Justia Public Benefits Opinion Summaries

The Ninth Circuit reversed the district court's grant of summary judgment in favor of Agendia in an action alleging that the HHS wrongfully denied its claims for reimbursement for diagnostic tests under the Medicare health insurance program. Agendia contends that the denial was improper because the local coverage determination was issued without notice and opportunity for comment in violation of a provision of the Medicare Act—specifically, 42 U.S.C. 1395hh.The panel held that section 1395hh's notice-and-comment requirement does not apply to local coverage determinations, and that the district court erred in interpreting the statute otherwise. The panel rejected Agendia's alternative argument that the Medicare Act and its implementing regulations have unconstitutionally delegated regulatory authority to Medicare contractors by permitting them to issue local coverage determinations. The panel held that, because those contractors act subordinately to the HHS officials implementing Medicare, there is no unconstitutional delegation. View "Agendia, Inc. v. Becerra" on Justia Law

Tadlock served in the Army, 1982-2003, including service in the Persian Gulf. In 2010, he suffered a pulmonary embolism (PE) that resulted in a heart attack. Tadlock sought presumptive service connection under 38 U.S.C. 1117, which refers to a “qualifying chronic disability” for veterans who served in the Persian Gulf War. The regulations limit the definition of “qualifying chronic disability” to one that, “[b]y history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis.” Tadlock underwent a final medical examination by a VA physician, who explained that Tadlock’s PE “is not an undiagnosed illness.” The Board of Veterans Appeals based its denial of service connection on that opinion.Neither the Board nor the examiner made any finding that Tadlock’s condition was not a “medically unexplained chronic multisymptom illness” (MUCMI). Tadlock contended that the statute expressly includes both “an undiagnosed illness” and a MUCMI. The Veterans Court found that Tadlock's PE was "not characterized by overlapping signs and symptoms and unique features ... and disproportional disability when compared with physical findings.” It held that "any error in the Board decision regarding whether his diagnosed illness could count as a MUCMI is harmless.”The Federal Circuit vacated. The Veterans Court exceeded its authority in making a fact-finding in the first instance that Tadlock’s illness did not qualify as a MUCMI because of a lack of overlapping symptoms. The Veterans Court’s jurisdiction to consider prejudicial error does not give it the right to make de novo findings of fact or otherwise resolve matters that are open to debate. View "Tadlock v. McDonough" on Justia Law

The Ninth Circuit affirmed the district court's preliminary injunction ordering E.E.'s current educational placement as his "stay put" placement during the pendency of judicial proceedings in a suit brought under the Individuals with Disabilities Education Act (IDEA).The panel concluded that the ALJ acted without legal authority in determining that E.E.'s potential future placement in the 2020 individualized education plan (IEP) constituted his current placement for purposes of E.E.'s stay put placement. Therefore, because the ALJ acted ultra vires, her stay put determination was void. Consequently, the parents' stay put motion did not seek to modify an existing stay put order, so the district court correctly entered an automatic preliminary injunction pursuant to Joshua A. v. Rocklin Unified Sch. Dist., 559 F.3d 1036, 1037 (9th Cir. 2009). Furthermore, the school district's proposed exception to the stay put provision is not supported by either the text of the IDEA or any other legal authority, and the panel declined to adopt it. View "E.E. v. Norris School District" on Justia Law

The Eighth Circuit reversed the district court's decision affirming the ALJ's termination of plaintiff's disability insurance benefits and supplemental security income, because substantial evidence does not support the termination of benefits. In this case, plaintiff alleged that her disability began in July 2012 due to degenerative disc disease (DDD), bulging disc, irritable bowel syndrome, depression, anxiety, bipolar disorder, and post-traumatic stress disorder (PTSD).The court concluded that substantial evidence on the record as a whole does not support the finding that plaintiff's pain significantly improved to the point where she would no longer miss two days or more of work per month. In this case, the ALJ erroneously discounted plaintiff's allegations regarding her pain and also erroneously discounted other physicians' opinions. Finally, the court concluded that substantial evidence did not support the residual functioning capacity finding. The court remanded with instructions to return the case to the Social Security Administration for a new medical-improvement evaluation. View "Koch v. Kijakazi" on Justia Law

Butler, age 51, worked in the past as a millwright and machine repair maintenance worker. He stopped working, claiming he was disabled as of November 4, 2015, because of severe impairments stemming from a stroke, seizures, and heart disease and that he is unable to perform his prior occupation. Butler’s claim for disability insurance benefits under the Social Security Act, 42 U.S.C. 401–433, was denied by the Administrative Law Judge (ALJ) following a hearing. The Appeals Council declined to review the denial.The Seventh Circuit affirmed, upholding the ALJ’s determination that Butler was capable of doing light work with some restrictions, and that a sufficient number of such jobs existed that he could perform. Butler has limitations that precluded a determination that he could either perform all light work or perform none. The ALJ clearly recognized that Butler was in the category of persons closely approaching advanced age and appropriately considered that factor as well as Butler’s exertional and non-exertional residual capacity in consulting a vocational expert. View "Butler v. Kijakazi" on Justia Law

