Justia Public Benefits Opinion Summaries

Military-Veterans Advocacy (MVA) filed suit under 38 U.S.C. 502, seeking review and revision of certain instructions and practices set forth in the Veterans Affairs Adjudication Procedures Manual (M21-1 Manual), which provides guidance and instructions to the administrators of veterans’ benefits and claims, by interpreting and coordinating the application of statutes, regulations, policies, and judicial decisions. The M21-1 Manual “limits VA staff discretion, and, as a practical matter, impacts veteran benefits eligibility for an entire class of veterans.”The Federal Circuit dismissed challenges to presumptions and procedures concerning Vietnam-era exposure to the Agent Orange defoliant. MVA waived its challenge to the “Thailand Rules.” The VA’s interpretation of the “Blue Water Navy Rule” of 2019 did not unduly narrow the presumption of exposure and service connection as applied to shipboard service. MVA’s challenge to the “Airspace Rule” is barred by the six-year limit provided in section 2401(a) because the rule has been in full force and effect since 1993. Even if the time bar did not apply, Congress has consistently preserved the high-altitude exception to the presumption of exposure since its adoption in 1993. View "Military-Veterans Advocacy Inc. v. Secretary of Veterans Affairs" on Justia Law

Plaintiff initiated a civil action in district court contesting the denial of her claim for disability insurance benefits by Defendant Commissioner of the Social Security Administration (the “SSA”). Plaintiff has asserted that the SSA Commissioner erred in multiple ways. Her arguments include that, pursuant to precedents of this Court, the Commissioner should have accorded substantial weight to a prior determination by the Department of Veterans Affairs (the “VA”) that Plaintiff is 100% disabled, but the Commissioner instead followed contrary new SSA rules providing that such a determination need not be considered, much less given any weight. As Rogers would have it, the new SSA rules cannot — and thus do not — abrogate this Court’s precedents. The district court concluded, however, that the new SSA rules supersede our precedents and that the Commissioner acted appropriately in adhering to those rules. After then addressing many, but not all, of Plaintiff’s other arguments, the court affirmed the Commissioner’s decision. Plaintiff appealed from the court’s judgment.   The Fourth Circuit vacated the court’s judgment and remanded for the court to further remand this matter for administrative proceedings. The court concluded that by omitting the menstrual cycle evidence from the residual functional capacity assessment as to Plaintiff, the ALJ’s decision is sorely lacking in the analysis needed for the court to review meaningfully the ALJ’s conclusions. That legal error alone demands further administrative proceedings. View "Shanette Rogers v. Kilolo Kijakazi" on Justia Law

Crews served in the Air Force from 1954-1958. In connection with his service, he was originally granted a 100% disability rating for schizophrenia. In 1960, his disability rating was lowered to 70%. In 2006, Crews sought an increased schizophrenia rating, which was denied in 2007. In 2009, Mrs. Crews (Yvonne) submitted a letter stating that Crews was 100% disabled and requested further evaluation; she did not mention an effective date. The VA responded that it would not consider the letter a notice of disagreement (NOD) with the 2007 decision because it was filed more than one year after that decision. It construed the letter as a new “claim for an increased rating. In March 2010, the VA increased his schizophrenia rating from 70% to 100% effective from September 2009. In October 2010, Crews died. In 2011, Yvonne moved to be substituted as the appellant and filed a notice of disagreement with the 2009 effective date, alleging clear and unmistakable error (CUE) in the 1960 rating decision.The VA rejected her request for substitution because Crews had no claim or NOD pending at the time of his death. Yvonne was not eligible to seek benefits on past decisions that had been finalized; the 1960 rating decision became final once the appeal window closed. The Veterans Court and Federal Circuit affirmed. Yvonne’s CUE allegation is not part of a “pending” claim for which she could substitute under 38 U.S.C. 5121A. View "Crews v. McDonough" on Justia Law

