Justia Public Benefits Opinion Summaries

Gilbert served in the Navy. His reported medical history upon entry into service revealed no psychiatric defects. After leaving service, Gilbert was diagnosed with major depression and required treatment for psychiatric illness and alcohol dependence. Gilbert acknowledged that he experienced depressive episodes and suicidal ideation throughout his life, that he has been abusing drugs and alcohol since he was a teenager, and that he continued to abuse alcohol while in the Navy. Gilbert sought compensation for psychiatric disability and other conditions with the VA. Multiple psychiatric examinations produced conflicting opinions. The VA denied service connection; the Board affirmed. The statutory “[p]resumption of sound condition” was applicable because no psychiatric condition was noted upon entry into service, 38 U.S.C. 1111; to rebut the presumption, the government had to provide clear and unmistakable evidence demonstrating that the disease existed before enrollment and was not aggravated by service. Based on Gilbert’s acknowledged history, the Board concluded that the government proved that his psychiatric illness pre-existed enrollment, but that the government failed to establish that Gilbert’s “pre-existing depression was not aggravated by active service,” and did not rebut the presumption of soundness. The Board nevertheless denied service connection, concluding that Gilbert failed to prove that his post-service psychiatric conditions “were correlated to [his] military experiences.” The Veterans Court and Federal Circuit affirmed.View "Gilbert v. Shinseki" on Justia Law

Checo sought an increased disability rating for lumbosacral spinal stenosis, including disk bulges, which was rated at a 20% disability. On July 6, 2011, the Board of Veterans’ Appeals denied her request. Checo was homeless, residing in shelters and temporary housing without the ability to receive mail. On September 27, 2011, she contacted the VA to provide a new address, and received a copy of the adverse decision on October 6, 2011; 91 days of the 120-day filing period under 38 U.S.C. 7266 had passed. On December 7, 2011, Checo filed a Notice of Appeal, 33 days late. She wrote: “Due to economic hardship, I’ve been homeless for extensive periods of time since July 2009 … and did not learn about the hearing and subsequent decision until” October 2011. The Clerk of the Veterans Court ordered the Secretary to file a response discussing whether the circumstances warranted equitable tolling of the judicial appeal period. In its response, the Secretary noted that “it appears that [Ms. Checo’s] homelessness was due to circumstances beyond her control” and that homelessness “would have delayed her filing of her NOA.” After the Veterans Court accepted the Secretary’s concession that Checo’s homelessness qualified as an extraordinary circumstance, it dismissed, finding that Checo failed to prove two other necessary elements, due diligence and direct causation,—to warrant equitable tolling. The Federal Circuit vacated. The Veterans Court used an inappropriate due diligence standard and erred in determining that homelessness did not cause the delay.View "Checo v. Shinseki" on Justia Law

Plaintiff appealed the district court's order denying his motion for attorney's fees under the Equal Access to Justice Act (EAJA), 28 U.S.C. 2412. The court concluded that the underlying agency action lacked a reasonable basis in law because the Social Security ALJ disregarded competent lay witness evidence on plaintiff's symptoms without comment. The court concluded that, because the ALJ disregarded competent lay witness evidence without comment, the position of the United States in the underlying action was not substantially justified. Because the government's underlying position was not substantially justified, the court awarded fees, even if the government's litigation position may have been justified. Therefore, plaintiff was entitled to an award of attorney's fees. Accordingly, the court reversed and remanded.View "Tobeler v. Colvin" on Justia Law

Bowers served in the Army National Guard 1972-1978, with a continuous period of active duty for training from August 1972 to February 1973. His records do not reflect that he incurred any injury or disease during service. In 2009, shortly after his diagnosis with Lou Gehrig’s disease (ALS), Bowers sought benefits for ALS and secondary conditions. A VA Regional Office denied the claim, finding that his ALS was not incurred or aggravated in service. The Board of Veterans’ Appeals rejected his argument that he was entitled to presumptive service connection for ALS under 38 C.F.R. 3.318, noting that reserve duty and active duty for training of the type Bowers performed does not generally entitle an individual to evidentiary presumptions. While his appeal to the Veterans Court was pending, Bowers died and his wife was substituted as the appellant. The Veterans Court affirmed, finding that Bowers did not achieve “veteran status,” and was not entitled to presumptive service connection. The Federal Circuit affirmed. View "Bowers v. Shinseki" on Justia Law

Marilyn Davidson, an intellectually disabled individual, was in the care of the Massachusetts Department of Developmental Services (DDS) most of her life. In 1985, Marilyn was transferred to the Fernald Developmental Center, an intermediate care facility (ICF). In 2003, the Commonwealth of Massachusetts decided to close Fernald. DDS planned to transfer Marilyn to the Wrentham Developmental Center, another ICF. Plaintiffs, Marilyn’s guardians, filed a complaint in the federal district court, alleging that Marilyn’s transfer violated the federal Medicaid statute and various implementing regulations. Plaintiffs also sought a motion for a preliminary injunction. The district court denied the injunction and held that the statutory and regulatory provisions cited in the complaint did not create a private right of action. Marilyn was subsequently transferred to Wrentham, and Fernald was closed. The First Circuit Court of Appeals remanded the case to the district court with instructions to dismiss Plaintiffs’ complaint, holding (1) Plaintiffs’ claim for damages was barred by the Commonwealth’s Eleventh Amendment immunity from suit for damages in federal court; and (2) Plaintiffs’ claims for declaratory and injunctive relief were moot.View "Davidson v. Howe" on Justia Law

