Justia Public Benefits Opinion Summaries

Sellers served in the Navy in 1964-1968, and in the Army, 1981-1996. He suffers from major depressive disorder (MDD). Sellers has a 2009 effective date for his disability benefits. He seeks an effective date of March 1996, the date of his formal claim seeking compensation for specific injuries to his leg, knee, back, finger, and ears. On his application, under “Remarks,” Sellers wrote “Request for s/c [service connection] for disabilities occurring during active duty service.” Sellers contends that the law in effect in 1996 requires his remarks to be understood as a claim for compensation for his MDD, although his claim in no way refers to MDD. The Veterans Court agreed with Sellers. The Secretary of Veterans Affairs challenged that decision.The Federal Circuit reversed, finding that Sellers is not entitled to an earlier effective date. A legally sufficient formal claim must identify, at least at a high level of generality, the current condition upon which the veteran’s claim is based. The Secretary’s duty to assist begins upon receipt of a formal claim that identifies the medical condition for which benefits are sought, which triggers the Secretary’s duty to obtain the veteran’s medical records, 38 U.S.C. 5103A(c)(1)(A), and then to fully develop the stated claim. Until the Secretary comprehends the condition on which the claim is based, the Secretary does not know where to begin to develop the claim. View "Sellers v. Wilkie" on Justia Law

Jones served on active duty with the Army in 1967-1974 and in the Army National Guard in 1987-1990. In 1994, he sought disability benefits for a nervous disorder and a leg wound. A VA regional office granted service connection for a leg scar but found that disability non-compensable and denied the claim for a nervous condition. Jones did not appeal. In 2002, Jones filed a request to reopen his claim, asserting that he was assaulted by muggers while stationed in Germany, which resulted in his developing PTSD. The regional office denied his request. In 2008, the Board of Veterans’ Appeals granted the request to reopen, directing the regional office to obtain additional information from two individuals with knowledge of the assault. In 2010, the regional office granted Jones service connection for PTSD and a schizoaffective disorder, with a 100% disability rating effective from October 2002, when he sought to reopen his claim. Jones sought to have the effective date made retroactive to 1994. In 2016, after Jones’s death, the Board held that the effective date was 2002. The Veterans Court and the Federal Circuit affirmed, citing 38 C.F.R. 3.156(c); the decision in Jones’s favor was based on evidence created in 2003 and 2008, which did not exist in 1994. View "Jones v. Wilkie" on Justia Law

The Eighth Circuit affirmed the denial for disability insurance benefits and supplemental security income to plaintiff. The court held that the ALJ properly weighed the opinions of medical professionals, including a physician's assistant, and gave partial weight to the opinion of a certain medical expert. The court also held that sufficient evidence in the record supported the ALJ's decision, including clinical notes that plaintiff lost weight from moving around so much, left a clinical appointment with a brisk walk and no cane, and stated he was doing well after a total hip replacement. Finally, the court held that a hypothetical question given to the vocational expert captured the concrete consequences of plaintiff's impairments, and the court need not consider plaintiff's Appointments Clause challenge. View "Hilliard v. Saul" on Justia Law

In this case requiring the Supreme Court to determine the scope of the authority of the Wisconsin Department of Health Services (DHS) to recoup payments made to Medicaid service providers the Supreme Court held that DHS does not have the authority to enforce its recoupment policy.Plaintiffs, Kathleen Papa and Professional Homecare Providers, Inc. (collectively, PHP), challenged DHS's recoupment policy as it had been enforced against PHP nurses to recover payments made for services they provided to Medicaid patients. PHP claimed that DHS recoups payments nurses earned and received for their Medicaid services because the nurses' supporting records contained documentation shortcomings. The Supreme Court held (1) DHS may recoup Medicaid payments from service providers only in cases where DHS cannot verify certain facts; and (2) DHS's recoupment policy exceeds its authority. View "Papa v. Wisconsin Department of Health Services" on Justia Law

Hargett, born in 1965, has a high-school education and previously worked as a semi-truck driver, municipal worker, maintenance mechanic, and industrial cleaner. He last worked in March 2015. Hargett applied for disability insurance benefits; he had high blood pressure, type-two diabetes, curvature of the spine, and COPD. Hargett’s primary care physician, Lucardie, referred Hargett to a physical therapist for a functional capacity evaluation (FCE), which indicated that Hargett had a maximum lifting capacity of 35 pounds and maximum carrying capacity of 20 pounds--the “medium strength” category-- but that Hargett could continuously stand for no more than five minutes; could continuously walk for no more than 0.1 miles; could never balance while standing, crouching, or walking; and could never crouch, stoop, or crawl. Lucardie reviewed and signed the FCE.An ALJ denied Hargett’s claim, finding that Hargett retained the residual functional capacity to perform light work. The ALJ gave only “partial weight” to the FCE, discounting its indication that Hargett’s ability to stand or walk did not meet any standard for work activity. The Sixth Circuit vacated. The ALJ should have considered the FCE as a treating-source opinion, which, in 2015, had to be given controlling weight if “well-supported by medically acceptable clinical and laboratory diagnostic techniques” and “not inconsistent with the other substantial evidence.” The error was not harmless. View "Hargett v. Commissioner of Social Security" on Justia Law

