CSRS & FERS Medical Disability Retirement: Some Basics

Federal Disability Retirement benefits from the U.S. Office of Personnel Management, whether under FERS or CSRS, is an administrative process which one must undergo if a Federal or Postal employee is medically unable to perform one or more of the essential elements of one’s position.

It is a benefit which is accessible only if proven; and proof must meet the legal standard of “preponderance of the evidence“, through a tripartite methodology:  Evidence of the existence of a medical condition; the nexus of that medical condition impacting upon one’s ability/inability to perform the essential elements of one’s job; and that such a medical condition(s) cannot be legally accommodated by the agency such that the Federal or Postal employee can perform all of the essential elements of the Federal or Postal job.

While the Federal or Postal employee has up until one (1) year from the date of separation from Federal Service to file for Federal Disability Retirement benefits, the proof of when the nexus formed between one’s medical condition and the impact upon the position of one’s Federal Service, must have occurred during the Federal Service.

These are just some basics of Federal Disability Retirement law; the complexity, of course, resides in the details, and it is always the details which provide the fodder for an OPM denial.

Sincerely,

Robert R. McGill, Esquire

Federal Worker Disability Retirement: Algorithms & Human Peculiarities

In maneuvering through the process of filing for Federal Disability Retirement benefits from the U.S. Office of Personnel Management, there are potentially multiple stages that one may encounter:  The First Stage of the process — the initial filing; if denied, one has a right to have the denial “reconsidered” by filing a Request for Reconsideration within thirty (30) days of the denial; if denied by OPM a second time, then one has a right to file an appeal to the U.S. Merit Systems Protection Board, before an Administrative Judge.

There are, beyond the three stages identified, additional appellate stages of the process, including a Petition for Full Review before a 3-Judge panel of the MSPB, as well as an appeal to the Federal Circuit Court of Appeals.

At each stage of the process, the Federal Disability Retirement application is reviewed and evaluated for sufficiency of proof and satisfaction of the statutory criteria for eligibility; and, moreover, a different person looks at the application at each stage of the bureaucratic process.

Thus, there is no singular algorithm — no application of a computer model which is identical across the board — in the evaluation of one’s Federal Disability Retirement application.  Instead, a different person reviews and evaluates the Federal Disability Retirement application at each stage.  This is probably a positive approach, and one which would be deemed “fair” by any objective standard.  For, while an application of a standard algorithm may be deemed objectively impersonal and unbiased, whereas human beings, in their inherently fallible nature may indeed possess biases and inclinations; nevertheless, it is the peculiarities of human imperfections which are still the trusted traits for procedural determinations.

That is why there is such a hue and cry over the increasing use of video replays and electronic line judges in sports; for some reason, we still trust in the human perspective, as opposed to the cold hardware of computers.  Perhaps, in our collective childhoods, we all became paranoid from watching HAL 9000 in Kubrick’s 2001:  A Space Odyssey.  A shivering thought.

Sincerely,

Robert R. McGill, Esquire

Federal Employee Medical Retirement: The Other 12-month Confusion

The other issue which may involve a 12-month period — aside from the Statute of Limitations, which allows a Federal or Postal employee to file for Federal Disability Retirement benefits within 1 year of being separated from Federal Service — is the duration of one’s medical condition.

Federal and Postal employees will often confuse the issue, and believe in error that they must suffer through a minimum period of 12 months before they can even begin the process of filing for Federal Disability Retirement benefits. This is an error either in the proper interpretation of the law, or through receipt of misguided information from third parties.  The law simply requires that a Federal or Postal employee filing for Federal Disability Retirement benefits from the U.S. Office of Personnel Management, have a medical condition which will impact him or her for a period of at least 12 months.

Practically speaking this would make sense.  For, since the bureaucratic process of preparing, formulating and filing for Federal Disability Retirement benefits from the U.S. Office of Personnel Management takes a minimum of 8 – 10 months for the entire process anyway, it would make no sense to have a medical condition which will be “cured” within that time frame, for a Federal or Postal employee to file in the first place.

The minimum requirement of the 12-month period can be easily addressed in the “prognosis” portion of a doctor’s statement.  Most doctors can prognosticate within a couple of months of beginning treatment, concerning the long-term duration of a medical condition; whether it is chronic, lasting, or likely permanent.

In preparing, formulating and filing for Federal Disability Retirement benefits from the U.S. Office of Personnel Management, knowledge equals the ability to overcome obstacles, and knowing the law will allow the Federal and Postal employee contemplating filing for Federal Disability Retirement benefits to possess the necessary tools to effectively manage his or her life and future.

Sincerely,

Robert R. McGill, Esquire

Federal Worker Disability Retirement: Application of a Neutral Legal Criteria

The application of law upon determination of a Federal Disability Retirement application is based upon a set of criteria which focuses upon the impact of a medical condition on the Federal or Postal employee’s ability or inability to perform all of the essential elements of his or her job.  Thus, it is different from other government programs or compensation benefits, in that it ignores such issues as causality or prima facie accepted medical diagnoses.