Stephanie Owens appealed a district court’s order affirming the findings of fact and conclusions of law made by the Ada County Board of Commissioners (the “Board”) in which it determined that Owens was an “applicant” under the Medical Indigency Act (the “Act”) and, therefore, required to pay reimbursement for the medical expenses incurred by her two children at public expense. In 2017, Owens’s children were involved in a serious car accident and suffered substantial injuries, which later resulted in the death of one of the children. Because the children’s father, Corey Jacobs, was unable to pay for the children’s medical bills, he filed two applications for medical indigency with the Board. Owens and Jacobs were never married and did not have a formal custody agreement for their children. At the time of the accident, the children resided with their father. The Board determined that Owens and her children met the statutory requirements for medical indigency. Although Jacobs filed the applications for medical indigency, the Board concluded that Owens was also an “applicant” under the Act and liable to repay the Board. As a result, the Board “recorded notices of statutory liens” against Owens’s real and personal property and ordered Owens to sign a promissory note with Ada County to repay the medical bills. Owens refused to sign the note and instead challenged the sufficiency of her involvement with the applications via a petition for reconsideration with the Board and a subsequent petition for judicial review. Both the Board and the district court ultimately concluded that Owens was an “applicant” and liable for repayment of a portion of the children’s medical bills. Owens timely appealed. The Idaho Supreme Court reversed: because she never signed the medical indigency applications for her children and she did not affirmatively participate in the application process, Owens was not an "applicant" as defined by the Act. As a result, the Board acted outside its authority when it ordered Owens to reimburse Ada County for its expenses and when it placed automatic liens on her property. View "Owens v. Ada County Board of Commissioners" on Justia Law

Bakke, a Wisconsin beef farmer, began suffering from serious back pain in 2017. He has had temporary relief from epidural steroid injections, spinal fusion surgery, physical therapy, and pain medications. Bakke sold his farm because the upkeep was too physically demanding and applied for disability benefits in 2019. Two state agency physicians examined him and concluded that Bakke was capable of light, full-time work. His general practitioner concluded that he could tolerate no more than four hours of work per day. At a hearing, Bakke testified about intense pain, with some days so bad he could not get out of bed; that he could not sit for more than two hours; that pain often required him to lay down during the day; that he could not lift or carry much weight; and that he was unsteady on his feet.An ALJ performed the Social Security Administration’s five-step disability analysis and agreed that Bakke could not engage in substantial gainful activity due to his back injury and obesity but concluded that his impairments were not as severe as those listed in 20 C.F.R. 404. Considering residual functional capacity, he determined that Bakke could still perform light, full-time work. Citing the vocational expert’s testimony, the ALJ decided that light, full-time work was available in significant numbers in the national economy, precluding a finding that Bakke was disabled. The district court and Seventh Circuit affirmed the denial as supported by substantial evidence. View "Bakke v. Kijakazi" on Justia Law

More than a decade ago, Medicaid recipients filed this suit alleging that in violation of the Due Process Clause, the District of Columbia is failing to provide them notice and an opportunity to be heard when denying them prescription coverage. The case is now before the DC Circuit for the third time. In the first two appeals, the DC Circuit reversed the district court’s dismissals for lack of standing and for failure to state a claim, respectively. On remand, the district court once more dismissed the case, this time for mootness.   The DC Circuit again reversed and remanded with instructions to proceed expeditiously with discovery and allow Plaintiffs to make their case. The court explained that Plaintiffs challenged the District’s failure to give Medicaid recipients reasons for denying their prescriptions and an explanation of how to appeal, and uncontested evidence demonstrates that, notwithstanding the transmittal memorandum, some number of Plaintiffs are still not receiving the information they claim they are entitled to under the Due Process Clause. Because it is not “impossible for [the district] court to grant any effectual relief,” the case is not moot. View "Elsa Maldonado v. DC" on Justia Law

Fetting, 50 years old and suffering from back pain, headaches, depression, and anxiety, unsuccessfully applied for supplemental security income. During an administrative hearing, a vocational expert (VE) testified to Fetting’s physical and mental limitations and his ability to perform certain jobs, stating that Fetting could perform the representative occupations of a cleaner/housekeeper, routing clerk, and marker. The VE estimated that, in the national economy, there were 200,000 cleaner/housekeeper jobs, 40,000 routing clerk jobs, and 200,000 marker jobs. During cross-examination, the VE stated that he calculated his estimates from numbers published by the Bureau of Labor Statistics, using his “knowledge of the labor market, [acquired] over 30+ years of job placement activities.” He stated: “It’s not a hard and fast scientific type formula” and that he had not conducted any “formal analysis” to validate his estimates but had “in the past checked numbers in other reporting formats.”The ALJ found that Fetting did not have a disability under the Social Security Act based on the VE’s testimony. The district court and Seventh Circuit affirmed, rejecting an argument that the VE’s methodology for calculating his job number estimates was unreliable. Substantial evidence supports the finding that a significant number of the identified jobs exist in the national economy. View "Fetting v. Kijakazi" on Justia Law

