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

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.

Recommendations

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

Director: Rosslyn S. Kleeman Team: General Accounting Office: Federal Personnel and Compensation Division Phone: (202) 512-9204