Medical Retirement Benefits for US Government Employees: Frameworks

To be successful in any endeavor, one must identify the relevant issues, sift through and discard the peripheral contents, and maintain a thematic thread throughout in order to keep the focus upon the essence of the project. Anyone who has attended a meeting which lacks a subject-matter focus, and where a free-for-all is allowed, without a circumscribed set of agendas, can attest to the importance of setting priorities and understanding the difference between points of significance and irrelevant detractions.

Frames are important, and sometimes as much as the painting itself.  For, art is merely a slice of the greater exposure to life, and it is the frame which distinguishes that parcel of perspective and allows the viewer to participate in a moment of time and a pause for reflection.  For the Federal or Postal Worker who is contemplating filing for Federal Disability Retirement benefits through the U.S. Office of Personnel Management, whether under FERS or CSRS, it is important to provide a “roadmap” to OPM, and thus circumscribe the framework of the relevant attachments, medical and legal issues to be evaluated, and the pathway to resolutions preemptively proposed.

Thus, the three tiers of an effective framework should include: (1) A clear and concise Statement of Disability (here, one must be careful because of the legal consequences of failing to include and fully describe the medical conditions), (2) A reference to the relevancy of the attached documents which support the statement, and (3) the pertinent legal foundations which are satisfied by the first two tiers.

He who frames the picture has the power to direct the viewer’s perspective; for, it is the frame which enhances the content of the artistry, and directs the appreciation to an irrelevant empty sky in a schematically unimportant corner of the painting, or to the central theme where the brilliance of bursting colors explode forth in magnificent reflections of a masterpiece’s slice of life.

Sincerely,

Robert R. McGill, Esquire

Postal and Federal Disability Retirement: Effective Negations

Why is it that some words are known primarily by their negation?  For example, we use the word “unfettered” to convey the meaning of freedom and release, but rarely see the usage of its non-negative form, as in, “He is fettered”.  Perhaps it is because we no longer approve of placing chains or manacles upon prisoners, and instead have become more civilized, with a concurrent alteration in the usage of the term for more genteel societies.

Often, it is the very negation of X — whether through minimization or leaving out completely that which we originally thought to be so indispensable — which makes for the effective case.  Thus, in a Federal Disability Retirement application through the U.S. Office of Personnel Management, whether under FERS or CSRS, the problem is normally not one of what to write about or how much to submit; rather, it is the editing process and the paring down and streamlining of a case which is the hard part.

Most people who suffer from a medical condition which has come to a crisis point where it prevents one from performing one or more of the essential elements of one’s job, are not at a loss for words or volumes of documents ready to submit.  But not everything which is material to a case is relevant, and in order to obtain a Federal Disability Retirement from the U.S. Office of Personnel Management, it is always best to streamline on the basis of relevance per statutory criteria.

Thus, we come full circle:  negation of a concept is often the most effective avenue of discourse; the un-negated bundle, left alone, may include too much baggage for the untrained eye.

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

Medical Retirement for Federal Workers: Relevance & the Intended Audience

Relevance within the context of a particular subject can branch out into parallel areas of substantive issues; thus, it may be “relevant” that in Set-X, subset a,b,c…w be included in the discussion of the  primary issue.  But relevance may not be the proper criteria to apply; rather, it may be important to consider the “intended audience” in an effort to tailor, streamline, and make succinct that which can become potentially unwieldy.

In a Federal Disability Retirement application submitted to the U.S. Office of Personnel Management, whether under FERS or CSRS, the compilation of the evidence needed in order to prove by a preponderance of the evidence that the Federal or Postal employee is eligible for Federal Disability Retirement, will necessarily involve the selective customization of the evidence to be presented.

One can argue, in compiling a case, that everything is “relevant” — from one’s history of a personal nature (which then resulted in one’s education, one’s background, how one came to become a Federal employee, etc.), to the historical genesis of one’s agency (to the extent that the Federal Disability Retirement applicant’s involvement and intersection with the agency came into being); and many other “relevant” facts.

By such logical connections, one can argue that every event which occurs around the world has some logically relevant connection to every Federal Disability Retirement application.  Obviously, such an approach would be absurd, and ultimately untenable.

How to temper the inclusion of all that is “relevant”?

Always keep in mind the intended audience of one’s submission.  Then, ask yourself the questions:  What is the intended audience seeking?  Will this information help or obfuscate the main point of my application?  Will the intended audience have the time to read through this corollary issue?  And many other similar questions.

Questions are asked not only to seek unknown answers; they are also pointedly applied in order to self-correct the potential pitfalls which the questioner may be advocating.

