Justia Public Benefits Opinion Summaries

Three teaching hospitals challenged the denial of Medicare reimbursements. At that time, a teaching hospital could obtain reimbursement only by incurring “substantially all” of a resident’s training costs. Because the teaching hospitals had shared the training costs for each resident, the government denied reimbursement. The denials led the teaching hospitals to file administrative appeals. While they were pending, Congress enacted the Affordable Care Act (ACA), which created a new standard for reimbursement. The parties disagreed on whether the ACA’s new standard applied to proceedings reopened when Congress changed the law. The agency answered no, and the district court granted summary judgment to the agency. Finding no reversible error in that decision, the Tenth Circuit affirmed. View "St. Francis Hospital, et al. v. Becerra" on Justia Law

In 2009, Grotts applied for Social Security disability benefits, citing depression and low functional capacity. She had previously worked as a caretaker for a child with disabilities and he cared for her own child. Her case was remanded four times. Five times, an ALJ concluded that Grotts was not disabled. The final ALJ found that she could still perform light work with some restrictions and because a significant number of jobs fitting that description existed in the national economy.The district court agreed. The Seventh Circuit affirmed, rejecting arguments that the ALJ erred in its evaluation of Grotts’s subjective complaints about her symptoms, in its evaluation of the medical opinion evidence, and in its residual functional capacity determination. Substantial evidence supported the ALJ’s weighing of the medical opinion evidence and its RFC determination. The ALJ did not patently err in its evaluation of Grotts’s subjective complaints. View "Grotts v. Kijakazi" on Justia Law

After working underground in coal mines for three decades, Casey developed pneumoconiosis (black-lung disease). His widow, Mabel, sought benefits under the Black Lung Benefits Act, 30 U.S.C. 901–44. It took the Department of Labor 17 years to deny her claims. During this time, the claims bounced back and forth between an ALJ and the Benefits Review Board. In the last appeal, the Board also rejected one of Mabel’s main arguments, citing “law-of-the-case,” without reaching the merits. The Department of Labor then delayed things further by filing an incomplete and disorganized administrative record in the Sixth Circuit.The Sixth Circuit affirmed. While the government’s actions “perhaps could be described as poor customer service, they do not show any reversible legal error.” The Board could lawfully invoke the discretionary law-of-the-case doctrine to avoid reexamining an issue on which it had affirmed the ALJ years before. The credibility findings concerning the conflicting medical opinions concerning whether Casey was totally disabled or had only “moderate impairment” pass muster under the deferential “substantial evidence” test. View "Samons v. National Mines Corp." on Justia Law

Mandrell, born in 198, pursued her education through one year in college. In 2005-2009, she served in the Coast Guard, which she left with an honorable discharge. While in service she was the victim of a rape by a fellow service member. She developed PTSD and anxiety afterward. The VA found her to be 100% disabled based on a service-related cause and awarded benefits but later revised her level of disability down to 70%. Mandrell’s 2017 application for Social Security disability benefits was denied and the Appeals Council denied her request for review. The district court affirmed.The Seventh Circuit reversed and remanded. The ALJ failed to connect the residual functional capacity he found with the evidence in the record, and he did not adequately account for her deficits in concentration, persistence, and pace. The ALJ apparently accepted that Mandrell suffered from PTSD as a result of the rape, but dismissed most of the symptoms that accompanied that condition. While the Social Security Administration is not bound by the VA’s assessment of Mandrell’s disability, the underlying medical evidence on which the VA relied is just as relevant to the social‐security determination as it was to the VA. View "Mandrell v. Kijakazi" on Justia Law

Plaintiffs-appellees Ronda Owens, Darryl Hubbard, Selena Freymiller, Shanika Crowley, Valerie Killman, Michael Lee Pitts, Ebony Warrior, John Ball, Michelle Bullock, Logan Bellew, Sondia Bell, Tumeeka Baker, and Jay Reid (collectively "Citizens") filed the underlying lawsuit seeking declaratory and injunctive relief. Citizens claimed that Oklahoma Governor J. Kevin Stitt and Defendant-appellant Shelley Zumwalt, in her official capacity as Executive Director of the Oklahoma Employment Security Commission, acted without authority and violated 40 O.S.2011 section 4-313 of the Oklahoma Employment Security Act by terminating agreements with the U.S. Department of Labor to administer COVID-related unemployment programs. The trial court entered a preliminary injunction ordering Zumwalt to immediately reinstate and administer the programs. Zumwalt appealed, and the Oklahoma Supreme Court stayed the trial court's order pending appeal. The Supreme Court found 40 O.S. 4-313 did not create a private right of action and, therefore, the trial court abused its discretion by granting a preliminary injunction. View "Owens, et al. v. Zumwalt" on Justia Law

