CSRS & FERS Disability Disability Retirement: The “Process”

In my last writing, I briefly discussed why filing for Federal Disability Retirement benefits is, and must be looked upon as, a “process” as opposed to a mere “filing” with an expectation of an “automatic” approval.  This is because there is a legal standard of proof to be met, based upon a statutory scheme which was passed by Congress, and based upon a voluminous body of “case-law” handed down by the Merit Systems Protection Board and the Federal Circuit Court of Appeals.  With this in mind, it is wise to consider that, because it is a “process” with two administrative “stages” to the process, as well as an Appeal to an Administrative Judge at the Merit Systems Protection Board, then potentially to the Full Board via a Petition for Review, and finally to the Federal Circuit Court of Appeals — as such, each “step” in the process would naturally have a different and “higher” level of the laws governing Federal Disability Retirement. 

Because of this, it is often a frustrating experience for applicants, because a rejection or denial at the First Stage of the process often reveals the utter lack of knowledge by the OPM representative of the larger compendium of case-laws that govern and dictate how disability retirement applications are to be evaluated and decided upon.  Often, the so-called “discussion” of a denial letter is poorly written, meandering in thoughtlessness, and self-contradictory and with unjustifiable selectivity of statements from a medical report or record.  Such poor writing reflects a first-level decision-making process, and can be a frustrating experience upon reading the denial letter.  It is good to keep in mind, however, that the entire application procedure is a “process”, and each level is designed to have a greater level of competency and knowledge in the law.

Sincerely,

Robert R. McGill, Esquire

CSRS & FERS Disability: Perennial Issues

Like perennial plants, some issues continue to repeatedly crop up; once planted, they keep showing up in various question-forms.  The one which needs to be addressed, again, is the “1-year” issue:  there are actually two (2) questions which keep resurrecting themselves: A.  Filing a disability retirement application within 1 year of separation from service, and B. A medical condition which must last for a minimum of one year. 

As to the former:  The statute of limitations begins to toll when a person has been officially separated from Federal Service.  This means that the Agency must take you off of the Federal rolls.  If you continue to receive a paycheck, you are likely not separated (unless, of course, it is some form of a severance paycheck); if you receive a paycheck with “0-balances”, you are still not likely separated. If you are injured and you haven’t worked for a year, but you have not received notification that you have been separated from Federal Service, the 1-year mark has likely not begun.  On the other hand, if your SF-50 or PS Form 50 states that you are separated, then you are separated.  At that point, you have one (1) year to file your Federal Disability Retirement application. 

As to the latter (Issue “B” herein):  In most cases, it is a prospective issue.  It doesn’t mean that you must “have been” medically unable to work for a year; it doesn’t mean that you have to wait around for a year, out of work and penniless, for a year; it doesn’t mean that you must be on OWCP or on LWOP or on sick leave for a year — instead, it means that your medical condition must last for at least a year.  In other words, as is the case with most medical conditions, after a couple of months, your doctor should have an opinion — a “prognosis” — of how long your medical condition which impacts your ability to perform the essential elements of your job, will likely last, within reasonable medical certainty.  Indeed, since the Federal Disability Retirement process often takes from 8 – 10 months (from start to finish) to obtain an approval, by the end of the process, the full year will likely have occurred anyway.  In other words, you don’t need to wait around for a year to show that you can’t perform the essential elements of your job; indeed, that would be foolish. 

Sincerely,

Robert R. McGill, Esquire

OPM Disability Retirement: The Denial at the First Stage

Many individuals who have tried to file for Federal Disability Retirement benefits under CSRS or FERS get the disability retirement application denied at the Initial Stage of the process.  Would I rather have had that person come to me at the First Stage and have me prepare & file it?  Yes.  Are the mistakes made by the unrepresented Federal or Postal Worker irreversible?  No.  Would the disability retirement application been approved at the First Stage had it been prepared and filed by me?  Probably.  This is not to say, however, that all of my cases get passed through at the First Stage.  However, many of the mistakes which I see over and over, made by unrepresented individuals, could — and should — have been avoided. 

