FERS & CSRS Disability Retirement: The “nexus” between the Reconsideration Stage and the Merit Systems Protection Board

It is an accepted fact that there is a “psychological” aspect to almost everything in life, and this is no less true in the field of disability retirement law.  The “psychological” aspect is the nexus, or bridge, from the Reconsideration Stage to the Merit Systems Protection Board.  From OPM’s viewpoint, this is the last chance to make a decision on a case, before it is taken out of the hands — and therefore “control” — of the Office of Personnel Management.  Thus, OPM wants to be able to “justify” that its decision was reasonable, and legally-based and legally sufficient to withstand the scrutiny of an Administrative Judge.   From the Applicant’s viewpoint, it is a chance to show that OPM was unreasonable for not approving the case.

While it is true that all cases which come before the MSPB are heard de novo (meaning, anew, without regard to prior decisions by OPM), OPM nevertheless never wants to be viewed as ignoring the law and appearing unreasonable, and the Applicant wants OPM to appear unreasonable in the face of the medical evidence already provided.  This is the psychology behind trying to convince OPM to approve a case at the Reconsideration Stage.  Thus, at the Reconsideration Stage, it is important to cite applicable law to OPM, to corner them into a position of appearing unreasonable if the disability retirement application is denied.  On the other hand, the reasonings and underpinning of foundational bases provided in Reconsideration Decisions are often far more superior and accurate than those handed down at the Initial Stage.  In any event, always remember that there is a “psychological” aspect to everything, and it is the duty of an attorney to identify it, use it to the best advantage possible, and cite the appropriate law.

Sincerely,

Robert R. McGill, Esquire

FERS & CSRS Disability Retirement: Failing to follow “Reasonable Treatment”

In fighting to prove one’s eligibility for Federal Disability Retirement benefits, a recurring argument which the Office of Personnel Management often alleges is that an applicant failed to follow the treatment recommendations of the treating doctor.

Such an argument can prove to be fatal to an applicant’s case, but it is good to know the parameters of what it means to “fail to follow” reasonable medical treatment.  For instance, non-compliance with a medication regimen can be fatal to a case.  Thus, OPM will successfully argue that an individual who has failed to follow the medication regimen of the treating doctor has thus failed to show that the individual could have returned to work precisely because non-compliance with a medication regimen would logically undermine the potential efficacy of the medical treatment.

On the other hand, invasive surgery is normally not required, and the Merit Systems Protection Board has stated that an “estimated probability of success of future surgery is speculative, just as a prediction as to the worsening of a condition may be, and will not necessarily provide a basis for denial of a disability annuity.”

These are two light-posts on the spectrum of what is deemed “reasonable treatment”.  Most issues concerning reasonable medical treatment fall somewhere between these two extremes, and the best course of action (obviously) is never to self-treat, or make medical decisions without the input of your treating doctor.  Indeed, to not follow the medication regimen of your doctor is a manner of self-treatment; on the other hand, to elect not to have surgery because of the speculative success/failure rate is a reasonable decision which the Merit Systems Protection Board will not second-guess.  What falls in-between these two extremes should always be with the guidance of “reasonableness”, in close consultation with your treating doctor.

Sincerely,

Robert R. McGill, Esquire

Federal OPM Disability Retirement: Notifying the Agency

Fervent loyalty by the Federal and Postal Employee to want to work for as long as possible, and to do the best job possible, is often taken for granted; what is not as common, however, is a “bilateral loyalty” — meaning, loyalty shown by the Agency back to the Federal or Postal employee, especially when such loyalty is needed, during the long process of filing for, and obtaining, disability retirement benefits from the Office of Personnel Management.

In representing a client, I am often asked whether or not the Agency should be notified of our intentions immediately, and my response always is: It depends.  If there is a strong and positive relationship between the employee and supervisor, where there are strong indicators that the Agency will be supportive during the lengthy process, then I will often advise informing them fairly quickly.

More often, however, the Agency has had a long history of acting in a “less than sympathetic” manner — and that is in most cases.  In such cases, I normally advise to wait until the disability retirement packet has been prepared and finalized, and it is ready to be submitted to the Personnel or District H.R. Office.

Each case must be looked at independently, and there are never any easy answers.  Agencies are comprised of individuals; individuals are complex beings, with the potential for compassion and empathy, but just as well with a potential for cold disregard for the plight of an individual. So long as Agencies are comprised of individuals, Agencies themselves act as individuals, and each case must be viewed in that light.

Sincerely,

Robert R. McGill, Esquire

Federal Disability Retirement: OPM’s Methodology (Part I of II)

When the Office of Personnel Management (OPM) approves a Federal Disability Retirement application, a separate page from the approval letter will often be attached, which states the medical basis upon which the disability retirement application was approved.  The separate page will often state something to the effect of: “You submitted an application for disability retirement based upon medical conditions, A, B, C & D; however, your application was approved for medical condition B only.”

