Justia Public Benefits Opinion Summaries

Before enactment of the 2008 Veterans’ Benefits Improvement Act, if a veteran seeking DVA benefits died while his claim was pending, the veteran’s survivor could not take the place of the veteran and continue prosecuting the claim. The survivor had to file a claim for accrued benefits, 38 U.S.C. 5121, proceeding from the beginning of the process, regardless of how far the veteran’s claim had progressed. The Act, 38 U.S.C. 5121A, authorizes eligible survivors to be “substituted as the claimant for the purposes of processing the claim to completion.” The Federal Circuit rejected a challenge to regulations intended to implement the Act, which require that a request to substitute be filed with the agency of original jurisdiction (DVA regional office) within one year of the claimant’s death; the prospective substitute is required to submit evidence of his eligibility to substitute; and, if the claimant died while his appeal was pending before the Board of Veterans’ Appeals, the Board must dismiss the appeal without prejudice so that the agency of original jurisdiction can address the substitution request. If the agency of original jurisdiction grants the request to substitute, then the case returns to the same place on the Board’s docket that it held at the time of the veteran’s death. View "Nat'l Org. of Veterans Advocates, Inc. v. Sec'y of Veterans Affairs" on Justia Law

A Welfare and Institutions Code section 602 petition alleging violations of Penal Code section 288, subdivision (a) (lewd or lascivious acts with a child under the age of 14) was sustained against A.A., a juvenile court dependent from 2007-2015. A.A. was committed to a period of confinement with the DJJ. A.A. subsequently turned 18 years old and the juvenile court terminated its dependency jurisdiction over him. In this appeal, the court rejected A.A.'s contention that the juvenile court should have maintained dependency jurisdiction over him and provided him with services under the California Fostering Connections to Success Act, Assembly Bill No. 12. In this case, A.A. is not eligible for A.B. 12 benefits where A.A. is not a nonminor dependent; the juvenile court reasonably concluded that A.A. did not wish to remain subject to dependency jurisdiction; and the juvenile court did not err in concluding that A.A. was not participating in a transition to living independently case plan where he was committed to a juvenile detention facility. Further, DCFS has complied with the requirements of section 391, subdivision (b), and the juvenile court's order did not violate section 303, subdivision (b). Accordingly, the court affirmed the judgment. View "LA Cnty. DCFS v. A.A." on Justia Law

Cogburn served in the Army, 1968-1971, including 12 months in Vietnam. In 1974, Cogburn sought VA disability compensation and pension benefits based on a severe nervous condition. A 1975 denial of his pension claim did not address the disability claim. He did not appeal. In 1983, Cogburn again sought disability compensation and pension benefits. He was diagnosed with Post-PTSD after a VA examination that failed to connect Cogburn’s PTSD to stressors from military service; the VA granted a non-service connection pension but denied service connection. In 1985, the Board of Veterans’ Appeal concluded that the record did not identify any in-service traumatic events, noting that Cogburn repeatedly failed to attend VA examinations to determine if service-connected stressors caused his PTSD. The Board determined that “the preponderance of the medical evidence suggests that the veteran’s post service emotional and adjustment difficulties are manifestations of schizophrenia.” There was no opportunity for further review. In 2002, Cogburn claimed that his 1974 disability compensation claim was never adjudicated. The RO determined that the claim was adjudicated as a claim for PTSD and had been implicitly denied in the 1985 decision. In 2012, on remand, the Board affirmed the finding of implicit denial. The Veterans Court and Federal Circuit affirmed; the implicit denial rule applies to both formal and informal claims. Its use does not violate the VA due process regulation's notice provision.. View "Cogburn v. McDonald" on Justia Law

Plaintiffs, 194 employees who were terminated by Vanderbilt University on July 1, 2013, sued, claiming violation of the Worker Adjustment and Retraining Notification Act (WARN), 29 U.S.C. 2101, which requires certain employers to provide at least 60 days’ written notice to affected employees before a mass layoff. The plaintiffs’ class is insufficient to constitute a “mass layoff” (of 500 workers during a 30-day period) as defined by WARN; they cited the Act’s aggregation provision, which allows for separate layoffs within a 90-day period to be counted togetherf. They alleged that a second group of Vanderbilt employees was notified on September 17, 2013, that their jobs would be eliminated 60 days later, on November 16. Although they were no longer permitted to report for work, they continued to receive wages and accrue benefits after the notice was given. They were not eligible for state unemployment benefits until November 16, when they no longer received wages and accrued benefits. The Sixth Circuit ruled in favor of Vanderbilt. The employment relationship between Vanderbilt and the September employees did not end until November 16; they suffered an employment loss more than 90 days after the plaintiffs were terminated and thus cannot be counted under the aggregation provision. View "Morton v. Vanderbilt Univ." on Justia Law

