Justia Public Benefits Opinion Summaries

by
In October 2012, Jeske, working at a cemetery, was carrying a heavy casket when she stumbled, injuring her back. Four years later, she applied for disability insurance benefits and supplemental security income based on disability; she claimed that back and spine problems, anxiety, depression, and suicidal tendencies made her unable to work. At a hearing, Jeske told the ALJ that she was 44 years old and lived with her husband and three sons. She changed the date on which she allegedly became disabled to more than a year after her injury because she had substantial gainful activity in 2013. She explained that she received treatment through a workers’ compensation program and her employer allowed her to work from home many days. When the doctor released her from treatment, Jeske’s boss no longer permitted her to work from home and she quit. Since then she has worked as a part-time security guard. The ALJ found Jeske not disabled under the Social Security Act, 42 U.S.C. 423(d), 1382c(3). The Seventh Circuit affirmed. The ALJ applied the proper standards and sufficiently explained the decision. Although the evidence showed Jeske suffered from limiting back pain, abundant evidence supports the ALJ’s determination that her condition lacked the requirements of a presumptively disabling impairment. The use of daily-living activities, to assess credibility and symptoms, was not improper. The evidence supported a conclusion that Jeske could perform light work with specific restrictions. View "Jeske v. Saul" on Justia Law

by
Plaintiff Steven Kientz spent many years as a "dual status" technician with the Kansas Army National Guard, where he worked as a mechanic on electronic measurement equipment. Plaintiff’s position required him to simultaneously serve as a member of the National Guard, a second job with separate pay and separate responsibilities. In retirement, Plaintiff receives a monthly pension payment under the Civil Service Retirement System based on his service as a dual status technician. Plaintiff also receives Social Security retirement benefits based on contributions he made to the Social Security system from his separate pay as a National Guard member. The issue this case presented for the Tenth Circuit's review centered on whether a dual status service technician’s civil service pension was “based wholly on service as a member of a uniformed service” under 42 U.S.C. 415(a)(7)(A). After review, the Court concluded Plaintiff's civil service pension is not “wholly” based on service as a member of a uniformed service, and his pension payments were therefore subject to the Windfall Elimination Provision ("WEP"). Plaintiff’s dual status technician work was at least partially distinct from the performance of his military duties. And Plaintiff received separate compensation and separate pensions for his performance of those distinct roles. The Court concurred with the district court and Social Security Administration that Plaintiff's Social Security retirement benefits were subject to the WEP. View "Kientz v. Commissioner, SSA" on Justia Law

by
An unsuccessful bidder on managed-care contracts for MississippiCAN, the state’s managed-care program, argued that the Division of Medicaid and its executive director violated multiple statutes and regulations in procuring the contracts. Mississippi True appealed the decision of the chancery court affirming the Division of Medicaid’s award of the contracts to three other companies and the chancery court’s order denying its motion to sever and transfer its damages claims to circuit court. The Mississippi Supreme Court "thoroughly reviewed the voluminous record" and concluded that Mississippi True has failed to prove any basis for reversal. "The decision of the DOM was supported by substantial evidence, was not arbitrary or capricious, was not beyond the DOM’s power to make, and did not violate Mississippi True’s statutory or constitutional rights." View "Mississippi True v. Dzielak et al." on Justia Law

by
Emard, age 33, was injured in a 2010 motorcycle accident. Emard had previously worked as a truck driver, assembler, and packager. He ceased working after the accident. His application for Social Security disability-insurance benefits claimed chronic low-back pain, chronic neck pain, cervical radiculopathy, lumbar radiculopathy, chronic migraine headaches, fatigue, mood swings, anxiety, and Crohn’s disease. An ALJ determined that Emard had not engaged in substantial gainful activity during his insured period; that Emard’s degenerative disc disease, asthma, obstructive sleep apnea, anxiety, and depression were severe impairments, but that his other conditions were mild impairments; that none of Emard’s impairments or any combination thereof met the criteria of any listed impairment; that Emard had the residual functional capacity to perform sedentary work; that Emard’s “subjective complaints exceed the available objective records,” particularly in light of Emard’s conservative course of treatment; that Emard could not perform past relevant work; and that Emard could perform jobs that existed in significant numbers in the national economy. The district court and Sixth Circuit affirmed the denial of benefits. The ALJ made no procedural error by declining to give weight to the opinion of a treating source offered after the claimant’s date last insured that did not relate back to the insured period. The ALJ complied with requirements to view Emard’s impairments in combination and to consider Emard’s ability to work on a sustained basis. View "Emard v. Commissioner of Social Security" on Justia Law

