The Ultimate Guide to Protecting Your Job When Your Health Is on the Line

For federal employees, medical issues and leave are rarely simple.

You’ve got:

  • FMLA (Family and Medical Leave Act)

  • Reasonable Accommodation (RA) leave under the Rehabilitation Act

  • OWCP (workers’ comp through the Office of Workers’ Compensation Programs)

  • Threats of “Medical Inability to Perform” removal

…and agencies themselves often don’t understand how these pieces fit together.

The result?
Confusion, fear, and sometimes completely avoidable removals.

This guide is designed to be the most complete, accurate, and practical resource on the internet for federal employees trying to understand:

  • How FMLA, RA leave, OWCP, and medical removal interact

  • What each one does (and doesn’t) do for you

  • How to use them strategically to save your job

  • What agencies are allowed to do — and where they cross the line

  • What to do if you’re being pushed out while you’re sick or disabled

If you want a central place to keep learning about federal employment survival strategies, bookmark the Federal Employment Defense Hub. We built it to be the “one-stop” knowledge base for federal workers facing discipline, removals, disability issues, and retaliation.

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

Big Picture: How These Four Systems Fit Together

Let’s start with the “map” before diving into each piece.

FMLA (Family and Medical Leave Act)

  • Gives eligible federal employees up to 12 workweeks of job-protected unpaid leave in a 12-month period for:

    • Your own serious health condition

    • Some family care situations, birth/adoption, etc.

  • Protects your job and health insurance during that period.

  • Does not require your agency to accommodate you beyond that time.

RA (Reasonable Accommodation) Leave

  • Under the Rehabilitation Act, an agency must provide reasonable accommodations to qualified employees with disabilities.

  • Leave itself (paid or unpaid) can be a reasonable accommodation, even if:

    • You’re not FMLA-eligible

    • You’ve exhausted FMLA

    • You have no sick/annual leave left

  • Requires an individualized assessment and an interactive process.

OWCP (Workers’ Comp – Injury Compensation)

  • Administered by DOL/OWCP, not your agency.

  • Covers work-related injuries/illnesses.

  • Provides:

    • Wage-loss compensation

    • Medical treatment coverage

    • Potential “continuation of pay” (COP) for some injuries

  • Doesn’t itself guarantee you’ll keep your job forever — it’s mostly about benefits.

Medical Inability to Perform Removal

  • A basis for removing a federal employee when:

    • You cannot perform the essential functions of your position

    • Even with reasonable accommodation

  • The agency must:

    • Have solid medical evidence

    • Consider accommodations and reassignment

    • Follow due process (proposal, reply, decision)

  • Can sometimes support your disability retirement but is still a career-ending action if not fought or managed strategically.

Key truth:
These systems overlap. They are not “either/or.”

You can:

  • Take FMLA

  • Ask for RA leave

  • Have an OWCP claim

  • And still be at risk of medical inability removal if the agency handles things badly (or you don’t defend yourself properly).

The rest of this guide shows you how to use them together to protect your job instead of getting buried under the complexity.

Part 1: FMLA for Federal Employees — What It Really Does (and Doesn’t) Do

Who Is Eligible?

You’re generally FMLA-eligible if:

  • You have 12 months of federal civilian service, and

  • You’ve worked 1,250 hours in the previous 12 months in a covered position.

Some federal positions are covered under Title I FMLA; others have analogous Title II provisions (for many executive branch employees). In practice, most full-time federal employees can qualify for FMLA-type protections, but you should confirm with HR or your agency policy.

What Do You Get?

  • Up to 12 workweeks of job-protected leave in a 12-month period (for your own serious health condition or other qualifying events).

  • Leave is unpaid, but:

    • You can usually use sick/annual leave concurrently so you still get paid.

  • Job protection: You must be returned to the same or equivalent position at end of FMLA.

  • Continuation of health benefits on the same terms.

What FMLA Does Not Do

  • It does not give you more sick or annual leave; it just protects your job while you’re out.

  • It does not guarantee the same exact desk/caseload if restructuring occurred. The job must be equivalent in pay, grade, benefits.

  • It does not require your agency to hold your job forever if:

    • You cannot return at the end of FMLA, and

    • You do not have other legal protections (like RA leave).

Critical point:
When FMLA ends, your rights don’t stop — they just shift from FMLA to reasonable accommodation law if you have a disability.

