Justia Public Benefits Opinion Summaries

Stallworth served in the U.S. Army, 1974-1975, during which time he experienced a psychotic episode that was attributed to his illicit use of the drug LSD. He recovered with hospitalization, but relapsed following return to active duty and was diagnosed with acute paranoid schizophrenia. A treating physician noted that it was not clear whether Stallworth’s illness was caused by his drug use or by independent psychosis. An Army medical board found him unfit for further military duty. Weeks later, a VA Regional Office awarded Stallworth service connection for schizophrenia at a 50% disability rating. Thereafter, Stallworth was often admitted to inpatient psychiatric facilities where medical professionals repeatedly opined that he had “no mental disorder” and that Stallworth’s service connection diagnosis was in error. The VA severed Stallworth’s service connection on the basis of clear and unmistakable error (CUE) and declined to reopen his claim because of a lack of new evidence. In 1981, the Appeals Board affirmed. The Veterans Court and Federal Circuit affirmed. View "Stallworth v. Shinseki" on Justia Law

Dixon served in the Army, 1979-1992, including as a chemical operations specialist in the Persian Gulf, where he was exposed to pyridostigmine and “encountered smoke from oil fires, diesel, and burning trash,” and had “cutaneous exposure [to] diesel and petrochemical fuel.” In 2003, Dixon was diagnosed with sarcoid lungs and transverse myelitis, which left him temporarily paralyzed from the waist down. He sought service-connected disability benefits. In 2004 a VA regional office denied Dixon’s claim. The Board of Veterans’ Appeals affirmed, Dixon filed a pro se notice of appeal, 60 days after the 120-day filing deadline, 38 U.S.C. 7266(a). The Veterans Court dismissed, concluding that it was “without jurisdiction.” In 2011 the Supreme Court held that the filing deadline is not jurisdictional. The Veterans Court issued an order allowing Dixon and others to move to recall the dismissals. Still acting pro se, Dixon sought equitable tolling, explaining that he suffered from physical and psychiatric disabilities that prevented him from filing in a timely manner, accompanied by a statement from his psychiatrist. The Veterans Court denied Dixon’s motion. Attorneys subsequently agreed to represent Dixon. The Veterans Court allowed until October 4, 2012 to move for reconsideration. The VA refused to provide a copy of the file and the earliest available appointment for reviewing the file was October 1. On that dated, VA staff monitored the review and declined requests for copies of documents. The Federal Circuit reversed the denial of an extension, stating that the disability compensation system is not meant as a trap for the unwary, or a stratagem to deny compensation to a veteran who has a valid claim.View "Dixon v. Shinseki" on Justia Law

Gentry has psoriasis, a chronic autoimmune condition causing patches of raised skin covered with flaky buildup of dead skin cells that crack and bleed and can interfere with sleeping, walking, sitting, standing, and using one’s hands. She also has psoriatic arthritis, an inflammatory disease that causes fatigue, stiffness and swelling in and around the joints, tenderness, pain and swelling in the tendons, swollen fingers and toes, and reduced range of motion. There is no cure for either condition. Gentry suffered severe injuries to her ankle, arm and wrist, and hip in a 1994 car accident and developed avascular necrosis and post-traumatic arthritis. She requires a brace on her leg to walk, has a limp and waddling gait, and has frequent pain in her leg and foot, back, neck, and hands. She also has deformities in her foot, ankylosing spondylitis cervical radiculopathy, cervical stenosis, lumbar spondylosis, possible sacroilitis or facet arthropathy in the low back, degenerative joint disease in the low back, chronic lumbar strain, possible herniated disc carpal tunnel syndrome, and lumbosacral/thoracic radiculopathy, among other things. In 2004, Gentry (age 29) applied for disability benefits under the Social Security Act, 42. U.S.C.401. She had worked 10 years as a pizza maker and delivery driver. She had most recently worked as a receptionist, but was discharged because her psoriasis bled on the paperwork. After Gentry’s application was denied, the case was remanded twice. The district court affirmed the denial of benefits. The Sixth Circuit reversed the denial as not supported by substantial evidence. View "Gentry v. Comm'r of Soc. Sec." on Justia Law

