Will OPM Deny my Disability Claim If I Am Denied SSDI?

Will OPM Deny my Disability Claim If I Am Denied SSDI?

If you are applying (or thinking about applying) for FERS Disability Retirement (FDR), then you probably already know that you are required to apply for Social Security Disability Insurance (SSDI) as part of the FDR application process.  Furthermore, you need to provide OPM proof that you have applied for SSDI. 

The most common form of proof is either (a) an acknowledgement letter or (b) a decision letter from the Social Security Administration (SSA).  Applicants typically receive an acknowledgement letter within two weeks of submitting the initial SSDI application.  Once the application has been fully processed, the applicant will receive a decision letter.

So, should you submit the SSA acknowledgement letter, decision letter, or both to OPM?

It depends.

If the decision letter is favorable (i.e., you are approved for SSDI benefits), then it makes sense to submit both letters.  However, submitting an unfavorable decision letter (i.e., you are denied SSDI benefits) to OPM may adversely affect your FDR claim.  This is exactly what happened to one of my clients, and this is how we addressed it.

Case Study

For many years, Timothy (not his real name) had been suffering from several, serious psychiatric conditions, including Post Traumatic Stress Disorder (PTSD), Generalized Anxiety Disorder, and Panic Disorder with Agoraphobia.  Eventually, the severity of his symptoms prevented him from reporting to work altogether, and he resigned from his high-paying federal position and applied for FDR.

As required, Tim applied for SSDI.  He was subsequently denied and opted not to file an appeal with SSA.

Tim submitted his SSDI denial letter to OPM as proof of application for SSDI.

Several months later, Tim received a letter from OPM, which denied his FDR claim.  In addition to claiming that Tim did not meet specific eligibility requirements for FDR, the denial letter included the following statement:

“… SSA says trained staff and certified physicians looked at your case and rendered a denial.  They have determined that your condition is not severe enough to be considered disabling.”

I found this statement peculiar, because technically, one does not need SSDI approval to be eligible for FDR.  As discussed above, one must simply show proof of application for SSDI.  In fact, the majority of my clients who have been approved for FDR, have been denied SSDI.  To be clear, however, the OPM reviewer did not specify that the FDR claim had been denied, in whole or part, on the basis of the SSDI denial.  Yet, from the above statement, it would seem that the SSDI denial may have influenced (even if only subconsciously) the reviewer’s decision.

Luckily, Tim had a strong FDR claim.  Together, he and I drafted his Reconsideration Appeal in which we addressed each of the eligibility requirements for FDR.  Specifically, we (1) explained how and why Bob met each requirement and (2) supported our arguments with the appropriate agency and medical documents. 

In addition, we included a discussion about Tim’s SSDI denial.  We respectfully emphasized that an SSDI denial should have no bearing on an FDR claim, and that the FDR claim should be adjudicated solely on the eligibility requirements set forth by OPM.

Shortly after reviewing his Reconsideration Appeal, OPM approved Tim’s FERS Disability Retirement claim.

Bottom Line

Considering the above example, it is unclear as to whether Tim’s SSDI denial played a major, minor, or no role at all in the denial of his initial FDR application.  His case illustrates, however, that an SSDI denial could conceivably have an adverse effect on an FDR claim.  You may, therefore, want to consider only submitting your SSDI acknowledgement letter to OPM as proof of application for SSDI.

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I hope you find this information helpful.  For similar topics, please visit my Blog and FAQ.  Should you ever have questions about your eligibility for FERS Disability Retirement, please contact me to schedule your free 30-minute consultation!

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