Retirement Security:

Most Civil Service Disability Retirement Claims Are Decided Fairly, but Improvements Can Be Made

FPCD-83-1: Published: Apr 13, 1983. Publicly Released: Apr 20, 1983.

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In response to a congressional request, GAO reviewed the Office of Personnel Management's (OPM) civil service disability retirement program to determine whether OPM has been consistent in applying its eligibility criteria and to assess the reasons for the increase in the number of OPM claims decisions that have been reversed by the Merit Systems Protection Board (MSPB).

Although GAO estimated that at least 90 percent of the OPM decisions reviewed were based on standard evaluation criteria, GAO identified problems within the review system that could cause inconsistencies in claims decisionmaking. GAO found that those OPM decisions which denied claims because of a belief that the involved agencies could have retained the disabled persons were improper and inconsistent with OPM criteria. In addition, GAO found that OPM needs to develop better criteria for determining psychiatric disability and to expand its psychiatric assessment capabilities. GAO felt that a recently started internal review of the claims process should help, if it is continued on a regular basis. In addition, OPM has proposed new forms and instructions which will address problems which GAO found. GAO stated that OPM had not been telling applicants why their initial claims were denied. Consequently, applicants did not know whether they could appeal their claims with additional evidence. Further, claims are often approved during reconsideration if they contain additional information. OPM has not yet implemented a process to alleviate this problem because of clerical staff shortages. Case files showed that OPM made virtually no effort to defend its decisions which were reversed by an appeal to MSPB, although many of these cases had arguable deficiencies or inconsistencies. OPM is considering a strategy to reduce the number of cases which it loses through appeals, but this strategy has been delayed due to the claims backlog.

Status Legend:

More Info
  • Review Pending-GAO has not yet assessed implementation status.
  • Open-Actions to satisfy the intent of the recommendation have not been taken or are being planned, or actions that partially satisfy the intent of the recommendation have been taken.
  • Closed-implemented-Actions that satisfy the intent of the recommendation have been taken.
  • Closed-not implemented-While the intent of the recommendation has not been satisfied, time or circumstances have rendered the recommendation invalid.
    • Review Pending
    • Open
    • Closed - implemented
    • Closed - not implemented

    Recommendations for Executive Action

    Recommendation: The Director of OPM should use revised claims forms and instructions.

    Agency Affected: Office of Personnel Management

    Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Director of OPM should notify applicants of the specific reasons for denial of their initial claims.

    Agency Affected: Office of Personnel Management

    Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

    Recommendation: The Director of OPM should carry out the OPM proposed strategy for evaluating and defending disability decisions appealed to MSPB.

    Agency Affected: Office of Personnel Management

    Status: Closed - Implemented

    Comments: The agency's work plans call for testing attendance at MSPB hearings. Not enough hearings were attended to draw conclusions because of a shortage of agency travel funds. Assessment of the success and expansion decision will be made as soon as the test is completed. Tentatively, results are not worth the efforts to defend.

    Recommendation: The Director of OPM should develop better criteria for deciding mental illness cases, using generally accepted psychiatric principles and practices, and provide psychiatric expertise as necessary.

    Agency Affected: Office of Personnel Management

    Status: Closed - Implemented

    Comments: When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.

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