Justia Public Benefits Opinion Summaries

Goodman served in the U.S. Army, 1972-1992, with service in Southwest Asia during the Persian Gulf War. During his service and at his discharge, Goodman underwent medical examinations that returned negative for rheumatoid arthritis; he denied having pain in his joints or arthritis. In 2007, Goodman sought treatment at a VA medical center for hand stiffness and knee pain, which he said had begun during service. He sought VA benefits for rheumatoid arthritis. The Board sought an independent medical advisory opinion from the Veterans Health Administration, which was conducted by a VA medical center Director of Rheumatology in 2014 and concluded that “it is less likely than not” that Goodman’s rheumatoid arthritis can be characterized as a medically unexplained chronic multi-symptom illness (MUCMI) under 38 C.F.R. 3.317, and that it “is less likely than not that his rheumatoid arthritis is related to a specific exposure event experienced … during service. The Board concluded that Goodman was not entitled to a presumptive service connection for a MUCMI; the Federal Circuit affirmed. The VA adjudicator may consider evidence of medical expert opinions and all other facts of record to make the final determination of whether a claimant has proven, based on the claimant’s unique symptoms, the existence of a MUCMI. View "Goodman v. Shulkin" on Justia Law

Schloesser worked for 23 years as a dry curer in a meat‐processing factory, regularly lifting more than 70 pounds. After undergoing rotator cuff surgery on his left shoulder in 2001 and then a lactimectomy (disc removal in his lower back) in 2002, Schloesser left the factory in 2003. Until 2009, he was self‐employed in construction, until his persistent shoulder and lower back problems prevented him from being able to regularly lift more than 50 pounds as required by his work. In 2012, Schloesser applied for disability insurance benefits under 42 U.S.C. 416(i). The Social Security Administration initially denied his application but an Administrative Law Judge found him disabled and granted benefits in 2014. One month later, sua sponte, the SSA Appeals Council commenced review and reversed the ALJ’s favorable decision. The district court affirmed the Appeals Council’s decision as supported by substantial evidence. The Seventh Circuit affirmed, upholding findings that Schloesser did not suffer from severe impairments of cervical radiculopathy, major joint dysfunction, and history of left shoulder surgery and that his residual functional capacity did not include being off‐task up to 10% of the workday or needing unscheduled breaks. View "Schloesser v. Berryhill" on Justia Law

Kisor served in the Marine Corps from 1962-1966. In 1982, he sought disability compensation benefits for PTSD with the Portland, Oregon VA Regional Office (RO), which received a letter from a Vet Center counselor, expressing concerns that Kisor had “depression, suicidal thoughts, and social withdraw[a]l.” In 1983, the RO obtained a psychiatric examination for Kisor, which noted that Kisor had served in Vietnam; that he had participated in “Operation Harvest Moon”; that he was on a search operation when his company came under attack; that he reported several contacts with snipers and occasional mortar rounds fired into his base of operation; and that he “was involved in one major ambush which resulted in 13 deaths in a large company.” The examiner expressed his “distinct impression” that Kisor suffered from “a personality disorder as opposed to PTSD,” which cannot be a basis for service connection. Kisor did not pursue an appeal. In 2006, Kisor submitted a request to reopen and presented a 2007 report of a psychiatric evaluation diagnosing PTSD. He was granted a 50% rating. The Veterans Court and Federal Circuit affirmed that Kisor was not entitled to an effective date earlier than June 2006 for the PTSD. Kisor’s remedy for the earlier denial would have been an appeal. View "Kisor v. Shulkin" on Justia Law

The Ninth Circuit reversed the denial of Disability Insurance Benefits and Supplemental Security Income, holding that plaintiff's contention that the ALJ made two errors at step two of its analysis of disability claims had no merit; all impairments were taken into account both times; any alleged error was harmless and could not be the basis for remand; using the shorthand "personality disorder" did not indicate any error in the ALJ's determination of plaintiff's residual functioning capacity (RFC); Dr. Kenderdine's partial reliance on plaintiff's self-reported symptoms was not a reason to reject his opinion; conflict in the record corroborated the rejection of Dr. Toews' testimony as a basis for rejecting Dr. Kenderdine's opinion; the ALJ did not err in rejecting Dr. Schechter's opinion; plaintiff's complaint that the ALJ only considered Dr. Fisher's opinion in the third section of a submitted form and ignored the first section lacked merit; any error in excluding three jobs identified by the vocational expert (VE) was harmless; but, the vast discrepancy between the VE's job numbers and those tendered by plaintiff, presumably from the same source, was simply too striking to be ignored. Therefore, this inconsistency in the record must be addressed by the ALJ on remand. View "Buck v. Berryhill" on Justia Law

An educational agency does not commit a per se violation of the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1414, by not specifying the anticipated school where special education services will be delivered within a child's individualized education program. The Ninth Circuit affirmed the district court's grant of summary judgment for the Department in an action brought on behalf of a student under the IDEA. The panel held that the IDEA did not require identification of the anticipated school where special education services would be delivered in light of the student's planned move to a new school district. Therefore, the student was not denied a free appropriate public education because of a purported procedural error. View "Rachel H. v. Department of Education, State of Hawaii" on Justia Law

