How to Get Medical Retirement: Filing, Deadlines, and Appeals

To get medical retirement, you have to prove that a lasting medical condition prevents you from performing your job, file the specific forms your retirement system requires before its deadline, and back the claim with medical and employment records strong enough to convince a reviewer who will never meet you. The exact route depends on whether you are a federal civilian employee, a military service member, or covered by a private employer’s long-term disability plan. Each system has its own eligibility rules, forms, timelines, and appeal paths, and the fastest way to a denial is treating them as interchangeable.

Figure Out Which System Covers You

Every medical retirement system asks the same core question: is your condition severe enough to stop you from doing your job, and will it last? Everything else varies.

Federal Civilian Employees Under FERS or CSRS

Under the Federal Employees Retirement System, you need at least 18 months of creditable civilian service.¹ The condition must prevent you from providing “useful and efficient service” in your current position, meaning you cannot perform the critical elements of the job at a fully successful level, and it must be expected to last at least a year.²

Your agency has to certify two things before OPM will consider the case: that it cannot reasonably accommodate your condition in your current position, and that no suitable vacant position exists at the same grade or pay level within your commuting area.² Turning down a reasonable reassignment can disqualify you on its own.¹

Under the older Civil Service Retirement System, the service threshold is five years of creditable civilian service instead of 18 months.³ The medical standard is otherwise similar.

Military Service Members

Military disability retirement runs on a rating number. You must be found unfit to perform the duties of your office, grade, rank, or rating because of a physical disability, and your disability must be rated at 30% or higher under the VA rating schedule to qualify for retirement rather than separation, unless you have 20 or more years of service.⁴ A rating below 30% with fewer than 20 years of service results in separation with severance pay.⁵ Retirement carries lifetime benefits, including TRICARE eligibility; separation does not.

Private Employer Plans

Most employer-sponsored long-term disability plans are governed by ERISA rather than a pension retirement system. Eligibility comes down to the policy language, which varies by insurer. You typically have to prove your condition prevents you from performing the core duties of your own occupation. Some policies shift to an “any occupation” standard after two years, meaning you must show you cannot do any job for which you are reasonably qualified. Read the plan document; those definitions decide the case.

The Filing Deadline That Ends Cases Before They Start

For federal employees, the disability retirement application must be filed before you separate from service or within one year after separation. Miss that window and eligibility is gone. The only exception is mental incompetence at the time of separation or within the year following it, in which case you or a fiduciary have one year from the date competency is regained or a court-appointed fiduciary is named.⁶

Do not wait for the medical picture to settle before starting. An incomplete application filed on time counts as timely. A perfect one filed a day late does not.

Build the Documentation Before You Build the Application

Reviewers at OPM, a military board, or an insurance company decide your case entirely on paper. The quality of what you put in that file is the single biggest factor you control.

Medical Records

You need comprehensive, recent records that tell a clear story: diagnosis, treatment history, and how the condition limits your ability to work. Include diagnostic imaging, lab work, medication lists, and therapy notes. Gaps in treatment hurt, because reviewers read them as evidence the condition is not that limiting.

Physician statements carry particular weight. Your treating doctor should explain in plain terms what you can and cannot do, tie those limitations directly to the diagnosis, and state a prognosis. A vague letter saying you “have a condition” is close to useless. The statement should name specific job duties you can no longer perform.

A Functional Capacity Evaluation, where a physical therapist formally tests what your body can handle in a work setting, provides objective evidence of your limitations. Standard medical records establish that you have an impairment; an FCE shows how that impairment restricts lifting, sitting, standing, and other work activities. These reports can be especially persuasive when the diagnosis alone does not obviously translate to total disability.

Employment Records

Pull your official position description, performance reviews, attendance records, and any documentation of accommodations that were attempted or denied. Together they establish what the job requires and how your condition has affected your ability to meet those requirements. Performance problems that began after the condition worsened are powerful supporting evidence.

