Justia Public Benefits Opinion Summaries

Emard, age 33, was injured in a 2010 motorcycle accident. Emard had previously worked as a truck driver, assembler, and packager. He ceased working after the accident. His application for Social Security disability-insurance benefits claimed chronic low-back pain, chronic neck pain, cervical radiculopathy, lumbar radiculopathy, chronic migraine headaches, fatigue, mood swings, anxiety, and Crohn’s disease. An ALJ determined that Emard had not engaged in substantial gainful activity during his insured period; that Emard’s degenerative disc disease, asthma, obstructive sleep apnea, anxiety, and depression were severe impairments, but that his other conditions were mild impairments; that none of Emard’s impairments or any combination thereof met the criteria of any listed impairment; that Emard had the residual functional capacity to perform sedentary work; that Emard’s “subjective complaints exceed the available objective records,” particularly in light of Emard’s conservative course of treatment; that Emard could not perform past relevant work; and that Emard could perform jobs that existed in significant numbers in the national economy.The district court and Sixth Circuit affirmed the denial of benefits. The ALJ made no procedural error by declining to give weight to the opinion of a treating source offered after the claimant’s date last insured that did not relate back to the insured period. The ALJ complied with requirements to view Emard’s impairments in combination and to consider Emard’s ability to work on a sustained basis. View "Emard v. Commissioner of Social Security" on Justia Law

Until 2010, Reinaas, now in his mid‐fifties, worked as a machine operator. He injured his spine and tore his rotator cuff on the job, and underwent two neck fusion surgeries. Reinaas planned to return to work but continued to suffer from severe headaches (treated with hydrocodone), shoulder pain, and a decreased range of motion. A neurologist diagnosed him with cervicogenic headaches, and his family doctor diagnosed “long term nuchal headaches” and “[p]ermanent pain syndrome post cervical fusion.” Dr. Bodeau, a Mayo Clinic occupational physician, opined that Reinaas could not return to his factory job and suggested surgical intervention. In 2013, Reinaas had shoulder surgery and attended physical therapy; he took naproxen and Vicodin for pain.Reinaas applied for social security disability benefits. Benefits were denied after state‐retained physicians reviewed his records and concluded that Reinaas’s accounts of his symptoms were not fully credible. Dr. Bodeau opined that Reinaas had “deteriorated significantly” and was “highly unlikely to successfully regain employment at any physical demand level.” The ALJ concluded that Reinaas was not disabled. In determining Reinaas’s residual functional capacity, the ALJ afforded great weight to the opinions of the two non‐examining physicians and gave little weight to Dr. Bodeau’s opinion, explaining that Bodeau lacked knowledge of Social Security disability rules and that his report was based on subjective complaints of questionable credibility.The Seventh Circuit vacated. Substantial evidence does not support the ALJ’s decision to discount the treating physician’s opinion and the ALJ did not adequately evaluate Reinaas’s subjective complaints. View "Reinaas v. Saul" on Justia Law

This case involved an obligor father who never missed a child support payment to the obligee, mother for their minor child. The father retired and began collecting Social Security retirement benefits. As a result, the child became eligible to receive a derivative monthly children’s insurance benefit (CIB) from the Social Security Administration (SSA). The mother received four years of CIB payments in addition to regular monthly child support payments from the obligor; the law allowed the CIB payments to be credited against the child support obligation. However, neither parent notified the Alaska Department of Revenue, Child Support Services Division (CSSD) that they were receiving CIB payments for their daughter. After four years of overpayments, CSSD discovered the CIB payment from SSA and credited the father more than $47,000 in child support overpayment. The father filed suit, asking the superior court for a judgment against the mother for overpaid child support. He also requested reimbursement or credit for overpaid health insurance premiums. The superior court denied reimbursement for either overpayment, and the father appealed. After review, the Alaska Supreme Court affirmed, finding no reversible error in the superior court's judgment. View "Rosenbaum v. Shaw" on Justia Law

The Fifth Circuit affirmed the district court's denial of a parent's motion for summary judgment against the school district for alleged procedural and substantive violations of the Individuals with Disabilities Education Act (IDEA). The court held that the district court did not err in finding that the parent failed to meet her burden of showing that the school district violated the procedural requirements of the IDEA. In this case, none of the incidents the parent claimed amounted to a procedural violation and the court was not convinced that the student was denied a free and appropriate public education.The court also held that there were no substantive IDEA violations. The court was satisfied that the school district took the necessary steps to ensure that the student was being properly serviced under this individualized education plan, despite his absences. Accordingly, the court affirmed the district court's grant of the school district's motion for summary judgment. View "A. A. v. Northside Independent School District" on Justia Law

The Supreme Court affirmed the judgment of the trial court enjoining the application of Arizona statutes authorizing the recording of liens against third-party tortfeasors to allow hospitals to recover health care costs for Medicaid patients beyond the amounts provided by Medicaid, holding that the statues are preempted to the extent hospitals utilize them against third-party tortfeasors for "balance billing" to recover costs beyond Medicaid reimbursement.Plaintiffs were patients who were treated at defendant hospitals under the state's contract provider for the federal Medicaid program, which negotiates reimbursement rates with hospitals. Defendants recorded liens against the third-party tortfeasors who caused the patients' injuries in order to recover the remainder of their fees exceeding Medicaid reimbursement. Plaintiff brought this class action challenging the liens, arguing that Ariz. Rev. Stat. 33-931(A) and 36-2903.01(G)(4) (the lien statutes) were preempted by federal Medicaid law. The trial court enjoined application of the lien statutes. The Supreme Court affirmed, holding (1) Plaintiffs had a private right of action to challenge the lien statutes; and (2) the lien statutes are unconstitutional as applied. View "Ansley v. Banner Health Network" on Justia Law

