CSRS & FERS Disability Retirement: Denial at the First Stage

I would like to state that none of my cases have ever been denied at the Initial Stage of filing for Federal Disability Retirement benefits; not only would such a statement be untrue; it would also be unbelievable.

And yes — even the cases that I file on behalf of my clients, get a similarly formatted denial:  a restatement of the criteria for eligibility for Federal Disability Retirement under FERS & CSRS; a discussion with an elaborate reference to doctor’s notes, dates of treatment, targeted extrapolations of statements by the doctors which are not only selectively chosen in a narrow manner to favor the decision of denial, but further, which are often taken out of context.

Some might wonder:  Doesn’t OPM have greater respect for Mr. McGill?  The answer is:  At the First Level, the representative from the Office of Personnel Management is merely making a decision on one of thousands of files, and a template is being used to process and get rid of cases.  However, one must always remember (as I try to remind everyone) that this is a “process”.  A denial at the First Stage of the process is merely part of the greater process.

It is not something to get annoyed at, or concerned about; it is a stage and a decision which must be dealt with, argued against, and rebutted in the proper, rational, legal manner.

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

Federal Disability Retirement & the Reconsideration Process

In the process of applying for Federal Disability retirement under FERS or CSRS, it is the “hope and wish” of each applicant that it will smoothly sail through at the initial stage of the application. However, the reality of the process is that a certain percentage of applications get denied at the initial stage (Stage 1 of the process). It is both discouraging and befuddling to receive a letter from the Office of Personnel Management informing you that your disability retirement application has been “denied”.

You are now required to Request Reconsideration of your case within thirty (30) days of the date of denial, and you must submit additional medical evidence or other supporting documentation within 30 days of requesting such reconsideration (Stage II of the process). It is, indeed, a time of disappointment to receive a denial. It is all the more so when it is unclear as to the basis for the denial. Often, a denial letter will refer to the medical evidence without much commentary beyond acknowledging the submission of a medical report, then in the last paragraph, simply make a declarative statement that the medical evidence submitted “was insufficient” to show that you are disabled. Or, more often than not, the OPM Benefits Specialist will actually mis-state the law by claiming that you have “not shown that you are so disabled as to keep you from the workplace” (no such legal standard is required under disability retirement rules, regulations or case-law).

Whatever the reasons given, it is both discouraging and disheartening to receive a denial letter from OPM. However, it is important to calmly, systematically, and with pinpoint focus reply to the letter of denial — even if it doesn’t seem to make any sense. This is done most effectively by using all of the tools required in persuading eligibility and entitlement to disability retirement benefits: the law; the medical report; the medical records; rational and legal arguments –in short, the “nexus” needed to win.

Sincerely,

Robert R. McGill, Esquire