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

OPM Disability Retirement: Logic versus Pragmatic Social Policy

In a Federal Circuit Court case a few years ago, a dissenting opinion concerning Federal Disability Retirement benefits argued that it was “contrary to logic” to allow for Federal or Postal employees to become eligible for Federal Disability Retirement under FERS or CSRS if they have been accorded light duty and allowed to remain in his or her official position while not performing many of the essential elements of the job.  

The “logic” which is argued here is based upon the paradigm that, so long as one is allowed to continue to work and receive a paycheck, one should not be considered “disabled”.  But such an argument refuses to acknowledge both the law (under the Bracey v. OPM decision), as well as good economic and social policy.  

The fact is that under Federal Disability Retirement rules, laws and case-laws, what the Administrative Judges and Courts have acknowledged is that a Federal or Postal worker should not be subjected to the arbitrary whims and actions of a single supervisor or Agency; instead, there should be a criteria upon which a Federal or Postal worker should be able to rely upon.  That objective criteria is in essence as follows:   A Federal or Postal worker should have to perform all of the essential elements of one’s job.  If not, that Federal or Postal worker is deemed “disabled” under the laws governing Federal Disability Retirement benefits.  

While an Agency may allow for light duty, or temporary assignments, such light duty or temporary assignments should not preclude the obvious fact that the Federal or Postal worker continues to remain disabled.  This way, there is an objective criteria of the law to be followed, which cannot be altered based upon the arbitrary whim of a Supervisor or an Agency, who may come along a year later and disallow all light duties or temporary assignments.  Thus, in this case, the social and economic policy as envisioned under the Federal Disability Retirement rules, regulations and laws, are not only pragmatic, but logical.

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

Federal and Postal Disability Retirement: Approaches & Decisions

With each case, a story must be told.  If the case gets denied, normally my approach is not so much that a “narrative” must be retold, but rather, I tend to view the Reconsideration Stage of the Federal Disability Retirement application process more as the “battle” to set the proper stage — to either win at the Reconsideration Stage, or to win at the Merit Systems Protection Board stage.  What is interesting is that, within the three stages of the process (excluding the appellate stages of the Full Board Review and the appeal to the Federal Circuit Court of Appeals), the need to tell a coherent, empathetic, sympathetic and compelling story of a dedicated and loyal Federal employee who suffers from a medical condition such that it impacts him or her from performing one or more of the essential elements of one’s job, comes “full circle”. 

I approach the “Reconsideration Stage” of the Federal Disability Retirement process under FERS & CSRS as the “center point” of battle, in many ways, precisely because it is the step just before taking it before an Administrative Judge at the Merit Systems Protection Board.  It is the place to give the Office of Personnel Management a subtle warning:  This is your last chance before the destiny of the Disability Retirement Application is taken completely out of your hands and control, and placed into the hands of an Administrative Judge.

Sincerely,

Robert R. McGill, Esquire

OPM Disability Retirement: Legal Arguments

Whether and to what extent legal arguments in Federal Disability Retirement cases under FERS or CSRS should be made, should rarely be ventured into by non-lawyers.  The boundaries of legal arguments are naturally constrained for lawyers both internally and externally:  internally, because (hopefully) lawyers are trained to recognize that maintaining the integrity of legal precedents is vital to the process, and externally, because all legal arguments are ultimately subjected to the review of a Judge — in the case of administrative laws governing Federal and Postal Disability Retirement, at the first instance by the Administrative Judge at the Merit Systems Protection Board, then potentially at the Federal Circuit Court of Appeals.  When laymen attempt to make legal arguments, there is the added danger of misinterpretation and mis-application of the law, which can further injure the chances of an Applicant filing for Federal Disability Retirement benefits to obtain an approval.  And, finally, such chances for success may be further damaged if it needs to come before an Administrative Judge for review.

Sincerely, Robert R. McGill, Esquire

CSRS & FERS Disability Retirement: The Law

Technically, the law does not have to be applied at the administrative, agency-level of the Office of Personnel Management.  Let me clarify:  one likes to always think that when an applicant for Federal Disability Retirement under FERS or CSRS is filing for the benefit, that the agency which oversees the application will review it with an overarching umbrella of criteria which is governed by an objective foundation deemed as “the law”.  Thus, in a perfect world, one might imagine an efficient line of technocrats sitting in cubicles, all with a reference book containing the relevant laws governing the eligiblity criteria for Federal Disability Retirement.  But that would be in a perfect world; and since such a perfect world fails to exist, what we have is an arbitrary sprinkling of various personnel, who collectively comprise the Office of Personnel Management, some of whom apply the law well, and some of whom apply the law less than competently. 

To some extent, the arbitrary methodology applied at the agency level is counter-balanced with the threat of a review by an Administrative Judge at the Merit Systems Protection Board, followed by a Full Review at the MSPB, then to be further appealed to at the Federal Circuit Court level; but it is nevertheless sometimes disconcerting that, at the Agency level, this peculiar animal called “the law” is not uniformly applied in all cases, at all times.  And sometimes rarely.

Sincerely,

Robert R. McGill, Esquire