Medical Retirement Benefits for US Government Employees: Office Notes

The Office of Personnel Management will often request that a doctor’s “office” or “treatment” notes be attached for approximately the last 1 – 2 years.  What is the purpose of this request?  Normally, to compare whether or not the doctor’s treatment notes reveal the consistency with what is stated in the narrative report prepared by the doctor.  This is often unfair, of course, because the purpose of office notes is quite different from the purpose behind a narrative report requested to support a Federal Disability Retirement application under FERS or CSRS.  

Office notes often reflect a cursory overview of the type of treatment rendered, and will sometimes contain statements of the positive advances and treatment responses of the patient/applicant, including any progress made in response to therapy, surgery, treatment, and medication regimens.  Thus, statements such as, “patient is showing good progress” or “Patient comes in today feeling much better” may be used by the Office of Personnel Management to deny a Federal Disability Retirement application under FERS or CSRS, and yet such statements must always be seen within the context of treatment, and in no way are inconsistent with a medical narrative report which clearly and unequivocally shows that a Federal or Postal employee is no longer able to perform one or more of the essential elements of one’s job.  Next:  How to overcome OPM’s unwarranted focus upon the Office/Treatment notes.

Sincerely,

Robert R. McGill, Esquire

FERS & CSRS Disability Retirement for Federal and USPS Workers: Preempting OPM’s Arguments

It is important at all stages of a Federal Disability Retirement application for FERS & CSRS employees to predict, anticipate, and preempt the arguments which the Office of Personnel Management may make, will make, and can be expected to make.  Obviously, the three main areas of such concern are:  Sufficiency of medical documentation; Agency efforts for accommodation and reassignment; the impact and interconnection between one’s medical condition(s) and the positional duties of one’s job. 

However, there are multiple other areas, and it is the job of an applicant filing for Federal Disability Retirement benefits, or his/her attorney, to anticipate the areas of OPM’s concerns, and to address them both factually and legally — the latter, by pointing out statutory authorities and case-law holdings directly or implicitly touching upon those very areas of concern.  Further, one should never be fooled if, in an initial denial of an OPM Disability Retirement application, the substance of a denial is fairly short or if it is detailed and lengthy; the content of a denial letter should not determine the extent of a response by an applicant at the Reconsideration Stage.  Instead, whether short, of “middle length”, or extremely detailed, a response should anticipate all areas of concern, and the applicant who is attempting to secure an approval for his or her Federal Disability Retirement benefits should always preempt any potential areas for a further denial.

Sincerely,

Robert R. McGill, Esquire

OPM Disability Retirement: Always Verify Submissions

The old saying:  Measure twice, cut once, can be adapted here:  Verify twice, submit once.  I am always surprised by Federal and Postal employees who have filed for Federal Disability Retirement benefits under FERS or CSRS to hear that a document, a submission, a Request for Reconsideration, an appeal, etc., was sent to the Office of Personnel Management by regular mail, with no manner of verification.  While I have great respect for the personnel who work at the U.S. Postal Service as well as the Office of Personnel Management, such issues have nothing to do with individual competence; instead, it has to do with the recognition that all oversized agencies (do we even have to argue as to what is defined as an “oversized agency”?) have their internal mail problems — not only of sending or receiving mail, but getting it to the right person, etc.  Not everyone needs to be overly “verification-sensitive” like I am, but my methodology for every document forwarded to OPM is as follows:  faxed (with a print-out of a receipt showing that the fax went through), as well as an express mail or FedEx tracking number.  Verify twice, submit once.  The Office of Personnel Management has never won an argument with me that they “never received it.”

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

FERS & CSRS Disability Retirement: Pragmatic Considerations

Often, pragmatic judgments and decisions must be considered at different stages of a disability retirement application. For instance, whether to submit all of the medical documentation in your possession is a discretionary judgment which needs to be considered. One might wonder why an applicant may withhold some or part of the medical documentation, and the answer is quite simple: if the Office of Personnel Management requests additional medical documentation, or it is rejected at the Initial Stage and further medical documentation needs to be submitted — if the applicant does not have additional medical documentation to submit, then there is very little incentive or basis for OPM to “reconsider” their position of denial.

Now, one might wonder, If the “additional” medical documentation had been submitted in the first place, perhaps OPM would never had requested more documentation, or perhaps they would have approved it to begin with. Not necessarily so. If you have already provided sufficient medical documentation to prove by a preponderance of the evidence your case, sometimes reserving that “extra” set of office or treatment notes is a wise decision. It may be the difference between being able to respond to OPM’s request for additional medical documentation, and not being able to — and the difference between an approval or a denial, and a basis for OPM to “reconsider” their position.

Sincerely,

Robert R. McGill, Esquire