Justia Public Benefits Opinion Summaries

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

Plaintiffs, residents of privately-owned Chicago building, received housing vouchers from the Chicago Housing Authority to enable them to rent apartments. They claimed that the Authority is complicit in and responsible for a deprivation of their constitutionally protected privacy by the building owners. The owners require their tenants to be tested annually for illegal drugs; passing the test is a condition of a tenant’s being allowed to renew his or her lease for another year. The requirement applies to all tenants, not just those who might be suspected of using illegal drugs. The district court denied a preliminary injunction on the ground that the drug-testing policy was private rather than state action. The Seventh Circuit affirmed. None of the plaintiffs had requested transfer from the drug-testing building in which he or she currently resides to a building that does not require drug testing. A CHA representative testified that his agency would have approved such a request. That the CHA may encourage or even request testing does not constitute state action. View "Stubenfield v. Chicago Hous. Auth." on Justia Law

Plaintiff is a health insurance company that offers a choice of federal government-regulated alternatives to Medicare known as Medicare Advantage plans. These plans allow Medicare-eligible individuals to purchase health insurance from private insurance companies. Those companies are reimbursed by the government for health care services provided to the plans’ members. Before the Supreme Judicial Court was Plaintiff’s demand for indemnification to cover losses resulting from health care claims for unprovided services paid through Plaintiff’s computer system. At issue was the coverage available to Plaintiff pursuant to Rider #3 of a financial institution bond issued by Defendant. The bond insured Plaintiff against various losses, and the Rider amended the bond to provide indemnification specifically for computer systems fraud. When Plaintiff suffered more than $18 million in losses for payment for fraudulent claims for services never actually performed under its Medicare Advantage plans, Plaintiff sought payment from Defendant for its post-deductible losses. Defendant denied coverage, and Plaintiff sued. Supreme Court granted summary judgment for Defendant. The Court of Appeals affirmed, holding that the Rider applies to losses resulting directly from fraudulent access, not to losses from the content submitted by authorized users. View "Universal Am. Corp. v Nat’l Union Fire Ins. Co. of Pittsburgh, PA" on Justia Law

The federal government provides low-income housing tax credits that are distributed to developers by state agencies, including the Texas Department of Housing and Community Affairs. The Inclusive Communities Project (ICP), which assists low-income families in obtaining affordable housing, brought a disparate-impact claim under Fair Housing Act sections 804(a) and 805(a), alleging that allocation of too many credits to housing in predominantly black inner-city areas and too few in predominantly white suburban neighborhoods resulted in continued segregated housing patterns. Relying on statistical evidence, the district court ruled in favor of ICP. While appeal was pending, HUD issued a regulation interpreting the FHA to encompass disparate-impact liability and establishing a burden-shifting framework. The Fifth Circuit held that disparate-impact claims are cognizable under the FHA, but reversed, concluding that the court had improperly required proof of less discriminatory alternatives. The Supreme Court affirmed and remanded. Disparate-impact claims are cognizable under the FHA. The Court noted that the statute shifts emphasis from an actor’s intent to the consequences of his actions. Disparate-impact liability must be limited so that regulated entities can make practical business choices that sustain the free-enterprise system. Before rejecting a business justification—or a governmental entity’s public interest—a court must determine that a plaintiff has shown “an available alternative . . . that has less disparate impact and serves the [entity’s] legitimate needs.” A disparate-impact claim relying on a statistical disparity must fail if the plaintiff cannot point to a policy causing that disparity. Policies, governmental or private, are not contrary to the disparate-impact requirement unless they are “artificial, arbitrary, and unnecessary barriers.” When courts find disparate impact liability, their remedial orders must be consistent with the Constitution and should concentrate on eliminating the offending practice. Orders that impose racial targets or quotas might raise difficult constitutional questions. View "Texas Dep't of Hous, & Cmity Affairs v. Inclusive Communities Project, Inc." on Justia Law

Hansler was hired by Lehigh Valley in 2011. In 2013, Hansler began experiencing shortness of breath, nausea, and vomiting, of unknown origins. Hansler’s physician completed a medical certification form “requesting intermittent leave at a frequency of 2 times weekly starting on March 1, 2013 and lasting for a probable duration of one month.” Hansler submitted the certification as part of a formal request for leave under the Family Medical Leave Act, 29 U.S.C. 2601. Hansler was unable to work on March 13, 14, 23, 24, and 25. Without seeking further information from either Hansler or her physician, Lehigh terminated Hansler on March 28, citing absenteeism, including the five days she took off in March. Lehigh informed her, for the first time, that her leave request had been denied because her “condition presently does not qualify as a serious health condition under the criteria set forth by the [Act].” After her dismissal, Hansler received a diagnosis of diabetes and high blood pressure. The district court dismissed her suit under the Act, on the basis that the medical certification supporting Hansler’s request for leave was “invalid.” The Third Circuit reversed, finding that Lehigh violated the Act in failing to afford Hansler a chance to cure any deficiencies in her medical certification. View "Hansler v. Lehigh Valley Hosp. Network" on Justia Law

Plaintiff appealed the denial of her application for social security disability benefits. In this case, where the ALJ did not even mention a treating physician’s opinion that plaintiff’s chronic bursitis rendered her “pretty much nonfunctional,” the court cannot “confidently conclude” that the error was harmless. The court vacated the district court's opinion and remanded with instructions to the district court to remand to the ALJ to comment on the physician's medical opinions and records before a final decision is made by the court. View "Marsh v. Colvin" on Justia Law