Chhibber, an internist, operated a walk‐in medical office on the south side of Chicago. For patients with insurance or Medicare coverage, Chhibber ordered an unusually high volume of diagnostic tests, including echocardiograms, electrocardiograms, pulmonary function tests, nerve conduction studies, carotid Doppler ultrasound scans and abdominal ultrasound scans. Chhibber owned the equipment and his staff performed the tests. He was charged with eight counts of making false statements relating to health care matters, 18 U.S.C. 1035, and eight counts of health care fraud, 18 U.S.C. 1347. The government presented witnesses who had worked for Chhibber, patients who saw him, and undercover agents who presented themselves to the Clinic as persons needing medical services. Chhibber’s former employees testified that he often ordered tests before he even arrived at the office, based on phone calls with staff. Employees performed the tests themselves with little training, and the results were not reviewed by specialists; normally, the tests were not reviewed at all. Chhibber was convicted of four counts of making false statements and five counts of health care fraud. The Seventh Circuit affirmed, rejecting challenges to evidentiary rulings. View "United States v. Chhibber" on Justia Law

In 2007, the Secretary revamped Medicare's Inpatient Prospective Payment System, updating the diagnostic weighting used to calculate reimbursements for hospitals treating the program's beneficiaries. Plaintiffs sought review of the Secretary's decision regarding a downward prospective adjustment for hospital-specific rate payments. The district court concluded that the statutory scheme was ambiguous and deferred to the Secretary's reasonable interpretation of the adjustment provisions. Applying Chevron deference, the court agreed with the district court's conclusion that the statutory scheme was ambiguous and unclear. Accordingly, the court affirmed the judgment of the district court. View "Adirondack Medical Center, et al. v. Sebelius" on Justia Law

The former miner sued in 1992 and an administrative law judge determined that he was not medically qualified for benefits under the Black Lung Benefits Act, 30 U.S.C. 901 and indicated that Arkansas Coals was not the “responsible operator” required to pay benefits. About 17 years later, the miner filed a second claim. After finding that his medical condition had worsened and that he was now disabled, an ALJ awarded benefits and determined that Arkansas Coals was the responsible operator. The Benefits Review Board and the Sixth Circuit affirmed, rejecting the company’s finality, waiver, and collateral estoppel arguments; the miner was entitled to bring a second claim under 20 C.F.R. 725.309(d)(4) and the determination that Arkansas Coals was the responsible operator was not “necessary” to the resolution of the initial claim. Substantial evidence supports the determination that Arkansas Coals is the responsible operator. View "Arkansas Coals, Inc. v. Lawson" on Justia Law

Maynes, a miner who developed pneumoconiosis after working in Consolidated’s coal mine for 25 years, received benefits under the Black Lung Benefits Act, 30 U.S.C. 901-944, from 1997 until he died of respiratory failure in 2003. His widow sought survivors’ benefits. The then-current version of the BLBA conditioned her eligibility for benefits on proof that pneumoconiosis either caused or hastened her husband’s death. Her 2003 claim was denied. The Benefits Review Board and Sixth Circuit affirmed. In 2010, Congress passed the Affordable Care Act, which amended the law so that survivors are automatically entitled to benefits if the miner received BLBA benefits during his lifetime. Congress specified that the changes would apply to claims filed after January 2005, but did not address whether persons whose claims had been denied under the previous eligibility framework, could receive benefits by filing a subsequent claim. The issue was answered in the affirmative by the Benefits Review Board and affirmed by the Third and Fourth Circuits. Although the Department of Labor, an administrative law judge, and the Benefits Review Board agreed Maynes was entitled to benefits, they disagreed about the appropriate commencement date for benefits. The Sixth Circuit rejected Consolidated’s appeal, upholding the 2009 commencement date. View "Consolidation Coal Co. v. Maynes" on Justia Law

