Justia Public Benefits Opinion Summaries

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

Following the entry of a judgment in favor of plaintiffs Terence and Paula Kilker against defendant Frank Stillman, the trial court ordered Stillman to produce documents regarding his assets to the Kilkers. After Stillman failed to comply with that order, the trial court found Stillman in contempt and ordered that Stillman pay the Kilkers reasonable attorney fees and costs, plus interest. The underlying judgment was eventually satisfied. To collect on the attorney fees and costs award, the Kilkers served a writ of execution on Preferred Bank to levy funds in Stillman’s bank account. Stillman submitted a claim of exemption to the writ. He asserted the funds in the account were Social Security payments exempt from levy. The Kilkers opposed Stillman’s claim of exemption, arguing that under Code of Civil Procedure section 704.080, only Social Security funds directly deposited into a bank account by the government are protected by the exemption. The trial court found Stillman’s bank account at Preferred Bank solely contained Social Security payments, but, nevertheless, denied Stillman’s exemption claim. The court did so because those funds were not directly deposited into the bank account by the government. On review, the Court of Appeal concluded the trial court’s conclusion was legally erroneous because Stillman’s Social Security payments were protected by federal law from levy. View "Kilker v. Stillman" on Justia Law

In 1992, Fugate, receiving workers’ compensation, obtained disability benefits from the Social Security Administration. In such cases, SSA reduces payments until the total benefits equal 80 percent of the recipient's “average current earnings.” Using Fugate’s December 1991 pay stub, SSA calculated “one-twelfth of the total of his wages . . . for the calendar year in which he had the highest such wages,” on which FICA taxes are paid. Fugate had 1991 gross earnings of $22,964.41. After subtracting pretax benefits and retirement contributions (not subject to FICA), SSA calculated his covered earnings as $21,693.30. Fugate complained that SSA should have used pay stubs from his three highest months of earnings in 1991. In 2004, after a periodic review, SSA erroneously determined that Fugate’s covered earnings should have been $22,964.41 and paid Fugate an extra $8,875. In 2006, after another periodic review, SSA realized its mistake and asked Fugate to refund the $8,875. Instead of requesting a refund waiver, Fugate sought reconsideration of calculation of benefits for the same reasons he had cited since 1993. An ALJ declined to reconsider the 2004 decision, but erroneously held that Fugate was entitled to a waiver even though he had not requested one. Fugate nonetheless appealed. The Appeals Council vacated. The district court granted the Administration summary judgment. The Eighth Circuit affirmed. View "Fugate v. Comm'r of Social Sec." on Justia Law

Petitioner was admitted to a nursing home in September 2010. She was eighty-seven years old at the time, and had a diagnosis of dementia and Alzheimer's disease. Petitioner's adult daughter, who had the authority to act on petitioner's behalf by virtue of a power of attorney, submitted an application for long-term care Medicaid benefits in January 2011. The application sought coverage for petitioner, retroactive to October 1, 2010, pursuant to a Medicaid rule authorizing benefits for up to three months preceding the month of application. A benefits specialist with the Department for Children and Families testified that, in response to the application, she sent two separate verification requests to petitioner's daughter and an administrator at petitioner's nursing home. The Department received no response to these requests. Accordingly, in March 2011, the Department issued a Notice of Decision ("Notice") denying the application. No appeal of the denial was filed by petitioner or a person acting on her behalf within the ninety-day limit. Petitioner's daughter would submit a total of four applications, each with a request from the Department for additional information, and each time, no information was provided, and the applications were denied. With the assistance of her son, petitioner filed a fifth application for benefits in February 2012. This time, additional information verifying petitioner's financial eligibility was provided, and the application was approved by the Department in May 2012 with benefits retroactive to November 2011, which was three months prior to the date of the fifth and final application. Petitioner appealed that decision, seeking coverage retroactive to October 2010, which would have been three months prior to her first application from January 2011. An evidentiary hearing was held in July 2013 before a Department hearing officer. The Board adopted the hearing officer's findings and issued a decision reversing the Department's decision to limit retroactive benefits to November 2011. The Board concluded that, for reasons of equitable estoppel, petitioner could be awarded benefits retroactive to October 1, 2010 based on the date of the initial application. The Department sought review by the Secretary, who reversed the Board's decision. Because petitioner did not respond to the Department's multiple requests for verification, did not advise the Department of any valid reasons for failing to respond, and informed the Department's benefits specialist that the failure to respond was her responsibility, that she had "dropped the ball." Accordingly, the Secretary found no justification to invoke the doctrine of equitable estoppel, and reversed the Board's decision. Finding no reversible error, the Vermont Supreme Court affirmed the Secretary's reversal of the Board's ruling. View "In re Bernice Landry" on Justia Law