Indeed, one can have a serious medical condition and still be denied one’s Federal Disability Retirement application if one fails to show the nexus, or the impacting connection, between the serious medical condition and one’s ability/inability to perform all of the essential elements of one’s Federal or Postal job.  In that sense, the applicable legal criteria is neutral in its very essence:  first, the Office of Personnel Management should (obviously) apply the law in a “neutral” manner, without regard to the person who applies, or be influenced in any way by the agency; but, moreover, and more importantly, the law itself is neutral to the extent that it makes no judgment upon the medical condition itself — only upon the medical condition in conjunction with the impact to one’s ability/inability to perform the essential elements of one’s job.

As such, in preparing, formulating and filing for Federal Disability Retirement benefits from the U.S. Office of Personnel Management, whether under FERS or CSRS, the primary focus in attempting to prove this point — both from a medical perspective as well as from the applicant’s approach — should be to emphasize the connection between the diagnosed medical condition and the essential elements of one’s job, and not merely upon the seriousness of the former.  Only in this way can the neutrality of the legal criteria properly assess the viability and force of one’s Federal Disability Retirement application.

Sincerely,

Robert R. McGill, Esquire

Medical Retirement Benefits for US Government Employees: Time and Clarity

In preparing, formulating and filing for Federal Disability Retirement benefits from the U.S. Office of Personnel Management, whether under FERS or CSRS, two primary elements must be shown:  A.  That one suffers from a medical condition such that the medical disability prevents one from performing one or more of the essential elements of one’s job, and B.  That the medical condition will last for a minimum of twelve (12) months.  This second part of the requirement — the 12 month period — can bring about some interesting issues.

Despite the simplicity of what it requests in terms of information, the issue is often confused and confusing.  Federal and Postal workers contemplating filing for Federal Disability Retirement benefits will often wonder whether one has to be “out of work” for a period of 12 months before even filing (somewhat similar to SSDI, where one must be out of work for a specified period of time) — but that is not what the statute requires.  What is required is merely that the medical condition must have a duration of at least 12 months, and so a prognosis should suffice — i.e., if the medical condition suffered has lasted for 5 months, say, and the doctor provides a prognosis that it will continue for a minimum of 2 – 3 more years, and perhaps permanently, that should satisfy the legal requirement of a medical condition lasting for a minimum of 12 months.

On the other hand, when the doctor states that it has lasted since X date and will be a “permanent” condition, that should also satisfy the legal requirement.  However, OPM will often fail to comprehend what “permanent” means, and will deny a case based upon the fact that the “12 month period” has not been met.

Further, the issue of “when” a medical condition began is an interesting one, because if one goes too far back, then that may show that despite the medical condition, the Federal or Postal employee has been able to perform the essential elements of one’s job.  The question is thus not one of “when the medical condition began”; rather, the question is one of “when did the medical condition prevent one from performing one or more of the essential elements of one’s job.”

Clarity is the key, always, and when one is dealing with Claims Specialists at the U.S. Office of Personnel Management who are reading multiple files day after day, and confusing and confounding one with the other, making certain that the medical reports, legal arguments and Applicant’s Statement of Disability are clearly and concisely delineated, will help to guide OPM to a proper and successful decision.

Sincerely,

Robert R. McGill, Esquire

Postal and Federal Disability Retirement: Affirmative Proof

It is a single agency — the U.S. Office of Personnel Management, and specifically the Disability, Reconsideration and Appeals Division — which makes the determination on all Federal and Postal Disability Retirement applications.

It is not the agency (although the agency can provide some nominal assistance on some peripheral issues); it is not the U.S. Postal Service; it is not the Human Resources Department of the agency (the personnel of whom will often claim that they have processed “thousands” of such submissions and never had one rejected); and it is certainly not the H.R. Shared Services office of the U.S. Postal Service in Greensboro, N.C. — these are not the Federal or Postal entities which make a determination upon a Federal Disability Retirement application under FERS or CSRS.

In preparing, formulating and filing for Federal Disability Retirement benefits under either FERS or CSRS, it is the affirmative duty of the applicant — the Federal worker employed by a Federal agency; or the U.S. Postal Worker — who must prepare the case, formulate the content of the proof and arguments to be used; and ultimately file the case, either through the agency if the Federal or Postal employee is still employed or any separation from Federal or Postal Service has been less than thirty one (31) days; or, if the Federal or Postal worker has been separated from Federal Service for more than thirty one (31) days, then to file it directly with the U.S. Office of Personnel Management, and to do so within one (1) year of being separated from Federal Service.

The proof to submit must be affirmative — meaning, thereby, that it addresses each of the legal criteria necessary to be found “eligible” for Federal Disability Retirement benefits.  You cannot rely upon the agency, third parties or other entities to do this; it must be done by the particular “you”, or if the referential point is reversed, by the “I”, as in the Federal or Postal employee.

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: Criteria and Proof, II

In preparing, formulating and filing a Federal Disability Retirement application under either FERS or CSRS, it is important to pause in the beginning stages of the process, prior to “going down the road” of the long and difficult administrative process of preparing a Federal Disability Retirement application, to consider the conceptual distinction between a legal criteria and the proof which is needed in order to satisfy the eligibility requirements of the legal criteria.  

