Justia Public Benefits Opinion Summaries

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Mitze unsuccessfully appealed the denial of her application for social security benefits. Several years later, Mitze moved to seal her medical information and all other information pertaining to her case, citing “harassing phone calls from solicitors” who knew her personal medical information because the courts had “publicized” it by issuing opinions. She claims that she and her children have experienced social stigma and that thieves broke into her home to steal pain medication, which publicly available documents revealed that she had been prescribed. The Seventh Circuit affirmed the denial of Mitze’s motion. A strong presumption exists in favor of publishing dispositional orders, even in cases involving substantial privacy interests such as state secrets, trade secrets, and attorney-client privilege. The court acknowledged that the existing remedies of proceeding anonymously, requesting redactions, or sealing records may be inadequate in the social security context. News outlets have the right to publish information obtained from public court records and cannot be ordered to remove articles reporting on the decisions in her case. The court rejected an argument under the Health Insurance Portability and Accountability Act, 42 U.S.C. 1320d-6, which regulates the disclosure of information by only healthcare providers and their affiliates. View "Mitze v. Saul" on Justia Law

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The Eighth Circuit affirmed the district court's dismissal of plaintiff's challenge to the Commissioner's denial of her application for disability insurance benefits and supplemental security income. The court held that substantial evidence supported the ALJ's determination concerning the limits of plaintiff's ability to reach and handle throughout an otherwise sedentary workday. In this case, one of the jobs cited by the vocational expert as available in the national economy—call out operator—requires only occasional, rather than frequent, handling. Therefore, the identified job is even less demanding on plaintiff's upper extremities than would be permitted by the Commissioner's residual functional capacity limitation. View "Lawrence v. Saul" on Justia Law

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Surprise injured a tendon in the middle finger of his right hand in 2009, resulting in two surgeries and several months of physical therapy. He initially experienced severe pain. Weeks later Surprise’s therapist noted that his pain had decreased significantly and that therapy was no longer necessary as he could open soda cans and use a coffee cup with his right hand. Surprise suffered a concussion, resulting in post-concussion syndrome, in a 2000 snowmobile accident. In 2009, a psychologist noted Surprise could not read well, could follow only a simple, three-step command, and had poor short-term memory and a limited knowledge base. Surprise also experiences depression and anxiety, although his doctors noted that medications kept these conditions under control. Surprise’s claim for disability insurance benefits and supplemental social security income was denied following a remand. Surprise argued that the ALJ failed to adequately account for a portion of the medical expert’s opinion in the hypothetical question posed to the vocational expert and that her decision violated the law of the case doctrine by failing to adopt the fine manipulation limitation the initial ALJ found in the course of his RFC assessment. The Seventh Circuit affirmed. Surprise did not identify any obvious conflict between the hypothetical question and the Dictionary of Occupational Titles nor did the district court make any factual findings that became the law of the case. View "Surprise v. Saul" on Justia Law

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Independent of the Individuals with Disabilities Education Act (IDEA), Minnesota has adopted an "open enrollment" process that allows a parent to enroll a student in a school outside of the student's local district. The Eighth Circuit held that the IDEA does not require a school district that enrolls a nonresident student like M.N.B. to provide transportation between the student's home and the school district where her parent has chosen to enroll her. The court saw nothing in the IDEA that provides clear notice to a state that it must cover transportation expenses when a student's travel is the result of a parent's choice under an open enrollment program. Therefore, under the circumstances presented here, the court concluded that the IDEA does not require the Osseo District to reimburse M.N.B.'s parent for the cost of transportation between her home and the border of the Osseo District. The court reversed the district court's grant of summary judgment in favor of M.N.B. View "Osseo Area Schools v. M.N.B." on Justia Law

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The Eleventh Circuit vacated the district court's order affirming the denial of plaintiff's application for benefits under the Social Security Act. The court agreed with plaintiff that substantial evidence does not support the ALJ's finding that plaintiff could perform a job that exists in significant numbers in the national economy. The court held that the vocational expert's testimony as to available jobs, on which the ALJ relied, was significantly and admittedly flawed. In this case, the vocational expert used the wrong Standard Occupational Classification (SOC) group code to determine whether there are a significant number of jobs in the national economy that plaintiff could perform. Furthermore, even if the court overlooked this foundational problem, the numbers that the vocational expert cited from the wrong SOC group code substantially overstated the number of available bakery worker jobs that plaintiff could perform. Accordingly, the court remanded for further proceedings. View "Goode v. Commissioner of Social Security" on Justia Law

