Medical Retirement Benefits for US Government Employees: The Legal Standards

Recent decisions issued by the Full Board of the U.S. Merit Systems Protection Board — specifically, Henderson v. OPM, decided on January 31, 2012, reestablishes the two general standards of applicable evidentiary approaches in proving a Federal Disability Retirement case, whether under FERS or CSRS.  Whether or not the U.S. Office of Personnel Management will “comply” with the applicable standards as set forth by the MSPB is another question.

Often, the “trickle-down” effect of a legal opinion can take years to accomplish — and by that time, further refinements by the courts and by the MSPB may have made such legal opinions moot, irrelevant or otherwise restrictive in its practical application, anyway.  For the time being, however, the two legal approaches can be generally stated thus:  One must prove, by a preponderance of the evidence in all Federal Disability Retirement cases, either (A)  That certain specific medical conditions prevent one from performing certain specific essential elements of one’s job (somewhat like a 1 – 1 correspondence, or more generally, a medical opinion showing that medical condition X prevents job duties Y because of Z) or (B) as stated previously in Bruner and multiple other cases, there is an “inconsistency” between one’s medical condition (or multiplicity of medical conditions) and the type of positional duties one must engage in to perform the essential elements of one’s Federal or Postal job.

The former criteria to satisfy may be deemed “particularized”; the latter may be seen as a more “generalized” approach.  While there is certainly a conceptual distinction between the two, in pragmatic terms, such a distinction may be without too much difference, if only because doctors will often go back and forth between the two approaches, anyway, in writing a medical narrative report.

The conceptual distinction is not as apparent as one between “explicit” and “implicit”, but certainly the former approach encapsulates a greater specificity of detailing a connection between X and Y, whereas the latter requires the reader or reviewer (i.e., OPM or the Administrative Judge) to think through and analyze the entirety of the issue.  But that life would not be so complicated.

Sincerely,

Robert R. McGill, Esquire

Federal and Postal Disability Retirement: Citing Case-Law

In preparing, formulating and filing a Federal Disability Retirement application under FERS or CSRS, it is important to provide a guiding cover letter to the Office of Personnel Management — whether termed as a “Legal Memorandum”, a “Cover Page”, or some other designation — in order to introduce a “road map” to the OPM Representative who will be reviewing the case.  

While the OPM Representative will ultimately be able to “figure out” the documents to be reviewed (i.e., the Standard Forms are obviously familiar; the medical documentation should be self-evident, etc.), there is a distinction to be made between the documentation submitted, and the persuasive effect of the documentation.  There are times, of course, when the strength of a case is so irrefutable and unrebuttable that no guidance is needed; most cases, however, require some persuasive authority.  

The best road map will cite some relevant statutory authority or judicial cases of known precedence.  If one is to cite relevant legal authority, however, it is important to do so properly.  To mis-cite a case, its relevance, or its correct interpretive impact, can do more harm than good, especially if the case proceeds to the later stages of being argued before a Merit Systems Protection Board Administrative Judge.  

Knowing what one is speaking about is the basis for credibility; credibility in making a persuasive presentation of one’s medical conditions and their impact upon one’s ability or inability to perform the essential elements of one’s job is crucial to the effectiveness of one’s case.  Citing cases properly, forcefully, and with technical appropriateness is important in presenting a road map for OPM to follow — from the point of initial introduction, to the final conclusion of agreeing that the Federal or Postal employee is indeed eligible and entitled to Federal Disability Retirement benefits under FERS or CSRS.

Sincerely,

Robert R. McGill, Esquire

OPM Disability Retirement: Additional Comment on Medical Documentation

There are two (2) fundamental reasons why SF 3112C (Physician’s Statement) “doesn’t work” for physicians:  First, it is a government “form”.  It requests of a doctor to mechanically engage in the very performance of a duty which all doctors (generally speaking) hate:  writing up a report.  It does not provide for a context; it does not attempt to simplify the process for the doctor.  Second, for any doctor, it is an unappealing request.  To shove a government form which is written in fine print, and ask him to “follow the directions” is something all doctors (again, generally speaking) hate to do.  What I have found to be much more effective, is to provide a context and background — an “explanation” — to the doctor, concerning the medical disability retirement process.  That is one of the primary reasons why I never have my clients sign or submit an SF 3112C.  Aside from the danger of allowing for the blind release of any and all medical information to the Agency, and ultimately to the Office of Personnel Management when one signs the 3112C, it is simply not an effective means by which to obtain the necessary medical narrative report from the treating doctor.  To obtain an effective narrative report, it is important to have an attorney make a proper and thorough request.

