Federal Employee Medical Retirement: Assumptions and Presumptions

At what point does a house of cards collapse, when based upon assumptions and presumptions?  The words are used interchangeably; the slight conceptual distinctions may be of irrelevant import to justify differentiation.  One can perhaps quibble that assumptions point more toward the conclusory stage of an argument, whereas presumptions often involve the prefatory issues in a logical sequence of argumentation.

Both engage suppositions not based upon “facts”; and, of course, there is the problematic issue of what constitutes facts, as opposed to mere assertions of events and opinions derived from such facts and events; with the further compounding and confounding task of sifting through what was witnessed, what was thought to have been observed, when, who, the intersection between memory, event, and sequence of occurrences, etc.

Presumably (here we go using the very word which we are writing about, which is rather presumptuous to begin with), Bishop Berkeley would have allowed for either and both to be used in order to maneuver through the world without bumping into chairs and tables which, for him, were mere perceptual constructs in the subjective universe of “ideas” in the heads of individuals.  And Hume, for all of his logical deconstructionism concerning the lack of a “necessary connection” between cause and effect, would assume that, in the commonplace physical world we occupy, presumptions are necessary in order to begin the chain of sequential events. Waking up and walking down the stairs to get a cup of coffee, one need not wait for the necessary connection between thought and act in order to begin the day.

For Federal and Postal employees who are considering filing for Federal Disability Retirement benefits, whether one is under FERS or CSRS, proceeding through the administrative morass of one’s agency and ultimately into the U.S. Office of Personnel Management, based upon the dual deterrents of assumptions and presumptions, can be a harrowing experience.  It is not the factual basis which defeats a Federal Disability Retirement application filed with OPM; rather, it is always the baseless presumptions and assumptions which kill the successful outcome.

Medical facts must be established; narrative facts about the impact upon one’s inability to perform the essential elements of one’s job can be asserted; but it is always the connective presumptions and unintended assumptions which complicate and confuse. Always remember that a narrative based purely upon presumptions and assumptions cannot possibly exist without the concrete adhesives of some foundational facts; like a house of cards, it waits merely for the gods of chance to blow a puff of unforeseen breath to topple the structure that was built without an adequate foundation.

Sincerely,

Robert R. McGill, Esquire

OPM Disability Retirement: The Non-nexus

Meeting an adequacy test may constitute sufficiency for some purposes, but not for others.  Thus, it may be enough in completing an FMLA form to have a diagnosis, along with answers to other questions on WH-380-E.  But mere identification of a medical condition via a diagnosis, along with a description of symptomatologies will not be enough to meet the sufficiency test in a Federal Disability Retirement application.

People often assume that having a medical condition in and of itself sufficiently explains the severity of one’s condition, and any implied “blank spaces” can be filled in by the mere existence of such a medical condition.  But Federal Disability Retirement, whether under FERS or CSRS, filed through, reviewed by, and approved or disapproved by the U.S. Office of Personnel Management, must be proven by a preponderance of the evidence that the medical condition itself prevents the Federal or Postal employee from performing one or more of the essential elements of one’s positional duties.

As such, the identification and description of a medical condition fails to comply with the adequacy standards in proving eligibility for Federal Disability Retirement benefits.  One must establish, through the conduit of a medical professional, the “nexus” or “connection” between one’s identified medical condition and the inability to perform one or more of the essential elements of one’s job.

The weight of the proof is upon the Federal or Postal applicant.

The foundation of such evidence begins with the identified medical condition, but in and of itself, it is a non-nexus — until it is squarely placed in the context of one’s official position and the duties required by one’s duties.  Thus, the non-nexus become the nexus-point when combined with the identification and description of one’s positional duties.

It is this realization of the step-by-step sequence of proof which constitutes adequacy and sufficiency of evidence, and one of which the Federal or Postal applicant for OPM Disability Retirement benefits must be aware.

Sincerely,

Robert R. McGill, Esquire

Postal and Federal Disability Retirement: The Beast of Burden

The burden is undertaken by those have little choice in the matter, but who willingly submit to the responsibility and obligation.  Traditionally, the “beast of burden” (other than being a Rolling Stone song) refers to a somewhat-domesticated animal, perhaps a donkey or an ox, who must bear the weight of man’s work.

In law, the “burden” is one of proof — of the affirmative obligation to present one’s facts, persuasive argumentation based upon such facts, and the application of the relevant law which supports both the facts and the arguments.  The “other side” in the litigation has no burden at all, and can simply sit and do nothing, if he or she so chooses, and see whether or not the plaintiff, the appellant or the Federal Disability Retirement applicant has submitted sufficient proof such that he or she has met his/her burden of proof.

As the weight placed upon a beast of burden is often heavy and demanding, so in a similar vein the litigant who has the burden of proof should always expect to exceed what is “necessary” in any given case.  For the Federal or Postal employee who is filing for Federal Disability Retirement benefits through the U.S. Office of Personnel Management, whether under FERS or CSRS, it is indeed a heavy burden to bear in order to meet the legal criteria of a Federal bureaucracy who has the unmitigated power and authority to approve or deny.

