Federal Employee Disability Information: OPM’s Methodology

There may be a single criteria to meet, with subsets of requirements that must be complied with; yet, multiple methodologies in approaching the singular.  How can that be?  Isn’t it all simple, where you read what is required, then gather up all of the evidence that appears to meet it and simply send it all in?  That is the “volume methodology”.

Can a single sentence in a medical report ever meet the legal criteria in an OPM Disability Retirement case — i.e., a “qualitative” methodology, as opposed to a quantitative one?  Sometimes.

Isn’t the law clear in what is required, and isn’t it a matter of just amassing the medical evidence to meet the requirements as stated?  Hmmm…. For Federal employees and U.S. Postal workers who suffer from a medical condition such that the medical conditions prevent the Federal or Postal employee from performing one or more of the essential elements of one’s Federal or Postal job, it is important to understand, somewhat, OPM’s Methodology in reviewing and deciding upon a case.

First of all, not all medical conditions are equal.  Perhaps that is self-evident, but for the Federal or Postal employee who suffers from one or another medical condition, and must endure the daily pain, restriction and limitations imposed thereby, it may not be so self-evident.

Second, OPM is not some “neutral” Federal Agency that reviews a Federal Disability Retirement application with dispassionate objectivity, ready to grant an “approval” because you “believe” your medical evidence is “sufficient” to meet the legal requirements as stated.  Sufficiency is the gatekeeper that denies many a Federal Disability Retirement case — and it is not a methodology that is satisfied by quantitative (volume) means, not even necessarily by qualitative standards; rather, it is the reviewer (i.e., the “Medical Specialist” at OPM) who determines by some unknown and unknowable standard when the goal-post has been crossed.

Thus, in an OPM Disability Denial Letter, one may read a reference to one’s doctor’s note or a quotation from a medical report from one’s doctor, and think, “Good, this is very supportive” —then, with an appended end to the paragraph stating, “Such medical evidence does not sufficiently meet the standards to qualify for OPM Disability Retirement”.  Huh?

Think about it this way: “Sufficiency” may mean different things to different audiences; for example, what is a “sufficient” amount of food for a lion, as opposed to a domesticated kitten?

OPM’s methodology is, at best, malleable, as language in law is likewise changeable.  It is good to know this for Federal and Postal employees who are either getting ready to file for Federal Disability Retirement benefits, or who are in the middle of a fight to obtain it; for, in the end, consulting with an OPM Disability Retirement lawyer allows you to arm yourself with knowledge for the battle that OPM’s Methodology in determining Federal Disability Retirement cases must be prepared, like any legal battle that involves “criteria” to be interpreted.

Sincerely,

Robert R. McGill, Esquire

 

CSRS & FERS Disability Retirement: OPM’s Generic Denial

Often, cases are mishandled not because of the “present” mistake, but because the case was never prepared for the “long-term” event.  Let me elaborate and explain. Obviously, an applicant for disability retirement benefits under FERS & CSRS wants to win the case at the earliest stage of the process.  The attorney who is handling any such disability retirement case, similarly, would like to “win” the case at the earliest stage possible.  However, sometimes that is simply not going to be the case. 

In an initial denial, it is often important to not only address the case for the Reconsideration Stage, but also to prepare the case for the next stage — the Merit Systems Protection Board (and, similarly, in preparing an application for Disability Retirement, it is important to prepare such an application not only for the initial review at OPM, but also for the Reconsideration Stage).  By this, I mean that, because there is at least a “possibility” that the disability retirement application will be denied again at the Reconsideration Stage, it is important to point out the deficiencies, the lack of clarity, the inadequate reasoning, the outright lies and mis-statements which the Office of Personnel Management may have engaged in as part of the “Discussion” Section of the denial letter.  Often, while OPM may give some “lip-service” to make it appear as if your case was thoroughly reviewed, a closer reading (on second thought, it need not even be a closer reading) clearly shows that OPM did a shabby job in denying a case.  It is what I ascribe as OPM’s “generic denial” — a denial so devoid of any particularity or care as to reveal a complete lack of proper administrative review of the case.  Such lack of proper administrative review is what needs to be shown; it needs to be shown because, if OPM denies the case again, then it is advantageous to the applicant to have the Administrative Law Judge at the Merit Systems Protection Board see that he will be hearing a case which may not have been necessary — but for the lack of diligence on the part of OPM.

