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 Disability Retirement: The Viability of the Case

In preparing, formulating and filing for Federal Disability Retirement benefits from the U.S. Office of Personnel Management, whether under FERS or CSRS, the initial question for the Federal or Postal employee who is contemplating such an endeavor — i.e., he or she is in the “preparation” state of the administrative process — is whether or not one has a “viable” case.

Viability of a Federal Disability Retirement case is based upon the supportive input of a treating doctor — whether it is one’s Primary Care Physician, Orthopaedic Specialist, Neurologist, Psychiatrist, etc. Because Federal Disability Retirement is not an entitlement, but rather a benefit which must be proven by a preponderance of the evidence, as such, one must approach the preparation and formulation of the case based upon factors pointing towards the viability of “winning”. There is never a guarantee that a Federal or Postal employee will be approved for a Federal Disability Retirement application.  Each case must be evaluated in light of the uniqueness of the facts, circumstances, and relevant positional requirements involved.

As part of any such review and analysis of a case, one must look at the extent of support one can expect from the treating doctor.  As such, a case will often require some further development; of persuasion on the part of the doctor that all reasonable modalities of treatment have been engaged in; that the condition will reasonably last for a minimum of 12 months (which can be part of the prognosis of the patient); and that it meets the legal standard in accordance with OPM, the MSPB and the statutory authorities which govern such standards — that, essentially, the medical conditions are inconsistent with the particular type of job which the Federal or Postal employee must perform.

Viability is determined by multiple factors — medical, legal, and the rational nexus between one’s medical condition and the particular kind of job one is required to perform.  It must be evaluated with a knowledge of all three — the law, the medical condition, and the unique, intimate connection to the Federal or Postal position.

Sincerely,

Robert R. McGill, Esquire

Federal and Postal Disability Retirement: The Necessary Doctor

Ultimately, the doctor who is necessary is the one who will be supportive.  Whenever the question is asked of me whether it is “necessary” to have the support of this or that doctor, my answer is generic in nature:  It is better to have one excellent narrative report in support of one’s Disability Retirement Application, than to have 5 mediocre or lukewarm reports.  Excellence in a Federal Disability Retirement application is encapsulated by the level of passion and support by the treating doctor.  The character and texture of a medical report is not just a set of factual listings of medical conditions and a dry statement of an opinion; rather, the underlying sense of a doctor’s firm and passionate belief in a patient is often evident in the intangible underpinnings of a good report.  There are simply some reports written by a doctor where one knows that it is improbable that the Office of Personnel Management will want to entangle themselves in; the unequivocal voice, tone and tenor of such a report can make the difference between getting an initial approval of an Application for Federal Disability Retirement under FERS or CSRS, or a denial, resulting in the necessity of going to another stage of the process.

Sincerely,

Robert R. McGill, Esquire