by
Until 2010, Reinaas, now in his mid‐fifties, worked as a machine operator. He injured his spine and tore his rotator cuff on the job, and underwent two neck fusion surgeries. Reinaas planned to return to work but continued to suffer from severe headaches (treated with hydrocodone), shoulder pain, and a decreased range of motion. A neurologist diagnosed him with cervicogenic headaches, and his family doctor diagnosed “long term nuchal headaches” and “[p]ermanent pain syndrome post cervical fusion.” Dr. Bodeau, a Mayo Clinic occupational physician, opined that Reinaas could not return to his factory job and suggested surgical intervention. In 2013, Reinaas had shoulder surgery and attended physical therapy; he took naproxen and Vicodin for pain. Reinaas applied for social security disability benefits. Benefits were denied after state‐retained physicians reviewed his records and concluded that Reinaas’s accounts of his symptoms were not fully credible. Dr. Bodeau opined that Reinaas had “deteriorated significantly” and was “highly unlikely to successfully regain employment at any physical demand level.” The ALJ concluded that Reinaas was not disabled. In determining Reinaas’s residual functional capacity, the ALJ afforded great weight to the opinions of the two non‐examining physicians and gave little weight to Dr. Bodeau’s opinion, explaining that Bodeau lacked knowledge of Social Security disability rules and that his report was based on subjective complaints of questionable credibility. The Seventh Circuit vacated. Substantial evidence does not support the ALJ’s decision to discount the treating physician’s opinion and the ALJ did not adequately evaluate Reinaas’s subjective complaints. View "Reinaas v. Saul" on Justia Law

by
This case involved an obligor father who never missed a child support payment to the obligee, mother for their minor child. The father retired and began collecting Social Security retirement benefits. As a result, the child became eligible to receive a derivative monthly children’s insurance benefit (CIB) from the Social Security Administration (SSA). The mother received four years of CIB payments in addition to regular monthly child support payments from the obligor; the law allowed the CIB payments to be credited against the child support obligation. However, neither parent notified the Alaska Department of Revenue, Child Support Services Division (CSSD) that they were receiving CIB payments for their daughter. After four years of overpayments, CSSD discovered the CIB payment from SSA and credited the father more than $47,000 in child support overpayment. The father filed suit, asking the superior court for a judgment against the mother for overpaid child support. He also requested reimbursement or credit for overpaid health insurance premiums. The superior court denied reimbursement for either overpayment, and the father appealed. After review, the Alaska Supreme Court affirmed, finding no reversible error in the superior court's judgment. View "Rosenbaum v. Shaw" on Justia Law

by
The Fifth Circuit affirmed the district court's denial of a parent's motion for summary judgment against the school district for alleged procedural and substantive violations of the Individuals with Disabilities Education Act (IDEA). The court held that the district court did not err in finding that the parent failed to meet her burden of showing that the school district violated the procedural requirements of the IDEA. In this case, none of the incidents the parent claimed amounted to a procedural violation and the court was not convinced that the student was denied a free and appropriate public education. The court also held that there were no substantive IDEA violations. The court was satisfied that the school district took the necessary steps to ensure that the student was being properly serviced under this individualized education plan, despite his absences. Accordingly, the court affirmed the district court's grant of the school district's motion for summary judgment. View "A. A. v. Northside Independent School District" on Justia Law

by
The Supreme Court affirmed the judgment of the trial court enjoining the application of Arizona statutes authorizing the recording of liens against third-party tortfeasors to allow hospitals to recover health care costs for Medicaid patients beyond the amounts provided by Medicaid, holding that the statues are preempted to the extent hospitals utilize them against third-party tortfeasors for "balance billing" to recover costs beyond Medicaid reimbursement. Plaintiffs were patients who were treated at defendant hospitals under the state's contract provider for the federal Medicaid program, which negotiates reimbursement rates with hospitals. Defendants recorded liens against the third-party tortfeasors who caused the patients' injuries in order to recover the remainder of their fees exceeding Medicaid reimbursement. Plaintiff brought this class action challenging the liens, arguing that Ariz. Rev. Stat. 33-931(A) and 36-2903.01(G)(4) (the lien statutes) were preempted by federal Medicaid law. The trial court enjoined application of the lien statutes. The Supreme Court affirmed, holding (1) Plaintiffs had a private right of action to challenge the lien statutes; and (2) the lien statutes are unconstitutional as applied. View "Ansley v. Banner Health Network" on Justia Law

by
The Eighth Circuit affirmed the denial of social security disability benefits to plaintiff, holding that substantial evidence supported the ALJ's residual functional capacity (RFC). The court held that the ALJ's finding that plaintiff can perform frequent but not constant grasping, handling, and fingering with her right arm is supported by substantial evidence. View "Pemberton v. Saul" on Justia Law

by
In 2011, K.G., age 48, received an influenza vaccination in advance of knee replacement surgery. Over the next several months, she experienced increasingly severe nerve pain in her hands, arms, feet, and legs; she succumbed to alcoholism, spent months in the hospital, and developed amnesia. In 2014, an Iowa state court declared K.G. incapable of caring for herself and, against K.G.’s will, appointed K.G.’s sister as her guardian. K.G. regained her mental faculties by May 2016. She then retained an attorney who filed her claim under the National Childhood Vaccine Injury Act, 42 U.S.C. 300aa-1. A Special Master held that equitable tolling was not available during the period that K.G.’s sister acted as K.G.’s guardian and dismissed K.G.’s claim as not timely filed within the three-year statute of limitations. The Federal Circuit vacated. Equitable tolling is available in Vaccine Act cases and the appointment of a legal guardian is only one factor a court should consider when deciding whether equitable tolling is appropriate in a particular case. K.G. was not required to argue the legally irrelevant question of whether she personally was diligent while she was mentally competent and she preserved her argument that her legal representative exercised reasonable diligence under the circumstances. The Special Master erred in adopting a per se rule. View "K.G. v. Secretary of Health and Human Services" on Justia Law