OPM Disability Retirement: The Non-nexus

Meeting an adequacy test may constitute sufficiency for some purposes, but not for others.  Thus, it may be enough in completing an FMLA form to have a diagnosis, along with answers to other questions on WH-380-E.  But mere identification of a medical condition via a diagnosis, along with a description of symptomatologies will not be enough to meet the sufficiency test in a Federal Disability Retirement application.

People often assume that having a medical condition in and of itself sufficiently explains the severity of one’s condition, and any implied “blank spaces” can be filled in by the mere existence of such a medical condition.  But Federal Disability Retirement, whether under FERS or CSRS, filed through, reviewed by, and approved or disapproved by the U.S. Office of Personnel Management, must be proven by a preponderance of the evidence that the medical condition itself prevents the Federal or Postal employee from performing one or more of the essential elements of one’s positional duties.

As such, the identification and description of a medical condition fails to comply with the adequacy standards in proving eligibility for Federal Disability Retirement benefits.  One must establish, through the conduit of a medical professional, the “nexus” or “connection” between one’s identified medical condition and the inability to perform one or more of the essential elements of one’s job.

The weight of the proof is upon the Federal or Postal applicant.

The foundation of such evidence begins with the identified medical condition, but in and of itself, it is a non-nexus — until it is squarely placed in the context of one’s official position and the duties required by one’s duties.  Thus, the non-nexus become the nexus-point when combined with the identification and description of one’s positional duties.

It is this realization of the step-by-step sequence of proof which constitutes adequacy and sufficiency of evidence, and one of which the Federal or Postal applicant for OPM Disability Retirement benefits must be aware.

Sincerely,

Robert R. McGill, Esquire

Disability Retirement for Federal Government Employees: Beyond the Diagnosis

The diagnosis of the medical condition in a Federal Disability Retirement case, either under FERS or CSRS, is merely the beginning point in preparing a case. As the Office of Personnel Management in Washington, D.C., is fond of repetitively pointing out, “The mere existence of a medical condition is not a basis for approval under Federal Disability Retirement laws.” While there may be some exceptions for certain severe medical conditions, the statement itself contains a truism which needs to be kept in mind throughout the process.  

Ultimately, in preparing a Federal Disability Retirement case, one must approach the entire process (a process, by the way, which is taking longer and longer to complete, as the backlog at the Office of Personnel Management is increasingly extending the wait-time) with a view towards bridging the two critical elements in any successful filing:  (A) the medical condition and (B) its impact upon one or more of the essential elements of one’s job.  It is that “connective tissue” between the two which must be the focus, and that is why the symptoms which manifest themselves from the origin (the diagnosis) is what must be discussed.  For, ultimately, while the diagnosis of a medical condition provides the basis for which a medical specialist may begin treatment on a patient, it is the symptoms/symptomatologies which provide the answer to the question in all Federal Disability Retirement applications under FERS or CSRS:  In what way does one’s medical condition prevent a Federal or Postal Employee from performing the essential elements of one’s job?  That is the critical question which must be answered, in order to have a chance at having one’s Federal Disability Retirement application approved by the Office of Personnel Management.

Sincerely,

Robert R. McGill, Esquire

Federal and Postal Disability Retirement: The Tailored Approach

By a “tailored” approach, it does not mean that it must be narrow and without flexibility.  Flexibility is important in a Federal Disability Retirement Applicant’s Statement of Disability (Standard Form 3112A).  For, if you tailor an Applicant’s Statement of Disability too narrowly, there are multiple unintended consequences which can occur — from being pigeonholed into a narrow disability (which can become problematic later on if you get a Medical Questionnaire for updated medical information); to being unable to provide supplemental medical documentation to prove your case because the additional medical documentation does not apply directly to an identified medical condition on the SF 3112A; to multiple other potentially problematic areas.  Thus, always make the distinction between a formally diagnosed medical condition from the symptoms which may be delineated.  Further, there does not have to be a 1-to-1 correspondence between diagnosis and symptom; rather, the symptomatology can interweave between the formal diagnosis and the experiential pain, discomfort or cognitive dysfunctions (especially for psychiatric disabilities).  By allowing for some flexibility, one leaves enough “wiggle room” without sacrificing a clear and concise tailoring of descriptive delineation.

Sincerely,

Robert R. McGill, Esquire

Federal and Postal Disability Retirement: Medical Conditions

In filing for Federal Disability Retirement benefits under FERS or CSRS, it is important to note that the Office of Personnel Management will often argue that the mere fact that a person suffers from a medical condition is not in and of itself a basis for granting disability retirement benefits.  So far as such a statement goes, the Office of Personnel Management is correct on the laws governing the eligibility criteria for Federal Disability Retirements (which is rare in and of itself).  Having a medical condition is not a sufficient cause in granting a Disability Retirement benefit.  As it is often argued in the world of philosophy, it is a necessary cause, but not a sufficient one.  In other words, one must indeed suffer from a medical condition (it is thus a “necessary cause”); however, suffering from a medical condition is not sufficient in and of itself to qualify for Federal Disability Retirement benefits under FERS or CSRS (it is not a “sufficient cause”).  One must, beyond having a necessary cause, prove that the medical condition is also the source and impact upon one’s inability to perform one’s job.  Thus, to the limited extent of its truth, suffering from a medical condition is indeed insufficient to obtain an approval from the Office of Personnel Management; it is not “proof enough” in and of itself.

Sincerely,

Robert R. McGill, Esquire

CSRS & FERS Disability Retirement: Diagnosis v. Symptoms

Is an official diagnosis important?  It certainly makes for a “clean” Federal Disability Retirement application under FERS & CSRS, and indeed, sometimes the Office of Personnel Management will question the validity of a Federal Disability Retirement application if a treating doctor equivocates on ascribing a clean, clear-cut diagnosis.  But, as they say in philosophy, and specifically in symbolic logic, while a medical diagnosis may be necessary, it is not sufficient.  That is, while a medical diagnosis is often necessary in order to easily identify the medical condition, it is not sufficient to get a Federal or Postal worker an approved Federal Disability Retirement claim.  This is because, beyond an official diagnosis of a medical condition, it is important to describe the manifestation of symptoms, and how those symptoms impact one’s ability to perform the essential elements of one’s job.  To that extent, it is analogous to the story of a primitive tribesman who feared having his picture taken, because to have one’s image captured was to circumscribe the essence of an individual.  Similarly, while a medical diagnosis identifies the “what” of a condition, it fails to show the endless “hows” of that condition — as in, how does it impact one’s job, one’s personal life, one’s sense of well-being, self-image, etc.

Sincerely,

Robert R. McGill, Esquire