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On appeal from a federal appellate court's decision that the Federal Medicare scheme prohibits State Medicaid agencies, including MassHealth, from receiving funds from Medicare, the Supreme Judicial Court ordered that this case be remanded for modification of the declaratory judgment, holding that MassHealth demonstrated a sufficient change in circumstances to warrant modification to allow MassHealth to seek reimbursement where the liable third party is Medicare. In Atlanticare Medical Center v. Commissioner of the Division of Medical Assistance, 439 Mass. 1, 3, 5 (2003) (Altanticare I), the Supreme Judicial Court concluded that the Federal Medicaid scheme tasked the State Medicaid agency, not individual providers, with seeking reimbursement from liable third-party insurers, including Medicare. When the Center for Medicare & Medicaid Services (CMS) refused to issue reimbursements from Medicare to MassHealth, MassHealth brought suit. In 2011, the United States Court of Appeals for the First Circuit held that the Federal Medicare scheme prohibited MassHealth from receiving funds from Medicare. Therefore, a Federal Medicare regulation was amended to acknowledge the practice of State Medicaid agencies obtaining Medicare reimbursements through providers, rather than seeking such reimbursements directly from Medicare. MassHealth sought to modify the declaratory judgment and restore its ability to obtain reimbursements from providers, rather than liable third parties. The Supreme Judicial Court remanded the case for modification of the judgment, holding that changed circumstances required modification. View "Atlanticare Medical Center v. Division of Medical Assistance" on Justia Law

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The California State Teachers’ Retirement System (CalSTRS) determined that Ernest Moreno’s retirement benefits had been incorrectly calculated and initiated proceedings to adjust Moreno’s retirement benefits and collect the overpayment. The trial court denied Moreno’s petition for writ of administrative mandamus challenging the CalSTRS actions. Moreno appealed, contending: (1) CalSTRS’s adjustment of his retirement benefits and collection of the overpayment were barred by the statute of limitations found in Education Code section 22008 (c) because CalSTRS was on inquiry notice of the problem as early as 2008; and (2) CalSTRS should have been equitably estopped from adjusting his retirement benefits and collecting the overpayments. After review, the Court of Appeal concluded: (1) CalSTRS was not on inquiry notice of the reporting error that led to overpayment until December 2014 when it began an audit of Moreno’s retirement benefits, and, therefore, CalSTRS’s adjustments to Moreno’s retirement benefits and collection of overpayments were not barred by the statute of limitations; and (2) CalSTRS was not equitably estopped because CalSTRS was not apprised of (or on notice about) the overpayments until December 2014. View "Moreno v. Cal. State Teachers' Retirement System" on Justia Law

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The Ninth Circuit affirmed the Commissioner's reduction of claimant's social security retirement benefits pursuant to the Windfall Elimination Provision (WEP) of the Social Security Act. The WEP applies to retirees who, like claimant, are entitled to social-security benefits and pension benefits from employment not covered by social security. The panel held that the text of the uniformed-services exception is ambiguous as applied to dual-status technicians. However, because the Commissioner's interpretation of the uniformed-services exception is reasonable, it is entitled to Skidmore deference. View "Larson v. Saul" on Justia Law

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While serving in the Navy 1968-1970, Simmons experienced feelings of depression and homesickness. A VA physician diagnosed Simmons with situational depression but no permanent disability. Another VA physician diagnosed him with immature personality disorder and recommended he be discharged. In 1972, the VA awarded Simmons a non-service-connected pension on his polyarthritis claim. In 1974, Simmons sought additional compensation, asserting that his arthritis was service-connected and that he also had a nervous condition that justified compensation. The VA denied the claim. In 2005, after receiving a total disability rating for an unrelated asbestosis-based claim, Simmons claimed that there was clear and unmistakable error (CUE) in the 1974 decision, with respect to the denial of service connection, citing the presumptions of soundness and service connection in 38 U.S.C. 105(a) and 1111. The Board found that Simmons’s current psychiatric disorder was due to his non-service-connected arthritis and that the presumptions did not apply. The Veterans Court affirmed, finding that although the Board erred in analyzing the presumptions, that error was harmless because Simmons’s current disability was not causally related to his in-service condition. The Federal Circuit affirmed, rejecting an argument that a failure to apply an evidentiary presumption is per se prejudicial. A per se rule of prejudice for failure to apply the presumptions would undo any proper VA finding that the claimant had failed to establish a causal nexus. View "Simmons v. Wilkie" on Justia Law

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While serving in the Navy, 1972-1073, Merritt sustained a concussion in an automobile accident. In 2006, a VA psychologist prepared a note. stating that Merritt had “[s]ymptoms of bipolar disorder[, which] first began ... on active duty,” and that Merritt’s “work performance began to suffer” after the in-service accident. In 2010, Merritt sought disability benefits for bipolar disorder, anxiety, and personality disorders. The Board determined that Merritt’s psychiatric disorders were not service-connected, relying solely on an independent medical expert opinion. On remand, the Board again denied Merritt’s claim, stating that the VA psychology note was entitled to little probative weight, apparently because there was no evidence that the VA psychologist had access to Merritt’s records, and there was a discrepancy between that note and Merritt’s treatment records as to the length of time that Merritt was unconscious following the automobile accident. The Veterans Court affirmed, finding the Board’s error in not following the remand order harmless because the VA note “described no symptoms that . . . supported . . . a retrospective diagnosis” of bipolar disorder, and “there [was] no possibility that the Board could have awarded service connection based on [the note].” Merritt died; Mrs. Merritt was allowed to substitute herself as the surviving spouse. The Federal Circuit subsequently dismissed her appeal as moot. Mrs. Merritt did not preserve her claim by filing a formal claim with the VA within one year of Merritt’s death as required. View "Merritt v. Wilkie" on Justia Law