Justia Public Benefits Opinion Summaries

A psychologist challenged the government's claim that he had over-billed Medicare and owed the government more than $600,000 in overpayments. At a hearing on the claim, the doctor presented extensive evidence, but the government neither appeared nor presented argument or advocacy, either written or in person. The ALJ concluded that the overpayment was actually $5,434.48. The doctor moved, under the Equal Access to Justice Act, 5 U.S.C. 504(a)(1), to recoup tens of thousands of dollars in attorneys' fees and expenses incurred in fighting the claim. His request was denied by an administrative appeals council and the district court based on their conclusion that the hearing before the ALJ was not an adversary adjudication, as is required for a fee award under the EAJA. The Third Circuit affirmed denial, finding that the government did not engage in purposeful advocacy.View "Handron v. Sec'y of Health & Human Servs." on Justia Law

Donnellan served in the National Guard from 1969 until 2000. In 1996, a portion of his sigmoid colon was removed as treatment for colon cancer. In March 1998, after diagnosis of acquired polyposis, he had a total colectomy. While on active duty for training in May-June 1998, he became ill and underwent emergency surgery to remove a portion of his small intestine because of a small bowel perforation. After surgery, his doctors treated a small bowel fistula. The DVA denied a service connection to ensuing complications. In 2007, the Board of Veterans’ Appeals denied benefits, finding by clear and unmistakable evidence that Donnellan’s disease and ensuing complications did not increase in severity beyond natural progression during his period of active duty for training. The Veterans Court remanded, holding that the statutory presumption of aggravation does not apply to an increase in the degree of a disability suffered by a member of the National Guard while on active duty for training who is not a veteran under 38 U.S.C. 101(2) and that his doctor’s medical opinion did not satisfy the Board’s instructions on remand. The Federal Circuit dismissed an appeal. The Veterans Court’s remand order is not a final decision. View "Donnellan v. Shinseki" on Justia Law

For 20 years, George was a clerk-magistrate. In 1995, he was charged with conspiracy to commit honest-services wire fraud, 18 U.S.C. 371, 1343, 1346 for selling blank search warrants, used to commit robberies. George entered a plea for a sentence of 20 months and a $10,000 fine. George retired before his plea and began receiving a monthly benefit of $1,424.91, plus health-care. In 2003, the state retirement board suspended benefits; his attorney had advised him that he would remain eligible if he started receiving benefits before he entered a plea. The district court denied his petition for a writ of error coram nobis. The First Circuit affirmed. The Board authorized recoupment of benefits in excess of contributions. In 2010, the Supreme Court held that "intangible right of honest services," in 18 U.S.C. 1346, would be unconstitutionally vague unless limited to schemes involving bribes or kickbacks. George’s second petition was denied. The court found that, in light of Skilling, a fundamental error had occurred, but that cessation of benefits did not constitute a continuing collateral consequence sufficient to justify the remedy. The First Circuit affirmed, referring to a “Hail Mary pass.” A court has discretion to withhold the remedy where the interests of justice dictate.View "United States v. George" on Justia Law

This case addressed the effect of a pooled special-needs trust created by an over-65-year-old beneficiary on his medicaid benefits. The Center for Special Needs Trust Administration appealed a summary judgment in favor of the North Dakota Department of Human Services. Invoking 42 U.S.C. 1983 and the Constitution's Supremacy Clause, the Center alleged that North Dakota's demand for reimbursement and its state regulations violated a paragraph of the Medicaid Act, 42 U.S.C. 1396p(d)(4)(C). The court held that the district court properly determined that section 1396p(d)(4)(C) afforded the Center a right of action under section 1983; that North Dakota did not waive its claim to recover for reimbursements and should not be estopped from making that claim; that the Center's claim was without merit; and that preemption did not apply. View "Center for Special Needs, etc. v. Olson, etc." on Justia Law

Plaintiffs, parents of children who were eligible to receive a free and appropriate public education, filed suit to challenge the exclusion of mapping of cochlear implants from the regulatory definition of "related services" under the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1401(26)(B). The court concluded that the phrase "audiology services" as used in the IDEA's "related services" definition did not unambiguously encompass mapping of cochlear implants. The court also found that the Mapping Regulations embodied a permissible construction of the IDEA because they were rationally related to the underlying objectives of the IDEA. The court further found that the Mapping Regulations did not substantially lessen the protections afforded by the 1983 regulations. Because the Department's construction of its own regulation was neither plainly erroneous nor inconsistent with the regulation, the court owed it deference. Accordingly, the court affirmed the district court's grant of summary judgment to the Department. View "Petit, et al. v. US Dept. of Education, et al." on Justia Law