Sincerely,

Robert R. McGill, Esquire

CSRS & FERS Disability Retirements: The Office of Personnel Management

I once heard a pastor make a rather unremarkable statement, but profound nevertheless in its simplicity and truth: “Where there are people, there are problems.” To assume that an Agency will make a proper, objective and legally sufficient decision all the time, most of the time, or even more often than not, is probably asking too much. The Office of Personnel Management, as with any Agency, is an entity — a large bureaucracy — made up of “people”. Yes, there are laws governing disability retirement; yes, there are rules, regulations and “criteria” which form the foundational basis for the “decision-making” part of evaluating each disability retirement case; but more profoundly, there are “people” who review, interpret, and apply those rules, regulations, and legal criteria in determining the final outcome: approval or disapproval of a claim.

That is why it is important in “how” a case is presented, as much as “what” it is that is being presented. With people, there are personalities; with personalities, there are variances in how any given OPM person reviews a case and makes a decision, from one to another. Where an attorney can be most helpful, is to “elevate” a case out of being merely one case among many, to making a presentation of a case on three fundamental levels: (1) the seriousness of the medical condition, (2) the legal sufficiency of the disability retirement application, and (3) persuasion by argumentation that it would be a mistake — a misapplication of the legal criteria — to disapprove a disability retirement application. All in all, this comes down to one profound issue: Where there are people, there are problems; and where there are problems, it is often a good idea to make the best presentation possible, at the outset of a disability retirement case.

Sincerely,

Robert R. McGill, Esquire

OPM Disability Retirement: Future Perspectives

People often act without forecasting prospective issues. In filing for disability retirement, it is important to take into account the emphasis and basis upon which one files for Federal Disability Retirement, because when an approval is given by the Office of Personnel Management, OPM identifies the specific medical disability upon which they granted the approval. As such, it is important for the applicant to base the application upon the medical condition/disability, in the sequence of importance, the most serious to the least serious.  This is important not only for purposes of winning disability retirement cases, but further, with a view to the future:  when the random Medical Questionnaire is sent to a disability retirement annuitant, if the medical condition upon which you were approved for was a minor, “least serious” medical condition, then 5 years or 10 years down the road, it may well have “resolved”, which puts you in danger of losing your disability retirement benefits.  This is why it is important to have a view to the future, and guidance and advice from an attorney is important in securing that future investment.  For, ultimately, obtaining disability retirement benefits which could potentially be the primary source of income for the next decade or two, is an investment for the future.

Sincerely,

Robert R. McGill, Esquire

Federal Disability Retirement & the Reconsideration Process

In the process of applying for Federal Disability retirement under FERS or CSRS, it is the “hope and wish” of each applicant that it will smoothly sail through at the initial stage of the application. However, the reality of the process is that a certain percentage of applications get denied at the initial stage (Stage 1 of the process). It is both discouraging and befuddling to receive a letter from the Office of Personnel Management informing you that your disability retirement application has been “denied”.

You are now required to Request Reconsideration of your case within thirty (30) days of the date of denial, and you must submit additional medical evidence or other supporting documentation within 30 days of requesting such reconsideration (Stage II of the process). It is, indeed, a time of disappointment to receive a denial. It is all the more so when it is unclear as to the basis for the denial. Often, a denial letter will refer to the medical evidence without much commentary beyond acknowledging the submission of a medical report, then in the last paragraph, simply make a declarative statement that the medical evidence submitted “was insufficient” to show that you are disabled. Or, more often than not, the OPM Benefits Specialist will actually mis-state the law by claiming that you have “not shown that you are so disabled as to keep you from the workplace” (no such legal standard is required under disability retirement rules, regulations or case-law).

Whatever the reasons given, it is both discouraging and disheartening to receive a denial letter from OPM. However, it is important to calmly, systematically, and with pinpoint focus reply to the letter of denial — even if it doesn’t seem to make any sense. This is done most effectively by using all of the tools required in persuading eligibility and entitlement to disability retirement benefits: the law; the medical report; the medical records; rational and legal arguments –in short, the “nexus” needed to win.

Sincerely,

Robert R. McGill, Esquire