Medical Retirement Benefits for US Government Employees: Sounds Good

There are various stages of the administrative process designated and defined as “Federal Disability Retirement” — the initial application stage of the process, where one must attempt to prove by a preponderance of the evidence that one is eligible for Federal Disability Retirement benefits; if disapproved and denied, then the Reconsideration Stage of the process (where one may submit additional medical and other documentary evidence to persuade the Office of Personnel Management to reverse themselves); an appeal to the U.S. Merit Systems Protection Board, where the Federal or Postal applicant’s Disability Retirement application is taken out of the hands of OPM and transferred to an Administrative Judge, who will hear the case anew, without regard to what OPM has decided in the past; a further appeal to the Full Board of the MSPB in the event that the Administrative Judge issues an Initial Decision which affirms and upholds OPM’s denial of the case; and a further appeal to the Federal Court of Appeals for the Federal Circuit.

Throughout this process, and especially in the administrative stages before the Office of Personnel Management, one should make a distinction between “sounding good” and “being right”.  Hopefully, the Federal or Postal employee who has filed for Federal Disability Retirement benefits from the U.S. Office of Personnel Management, whether under FERS or CSRS, is both right and sounding good. But there is a distinction to be made.  For example, OPM will often — in their denial letter — “sound good” but be completely wrong on the law.  They will cite medical textbooks which skew the legal standard of review; creep into the discussion of a denial letter such terms as “no significant disability rating to speak of,” or that you don’t suffer from a disability which “incapacitates” you.  It all “sounds good”, but it is not true precisely because it is not the applicable standard of law to be applied.

At the initial stages of the process, OPM can get away with such nonsense, because most people don’t recognize the untrue and inapplicable standard of law being applied.  In the later stages of the process, however, when an Administrative Judge hears a case, it becomes important not only to “sound good”, but to also apply the right legal criteria.

Appearance versus reality — it is the argument of Western Civilization from the pre-Socratics onward.  As Alfred North Whitehead once observed, all of philosophy was already written by Plato and footnoted by Aristotle.  That statement both sounds good, and is indeed right on point.

Sincerely,

Robert R. McGill, Esquire

Federal Employee Medical Retirement: Proper Responses

A receipt of a denial from the Office of Personnel Management to a Federal Disability Retirement application under either FERS or CSRS is always an event which is upsetting to a Federal or Postal employee, but it is “part of the process” which occurs often enough.  

If it is a second denial (where a Request for Reconsideration has already been accomplished, and the Office of Personnel Management has denied it again), then the only appropriate response is to file an appeal to the Merit Systems Protection Board (no response is required, or even appropriate, to OPM, as it is out of their jurisdictional purview upon denying it a second time).  

If it is a “first denial“, then a “Request for Reconsideration” must be filed within thirty (30) days of the date of the denial letter (one can argue that the 30 days should be counted from the date of receipt, but it is always better to be on the safe side), and if requested, an additional thirty (30) days is automatically granted in order to have sufficient time to gather and submit further documentation to rebut and answer the denial from the Office of Personnel Management.

Submission of the Request for Reconsideration, and participation in the process of having the Office of Personnel Management reconsider the initial denial, is mandatory, not elective.  By this is meant the following:  You cannot bypass or skip the Reconsideration Stage and jump directly to the MSPB; you must first get a decision on the Request for Reconsideration before the Merit Systems Protection Board will consider your case.  

You cannot get angry or reactive and declare, “I will just file an appeal to the MSPB and have an Administrative Judge look at my case”.  You must patiently go through the proper channels of justice, and respond accordingly.

Sincerely,

Robert R. McGill, Esquire

Federal and Postal Disability Retirement: Beyond the MSPB

With certain notable exceptions (e.g., documents which could not be obtained prior to or during the Hearing; an SSDI approval which was awarded after the close of the record, etc.), the Hearing which is set for the Merit Systems Protection Board (better known by its acronym, the “MSPB”) is the time and place to prove by a preponderance of the evidence that a Federal or Postal employee is eligible to meet each of the legal criteria in a Federal Disability Retirement case.

MSPB Hearings for Federal Disability Retirement applications are performed telephonically; but beyond the time to submit all additional medical documentation and have any witnesses testify, it is the time to set the stage for a future Petition for Review (PFR) or an appeal to the U.S. Court of Appeals for the Federal Circuit. Any legal issues concerning the eligibility criteria, accommodations, sufficiency of medical documentation, etc., needs to be argued at this stage of the process, in order to be able to make the argument later that the Administrative Judge committed “legally reversible” errors in his or her Initial Decision on the case.  As with anything well-built, a solid foundation must be prepared, and in the arena of legal battles, the introduction of clear legal precedent is what establishes the foundation for a future appeal.

