This attachment discusses OPM's role in the adjudication of psychiatric suitability referrals, provides an understanding of the procedures and provides guidance used in evaluating these types of cases.

Please note that OPM regulations governing the use of medical examinations (5 CFR 339 Medical Qualification Determinations) severely restrict the use of psychiatric/psychological assessments as a means of determining qualification for federal employment. A psychiatric/psychological assessment is permissible only when it is specifically required as part of an OPM approved medical standard, or where a medical doctor who is otherwise authorized to conduct a medical examination believes a psychiatric assessment is indicate.

Psychiatric Suitability Referrals submitted to OPM usually contain Agency Investigation Reports, application materials and some form of medical examination results or records for a medical history. The medical psychiatric records normally fall into one of the following categories:

1. The record includes evidence that the applicant is currently under treatment for psychiatric or behavior disorder, that may or may not require medication.
   
   
2. The record includes evidence that the applicant has been treated in the recent past for a psychiatric or behavior disorder, but is no longer under treatment.
   
   
3. The record includes evidence that the applicant has been treated in the distant past for a psychiatric disorder, and also includes results of a recent psychiatric evaluation that concludes, while there is no present condition warranting treatment, the type of behavior manifested in the past is still evident.
   
   
4. The record includes no evidence of present or past treatment, but does include results of a current psychiatric evaluation that identifies a specific psychiatric condition or behavior disorder which may affect job performance.
   
   
5. The record includes evidence that the applicant has been treated in the distant past for psychiatric disorder, and may include results of a recent psychiatric evaluation showing no current significant psychiatric or behavioral problem.
   
   
6. The record includes no evidence of present or past treatment, but does include results of a current psychiatric/psychological evaluation that does not identify a specific psychiatric condition as outlined in the Diagnostic and Statistical Manual of Mental Disorders. DSM-IV, published by the American Psychiatric Association, Washington, D.C., and cites specific behavior and personality tendencies which may affect job performance.
   
   
7. The record includes no evidence of present or pasts treatment, but does include the results of a test or tests of psychological functioning that doses not support a clinical diagnosis per se of a mental health condition or impairment.
   
   

Psychiatry/psychological case records in categories 1-4 above are generally straightforward. We evaluate these cases in conjunction with the applicant's with the applicant's past/present work history to determine whether the psychiatric/psychological condition is likely to adversely affect safe and efficient job performance.

Psychiatric case records in category 5 above is based on history alone, and cannot be easily handled as a medical objection unless there is a medical standard which specifically addresses the question of past psychiatric history. Generally, our view is that evidence of past psychiatric history is not critical to the decision to hire, and the question of other types of suitability issues would take precedence.

Psychiatric case records in categories 6 and 7 above are problematic in that they generally provide no basis to consider a medical disqualification.

OPM Decision Criteria

Psychiatric/psychological cases are very complex and require an extensive evaluation that cannot be accomplished by using only the results of a psychological screening test(s).

Before reaching a conclusion about whether or not the medical objection is warranted, OPM evaluates the nature and extent of that applicant's psychiatric/psychological condition, medication requirements, its duration, the duties and requirements of the job (i.e., safety sensitive and safety critical jobs, law enforcement, fire fighter, individuals holding security clearances, etc.), and the applicant's past and present work history (especially during the period covered by the psychiatric/psychological condition). Even in cases where a physical/medical standard has been approved that explicitly provides for disqualification on the basis of a psychiatric condition, further analysis is required to determine if that blanket disqualification can be sustained under the provisions and guidance contained in 5 CFR 339 Medical Qualification Determinations, ADA, EEOC, and the Rehabilitation Act of 1973.

Any mental health diagnosis must be consistent with the diagnostic criteria as outlined in the Diagnostic and Statistical Manual of Mental Disorders, DSM-IV, and should include the results of a multiaxial assessment.

Additionally, some cases may require a neuropsychological evaluation to determine whether or not there are any alterations in cognitive functioning (long/short term memory problems, impaired judgment, ability to process information, reaction time, etc.) that may adversely affect safe and efficient job performance.

In summary, OPM is committed to ensuring that: (1) medical standards and physical requirements relating to the employment of individuals with mental health problems are applied reasonably and fairly; and (2) individuals who have fully recovered or whose mental health symptoms are controlled by various therapeutic and treatment plans are not discriminated against, or treated differently from those individuals suffering from other medical and physical illnesses. This effort is further supported by the significant advances in medicine, research, and treatment that allows individuals with mental health problems to make a significant contribution to federal employment.

If you have any questions on this subject please contact J. C. Phillip Spottswood, Staffing Reinvention Office, Employment Service on:

Telephone: 202-606-1389
E-mail:         jcspotsw@opm.gov
Fax:             202-606-0390