Sincerely,

Robert R. McGill, Esquire

OPM Disability Retirement: Quality versus Quantity

While most Federal Disability Retirement applicants whom I represent, and have represented, retain me at the initial stage of the application, a good many of my clients come to me at the Second (Reconsideration) and Third (Merit Systems Protection Board) Stages of the process.  I find that the vast majority of the individuals who attempted to put his or her disability retirement packet together, and got it denied at the first level, attempted to simply overpower the Office of Personnel Management with a voluminous compendium of medical records.  Wrong move.  Always place quality over quantity.  Streamlining a case is often the key to winning a disability retirement case. 

This is just as true for cases involving Fibromyalgia, Chronic Fatigue, Multiple Chemical Sensitivity, etc.  Because such medical conditions are often thought of as “not quite” legitimate conditions, applicants often make the mistake of thinking that by overloading the Office of Personnel Management with a thick, unwieldy file of medical records, that the sheer weight of the records will convince OPM that it is a “legitimate” case.  Wrong move.  Don’t be defensive.  Such conditions as Fibromyalgia, Chronic Fatigue, Multiple Chemical Sensitivity, Bi-polar Disorder, panic attacks, Generalized Anxiety Disorder — they are all legitimate basis for disability retirement.  Such medical conditions need not be apologized for.  Such conditions need not be “defensively” or “apologetically” submitted.  They are legitimate conditions to file; they just need to be submitted in the proper manner — by having a strong, streamlined, and cohesive medical narrative, properly prepared by the doctor, under the guidance of a Federal Disability Retirement attorney.

Sincerely,

Robert R. McGill, Esquire

CSRS & FERS Disability Retirement: The OWCP Danger of Complacency

I have had far too many calls by individuals who were complacent with being on OWCP/DOL temporary total disability compensation. The old adage, “Ignorance of the law is not an excuse”, is still generally true. It is the responsibility of the Federal or Postal employee to file for Federal Disability retirement benefits under FERS or CSRS in a timely fashion — within one (1) year of being separated from Federal Service.  The fact that an individual is on the rolls of Worker’s Comp, receiving Worker’s Comp, receiving a scheduled award, going through rehabilitation or job retraining does not protect or extend the Statute of Limitations of 1 year.  Many people, especially Postal Workers, become separated from service without being properly notified.  A hint:  If you all of a sudden stop receiving those “Zero-balance” pay checks, chances are, you have been terminated & separated from service.  The burden is on the Federal employee to keep on top of things:  ask for your PS Form 50, or SF-50, whichever the case may be; call your agency on a regular basis to make sure that you are still on the rolls of the Agency.  If you have been separated from service, a personnel action should have been initiated.  From that moment — when you have been separated from Federal Service — you have one — I emphasize and reiterate — ONE YEAR from the date of separation from Federal Service to file for disability retirement benefits.

Sincerely,

Robert R. McGill, Esquire

CSRS & FERS Federal Disability Retirement: When the Office of Personnel Management Fails to Apply the Law

Federal disability retirement law is often a frustrating process. On the one hand, for an attorney, it can be a professionally satisfying area of law to practice because the end result — obtaining a benefit for an individual who has shown long years of loyal service to working for the Federal Government; providing a source of income for a person who has been impacted by a medical condition; reaching a successful conclusion to a process: these factors are always satisfying for a practicing attorney. On the other hand — this is an administrative process; it is an area called, “Administrative Law”, and at least at the initial stages of the process, the Attorney handling such a case is dealing with non-attorneys at the Office of Personnel Management.

In other areas of practice, there is often an “equality of competence” (presumably), where attorneys compete or engage in adversarial battle with other attorneys. With Disability Retirement Law, however, the “Disability Specialist” at the Office of Personnel Management often has absolutely no clue as to the current laws governing disability retirement. They simply apply a template and, if a specific case goes outside of that preconceived “template”, then the OPM Representative will often deny the case.

Now, in all fairness, most of the people at OPM have a fair idea of the current law, and more importantly, are open to being informed, educated and persuaded by an attorney that a particular case, with its various wrinkles (and all cases have their unique wrinkles), should be approved because of compliance with a particular statute, a relevant case-law, or a particular regulatory statement. In some particular cases, however, when an OPM representative makes a decision based upon complete ignorance of the prevailing disability retirement laws, one can only throw up one’s hands, and hope that the Reconsideration Specialist will have greater knowledge — or, at the very least, is open to being educated on the proper application of the law.

