Federal Disability Reconsiderations & Additional Medical Information

The denial comes in the mail; it is a further delay, a negation of prior efforts; for many, it undermines and constitutes a condemnation of sorts, and a refusal of an affirmation sought in places and from people where none is offered.  It is, after all, another piece of correspondence which negates the negative:  the medical condition itself and the loss of one’s ability to perform one or more of the essential elements of one’s job, represented the first foundation of negation; now, a denial from the U.S. Office of Personnel Management merely confirms, via a second negation, the loss of positive forces inherent in failure and Federal bureaucracies.

But all things in life must be kept in their proper perspective, and a reaction of disproportionate magnitude must be kept in check; life is often a series of mishaps; yes, it just seems that such unfortunate events happen to certain individuals, and as the old adage goes, when it rains, it pours.  Once the initial shock of the denial is withstood, then the trepidation and cautious perusal, followed by an obsessively careful scrutiny, of the reasons for the denial issued by the U.S. Office of Personnel Management, is engaged; but the futility of such efforts will become apparent.

The monotony and disinterested voice behind the volume of verbiage and almost bellicose verbosity becomes more than apparent: either the administrative specialist at the U.S. Office of Personnel Management did not read the medical file or, more likely, selectively chose to extrapolate statements and findings out of context in order to justify the denial of one’s Federal Disability Retirement application.

At this Second Stage of the process of trying to obtain Federal Disability Retirement benefits from the U.S. Office of Personnel Management, whether the Federal employee is under FERS or CSRS, it matters not what the words say with respect to the denial issued by OPM; the file is immediately transferred to a general, unassigned file, awaiting further instructions from the person to whom the denial has been issued:  if left unanswered, the file will disappear within the cauldrons of bureaucratic warehouses; if a Request for Reconsideration is timely filed, then it will ultimately be assigned to someone in the Reconsideration Division at OPM; but, in either case, it is no longer the responsibility of the OPM representative who issued the denial, and no amount of phone calls, venting or sending of additional information to that person will make a whit of difference, until (a) the Request for Reconsideration is timely filed, and (b) the Federal or Postal employee addresses some of the concerns brought up in the denial itself.

The Reconsideration process itself is fraught with dangers and potential pitfalls; it confirms that perhaps the Federal or Postal employee should have sought the advice, counsel and guidance of an attorney who specializes in Federal Disability Retirement law, but moreover, as most mistakes are correctable, it may be a wise avenue of choice to seek legal assistance, finally.

In any event, time factors must be considered, and the time lost today by extension of a denial, further confirms the oldest adage of all, that being penny wise is to be pound foolish,  a saying that is often attributed to Benjamin Franklin, but can be traced to those earlier.

Sincerely,

Robert R. McGill, Esquire

 

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

Disability Retirement for Federal Workers: Patience & the Hinge

The hinge on a door is the mechanical contraption which allows for the swinging motion to occur.  Without it, the door will remain in place or, if one attempts to pull at the door, it will merely move towards you and continue to block the pathway.  Metaphors have been created from the invented device — a person can become “unhinged” meaning, similar to a door collapsing, a man or woman can lose the hope that a door represents as an entrance or an exit, to enter or leave.  

Preparing, formulating and filing a Federal Disability Retirement application under FERS or CSRS for the Federal or Postal employee can represent that “hinge” on a door.  It allows for hope viewed from a perspective of “now”, representing one side of the doorway, involving the debilitating medical conditions, the impact both upon one’s professional abilities, as well as upon the personal life with its correlative issues touching upon wives, children, parents, financial instability, etc.; and on the other side, the potential to receive a basic annuity so that one may exit in order to attend to the serious medical conditions without fear of becoming homeless.  

Yet, during the process of attempting to obtain Federal Disability Retirement benefits, because of the long delays, the months upon months of uncertainty awaiting for the decision from the Office of Personnel Management, the hinges can begin to rust and crumble.  This is especially true if a denial is received at the First Stage of the process, because it appears as if the door has slammed shut, and the hope for exiting and entering a different phase of one’s life has been lost.  But one must never lose the proper balance and perspective that is necessary to survive the fulfillment of the entire administrative process.  

Filing for, and obtaining, Federal Disability Retirement benefits under FERS or CSRS is a process — the First Step is merely that:  part of the entirety of the process.  A denial at the Initial Stage of the process does not constitute an unhinging of the doorway to the future; rather, it merely represents a moment of time when the door got stuck because of the change in weather, where the wood expanded for a season, making it difficult to open it.  It just needs a little more effort, and patience, to take it to the next step of the process.

Sincerely,

Robert R. McGill, Esquire

FERS & CSRS Disability Retirement for Federal and USPS Workers: Medical v. Legal

Issues concerning Federal Disability Retirement applications under FERS or CSRS, both for Federal and Postal employees, rarely “conflict” with the goal of obtaining the proper medical care for a medical condition which one suffers from.  First and foremost, one should seek to obtain the proper medical care, and undergo all of the appropriate treatment modalities necessary to take care of the medical condition. 

