Granted Social Security Disability but Denied FERS/CSRS Disability Retirement?

Are you a federal employee or postal worker who's been approved for Social Security disability insurance (SSDI) benefits but later denied federal disability retirement under FERS or CSRS by the Office of Personnel Management (OPM)? This can be very confusing—after all, how can two federal agencies reach seemingly contradictory conclusions?

First, understand as a federal employee or postal worker, you don't have to be approved for federal disability retirement to get Social Security disability benefits, and vice versa. And it's not common, but it's possible to win SSDI and still be denied federal disability retirement. This article will attempt to explain how this might happen—and what you can do about it.

When to Consider Applying for FERS/CSRS Disability Retirement

If you're a qualified federal employee (civilian) or postal worker who can no longer do your job because of an injury or illness, you should consider applying for FERS/CSRS disability retirement benefits.

To qualify, you must meet the work requirements, and they differ for FERS vs CSRS:

• For FERS, you must have worked for a federal agency or the United States Postal Service (USPS) for at least 18 months.
• For CSRS, you'll need at least five years of service.

Before you can apply for federal disability retirement under FERS or CSRS, two things need to happen:

• You must provide your employing agency with complete documentation of your medical condition, and
• Your agency must exhaust all reasonable attempts to keep you working productively (like making appropriate changes to your work environment or reassigning you to a job you can do).

When you apply for federal disability retirement, you must also apply for Social Security disability benefits—once you've stopped working for the federal government or postal service. But getting approved for SSDI doesn't mean you'll get federal disability retirement.

Can Federal Disability Be Denied After You Win SSDI?

It's possible to win SSDI benefits and not federal retirement disability. And the most likely reason that you might receive different decisions—an approval of Social Security disability but not federal disability retirement under FERS or CSRS (or vice versa)—is because the legal standards for the two types of disability claims are different.

How Social Security Defines Disability

Generally, to get Social Security disability, you need prove that you can't engage in any "substantial gainful activity" because of a medical condition that's:

• lasted at least a year (or is expected to last at least a year), and
• is "medically determinable" by objective evidence, like lab tests or diagnostic imaging.

Under this standard, to get SSDI benefits, you must show that your impairment prevents you from doing any kind of work.

How OPM Defines Disability

To get federal disability retirement benefits, you'll need to prove that you can't do your current job because of a medical condition. Specifically, you'll need to prove that all of the following are true:

• you can't perform "useful and efficient service" in your current position
• accommodations can't be made to allow you to continue doing your job, and
• you don't qualify for reassignment.

(Do you meet the requirements for FERS/CSRS disability retirement?)

Why OPM Rejects Disability Claims That Social Security Approved

Since the Social Security definition of disability requires that you can't perform any type of substantial work, while the FERS and CSRS definition only requires that you can't perform useful and efficient service in your current job, it's hard to imagine being approved for SSDI and not federal disability retirement. But it does happen. And the most common issues that cause OPM to deny federal disability retirement are often within your control.

OPM Finds Inconsistent or Inadequate Evidence

If you've filed a federal disability retirement application or appeal, both OPM and the Merit Systems Protection Board (MSPB) must consider whether or not you received an award of Social Security disability benefits. You can lose your FERS care if the OPM or the MSPB concludes that the evidence of a Social Security disability award is outweighed by inconsistent and inadequate medical evidence in your federal disability retirement application.

OPM Doesn't See How Your Condition Prevents You From Doing Your Job

To get a FERS or CSRS disability retirement grant, you'll need to prove that your medical condition is the reason you can no longer do your job. If you're awarded Social Security disability but denied federal disability retirement, the issue might come down to the objective nature of the medical evidence and what it says—or, more importantly, what it doesn't say.

Your medical evidence must include your doctor's objective reasoning as to why your medical condition makes you unable to perform specific work requirements. If it doesn't, OPM and the MSPB might conclude that your medical evidence is inadequate to support a grant of federal disability retirement—even though you're getting SSDI for the same condition.