Further, many people who call me after getting the initial denial are surprised to hear me tell them that I don’t care what the OPM denial letter states.  While making for interesting bedside reading, the fact of the matter is that once you have read one such denial letter, you’ve essentially “read them all”.  Rarely is there anything new in an OPM denial letter.  OPM representatives use a template, and fill in dates and references to various medical reports and doctor’s records; but the conclusion of the denial letters are fairly identical:  the medical evidence is considered “insufficient” to meet the legal criteria to be eligible for disability retirement benefits.  It is the job of the attorney to go back to the doctors, get the proper medical documentation, then argue the law to the Office of Personnel Management.  The Second (Reconsideration) Stage of the process is a critical stage — for, if it is denied at this level, the next level takes it a “notch” higher — before an Administrative Judge at the Merit Systems Protection Board.

Sincerely,

Robert R. McGill, Esquire

When Federal Employees Don’t Know about OPM Disability Retirement Benefits and Fall into a Comfort Zone

Many people get confused when they first consult with an attorney about USPS or Federal Disability Retirement benefits.  Indeed, before consulting with an attorney, an individual who is faced with a medical condition which (1) is beginning to impact one’s ability to perform one or more of the essential elements of one’s position and (2) will likely last at least a year — such an individual should first take the time to research various websites to “get the facts” about Federal Disability Retirement.

I have had many individuals tell me that they didn’t even know that such a benefit existed; that when they were separated from their U.S. Government gency, the Postal worker or Federal employee was never informed that he or she could file for Federal Disability Retirement.  Unfortunately, ignorance of the law is not a valid excuse; if you don’t file for disability retirement benefits under FERS or CSRS with the Office of Personnel Management within one (1) year of being separated from service with the Federal Government, you will have lost your right to file — forever.

Furthermore, it is dangerous to “take comfort” in the fact that the Department of Labor/The Office of Worker’s Compensation Programs deemed you to be 100% disabled.  That “100%” disabled status may last a lifetime, or it may last only so long as your particular OWCP caseworker is working on your case.  The next caseworker may take it upon him or herself and decide that, Well, no, perhaps you are not 100% disabled, and perhaps sending you to a “Second Opinion” doctor (who, it just so happens, is receiving about 95% of his or her income expounding such “second opinions”) will result in a medical finding that you miraculously “recovered” and are able to go back to work.  Benefits cut off.  You waited a year or more after being separated from Federal Service to find this out, without having filed for Federal Disability Retirement benefits.  You are then, unfortunately, “out of luck”.  Make sure that you file in a timely manner; make sure that you do not take comfort in being on OWCP rolls.  Don’t forget —  Postal or Federal Disability Retirement is an annuity that you can rely upon as a “base income” for your financial security.

Sincerely,

Robert R. McGill, Esquire

OPM Disability Retirement: The Long View

What I find when individuals have attempted to file on their own, and get it rejected, is the lack of preparing for the “long view.” Many people hear stories about how “such and such” obtained a disability retirement approval for “far less than the medical conditions I have.”

Fair enough. Those stories may be true (I never engage in a discussion about the validity or truth of such stories; they are what they are — stories); nevertheless, there are multiple factors which are considered at each stage of the process of filing for disability retirement: Who the OPM Specialist is that will be reviewing an application; the subjective application of which criteria are applied in a given case; the personal and professional differences that arise between different bureaucrats at the Office of Personnel Management (no, don’t believe in the story that there is an “objective” methodology of applying the law when reviewing each disability retirement application); and multiple other factors, including whether or not your particular disability retirement packet was reviewed by someone at the Office of Personnel Management when he or she had a “bad day”.

