Medical Retirement Benefits for US Government Employees: Denials

Denials issued by the U.S. Office of Personnel Management in a Federal Disability Retirement application are informative in multiple ways; while based upon templates for the most part, they often make arguments which are neither based upon the legal precedents which currently prevail, nor on standards of proof which are applicable.

In preparing, formulating and filing for Federal Disability Retirement benefits from the U.S. Office of Personnel Management, whether under FERS or CSRS, the Federal or Postal employee is expected to submit a Federal Disability Retirement application based upon the standard of proof and legal requirements which are current, applicable, and relevant.

Yet, if a denial is issued by OPM — one that is based upon language which is clearly contravening the statutory standards of legal precedents — that requires things which are not truly required, then what does one do?

It is tantamount to proving a negative:  how does one prove that a murder did not occur?  Or that a man did not say something asserted to have been stated?  Or that one’s Federal Disability Retirement application does not contain “compelling” medical evidence, or here’s a better one:  “According to AMA Guidelines, you do not have more than a 5% permanent disability rating…”  What?  For OWCP purposes, that may hold some meaning or relevance, but for a Federal Disability Retirement application, it means absolutely nothing.

The answer to the question, What does one do?  What one must — go to the next level, with the proper legal tools in hand, to answer such nonsense.  Or, better yet, start at the first level with some preemptive legal arguments.

Sincerely,

Robert R. McGill, Esquire

Medical Retirement for Federal Workers: How to Use Percentage Designations

Carefully.  With discretion.  With an intelligent approach.  Not indiscriminately (a double-negative which, in common parlance, means “discriminately”).  Quantification of pain, of a medical condition, of a loss of use of one’s body functions, ability to have the manual dexterity of the use of one’s fingers, hands, arms; of the flexion and range of motion of shoulders, etc., includes a level of subjectivity at best, and at worst, possibly misrepresents the extent and severity of a disability.

Further, when quantification of the disability of a particular body part is further interpreted to represent a part of a greater whole — as in OWCP/FECA’s attempt to assign a percentage disability of the “whole person”, or when the Department of Veteran’s Affairs calculates a combined percentage rating which is not merely the addition of all lesser individual ratings — it needs some explaining.

In preparing, formulating and filing for Federal Disability Retirement benefits from the U.S. Office of Personnel Management, whether under FERS or CSRS, one should obviously utilize all of the available tools, evidence, compilation of documentary evidence, etc., all of which, in their combined entirety, could help to provide persuasive evidence in obtaining an approval from OPM in a Federal Disability Retirement application.  But use of those tools, how it is used, what is used, how it is explained, and whether the explanation is adequate, are all important keys to keep in mind.

OPM is an independent agency.  When you attempt to dictate an outcome based upon a decision of another agency, such an attempt will often appear to be a threat to the very independence of an agency; something which needs to be kept in mind.  What should be submitted is rarely an issue; how it is stated is always a concern.

Sincerely,

Robert R. McGill, Esquire

Federal and Postal Disability Retirement: Quantification v. Symptom Delineation

Different systems and processes require different standards of proof, criteria, and elements of qualifying evidence in order to be eligible and entitled.  Applying for, and getting approved, a Federal Disability Retirement application under either FERS or CSRS, requires that certain legal criteria be met. 

Quantification of a medical condition, although sometimes helpful in further expanding a descriptive narrative of a specific medical condition, is normally rather irrelevant in a Federal Disability Retirement case.  By “quantification” is meant the assigning of a number — of rating a person’s specific medical condition or relative to the “whole body”. 

Thus, in OWCP and VA Claims, there will often be a number assigned — 10% for X medical condition; a “combined” rating of 80%, etc.  One would expect that a high quantification of a medical condition would translate into a more serious appraisal of that medical condition, but various factors need to be considered when attempting to utilize such numbers in preparing, formulating and filing a Federal Disability Retirement application under FERS or CSRS.  Thus, for instance, a 10% rating upon a person’s foot may seem relatively insignificant when applied to a sedentary job, but for a person who must be on his or her feet all day, with requirements of constant standing, walking, etc., it becomes not only “significant”, but potentially a singularly viable basis for filing a Federal Disability Retirement application under FERS or CSRS. 

One must be careful in playing the “numbers game” in formulating, preparing and filing a Federal Disability Retirement application under FERS or CSRS.  Numbers never tell the full story, but they can be used to help describe and delineate the necessary requirements to be approved for a Federal Disability Retirement application by the Office of Personnel Management.

Sincerely,

Robert R. McGill, Esquire

Disability Retirement for Federal Workers: Utilizing those “Tools”

To the question, “What disabilities do you have?” or “What medical conditions do you suffer from?” — is often the answer, “I have reached MMI” or “I have been 20% permanently rated”, or even “I am being considered for unemployability”.  These are all good answers — in the proper context, in the proper forum, for the proper administrative procedures.  The old adage, “Everything in its place; everything in its time” becomes applicable in filing for Federal Disability Retirement benefits under FERS or CSRS.

While such rating decisions by other agencies and entities may be relevant for a particular purpose, within a specific context, for the purpose of the sought-after benefit from a Federal Agency, one must always understand that the administrative procedure known as Federal Disability Retirement under FERS or CSRS, for Federal and Postal employees who are impacted by one or more medical conditions, and who cannot perform one or more of the essential elements of one’s particular kind of job in the Federal or Postal System — that there are individualized rules, regulations and legal precedents.

While the tools used in one context, for one benefit, may be adapted and tailored for the Federal Disability Retirement process, the utilization of such tools must be independently assessed, and characterized in an effective, context-valid manner.

Sincerely,

Robert R. McGill, Esquire

 

FERS & CSRS Disability Retirement: The Reasonableness of the Governing Law

Without getting into too many comparisons, the laws governing disability retirement benefits are, upon reflection, actually quite reasonable.  Think about it this way:  yes, it doesn’t pay a great amount, but at the same time, you are encouraged to go out and be productive in some other employment capacity, and are able to make up to 80% of what your former job pays currently.

Unlike the stringent and onerous OWCP/DOL laws, you are not subjected to arbitrary, so-called “independent” medical examinations by doctors who make a substantial portion of their livelihood on rendering such “independent” second, third, and fourth opinions; your application is based upon what your own treating doctor says — not by some doctor who is a specialist in “disability ratings” or “disability determinations”.

This latter criteria is actually for the benefit of the applicant, when you stop and think about it.  For, if the law allowed for disability retirement applications to be determined by doctor’s opinions who are “disability specialists”, and not by your own treating doctor, then what would happen is that the entire disability retirement process would become a war between doctors and so-called specialists, overshadowing the one who should count the most — the treating doctor.

Instead, as the reasonableness of the present law stands, the weight of the medical determination is based upon the applicant’s longstanding treating doctor — and that is the way it should be.  For it is only a doctor who has enjoyed many years of an intimate doctor-patient relationship who should be granted the special weight and status that is accorded in disability retirement laws:  the special status of one who can make a viable, respectable determination of one’s employment capabilities, based upon the medical conditions he or she suffers from.  All in all, the disability retirement laws are governed by a criteria of reasonableness.

Sincerely,

Robert R. McGill, Esquire