Medical Retirement Benefits for US Government Employees: Sounds Good

There are various stages of the administrative process designated and defined as “Federal Disability Retirement” — the initial application stage of the process, where one must attempt to prove by a preponderance of the evidence that one is eligible for Federal Disability Retirement benefits; if disapproved and denied, then the Reconsideration Stage of the process (where one may submit additional medical and other documentary evidence to persuade the Office of Personnel Management to reverse themselves); an appeal to the U.S. Merit Systems Protection Board, where the Federal or Postal applicant’s Disability Retirement application is taken out of the hands of OPM and transferred to an Administrative Judge, who will hear the case anew, without regard to what OPM has decided in the past; a further appeal to the Full Board of the MSPB in the event that the Administrative Judge issues an Initial Decision which affirms and upholds OPM’s denial of the case; and a further appeal to the Federal Court of Appeals for the Federal Circuit.

Throughout this process, and especially in the administrative stages before the Office of Personnel Management, one should make a distinction between “sounding good” and “being right”.  Hopefully, the Federal or Postal employee who has filed for Federal Disability Retirement benefits from the U.S. Office of Personnel Management, whether under FERS or CSRS, is both right and sounding good. But there is a distinction to be made.  For example, OPM will often — in their denial letter — “sound good” but be completely wrong on the law.  They will cite medical textbooks which skew the legal standard of review; creep into the discussion of a denial letter such terms as “no significant disability rating to speak of,” or that you don’t suffer from a disability which “incapacitates” you.  It all “sounds good”, but it is not true precisely because it is not the applicable standard of law to be applied.

At the initial stages of the process, OPM can get away with such nonsense, because most people don’t recognize the untrue and inapplicable standard of law being applied.  In the later stages of the process, however, when an Administrative Judge hears a case, it becomes important not only to “sound good”, but to also apply the right legal criteria.

Appearance versus reality — it is the argument of Western Civilization from the pre-Socratics onward.  As Alfred North Whitehead once observed, all of philosophy was already written by Plato and footnoted by Aristotle.  That statement both sounds good, and is indeed right on point.

Sincerely,

Robert R. McGill, Esquire

Postal and Federal Disability Retirement: The MSPB & the Window of Opportunity

At the Merit Systems Protection Board (MSPB), there are multiple critical points of opportunity in which to convince, persuade and otherwise have a discussion with the Office of Personnel Management (OPM) to reverse their earlier denial of a Federal Disability Retirement application.

Remember, however, that this is the arena and playground of lawyers.  While an applicant who has meandered through the intricate administrative process of preparing, formulating and filing for Federal Disability Retirement benefits from the Office of Personnel Management, can certainly survive the administrative procedures as circumscribed by the Merit Systems Protection Board, it is a good idea to have legal representation— obviously, from the very beginning; if not, then to represent one’s interests in rebutting an initial denial at the Reconsideration Stage; if not (again), then to have proper representation before the Merit Systems Protection Board (MSPB).

Whether at a Preliminary Conference to discuss the forthcoming issues, or at a Prehearing Conference — or, in preparing and filing a Prehearing Statement as ordered by the Administrative Judge at the MSPB — opportunities arise for the Federal or Postal worker to submit additional medical evidence which can potentially persuade OPM’s representative to reverse the two previous decisions of denial.

Such opportunities must be carefully embraced.  Yet, often, a Federal or Postal employee who is unrepresented at the MSPB is unaware of the opportunities which arise, at which points, in what circumstances, and the Administrative Judge is bound by duty and position to remain neutral.  Then, of course, there is the Hearing at the MSPB, in the event that OPM does not reverse.  Whatever the circumstances of the Federal or Postal employee who is or will be filing for Federal Disability Retirement benefits under FERS or CSRS, an advocate to represent the Federal or Postal employee’s interests is paramount. Don’t “go it alone”; for, to do so will often only lengthen the process.

Sincerely,

Robert R. McGill, Esquire

 

Federal Employee Medical Retirement: Proper Responses

A receipt of a denial from the Office of Personnel Management to a Federal Disability Retirement application under either FERS or CSRS is always an event which is upsetting to a Federal or Postal employee, but it is “part of the process” which occurs often enough.  

If it is a second denial (where a Request for Reconsideration has already been accomplished, and the Office of Personnel Management has denied it again), then the only appropriate response is to file an appeal to the Merit Systems Protection Board (no response is required, or even appropriate, to OPM, as it is out of their jurisdictional purview upon denying it a second time).  

