CSRS & FERS Medical Disability Retirement: Against Reason

One can put in all of the necessary and requisite effort into preparing, formulating and filing a Federal Disability Retirement application under FERS or CSRS, obtain a comprehensive medical narrative report with supportive office and treatment notes, verifying MRIs and other diagnostic evidence, follow the informational guidelines from various research sources — and provide a compelling case based upon rational and reasoned argumentation — and still get a denial from the Office of Personnel Management.  

This happens often enough, and one must conclude that, even when a Federal Disability Retirement application is prepared with the utmost of care and effort, a decision of denial can be issued against reason, or the reasons provided are selectively chosen and manufactured.  It is therefore well to understand the entirety of a Federal Disability Retirement process as necessarily involving multiple stages, with internal checks and balances to ensure the “fairness” of the administrative procedure.

Thus, the first two stages of the process (the Initial Stage; then the Reconsideration Stage) are internally reviewed by the Office of Personnel Management.  The Third and Fourth Stage of the process (an appeal to the Merit Systems Protection Board; a Petition for Full Review) may be considered as “administrative judicial review” stages.  Then, an appeal to the U.S. Federal Circuit Court of Appeals.  

Each stage allows for a “check” upon the other stages of the process, and by imposing the right of the disability retirement applicant to access such “checks”, it allows for the “balance” of the process — thereby (hopefully) negating and nullifying what may have initially been an irrationally-based decision.  

As Western Culture has a history of recognizing the power of rationality, it is well that an institutionalized process of “checks and balances” attempts to supersede legal decisions which go against reason.

Sincerely,

Robert R. McGill, Esquire

Medical Retirement Benefits for US Government Employees: Different Denials

After having formulated, prepared and filed a Federal Disability Retirement application under FERS or CSRS, the period of long waiting ensues with the review process of the Office of Personnel Management (having survived the waiting process through the Agency).  

At this initial stage of the application, the Federal or Postal applicant will be forced to wait (anxiously) for a decision by OPM.  Thus, when the Office of Personnel Management makes a decision at the First Stage, and that decision is a “denial” of the Federal Disability Retirement application, there is a spectrum of possible responses — immediate, emotional, angry, frustrated, etc.  

Instead, however, the proper response is to recognize that this initial denial is merely part of a greater process which involves many steps, procedures, responses and replies.  Indeed, part of the reason why a Federal or Postal employee feels the pressure and anxieties is because one tends to view the application process as a “one-time” deal — where submission of an application should be reviewed by OPM and an approval is granted.  This can be true — but should be viewed as merely an anomaly, and not the standard.  

While having a Federal Disability Attorney prepare the application for Disability Retirement should increase the chances of an approval at any level of the process, it is nevertheless first and foremost a process involving multiple steps and stages, with potential pitfalls and denials throughout.  Thus, a Federal Disability Retirement application may be initially denied, then responded to, then denied a second time at the Reconsideration Stage of the process, and require a further response.  

Different denials require different responses, not because they are not all part of the same process (I know, the double negative gives one pause), but because each denial is given by different departments and personnel at the Office of Personnel Management. Remember, one must prove one’s eligibility for Federal Disability Retirement benefits from the Office of Personnel Management, and proof means that there is the potential for an adversarial component of the process.

Sincerely,

Robert R. McGill, Esquire

Federal and Postal Disability Retirement: The Strategy of Disheartening the Opposition

When Federal and Postal employees who have filed for Federal Disability Retirement benefits under FERS or CSRS, and have been denied at the initial stage of the process, many are sincerely disheartened.

In my initial contact with the denied applicant, there are multiple levels of reactions, including:  the denial letter points to legal criteria which they were unaware of; it refers to doctors notations which are taken completely out of context; they have completely ignored major portions of what the doctor has stated; OPM points to legal criteria which has been met, but which OPM simply denies that it has been met.

What can be done?  This is the strategy of disheartening the opposition.

In other denials, it is simply a matter of referring to a doctor’s report here, and to a medical notation there; then to simply declare:  You have not submitted sufficient medical documentation and fail to meet the legal criteria to be eligible for Federal Disability Retirement benefits.  What can be done?  No explanation; just scant references, then a unilateral declaration.  Again, this is the strategy of disheartening the opposition.  What to do?  Don’t get disheartened.  Respond.

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

CSRS & FERS Disability Retirement: Denials II

It is, indeed, frustrating when a governmental agency makes life-impacting decisions which seem to be spurious and capricious. A review of a disability retirement application by the Office of Personnel Management is supposed to be thorough, with sound reasoning and a fair application of the law. And, in all fairness, the majority of cases appear to meet that standard. It may well be, of course, that since all approval letters of disability retirement applications are standard templates, with boilerplate language and instructions, and since most of my cases are approved at the first level, the impression left is that OPM does a good job in reviewing the cases.

When a case is disapproved, however, it is often the case that the denial is based upon factors which defy logic, which appear to have little or no rational basis, and which selectively focuses upon a narrow reading of the medical reports and records. Thus, often the OPM Representative will take a statement out of context, and declare that the doctor stated X when a full reading of the medical report shows that the doctor actually stated Y. This is unfortunate, and does not reflect the careful review, analysis, and fair rendering of a decision made by most OPM representatives, but occurs often enough to be of concern. On the bright side, however, is that there is always the ability to take it completely out of the hands of OPM, after a second denial — and allow an administrative judge to review it objectively, at the Merit Systems Protection Board. That is why the MSPB was created and exists — to have a third party, objective body review the decision-making process of the Office of Personnel Management.

Sincerely,

Robert R. McGill, Esquire