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

OPM Disability Retirement: “It May Sound Good”

There is the statutory legal criteria which is mandated by law, by case-law, and by regulatory dictum as to the proper application of review in making a determination on a Federal Disability Retirement application, whether under FERS or CSRS.  Yet, the question is whether or not the Office of Personnel Management has applied the proper legal criteria in making its determination, and the answer to such a question can only be evaluated based upon the language which is utilized by OPM in its denial letter. 

An approval letter issued by the Office of Personnel Management is entirely unrevealing, precisely because it is simply a template letter advising the approved Federal Disability Retirement annuitant of the next steps to follow.  However, when a denial letter is issued by the Office of Personnel Management, often the Claims Representative will insert language which “sounds good” and proper, and even convincing — but ultimately, wrong as far as the proper application of the law is concerned.  For example, OPM may assert with unequivocal brevity that there lacks “compelling medical evidence” in the Federal Disability Retirement application.  “Compelling” is not a legal criteria required by statute, case-law, or regulatory dictum.  As such, it is a meaningless word-usage.

Moreover, it is harmful to a case because it means that OPM applied a standard of review which is nowhere found in any statute.  Further, it gives an appearance of authenticity and authoritative credibility where none exists.  What to do about it?  It needs to be addressed and pointed out — but diplomatically.  Diplomacy is nothing more than a forceful rebuttal clothed in the finery of courtesy, but it is a necessary ingredient in establishing the proper tone and tenor of a response to OPM.

Sincerely,

Robert R. McGill, Esquire

Medical Retirement Benefits for US Government Employees: Meeting the Statutory Minimum

In preparing, formulating and filing a Federal Disability Retirement application under FERS or CSRS, the Federal or Postal employee must prove, by a preponderance of the evidence (that burden of proof which is fairly minimal in the order of difficulty, requiring that a Federal or Postal employee show that he or she is “more likely than not” entitled to Federal Disability Retirement benefits under FERS or CSRS) that the compilation of the evidence meets the statutory requirements such that one is eligible and entitled to Federal Disability Retirement benefits.  

Thus, it is the cumulative set of evidence which is reviewed by the Office of Personnel Management, and not merely a single piece of evidence.  Yet, the manner and methodology of how OPM reviews the evidence is revealed in any given denial letter issued by the claims representative, or the “Legal and Administrative Specialist” assigned to any particular case.  

It is a methodology of (A)  listing whatever medical evidence which was submitted by naming the doctors, thereby giving an appearance of a full and thorough review of the documents, and (B) selectively extrapolating statements made by the Applicant, the Supervisor, the doctor(s) and anyone else in attempting to undermine the conclusion that the statutory criteria for eligibility has been met.  In laymen’s terms, this is called, “Taking potshots” at something.  If meeting the criteria for eligibility is to show a sequence of connecting dots from point A to point B, then OPM’s view is that if there are enough potshots which sever the line between the points, then OPM has shown that a Federal or Postal employee is ineligible for Federal Disability Retirement benefits.  

This is the approach; it is up to the applicant who is preparing, formulating and filing a Federal Disability Retirement application under FERS or CSRS to ensure that any weak links in the line are sufficiently reinforced.

Sincerely,

Robert R. McGill, Esquire

Federal and Postal Disability Retirement: Statute of Limitations

In filing a Federal Disability Retirement application with the Office of Personnel Management, whether under FERS or CSRS, one must file within one (1) year of being “separated from service”.  That is what is often referred to as the “statute of limitations” — a limit placed upon the ability of a Federal or Postal worker to file for a claim, based upon pragmatic policies of making sure that a claim is “recent” enough to allow for evidence which is neither stale nor outdated.

There is sometimes a level of confusion as to what it means to be “separated from service”, and it often appears that such confusion arises from mixing issues with other administrative claims.  Thus, OWCP/FECA has its own sets of rules; Social Security has its own set of rules, etc.  For Federal Disability Retirement applications under FERS or CSRS from the Office of Personnel Management, to be “separated from service” and thus to trigger the 1-year timeframe, means that a Federal or Postal worker is terminated, taken off the rolls, and an SF 50 and PS Form 50 needs to be issued showing that a person has been effectively separated from Federal Service.