Part 2: Reasonable Accommodation Leave — Your “Second Layer” of Protection

If you have a physical or mental impairment that substantially limits a major life activity, you likely have a disability under the Rehabilitation Act.

That unlocks a second world of protection:

Leave as Reasonable Accommodation

Under the law, time off to get treatment or stabilize a condition can itself be a reasonable accommodation if it allows you to eventually:

  • Return to work

  • Perform the essential functions of your job

This can include:

  • Additional unpaid leave after FMLA is exhausted

  • Intermittent days off for treatment or flare-ups

  • Reduced schedule for a period of time

  • “Return to work gradually” plans (building up hours over weeks)

Differences Between FMLA and RA Leave

Feature FMLA RA Leave
Based on Serious health condition Disability & need for accommodation
Eligibility 12 months + 1,250 hours Disability, qualified for job
Duration 12 weeks/year No fixed number; case-by-case
Paid? Unpaid by default Usually unpaid LWOP, but can overlap with paid leave
Job protection Strong but finite Tied to whether leave is reasonable/undue hardship

Big takeaway:
Even if HR says: “You’ve used all 12 weeks, we can remove you now,” that is not the end of the story if a disability is involved.

You can say:

“I am requesting additional leave as a reasonable accommodation for my disability.”

Now the agency must:

  • Engage in an interactive process

  • Consider the request individually

  • Evaluate undue hardship based on resources and feasibility, not just policy

Part 3: OWCP (Workers’ Comp) — What It Protects, and What It Doesn’t

If your medical condition is caused by your job, OWCP may come into play.

What OWCP Gives You

Through DOL’s Office of Workers’ Compensation Programs:

  • Continuation of Pay (COP) for certain traumatic injuries (up to 45 days).

  • Wage-loss benefits if you can’t work due to accepted work injury.

  • Medical coverage for treatment related to the injury.

  • Possible schedule awards for permanent impairment.

What OWCP Does Not Automatically Do

  • It doesn’t guarantee your position will be held open indefinitely.

  • It doesn’t forbid your agency from:

    • Reassigning you

    • Requiring fitness-for-duty exams

    • Starting a medical inability to perform action

  • It doesn’t replace your RA rights — agencies still must consider accommodation separate from OWCP.

The OWCP / RA Interaction

This is where things get messy.

Common pattern:

  1. You’re injured at work, file OWCP.

  2. OWCP accepts your claim; you are off work.

  3. Agency pressures you to come back or take a different job.

  4. You feel caught between OWCP, your doctor, and agency demands.

Important:

  • OWCP is primarily about compensation and treatment.

  • RA is about whether your agency must modify your job or leave to keep you working.

  • Your agency cannot just say: “We don’t have to accommodate you because OWCP is paying you.”

If you are medically able to work with accommodation (telework, light duty, reduced hours, etc.), your agency has to evaluate that under the Rehabilitation Act.

Part 4: Medical Inability to Perform — When the Agency Tries to Remove You

“Medical inability to perform” is a way for agencies to say:

“You can’t do your job medically, and we can’t accommodate you, so we’re firing you.”

They usually justify this under Chapter 75 (for cause promoting the efficiency of the service), or occasionally under performance statutes.

What the Agency Must Prove

To lawfully remove you for medical inability to perform, they typically must show:

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

  2. Your medical condition is likely to continue (not just a brief flare),

  3. They have considered and either:

    • Provided reasonable accommodations that didn’t work, or

    • Shown that no reasonable accommodation is available, and

  4. They’ve considered reassignment (the accommodation of last resort in federal RA cases).

They also must give you:

  • A notice of proposed removal,

  • Evidence they’re relying on (medical documents, etc.),

  • A chance to respond, and

  • A written decision.

You have the right to:

  • Provide your own medical evidence,

  • Argue that you can perform with accommodation,

  • Argue that they’ve failed to consider RA or reassignment,

  • Appeal to MSPB after removal.

The “Bruner Presumption” (Disability Retirement Angle)

If you are removed for medical inability to perform and later apply for federal disability retirement, case law (Bruner) gives you a presumption that you’re disabled for retirement purposes. That helps with OPM, but it doesn’t undo the removal.

Our view at NSLF:
You should never accept a medical inability removal without fighting for every possible accommodation and reassignment first.

Putting It Together: How These Systems Interact in Real Life

Let’s walk through typical hypos.

