Justia Public Benefits Opinion Summaries

Claimant appealed the denial of her application for supplemental security income. At issue is whether the ALJ erred in according “limited weight” to the opinion of a nurse practitioner. The court held that an ALJ errs when he discounts an other source’s entire testimony because of inconsistency with evidence in the record, when the ALJ has divided the testimony into distinct parts and determined that only one part of the testimony is inconsistent. Thus, the ALJ’s determination in this case that the nurse practitioner’s opinion regarding Claimant’s “exertional and postural” limitations was inconsistent with other evidence in the record was an insufficient reason to reject her testimony regarding Claimant’s manipulative and mental limitations. That error was not harmless, because the vocational expert opined that a person with the mental limitations identified by the nurse practitioner could not work. The court concluded that further proceedings are required to reconcile all the record evidence and to consider additional issues. Therefore, the court reversed and remanded. View "Dale v. Colvin" on Justia Law

Hudgens injured his right knee while serving on active duty in the U.S. Army. In 2003, Hudgens had partial knee replacement surgery; in 2006, he sought VA benefits. The Board of Veterans’ Appeals denied him a disability rating of greater than 10 percent for degenerative joint disease in the right knee and denied him entitlement to a compensable disability rating for instability in the right knee for a prior time period. The Veterans Court vacated those decisions; held that Hudgens was not entitled to compensation for his prosthetic knee replacement under 38 C.F.R. 4.71a, Diagnostic Code 5055; and remanded for determination of whether his knee replacement could be rated by analogy to that code. The Federal Circuit reversed, holding that Hudgens may be compensated under DC 5055 based on his partial knee replacement. Hudgens’s interpretation of DC 5055 is consistent with the beneficence inherent in the veterans’ benefits scheme and with the majority of Board decisions that have interpreted the regulation. View "Hudgens v. McDonald" on Justia Law

The Home and Community‐Based Care Waiver Program allowed states to diverge from the traditional Medicaid structure by providing community‐based services to people who would, under the traditional structure, require institutionalization, 42 U.S.C. 1396n. The Indiana Family and Social Services Administration operates the Aged and Disabled Medicaid Waiver Program (A&D waiver), the Community Integration and Habilitation Medicaid Waiver Program (CIH waiver), and the Family Supports Medicaid Waiver Program (FS waiver). Because Indiana has closed most of its institutional facilities, these waiver programs serve the vast majority of its people with disabilities. Until 2011, the Administration placed many people with developmental disabilities on the A&D waiver, which has no cap on services. The Administration then changed its policies, rendering many developmentally disabled persons ineligible for the A&D waiver. These people were moved to the FS waiver, under which they may receive services capped at $16,545 annually. The CIH waiver is uncapped, but not everyone qualifies for the CIH waiver. Plaintiffs argue that their new assignments violated the integration mandate of the Americans with Disabilities Act, 42 U.S.C. 12101 because it deprives them of community interaction and puts them at risk of institutionalization. The court granted defendants summary judgment on the integration‐mandate claims and denied class certification. The Seventh Circuit reversed, finding that there is a genuine dispute of material fact with respect to the individual claims based on the integration mandate. The court agreed that the proposed class is too vague. View "Steimel v. Wernert" on Justia Law

Plaintiff-appellant Laurie Smith sought review when her Social Security disability benefit claims were denied. She alleged disability based in part on: impingement of her left shoulder; restrictions on her ability to: (1) reach and (2) handle and finger objects; and moderate nonexertional limitations. The administrative law judge concluded that Smith could work as a telequotation clerk, surveillance systems monitor, or call-out operator. As a result, the judge concluded that Smith was not disabled. Ms. Smith appealed to the district court, which upheld the administrative law judge’s determination. After its review, the Tenth Circuit found no reason to disturb the ALJ's or the district court's judgments and affirmed. View "Smith v. Colvin" on Justia Law

Plaintiff, the beneficiary of a testamentary trust, entered a long-term care facility in 2012, at which time she applied for financial and medical assistance under Medicaid. The Department of Social Services denied the application for Medical benefits, finding that Plaintiff’s assets, including the trust, exceeded the relevant asset limits. A hearing officer upheld the department’s denial. Plaintiff appealed, arguing that the trust was not an asset available to her as defined by relevant Medicaid regulations. The trial court dismissed Plaintiff’s appeal. The Supreme Court reversed, holding that the testator intended to create a discretionary, supplemental needs trust and, therefore, the trust corpus and income may not be considered to be available to Plaintiff for the purpose of determining eligibility for Medicaid benefits. View "Pikula v. Dep’t of Social Servs." on Justia Law

