Federal Employee Medical Retirement: Assumptions and Presumptions

At what point does a house of cards collapse, when based upon assumptions and presumptions?  The words are used interchangeably; the slight conceptual distinctions may be of irrelevant import to justify differentiation.  One can perhaps quibble that assumptions point more toward the conclusory stage of an argument, whereas presumptions often involve the prefatory issues in a logical sequence of argumentation.

Both engage suppositions not based upon “facts”; and, of course, there is the problematic issue of what constitutes facts, as opposed to mere assertions of events and opinions derived from such facts and events; with the further compounding and confounding task of sifting through what was witnessed, what was thought to have been observed, when, who, the intersection between memory, event, and sequence of occurrences, etc.

Presumably (here we go using the very word which we are writing about, which is rather presumptuous to begin with), Bishop Berkeley would have allowed for either and both to be used in order to maneuver through the world without bumping into chairs and tables which, for him, were mere perceptual constructs in the subjective universe of “ideas” in the heads of individuals.  And Hume, for all of his logical deconstructionism concerning the lack of a “necessary connection” between cause and effect, would assume that, in the commonplace physical world we occupy, presumptions are necessary in order to begin the chain of sequential events. Waking up and walking down the stairs to get a cup of coffee, one need not wait for the necessary connection between thought and act in order to begin the day.

For Federal and Postal employees who are considering filing for Federal Disability Retirement benefits, whether one is under FERS or CSRS, proceeding through the administrative morass of one’s agency and ultimately into the U.S. Office of Personnel Management, based upon the dual deterrents of assumptions and presumptions, can be a harrowing experience.  It is not the factual basis which defeats a Federal Disability Retirement application filed with OPM; rather, it is always the baseless presumptions and assumptions which kill the successful outcome.

Medical facts must be established; narrative facts about the impact upon one’s inability to perform the essential elements of one’s job can be asserted; but it is always the connective presumptions and unintended assumptions which complicate and confuse. Always remember that a narrative based purely upon presumptions and assumptions cannot possibly exist without the concrete adhesives of some foundational facts; like a house of cards, it waits merely for the gods of chance to blow a puff of unforeseen breath to topple the structure that was built without an adequate foundation.

Sincerely,

Robert R. McGill, Esquire

Medical Retirement Benefits for US Government Employees: The Watchmaker

Artisans are scarce in existence, these days.  With the constant drone for the economic push for profits, and the incessant pressures of everyday expenses, the village watchmaker, the goldsmith who personally fashions the engagement rings for the couple whom he saw just a moment ago playing outside his shop window as two children lost in the world of make-believe; that is a world we once read about, perhaps in a Dickens novel, of characters out of an era long lost and forgotten.

But the remnants of the characteristics evidencing quality and craftsmanship must survive, lest perfection be lost as a goal and exactitude no longer an achievement worth applauding.  Of course, there will always be cheap replicas; of digital watches manufactured en masse in factories where labor is inexpensive and the worth of human creativity barely given a moment’s glance.  That is why, when one comes upon a true craftsman, observing the care and skill being put into creating a product of worth is indeed something to behold.

And so it is in every endeavor.

For the Federal and Postal employee who must find, of necessity, that filing for Federal Disability Retirement can no longer be put off, it is well to heed the warnings of those predecessors who have experienced the nightmarish administrative procedures required in attaining the benefit.  While it need not take an artisan to put together an effective case, the approach one embraces should include the characteristics of that unique watchmaker:  care in the details; slowly building from a solid foundation; bringing together all of the variegated “parts”, including the medical documentation, legal arguments, effective factual statements, etc.

The Federal and Postal employee, whether under FERS or CSRS, needs to look at the process of preparing, formulating and filing for Federal Disability Retirement benefits as not only the presentation of the case, but the lasting impact of the finished product.  For, in the end, the true artisan creates not only a timepiece, but a timeless piece of work which should last well into a bright future.

Sincerely,

Robert R. McGill, Esquire

Postal and Federal Disability Retirement: The Volume-based Application

A declaration of the sheer volume of medical evidence submitted is often an indicator of the basis for which a Federal Disability Retirement application was formulated; for, in the end, if reliance of the successful outcome of a Federal Disability Retirement application is expected based upon the longevity and extent of a medical condition, the chances of an initial approval may be somewhat compromised to begin with.

Volume can never replace content; and from the perspective of the U.S. Office of Personnel Management, there is often an underlying suspicion that receipt of a thousand pages of medical documentation indicates merely that volume of treatment is being substituted for the substantive content of meeting the required legal standards.