The Eighth Circuit affirmed the denial of social security disability benefits to plaintiff, holding that substantial evidence supported the ALJ's residual functional capacity (RFC). The court held that the ALJ's finding that plaintiff can perform frequent but not constant grasping, handling, and fingering with her right arm is supported by substantial evidence. View "Pemberton v. Saul" on Justia Law

In 2011, K.G., age 48, received an influenza vaccination in advance of knee replacement surgery. Over the next several months, she experienced increasingly severe nerve pain in her hands, arms, feet, and legs; she succumbed to alcoholism, spent months in the hospital, and developed amnesia. In 2014, an Iowa state court declared K.G. incapable of caring for herself and, against K.G.’s will, appointed K.G.’s sister as her guardian. K.G. regained her mental faculties by May 2016. She then retained an attorney who filed her claim under the National Childhood Vaccine Injury Act, 42 U.S.C. 300aa-1. A Special Master held that equitable tolling was not available during the period that K.G.’s sister acted as K.G.’s guardian and dismissed K.G.’s claim as not timely filed within the three-year statute of limitations. The Federal Circuit vacated. Equitable tolling is available in Vaccine Act cases and the appointment of a legal guardian is only one factor a court should consider when deciding whether equitable tolling is appropriate in a particular case. K.G. was not required to argue the legally irrelevant question of whether she personally was diligent while she was mentally competent and she preserved her argument that her legal representative exercised reasonable diligence under the circumstances. The Special Master erred in adopting a per se rule. View "K.G. v. Secretary of Health and Human Services" on Justia Law

Arthur Noreja appeals the denial of his claim for disability benefits. Noreja filed his disability claim in March 2012. In July 2013, following a hearing, an ALJ issued a detailed written order – exceeding 13 pages with single spacing – in which she denied Noreja’s claim. The ALJ found Noreja had several severe impairments, including “arthritis of the left upper extremity and right lower extremity,” “cognitive disorder,” and “headaches.” Nevertheless, the ALJ determined that these impairments (or a combination of the impairments) did not warrant relief. The ALJ found that Noreja had the residual functional capacity (“RFC”) to do “medium” work, subject to various limitations, and that there were “jobs that exist in significant numbers in the national economy” which Noreja could perform. The Appeals Council disagreed with the ALJ’s assessment, and remanded with direction for further proceedings. Once more, however, the ALJ determined that Noreja did not have “an impairment or combination of impairments” that warranted relief, reiterated that Noreja had the RFC to do "medium" work, subject to various limitations, and that there were jobs in existence "in significant numbers" which Noreja could perform. The ALJ did not obtain a new consultative mental examination before issuing her May 2016 decision, but she procured additional evidence regarding Noreja’s impairments. On appeal of the second ALJ decision, Noreja alleged the ALJ failed to follow an instruction in the Appeals Council's remand order. The Tenth Circuit held: (1) it had jurisdiction to determine whether an alleged ALJ violation of an Appeals Council order warranted reversal; but (2) the Court's “usual” review standards remained in force, meaning that the alleged violation was material only if it showed the ALJ meaningfully failed to apply the correct legal standards, or the denial of benefits was unsupported by substantial evidence; and (3) applying those standards here, the ALJ’s denial of Noreja’s application had to be affirmed. View "Noreja v. Commissioner, SSA" on Justia Law

Care Alternatives provides hospice care to New Jersey patients, employing “interdisciplinary teams” of registered nurses, chaplains, social workers, home health aides, and therapists working alongside independent physicians who serve as hospice medical directors. Former Alternatives employees filed suit under the False Claims Act, 31 U.S.C. 3729–3733 alleging that Alternatives admitted patients who were ineligible for hospice care and directed its employees to improperly alter those patients’ Medicare certifications to reflect eligibility. They retained an expert, who opined in his report that, based on the records of the 47 patients he examined, the patients were inappropriately certified for hospice care 35 percent of the time. Alternatives’ expert testified that a reasonable physician would have found all of those patients hospice-eligible. The district court determined that a mere difference of opinion between experts regarding the accuracy of the prognosis was insufficient to create a triable dispute of fact as to the element of falsity and required that the plaintiffs provide evidence of an objective falsehood. Upon finding they had not adduced such evidence, the court granted Alternatives summary judgment. The Third Circuit vacated, rejecting the objective falsehood requirement for FCA falsity. The plaintiffs’ expert testimony created a genuine dispute of material fact as to falsity. View "Druding v. Care Alternatives" on Justia Law

Under the GI Bill, the VA provides monetary benefits to veterans enrolled in “approved” “course[s] of education,” 38 U.S.C. 3483. Approval must be provided by the state approving agency (SAA) for the state where the educational institution is located. For online courses, the educational institution must obtain approval from the SAA where the institution’s “main campus” is located. The VA may discontinue educational assistance, after following certain procedures, if this requirement is not met. Ashford is a for-profit educational institution that provides online courses to veterans and others. In November 2017, the VA sent a Cure Letter to Ashford stating that Ashford’s online courses were not approved by the correct SAA, expressing its “inten[t] to suspend payment of educational assistance and suspend approval of new enrollments and re-enrollments [for Ashford’s online programs] in 60 days unless corrective action is taken.” The Letter noted the availability of a hearing before the Committee on Educational Allowances. Ashford sought review, contending that the Cure Letter “announces” new “rules” and that 38 U.S.C. 502 provided the court with jurisdiction to review those alleged rules. The Federal Circuit dismissed the petition, finding that the Cure Letter is not rulemaking or any other reviewable action; it is also not a final agency action under the Administrative Procedure Act. View "Ashford University, LLC v. Secretary of Veterans Affairs" on Justia Law