Justia Public Benefits Opinion Summaries

Dalton worked in coal mine jobs from 1957 until 1991 and was exposed to substantial coal and rock dust. He developed trouble breathing; he quit his job and was never employed again. In 1999 Dalton sought benefits under the Black Lung Benefits Act, 30 U.S.C. 901‐45. In 2003, an ALJ awarded benefits, finding that Dalton was a “miner,” that Frontier was the “responsible operator,” and that Dalton had established clinical pneumoconiosis, based on the opinions of pulmonary experts, but could not determine the date of onset of total disability, so Dalton’s benefits began in 1999. The Board vacated, finding that the ALJ had not properly evaluated CT scans. The ALJ again awarded benefits beginning in 1999. In 2007, the case was again remanded. A new ALJ reweighed the evidence and ordered benefits to begin in 1999. Dalton died in 2007. The ALJ denied a motion by Dalton’s children to substitute as claimant. The Board dismissed an appeal and a cross‐appeal. The District Director returned the case to its third ALJ, who allowed the children’s motion, modified the date for commencement of benefits to 1991, and awarded attorneys’ fees and expenses. The Board vacated with respect to the onset date. The Seventh Circuit remanded for entry of the 1991 onset date, rejecting a claim that the children lacked standing. Substantial evidence supported the ALJ’s finding that 1991 marked the time of onset for Dalton’s total disability on account of pneumoconiosis. View "Dalton v. Office of Workers' Compensation Programs" on Justia Law

Garcia, previously a construction worker and then age 40, applied for social security disability benefits in 2010, claiming abdominal pain caused by cirrhosis of the liver, severe low platelet count, hepatitis C, and an umbilical hernia, all of which had been diagnosed by several physicians that year. All were caused or exacerbated by alcoholism, but he stopped drinking and alcoholism is no longer a “contributing factor” barring him from obtaining disability benefits, 42 U.S.C. 423(d)(2)(C). An ALJ ruled that Garcia is capable of doing limited sedentary work. The district court affirmed. The Seventh Circuit reversed, noting that Garcia would be a candidate for a liver transplant, but was not on the list because he was too sick for surgery. His platelet count was too low to for even a liver biopsy. Garcia has been repeatedly hospitalized and treated for pain with morphine and other opium derivatives, with limited success. He has lupus, anemia, colitis, anxiety and other psychological problems, and chronic fatigue. One physician described Garcia’s condition as “chronic and terminal.” The court stated that Garcia is “one of the most seriously disabled applicants for social security disability benefits whom we’ve encountered in many years … We are surprised that the Justice Department would defend such a denial.” View "Garcia v. Colvin" on Justia Law

Ogle, born in 1954, worked in underground coal mines for 21 years, most recently in 1996 in Kentucky. Ogle smoked since age 12. He sought black lung benefits in 2007. After the record closed but before the ALJ issued a decision, Congress revived a rebuttable statutory presumption that a coal miner who worked in an underground mine for at least 15 years and suffers from a total respiratory or pulmonary disability is presumed to be totally disabled due to pneumoconiosis, 30 U.S.C. 921(c)(4). The ALJ awarded benefits, finding that Ogle suffered from totally disabling respiratory impairment, a conclusion with which all medical opinions agreed. The ALJ stated that the presumption shifts the burden to demonstrate by a preponderance of the evidence that either the miner’s disability does not, or did not, arise out of coal mine employment or the miner did not, suffer from pneumoconiosis. The Fund demonstrated that Ogle did not suffer from clinical pneumoconiosis, but failed to rebut the presumption that Ogle suffers from legal pneumoconiosis. The Board affirmed. The Sixth Circuit denied a petition for review, finding no evidence that the ALJ improperly restricted the Fund’s ability to rebut the 15-year presumption or that the ALJ applied the wrong standard. View "Big Branch Res., Inc. v. Ogle" on Justia Law

Ramage, born in 1933, worked for Island Creek for 28 years, five years underground and 23 years on the surface. In 2007 he sought black lung benefits. While the claim was pending, Congress revived a statutory rebuttable presumption that a coal miner who worked in an underground coal mine for 15 years and suffers from a total respiratory or pulmonary disability is presumed to be totally disabled due to pneumoconiosis, 30 U.S.C. 921(c)(4), applicable to pending claims filed after January 1, 2005. The ALJ noted that x-rays did not show pneumoconiosis, that Ramage could not complete a pulmonary function test due to a tracheostomy, and that arterial blood-gas studies were qualifying under the federal standards. The ALJ summarized the medical opinions of five doctors, including one who emphasized that it was impossible to distinguish between the damage due to coal dust as opposed to the damage due to smoking. The ALJ awarded benefits and the Benefits Review Board affirmed. The Sixth Circuit denied a petition for review, holding that the ALJ’s determinations were reasoned and reasonable and that the legislative provisions creating the presumption are self-executing.View "Island Creek KY Mining v. Ramage" on Justia Law

Sneed is the surviving spouse of Reginald, who served on active duty 1964-1968 and suffered service-connected disabilities, including post-traumatic stress syndrome, post-concussion syndrome, degeneration of the vertebrae, narrowing of the spinal column, tinnitus, a perforated tympanic membrane, and scarring of the upper extremities. In 2001, Reginald fell and suffered a spinal cord contusion, rendering him a quadriplegic. In 2003, he was living in a nursing home for paralyzed veterans. There was a fire and all of the residents died of smoke inhalation. Sneed sought dependency and indemnity compensation, 38 U.S.C. 1310, alleging that her husband’s service-connected disabilities were a cause of his death. The VA denied the claim. The Board affirmed. Sneed’s notice of appeal was due by August 3, 2011. Sneed retained attorney Eagle, communicated with Eagle’s office “for a year or longer” and stated that “Eagle knew that there was a deadline.” On August 2, 2011 Sneed received a letter stating that Eagle would not represent Sneed in her appeal. Failing to find new counsel, Sneed filed notice of appeal on September 1, 2011, with a letter explaining her late filing. The Veterans Court dismissed the appeal as untimely. The Federal Circuit vacated, holding that attorney abandonment can justify equitably tolling the deadline for filing an appeal. View "Sneed v. Shinseki" on Justia Law