File the Right Forms With the Right Office

Federal employees under FERS or CSRS use specific OPM forms. The core documents are SF 3107 (Application for Immediate Retirement) and SF 3112 (Documentation in Support of Disability Retirement), which includes Schedules A through E covering the applicant’s statement, the supervisor’s statement, the agency’s statement, and the physician’s statement. If you are still employed, your agency assembles the complete package (including your preliminary Individual Retirement Record on SF 3100) and forwards it to OPM.² If you have already separated, you file directly with your former agency or with OPM.

Military service members and state pension participants use their own systems’ forms, obtained through their personnel or HR offices.

If You’re Filing Under FERS, Apply for Social Security Too

Something that surprises many federal employees: if you are applying for FERS disability retirement, you must also apply for Social Security Disability Insurance. It is not optional. OPM will not pay your disability annuity until it receives proof you applied for SSDI, and if you withdraw the Social Security application for any reason, OPM will dismiss your FERS disability retirement application entirely.²

Submit either a copy of your SSDI application confirmation or a written notice of approval or denial from the Social Security Administration. A verbal denial is not acceptable proof.³ If Social Security denies your claim, insist on a formal written denial letter. You will need it.

What Happens After You File

OPM first checks that the package is complete. Missing forms or unsigned schedules trigger a request for additional information, which can add months. Federal disability retirement applications commonly take six to twelve months for a decision, though simple cases with strong documentation resolve faster. The best thing you can do to speed things up is submit a complete package on the first attempt.

For private employer claims under ERISA, the plan administrator has 45 days to make an initial decision. If the administrator needs more time for reasons beyond its control, it can take up to two additional 30-day extensions, for a maximum of 105 days. The clock stops when the administrator requests information from you and does not restart until you respond.⁷

Independent Medical Examinations

Insurance companies, OPM, and military boards may require you to see a doctor they select. The Social Security Administration calls these “consultative examinations” and orders them when existing evidence is not enough to make a decision.⁸ The examining doctor works for the entity deciding your claim, not for you. That does not mean the exam is rigged, but it does mean you should arrive prepared, answer questions honestly, and not minimize your symptoms. There is no benefit to stoicism in this setting.

Military Medical and Physical Evaluation Boards

Military disability determinations run through two boards. A Medical Evaluation Board reviews your medical records and documents the nature of your conditions; it does not decide fitness. Its findings go to a Physical Evaluation Board, which determines whether you are unfit for duty and assigns a disability rating.⁹ That rating decides whether you are retired (30% or higher) or separated (below 30%). If your disability may not be permanent, you can be placed on the Temporary Disability Retired List rather than the Permanent Disability Retired List, receiving retired pay and benefits while the military monitors whether the condition improves.⁵

What Approval Actually Pays

For FERS, the first 12 months pay 60% of your high-3 average salary, reduced by 100% of any SSDI benefit you receive that month. After the first year, the formula drops to 40% of your high-3 minus 60% of your SSDI benefit. If your “earned” annuity based on actual years of service is higher than either formula, you receive the earned amount instead.¹⁰

Military disability retired pay is calculated two ways, and you receive whichever amount is higher. The first multiplies your high-36 average base pay by your disability percentage (capped at 75%). The second multiplies your years of service by 2.5%, then multiplies that result by your high-36 average base pay.¹¹ The service-based method matters most for members with many years of service but a relatively low rating.

Protecting Your Health Insurance

Federal disability retirees can carry Federal Employees Health Benefits coverage into retirement, but only if they were continuously enrolled in an FEHB plan for the five years of service immediately before retirement, or for all service since first becoming eligible if employed less than five years. Canceling and later re-enrolling restarts the five-year clock from re-enrollment.¹² The practical rule: do not drop FEHB in the years leading up to a possible disability retirement.

