Federal Employee Medical Retirement: The Chasm between Denials

From the perspective of an individual Applicant for Federal Disability Retirement benefits under FERS & CSRS, the individual applicant does not normally observe some other person’s Federal Disability Retirement application, and therefore never has the opportunity to see the “greater process” at work, or patterns of behavior on the part of the Office of Personnel Management.  Yet, there are indeed patterns, and that is why an experienced attorney who has seen literally thousands of Federal Disability Retirement cases over numerous years, has an advantage in responding to OPM’s denials.  Experience lends itself to greater observation.  Experience over time reveals certain patterns.  And patterns of behavior can reveal important principles. 

Certain OPM Representatives provide detailed and (often) irrelevant factual references which can be ignored; others like to “cite the law” and believe that such citations appear irrefutable and authoritative; and still others give scant discussion to laws or to facts.  Thus, there often appears to be a great chasm between the types of denials.  Whether or not there are such differences, an applicant who has received a denial for his or her Federal Disability Retirement case needs to respond to any such denial with a three-pronged attack:  Medical refutation; Factual correction; Legal assertion.  Such an attack will cover any chasm which might exist between the different individuals who send out a denial letter.  More importantly, it will cover the necessary elements for winning a Federal Disability Retirement case.

Sincerely,

Robert R. McGill, Esquire

FERS & CSRS Disability Retirement for Federal and USPS Workers: Changes

Changes in life occur at critical times, and whether the critical time-period is determined by the medical condition, or other events, what is always important is to take the affirmative steps yourself, as opposed to waiting for events to spiral out of control.  Rarely should one await for the Agency to “do something” which is advantageous to one’s situation.  In filing for Federal Disability Retirement benefits under FERS or CSRS, it is important to always be the one to take the lead on everything — from obtaining the proper medical documentation, to ensuring that the Agency is completing their portion of required forms, to making sure that a Federal Disability Retirement packet is fully and completed formulated, such that it will prove one’s case by a preponderance of the evidence and meet the legal criteria for an approval.  Time is of the essence in each Federal Disability Retirement case, especially when time conspires against one’s own interests.

Sincerely,

Robert R. McGill, Esquire

CSRS & FERS Disability Retirement: The 80% Rule

I recently wrote an article on FedSmith.com concerning the legal process of filing for Federal Disability Retirement benefits under FERS or CSRS, and a reader posted a comment implying and suggesting a lack of understanding about a benefit which would allow for payment of 40% of the average of one’s highest three consecutive years, and in addition, to allow for that annuitant to make up to 80% of what the former federal position currently pays.

I beg to differ. The purpose of allowing an annuitant to potentially go out and earn additional compensation in the private sector are multi-fold: it allows for an individual to remain productive; he or she continues to contribute in the workforce and, as a consequence, pays taxes, FICA, etc.; the amount of 40% (after the first year) is an incentive to go out and do something else. Further, Federal Disability Retirement benefits are part of a compensation package offered to a Federal or Postal employee — it is part of the total employment package, and there is certainly nothing wrong with taking advantage of that employment benefit if and when the need arises. The truth is that most people don’t get anywhere near the 80% mark, but hover closer to the 40 – 50% mark, and together with the disability annuity, are able to make a decent living. All in all, the 80% rule is a smart and thoughtful incentive for those who are disabled.

Sincerely,

Robert R. McGill, Esquire

OPM Disability Retirement: Service Deficiency & Medical Condition

The Office of Personnel Management will often use as a criteria of denial the argument/basis that despite the fact that an individual may have a medical condition such that the medical documentation states that the Federal or Postal worker can no longer perform one or more of the essential elements of one’s job, nevertheless, there has not been a showing that a “service deficiency” has occurred.  Often, agencies systematically write up performance appraisals without much thought or consideration; more often, Federal and Postal workers quietly suffer through his or her medical condition, and strive each day to meet the requirements of their duties. 

Whatever the reason for the lack of attention or perception on the part of the supervisor or the agency to recognize that the Federal or Postal worker has not been able to perform one or more of the essential elements of one’s job, such basis for a denial of a disability retirement application by the Office of Personnel Management is not a legitimate one, because existence of a “service deficiency” is not the whole story:  if it is found that retention in the job is “inconsistent” with the type of medical condition the Federal or Postal Worker has, then such a finding would “trump” the lack of any service deficiency.  That is not something, however, that the Office of Personnel Management is likely to tell you as they deny your disability retirement application.

