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

Federal Disability Retirement: The Syndrome of, “I Can’t Understand It”

In all aspects of life, both professional and personal, it is easy to get stuck in a rut where one cannot walk away from a particular irritant.  

In preparing, formulating and filing for Federal Disability Retirement benefits under FERS or CSRS, one cannot afford to engage in the luxury of pausing for too long in attempting to understand the reasoning, rationale, or alleged justification for a denial of a Federal Disability Retirement application under FERS or CSRS, as issued by the Office of Personnel Management.  

It is easy to get caught up in attempting to “figure out” the foundational basis of an OPM denial.  One can get stuck in a self-pity mode of asserting to one’s self that everything had been carefully gathered; the medical documentation was impeccable and irrefutable; even the Agency supported the Federal Disability Retirement application by acknowledging and conceding the fact that (A) the Federal or Postal employee’s medical documentation was of a severity such that (B) it prevented him or her from performing one or more of the essential elements of one’s job.  

Yet, while listing each of the medical evidence and recognizing the extent of the symptomatologies, the prior surgeries, the medication regimens, etc. — despite all of that, the concluding sentence by the Office of Personnel Management states:  “We cannot determine by the evidence presented that you are disabled under the law,” or, “The medical evidence submitted is insufficient to meet the criteria for Federal Disability Retirement purposes.”  

What?  However, it is best to simply “move on”.  

It does little to no good to remain entrapped in the syndrome of, “I can’t understand it,” because that same syndrome inevitably leads to, “I am going to waste my time trying.”  Extract what can rationally be understood; present updated medical information; prepare the best and most compelling legal arguments, and prepare for the long haul of the legal administrative process.

Sincerely,

Robert R. McGill, Esquire

FERS & CSRS Disability Retirement for Federal and USPS Workers: Office Notes

The Office of Personnel Management, in reviewing a Federal Disability Retirement application under either FERS or CSRS, will often request to see the doctor’s office/progress notes, detailing the history of treatment for the previous 18 months.

Such scrutiny of clinical notations made by the treating doctor is meant to verify and validate the statements made by the doctor in his or her medical narrative report, to see if there are internal contradictions between the clinical notes and the narrative report prepared for purposes of obtaining Federal Disability Retirement benefits.  Such a review of clinical notes can be an unfair process, precisely because they are being reviewed with a paradigmatic purpose in mind:  to “find” any inherently contradictory remarks or evidence which conflicts with statements made in the primary medical report.  

Thus, reviewing the medical notes in a vacuum, outside of the context of the entirety of treatment, and with the intention and motive of seeking out any “discrepancies”, will sometimes result in a denial based upon selective interpretation of the office/progress notes.  Statements such as, “medications are helping”, “patient notes feeling better”, “Is sleeping much better”, can provide a false picture of the actual progress of the Federal Disability Retirement applicant.  Indeed, such a skewed picture will often come up in the denial letter issued by the Office of Personnel Management, where the denial letter will selectively quote from the progress notes.

This reminds one of a particular case where the Office of Personnel Management quoted from clinical notes, statements made by the applicant:  “Feeling much better”; “Making great progress”; “overall doing very well.”  The problem, however, is that the applicant was permanently in a wheelchair, and the job was that of a Law Enforcement Officer.  It was denied at the Initial Stage; at Reconsideration, when the pertinent facts were pointed out to OPM, it was quickly approved.

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

Federal and Postal Disability Retirement: Resisting Tendencies

In filing an application for Federal Disability Retirement benefits under FERS or CSRS, there is a tendency to assuming that the Federal Agency will be providing a complete, fair, impartial, and thorough review of one’s application, and that one’s disability retirement application will be applied in accordance with the law.  Such a tendency to expect a certain level of competence and impartiality is certainly understandable; but the reality is far from the tendency of such expectation.

There are many factors which interfere with such expectations: the competency of the assigned OPM representative; the knowledge (or lack thereof) of the individual Representative; the caseload; and multiple other factors. Thus, when there is the false expectation that one’s Federal Disability Retirement application has been fully reviewed and the entirety of the law has been taken into consideration, there is a tendency to believe what the Office of Personnel Management has said as gospel truth.  “There is insufficient objective medical evidence to…”   “The MRIs failed to reveal that…”   “Your doctors failed to state that…”

These are all generic statements that may or may not be true, but sound like they provide a basis for a denial.  Resist the tendency to believe what OPM says; ultimately, a Federal Disability Retirement application must comply with the laws which govern the administrative process, and may well have to go to an administrative judge to prove the issue.

Sincerely,

Robert R. McGill, Esquire

FERS Disability Retirement for Federal and USPS Workers: Selective Reality

The problem with an unrepresented Federal or Postal employee who files for Federal Disability Retirement benefits from the Office of Personnel Management, is that because this is the one and only encounter with OPM, any response from them will be a narrow, one-dimensional perspective.

Thus, if the Office of Personnel Management denies the Federal or Postal disability retirement application, such a denial, the manner in which it is written, the content, the apparent delineation of “the law”, and the loosely-stated declarative statement while vaguely referring to the insufficiency of one’s medical documentation, will result in a narrow perspective, in a vacuum of reality created by OPM.

OPM’s denial letters are notorious for its selective reality.  Such selective reality will completely ignore all medical statements which seem to support the OPM disability retirement application, while selectively focusing upon every tidbit of medical notations which favor the denial.

Thus, be careful if on any given day, you arrive at the doctor’s office and the doctor asks you how you are feeling, and you respond with, “I’m feeling pretty good, today.”  Such a conversational statement may nullify the fact that, in its proper context, what the reality of your statement meant to convey was:  “I’m feeling better today in comparison with yesterday and the entire month before, but in no way could I perform my job even today.”  But OPM will selectively pick upon that one statement, and run with it — to a complete and total basis in denying your Federal Disability Retirement application under FERS or CSRS.

Sincerely,

Robert R. McGill, Esquire