Federal and Postal Disability Retirement: Targeted Use of Collateral Evidence

Case-law from the U.S. Merit Systems Protection Board, as well as judicial opinions rendered by the U.S. Court of Appeals for the Federal Circuit, maintain the standard of acceptable proof for a Federal Disability Retirement case submitted to the U.S. Office of Personnel Management, for Federal and Postal employees under either FERS or CSRS.

The primary basis for a Federal Disability Retirement application is clear:  A medical condition which exists, which prevents the Federal or Postal employee from performing at least one, if not more, of the essential elements of one’s job; that a legally viable accommodation is not possible; that reassignment to another position at the same pay or grade is not reasonably feasible; that the medical condition will last a minimum of 12 months; and that the Federal or Postal employee must file for such benefits during the tenure of one’s employment as a Federal or Postal Employee, or within 1 year of being separated from Federal employment.

The core of one’s proof is generally based upon the treatment and opinion of one’s treating doctor.

Every now and again, however, there are “collateral” sources of proof which should be considered, and for various reasons, which must be relied upon for establishment of one’s eligibility for Federal Disability Retirement benefits.  Such proof may include: opinions rendered by Second-opinion or “referee” doctors in an OWCP case; percentage ratings provided by the Department of Veterans Affairs; SSDI approval determinations; separation from the Agency based upon one’s medical inability to perform the essential elements of one’s job; medical notes for FMLA; and even (sometimes, but rarely) a decision granting disability benefits by a private insurer; and other such collateral sources of proof.

Such proof, of course, should never replace the centrality of one’s own treating doctor, and further, should always be targeted and submitted with discretionary judgment.  Sometimes, it can be the “other evidence” which makes the difference in a case; other times, if used indiscriminately, can be an indicator of the weakness of one’s case.

Be careful; be targeted; use discretion.

Sincerely,

Robert R. McGill, Esquire

Federal and Postal Disability Retirement: The Proper Balance

Meeting and arriving at the “proper balance” in any endeavor is an Aristotelian concept found in his Nichomachean Ethics, of achieving a median between any two extremes.  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 ascertain, then apply, this concept of a “middle” balance between providing too much information (which then includes much superfluous content and documentation which merely provides volume, but not qualitative evidence of one’s Federal Disability Retirement eligibility), and not enough to meet the legal criteria.

By appearance alone (and here, of course, the philosophical outlook and distinction between that which is merely “appearance” as opposed to “substance” applies beautifully), it is sometimes necessary to provide a certain level of volume of medical records in order to satisfy OPM that there is indeed “substance” to one’s medical claim.

It is an unfortunate anomaly that, while on the one hand OPM is looking for “relevant” information, and much of the office and treatment notes of a doctor merely contain passing and quick notations on treatment modalities, medication regimens prescribed, etc.; nevertheless, the appearance of office notes, regardless of their irrelevant nature and lack of substantive content, accompanying a qualitatively significant medical narrative report, often satisfies OPM’s request for “documentation” of a medical condition.  On the other hand, too great a volume of immaterial medical documentation which tends to show nothing, should be streamlined, if possible.  Meeting that Aristotelian “median” between providing too much and too little is something which is discretionary, but important to attain.

It is normally through experience of having handled a volume of cases that one can gain a sense of what the “proper balance” means, but for the particular Federal or Postal employee who is preparing, formulating and filing for Federal Disability Retirement benefits from the U.S. Office of Personnel Management, such an endeavor is, and should be, the one and only time that such an encounter would be engaged in.

That, in and of itself, is a conundrum which can only be resolved by consulting someone who is knowledgeable in the area of Federal Disability Retirement law, and as knowledge of first principles is also an Aristotelian mandate, so consultation with those who are familiar with such first principles (or any principle which applies to OPM’s arbitrary approach, for that matter) should be a must for the Federal or Postal employee considering a Federal Disability Retirement application.

Sincerely,

Robert R. McGill, Esquire

OPM Disability Retirement: Remembering What “Supportive” Means

Over time, one’s memory and historical perspective becomes clouded and obscured.  In preparing, formulating and filing for Federal Disability Retirement benefits from the U.S. Office of Personnel Management, there is obviously a long and complex history of changes, amendments and refinements to the aggregate compendium of that which constitutes the totality of “the law” governing Federal Disability Retirement benefits.

Thus, since the initial inception of the enactment of statutory authority granting the U.S. Office of Personnel Management authority to approve Federal Disability Retirement benefits under CSRS (and later under FERS), there has been an evolution of statutory amendments, regulatory clarifications, case-law expansion, contraction and clarifications — the composite of which constitutes “the law” governing Federal Disability Retirement applications whether under FERS or CSRS.

