Federal Employee Medical Retirement: Deprogramming a Preconditioned Approach

The preconditioned attitude of the general public is that, if X has a medical condition, then such medical condition, by the very nature of the condition itself, will either entitle one to benefits, or not.  Such an approach is what one is conditioned to expect — that by the very nature of the medical condition itself, means that it will either lead to, or not lead to, a specified result.  This viewpoint and approach is based upon a definitional standard, where the very essence of what it means to suffer from X already predetermines whether one is eligible and entitled to benefit Y.

Social Security assumes such an approach.  To some extent, so does OWCP, because the Department of Labor is willing to pay a certain amount of compensation based upon a predetermined calculus of a percentage rating, for loss of limb, loss of use, loss of functional capacity, etc.

This is why Federal and Postal employees who first contemplate preparing, formulating and filing for Federal Disability Retirement benefits from the U.S. Office of Personnel Management, whether under FERS or CSRS, will attempt to tie the fact of having a medical condition with the question, “Does this qualify me for Federal Disability Retirement benefits?”  But that is the wrong paradigm to use in asking the question.  For, eligibility for Federal Disability Retirement benefits from OPM is not based upon a definitional ascription of a medical condition; rather, it is that “third element” — the connection between X and Y, X representing the medical condition and Y standing for the positional duties which the Federal or Postal employee must engage.

In many respects, Federal Disability Retirement answers the philosophical question which David Hume asked:  Is there a necessary connection between cause and effect?  For Federal Disability Retirement purposes, the answer is a resounding “yes”.

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

Disability Retirement for Federal Government Employees: The Realizing Process

By definition, a process entails multiple procedural steps.  Filing for Federal Disability Retirement benefits from the U.S. Office of Personnel Management encapsulates procedural administrative steps, and these include denials and appeals.

Yes, it is true that a certain percentage are approved at the first stage of the process.  Yes, it is also true that not everyone must go to the Second, or Reconsideration Stage of the process, or the Third Stage, the U.S. Merit Systems Protection Board.  But the fact that “not everyone” must be subjected to X, does not undermine, erase, or otherwise nullify the truism that it still remains a “process”, as opposed to an application for an entitlement benefit.

As a process, one’s Federal Disability Retirement application with OPM must be proven.  In order to prove a case, one must submit certain qualifying documentation.  As the U.S. Office of Personnel Management is the initial and secondary reviewer and determining agency for the first two stages of the process, so they have personnel of differing qualitative abilities — from pure incompetence, to indifference, to superior case workers who understand the full and complete application of the law, the regulatory criteria, and the statutory applicability of case-law interpretation.

Since it is the only process around, it is something we have to live with, and ultimately, follow.

Sincerely,

Robert R. McGill, Esquire

Federal Disability Retirement: Proof

This is a proof-based process.  It is not merely a matter of completing some forms and meeting procedural guidelines in order to obtain a benefit; rather, it is an administrative process in which evidence and documentary support from third parties must be obtained in order to meet the legal criteria imposed by statute, regulation, and ever-evolving case-laws as handed down by the Administrative Judges of the U.S. Merit Systems Protection Board, as well as the U.S. Court of Appeals for the Federal Circuit.

There are administrative processes which are “entitlements”, such as certain economic assistance programs, Social Security, Medicare, etc., where one has paid into a system, and upon reaching a certain age, or meeting income-qualification criteria, etc., such procedural guidelines are merely shown, met, and approved.

In preparing, formulating and filing for Federal Disability Retirement benefits from the U.S. Office of Personnel Management, however, it is not merely a matter of meeting procedural criteria (although that, too, is required), but moreover, one must prove by a preponderance of the evidence that one is eligible, by submission of substantial and adequate documentation that one cannot perform, because of a medical condition, one or more of the essential elements of one’s Federal or Postal job.

Proof is the lynchpin by which the standard of winning a Federal Disability Retirement case is won or lost.  Proof is a “must”.  As such, never consider filing for Federal Disability Retirement benefits as merely a matter of filling out paperwork; one must prove one’s case.

Sincerely,

Robert R. McGill, Esquire

CSRS & FERS Disability Retirement: Decisions during the Process

In making decisions during the process of filing for Federal Disability Retirement benefits under FERS or CSRS, it is obviously important to make the “right decision” at each stage of the process.  Thus, for example, if a person files for Federal Disability Retirement, at the first stage it is important to determine which medical conditions to identify and base the application upon; at the Second, Reconsideration Stage, it is important to first identify what substantive concerns which the Office of Personnel Management is proposing (in any given denial of a Federal Disability Retirement case, it is often not that obvious what the OPM Representative is actually stating), and how to go about rebutting and answering the concerns (as opposed to taking a “shotgun approach” and trying to answer each and every concern expressed by the OPM Representative), and further, at the Merit Systems Protection Board, it is vitally important to place all evidence, legal precedents, arguments and objections on the record, so that if the Administrative Judge in the case denies your claim, you have a legal basis to file an appeal.  As always, it is important to see the entire application submission, from beginning to end, as a “process”.

Sincerely,

Robert R. McGill, Esquire

Federal and Postal Service Disability Retirement: Each Level of the Process

Disability retirement, as I have often written about, is a process.  Each stage of the process has certain “requirements” which should be met — by “requirements”, I mean that each stage of the process (the Initial Application Stage, the Reconsideration Stage, and the Third Stage of the Process, a Hearing before an Administrative Judge at the Merit Systems Protection Board) has certain aspects of proof, certain methods of approaching the level of satisfying the burden of proof, etc.  There are, of course, the further stages of Appeal — at the Full Review at the MSPB, and the Federal Circuit Court of Appeals — but these appellate stages deal only with whether or not the Administrative Judge applied “the law” properly or not.

Thus, at the first three stages of the process, there is the necessary requirement of “winning” by submitting the proper medical and other evidence, to persuade the Office of Personnel Management and the Administrative Judge that your Federal Disability Retirement application under FERS or CSRS meets the legal criteria for eligibility.  This is the season for Reconsiderations; the Office of Personnel Management will often make many of its decisions just before Christmas, and just before the end of the year.  If an applicant under FERS or CSRS gets denied at the Initial Stage, just make sure that you hire an attorney who knows what he or she is doing, and isn’t just a “general practice” lawyer who is as blind as the next person, and will merely be one blind person leading the blind.  Each Stage of the process requires a level of expertise to meet the “requirements” necessary to satisfy that particular level; just make sure that you will be led by an attorney who not only knows what those requirements are, but further, knows how to meet those requirements.

Sincerely,

Robert R. McGill, Esquire