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

Federal and Postal Disability Retirement: Sufficiency of Evidence

At what point is the sufficiency test satisfied?  Who determines when the bathtub is full enough in order to bathe?  What constitutes the threshold of being gluttonous on Thanksgiving, as opposed to having had a hearty meal? And, for a FERS or CSRS Disability Retirement application, what standard determines whether or not a person has submitted evidence sufficient to meet the preponderance of the evidence test, in order to persuade the U.S. Office of Personnel Management that a Federal Disability Retirement application has met its burden, and that the Federal or Postal employee is therefore eligible and entitled to receive an approval and a subsequent annuity?

Clearly, it cannot be mere volume of medical reports and records; for, otherwise, cases with barely a dozen pages of a report, diagnostic test results and some office notes would not pass through the scrutiny of the OPM Caseworker.  If not volume, then is it the quality of the report and records?  Here, too, while a well-documented file may generally meet the sufficiency test, there are times when OPM will insist upon treatment notes for the past 18 – 24 months before considering a case for approval.

The sufficiency test is often an admixture of quality, quantity, and a compendium of selectively highlighted documentation which, in their totality, prove an OPM Federal Disability Retirement case.  There are no two cases alike, though similarities may abound.  Each case must be seen in its own unique light, and within that context, a case must be carefully constructed and compiled.  Only in this manner and approach will the sufficiency test be met, and only after a careful and thorough review of the facts, issues and particular uniqueness of a given case — somewhat in a reflectively similar manner as OPM will do in reviewing the submitted case.

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

FERS & CSRS Disability Retirement for Federal and USPS Workers: Proof, Assertion, and the Conceptual Distinction

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 necessary — first and foremost — to understand that the benefit of Federal Disability Retirement is not an “entitlement” under any definition of the word; there is no automatic triggering mechanism by which a Federal or Postal employee becomes a Federal Disability Annuitant, unless one proves, by a preponderance of the evidence, that one has met all of the eligibility requirements necessary to obtain the benefit. 

Further, while the standard of proof established by statute is a relatively low one in comparison to others (i.e., “preponderance of the evidence” merely requires that the truth of X is more likely than not, as opposed to other, more onerous standard of proof, such as “beyond a reasonable doubt” or “clear and convincing”, etc.), nevertheless, the mere assertion of a statement of facts will not qualify the Federal or Postal employee for Federal Disability Retirement benefits.

A standard — or “burden of proof” — means exactly that:   One must prove it, and proof requires more than the mere assertion that X is so.  Specifically, in an OPM Disability Retirement application, one must prove that one is medically unable to perform one or more of the essential elements of one’s Federal or Postal position, and in order to meet that burden, medical documentation of a sufficient and persuasive nature must be submitted along with a Federal Disability Retirement application, which includes many Standard governmental forms.

Knowing and recognizing the conceptual distinction between asserting X and proving X is an important first step in preparing, formulating, and successfully filing for OPM Disability Retirement benefits.

Sincerely,

Robert R. McGill, Esquire

OPM Disability Retirement: Medical Support, Belief, Documentation and the Diagnosis

Ultimately, in preparing, formulating and filing for Federal Disability Retirement benefits from the U.S. Office of Personnel Management, one must always remind one’s self that this is a “paper presentation” (regardless of the prevailing and inevitable march towards a paperless society) to the U.S. Office of Personnel Management (OPM).  As such, there are certain inextricable components in the presentation itself, which must be reviewed, evaluated, and decided upon before proceeding.

As a “presentation” which is meant to be persuasive — i.e., proving by a preponderance of the evidence that one is entitled to the Federal Disability Retirement benefit, whether under FERS or CSRS — it must obviously have the essence of the proof itself:  Medical Support.  Without the medical support, one need not consider moving forward at all.

Once the Federal or Postal employee has ascertained that he or she has the medical support to proceed, then the question is one of obtaining the documentation which confirms such support.  For, a pat on the back and a wonderful smile from the doctor will not be persuasive to OPM; the doctor must be willing to document, in detailed format, the support which is expressed.

Next, in sequential order, the medical documentation must reveal, convey, and persuasively reflect, a level of belief which will be tested in the event that the Federal Disability Retirement application is denied at the First Stage of the Process, and further tested if it is denied at the Second, or Reconsideration Stage, of the process.  Thus, in short, the treating or supporting doctor must possess a level of belief in one’s case, and be willing to support that belief throughout the entire administrative process.

Finally, the doctor must be able to make a diagnosis, but more than that, to support the diagnosis, and be willing to make the “nexus” between the diagnosis, the patient’s physical, emotional and cognitive capabilities, and to relate them to one’s positional duties of one’s job.  It is through this process of connecting the dots, where the end-goal is achieved:  of obtaining one’s Federal Disability Retirement benefits.

Sincerely,

Robert R. McGill, Esquire

Disability Retirement for Federal Workers: Corresponding Responsibilities

The problem with being responsible for something, is that the moment there are any consequences which result from the assertion of it, everyone lifts their finger and points it in another direction.

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 the responsibility of the Applicant to prove by a preponderance of the evidence, that he or she is eligible and entitled to Federal Disability Retirement benefits.  Yet, those who simply go through either the local or district Human Resources (sometimes euphemistically referred to as the “Human Capital” or appended with a conceptually interesting term, “Services”) Office, will be requested to sign SF 3112C, the “Physician’s Statement“, where, at the top of the form, a box for a return address exists.  The address to which the physician’s statement and medical records are sent, is often filled in as the Agency’s H.R. Office.

Thus, the consequence of such a chain of events will often be:  the individual Federal or Postal employee, who has the responsibility to prove by a preponderance of the evidence one’s Federal Disability Retirement application from OPM, will have a doctor, medical facility, psychiatrist, therapist, and any number of medical providers, directed to forward sensitive medical documentation directly to an agency’s Human Resources Office, prior to reviewing such documents for accuracy, effectiveness or requested formulation.  And if the Federal Disability Retirement packet is sent over to OPM, and is then denied based upon information which is either inaccurate or incomplete, to whom will the finger be pointed at?

Sincerely,

Robert R. McGill, Esquire