Hypo 1: FMLA Expired, Agency Says “Come Back or We’ll Remove You”

  • You took 12 weeks FMLA for surgery and complications.

  • You’re still not medically ready to work.

  • HR says, “Your FMLA is exhausted; if you don’t return, we will consider you AWOL or start removal.”

What you should do:

  1. Get an updated note from your doctor stating:

    • You have a long-term condition (disability),

    • You need additional leave of X weeks/months,

    • You’re expected to be able to return at that point.

  2. Send an email:

    “I am requesting additional unpaid leave as a reasonable accommodation for my disability.”

  3. Ask HR to process this as an RA request, not just leave.

  4. If they outright refuse or ignore, consider EEO contact.

Key point:
They cannot just say “No more FMLA, you’re done” if disability and RA are in play.

Hypo 2: Work Injury + OWCP + Agency Wants to Cut You Loose

  • You hurt your back at work. OWCP accepted your claim.

  • You’re getting wage-loss benefits and treatment.

  • The agency says:

    • “We don’t have light duty for you.”

    • “You’ve been out too long.”

    • “We’re proposing removal for medical inability to perform.”

What you should do:

  1. Talk to your treating doctor:

    • Can you work with restrictions (telework, no lifting, partial days)?

    • If yes, get that in writing.

  2. Put in writing to your agency:

    “My physician has indicated I can work with the following restrictions. I am requesting reasonable accommodation and/or reassignment consistent with these limitations.”

  3. Emphasize you want to return to work if safely possible.

  4. If they push for removal anyway:

    • Challenge the proposal,

    • Argue failure to accommodate,

    • Consider connecting this with an RA/EEO claim and MSPB strategy.

OWCP doesn’t stop them from removing you, but RA can — or at least give you leverage.

Hypo 3: Chronic Medical Condition + RA Telework + Threat of Medical Removal

  • You have a chronic condition (e.g., MS, PTSD, severe migraines).

  • You’ve had intermittent FMLA/RA leave.

  • You ask for telework or modified schedule as RA.

  • The agency drags its feet, then hints at:

    • “Maybe you just can’t perform this job anymore.”

    • “We may need to consider a medical removal.”

What you should do:

  1. Make sure your RA telework/leave request is in writing and well-documented medically.

  2. Ask the agency directly:

    “Has the agency considered telework/modified duties/reassignment as an alternative to any proposed action?”

  3. If they start a fitness-for-duty exam or talk about removal:

    • Consult a federal employment lawyer immediately.

    • Prepare medical evidence that you can perform with accommodation.

  4. If they propose removal:

    • Use your reply to highlight every RA failure:

      • No interactive process,

      • No trial of telework,

      • No reassignment search.

Medical inability removal should be last resort, not step one.

Strategy Section: How to Use These Tools to Save Your Job (Not Just Survive)

Strategy 1: Layer Your Protections — Don’t Treat Them as Either/Or

If you’re facing serious health issues, think in layers:

  1. Sick/annual leave

  2. FMLA

  3. RA leave (additional unpaid time)

  4. Telework or modified schedule

  5. Light duty / modified duties

  6. Reassignment

  7. Disability retirement (when truly necessary)

Too many employees go straight from FMLA exhaustion to “I guess I’ll be fired or retire.”

There is so much in between.

Strategy 2: Always Frame Extended Absence As RA, Not Just “I’m Out Sick”

Instead of:

“I’m just staying out because my doctor says I shouldn’t work.”

Say:

“Based on my condition, my doctor recommends that I remain out of work until [date]. I am requesting this additional leave as a reasonable accommodation for my disability.”

That single sentence:

  • Forces the agency into the RA framework

  • Triggers the interactive process

  • Gives you EEO leverage if they mishandle it

Strategy 3: Use Medical Evidence to Control the Narrative

Your agency will get some medical info (their own exam, partial reports, etc.).
You need to control the story:

  • Make sure your doctor:

    • Describes your limits clearly

    • States what you can do (with or without accommodation)

    • Proposes realistic accommodations (telework, schedule change, leave)

  • Avoid “I am totally disabled forever” language unless you truly are going the disability retirement route.

For job preservation, the best phrasing is usually:

“Patient is currently unable to perform their job without accommodation, but with [X, Y, Z] adjustments, they can perform the essential functions.”

