Disability Retirement for Federal Government Employees: Someone Else’s Argument

Have you ever sat with company at a dinner table, and engaged in a conversation where it appears as if you are continuing someone else’s conversation?  Or your presence is merely a substitute for an extension of a previous debate or discussion?  Where a topic is brought up, and immediately a barrage of critical attacks — of arguments you have never made, and of statements you don’t recall disseminating (and where this is only 5 minutes into the salad and you’ve barely tasted the first glass of wine)?

The problem with unfinished business is that the transference of what one wanted to say is normally unloaded upon the wrong subject.  Conversations, debates, forums of intellectual exercises in linguistic battles — it is a rare person who has been able to convey the full force of one’s collective thoughts and beliefs on the matter, and it is more often the case that one leaves with the regretful remorse of, “I wish I had brought that point up…”  But rarely do second chances present themselves in a satisfactory follow-up forum; unless you are the unfortunate object for an unexpected dinner invitation.

In responding to a denial of a Federal Disability Retirement application with the U.S. Office of Personnel Management, whether under FERS or CSRS, the applicant — through his or her Federal Disability Retirement attorney — needs to understand that the person who issues the denial will not be the same person who will review any additional submissions or legal arguments at the Reconsideration Stage.

It will be reviewed, in legal parlance, de novo.  As such, while the basis of the denial as issued by the Caseworker at OPM at the First Level should be taken into consideration, one should approach the case in light of the following question: To what extent will the Reconsideration Branch care as to the original basis of the denial of the first caseworker?  If it is being reviewed de novo, the approach should be to go over all of the elements — and to reinforce and amend those weak points, some of which may overlap what the first caseworker pointed out, others which may not.

It may not be the best approach to argue to a dinner guest who wasn’t present at the first round of arguments; the points you are trying to make may not be heard because the bell has already rung, and the fighter in the second round has been replaced with someone upon whom you have never previously landed a punch.

Sincerely,

Robert R. McGill, Esquire 
FERS Disability Retirement Lawyer

   

Medical Retirement for Federal Workers: To Just Walk Away

One suspects that the U.S. Office of Personnel Management “plays the odds” and finds that a certain percentage of the population will accept at face-value the stated basis of a denial of a Federal Disability Retirement application, regardless of the lack of substantive basis for such a denial.  And, indeed, there will be a segment of the population, within the entire universe of Federal and Postal employees who submit a Federal Disability Retirement application, who will simply feel discouraged, and simply give up.

This is precisely why, in many administrative processes, there is an automatic first-level denial.

FERS & CSRS Disability Retirement is somewhat different, and one would assume that there is no internal mechanism of automatically rejecting a submission at the initial stage of the application, because the merits of each case should be determined at each stage of the process.

Nevertheless, it would be “prudent” for the U.S. Office of Personnel Management to take such an approach, if only to test the determination and seriousness of each applicant.  This is not to allege that such an approach is deliberately engaged in by OPM; rather, whether on a valid basis or not, there is nevertheless the likelihood that a certain percentage of Federal Disability Retirement applicants who are denied at the first stage, will simply walk away, not fighting for a benefit which they may well be eligible for.

And, of course, “walking away without a fight” is certainly an option for everyone; not a very viable one, and one which should not be recommended.  The sad part, of course, is that the very basis for not having “the fight” to contest an OPM denial, is often the same basis for which the Federal or Postal worker filed for Federal Disability Retirement benefits in the first place:  the medical condition itself, and the debilitating manifestations which have weakened the human spirit to persevere.

Sincerely,

Robert R. McGill, Esquire
Postal & Federal Employee Attorney

 

Federal Disability Retirement: Surprise in the Universe of Reconsiderations

Until the science of Physics can implement the ability of molecular and particle transference technology (i.e., “Beam me up, Scotty”), there is little potential of resolving the Cartesian mind/body dualism (i.e., that French Philosopher Rene Descartes, who bifurcated the world between the material and the spiritual). But such dualism in philosophical terms does not mean that we can be at two places at one time; or even attempt to be “objective” when the subjective “I” is the very same person who is attempting to appear objective.

