While discouraging, denials for Federal Disability Retirement are a common occurrence. When you submit your application to the Office of Personnel Management (OPM), a medical specialist will be assigned to your case to review any documents you have included. It is the medical specialist’s job to make a decision based solely off the information provided in your application, so one specialist may come to a different conclusion than another. The best approach to a Federal Disability Retirement application is to ensure you include all supportive medical evidence and information to create an airtight case from the beginning.
But, like we said, denials happen, and there are a myriad of reasons why. Just know that even if you receive a denial, you still have options, and we are here to help take the weight off your shoulders. Let’s look at some reasons for denial so you know what to avoid in the future.
#1 – An Unclear Prognosis
When filling out the necessary forms, your doctor must clearly state that your condition is expected to last at least 12 months.
We have seen denials based on contradictory wording such as the word “chronic” being used rather than “expected to last longer than twelve months.”
This may seem like a silly reason for denial as it should be clear to the medical specialist that chronic or permanent means at least 12 months, but the OPM wants everything to be as straightforward as possible.
To avoid any confusion, make sure your doctor has stated that your disability is expected to last at least 12 months or one year.
#2 – Unfinished Reasonable Accommodation/Reassignment
In order to be eligible for Federal Disability Retirement, you must clearly show that you and your agency have worked together on the reasonable accommodation process and that there is no accommodation available to help you continue to perform your job.
If the OPM thinks there might be a reasonable accommodation or reassignment available, they will not approve your application.
Additionally, if you are still on your agency’s rolls, your agency must continue to try to accommodate you even after you have applied for Federal Disability Retirement.
To avoid being denied, submit all reasonable accommodation efforts as evidence to the OPM and make sure it is clear that there is no accommodation that would allow you to perform useful and efficient service.
#3 – No Doctor Restrictions
Your doctor must be supportive and state any medical restrictions you have that will prevent you from performing your job duties.
Any medical restrictions that are placed on you must be clearly stated and show your service deficiency. If your service deficiency is unrelated to your disability, that could harm your case.
To avoid this issue, make sure your doctor clearly states your medical restrictions and how you are unable to perform the functions of your job description.
#4 – Agency Forms Are Filled Out Incorrectly
Your agency must fill out sections B, D, and E of the 3112. These forms are crucial to your approval and if any information is blank, incorrect, or contradictory to any other evidence included, the OPM could deny your application.
To avoid this issue, make sure your supervisor and agency are aware of your disability and struggles with your position. That way when you’re applying, it’s not the first time they have heard of your situation.
Additionally, many times this is the first time your agency’s HR department has handled a disability retirement claim and are unfamiliar with the process and requirements. Having an experienced legal team on your side can make sure that you are getting the correct and supportive documentation.
#5 – Treatment Compliance
If you have a treatment plan from your doctor, but the OPM sees that you have not been following your doctor’s treatment plans, that could be a reason for denial as treatment may help your condition. The only exception to this is if the treatment comes with risks that are not worth the outcome.
To avoid being denied due to noncompliance, make sure you follow any doctors’ recommendations and show proof of risks if you deny a treatment.
#6 – VA Ratings
Occasionally, if the OPM sees that you have a VA rating that has remained the same or has lowered, they use that as evidence to deny your application. Stagnant VA ratings are not inherently bad, but the OPM often wants to see that your disability has worsened while in your federal position, and if your VA rating has not changed, that does not support your case.
This reasoning is often unfair and cannot be predicted, but to avoid this issue, you must show definitive proof that your disability is preventing you from performing useful and efficient service.
#7 – An SSDI Denial
In order to be approved for Federal Disability Retirement you must apply for Social Security Disability Insurance, but you do not have to be approved for SSDI to still be eligible. However, the OPM has denied cases due to the applicant being denied for SSDI.
Being denied for SSDI should be unrelated to your Federal Disability Retirement but to make sure it does not impact your Federal Disability Retirement application; you must show definitive proof that you are no longer able to continue successfully performing your job.
Receiving a Denial
Getting an OPM denial can be scary and disheartening. But don’t worry, if you receive a denial, you have 30 days from the date of the denial letter to request a reconsideration. This will officially appeal the OPM’s decision, and you’ll be assigned to a new medical specialist to review your case. While you won’t be able to change your initial application, you will be able to submit new medical evidence and legal arguments.
The most important thing to remember is that medical evidence and documentation is key. It’s critical to make sure you have a strong initial application to avoid denials or additional requests for information.
Every OPM reviewer is different and may not all be objective.
Choosing the right legal team can make or break your claim. Don’t risk your future. Our legal team has taken on hundreds of appeals and can help guide you through the entire process.
Schedule a FREE consultation with our firm today and find out what your options are.