The State redesigned the dental insurance plan offered to public retirees in 2014, narrowing coverage but also decreasing premiums paid by retirees. The Retired Public Employees of Alaska challenged the redesign. After a bench trial the superior court concluded that the new plan unconstitutionally diminished retirees’ accrued benefits. The State appealed, arguing that the superior court erred by determining the dental plan was a constitutionally protected “accrued benefit” and by refusing to consider premium rates for retirees as relevant to the diminishment analysis. The Alaska Supreme Court agreed with the State on the second point only: "The Alaska Constitution does protect public retirees’ option to purchase dental insurance as an accrued benefit, but both coverage for retirees and price to retirees influence the value of this option." The Court therefore vacated and remanded for the superior court to reevaluate the plan changes and incorporate premium pricing into its analysis. View "Tshibaka v. Retired Public Employees of Alaska, Inc." on Justia Law

Ruenger applied for Social Security Disability benefits in 2015, alleging that he had limited use of his left arm and mental impairments including anxiety and depression. At a hearing, the ALJ determined that Ruenger had not worked within the claim period, that his mental and physical impairments were severe but did not presumptively establish a disability, and that he had the capacity to perform light work with certain physical and social limitations. At the final step of the inquiry, the ALJ determined—based on a vocational expert’s testimony—that Ruenger could still perform jobs that exist nationwide in significant numbers and denied Ruenger’s application.The Seventh Circuit vacated and remanded. Substantial evidence does not support the ALJ’s decision. ALJs cannot afford complete discretion to vocational experts. When a claimant challenges a vocational expert’s job-number estimate, the ALJ must inquire whether the methodology used by the expert is reliable. In this case, the vocational expert enlisted by the agency to estimate the number of jobs suitable for Ruenger omitted crucial details about her methodology, such as the source of her job numbers and the reason she used the equal distribution method; the ALJ nevertheless relied on the expert’s testimony. View "Ruenger v. Kijakazi" on Justia Law

Social Security retirement benefits are calculated using a formula based on past earnings, 42 U.S.C. 415(a)(1)(A). Under the “windfall elimination” provision, benefits are reduced when a retiree receives a separate pension payment based on employment not subject to Social Security taxes. Pension payments exempt from the windfall reduction include those "based wholly on service as a member of a uniformed service.”A “military technician (dual status),” 10 U.S.C. 10216, is a “civilian employee” assisting the National Guard. Such technicians are required to maintain National Guard membership and must wear uniforms while working. For their work as full-time civilian technicians, they receive civil-service pay. If hired before 1984, they receive Civil Service Retirement System pension payments. As part-time National Guard members, they receive military pay and pension payments from a different arm of the government.The SSA applied the windfall elimination provision to the benefits calculation for Babcock, a dual-status technician. The district court and Sixth Circuit upheld that decision, declining to apply the uniformed-services exception.The Supreme Court affirmed. Civil Service Retirement System pensions generally trigger the windfall provision. Babcock’s technician work was not service “as” a National Guard member. A condition of employment is not the same as the capacity in which one serves. The statute states: “For purposes of this section and any other provision of law,” a technician “is” a “civilian employee,” “authorized and accounted for as” a “civilian.” While working in a civilian capacity, technicians are not subject to the Uniform Code of Military Justice. They possess characteristically civilian rights concerning employment discrimination, workers’ compensation, disability benefits, and overtime work; technicians hired before 1984 are “civil service” members, entitled to pensions as civil servants. Babcock’s civil-service pension payments are not based on his National Guard service, for which he received separate military pension payments. View "Babcock v. Kijakazi" on Justia Law

The Medi-Cal program, California’s enactment of the federal Medicaid program, was administered by the California Department of Health Care Services (the department) administers the Medi-Cal program. In this case, the department sought reimbursement from a revocable inter vivos trust for the Medi-Cal benefits provided on behalf of Joseph Snukst during his lifetime. Following his death, the probate court ordered the assets in the revocable inter vivos trust to be distributed to the sole beneficiary, Shawna Snukst, rather than to the department. The Court of Appeal concluded federal and state law governing revocable inter vivos trusts, as well as public policy, required that the department be reimbursed from the trust before any distribution to its beneficiary. Judgment was therefore reversed and remanded. View "Riverside County Public Guardian v. Snukst" on Justia Law

B.W., a two-year-old in good health, experienced immune thrombocytopenic purpura after receiving his measles, mumps, and rubella vaccine. Later blood tests showed his condition had resolved. More than six months after he was first diagnosed, B.W. presented with bruising, a possible symptom of immune thrombocytopenic purpura, but blood tests showed the condition had not recurred. In a suit under the National Childhood Vaccine Injury Act of 1986, the Claims Court ruled in favor of B.W., holding that those blood tests, occurring more than six months after his initial diagnosis, were “residual effects” of B.W.’s vaccine injury that satisfied the severity requirement of 42 U.S.C. 300aa-11(c)(1)(D).The Federal Circuit reversed. A residual effect must be a change within the patient that is caused by the vaccine injury. B.W.’s later bruising was not caused by his vaccine injury, and his tests did not reveal, constitute, or cause any somatic change. Tests revealed B.W. had no lingering symptoms or recurrence of thrombocytopenic purpura. There was no argument that the testing itself was detrimental to B.W.’s health such that it might qualify under section 300aa-11(c)(1)(D)(i) as a “residual effect” or a “complication” of thrombocytopenic purpura. View "Wright v. Secretary of Health and Human Services" on Justia Law