Justia Public Benefits Opinion Summaries

Walker has degrees in robotics and electrical engineering and worked for 21 years, primarily as an engineer, before suffering a stroke in 2008. Walker was not able to return to work after his stroke. Medical records show that his physical and cognitive condition has gradually worsened since 2008. In 2012, medical professionals documented his cognitive and memory deficits, and difficulty with balance and walking, dizziness. By 2013 Walker was unable to live alone and moved in with his mother. The Social Security Administration determined that Walker became disabled in December 2014. An ALJ, in a separate proceeding, determined that Walker was not disabled before that date. The district court affirmed. The Seventh Circuit vacated and remanded. The ALJ’s conclusion sweeps too broadly by not accounting for medical and other evidence strongly suggesting that Walker’s condition and residual functional capacity had worsened to such a degree that he became disabled by approximately the middle of 2012. View "Walker v. Berryhill" on Justia Law

Penrod applied for disability benefits and supplemental security income in 2010, at age 45, after having a heart attack. The district court affirmed the denial of benefits. Penrod filed a second application for disability insurance benefits only, alleging that he was disabled because of arthritis, diabetes, high blood pressure, high cholesterol, short‐term memory loss, and asthma, from April 2012-June 2013. Medical evidence was sparse. After his heart attack, Penrod received a stent and regular follow‐up care. Penrod’s poverty and lack of health insurance complicated his treatment. After reviewing Penrod’s medical records, two consultative doctors agreed that he could perform light work, with postural and environmental limitations. At a hearing, Penrod focused on the difficulty of finding a job with his limited education, noting his inability to stand or sit for prolonged periods, limited grip, fatigue and dizziness from his medications, pain in his hips and back, and kidney stones. He had suffered another heart attack in 2014. After the hearing, Penrod died from cardiac arrest. The ALJ denied Penrod’s application, finding that although Penrod’s impairments could result in the types of symptoms he alleged, the medical evidence did not support his testimony about his limitations. The ALJ noted Penrod’s smoking and his frequent reports that he was unable to afford medications and recommended tests in assessing his credibility. The Seventh Circuit affirmed. Substantial evidence supported a finding that Penrod retained the capacity to work through his last insured date. View "Penrod v. Berryhill" on Justia Law

Michigan’s Medicaid waiver program provides individuals with developmental disabilities community-based services. Washtenaw County changed its budgeting method in 2015. Notices sent to recipients acknowledged that recipients would have to pay service-providers less in order to maintain their approved hours of service. The Association, a nonprofit community organization assisting individuals with developmental disabilities, joined with three individual plaintiffs to filed suit, alleging due process violations and seeking a preliminary injunction. The Association’s CEO testified that 169 individuals, including the three named plaintiffs, had received notices and that the three were Association members. The district court concluded that the Association lacked associational standing because the 169 people for whom it claimed associational standing were not shown to be members; the named members, in their individual capacities, were not entitled to injunctive relief because they had appealed the reductions and received favorable decisions so “there can be no irreparable harm suffered by the named Plaintiffs as a result of the inadequate notice.” The Sixth Circuit affirmed, noting that “standing is not dispensed in gross.” An individual must demonstrate standing for each claim he seeks to press and for each form of relief sought; an association that relies upon an individual member for standing purposes must do the same. The Association has not shown that any named member had standing to seek fresh notices and hearing rights when it filed its complaint.. View "Waskul v. Washtenaw County Community Mental Health" on Justia Law

The First Circuit vacated and remanded the district court’s order upholding an administrative law judge’s (ALJ) conclusion that although Appellant had previously been eligible for Supplemental Security Income (SSI) benefits as a child, Appellant was ineligible for SSI benefits as an adult, holding that the record before the ALJ was insufficient to conclude that Appellant was no longer disabled.When Appellant was twelve years old, the Commissioner of Social Security Administration (SSA) determined that he was entitled to SSI benefits because he was found to have met the SSA's requirements for mental retardation. The Commissioner later found that Appellant was no longer disabled and that his benefits should stop. Appellant requested a hearing with an ALJ, who found that Appellant was not disabled under the Social Security Act. Upon de novo review, the First Circuit held that the record before the ALJ was not adequately developed enough to conclude that Appellant was no longer disabled, particularly in light of the fact that the ALJ was on notice, through both Social Security Administration filings and hearing testimony, that Appellant was undergoing psychiatric treatment. View "Torres-Pagan v. Berryhill" on Justia Law

