Justia Public Benefits Opinion Summaries

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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

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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

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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

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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

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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

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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

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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

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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

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Plaintiffs, former recipients of Social Security disability benefits and former clients of an attorney who orchestrated one of the largest fraud schemes in the history of the SSA, argued in consolidated appeals that SSA's categorical exclusion of allegedly fraudulent medical evidence during the redetermination process was unlawful because they were never afforded any opportunity to rebut the allegation that their evidence was tainted by fraud.The Fourth Circuit joined its sister circuits and held that the SSA's redetermination procedures violate the Administrative Procedure Act (APA) and the Due Process Clause of the Fifth Amendment. The court agreed with plaintiffs that it is arbitrary and capricious for the agency to deny beneficiaries an opportunity to contest the Office of the Inspector General's fraud allegations as to their cases, while permitting other similarly situated beneficiaries to challenge similar allegations arising from SSA's own investigations. The court also agreed with plaintiffs that the SSA's redetermination procedures violated their due process rights under the Fifth Amendment because they were denied the opportunity to contest the Office of the Inspector General's fraud allegations against them. In this case, the court considered each Mathews factor and concluded that each factor supports a finding that the SSA's redetermination procedures violated plaintiffs' due process rights. Accordingly, the court affirmed in No. 19-1989 and reversed in No. 19-2028. View "Kirk v. Commissioner of Social Security Administration" on Justia Law

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For many years, attorney Conn obtained social security benefits for his clients by submitting fraudulent reports and bribing an Administrative Law Judge. After the government discovered this fraud, the SSA decided to redetermine whether each of Conn’s 1,500 claimants was actually eligible for disability benefits. The SSA held hearings and allowed the claimants to submit evidence but categorically excluded medical reports created by the doctors with whom Conn had conspired because it had “reason to believe” fraud was involved in the creation of the reports (42 U.S.C. 1383(e)(7)(A)(ii))). The claimants were not permitted to challenge that finding. After the denials of their claims, 57 plaintiffs filed suit.The Sixth Circuit held that the exclusion of the reports violated the Due Process Clause and the APA. On remand, the district courts concluded that remand to the SSA was proper because “the Commissioner erred in some respect in reaching the decision to deny benefits.”The Sixth Circuit affirmed the subsequent denial of the plaintiffs’ motions for attorney’s fees under the Equal Access to Justice Act. The government’s position in the litigation was “substantially justified,” in light of the precedent cited by the government, the rationale for the decision, and the fact that district courts across the country have split on this issue. The case involved numerous issues of first impression. Despite the fact that the government’s arguments were rejected, a reasonable person could have believed them to be correct. View "Wireman v. Commissioner of Social Security" on Justia Law