How Agencies Remove Employees for Medical Reasons — and How to Stop It

Being told you may be removed for “medical inability to perform” is one of the most frightening experiences a federal employee can face.

It often comes without warning:
A supervisor whispers that you’re “not able to do the job anymore.”
HR asks for doctor’s notes repeatedly.
Occupational Health schedules a fitness-for-duty exam.
Your telework or leave gets denied.
Suddenly you’re told:

“We may have to separate you based on medical inability to perform.”

Most federal employees:

  • Do not know this is a removal action, just like misconduct or performance

  • Do not know they have significant legal rights

  • Do not know that agencies often perform these removals illegally

  • Do not know how to use RA law, documentation, and reassignment to avoid removal entirely

This guide explains everything — in plain English — so you can understand the process, recognize agency violations, and protect your career, your benefits, and your future.

For deeper strategy on medical documentation, RA, telework, removals, and disability retirement, explore the Federal Employment Defense Hub.

National Security Law Firm: It’s Our Turn to Fight for You.

What Is a Medical Inability to Perform Removal?

A Medical Inability Removal is when a federal agency removes an employee because:

  • You are allegedly unable to perform one or more essential functions of your job due to a medical condition, and

  • The agency claims no reasonable accommodation exists that would allow you to perform the job.

It is not disciplinary — but it is a removal, and must follow:

  • Due process

  • Evidence requirements

  • RA rules under the Rehabilitation Act

  • Reassignment obligations

  • MSPB standards

Many agencies get this wrong.

When Agencies Consider Medical Removal

Agencies typically begin considering medical removal when:

  • You have been on extended medical leave

  • You used FMLA and RA leave extensively

  • You have frequent absences

  • You submitted recurring doctor’s notes

  • You cannot return to full duty without restrictions

  • Occupational Health raises concerns

  • You cannot obtain medical clearance for certain job duties

  • You are unable to meet physical requirements (e.g., law enforcement, EMS, aviation, corrections)

But here is the critical truth:

Medical removal should NEVER be considered until all reasonable accommodations AND reassignment options have been exhausted.

Most agencies skip these steps — illegally.

Legal Standard: What the Agency Must Prove to Remove You

To lawfully remove you for medical inability, an agency must show:

1. You cannot perform one or more essential functions of your job

They must prove inability with medical evidence.
Supervisor opinions don’t count.

2. The condition is likely to continue

Not a temporary illness.
Not a flare-up.
Not “we’re tired of dealing with this.”

3. They considered and attempted reasonable accommodation

This includes:

  • Telework

  • Modified schedule

  • Leave as accommodation

  • Restructured duties

  • Light duty (if offered to others)

  • Equipment or workspace modifications

If they didn’t try — the removal is unlawful.

4. They considered reassignment (the last resort accommodation)

This is where most agencies violate the law.

The law requires:

  • Search for vacant positions

  • Within the same grade or lower

  • Within the commuting area (maybe beyond if reasonable)

  • For which you are qualified

If they don’t conduct a real reassignment search, removal can be overturned.

5. They followed due process

This includes:

  • Written proposal

  • Documentation provided to you

  • Time to reply

  • Opportunity to submit medical evidence

  • Written final decision

A one-sided or rushed process is challengeable.

The “Essential Functions” Analysis (What Agencies Get Wrong)

An agency cannot remove you simply because:

  • You can’t perform some duties

  • Your supervisor thinks your duties “require” something

  • You can’t perform marginal tasks

  • You can’t do tasks that could be temporarily reassigned

  • You need telework or schedule adjustments

  • You’re slower, recovering, or limited temporarily

The only question is:

Can you perform the essential functions of the position with or without accommodation?

To determine this, consider:

  • Official position description

  • Actual duties performed

  • What others in the job do

  • Telework feasibility

  • Whether tasks can be redistributed

  • Whether accommodations eliminate barriers

Agencies often exaggerate what is “essential” to justify removal.

The Role of Reasonable Accommodation in Preventing Removal

Before removing you, the agency must evaluate every possible accommodation, including:

  • Telework (full-time or hybrid)

  • Modified schedule

  • Partial-day schedule

  • Leave as accommodation

  • Reassignment

  • Assistive equipment

  • Light duty (if similarly offered)

  • Quiet workspace

  • Reduced physical tasks

  • Modified exposure to hazards

  • Ergonomic adjustments

If any accommodation would allow you to perform essential functions, you cannot be removed.

Many removals are reversed at MSPB because the agency failed to try accommodations.

Reassignment: The Most Overlooked Tool to Stop Medical Removal

Reassignment is the last resort accommodation under the Rehabilitation Act.

It means:

  • If you cannot perform your current job even with accommodations,

  • The agency must search for another vacant position you can perform.

