CSRS & FERS Medical Disability Retirement: You Still Have to Prove your Case

In preparing, formulating and filing a Federal Disability Retirement application under FERS or CSRS, many Federal and Postal employees operate under the misguided presumption that, if the Agency has acknowledged one’s medical conditions, cannot accommodate the Federal or Postal employee, and explicitly concedes that the disabled Federal or Postal employee cannot perform one or more of the essential elements of one’s job, that an approval of the Federal Disability Retirement application is nothing more than a mere formality beyond its submission.  

Thus, for example, the scenario as painted herein might include the Flight Surgeon’s determination for the Air Traffic Control Specialist who works for the FAA, who disqualifies the ATS for either his/her medical condition, or the medication regimen that he/she is taking; or it may involved the Postal Worker who is sent home pursuant to the National Reassessment Process; or it may be a Federal or Postal worker who has been administratively separated from Federal Service based upon his or her medical inability to perform the essential functions of one’s job, and thereby is entitled to the Bruner Presumption.  

All of these case-studies are “nice”; they are promising, and there is obviously substantive and useful evidence that the Federal or Postal employee is probably eligible for Federal Disability Retirement benefits — but what the Agency does or says is not enough.  The Federal or Postal employee must still meet the burden of proof and prove by a preponderance of the evidence that he or she is eligible and entitled to Federal Disability Retirement benefits under FERS or CSRS.  

The Office of Personnel Management is an independent agency, separate and apart from the other Federal Agencies or the Postal Service.  What determinations are made by the other agencies will not persuade OPM of anything; in a Federal Disability Retirement case, you must prove your case of medical eligibility, above and beyond what the Agency says or does.

Sincerely,

Robert R. McGill, Esquire

Medical Retirement Benefits for US Government Employees: Meeting the Statutory Minimum

In preparing, formulating and filing a Federal Disability Retirement application under FERS or CSRS, the Federal or Postal employee must prove, by a preponderance of the evidence (that burden of proof which is fairly minimal in the order of difficulty, requiring that a Federal or Postal employee show that he or she is “more likely than not” entitled to Federal Disability Retirement benefits under FERS or CSRS) that the compilation of the evidence meets the statutory requirements such that one is eligible and entitled to Federal Disability Retirement benefits.  

Thus, it is the cumulative set of evidence which is reviewed by the Office of Personnel Management, and not merely a single piece of evidence.  Yet, the manner and methodology of how OPM reviews the evidence is revealed in any given denial letter issued by the claims representative, or the “Legal and Administrative Specialist” assigned to any particular case.  

It is a methodology of (A)  listing whatever medical evidence which was submitted by naming the doctors, thereby giving an appearance of a full and thorough review of the documents, and (B) selectively extrapolating statements made by the Applicant, the Supervisor, the doctor(s) and anyone else in attempting to undermine the conclusion that the statutory criteria for eligibility has been met.  In laymen’s terms, this is called, “Taking potshots” at something.  If meeting the criteria for eligibility is to show a sequence of connecting dots from point A to point B, then OPM’s view is that if there are enough potshots which sever the line between the points, then OPM has shown that a Federal or Postal employee is ineligible for Federal Disability Retirement benefits.  

This is the approach; it is up to the applicant who is preparing, formulating and filing a Federal Disability Retirement application under FERS or CSRS to ensure that any weak links in the line are sufficiently reinforced.

Sincerely,

Robert R. McGill, Esquire

Medical Retirement for Government Employees: The Duration of a Medical Condition

In being eligible for a Federal Disability Retirement annuity from the Office of Personnel Management, one of the basic criteria which must be met for eligibility determination is that a medical condition, its symptomatologies and impact upon one’s ability/inability to perform the essential elements of one’s job, must last for a minimum of 12 months.  

