OPM Disability Retirement: Treatment, Surgery and Medication Regimens

In contemplating 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 bifurcate issues which are “legal”, “employment-related”, and “medical”, etc.  Of course, issues can easily cross over between neatly-construed, artificial boundaries, such that certain issues contains multiple areas.

For example, there is the question of compliance with medical treatment.  First and foremost, whether it concerns or impacts a Federal or Postal employee — or any employee of any organization — the question of whether an individual is complying with the treatment recommendations of a doctor is one which is, and should be, first and foremost a medical one.

In preparing a Federal Disability Retirement application, however, that same question can indeed cross over into becoming a legal issue concurrently, because non-compliance with certain types of treatment regimens can be a basis for a denial of a Federal Disability Retirement application by the Office of Personnel Management.

As to “which” treatment modalities would be a basis for a denial, in general terms, those treatment modalities which one might construe as “minimal” in nature, certainly qualify.  Thus, compliance with a medication regimen is certainly a basis for a denial in a Federal Disability Retirement application; refusing to undergo a prescribed course of physical therapy may be another.  On the other hand, deciding to forego surgery is normally not a basis for a denial of a Federal Disability Retirement application, if only because of the percentages of success even with surgery are tenuous at best, and even with surgery, there is always the question of whether the Federal or Postal employee would be able to perform all of the essential elements of the job anyway.

Questions of medical treatment compliance should first and always be considered a medical question, and only in a secondary sense, a legal question.  One’s health should be the penultimate concern; the legal consequences, an afterthought.

Keeping one’s priorities in order is always the best approach, whether contemplating filing for Federal Disability Retirement under FERS or CSRS, or not.

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

OPM Disability Retirement: Spectrum of Medical Requirements

In considering a Federal Disability Retirement application under FERS or CSRS, a Federal or Postal employee must ask questions beyond the primacy of obtaining the necessary and proper medical care for treatment of one’s own medical condition.  Thus, evidentiary issues must be considered; issues of obtaining proper medical documentation; seeking the active support of a treating doctor, etc.  These are all “non-medical” considerations, which have little to do with the actual treatment and care of one’s medical condition, but have everything to do with preparing, formulating, and filing for Federal Disability Retirement benefits under FERS & CSRS.  

There is a distinction between the two (receiving the necessary medical care and preparing a Federal Disability Retirement application), and it is important to recognize the conceptual distinction, because the former can impact the latter.  For instance, on the spectrum of medical care (or refusal thereof) which can impact a Federal Disability Retirement application, refusal to undergo “facially reasonable medical treatment” can defeat a Federal Disability Retirement application.  

The question, of course, is how to interpret what constitutes “facially reasonable medical care”?  There are certain “obvious” ones, and then others which are not so obvious.  Normally, the Merit Systems Protection Board has held that refusal to undergo invasive surgery is not a bar to being eligible for Federal Disability Retirement benefits; on the other hand, refusing to take prescribed medications can, and often is, a bar to eligibility.  All else fall within the middle of the spectrum of such medical/legal requirements.  

Sincerely,

Robert R. McGill, Esquire

Medical Retirement Benefits for Federal & Postal Employees: The Job Description

Remember that the official Job Description may provide an antiseptic-like delineation of the major functions of a particular position.  From that, one may infer, imply and extract the daily physical and cognitive requirements in order to efficiently perform those major functions.

However, in filing a Federal Disability Retirement application under FERS or CSRS, one must remember that it is never a wise endeavor to think that the Office of Personnel Management will infer, imply or extract anything, leaving aside making the logical connection between a Job Description and the physical, emotional and cognitive requirements to implement the job requirements.

As such, in formulating the impact between one’s medical conditions and the essential elements of one’s job, it is encumbent upon the applicant who is filing for Federal Disability Retirement benefits to make explicit that which is implicit; to reveal that which may be contained “between the lines”; and to make sure that, instead of infering, implying or extracting, that the daily physical, emotional and cognitive requirements are boldly revealed.

Sincerely,

Robert R. McGill, Esquire