In this day and age when the “culture at large” believes that an individual who speaks the loudest, uses words which appear in form articulate, and in cadence of some eloquence, the reverberations to the legal community have been felt both qualitatively and quantitatively.  Lawyers are supposed to be word-crafters; lay individuals who have some inkling of “the law”, may have some competence in the legal arena, but in order to survive the multiple pitfalls which are inherent in any area of law, it is wise to consider “that which” must be proven, as opposed to the proof itself.  

It is thus important, in preparing to formulate a Federal Disability Retirement application under FERS or CSRS, to review the statutes which govern the eligibility criteria for Federal and Postal employees; to read through the regulations; to research the case-laws as interpretive devices which can expand, constrict or regurgitate the statutory authority as written, as handed down by Administrative Judges at the Merit Systems Protection Board; then, upon a thorough and competent understanding of the legal criteria applicable in a Federal Disability Retirement application under FERS or CSRS, to begin to gather the “proof” which is necessary in order to satisfy and meet the legal criteria.  

Only upon an understanding of the distinction between criteria and proof can one then proceed to gather the latter in order to satisfy the former.  Early distinctions made can clarify and avoid later confusions encountered; or, as the age-old dictum goes, being penny wise is preferable to ending up pound foolish (or some variation thereof).

Sincerely,

Robert R. McGill, Esquire

Federal Worker Disability Retirement: Criteria & Proof

In preparing, formulating and filing a Federal Disability Retirement application under FERS or CSRS, a two-step process (at a minimum) must be engaged in when compiling the foundational presentation of a Federal Disability Retirement application.  

First, a thorough reading, comprehension and understanding of the “what” in reviewing the criteria applicable for eligibility and entitlement to a Federal Disability Retirement application:  What does it say?  What is required?  What type of evidence meets the requirements?  And sometimes just as importantly:  What has previously failed to meet the requirements?  

Thereafter, once the conceptual framework of grasping and understanding the “what” of the process, and proceeding to gather the information requested in preparing and formulating one’s Federal Disability Retirement application under FERS or CSRS, then the pre-filing conceptual stage of the second-order should be engaged in:  “Whether”.  

Whether what is gathered is sufficient to meet the legal criteria necessary to be eligible and entitled to Federal Disability Retirement benefits under FERS or CSRS; whether it is either (or both) qualitatively and quantitatively sufficient to meet the legal criteria for eligibility.  The “whether” question is a much more universal one, in that it must encompass the full panoply and compendium of the evidence gathered.  Not that it cannot be supplemented at a later date (it can), although there are restrictions and limitations imposed by what is delineated on one’s Applicant’s Statement of Disability (SF 3112A).

Understanding the conceptual distinction between the “what” and the “whether” is an important mental exercise to undertake, if only on a superficial level of making one pause for a moment to consider whether the extensive effort one must endure will be worthwhile.  

It is better to take the necessary and sufficient time at the outset, than to find out after much effort has been expended, that both the “what” and the “whether” have been insufficient to meet the basic legal criteria for eligibility for Federal Disability Retirement benefits under FERS or CSRS from the Office of Personnel Management.

Sincerely,

Robert R. McGill, Esquire

Disability Retirement for Federal Workers: SSDI Impact

In preparing, formulating and filing a Federal Disability Retirement application under FERS (CSRS individuals are exempted for this particular issue), the Federal or Postal employee who is contemplating filing for the benefit must at some point in the process file for Social Security Disability benefits (SSDI).  This is because the law is set up for an off-setting feature between the two “pockets” of benefits — where, in the first year, there is a 100% offset between FERS & SSDI, and a 60% offset every year thereafter.  

In some rare instances, Social Security will approve a person’s disability application before the Office of Personnel Management has approved a FERS Disability Retirement application.  In that instance, one can use the SSDI approval as “persuasive” evidence to the Office of Personnel Management.  It is not determinative evidence, but there are legal arguments to be made which essentially state that, since a person has been found to be “totally disabled” by the Social Security Administration, based upon the same or identical medical evidence and documentation, that the Office of Personnel Management should grant a FERS Disability Retirement application based upon the same or identical medical evidence.  

Is the reverse true?  If a FERS Disability Retirement application is approved, can such an approval be used as evidence — persuasive or determinative — for an SSDI application?  That would be a weaker argument, precisely because OPM Disability Retirement does not make a determination of total disability, but rather, a decision that the Federal or Postal employee cannot perform one or more of the essential elements of one’s particular kind of job.  Moreover, the Social Security Administration might also argue that inasmuch as SSDI does allow for some earned income (about $1,000 per month) from a job, such allowance shows that approval of a FERS Disability Retirement, which recognizes that one is merely disabled from performing one or more of the essential elements of one’s particular kind of job, should not be determinative of a Social Security criteria which requires a higher standard of disability.

Knowing what impact each aspect or element of a process will have upon another is an important step in preparing, formulating and filing a Federal Disability Retirement application. As knowledge is the source of success, utilization of such knowledge is the pathway to an approval in a Federal Disability Retirement application under FERS and CSRS.

Sincerely,

Robert R. McGill, Esquire