Justia Public Benefits Opinion Summaries

Delisle served on active duty in the U.S. Army, 1952-1954, and injured his left knee in a ski accident. After that injury, Delisle also began to experience chronic pain in his other knee. In 1978, the Department of Veterans Affairs granted Delisle’s claim for entitlement to a service connection for his right-knee disorder and assigned a 10 percent disability rating. Despite continued treatment, the condition of Delisle’s right knee continued to deteriorate. In 2009, Delisle unsuccessfully sought an increase to the 10 percent disability rating for his right knee. While appeal to the Board of Veterans Appeals was pending, he underwent the total right-knee replacement. As a result, the VA assigned a 100 percent disability rating for the period from April 7, 2010 to May 31, 2011, and assigned a 60 percent rating, along with a total disability rating based on individual employability for the period following May 31, 2011. Delisle challenged only the determination that he was not entitled to a higher disability rating for the nine months before his surgery. The Board rejected the claim. The Veterans Court affirmed. The Federal Circuit dismissed. The Veterans Court’s determination concerned questions of fact, which are beyond the court’s jurisdiction, 38 U.S.C. 7292(d)(2) View "Delisle v. McDonald" on Justia Law

Shelley and Christopher married in 1992. Shelley works in the private sector and has Social Security tax withheld from her pay; she expects to receive full benefits in 2033 at age 67. Christopher works for the police department and does not have Social Security tax withheld. He contributes to the Police Pension Fund and can retire with full benefits in 2017 at age 50. In their 2012 divorce, Christopher computed the estimated present value of his pension benefits, using a “Windfall Elimination Provision” to determine what part of those benefits were in lieu of Social Security, which is exempt from equitable distribution. Using Christopher’s wages, as if covered by Social Security, predicted that his Social Security benefit at age 67 would be $1,778 per month; using his wages for those years in which he contributed to Social Security, predicted that his benefit at age 67 would be $230 per month. The difference of $1,548 was posited as “in lieu of Social Security.” The difference between that amount and the pension amount was $2,479 per month, with an estimated present value of $639,720.74. The court determined that the proposed valuation would violate federal law as interpreted by Illinois Supreme Court precedent. Christopher recalculated the present value of his pension, without the offset, as $991,830. The court adopted that figure, and awarded Shelley about 35%. The Illinois Supreme Court affirmed, reasoning that Social Security benefits cannot be calculated until the participant collects them. Decreasing Shelley’s share of Christopher’s pension based on the present value of hypothetical Social Security benefits that, even if he had participated in that program, he might never receive is illogical and inequitable. Failing to consider Social Security may paint an unrealistic picture of their future finances, but Congress intended to keep those benefits out of divorce cases. View "In re Marriage of Mueller" on Justia Law

In the “NOVA” decision, the Federal Circuit approved a plan requiring the Department of Veterans Affairs (VA) to identify and rectify harms caused by wrongful application of former 38 C.F.R. 3.103. The Plan required that the VA notify every claimant who received a final Board decision during the specified period and did not receive full relief. If a claimant had a case outside of the Board’s jurisdiction, but mandate had not issued and the appellate court’s judgment was not final, the VA was obligated to offer to submit a joint motion for remand. If the mandate had issued, the VA was required to offer to submit a joint motion to recall mandate and a joint motion for remand. Smith served in the Army, 1963-1965. In 2000, Smith filed an unsuccessful claim for compensation for post-traumatic stress disorder (PTSD). In 2008, Smith was awarded service connection for PTSD with a 100% disability rating and a 2006 effective date. Smith appealed to the Board, which, in 2011, denied entitlement to an earlier effective date. The Board did not apply the invalid Rule interpretation. The Veterans Court affirmed and, days before the NOVA decision, entered judgment. In 2013, the parties filed a joint motion to recall that judgment. The decision fit the search terms profile under the Plan and triggered the VA’s obligation to offer to submit a joint motion. Smith did not claim that VA failed to comply with 38 C.F.R. 3.103(c)(2) or any prejudice in the conduct of the Board hearing. The Federal Circuit affirmed denial of the motion, stating that neither its decisions nor the Plan preclude appropriate denial. View "Smith v. McDonald" on Justia Law

Plaintiff Diane Stayton suffered serious burns while a resident at Harbor Healthcare and Rehabilitation Center ("Harbor Healthcare"), a skilled nursing center in Lewes. She sued alleging medical negligence against those responsible for her care. In addition to general damages, Stayton sought special damages for the cost of her medical care after she was burned. Absent Medicare coverage, the burn hospital and other providers who treated her for her injuries would have billed Stayton $3,683,797.11. Because Stayton qualified for Medicare, the Centers for Medicare and Medicaid Services ("CMS") paid Stayton's healthcare providers $262,550.17 in full satisfaction of the expense of Stayton's hospital stay and other care. Medicare regulations required the write-off of $3,421,246.94, and Stayton's healthcare providers could not "balance bill" her for the amount written off. Defendants moved for judgment on the pleadings seeking judgment as a matter of law that Stayton's medical expense damages were limited to the amount actually paid by CMS, rather than the amount Stayton might have been billed for her care. Stayton opposed the motion, relying on the collateral source rule. The Superior Court granted defendants' motion, and limited Stayton's medical expense claim to the amount paid by CMS. The court decided that the collateral source rule did not apply to amounts required by federal law to be written off by healthcare providers. On appeal to the Supreme Court, Stayton argued that the Superior Court should have applied the collateral source rule to the Medicare write-offs. The Supreme Court concluded the collateral source rule did not apply to amounts required to be written off by Medicare. "Where a healthcare provider has treated a plaintiff covered by Medicare, the amount paid for medical services is the amount recoverable by the plaintiff as medical expense damages." View "Stayton v. Delaware Health Corporation, et al." on Justia Law