Sincerely,

Robert R. McGill, Esquire

FERS & CSRS Disability Retirement for Federal and USPS Workers: The MSPB

The Merit Systems Protection Board (better known by its acronym, the “MSPB”) is the third stage of the administrative process in attempting to obtain Federal Disability Retirement benefits under FERS or CSRS.  By this Stage, while the Office of Personnel Management has been both the “judge and jury” for determining one’s eligibility for Federal Disability Retirement benefits, the case is then handed over to an Administrative Judge to be the arbiter of such determination.

While it is advisable for a Federal or Postal Worker to obtain a FERS/CSRS Disability Attorney from the start of the administrative process, it is of even greater importance to consider obtaining proper legal representation before proceeding down the path of the MSPB.  This statement of advising any Federal or Postal employee to obtain proper representation at the MSPB is made for several reasons, not the least of which includes the following:  The MSPB is the last “stage” of the process in which a Federal or Postal employee who is seeking to obtain Federal Disability Retirement benefits may submit evidence in order to prove one’s case (with some special exceptions); any basis for an appeal, upon the chance that the Administrative Judge rules against you, must be established during the Hearing of the case at this stage; and since this stage is the arena of “the law”, it is important to be familiar with the most recent case-laws which govern Federal Disability Retirement.  The MSPB is not a place to feel one’s way through; it is the playground where the “grown-ups” play.

Sincerely,

Robert R. McGill, Esquire

Federal Worker Disability Retirement: MSPB & Prehearing

When a Federal Disability Retirement case has been denied by the Office of Personnel Management at the Initial Stage of the application process, and then again at the Reconsideration Stage of the administrative process, then it must be appealed to the Merit Systems Protection Board.  At that stage, the applicant (with the help of his or her attorney) must meet some crucial dates.  

While the Administrative process of having a Hearing before the Merit Systems Protection Board is fairly straightforward, once the Prehearing Statements are filed, it is important to participate in the Prehearing Conference with the Administrative Judge.  At the Prehearing Conference, it is important to define and limit the issues which will have to be proven at the Hearing of the case.  Issues such as accommodations and even the extent of the medical conditions which impact one’s inability to perform the essential elements of one’s job, can be clearly defined.  The individual (but more likely the attorney — because at this level, it is helpful to have the guidance of an attorney) should be very familiar with entirety of the Agency file (a copy of which OPM is required to provide after an appeal is filed with the MSPB).  This way, during the conversation with the Administrative Judge, one can say:  “Yes, Your Honor, that is already proven by document at Tab ____ of the Agency file, and need not be re-proven at the Hearing of the case.”  As with everything in life, preparation, preparation, preparation…

Sincerely,

Robert R. McGill, Esquire

OPM Disability Retirement: Opinions, OPM and Power

In filing a Federal Disability Retirement application under FERS or CSRS, one must always be aware of the distinction between the two — opinions and power — and apply it with that awareness in filing an application for Federal Disability Retirement to the Office of Personnel Management (OPM).  

There will be multiple opinions involved in any Federal Disability Retirement packet — the opinion of the medical doctor who is treating the applicant; the opinion of the applicant as to one’s ability or inability to perform some, which or all of the essential elements of one’s job; the opinion of the Supervisor or someone at the Agency on multiple issues, rendered in the Supervisor’s Statement and the Agency’s Certification for Reassignment and Accommodation; and the “opinion” handed out by the Office of Personnel Management as to whether all of the compendium of opinions, collectively gathered to present the evidence for approval in a Federal Disability Retirement application, constitute sufficient evidence such that it meets the preponderance of the evidence in proving one’s case.  It is thus helpful to understand that all of these identifiable propositions are all “opinions”.  

The one distinction, however, is that the opinion of the Office of Personnel Management carries with it the power of approval or disapproval, and so one may designate it as carrying more “weight” because it contains an inherent authority which all other opinions lack — that of the power to say yea or nay.  But remember that such power, fortunately, is not absolute, nor necessarily arbitrary and capricious, and there is ultimately an appeal process to have such raw power reviewed for viability and sufficiency.  That is why the validity and force of the “other” opinions is important to maintain — the medical opinion and the opinion of the Applicant — so that when it is reviewed by an Administrative Judge, the integrity of a Federal Disability Retirement application under FERS or CSRS may be properly adjudicated.

Sincerely,

Robert R. McGill, Esquire

Federal Employee Medical Retirement: The Connection between the Prehearing Statement and the Hearing

When a Federal Disability Retirement application under FERS or CSRS has been denied twice by the Office of Personnel Management, and one appeals the Federal Disability Retirement case to the Merit Systems Protection Board, there comes a point when the scheduling order requires that each side (the “Appellant” or the one who filed the appeal, and the Office of the Personnel Management) file a “Prehearing Statement”.  