In 2011, Bogina sued under the False Claims Act, 31 U.S.C. 3729, seeking compensation for exposing fraud allegedly perpetrated against the federal government and several state governments. Defendants included a major supplier of medical equipment to institutions reimbursed by Medicare and other federal programs and its customer, a chain of nursing homes. The district judge dismissed the federal claims as being too similar to those in a prior suit and relinquished jurisdiction over the state claims. The Seventh Circuit affirmed, finding differences between this suit and an earlier suit “unimpressive” and stating that it did not matter that the alleged fraud continued. View "Bogina v. Medline Indus., Inc." on Justia Law

The Hospital challenged the method used by the Secretary to calculate its reimbursement for services it provided during 2003 and 2004 - the two years after statutory caps on reimbursements for psychiatric hospitals expired but before psychiatric hospitals were moved to a prospective-payment system. The court affirmed the district court's denial of the hospital's motion for summary judgment and grant of HHS's cross-motion for summary judgment because HHS’s interpretation was not only reasonable but also the best interpretation of the controlling statute, 42 U.S.C. 1395ww, and regulation, 42 C.F.R. 413.40. View "Washington Regional Medicorp v. Burwell" on Justia Law

In 2008, Javidan shadowed Shahab, who was involved with fraudulent home-health agencies. Javidan, Shahab, and two others purchased Acure Home Care. Javidan managed Acure, signing Medicare applications and maintaining payroll. She had sole signature authority on Acure’s bank account and, was solely responsible for Medicare billing. Javidan illegally recruited patients by paying “kickbacks” to corrupt physicians and by using “marketers” to recruit patients by offering cash or prescription medications in exchange for Medicare numbers and signatures on blank Medicare forms. Javidan hired Meda as a physical therapist. Meda signed revisit notes for patients that he did not visit. He told Javidan which patients were not homebound and which demanded money for their Medicare information. The government charged both with health care fraud conspiracy (18 U.S.C. 1347) and conspiracy to receive kickbacks (18 U.S.C. 371). At trial, Javidan testified that she did not participate in and was generally unaware of Acure’s fraudulent business practices. Meda called no witnesses. Javidan and Meda were sentenced to terms of 65 and 46 months of imprisonment, respectively. The Sixth Circuit affirmed, rejecting Meda’s claims that his conviction violated the Double Jeopardy Clause and that he was subjected to prosecutorial vindictiveness for refusing to plead guilty and requesting a jury trial in prior case and Javidan’s claims of improper evidentiary rulings and sentence calculation errors. View "United States v. Javidan" on Justia Law

Plaintiff appealed the denial of his application for Social Security disability benefits, contending that the ALJ failed to resolve a conflict between the vocational expert's testimony and the Dictionary of Occupational Titles. The court held that an ALJ has not fully developed the record if it contains an unresolved conflict between the expert’s testimony and the Dictionary; nor has the ALJ fulfilled this duty if he ignores an apparent conflict because the expert testified that no conflict existed. In this case, the ALJ did not fulfill his duty to make an independent identification of apparent conflicts. Accordingly, the court reversed and remanded for further proceedings. View "Pearson v. Colvin" on Justia Law

Plaintiff appealed the denial of her application for disability insurance benefits, contending in part that the district court should have remanded the case to the Commissioner for further proceedings to consider new evidence. The court agreed with the Sixth Circuit's rejection of the notion that the mere existence of a subsequent decision in the claimant's favor, standing alone, warranted reconsideration of the first application. In this case, the only “new evidence” plaintiff cites in support of her request for remand is the later favorable decision. The court concluded that the later decision is not evidence for purposes of 42 U.S.C. 405(g). Because plaintiff does not offer any other new evidence, she has not established that remand is warranted. The court also concluded that the ALJ's conclusion that plaintiff was able to perform light work was supported by substantial evidence and that the ALJ gave adequate weight to the opinion of her treating physician, finding it inconsistent with the medical records and other evidence. Accordingly, the court affirmed the judgment. View "Hunter v. SSA" on Justia Law

After plaintiff's second application for disability benefits was denied by the ALJ, the government conceded that the ALJ made a legal error when it rejected the opinions of plaintiff's treating physician without giving sufficient reason. On appeal, plaintiff challenged the district court's decision to exercise its discretion and remand to the ALJ for further proceedings. The court concluded that the district court did not err in remanding this case to the ALJ for further factual proceedings, rather than for payment of benefits. Further, in light of the inconsistencies, conflicts, and gaps in the record that require further administrative proceedings, the court did not proceed to the next question: whether the ALJ would be required to find plaintiff disabled if the physician's inconsistent reports were credited as true. Accordingly, the court affirmed the judgment. View "Dominguez v. Colvin" on Justia Law