An employee continued to work for over ten years after a job-related knee injury but had multiple surgeries on her injured knee. Over time, her employer made several permanent partial impairment payments, and she was eventually determined to be permanently and totally disabled because of the work injury. She began to receive Social Security disability at about the same time she was classified as permanently and totally disabled for workers’ compensation. Her employer asked the Alaska Workers’ Compensation Board to allow two offsets to its payment of permanent total disability (PTD) compensation: one related to Social Security disability benefits and one related to the earlier permanent partial impairment (PPI) payments. The Board established a Social Security offset and permitted the employer to deduct the amount of previously paid PPI. The employee appealed to the Alaska Workers’ Compensation Appeals Commission, arguing that the Board had improperly applied one of its regulations in allowing the PPI offset and had incorrectly calculated the amount of the Social Security offset. She also brought a civil suit against the State challenging the validity of the regulation. The State intervened in the Commission appeal; the lawsuit was dismissed. The Commission reversed the Board’s calculation of the Social Security offset and affirmed the Board’s order permitting the PPI offset. The employer appealed the Commission’s Social Security offset decision to the Alaska Supreme Court, and the employee cross- appealed the PPI offset. The Court affirmed that part of the Commission’s decision reversing the Board’s calculation of the Social Security disability offset and reversed that part of the Commission’s decision permitting an offset for permanent partial impairment benefits. The case was remanded back to the Commission for further proceedings. View "Alaska Airlines, Inc. v. Darrow" on Justia Law

New York's intestacy law, as it existed in 2013 at the time of the agency's final determination, did not permit children conceived posthumously to inherit via intestacy. In this case, plaintiff had conceived twins via in vitro fertilization eleven years after her husband, the donor spouse, died. Plaintiff filed applications for child's survivors' benefits, based on her husband's earnings history, with the Social Security Administration. The Second Circuit held that, under the applicable provisions of New York's Estates, Powers and Trusts Law (EPTL) in effect at and prior to the time of the agency's final decision, the twins were not entitled to inherit from the decedent in intestacy. Accordingly, the court affirmed the district court's denial of benefits. View "MacNeil v. Berryhill" on Justia Law

A claimant must, at a minimum, raise the issue of the accuracy of the vocational expert's estimates at some point during administrative proceedings to preserve the challenge on appeal in federal district court. The Ninth Circuit affirmed the denial of plaintiff's application for disability insurance benefits. In this case, the ALJ's residual functional capacity determination was supported by substantial evidence and there was no inconsistency between the opinions of two physicians regarding his capability for interaction with colleagues. Furthermore, plaintiff waived his challenge to the vocational expert's job numbers where he did not suggest that the vocational expert's job estimates might be unreliable at any point during administrative proceedings. View "Shaibi v. Berryhill" on Justia Law

Rosewood is a skilled nursing facility, 42 U.S.C. 1395i-3(a), participating in Medicare and Medicaid as a provider. The Secretary of Health and Human Services, which enforces the statutory and regulatory provisions governing nursing homes operating in the Medicare/Medicaid network, assessed a civil monetary penalty against Rosewood on the grounds that it had failed to protect a resident from abuse, failed to timely report or to investigate thoroughly allegations of abuse, and failed to implement its internal policies on abuse, neglect, and misappropriation of property. The Centers for Medicare and Medicaid Services (CMS) determined that these deficiencies placed residents in “immediate jeopardy.” An Administrative Law Judge and the Department Appeals Board affirmed the $6,050 per day penalty imposed by CMS. The Seventh Circuit affirmed. Substantial evidence supports the Agency’s findings. The court noted three specific examples of noncompliance and concluded that there was a systemic failure to implement Rosewood’s policies aimed at conforming to federal regulations View "Rosewood Care Center of Swansea v. Price" on Justia Law

Gazelle served in the U.S. Army, 1962-1965, and incurred service-connected disabilities. He receives compensation for: degenerative disc disease and joint disease of the cervical spine rated at 20 percent; degenerative disc disease and spondylosis of the thoracolumbar spine rated at 20 percent; left upper extremity radiculopathy rated at 10 percent; left lower extremity radiculopathy rated at percent; and post-traumatic stress disorder. In 2009, the VA increased Gazelle’s disability rating for his service-connected PTSD to 100 percent. Gazelle filed a Notice of Disagreement, alleging the VA failed to award him additional special monthly compensation under 38 U.S.C. 1114(s)(1). In 2011, Gazelle was denied entitlement to special monthly compensation because he did not have additional service-connected “disabilities . . . independently ratable as [60 percent] or more disabling.” Instead of adding together Gazelle’s additional service-connected disabilities at their respective amounts, the VA calculated the independent additional rating via the combined ratings table pursuant to 38 C.F.R. 4.25 (2010), which resulted in a combined rating of 50 percent. In 2014, the Board affirmed. The Veterans Court and Federal Circuit affirmed, holding that consistent with the plain meaning of subsection 1114(s), the Board appropriately applied the combined ratings table to determine eligibility for special monthly compensation benefits. View "Gazelle v. Shulkin" on Justia Law