Justia Public Benefits Opinion Summaries

Petitioner appealed from the district court's judgment affirming the Commissioner's denial of his application for disability benefits. The court held that the ALJ erred in her treatment of plaintiff's claim that he suffered from fibromyalgia by failing to accord the proper weight to the opinion of plaintiff's treating physician, by misconstruing the record, and by failing to evaluate the claim in light of medically accepted diagnostic criteria. The court also held that the ALJ's determination that plaintiff could perform light work was not supported by substantial evidence, and that the ALJ further erred by not determining whether plaintiff's reaching limitation was non-eligible and would therefore require the testimony of a vocational expert. Accordingly, the court vacated and remanded for further proceedings. View "Selian v. Astrue" on Justia Law

Prasch worked as a mail carrier for the Postal Service until suffering a work-related injury, compensable under the Federal Employees’ Compensation Act. He received benefits from the Office of Workers’ Compensation Programs from December 2007 until October 2008. Prasch applied for disability retirement. OPM approved his application and deposited $14,640.27, representing retroactive retirement annuity payments from December 2007 through the approval of his application. OPM paid him another $5,869.60 in retirement annuity benefits before determining that Prasch had received FECA disability benefits from OWCP during the period that OPM was paying him retirement annuity benefits. Because governing statutes prohibit dual benefits, OPM adjusted the commencement date of Prasch’s retirement annuity and computed an overpayment of $14,703.62.and sent a proposed repayment schedule. Prasch requested a waiver of the repayment obligation, lower installments, or a compromise payment, but he did not ask for reconsideration of OPM’s decisions as to the existence of the overpayment or its amount. OPM affirmed its initial decision, finding that Prasch should have known that he could not receive dual benefits and rejecting his claim of financial hardship, but extended the time for repayment. The Merit Systems Protection denied an appeal. The Federal Circuit affirmed. View "Prasch v. Office of Pers. Mgmt." on Justia Law

Viegas served in the U.S. Army, 1965-1967. After leaving the service, he was injured in a diving accident, resulting in “incomplete” quadriplegia. In 2004, Viegas participated in a prescribed aquatic therapy session at a VA medical center. He used a restroom in the VA facility. The grab bar he used to lift himself into his wheelchair came loose from the wall and he fell to the ground. As a result of the fall, Viegas sustained injuries to his upper and lower extremities. Viegas’ medical condition deteriorated after his fall. Prior to his fall, Viegas could sometimes walk with a walker, but since the accident he can only stand with assistance. Viegas sought disability benefits under 38 U.S.C. 1151. A VA regional office denied the claim. The board affirmed, stating that such benefits are available only if additional disability results from injury that was part of the natural sequence of cause and effect flowing directly from the actual provision of hospital care, medical or surgical treatment, or examination furnished by the VA and such additional disability was directly caused by that VA activity. The Veterans Court affirmed. The Federal Circuit reversed, holding that the Veterans Court misinterpreted the causation requirement. View "Viegas v. Shinseki" on Justia Law

The court consolidated appeals by veterans claiming that their current disabilities are connected to injuries sustained during military service. In both cases, the veterans’ medical records contained at least one physician’s report opining that the claimed disabilities were service-connected and at least one ambiguous or inconclusive report declining to confirm such a nexus. The Department of Veterans Affairs relied on inconclusive opinions in denying the veterans entitlement to service-connected disability benefits, and the Board of Veterans’ Appeals affirmed. Finding that the medical examination did not comply with the Board’s instructions and that the Board failed to explain its reasons and bases for denying service connection, the U.S. Court of Appeals for Veterans Claims remanded. The Federal Circuit affirmed that remand, rather than reversal, was appropriate. View "Deloach v. Shinseki" on Justia Law

Since enacting a program for black-lung benefits in 1969, known as the Black Lung Benefits Act,83 Stat. 742, Congress has repeatedly amended the claim-filing process, sometimes making it harder for miners and survivors to obtain benefits, sometimes making it easier. The most recent adjustment, part of the 2010 Patient Protection and Affordable Care Act, reinstated a presumption that deceased workers who had worked for at least 15 years in underground coal mines and had developed a totally disabling respiratory or pulmonary impairment were presumed to be totally disabled by pneumoconiosis and to have died from it. The presumption is rebuttable. The Act also reinstated automatic benefits to any survivor of a miner who had been awarded benefits on a claim filed during his lifetime, 124 Stat. at 260. Groves, a miner for 29 years, filed a claim for benefits in 2006 and died four months later. An ALJ denied his widow benefits. The law changed while her appeal was pending. The Benefits Review Board concluded that the new law covered this claim. The Sixth Circuit affirmed. View "Vision Processing, LLC v. Groves" on Justia Law

Plaintiff appealed the denial of his claim for disability-insurance benefits and supplemental-security-income benefits. The magistrate judge recommended reversing the SSA's denial of benefits and remanded for plaintiff's claim to the SSA for further proceedings. The district court then entered an order adopting the magistrate judge's recommendation and granted plaintiff's counsel's request and award for attorneys' fees. At issue in this appeal was the type of judgment for which a district court could grant attorneys' fees under the Social Security Act, 42 U.S.C. 406(b). The court reversed the district court's denial of attorneys' fees, concluding that the district court's construction of section 406(b) unavoidably reduced the likelihood that an attorney who undertook a disability benefits representation would receive reasonable compensation for his work. Section 406(b) fees were authorized in cases where an attorney obtained a favorable decision on remand and the SSA has not opposed such fees for over 25 years. View "Jackson v. Astrue" on Justia Law