In 1992, at age 57, Navy veteran who served on active duty during the Korean Conflict began receiving pension benefits under 38 U.S.C. 1521(a) for non-service connected disabilities. He had a combined disability rating of 80% based on prostate cancer, osteoarthritis of both knees, glaucoma/cataracts, hypertension, hyperthyroidism, and major depressive disorder. The disabilities rendered him "permanently and totally disabled." In 2006, he applied for an enhanced pension under the special monthly rate (38 U.S.C. 1521(e)), seeking consideration for housebound status because he was older than 65 years of age and had a disability rating of more than 60%. The regional office denied the claim because he had received a pension under section 1521 before turning 65. The Board of Veterans’ Appeals denied an appeal. The Veterans Court reversed and remanded. The Federal Circuit reversed and remanded, overruling Veterans Court’s interpretation of 38 U.S.C. 1513(a) in Hartness v. Nicholson (2006). Veterans applying for special monthly pension benefits under section 1521(e) should be on equal footing regardless of when they apply for a pension, i.e., whether the veteran applies before or after turning 65 years old.View "Chandler v. Shinseki" on Justia Law

Plaintiff appealed the district court's decision affirming the Commission's denial of her application for disability insurance benefits and supplemental security income under the Social Security Act (SSA), 42 U.S.C. 301 et seq. The court held that the ALJ did not err in weighing the evidence as she did or finding that plaintiff's testimony regarding the severity of her impairment was not credible. Although the ALJ erred in failing to give germane reasons for rejecting the lay witness testimony, such error was harmless given that the lay testimony described the same limitations as plaintiff's own testimony, and the ALJ's reasons for rejecting plaintiff's testimony applied with equal force to the lay testimony. Applying the principles set forth in the court's social security cases, as well as in Shinseki v. Sanders, the court upheld the ALJ's decision as supported by substantial evidence. View "Molina v. Astrue" on Justia Law

Petitioner, then 45 years old and having previously worked in a factory and as a health aid, applied for disability benefits in 2004, claiming an onset date in 2004. Her conditions include peripheral vascular disease, chronic obstructive pulmonary disease, osteoarthritis, obesity, vascular dementia, depression, panic disorder, and anxiety. The Social Security Appeals Council denied review of the ALJ's adverse decision. The Seventh Circuit reversed and remanded. The ALJ failed to adequately consider petitioner's mental impairments, her obesity, and several of her physical problems. View "Arnett v. Astrue" on Justia Law

This appeal arose from the district court's order granting final judgment to the United States upon equitable claims of payment by mistake of fact and unjust enrichment against Tuomey arising out of alleged violations of the Social Security Act, 42 U.S.C. 1395nn, (the Stark Law), and awarding damages plus pre- and post-judgment interest. Because the court concluded that the district court's judgment violated Tuomey's Seventh Amendment right to a jury trial, the court vacated the judgment and remanded for further proceedings. Because the court was remanding the case, the court also addressed other issues raised on appeal that were likely to recur upon retrial. View "Drakeford v. Tuomey Healthcare System" on Justia Law

Federal employees are entitled up to 15 days each year of military leave to attend training as a member of a reserve of the armed forces or National Guard. 5 U.S.C. 6323(a)(1). The Federal Circuit held that federal agencies cannot charge military leave on non-workdays. Duncan worked as a civilian for the Air Force until his retirement in 2005. From 1980 to 1998, he was also in the Air Force Reserve and performed 12 days each year of active duty plus additional duty for training. In 2009, he filed a claim with the Merit Systems Protection Board, alleging that the Air Force had charged his leave on non-workdays in violation of the Uniformed Services Employment and Reemployment Rights Act of 1994, seeking compensation for six days. An Administrative Law Judge granted the request, finding Duncan's recollection credible. The Board reversed, holding that it requires more than personal recollection and reliance on military documents. The Federal Circuit affirmed. The record did not show that all corroborating evidence was unavailable. View "Duncan v. Dep't of the Air Force" on Justia Law