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Ray lives with diabetes, hypertension, obesity, kidney disease, degenerative disc disease, anxiety, and depression. When his conditions worsened, he began working gradually easier jobs, from janitor to forklift operator to bus monitor for children with special needs, until eventually, he gave up his employment entirely. An ALJ denied Ray’s application for Supplemental Security Income and Disability Insurance Benefits, finding that Ray was severely impaired by most of his physical conditions, but that the ALJ erroneously evaluated Ray’s symptoms and daily activities, misinterpreted medical evidence, and failed to ask why he skipped some appointments. he could perform his past relevant work as a school bus monitor. The Seventh Circuit vacated. The ALJ erroneously evaluated Ray’s symptoms and daily activities, misinterpreted medical evidence, and failed to ask why he skipped some appointments. Substantial evidence does not support the ALJ’s conclusion that Ray’s previous job was not a composite job. On remand, the ALJ should revisit her assessment of Ray’s mental impairment View "Ray v. Berryhill" on Justia Law

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Winsted was 42 years old when he applied for disability benefits, asserting an onset date of October 2010. Although he initially alleged he became disabled in 2005, two prior applications alleging this onset date were denied and deemed administratively final. Winsted suffers from multiple physical impairments, including degenerative disc disease, osteoarthritis, and anxiety, mostly associated with his previous work in hard labor as an industrial truck driver, a highway maintenance worker, and an operating engineer. An ALJ denied benefits, finding that Winsted could work with certain limitations. The district court affirmed. The Seventh Circuit remanded. The ALJ did not adequately explain how the limitations he placed on Winsted’s residual functional capacity accounted for the claimant’s mental difficulties; the ALJ did not consider Winsted’s difficulties with concentration, persistence, and pace. View "Winsted v. Berryhill" on Justia Law

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Tramble worked for various Kentucky coal companies from at least May 1963 until June 1985. Tramble’s 1987 claim for benefits under the Black Lung Benefits Act (BLBA), 30 U.S.C. 901–944, indicated that he had stopped working due to a job-related back injury. That claim was denied although the parties stipulated to 17 years of qualifying coal mine employment. The ALJ found that medical evidence established that Tramble suffered from coal workers’ pneumoconiosis but was not totally disabled. After his 2008 death, Tramble’s widow sought survivor’s benefits. Reversing an award by an ALJ, the Department of Labor Benefits Review Board found that the ALJ failed to explain adequately how he calculated the 15.25-years of underground coal mine employment that justified application of the 15-year statutory presumption of entitlement to benefits. On remand, the ALJ again awarded benefits. The Board again reversed. The Sixth Circuit remanded. Further fact-finding is required to ensure that all relevant evidence has been considered. The court rejected Incoal’s argument that, in order to be credited with one year of coal mine employment, a miner must be on the payroll of a mining company for 365 consecutive days and have worked 125 of those days in or around a coal mine . View "Shepherd v. Incoal, Inc." on Justia Law

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On November 20, 2018, the Acting Governor of Idaho issued a proclamation that Proposition 2 had passed, and subsequently the Idaho Code was amended to add section 56-267, a statute to expand Medicaid eligibility in Idaho. Petitioner Brent Regan argued 56-267 violated Idaho’s Constitution by delegating future lawmaking authority regarding Medicaid expansion to the federal government. Regan requested the Idaho Supreme Court declare section 56-267 unconstitutional and issue a writ of mandamus to direct the Secretary of State Lawerence Denney to remove section 56-267 from the Idaho Code. Finding the statute constitutional, the Supreme Court dismissed Regan’s petition and denied his request for a writ of mandamus. View "Regan v. Denney" on Justia Law

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Procopio served aboard the U.S.S. Intrepid in 1964-1967. In July 1966, the Intrepid was deployed in the waters offshore the landmass of the Republic of Vietnam, including its territorial sea. Procopio sought entitlement to service connection for diabetes mellitus in 2006 and for prostate cancer in 2007 but was denied service connection for both in 2009. The Federal Circuit reversed, holding that the unambiguous language of the Agent Orange Act, 38 U.S.C. 1116, entitles Procopio to a presumption of service connection for his prostate cancer and diabetes mellitus. The term “in the Republic of Vietnam,” unambiguously includes the territorial sea under all available international law. Congress indicated those who served in the 12 nautical mile territorial sea of the “Republic of Vietnam” are entitled to section 1116’s presumption if they meet the section’s other requirements. View "Procopio v. Wilkie" on Justia Law

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The Second Circuit reversed the district court's decision upholding the denial of plaintiff's application for disability insurance benefits. The court held that the Commissioner's decision was not supported by substantial evidence because it relied on testimony from a vocational expert that appeared to be in conflict with the authoritative guidance set out in the Department of Labor's Dictionary of Occupational Titles. In this case, the Commissioner was not entitled to rely on this testimony without first identifying and inquiring into the apparent conflict. Therefore, the district court erred by declining to set aside the Commissioner's benefits decision. View "Lockwood v. Commissioner" on Justia Law

