Justia Public Benefits Opinion Summaries

Eilise was born in 1996 and had problems with gross motor skills and language development. After therapy, Eilise showed dramatic improvement. In 2001, Eilise received three vaccinations, including her second dose of the measles, mumps, and rubella vaccine. Five days later, Eilise’s brother witnessed her arching her back, thrusting her head back, rolling her eyes, and jerking. He did not know what was happening. Her parents, who did not witness the seizure, noted that Eilise was feverish and lethargic. Eilise had a grand mal seizure at school. She was taken to a hospital. She had another seizure there. Eilise’s MRI results were generally normal, but her EEG results were “consistent with a clinical diagnosis of epilepsy.” She continued to suffer seizures until she started a ketogenic diet. Her parents filed suit under the National Childhood Vaccine Injury Compensation Program, 42 U.S.C. 300aa, alleging that Eilise suffered from autism as a result of her vaccinations; they later amended to allege, instead, that Eilise suffered from a “seizure disorder and encephalopathy.” The Claims Court affirmed denial of her petition. The Federal Circuit vacated: in certain cases, a petitioner can prove a logical sequence of cause and effect between a vaccination and the injury with a physician’s opinion where the petitioner has proved that the vaccination can cause the injury and that the vaccination and injury have a close temporal proximity. View "Moriarty v. Sec'y of Health & Human Servs." on Justia Law

Plaintiff’s 1998 dislocation of a kneecap required implantation of a steel plate; a year later a shattered femur required implantation of a steel rod from hip to knee. In 2011, he fractured an ankle. A podiatrist inserted a bar with pins in the ankle and later repeated the procedure. Months later, plaintiff’s ankle pain returned and he was prescribed Vicodin and Percocet, providing limited relief. Two treating physicians reported that he could sit, stand, and walk for only 15 minutes at a time and for no more than one hour in an eight-hour work day; that he could lift a weight of 10-20 pounds only occasionally; and that he could not reach up with his right arm at all. One reported that plaintiff was “fully and completely disabled” with constant and worsening pain that caused constipation, drowsiness, and upset stomach, with a “poor” prognosis. An ALJ denied social security disability benefits, noting that the medical records varied from the reports and finding that plaintiff’s injuries were severe, but he could perform unskilled sedentary jobs. The Seventh Circuit reversed. The question was not whether plaintiff was less disabled than he was four years ago, but whether he was sufficiently recovered to hold down a 40-hour-a-week job; the ALJ did not adequately explain what jobs plaintiff might be capable of. View "Forsythe v. Colvin" on Justia Law

Morris worked as a coal miner for nearly 35 years, 19 years underground. Morris’s breathing difficulties caused him to leave work. In 2006, Dr. Cohen diagnosed him with pneumoconiosis (black lung disease). Eighty Four Mining’s physician also examined Morris, but determined that Morris’s breathing difficulties were caused by smoking and that there was no radiographic evidence of pneumoconiosis. In 2008, aPennsylvania Workers’ Compensation Judge denied benefits. Morris did not appeal. Morris’s breathing problems worsened; a doctor put him on oxygen nearly full-time. In 2011, Morris sought Black Lung Benefits Act (BLBA), 30 U.S.C. 901, benefits. He did not rely upon the 2006 report that had been discredited, but on a 2011 arterial blood gas study and pulmonary function testing that supported a finding of black lung disease. In 2013, an ALJ granted BLBA benefits, rejecting a timeliness challenge and reasoning that a denial of black lung benefits due to the repudiation of the claimant’s pneumoconiosis diagnosis renders that diagnosis a “misdiagnosis” and resets the three-year limitations period for subsequent claims. Morris sufficiently established the existence of pneumoconiosis through medical evidence obtained after 2010 and Eighty Four failed to adequately explain why Morris’s years of coal dust exposure were not a substantial cause of his impairment. The Benefits Review Board affirmed, citing judicial estoppel as precluding the timeliness argument. The Third Circuit denied a petition for review. View "Eighty Four Mining Co. v. Morris" on Justia Law

Legislation, effective in 2004 requires that injured workers’ requests for medical treatment be evaluated through a process called utilization review (UR). Under the UR process, a request for treatment cannot be denied by a claims adjustor and must be approved unless a clinician determines that the treatment is medically unnecessary. Workers can challenge decisions denying requested treatment, but employers cannot challenge decisions approving it. The 2004 legislation called for administrative adoption of uniform standards for physicians to use in evaluating treatment. In 2013, additional reforms went into effect, establishing a new procedure, independent medical review (IMR), to resolve workers’ challenges to UR decisions. Stevens challenged the constitutionality of the IMR process, arguing that it violated the state Constitution’s separation of powers clause, its requirements that workers’ compensation decisions be subject to review and the system “accomplish substantial justice,” and principles of due process. The court of appeal rejected those claims, but remanded Stevens’s request for a home health aid. The Legislature has plenary powers over the workers’ compensation system under article XIV, section 4 of the state Constitution. California’s scheme for evaluating workers’ treatment requests is fundamentally fair and affords workers sufficient opportunities to present evidence and be heard. View "Stevens v. Workers' Comp. Appeals Bd," on Justia Law

Alaura, age 22, was struck in the back of his head by an assailant wielding a bar stool. The blow shattered his skull, necessitating emergency surgery to remove part of his brain and place a metal plate in his skull. During this craniotomy Alaura had a seizure. Alaura has repeatedly seen neurologists, complaining of headaches, dizziness, and confusion, and has been diagnosed with post-traumatic headaches, cognitive impairment, and occipital neuralgia, an injury to or inflammation of nerves that run from the spinal cord at the base of the neck up through the scalp. It causes piercing or throbbing pain in the neck, the back of the head, and the front of the head behind the eyes. A year later, Alaura still complained of daily headaches, “absence-type” seizures several times a week, and back and neck pain. The Seventh Circuit reversed denial of Alaura’s claim for social security disability benefits as premature, stating that the “long list” of severe impairments “don’t sound like trivial obstacles to being able to hold full-time employment.” The administrative law judge’s explanations were “thin,” he made no effort to consider the combined effects on Alaura’s ability to work of all his impairments and limitations. View "Alaura v. Colvin" on Justia Law