Minnick suffers from several serious medical problems, including fibromyalgia, chronic obstructive pulmonary disease (COPD), and degenerative disc disease. Minnick was a truck driver for 24 years until taking short term leave in 2008 due to pain in his legs and hip. After returning to work, he was laid off. In 2010, he applied for disability insurance benefits under the Social Security Act. After the Disability Determination Bureau denied Minnick’s claim, an Administrative Law Judge determined that Minnick is not disabled within the meaning of the Social Security Act. The Appeals Council denied review. The district court affirmed. The Seventh Circuit reversed, finding that the ALJ did not fully develop the record nor adequately articulate her analysis in discrediting the testimony of one of Minnick’s treating physicians. View "Minnick v. Colvin" on Justia Law

At issue in this case was services that Maine Medical Center provided to Medicare/Medicaid “dual-eligible” patients, that is, patients covered by both Medicare and the state-administered Medicaid insurance program, MaineCare. The Secretary for the Department of Health and Human Services denied Maine Medical’s claim for partial federal reimbursement of “bad debt” for the fiscal years 2002 and 2003. A “bad debt” is an amount considered to be uncollectible for covered services that may be eligible for federal reimbursement under certain conditions. The Secretary denied reimbursement because Maine Medical had not acquired from MaineCare a state-issued remittance advice to use as proof. The district court affirmed. The First Circuit affirmed, holding that it was not arbitrary and capricious for the Secretary (1) to demand that Maine Medical provide documentation from the State confirming the identity of Medicaid-eligible beneficiaries and qualified Medicare beneficiaries, the amount that is the State’s to pay, and the State’s refusal to pay; and (2) to deny Maine Medical’s reimbursement claims that were unsupported by such documentation. View "Me. Med. Ctr. v. Burwell" on Justia Law

Plaintiff appealed the denial of his application for social security disability benefits. The court concluded that substantial evidence supports neither the ALJ's rejection of plaintiff's testimony nor his rejection of the medical assessment by plaintiff's treating physician. Consequently, the court reversed the district court's affirmance of the denial of benefits. However, because the court has "serious doubt" as to whether plaintiff is, in fact, disabled under Garrison v. Colvin, the district court shall remand the case to the ALJ for further proceedings on an open record. On remand, the court did not require the ALJ to require as true plaintiff's testimony, the treating physician's assessment, or any other evidence. View "Burrell v. Colvin" on Justia Law

Babaria, a licensed radiologist and medical director and manager of Orange Community MRI, an authorized Medicare and Medicaid provider, pleaded guilty to one count of making illegal payments (kickbacks), 42 U.S.C. 1320a-7b(b)(2)(A). From 2008 through 2011, he paid physicians to refer patients to Orange for diagnostic testing and billed Medicare and Medicaid for testing that was tainted by the corrupt referrals. Orange received $2,014,600.85 in payments that were directly traceable to the kickback scheme. There was no evidence that Babaria falsified patient records, billed Medicare or Medicaid for testing that was not medically necessary, or otherwise compromised patient care. Babaria objected to the PreSentence Investigation Report, which recommended a two-level adjustment for abuse of a position of trust (USSG 3B1.3) and a four-level adjustment for aggravating role (USSG 3B1.1(a)), resulting in a recommended Guidelines range of 70-87 months’ imprisonment. Ultimately, the Guidelines range was 60 months, capped by the statutory maximum for Babaria’s count of conviction. He argued that the correct range was 37 to 46 months. The court applied both adjustments but granted a downward variance and sentenced Babaria to 46 months’ imprisonment, a fine of $25,000, and forfeiture of the $2,014,600.85. The Third Circuit affirmed the sentence. View "United States v. Babaria" on Justia Law

Plaintiff appealed the district court's judgment, affirming in part and reversing and remanding in part, the Commissioner's denial of his application for social security disability insurance. The court concluded that the ALJ erred in failing to provide specific reasons for rejecting plaintiff's testimony regarding the severity of his symptoms and, therefore, reversed the judgment of the district court affirming that portion of the ALJ's decision. The court also concluded that the record does not compel a finding of disability and, therefore, the court remanded for further proceedings. View "Treichler v. Comm'r of Soc. Sec." on Justia Law

Navarro served in the Army from 1958-1960. He is not a combat veteran, but served near the demilitarized zone after the Korean War. In 2005, Navarro sought service connection for PTSD. He established the condition under 38 C.F.R. 4.125(a). He provided testimony about hearing shots, seeing injured soldiers, and hearing noises while on night guard duty. The Board of Veterans’ Appeals denied the claim in 2008. While appeal was pending, the VA amended 38 C.F.R. 3.304(f) with respect to evidence required to establish claimed in-service stressors for PTSD claims. The Veterans Court vacated. On remand, the Board found that revised 3.304(f) did not apply because Navarro had been diagnosed by a therapist, not a “VA psychiatrist or psychologist” and that Navarro was not entitled to a VA medical examination because “none of his claimed stressor events have been sufficiently corroborated by credible supporting evidence and his account of having a continuity of PTSD symptomatology since service is not deemed credible.” The Veterans Court affirmed. The Federal Circuit remanded for determination of whether Navarro’s “claimed stressor[s are] consistent with the places, types, and circumstances of the veteran’s service.” If so, he is entitled to examination by a VA psychiatrist or psychologist. View "Sanchez-Navarro v. McDonald" on Justia Law