Justia Public Benefits Opinion Summaries

Varga, now 42, had a 1994 medical discharge from the military because of severe endometriosis (a condition which causes pelvic pain). She then worked as a correctional officer, and later an office worker, at the Federal Correctional Institute (FCI) in Oxford, Wisconsin. She left the FCI in 2005 because of her continuing physical and mental impairments and has not worked since March 2006, when her application for disability retirement under the Federal Employees Retirement System was approved. She applied for disability insurance benefits in 2006, alleging she had been disabled since 2005. Between 2005 and 2011, Varga was diagnosed with: PTSD, endometriosis, major depression, irritable bowel syndrome, and fibromyalgia. An Administrative Law Judge denied her application. The district court, affirmed. The Seventh Circuit reversed, agreeing that the ALJ erred by failing to include her mental limitations in the areas of concentration, persistence, and pace in the hypothetical question that he posed to the vocational expert. The flawed hypothetical led the vocational expert and the ALJ to erroneously conclude she was not disabled. View "Varga v. Colvin" on Justia Law

Hospitals that are disadvantaged by their geographic location may reclassify to a different wage index area for certain Medicare reimbursement purposes by applying for redesignation to the Medicare Geographic Classification Review Board. Section 401 of the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999, enacted 10 years after the Board was established, creates a separate mechanism by which qualifying hospitals located in urban areas “shall [be] treat[ed] . . . [as] rural” for the same reimbursement purposes. To avoid possible strategic maneuvering by hospitals, the U.S. Department of Health and Human Services issued a regulation providing that hospitals with Section 401 status cannot receive additional reclassification by the Board on the basis of that status, 42 C.F.R. 412.230(a)(5)(iii) (Reclassification Rule). Geisinger, a hospital located in an urban area, received rural designation under Section 401 but was unable to obtain further reclassification by the Board pursuant to the Reclassification Rule. Geisinger sued. The district court upheld the regulation. The Third Circuit reversed, finding that Section 401 is unambiguous: HHS shall treat Section 401 hospitals as rural for Board reclassification purposes, 42 U.S.C. 1395ww(d)(8)(E)(i) View "Geisinger Cmty. Med. Ctr. v. Sec'y United States Dep't of Health & Human Servs." on Justia Law

Carter served in the Army, 1965-1967. In 1989, he sought disability benefits for an injury to his back. The VA denied his claim. He sought to reopen in 2005, filing new evidence that he had aggravated the injury during his service. In 2006, the VA reopened, but denied the claim. The Board of Appeals affirmed in 2009. While appeal was pending, Carter changed counsel. He filed Form 21-22a in March 2010, naming a private attorney in place of Disabled American Veterans. New counsel requested a copy of Carter’s claim file. In June 2010, new counsel and the government jointly requested partial vacatur of the 2009 decision; the Veterans Court remanded the case with instructions. The Board sent a letter to Carter and Disabled American Veterans, stating that additional evidence must be submitted within 90 days (November 4, 2010). Counsel did not receive the letter. On December 13, 2010, the VA sent new counsel Carter’s file, nearly nine months after her requested. She did not immediately read the file and did not see the letter. In February 2011, without hearing from Carter, the Board again denied his claim. Carter’s attorney received a copy of the decision in December 2011. The Veterans Court affirmed. The Federal Circuit vacated. The Veterans Court incorrectly understood the law governing this notice defect. View "Carter v. McDonald" on Justia Law

Plaintiff appealed the denial of her claims for disability insurance benefits (DIB) and supplemental security income benefits (SSI) based on a fractured ankle in 2011. The ALJ denied her claim, concluding that plaintiff's impairment did not equal the medical severity of an impairment listed in the C.F.R., which required plaintiff to show that her ankle injury rendered her unable to ambulate effectively for a full year after the May 2011 onset. Plaintiff requested review of her claim and submitted additional medical records. The Appeals Council made this additional evidence part of the record but denied the review without providing discussion of the newly submitted evidence. The court reversed and remanded for further proceedings because the court was unable to determine, from review of the record as a whole, if substantial evidence supports the Commissioner’s denial of benefits. View "Sun v. Colvin" on Justia Law

Plaintiffs, Medicaid recipients who unsuccessfully sought coverage for prescription drugs, filed suit contending that the District and its officials unlawfully failed to afford them notice of their entitlement to a hearing before denying their prescription drug claims. The court affirmed the district court's dismissal of plaintiffs' claims under Title XIX of the Social Security Act, 42 U.S.C. 1396 et seq., and rejected plaintiffs’ argument that Title XIX’s notice regulations are triggered whenever there has been a denial of a claim for prescription drug coverage at the point-of-sale. However, the court reversed the district court's dismissal of the due process claims because the prescription drug coverage sought by plaintiffs qualifies as a property interest protected by the Fifth Amendment; plaintiffs adequately alleged that Xerox, a private company, determined their eligibility for benefits while acting as an agent of the District; and the court remanded the case to permit the district court to conduct an inquiry in the first instance into what process is due. The court also remanded to the district court to reconsider its jurisdiction over the D.C. -law claims in light of the court's partial reversal. View "NB v. District of Columbia" on Justia Law