Scott served on active duty in 1972. In 1999, Scott tested positive for hepatitis C. He applied for disability benefits in 2005, alleging that he contracted hepatitis C in service from air-gun inoculations. The VA denied service connection. Scott was incarcerated during his appeal. The VA acknowledged Scott’s request for a video conference hearing, and requested the date on which he was expected to be released. Scott responded “January 13, 2017,” and “next parole review date is scheduled for March of 2009.” The VA notified Scott that his hearing was scheduled for March 14, 2008. Scott, still incarcerated, failed to appear. On March 23, Scott requested a rescheduled hearing. The Board of Veterans’ Appeals found that Scott had “not shown good cause,” with no mention of Scott’s incarceration. The Board denied Scott’s claim for service connection, noting that Scott “failed to report for his scheduled hearing.” Before the Veterans Court, Scott, then represented by counsel, did not raise the hearing issue. The Veterans Court vacated based on an inadequate medical examination. In 2011, the VA continued the denial without mentioning the hearing issue. Scott submitted a re-certification of appeal form which checked “YES” in answer to “WAS HEARING REQUESTED?” Scott did not raise the hearing issue with the Board, which affirmed, noting that Scott “has not renewed his request” for a hearing. Before the Veterans Court, in 2013, Scott raised the hearing issue for the first time since March 23, 2008. That court affirmed, stating that raising the hearing issue “amounts to … undesirable piecemeal litigation” for no compelling reason. The Federal Circuit affirmed. The obligation to read filings in a liberal manner does not require the Board or the Veterans Court to search the record and address procedural arguments when the veteran fails to raise them. View "Scott v. McDonald" on Justia Law

Delisle served on active duty in the U.S. Army, 1952-1954, and injured his left knee in a ski accident. After that injury, Delisle also began to experience chronic pain in his other knee. In 1978, the Department of Veterans Affairs granted Delisle’s claim for entitlement to a service connection for his right-knee disorder and assigned a 10 percent disability rating. Despite continued treatment, the condition of Delisle’s right knee continued to deteriorate. In 2009, Delisle unsuccessfully sought an increase to the 10 percent disability rating for his right knee. While appeal to the Board of Veterans Appeals was pending, he underwent the total right-knee replacement. As a result, the VA assigned a 100 percent disability rating for the period from April 7, 2010 to May 31, 2011, and assigned a 60 percent rating, along with a total disability rating based on individual employability for the period following May 31, 2011. Delisle challenged only the determination that he was not entitled to a higher disability rating for the nine months before his surgery. The Board rejected the claim. The Veterans Court affirmed. The Federal Circuit dismissed. The Veterans Court’s determination concerned questions of fact, which are beyond the court’s jurisdiction, 38 U.S.C. 7292(d)(2) View "Delisle v. McDonald" on Justia Law

Shelley and Christopher married in 1992. Shelley works in the private sector and has Social Security tax withheld from her pay; she expects to receive full benefits in 2033 at age 67. Christopher works for the police department and does not have Social Security tax withheld. He contributes to the Police Pension Fund and can retire with full benefits in 2017 at age 50. In their 2012 divorce, Christopher computed the estimated present value of his pension benefits, using a “Windfall Elimination Provision” to determine what part of those benefits were in lieu of Social Security, which is exempt from equitable distribution. Using Christopher’s wages, as if covered by Social Security, predicted that his Social Security benefit at age 67 would be $1,778 per month; using his wages for those years in which he contributed to Social Security, predicted that his benefit at age 67 would be $230 per month. The difference of $1,548 was posited as “in lieu of Social Security.” The difference between that amount and the pension amount was $2,479 per month, with an estimated present value of $639,720.74. The court determined that the proposed valuation would violate federal law as interpreted by Illinois Supreme Court precedent. Christopher recalculated the present value of his pension, without the offset, as $991,830. The court adopted that figure, and awarded Shelley about 35%. The Illinois Supreme Court affirmed, reasoning that Social Security benefits cannot be calculated until the participant collects them. Decreasing Shelley’s share of Christopher’s pension based on the present value of hypothetical Social Security benefits that, even if he had participated in that program, he might never receive is illogical and inequitable. Failing to consider Social Security may paint an unrealistic picture of their future finances, but Congress intended to keep those benefits out of divorce cases. View "In re Marriage of Mueller" on Justia Law

In the “NOVA” decision, the Federal Circuit approved a plan requiring the Department of Veterans Affairs (VA) to identify and rectify harms caused by wrongful application of former 38 C.F.R. 3.103. The Plan required that the VA notify every claimant who received a final Board decision during the specified period and did not receive full relief. If a claimant had a case outside of the Board’s jurisdiction, but mandate had not issued and the appellate court’s judgment was not final, the VA was obligated to offer to submit a joint motion for remand. If the mandate had issued, the VA was required to offer to submit a joint motion to recall mandate and a joint motion for remand. Smith served in the Army, 1963-1965. In 2000, Smith filed an unsuccessful claim for compensation for post-traumatic stress disorder (PTSD). In 2008, Smith was awarded service connection for PTSD with a 100% disability rating and a 2006 effective date. Smith appealed to the Board, which, in 2011, denied entitlement to an earlier effective date. The Board did not apply the invalid Rule interpretation. The Veterans Court affirmed and, days before the NOVA decision, entered judgment. In 2013, the parties filed a joint motion to recall that judgment. The decision fit the search terms profile under the Plan and triggered the VA’s obligation to offer to submit a joint motion. Smith did not claim that VA failed to comply with 38 C.F.R. 3.103(c)(2) or any prejudice in the conduct of the Board hearing. The Federal Circuit affirmed denial of the motion, stating that neither its decisions nor the Plan preclude appropriate denial. View "Smith v. McDonald" on Justia Law