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

Medical Retirement for Government Employees: The Duration of a Medical Condition

In being eligible for a Federal Disability Retirement annuity from the Office of Personnel Management, one of the basic criteria which must be met for eligibility determination is that a medical condition, its symptomatologies and impact upon one’s ability/inability to perform the essential elements of one’s job, must last for a minimum of 12 months.  

As a practical matter, the medical condition normally lasts for much longer, and is quite often a chronic, progressively deteriorating condition.  If the medical condition is expected to last for a short period of time, then the Federal or Postal employee must seriously consider whether filing for Federal Disability Retirement benefits is “worth it”, inasmuch as it often takes 8 – 10 months to obtain an approval from the Office of Personnel Management for the First Stage of the process.  

As such, for most Federal and Postal employees who are contemplating preparing, formulating and filing a Federal Disability Retirement application under either FERS or CSRS, there is an implicit acknowledgement and understanding the the medical condition itself is one of chronicity, debilitating in nature, and often progressively deteriorating.  

The fact that a medical condition must last for a minimum of 12 months, however, does not mean that a Federal or Postal employee should wait for the 12 months to pass before filing for Federal Disability Retirement benefits.  That would, upon reflection, be a cruel absurdity — to have to wait for 12 months, then to file and wait about 10 months before the Office of Personnel Management makes a decision, and all of this, only at the First Stage of the process. No — the legal standard is that the medical condition must be “expected” to last a minimum of 12 months; meaning, thereby, that a doctor can normally make a reasonable prognosis as to the duration, chronicity and future behavior of the medical condition; and this can normally be accomplished soon after the identification of a particular medical condition.

Sincerely,

Robert R. McGill, Esquire