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The Supreme Court reversed the order of the district court on remand in this case involving a claimant’s eligibility for Medicaid funding, holding that the district court erred in its instructions on remand. The Nebraska Department of Health and Human Services determined that Paige V. was ineligible for Medicaid funding through he Nebraska Medicaid Assistance Program and, thus, ineligible for “assistance to the aged, blind, or disabled” (AABD) Medicaid waiver services. Paige’s parents sought review. The district court (1) found that the evidence showed that Paige was disabled for purposes of determining Medicaid benefits, and (2) remanded the matter with directions to award Page AABD waiver services and to reimburse her parents for medical expenses. The Supreme Court (1) affirmed the portion of the district court’s order finding that Paige was disabled, but (2) reversed the district court’s order of remanded that awarded Medicaid waiver services because the district court exceeded its scope of review in determining that Paige was eligible for Medicaid waiver services. The Court remanded the case. View "Leon V. v. Nebraska Department of Health & Human Services" on Justia Law

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Parents of C.J. filed suit under the Individuals with Disabilities in Education Act (IDEA), alleging that the school district failed to provide him with a Free Appropriate Public Education (FAPE). The Fifth Circuit affirmed the district court's judgment in favor of the school district and rejected parents' claim that the school district's refusal to provide Applied Behavioral Analysis (ABA) services denied C.J. a FAPE where parents could not meaningfully claim that C.J.'s individualized education plan (IEP) was predetermined; the district court did not clearly err by finding that sufficient notice of C.J.'s eligibility for summer school classes was provided; in light of the facts, the school district did not deny C.J. a FAPE by failing to protect him from bullying; and C.J.'s transition plan did not deny him a FAPE. View "Renee J. v. Houston Independent School District" on Justia Law

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For representation in administrative proceedings, the Social Security Act provides that if a fee agreement exists, fees are capped at the lesser of 25% of past-due benefits or a set dollar amount—currently $6,000, 42 U.S.C. 406(a)(2)(A); absent an agreement, the agency may set any “reasonable” fee, section 406(a)(1). In either case, the agency is required to withhold up to 25% of past-due benefits for direct payment of fees. For representation in court proceedings, section 406(b) caps fees at 25% of past-due benefits; the agency may withhold benefits to pay these fees. Culbertson represented Wood in Social Security disability benefit proceedings before the agency and in court. The agency ultimately awarded Wood past-due benefits, withheld 25%, and awarded Culbertson fees under section 406(a) for representation before the agency. Culbertson sought a separate award under 406(b) for the court proceedings, requesting 25% of past-due benefits. The Eleventh Circuit held that 406(b)’s 25% limit applies to the total fees awarded under both sections. The Supreme Court reversed. Section 406(b)(1)(A)’s 25% cap applies only to fees for court representation, not to the aggregate fees awarded under 406(a) and (b). The subsections address different stages of the representation and use different methods for calculating fees. Applying 406(b)’s 25% cap on court-stage fees to 406(a) agency-stage fees, or the aggregate fees, would make little sense and would subject 406(a)(1)’s reasonableness limitation to 406(b)’s 25% cap—a limitation not included in the statute. The fact that the agency presently withholds a single pool of past-due benefits for payment of fees does not support an aggregate reading. The amount of past-due benefits that the agency can withhold for payment does not delimit the amount of fees that can be approved for representation before the agency or the court. View "Culbertson v. Berryhill" on Justia Law

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Ashlee Oldham and Robert Prunckun (collectively, “Recipients”) were the only two Delaware Medicaid recipients housed at Judge Rotenberg Center (“JRC”), a facility in Massachusetts and the only facility in the United States known to use electric shock therapy as part of their comprehensive behavioral treatment plans. These services were covered by Medicaid with the knowledge and approval of Delaware’s Department of Health and Social Services (“DHSS”). in 2012, the Center for Medicare and Medicaid Services (“CMS”) advised the Massachusetts state agency responsible for Medicaid administration that continued use of electric shock therapy would place that state’s waiver program in jeopardy of losing federal funding. Following CMS’s letter to Massachusetts, Delaware took measures to avoid placing its own Home and Community Based Services (“HCBS”) waiver program at risk. DHSS finally terminated JRC as a qualified provider after JRC refused to cease using electric shock therapy. Although the procedural history was complex, the gist of Appellants’ challenge on appeal to the Delaware Supreme Court was that they were denied due process because Delaware’s administrative hearing officer bifurcated proceedings to address what she concluded was a threshold issue, namely, whether electric shock therapy was a covered Medicaid service under the Medicaid HCBS Waiver program. Instead, Recipients contended they should have been allowed to introduce evidence that electric shock therapy was medically necessary, and that by removing shock services, DHSS threatened Recipients’ ability to remain in a community-based setting (a conclusion they desired to prove through evidence and expert testimony). The Supreme Court determined the hearing officer's determination that electric shock therapy was not a covered service under federal and state law was supported by substantial evidence and free from legal error, and affirmed the district court. View "Prunckun v. Delaware Dept. of Health & Social Services" on Justia Law