OPM Disability Retirement: Reconsiderations

The Office of Personnel Management does not give a decision over the telephone.  At least, that is their stated policy.  They ask that you instead wait for their written decision, which will be “sent in the mail shortly”.  Sometimes, of course, either by the tone of the conversation or by some slip of the tongue, one can discern whether or not a Federal Disability Retirement application has been approved or denied.  But such “guessing” can be a dangerous endeavor to engage in, and as such, I follow the very policy of OPM and will not convey to my client any “internal thoughts” following upon any discussions with an OPM representative. 

First of all, I find that calling an OPM representative too often is counter-productive; they are overworked as it is, and repeatedly inquiring about the “status” of one of my cases only irritates them further, and there is always the danger of having it denied simply to get rid of it (aghast — can this possible ever happen?)  Second, I made the mistake many, many years ago of once telling my client that his/her case had been approved, when in fact it had been denied.  I learn from my mistakes.  Hopefully, my experiences gained from such mistakes have made me wiser today.

Sincerely,

Robert R. McGill, Esquire

CSRS & FERS Disability Retirement: OPM and a Delicate Balance

The Office of Personnel Management, as a Federal Agency, always maintains a “public face” of stating that they welcome inquiries and telephone calls to check on the status of a pending Disability Retirement application.  Yet, we all know that Agencies, Departments and the personnel and offices which comprise all Federal entities, are made up of “people”, and people are complex bundles made up of different and differing personalities.

There is a fine and delicate balance to be maintained between an “inquiry” and a “bugging”, and further, between an acceptable level of “bugging” and one which crosses the line into annoyance.  It is good to recognize and know when and if the lines are crossed.  A power struggle is a fine thing to get into, where there are two camps of equal power.  Where there is an imbalance of power, however, it is often unwise to insist upon the tug-and-pull of such a struggle.

A word to the wise:  in dealing with any Federal Agency, be it the Office of Personnel Management or a Supervisor at a given Agency X, maintain a voice and tone of professionalism; the person on the other end of the telephone, no matter how friendly, is not your next-of-kin; be courteous, always, even if you want to insist upon something.

Sincerely,

Robert R. McGill, Esquire

CSRS & FERS Disability Retirement: OPM May Say So, But… (Part 2)

Then, of course, there are the multiple “other” issues which the Office of Personnel Management “says so”, such as failure to pay the full amount of back-pay due; failure to compute the average of the highest-3 consecutive years correctly; reinstating the full amount of FERS once a person becomes no longer eligible for Social Security Disability benefits; arbitrarily and capriciously deciding that the medical report is not “good enough” in answering a post-disability approved, Medical Questionnaire; failing to compute the earned income in any given year properly, and thereby informing the disability retirement annuitant that he or she earned over the 80% limit of what the former federal employee’s former job currently pays; and a host of other issues.  My specialty is in obtaining disability retirement benefits for my clients; I only selectively get involved in post-disability annuity issues, but the point here is that the Office of Personnel Management has a track-record of being in error, in multiple ways, on multiple issues, in volumes of cases.

It is thus important to recognize that the Office of Personnel Management is not an infallible agency.  Far, far from it, they are merely made up of people who are subject to error, but often stubbornly so — unless you counter their denial in an aggressive, but calm and rational manner.  If a denial comes your way, do not get distressed; prepare your case well, and lay out the groundwork necessary to win.

Sincerely,

Robert R. McGill, Esquire

 

See also: OPM May Say So, But… (Part 1)

Federal & Postal Service Disability Retirement: How Many Should Be Listed (Part 2)?

The listing of the medical conditions in a Federal Disability Retirement application, as it is descriptively written on the Applicant’s Statement of Disability (SF 3112A) for FERS & CSRS disability retirement, to be submitted to the Office of Personnel Management, is a separate issue from the creative description of the symptoms which the applicant experiences as a result of the identified listing of the medical conditions.  Thus, a distinction should be made between the “official” diagnosed medical conditions (which should be limited in number, for reasons previously delineated) and the multiple and varied “symptoms” which result from the listed medical conditions.  Thus, while one may suffer from the medical condition termed as “Fibromyalgia”, the symptoms can be multiple:  chronic and diffuse pain; impact upon cognitive abilities, inability to focus and concentrate, symptoms which are often termed as “fibro-fog”, etc. 

