Justia Public Benefits Opinion Summaries

Hall, an aviation mechanic, was discharged in 2001 by the military because of pain from an ankle injury. He was deemed by the Department of Veterans Affairs to be 70 percent disabled and to be “unemployable” in “a substantially gainful occupation” and totally disabled, 38 C.F.R. 4.16. In 2010 he applied for social security disability benefits on the ground that pain from his ankle injury, plus back and knee pain and other ailments, had worsened and rendered him totally disabled under Social Security Act standards. From 2005-2011 he underwent physical examinations and diagnostic tests. Some results were normal but many were not, revealing torn ligaments, obesity, possible arthritis, an “alignment problem” in his back, and fibromyalgia. Hall testified about his pain and inability to perform normal functions. The Seventh Circuit reversed the denial of benefits. Several doctors noted that Hall had been in pain when examined, which was some corroboration of his testimony. The ALJ could have resolved her doubts by ordering an MRI or directing a further examination by a medical expert. In addition, her failure to analyze and weigh the VA determination that Hall is totally disabled was a further oversight. View "Hall v. Colvin" on Justia Law

When the applicant was 15 years old, “Harrington rods” were inserted into his spine to correct a 57-degree curvature of the spine. He then developed chronic back pains. He also has cognitive difficulties. At age 20 he was determined to be eligible for social security disability benefits, but he later obtained a job at a nonprofit organization, driving disabled clients, helping with cooking and cleaning, and performing clerical tasks. The Social Security Administration determined in 1999 (when the applicant was 32) that he was not disabled and tried to recover the $65,000 in benefits. He declared bankruptcy. Three years later, he was fired because he could not keep up with the demands of the job. Two years later he reapplied for social security disability benefits. Several physicians and mental-health professionals diagnosed: chronic back pain; cubital tunnel syndrome; a somatoform disorder; depression, anxiety, panic attacks, agoraphobia, low intelligence, dizziness, migraine headaches, and deficient short-term memory. The applicant and his father testified to sleeplessness, loss of balance, blurred vision, and abdominal pain. The ALJ concluded that he was capable of unskilled light work of a routine and repetitive character and was not disabled. The Seventh Circuit reversed the denial of benefits, finding the opinion “riddled with errors.” View "Adaire v. Colvin" on Justia Law

Nealy was hired by Santa Monica in 1996 and became a recycling worker. Nealy injured his knee on the job in 2003. A doctor declared him temporarily totally disabled until 2005, when he was released to “light duty” with the restriction that he could not push large trash bins. Nealy requested a clerical or refuse collection vehicle operator position, but began working as a groundskeeper. Nealy met with the accommodations committee again in 2006 because of difficulty climbing or descending stairs. The city did not have any office work available; Nealy never returned to work after a 2006 emergency room visit. After additional accommodation meetings, in 2010, the city indicated that it was unable to provide reasonable accommodation into an alternative position because Nealy was not minimally qualified for the only available position that was not a promotion. The city filed a disability retirement application but, in 2011, CalPERS canceled the application for failure to submit necessary information. Nealy obtained a right-to-sue notice from the California Department of Fair Employment and Housing. The court entered judgment for the city on disability discrimination, failure to provide reasonable accommodation, failure to engage in the interactive process, and retaliation. Meanwhile, an ALJ awarded Nealy $36,260 on his workers’ compensation claim. The court of appeal affirmed, in favor of the city. View "Nealy v. City of Santa Monica" on Justia Law

Zirnsak was involved in a motor vehicle accident. She sustained head and lung injuries and skeletal fractures and was hospitalized from October 8 through November 14, 2001, temporarily on life support. Upon her discharge, she was sent to a rehabilitation facility, where she was treated from January 16, 2002 through October 18, 2005. In 2003, she suffered a seizure. She was prescribed medication and did not suffer any further seizures. Between January 5, 2005 and August 11, 2006, Zirnsak underwent plastic surgery for lipoma reductions. Zirnsak sought treatment from several medical professionals, including treatment for “traumatic brain injury, left hemiparesis cognitive impairments with short-term memory deficits, organic affective changes[,] and a seizure disorder.” In 2010, Zirnsak applied for Social Security Disability Insurance benefits alleging a disability commencing on May 11, 2006. Zirnsak’s date last insured was December 31, 2007. The SSA denied Zirnsak’s application, finding that Zirnsak was capable of performing certain jobs available in the national economy, so long as those jobs were sedentary and routine. The district court and Third Circuit affirmed. Substantial evidence supports Zirnsak’s ability to perform jobs widely available in the national economy: order clerk, food and beverage; charge account clerk; and telephone clerk. View "Zirnsak v. Colvin" on Justia Law

In 2010, Curvin applied for disability benefits under the Social Security Act, 42 U.S.C. 401, alleging that she became disabled beginning in January 2009 from glaucoma, overactive thyroid, high blood pressure, difficulty sleeping, and knee pain. The ALJ denied her claim in 2011, finding that Curvin had not engaged in substantial gainful activity since the alleged onset of her disability; that Curvin’s glaucoma in her right eye was a severe impairment, and that the objective medical evidence showed that her remaining impairments were not severe; that based on the conclusions of Curvin’s treating and examining physicians and objective medical evidence, Curvin did not have an impairment or combination of impairments that met the severity of a listed impairment. The ALJ determined that Curvin had a residual functional capacity to perform a full range of work at all exertion levels, but with a nonexertional limitation of no peripheral vision on her right side due to her glaucoma. The district court vacated. The agency appealed. The Seventh Circuit reinstated the denial as being supported by substantia evidence. View "Curvin v. Colvin" on Justia Law