For Postal Workers, a good indication that this action has been effectuated is when one stops received the “0”-balance paystubs.  Further, one must remember that, once separated from the Agency, after 31 days or more of such separation, any Federal Disability Retirement application must be filed directly with the Office of Personnel Management.  Filing with the Agency after the 31 day period and waiting for them to process the case, and relying upon them to forward it to OPM may result in a case simply sitting on someone’s desk…until the year has run out.

Sincerely,

Robert R. McGill, Esquire

 

Federal Employee Medical Retirement: OPM and the Law

The Office of Personnel Management is the agency which determines all applications for Federal Disability Retirement, whether under FERS or CSRS (or CSRS-Offset).  In making such a determination, a standard of “objectivity” is expected by each and every Federal and Postal employee, in making such a determination.  

The Office of Personnel Management (OPM) applies a set of criteria as determined by statute and further expanded upon by the Merit Systems Protection Board and the Federal Circuit Court of Appeals.  The entirety of “the Law” which governs and guides the eligibility and entitlement to Federal Disability Retirement benefits is thus based upon a patchwork of legal holdings, statutory language, and cases and legal opinions which have “evolved” over the years.  From this patchwork of laws, one expects a “representative” from OPM to apply it fairly, objectively, and without any arbitrariness or capricious intent.  Yet, since the individuals applying “the Law” at OPM — at least at the first and second “Stages” of the process — are not themselves lawyers, how realistic is this?  

Ultimately, legal arguments in persuading OPM to approve a case are best made when they are concurrently explained — explained in their logic, their force of argumentation, and in their applicability to a given issue.  Simply declaring that “the Law” applies will not do; one must sensitively guide OPM to understand the very laws which govern their behavior.

Sincerely,

Robert R. McGill, Esquire

OPM Disability Retirement for Federal and Postal Employees: Causality

Hume’s exposition on causality is both interesting and instructive in terms of looking at the validity of an argument.  In this instance, we are obviously making an analogy with how the Office of Personnel Management, and to a larger degree, people in general who make a causal argument and declare that it is a ‘valid’ argument.  David Hume’s argument on causality essentially states that there is nothing in the world other than two independent events (which we merely deem as ’cause’ and ‘effect’), which we repetitively witness.  However, because there is no ‘meta-factor’ beyond the independent events, what he terms as a ‘necessary connection’, therefore there is no certainty beyond a repetition of events.  Thus, Hume argues that we actually never see anything ‘new’ — no ‘necessary connection’ between cause and effect, in the 100th time we observe an event, any more than the first time. 

This is, indeed, analogous to how the Office of Personnel Management views rendering a denial in a Federal Disability Retirement application under FERS or CSRS. Look at the lack of logical argumentation in an OPM denial.  It is a series of independent events, delineated and categorized in some semblance of chronological order (perhaps the order that the OPM Representative read the medical documentation):  Dr X says this; Dr. Y says that; then the effect:  “The medical evidence fails to meet the criteria for eligibility for Federal Disability Retirement.”  Like Hume’s description of the world, there lacks a ‘meta-factor’.  Whether the stated causes have any connection (see the analogy?  It is like Hume’s reference to “necessary connection”) to the “effect” is entirely irrelevant.  Events do not need to justify the decision.  It is acceptable to merely refer to medical documents and then come to a conclusion, without any need to justify the validity of an argument.  But, then, that seems to be how most people in the general population formulate an argument these days — based upon how one “feels”.

Sincerely,

Robert R. McGill, Esquire

CSRS & FERS Disability Retirement: Statute of Limitation Reminder

The “end of year” and beginning of the new year is a good reminder for people, that once you are separated from Federal Service, you only have one (1) year to file for Federal Disability retirement benefits.  Furthermore, many people are separated from service right around this time, and just remember:  You can always “supplement” a Federal disability retirement application with additional medical reports, documentation, etc.; however, unless you file the necessary forms before the deadline, you cannot do anything.  The first and most important step in the process is to always file on time; thereafter, you can make other additional medical and legal arguments on behalf of your case.

