Don't expect courts to go an extra mile

A recent case at the U.S. Court of Appeals illustrates the importance of meticulously documenting any medical condition that may lead you to seek a disability retirement annuity.

The case involved Kimberle Rinderle, an industrial engineering technician at Newark Air Force Base, Ohio, who left federal service after a reduction in force (RIF) in September 1996. A few months later, Rinderle applied for a disability retirement annuity based on claims of arthritis, asthma, high blood pressure and diabetes.

The Office of Personnel Management denied Rinderle's application after reviewing the medical information she submitted, concluding that the evidence presented by Rinderle did not prove that she was disabled before her separation from government service and unable to do her job adequately.

An administrative judge at the Merit Systems Protection Board reviewed the case and supported OPM's ruling that Rinderle's medical difficulties had not prevented her from performing her duties before the RIF. In other words, her medical problems were not severe enough to permit her to qualify for a disability annuity.

In her subsequent appeal to the court, Rinderle alleged that she was never told by OPM exactly what medical information she needed to present to support her claim and that the medical information she did submit was not reviewed by qualified medical personnel (U.S. Court of Appeals for the Federal Circuit, 98-3396, Jan. 12, 1999).

The problem with Rinderle's appeal was that she could not prove her allegations. As to her first allegation, Rinderle was advised of the medical documentation she needed to present on a form that she signed and submitted in her original disability benefits application filed Jan. 10, 1997. Although the form, which is not discussed at all in this case, may have been poorly written or unclear, Rinderle was given the same form that all other disability applicants receive. If she was unsure as to the type of medical information to submit, there was no record of her seeking clarification or expressing confusion.

In addition, she was advised of the requisite medical information in a letter from OPM dated June 16, 1997. Again, the content of the letter is not in the court record, but there is no evidence that Rinderle did not understand it.

For these reasons, the court reasonably held that Rinderle could not claim that she was not aware of the required documentation.

Also, the court pointed out that it lacked jurisdiction regarding the medical determination made by OPM based on the evidence submitted. The court could not - and in my opinion should not - review the factual determinations that the medical information Rinderle submitted failed to show "a progression of [her] long-standing conditions."

Evaluating medical evidence is best left to those trained to do so, and I don't think the judges on the Court of Appeals have been trained for that kind of work.

Rinderle also argued that medical personnel did not review her submitted documentation. On this issue, Rinderle was on firmer footing, but the court wasn't very helpful to her. It noted that Rinderle failed to identify a statute or regulation requiring OPM to provide a medical panel to review her evidence. The court went on to say that Rinderle had the burden of establishing her disability as a prerequisite for benefits entitlement.

While the court's ruling is technically correct, it does not address the question of how an applicant is supposed to establish that she is entitled to disability benefits if qualified personnel do not review the evidence she submits.

OPM maintained that to the extent a medical analysis of her records was required to establish the validity of her claim, Rinderle was required to provide that medical analysis. The court went along with that position, but only for technical reasons.

In my view, OPM should have qualified personnel to review claims for disability benefits. These people should have sufficient medical knowledge to analyze an applicant's medical evidence and reach an informed decision. It may be up to the applicant to prove her entitlement to disability benefits, but what is the standard of proof? OPM and the court appear to be silent on this question.

Rinderle also submitted a letter from her physician stating that she "should be reconsidered for disability." The court held that this letter was irrelevant because it did not prove that Rinderle was disabled on the day she lost her job. That is true, but why not contact the doctor for additional information?

To this observer, this looks like a case of a former federal employee trying desperately to stay off the unemployment lines, with no one willing to help her.

--Bureaucratus is a retired federal employee who contributes regularly to Federal Computer Week.


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