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

Federal Employee Medical Retirement: Statutory Violations

As with most bureaucracies, the Office of Personnel Management is first and foremost established and guided by statutory mandate.  However, there is a distinction to be made between the establishment of a particular agency, and the mission and substantive enforcement of the mission as mandated by statute.  

Often, in its very decision-making process of reviewing, evaluating and deciding upon a Federal Disability Retirement application (whether under FERS or CSRS), it is important to recognize that if a decision is made erroneously, it does not imply or infer a statutory violation.  The statute is open to various interpretations, and such openness lends itself to a wide array of discretionary decision-making.  Complaining or fuming about whether or not OPM violated its statutory mandate is an act of futility; the process itself provides for a paradigm of “checks and balances”  — of having the Merit Systems Protection Board and an Administrative Judge look at a case and hold a Hearing on a case “de novo” — meaning, “anew” or “starting fresh”.  

Further, if one believes that the MSPB Hearing and Administrative Judge rendered a wrong decision, there is the further step in the process of a Petition for Full Review, or an appeal to the Federal Circuit Court for review of any error of law made in the decision-making process.  However, the best course of action if one is still before the Office of Personnel Management, or about to present one’s case at the Hearing Stage of the MSPB, is to focus upon the substance of one’s case, and not upon whether or not OPM or anyone else violated its statutory mandate.  

Save your energy and choose your battles; moreover, it is important to keep a singular focus upon the proper goal — of obtaining one’s Federal Disability Retirement annuity.

Sincerely,

Robert R. McGill, Esquire

FERS & CSRS Disability Retirement for Federal and USPS Workers: The MSPB

The Merit Systems Protection Board (better known by its acronym, the “MSPB”) is the third stage of the administrative process in attempting to obtain Federal Disability Retirement benefits under FERS or CSRS.  By this Stage, while the Office of Personnel Management has been both the “judge and jury” for determining one’s eligibility for Federal Disability Retirement benefits, the case is then handed over to an Administrative Judge to be the arbiter of such determination.

While it is advisable for a Federal or Postal Worker to obtain a FERS/CSRS Disability Attorney from the start of the administrative process, it is of even greater importance to consider obtaining proper legal representation before proceeding down the path of the MSPB.  This statement of advising any Federal or Postal employee to obtain proper representation at the MSPB is made for several reasons, not the least of which includes the following:  The MSPB is the last “stage” of the process in which a Federal or Postal employee who is seeking to obtain Federal Disability Retirement benefits may submit evidence in order to prove one’s case (with some special exceptions); any basis for an appeal, upon the chance that the Administrative Judge rules against you, must be established during the Hearing of the case at this stage; and since this stage is the arena of “the law”, it is important to be familiar with the most recent case-laws which govern Federal Disability Retirement.  The MSPB is not a place to feel one’s way through; it is the playground where the “grown-ups” play.

Sincerely,

Robert R. McGill, Esquire

Federal Worker Disability Retirement: MSPB & Prehearing

When a Federal Disability Retirement case has been denied by the Office of Personnel Management at the Initial Stage of the application process, and then again at the Reconsideration Stage of the administrative process, then it must be appealed to the Merit Systems Protection Board.  At that stage, the applicant (with the help of his or her attorney) must meet some crucial dates.  

While the Administrative process of having a Hearing before the Merit Systems Protection Board is fairly straightforward, once the Prehearing Statements are filed, it is important to participate in the Prehearing Conference with the Administrative Judge.  At the Prehearing Conference, it is important to define and limit the issues which will have to be proven at the Hearing of the case.  Issues such as accommodations and even the extent of the medical conditions which impact one’s inability to perform the essential elements of one’s job, can be clearly defined.  The individual (but more likely the attorney — because at this level, it is helpful to have the guidance of an attorney) should be very familiar with entirety of the Agency file (a copy of which OPM is required to provide after an appeal is filed with the MSPB).  This way, during the conversation with the Administrative Judge, one can say:  “Yes, Your Honor, that is already proven by document at Tab ____ of the Agency file, and need not be re-proven at the Hearing of the case.”  As with everything in life, preparation, preparation, preparation…

Sincerely,

Robert R. McGill, Esquire

Federal and Postal Disability Retirement: Understanding the Doctor

A question I often ask the treating doctor at the end of a Hearing before an Administrative Judge at the Merit Systems Protection Board (obviously for Disability Retirement benefits under FERS & CSRS) is:  Do you have an opinion as to whether Mr. X/Ms. Y is a malingerer? The reason I ask such a question is to establish in the mind of the Administrative Judge, that after all of the clinical examinations, the treatment modalities, the diagnostic testing, etc., does the doctor have a personal opinion about the individual who is seeking to obtain Federal Disability Retirement benefits

Obviously, there are multiple questions which I ask as a follow-up; and, indeed, the question as to the status of the client/applicant requests a professional opinion about the patient — but implicit in that question is also a rather personal one.  It goes to the heart of who the patient/applicant is, and what the doctor believes about this particular applicant/patient.  For, to resolve any doubts about the underlying motive of the patient is not only important to the Administrative Judge in a Federal Disability Retirement application; it is equally important that the doctor is comfortable in his own mind, as to the clear and honest intention of his patient.  Conveying that comfort from the voice of the treating doctor to the ears of the deciding Judge, is no small matter.

Sincerely,

Robert R. McGill, Esquire

CSRS & FERS Disability Retirement: OPM & the Problem of Templates

The problem with the use of templates is that they are, over time and overusage, predictable; being predictable, they become ineffective.  Now, from the perspective of the Office of Personnel Management, applying a template to a Federal Disability Retirement application under FERS or CSRS, whether predictable or not, is somewhat irrelevant, to the extent that a denial is still a denial, and an approval is simply an approval. 

It is only if and when a case is appealed (after an initial denial and a denial at the Second Stage, at the Request for Reconsideration Stage) to the Merit Systems Protection Board, that the template has to be “defended” if the Administrative Judge asks for clarification of the issues by referring to the template-based denial.  Moreover, what is predictable is the combination of medical condition/denial rationale.  For instance:  for Fibromyalgia:  “The condition waxes and wanes”; for Major Depression:  “Not enough time has been allowed for the efficacy of a medication regimen“; for anxiety & panic attacks:  “There is insufficient objective medical evidence”; for Chronic pain:  “Physical therapy has not been sufficiently given a chance to…”   These are some examples of templates used by the Office of Personnel Management, each of which can easily be refutted in any particular case.  The methodology of refutation, obviously, is where a federal disability attorney can be of greatest counsel and representation.

Sincerely, Robert R. McGill, Esquire