If that medical condition — despite treatment, intervention, medication regimens, etc. — fails to allow for recovery sufficient to return to a level of functionality such that the Federal or Postal Worker can continue to perform all of the essential elements of one’s job, then one should certainly consider preparing, formulating and filing for Federal Disability Retirement benefits under FERS or CSRS. 

Throughout the process, however, the primary focus should always be upon obtaining the proper medical care.  Logically, the Merit Systems Protection Board has held in various Federal Disability Retirement cases that where such treatment modalities as a medication regimen has been refused, then such refusal may be a basis for denial of a Federal Disability Retirement application.  Why would this be?  The reasoning is that there is an intervening cause for the continuation of the medical condition which prevents one from performing one or more of the essential elements of one’s job — not the medical condition, but rather the refusal to follow a prescribed course of medical treatment. 

Sometimes, however, failing to follow a prescribed medication regimen may not be an outright “refusal”, but rather a recognition on the part of the Federal or Postal employee that taking such medications while working will further impede one’s ability to perform the essential elements of one’s job.  This is where an intersection between the Medical and the Legal can “conflict”.  The best thing to do in such a circumstance, of course, is to consult with the treating doctor and explain the potential conflict.  There may be no resolution, but it is always best to have such attempts annotated so that it can be “proven” later on, if needed.

Sincerely,

Robert R. McGill, Esquire

Disability Retirement for Federal Government Employees: Initial Application, Reconsideration & MSPB Appeals

Each Stage of the process in attempting to obtain a Federal Disability Retirement application under FERS or CSRS offers a distinct, yet similar, challenge.  Do not be fooled by responding to a “template” approach; while the Office of Personnel Management may respond in an indifferent, antiseptic manner, a Federal or Postal employee who must respond to OPM’s denial at each stage of the process must pinpoint what OPM is looking for, and respond appropriately.  Indeed, it is the distinction which one observes, which makes all of the difference in the case.  

Often, it is clear that OPM’s denial at the Initial Stage of the process, as well as a denial at the Reconsideration Stage of the process (which then compels an appeal to the Merit Systems Protection Board), is merely a regurgitation of thousands of previous denial letters, with some minor insertions which are meant to appear “as if” the denial letter has been tailored to a particular case.  

Thus, references to a particular physician’s letter, and even extrapolating a quotation from a doctor’s note or narrative (often something like, “Your doctor stated that you were recovering well from your surgery,” or “Your psychiatrist stated that the medications were working”) have the effect of personalizing a denial letter.  Yet, the remainder of the denial letter is in an antiseptic, template form, and it is clear that you are merely one of hundreds & thousands of responses written by OPM’s representative.  However, while OPM has the power to generate such template-driven denials, the individual Federal or Postal Worker must respond in an independent, individualistic manner.  It must be based upon one’s particular case, and thus the response must not be a “generic” one, but one based upon the uniqueness of the case.

Sincerely,

Robert R. McGill, Esquire

OPM Disability Retirement: Reconsideration Response — Refrain from Reflexive Response

When a denial is received for an Application for Federal or Postal Disability Retirement benefits under FERS or CSRS, sometimes they are replete with comical “errors” and omissions.  Thus, anywhere from mistaken identities, to wrong job identifications, to the wrong doctors named; from medical conditions which were never claimed, to diagnostic tests and surgeries which were never submitted; these are just some examples of errors and omissions which one might find in the body of the “Discussion” in an OPM denial letter.

The reflexive temptation is to put together a string of harangues and accuse the OPM Representative of incompetence, incoherence, ineptitude, and inability to perform the essential element of his or her job.  Such a reflexive response would be the wrong tact to take, however.  One should refrain from making such “ad hominem” attacks.

Instead, the better way to go about it would be to politely point out the major errors, the omissions of any medical or other substantiating documentation, in an understated way, then to argue the main points that need to be argued to rebut the denial letter.  While the former methodology may make you feel good, in the end, it is an approval which will prove to be of lasting elation.

Sincerely,

Robert R. McGill, Esquire

FERS & CSRS Disability Retirement: Logical Argumentation

Reading a denial of a Federal Disability Retirement application under FERS or CSRS from the Office of Personnel Management is often a fascinating exercise in attempting to imply, infer, “read between the lines”, assume and presume what the basis of the denial is/are.  Just as gathering a 6-inch thick set of medical records and attaching them to a Federal Disability Retirement application does not constitute a logical, persuasive argument that you are entitled to Federal Disability Retirement benefits, conversely, referring to submitted medical documentation and acknowledging their existence, then concluding:  “You have not submitted sufficient medical documentation to be eligible for Federal Disability Retirement benefits” — does not constitute a sufficiently informative denial.  As the applicant must meet the legal criteria, the Office of Personnel Management has a duty and obligation to review it fairly, evaluate it objectively, and apply the laws and legal criteria.  If OPM decides that the application does not meet the legal criteria, then OPM has an obligation to provide a sufficient explanation that is clear, cogent, and logically persuasive.  Anything less would not meet the statutory obligation that OPM is under.

