OPM Disability Retirement: The Human Element & Application of the Law

It may well be that technological advances will one day allow for imputed algorithms to precisely calibrate and decide everything in life; but for the time being, we must all deal with the human element in the process of decision-making.  

Comparative stories abound about how X obtained disability retirement benefits with minimal documentary proof, and even less of an actual medical condition.  It is always an anomaly as to how one can possibly answer the query which involves the following:  “X told a friend of Y, who knows of Z who filed and got his Disability Retirement benefits approved within T-amount of time”.

The particulars of each case must always determine the outcome of the case; some stories become inflated with the telling of the narrative when passed through third parties multiple times; but, on the other hand, there is the possibility that the final narration of the story is entirely true.  The reason is because the human element is still the determinative factor in any Federal Disability Retirement application.  

There is no computerized algorithm which is applied in making a determination at the U.S. Office of Personnel Management.  And, so long as human beings continue to remain a part of the administrative, bureaucratic process in scrutinizing a Federal Disability Retirement application, by analyzing the content and substance and applying the relevant laws, there will never be a perfect continuity or consistency of application.  

In some ways, this is a good thing; for, as each human being is unique, so the story of each medical condition and the impact upon one’s inability to perform all of the essential elements of one’s positional duties, in preparing, formulating and filing for Federal Disability Retirement benefits from the U.S. Office of Personnel Management, whether under FERS or CSRS, is also particularized and unparalleled.  May it be so in the future, lest we ourselves become mere drones in this world of conventionalized perspectives.

Sincerely,

Robert R. McGill, Esquire

Federal Worker Disability Retirement: Application of a Neutral Legal Criteria

The application of law upon determination of a Federal Disability Retirement application is based upon a set of criteria which focuses upon the impact of a medical condition on the Federal or Postal employee’s ability or inability to perform all of the essential elements of his or her job.  Thus, it is different from other government programs or compensation benefits, in that it ignores such issues as causality or prima facie accepted medical diagnoses.

Indeed, one can have a serious medical condition and still be denied one’s Federal Disability Retirement application if one fails to show the nexus, or the impacting connection, between the serious medical condition and one’s ability/inability to perform all of the essential elements of one’s Federal or Postal job.  In that sense, the applicable legal criteria is neutral in its very essence:  first, the Office of Personnel Management should (obviously) apply the law in a “neutral” manner, without regard to the person who applies, or be influenced in any way by the agency; but, moreover, and more importantly, the law itself is neutral to the extent that it makes no judgment upon the medical condition itself — only upon the medical condition in conjunction with the impact to one’s ability/inability to perform the essential elements of one’s job.

As such, in preparing, formulating and filing for Federal Disability Retirement benefits from the U.S. Office of Personnel Management, whether under FERS or CSRS, the primary focus in attempting to prove this point — both from a medical perspective as well as from the applicant’s approach — should be to emphasize the connection between the diagnosed medical condition and the essential elements of one’s job, and not merely upon the seriousness of the former.  Only in this way can the neutrality of the legal criteria properly assess the viability and force of one’s Federal Disability Retirement application.

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 employee 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

OPM Disability Retirement for Federal and Postal Employees: Causality

Hume’s exposition on causality is both interesting and instructive in terms of looking at the validity of an argument.  In this instance, we are obviously making an analogy with how the Office of Personnel Management, and to a larger degree, people in general who make a causal argument and declare that it is a ‘valid’ argument.  David Hume’s argument on causality essentially states that there is nothing in the world other than two independent events (which we merely deem as ’cause’ and ‘effect’), which we repetitively witness.  However, because there is no ‘meta-factor’ beyond the independent events, what he terms as a ‘necessary connection’, therefore there is no certainty beyond a repetition of events.  Thus, Hume argues that we actually never see anything ‘new’ — no ‘necessary connection’ between cause and effect, in the 100th time we observe an event, any more than the first time. 

This is, indeed, analogous to how the Office of Personnel Management views rendering a denial in a Federal Disability Retirement application under FERS or CSRS. Look at the lack of logical argumentation in an OPM denial.  It is a series of independent events, delineated and categorized in some semblance of chronological order (perhaps the order that the OPM Representative read the medical documentation):  Dr X says this; Dr. Y says that; then the effect:  “The medical evidence fails to meet the criteria for eligibility for Federal Disability Retirement.”  Like Hume’s description of the world, there lacks a ‘meta-factor’.  Whether the stated causes have any connection (see the analogy?  It is like Hume’s reference to “necessary connection”) to the “effect” is entirely irrelevant.  Events do not need to justify the decision.  It is acceptable to merely refer to medical documents and then come to a conclusion, without any need to justify the validity of an argument.  But, then, that seems to be how most people in the general population formulate an argument these days — based upon how one “feels”.

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

CSRS & FERS Disability Retirement: Agency Interaction

Federal Agencies often act like little fiefdoms.  This is not necessarily a negative thing; each agency is an independent entity, and each has a province of responsibilities which it must carry out and execute according to the statutory mandate provided by Congress.  As independent entities, each agency acts without coordination or regard to other agencies. 

