Situational Disability in a Federal Disability Retirement Application

A lesser-known basis for a denial of a Federal Disability Retirement application is what is called “situational disability.” The author explains what this means and why most situational disability cases are failed applications at the outset as well as how to avoid them.

A Federal Disability Retirement application, whether the subject Federal or Postal employee is under FERS or CSRS, is first and foremost a paper presentation to the U.S. Office of Personnel Management.  As such, it is a submission which is tested against a myriad of legal and statutory criteria – not the least of which involves the facial cogency of articulation and comprehensible presentation.  Beyond that, however, is the issue of proof – of what meets the preponderance of the evidence test; whether all of the legal criteria have been satisfied; and to what extent the evidence has been persuasive enough to satisfy OPM’s scrutiny.

Ultimately, the Office of Personnel Management has a limited basis upon which to deny a Federal Disability Retirement application.  That purports good news for the Federal or Postal employee applying for Federal Disability Retirement benefits.  From OPM’s perspective, the vast majority of Federal Disability Retirement applications which are disapproved, are based upon the insufficiency of medical documentation submitted.  Such a basis for a denial of a Federal Disability Retirement application, of course, is somewhat arbitrary and subjective; for, what constitutes “sufficiency” can encapsulate a wide range on a spectrum, based upon the Caseworker to whom it is assigned.  What appears to be “enough” to one, may be minimally acceptable to another.

A lesser-known basis for a denial of a Federal Disability Retirement application is what is called “situational disability.”  There is, in many respects, a vast misunderstanding of what constitutes satisfaction of the criteria which would deem a particular case as falling within the parameters of a situational disability.

At the outset, one must understand that certain “indicators’ cause red flags to immediately pop up to declare the inherent dangers of being relegated to a situational disability case.  Indeed, most situational disability cases are failed applications at the outset, for the manner in which the case is presented.  For example, the most prevalent situational disability case will often involve the generic medical condition of “stress”.

Stress, in and of itself, is inherent in every workplace environment.  It is something which cannot be avoided; in the greater society at large, it has become the genetic harbinger of man’s evolutionary progress, as the test and indicator of those who can withstand, survive, and advance in a world beset with stressors and anxiety flashpoints.  Stress is the testosterone litmus test of those who can make it in this world; and for those who succumb to the debilitating effects of stress, the piranhas rush in to strip the skeletal remains dry.  For, in our society, the sum total of the stresses to which we succumb, determine the character of our life’s value and worth.

But in the context of a Federal Disability Retirement claim, why does a “stress” claim become associated with situational disability, and thus a legal basis for denying an application for Federal Disability Retirement benefits by the U.S. Office of Personnel Management?  The fundamental reason is that stress is normally considered situs-specific; thus, once a person is removed from the originating source of the stress, one can argue somewhat persuasively that it is not the “medical condition” of stress which prevents one from performing one or more of the essential elements of one’s job; rather, it is the causal element of stress in the workplace (i.e., a harassing supervisor; a difficult coworker; a hostile work environment, etc.) which is the basis of preventing the performance of the essential elements.

How does one avoid the pitfalls inherent in having one’s Federal Disability Retirement application relegated to a “situational disability” case, and therefore face a denial from the U.S. Office of Personnel Management?  First and foremost, by understanding what situational disability is, and what it isn’t.  The prevailing case which gives clarity and cohesive differentiation in defining what “situational disability” constitutes, is found in the case of Luzi v. Office of Personnel Management, a 2008 case, in which the U.S. Merit Systems Protection Board clearly defined what situational disability is, and more importantly, what it is not:

“The Board has rejected disability claims based exclusively on an employee’s reaction to a particular workplace. Cosby v. Office of Personnel Management, 106 M.S.P.R. 487, ¶¶ 7, 10 (2007) (medical evidence consistently attributed the appellant’s medical condition to conflicts with a former supervisor and recommended reassignment to another location under a different supervisor to address the appellant’s condition); Guthrie v. Office of Personnel Management, 105 M.S.P.R. 530, ¶ 12 (2007) (medical evidence suggested that the appellant’s conditions were largely situational, that is, apparent only in her work environment). Here, however, the medical evidence does not support a finding that the appellant’s PTSD was a reaction to his particular workplace. See, e.g., Kimble v. Office of Personnel Management, 102 M.S.P.R. 604, ¶¶ 12, 15 (2006) (finding that the appellant was entitled to disability retirement benefits where, inter alia, the medical evidence established that the appellant’s depression and anxiety prevented her from working at any position in the U.S. Postal Service).”

“Situational disability” is thus clearly and unequivocally defined:

  1. It is “location-specific” (‘attributed to a supervisor within a specific location’)
  2. The medical condition is not pervasive, but manifests itself within a specific work context (‘appellant’s conditions showed up only in the workplace’)
  3. A disability is NOT situational if it extends beyond a particular work situs (‘the medical evidence showed that the condition prevented the person from working at any position within the agency’)

Thus, to reiterate, “situational disability” is defined as that disability which occurs specifically and exclusively within the situs of a particular workplace; if it extends beyond the particularity of a person’s workplace, and pervades to the extent that a person is unable to perform his or her work anywhere else within the agency or the Postal Service, then it is no longer considered “situational”.

Why, then, is “stress” a condition which uniquely raises “red flags” in an OPM Disability Retirement case?  First, because stress is considered causally connected to something – i.e., it manifests itself as a result of an originating X.  Second, because in the common understanding of everyday linguistic parlance, it is natural to ask a person who is experiencing a stressful day, “What is making you stressed”?  This question presupposes that there is a particularized, originating circumstance or event which, once removed, will result in the dissipation of the condition of stress.  And, Third, what we loosely characterize as “stress” is often a generic, umbrella term which we thoughtlessly attribute to cover quite complex psychiatric conditions involving Major Depression, Generalized Anxiety Disorder, Panic Disorder, symptoms of Bipolar Disorder, and other attendant and related conditions and manifestations of serious psychiatric disorders.  The problem, as always, comes back full circle:  How the layman characterizes, at the outset, one’s medical condition as presented and submitted to the U.S. Office of Personnel Management, will often determine the outcome of a case.

Federal Disability Retirement is a benefit offered to all Federal and Postal employees who have a minimum of 18 months of Federal Service under FERS, and 5 years under CSRS.  As first impressions are what often stick to a lifetime of a person’s value and worth, so how one initially characterizes a case in a paper presentation to the U.S. Office of Personnel Management, will make all the difference in the outcome of a case.  Stress is an inherent condition in our society; for a Federal Disability Retirement case, however, in what manner it is characterized, and how it is first revealed, may make all the difference in the world.  As a handshake presenting a first impression, so similarly how stress is characterized to the U.S. Office of Personnel Management may not be the true substance of the person behind the extended extremity; but first impressions stick, and how stress is presented may be the difference between having it characterized as a situational disability, or as a plant’s first shoot which indicates deeps roots of severe psychological trauma.

About the Author

Attorney Robert R. McGill specializes in Federal Disability Retirement cases helping Federal and Postal workers secure their OPM Disability Retirement benefits under both FERS and CSRS. For more information about his legal services, visit his Federal Disability Lawyer website.