The burden of proof — it is as heavy as that which we place upon a beast of burden, and the weight of such responsibility can overwhelm us, lest we have the reserve of strength to plod onward.

Sincerely,

Robert R. McGill, Esquire

FERS & CSRS Disability Retirement for Federal and USPS Workers: The Burden

Ultimately, a Federal Disability Retirement application is a paper-presentation to the U.S. Office of Personnel Management.  Yes, yes, we are entering into a “paperless” technological society, and that is fine; but by “paper presentation” is meant in a generic sense, that the proof necessary to obtain eligibility and entitlement to a Federal Disability Retirement benefit, must be presented in a format which is readable, comprehensible, and coherent — whether on a computer screen or in paper format.

The burden of providing such proof is upon the “applicant” — the Federal or Postal employee who is attempting to obtain Federal Disability Retirement benefits.  That “burden” is both a legal one, as well as a regulatory one.  There are different levels or requirements of what constitutes proof, depending upon the requirements of what must be proven.

In a general sense, one can assert that all that is necessary in a Federal Disability Retirement case is to gather together one’s medical records, wrap them in a secure bundle, and forward them to the U.S. Office of Personnel Management.  Will such an approach “prove” one’s Federal Disability Retirement application?  It might — depending upon the seriousness of one’s medical condition, and whether the Disability Retirement Specialist assigned to such a case will take the time to infer and imply.  But to make an inference, or to expect an implication to be discerned, takes an unnecessary chance at misunderstanding, failure, and the unwanted “denial”.

Instead, the better approach is to explicitly explicate.  Always remember that in preparing, formulating and filing for Federal Disability Retirement benefits from the U.S. Office of Personnel Management, whether under FERS or CSRS, there is a difference between suffering from a medical condition, and proving that the medical condition prevents one from performing one or more of the essential elements of one’s job.  It is the latter which is necessary to be approved for a Federal Disability Retirement benefit.  As to the former — while an unfortunate circumstance — it is not enough to suffer to prove one’s case.

Sincerely,

Robert R. McGill, Esquire

FERS & CSRS Disability Retirement for Federal and USPS Workers: Standards

The existence of a standard constitutes an irrelevancy if the application of it is based upon an unknowable, incalculable methodology.  Standards represent a paradigm which, if implemented, provide for stability and consistency, precisely because one can rely upon the same application in all instances, and indeed, that is what is often defined as “fairness”.

Thus, in sports — if the referee makes all calls based upon a known standard, there is very little to argue with respect to the “rules”; one may, of course, challenge the interpretation of the “facts” and charge that the referee is blind and did not see the play as reality reflected; but no one can argue the minutiae of the standard itself.  In society, and in a civilization governed by rules and accepted procedures of administration, if a standard is disagreed upon, then a democratic method of change is normally considered an appropriate methodology of redefining the lines previously demarcated by the “old” standard.

In preparing, formulating and filing for Federal Disability Retirement benefits from the U.S. Office of Personnel Management, whether under FERS or CSRS, it is assumed that the standard which would constitute “fair play” will be one of “preponderance of the evidence”, but the actual implementation of such a legal standard will necessarily depend upon whether the Case Worker at OPM actually understands what that standard means.

It is, ultimately, a low civil “bar” to meet; and when a denial is rendered, the language contained within the denial will often reveal the extent of comprehension on the part of the OPM Case Worker.  Pointing a misapplication of the standard is sometimes a useful tool in taking the Federal Disability Retirement case to the next level — the Reconsideration Stage of the process — but unduly focusing upon the mistakes of the previous Case Worker is often a waste of time.

Balance is the key; application of the correct standard is vital to the working efficiency of a bureaucracy; pointing out a misapplication is why attorneys exist.  They are, ultimately, technicians of written standards.

Sincerely,

Robert R. McGill, Esquire

Federal Disability Retirement: Proof

This is a proof-based process.  It is not merely a matter of completing some forms and meeting procedural guidelines in order to obtain a benefit; rather, it is an administrative process in which evidence and documentary support from third parties must be obtained in order to meet the legal criteria imposed by statute, regulation, and ever-evolving case-laws as handed down by the Administrative Judges of the U.S. Merit Systems Protection Board, as well as the U.S. Court of Appeals for the Federal Circuit.

There are administrative processes which are “entitlements”, such as certain economic assistance programs, Social Security, Medicare, etc., where one has paid into a system, and upon reaching a certain age, or meeting income-qualification criteria, etc., such procedural guidelines are merely shown, met, and approved.

In preparing, formulating and filing for Federal Disability Retirement benefits from the U.S. Office of Personnel Management, however, it is not merely a matter of meeting procedural criteria (although that, too, is required), but moreover, one must prove by a preponderance of the evidence that one is eligible, by submission of substantial and adequate documentation that one cannot perform, because of a medical condition, one or more of the essential elements of one’s Federal or Postal job.

Proof is the lynchpin by which the standard of winning a Federal Disability Retirement case is won or lost.  Proof is a “must”.  As such, never consider filing for Federal Disability Retirement benefits as merely a matter of filling out paperwork; one must prove one’s case.

Sincerely,

Robert R. McGill, Esquire