Justia Public Benefits Opinion Summaries

Stepp, a former correctional officer, training secretary and coordinator, and parole probation officer, applied for a period of disability and disability insurance benefits under the Social Security Act, 42 U.S.C. 401. Stepp was 47 years old, 5’6” tall, and weighed 237 pounds. She primarily claimed degenerative disc disease and depression. An ALJ denied Stepp’s claim, acknowledging that Stepp suffered from chronic pain, but finding that surgery, medication, and therapy had resulted in improvement such that she retained the capacity to engage in sedentary work. Stepp submitted to the Appeals Council additional evidence in the form of medical records created just before the ALJ’s denial of her claim. This evidence, the treatment notes of pain management specialist Dr. MacKay, tends to suggest that Stepp’s condition did not improve over the course of the adjudicative period to the extent that the ALJ estimated. The Appeals Council declined to engage in plenary review and did not address Dr. MacKay’s notes. The district court affirmed. The Seventh Circuit remanded, finding that the ALJ properly analyzed a range of conflicting testimony and medical opinions and reached a conclusion adequately supported by the record, but that the Council erred in not accepting Dr. MacKay’s treatment notes as new and material evidence. View "Stepp v. Carolyn Colvin" on Justia Law

The Section 8 low-income housing assistance voucher program, 42 U.S.C. 1437f(o), is administered by public housing agencies such as Cuyahoga Metropolitan Housing Authority (CMHA). Program regulations define “rent to [the] owner” as “[t]he total monthly rent payable to the owner under the lease for the unit. Rent to owner covers payment for any housing services, maintenance and utilities that the owner is required to provide and pay for.” Velez and Hatcher, voucher recipients, entered into one-year leases with K&D. The leases provide: “If Resident(s) shall holdover after the end of the term of this Rental Agreement, said holdover shall be deemed a tenancy of month to month and applicable month to month fees shall apply.” Velez entered into a month-to-month tenancy after her one-year term expired; Hatcher entered into month-to-month tenancies, and, later, a nine-month agreement. K&D charged fees of $35.00 to $100.00 per month. CMHA did not treat these short-term rental fees as rent under the voucher program. Velez and Hatcher were required to pay the fees and filed suit under 42 U.S.C. 1983. The court granted CMHA summary judgment, holding that the fees were not rent. The Sixth Circuit reversed. Recasting the charge as a short-term fee, rather than rent, does not change that it is consideration paid by the tenant for use of the rental unit. View "Velez v. Cuyahoga Metro. Hous. Auth." on Justia Law

Price, an almost illiterate, mentally retarded 44-year-old who also suffers from psychiatric ailments, intermittently received Supplemental Security Income (SSI) benefits, having been adjudged disabled in 1988, 1991, and 2007. His benefits should have been terminated in 2005 because he was sent to prison for a felony sex offense, but the record is unclear as to when benefits stopped. Paroled in 2010, he unsuccessfully applied for the same benefits that he had received before he entered prison. After reviewing the history of Price’s mental problems, his inability to function in society, doctor’s assessments, his nocturnal habits, and test scores, the Seventh Circuit remanded, finding the administrative law judge’s reasons for finding that Price was not disabled “unconvincing.” As is common in social security disability proceedings, the administrative law judge inferred from Price’s ability to perform simple household chores, such as cooking food in a microwave oven and mowing the lawn, that he could be gainfully employed, but “it’s easier—especially for someone with an antisocial psychiatric disorder—to work in one’s own home, at one’s own pace, at one’s own choice of tasks, than to work by the clock under supervision in a place of business.” View "Price v. Colvin" on Justia Law

Milam applied for disability insurance benefits in 2011, identifying conditions of back pain, knee pain, hip pain, and osteoporosis and a 2009 disability onset date—the same day she was laid off. Milam had worked for 20 years, most recently as an administrative assistant. The ALJ noted his general suspicions about claimants who are "laid off—they work until the last day and then all of a sudden they're disabled," noting that after alleged onset date, Milam received unemployment benefits and looked for a new job. Milam testified that she can drive for only 20 minutes without back and hip pain, can sit for only 30 minutes continuously before needing to stand, can lift five to ten pounds, has limited ability to bend her back, and has difficulties rotating and squatting. She testified that she is in pain "24/7" and sleeps four to five hours per night. She submitted letters from three former coworkers stating that Milam was absent from work up to five days per month. The ALJ found that Milam was not disabled, but could perform sedentary work with restrictions. The Appeals Council denied her request for review. The district court and Eighth Circuit affirmed the denial as supported by substantial evidence. View "Milam v. Colvin" on Justia Law

Varga, now 42, had a 1994 medical discharge from the military because of severe endometriosis (a condition which causes pelvic pain). She then worked as a correctional officer, and later an office worker, at the Federal Correctional Institute (FCI) in Oxford, Wisconsin. She left the FCI in 2005 because of her continuing physical and mental impairments and has not worked since March 2006, when her application for disability retirement under the Federal Employees Retirement System was approved. She applied for disability insurance benefits in 2006, alleging she had been disabled since 2005. Between 2005 and 2011, Varga was diagnosed with: PTSD, endometriosis, major depression, irritable bowel syndrome, and fibromyalgia. An Administrative Law Judge denied her application. The district court, affirmed. The Seventh Circuit reversed, agreeing that the ALJ erred by failing to include her mental limitations in the areas of concentration, persistence, and pace in the hypothetical question that he posed to the vocational expert. The flawed hypothetical led the vocational expert and the ALJ to erroneously conclude she was not disabled. View "Varga v. Colvin" on Justia Law

