OPM Disability Retirement: The Arbitrary Denial

A denial from the U.S. Office of Personnel Management of a Federal Disability Retirement application is disappointing enough.  For, after waiting for countless and seemingly endless months, exhausting one’s resources and relying upon the reality of one’s medical conditions and limitations thereby imposed in persuading OPM to draw and infer the conclusion that the Federal or Postal employee is no longer able to perform one or more of the essential elements of one’s Federal or Postal job, it is understandable how overwhelmingly dispiriting a denial can be.

Denials of a Federal Disability Retirement application often appear to be “arbitrary”.  Yes, there may be multiple paragraphs in a “Discussion” Section of the Denial Letter delineating a “reason”, but such explanatory posits are often non sequiturs where conclusions fail to follow upon selective extrapolations from medical reports submitted.

Clearly, “something” did not satisfy the reviewing “medical specialist” who came to the conclusion of a denial, and whether the Federal or Postal applicant believes that the denial is both unfounded and unjustified, it is an irrefutable fact that OPM possesses both the power and the authority to approve or deny a Federal Disability Retirement application, and whether a denial appears “arbitrary” or convincingly persuasive in delineating reasons for the denial, the process itself must be seen as an “adversarial” one.

Arbitrariness can only be countered by rational discourse, and the power to deny must be refuted by a reasoned rebuttal supported by convincing medical documentation.  Don’t fume over unfair, selective extrapolations that are intellectually disingenuous; instead, contact an attorney who specializes in Federal Disability Retirement Law and begin the process of countering the arbitrary denial by mapping out a reasoned rebuttal.

Sincerely,

Robert R. McGill, Esquire

 

Medical Retirement for Federal Workers: Inconsistencies and the Perfect Case

Perhaps there will never be the “perfect” case in a FERS Disability Retirement application, and one should not expect to find one.  There are “near-perfections” and ones which cannot possibly be denied by the U.S. Office of Personnel Management.  But it is the imperfect ones — the ones which might be consider tenuous at best, but which are nevertheless approved, which provide greater lessons in preparing, formulating and filing for Federal Disability Retirement benefits from the U.S. Office of Personnel Management.

Further, denial letters issued by the U.S. Office of Personnel Management are instructive for future events and cases, precisely because they indicate the focus, in any particular context or time, of the central and essential concerns expressed by OPM.  Inconsistencies are often what is reviewed and scrutinized most closely — between what the doctor asserts in conclusory fashion, in a medical narrative report, as opposed to the daily office and treatment notes; between one’s statement of disability and what the Supervisor observes; between what the applicant for Federal Disability Retirement benefits states, and what the doctor annotates.

Granted, much of it is selectively chosen with a biased and slanted perspective — as if the Caseworker at OPM had already decided to issue a denial.  Further, OPM makes unfounded assertions concerning the applicable standard of law all the time, which undermines the very basis of any denial, and puts into question the credibility of the reasons given in a denial letter.

Ultimately, there is no such thing as the “perfect” case; as life provides for inconsistencies and lack of continuum, so a Federal Disability Retirement application often reflects the imperfection of life.  Unfortunately, OPM doesn’t have such a philosophical outlook on such matters, and we must deal with it accordingly.

Sincerely,

Robert R. McGill, Esquire

Disability Retirement for Federal Government Employees: Initial Application, Reconsideration & MSPB Appeals

Each Stage of the process in attempting to obtain a Federal Disability Retirement application under FERS or CSRS offers a distinct, yet similar, challenge.  Do not be fooled by responding to a “template” approach; while the Office of Personnel Management may respond in an indifferent, antiseptic manner, a Federal or Postal employee who must respond to OPM’s denial at each stage of the process must pinpoint what OPM is looking for, and respond appropriately.  Indeed, it is the distinction which one observes, which makes all of the difference in the case.  

Often, it is clear that OPM’s denial at the Initial Stage of the process, as well as a denial at the Reconsideration Stage of the process (which then compels an appeal to the Merit Systems Protection Board), is merely a regurgitation of thousands of previous denial letters, with some minor insertions which are meant to appear “as if” the denial letter has been tailored to a particular case.  

Thus, references to a particular physician’s letter, and even extrapolating a quotation from a doctor’s note or narrative (often something like, “Your doctor stated that you were recovering well from your surgery,” or “Your psychiatrist stated that the medications were working”) have the effect of personalizing a denial letter.  Yet, the remainder of the denial letter is in an antiseptic, template form, and it is clear that you are merely one of hundreds & thousands of responses written by OPM’s representative.  However, while OPM has the power to generate such template-driven denials, the individual Federal or Postal Worker must respond in an independent, individualistic manner.  It must be based upon one’s particular case, and thus the response must not be a “generic” one, but one based upon the uniqueness of the case.

Sincerely,

Robert R. McGill, Esquire

Federal Employee Medical Retirement: The Chasm between Denials

From the perspective of an individual Applicant for Federal Disability Retirement benefits under FERS & CSRS, the individual applicant does not normally observe some other person’s Federal Disability Retirement application, and therefore never has the opportunity to see the “greater process” at work, or patterns of behavior on the part of the Office of Personnel Management.  Yet, there are indeed patterns, and that is why an experienced attorney who has seen literally thousands of Federal Disability Retirement cases over numerous years, has an advantage in responding to OPM’s denials.  Experience lends itself to greater observation.  Experience over time reveals certain patterns.  And patterns of behavior can reveal important principles. 

