Tag Archives: opm medical documents

Federal and Postal Service Disability Retirement: Each Level of the Process

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Disability retirement, as I have often written about, is a process.  Each stage of the process has certain “requirements” which should be met — by “requirements”, I mean that each stage of the process (the Initial Application Stage, the Reconsideration Stage, and the Third Stage of the Process, a Hearing before an Administrative Judge at the Merit Systems Protection Board) has certain aspects of proof, certain methods of approaching the level of satisfying the burden of proof, etc.

There are, of course, the further stages of Appeal — at the Full Review at the MSPB, and the Federal Circuit Court of Appeals — but these appellate stages deal only with whether or not the Administrative Judge applied “the law” properly or not.

Thus, at the first three stages of the process, there is the necessary requirement of “winning” by submitting the proper medical and other evidence, to persuade the Office of Personnel Management and the Administrative Judge that your Federal Disability Retirement application under FERS or CSRS meets the legal criteria for eligibility.

This is the season for Reconsiderations; the Office of Personnel Management will often make many of its decisions just before Christmas, and just before the end of the year.  If an applicant under FERS or CSRS gets denied at the Initial Stage, just make sure that you hire an attorney who knows what he or she is doing, and isn’t just a “general practice” lawyer who is as blind as the next person, and will merely be one blind person leading the blind.

Each Stage of the process requires a level of expertise to meet the “requirements” necessary to satisfy that particular level; just make sure that you will be led by an attorney who not only knows what those requirements are, but further, knows how to meet those requirements.

Sincerely,

Robert R. McGill, Esquire

 

Federal & Postal Disability Retirement: The Futility of Waiting for an Agency

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In Federal Disability Retirements, the general rule is as follows:  waiting for your agency to act in some way that may prove to be beneficial to your case, is an act of futility.

Whether it is to wait for a performance appraisal; whether to see if the Agency will accommodate you, or not; whether you are waiting for a response from your Supervisor to see if he or she will support your Federal Disability Retirement application, etc. — in the end, a disability retirement application under FERS or CSRS is a medical issue.  It is not an “Agency Application for Disability Retirement”; it is not a “Supervisor’s Application for Disability Retirement”.  It is a medical disability retirement, inseparable from the Federal or Postal employee who is filing for the benefit.

As such, the proper focus should be placed upon the sufficient and substantiating medical documentation.  If the medical documentation, combined with the applicant’s statement of disability, are persuasive with respect to the correlative force of being unable to perform one or more of the essential elements of one’s job, then such a combined force makes all other issues essentially moot and irrelevant.  Don’t wait upon an agency to act; to act affirmatively without depending upon the agency is always the best route to follow.

Sincerely,

Robert R. McGill, Esquire

OPM Disability Retirement: Always Verify Submissions

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The old saying:  Measure twice, cut once, can be adapted here:  Verify twice, submit once.  I am always surprised by Federal and Postal employees who have filed for Federal Disability Retirement benefits under FERS or CSRS to hear that a document, a submission, a Request for Reconsideration, an appeal, etc., was sent to the Office of Personnel Management by regular mail, with no manner of verification.

While I have great respect for the personnel who work at the U.S. Postal Service as well as the Office of Personnel Management, such issues have nothing to do with individual competence; instead, it has to do with the recognition that all oversized agencies (do we even have to argue as to what is defined as an “oversized agency”?) have their internal mail problems — not only of sending or receiving mail, but getting it to the right person, etc.

Not everyone needs to be overly “verification-sensitive” like I am, but my methodology for every document forwarded to OPM is as follows:  faxed (with a print-out of a receipt showing that the fax went through), as well as an express mail or FedEx tracking number.  Verify twice, submit once.  The Office of Personnel Management has never won an argument with me that they “never received it.”

Sincerely,

Robert R. McGill, Esquire

CSRS & FERS Disability Retirement: Agency Interaction

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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

FERS Disability Retirement: Summer Doldrums & the Physician’s Statement

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I have often pointed out in past blogs and articles that I do not have my clients sign the Physicians Statement (SF 3112C), for multiple and various reasons, not the least of which is that it is a confusing form, and in smaller print than necessary, leaving the impression to the doctor that what is requested is far more complex than what is actually required.  In its place, for my clients, I write a 4 – 5 page letter outlining the type of medical narrative report which I need.

This is the summer months; everyone from OPM representatives to lawyers, to doctors and Federal and Postal employees, take time off to recover from the hard work throughout the rest of the year.  When doctors take off for some “summer fun”, it just means that they have less time to spend on administrative matters — such as writing up a medical narrative report for their patients.

Because of this, it is important to try and simplify the matter as much as possible, and a blanket submission of the SF 3112C without some explanatory guidance, is not the best course of action.  Doctors need guidance, and in this busy world, it is best to streamline the process for them as much as possible.

