Justia Public Benefits Opinion Summaries

Burchett and Jude suffered from serious mental illnesses. Each hired attorney Conn to represent them in applying for Social Security disability benefits, 42 U.S.C. 405(a), which were granted in 2009 and 2010. Conn was perpetrating a fraudulent scheme. Conn paid doctors to submit fraudulent letters concerning his clients' ailments and bribed an ALJ to assign Conn’s cases to his own docket and to decide nearly all of those cases in favor of Conn. Plaintiffs allege that the SSA had reason to suspect Conn's fraud in 2007 due to the reports of internal whistle-blowers. In 2011, the Wall Street Journal published a story about Conn’s exploits. Conn was indicted and pleaded guilty. The Huntington, West Virginia SSA office's former Chief ALJ, pleaded guilty to retaliation against a whistle-blower. The SSA’s Appeals Council informed Jude and Burchett that it was legally required to redetermine their eligibility for benefits (42 U.S.C. 1320a-8(l). Their benefits were suspended pending redeterminations. Each requested additional time to gather evidence. About two weeks after the SSA notices, before the SSA granted those requests, Jude and Burchett each committed suicide. Their estates filed Federal Tort Claims Act (FTCA) claims for wrongful death with the SSA, 28 U.S.C. 1346(b) and 2671, and a Bivens claim alleging procedural due process violations. The Federal Circuit affirmed dismissal of the claims, concluding that the FTCA’s discretionary function exception applied to preclude that claim and that the Bivens claim was improperly formulated. View "Jude v. Commissioner of Social Security" on Justia Law

In this interlocutory appeal from the circuit court’s review of an agency ruling, the Supreme Court adopted the United States Supreme Court’s test for standing as set forth in Lujan v. Defenders of Wildlife, 504 U.S. 555, 560-561 (1992) and held that the existence of a plaintiff’s standing is a constitutional requirement to prosecute any action in the courts of the Commonwealth, including seeking judicial review of an administrative agency’s final order.The putative petitioner in this case, a Medicaid beneficiary (the patient), sought judicial review of a final order of the Kentucky Cabinet for Health and Human Services ruling that the patient lacked standing to pursue an appeal of an insurer’s denial of reimbursement to a hospital for the patient’s services. The hospital, acting as the patient’s representative, sought judicial review of the Cabinet’s final order. The circuit court denied the Cabinet and the insurer’s motions to dismiss the petition. The Supreme Court remanded the case with instructions to dismiss the case, holding (1) Kentucky courts have the responsibility to ascertain whether a plaintiff has constitutional standing to pursue the case in court; and (2) under that test, the patient did not have the requisite constitutional standing to pursue her case in the courts of the Commonwealth. View "Commonwealth v. Sexton" on Justia Law

Pursuant to the terms of Social Security Ruling 00-4p, and in light of the overall regulatory scheme that governs disability claims, the ALJs within the SSA have an affirmative duty to identify apparent conflicts between the testimony of a Vocational Expert (VE) and the DOT and resolve them. The Eleventh Circuit held that this duty requires more of the ALJ than simply asking the VE whether his testimony is consistent with the DOT. The court explained that, once the conflict has been identified, the Ruling requires the ALJ to offer a reasonable explanation for the discrepancy, and detail in his decision how he has resolved the conflict. Furthermore, the failure to discharge this duty means that the ALJ's decision, when based on the contradicted VE testimony, is not supported by substantial evidence.In this case, the ALJ failed to meet his obligations to identify, explain, and resolve an apparent conflict between the testimony of the VE and the DOT on a matter of considerable importance. Accordingly, the court reversed and remanded with instructions. View "Washington v. Commissioner of Social Security" on Justia Law

A social security disability claimant does not have an absolute right to question medical consultants. The Fifth Circuit affirmed the denial of disability benefits to plaintiff, holding that disability claimants' interest in accurate disability decisions was adequately protected by the qualified right to question medical consultants they already enjoyed. The type of case-by-case assessment of need was common for procedural issues in disability cases. In this case, the ALJ did not abuse his discretion by refusing to issue the subpoena or interrogatories at issue. Accordingly, the court affirmed the denial of benefits. View "Barrett v. Berryhill" on Justia Law

The Seventh Circuit affirmed the district court's denial of disability insurance benefits to plaintiff. The court held that substantial evidence supported the ALJ's decision to deny benefits where the opinion's of plaintiff's treating physician were inconsistent with the opinions from other doctors, and the physician's opinions lacked detail and did not show that he knew of the functional capacity evaluation from 2008. Furthermore, the ALJ did not improperly discount plaintiff's own testimony where the ALJ found plaintiff not fully credible for many specific reasons supported by the evidence. View "Hall v. Berryhill" on Justia Law

