Justia Public Benefits Opinion Summaries

The plaintiff claimed that an influenza vaccination he received n 2004 at the age of 34 resulted in the onset of multiple sclerosis or significantly aggravated his preexisting, but asymptomatic, multiple sclerosis. A special master denied his claim for compensation under the National Childhood Vaccine Injury Act of 1986, 42 U.S.C. 300aa-1 to -34. The Claims Court and the Federal Circuit affirmed. View "W.C. v. Sec'y of Health & Human Servs." on Justia Law

Sexton, a smoker, spent 25 years working in coal mines. He first applied for Black Lung Act (30 U.S.C. 901) benefits in 1973. The application was unsuccessful as were two other claims. In 2001, two years after the denial became final, Sexton filed a subsequent claim. The district director recommended an award of benefits. Buck Creek Coal requested a formal hearing. While his claim was pending Sexton died. His widow filed her own claim and the district director issued a proposed order awarding benefits in the survivor claim. Buck Creek requested a hearing. The administrative law judge considered four medical opinions, and based on that new evidence, determined that Sexton suffered a total disability from clinical and legal pneumoconiosis and that Sexton established a change in an applicable condition of entitlement pursuant to 20 C.F.R. 725.309 and awarded benefits. The Benefits Review Board affirmed with respect to Sexton’s claim and affirmed in part and vacated in part with respect to the survivor claim. The Sixth Circuit affirmed, holding that 20 C.F.R. 725.309 is valid and was correctly applied and that the Board’s decision did not violate principles of finality or res judicata. View "Buck Creek Coal Co. v. Sexton" on Justia Law

Plaintiff appealed the denial of his disability benefits. The court held that the ALJ's failure to complete the psychiatric review technique (PRT) was not harmless where the ALJ specifically found that plaintiff had the severe impairment of a closed-head injury, with symptoms that were mental in nature. On remand, the ALJ must reevaluate its findings in light of the PRT. Thus, the court need not address plaintiff's arguments about the evaluation of evidence and his residual functioning capacity. Accordingly, the court reversed and remanded. View "Cuthrell v. Astrue" on Justia Law

Harris served on active duty in the U.S. Army from 1963 to 1966 and from 1967 to 1970. In 1985, he had a VA Medical Center examination; an “Agent Orange” form associated with that examination indicates that Harris complained of “skin rashes on trunk and arms.” Another form, listing his service in Vietnam, is an “Application for Medical Benefits,” stated that it “will be used to determine your eligibility for medical benefits.” In 2002, Harris, pro se, sought service-connected disability compensation for contact dermatitis and latex allergy. The DVA regional office ultimately granted the claims and assigned an effective date of 2002. Harris sought an effective date of 1985. The Board held that the report of the Agent Orange Registry examination did not constitute a claim. The Veterans Court affirmed The Federal Circuit vacated, stating that pro se filings must be read liberally; the Veterans Court did not apply the proper legal standard for determining whether the Board had correctly determined the earliest applicable date for the claim. View "Harris v. Shinseki" on Justia Law

Plaintiff appealed the district court's decision affirming the Commissioner's denial of social security benefits. The court rejected plaintiff's contention to the extent that she alleged the ALJ failed to develop the record or make explicit findings regarding the mental and physical demands of her past relevant work as a factory packer and assembler. The court concluded that the ALJ had sufficient evidence on the record as a whole to reach his determination where the ALJ adequately compared the demands of plaintiff's past with her residual functioning capacity to perform light work, including with her manipulative limitations. Accordingly, the court affirmed the denial of benefits. View "Young v. Astrue" on Justia Law