But agencies often:

  • Don’t search at all

  • Do a fake search

  • Limit search to your office

  • Ignore lower-graded positions

  • Pretend no vacancies exist

MSPB has repeatedly ruled that failure to consider reassignment = illegal removal.

If removal is proposed, ALWAYS ask:

“What positions were considered for reassignment, and what were the results of the search?”

If they cannot answer — they violated the law.

How Agencies Try to Push Employees Into Medical Removal (And How to Recognize It)

These are the top warning signs:

1. Constant demands for updated medical documentation

Especially for permanent conditions.

2. Increased scrutiny of attendance or sick leave

Often a precursor.

3. Sudden refusal to accept previous accommodations

A shift in agency attitude.

4. Fitness-for-duty exams without clear justification

Used as leverage.

5. Statements like:

  • “Maybe this job isn’t a good fit anymore.”

  • “We need someone who can be here consistently.”

  • “It’s not personal, but we can’t rely on you.”

6. Blocking telework or leave — then complaining about performance

A classic discrimination pattern.

7. Proposing leave restrictions that ignore your doctor’s limitations

Setting you up for failure.

8. Mixing performance issues with medical concerns

A sign the agency is confused — or acting in bad faith.

If you see ANY of these signs, call NSLF immediately.

The “Bruner Presumption”: Medical Removal & Disability Retirement

If you are removed for medical inability to perform, the Bruner Presumption often applies.

This means:

  • OPM presumes you are disabled for FERS disability retirement

  • The burden shifts to OPM to rebut the presumption

  • Your removal can significantly help your retirement claim

But this cuts both ways:

  • Removal ends your federal career

  • You lose income unless retirement is approved

  • You may have to wait months to years

This is why you should never accept removal without exploring accommodations, reassignment, or alternative options first.

How to Fight a Medical Inability Removal (Step-by-Step)

Step 1 — Strengthen your medical documentation

Your doctor must address:

  • Functional limitations

  • Your ability to perform essential duties

  • Accommodations that would allow you to return

  • The expected duration

  • Why removal is unnecessary

Step 2 — Demand a real accommodation analysis

Ask:

“Which accommodations were considered and why were they rejected?”

Step 3 — Demand a reassignment search

Put it in writing.

Step 4 — File or prepare for an EEO claim

If disability discrimination or RA failures exist.

Step 5 — Prepare your MSPB defense

Most medical removals are appealable to the MSPB.

Step 6 — Consider disability retirement only as a backup plan

Do not let the agency push you into unnecessary removal.

Hypos: How Federal Employees Win These Cases

Hypo 1 — Telework Would Have Solved Everything

Employee with autoimmune condition removed for “inability to perform onsite.”

But job could be performed remotely.

Outcome:
MSPB reverses removal.
Agency violated RA law by refusing telework.

Hypo 2 — Agency Ignored Reassignment

Law enforcement employee cannot meet physical requirements.

Agency removes him.

But agency never searched for:

  • Desk roles

  • Administrative roles

  • Analyst positions

Outcome:
Removal reversed; employee reassigned.

Hypo 3 — Temporary Condition Misinterpreted as Permanent

Employee undergoing short-term treatment removed prematurely.

Outcome:
Evidence showed the condition was temporary.
MSPB reverses removal; reinstatement + back pay.

Hypo 4 — Improper Fitness-for-Duty Used as a Weapon

Employee forced into a mental health fitness-for-duty without objective evidence.

Agency used flawed exam to justify removal.

Outcome:
NSLF challenges entire process.
Agency settles; removal withdrawn.

FAQs: Medical Inability Removals

Can I be removed if I’m on OWCP?

Yes — OWCP benefits do NOT prevent removal.
But RA rights still apply.

Can they remove me while waiting for medical documentation?

Not lawfully.

Can they remove me without offering accommodations?

No — that violates the Rehabilitation Act.

Can FMLA exhaustion justify removal?

No — RA leave may still apply.

Do I need a lawyer?

If medical removal is mentioned even once, YES.

Will a removal help with disability retirement?

Yes — but at the cost of losing your job.

Why You Should Use the Federal Employment Defense Hub

Every medical removal involves:

  • Documentation battles

  • Leave issues

  • Failed accommodations

  • Supervisor hostility

  • Fitness-for-duty questions

  • Telework disputes

  • Privacy violations

The Federal Employment Defense Hub organizes everything you need to know in one place.

Why Federal Employees Trust NSLF With Medical Removal Cases

We understand your agency’s playbook — we helped design it.

Now we use it to protect your career.

Book a Free Case Plan Today

If medical removal has been mentioned — even casually — your career is at risk.

We can help you:

  • Strengthen your medical documentation

  • Secure accommodations

  • Stop improper removals

  • Force reassignment analysis

  • Build your MSPB defense

  • Coordinate disability retirement strategy

Schedule your free consultation now:
👉 Book a Free Case Plan

National Security Law Firm: It’s Our Turn to Fight for You.