The concern here, of course, is that if you are later selected to answer an OPM Medical Questionnaire asking you to re-establish your medical disability for continuation of your disability annuity some years later, that you make certain that you answer such a Medical Questionnaire based upon that very medical condition upon which you were approved.  This is obviously important.

Some have questioned whether or not you can appeal the approval letter based upon the fact that you believe OPM should have approved you based upon a different medical condition.  In my view, this is not an appealable issue, and if you question OPM as to whether they should have considered you disabled based upon another medical condition, you may be in greater danger by OPM reversing themselves based upon a re-review of your case.

It is best to leave “well enough alone”.  Accept the approval letter based upon the identified medical condition, and inform your treating doctor that you may need his input in the future — to address that very medical condition for which you were approved.

Sincerely,

Robert R. McGill, Esquire

OPM Disability Retirement: Connecting the Dots

Care at every step of the way in preparing an OPM disability retirement application is the key to winning. The metaphorical “dots” that need to be created and connected, will ensure that each aspect of a disability retirement claim is not seen as independent entities, but a part of a larger whole.

When an individual is unrepresented, there is a tendency in filling out the multiple forms that each form is a separate piece of information. That is an incorrect approach to take. What results from such an approach is why certain cases end up at the Merit Systems Protection Board, where the Board has to figure out whether they can accept a medical condition that the applicant failed to list or identify in the original application; or whether the connection to an essential job element was properly made.

While it is true that the Board engages in “de novo” consideration of a disability retirement eligibility issue, their jurisdiction is nevertheless limited by the substantive conditions which are identified in the original application. Thus, for instance, in writing up the Applicant’s Statement of Disability, it is wise to coordinate it by reviewing the medical documentation; when writing up the impact of the medical condition upon the essential elements of one’s job, it is wise to concurrently review one’s official job description. While preparing a Federal Disability Retirement application in a disjointed, independent approach, you are in danger of missing an essential dot; by seeing the inter-dependency of each part of the application, you stand a greater chance of not having to go before the MSPB to test whether they can even listen to your case. Disability retirement applications must be approached in this “wholistic” methodology; that is ultimately the “winning” approach, where all of the dots have been connected.

Sincerely,

Robert R. McGill, Esquire

Remember the Details in Your FERS Disability Retirement Application

At each state of attempting to get a Federal disability retirement application approved, it is important to “remember the details”.  For example, at the Merit Systems Protection Board level, in conducting a Hearing, remember that if the best medical evidence/testimony you are able to provide is through a health professional other than an “M.D.” (e.g., a Therapist, a Nurse Practitioner, a Chiropractor, etc.), always point out the unique credentials of the provider, to include whether in the particular state in which he/she practices, if greater latitude and responsibilities are given to the practitioner.

Thus, it may be that in one state a Nurse Practitioner can exam, diagnose, and prescribe a medication regimen without the direct oversight of a medical doctor, whereas in other states such latitude may not be allowed. This should be pointed out to the Judge, to emphasize greater credibility of the testimony of the practitioner.

Further, remember that in Vanieken-Ryals v. OPM (U.S. Court of Appeals for the Federal Circuit, November, 2007), the Court therein reiterated that the medical documentation/evidence required must come from a ‘licensed physician or other appropriate practitioner’, and so long as that medical practitioner utilizes “established diagnostic criteria” and that which is “consistent with generally accepted professional standards”, the testimony cannot be undermined.

Use the strengths of the case you have, and emphasize the little details that matter.

Sincerely,

Robert R. McGill, Esquire

FERS & CSRS disability retirement & treatment compliance issues

While the issue of ‘causality’ is not one which often comes up in OPM disability retirement cases (by obvious contrast, of course, is the fact that causality, whether it was caused while working, on the way to work, outside of the parameters of work, etc, is often an issue in OWCP/DOL cases), there are certain cases where such an issue may be important to address. Baker v. OPM, 782 F.2d 993 (Fed. Cir. 1986) is actually a case which continues to remain of interest, in that, there, the Court noted that where obesity had a causal impact upon the appellant’s back pain, and since the appellant failed to follow medical instructions to lose weight, therefore the cause of the back pain was not as a primary and direct result of a medical condition, but rather because of non-compliance of reasonable available corrective or ameliorative action.

Thus, there are certain areas where you will be in danger of having your disability retirement application denied: one such area, where the Merit Systems Protection Board has been fairly consistent, is non-compliance of a prescribed medication regimen. In other areas, however, especially where surgery is recommended but where the percentage of success cannot be easily quantified, there is much more leeway. Disability Retirement is an area of law which encompasses a wide range of complex and potential “legal landmines”, and it is often a good idea to seek the counsel of an experienced attorney to help guide your way.

Sincerely,

Robert R. McGill, Esquire