Disability Retirement for Federal Workers: Necessary Connections

Necessity is determined by how one defines and confines the parameters required to reach the requisite conclusion; if the criteria governing the roadmap to a successful outcome is replete with heightened qualitative specifications, greater care and effort may be mandated; conversely, if a looser, more informal measure is imposed, the tendency is to respond accordingly.

But what determines the response — outside influences, or one’s own standard of excellence? In Hume’s argument concerning causality, of course, the prerequisites defined were instituted at the outset to defeat the argument for causality; by setting up the requirement of what constitutes a “necessary connection” in order to establish a causal connection, he allowed for no amount of evidence which would satisfy his rule; thus, it was already a self-contained tautology from the outset.

For preparing, formulating and filing for Federal Disability Retirement benefits, whether the Federal or Postal employee is under FERS or CSRS, the question becomes: Does the medical condition itself determine the extent of groundwork necessary for a successful approval from the U.S. Office of Personnel Management, or should the identical set of stringent prerequisites be satisfied regardless of the seriousness of the medical condition?  The obvious answer, of course, should always ascribe to the latter, as acceptance of the former entails potential pitfalls which may result in lost time and unnecessary efforts expended for satisfaction of additional stages in the administrative process.

Necessary connections in a Federal Disability Retirement application must be proven and established at all levels; for, as the age-old adage reminds us, it is the weakest link in the chain of arguments which will ultimately defeat the entire structure of an otherwise solid case.

It is the U.S. Office of Personnel Management, through statutory impositions and regulatory requirements, which has “pre-set” the necessary connections to be made in proving eligibility for Federal Disability Retirement benefits; it is up to the applicant (you) to make sure that all such causal connections are established, proven, confirmed and supported, in order to ensure the best chances for success in an administrative process fraught with human frailties and foibles.

Sincerely,

Robert R. McGill, Esquire

 

Medical Retirement Benefits for US Government Employees: Qualifying

The concept of “qualifying” is both peculiar as well as interesting; for, one questions whether one can “qualify” for a sports event (often, this encompasses issues of age, physical ability, whether gender may disqualify you, etc.); and then there are “qualifying events”, where you must pass certain levels of “test” activities in order to get to the next round, as in golfing events.  In racing events, there is always talk about getting through the “qualifying” stages; and, similarly, in attempting to secure a job, the applicant is often questioned as to whether he or she has the “qualifications” for the position.

In preparing, formulating and filing for Federal Disability Retirement benefits from the U.S. Office of Personnel Management, there is also the initial question of whether a Federal or Postal worker “qualifies” for the benefit identified as “Federal Disability Retirement”. Here again, to “qualify” means that a Federal or Postal worker meets certain requirements. Thus, there are automatic dis-qualifiers, such as: If you are not a Federal or Postal worker, but work for the county or state, then you do not qualify for benefits under FERS or CSRS from the Federal system. Similarly, if a FERS individual does not have at least 18 months of Federal Service, or a CSRS Federal employee does not have at least 5 years of Federal Service (which is obviously unlikely), then you cannot “qualify” to even apply for Federal Disability Retirement benefits from the Office of Personnel Management.

Those are immediate qualifying “events”.  Then, of course, the main event — the tournament of all competitive activities for Federal Disability Retirement purposes — concerns whether or not a Federal or Postal Worker qualifies for Federal Disability Retirement benefits because of his or her medical condition.  This foundational qualification can only be answered by looking at the medical condition, the support of the treating doctor, and whether and to what extent the medical condition impacts one’s physical or psychological ability to perform the essential elements of one’s job.

For that main event, one must rise to the level akin to the professional athlete.

Sincerely,

Robert R. McGill, Esquire

Medical Retirement Benefits for US Government Employees: Meeting the Statutory Minimum

In preparing, formulating and filing a Federal Disability Retirement application under FERS or CSRS, the Federal or Postal employee must prove, by a preponderance of the evidence (that burden of proof which is fairly minimal in the order of difficulty, requiring that a Federal or Postal employee show that he or she is “more likely than not” entitled to Federal Disability Retirement benefits under FERS or CSRS) that the compilation of the evidence meets the statutory requirements such that one is eligible and entitled to Federal Disability Retirement benefits.  

