Tag Archives: medical records in opm disability application

FERS Disability Retirement: The Simplicity of the Complex

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It is not the forms which make it complex — although, the instructions which accompany the filling out of the Standard Forms make it appear more convoluted than necessary.

Federal Disability Retirement for FERS employees of the Federal Government and the U.S. Postal Service is actually quite simple in conceptual terms, and in the process of attempting to win an approval from the Office of Personnel Management, we encounter the complexity of the entire administrative process, thereby overlooking the simplicity of the actual law underlying the process.

That is why it is often a good idea to periodically pause and “go back to basics” before moving forward on a FERS Disability Retirement application.  As stated multiple times, disability retirement is essentially the linking of a “nexus” between one’s medical conditions, and one’s Federal or Postal position.

By “linking” is meant the following: Does the medical condition from which one suffers prevent one from performing one or more of the essential elements of one’s job?  If the answer to the question is “yes”, then you have passed the preliminary, fundamental, preconditional question.  The next question, or series of questions, of course, include the following: Do you have the minimum of 18 months of Federal Service (for CSRS individuals, 5 years)? Do you have a supportive doctor? Will your medical condition last for at least 1 year?

These are just some of the basic, preliminary questions to ask, before considering the option of filing for Federal Disability retirement benefits.  The questions and answers themselves are simple; as one gets more and more involved in the process, they become, in combination, procedurally and substantively a complex issue of meeting the legal criteria for approval.

Underlying it all is a simple conceptual basis; the complexity comes in applying the law.

Sincerely,

Robert R. McGill, Esquire

 

FERS Disability Retirement: Why is mine denied?

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There are always multiple (unverified) stories of people who have filed for Federal Disability retirement benefits under FERS, based upon what appears to be a “minor” medical condition (at least “minor” in comparison to the medical conditions which were rejected by the Office of Personnel Management per a denial letter), which was approved; yet, you filed a FERS Disability Retirement application based upon multiple major medical conditions, which was denied.

Why me?

Remember that “fairness” is not the criteria in determining the viability of a disability retirement application.

Comparisons of medical conditions with other applicants or co-workers rarely provide any fruitful insight; the point is, the “other guy” got his disability retirement application approved, and you did not.  It may be several factors beyond your control:  Your Supervisor tried to “get back at you” by declaring that all reasonable medical accommodations were provided; the OPM representative which was assigned to your case was overworked and wanted to clear some of the workload, and yours was one of them; one of your doctors made statements which came perilously close to making your case one of “situational disability”.

Whatever the reasons, you should not worry about factors beyond your control; instead you need to focus upon those factors over which you do have control:  You need to have a strategy on how you will counter the initial denial.

Sincerely,

Robert R. McGill, Esquire
Postal & Federal Employee Retirement Attorney

 

OPM Disability Retirement: The Denial at the First Stage

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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

FERS Disability Retirement: The First Denial

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Your Federal disability retirement application was well-prepared:  perhaps it was prepared with the help of an attorney; the medical documentation seemed solidly unequivocal; the doctor made the necessary connections between one’s medical conditions and the type of essential elements of one’s job; the packet, by all accounts, should have been approved, and by all expectations, the approval should have been reasonably expected.

Instead, you receive a letter stating that your disability retirement application was disapproved, and a “Discussion” section follows, explaining why the Office of Personnel Management denied your application.  Why did this happen?  There are multiple reasons why such a denial can occur:  the OPM specialist could be a person who lacks a clear understanding of the applicable laws governing disability retirement applications (more often than not, this is the case, and what you actually get in the so-called “Discussion” Section of the denial letter is merely a regurgitation of the statutory criteria for eligibility for disability retirement, without a recognition of the interpretation of such criteria by Federal Judges for the Federal Court of Appeals or by Administrative Judges from the Merit Systems Protection Board); it could be as simple as the OPM representative selectively choosing to read the medical reports and records, and disregarding or ignoring supportive portions of the medical records and reports; or it could be that additional medical reports and records need to be obtained in order to “shore up” the application.

In any event, whatever the reason for the denial, one should not panic.  It is merely one step in a long, administrative process.  The mere fact that OPM denies your disability retirement application does not mean that they are “right” in doing so; indeed, in my opinion, they are rarely right.  That is why one has the right to have it “reconsidered”, and the opportunity to make further legal arguments, and obtain further medical documentation in support of your claim.  And, beyond that, you have the right to file an appeal to the Merit Systems Protection Board — and beyond.  Never give up; always take it to the next step.  In most cases, it will prove that OPM was in error, and in fighting the denial, you will have secured some semblence of financial security for your future.

Sincerely,

Robert R. McGill, Esquire

 

OPM Disability Retirement: The Responsibility of the Office of Personnel Management

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Perhaps it is an anomaly to even speak about the issue of “the responsibility” of the Office of Personnel Management — at least, from the general consensus of experiences as told by countless individuals who have filed for disability retirement benefits from the Office of Personnel Management, especially in recent years, one might conclude that OPM is slow to respond, or often refuses to respond at all.

However, to be fair, OPM — as with all other Federal Agencies — is made up of individuals; and the “good” or “bad” of an Agency is entirely dependent upon such individuals.  Most of the disability retirement specialists at OPM are, in my opinion, of the “good” sort.  Without naming names, there are a few of the “bad” sort.  Of course, that says very little, because such a generalized statement could be true of all Federal Agencies.

Moreover, OPM is presently short-staffed, overworked, and way behind on the processing of disability retirement claims.  What used to be a 60-day wait at the initial application stage is taking 90 – 120 days; and at the Reconsideration (2nd) Stage, what used to take 90 days is now taking 120 – 150 days, in many cases.

More than the “time” it takes, however, just remember that the primary responsibility of OPM is to take a careful and serious look at your disability retirement application/packet.  Also, remember that those disability retirement packets which are streamlined, logically constructed, and coherently argued, are the ones which will likely be quickly processed.  Don’t just strap a volume of medical records onto an application and hope for approval; in this day and age, it might be a wise investment to hire an attorney to “streamline” your packet.

Sincerely,

Robert R. McGill, Esquire

Common Mistakes in Filing for CSRS & FERS Disability Retirement (Part I)

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There are multiple mistakes often made when an unrepresented individual files for disability retirement under FERS & CSRS. One such common mistake is the very presentation of an application packet that is presented to the Office of Personnel Management.

Often, when an individual has a disability retirement application denied at the First Stage, and has asked me to represent him/her at the second, Reconsideration Stage, I find that what the individual did at the first stage was to put together the packet of medical records — often, a voluminous set breathtaking in its sheer quantity of pages — thinking that because he/she has serious medical issues, that the great quantity of medical records in itself will justify qualification of a disability retirement packet.

Volume of medical records rarely qualifies an individual for disability retirement. Instead, it must be remembered that eligibility and qualification for disability retirement benefits is determined by a set of legal criteria that must be met by a preponderance of the evidence, and it is up to the applicant and his/her legal representative to meet that burden of proof.

Sincerely,

Robert R. McGill, Esquire