Retirement applications is often defined by the disjunctive nature between what the Federal or Postal employee states in his or her Applicant's Statement of Disability (Standard Form 3112A), and what the actual medical documentation offers as substantive medical evidence. Remember -- the quality of the medical documentation is not necessarily "extended" by what the Federal or Postal applicant states. In other words, the statements made by the Federal or Postal employee are not considered "medical evidence" when the attempt is made to "explain" what the medical report or treatment records have already revealed. The doctor, the Nurse Practitioner, the Psychiatrist, Psychologist, Chiropractor, etc., must necessarily be the one who formulates the nexus between the medical condition suffered by the Federal or Postal employee, and the particular kind of job which the Federal or Postal worker engages in. While the Applicant of a Federal Disability Retirement submission (or his or her legal representative) can certainly make legal arguments, and advocate for the particular statements made by the medical doctor; nevertheless, the medical documentation must in and of itself, by its own weight and substantive content, carry sufficient weight in order to meet the burden of proof.
Moreover, while treating doctors are often reluctant to make a conclusory finding of disability from one's occupation, such reluctance is normally based upon a misunderstanding of the administrative process of Federal Disability Retirement. Most doctors are familiar with other forms of disability programs - Social Security Disability benefits, for instance, where the standard of proof is a much higher one - one of "total disability", and therefore a finding that the Federal or Postal employee is unable to be employable in any gainful or meaningful manner. Or, many doctors, through professional encounter with state Worker's Compensation programs, are familiar with Federal Worker's Compensation issues, which often involves proof of causality as well as percentage ascription of physical disabilities which are related to, or caused by, one's job. But where Federal Disability Retirement comes into play, doctors are often unfamiliar with the requirements, and therefore fail to understand the "nuts and bolts" of what is needed in a medical narrative report.
Guidance is often the key. While the Physician's Statement, SF 3112C, is often handed to the treating physician, it is merely another government form which is confusing, in small print, and unhelpful in providing the necessary guidance from a physician's viewpoint. What often ends up happening, is that a medical report which addresses issues familiar to a doctor - either for Worker's Compensation or for Social Security - is what results as the end product.
But quality of a medical report is ultimately the end product to achieve, and unless the treating doctor becomes familiar with the legal criteria and what constitutes sufficiency of evidence to meet the burden of proof of "preponderance of the evidence," then the production of a medical report is often merely another quantitative piece of evidence. Quality is achieved through knowledge and guidance; quantity is produced by rote or habit. Look at any random medical file - of office notes, treatment notes, doctor's notes, etc. More often than not, most of the findings are identical reiteration of past statements, page after page; changes in medications may be noted; some clinical examination findings may be annotated with some significant changes; but the history of the medical condition is normally regurgitated; the diagnostic findings are identical; any short discussion (if it is reflected at all) will often refer to the same couple of lines.
Merely stating what the diagnosis is, and the symptoms manifested, will not satisfy the legal burden of preponderance of the evidence. Something more is needed - the bridge, the nexus, and connection between the medical condition and the particular elements of one's position as a Federal or Postal employee. Quality of the medical documentation is never compensated by quantity; quantity of medical documentation will never, in and of itself, meet the sufficiency test of the burden of proof; and an Applicant's Statement of Disability, no matter how well crafted, will not explain away the deficiencies evident in a medical narrative report. Guidance, in all aspects of preparing, formulating and filing a Federal Disability Retirement application, whether under FERS or CSRS, is the key to the successful conclusion at all stages of the administrative process. As guidance requires knowledge and thoughtfulness, so the ultimate product of a Federal Disability Retirement application which leads to a successful conclusion, must be one prepared, formulated, and filed, with knowledge, foresight, and thought. Anything less will merely result in a stack of papers barely worth their weight, and insufficient to meet the legal burden of proof, one of "preponderance of the evidence".
Attorney Robert R. McGill specializes in securing Federal Disability Retirement benefits for Federal and Postal workers under both FERS and CSRS. He represents Federal and Postal employees from all across the United States, from the West Coast to the East, and every state in between, as well as Alaska, Hawaii, Puerto Rico, Europe, Japan, etc. For more information about his legal services, please visit his CSRS and FERS Disability Retirement Website and USPS Disability Retirement websites.
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