Sincerely,

Robert R. McGill
Federal Disability Attorney

OPM Disability Retirement: The Proper Approach

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Some believe that, when formulating and compiling a disability retirement application, that quantity of supporting documentation will win the day — all medical reports, records, statements from friends, family, co-workers, etc.

Sometimes, however, it is better to refrain from providing everything all at once; for, if a determination is made that there is sufficient documentation to prevail in a disability retirement application, it is sometimes the wiser course to restrain the natural inclination to bombard the Office of Personnel Management with all of the available documentation.

This is merely a strategic bit of advice; yet, in practical terms, inasmuch as every disability retirement case has the potential to be denied at the First Stage, and OPM would in that event be requesting additional supporting documentation, it is often a good idea to “withhold” and “keep back” a secondary source of supporting documentation — but only if the primary source of supporting documentation is confidently adequate to win at the first stage.

It is a discretionary method of approaching the compiling of data and documentation at the first stage — a decision which should be made with wise counsel.

Sincerely,

Robert R. McGill, Esquire

Federal Disability Retirement: SSA Approval, Part II

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In order for an SSA approval to have an impact upon a Federal disability retirement application, the Social Security Administration’s decision letter granting benefits must provide a detailed explanation as to the basis for the approval, delineating the medical basis, the medical conditions upon which the decision was made, etc.  Thereafter, the applicant can submit the decision letter, but this is where it is important to have an attorney provide the proper legal & foundational argument — to provide the contextual applicability.

The legal basis, to start with, is found in Trevan v. Office of Personnel Management, 69 F.3d 520, 526-27 (Fed. Cir. 1995), in which the Federal Circuit Court found that in making a determination of eligibility for disability retirement, the Board (and thus, by analogy, OPM) must consider an award of SSA disability benefits together with medical evidence provided by the appellant to OPM, and other evidence of disability.  This is when an attorney’s tools of “argument by analogy” and pointing out the significant contextual language in an SSA decision letter comes in handy.  Next:  What if an SSA decision letter is not immediately forthcoming, or does not address the same medical conditions as that applied for in one’s disability retirement application?

Sincerely,

Robert R. McGill, Esquire

Federal Disability Retirement: SSA Approval, Part I

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Of interest is what to do when a Social Security filing for disability benefits has been approved prior to the FERS/CSRS disability retirement application being approved.  This is a rarity, and indeed, it should logically be that way:  for Social Security disability requires a higher standard of (essentially) “total disability”; while the criteria for approval under FERS/CSRS is that of an “inability to perform the essential elements” of a particular job — meaning, in essence, that an individual is no longer a good fit for a particular type of job, but could certainly be productive in some other capacity of employment.

The cases at the Merit System Protection Board which have addressed this issue have been fairly consistent.  An approval in and of itself will not necessarily help a FERS/CSRS application; as with the application process itself, the applicant has the preponderance of the evidence of proving the relevance of the approved Social Security filing.  I am often asked whether, in a denial of an SSA disability application, where the decision by the Social Security Administration states that, while SSA acknowledges that the applicant is unable to perform his or her current employment because of the medical condition, yet the applicant for SSA disability benefits is denied because he or she may engage in other productive employment — whether such a statement in the denial (that SSA acknowledges the applicant’s inability to perform his or her current job) should be forwarded to OPM.  My answer is that it should not be, because it is not relevant to OPM’s criteria for making a determination.

As to the two most important questions:  1.  If a Social Security Disability application is approved, what needs to be sent to OPM, and 2. If Social Security’s determination doesn’t provide the necessary language to be relevant for forwarding to OPM, what can take its place?  As to these two questions, I will be addressing each in a blog to be written in the very near future.

Sincerely,

Robert R. McGill, Esquire

FERS & CSRS Disability Retirement: The Packet

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It is often a good idea to understand the process of Federal Disability Retirement, in order to effectuate the best approach in winning a case.  Remember, for instance, that in all likelihood, the Applicant will not be speaking with the Benefits Specialist at the Office of Personnel Management; even if you call them (and I never recommend calling too often, for there is the “irritant” factor, which may — thinking in purely pragmatic terms — result in a First Stage Denial of your case), you will be a faceless entity, and merely one case in a long line of cases for the OPM representative to review and decide upon.

Thus, the key is to prepare your packet well — to not place superfluous medical evidence into the pile; to not just make a complete copy of your medical records (OPM is not interested in medical records dating back more than 2 years, at most, and in most cases, should only go back 1 year) and send it in, hoping that the sheer thickness of your file will convince and persuade OPM that your case is “serious”; instead, to make your packet neat, essential, and to the point. Think about it in pragmatic terms: If you have a project to tackle, and you have a choice to tackle the one with little or no effort, or that “other one” that is a headache and will consume your entire day, which one entices you?

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