Medical Retirement Benefits for US Government Employees: Insufficiency Test

The validity of an allegation that there is an insufficiency of X is partly determined by an objective standard, and partly (if not mostly) derived from a judgment as to the nexus between X and the standard to be applied.  

In Federal Disability Retirement cases, whether under FERS or CSRS, the basis of most Federal Disability Retirement denials is that there is an insufficiency of proof, whether as to issues of accommodation, medical opinion, medical documentation; questions about deficiency of service; and multiple other specified areas — but all will ultimately be determined to have a “lack” of something such that it fails to meet a “sufficiency” test.  But sufficiency can only be determined by comparing what exists (i.e., what has been previously submitted to the U.S. Office of Personnel Management) to what the legal standard of proof requires.  

Further, since the overriding legal standard is based upon a “preponderance of the evidence“, which requires that something be ‘more likely than not’, the narrow gap between human involvement in the judgement of sufficiency, and a truly objective basis for such insufficiency, is susceptible to human error.  Because of this, appearance of quantity in addition to quality is often what is required.  

As decisions by OPM are rendered by a wide range of people whose judgment, competence and approach in evaluating a case differ greatly, it is unfortunately necessary to take into consideration the foibles of human error.  Until a precise algorithm is invented which applies fairly and accurately in all cases across the board, we must continue to deal with human beings, the their errors of judgment.

Sincerely,

Robert R. McGill, Esquire

OPM Disability Retirement: The Initial Denial & Reconsideration

In the Animal Kingdom, there are artificial classifications superimposed by a class of individuals commonly and generically referred to as “scientists”, in which more generalized identifiers are further categorized, until you reach the “genus” classification, and within that genus, the “species” classification.  In the objective world of animals, such classifications are irrelevant and taken no notice of.  Instead, the necessity to be able to identify various species is essentially based upon the ability to recognize one’s natural predators, as well as one’s food source.  

Such anthropomorphic imposition on ordering the world for purposes of our understanding of the world was recognized by Kant in his Critique of Pure Reason, and the ability of Man to impose his a priori categories upon the objective noumenal world.  But in the world of Man, especially for the Federal or Postal employee who has prepared, formulated and filed a Federal Disability Retirement application under FERS or CSRS, it is important to understand the categorized arena within which he or she finds one’s self in.  

Thus, when an initial denial is received by the Federal or Postal worker, it is important to understand that filing a “Request for Reconsideration” does not take the Federal Disability Retirement case out of the hands of the agency which made the initial denial — instead, it is within the same agency (the Office of Personnel Management), but assigned to a next “level” in order for both the Federal or Postal employee to get a “second bite at the apple“, as well as for the deciding body (OPM) to review the case afresh, along with any new or additional evidence which the Federal or Postal employee can supply to OPM.  

This methodology of a second “review” makes sense, in that it allows for the deciding Federal Agency (OPM) to have a chance at correcting itself in the event that its initial decision was made in error, before it is allowed to be appealed to an independent, separate entity, called the Merit Systems Protection Board.  Thus, that same categorization and ordering of the world, superimposed upon the Animal Kingdom, is also utilized in the world of Man.  The same agency, but different sections; if the second review fails, then it is kicked up to a different genus — before an Administrative Judge at the Merit Systems Protection Board.

Sincerely,

Robert R. McGill, Esquire

Federal Employee Medical Retirement: Sometimes, It’s “The Law”

An assumption is often made that the “Disability Specialist” at the Office of Personnel Management who reviews the Federal or Postal Disability Retirement application understands, comprehends, and applies the laws governing Federal Disability Retirement applications.  Now, such an assumption may be logical and reasonable, to the extent that one thinks (A) that those who aspire to working in a specific specialty have some knowledge or understanding of the specialty, and (B) if a decision is made which involves discussing “the law”, one presumes that the mere discussion of it proves some knowledge of it.  

The problem with such reasoning, however (apart from the popular tripartite acronym which originates from the word “********-u-me”), is that it betrays the facts:  often, from reviewing the denial letters generated from the Office of Personnel Management, it is painfully clear that the administrative specialist, the legal specialist, or whatever other “specialist” designation has been embraced by the worker at the Office of Personnel Management, simply fails to apply all of the applicable laws which govern Federal Disability Retirement applications.  This is understandable, to this extent:  OPM representatives (other than those representing OPM at the MSPB level) are not lawyers, and as such, do not keep up with the latest evolution of the laws governing Federal Disability Retirement issues.  Whether that is a good thing or a bad thing, is another matter altogether.

Sincerely,

Robert R. McGill, Esquire

Federal and Postal Disability Retirement: Applicant Tendency

An applicant or potential applicant for Federal Disability Retirement benefits under FERS or CSRS exhibits tendencies which can range on a wide spectrum of behavior, thoughts, fears, actions and reactions.  Some individuals believe that his or her application is so self-evident and self-explanatory, that all that is necessary is to obtain the medical records, list the diagnosed medical conditions on the Applicant’s Statement of Disability, file it, and…  When the Denial letter appears from the Office of Personnel Management, there is the surprise and shock, and the:  “I thought that…” 

Then, there is the other extreme of the spectrum, where there is an almost irrational fear that unless every ache and pain is detailed in long, explanatory narratives, and pages of pages of “personal experience” diary-like formatted chronologies are submitted with the packet, with tabulated references to justify each and every medical experience from two decades before until the present, that the Office of Personnel Management will deny the application.  Remember this:  It takes just as short a time to deny the first type of application as it does the second.  The Office of Personnel Management does not read through any materials which it deems “superfluous“.  Somewhere in the middle between the two extremes is normally the correct balance.  Or, as Aristotle would say, it is important to achieve the mean between the two extremes.

Sincerely,

Robert R. McGill, Esquire