Strategy 4: Ask About Reassignment Before They “Solve It” With Removal

The federal RA framework says reassignment to a vacant position can be a required accommodation when:

  • You cannot perform your current job, even with accommodation,

  • But you can perform another federal job at your grade (or sometimes lower grade) with or without accommodations.

Before you accept any removal for medical reasons, you want the record to show:

  • You asked about reassignment

  • They either ignored or refused

This significantly strengthens your position in any appeal or EEO claim.

Strategy 5: Watch the Timing: Retaliation, FMLA Interference, and Disability Bias

Red flags:

  • PIP or disciplinary actions announced right after you:

    • Requested FMLA

    • Requested RA

    • Filed OWCP

    • Submitted medical notes

  • Denials of leave or RA for ambiguous reasons (“operational needs”) with no real analysis.

  • Remarks like:

    • “You’re sick too much.”

    • “We need someone more reliable.”

    • “Maybe this job is not right for you with your condition.”

These can support:

  • FMLA interference/retaliation (if tied to FMLA leave)

  • Disability discrimination (if tied to RA or your health)

  • Reprisal (if you engaged in EEO activity)

Document every comment and event in a simple timeline.

FAQs: Medical Leave, RA, OWCP & Medical Removal

Do I have to use FMLA before asking for RA leave?

No. If you have a disability, you can ask for RA leave even if you’re not FMLA-eligible yet. But practically, many agencies expect you to use whatever leave you already have (sick/annual) before requesting additional unpaid RA leave.

Can my agency fire me the day after my FMLA runs out?

Not lawfully, if you have a disability and could be accommodated with additional leave or other adjustments. They must consider RA before removing you.

How long can RA leave last?

There’s no fixed number. It must be reasonable and not unreasonable or indefinite. A defined period (e.g., 3–6 months) with medical support is often considered.

Can I be on OWCP and still be removed for medical inability?

Yes — OWCP benefits don’t immunize you from removal. But if you can work with accommodation or reassignment, a medical inability removal may be challengeable.

If I’m removed for medical inability, should I also apply for disability retirement?

Often, yes. But this is a strategic question. Removal can help you qualify for disability retirement, but you may want to fight the removal first or simultaneously. A federal employment lawyer can help you balance these.

Can I force my agency to hold my job forever while I’m out?

No. There are limits. At some point, if you truly cannot return or perform essential functions even with accommodations, the agency can likely remove you. The goal is to maximize your chances of return and protect your record and benefits.

Why You Should Live Inside the Federal Employment Defense Hub

This guide is just one piece of a much larger puzzle.

If you’re dealing with:

  • Performance issues linked to medical conditions

  • PIPs and “unacceptable performance”

  • AWOL or time and attendance allegations

  • OWCP and injury-related disputes

  • Disability discrimination or failure to accommodate

  • Threatened removal or medical inability cases

…you will benefit enormously from having one central knowledge base.

That’s why we created the Federal Employment Defense Hub — a curated library of:

  • Deep-dive guides like this one

  • Strategy articles on specific charges (AWOL, conduct, PIPs)

  • Practical checklists and red flag lists

  • Attorney-level explainers in plain English

  • Internal links to related content (Douglas factors, misconduct, PIPs, RA, telework, etc.)

Make it your home base each time something new happens in your federal career.

Why National Security Law Firm Is Uniquely Positioned to Handle These Cases

  • Our attorneys are former agency counsel, JAG officers, DOJ litigators, and federal insiders who know how these decisions get made.

  • We focus on federal employment, disability, security, and national security–adjacent practice — not generic employment law.

  • We use a proprietary Attorney Review Board model so multiple seasoned lawyers weigh in on your strategy.

  • We represent federal employees nationwide, across virtually every major agency.

  • Our clients give us 4.9-star Google reviews and trust us with their careers and futures.

We don’t just know the law.
We know the system you’re trapped in.

Ready to Get Clarity on Your Medical Situation? Book a Free Case Plan.

If you’re:

  • On FMLA and worried what happens next

  • Struggling to get RA leave or telework approved

  • Out on OWCP and hearing whispers of “medical removal”

  • Already facing proposed removal for medical inability to perform

…you should not try to navigate this alone.

We can:

  • Review your leave / RA / OWCP / medical-removal posture

  • Map your best path to job protection

  • Help you coordinate medical evidence strategically

  • Show you how to use FMLA, RA, OWCP, and appeals together instead of against each other

Schedule your free, confidential case plan:
👉 Book a Free Consultation

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