Wright, a 50-year-old man, suffers from back and knee pain. Wright suffered a shoulder injury and complained of low back pain after being involved in a severe car accident in 2000. Wright suffered from another severe automobile accident in 1987. Wright has not reported earning any income in the years 2006–11. When he has earned income, it was seldom over $10,000 for the year. In his applications for disability insurance benefits and supplemental security income benefits Wright testified that his average day consists principally of laying on his back trying to get comfortable and spending around 30 minutes cooking basic meals for himself. His physician noted that Wright had "type 2 diabetes, vitamin D deficiency, tobacco abuse, obesity, [and] bilateral knee arthritis." The district court upheld the Social Security Commissioner's denial of benefits. The Eighth Circuit affirmed, rejecting arguments that the administrative law judge erred by discrediting the opinions of two examining physicians, discrediting Wright's testimony, not considering Wright's mental condition as a severe impairment, and not considering the record as a whole. View "Wright 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

Johnson has severe impairments, including chronic asthma, morbid obesity, borderline intellectual functioning, depression, anxiety, and post-traumatic stress disorder. She has never worked, has a ninth grade education, and does not have a drivers’ license. At the request of the Social Security Administration, a Ph.D conducted cognitive tests and reported Johnson was not “functioning within or near the mentally retarded range” and could “sustain concentration and persistence in completing tasks,” and Johnson’s “[m]ental impairments d[id] not significantly interfere with her day to day adaptive functioning.” To determine Johnson’s eligibility for Vocational Rehabilitation Services, another Ph.D., conducted a psychological evaluation o and concluded Johnson had a full scale IQ of 67, found that “a Mild Mental Retardation diagnosis [wa]s warranted,” and suggested Johnson “be encouraged to find employment … that is mechanical in nature, as she showed strength on tasks that require ability to analyze and synthesize abstract stimuli.”, Johnson occasionally attended counseling. Johnson’s counselors estimated she was of “low average” intelligence and education. Johnson was denied supplemental security income benefits, 42 U.S.C. 1381; an ALJ denied benefits, finding that Johnson had “residual functional - capacity to perform light work” with some restrictions. The district court and Eighth Circuit affirmed the denial as supported by substantial evidence. View "Johnson v. Colvin" on Justia Law

The Department appealed the district court’s order expanding a preliminary injunction forbidding the Department from decreasing the individual budgets of a class of participants in and applicants to Idaho’s Developmental Disabilities Waiver program (DD Waiver program) without adequate notice. The court rejected the Department's ripeness argument and concluded that the dispute is ripe for adjudication where plaintiffs alleged that they have already felt the effects of the Department's actions in a concrete way; the district court reasonably found that participants’ services are capped by their individual budgets under Idaho law; the district court also did not abuse its discretion in holding that plaintiffs were likely to show that the 2011 Budget Notices did not comply with the notice requirements of the Medicaid regulations; the district court did not abuse its discretion in holding that plaintiffs were likely to prevail on their claim that they were denied adequate notice under the Due Process Clause; the Department waived its argument that plaintiffs failed to show that the proposed class was likely to suffer irreparable harm; the court joined a number of its sister circuits in rejecting Eleventh Amendment challenges directed at orders reinstating social assistance benefits prospectively; and the court declined to exercise jurisdiction to review the district court’s order denying the motion to approve the 2013 Proposed Notice. Accordingly, the court affirmed the district court's judgment. View "K.W. v. Armstrong" on Justia Law

Plaintiffs, parents of a disabled student, filed suit under the Individuals with Disabilities Education Act (“IDEA”), 20 U.S.C. 1400 et seq., seeking reimbursement by the DOE for the costs of attending a private program. The hearing officer denied the request for reimbursement, concluding that it was untimely under Haw. Rev. Stat. 302A-443(a). The district court held, however, that the student's placement by the parents was “bilateral,” not “unilateral,” so that the parents’ request was not untimely, and concluded that the parents were entitled to reimbursement. The court agreed and concluded that the student's family is entitled to reimbursement for the 2010–11 school year because the DOE tacitly consented to his enrollment at the private school program by failing to provide an alternative. The court also affirmed the district court's fee award. View "Sam K. v. Hawaii Dept. of Educ." on Justia Law

Engstrand, a former dairy farmer, applied for Disability Insurance Benefits and Supplemental Security Insurance because of pain caused by diabetic neuropathy and osteoarthritis, in July 2010, when he was 47. He alleged an onset of disability in July 2007, more than a year before his date last insured in September 2008. The ALJ concluded that his account of his limitations was not credible, that the opinion of his treating physician was not entitled to deference, and that Engstrand was not disabled. The Seventh Circuit reversed and remanded, stating that the ALJ wrongly evaluated the significance of his daily activities and did not explain his rejection of the doctor's testimony. View "Engstrand v. Colvin" on Justia Law