Thus, while approval for disability benefits from the Social Security Administration will mean an offset of monetary payments under FERS, such interaction between the two agencies simply goes to the financial payments — not to the substantive issues of approval or disapproval of a disability retirement claim.  Similarly, while receipt of temporary total disability payments from the Office of Worker’s Compensation Programs means that you cannot concurrently receive payments under CSRS or FERS disability retirement (unless you are receiving a scheduled award from OWCP/DOL), the substantive basis of approval or denial of a claim rarely overlaps.  This is because each agency has its own independent criteria for eligibility — meaning that, for Social Security, the “disability” has a higher standard of “total disability”, whereas under FERS & CSRS, it is a lower standard of “inability to perform one or more of the essential elements of one’s job”.  Similarly, with OWCP/DOL, the issue of “causality” and whether it is “work-related” is often the important component of consideration. 

All of this is not to say, however, that an approval of a disability benefit from one agency,or a report from a doctor considered for one benefit, should not be used by the applicant for submission to another agency.  Indeed, this should be done — but carefully, and with thoughtfulness. 

Sincerely,

Robert R. McGill, Esquire

CSRS & FERS Disability Retirement: Beware the Layman

Federal employee attorneys create and manufacture a parallel universe of statutory interpretation, legal argumentation, case-law citations, and extrapolations from esoteric provisions in arguing the “finer points” of law.

Thus, it is a temptation for the lay person — the “non-lawyer” — to attempt to borrow from cases and take a stab at citing case-law and statutory authority in trying to garner support for his or her Federal Disability Retirement application. 

In taking on a case at the Reconsideration Stage or the Merit Systems Protection Board, I have the opportunity to read some of the “legal arguments” which non-lawyers have attempted to make.  While many such arguments are valid, some (i.e., too many) mis-cite the law, and often fail to understand and proffer the substantive import of what the cases are saying. 

On top of it all, I suspect that the Office of Personnel Management gets a bit annoyed when a non-lawyer applicant attempts to preach the law to another non-lawyer OPM Representative. 

A word to the wise:  let lawyers entertain themselves in the parallel universe of the law; let the doctors render their medical opinions; let the non-lawyers make the best arguments possible, in layman’s language. 

Sincerely,

Robert R. McGill, Esquire

OPM Disability Retirement: The Perspective from the Office of Personnel Management

In effective argumentation, persuasion, written memoranda, oral presentation, and the entire spectrum of attempting to convince the “other side” of the validity, force, appropriateness, and viability of any administrative or legal filing of any nature, it is often a useful tool to attempt to view an issue from that “other” perspective.

Remember that, in filing a Federal disability retirement application under FERS or CSRS, it is good to consider the fact that the OPM representative who will be reviewing your particular application, merely sees your application as one among hundreds of files assigned to him or her. With that in mind, the essential question becomes: How can my particular application, as one among many, be reviewed in such a way that it “stands apart” so that it will be quickly approved? If you ask that question, or any variation of such a question, then you may be taking a wrong approach.

Remember that filing for disability retirement under FERS or CSRS is not like applying for a job; you are not filing a resume that needs to stand out; rather, it is often best if your particular application is nothing more than a “run of the mill” application — with strong, unequivocal and irrefutable medical evidence, along with strong legal arguments to support your case. Yes, of course your Applicant’s Statement of Disability should explicitly describe the human condition of medical disablement; yes, the “nexus” between your medical condition and your job should be carefully constructed; but no, your application should not necessarily “stand out” as uniquely different — for such an application will often be viewed as “suspicious” and “over-stated”, and may well lead to not just a first viewing, but a re-viewing, and a possible denial

Sincerely,

Robert R. McGill, Esquire

Federal OPM Disability Retirement: Preexisting Conditions

There is still some confusion with respect to the relevance of preexisting medical conditions, or medical conditions which were incurred while working, or outside of the workplace, and the impact of such medical disabilities upon one’s right to file for disability retirement under FERS or CSRS. This confusion is evident from some of the questions I have been recently asked.

Remember that preexisting medical conditions are irrelevant to filing for Federal Disability Retirement benefits, in most cases; the fact that an individual has been able to perform the essential elements of one’s job for many years, but comes to a point in his or her career where the medical condition has been exacerbated, or deteriorated, to the point where it begins to prevent one from performing one or more of the essential elements of one’s job, is all that is needed to be shown.

It matters not that the medical condition “preexisted” one’s Federal service; and, indeed, many of my client’s began working with a VA disability rating, but worked successfully for a number of years, until the medical condition(s) underlying the VA disability rating worsened, or came to a point where it began to impact his or her ability to perform the job functions. Similarly, whether or not the injury or medical disability was incurred while working or while on a skiing trip, is irrelevant. The primary point and focus in FERS & CSRS disability retirements cases, is that a person has the minimum years of Federal Service (5 years for CSRS; 18 months for FERS), and during the person’s Federal Service, he or she incurred a medical condition such that it prevents one from performing one or more of the essential elements of one’s job.

Sincerely,

Robert R. McGill, Esquire