In 2003 the Social Security Administration denied DeLong’s applications for Disability Insurance Benefits. After each of three hearings, the ALJ concluded that DeLong was not disabled. After the third determination, the Appeals Council declined further review. In 2010, DeLong challenged the denial under 42 U.S.C. 405(g) and 1383(c)(3). The district court vacated and remanded, concluding that the ALJ had failed to provide ‘good reasons’ for the weight he gave to the opinions of treating physicians,” but rejected two other claims, noting that credibility determinations are peculiarly within the province of the ALJ, that the ALJ had not mischaracterized underlying medical evidence, and no error in the consideration of lay opinion evidence. DeLong sought attorney fees under the Equal Access to Justice Act, 28 U.S.C. 2412, contending that the denial of benefits and defense of the denial had lacked substantial justification. The district court denied the motion, reasoning that the agency’s position was substantially justified because the court had rejected all but one argument; DeLong had improperly attempted to present evidence in court that she had not presented to the ALJ; the record did not “strongly establish” entitlement to benefits; and the reversal was on procedural, not substantive, grounds. The Sixth Circuit affirmed.View "DeLong v. Comm'r of Social Sec." on Justia Law

Defendant Sevgi Muhammad was indicted on 24 counts of mail fraud, two counts of making a false statement, and one count of stealing public money. All the charges arose out of Defendant’s obtaining housing assistance through the Housing Choice Voucher Program of the United States Department of Housing and Urban Development (HUD). She pleaded no contest to one count of making a false statement. At the sentencing hearing, however, she moved to withdraw her plea. The district court denied the motion, and sentenced defendant to serve three years of probation and pay restitution. On appeal defendant argued her plea was not knowing and voluntary and that the district court erred when it denied her motion to withdraw the plea. Finding no reversible error, the Tenth Circuit affirmed.View "United States v. Muhammad" on Justia Law

PAMC appealed the district court's affirmance of the Secretary's decision denying PAMC its full Medicare Annual Payment Updated for the fiscal year 2009. PAMC claimed that the Department acted arbitrarily and capriciously when it refused to excuse PAMC's late filing of the required Reporting Hospital Quality Data for Annual Payment Updated (RHQDAPU) program data by the admittedly applicable deadline. The court concluded that PAMC neither pointed to any contrary or antithetical decisions by the Department under similar circumstances, nor otherwise demonstrated that the Board acted arbitrary or capriciously when it denied equitable relief. The court rejected PAMC's argument that the Board should have used the contract doctrine of substantial performance to excuse PAMC's failure to submit data at the proper time. The court did not view the Board's adherence to the policy of strict compliance with a deadline as arbitrary and capricious. Accordingly, the court affirmed the judgment of the district court.View "PAMC, LTD. v. Sebelius" on Justia Law

Petitioner Scott Anderson appealed a superior court order granting summary judgment to respondents, the Executive Director of the New Hampshire Retirement System (NHRS) and the State, and denying summary judgment to Anderson and three other petitioners. Anderson was a retired Plaistow police officer who was a member of the NHRS, and the only petitioner who appealed. After retiring, he worked part-time as a police officer in Plaistow, Atkinson, and Hampstead. When he retired, RSA 100-A:1, XXXIV provided that "[p]art-time," for the purposes of employing a NHRS retiree meant, "employment by an [NHRS] employer" of no more than "32 hours in a normal calendar week," or if the work hours in some weeks exceeded thirty-two hours, then no more than "1,300 hours in a calendar year." Anderson understood that provision "to mean [he] could work potentially up to 32 hours per week for Plaistow, up to 32 hours per week for Atkinson, and up to 32 hours per week for Hampstead." In 2012, the legislature amended RSA 100-A:1, XXXIV to provide that "[p]art-time," for the purposes of employing a NHRS retiree, "means employment during a calendar year by one or more employers of the retired member which shall not exceed 32 hours in each normal calendar week," or if the work hours in some weeks exceed thirty-two hours, then no more than 1,300 hours in a calendar year. In August 2012, Anderson and three other NHRS retirees petitioned for declaratory and injunctive relief. Anderson contended that to apply the 2012 amendment to him violated Part I, Article 23 of the New Hampshire Constitution. Specifically, he asserted that, as a result of the 2012 amendment, he would be "restored to service" under RSA 100-A:7 (2013) and, thus, lose his retirement benefits if he worked more than "[p]art-time" as defined in RSA 100-A:1, XXXIV. Under RSA 100-A:7, when a retiree is "restored to service," his "retirement allowance shall cease," and he "shall again become a member of the [NHRS] and . . . shall contribute" to that system. Anderson contended that the 2012 amendment substantially impaired his vested right because its effect is to restore him to service if he works more than thirty-two hours per week or 1,300 hours per year for any combination of NHRS employers, even if he did not work full-time hours for any single NHRS employer. Thereafter, the petitioners moved for summary judgment, and the State cross-moved for summary judgment. The trial court ruled in the State's favor, and Anderson's appeal followed. Finding no reversible error, the Supreme Court affirmed. View "Anderson v. Executive Director, New Hampshire Retirement System" on Justia Law

A Job Service claims deputy issued an initial determination that Kenneth Risovi misrepresented facts in order to obtain unemployment benefits, which he was not eligible to receive. Job Service disqualified Risovi from receiving unemployment benefits from November 4, 2012, to October 26, 2013. Risovi appealed the determination. Finding no reversible error, the Supreme Court affirmed. View "Risovi v. Job Service" on Justia Law