Part of the evolutionary process includes what is termed “supportive” documentation or evidence, such as an Agency’s determination that the Federal or Postal employee cannot be accommodated; the Flight Surgeon’s decertification of an Air Traffic Controller’s medical clearance; a Law Enforcement agency’s conclusions that a Federal Law Enforcement Officer is unable to meet the physical requirements of his or her position; and many other agency determinations which “support” a Federal Disability Retirement application.  But “supportive” does not mean “primary”, and the Federal or Postal worker must always remember that such ancillary evidence must be in addition to the primary evidence submitted in a Federal Disability Retirement application.

Don’t mistake the support evidence as replacing the essential evidentiary component of a Federal Disability Retirement application, whether under FERS or CSRS. The primary evidence must always come first — both by definition, as well as by statutory requirement.

Sincerely,

Robert R. McGill, Esquire

 

Postal and Federal Disability Retirement: Providing Information

In every area of law, in most facets of life, and certainly in the administrative procedures of preparing, formulating and filing for Federal Disability Retirement benefits either under FERS or CSRS with the Office of Personnel Management, one must determine the extent, scope and substance of the information which will be provided to the requesting entity.  

Most of the time, the extent of information is pre-determined by the requirements which must be satisfied.  Similarly, the scope of the information to be submitted must meet certain criteria, but additionally, it will depend upon the question asked.  More importantly, the substance of the information one needs to provide, will be determined by the question asked, the criteria to be addressed, and the statutory and regulatory guidelines which must be met — in the case of Federal Disability Retirement under FERS or CSRS, that which would meet the legal standard of “preponderance of the evidence.”  

In venturing and maneuvering through the administrative process of applying for Federal Disability Retirement benefits, however, there will be times when either the Agency or the Office of Personnel Management may request “additional” information, indicating that they are not satisfied with what has been submitted.  

An appraisal of what information is being asked; whether the question is properly formulated as posed, or whether it can be reformulated and still satisfied; and the harm or good in responding fully or partially to the request — these are all determinations which are best guided by the advice and counsel of an attorney who understands the laws governing the legal criteria in Federal Disability Retirement cases.  

Not every question deserves a full answer.  Sometimes, the question itself must be re-formulated and answered in the re-formulated format.  Agencies are not gods; they are not omnipotent, and certainly not omniscient.

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

Federal and Postal Disability Retirement: Sufficiency of Medical Evidence

In meeting the eligibility criteria for Federal Disability Retirement benefits under FERS or CSRS, one must obtain the proper medical documentation, meeting a “preponderance of the evidence” burden of proof, such that it is more likely than not that you are entitled to Federal Employee Disability Retirement benefits.  

Whether a medical report and supporting documentation satisfies the eligibility criteria is based upon the subjective interpretation of the evidence presented.  By “subjective” is meant the following:  The reviewing Claims Representative at the Office of Personnel Management, while allegedly applying a 7-part legal criteria in making a determination of eligibility for each FERS or CSRS Federal Disability Retirement application, must nevertheless make an interpretive determination based upon the sufficiency of the medical evidence, and taking into account all other evidence.  

Indeed, often the interpretation of the statutory meaning which governs all Federal Disability Retirement applications is misunderstood and misinterpreted by OPM.  That being the case, how can one expect that OPM will “get it right” when reviewing and interpreting complex medical documentation?  For example, OPM will often cite as necessary that the medical evidence was not “compelling” enough; or, that the medical evidence presented did not show that it warranted the applicant’s “total exclusion from the workplace” — despite the fact that neither of these standards are required by law.  

The sufficiency of the medical documentation is the linchpin of a Federal Disability Retirement application.  As such, it must be prepared by the treating doctor by pulling together a compendium of multiple factors.  While it need not be compelling, one thing is for certain:  quantity versus quality will not meet the sufficiency test, and it is always better to have one excellent medical report, than numerous mediocre ones.

Sincerely,

Robert R. McGill, Esquire

Disability Retirement for Federal Workers: The Quantitative Approach

The problem with submitting a Federal Disability Retirement application under FERS or CSRS based upon the “quantitative approach” (submitting a voluminous medical file which, by the sheer weight, extent and thickness of the file, reveals the severity of the multiple medical conditions) is that it often fails to provide the proper bridge between the particular medical condition a Federal or Postal employee suffers from, and the impact upon the essential elements of one’s job.

