Justia Public Benefits Opinion Summaries

by
Euzebio served in the U.S. Navy, 1966-1969, including two tours of duty in Vietnam, where he was exposed to Agent Orange. In 2009, Euzebio began experiencing problems swallowing. In 2011, medical examinations and testing by private physicians indicated that he had benign thyroid nodules. The Veterans Court affirmed the Board of Veterans’ Appeals’ denial of Euzebio’s entitlement to service connection for a thyroid condition due to exposure to Agent Orange. The Board noted that the Agent Orange Act requires that when the Secretary determines that a presumption of service connection based on herbicide exposure is not warranted for certain conditions, he must consider reports of the National Academy of Sciences (NAS), 38 U.S.C. 1116; Euzebio’s thyroid disorder was not among the conditions listed by the Secretary for presumptive service-connection.The Federal Circuit vacated. The Board is required to consider relevant documents within its constructive possession; all relevant and reasonably connected VA-generated documents are part of the record, constructively known by the VA adjudicator. The Veterans Court applied an erroneous legal standard when it concluded the Board did not have constructive possession of the NAS Update 2014. While the VA has not published that Update in the Federal Register, it appears on its website. Update 2014 includes statements that, “thyroid conditions overall showed an indication of increased risk with herbicide exposure” and that “consistent observations of exposures to herbicide agents” indicated that they were “related to perturbations of thyroid function.” View "Euzebio v. McDonough" on Justia Law

by
The Individuals with Disabilities Education Act (IDEA) does not permit a school district to amend an individualized education program (IEP) unilaterally during the thirty-day resolution period. The Act envisions the resolution period as a time for mediation and agreement, not one-sided action. In this case, the first IEP that the school district prepared for the child and presented to the parents indicated erroneously that the child would be placed in a 12-student classroom, which the parents deemed insufficient. After the parents filed a due process complaint, the school district sought to cure this deficiency by unilaterally amending the original IEP to reflect that the student would be in a 15-student class. The district court found in favor of the parents and ordered the school district to reimburse the parents for the private school tuition.The Second Circuit affirmed and concluded that because the school district argues only that it provided the student with a free appropriate education (FAPE) based on her IEP as unilaterally amended during the resolution period, and does not dispute that the unamended IEP denied the student a FAPE, the school district denied the student a FAPE for her 2016-17 school year. Finally, the district court's other conclusions relevant to the reimbursement order are not challenged on appeal and therefore stand unaltered. View "Board of Education of the Yorktown Central School District v. C.S." on Justia Law

by
Karr applied for Social Security disability benefits based on her complaints of chronic lower back pain and other ailments. Karr traces the source of her back pain to a car accident in the late 1990s. She has tried multiple forms of treatment for her pain, numbness, and weakness in her lower back and legs.An ALJ concluded that Karr was not disabled because she still could perform sedentary work with some restrictions. The district court and Seventh Circuit affirmed, rejecting Karr’s claim that the ALJ improperly discounted a statement from her treating neurosurgeon that she could not sit, stand, or walk for sustained periods. The ALJ’s decision was supported by substantial evidence Although acknowledging that the neurosurgeon was a treating provider who had examined Karr, the ALJ found “extreme” his notation that Karr could not “sit, stand or walk for any sustained period of time” because the record contained reports of multiple physical examinations showing that Karr had full strength and could walk normally. View "Karr v. Saul" on Justia Law

by
The Eighth Circuit affirmed the denial of disability insurance benefits and supplemental social security income to plaintiff. The court held that substantial evidence supported the ALJ's decision to give little weight to plaintiffs' treating physicians because their opinions were vague and imprecise and did not provide any function-by-function analysis. Furthermore, substantial evidence supports the ALJ's decision to give greater weight to the medical consultants' opinions than to the treating physicians' opinions.Finally, the vocational expert's answer to the first hypothetical question, regarding whether a hypothetical person—who could lift amounts that plaintiff could, sit and stand for periods that she could, and work in a workplace devoid of fumes that irritated her—could work, is substantial evidence because it is a response to a hypothetical with the impairments accepted as true by the ALJ and reflected in the residual functional capacity (RFC). However, the vocational expert's answer to the second hypothetical question, regarding whether a hypothetical person with the impairments plaintiff alleged could work, was not substantial evidence because the hypothetical person in the second hypothetical did not have the same RFC as plaintiff. View "Kraus v. Saul" on Justia Law

by
The Ninth Circuit affirmed the district court's judgment affirming the ALJ's denial of claimant's application for Supplemental Security Income (SSI) under the Social Security Act. The panel published this decision to draw attention to the government's incorrect description, in its briefs in this and in other recent SSI cases, of the standard of review.In an SSI case, the panel reviews the decision of the ALJ for substantial evidence. If substantial evidence in the record supports the ALJ's decision, the panel must defer to the ALJ. In the absence of substantial evidence, however, the panel must set aside the ALJ's decision. The panel is not restricted to setting aside the ALJ's decision only when the evidence in the record compels a contrary conclusion. The panel rejected the government's application of I.N.S. v. Elias-Zacarias, 502 U.S. 478 (1992), which is an immigration case, and clarified that Elias-Zacarias does not describe the standard of review in an SSI case. In this case, considering the record as a whole, the panel held that the ALJ's disability determination was supported by substantial evidence. View "Ahearn v. Saul" on Justia Law

