OPM Lawyers Strategy: What If My OPM Disability Claim Is Denied?

Doubting can become infectious.  Once the confidence wanes, the seeds of doubt have been planted; once the seeds begin to sprout, further fears of shaken self-confidence begin to appear, and the shattering of a once-certain sense of calm begins to pervade insidiously within the soul of a questioning mind.

A denial from the U.S. Office of Personnel Management in a Federal Disability Retirement case is intended to do exactly that: Doubt the strength of your case.  It may quote directly from the office notes of your medical providers, and even selectively extrapolate statements that you once thought were “supportive” of your case, and the OPM “Medical Specialist” will yet conclude: “This does not meet the eligibility standards for Federal Disability Retirement, and it is insufficient and lacks objective and subjective evidence.  Therefore, you have not proven your case.”

Perhaps you believe you have given your “best shot”, and even with that, OPM has stated in rendering its denial that you do not meet the criteria to be eligible for Federal Disability Retirement benefits.  You have started down the pathway of “doubts”, and your confidence has been shaken.

The natural reaction?  Why even request reconsideration?

Of course, that is precisely what OPM wants you to think — that your Federal Disability Retirement case is so “weak” and unsubstantiated that you might as well give up and not pursue this, anymore.  Do NOT get trapped and deceived by the denial letter of OPM; the intent is to sow the seeds of doubt, so that a certain percentage of cases will simply give up without filing for Reconsideration of the OPM Denial Letter.

Time is of the essence in filing a Request for Reconsideration in every denial issued by the U.S. Office of Personnel Management, and while the selective extrapolation of evidence submitted is intended to sow those seeds of doubt, one must forge forward with confidence in the same manner that originally prompted the Federal or Postal employee into preparing and submitting the OPM Disability Retirement application in the first place: that one’s medical condition prevents one from continuing in the line of one’s chosen career, and thus does one become eligible for Federal Disability Retirement benefits.

It is simply a matter of proving it, and consulting with an attorney who specializes in preparing, formulating and filing for Federal Disability Retirement benefits under FERS is the next step in reinstating that self-confidence and setting aside the seeds of doubt that OPM has so deviously sown.

Sincerely,

Robert R. McGill, Esquire

 

OPM Disability Retirement: “It May Sound Good”

There is the statutory legal criteria which is mandated by law, by case-law, and by regulatory dictum as to the proper application of review in making a determination on a Federal Disability Retirement application, whether under FERS or CSRS.  Yet, the question is whether or not the Office of Personnel Management has applied the proper legal criteria in making its determination, and the answer to such a question can only be evaluated based upon the language which is utilized by OPM in its denial letter. 

An approval letter issued by the Office of Personnel Management is entirely unrevealing, precisely because it is simply a template letter advising the approved Federal Disability Retirement annuitant of the next steps to follow.  However, when a denial letter is issued by the Office of Personnel Management, often the Claims Representative will insert language which “sounds good” and proper, and even convincing — but ultimately, wrong as far as the proper application of the law is concerned.  For example, OPM may assert with unequivocal brevity that there lacks “compelling medical evidence” in the Federal Disability Retirement application.  “Compelling” is not a legal criteria required by statute, case-law, or regulatory dictum.  As such, it is a meaningless word-usage.

Moreover, it is harmful to a case because it means that OPM applied a standard of review which is nowhere found in any statute.  Further, it gives an appearance of authenticity and authoritative credibility where none exists.  What to do about it?  It needs to be addressed and pointed out — but diplomatically.  Diplomacy is nothing more than a forceful rebuttal clothed in the finery of courtesy, but it is a necessary ingredient in establishing the proper tone and tenor of a response to OPM.

Sincerely,

Robert R. McGill, Esquire

Federal and Postal Disability Retirement: The Initial, Reactive Response

When a denial is received at the first stage of a Federal Disability Retirement application process, the initial, reactive response is often one of two avenues, both of which are the wrong paths to venture down:  either a Federal or Postal employee immediately writes an angry, emotional response or he/she gives up and decides that the statements made, the reasons given, etc., in the denial letter from the Office of Personnel Management are too powerful and overwhelming to overcome.  

Both responsive avenues constitute the wrong approach; neither responsive approach reflects the true state of the case.  