Much of medical notation and treatment records merely reflect a particular appointment’s mechanical applications — continuation of previous treatment plan; refill of prescriptions; standard positive or negative responses to particular questions; prospective treatment modalities; and, as supportive evidence attached to a substantive medical report, they can reinforce the satisfaction of the legal criteria of establishing the necessary nexus between one’s medical condition and the inability to perform the essential elements of one’s job.  But left as a replacement for the doctor’s explicit statement confirming such a nexus, it remains a hollow voice within an expansive but empty chamber.

One should never mistake the legal distinction between “primary” evidence and “supportive” evidence.  The former is meant to establish the nexus between one’s medical condition and the essential elements of one’s job; the latter is submitted to reinforce the former.  When one utilizes the former as the substitute for the latter, it is like the self-delusion that just because you are the best player on a pick-up team in your neighborhood, you are ready to enter into the world of professional sports.

Sincerely,

Robert R. McGill, Esquire

Federal Government and USPS Disability Retirement: Excessive Reliance

In preparing, formulating and filing for Federal Disability Retirement benefits from the U.S. Office of Personnel Management, whether under either the FERS or CSRS system, it is never a good idea to proceed with excessive reliance (or any at all, for that matter) upon expected or presumed actions on the part of one’s Agency.

The preponderance of the evidence in proving an OPM Disability Retirement application is always upon the Federal or Postal worker, and one should affirmatively and pro-actively proceed without regard to what the Agency or the Postal Service will do, says it will do, or might do during the process.

Yes, the Federal Agency has its own OPM disability forms to complete; yes, the U.S. Office of Personnel Management does review the entirety of the OPM Federal Disability Retirement forms packet, including the standard forms which the Federal agency must complete, along with other personnel information that is forwarded to OPM.

But the crux and essence of a Federal Disability Retirement applications always remains the medical information gathered and submitted, along with the Applicant’s Statement of Disability, in conjunction with the asserted nexus constructed between one’s medical condition and the positional duties of one’s job.

Any other approach is merely to run a fool’s errand for a fiefdom from which one is attempting to flee.

Sincerely,

Robert R. McGill, Esquire

 

OPM Disability Retirement: Additional Supporting Evidence

In preparing, formulating and filing for Federal Disability Retirement benefits from the U.S. Office of Personnel Management under FERS, there is nothing to preclude one from attaching multiple supporting documentation in proving one’s eligibility for Federal Medical Retirement benefits.

In doing so, however, it is appropriate to keep in mind that the conceptual paradigm of “supporting” should be just that — it must be to assist, help, or otherwise enhance such evidence which constitutes the central component of one’s Federal or Postal Disability Retirement application.

Thus, “supporting” should not be the primary basis of one’s evidence, but rather, that which further enlightens and advances the primary documentary evidence.  For example, statements from co-workers, photographs, and similar supporting evidence can be provided to OPM, but only if –and as — it enhances the primary documentation, which should be comprised of medical documentation from treating doctors, specialists, referral consultative medical providers, etc.  Even ancillary supporting documentation — SSDI approvals, VA assignation of disability ratings, OWCP acceptance, OWCP second-opinion doctor’s reports, etc — should be viewed as “supporting”.

It is important, as an aside, to recognize that the OPM Case Worker does not, and will not, expend hours upon hours reviewing every piece of document one submits, and therefore it is important to streamline and provide an efficient, effective paper presentation.

Think about it this way as a guiding principle:  If you approach a file which is an inch thick, or one which is 8 inches thick, which do you tackle on a Friday afternoon?

Sincerely,

Robert R. McGill, Esquire

 

OPM Disability Retirement: Quality & Quantity of Medical Report

In preparing, formulating and filing a Federal Disability Retirement application under FERS or CSRS, it is often asked as to the quantitative sufficiency of the medical documentation to be submitted.

Qualitative sufficiency for Federal Disability Retirement applications, at least on a generic level, is an easy one to answer — the substance of the medical documentation must meet the legal standard of proof.  If the Office of Personnel Management or the Merit Systems Protection Board approves the Federal or Postal employee’s Federal Disability Retirement application under FERS or CSRS, then obviously both the quality and quantity of medical documentation met the standard of proof.  

But an answer based upon “after the fact” circumstances is rarely useful; the generic answer of, “Submit medical evidence such that it meets the legal burden of proof, of Preponderance of the Evidence”, might be well and good, but what does that mean?  

Ultimately, the reason why such questions as to sufficiency of medical documentary submission cannot be answered in a generic manner, is that each particular case is unique, and any imposition of a general rule is dangerous because, the moment the general rule is followed and violated (with a denial from the Office of Personnel Management), then the rule becomes obsolete and irrelevant.  

The quality of the medical documentation to be submitted must ultimately show to OPM that each of the legal criteria are met, and that there is a nexus between one’s medical conditions and the type of work that one performs.  