When the Office of Personnel Management approves a Federal Disability Retirement application under FERS & CSRS and identifies the specific medical condition by which it is approved, it will identify the medical condition, and not the symptoms.  This distinction is important because, when an applicant prepares the narrative to show the Office of Personnel Management what he or she suffers from, the differentiation between conditions and symptoms is important to recognize when creatively and descriptively writing the narrative of one’s medical conditions.

Sincerely,

Robert R. McGill, Esquire

CSRS & FERS Disability Retirement: How Many Should Be Listed?

I am often asked the question:  How many medical conditions or disabilities should I list in my Applicant’s Statement of Disability (SF 3112A)?  This question is often preceded by another question and answer:  What are your medical disabilities (me to the caller)?  Answer:  I have about ten of them (caller to me).  Let me start out by giving some free advice:  Don’t list ten medical conditions.  Don’t list nine.  Don’t list eight.

When the Office of Personnel Management reviews a Federal Disability Retirement submission under FERS or CSRS, the OPM Representative will review your disability retirement packet until it is approved — and no further.  Approval comes about upon a finding that one of your listed medical conditions disables you from performing one or more of the essential elements of your job.  Now, sometimes OPM will find that a combination of 2 or 3 medical conditions disables you together:  meaning that OPM perhaps found that while a single one did not disable you under their criteria, a combination of two or three did.

Furthermore, it is important to understand that, because the medical conditions and disabilities upon which OPM makes their decision on will be the basis for future continuation of your disability retirement annuity (in the event that you receive a Medical Questionnaire in the future), it is important to limit the listing of one’s medical disabilities on the SF 3112A to those conditions which will likely last for more than 12 months.

Conclusion:  It is important to sequentially prioritize the medical disabilities, in the order of severity, chronicity and duration.  Further, it is important to NOT list the minor medical conditions which, while they may be aggravating, and have impacting symptoms, may not necessarily prevent one from performing the essential elements of your job.

Sincerely,

Robert R. McGill, Esquire

Federal Disability Retirement: OPM’s Detailed Denial

Neither length nor detail constitutes legitimacy.  The spectrum of the types and styles of denial letters issued by the Office of Personnel Management in Federal Disability Retirement cases under FERS & CSRS range from a short paragraph under the “Discussion Section”, to 3 – 4 pages of apparent references to doctor’s notes, reports, etc. — with a lengthy lecture about the need for “objective” medical evidence, and about how a particular medical condition “may be” treated by X, Y or Z treatment modalities.

Don’t be fooled.  One may think that, because OPM provides a seemingly “detailed” explanation of why a particular disability retirement application was denied, that such lengthy detail means that it is somehow “substantive”.  In fact, I often find the opposite to be true:  the shorter the denial, the greater the substance.

The lengthy denial letters contain “substance”, all right — but substance of the wrong kind.  They contain:  Mis-statements of the law; mis-statements of the criteria to be applied; inappropriate assertions of medical opinions (contrary to what one might think, the OPM representative does not normally have a medical degree, let alone a law degree), and a host of other “mis-statements”.

Sometimes, the weightier the denial, the more confusing as far as how to respond.  And, perhaps, that is one methodology as to how OPM wants to approach the case:  If it seems long and complicated, maybe the applicant will sigh, give up, and go away.  Don’t.

Sincerely,

Robert R. McGill, Esquire

OPM Disability Retirement: Service Deficiency & Medical Condition

The Office of Personnel Management will often use as a criteria of denial the argument/basis that despite the fact that an individual may have a medical condition such that the medical documentation states that the Federal or Postal worker can no longer perform one or more of the essential elements of one’s job, nevertheless, there has not been a showing that a “service deficiency” has occurred.  Often, agencies systematically write up performance appraisals without much thought or consideration; more often, Federal and Postal workers quietly suffer through his or her medical condition, and strive each day to meet the requirements of their duties. 

Whatever the reason for the lack of attention or perception on the part of the supervisor or the agency to recognize that the Federal or Postal worker has not been able to perform one or more of the essential elements of one’s job, such basis for a denial of a disability retirement application by the Office of Personnel Management is not a legitimate one, because existence of a “service deficiency” is not the whole story:  if it is found that retention in the job is “inconsistent” with the type of medical condition the Federal or Postal Worker has, then such a finding would “trump” the lack of any service deficiency.  That is not something, however, that the Office of Personnel Management is likely to tell you as they deny your disability retirement application.