While there may be cases where the applicant has failed to make even a minimal attempt at meeting the burden of proof in a Federal Disability Retirement application, such a case is one in which the undersigned attorney has never encountered.  For, there is a presumption (a truthful one, I believe) that filing for Federal Disability Retirement benefits is never out of choice, but always out of necessity.  

Federal and Postal workers don’t file for Federal Disability Retirement benefits without good cause.  In a denial letter from the Office of Personnel Management, the statements made and the claims of rational discourse as to the reasons for the denial, do not mean that they are true.  Just because OPM says so, doesn’t make it true. Careful thought, reflection, and thoughtfulness of strategy in responding to an OPM denial is what is needed.  Do not react — at least, not initially.

Sincerely,

Robert R. McGill, Esquire

OPM Disability Retirement: Unequivocal Doesn’t Mean That One Is “Right”

In a denial letter from the Office of Personnel Management, the Claims Specialist/Representative will often make statements in confident, unequivocal terms.  “You have not…”   “The medical evidence fails to show…”    “Your doctor never…”   “The law requires that you…”  Such a voice of unequivocal confidence often leaves the impression that there is no room for argument; that the case is lost; that there really is no point in even attempting to argue with the Office of Personnel Management.  Nothing could be further from the truth. 

Merely because an individual makes statements in an unequivocal manner, is not a basis for determining the truth or falsity of his or her argument.  In a Federal Disability Retirement application under FERS or CSRS, there is almost always room for disagreement.  We are speaking about interpretation of medical documents, the significance of what is said, etc.  We are talking about the different and proper application of the OPM Disability law, and the multitude of case-law which would be applicable.  Don’t let the voice of a statement fool you as to the validity of the statement.  In a Federal Disability Retirement case, the Office of Personnel Management is rarely right; they just like to sound like they are.

Sincerely,

Robert R. McGill, Esquire

Federal and Postal Disability Retirement: The Strategy of Disheartening the Opposition

When Federal and Postal employees who have filed for FERS Medical Retirement benefits and have been denied at the initial stage of the process, many are sincerely disheartened.

In my initial contact with the denied applicant, there are multiple levels of reactions, including:  the denial letter points to legal criteria which they were unaware of; it refers to doctors notations which are taken completely out of context; they have completely ignored major portions of what the doctor has stated; OPM points to legal criteria which has been met, but which OPM simply denies that it has been met.

What can be done?  This is the strategy of disheartening the opposition.

In other denials, it is simply a matter of referring to a doctor’s report here, and to a medical notation there; then to simply declare:  You have not submitted sufficient medical documentation and fail to meet the legal criteria to be eligible for Federal Disability Retirement benefits.

What can be done?  No explanation; just scant references, then a unilateral declaration.  Again, this is the strategy of disheartening the opposition.  What to do?  Don’t get disheartened.  Respond.

Sincerely,

Robert R. McGill, Esquire

OPM Disability Retirement: An Additional Problem with Answering an OPM Denial

Spring and summer are finally upon us; the warmth of the sun finally brings some hope that the multiple series of snowstorms may be finally behind us (now that I have said it, the chances are exponentially multiplied that we will accumulate an additional 20 inches of snow in March).  Thoughts of the beach will soon become visually real, as opposed to virtually experienced.  Sand.  The metaphor of the “shifting sand” is one which is applicable to the Office of Personnel Management in its denial of a Federal Disability Retirement application under FERS or CSRS.  Those of you who have followed my stream of consciousness on the issue of templates, denial letters and the arbitrary nature of OPM’s decision-making process, will not find it surprising to find that OPM merely shifts, changes positions, and dances around (albeit, not always gracefully) any attempt to “corner” the argument which purportedly is the basis for a denial of a Federal or Postal Disability Retirement application. 

Do not, however, underestimate the importance of properly, directly, and clearly answering the concerns of an OPM denial.  It is not enough to gather more medical documentation and sending them in.  It is not enough to address, point by point, the basis of a denial letter.  One must corner, clarify, and clearly define the basis of an OPM denial, then refute them.  This way, if it is denied a second time, and the case goes before an Administrative Judge at the Merit Systems Protection Board, the AJ will see that the issues previously brought forth by OPM have already been addressed, and that any necessity for a Hearing may be avoided by clarifying any remaining concerns which the OPM representative may need to search for and articulate. 