As a practical matter, the medical condition normally lasts for much longer, and is quite often a chronic, progressively deteriorating condition.  If the medical condition is expected to last for a short period of time, then the Federal or Postal employee must seriously consider whether filing for Federal Disability Retirement benefits is “worth it”, inasmuch as it often takes 8 – 10 months to obtain an approval from the Office of Personnel Management for the First Stage of the process.  

As such, for most Federal and Postal employees who are contemplating preparing, formulating and filing a Federal Disability Retirement application under either FERS or CSRS, there is an implicit acknowledgement and understanding the the medical condition itself is one of chronicity, debilitating in nature, and often progressively deteriorating.  

The fact that a medical condition must last for a minimum of 12 months, however, does not mean that a Federal or Postal employee should wait for the 12 months to pass before filing for Federal Disability Retirement benefits.  That would, upon reflection, be a cruel absurdity — to have to wait for 12 months, then to file and wait about 10 months before the Office of Personnel Management makes a decision, and all of this, only at the First Stage of the process. No — the legal standard is that the medical condition must be “expected” to last a minimum of 12 months; meaning, thereby, that a doctor can normally make a reasonable prognosis as to the duration, chronicity and future behavior of the medical condition; and this can normally be accomplished soon after the identification of a particular medical condition.

Sincerely,

Robert R. McGill, Esquire

Disability Retirement for Federal Government Employees: OPM and the 7-Part Criteria

In any denial of a Federal Disability Retirement application under FERS or CSRS, the Office of Personnel Management incessantly refers to their 7-part criteria of eligibility, in making their determination as to the legal viability of a case.

The criteria, as stated, can be both helpful, as well as result in a negative determination, for multiple reasons.  To the extent that it extrapolates and extracts from the relevant Code of Federal Regulations, it minimally states the fundamental legal requirements for eligibility of a Federal or Postal employee who is filing for Federal Disability Retirement benefits.

However, because such a basis only extracts from the originating statutory foundation for eligibility, what it completely ignores is the continually evolving cases which clarify, interpret and define the very terms which constitute the criteria.  To that extent, OPM’s adherence to the strict and narrow application of the original “law” can often result in a negative determination, precisely because such an application ignores the subsequent clarifications which have evolved and progressed from various cases which have been litigated, both in the Federal Circuit Courts as well as at the Merit Systems Protection Board level.

Beware of the 7-part criteria; if followed, it can backfire; if not followed, it can backfire.  The 7-part criteria is a Catch-22 in sheep’s clothing.

Sincerely,

Robert R. McGill, Esquire

Medical Retirement from the Office of Personnel Management: Legal Criteria

There is “The Law” — the originating, statutory authority which is passed by Congress — then, the compendium of the entirety of the legal arena, which includes decisions handed down by Administrative and Federal Judges, which comprise the expanding and evolving interpretation, clarification and extension of “The Law”.  

Unfortunately, in making its decision on an Application for Federal Disability Retirement benefits under FERS or CSRS, the Office of Personnel Management constrains itself (and its knowledge of the law) to a template based upon a “7-part criteria” which is extrapolated from the Code of Federal Regulations.  

This 7-part criteria is a simplistic and misleading application of the law.  It is not so much that it is an “error” on the part of the Office of Personnel Management to apply such a criteria; rather, it is that, in evaluating and determining the sufficiency, viability, and meeting of the standard of proof of “preponderance of the evidence” of a Federal Disability Retirement application under FERS or CSRS, it simply does not go far enough.  Because the 7-part criteria fails to include the interpretive evolution of the entirety of the laws governing Federal Disability Retirement, it fails by excluding many Federal Disability Retirement applications which are based upon legal criteria which fall outside of the delimited circumference and parameters of what OPM has set forth. 

In short, they are “behind the times” in many instances, and so when a denial is based upon a misapplied criteria, it is important to point out to OPM that X law applies in particular case Y — where “X” is outside of the scope or knowledge of the Office of Personnel Management.

