Justia Public Benefits Opinion Summaries

The Eighth Circuit affirmed the denial of plaintiff's application for supplemental security income, holding that substantial evidence supported the ALJ's determination that plaintiff had only a moderate restriction on his activities of daily living. In this case, while the ALJ could have weighed the evidence differently, substantial evidence supported the ALJ's determination that the psychological expert's review of all the evidence should be credited over the counselor's observations as a non-medical, other source. View "Dols v. Saul" on Justia Law

A 1941 Executive Order, ordered into the service of the U.S. armed forces all of the organized military forces of the Philippines, a U.S. territory. Various Filipino military organizations and more than 100,000 members of the Philippine Commonwealth Army served the U.S. during World War II. After the war, Congress passed Surplus Appropriation Rescission Acts, 38 U.S.C. 107, providing that service in these Filipino military organizations “shall not be deemed to have been active military, naval, or air service.” Filipino veterans were not eligible for the same benefits as U.S. veterans. The American Recovery and Reinvestment Act of 2009, 123 Stat. 115, 200–02, established a $198 million fund to provide one-time payments to Filipino veterans: $15,000 for U.S. citizens and $9,000 for non-citizens. The statute required Filipino veterans to apply for this payment within one year of the statute’s enactment. The VA required that the relevant service department verify the veteran’s service. The VA treats the service department’s decision as conclusive, regardless of other evidence documenting service. The VA denied Cruz’s application because the Army certified that Cruz did not have service as a member of the Philippine Commonwealth Army, including recognized guerillas, as “he was not listed in the Reconstructed Guerilla Roster” The Federal Circuit reversed in part. The VA can generally rely on the service department’s determination in deciding eligibility for payment but, in this context, must give the veteran a meaningful opportunity to challenge his service record through the Army Board for Correction of Military Records. View "Dela Cruz v. Wilkie" on Justia Law

Krell, a former ironworker, applied for Social Security disability benefits. Krell was notified that a vocational expert would testify at his hearing and that Krell had the right to request a subpoena for documents or testimony “that you reasonably need to present your case.” Krell’s counsel requested a subpoena to require the vocational expert to produce documents upon which the expert may rely in forming opinions, including statistics, reports, surveys, summaries, work product, and a description of the methodologies used by publishers or compilers of the statistics. The ALJ did not respond. At the hearing, the ALJ denied the request, reasoning that it had not specified what the documents would show and why these facts could not be shown without a subpoena and that counsel could challenge the testimony post‐hearing. During cross‐examination, the vocational expert stated that to determine available job numbers, he relied on Wisconsin occupational projections produced by the Department of Workforce Development. Krell made no post‐hearing challenge. The ALJ found that Krell was disabled and entitled to benefits, but only as of 2014, rather than 2011. Based on the expert’s testimony, the ALJ concluded that up to 2014, Krell was able to perform work existing in significant numbers in the economy. The Social Security Appeals Council denied review. The district court concluded that the ALJ had erred in denying Krell’s subpoena request. The Seventh Circuit reversed. While Krell’s case was pending, the Supreme Court held (Biestek) that a vocational expert is not categorically required to produce his supporting data. Krell advanced no reason why it was necessary for the expert to produce his underlying sources. View "Krell v. Saul" on Justia Law

While serving on a Navy aircraft carrier in 1969, Francway was hit by wind: “[t]he resulting fall caused him to injure his back.” He “was placed on bedrest for a week and assigned to light duty for three months.” In 2003, Francway filed a VA claim for service connection for his back disability. In 2003-2011, Francway was examined multiple times by an orthopedist and had his medical records separately reviewed by the orthopedist and an internist. They concluded that Francway’s current back disability was not likely connected to his 1969 injury. After multiple appeals and remands, Francway submitted new evidence from his longtime friend, attesting to Francway’s history of back disability. The Board again remanded, with instructions that Francway’s “claims file should be reviewed by an appropriate medical specialist” and that the examiner should reconcile any opinion with the statements from Francway's "buddy statement.” Francway was again examined by the orthopedist, who concluded that Francway’s symptoms were unlikely to be related to his injury but did not address the “buddy statement.” The internist reviewed Francway’s file and the “buddy statement,” and reached a similar conclusion. The Board concluded that there was insufficient evidence of a nexus between Francway’s 1969 injury and his current disability and that the VA had complied with the remand orders. The Veterans Court concluded that Francway had not preserved his claim that the internist who reviewed the “buddy statement” was not an “appropriate medical specialist” under the remand order. Francway had not challenged the examiner’s qualifications before the Board. The Federal Circuit affirmed, noting that the Board and Veterans Court properly apply a presumption of competency in reviewing the opinions of VA medical examiners. View "Francway v. Wilkie" on Justia Law

