Justia Public Benefits Opinion Summaries

Filus, a 50-year-old former truck driver, has twice applied for disability benefits under the Social Security Act, claiming that back problems have left him incapable of gainful employment. An administrative law judge concluded that Filus could perform some light work and denied his most recent application. The Seventh Circuit affirmed, holding that substantial evidence supports the denial. The ALJ adequately considered Filus’s testimony about the limiting effects of his pain along with his testimony that he regularly completed his daily household activities without any pain medication, not even over-the-counter products.View "Filus v. Astrue" on Justia Law

Claiming anxiety, depression, suicidal tendencies, insomnia, vertigo, migraine headaches, fibromyalgia, carpal tunnel syndrome, and plantar fasciitis, Farrell, then 33 year old, applied for disability insurance benefits. Her initial application was denied, but the Social Security Administration Appeals Council remanded. The Administrative Law Judge again ruled against her, in part because of her failure to establish definitively that she suffered from fibromyalgia. The Appeals Council summarily affirmed this decision, despite new evidence before it that confirmed the fibromyalgia. The district court affirmed. The Seventh Circuit reversed. The Social Security Administration’s regulations require the Appeals Council to consider “new and material evidence.” The ALJ did not adequately deal with competing expert opinions. View "Farrell v. Astrue" on Justia Law

Plaintiff sought review of the SSA's denial of his application for social security disability benefits. The federal magistrate judge who presided over plaintiff's action determined that the agency's decision improperly disregarded the opinions of an examining psychologist and remanded to the agency. Plaintiff sought reasonable attorney's fees pursuant to the Equal Access to Justice Act (EAJA), 28 U.S.C. 2412(d). The magistrate judge granted the request in part but determined that the 60.5 hours plaintiff's attorneys spent working on the case were excessive and subsequently reduced the number of hours by nearly one-third. The court held that it was improper for district courts to apply a de facto cap on the number of hours for which attorneys could be compensated under the EAJA in a "routine" case challenging the denial of social security benefits. Rather individualized consideration must be given to each case. Accordingly, the court reversed and remanded. View "Costa v. Commissioner of Social Security Admin." on Justia Law

Plaintiff appealed the denial of her social security disability benefits, arguing that the ALJ improperly disregarded evidence from her treating physicians without re-contacting him to obtain further documentation. Because (1) the ALJ had no duty to re-contact that physician where the record contained sufficient evidence from other physicians and (2) any error was harmless even if the ALJ were required to re-contact the doctor, the court affirmed the judgment. View "Jones v. Astrue" on Justia Law

This appeal concerned the implementation of a federally-assisted Medicaid program by the Commonwealth of Puerto Rico, represented by its Secretary of Health. This was the sixth time the First Circuit Court of Appeals considered issues related to a dispute between the Commonwealth and several federally qualified health centers (FQHCs). The FQHCs here took to federal courts their claims for reimbursement payments owed to them under the Medicaid program. The district court, among other things, set a formula in place by way of a preliminary injunction that calculated payments the Commonwealth owed the FQHCs for providing Medicaid services. The First Circuit (1) concluded the formula that the district court endorsed in its preliminary injunction was not sufficiently supported by the factual record, and therefore, the Court remanded for further reformulation; (2) affirmed the district court's denial of the FQHCs' request for indemnification from debts owed to third party managed care organizations; and (3) affirmed the district court's determination that the Eleventh Amendment precludes a federal court from imposing a judgment for money damages upon the Commonwealth to make payments for periods predating the date of the district court's preliminary injunction. View "Consejo de Salud De La Communidad de Playa de Ponce, Inc. v. Gonzalez-Feliciano" on Justia Law

Cage, born in 1960, has an extensive medical history. She offered evidence of: bipolar disorder, depression, suicidal ideation, dizziness, blackouts, memory loss and chest pain. She has not worked since November 2003. Before then, she had worked as a retail cashier, hotel maid and home healthcare aide. Cage also has a long history of drug and alcohol abuse. Her ongoing medical care has included treatment for drug addiction and alcoholism and her other conditions. An Administrative Law Judge of the Social Security Administration denied Cage’s application for Supplemental Security Income benefits, finding that although Cage met certain requirements for being “disabled” under the Social Security Act, 42 U.S.C. 301, she was ineligible for SSI because drug addiction or alcoholism was a contributing factor material to that determination. The district court affirmed. The Second Circuit affirmed. The ALJ properly imposed upon Cage the burden of proving that she would be disabled in the absence of drug addiction and alcoholism and the record supported the ALJ’s finding that she would not be disabled absent drug addiction and alcoholism. View "Cage v. Comm'r of Soc. Sec." on Justia Law