Sincerely,

Robert R. McGill, Esquire

FERS & CSRS Disability Retirement: The Problem with Answering an OPM Denial

A denial of a Federal Disability Retirement application under FERS or CSRS from the Office of Personnel Management always leaves the applicant and his or her attorney at a disadvantage.  This is because OPM is never answerable to any resulting consequence of a denial; at least, not directly.  Think about it this way:  In the initial application, if an OPM Disability Retirement application is properly prepared and submitted according to, and within the parameters of the laws governing Federal Disability Retirement, one would assume that it should be approved.  If it is denied, then the case is sent to the “Reconsideration” division of OPM — meaning, to another person. 

Now, taking it out of the hands of one OPM Representative into the hands of another, has both the good and the bad mixed together:  the good is that it will now be reviewed afresh by someone else; the bad is that the person who denied the original application has no further responsibility for the denial.  This is true, incidentally, with respect to the Reconsideration Stage of the process; if a second denial is issued, the person who issues the second denial also has no responsibility to answer for the basis given in the denial. 

The “light at the end of the tunnel“, however, comes when it is finally taken up by an Administrative Judge at the Merit Systems Protection Board.  While the AJ cannot hold anyone at OPM responsible for a denial which never should have been, at the very least, when the AJ reviews the record and finds that the previous denials were unfounded or rationally without legal foundation, an immediate recognition of a baseless denial can help the applicant.  Ultimately, rationality and legal integrity has a chance to prevail; it sometimes takes more than one bite at the apple.

Sincerely,

Robert R. McGill, Esquire

OPM Disability Retirement: The Template Approach

The Office of Personnel Management essentially renders both approvals and denials of a Federal Disability Retirement application with a “template” approach.  This is not surprising, but it is little noticed, and this is why:  For disabled Federal and Postal workers who file for Federal Disability Retirements benefits under FERS or CSRS, and who are not represented by a federal disability attorney, it is their “one-and-only” exposure to the Office of Personnel Management.

Thus, if an approval is received, that approval is the first and only time of having any correspondence from the Office of Personnel Management.  Similarly, if a denial is received, then that is the first exposure and contact from the Office of Personnel Management.  There would be no way of knowing whether or not the approval letter, or the denial letter, was or was not a “standard template”.  Certainly, in a denial letter from the Office of Personnel Management, there are references to submitted medical documents, or supervisor’s statement, or some other document which was part of the Federal Disability Retirement application; but the remainder of the denial letter is in “template form”. 

However, when an attorney represents a Federal or Postal worker and receives an initial denial letter, or a denial at the Reconsideration Stage, it is an obvious issue, because any attorney who specializes in Federal Disability Retirement law has viewed hundreds, if not thousands, of such letters.  Why is it important to recognize that the format is in “template” form?  For many reasons.  The type of template; from whom the template is received; the extent of the template; the issues presented in the format; these are all helpful for any experienced Federal Attorney who specializes in Federal Disability Retirement law, to successfully answer such formatted denials.

Sincerely,

Robert R. McGill, Esquire

CSRS & FERS Disability Retirement: OPM & the Problem of Templates

The problem with the use of templates is that they are, over time and overusage, predictable; being predictable, they become ineffective.  Now, from the perspective of the Office of Personnel Management, applying a template to a Federal Disability Retirement application under FERS or CSRS, whether predictable or not, is somewhat irrelevant, to the extent that a denial is still a denial, and an approval is simply an approval. 

It is only if and when a case is appealed (after an initial denial and a denial at the Second Stage, at the Request for Reconsideration Stage) to the Merit Systems Protection Board, that the template has to be “defended” if the Administrative Judge asks for clarification of the issues by referring to the template-based denial.  Moreover, what is predictable is the combination of medical condition/denial rationale.  For instance:  for Fibromyalgia:  “The condition waxes and wanes”; for Major Depression:  “Not enough time has been allowed for the efficacy of a medication regimen“; for anxiety & panic attacks:  “There is insufficient objective medical evidence”; for Chronic pain:  “Physical therapy has not been sufficiently given a chance to…”   These are some examples of templates used by the Office of Personnel Management, each of which can easily be refutted in any particular case.  The methodology of refutation, obviously, is where a federal disability attorney can be of greatest counsel and representation.

Sincerely, Robert R. McGill, Esquire