Certainly, medical records, notes, diagnostic test results, etc., can provide a narrative delineation of one’s continuing medical conditions — but the question becomes, a narrative to what end?  The Office of Personnel Management will often review a large stack of medical documentation and simply conclude that there has been insufficient medical documentation, and further, that the medical documentation submitted fails to show that such conditions are severe enough to prevent one from perform one or more of the essential elements of one’s job. That is because the mere existence of a medical condition — no matter how extensive such medical conditions have required in terms of hospitalizations, testing, surgical or other procedures, etc. — is not enough to satisfy, by a preponderance of the evidence, the criteria applicable for eligibility for Federal Disability Retirement benefits under FERS or CSRS.

Remember, always use the golden rule:  quality over quantity.  And in a Federal Disability Retirement application under FERS or CSRS, quality means the bridging of that conceptual gap between the medical condition, and the essential elements of one’s job.

Sincerely,

Robert R. McGill, Esquire

Federal and Postal Disability Retirement: Other Processes

Does it make a difference to list that one’s Federal Disability Retirement case is also accepted by OWCP/Department of Labor as an “accepted case“?  Or that one has been deemed 90% disabled by the Veterans Administration — or, more to the point, that one has received a 100% unemployability rating?  How about having been approved for Social Security Disability Insurance benefits (SSDI)?  Aren’t these all “indicators” of a medical disability?

The short, uncomplicated answer is that, yes, such acceptance and approval by other agencies and sources can be indicators of a medical disability, and these findings can help you to enhance your chances with Office of Personnel Management (OPM).  The longer, more complicated issue, however, is how to divulge and inform the OPM about the “other” Agency, the acceptance, and the relevance of what an approval or an acceptance by another agency should mean to one’s Federal and Postal Disability Retirement application.

Unfortunately, there is no generic or universal rule concerning OWCP-accepted claims, SSDI approvals, VA determinations, etc., with respect to their relevance to an OPM Disability Retirement application.  Each case is unique; there is case-law which is applicable to each one, independent of the other; and because the criteria which governs each is different from any other, they must be dealt with in an independent manner.  This is not a reflection upon the individual filing for Federal Disability Retirement benefits under FERS or CSRS; this is more a reflection upon the asserted independence of each Agency from each other.

Sincerely,

Robert R. McGill, Esquire

 

OPM Disability Retirement: Tools to Use

I am often asked, when filing for Federal Disability Retirement benefits under FERS or CSRS, Will you use … ?  From the range of tools of evidence to use — including VA disability ratings, to OWCP “CA” forms, MMI ratings, Veterans Administration records, Second opinion doctor’s report, referee opinion report, letters from the Agency indicating unavailability of work; letters from the agency indicating the extent and limitation of willingness to provide for an “accommodation” (whether legally sufficient to rise to the level of meeting the definition of what it means to be an “accommodation” under the law), and multiple other tools — all of it is a matter of legal discretion.  

The general rule that I utilize is that, If it is helpful to my client’s case to prove to the Office of Personnel Management that my client’s Federal Disability Retirement application under FERS or CSRS will be enhanced and aided by the material, then I will use it.  The discretionary issue which the attorney representing an applicant for Federal Disability Retirement benefits is essentially to “match” the document or piece of evidence with the particular issues which must be proven, and that is a matter of carefully reviewing each piece of evidence in compiling a compendium of evidence which makes up the “whole”.  It takes time, patience, and sufficient legal knowledge to understand which issues are important in proving a Federal Disability Retirement case under FERS or CSRS to the Office of Personnel Management.

Sincerely,

Robert R. McGill, Esquire

Disability Retirement for Federal Government Employees: The Medical Records

Federal Disability Retirement under FERS & CSRS is essentially “connecting the dots” between one’s medical conditions (whether singular or multiple) and the impact of the medical condition(s) upon one’s ability to perform all of the essential elements of one’s job.  The treatment records, also, are helpful in the matter of connecting the dots, as the Office of Personnel Management will often request a copy of the medical records — evidence of treatment over the years — in order to ascertain the extent of the medical conditions claimed.  

This can sometimes present a problem, when a Federal or Postal employee has switched doctors, has quietly endured the pain of the medical condition with little or no treatment over the years, or where the doctor fails to annotate any legible or detailed notes in his or her treatment notes.  Normally, however, there is a consistency of evidence between treatment/office notes and the medical narrative which the doctor prepared; or, between the diagnostic results and the clinical findings and conclusions of the treating doctor.  Where there is a lack of medical records “backing up” the narrative report of the doctor, often a Functional Capacity Evaluation or an “independent medical evaluation” by a referral doctor will help a case.  As always, there are ways to counter the problems which arise, in order to meet the eligibility criteria as proposed by the Office of Personnel Management in a Federal Disability Retirement case.

Sincerely,

Robert R. McGill, Esquire