Justia Public Benefits Opinion Summaries

Larson, a Vietnam War veteran, suffered a gunshot wound in service. In 1969, he was granted a 40 percent combined disability rating. He did not appeal. In 2007, he claimed clear and unmistakable error (CUE), arguing misapplication of diagnostic codes in effect in 1969. The Regional Office denied his claim. The Board affirmed, stating: “the Veteran has not demonstrated that the law in effect during that time was incorrectly applied or that the correct facts, as they were known at the time, were not before the adjudicators.” The Veterans Court rejected his challenges on the merits and a motion to modify the decision by deleting the phrase “or that the correct facts, as they were known at the time, were not before the adjudicators.” Larson was concerned that the language could be interpreted as a ruling on a “correct facts” CUE claim, precluding him from raising such a claim in the future. The Federal Circuit reversed. The Veterans Court erred in holding that there is only one opportunity to raise any allegation of CUE for each claim decided by the Board. Under 38 C.F.R. 3.105(a) a veteran may raise a new argument that a RO committed CUE at any time. Larson only challenged the legal basis for the 1969 determination, and did not assert that the adjudicators did not have the correct facts before them; he remains free to raise a “correct facts” CUE claim, so his request for clarification of the Board’s decision was not moot. View "Larson v. Shinseki" on Justia Law

Plaintiffs filed suit against the Secretary of Health and Human Services (HHS) and the Commissioner of the Social Security Administration (SSA) raising constitutional challenges to the Patient Protection and Affordable Care Act (ACA), Pub. L. No 111-148, 124 Stat. 119; raising statutory challenges to actions of HHS and the Commissioner relating to the implementation of the ACA and prior Medical legislation; and attacking the failure of defendants to render an "accounting" that would alter the American people to the insolvency towards which Medicare and Social Security programs were heading. On appeal, plaintiffs challenged the district court's dismissal of their claims. The court rejected plaintiffs' claims that 26 U.S.C. 5000A, which was sustained as a valid exercise of the taxing power, violated the Fifth Amendment's prohibition of the taking of private property without just compensation and violated the origination clause. The court concluded that plaintiffs' substantive attack on the Social Security Program Operations Manual System (POMS) provisions was clearly foreclosed by its decision in Hall v. Sebelius, holding that the statutory text establishing Medicare Part A precludes any option not to be entitled to benefits. The court rejected plaintiffs' second statutory claim attacking an interim final rule. Finally, the court concluded that plaintiffs failed to provide a legal argument for their claims against the Commissioner and Secretary, and therefore, the court lacked jurisdiction over plaintiffs' claim to an "accounting." Accordingly, the court affirmed the judgment of the district court. View "Assoc. Amer. Physicians, et al. v. Sebelius, et al." on Justia Law

Moore applied for Social Security disability benefits, alleging that she became disabled in 2007. An ALJ concluded that Moore suffered from a number of severe impairments, including migraine headaches, asthma, morbid obesity, and rheumatoid arthritis, and less severe impairments including irritable bowel syndrome, gastroesophageal reflux disease, hypertension, hypothyroid and prolactin irregularities, carpal tunnel syndrome, depression, anxiety, and possible Crohn’s disease. The ALJ found that she was, nonetheless, capable of performing her past work and not entitled to benefits. The district court affirmed. The Seventh Circuit reversed and remanded. The ALJ did not err in considering evidence that Moore’s emergency room visits may have been related to an addiction problem, but the ALJ erred in failing to even acknowledge contrary evidence or to explain the rationale for crediting the identified evidence over contrary evidence. The ALJ never related Moore’s specific limitations to certain impairments. On remand, the ALJ must make those findings and present the limitations to the vocational expert to determine whether Moore is capable of performing her past relevant work. View "Moore v. Colvin" on Justia Law

Plaintiff, the surviving spouse of Charles Kemp, appealed the denial of disability insurance benefits and supplemental security income. An ALJ found that Kemp was not disabled because he could perform a job a vocational expert (VE) identified in response to a hypothetical the ALJ posed. The court remanded the case for further proceedings because the court was unable to discern from the record whether there was a conflict between the occupational listing at issue and the VE's response to the hypothetical. View "Kemp v. Colvin" on Justia Law

Relator filed a qui tam action under the False Claims Act (FCA), 31 U.S.C. 3729-3733, against Omnicare, alleging that defendants violated a series of FDA safety regulations requiring that penicillin and non-penicillin drugs be packaged in complete isolation from one another. The court concluded that the public disclosure bar did not divest the district court of jurisdiction over relator's FCA claims. The court concluded that once a new drug has been approved by the FDA and thus qualified for reimbursement under the Medicare and Medicaid statutes, the submission of a reimbursement request for that drug could not constitute a "false" claim under the FCA on the sole basis that the drug had been adulterated as a result of having been processed in violation of FDA safety regulations. The court affirmed the district court's grant of Omnicare's motion to dismiss, holding that relator's complaint failed to allege that defendants made a false statement or that they acted with the necessary scienter. The court also concluded that the district court did not abuse its discretion in denying relator's request to file a third amended complaint. View "United States ex rel. Rostholder v. Omnicare, Inc." on Justia Law