To counter all of the multiple factors over which we don’t have any control, one must always take the “long view” — the view that it may take two denials, and end up before a Judge at the Merit Systems Protection Board. At that point, it is important for the Judge to see how well-documented the case has been prepared; that legal arguments have already shown that OPM was unreasonable in its initial decision and its Reconsideration Denial; and how, despite additional attempts at fulfilling OPM’s requests for additional medical documentation, that OPM continued to be unreasonable. By preparing for the “long view”, a disability retirement packet not only has the best chance of getting it approved in the “short run”, but also at the Merit Systems Protection Board.Sincerely,

Robert R. McGill, Esquire

CSRS & FERS Disability Retirement: The Process & the Office of Personnel Management

The “British Rule” is that “good manners will always get you through any and every form of trouble.”  The process at the Office of Personnel Management is a long and arduous one.  When the disability retirement packet finally arrives at Boyers, PA, it will often sit for approximately thirty (30) days, before it is finally assigned a CSA number (for CSRS employees, it will begin with the number “4”; for FERS employees, it will begin with the number “8”).

The Applicant will receive a form letter from OPM in Boyers, PA, informing you that you have been assigned a CSA number, and that it has been forwarded to the OPM office in Washington, D.C.  This is when patience and good manners must come to the fore.

Of course, there is nothing wrong with calling OPM and inquiring about the status of your case.  However, always remember to be courteous; inquire as to the time-frame that the adjudicating disability specialist is expecting; and ask if it would be okay to call periodically, and to let him/her know that if any further documentation is needed, to give you a call — or, if you are represented, to call your attorney.  Whatever you do, do not get angry, and keep it professional — and courteous.

Sincerely,

Robert R. McGill, Esquire

OPM Disability Retirement: The Process & Time

Time is also part of the entire process of filing for Federal Disability Retirement; time factors involve multiple issues from multiple aspects and perspectives:  The Statute of Limitations of filing a Federal Disability Retirement within one (1) year of being separated from federal service; the fact that the 1-year mark begins from the date of actual separation, not from the date of disability, or the date of one’s inability to perform one’s job (although those dates may, on occasion, coincide); the fact that the medical condition must last for at least 1 year (while, at the same time, recognizing that one normally should not wait for the year to pass before filing for Federal Disability Retirement, because most doctors can provide an opinion, within reasonable medical certainty, that the medical condition impacting one’s inability to perform the essential elements of one’s job will last for at least a year, normally quite early on in the process); the time it takes for the doctor to prepare a proper medical narrative report; the time it takes for the Agency to prepare and attach to the disability retirement packets its required forms; the time it takes for Boyers, PA to process the case and assign a CSA Number to it (which begins with a “4” for CSRS employees, and an “8” for FERS employees); the time it takes to get the case assigned once it is sent down to Washington, D.C.; the time it takes, once assigned, for an Initial Approval or Denial.  And, of course, all the while, during this entire “process” of time, issues as to whether the applicant should, could, or will continue to work, either at the Agency, in some light duty capacity, or in some other job.  These are all “time/process” issues which an attorney can guide and assist a client with, in the complex “process” of filing for Federal Disability Retirement under FERS or CSRS.

Sincerely,

Robert R. McGill, Esquire

Federal Disability Retirement: Patience is the Key

There is a cyclical pattern which can be identified with the passing of time, and the Office of Personnel Management is no different from other Federal Agencies, departments, or personnel “make-up”.  Summer is here; with the season of vacations and time with families, combined with an already back-logged line of cases and overworked, understaffed personnel, expect delays in receiving a decision on a disability retirement application.  Patience is the key, and Federal and Postal workers have learned by the very nature of working for the Federal Service, how to be patient.

At the same time, being dependent upon an approval of a disability retirement application is worrisome, especially where finances are tight, and the future is uncertain.  Pestering an OPM representative rarely helps to move a case along, and indeed, may even bring about a negative result.  Remember that OPM representatives are simply doing their jobs; do not unnecessarily take up their time by calling them about the status of your particular case.  It has been said that patience is a virtue; by that account, Federal and Postal workers who have filed for disability retirement must be the most virtuous of human beings, for they have endured not only the years of loyal work to the Federal Service, but beyond, while waiting for a decision from the Office of Personnel Management.

Sincerely,

Robert R. McGill, Esquire