If it is a “first denial“, then a “Request for Reconsideration” must be filed within thirty (30) days of the date of the denial letter (one can argue that the 30 days should be counted from the date of receipt, but it is always better to be on the safe side), and if requested, an additional thirty (30) days is automatically granted in order to have sufficient time to gather and submit further documentation to rebut and answer the denial from the Office of Personnel Management.

Submission of the Request for Reconsideration, and participation in the process of having the Office of Personnel Management reconsider the initial denial, is mandatory, not elective.  By this is meant the following:  You cannot bypass or skip the Reconsideration Stage and jump directly to the MSPB; you must first get a decision on the Request for Reconsideration before the Merit Systems Protection Board will consider your case.  

You cannot get angry or reactive and declare, “I will just file an appeal to the MSPB and have an Administrative Judge look at my case”.  You must patiently go through the proper channels of justice, and respond accordingly.

Sincerely,

Robert R. McGill, Esquire

Federal Disability Retirement: The Entirety of the Process

There is a common understanding, based upon comments and statements made by people over several years, that when an individual files for Social Security Disability benefits, most such cases are denied at the initial stage.  It is almost understood as an “automatic” denial at the first stage of the process. 

Whether this is true or not or, more importantly, whether or not there are some who get it approved at the initial application stage and therefore betray the truth of such a belief, is besides the point.  What is important is the perception that it is so, and therefore, the approach which individuals take in filing for Social Security Disability benefits is altered and adapted accordingly. 

Similarly, in preparing, formulating and filing for Federal Disability Retirement benefits under FERS or CSRS, whether or not most cases get approved at the Initial Stage of the Process, or at the Second, Reconsideration Stage of the process, is ultimately besides the point.  It is important to understand and approach the entirety of the administrative process with a proper frame of mind:  a denial at the Initial Stage of the process of filing for Federal Disability Retirement benefits under FERS or CSRS is not the end of the process; rather, it is just the beginning. 

By approaching the entirety of the process with a correct frame of mind — and reference — one can maintain one’s sanity while waiting for the conclusion of the long and arduous process to unfold.

Sincerely,

Robert R. McGill, Esquire

CSRS & FERS Medical Disability Retirement: The Denial Letter

During this Holiday Season when Federal and Postal employees who have filed for Federal Disability Retirement benefits under FERS or CSRS, who are anxiously awaiting the decision from the Office of Personnel Management, a denial letter from OPM can appear disproportionately devastating.  Christmas and the New Year tend to bring difficulties precisely because it is seen as a season of celebration, when families get together, where work continues, but an expectation of being “joyous” pervades.  At such a time, a denial of a Federal Disability Retirement application from the Office of Personnel Management can be a seeming conclusion to a long wait.  It is not.  

Do not become discouraged just because someone at OPM has “decided” that your Federal Disability Retirement application did not “meet” the legal criteria.  Set the denial letter aside for a day or two (so long as it is not nearing the 30-day period to either file for Reconsideration or an appeal).  Then, proceed to fight it.  

Don’t let the Holiday Season become confused with the right to file for, be eligible for, and be entitled to Federal Disability Retirement benefits under FERS or CSRS.  The filing of an application for Federal Disability Retirement benefits is a process which may take 6 – 8 months, or longer if it is needed to go to the Reconsideration Stage, or to the Merit Systems Protection Board.  

Do not get discouraged; instead, fight for your benefits.

Sincerely,

Robert R. McGill, Esquire

OPM Disability Retirement: Unequivocal Doesn’t Mean That One Is “Right”

In a denial letter from the Office of Personnel Management, the Claims Specialist/Representative will often make statements in confident, unequivocal terms.  “You have not…”   “The medical evidence fails to show…”    “Your doctor never…”   “The law requires that you…”  Such a voice of unequivocal confidence often leaves the impression that there is no room for argument; that the case is lost; that there really is no point in even attempting to argue with the Office of Personnel Management.  Nothing could be further from the truth. 

Merely because an individual makes statements in an unequivocal manner, is not a basis for determining the truth or falsity of his or her argument.  In a Federal Disability Retirement application under FERS or CSRS, there is almost always room for disagreement.  We are speaking about interpretation of medical documents, the significance of what is said, etc.  We are talking about the different and proper application of the OPM Disability law, and the multitude of case-law which would be applicable.  Don’t let the voice of a statement fool you as to the validity of the statement.  In a Federal Disability Retirement case, the Office of Personnel Management is rarely right; they just like to sound like they are.

Sincerely,

Robert R. McGill, Esquire

OPM Disability Retirement: The Template Approach

The Office of Personnel Management essentially renders both approvals and denials of a Federal Disability Retirement application with a “template” approach.  This is not surprising, but it is little noticed, and this is why:  For disabled Federal and Postal workers who file for Federal Disability Retirements benefits under FERS or CSRS, and who are not represented by a federal disability attorney, it is their “one-and-only” exposure to the Office of Personnel Management.

