Justia Public Benefits Opinion Summaries

The Ninth Circuit dismissed for lack of jurisdiction relators' appeal of the district court's dismissal of their qui tam suit against UOPX. The panel held that the appeal was untimely because relators' post-judgment motion, although styled as a Fed. R. Civ. P. 59(e) motion, was in substance a motion only to stay the entry of judgment, which did not toll the time to file a notice of appeal. View "United States ex. rel. Hoggett v. University of Phoenix" on Justia Law

Federal Medicaid funds are not available for state medical expenditures made on behalf of “any individual who is an inmate of a public institution (except as a patient in a medical institution),” 42 U.S.C. 1396d(a)(29)(A). "Inmate of a public institution" means a person who is living in a public institution. However, an individual living in a public institution is not an “inmate of a public institution” if he resides in the public institution “for a temporary period pending other arrangements appropriate to his needs.” Ohio submitted a proposed plan amendment aimed at exploiting this distinction: it sought to classify pretrial detainees under age 19 as noninmates, living in a public institution for only “a temporary period pending other arrangements appropriate to [their] needs,” for whom the state could claim Medicaid reimbursement. The Centers for Medicare and Medicaid Services rejected the amendment, finding that the inmate exclusion recognizes “no difference” between adults and juveniles, or convicted detainees and those awaiting trial. The Sixth Circuit denied a petition for review, agreeing that the involuntary nature of the stay is the determinative factor. The exception does not apply when the individual is involuntarily residing in a public institution awaiting adjudication of a criminal matter. View "Ohio Department of Medicaid v. Price" on Justia Law

By 2009 Vanprooyen’s physician had prescribed Xanax to treat her panic attacks. She was treated for anxiety, depression, and bipolar disorder. She had a history of addiction. In 2010, Vanprooyen, then age 26, fell down a flight of stairs and suffered a brain hemorrhage. She claimed post-traumatic stress disorder, short-term memory loss, attention-deficit hyperactivity disorder, seizures, and fibromyalgia. She was prescribed medication for pain, migraine headaches, and seizures. Vanprooyen applied for Disability Insurance Benefits and Supplemental Security Income. An administrative law judge found her impairments to be severe but not disabling and denied benefits. The district court upheld the ALJ’s decision. The Seventh Circuit reversed, finding “serious deficiencies” in the ALJ’s analysis, which failed to mention that a state consultative examiner who had given Vanprooyen a mental-status examination concluded that she was unable to manage her own money because of her “emotional adjustment and medical difficulties,” although at least two of the three jobs that the ALJ found that Vanprooyen could do involve handling money. Without explanation, the ALJ gave substantial weight to the opinions of consulting physicians who had never examined Vanprooyen. An ALJ can reject an examining physician’s opinion only for reasons supported by substantial evidence; a contradictory opinion of a non-examining physician does not, alonef, suffice. View "Vanprooyen v. Berryhill" on Justia Law

Claimants appealed the denial of civil claims under the Settlement Program that was established following the Deepwater Horizon oil spill. Claimants submitted Individual Economic Loss (IEL) claims for lost wages as employees of their architectural firm. The firm had already received a Business and Economic Loss (BEL) award under the Settlement Program. The Fifth Circuit held that the BEL framework, by compensating the business for the owners' lost wages through the fixed-cost designation of their wages, precluded compensating those same owners for the same wages through an IEL claim. Because the Settlement Program did not contemplate the requested compensation, the court affirmed the judgment. View "In Re: Deepwater Horizon" on Justia Law

Summers was fired from her job as an Elkhart, Indiana production-line worker. She applied for disability insurance benefits, alleging that she became disabled on the date she was fired. The Social Security Administration denied the application. Summers attended a hearing with counsel and testified that she was unable to work because of headaches, difficulty breathing, atrial fibrillation, and dizziness with blackouts. She submitted medical evidence that she suffered from depression, anxiety, obesity, and sleep apnea. Summers made several inconsistent statements during the hearing, mostly about her work history and her use of drugs and alcohol. A Vocational Expert testified that a hypothetical individual who was limited to a restricted range of light work could perform Summers’s past job as an assembler, as well as other jobs (inspector, hand packager, photocopy machine operator, and palletizer) that exist in significant numbers in the national economy. The ALJ concluded that Summers retained the Residual Functional Capacity to perform a substantially limited range of light work; that Summers was not entirely credible; and that Summers was not disabled from the time of her alleged onset date through the date of the ALJ’s decision. The Appeals Council, the district court, and the Seventh Circuit affirmed the denial as supported by substantial evidence. View "Summers v. Berryhill" on Justia Law