Quantity of medical documentation is ultimately determined by the quality of the medical narrative.  While generic in scope, the general approach is that one should submit only the extent of medical documentation sufficient to prove one’s case; and in each particular case, what that proof must consist of, is unique, particularized, and ultimately personalized to the individual Federal or Postal Worker who is preparing, formulating and filing a Federal Disability Retirement application under FERS or CSRS.

Sincerely,

Robert R. McGill, Esquire

Disability Retirement for Federal Workers: The Quantitative Approach

The problem with submitting a Federal Disability Retirement application under FERS or CSRS based upon the “quantitative approach” (submitting a voluminous medical file which, by the sheer weight, extent and thickness of the file, reveals the severity of the multiple medical conditions) is that it often fails to provide the proper bridge between the particular medical condition a Federal or Postal employee suffers from, and the impact upon the essential elements of one’s job.

Certainly, medical records, notes, diagnostic test results, etc., can provide a narrative delineation of one’s continuing medical conditions — but the question becomes, a narrative to what end?  The Office of Personnel Management will often review a large stack of medical documentation and simply conclude that there has been insufficient medical documentation, and further, that the medical documentation submitted fails to show that such conditions are severe enough to prevent one from perform one or more of the essential elements of one’s job. That is because the mere existence of a medical condition — no matter how extensive such medical conditions have required in terms of hospitalizations, testing, surgical or other procedures, etc. — is not enough to satisfy, by a preponderance of the evidence, the criteria applicable for eligibility for Federal Disability Retirement benefits under FERS or CSRS.

Remember, always use the golden rule:  quality over quantity.  And in a Federal Disability Retirement application under FERS or CSRS, quality means the bridging of that conceptual gap between the medical condition, and the essential elements of one’s job.

Sincerely,

Robert R. McGill, Esquire

Federal & Postal Disability Retirement: The Futility of Waiting for an Agency

In Federal Disability Retirements, the general rule is as follows:  waiting for your agency to act in some way that may prove to be beneficial to your case, is an act of futility.  Whether it is to wait for a performance appraisal; whether to see if the Agency will accommodate you, or not; whether you are waiting for a response from your Supervisor to see if he or she will support your Federal Disability Retirement application, etc. — in the end, a disability retirement application under FERS or CSRS is a medical issue.  It is not an “Agency Application for Disability Retirement”; it is not a “Supervisor’s Application for Disability Retirement”.  It is a medical disability retirement, inseparable from the Federal or Postal employee who is filing for the benefit.  As such, the proper focus should be placed upon the sufficient and substantiating medical documentation.  If the medical documentation, combined with the applicant’s statement of disability, are persuasive with respect to the correlative force of being unable to perform one or more of the essential elements of one’s job, then such a combined force makes all other issues essentially moot and irrelevant.  Don’t wait upon an agency to act; to act affirmatively without depending upon the agency is always the best route to follow.

Sincerely,

Robert R. McGill, Esquire

Federal Disability Retirement: SSA Approval, Part II

In order for an SSA approval to have an impact upon a Federal disability retirement application, the Social Security Administration’s decision letter granting benefits must provide a detailed explanation as to the basis for the approval, delineating the medical basis, the medical conditions upon which the decision was made, etc.  Thereafter, the applicant can submit the decision letter, but this is where it is important to have an attorney provide the proper legal & foundational argument — to provide the contextual applicability.

The legal basis, to start with, is found in Trevan v. Office of Personnel Management, 69 F.3d 520, 526-27 (Fed. Cir. 1995), in which the Federal Circuit Court found that in making a determination of eligibility for disability retirement, the Board (and thus, by analogy, OPM) must consider an award of SSA disability benefits together with medical evidence provided by the appellant to OPM, and other evidence of disability.  This is when an attorney’s tools of “argument by analogy” and pointing out the significant contextual language in an SSA decision letter comes in handy.  Next:  What if an SSA decision letter is not immediately forthcoming, or does not address the same medical conditions as that applied for in one’s disability retirement application?

Sincerely,

Robert R. McGill, Esquire

Common Mistakes in Filing for CSRS & FERS Disability Retirement II

Always emphasize quality over quantity of medical records & reports. A common mistake often made by unrepresented individuals is that he or she will ship off to the Office of Personnel Management a large packet of medical records, bills, appointment sheets, raw blood test results, etc. A potential applicant is always wise to try and look at it from OPM’s viewpoint: if you were a reviewer at OPM, which disability retirement application that is assigned to you would you look at on a Monday morning — the one that is 6-inches thick, or the one that is 1/2 inch thick? Further, untranslated raw test results rarely effectuate a positive response. Raw data that merely conveys numbers, unless interpreted by a physician as to the medical significance of such raw data, will not impress anyone at the Office of Personnel Management. It is the job of an attorney to use the tools of an attorney: effective and descriptive words, and to help the applicant to find the proper descriptive words to convey the serious medical conditions that he or she suffers from.

Sincerely, Robert R. McGill, Esquire