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

Federal Employee’s Disability Retirement: The Non-standard Approach to Standard Forms

Standard Forms are created, produced and promulgated precisely for their stated and intended purpose:  to streamline and conventionalize (yes, that is really a proper word, and spellcheck did not put a red line beneath it) the formatted receipt of information by an agency of the Federal Government.  Without Standard Forms, there would be no confining methodology of what to say, how to say it, and how much to say it.

The theory behind standard government forms is simple:  By providing the space, the questions and the apparent limitations, ease of processing will be expedited.

Of course, in pragmatic terms, the reality behind the theory is that Standard Forms create an intended limitation on space, as well as the content of what a person states or desires to state.  Yet, by self-confining the answers and information provided, the applicant for Federal Disability Retirement is essentially depending upon government lawyers to properly interpret what the statute for eligibility for Federal Disability Retirement requires.

While staying somewhat within the confines of what the Standard Forms request is a “good” thing (for Federal Disability Retirement purposes, SF 3107 series for FERS applicants; SF 2801 series for CSRS applicants; SF 3112A, SF 3112B, SF 3112C, SF 3112D, and SF 3112E for both FERS and CSRS applicants), it should not limit or otherwise prevent the submission of relevant information.  “Relevancy”, of course, is a relative term, and should be noted and applied by those who understand the statutory underpinnings of the legal requirements for a successful Federal Disability Retirement application.

Ultimately, one should approach the standardization of the administrative process called “Federal Disability Retirement” as merely a piece of the larger puzzle, and not be precluded from submitting non-standardized information in an effort to prevail in the preparation, formulation and filing of a Federal Disability Retirement application, whether under FERS or CSRS, from the U.S. Office of Personnel Management.

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

Medical Retirement Benefits for US Government Employees: Sounds Good

There are various stages of the administrative process designated and defined as “Federal Disability Retirement” — the initial application stage of the process, where one must attempt to prove by a preponderance of the evidence that one is eligible for Federal Disability Retirement benefits; if disapproved and denied, then the Reconsideration Stage of the process (where one may submit additional medical and other documentary evidence to persuade the Office of Personnel Management to reverse themselves); an appeal to the U.S. Merit Systems Protection Board, where the Federal or Postal applicant’s Disability Retirement application is taken out of the hands of OPM and transferred to an Administrative Judge, who will hear the case anew, without regard to what OPM has decided in the past; a further appeal to the Full Board of the MSPB in the event that the Administrative Judge issues an Initial Decision which affirms and upholds OPM’s denial of the case; and a further appeal to the Federal Court of Appeals for the Federal Circuit.

Throughout this process, and especially in the administrative stages before the Office of Personnel Management, one should make a distinction between “sounding good” and “being right”.  Hopefully, the Federal or Postal employee who has filed for Federal Disability Retirement benefits from the U.S. Office of Personnel Management, whether under FERS or CSRS, is both right and sounding good. But there is a distinction to be made.  For example, OPM will often — in their denial letter — “sound good” but be completely wrong on the law.  They will cite medical textbooks which skew the legal standard of review; creep into the discussion of a denial letter such terms as “no significant disability rating to speak of,” or that you don’t suffer from a disability which “incapacitates” you.  It all “sounds good”, but it is not true precisely because it is not the applicable standard of law to be applied.

At the initial stages of the process, OPM can get away with such nonsense, because most people don’t recognize the untrue and inapplicable standard of law being applied.  In the later stages of the process, however, when an Administrative Judge hears a case, it becomes important not only to “sound good”, but to also apply the right legal criteria.

Appearance versus reality — it is the argument of Western Civilization from the pre-Socratics onward.  As Alfred North Whitehead once observed, all of philosophy was already written by Plato and footnoted by Aristotle.  That statement both sounds good, and is indeed right on point.

Sincerely,

Robert R. McGill, Esquire

Disability Retirement for Federal Government Employees: The Weight of Evidence

In preparing, formulating and filing a Federal Disability Retirement application under FERS or CSRS, the reason why it is important to understand, reflect upon, and have a practical knowledge of the laws governing Federal Disability Retirement issues — both in terms of statutes which govern and dictate the criteria for eligibility of Federal Disability Retirement benefits; the regulations which are propounded by the Office of Personnel Management; and the case laws which are administrative judicial opinions handed down (from the Merit Systems Protection Board, to the Full Board of the Merit Systems Protection Board; to the Federal Circuit Court of Appeals, etc.) — is that there is always a “trickle down” aspect to the evolving laws in any system of laws.

Thus, the opinions handed down by Administrative Judges at the Merit Systems Protection Board, as well as by Judges of the Circuit Court of Appeals for the Federal Circuit, are dictates and interpretation of statutory authority which are to be “followed” by the Federal Agency which is empowered to administer the decision-making process of Federal Disability Retirement benefits.

Part of that application of law, for instance, is the “standard of proof” which must be applied, and in the case of all Federal Disability Retirement applications, the standard of proof to be applied is the “Preponderance of the Evidence” standard.  But what does that standard mean?  While entirely subjective at worst, and somewhat confusing at best, the individual words which make up the conceptual entirety provides some inkling of what must be understood.

Whether qualitatively or quantitatively, one must have a showing of “preponderance” — of more, better, or of greater persuasive effect than not.  Thus, whether by sheer volume of the evidence presented, or in the quality of the presentation, the persuasive impact must be accepted as more likely than not, by the Office of Personnel Management or, if appealed to the Merit Systems Protection Board, then by the Administrative Judge.

It is important to not only apply a standard, but to have an understanding of the standard.  For, only by understanding can one then determine its proper application.

Sincerely,

Robert R. McGill, Esquire

OPM Disability Retirement: “It May Sound Good”

There is the statutory legal criteria which is mandated by law, by case-law, and by regulatory dictum as to the proper application of review in making a determination on a Federal Disability Retirement application, whether under FERS or CSRS.  Yet, the question is whether or not the Office of Personnel Management has applied the proper legal criteria in making its determination, and the answer to such a question can only be evaluated based upon the language which is utilized by OPM in its denial letter. 

An approval letter issued by the Office of Personnel Management is entirely unrevealing, precisely because it is simply a template letter advising the approved Federal Disability Retirement annuitant of the next steps to follow.  However, when a denial letter is issued by the Office of Personnel Management, often the Claims Representative will insert language which “sounds good” and proper, and even convincing — but ultimately, wrong as far as the proper application of the law is concerned.  For example, OPM may assert with unequivocal brevity that there lacks “compelling medical evidence” in the Federal Disability Retirement application.  “Compelling” is not a legal criteria required by statute, case-law, or regulatory dictum.  As such, it is a meaningless word-usage.

Moreover, it is harmful to a case because it means that OPM applied a standard of review which is nowhere found in any statute.  Further, it gives an appearance of authenticity and authoritative credibility where none exists.  What to do about it?  It needs to be addressed and pointed out — but diplomatically.  Diplomacy is nothing more than a forceful rebuttal clothed in the finery of courtesy, but it is a necessary ingredient in establishing the proper tone and tenor of a response to OPM.

Sincerely,

Robert R. McGill, Esquire