Service members placed on the TDRL or PDRL remain eligible for TRICARE as retired service members. A rating below 30% that leads to separation instead of retirement means the loss of full TRICARE eligibility, though transitional health care programs may apply.¹³

Approval Isn’t Permanent

Federal disability retirees under FERS are re-examined at the end of the first year of retirement and annually after that until age 60, unless OPM determines the disability is permanent. After age 60, OPM will re-evaluate only if you request it.¹⁴

Military members on the TDRL must undergo a physical examination at least once every 18 months. The TDRL has a three-year limit: at the end of three years, the military makes a final determination. If your disability is permanent and stable you transfer to the PDRL; if your condition has improved enough that you are no longer rated at 30% or higher, you may be separated. Failing to report for a scheduled examination can result in termination of retired pay.¹⁵

If You’re Denied

Denials are common, and the appeal path depends on which system denied you.

Federal Civilian Denials

If OPM denies your FERS or CSRS application, request reconsideration in writing within 30 calendar days of the initial decision, explaining why you believe the decision was wrong. OPM may extend this deadline if you were unaware of the time limit or prevented by circumstances beyond your control.¹⁶ If reconsideration also denies the claim, you can appeal to the Merit Systems Protection Board within 30 calendar days of receiving OPM’s final decision. File in writing with the MSPB regional or field office serving the area where you live.¹⁷ In some cases, OPM issues an initial decision that is also a final decision, letting you skip reconsideration and appeal directly to MSPB.

Military PEB Findings

If you disagree with the informal PEB’s findings, you can submit a rebuttal for reconsideration and request a formal PEB hearing. At the formal hearing you can appear in person, have a military counsel appointed at no cost, and request witnesses.¹⁸ Requests to delay the formal hearing are rarely granted, and additional time to obtain new medical evidence is generally not treated as a sufficient reason. Prepare quickly.

Private Plans Under ERISA

You must exhaust internal appeals before you can sue. The plan must give you at least 180 days from receipt of the denial to file your first-level appeal.⁷ The record you build during that administrative appeal is often the only evidence a court will consider later, so submit every piece of supporting medical evidence you have, including new physician opinions and updated test results.

Steps That Improve Your Odds

Tie every diagnosis to specific job duties. A diagnosis alone is not enough; each medical document should name the work tasks the condition prevents. Reviewers reject claims where the connection is implied rather than stated.
Do not leave treatment gaps. Continuing regular treatment shows the condition is ongoing and serious. Stopping, even if nothing more can be done, reads as improvement.
Get the supervisor’s statement right. For federal employees, SF 3112-B carries real weight. Make sure your supervisor accurately describes the job requirements and the performance or attendance problems your condition has caused.
Budget for medical records. Retrieval fees vary widely by provider and state, so request records early and plan for the cost.
Keep copies of every form, letter, and medical record before submitting. If something is lost in processing, you will need to reproduce it quickly.
Consider professional help at the appeal stage. Attorneys who specialize in disability retirement can improve your chances, particularly on appeal. For ERISA and federal cases, fees typically come as a percentage of back benefits recovered. Weigh the cost against the complexity of your case.

1
Office of the Law Revision Counsel. 5 U.S. Code 8451 – Disability Retirement
2
OPM. Information About Disability Retirement (FERS)
3
OPM. Chapter 60 – Disability Retirement
4
Office of the Law Revision Counsel. 10 USC 1201 – Regulars and Members on Active Duty
5
Defense Finance and Accounting Service. Disability Retirement
6
eCFR. 5 CFR Part 844 Subpart B – Applications for Disability Retirement
7
U.S. Department of Labor. Benefit Claims Procedure Regulation FAQs
8
Social Security Administration. A Special Examination Is Needed For Your Disability Claim
9
The Official Army Benefits Website. DoD Disability Retired Pay
10
OPM. Computation
11
Defense Finance and Accounting Service. Retired Disability Income Estimator
12
OPM. Health Insurance FAQs
13
TRICARE. Retired Service Members and Families
14
eCFR. Part 844 – Federal Employees Retirement System Disability Retirement
15
Office of the Law Revision Counsel. 10 USC 1210 – Members on Temporary Disability Retired List
16
OPM. Chapter 3 – Reconsideration and Appeal
17
U.S. Merit Systems Protection Board. Appellant Questions and Answers
18
Army.mil. Physical Evaluation Boards Explained