Do not underestimate the importance of preparing a Prehearing Statement.  It is not simply a listing of the witnesses to be testifying at the MSPB Hearing; more than that, it is an opportunity to set the issues, to form in the mind of the Administrative Judge the parameters of what will be proven; an opportunity to proffer and plant the seeds of the evidence which will be presented; to undermine and preempt many of the arguments which are used customarily by the Office of Personnel Management; to argue for the Bruner Presumption (even if it does not strictly apply); and to show how, at this preliminary stage of the process, that the upcoming Hearing is really an unnecessary event.  Thus, the Prehearing Statement, as well as the Prehearing Conference, is an important preliminary step in setting the stage for success in a Federal Disability Retirement case.

Sincerely,

Robert R. McGill, Esquire

Federal and Postal Disability Retirement: Understanding the Doctor

A question I often ask the treating doctor at the end of a Hearing before an Administrative Judge at the Merit Systems Protection Board (obviously for Disability Retirement benefits under FERS & CSRS) is:  Do you have an opinion as to whether Mr. X/Ms. Y is a malingerer? The reason I ask such a question is to establish in the mind of the Administrative Judge, that after all of the clinical examinations, the treatment modalities, the diagnostic testing, etc., does the doctor have a personal opinion about the individual who is seeking to obtain Federal Disability Retirement benefits

Obviously, there are multiple questions which I ask as a follow-up; and, indeed, the question as to the status of the client/applicant requests a professional opinion about the patient — but implicit in that question is also a rather personal one.  It goes to the heart of who the patient/applicant is, and what the doctor believes about this particular applicant/patient.  For, to resolve any doubts about the underlying motive of the patient is not only important to the Administrative Judge in a Federal Disability Retirement application; it is equally important that the doctor is comfortable in his own mind, as to the clear and honest intention of his patient.  Conveying that comfort from the voice of the treating doctor to the ears of the deciding Judge, is no small matter.

Sincerely,

Robert R. McGill, Esquire

FERS & CSRS Disability Retirement for Federal and USPS Workers: The MSPB

The entire process of preparing and filing a Federal Disability Retirement application under FERS or CSRS should be accomplished with the view that it will end up at the Merit Systems Protection Board, being heard by an Administrative Judge.  This is why much thought and preparation should foreshadow each application.  There should be a running theme throughout the narrative which reveals the individuality of a person’s medical condition and how that medical condition impacts his or her ability/inability to perform one or more of the essential elements of one’s job

Truth should always be the guide; however, truth is always influenced by perspective.  It is the “perspective” of the Office of Personnel Management, in all Federal Disability Retirement cases under FERS & CSRS, to carefully scrutinize the narrative of the medical condition, impact upon the job, and the ability and inability to have the necessary connection between the two.  It is the perspective of the supervisor who will render his or her opinion based upon a limited knowledge and observation.  Perspectives must be questioned.  Thus, there is the opportunity for cross-examination at the MSPB level, which must be engaged in artfully and with care.  Each individual believes that his or her Federal Disability Retirement application is a “sure thing” at the First Stage of the process — until the reality sets in.  The reality, of course, is that every application must be prepared as if it is going to the MSPB, because it well might, and often does.

Sincerely,

Robert R. McGill, Esquire

Federal Disability Retirement Benefits for Federal & Postal Employees: Point of Necessity

Just as one should purchase insurance based upon the worst-case scenario, so one should generally prepare for anything in life with unexpected consequences in mind.  This is similar to the proper approach in preparing, formulating, deciding, and filing a Federal Disability Retirement application under FERS & CSRS.  People will often call an attorney only when he or she “thought it necessary”.  But who determined the point of necessity?  If the individual who determines the point of necessity is the same person who finds him or herself at the point of necessity, then it is often too little too late. 

Can most cases be reversed and won even after an initial denial?  Yes.  Can most cases be reversed and won even after a second denial at the Reconsideration Stage?  Yes.  Can most cases be reversed and won even after an initial denial, a denial at the Reconsideration Stage, then an adverse Initial Decision by an Administrative Judge at the Merit Systems Protection Board?  Perhaps.  How about thereafter?  You are then asking if, after all of the facts have been put forth, after all of the stages of consideration by the administrative process of filing for Federal Disability Retirement benefits, whether an error in the application of the law can be found.  Yes, at each state of the process, a Federal Disability Retirement application can be won; however, remember the the “point of necessity” is not best determined by the one who thinks it is finally necessary; it is often best determined by an experienced OPM Disability attorney.

Sincerely,

Robert R. McGill, Esquire