by
Giles served on active Army duty, 1976-1982. He first claimed a service-connected nervous condition with the VA in March 1984; he was diagnosed with a personality disorder. While his claim was pending, he reported for Reserve training in June 1984. He soon was hospitalized, was diagnosed with organic delusional syndrome, and was discharged in November 1984. The VA denied his claim. In 1985, Giles was hospitalized, with an admitting diagnosis of schizophrenia. Upon discharge, he was diagnosed with bipolar disorder. The VA denied his request to reopen. The Board of Veterans’ Appeals affirmed in 1987, finding that “[a]n acquired psychiatric disorder was neither incurred in nor aggravated by service nor may a psychosis be presumed to have been incurred in active military service.”In 1995, Giles claimed service-connected PTSD. The VA awarded him service connection for bipolar disorder, effective in 1995. In 2012, Giles filed a request to revise the 1987 Board decision for clear and unmistakable error because the Board failed to recognize Giles’s claim on a presumptive basis for his 1984 diagnosis. The Board rejected the motion, stating, that 1987 regulations provided that the presumption of service incurrence of certain diseases, such as psychosis, did not apply to a period of active duty for training; a person serving on active duty for training was not considered a “veteran” during that service. The Veterans Court and Federal Circuit affirmed; “psychoses,” under 38 C.F.R. 3.309(a), refers to a category of diseases; whether diseases falling within this category are the same is a factual question outside of the courts' jurisdiction. View "Giles v. McDonough" on Justia Law

by
The Eleventh Circuit affirmed the district court's decision affirming the ALJ's denial of social security disability benefits, holding that substantial evidence supports the ALJ's decision that plaintiff is not disabled. In this case, the ALJ assigned little weight to the opinions of a physician and a vocational rehabilitation specialist where the ALJ correctly understood that their statements were not dispositive. Furthermore, a vocational rehabilitation specialist is not a treating physician, and thus his opinion is not entitled to substantial or considerable weight, and the physician's opinion that plaintiff would be "permanently and totally disabled" conflicted with his own examinations of plaintiff, which showed no significant abnormalities. Finally, the court rejected plaintiff's argument under Bjornson v. Astrue, 671 F.3d 640, 647–48 (7th Cir. 2012). View "Walker v. Social Security Administration" on Justia Law

by
The Supreme Judicial Court reversed the judgment of the superior court judge affirming the decision of a hearing officer upholding MassHealth's denial of Plaintiff's application for Medicaid benefits on the grounds that Plaintiff's life estate interest in certain property as a beneficiary rendered Plaintiff ineligible for long-term care benefits, holding that Plaintiff's life estate was not a countable asset for Medicaid eligibility purposes.Plaintiff created a trust and transferred her home to the trust. Plaintiff had a life estate interest in the property under the trust, and the other five beneficiaries - her children - had a remainder interest as joint tenants with rights of survivorship. After Plaintiff moved to a long-term nursing facility she applied for long-term benefits from MassHealth. MassHealth denied the application, determining that Plaintiff's countable assets exceeded the $2,000 limit. A hearing officer and a superior court judge affirmed. The Supreme Court reversed, holding (1) because the trust was a nominee trust and not a true trust, Plaintiff's only interest in the property was a life estate; and (2) it was error to include the value of the property as an asset in Plaintiff's Medicaid eligibility determination. View "Guilfoil v. Secretary of Executive Office of Health & Human Services" on Justia Law

by
When Medicare overpays hospitals, it offsets that mistake by reducing future payments. By 2013, Medicare was out $11 billion because of new diagnostic codes and bookkeeping that did not keep up. Congress required that the Secretary of Health and Human Services recoup that amount by the end of fiscal year 2017 by reducing the base rate (standardized amount) paid for inpatient care and directed the Secretary to adjust the base rate by 0.5% each year through 2023, 129 Stat. 87, 163 (2015). Subsequently, while reviewing the 2017 budget, the Secretary realized that a -3.2% adjustment would leave the agency short of its $11 billion goal and announced a -3.9% adjustment. Congress then told the Secretary to increase the base rate by 0.4588% (not 0.5%) in 2018, 130 Stat. 1033, 1320 (2016). In 2017, the Secretary adjusted the base rate -3.9%. The agency met its goal. In 2018, the Secretary adjusted the base rate -3.4412%.Medicare providers sued, arguing that the Secretary should have reversed that expedient at the end of 2017 rather than carry it over into 2018, costing the hospitals $840 million in lost payments. The D.C. Circuit affirmed the dismissal of the suit. While the hospitals felt a “significant financial impact” from the -0.7% adjustment, Section 7(b)(5) bars judicial review of adjustments made under the Act. View "Fresno Community Hospital and Medical Center v. Cochran" on Justia Law

by
The Eighth Circuit affirmed the denial of social security benefits to plaintiffs, rejecting plaintiffs' claim that the ALJs who denied their claims were not properly appointed under the Appointments Clause of the Constitution. The court held that plaintiffs' unexhausted claims are foreclosed by Davis v. Saul, 963 F.3d 790 (8th Cir. 2020), cert. granted, 2020 WL 6551772 (Nov. 9, 2020) (No. 20-105). View "Smith v. Saul" on Justia Law