Justia Public Benefits Opinion Summaries

The plaintiff, now 62 years old, applied in 2011 to the Social Security Administration for disability benefits, citing ailments including asthma, chronic obstructive pulmonary disease (COPD), asbestosis, and a heel spur in his right foot. He had been a sheet metal journeyman for 33 years; the job requires physical strength and he had been given accommodations on the job for several years. The Social Security Appeals Council declined to review the administrative law judge’s denial and the district judge affirmed. The Seventh Circuit reversed and remanded, referring to the ALJ’s “seemingly inconsistent conclusions” and stating that the denial was “not a reasoned analysis of the plaintiff’s claim.” View "Dimmett v. Colvin" on Justia Law

Parents of M.C. appealed the district court's denial of reimbursement for tuition in a private school under the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1400 et seq. In this case, the parents adopted an all-or-nothing approach to the development of M.C.'s Individualized Educational Plan (IEP) and they adamantly refused to consider any of the school district's alternative proposals. The court affirmed the district court's denial of reimbursement because the district court’s findings and the underlying record support the conclusion that M.C.’s parents acted unreasonably in unilaterally terminating the process of developing M.C.’s IEP. View "Rockwall Indep. Sch. Dist. v. M. C." on Justia Law

SEARK, operator of two hospice-care facilities, voluntarily entered into a provider agreement with the Secretary of Health and Human Services to receive Medicare reimbursement pursuant to the Medicare Act, 42 U.S.C. 1395c, 1395f(a)(7), 1395cc. The Act annually caps Medicare reimbursement. SEARK filed suit after the Secretary sent it seven demands for repayment, arguing that the cap violates the Takings Clause of the Fifth Amendment. The district court concluded that SEARK’s voluntary participation in the Medicare program precludes a takings claim. The court concluded that SEARK has not met its burden to prove the demands for repayment based on the statutory cap are a taking where the reimbursement cap allocates the government's capacity to subsidize healthcare; SEARK presented no evidence to suggest the cap makes it impossible to profitably engage in their business; and SEARK voluntarily chose to participate in the Medicare hospice program. Accordingly, the court affirmed the judgment. View "Southeast Arkansas Hospice v. Burwell" on Justia Law

The Hospital system filed suit seeking to obtain a writ of mandamus compelling HHS to adjudicate immediately its administrative appeals on claims for Medicare reimbursement. The parties agree that, as of February 2014, the Secretary had 480,000 appeals awaiting assignment to an ALJ, and the Secretary conceded in her brief that the number had by then climbed to more than 800,000 appeals, creating a ten-year backlog. The court concluded that the Medicare Act, 42 U.S.C. 1395 et seq., does not guarantee a healthcare provider a hearing before an ALJ within 90 days, as the Hospital System claims. Rather, it provides a comprehensive administrative process that a healthcare provider must exhaust before ultimately obtaining review in a United States district court. The court further concluded that the issuance of a judicial order now, however, directing the Secretary to hear the Hospital System’s claims in the middle of the administrative process, would unduly interfere with the process and, at a larger scale, the work of the political branches. Moreover, such intervention would invite other healthcare providers suffering similar delays to likewise seek a mandamus order, thereby effectively causing the judicial process to replace and distort the agency process. Accordingly, the court affirmed the district court's dismissal of the complaint. View "Cumberland Cnty. Hosp. v. Burwell" on Justia Law

Plaintiff, complaining of right-shoulder and arm pain, appealed the denial of his application for disability benefits. The court concluded that the ALJ's denial of benefits is supported by substantial evidence because plaintiff has the residual functioning capacity (RFC) to perform sedentary work, and the ALJ limited plaintiff to work involving no overhead reaching with his right arm. Further, the medical evidence supports the RFC. Accordingly, the court affirmed the judgment. View "Liner v. Colvin" on Justia Law

In 2012, one in five female veterans and one in 100 male veterans reported that they experienced sexual abuse in the military, and an estimated 26,000 service members “experienced some form of unwanted sexual contact.” The trauma stemming from sexual abuse in the military (military sexual trauma (MST)) can result in severe chronic medical conditions, including Post-Traumatic Stress Disorder, depression, and anxiety. Generally, veterans with service-connected disabilities are entitled to disability benefits, 38 U.S.C. 1110, 1131. In response to what they viewed as the VA’s inadequate response to MST-based disability claims, veterans’ groups submitted a petition for rulemaking which requested that the VA promulgate a new regulation regarding the adjudication of certain MST-based disability claims. The Secretary of Veterans Affairs denied the petition. The Federal Circuit upheld the denial, noting its limited and deferential review and stating that the Secretary adequately explained its reasons for denying the petition. The court rejected a claim that in denying the petition, the Secretary violated the equal protection clause by intentionally discriminating against women without providing an exceedingly persuasive justification or discriminating against survivors of MST-based PTSD without providing a legitimate reason. View "Serv. Women's Action Network v. Sec'y of Veterans Affairs" on Justia Law