Robinson served in the Marine Corps in the 1960s, with a deployment in Vietnam. He subsequently experienced heart problems. In 20016, Robinson saw his VA cardiologist, Dr. Sadoughian, who recommended diagnostic testing, but the testing was not performed. Nine months later, Robinson returned after a week in the hospital with blood clots in his leg. Dr. Sadoughian again recommended testing. Robinson received the prescribed testing in April 2007, 14 months after his initial recommendation. The results indicated “[c]oronary artery disease with prior inferior wall myocardial infarction.” In August 2010 the VA amended its regulations to add coronary artery disease to its list of conditions that are presumptively service-connected for veterans who were exposed to certain herbicides, 38 C.F.R. 3.309(e). In 2011, the VA retroactively granted disability benefits to Robinson for that disease following a “Nehmer” review. The Board of Veterans’ Appeals denied Robinson’s claim for an earlier effective date because the April 2007 test results were the earliest medical evidence demonstrating that he satisfied the criteria the disability rating. Robinson argued that he should not be penalized for the delay in scheduling tests and that he would have received an earlier effective date if the VA had provided him with prompt treatment as required by section 17.33(a)(2). The Board concluded that section 17.33 applies only to treatment and has no bearing on effective date criteria. The Veterans Court and Federal Circuit affirmed, noting that the record did not indicate what caused the testing delay or whether Robinson would have satisfied the disability rating requirements earlier. View "Robinson v. Wilkie" on Justia Law

Plaintiff filed a civil rights action under 42 U.S.C. 1983, alleging that the termination of her housing voucher violated the Due Process Clause of the Fourteenth Amendment and regulations promulgated by the United States Department of Housing and Urban Development. The Eleventh Circuit vacated the district court's grant of summary judgment for the Authority, holding that indictments and evidence of an arrest did not constitute sufficient evidence to support the decision of a public housing authority to terminate housing subsidies provided under Section 8 of the Housing and Community Development Act of 1937. View "Yarbrough v. Decatur Housing Authority" on Justia Law

Cousin served in the Army, 1951-1953. His entrance examination showed normal findings as to his back. In service, he injured his back while lifting cans; a month later, he complained of back pain. He was diagnosed with a mild back strain and placed on medically restricted duty. In 1952, his back condition was noted to have improved, and he was removed from restricted duty. Records from 1953 note back pain before service; an x-ray showed a “pedicle defect L5” and “spondylolysis.” He was placed on a permanent profile for a “weak back.” An examination report of his discharge noted his back had been taped in 1952 and that he was then asymptomatic. In 1954, Cousin unsuccessfully sought disability compensation for his back condition. Between 1979-2009, Cousin filed three unsuccessful applications to reopen that claim. In 2012, Cousin filed another application. In 2013, the regional office granted him service connection for a back disability effective January 2012. Cousin filed a Notice of Disagreement, arguing that an earlier effective date was warranted because there was clear and unmistakable error (CUE) in the prior denials. The Veterans Court upheld the denial, finding the Board “offered a plausible explanation for why the RO may have discounted the 1953 records.” The Federal Circuit reversed. Given the proper legal interpretation of defect in the regulation then in effect and the government’s factual concessions, the regional office could not, without error, have determined that spondylolysis was a “defect.” The 1954 decision contained CUE.VA View "Cousin v. Wilkie" on Justia Law

Barrett applied for disability insurance benefits and supplemental security income based on limitations from bipolar disorder and alcohol addiction. If an administrative law judge (ALJ) had found him disabled, then Barrett would shoulder the burden of showing that his alcoholism was not material to his disability. An ALJ found that he was not disabled, however, even considering his alcohol addiction, and denied him benefits. The district court and Seventh Circuit affirmed, noting that the ALJ determined that Barrett’s impairments, including his alcoholism, taken together were at most moderately limiting, and that he could have sustained full-time employment. That conclusion is supported by substantial evidence: Barrett performed in workplace-like settings tasks such as summarizing depositions and medical records and maintaining attendance records of 100 people. He also sat for the LSAT—though the ALJ emphasized his “above-average” score when it was in fact below average, the fact that he sat for the test and achieved the score he did was consistent with someone capable of working. View "Barrett v. Berryhill" on Justia Law

The Fifth Circuit affirmed the district court's denial of attorneys' fees for plaintiff under the Individuals with Disabilities Education Act (IDEA). The court held that the hearing officer's decision did not make plaintiff a prevailing party under the IDEA and thus she was not entitled to attorneys' fees. In this case, the officer's decision effected no change to plaintiff's educational plan, which the officer agreed was entirely appropriate despite lacking a prior autism diagnosis. Furthermore, the IDEA focuses, not on a student's diagnostic label, but on whether the student received appropriate education services, which the officer found plaintiff had received from the school district. View "Lauren C. v. Lewisville Independent School District" on Justia Law