Manzanares served on active duty, 1986-1991. In 1992, she was awarded service connection for a history of stress fractures in both legs, with a non-compensable rating. In 2006, she sought an increased rating. The VA assigned a 10-percent rating for each ankle, with a February 2006 effective date. Manzanares filed a notice of disagreement and claimed: “[e]ntitlement to service connection for degenerative disc disease lumbar spine as secondary to bilateral ankle disabilities.” The VA granted secondary service connection for “degenerative arthritis and disc disease, lumbar spine” with a rating of 20 percent and an April 2007 effective date. Manzanares argued that the VA should have awarded a February 2006 effective date for the secondary service-connected condition, citing 38 C.F.R. 3.156(b), which provides that, for a pending claim, “[n]ew and material evidence received prior to the expiration of the appeal period . . . will be considered as having been filed in connection with the claim which was pending at the beginning of the appeal period.” The Board of Veterans’ Appeals, Veterans Court, and Federal Circuit rejected her argument. The effective date for service connection is the later of the date the VA receives the claim or the date that entitlement arose; Manzanares’s secondary service claim was not filed until April 2007 and was not part of the ankle claim. View "Manzanares v. Shulkin" on Justia Law

Minn. Stat. 125A.06(d), by its plain language, does not impose a heightened standard that burdens school districts with an absolute obligation to guarantee that each blind student will use the Braille instruction provided to attain a specific level of proficiency. I.Z.M. filed suit against the District, alleging claims under the Individuals with Disabilities Education Act (IDEA) and non-IDEA claims for relief under Title II of the Americans with Disabilities Act (ADA), and Section 504 of the Rehabilitation Act. The Eighth Circuit affirmed the district court's grant of the District's motions for judgment on the administrative record on the IDEA claim and for summary judgment on the non-IDEA claims. In this case, the ALJ cited the state regulation and expressly concluded that the District took all reasonable steps to provide instructional materials in accessible formats in a timely manner. In regard to the non-IDEA claims, the district court used the correct standard and correctly concluded that I.Z.M. failed to present evidence of bad faith or gross misjudgment View "I.Z.M. v. Rosemount-Apple Valley-Eagan Public Schools" on Justia Law

Johnson served in the Army, 1970-1971. In 2008, the VA granted Johnson a 30% rating for posttraumatic stress disorder (PTSD), and a 10% rating for tinea corporis, a skin condition which Johnson described as jungle rot under Diagnostic Code (DC) 7806. The Board of Veterans Appeals increased his PTSD rating to 70% and remanded with respect to his skin condition. After several rounds of review, the Board denied Johnson’s request for an increased rating for tinea corporis in 2014, finding that Johnson’s skin condition affected only a limited area of his body, and his topical corticosteroid treatment of that area did not qualify as a “systemic therapy” under DC 7806. The Veterans Court held that DC 7806 unambiguously defines a topical corticosteroid treatment as “systemic therapy” rather than “topical therapy.” The Federal Circuit reversed, holding that the Veterans Court gave an overly broad reading of the term “systemic therapy” in DC 7806 that encompasses any and all forms of topical corticosteroid treatment. The court noted that Johnson did not challenge factual findings that his use of topical corticosteroids affected only the area to which he applied treatment and did not affect his body as a whole, and reinstated the Board’s findings. View "Johnson v. Shulkin" on Justia Law

The Ninth Circuit reversed the denial of disability benefits and held that the ALJ did not follow the appropriate methodology for weighing a treating physician's medical opinion. In this case, the panel explained that the ALJ should have credited the treating physician's opinion and found that plaintiff was disabled, and the district court erred by developing its own reasons to discount the treating physician's opinion, rather than reviewing the ALJ's reasons for substantial evidence. The panel held that substantial evidence did not support the ALJ's finding that plaintiff's symptoms were not as severe as she testified, particularly in light of the extensive medical record objectively verifying her claims. Because each of the "credit-as-true" factors in Garrison v. Colvin, 759 F.3d 995, 1020 (9th Cir. 2014), was satisfied, remand for the calculation and award of benefits was warranted. View "Trevizo v. Berryhill" on Justia Law

The Ninth Circuit reversed the dismissal of relators' qui tam action alleging that the College violated the False Claims Act (FCA), 31 U.S.C. 3729-3733, by knowingly providing false progress reports on students in order to keep grant monies. The panel held that the Tribe is not a "person" under the FCA. The panel remanded for further jurisdictional factfinding on whether the College was an arm of the Tribe that shares the Tribe's status for purposes of the FCA. View "United States ex rel Cain v. Salish Kootenai College, Inc." on Justia Law