The Eighth Circuit reversed the district court's dismissal of a petition for review of the Commissioner's denial of plaintiff's application for disability insurance benefits and supplemental security income. The court held that, although the record provides ample support for determinations regarding the severity and limiting effect of most of plaintiff's impairments, further development is required as to the functional limitations on walking and standing. Therefore, the court remanded for further proceedings. View "Noerper v. Saul" on Justia Law

The Supreme Court reversed the decision of the court of appeals affirming the order of the district court that non-homestead life estates should not be included in Marvin Schmalz's assets, holding that the term "individual" in Minn. Stat. 256B.056, subd. 4a applies only to the applicant for medical assistance.Esther Schmalz was living at a long-term-care facility when she submitted an application for medical assistance for long-term-care benefits. As part of the assessment of her husband Marvin's assets, Renville County Human Services (RCHS) included Marvin's portion of several non-homestead life estate interests that he and Esther owned. Esther appealed, arguing that the life estates should not be included in the total amount of assets that Marvin may retain. The human services judge concluded that RCHS properly denied Esther's application for medical assistance based on the inclusion of the life estate assets owned by Marvin. The Commissioner of Minnesota Department of Human Services adopted the human services judge's recommendation. The district court concluded that the non-homestead life estates should not be included in Marvin's assets, ruling that the term "individual" in section 256B.056, subd. 4a included Marvin. The Supreme Court reversed, holding that an "individual" in the statute refers to the medical assistance applicant and not a community spouse. View "In re Schmalz" on Justia Law

In July 2010, L.M. was born at full-term and developed normally for six months. In February 2011, L.M. received childhood vaccines, including the diphtheria-tetanus-acellular pertussis vaccination. By that evening, L.M. had a fever, was lethargic, had poor muscle tone, and would not eat., Any disturbance caused L.M. to scream. L.M. began to have several seizures a day. At seven years of age, L.M. could crawl and walk with the assistance of a walker. She had a poorly coordinated grasp, suffered cortical visual impairments, and was nonverbal, though she could use a few signs to express ideas such as “yes,” and “no.” Testing revealed that L.M. had a genetic mutation.In a claim under the National Vaccine Injury Compensation Program, L.M. alleged that the vaccinations administered to L.M. in February 2011, significantly aggravated L.M.’s pre-existing condition under two alternative theories. The Special Master denied the petition, finding that L.M.’s genetic mutation was “the most compelling explanation for her predisposition to develop a seizure disorder.” The Federal Circuit affirmed the denial of an “on-table” claim, finding no support for an argument that most encephalopathies do not become acute until after vaccination. The court vacated and remanded the denial of an “off-table” claim, which requires determining whether the child’s receipt of vaccinations significantly aggravated her seizure disorder in the face of an underlying genetic mutation. View "Sharpe v. Secretary of Health and Human Services" on Justia Law

The Eleventh Circuit affirmed the denial of social security disability benefits to plaintiff. The court rejected plaintiff's claim that the ALJ erred in finding that plaintiff was not disabled because the ALJ failed to appropriately consider the VA's determination that plaintiff was unable to work due to a disability and thus entitled to veterans' benefits. Rather, the court held that the ALJ's decisions demonstrates that he considered the VA's determination. The court also held that substantial evidence, including recent medical records that postdate the VA's decision, supported the ALJ's rejection of the VA's disability decision as determinative of whether plaintiff was disabled for Social Security purposes. View "Noble v. Commissioner of Social Security" on Justia Law

In this class action, the Supreme Court reversed the judgment of the court of appeals affirming the common pleas court's decision to certify the class, holding that the common pleas court lacked subject matter jurisdiction over the class action for the named and prospective class plaintiffs whose claims for recovery fell within the express language of Ohio Rev. Code 5160.37.The class action sought a declaratory judgment that former Ohio Rev. Code 5101.58 relating to Medicaid reimbursements is unconstitutional. The action further sought to recover all sums paid to the Ohio Department of Medicaid (Department) under section 5101.58. Plaintiff moved to certify as a class all persons who paid any amount to the Department pursuant to the statute from April 6, 2007 to the present. The trial court certified the class. The court of appeals affirmed. The Supreme Court reversed, holding (1) section 5160.37 now provides the sole remedy for Medicaid program participants to recover excessive reimbursement payments made to the Department on or after September 29, 2007; and (2) therefore, the common pleas court lacked jurisdiction over the claims asserted by Plaintiffs. View "Pivonka v. Corcoran" on Justia Law