The parent of K.E., a student who was diagnosed with several learning issues, seeks reimbursement under the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1400 et seq., after she chose a private boarding school for K.E. The hearing officer and the district court denied reimbursement because, in their view, the child had no need to be in a residential program. The court concluded, however, that all statutory, regulatory, and judicial requirements for reimbursement of the costs of private school have been satisfied: the school district failed to offer the child a “free appropriate public education” in either a public school or a non-residential private school; the private boarding school the parent selected was, at the time, the only one on the record “reasonably calculated to enable the child to receive educational benefits” designed to meet the child’s needs; the residential component of the private school was in fact “necessary to provide a free appropriate public education to” the child; and the school district has not shown that the parent acted unreasonably. Accordingly, the court reversed and remanded for further proceedings. View "Leggett v. District of Columbia" on Justia Law

Lemons applied for social security disability benefits after being diagnosed with a pain disorder caused by inflammation of a membrane that surrounds the nerves of the spinal cord. An ALJ awarded benefits and Lemons began receiving $802 per month. The ALJ, advised that Lemons’s condition was expected to improve, recommended follow-up review. The Administration failed to conduct the review and never contacted Lemons until it received an anonymous letter, including photographs of Lemons engaged in various activities. Investigators conducted surveillance. The Administration initiated review. Lemons responded that she could not pick up anything over 20 pounds nor sit more than 30 minutes without causing increased pain. The Administration discontinued benefits. Lemons appealed and chose to continue benefits during the process. Investigators met with Lemons’s treating physician, and showed her surveillance videos; the doctor revised her assessment and concluded that Lemons could perform some work. A cessation of benefits decision recorded a finding of “Fraud or Similar Fault.” Lemons was convicted of making a false statement, 18 U.S.C. 1001, and theft of government funds, 18 U.S.C. 641. The district court calculated a guidelines range of 27-33 months’ imprisonment, based on an intended loss totaling $284,018.64, varied downward, and sentenced Lemons to 12 months and one day. The Eighth Circuit affirmed. View "United States v. Lemons" on Justia Law

Plaintiffs filed suit under 42 U.S.C. 1983 against DSS to enforce the Food Stamp Act's, 7 U.S.C. 2020(e)(3) and (9), time limits for awarding food stamp benefits. The district court certified a class consisting of all past, current, and future Connecticut food stamp applicants whose applications are not processed in a timely manner and the district court issued a preliminary injunction requiring DSS to process food stamp applications within the statutory deadlines. The court concluded that plaintiff can maintain a private lawsuit under 42 U.S.C. 1983 to enforce the statutory time limits in section 2020(e)(3) and (9). The court also concluded that federal regulations do not excuse DSS from processing food stamp applications within the statutory time limits. Accordingly, the court affirmed the judgment. View "Briggs v. Bremby" on Justia Law

Andrews, born in 1976, has a GED and work experience as a cashier, retail sales clerk, and a secretary/receptionist, all of which are classified as sedentary or light duty work. In 2010, Andrews applied for both DIB and SSI, claiming a disability onset of 2007, as a result of fibromyalgia/chronic pain syndrome, cervical disc disease, migraine headaches, major depressive disorder, generalized anxiety disorder and borderline personality disorder. The Commissioner denied her application. Andrews submitted extensive medical records to an ALJ. Her doctor’s opinion of Andrews' limitations, if deemed controlling, would have resulted in a finding of total disability. The ALJ placed little weight on his opinion, but placed great weight on the opinions of state agency medical consultants and credited the vocational expert's testimony in her final decision to deny Andrews' benefits. The Social Security Appeals Council denied review and the district court affirmed. The Eighth Circuit found that the denial was supported by substantial evidence. View "Andrews v.Colvin" on Justia Law

In 2000, Herbert, a Navy veteran, sought disability benefits for PTSD, which he alleged was connected to a typhoon that his ship encountered travelling to Japan in 1956. Ship logs and letters confirm that the USS Mount McKinley weathered a bad storm around that time. A 2002 VA medical examination revealed no PTSD; the Regional Office denied the claim. Herbert filed notice of disagreement, but his hearing did not occur until 2008. Herbert underwent a 2004 examination at the VA’s Veterans Center and a 2006 examination by a private psychologist that both produced diagnoses of PTSD. A 2006 VA examination and a 2007 examination conducted at the VA’s behest did not. The Board of Appeal denied service connection finding Herbert not credible in testifying to witnessing others go overboard. The Veterans Court remanded. A VA examiner concluded that experiencing the typhoon itself was an adequate stressor to support a PTSD diagnosis, but that Herbert’s symptoms did not meet diagnostic criteria for PTSD” In 2011, Herbert had another private medical examination, which diagnosed PTSD based on the storm alone. In 2012, the Board rejected Herbert’s claim, finding him “not credible in reporting his psychiatric symptoms or the stressors.” The Veterans Court and Federal Circuit affirmed. View "Herbert v. McDonald" on Justia Law