Tag Archives: denial letter as part of a long disability process

Federal Employee Medical Retirement: The Bureaucratized Process

One cannot expect any entity, organization, or group of individuals to reinvent the wheel for each product, service or response; streamlining and repetitive conformity of a product, issuance or completion of a case is the way of the world; it is how the Model T became a successful capitalistic venture; it is how China dominates the world of marketing.  But in the world of Due Process, one cannot formulate a mass production of effective advocacy without trampling upon the rights of an individual.

Thus, on both sides of the process of preparing, formulating and filing for Federal Disability Retirement benefits from the U.S. Office of Personnel Management, whether under FERS or CSRS, each case must be responded to in accordance with the specific, unique facts as constrained by the individual circumstances.

Conversely, one should expect — and demand of the U.S. Office of Personnel Management — that something more than a mere template of a response should be issued, after a careful and thorough review of a Federal Disability Retirement application.

If a FERS or CSRS Disability Retirement application is approved by OPM, then of course one can expect merely a letter of approval which is identical to thousands of others.  If denied, however, the denial letter should reflect a careful, thorough and individualized letter, reflecting the scrutiny of one’s particular OPM Disability Retirement packet.

Anything less would be to trample upon one’s due process rights as a Federal or Postal employee.

Sincerely,

Robert R. McGill, Esquire

Medical Retirement for Federal Workers: Rationality Still Exists

One may well disagrees with the U.S. Office of Personnel Management on its decision to deny a Federal Disability Retirement application, and yet find a rational basis for its denial.  Indeed, the fact that OPM may offer some rationality to its denial, does not mean that they are correct in their decision.  Often, there is a misunderstanding as to what “rational” behavior consists of.

On a recent Sunday morning talk show, a couple of political pundits were proposing the idea that certain hard-line regimes were not acting “rationally”.  The problem with such an analysis is that one assumes that if an individual or a country fails to act within certain universally-accepted normative behavior, that such actions constitute “irrational” conduct.  That is simply not true.

First of all, rationality — which finds its foundation in logic, whether propositional or syllogistic — depends upon the major and minor premises advanced.  Thus, if the major premise entails a person or country that cares for the welfare of his neighbor or its citizenry, then the logical conclusion may well be one which encapsulates rationality — of acting to protect its people, to safeguard human rights, etc.  On the other hand, if the major premise begins with the primary assertion of retaining authority and absolute power, then the conclusion would involve shooting or massacring its countrymen.  The latter logical trail is no less “rational” than the former. Such a mistake in defining and understanding the concept of “rationality” is often found in all areas of life.

Thus, in preparing, formulating and filing for Federal Disability Retirement benefits, whether under FERS or CSRS, the fact that there has been evidence of “irrational” behavior on the part of those parties involved in the administrative process, should not result in a conclusion that the process is “arbitrary” or dependent upon some non-legal criteria.

Ultimately, all human endeavors embrace some semblance of rationality.  While one may disagree with the analytical thought-processes of the U.S. Office of Personnel Management, which often strays far beyond what the law requires and allows for, nevertheless, one can recognize the rational analytical procedures used in every denial of a Federal Disability Retirement application, whether under FERS or CSRS — albeit, one in which radical jumps from premise-to-conclusion with gaping chasms of generous implications may have to be provided, in order to be able to say that such argumentation incorporated a rational basis of explanatory analysis.

Sincerely,

Robert R. McGill, Esquire

Federal Employee Medical Retirement: Proper Responses

A receipt of a denial from the Office of Personnel Management to a Federal Disability Retirement application under either FERS or CSRS is always an event which is upsetting to a Federal or Postal employee, but it is “part of the process” which occurs often enough.  

If it is a second denial (where a Request for Reconsideration has already been accomplished, and the Office of Personnel Management has denied it again), then the only appropriate response is to file an appeal to the Merit Systems Protection Board (no response is required, or even appropriate, to OPM, as it is out of their jurisdictional purview upon denying it a second time).  

If it is a “first denial“, then a “Request for Reconsideration” must be filed within thirty (30) days of the date of the denial letter (one can argue that the 30 days should be counted from the date of receipt, but it is always better to be on the safe side), and if requested, an additional thirty (30) days is automatically granted in order to have sufficient time to gather and submit further documentation to rebut and answer the denial from the Office of Personnel Management.

Submission of the Request for Reconsideration, and participation in the process of having the Office of Personnel Management reconsider the initial denial, is mandatory, not elective.  By this is meant the following:  You cannot bypass or skip the Reconsideration Stage and jump directly to the MSPB; you must first get a decision on the Request for Reconsideration before the Merit Systems Protection Board will consider your case.  

You cannot get angry or reactive and declare, “I will just file an appeal to the MSPB and have an Administrative Judge look at my case”.  You must patiently go through the proper channels of justice, and respond accordingly.