In the four cases giving rise to these eleven consolidated appeals, the Secretary of the Department of Health and Human Services (HHS) and the Director of the California Department of Health Care Services (DHCS), appealed the district court's grant of preliminary injunctions to plaintiffs, various providers and beneficiaries of California's Medicaid program (Medi-Cal). At issue was the implementation of Medi-Cal reimbursement rate reductions. The court held that Orthopaedic Hospital v. Belshe did not control the outcome in these cases because it did not consider the key issue here - the Secretary's interpretation of 42 U.S.C. 1396a(a)(30)(A); the Secretary's approval of California's requested reimbursement rates were entitled to Chevron deference; and the Secretary's approval complied with the Administrative Procedures Act, 5 U.S.C. 500 et seq. The court further held that plaintiffs were unlikely to succeed on the merits on their Supremacy Clause claims against the Director because the Secretary had reasonably determined that the State's reimbursement rates complied with section 30(A). The court finally held that none of the plaintiffs had a viable takings claim because Medicaid, as a voluntary program, did not create property rights. View "Managed Pharmacy Care, et al v. Sebelius, et al" on Justia Law

A VA regional office awarded King disability compensation for residuals of a left knee surgery and right knee arthritis. King later sought disability compensation for disabilities of the back and hips on a direct basis and as secondary to his service-connected knee disabilities. Records revealed no treatment for back or hip problems during King's active duty service 1973-1974. King underwent a VA spine examination in 2000. The examiner diagnosed minimal degenerative joint disease of both hips and lumbosacral spine, related to age. A private physician disagreed. In 2007, the Board of Veterans denied King's appeal. The Veterans Court remanded. Additional evidence was developed and, in 2008, the Board obtained an opinion from a Veterans Hospital Administration orthopedist that it was not likely that King’s back and bilateral hip disabilities were directly caused or permanently worsened by the service-connected knee disabilities. The Board and Court of Appeals for Veterans Claims affirmed the denial. The Federal Circuit affirmed, rejecting an argument that the Veterans Court erred by discounting lay testimony offered by King and his wife. The Veterans Court did not fail to consider the proffered lay evidence, so King’s appeal was merely a challenge to the weight given his evidence.View "King v. Shinseki" on Justia Law

Plaintiff challenged the district court's judgment upholding the decision of the SSA denying his application for disability benefits. The court held that a VA disability determination must be accorded substantial weight in Social Security disability proceedings. The court also held that an ALJ must give retrospective consideration to medical evidence created after a claimant's last insured date when such evidence could be "reflective of a possible earlier and progressive degeneration." After considering all relevant evidence, and upon determining that plaintiff was disabled at any time, an ALJ must consult with a medical advisor if the date of onset of the disability was ambiguous. In this case, the ALJ made two errors of law in conducting his analysis of the evidence concerning whether plaintiff was disabled before his DLI and therefore, the court vacated the district court's judgment. View "Bird v. Commissioner of Soc Sec" on Justia Law

Youngman, fiduciary for deceased veteran Richardson, sought payment of accrued benefits of about $350,000 that had been awarded to Richardson before his death. Payment had been delayed while the Kansas state courts were accrediting Youngman as successor fiduciary for Richardson, who had been adjudged incompetent several years earlier. Richardson died after the accreditation but before payment. The VA denied payment. The Court of Appeals for Veterans Claims affirmed. Periodic monetary benefits to which an individual was entitled at death are to be paid to the veteran's spouse, children, or dependent parents and, in “all other cases, only so much of the accrued benefits may be paid as may be necessary to reimburse the person who bore the expense of last sickness and burial” 38 U.S.C.5121(a). Richardson had only cousins as heirs. The Federal Circuit affirmed. While 38 U.S.C. 5502 allows a fiduciary to stand in the shoes of a veteran, it does not grant the fiduciary rights beyond those of the veteran himself. Richardson died without any heirs in the categories qualifying under 5121, so his unpaid benefits died with him. View "Youngman v. Shinseki" on Justia Law

Tim Wilborn appealed the reduction of attorneys' fees he earned while representing plaintiff in a Social Security benefits claim. At issue was whether Wilborn received fees for the same work under the Equal Access to Justice Act (EAJA), 28 U.S.C. 2412, and the Social Security Act (SSA), 42 U.S.C. 406(b)(1). The court held that the $5,000 award under the EAJA was for the "same work" as the work for which Wilborn received the section 406(b)(1) award, and therefore the district court correctly offset the $5,000 from the 25% award. View "Parrish v. Commissioner Social Security" on Justia Law