Justia Public Benefits Opinion Summaries

Appellant appealed a district court judgment affirming the Social Security Administration's (SSA) decision finding him disabled from September 26, 1997 through December 3, 1998, and concluding that the disability ended on December 4, 1998 due to medical improvement. Appellant contended that the ALJ's medical improvement finding was not supported by substantial evidence because she erred in relying on a single proposed rating decision from the Department of Veterans Affairs (VA) (the 2001 decision). Appellant also claimed that the ALJ erred by failing to mention the opinion of his treating physician. The Ninth Circuit Court of Appeals reversed, holding that the ALJ erred in relying solely on the 2001 decision, as (1) the 2001 only proposed changes while ignoring two other decisions that rejected the proposed changes recommended in the 2001 decision; and (2) the ALJ's misunderstanding led her to inaccurately conclude that her finding that Appellant's disability terminated on December 4, 1998 was consistent with the VA's ratings. View "Hiler v. Astrue" on Justia Law

Plaintiff filed for disability insurance benefits and supplemental security income under Title II and Title XVI of the Social Security Act. The Social Security Administration denied Hill's application. An ALJ also denied Plaintiff's application, and the appeals council denied Plaintiff's request for review. The district court granted summary judgment in favor of the Commissioner of Social Security and affirmed the ALJ's decision. The Ninth Circuit Court of Appeals reversed, holding (1) the ALJ failed to consider evidence favorable to Plaintiff and posed an improper hypothetical question to the vocational expert; and (2) therefore, substantial evidence did not support the ALJ's determination that Plaintiff was not disabled under the Social Security Act. View "Hill v. Astrue " on Justia Law

The Department of Health and Human Services denied Medicare coverage of the BIO-1000, a piece of durable medical equipment used to treat osteoarthritis of the knee. In four decisions, the Medicare appeals counsel, the highest level of agency adjudication, ruled that the BIO-1000 had not been shown to be reasonable and necessary for the treatment at issue. The supplier of the device challenged those decisions. The district court granted summary judgment for the BIO-1000 supplier. The Ninth Circuit Court of Appeals reversed the district court's judgment and joined the Fourth Circuit in holding that the appeals council's coverage denials for the BIO-1000 were not arbitrary, capricious, or unsupported by substantial evidence, as (1) the appeals council adequately explained its reasons for denying coverage; and (2) the coverage denials were supported by substantial evidence. Remanded. View "Int'l Rehab. Scis. v. Sebelius" on Justia Law

Howard Back filed this suit alleging that Secretary of Heath and Human Services Kathleen Sebelius violated her duties under the Medicare Act and the Due Process Clause by failing to provide an administrative process for beneficiaries of hospice care to appeal a hospice provider's refusal to provide a drug prescribed by their attending physician. The district court granted the Secretary's motion for judgment on the pleadings because Back had not exhausted his administrative remedies. The Ninth Circuit Court of Appeals vacated the district court's judgment and dismissed the appeal as moot, holding that although the government led Back to believe there was no appeal process, such a process did exist. Accordingly, no controversy existed and the appeal was moot. View "Back v. Sebelius" on Justia Law

Plaintiff appealed an order of the district court affirming the Commissioner's final decision denying her disability benefits under Title II of the Social Security Act (SSA), 42 U.S.C. 401-434. At issue, among other things, was whether the district court should have considered evidence plaintiff did not submit to the ALJ but submitted for the first time to the Appeals Council, which accepted and considered the new evidence but declined to review the ALJ's decision. The court held that when a claimant submitted evidence for the first time to the Appeals Council, which considering that evidence in denying review of the ALJ's decision, the new evidence was part of the administrative record, which the district court must consider in determining whether the Commissioner's decision was supported by substantial evidence. Considering the record as a whole, the court concluded that the Commissioner's decision was not supported by substantial evidence. Accordingly, the court reversed and remanded for an immediate award of benefits. View "Brewes v. Commissioner of Social Security" on Justia Law

Defendant appealed his conviction for social security fraud pursuant to 42 U.S.C. 408(a)(5). The court held that the district court committed no reversible error in the formulation of jury instructions; the district court acted within its discretion when it admitted computer-generated records into evidence; the prosecutor's comments did not warrant reversal of defendant's conviction; the district court committed no error when it denied defendant's motion for judgment of acquittal; and 42 U.S.C. 408(a)(5) was not unconstitutionally vague. Accordingly, the court affirmed the judgment. View "United States v. Berry" on Justia Law

This case began as a dispute over the results of CM's special education evaluation under the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1400 et seq. At issue on appeal was: (1) the ALJ's dismissal of several of CM's claims against Lafayette prior to holding a due process hearing; and (2) the district court's dismissal of MM's, CM's parents, separate claims against the California Department of Education (CDE). The court held that the district court correctly dismissed MM's claims against Lafayette challenging the ALJ's statute of limitations ruling as being premature. The district court did not abuse its discretion in dismissing the fourth claim as duplicative and correctly held that the CDE had no authority to oversee the individual decisions of OAH's hearing officers. Accordingly, the court affirmed the judgment of the district court. View "M. M., et al. v. Lafayette Sch. Dist., et al." on Justia Law

This case stemmed from the denial of plaintiff's claim of social security disability benefits. At issue was whether the ALJ's handling of an ex parte contact was error, and if so, whether it was harmless. Because the ALJ erred by considering the ex parte evidence without allowing a supplementary hearing, the court was required to evaluate whether there was prejudice. The court concluded that there was no prejudice from the error where, considering the record as a whole, and the ALJ's explanation of his decision, the court was convinced that plaintiff had not demonstrated that the decision would have been any different without the ex parte communication. Accordingly, the court affirmed the judgment. View "Ludwig v. Astrue" on Justia Law

Plaintiff appealed the district court's grant of summary judgment to the Commissioner in its review of the Commissioner's denial of Social Security Disability Insurance (SSDI) and Social Security Income (SSI) benefits. Based on the rarity of the surveillance system monitor jobs, and considering plaintiff's physical and mental limitations, the court was compelled to find that the ALJ's decision was not supported by substantial evidence. Accordingly, the court reversed the district court's grant of summary judgment and remanded for further proceedings. View "Beltran v. Astrue" on Justia Law

Plaintiff appealed the district court's decision affirming the Commission's denial of her application for disability insurance benefits and supplemental security income under the Social Security Act (SSA), 42 U.S.C. 301 et seq. The court held that the ALJ did not err in weighing the evidence as she did or finding that plaintiff's testimony regarding the severity of her impairment was not credible. Although the ALJ erred in failing to give germane reasons for rejecting the lay witness testimony, such error was harmless given that the lay testimony described the same limitations as plaintiff's own testimony, and the ALJ's reasons for rejecting plaintiff's testimony applied with equal force to the lay testimony. Applying the principles set forth in the court's social security cases, as well as in Shinseki v. Sanders, the court upheld the ALJ's decision as supported by substantial evidence. View "Molina v. Astrue" on Justia Law