Hillyard suffered a head injury and was hospitalized for two weeks while serving in the U.S. Army. Hillyard filed a single claim for service connection for a mental condition, which he attributed to his in-service head injury. The Veterans Administration denied his claim and the Board affirmed and subsequently denied Hillyard’s request for revision. The Veterans Court affirmed. Hillyard later filed a second request for revision alleging clear and unmistakable error (CUE) by the Board in failing to consider and apply 38 U.S.C. 105(a) and 1111, a different CUE allegation from the one he made in his first request. The Board dismissed the second request for revision with prejudice, concluding 38 C.F.R. 20.1409(c) permitted only one request for revision to be filed. The Veterans Court affirmed. The Federal Circuit affirmed. The interpretation of Rule 1409(c) proffered by the VA is consistent with the language of the regulation and is in harmony with the VA’s description of the regulation in its notice of rule-making. View "Hillyard v. Shinseki" on Justia Law

Jewish Home of Eastern Pennsylvania (JHEP) provides nursing care to Medicare beneficiaries and is required to comply with the mandatory health and safety requirements for participation. JHEP must submit to random surveys conducted by state departments of health. In 2005, the Pennsylvania Department of Health conducted a survey that concluded that JHEP had eight regulatory deficiencies, including violations of 42 C.F.R. 483.25(h)(2), which requires a facility to ensure that each resident receives adequate supervision and assistance with devices to prevent accidents. Based on those deficiencies and those found in a 2006 survey, the Center for Medicare and Medicaid Services imposed fines totaling $17,150 and $12,800. JHEP claimed that the allegations of noncompliance were based on the inadmissible disclosure of privileged‖ quality assurance records and that the monetary penalties violated its right to equal protection because they were the product of selective enforcement based on race and religion. An ALJ upheld the fines against JHEP. The Third Circuit denied a petition for review. View "Jewish Home of E. PA v. Centers for Medicare and Medicaid Servs." on Justia Law

Applicants for and recipients of Medicaid home health Services claimed that the New York State Office of Temporary and Disability Assistance and the New York State Department of Health, violated their statutory right, enforceable under 42 U.S.C.1983, to an opportunity for Medicaid fair hearings. They claimed that this right, as construed by federal regulation, entitles them to “final administrative action” within 90 days of their fair hearing requests. The district court declared that “final administrative action” includes the holding of Medicaid fair hearings, the issuance of fair hearing decisions, and the implementation of any relief ordered in those decisions and permanently enjoined the state agencies to ensure that “final administrative action” implemented within 90 days of fair hearing requests. The Second Circuit affirmed in part, holding that the plaintiffs have a right to a Medicaid hearing and decision ordinarily within 90 days of their fair hearing requests, and that such right is enforceable under section 1983. The permanent injunction was, however, overbroad because “final administrative action” refers not to the implementation of relief ordered in fair hearing decisions, but to the holding of fair hearings and to the issuance of fair hearing decisions. View "Shakhnes v. Eggleston" on Justia Law

Appellant applied for Social Security benefits, alleging that he became unable to walk because of a disability in 2005. Appellant's claim was denied in 2008. The ALJ held a hearing at Appellant's request and determined that Appellant's impairments notwithstanding, Appellant had the capacity to perform light work with specified limitations. The ALJ then concluded that Appellant was not disabled as defined in the Social Security Act. The Ninth Circuit Court of Appeals affirmed the ALJ's determination, holding (1) the ALJ conducted a full and fair hearing; (2) the ALJ properly documented his analysis of Appellant's psychiatric impairments, and his analysis was supported by the record; and (3) the ALJ's interpretation of the medical evidence was supported by the record, as was his credibility determination. View "Chaudry v. Astrue" on Justia Law