Hospitals that are disadvantaged by their geographic location may reclassify to a different wage index area for certain Medicare reimbursement purposes by applying for redesignation to the Medicare Geographic Classification Review Board. Section 401 of the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999, enacted 10 years after the Board was established, creates a separate mechanism by which qualifying hospitals located in urban areas “shall [be] treat[ed] . . . [as] rural” for the same reimbursement purposes. To avoid possible strategic maneuvering by hospitals, the U.S. Department of Health and Human Services issued a regulation providing that hospitals with Section 401 status cannot receive additional reclassification by the Board on the basis of that status, 42 C.F.R. 412.230(a)(5)(iii) (Reclassification Rule). Geisinger, a hospital located in an urban area, received rural designation under Section 401 but was unable to obtain further reclassification by the Board pursuant to the Reclassification Rule. Geisinger sued. The district court upheld the regulation. The Third Circuit reversed, finding that Section 401 is unambiguous: HHS shall treat Section 401 hospitals as rural for Board reclassification purposes, 42 U.S.C. 1395ww(d)(8)(E)(i) View "Geisinger Cmty. Med. Ctr. v. Sec'y United States Dep't of Health & Human Servs." on Justia Law

Carter served in the Army, 1965-1967. In 1989, he sought disability benefits for an injury to his back. The VA denied his claim. He sought to reopen in 2005, filing new evidence that he had aggravated the injury during his service. In 2006, the VA reopened, but denied the claim. The Board of Appeals affirmed in 2009. While appeal was pending, Carter changed counsel. He filed Form 21-22a in March 2010, naming a private attorney in place of Disabled American Veterans. New counsel requested a copy of Carter’s claim file. In June 2010, new counsel and the government jointly requested partial vacatur of the 2009 decision; the Veterans Court remanded the case with instructions. The Board sent a letter to Carter and Disabled American Veterans, stating that additional evidence must be submitted within 90 days (November 4, 2010). Counsel did not receive the letter. On December 13, 2010, the VA sent new counsel Carter’s file, nearly nine months after her requested. She did not immediately read the file and did not see the letter. In February 2011, without hearing from Carter, the Board again denied his claim. Carter’s attorney received a copy of the decision in December 2011. The Veterans Court affirmed. The Federal Circuit vacated. The Veterans Court incorrectly understood the law governing this notice defect. View "Carter v. McDonald" on Justia Law

Plaintiff appealed the denial of her claims for disability insurance benefits (DIB) and supplemental security income benefits (SSI) based on a fractured ankle in 2011. The ALJ denied her claim, concluding that plaintiff's impairment did not equal the medical severity of an impairment listed in the C.F.R., which required plaintiff to show that her ankle injury rendered her unable to ambulate effectively for a full year after the May 2011 onset. Plaintiff requested review of her claim and submitted additional medical records. The Appeals Council made this additional evidence part of the record but denied the review without providing discussion of the newly submitted evidence. The court reversed and remanded for further proceedings because the court was unable to determine, from review of the record as a whole, if substantial evidence supports the Commissioner’s denial of benefits. View "Sun v. Colvin" on Justia Law

Plaintiffs, Medicaid recipients who unsuccessfully sought coverage for prescription drugs, filed suit contending that the District and its officials unlawfully failed to afford them notice of their entitlement to a hearing before denying their prescription drug claims. The court affirmed the district court's dismissal of plaintiffs' claims under Title XIX of the Social Security Act, 42 U.S.C. 1396 et seq., and rejected plaintiffs’ argument that Title XIX’s notice regulations are triggered whenever there has been a denial of a claim for prescription drug coverage at the point-of-sale. However, the court reversed the district court's dismissal of the due process claims because the prescription drug coverage sought by plaintiffs qualifies as a property interest protected by the Fifth Amendment; plaintiffs adequately alleged that Xerox, a private company, determined their eligibility for benefits while acting as an agent of the District; and the court remanded the case to permit the district court to conduct an inquiry in the first instance into what process is due. The court also remanded to the district court to reconsider its jurisdiction over the D.C. -law claims in light of the court's partial reversal. View "NB v. District of Columbia" on Justia Law

The parent of K.E., a student who was diagnosed with several learning issues, seeks reimbursement under the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1400 et seq., after she chose a private boarding school for K.E. The hearing officer and the district court denied reimbursement because, in their view, the child had no need to be in a residential program. The court concluded, however, that all statutory, regulatory, and judicial requirements for reimbursement of the costs of private school have been satisfied: the school district failed to offer the child a “free appropriate public education” in either a public school or a non-residential private school; the private boarding school the parent selected was, at the time, the only one on the record “reasonably calculated to enable the child to receive educational benefits” designed to meet the child’s needs; the residential component of the private school was in fact “necessary to provide a free appropriate public education to” the child; and the school district has not shown that the parent acted unreasonably. Accordingly, the court reversed and remanded for further proceedings. View "Leggett v. District of Columbia" on Justia Law