Federal Employee Medical Retirement: Implicit v. Explicit

That which is not explicitly stated, may leave room for the listener to infer multiple meanings based upon the implicit statement of the speaker or writer.

Thus, in a Federal Disability Retirement application under FERS or CSRS, filed with and obtained through the U.S. Office of Personnel Management, it is important to state with explicit redundancy those elements which meet the legal criteria for eligibility for Federal Disability Retirement benefits.  X impacts positional element Y.  X may impact positional elements Y or Z.  X will surely prevent Mr. A from performing some of the essential elements of his job.  Of these three statements, which one states unequivocally and explicitly, while the other two allow for inferences which may well result in a denial from the Office of Personnel Management?  Obviously, the answer is the first statement, leaving the subsequent two room for inference and implication.

Remember that the Disability, Reconsideration and Appeals “Specialist” at the U.S. Office of Personnel Management is specifically targeting a Federal Disability Retirement application for any excuse to deny it.  The reviewer will selectively choose any cracks in the aggregate of the disability retirement packet, and where there is room for inference or implication, the language used will be interpreted in the light most favorable to the Office of Personnel Management, to issue a denial in a Federal Disability Retirement case.

Wherever and whenever possible, make explicit that which sounds implicit.  The crack of dawn is a time to get up and get things accomplished; a crack in the meaning and usage of language is merely an excuse for misuse and abuse.

Sincerely,

Robert R. McGill, Esquire

FERS & CSRS Disability Retirement: Failing to Follow “Reasonable Treatment”

In fighting to prove one’s eligibility for Federal Disability Retirement benefits, a recurring argument which the Office of Personnel Management often alleges is that an applicant failed to follow the treatment recommendations of the treating doctor.

Such an argument can prove to be fatal to an applicant’s case, but it is good to know the parameters of what it means to “fail to follow” reasonable medical treatment.  For instance, non-compliance with a medication regimen can be fatal to a case.  Thus, OPM will successfully argue that an individual who has failed to follow the medication regimen of the treating doctor has thus failed to show that the individual could have returned to work precisely because non-compliance with a medication regimen would logically undermine the potential efficacy of the medical treatment.

On the other hand, invasive surgery is normally not required, and the Merit Systems Protection Board has stated that an “estimated probability of success of future surgery is speculative, just as a prediction as to the worsening of a condition may be, and will not necessarily provide a basis for denial of a disability annuity.”

These are two light-posts on the spectrum of what is deemed “reasonable treatment”.  Most issues concerning reasonable medical treatment fall somewhere between these two extremes, and the best course of action (obviously) is never to self-treat, or make medical decisions without the input of your treating doctor.  Indeed, to not follow the medication regimen of your doctor is a manner of self-treatment; on the other hand, to elect not to have surgery because of the speculative success/failure rate is a reasonable decision which the Merit Systems Protection Board will not second-guess.  What falls in-between these two extremes should always be with the guidance of “reasonableness”, in close consultation with your treating doctor.

Sincerely,

Robert R. McGill, Esquire