You Failed to Follow Treatment Recommendations

You have to show that you're doing what you can (medically) to minimize your disabling symptoms. For instance, your doctor might recommend medical treatment (like medication or surgery) that could help control your medical condition and allow you to keep working.

If the evidence shows that you didn't follow your doctor's treatment plan, OPM (and the MSPB) could deny your federal disability retirement claim even though Social Security has approved you for disability benefits. (Not following your doctor's treatment plan can also affect your ability to get and keep SSDI benefits.)

How to Apply for Disability Retirement

You can apply for federal disability retirement while you're still working for the federal government or USPS. If you're still working or it's been less than 31 days since you stopped working, your employing agency will assemble the following forms and send them to OPM:

• Documentation in Support of Disability Retirement (SF 3112)
• Schedules A, B, C, D, and E for Form SF 3112
• your Application for Immediate Retirement (SF 3107), and
• other associated forms.

But you have up to a year to apply after you leave federal service. If it's been more than 31 days, you should submit your application directly to OPM rather than to your agency. Even though you'll submit the forms directly to OPM, you'll still need your former supervisor and employing agency to complete the following:

• SF 3112B
• SF 3112D, and
• SF 3112E.

How FERS/CSRS Disability Retirement Applications Are Processed

Once OPM has received your application for disability retirement, you should receive an acknowledgment letter with a CSA claim number. OPM will then review your application and documentation to determine if you qualify as disabled under FERS or CSRS.

It usually takes six to nine months for OPM to decide on your disability retirement claim and send you (and your agency) an approval or denial letter.

If your FERS or CSRS disability retirement grant is denied, you can appeal. There are three levels of appeal:

• OPM reconsideration
• the Merit Systems Protection Board (MSPB), and
• federal court (only after all administrative appeals are exhausted).

How Does a Federal or Postal Employee Win Disability Retirement on Appeal?

While nothing can guarantee you'll get federal disability retirement benefits even after you were approved for Social Security disability, there are some strategies that can strengthen your claim. Here are some steps you can take to get ahead of OPM denials throughout the process.

Step One: Familiarize Your Doctor With Your Position Description

When you apply for federal disability retirement, make sure that your doctor has your federal or postal position description. Make sure your doctor reviews and considers that position description and states that in writing.

And be sure your doctor explains how your mental or physical condition prevents you from performing the specific duties in that position description. (A simple statement that you can't perform those duties won't be enough.)

Step Two: Supplement the Medical Record on Appeal

If OPM has denied your application for federal disability retirement because your medical evidence didn't explain how your condition prevents you from performing your duties, you need to provide that explanation on appeal.

Ask your doctor for a reasoned explanation of exactly how the limitations of your condition prevent you from performing your duties. For example, your doctor might write that spinal nerve root compression caused by a herniated disc prevents you from bending and stooping, a requirement of your grade 7 carpentry position. Add the explanation to your record at the reconsideration stage.

Step Three: Secure Your Doctor's Testimony

When you're preparing for an appeal hearing at the MSPB, call your doctor to testify about how your condition prevents you from performing the duties of your federal or postal position.

Step Four: Submit a Copy of the Award Letter Granting Social Security Disability

Always provide a copy of the Social Security decision granting your disability. But you might or might not need to give your entire Social Security Disability application and supporting medical documentation to the OPM or the MSPB—you should always consult with a federal disability retirement lawyer before giving too much (possibly irrelevant) medical information to OPM or the MSPB.

Getting Legal Help With Your FERS/CSRS Claim

If you've been granted Social Security disability, it's clear you have a strong case—it isn't easy to get approved for SSDI. This means that your federal disability retirement denial might have been based on a problem with inconsistent, missing, or harmful evidence or a belief that treatment would have cured your disability. Consult with a disability lawyer to see what you can do to correct the problems in your specific situation.

_{Updated January 5, 2023}