Sincerely,

Robert R. McGill, Esquire

CSRS & FERS Disability Retirement: Again — Reminder as to the Statute of Limitations

I have many, many people who are on all sides of the spectrum concerning the time-line of filing for Federal Disability Retirement benefits under FERS & CSRS — people who call me 2, 3, 5, sometimes 10 years after being separated from service, saying they were never informed about the benefit of Federal Disability Retirement benefits.  Obviously, such former Federal employees cannot now (except in extremely peculiar and rare circumstances) file for Federal Disability Retirement benefits, under either FERS or CSRS. 

Then, there are those who are still “on the rolls” — those who have never been separated (normally because of the negligence or neglect of the Agency) from Federal Service, who call to ask whether they can file for Federal Disability Retirement now.  The answer is most often, Yes, and furthermore, once the disability retirement is approved, the annuitant can receive back-pay all the way back to the last date of pay.  Then, there are those who call me in a state of panic, saying that it has been almost a year after the injury; is it too late to file?  No, it is not too late, so long as it has not been over one year from the time of separation from service.  Thus, here is a reminder (again):  A Federal or Postal employee has up until one (1) year to file for Federal Disability Retirement benefits under FERS or CSRS, from the time of being separated from Federal Service — meaning, when you have been terminated from being a Federal or Postal employee, and are off of the “rolls” of the agency.  I don’t know how to make this any clearer.

Sincerely,

Robert R. McGill, Esquire

CSRS & FERS Disability Retirement: Don't Confuse the Standards

People who call me for advice, who are potential candidates as clients for Federal Disability Retirement benefits under FERS or CSRS, often interchangeably use terms which apply to different standards:  standards of total disability as opposed to a medical disability which impacts one’s ability to perform one or more of the essential elements of one’s job; whether a medical condition is an “accepted” disability (a concept which is often used in Social Security disability cases); whether a person can file for Federal Disability Retirement benefits even though he “hasn’t reached MMI” (“Maximum Medical Improvement”) — which is language encompassing a concept familiar to OWCP/DOL (Worker’s Comp) cases; or, on a different level, the statement that an agency has been “accommodating” an employee by allowing him/her to take sick leave, Leave Without Pay, or to “not have to travel as much” — mistakenly or loosely using the term “accommodation”, when in fact such agency actions do not constitute a legally viable accommodation, as that term is used in Federal Disability Retirement laws. 

It is the job of the attorney to correct, clarify, and otherwise explain the proper terminology and precise application of concepts in Federal Disability Retirement cases.  It is not surprising that people who are contemplating filing for Federal Disability Retirement benefits under FERS or CSRS use the various terms in error, or mix terms unknowingly — for there is alot of misinformation “out there”; it is the job of an Attorney who specializes in Federal Disability Retirement law to clarify such confusions.

Sincerely,

Robert R. McGill, Esquire

CSRS & FERS Disability Retirement: Agency Interaction

Federal Agencies often act like little fiefdoms.  This is not necessarily a negative thing; each agency is an independent entity, and each has a province of responsibilities which it must carry out and execute according to the statutory mandate provided by Congress.  As independent entities, each agency acts without coordination or regard to other agencies. 

Thus, while approval for disability benefits from the Social Security Administration will mean an offset of monetary payments under FERS, such interaction between the two agencies simply goes to the financial payments — not to the substantive issues of approval or disapproval of a disability retirement claim.  Similarly, while receipt of temporary total disability payments from the Office of Worker’s Compensation Programs means that you cannot concurrently receive payments under CSRS or FERS disability retirement (unless you are receiving a scheduled award from OWCP/DOL), the substantive basis of approval or denial of a claim rarely overlaps.  This is because each agency has its own independent criteria for eligibility — meaning that, for Social Security, the “disability” has a higher standard of “total disability”, whereas under FERS & CSRS, it is a lower standard of “inability to perform one or more of the essential elements of one’s job”.  Similarly, with OWCP/DOL, the issue of “causality” and whether it is “work-related” is often the important component of consideration. 

All of this is not to say, however, that an approval of a disability benefit from one agency,or a report from a doctor considered for one benefit, should not be used by the applicant for submission to another agency.  Indeed, this should be done — but carefully, and with thoughtfulness. 

Sincerely,

Robert R. McGill, Esquire