Thus, it is the cumulative set of evidence which is reviewed by the Office of Personnel Management, and not merely a single piece of evidence.  Yet, the manner and methodology of how OPM reviews the evidence is revealed in any given denial letter issued by the claims representative, or the “Legal and Administrative Specialist” assigned to any particular case.  

It is a methodology of (A)  listing whatever medical evidence which was submitted by naming the doctors, thereby giving an appearance of a full and thorough review of the documents, and (B) selectively extrapolating statements made by the Applicant, the Supervisor, the doctor(s) and anyone else in attempting to undermine the conclusion that the statutory criteria for eligibility has been met.  In laymen’s terms, this is called, “Taking potshots” at something.  If meeting the criteria for eligibility is to show a sequence of connecting dots from point A to point B, then OPM’s view is that if there are enough potshots which sever the line between the points, then OPM has shown that a Federal or Postal employee is ineligible for Federal Disability Retirement benefits.  

This is the approach; it is up to the applicant who is preparing, formulating and filing a Federal Disability Retirement application under FERS or CSRS to ensure that any weak links in the line are sufficiently reinforced.

Sincerely,

Robert R. McGill, Esquire

OPM Disability Retirement: Spectrum of Medical Requirements

In considering a Federal Disability Retirement application under FERS or CSRS, a Federal or Postal employee must ask questions beyond the primacy of obtaining the necessary and proper medical care for treatment of one’s own medical condition.  Thus, evidentiary issues must be considered; issues of obtaining proper medical documentation; seeking the active support of a treating doctor, etc.  These are all “non-medical” considerations, which have little to do with the actual treatment and care of one’s medical condition, but have everything to do with preparing, formulating, and filing for Federal Disability Retirement benefits under FERS & CSRS.  

There is a distinction between the two (receiving the necessary medical care and preparing a Federal Disability Retirement application), and it is important to recognize the conceptual distinction, because the former can impact the latter.  For instance, on the spectrum of medical care (or refusal thereof) which can impact a Federal Disability Retirement application, refusal to undergo “facially reasonable medical treatment” can defeat a Federal Disability Retirement application.  

The question, of course, is how to interpret what constitutes “facially reasonable medical care”?  There are certain “obvious” ones, and then others which are not so obvious.  Normally, the Merit Systems Protection Board has held that refusal to undergo invasive surgery is not a bar to being eligible for Federal Disability Retirement benefits; on the other hand, refusing to take prescribed medications can, and often is, a bar to eligibility.  All else fall within the middle of the spectrum of such medical/legal requirements.  

Sincerely,

Robert R. McGill, Esquire

CSRS & FERS Disability Retirement: OPM May Say So, But…

I often wonder how many unrepresented disability retirement applicants there are who, having received a denial letter at the First Stage of the process of filing for Federal Disability Retirement benefits under FERS & CSRS, never file a Request for Reconsideration because they believe what the Office of Personnel Management stated in the Denial Letter.  Sometimes, I will get telephone calls from people who want to file, and during the course of the conversation, it will come out that they had filed a few years previously, and had been denied.  “Did you file a Request for Reconsideration, at the time?” I ask.  “No,” is the answer.  “Why not?” I ask.  The typical answer?  “Because I just thought there was no way to fight them on it.” 

I used to be amazed at such answers, but after some thought, it makes sense.  As an attorney, my first instinct (both trained and natural) is to always take something to the next level, with the firm belief that I will prevail just by pure persistence, and by using the law as “a sword” in the process of fighting for my clients.  But most people are not lawyers (some would say, thank goodness for that, we have enough lawyers in the world), and when the Office of Personnel Management writes up a denial letter, then allegedly cites “the law”, and makes bold conclusions such as, “You do not meet the eligibility criteria under the laws governing disability retirement…”  It all sounds convincing.  It all sounds like any further action will be an act of futility.  But just because OPM “says so” doesn’t make it true, doesn’t make it right, and certainly doesn’t make it unwinnable.  They may say you don’t meet the eligbility criteria; I would argue otherwise.

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