Thus, if an approval is received, that approval is the first and only time of having any correspondence from the Office of Personnel Management.  Similarly, if a denial is received, then that is the first exposure and contact from the Office of Personnel Management.  There would be no way of knowing whether or not the approval letter, or the denial letter, was or was not a “standard template”.  Certainly, in a denial letter from the Office of Personnel Management, there are references to submitted medical documents, or supervisor’s statement, or some other document which was part of the Federal Disability Retirement application; but the remainder of the denial letter is in “template form”. 

However, when an attorney represents a Federal or Postal worker and receives an initial denial letter, or a denial at the Reconsideration Stage, it is an obvious issue, because any attorney who specializes in Federal Disability Retirement law has viewed hundreds, if not thousands, of such letters.  Why is it important to recognize that the format is in “template” form?  For many reasons.  The type of template; from whom the template is received; the extent of the template; the issues presented in the format; these are all helpful for any experienced Federal Attorney who specializes in Federal Disability Retirement law, to successfully answer such formatted denials.

Sincerely,

Robert R. McGill, Esquire

CSRS & FERS Disability Retirement: Decisions during the Process

In making decisions during the process of filing for Federal Disability Retirement benefits under FERS or CSRS, it is obviously important to make the “right decision” at each stage of the process.  Thus, for example, if a person files for Federal Disability Retirement, at the first stage it is important to determine which medical conditions to identify and base the application upon; at the Second, Reconsideration Stage, it is important to first identify what substantive concerns which the Office of Personnel Management is proposing (in any given denial of a Federal Disability Retirement case, it is often not that obvious what the OPM Representative is actually stating), and how to go about rebutting and answering the concerns (as opposed to taking a “shotgun approach” and trying to answer each and every concern expressed by the OPM Representative), and further, at the Merit Systems Protection Board, it is vitally important to place all evidence, legal precedents, arguments and objections on the record, so that if the Administrative Judge in the case denies your claim, you have a legal basis to file an appeal.  As always, it is important to see the entire application submission, from beginning to end, as a “process”.

Sincerely,

Robert R. McGill, Esquire

CSRS & FERS Disability Retirement: Denial at the First Stage

I would like to state that none of my cases have ever been denied at the Initial Stage of filing for Federal Disability Retirement benefits; not only would such a statement be untrue; it would also be unbelievable.  And yes — even the cases that I file on behalf of my clients, get a similarly formatted denial:  a restatement of the criteria for eligibility for Federal Disability Retirement under FERS & CSRS; a discussion with an elaborate reference to doctor’s notes, dates of treatment, targeted extrapolations of statements by the doctors which are not only selectively chosen in a narrow manner to favor the decision of denial, but further, which are often taken out of context.  Some might wonder:  Doesn’t OPM have greater respect for Mr. McGill?  The answer is:  At the First Level, the representative from the Office of Personnel Management is merely making a decision on one of thousands of files, and a template is being used to process and get rid of cases.  However, one must always remember (as I try to remind everyone) that this is a “process”.  A denial at the First Stage of the process is merely part of the greater process.  It is not something to get annoyed at, or concerned about; it is a stage and a decision which must be dealt with, argued against, and rebutted in the proper, rational, legal manner. 

Sincerely,

Robert R. McGill, Esquire

OPM Disability Retirement: The "Process" at the Reconsideration Stage

It is important to understand that the “process” of filing for Federal Disability Retirement, when it comes to the Second, or “Reconsideration” Stage, encompasses two factual prisms:  (1)  The application has now been denied (obviously, and for whatever reason — most likely because of “insufficient medical evidence”) and (2) it is the stage in the process prior to an appeal to the Merit Systems Protection Board. 

This dual prism of the stage, while self-evident, is important to keep in mind, because it requires a duality of duties:  A.  It requires (for the Disability Retirement Applicant) a duty to show something beyond what has already been shown, while B.  It requires the Office of Personnel Management to be careful in this “process” of review, because if OPM makes a mistake at this stage, then the likelihood is great that they will be required to expend their limited resources to defend a disability retirement case before an Administrative Judge, and if it becomes obvious that the case should have been decided favorably at the Second Stage, it reflects negatively upon the Agency.  OPM is an agency made up of people (obviously); as such, just as “people” don’t like to look foolish, OPM as an Agency made up of people, does not like to look “badly” or “foolish”.  This duality of factual prisms is important to understand when entering into the Second, Reconsideration Stage of the “process”.

Sincerely,

Robert R. McGill, Esquire