From 1977-2009, Kennard worked as a blaster on strip mines, sometimes directly for a coal company and sometimes for contractors. In 2009, Kennard filed for black lung benefits, 30 U.S.C. 901. Kennard has a significant history of smoking, which gave him cancer in his right lung. The lung was removed. He experiences shortness of breath, coughing, and sleep apnea. His treating physician diagnosed Chronic Obstructive Pulmonary Disorder (COPD). His breathing is extremely limited. After the claims examiner initially recommended that his claim, an ALJ concluded that Kennard was entitled to a rebuttable presumption that he had pneumoconiosis and that the disease caused his total disability because he had worked in conditions that were substantially similar to those in an underground mine. The ALJ held that the employer had successfully rebutted the presumption that Kennard had clinical pneumoconiosis, but had failed to rebut the presumption of legal pneumoconiosis or the presumption that Kennardʼs disability was caused by his employment in a coal mine. The employer appealed, arguing that the 15-year presumption should not apply, and, if it did apply, the company had successfully rebutted it. The Sixth Circuit denied a petition for review, finding the award supported by substantial evidence. View "Brandywine Explosives & Supply v. Office of Workers' Comp. Programs" on Justia Law

K.P. , born in 2004, exhibited no apparent signs of disability for several months, but was then referred to an infant development service. Extensive testing revealed that K.P. suffered significant delays in motor skills. His cognitive skills were within normal limits. K.P. experienced rashes, later identified as a symptom of erythema multiforme, and ear infections. At his one-year well baby visit, K.P. received the measles-mumps-rubella, pneumococcal, and varicella vaccines. He then had a fever and did not nap or eat well. After visits to multiple medical specialists, K.P. was diagnosed with an unspecified mitochondrial disorder, likely present at birth. He now lives in a state of severe neurological disability. He has “no purposeful movements” and breathes with a ventilator. Seeking benefits under the National Childhood Vaccine Injury Act, 42 U.S.C. 300aa, his parents alleged that K.P. sustained a permanent brain injury as a result of the vaccines. Their expert testified that K.P.’s underlying mitochondrial disorder prevented him from coping with the oxidative stress from the vaccines. On remand, the special master accepted that the expert had presented a plausible medical theory, but found that K.P.’s condition did not deteriorate as predicted by that theory. The Claims Court disagreed and awarded compensation. The Federal Circuit affirmed. The parents’ burden was to show that K.P.’s mitochondrial disorder was significantly aggravated by the vaccines, not to rule out every other potential cause. View "Paluck v. Sec'y of Health & Human Servs." on Justia Law

After years of working as a locomotive engineer, and more briefly as a limousine driver, Duncan applied for a disability annuity (Railroad Retirement Act, 45 U.S.C. 231a(a)(1)(v)) in 2010. His application alleged constant back pain stemming from a 2003 workplace injury in which he slipped on ice, hit his head, and injured his back. The Railroad Retirement Board denied his application and denied it again upon reconsideration in 2011. A hearing officer denied Duncan’s application in 2012. In 2013, a three-member board affirmed. The Seventh Circuit affirmed, concluding that substantial evidence supports the Board’s decision that Duncan retains the capacity to perform a reduced range of work. View "Duncan v. United States R.R. Ret. Bd." on Justia Law

Miller suffered: a brain injury in a 1998 car accident and had back surgery in 2004. Although his doctor described his brain injury as stable, but Miller complained of memory and balance problems and pan. Miller claims these injuries caused him to become disabled starting in 2007. In 2008, Miller requested disability insurance benefits as well as supplemental security income. He received a hearing before an administrative law judge, who denied his claim, finding that Miller had the residual functional capacity to perform light work, as defined by 20 C.F.R. 404.1567(b) and 416.967(b). The Appeals Council denied Miller’s request for review. The district court and Eighth Circuit affirmed, upholding the ALJ’s decision to give “little weight” to some of Miller’s medical evidence. View "Miller v. Colvin" on Justia Law

Draper, age 18, suffered traumatic brain injury in a 2006 car accident. Draper executed a durable power of attorney, authorizing her parents to collect money; compromise claims; and “fund, transfer assets to, and to instruct and advise the trustee of any trust wherein [Draper is] or may be the trustor, or beneficiary.” Draper began receiving Supplemental Security Income payments. In February 2008, father signed a personal-injury settlement. Draper received $429,259.41. Her parents signed documents creating a Special Needs Trust, intended to qualify under 42 U.S.C. 1396p(d)(4)(A), to provide for Draper’s needs without “displac[ing] or supplant[ing] public assistance or other sources of support that may otherwise be available” and transferred $429,259.41. In September 2008, Draper received notice that she had been overpaid $3,000 in SSI benefits because her trust exceeded the SSI-eligibility limit of $2,000, and that her SSI payments would cease. An ALJ found that for the trust to be exempt from consideration as a personal asset, Draper’s parents had to act as third-party creators when establishing it, but instead acted as agents under the power of attorney. Draper’s parents obtained a state court order modifying the trust, which retroactively listed the state court, rather than Draper’s parents, as the settlor. The Appeals Council denied review, finding that the order did not provide a basis for altering the ALJ’s decision. The district court and Eighth Circuit affirmed. View "Draper v. Colvin" on Justia Law