Via Christi seeks an upward adjustment of the capital-asset depreciation reimbursement paid to its predecessor hospitals under a since curtailed Medicare regulation. Via Christi argues that it received St. Francis’s and St. Joseph’s assets at a lower value, i.e., more depreciated, than was reflected in the Secretary’s earlier depreciation reimbursements. As the hospitals’ successor-in-interest, Via Christi thus seeks additional reimbursements to cover the proportional Medicare share of the depreciation. The court concluded that the Secretary reasonably interpreted the bona fide sale requirement as limited to arm’s length transactions between economically self-interested parties. The Secretary concluded that St. Francis’s transfer of its assets to Via Christi was not an arm’s-length transaction in which each party sought to maximize its economic benefit. The court concluded that the Secretary's determination was supported by substantial evidence, and was not arbitrary, capricious or otherwise unlawful. In this case, Via Christi is not entitled to additional depreciation reimbursement in the absence of a qualifying transaction. View "Via Christi Hosp. Wichita v. Burwell" on Justia Law

VRC filed suit against HHS and the Secretary, seeking the recoupment of payments VRC returned to Medicare after it was issued notice of an overpayment. At issue is the reimbursement rate of the intravitreal injection of Lucentis. VRC did not follow the Lucentis label’s instructions limiting dosage to one per vial. Instead, VRC treated up to three patients from a single vial. Because VRC was extracting up to three doses from a single vial, it was reimbursed for three times the average cost of the vial and three times the amount it would have received had it administered the drug according to the label. The court affirmed the denial of recoupment, concluding that VRC's charge to Medicare did not reflect its expense and was not medically reasonable; the Secretary's decision was supported by substantial evidence; and VRC is liable for the overpayment. View "Vitreo Retinal Consultants v. U.S. Dep't of Health & Human Servs." on Justia Law

Hensley, born in 1949, was employed as a coal miner for 13 years, before leaving in 1988 after seriously injuring his hand and arm in an accident. He has not worked since. Hensley also smoked cigarettes for 10-12 years, averaging half a pack a day before quitting 29 years ago. Hensley first noticed issues with his breathing in 1987. In 1990, he filed an unsuccessful claim for benefits under the Black Lung Benefits Act, 30 U.S.C. 901. He filed a second claim in 2003. The claim was denied, despite a finding of pneumoconiosis, because Hensley did not prove that he was totally disabled by the disease. Hensley filed another claim 2006. The Department of Labor recommended awarding benefits.The evidence, which consisted of chest x-rays, biopsy results, CT scans, pulmonary function studies, arterial blood-gas studies, treatment records and several medical opinions, was forwarded to the ALJ, who awarded benefits in 2010, initially holding that Hensley’s x-ray evidence alone was sufficient to establish the existence of pneumoconiosis.. On remand, the ALJ again concluded that Hensley was entitled to benefits. The Sixth Circuit upheld the award as supported by substantial evidence. View "Dixie Fuel Co. v. Office Workers' Comp. Progams" on Justia Law

Plaintiff, complaining chiefly of neck pain, appealed the denial of his application for disability benefits. The court concluded that the newly submitted evidence - namely, updated treatment records - was not so significant as to require remand to the ALJ for additional consideration; substantial evidence supports the ALJ's determination at step three of the evaluation process that plaintiff did not meet or medically equal Listing 1.04(A); and the ALJ's residual functioning capacity (RFC) finding is supported by substantial evidence where the ALJ found that plaintiff was capable of performing light work with certain limitations. The court agreed with the ALJ's ultimate determination that plaintiff was not disabled and affirmed the judgment. View "Whitehead v. Colvin" on Justia Law

The single mother of five children, 8 to 15 years old, struggled with abusive relationships, homelessness and unemployment. They lived primarily in Marin County from 2000 until they moved to Richmond in 2009. In 2015, Mother asked Contra Costa Children & Family Services to place the four youngest children in foster care. CFS did so and filed petitions alleging Mother’s failure to protect and inability to provide support. The court ordered supervised visitation and that CFS refer Mother to substance abuse treatment and parenting education. CFS's disposition report recommended that the court order family reunification services and transfer the case to Marin County. Mother was participating 12- step meetings and alcohol abuse education in Marin and expected to secure a Marin apartment. Marin County court accepted the transfer and continued the case. Later, Marin’s Health and Human Services Department asked the court to transfer the cases back to Contra Costa because it had discovered that a county employee had a familial relationship to the parties, rendering the Department unable to continue services. Mother opposed the transfer; there was no evidence that the proposed transfer served the children’s best interests. The court of appeal remanded the cases to Marin, noting that all of the parties conceded error. View "In re Nia A." on Justia Law