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

Federal Disability Retirement: “If Only They Understood”

Preparation of a paper presentation to the Office of Personnel Management must result in a product which is concise, effective and persuasive.  

The last term of the tripartite phrase, “persuasive”, is often the most difficult for the Federal or Postal employee, whether under FERS or CSRS, to objectively assess in a neutral, non-involved manner.  This is because the unrepresented Federal or Postal employee who attempts to prepare, formulate and file a Federal Disability Retirement application under FERS or CSRS is identical to the subject of the prepared application, and thus often has the approach and attitude of, “If only the case worker at the Office of Personnel Management knew what I am going through.”

Persuasion, the art of persuasion, and effective persuasion are comprised of a delicate balance between saying too little and overstating a case.  It is the ability to convey a state of facts which are confirmed by the medical records; involving a narrative which touches upon empathy, sympathy and a sense of pain or condition which the reader and recipient can somehow relate to; constrains ancillary issues which tend to detract from the central point of the narrative; and concludes with the idea that all of the “legal criteria” have been met.  

Obviously, it is through the power of words which such a persuasive Federal Disability Retirement application, submitted to the Office of Personnel Management, must be presented.  When the subject of the words is identical to the author of the words, the emotional turmoil is often mis-directed in the preparation of the Federal Disability Retirement packet.  

In the end, “if only OPM understood” — can become a reality if and only if the applicant understands first the objective legal criteria which must be met; then proceeds to meet those criteria in a systematic, detached manner; yet at the same time understanding the power of persuasion.

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

OPM Disability Retirement: The Simplicity of the Process

In becoming deeply involved in the morass of the bureaucratic process of preparing, formulating and filing a Federal Disability Retirement application under FERS and CSRS, it is often easy to become frustrated with the inherent complexity of the process.  

Because of the multi-faceted complexities of the administrative process (e.g., obtaining the proper format and language in a medical narrative report in order to meet the legal criteria for eligibility; creating and nexus between the essential elements of one’s position in the Federal Service with the symptomatologies of the interaction between the medical conditions and the essential elements; understanding and applying the various statutory authorities and legal precedents which have evolved over many years; of preempting — if necessary — statements by the Agency or the Supervisor; and multiple other issues to be addressed concurrently), it can be frustrating for an injured or disabled Federal or Postal employee to attempt to pull all of the intricate strings together into a singular yarn of coherency and succinct presentation of a narrative form.  

Such is the time to remind one’s self of the simplicity of the process — of the 3-part essence of a Federal Disability Retirement application which will ultimately be a paper-presentation to the Office of Personnel Management.  First, the medical narrative must be simple but concise, and must provide a proper bridge between the medical condition and why a Federal or Postal employee is unable to perform one or more of the essential elements of one’s job.  Second, one’s Applicant’s Statement of Disability must be consistent with the medical narrative reports — neither understated nor exaggerated, and guided by truth. And third, it is important to understand and apply the legal precedents, and use the law as what it is intended for — a tool for both a shield and a sword.  In life’s complexities, it is important to maintain a paradigm of simplicity.  Unfortunately, it is often the simplest forms which constitute the height of complexity.

Sincerely,

Robert R. McGill, Esquire