When an attorney successfully represents a veteran, the Veterans Administration may directly pay reasonable legal fees to the attorney from any past-due benefits awarded to the veteran, 38 U.S.C. 5904(d). For most types of claims, an attorney has one year to challenge denial of direct pay, 38 U.S.C. 7105, but for “simultaneously contested claims,” the period is 60 days, 38 U.S.C. 7105A. A regional office applied the 60-day period to reject a challenge filed by an attorney 90 days after written denial of his direct-fee request, based on its award to the veteran on a claim other than the claim for which the attorney represented the veteran. Because the statute does not define the term, the VA relied on 38 C.F.R. 20.3(p), which explains that simultaneously contested claim refers to the "situation in which the allowance of one claim results in the disallowance of another claim involving the same benefit or the allowance of one claim results in the payment of a lesser benefit to another claimant” and its Claim Adjudication Manual’s guidance that a denial of an attorney fee request should be treated as a simultaneously contested claim. The Board of Veterans Appeals, the Veterans Court, and the Federal Circuit affirmed. View "Mason v. Shinseki" on Justia Law

E attended kindergarten and first grade in the Ridley School District, 2006-2008, receiving special services for learning disabilities and health problems. After first grade, her parents concluded that the school was not meeting E’s needs, and enrolled her at a private school, Benchmark, that specializes in educating students with learning disabilities, then filed a complaint with the Pennsylvania Department of Education claiming violation of the Individuals with Disabilities Education Act, 20 U.S.C. 1415(j), and the Rehabilitation Act, 29 U.S.C. 794(b)(2), by failing to provide a suitable Individualized Education Program. A hearing officer found no violations during kindergarten year, but awarded compensatory education for first grade and ordered Ridley to reimburse tuition and transportation costs for 2008-2009. Two years later, a federal district court reversed, finding the proposed IEP adequate. The Third Circuit affirmed. Meanwhile, the parents sought payment for Benchmark costs from the date of the hearing officer’s decision forward pursuant to the IDEA, which states that a disabled child shall remain in the child’s current educational setting pending resolution of a dispute over the child‘s placement. The district court ruled in favor of the parents, rejecting the district’s timeliness contentions and awarded costs for three years, $57,658.38. The Third Circuit affirmed. It is impossible to protect a child‘s educational status quo without sometimes taxing school districts for private education costs that ultimately will be deemed unnecessary. View "M. R. v. Ridley Sch. Dist." on Justia Law

Before 1992, Chicago police officers received pension credit for time worked for the Cook County Sheriff’s Department. In 1992, the Retirement Board began denying pension credit to retiring officers for prior service with the Sheriff’s Department. In 2008, the Illinois Appellate Court ruled that this practice was improper under the Illinois Pension Code. Officers who had been denied pension credit sought reconsideration. The Board concluded that it lacked jurisdiction to reconsider the final rulings after the statutory 35‐day limit. The officers did not seek review in state court, but filed a federal suit on behalf of themselves and other similarly situated officers, alleging violations of procedural due process and equal protection rights under the U.S. and state constitutions. The district court dismissed. The Seventh Circuit affirmed, reasoning that the officers’ complaint is, essentially, that Illinois law provides no procedure for making the appellate decision retroactive Their sole remedy lies with the political branches of Illinois government. View "Rasario v. Ret. Bd. of the Policemens' Annuity & Benefit Fund" on Justia Law

Phillips worked at CTA as a trucker for 22 years, until, in 2010, he visited CTA’s onsite health services department to report that his fingers went numb at work and to initiate a workers’ compensation claim. CTA had a written substance abuse policy that required drug testing in certain situations, including initiation of workers’ compensation claim. Refusal to submit to testing was cause for immediate suspension pending termination. An injured employee could receive medical treatment in the health services department and return to work without being required to submit to a drug test if the employee did not seek to initiate a workers’ compensation claim and the situation did not fall into one of the other categories for which drug testing was required. Phillips was advised that if he didn’t take the drug test, his employment would be terminated. He refused to take the drug test and was terminated for refusing to submit to drug testing upon his initiation of a workers’ compensation claim. Phillips did file a workers’ compensation claim and eventually received benefits. The district court entered summary judgment, rejecting his claim that his termination was retaliation for filing a workers’ compensation claim. The Seventh Circuit affirmed.View "Phillips v. Cont'l Tire Americas, LLC" on Justia Law

Stallworth served in the U.S. Army, 1974-1975, during which time he experienced a psychotic episode that was attributed to his illicit use of the drug LSD. He recovered with hospitalization, but relapsed following return to active duty and was diagnosed with acute paranoid schizophrenia. A treating physician noted that it was not clear whether Stallworth’s illness was caused by his drug use or by independent psychosis. An Army medical board found him unfit for further military duty. Weeks later, a VA Regional Office awarded Stallworth service connection for schizophrenia at a 50% disability rating. Thereafter, Stallworth was often admitted to inpatient psychiatric facilities where medical professionals repeatedly opined that he had “no mental disorder” and that Stallworth’s service connection diagnosis was in error. The VA severed Stallworth’s service connection on the basis of clear and unmistakable error (CUE) and declined to reopen his claim because of a lack of new evidence. In 1981, the Appeals Board affirmed. The Veterans Court and Federal Circuit affirmed. View "Stallworth v. Shinseki" on Justia Law