Certain OPM Representatives provide detailed and (often) irrelevant factual references which can be ignored; others like to “cite the law” and believe that such citations appear irrefutable and authoritative; and still others give scant discussion to laws or to facts.  Thus, there often appears to be a great chasm between the types of denials.  Whether or not there are such differences, an applicant who has received a denial for his or her Federal Disability Retirement case needs to respond to any such denial with a three-pronged attack:  Medical refutation; Factual correction; Legal assertion.  Such an attack will cover any chasm which might exist between the different individuals who send out a denial letter.  More importantly, it will cover the necessary elements for winning a Federal Disability Retirement case.

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

FERS & CSRS Disability Retirement: Logical Argumentation

Reading a denial of a Federal Disability Retirement application under FERS or CSRS from the Office of Personnel Management is often a fascinating exercise in attempting to imply, infer, “read between the lines”, assume and presume what the basis of the denial is/are.  Just as gathering a 6-inch thick set of medical records and attaching them to a Federal Disability Retirement application does not constitute a logical, persuasive argument that you are entitled to Federal Disability Retirement benefits, conversely, referring to submitted medical documentation and acknowledging their existence, then concluding:  “You have not submitted sufficient medical documentation to be eligible for Federal Disability Retirement benefits” — does not constitute a sufficiently informative denial.  As the applicant must meet the legal criteria, the Office of Personnel Management has a duty and obligation to review it fairly, evaluate it objectively, and apply the laws and legal criteria.  If OPM decides that the application does not meet the legal criteria, then OPM has an obligation to provide a sufficient explanation that is clear, cogent, and logically persuasive.  Anything less would not meet the statutory obligation that OPM is under.

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

CSRS & FERS Disability Retirement: OPM’s Rationale

Too much time is often spent on the “rationale” or “reasons” for a denial from the Office of Personnel Management, under the “Discussion” Section of a denial letter.  By “time spent”, however, is not meant that one should not selectively rebut, refute and address some of the reasons delineated in an OPM denial letter; rather, what too many people do is to complicate matters by “reading into” the reasons given for the denial. 

One of the jobs of an attorney who specializes in Federal Disability Retirement law under FERS & CSRS is to prepare an application for Federal Disability Retirement benefits, rebut a denial, or file an appeal to the Merit Systems Protection Board, based upon one’s experience, wisdom and sense of that which OPM is looking for.  This is accomplished by having learned from a myriad of sources:  from seeing the types of prepared disability retirement packets which have been successful in the past; from learning from past legal arguments and rebuttal arguments as to which have been most persuasive for OPM; and from having conducted multiple Hearings before the Merit Systems Protection Board and learning exactly what the Administrative Law Judge has been most persuaded and convinced by.  Further, having read countless denial letters by people who have attempted to file for Federal Disability Retirement benefits at the first stage without an attorney, it is important to focus upon the relevant issues which OPM is seeking, and to disregard those issues which are peripheral or irrelevant.

Sincerely,

Robert R. McGill, Esquire

CSRS & FERS Disability Retirement: The Attorney’s Role

It may sound harsh; it may even sound “mean”; but I often tell my potential clients that I am not their therapist, doctor, or empathy-advisor.  I am their attorney.  When advising people to respond to an Office of Personnel Management denial with some “discretion”, it is often difficult for an individual who is so closely tied with his or her own case, to remain objective and detached.  Yet, detachment is the mark of professionalism, and that is why the old adage is true — that an individual who represents himself in court has a fool for a client. 

My job as an attorney who represents Federal and Postal employees to obtain Federal Disability Retirement benefits under FERS & CSRS must be guided with a focus of understanding the factual context, the medical conditions, the type of job, the symptomatologies manifested by the medical conditions, and apply the law governing disability retirement issues.  If I become a therapist, it detracts from my focus; if I become an empathy-advisor, I become “attached”, as opposed to de-tached.  That is not to say that I will not listen to the relevant medical background (note the confusing double-negative, which merely means that yes, I will listen, to some extent) — I certainly will.  But only to the extent that will allow me to win the case for my client.  For, that is my job:  to get an approval from the Office of Personnel Management.  If I am successful at that, then my client will have gained all the needed empathy of the world:  a semblence of financial security.

Sincerely,

Robert R. McGill, Esquire

CSRS & FERS Disability Retirement: Denials II

It is, indeed, frustrating when a governmental agency makes life-impacting decisions which seem to be spurious and capricious. A review of a disability retirement application by the Office of Personnel Management is supposed to be thorough, with sound reasoning and a fair application of the law. And, in all fairness, the majority of cases appear to meet that standard. It may well be, of course, that since all approval letters of disability retirement applications are standard templates, with boilerplate language and instructions, and since most of my cases are approved at the first level, the impression left is that OPM does a good job in reviewing the cases.

When a case is disapproved, however, it is often the case that the denial is based upon factors which defy logic, which appear to have little or no rational basis, and which selectively focuses upon a narrow reading of the medical reports and records. Thus, often the OPM Representative will take a statement out of context, and declare that the doctor stated X when a full reading of the medical report shows that the doctor actually stated Y. This is unfortunate, and does not reflect the careful review, analysis, and fair rendering of a decision made by most OPM representatives, but occurs often enough to be of concern. On the bright side, however, is that there is always the ability to take it completely out of the hands of OPM, after a second denial — and allow an administrative judge to review it objectively, at the Merit Systems Protection Board. That is why the MSPB was created and exists — to have a third party, objective body review the decision-making process of the Office of Personnel Management.

Sincerely,

Robert R. McGill, Esquire