Plaintiff, suffering a combination of impairments such as paranoid schizophrenia and depression, appealed the denial of his applications for disability insurance benefits (DIB) and supplemental security income (SSI). Plaintiff asserts that the ALJ’s residual functioning capacity (RFC) assessment does not adequately account for all the limitations he suffers due to the combination of paranoid schizophrenia, panic attacks, and chronic depression. The court found that the the ALJ did not rely solely on the opinions of the state agency doctors and sufficiently considered the medical records provided by plaintiff in assessing his RFC. The ALJ did consider the opinion of plaintiff's expert, but concluded that it was inconsistent with the rest of the doctor's report. Further, the ALJ also considered plaintiff's Global Assessment of Functioning (GAF) scores, but found that they were not controlling. In this case, the ALJ concluded that plaintiff's symptoms were reasonably controlled by medication and treatment. Therefore, substantial evidence supports the ALJ's RFC determination and the RFC determination included the necessary limitations to account for plaintiff's mental impairments. Accordingly, the court affirmed the judgment. View "Mabry v. Colvin" on Justia Law

Plaintiff challenged the trial court's denial of her petition for a writ of mandate. The trial court concluded that the Board correctly calculated plaintiff's effective date of disability retirement. Plaintiff raised two questions on appeal: (1) whether donated sick leave or vacation time from co-workers is considered "regular compensation" of the disabled employee under Government Code section 31724, and (2) whether the incremental payments of sick leave, vacation and holiday pay should be "compressed" to achieve an earlier date of retirement. The court concluded that the first question is not properly before it. In regards to the second question, the court concluded that Katosh v. Sonoma County Employees' Retirement Assn. confirmed the bright line rule that disability retirement benefits are not available until the day following the day paid leave was last received. Therefore, the trial court properly denied her petition for writ of mandate challenging that date. The court affirmed the judgment. View "Astorga v. Retirement Board" on Justia Law

Bozeman served in the Army, 1967-1970, including one year in Vietnam. In 1993, Bozeman sought disability benefits after substance abuse treatment at a VA Medical Center. The VA awarded him service-connected benefits for PTSD, rated as 10 percent disabling. Bozeman’s condition deteriorated. His disability rating was increased to a 50 percent rating in 1999. In 2000, the VA denied an increased rating. Bozeman underwent a VA Compensation and Pension Examination (C&P) in 2002. Bozeman submitted a Notice of Disagreement with its conclusion. He was hospitalized in 2003 and 2004, for “suicidal and homicidal thoughts[,] . . . severe depression.” In 2005 a C& P examiner concluded that Bozeman suffered from “chronic PTSD symptomatology off and on for the last 25 years” and that he would have “difficulty . . . work[ing] in gainful employment.” In 2006, Bozeman’s rating was increased to 70 percent, effective February 2003, with a temporary 100 percent rating for the hospitalization. The Board denied a rating in excess of 50 percent prior to February 2003, and a rating in excess of 70 percent after February 2003, but granted a rating of 100 percent, effective November 2010. The Veterans Court affirmed. The Federal Circuit vacated. Bozeman’s argument that the Board failed to consider relevant evidence was not a new legal argument raised for the first time on appeal; the Board’s reliance on issue exhaustion was improper View "Bozeman v. McDonald" on Justia Law

In 1998, Dickens filed a claim for PTSD caused by in-service events, stating that he received a Purple Heart and Bronze Star in connection with these events. His file was never located despite extensive searching. Dickens passed away in 2006 while his claim was pending, and Mrs. Dickens sought accrued benefits. In 2011, she testified that she did not know what had happened to her husband’s proof of a Purple Heart. In 2012, the Board of Veterans Appeals denied the claim, finding no evidence that Dickens was involved in combat during his military service. On remand, in 2013, the Board denied the claim, again finding insufficient evidence to establish that Dickens engaged in combat. Mrs. Dickens argued that the VA violated its duty to assist her with her claim because the Board hearing officer failed to suggest that she seek a copy of Mr. Dickens’s service records 2011. The Veterans Court rejected that argument and affirmed the denial, noting that if Mrs. Dickens believed that the hearing officer committed an error, she should have included that issue in the 2012 joint motion for partial remand. The Federal Circuit affirmed, citing principles of issue exhaustion. View "Dickens v. McDonald" on Justia Law