Arthur served on active Army duty, 1940-1945, as a prisoner of war of the German government for 25 months. He was service-connected for several disabilities and had VA claims pending when he died in 2011. Winters pursued those as a substituted claimant and her own claims for accrued benefits as his surviving spouse. In 2013, the Board of Veterans’ Appeals denied some claims and granted service-connected benefits for others, found that the awards were inextricably intertwined with Winters’s accrued benefits claim, and remanded for initial disability ratings and to readjudicate the accrued-benefits claim. The Board determined that a subsequent letter in which Winters sought earlier dates “d[id] not constitute [a] motion for revision,” directed the letter to the Regional Office, but did not notify Winters of its determination so that the 120-day appeal period did not start to run. In 2014, the Board denied Winters’s claims for entitlement to an earlier effective date and for accrued benefits. In 2016, the Veterans Court dismissed an appeal of the 2013 decision for lack of jurisdiction and vacated the 2014 decision as premature because the 2013 decision was not final. Winters sought attorney fees and expenses under the Equal Access to Justice Act, 28 U.S.C. 2412(d) for that decision. The Federal Circuit affirmed the denial of her application. The court lacked jurisdiction to award EAJA fees relating to an appeal over which it did not have jurisdiction. With respect to the 2014 Board decision, Winters was not a “prevailing party.” View "Winters v. Wilkie" on Justia Law

This matter stemmed from a lawsuit filed by the State of Mississippi against the defendant pharmacies. The State alleged deceptive trade practices and fraudulent reporting of inflated “usual and customary” prices in the defendant’s reimbursement requests to the Mississippi Department of Medicaid. The State argued that Walgreens, CVS, and Fred’s pharmacies purposefully misrepresented these prices to obtain higher prescription drug reimbursements from the State. Finding that the circuit court was better equipped to preside over this action, the DeSoto County Chancery Court transferred the matter to the DeSoto County Circuit Court in response to the defendants’ request. Aggrieved, the State timely filed an interlocutory appeal disputing the chancellor’s decision to transfer the case. After a thorough review of the parties’ positions, the Mississippi Supreme Court found that though the chancery court properly could have retained the action, the chancellor correctly used his discretion to transfer the case, allowing the issues to proceed in front of a circuit-court jury. As a result, the Supreme Court affirmed the chancellor’s decision. View "Mississippi v. Walgreen Co." on Justia Law

The Eighth Circuit reversed the district court's decision upholding the Social Security Commission's denial of plaintiff's applications for child insurance benefits and supplemental security income. The court held that the ALJ did not elicit a reasonable explanation to resolve an apparent conflict between testimony from the vocational expert and the Dictionary of Occupational Titles (DOT) when it determined that plaintiff's limitations did not prevent him from performing certain jobs in the national economy. In this case, the conflict was in regard to the DOT's listing related to the level of reasoning required for the job of hospital or industrial cleaner. Accordingly, the court remanded for further proceedings. View "Stanton v. Commissioner" on Justia Law

The Supreme Court affirmed the judgment of the trial court in this qui tam case filed by Relators alleging that several laboratories illegally inflated the bills they submitted to Virginia’s Medicaid program, holding that the trial court did not err in concluding that Relators were entitled to twenty-eight percent of the proceeds of the gross proceeds of the settlement in this case.After the parties settled, the parties disagreed with respect to whether Relators were entitled to twenty-eight percent of the gross proceeds of the settlement or whether the twenty-eight percent share should come out of the Commonwealth’s net share of the proceeds. At issue was the provision in Va. Code 8.01-216.7(B) that the relator is entitled to a share “of the proceeds of the award or settlement.” The Supreme Court held that the proceeds of settlement means the gross proceeds and, accordingly, affirmed the judgment of the court below. View "Commonwealth v. Hunter Laboratories, LLC" on Justia Law

Spicher suffers from osteoarthritis, degenerative disc disease, chronic obstructive pulmonary disease, fibromyalgia, and morbid obesity. In 2010, Spicher applied for Social Security Disability Insurance Benefits and Supplemental Security Income dating back to 2003. After a 2012 hearing, an ALJ found that Spicher was not disabled from 2003-2012. The district court remanded because the ALJ had not properly considered the limitations imposed by Spicher’s obesity, independently and in combination with her other impediments. On remand, Spicher focused on whether she had been disabled since December 2008, when her insured status expired. The ALJ consulted a second doctor who essentially adopted the findings of the medical reports already in the record. The ALJ stated that further consideration of Spicher’s obesity had not motivated her to change her conclusion, finding that Spicher could hold a sedentary position and perform three jobs identified by a vocational expert, and could occasionally crouch, crawl, balance, stoop, and kneel. The Seventh Circuit reversed, finding that the decision was not supported by substantial evidence. The ALJ did not address contradictory medical evidence when determining the types of sedentary jobs that Spicher could hold and failed to consider the interaction between her obesity and her non‐severe impairments. The court rejected a claim that the ALJ displayed antagonism toward Spicher in violation of her due process rights. View "Spicher v. Berryhill" on Justia Law

The Eighth Circuit affirmed the district court's denial of social security disability benefits to plaintiff. The court held that the ALJ properly relied on testimony from the vocational expert's testimony that a certain needed modification is part of the functional workplace. In this case, the vocational expert testified based on her expertise that bariatric chairs were commonly provided to individuals in the workplace and identified jobs that an individual who, like plaintiff, needs a bariatric chair, could perform. Therefore, substantial evidence supported the ALJ's finding that jobs exist in the national economy that plaintiff could adjust to, and that finding did not result from an error of law. View "Higgins v. Commissioner" on Justia Law