In Federal Disability Retirement law, when the U.S. Office of Personnel Management issues a denial letter, the customary response by the denied OPM applicant, whether a Postal Worker or a non-Postal Federal Worker, is that he or she is “surprised” by the initial denial because of the strength, completeness, and thoroughness of one’s Disability Retirement packet.  But that should be a given.

No one who files with OPM should do so without meeting the requisite foundations of thoroughness or completeness.  But this is where the problem is:  the very person who determines that a Federal Disability Retirement application is sufficient, is the same person who suffers from the very medical conditions of which the application speaks about.

The subjective/objective coalescence makes for a difficult mind/body dualism, in that the one who suffers from the medical condition can hardly assess and evaluate, in an objective manner, the strength of the Federal Disability Retirement application.

Thus, the Cartesian mind/body dualism lives on, and until Captain Kirk can guide us otherwise, such bifurcated dualism will continue to pervade all Federal Disability Retirement applications, whether under FERS or CSRS, and the denials which follow will still have the familiar response of, “Surprise!”

Sincerely,

Robert R. McGill, Esquire

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

Postal and Federal Disability Retirement: Denials

Denials come with an unexpected force and impact; for, in every Federal Disability Retirement case, there is the expectation that the application itself merits close scrutiny and a belief that a proper review will persuade the OPM trier of facts that the Federal Disability Retirement application should be approved.

Indeed, from the perspective of the applicant, who is suffering from the medical condition itself on a daily basis, it is often a reaction of disbelief and anger when a denial is issued by the U.S. Office of Personnel Management.  But one must understand that this administrative process identified as “Federal Disability Retirement” is one which is not an “entitlement”, but rather, an adversarial process where proof, argumentation and persistent appellate procedures must be invoked at every step of the way.

That is why, in preparing, formulating and filing for Federal Disability Retirement benefits from the U.S. Office of Personnel Management, whether under FERS or CSRS, one needs to always prepare a case as if it will ultimately go to the U.S. Merit Systems Protection Board.

Further, it is understandably disappointing to read an OPM denial and find that the OPM case worker does not even mention or refer to much of the substantive medical documentation submitted, but instead blindly (and generically) issues a template of tired old phrases, such as, “You did not meet the legal criteria“; “The evidence did not show that…”

With hundreds of cases assigned to each OPM Case Worker, one must understand that denials are rarely personal; but in responding to a denial from OPM, one must be diligent, forceful, and approach it with the use of all legal tools available.

Sincerely,

Robert R. McGill, Esquire

Medical Retirement for Federal Workers: Inconsistencies and the Perfect Case

Perhaps there will never be the “perfect” case in a FERS Disability Retirement application, and one should not expect to find one.  There are “near-perfections” and ones which cannot possibly be denied by the U.S. Office of Personnel Management.  But it is the imperfect ones — the ones which might be consider tenuous at best, but which are nevertheless approved, which provide greater lessons in preparing, formulating and filing for Federal Disability Retirement benefits from the U.S. Office of Personnel Management.

Further, denial letters issued by the U.S. Office of Personnel Management are instructive for future events and cases, precisely because they indicate the focus, in any particular context or time, of the central and essential concerns expressed by OPM.  Inconsistencies are often what is reviewed and scrutinized most closely — between what the doctor asserts in conclusory fashion, in a medical narrative report, as opposed to the daily office and treatment notes; between one’s statement of disability and what the Supervisor observes; between what the applicant for Federal Disability Retirement benefits states, and what the doctor annotates.

Granted, much of it is selectively chosen with a biased and slanted perspective — as if the Caseworker at OPM had already decided to issue a denial.  Further, OPM makes unfounded assertions concerning the applicable standard of law all the time, which undermines the very basis of any denial, and puts into question the credibility of the reasons given in a denial letter.

Ultimately, there is no such thing as the “perfect” case; as life provides for inconsistencies and lack of continuum, so a Federal Disability Retirement application often reflects the imperfection of life.  Unfortunately, OPM doesn’t have such a philosophical outlook on such matters, and we must deal with it accordingly.

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

CSRS & FERS Disability Retirement: OPM’s Rationale

Too much time is often spent on the “rationale” or “reasons” for a denial from the Office of Personnel Management, under the “Discussion” Section of a denial letter.  By “time spent”, however, is not meant that one should not selectively rebut, refute and address some of the reasons delineated in an OPM denial letter; rather, what too many people do is to complicate matters by “reading into” the reasons given for the denial. 