Sincerely,

Robert R. McGill, Esquire

CSRS & FERS Disability: The Decision

It is always a hard decision to file for disability retirement benefits.  Aside from the psychological anguish which must be confronted (feelings of worthlessness or devaluation of one’s worth because we live in a society which places a high value upon productivity, work, and output & competence in our jobs, despite our giving lip-service to “family”, “relationships” and “community”), the potential disability retirement applicant must also make pragmatic decisions based upon a variegated spectrum of financial, professional, family & economic circumstances.  Such foundational, decision-making factors could include:  one’s medical conditions (obviously); the type of job one is in; whether a disability retirement annuity is sufficient or even realistic; whether the job market outside of the federal sector is promising enough to allow for making up to 80% of what one’s job currently pays, in addition to the disability annuity; whether a parti-time position or partial income added to the disability annuity will be enough; whether one’s supervisor & agency will be “going after” you for performance, conduct, or excessive absences, and if so, how soon; and many other factors. 

It is always a trying time.  Consideration in filing for disability retirement benefits must be based upon a deliberative methodology, based upon serious consideration of multiple factors.  In basing a decision to file for disability retirement, it is best to do it right before considering doing it at all.  As such, consultation with an attorney who is an expert in the area of Federal Disability Retirement laws can be an invaluable source of information in making the “right” decision.

Sincerely,

Robert R. McGill, Esquire

CSRS & FERS Disability: Standard Forms

Remember that Standard Forms are produced with the intent of having you believe that you are constrained by the questions as posed, by the space as constrained, and by the language as restricted.  Nothing could be further from the truth.  All forms, including governmental standardized forms, are merely inquisitive templates requesting information.  If the form fails to ask the proper question, or does not pose a question such that it does justice to your particular situation or problem, then you should freely ask the question you believe should be asked, on a “continuation page”, or in an addendum created by you or your attorney.  In disability retirement applications, this is especially true of Standard Form 3112A (Applicant’s Statement of Disability).  Instead of answering only the constraining questions as posed within the framework of the form, it is often appropriate to add another page and create, and subsequently answer, relevant questions which are neither posed nor implied by the Standard Form.  This is not to say that the applicant should abuse the process by adding irrelevant questions; rather, it is to allow for the “full story” of a disability retirement application.

Sincerely,

Robert R. McGill, Esquire

CSRS & FERS Disability: an Art Form

As with all effective submissions — pleadings, motions, legal memorandums and, alas, Federal Disability Retirement applications — it should never be approached in a mechanical, one-to-one ratio-like, mathematical manner.  Of course it should contain the technical terms, the medical terms, and the legal arguments.  However, disability retirement under FERS & CSRS — especially the Applicant’s Statement of disability and any legal arguments — should not be matter of matching up a one-to-one correspondence between the medical condition and the particular essential elements which it prevents or impacts.  Certainly, the effect and the conclusion should contain that conceptual correspondence; however, as all good writing contains a technical side, it is also important to weave the story of the human condition and see the writing as an “art” form.

The impact of the human story is important in convincing and persuading the OPM representative to not only understand the medical condition, but to get a sense of empathy for what the applicant is going through.  It is a delicate balance to achieve; yes, the hard legal arguments should be made in order to “force” OPM to see that, legally, they are obligated to approve a disability retirement application; at the same time, if you can touch the empathetic nature of the OPM representative, so much the better.

Sincerely,

Robert R. McGill, Esquire

CSRS & FERS Disability: Perennial Issues

Like perennial plants, some issues continue to repeatedly crop up; once planted, they keep showing up in various question-forms.  The one which needs to be addressed, again, is the “1-year” issue:  there are actually two (2) questions which keep resurrecting themselves: A.  Filing a disability retirement application within 1 year of separation from service, and B. A medical condition which must last for a minimum of one year. 

As to the former:  The statute of limitations begins to toll when a person has been officially separated from Federal Service.  This means that the Agency must take you off of the Federal rolls.  If you continue to receive a paycheck, you are likely not separated (unless, of course, it is some form of a severance paycheck); if you receive a paycheck with “0-balances”, you are still not likely separated. If you are injured and you haven’t worked for a year, but you have not received notification that you have been separated from Federal Service, the 1-year mark has likely not begun.  On the other hand, if your SF-50 or PS Form 50 states that you are separated, then you are separated.  At that point, you have one (1) year to file your Federal Disability Retirement application. 

As to the latter (Issue “B” herein):  In most cases, it is a prospective issue.  It doesn’t mean that you must “have been” medically unable to work for a year; it doesn’t mean that you have to wait around for a year, out of work and penniless, for a year; it doesn’t mean that you must be on OWCP or on LWOP or on sick leave for a year — instead, it means that your medical condition must last for at least a year.  In other words, as is the case with most medical conditions, after a couple of months, your doctor should have an opinion — a “prognosis” — of how long your medical condition which impacts your ability to perform the essential elements of your job, will likely last, within reasonable medical certainty.  Indeed, since the Federal Disability Retirement process often takes from 8 – 10 months (from start to finish) to obtain an approval, by the end of the process, the full year will likely have occurred anyway.  In other words, you don’t need to wait around for a year to show that you can’t perform the essential elements of your job; indeed, that would be foolish. 

Sincerely,

Robert R. McGill, Esquire