The Supreme Court held that the determination of the California Department of Social Services (the Department) that a household member's income that is used to pay child support for a child living in another household counts as income "reasonably anticipated" to be "received" by the paying household within the meaning of Cal. Welf. & Inst. Code 11265.2 for the purposes of determining eligibility for state welfare benefits was reasonable and therefore valid.Plaintiff applied for California Work Opportunity and Responsibility to Kids (CalWORKs) aid to support herself and her family. The Director of the Department denied the claim, concluding that child support payments garnished from Plaintiff's husband's earned income and unemployment insurance benefits was correctly included as nonexempt available income in determining eligibility for CalWORKs benefits. The superior court declared the department's policy of counting court-ordered child support payments as available income of CalWORKs applicants invalid. The court of appeal reversed. The Supreme Court affirmed, holding that the Department’s determination that funds garnished to pay child support for the benefit of a child living in another household are not exempt from the paying household’s income for purposes of determining its eligibility for or amount of CalWORKs aid was a reasonable exercise of its lawmaking authority and was therefore valid. View "Christensen v. Lightbourne" on Justia Law

The Eighth Circuit affirmed the denial of social security disability insurance benefits and supplemental security income (SSI) benefits to claimant. The court held that substantial evidence supported the ALJ's findings that claimant's physical and mental impairments did not meet or equal the severity of any of the listed impairments. Furthermore, substantial evidence supported the ALJ's residual functioning capacity determination and the mental limitations included in that finding. The court also held that the vocational expert's testimony did not conflict with the Dictionary of Occupational Titles and the ALJ was entitled to rely on the expert's testimony. View "Twyford v. Commissioner" on Justia Law

Medi–Cal, California’s program under the joint federal-state Medicaid program (Welf. & Inst. Code 14000), provides health care services to certain low-income individuals and families, including the aged, blind, disabled, pregnant women, and others. (42 U.S.C. 1396). Beginning in 2013-2014, there were delays in the determination of applications for Medi-Cal benefits, sometimes with severe consequences for applicants who did not obtain needed medical care. Applicants and an advocacy organization sued the California Department of Health Care Services (DHCS). The court ordered DHCS to make Medi-Cal eligibility determinations within 45 days unless certain exceptions applied. The court of appeal reversed. The trial court did not abuse its discretion by declining to abstain but California law does not impose on DHCS a duty to make all Medi-Cal eligibility determinations within 45 days. There is an obligation to determine Medi-Cal eligibility within 45 days under federal regulation 32 CFR 435.912(c)(3)(ii), but that obligation is subject to exceptions so that the underlying obligation is not sufficiently clear and plain to be enforceable in mandate. It was not clear whether DHCS was out of compliance with an overall performance benchmark of processing 90% of applications within 45 days; absent such evidence, it was error to issue writ relief applicable across-the-board. View "Rivera v. Kent" on Justia Law

The materiality standard—asking whether a school has failed to implement substantial or significant provisions of the child's individualized education plan (IEP)—is the appropriate test in a failure-to-implement case. L.J. and his mother filed suit under the Individuals with Disabilities Education Act (IDEA), challenging the implementation of his IEP.The Eleventh Circuit held that the content outlined in a properly designed IEP is a proxy for the IDEA's educational guarantee, and thus a material deviation from that plan violates the statute. In this case, the court held that there was no material deviation from L.J.'s IEP and affirmed the district court's judgment in favor of the school. View "L.J. v. School Board of Broward County" on Justia Law

While Ethan Lomeli's guardian filed suit against medical care providers for his catastrophic birth injuries, Medi-Cal paid for his care before and during the lawsuit. After Lomeli settled with defendants, the Department moved to impose a lien on the settlement and the trial court granted the motion.The Court of Appeal affirmed and held that federal law did not block the Department's lien. The court rejected Lomeli's analysis from the dissent in Tristani ex rel. Karnes v. Richman (3rd Cir. 2011) 652 F.3d 360, 379–387, and adopted the majority's holding that two provisions of the Social Security Act did not bar state Medicare liens. The court also held that collateral estoppel did not bar the lien and the court's lien calculation of $267,159.60 was correct. In this case, substantial evidence supported the trial court's reality-based approach to determine the reasonable value of plaintiff's pretrial claim. View "Lomeli v. State Department of Health Care Services" on Justia Law

The Court of Appeal affirmed the probate court's order denying plaintiffs' request, following the death of their daughter, that the remainder of their daughter's special needs trust be distributed to them rather than to the Department of Health Care Services as reimbursement for Medi-Cal payments for their daughter's medical care.The court held that the mandatory recovery rules for special needs trusts apply to the trust remainder; plaintiffs' interpretation of Probate Code section 3605 conflicts with federal law; the Centers for Medicare & Medicaid Services' opinion letter supports the Department's position that section 3605 permits the Department to recover for the daughter's Medi-Cal expenses; public policy considerations weigh in favor of permitting reimbursement to the Department; and the trust itself requires reimbursement to the Department. The court also held that plaintiffs failed to show that the Department's claim impermissibly included services under the Individuals with Disabilities Education Act and Lanterman Act. View "Gonzalez v. City National Bank" on Justia Law