Sincerely,

Robert R. McGill, Esquire

OPM Disability Retirement: An Additional Problem with Answering an OPM Denial

Spring and summer are finally upon us; the warmth of the sun finally brings some hope that the multiple series of snowstorms may be finally behind us (now that I have said it, the chances are exponentially multiplied that we will accumulate an additional 20 inches of snow in March).  Thoughts of the beach will soon become visually real, as opposed to virtually experienced.  Sand.  The metaphor of the “shifting sand” is one which is applicable to the Office of Personnel Management in its denial of a Federal Disability Retirement application under FERS or CSRS.  Those of you who have followed my stream of consciousness on the issue of templates, denial letters and the arbitrary nature of OPM’s decision-making process, will not find it surprising to find that OPM merely shifts, changes positions, and dances around (albeit, not always gracefully) any attempt to “corner” the argument which purportedly is the basis for a denial of a Federal or Postal Disability Retirement application. 

Do not, however, underestimate the importance of properly, directly, and clearly answering the concerns of an OPM denial.  It is not enough to gather more medical documentation and sending them in.  It is not enough to address, point by point, the basis of a denial letter.  One must corner, clarify, and clearly define the basis of an OPM denial, then refute them.  This way, if it is denied a second time, and the case goes before an Administrative Judge at the Merit Systems Protection Board, the AJ will see that the issues previously brought forth by OPM have already been addressed, and that any necessity for a Hearing may be avoided by clarifying any remaining concerns which the OPM representative may need to search for and articulate. 

Sincerely,

Robert R. McGill, Esquire

FERS & CSRS Disability Retirement: The Problem with Answering an OPM Denial

A denial of a Federal Disability Retirement application under FERS or CSRS from the Office of Personnel Management always leaves the applicant and his or her attorney at a disadvantage.  This is because OPM is never answerable to any resulting consequence of a denial; at least, not directly.  Think about it this way:  In the initial application, if an OPM Disability Retirement application is properly prepared and submitted according to, and within the parameters of the laws governing Federal Disability Retirement, one would assume that it should be approved.  If it is denied, then the case is sent to the “Reconsideration” division of OPM — meaning, to another person. 

Now, taking it out of the hands of one OPM Representative into the hands of another, has both the good and the bad mixed together:  the good is that it will now be reviewed afresh by someone else; the bad is that the person who denied the original application has no further responsibility for the denial.  This is true, incidentally, with respect to the Reconsideration Stage of the process; if a second denial is issued, the person who issues the second denial also has no responsibility to answer for the basis given in the denial. 

The “light at the end of the tunnel“, however, comes when it is finally taken up by an Administrative Judge at the Merit Systems Protection Board.  While the AJ cannot hold anyone at OPM responsible for a denial which never should have been, at the very least, when the AJ reviews the record and finds that the previous denials were unfounded or rationally without legal foundation, an immediate recognition of a baseless denial can help the applicant.  Ultimately, rationality and legal integrity has a chance to prevail; it sometimes takes more than one bite at the apple.

Sincerely,

Robert R. McGill, Esquire

CSRS & FERS Disability Retirement: OPM’s Rationale

Too much time is often spent on the “rationale” or “reasons” for a denial from the Office of Personnel Management, under the “Discussion” Section of a denial letter.  By “time spent”, however, is not meant that one should not selectively rebut, refute and address some of the reasons delineated in an OPM denial letter; rather, what too many people do is to complicate matters by “reading into” the reasons given for the denial. 

One of the jobs of an attorney who specializes in Federal Disability Retirement law under FERS & CSRS is to prepare an application for Federal Disability Retirement benefits, rebut a denial, or file an appeal to the Merit Systems Protection Board, based upon one’s experience, wisdom and sense of that which OPM is looking for.  This is accomplished by having learned from a myriad of sources:  from seeing the types of prepared disability retirement packets which have been successful in the past; from learning from past legal arguments and rebuttal arguments as to which have been most persuasive for OPM; and from having conducted multiple Hearings before the Merit Systems Protection Board and learning exactly what the Administrative Law Judge has been most persuaded and convinced by.  Further, having read countless denial letters by people who have attempted to file for Federal Disability Retirement benefits at the first stage without an attorney, it is important to focus upon the relevant issues which OPM is seeking, and to disregard those issues which are peripheral or irrelevant.

Sincerely,

Robert R. McGill, Esquire