Rudisill served three periods of active duty military service: 2000-2002 in the Army (30 months); 2004-2005 in the Army National Guard (18 months); and 2007-2011 as a commissioned Army officer (45 months). He received 25 months and 14 days of education benefits under the Montgomery GI Bill (MGIB), 38 U.S.C. 3011(a), for completion of his college degree. After his third period of Army service, he applied for education benefits under the Post-9/11 GI Bill, 38 U.S.C. 3311, for a graduate program. The VA determined that he was entitled to the Post-9/11 benefits, but only for the remaining 10 months and 16 days of the 36 months authorized for Montgomery benefits. The Board of Veterans’ Appeals agreed.The Veterans Court reversed. A veteran is entitled to education benefits for each of his periods of separately qualifying service and is entitled to the aggregate cap of 48 months of benefits. The Federal Circuit affirmed. The legislation explicitly provides additional benefits to veterans with multiple periods of qualifying service, whereby each period of service qualifies for education benefits: “The aggregate period for which any person may receive assistance under two or more of the provisions of law listed below may not exceed 48 months,” 38 U.S.C. 3695(a). This provision has been in each GI Bill since at least 1968. View "Rudisill v. McDonough" on Justia Law

The Second Circuit affirmed the district court's judgment, which (A) declared the Board to be in violation of the Individuals with Disabilities Education Act (IDEA) for denying a free appropriate public education (FAPE) to disabled students between the ages of 21 and 22 while providing a free public education to nondisabled students in the same age range, and (B) permanently enjoined the Board and its successors, employees, and agents, etc., from terminating, on the basis of age, FAPEs for plaintiff class members who have not received a regular high school diploma before they reach the age of 22.The court concluded that the original plaintiff, D.J., had standing to bring the action where D.J. received ten months less of special education than he would have if not for the Board's enforcement of the challenged state regulation, thereby demonstrating injury for purposes of Article III standing. Furthermore, D.J.'s standing was entirely traceable to the Board's enforcement of the regulations at issue and the injury could be redressed by judicial action. On the merits, the court concluded that the district court did not abuse its discretion in interpreting the IDEA term "public education" to encompass free adult education programs offered by the State of Connecticut. The court considered all of the Board's arguments on appeal and found them to be without merit. View "A.R. v. Connecticut State Board of Education" on Justia Law

Plaintiff, an applicant for Social Security Income benefits, appeals the district court's judgment denying her motion for an extension of time to file an appeal pursuant to Federal Rule of Appellate Procedure 4(a)(5). Plaintiff contends that because of her mental impairments, she established both "good cause" and "excusable neglect" under Rule 4(a)(5) for her failure to file a timely appeal.The Second Circuit concluded that "excusable neglect," rather than "good cause," is the appropriate standard for evaluating plaintiff's claim because her failure timely to appeal was at least in part due to her own inadvertence. The court explained that, in evaluating claims of "excusable neglect" under Rule 4(a)(5), courts consider the four factors set forth by the Supreme Court in Pioneer Investment Services Company v. Brunswick Associates Limited Partnership, 507 U.S. 380 (1993): the risk of prejudice to the non-movant; the length of the movant's delay and its impact on the proceedings; the reason for the delay, including whether it was within the movant's reasonable control; and whether the movant acted in good faith.In this case, the district court did not abuse its discretion in applying these factors to plaintiff's claim and concluding that she failed to demonstrate excusable neglect. The court explained that because plaintiff's untimely appeal was caused by her failure to maintain contact with her attorney—a factor within her reasonable control—she failed to establish excusable neglect under the Pioneer test. While plaintiff attributes her delay to her mental illness, which she argues is beyond her control, the court determined that the record does not compel the conclusion that her impairments as opposed to her neglect caused her failure timely to appeal. Accordingly, the court affirmed the district court's judgment. View "Alexander v. Saul" on Justia Law

A.B., a 40-year-old male diagnosed to suffer from severe schizophrenia, has been subject to conservatorships on and off for 20 years. A.B. has no real property or significant assets; his only income is $973.40 in monthly social security benefits. The public guardian was most recently appointed as A.B.’s conservator in 2016 and reappointed annually until the dismissal of the conservatorship in 2019. In August 2017, the public guardian was awarded $1,025 and county counsel was awarded $365 in compensation for services rendered 2016-2017. In 2018, the court entered an order for compensation for the public guardian and county counsel in the same amounts covering 2017-2018. The public guardian sought compensation for services rendered 2018-2019, $1,569.79 for its services, and $365 for county counsel.The court found that the request for compensation was just, reasonable, and necessary to sustain the support and maintenance of the conservatee, and approved the petition, again ordering the public guardian to defer collection of payment if it determined that collection would impose a financial hardship on the conservatee. The court of appeal reversed. While the court had sufficient information before it to enable consideration of the factors enumerated in Probate Code section 2942(b), the court failed to do so and improperly delegated responsibility to the public guardian to defer collection. View "Conservatorship of A.B." on Justia Law

Kaplarevic filed for disability insurance benefits in 2012, alleging that he became disabled on August 1, 2012. His “date last insured” was December 31, 2014, meaning that if his disability arose any later than that, he would not be eligible for benefits.The Seventh Circuit affirmed the denial of benefits, rejecting Kaplarevic’s arguments that an ALJ improperly considered his own observations of Kaplarevic’s physical condition and ability to perform certain physical tasks at a 2018 hearing. Kaplarevic sought an open-ended period of disability so he needed to show that he became disabled before his date last insured and that he was still disabled. The court noted the ALJ’s 15-page opinion, which evaluated extensive medical and behavioral evidence. It was Kaplarevic’s burden to show disability, and if he wanted to do so, he should have accepted the ALJ’s invitation “to identify the portions of the medical records that he believed supported various of [his] allegations.” Vague references to the “totality of the evidence” are not helpful. The ALJ’s opinion did not rely on the failure to seek treatment as a factor demonstrating lack of disability; the record showed that Kaplarevic did not comply with prescribed therapy and that his pain complaints were not consistent with objective medical findings. View "Kaplarevic v. Saul" on Justia Law