One of the jobs of an attorney who specializes in Federal Disability Retirement law under FERS & CSRS is to prepare an application for Federal Disability Retirement benefits, rebut a denial, or file an appeal to the Merit Systems Protection Board, based upon one’s experience, wisdom and sense of that which OPM is looking for.  This is accomplished by having learned from a myriad of sources:  from seeing the types of prepared disability retirement packets which have been successful in the past; from learning from past legal arguments and rebuttal arguments as to which have been most persuasive for OPM; and from having conducted multiple Hearings before the Merit Systems Protection Board and learning exactly what the Administrative Law Judge has been most persuaded and convinced by.  Further, having read countless denial letters by people who have attempted to file for Federal Disability Retirement benefits at the first stage without an attorney, it is important to focus upon the relevant issues which OPM is seeking, and to disregard those issues which are peripheral or irrelevant.

Sincerely,

Robert R. McGill, Esquire

Federal Disability Retirement: OPM’s Detailed Denial

Neither length nor detail constitutes legitimacy.  The spectrum of the types and styles of denial letters issued by the Office of Personnel Management in Federal Disability Retirement cases under FERS & CSRS range from a short paragraph under the “Discussion Section”, to 3 – 4 pages of apparent references to doctor’s notes, reports, etc. — with a lengthy lecture about the need for “objective” medical evidence, and about how a particular medical condition “may be” treated by X, Y or Z treatment modalities. 

Don’t be fooled.  One may think that, because OPM provides a seemingly “detailed” explanation of why a particular disability retirement application was denied, that such lengthy detail means that it is somehow “substantive”.  In fact, I often find the opposite to be true:  the shorter the denial, the greater the substance.  The lengthy denial letters contain “substance”, all right — but substance of the wrong kind.  They contain:  Mis-statements of the law; mis-statements of the criteria to be applied; inappropriate assertions of medical opinions (contrary to what one might think, the OPM representative does not normally have a medical degree, let alone a law degree), and a host of other “mis-statements”.  Sometimes, the weightier the denial, the more confusing as far as how to respond.  And, perhaps, that is one methodology as to how OPM wants to approach the case:  If it seems long and complicated, maybe the applicant will sigh, give up, and go away.  Don’t.

Sincerely,

Robert R. McGill, Esquire

OPM Disability Retirement: The Administrative "Process"

I have previously written about how a Federal Disability Retirement application should be prepared:  that it should be looked upon as an administrative “process”, and as such, it is not like taking a test for a driver’s license, or filing an application to obtain a permit — both of which are similarly “administrative” issues.  The reason why filing for Federal Disability Retirement benefits under FERS or CSRS is different, and is a “process” as opposed to merely filing an “application” for something which will be essentially rubberstamped, is that it requires proof which must meet a certain statutory legal standard — it requires that one prove, by a preponderance of the evidence, that one is entitled to receive disability retirement benefits.  

Now, wherever “proof” of eligibility is required, there can be a disagreement as to whether or not such proof met the statutory eligibility requirements.  Other applications, such as filing for a Social Security Card, may also have certain statutory requirements, but normally such administrative applications are fairly “cut and dry” — such as, certain documents will be accepted to prove X, or certain forms may need to be filled out to obtain Y.  But where a legal standard of proof must be met, differences between the Applicant and the Agency may erupt. 

OPM may state, and argue, that the medical documentation, the Supervisor’s Statement, the Agency Certification of Accommodation efforts, the comparison between the applicant’s Statement of Disability and the doctor’s statements and notes — did not rise to the level of meeting the legal standard of “preponderance of the evidence”.  This is where many people get themselves into trouble — by thinking that it is merely an “application” to file in order to obtain an administrative benefit.  Then, when it gets denied at the first level, applicants become devastated, thinking that it is the end of the world.  From the outset, it should be looked at as a “process” — one which may take going to the Merit Systems Protection Board, or even further, to the Full Board Review, and then, if necessary, to the Federal Circuit Court of Appeals.

Sincerely,

Robert R. McGill, Esquire