Dalton worked in coal mine jobs from 1957 until 1991 and was exposed to substantial coal and rock dust. He developed trouble breathing; he quit his job and was never employed again. In 1999 Dalton sought benefits under the Black Lung Benefits Act, 30 U.S.C. 901‐45. In 2003, an ALJ awarded benefits, finding that Dalton was a “miner,” that Frontier was the “responsible operator,” and that Dalton had established clinical pneumoconiosis, based on the opinions of pulmonary experts, but could not determine the date of onset of total disability, so Dalton’s benefits began in 1999. The Board vacated, finding that the ALJ had not properly evaluated CT scans. The ALJ again awarded benefits beginning in 1999. In 2007, the case was again remanded. A new ALJ reweighed the evidence and ordered benefits to begin in 1999. Dalton died in 2007. The ALJ denied a motion by Dalton’s children to substitute as claimant. The Board dismissed an appeal and a cross‐appeal. The District Director returned the case to its third ALJ, who allowed the children’s motion, modified the date for commencement of benefits to 1991, and awarded attorneys’ fees and expenses. The Board vacated with respect to the onset date. The Seventh Circuit remanded for entry of the 1991 onset date, rejecting a claim that the children lacked standing. Substantial evidence supported the ALJ’s finding that 1991 marked the time of onset for Dalton’s total disability on account of pneumoconiosis. View "Dalton v. Office of Workers' Compensation Programs" on Justia Law

Garcia, previously a construction worker and then age 40, applied for social security disability benefits in 2010, claiming abdominal pain caused by cirrhosis of the liver, severe low platelet count, hepatitis C, and an umbilical hernia, all of which had been diagnosed by several physicians that year. All were caused or exacerbated by alcoholism, but he stopped drinking and alcoholism is no longer a “contributing factor” barring him from obtaining disability benefits, 42 U.S.C. 423(d)(2)(C). An ALJ ruled that Garcia is capable of doing limited sedentary work. The district court affirmed. The Seventh Circuit reversed, noting that Garcia would be a candidate for a liver transplant, but was not on the list because he was too sick for surgery. His platelet count was too low to for even a liver biopsy. Garcia has been repeatedly hospitalized and treated for pain with morphine and other opium derivatives, with limited success. He has lupus, anemia, colitis, anxiety and other psychological problems, and chronic fatigue. One physician described Garcia’s condition as “chronic and terminal.” The court stated that Garcia is “one of the most seriously disabled applicants for social security disability benefits whom we’ve encountered in many years … We are surprised that the Justice Department would defend such a denial.” View "Garcia v. Colvin" on Justia Law

Ogle, born in 1954, worked in underground coal mines for 21 years, most recently in 1996 in Kentucky. Ogle smoked since age 12. He sought black lung benefits in 2007. After the record closed but before the ALJ issued a decision, Congress revived a rebuttable statutory presumption that a coal miner who worked in an underground mine for at least 15 years and suffers from a total respiratory or pulmonary disability is presumed to be totally disabled due to pneumoconiosis, 30 U.S.C. 921(c)(4). The ALJ awarded benefits, finding that Ogle suffered from totally disabling respiratory impairment, a conclusion with which all medical opinions agreed. The ALJ stated that the presumption shifts the burden to demonstrate by a preponderance of the evidence that either the miner’s disability does not, or did not, arise out of coal mine employment or the miner did not, suffer from pneumoconiosis. The Fund demonstrated that Ogle did not suffer from clinical pneumoconiosis, but failed to rebut the presumption that Ogle suffers from legal pneumoconiosis. The Board affirmed. The Sixth Circuit denied a petition for review, finding no evidence that the ALJ improperly restricted the Fund’s ability to rebut the 15-year presumption or that the ALJ applied the wrong standard. View "Big Branch Res., Inc. v. Ogle" on Justia Law