Sincerely,

Robert R. McGill, Esquire

CSRS & FERS Medical Disability Retirement: The Denial Letter

During this Holiday Season when Federal and Postal employees who have filed for Federal Disability Retirement benefits under FERS or CSRS, who are anxiously awaiting the decision from the Office of Personnel Management, a denial letter from OPM can appear disproportionately devastating.  Christmas and the New Year tend to bring difficulties precisely because it is seen as a season of celebration, when families get together, where work continues, but an expectation of being “joyous” pervades.  At such a time, a denial of a Federal Disability Retirement application from the Office of Personnel Management can be a seeming conclusion to a long wait.  It is not.  

Do not become discouraged just because someone at OPM has “decided” that your Federal Disability Retirement application did not “meet” the legal criteria.  Set the denial letter aside for a day or two (so long as it is not nearing the 30-day period to either file for Reconsideration or an appeal).  Then, proceed to fight it.  

Don’t let the Holiday Season become confused with the right to file for, be eligible for, and be entitled to Federal Disability Retirement benefits under FERS or CSRS.  The filing of an application for Federal Disability Retirement benefits is a process which may take 6 – 8 months, or longer if it is needed to go to the Reconsideration Stage, or to the Merit Systems Protection Board.  

Do not get discouraged; instead, fight for your benefits.

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

CSRS & FERS Disability Retirement: OPM & the Problem of Templates

The problem with the use of templates is that they are, over time and overusage, predictable; being predictable, they become ineffective.  Now, from the perspective of the Office of Personnel Management, applying a template to a Federal Disability Retirement application under FERS or CSRS, whether predictable or not, is somewhat irrelevant, to the extent that a denial is still a denial, and an approval is simply an approval. 

It is only if and when a case is appealed (after an initial denial and a denial at the Second Stage, at the Request for Reconsideration Stage) to the Merit Systems Protection Board, that the template has to be “defended” if the Administrative Judge asks for clarification of the issues by referring to the template-based denial.  Moreover, what is predictable is the combination of medical condition/denial rationale.  For instance:  for Fibromyalgia:  “The condition waxes and wanes”; for Major Depression:  “Not enough time has been allowed for the efficacy of a medication regimen“; for anxiety & panic attacks:  “There is insufficient objective medical evidence”; for Chronic pain:  “Physical therapy has not been sufficiently given a chance to…”   These are some examples of templates used by the Office of Personnel Management, each of which can easily be refutted in any particular case.  The methodology of refutation, obviously, is where a federal disability attorney can be of greatest counsel and representation.

Sincerely, Robert R. McGill, Esquire

Federal Disability Retirement: OPM’s Detailed Denial

Neither length nor detail constitutes legitimacy.  The spectrum of the types and styles of denial letters issued by the Office of Personnel Management in Federal Disability Retirement cases under FERS & CSRS range from a short paragraph under the “Discussion Section”, to 3 – 4 pages of apparent references to doctor’s notes, reports, etc. — with a lengthy lecture about the need for “objective” medical evidence, and about how a particular medical condition “may be” treated by X, Y or Z treatment modalities. 

Don’t be fooled.  One may think that, because OPM provides a seemingly “detailed” explanation of why a particular disability retirement application was denied, that such lengthy detail means that it is somehow “substantive”.  In fact, I often find the opposite to be true:  the shorter the denial, the greater the substance.  The lengthy denial letters contain “substance”, all right — but substance of the wrong kind.  They contain:  Mis-statements of the law; mis-statements of the criteria to be applied; inappropriate assertions of medical opinions (contrary to what one might think, the OPM representative does not normally have a medical degree, let alone a law degree), and a host of other “mis-statements”.  Sometimes, the weightier the denial, the more confusing as far as how to respond.  And, perhaps, that is one methodology as to how OPM wants to approach the case:  If it seems long and complicated, maybe the applicant will sigh, give up, and go away.  Don’t.

Sincerely,

Robert R. McGill, Esquire

CSRS & FERS Disability Retirement: Denial at the First Stage

I would like to state that none of my cases have ever been denied at the Initial Stage of filing for Federal Disability Retirement benefits; not only would such a statement be untrue; it would also be unbelievable.  And yes — even the cases that I file on behalf of my clients, get a similarly formatted denial:  a restatement of the criteria for eligibility for Federal Disability Retirement under FERS & CSRS; a discussion with an elaborate reference to doctor’s notes, dates of treatment, targeted extrapolations of statements by the doctors which are not only selectively chosen in a narrow manner to favor the decision of denial, but further, which are often taken out of context.  Some might wonder:  Doesn’t OPM have greater respect for Mr. McGill?  The answer is:  At the First Level, the representative from the Office of Personnel Management is merely making a decision on one of thousands of files, and a template is being used to process and get rid of cases.  However, one must always remember (as I try to remind everyone) that this is a “process”.  A denial at the First Stage of the process is merely part of the greater process.  It is not something to get annoyed at, or concerned about; it is a stage and a decision which must be dealt with, argued against, and rebutted in the proper, rational, legal manner. 

Sincerely,

Robert R. McGill, Esquire