Appellant filed two amended qui tam actions against her employer, a pharmaceutical company and its subsidiary (collectively, Appellees), under the federal False Claims Act (FCA), alleging that Appellees failed adequately to disclose the risks associated with some of their drugs and that this failure resulted in the submission of false claims by third-party patients and physicians for government payment. The district court dismissed both of Appellant's actions under Fed. R. Civ. P. 9(b) for failure to plead fraud with particularity and under Fed. R. Civ. P. 12(b)(6) for failure to state a claim. Appellant subsequently sought to amend the second amended complaint, asserting more theories of FCA liability, but the district court refused to allow further amendment. The First Circuit Court of Appeals affirmed the district court's rulings regarding the dismissal of Appellant's claim under Rule 9(b) and the denial of Appellant's proposed amendments, holding (1) Appellant's claims on all theories which were presented failed under Rule 9(b); and (2) the district court did not err in denying Appellant's motion to amend. View "United States ex rel. Ge v. Takeda Pharm. Co. Ltd." on Justia Law

Bates has suffered from radiating neck pain since 2004, when a truck struck her car. Since then, she has continued to care for her six adopted children and dealt with the loss of her fiancé and her mother. As a result of the stress, Bates sought psychological and psychiatric treatment. She sought Supplemental Security Income. After her application was denied, Bates requested a hearing before an Administrative Law Judge. The ALJ denied her application; the district court affirmed. The Seventh Circuit reversed and remanded for rehearing, finding that the ALJ improperly discounted the opinion of Bates’s treating psychiatrist and improperly evaluated Bates’s testimony concerning her mental health. View "Bates v. Astrue" on Justia Law

From 1978 to 2000, Cerentano worked as a coal miner. He was injured in 15 mining incidents and received six separate awards of permanent partial disability, but was able to return to work after each injury. In 2000 Cerentano was wrongfully discharged after a false positive drug test. Months later, he was diagnosed with depression due to his firing and treated for dysthymia and anxiety. Eventually, Cerentano found work as a real estate agent and a vehicle transporter. In 2005, Cerentano’s car was hit, causing more injuries. Cerentano was awarded Social Security disability benefits. He was denied disability pension benefits under the United Mine Workers Pension Trust Plan, based on the trustees’ conclusion that there was no causal link between his mine injuries and the award of Social Security benefits. Cerentano sued under the Employee Retirement Income Security Act, 29 U.S.C. 1332(a)(1)(b). The district court granted summary judgment to the plan. The Seventh Circuit reversed and remanded. The trustees should have examined all of the injuries, severe and non‐severe, that the ALJ relied on in finding Cerentano disabled and should have determined which of those injuries were caused by mine accidents and whether, the mine‐related injuries, in combination, comprised “a causal link.” View "Cerentano v. UMWA Health & Retirement Funds" on Justia Law

Prinkey served in the Army, 1969 to 1970, including time in Vietnam. He was diagnosed with diabetes in 1996. Diabetes mellitus type II is presumed to be service connected if the veteran was exposed to Agent Orange, 38 U.S.C. 1116(a)(2)(H) (2002). In 2003, the VA received Prinkey’s claim for benefits on account of his diabetes, asserting exposure to Agent Orange. The VA Regional Office grantedservice connection for diabetes, evaluated at 20%, and lesser rated service connection for other disabilities secondary to diabetes. Prinkey sought to reopen his claim. During reexamination, the VA concluded that his diabetes more likely than not resulted from the surgery that removed most of his pancreas following years of alcohol abuse, not from his exposure to Agent Orange. Ultimately the Board of Veterans’ Appeals sustained severance of service connection for diabetes and related disabilities and denied entitlement to a total disability rating based on individual unemployability. The Veterans Court affirmed. The Federal Circuit affirmed. Under 38 C.F.R. 3.105(d) “service connection will be severed only where evidence establishes that it is clearly and unmistakably erroneous; the VA may consider medical evidence and diagnoses that postdate the original award of service connection. View "Prinkey v. Shinseki" on Justia Law

Under the Individuals with Disabilities Education Act (IDEA), states that provide special education funds are eligible for federal funds to implement state-wide special education programs that guarantee a free appropriate public education (FAPE) to eligible disabled children, 20 U.S.C. 1412(a)(1)(A). Pennsylvania enacted 24 P.S. 25-2509.5, its special education funding formula, under which each school district receives a base supplement, calculated by apportioning the total amount of base supplement money available among all districts based on the average daily membership of the district from the prior year under the assumption that 16% of students in each district are disabled. Plaintiffs, disabled students who attend schools in districts with a 17% or greater enrollment of special needs students and with a market value/personal income ratio of .65 or greater, claimed that Pennsylvania’s method violates IDEA, the Americans with Disabilities Act, and the Rehabilitation Act The district court found that the formula did not deprive the class of a FAPE as required by the IDEA and did not discriminate in violation of either the ADA or RA. The Third Circuit affirmed, noting that there was no evidence that any class member was deprived of a service available to nonclass members. View "CG v. PA Dep't of Educ." on Justia Law