Sincerely,

Robert R. McGill, Esquire

Postal and Federal Disability Retirement: The Independence of Each Program

The disparate nature of each Federal program, with little to no intersecting coordination amongst them (with the exception of SSDI and FERS Disability Retirement benefits in the coordination of payments upon approval of each) betrays the unplanned, thoughtless creation of each program, as well as a sense that each agency wants to maintain its feudal control and assertion of independent power.

That perhaps explains, in part, why each program ignores the extent of persuasive authority the approval of another program should logically have, upon an approval and acceptance by the “other” program.  Does it make sense that being granted “unemployability” status under the Department of Veterans Affairs ascription of percentage disability ratings would only have a nominal impact upon a FERS Disability Retirement application?  Or that an SSDI approval would have, at best, a persuasive effect upon a FERS Disability Retirement?

It is somewhat more understandable that a case accepted by OWCP/Department of Labor would have minimal impact upon a FERS or CSRS Disability Retirement application, precisely because the former is set up as a program of rehabilitation in an effort to return the Federal or Postal employee back to his or her job.

The only true “coordination” of benefits occurs between SSDI and FERS — and that, only if both are approved, and payments are received concurrently; but even then, there are often overpayment problems, lack of the left hand knowing what the right hand is doing, etc.

Thus Coordination and intersection between departments, agencies and various programs rarely occurs.  Agencies tend to want to remain independent.

Such lack of coordination, however, does not mean that the FERS or CSRS Federal or Postal employee should not force a legal argument upon OPM when a significant finding is made by another agency or program.  For, in the end, it may not be the U.S. Office of Personnel Management which listens, but an administrative judge at the MSPB, or a 3-judge panel on the Federal Circuit Court of Appeals; in which case, a precedent will have been set, for all to (hopefully) follow.

Sincerely,

Robert R. McGill, Esquire

Medical Retirement Benefits for US Government Employees: The Balance of Information

In every submission of documentary evidence for a Federal Disability Retirement application, whether under FERS or CSRS, there is the need for discretionary decision-making.

Not every piece of information is relevant or necessary; volume of attachments does not make for sufficiency of substantive content; allowing for certain information to “speak for itself” is often more effective than a long-winded explanatory addendum; and the extent of irrelevant or unimportant information attached or included may well have a decidedly negative impact upon a decision, both in terms of questions raised as to the reason for inclusion of such material, and the detracting nature of such information from the centrality and essence of the submission.

Balance of information is always a consideration.  As time is always of importance, so is maintaining the acuity of attention upon the case worker assigned to review, evaluate and decide upon a case.  Streamlining; making certain that the focus is always upon the nexus between one’s medical condition and the ability/inability to perform one or more of the essential elements of one’s job; and the editorial process of discretionary inclusion of relevant material — these should be the final steps in the formulation and compilation of a Federal Disability Retirement application just prior to submission to the U.S. Office of Personnel Management, whether under FERS or CSRS.

Balance the information — always in favor of relevance, importance, and substantive content.  Fluff is best left to descriptive articulation in a fictional genre.

Sincerely,

Robert R. McGill, Esquire

Federal Disability Retirement: Quantifying Quality & Qualitative Quantity

In preparing, formulating and filing for Federal Disability Retirement benefits from the U.S. Office of Personnel Management, whether under FERS or CSRS, it is important to make discretionary decisions concerning multiple aspects of a Federal Disability Retirement application — including the volume, extent, nature, and quality of the medical documentation to be submitted.

Because it is the Applicant (the Federal or Postal employee who is submitting the application) who has the “burden of proof” — that burden which states that by a preponderance of the evidence, one’s Federal Disability Retirement application is more likely to be so than not so — it is therefore up to the Applicant to make determinations as to the quality and quantity of the medical documentation and any other relevant attachments.

Qualitative sufficiency is often a difficult measure to determine; quantitative significance is equally difficult — as in, how much is enough? On the one hand, to submit a thousand pages of medical notes, reports, etc., would probably be “too much”.  But a case which only includes 5 pages of medical reports and notes, while seemingly “too little”, can be more than sufficient if the quality of the records and reports is indisputable and irrefutable in determining that a Federal or Postal employee is no longer able to perform one or more of the essential elements of one’s job.

Ultimately, the discretionary decision will come down to a matter of experience — for it is based upon prior experience that one can make better decisions for the future.  To that extent, to be inrepresented in attempting to obtain Federal Disability Retirement benefits is obviously a disadvantage, because an unexperienced Applicant is merely entering into the arena of Federal Disability Retirement law based upon a “hit or miss” history of inexperience.