Sincerely,

Robert R. McGill, Esquire

OPM Disability Retirement: Proper Response to the Agency

It is often difficult to inform an Agency of one’s decision to file for disability retirement. On the one hand, it is often a place where a Federal Employee has spent many years working for; with multiple years of interaction, both good and bad, it is a place which has grown to play a prominent role in the employee’s daily life, with necessary interpersonal infusions of personalities, playing such an influence as important as one’s personal family life — and, because a person may spend 8 – 10 hours a day, week after week, month after month, like life in a family, it has come to embrace a place of primary importance in one’s life. As such, to inform such a place of one’s decision to file for disability retirement is, in effect, to inform them of one’s separation from that primary location of importance. Such separation can be as psychologically devastating as a “divorce” which, in many respects, it is similar to. That is often why the role of an attorney can be important. An attorney can be a “middle-man”, an arbiter to soften the strain of such a separation from a federal employee from his or her “family”. Remember, this is an administrative process; it need not be an adversarial process. An attorney experienced in disability retirement law should know the process, and act to soften the separation which has been long in coming, and work to garner a sense of “teamwork” between Agency and employee, to attain as amicable a separation as possible.

Sincerely,

Robert R. McGill,Esquire

CSRS & FERS Disability Retirement: Christmas Season

Christmas is upcoming. The Office of Personnel Management, along with many other Federal Agencies, is beginning to “shut down” for the Holiday Season. OPM will be making many decisions concerning pending disability retirement applications. For those who receive a denial, obviously a negative decision coming during the Holidays is unwelcoming news; for those who receive an approval, the reaction is normally that it is great news and a needed Christmas present. But a negative decision — a denial from OPM — needs to be put into its proper perspective. Yes, it is an unfortunate bit of news coming at a bad time; but those who file for disability retirement benefits, must always look upon the process as one involving 4 steps: The initial application step; if denied, the Reconsideration step; if denied a second time, an appeal to the Merit Systems Protection Board; if denied by the Administrative Judge at the MSPB, an appeal to the full Board via a Petition for Review (PFR) — and even a fifth step, to the Federal Circuit Court. Remember, Disability Retirement is a “process”; the fact that it coincides with the Holiday Season does not change the long process which it involves.

Sincerely,

Robert R. McGill, Esquire

CSRS & FERS Disability Retirement: Other Stories of Success

There are obviously many, many pitfalls in the attempt to obtain disability retirement benefits from the Office of Personnel Management. Sometimes, I get calls from individuals who tell me that they “heard from a friend” that another employee prepared the disability retirement packet him/herself, and got it through within ___ months (you can fill in the blank with an unbelievably low number — say, 1, 2 or 3), and that there was no need for an attorney, and so why should anyone need an attorney?  I really have no response for such an inquiry; I am always suspicious of such “too good to be true” stories, but on the other hand, inasmuch as I don’t have any facts to refute or otherwise disbelieve such stories, I cannot comment on them.  I can only convey facts, circumstances, and experiences which I have with my own clients (don’t worry — all information received from and on behalf of my clients is protected by attorney-client confidentiality, and I never — ever — divulge personal information; I relate such experiences only in a generic sense, with no names ever mentioned), and indeed, each case is different and unique, and I try and treat each case based upon the specific facts, circumstances, and individual complexities inherent in each.  I really cannot comment on “that other story” that is heard through a chain of mouths and ears, only to be transformed into an unidentifiable success story.

People who come to me and ask for my legal guidance and expertise know that, to the extent I am able, I will answer each question based upon my professional experience; that I try to give a realistic assessment of each case, without embellishment; and my clients remain my clients for life.  Indeed, I get calls almost every week from people who I represented many, many years ago.  If a Medical Questionnaire is received, I am here to guide the recipient so that he/she will be able to retain the disability retirement benefits we fought so hard to obtain.  I have no idea about those “other success stories”; my goal is to satisfy the legal needs of my clients — those who have entrusted their cases in me, and for whom I have a special care and trust for.

Sincerely,

Robert R. McGill, Esquire

Federal Disability Retirement: Actions from the Federal Government or the Postal Service

I often receive telephone calls from Federal and Postal employees worried about what their Supervisor will write in the SF 3112B (Supervisor’s Statement) — the lies, half-truths, and vindictive statements that some Supervisors will, for whatever reason, attempt to have that “last parting shot”. Such acts by supervisors are, for the most part, and fortunately, the exception, and not the rule; but each time it happens, it is despicable to the exponential degree — especially in light of the context of attempting to harm a Federal or Postal employee who has a serious medical disability, and needs the financial security offered by disability retirement.

As a general rule, the best approach to take is to follow the rule of thumb of the wise man: Do not worry about those things over which you have no control; focus upon those things over which you do have control. Remember that this is a medical disability retirment — with the emphasis upon the term “medical”. Having said that, a disability retirement application must first and foremost focus upon obtaining the most excellent medical report. If this is accomplished, then in 99% of the cases, it will nullify and make irrelevant anything which the Supervisor puts down on the Supervisor’s Statement. This is the best and wisest approach to take; do not waste your time, emotional energy, or any further part of your life worrying about a Supervisor who lacks the fundamental compassion to be honest and truthful about an individual who has shown years of loyalty to the Federal Service. He/she is not worth it.

Sincerely,

Robert R. McGill, Esquire