Sincerely,

Robert R. McGill, Esquire

CSRS & FERS Disability Retirement: Agency Interaction

Federal Agencies often act like little fiefdoms.  This is not necessarily a negative thing; each agency is an independent entity, and each has a province of responsibilities which it must carry out and execute according to the statutory mandate provided by Congress.  As independent entities, each agency acts without coordination or regard to other agencies.

Thus, while approval for disability benefits from the Social Security Administration will mean an offset of monetary payments under FERS, such interaction between the two agencies simply goes to the financial payments — not to the substantive issues of approval or disapproval of a disability retirement claim.  Similarly, while receipt of temporary total disability payments from the Office of Worker’s Compensation Programs means that you cannot concurrently receive payments under CSRS or FERS disability retirement (unless you are receiving a scheduled award from OWCP/DOL), the substantive basis of approval or denial of a claim rarely overlaps.  This is because each agency has its own independent criteria for eligibility — meaning that, for Social Security, the “disability” has a higher standard of “total disability”, whereas under FERS & CSRS, it is a lower standard of “inability to perform one or more of the essential elements of one’s job”.  Similarly, with OWCP/DOL, the issue of “causality” and whether it is “work-related” is often the important component of consideration.

All of this is not to say, however, that an approval of a disability benefit from one agency,or a report from a doctor considered for one benefit, should not be used by the applicant for submission to another agency.  Indeed, this should be done — but carefully, and with thoughtfulness.

Sincerely,

Robert R. McGill, Esquire

CSRS & FERS Disability Retirement: Viewing the Office of Personnel Management

Agencies are “like” people; they are “organic” organizations (a redundancy?), and as a corporate-like entity, they respond and react as people do:  cerebrally, emotionally, reactively, angrily, etc.  If one views an agency in this way — treating the entity as one would a person — then you will often get the same or similar results as when dealing with your brother, a spouse, or a neighbor.  And, indeed, as a logical approach, this only makes sense, because agencies and organizations are made up of people.

Thus, when filing an application for Federal Disability Retirement benefits, it is often important to think of “incentives” in approaching the Office of Personnel Management, to make every effort to have a carrot/stick approach in filing a disability retirement application.  The “stick” part of it, of course, is the law — the threat of making sure that OPM knows that you will be willing to go the full course — to the Merit Systems Protection Board, to the Full Board Appeal, to the Federal Circuit Court of Appeals.  If OPM denies your case and they get it reversed at the appellate level, it makes them “look bad”.

That is the stick to hold over them — the force of the law.  The carrot part of it is to streamline it and make it as easy as possible by obtaining a clear and concise medical report.

Sincerely,

Robert R. McGill, Esquire

OPM Disability Retirement Denials

When your OPM Medical claim is denied by the OPM Disability Retirement Specialist

 

A received letter from the U.S. Office of Personnel Management quashes the Federal employee’s plans for the future. The deep, emotional disappointment is understandable because it prevents the employee to secure a stream of income; to have the recuperative period in which to recover from a progressively deteriorating medical condition; and generally to be able to “move on” in life.  As all rejections have a negative impact upon a person — in terms of emotional, psychological as well as practical consequences — so an OPM denial letter is seen as a rejection of a compendium of submitted proof concerning a Federal OPM Disability Retirement application.

It is not so much that the denial itself obviously represents “bad news” (that is difficult enough), but again for the OPM Disability Retirement applicant, it casts a long and foreboding shadow upon one’s financial and economic future.  For, obviously, the income from the disability annuity is being relied upon; the applicant filed for Federal disability retirement benefits under FERS or CSRS based upon the assumption that it would be approved, and the future calculation of economic and financial stability was based upon the obvious assumption of an approval.

Long-term plans are made based upon the assumption of approval.  Further, it doesn’t help that the basis for the denial, as propounded by the Office of Personnel Management, is often confusing, self-contradictory, and without a rational basis.

It is often as if the OPM Medical Retirement representative just threw in a few names, referred to some doctor’s reports, and essentially denied it with a selective, almost pre-determined view towards denying the claim.  This is unfortunate, because the Office of Personnel Management is under a mandate to make its decision based upon a careful and thorough review of the applicant’s supporting documention.

However, when an OPM Disability Retirement denial is received, one must fight against the initial feelings of defeat and dismay; work is yet to be done, and a view towards the future must always be kept at the forefront.  A time to give up is not now; it is time to fight onward, and to move forward.

Sincerely,

Robert R. McGill, Esquire