Sincerely,

Robert R. McGill, Esquire

Federal Employee Medical Retirement: The Relevant Medical Condition

In preparing, formulating and filing for Federal Disability Retirement benefits under FERS or CSRS, make sure that the medical condition which the Federal or Postal employee is listing, describing and delineating, including the symptoms and impact, etc., is “relevant” to one’s Federal Disability Retirement application under either FERS or CSRS.

Let me clarify with the following (outlandish) hypothetical:  A Federal employee has the job and positional duty of pushing a button with his right index finger once every 2 hours.  He suffers a horrendous injury to his left shoulder, left arm, left leg and left side of his body. Use of the left side of his body is nowhere described or required in his position description, and the Agency has never requested that he use the left arm, shoulder or leg, or any part of the left side of his body, in performing the essential elements of his job.  He prepares and formulates his Federal Disability Retirement application, describing the extent of his medical limitation of the left side of his body.  Result:  he is denied by the Office of Personnel Management because the relevance of his medical condition has not been established with respect to the essential elements of his job.

“Relevance” of a medical condition is essential to establish in a Federal Disability Retirement application. Now, had the Federal or Postal worker gone on to describe how the chronic and radiating pain from the left-sided injuries (taking the hypothetical one step further) impacted his ability to use his right index finger, and this was established through the medical opinion of his treating doctor, the case would have had merit and a basis for an appeal, argumentation, etc., would have been established.

But in preparing, formulating and filing for Federal Disability Retirement benefits under FERS or CSRS, it is important to understand and apply the basic principle in the Federal Disability Retirement case:  It is not just the medical condition which is at issue; it must encompass the relevance of the medical condition to the essential elements of one’s job.

Sincerely,

Robert R. McGill, Esquire

Federal Employee Disability Retirement: Discretionary Decisions

In preparing, formulating and filing for Federal Disability Retirement benefits under FERS or CSRS, there are obviously the “basics” which one must submit, in order to meet the legal standard of proof of preponderance of the evidence.  

Thus, submitting “adequate” medical documentation which formulates a nexus between the medical condition upon which the Federal Disability Retirement application is based, and the essential elements of one’s job; writing the descriptive narrative to complete the Applicant’s Statement of Disability (SF 3112A), and filling out the other standard forms in order to meet the minimum requirements, are deemed “non-discretionary”, in that one does not have the choice of filing such paperwork  — it is a requirement.  

However, certain other documentation can be designated and categorized as “discretionary” —  whether to include certain medical conditions, and therefore medical documentation which bears upon the particular medical condition; whether to include paperwork from one’s OWCP, Department of Labor filing; Veteran’s Administration ratings, findings, medical documentation; Social Security Disability paperwork; additional statements from co-workers; Private Disability Insurance paperwork, etc.  

“Discretion” implies freedom to act or not act, but the problem will often arise, “In what context”?  Discretion is a wonderful, liberating position to be in; acting effectively in a discretionary manner requires research, and knowing the relevant criteria to apply in making a proper decision; and an understanding of the laws governing Federal Disability Retirement in making the “right” discretionary decision.  

Using discretion in making discretionary decisions is the key to obtaining a positive discretionary determination from the Office of Personnel Management.

Sincerely,

Robert R. McGill, Esquire

Disability Retirement for Federal Workers: Different Benefits

In preparing, formulating and filing a Federal Disability Retirement application under FERS and CSRS, it is often thought that medical documentation obtained for one venue of eligible benefits (e.g., Worker’s Compensation or SSDI, or VA benefits) can be utilized in the pursuit of FERS or CSRS Disability Retirement benefits.  However, because the applicable criteria which each Federal program or benefit is different, one should always take care before submitting the same, or similar, medical documentation, for multiple and varied applications.  

It is not so much that such documentation cannot be deemed relevant for multiple purposes; rather, relevance is a relative concept, and while X can be relevant for A & B, it may only meet the statutory criteria for A but not for B.

Further, every answer to a question depends upon what the question is.  For FERS & CSRS Disability Retirement, the question always involves whether or not a Federal or Postal employee’s medical condition(s) prevents one from performing one or more of the essential elements of one’s job.  The question involving SSDI, VA Benefits or OWCP is a completely different one.  

However, a particular medical document may in fact cross the boundaries of relevance and address a specific issue or aspect of a question, and for that limited purposes, may in fact be “relevant enough” to be submitted.  Such submissions crossing boundaries, however, must be done with care and deliberation; for, while it may answer one aspect of a Federal Disability Retirement application, it could potentially raise multiple other questions which might have been best to leave alone.

Sincerely,

Robert R. McGill, Esquire