Reimbursement providers for inpatient services rendered to Medicare beneficiaries is adjusted upward for hospitals that serve disproportionate numbers of patients who are eligible for Supplemental Security Income. The Centers for Medicare & Medicaid Services annually submit the SSI fraction for eligible hospitals to a “fiscal intermediary,” a Health and Human Services contractor, which computes the reimbursement amount and sends the hospitals notice. A provider may appeal to the Provider Reimbursement Review Board within 180 days, 42 U. S. C. 1395oo(a)(3). The PRRB may extend the period, for good cause, up to three years, 42 CFR 405.1841(b). A hospital timely appealed its SSI fraction calculations for 1993 through 1996. The PRRB found that errors in CMS’s methodology resulted in a systematic under-calculation. When the decision was made public, hospitals challenged their adjustments for 1987 through 1994. The PRRB held that it lacked jurisdiction, reasoning that it had no equitable powers save those granted by legislation or regulation. The district court dismissed the claims. The D. C. Circuit reversed. The Supreme Court reversed. While the 180-day limitation is not “jurisdictional” and does not preclude regulatory extension, the regulation is a permissible interpretation of 1395oo(a)(3). Applying deferential review, the Court noted the Secretary’s practical experience in superintending the huge program and the PRRB. Rejecting an argument for equitable tolling, the Court noted that for nearly 40 years the Secretary has prohibited extensions, except as provided by regulation, and Congress not amended the 180-day provision or the rule-making authority. The statutory scheme, which applies to sophisticated institutional providers, is not designed to be “unusually protective” of claimants. Giving intermediaries more time to discover over-payments than providers have to discover underpayments may be justified by the “administrative realities” of the system: a few dozen intermediaries issue tens of thousands of NPRs, while each provider can concentrate on its own NPR. View "Sebelius v. Auburn Reg'l Med. Ctr." on Justia Law

Roddy, born in 1964, suffers from several serious medical problems, including severe lower back pain attributable to degenerative disc disease. When her pain became unbearable, she stopped working and applied for disability insurance benefits. She was unsuccessful before the Social Security Administration. An administrative law judge found that there were jobs in the national economy within her capabilities, although she no longer could perform her old job as a shift manager at a Taco Bell restaurant. The district court affirmed. The Seventh Circuit vacated and remanded. The ALJ improperly discounted the opinion of a physician and improperly considered Roddy’s testimony about her ability to do housework. View "Roddy v. Astrue" on Justia Law

Stephenson began receiving a Federal Employees Retirement System disability retirement, annuity and applied for SSA disability benefits, as required of applicants for FERS disability retirement. SSA determined that he was entitled to receive monthly SSA disability benefits; the Office of Personnel Management reduced his FERS annuity, 5 U.S.C. 8452(a)(2)(A); 42 U.S.C. 423. The Social Security Act allows a “trial work period,” without loss of benefits. Stephenson completed a nine-month trial work period and demonstrated ability to work. SSA notified Stephenson that he was not entitled to payments beginning September 2009, but that he could get a 36-month extended period of eligibility after the trial work period. Stephenson requested that OPM terminate the offset in his FERS annuity. OPM denied the request finding that he retained eligibility for Social Security benefits and that the offset did not depend on actual receipt of benefits. An administrative judge and the Merit Systems Protection Board denied appeals, acknowledging section 8452’s use of the word “entitled,” not “eligible,” but finding Stephenson remained “entitled” to SSA benefits during the 36-month period. The Federal Circuit reversed; because Stephenson performed substantial gainful activity during that period, he was not “entitled” to benefits under section 223 of the Social Security Act. View "Stephenson v. Office of Pers. Mgmt." on Justia Law

The 57-year-old woman, diagnosed with frozen shoulder and later with chronic obstructive pulmonary disease, stopped medical treatment in 2003, having no health insurance and income of $4500 to $9000 a year as a clerical worker. Her last significant employment, as a hotel night-clerk, ended in 2007. She got another clerical job, but was immediately fired because unable to lift a box of paper. She sought social security disability benefits and resumed treatment. She had regained the full range of motion, but muscles in her arms and shoulders were weak and she had chronic obstructive pulmonary disease, causing bronchitis, respiratory infections, and shortness of breath. The ALJ decided that she was capable of performing as hotel clerk and was not disabled; he disregarded findings by a doctor whom he had appointed and with whom the applicant had no prior relationship. He noted the “lack of aggressive treatment” and that she smoked, overlooking that she stopped smoking 30 years earlier. The ALJ focused on her ability to do laundry, take public transportation, and grocery shop. The Appeals Council declined review. The Seventh Circuit remanded, stating that: “Really the Social Security Administration and the Justice Department should have been able to do better.” View "Hughes v. Astrue" on Justia Law