Spicer served in the Air Force from 1958-1959 and was exposed to benzene in aircraft fuel. Years later, he developed chronic myeloid leukemia, a blood cancer. The VA recognized his leukemia as service-connected and granted him a 100 percent disability rating. Spicer developed arthritis in both knees, which required him to use a wheelchair. His scheduled knee replacement surgery was canceled because the leukemia medications lowered his hematocrit (red blood cell level). Spicer's hematocrit will never rise to a level that would permit surgery. He sought secondary service connection for his knee disability. The Board of Veterans’ Appeals and Veterans' Court affirmed the VA's denial of his claim. The statute, 38 U.S.C. 1110 establishes entitlement to service connection, providing compensation for veterans “[f]or disability resulting from personal injury suffered or disease contracted in line of duty.” The court reasoned that unless “the current state of his arthritis would not exist in the absence of his cancer or chemotherapy,” there is “no actual but-for causation.”The Federal Circuit vacated. Section 1110 provides that the United States will pay a veteran “[f]or disability resulting from personal injury suffered or disease contracted in line of duty”; “disability” refers to a veteran’s present-day “functional impairment.” “Resulting from" requires “but-for causation,” which is not limited to bringing something about or the onset or etiological link. That language may encompass situations where the service-connected disease or injury impedes the treatment of a disability. View "Spicer v. McDonough" on Justia Law

Plaintiff applied for and was denied disability benefits from the Social Security Administration (“SSA”). Plaintiff appealed the decision to the District of Minnesota, arguing in part that the Administrative Law Judge (“ALJ”) who oversaw the case lacked authority because SSA Acting Commissioner Nancy Berryhill was not properly serving as Acting Commissioner when she ratified the ALJ’s appointment. The district court agreed.   The Eighth Circuit reversed. The court found that Berryhill was properly serving as Acting Commissioner when she ratified the appointment. Plaintiff argued the district court’s decision can be affirmed because Berryhill was never directed to serve by the president. In essence, he argued the 2016 succession memo became null and void when administrations changed in 2017. The court concluded that this argument fails. The general rule is that presidential orders without specific time limitations carry over from administration to administration. Plaintiff provides no authority indicating succession orders are any different from other presidential orders. The text of the FVRA likewise does not change the default position that presidential orders, including succession memos under the FVRA, carry over from one administration to the next. View "Brian Dahle v. Kilolo Kijakazi" on Justia Law

The Northern Arapaho Tribe and the Indian Health Service (IHS) entered into a contract under the Indian Self-Determination and Education Assistance Act for the Tribe to operate a federal healthcare program. Under the contract, the Tribe provided healthcare services to Indians and other eligible beneficiaries. In exchange, the Tribe was entitled to receive reimbursements from IHS for certain categories of expenditures, including “contract support costs.” The contract anticipates that the Tribe will bill third-party insurers such as Medicare, Medicaid, and private insurers. The Tribe contended that overhead costs associated with setting up and administering this third-party billing infrastructure, as well as the administrative costs associated with recirculating the third-party revenue it received, qualified as reimbursable contract support costs under the Self-Determination Act and the Tribe’s agreement with the IHS. But when the Tribe attempted to collect those reimbursements, IHS disagreed and refused to pay. Contending it had been shortchanged, the Tribe sued the government. The district court, agreeing with the government’s reading of the Self-Determination Act and the contract, granted the government’s motion to dismiss. A divided panel of the Tenth Circuit Court of Appeals voted to reverse (for different reasons). Under either of the jurists' interpretations, the administrative expenditures associated with collecting and expending revenue obtained from third-party insurers qualified as reimbursable contract support costs. View "Northern Arapaho Tribe v. Becerra, et al." on Justia Law