Sincerely,

Robert R. McGill, Esquire

Federal and Postal Disability Retirement: Argument, Persuasion & Logic

Filing an application for Federal Disability Retirement benefits under FERS or CSRS, either by a Postal employee or a non-Postal, Federal employee, is an administrative process which “requests” that a certain benefit be paid by the Federal Government.  In order to be approved, one must prove, by a preponderance of the evidence, that one has met the eligibility criteria that has been set forth through statute, regulation, and cases which have interpreted those statutes and regulations over the years.  Thus, like any other area of law, there is a large pool of legal issues which have arisen over the years.  Because of this, it is important to understand that a certain amount of argumentation, persuasion, and logical analysis and delineation must occur.  Many people are surprised when, after submitting the “paperwork” and attaching some medical documents to the application, that the Office of Personnel Management would deny the applicant’s submission, saying with surprise, “I thought it would be easy”.  In any area of law, administrative or otherwise, where the pool of issues has grown over many decades, there must be a level of argument, persuasion and logic which must be engaged.  The legal arena for being approved in a Federal Disability Retirement case for those under FERS or CSRS is no different.

Sincerely,

Robert R. McGill, Esquire

CSRS & FERS Disability Retirement: Again — Reminder as to the Statute of Limitations

I have many, many people who are on all sides of the spectrum concerning the time-line of filing for Federal Disability Retirement benefits under FERS & CSRS — people who call me 2, 3, 5, sometimes 10 years after being separated from service, saying they were never informed about the benefit of Federal Disability Retirement benefits.  Obviously, such former Federal employees cannot now (except in extremely peculiar and rare circumstances) file for Federal Disability Retirement benefits, under either FERS or CSRS. 

Then, there are those who are still “on the rolls” — those who have never been separated (normally because of the negligence or neglect of the Agency) from Federal Service, who call to ask whether they can file for Federal Disability Retirement now.  The answer is most often, Yes, and furthermore, once the disability retirement is approved, the annuitant can receive back-pay all the way back to the last date of pay.  Then, there are those who call me in a state of panic, saying that it has been almost a year after the injury; is it too late to file?  No, it is not too late, so long as it has not been over one year from the time of separation from service.  Thus, here is a reminder (again):  A Federal or Postal employee has up until one (1) year to file for Federal Disability Retirement benefits under FERS or CSRS, from the time of being separated from Federal Service — meaning, when you have been terminated from being a Federal or Postal employee, and are off of the “rolls” of the agency.  I don’t know how to make this any clearer.

Sincerely,

Robert R. McGill, Esquire

Federal & Postal Service Disability Retirement: Differing Legal Criteria

Similar benefits, at the State, Local, Private levels, and at the Federal level, each contain differing legal criteria for eligibility. Thus, for instance, Social Security Disability benefits require one set of standards of eligibility; private disability insurance policies require a different set of standards; and state disability benefits often differ from state to state.  This is of course true of Federal Disability Retirement benefits under FERS and CSRS — where the legal standard of eligibility is different from Social Security, Worker’s Comp, and State or private disability criteria.

Often, a question is asked whether a medical narrative report which is prepared for submission to the Office of Personnel Management can be used for submission for other “similar” benefits.  The short answer is, “It all depends”, but the long answer is that, in most cases, one must be very cautious.  When I represent a Federal or Postal employee under FERS or CSRS, one of the first steps in preparing a viable case is to request of the treating doctors a detailed medical narrative report.  One must understand that the treating doctor has, generally speaking, next to no idea as to the legal criteria that must be met under FERS or CSRS.  Furthermore, the treating doctor has no legal knowledge as to the differences between private disability insurance policies, State, Social Security, OWCP or FERS & CSRS.  It is the job of the Attorney to make sure and guide the treating doctors as to the criteria which must be met as to the particular and specialized field for which the medical narrative is being prepared.  This must be done with care, and with detailed guidance.

Sincerely,

Robert R. McGill, Esquire