Lisa Bailey, a fifty-one-year old who was considered morbidly obese, requested, through her physician, Medicaid authorization for gastric bypass surgery. The Montana Department of Public Health and Human Services (Department) denied the request because gastric bypass surgery is a non-covered service under Department administrative rules. A hearing officer upheld the Department’s determination, and the Board of Public Assistance adopted the decision of the hearing officer. The district court affirmed. Bailey appealed, asking that the Department be required to conduct a determination of medical necessity for the procedure. The Supreme Court affirmed, holding that the Department’s rule excluding coverage for all invasive procedures undertaken for the purpose of weight reduction, including gastric bypass surgery, is not unreasonable or contrary to federal law. View "Bailey v. Mont. Dep’t of Pub. Health & Human Servs." on Justia Law

In 1996 Ritzhoff was injured while working as a banquet server. He sustained permanent injuries to his ankle and injured his hand and back. His treating psychiatrist initially evaluated Ritzhoff in 2001 and noted that Ritzhoff demonstrated diminished cognitive functioning, had severe depression, suicidal ideation, severe anxiety, and total neuroticism. The doctor found Ritzhoff temporarily totally disabled on a psychiatric basis and in need of emotional treatment. His employer made temporary disability payments until 2006. Ritzhoff admitted working from time-to-time since his injury. At a third hearing in 2013, Ritzhoff refused to respond to cross-examination. The workers’ compensation judge found Ritzhoff totally permanently disabled on a psychiatric basis, originating in the orthopedic injury. The Workers’ Compensation Appeals Board affirmed. The court of appeal annulled the determination. That the decision was supported by substantial evidence is beside the point. The appeals board exceeded its powers when it adopted a decision as its own that was flawed by a denial of due process with respect to cross-examination. View "Ogden Entm't Servs. v. Workers' Comp. Appeals Bd." on Justia Law

Sprinkle applied for supplemental social security income. After exhausting administrative remedies, Sprinkle sought judicial review of a final decision that he was not disabled. The district court held that the agency failed to properly evaluate evidence of Sprinkle’s disability and reversed. Sprinkle sought attorney’s fees under the Equal Access to Justice Act. While the EAJA contains a presumptive rate cap of $125 an hour, courts may award enhanced fees if justified because of an increase in the cost of living. The court found that Sprinkle was entitled to fees, but rejected his request for a cost-of-living enhancement. The Seventh Circuit vacated. An EAJA claimant seeking an adjustment need not offer proof of the effects of inflation on the particular attorney’s practice or proof that no competent attorney could be found for less than the requested rate. The claimant may rely on a readily available measure of inflation such as the Consumer Price Index, as well as proof that the requested rate does not exceed the prevailing market rate in the community for similar services by lawyers of comparable skill and experience. An affidavit from a single attorney testifying to the prevailing market rate may suffice to meet that burden. View "Sprinkle v. Colvin" on Justia Law

Plaintiffs filed a putative class action suit against the Secretary on behalf of Medicare beneficiaries who were placed into "observation status" by their hospitals rather than being admitted as "inpatients." Placement into "observation status" allegedly caused these beneficiaries to pay thousands of dollars more for their medical care. The district court granted the Secretary's motion to dismiss and plaintiffs appealed. The court affirmed the dismissal of plaintiffs' Medicare Act, 42 U.S.C. 1395, claims where plaintiffs lack standing to challenge the adequacy of the notices they received and nothing in the statute entitles plaintiffs to the process changes they seek. However, the court vacated the district court's dismissal of plaintiffs' Due Process claims where the district court erred in concluding that plaintiffs lacked a property interest in being treated as "inpatients," because the district court accepted as true the Secretary's assertion that a hospital's decision to formally admit a patient is "a complex medical judgment" left to the doctor's discretion. The district court's conclusion constituted impermissible factfinding, which in any event is inconsistent with the complaint's allegations that the decision to admit is guided by fixed and objective criteria. View "Barrows v. Burwell" on Justia Law

Moffitt served in the Army, 1944-1946, and was discharged due to injuries sustained during service. The VA awarded him a combined disability rating of 100%, which was later reduced to a combined 60% rating, effective 1953. Moffitt died in 1982. If a veteran’s death is not service-connected, the surviving spouse may qualify for dependency and indemnity compensation (DIC) if the veteran received, or was “entitled to receive,” benefits for a service-connected disability that was rated totally disabling for the 10-year period prior to the veteran’s death, 38 U.S.C. 1318. Mrs. Moffitt sought DIC benefits under 38 U.S.C. 1151, which provides that, when a veteran suffers an additional disability or death as the result of VA hospitalization, treatment, or examination, benefits shall be awarded as if such disability or death were service-connected. The Board concluded that Moffitt’s death was the result of injury incurred during hospitalization at a VA facility and posthumously granted Moffitt’s pending claim for total disability based on individual unemployability with a 1979 effective date. After several related decisions, the Board of Appeals denied Mrs. Moffitt enhanced DIC benefits, finding that regulations, amended while the claim was pending, precluded her hypothetical entitlement theory (38 C.F.R. 20.1106). The Veterans Court and Federal Circuit affirmed, applying the amendment retroactively. View "Moffitt v. McDonald" on Justia Law