Justia Public Benefits Opinion Summaries

In 2017 Durham, age 46, applied for Social Security disability benefits, she had been diagnosed with diabetes and hypertension. She had also seen medical professionals about neck pain and heart palpitations. She had been experiencing shortness of breath and lightheadedness and was referred to a cardiologist, who counseled her to reduce her caffeine intake and to adopt a healthy lifestyle. Durham continued to have intermittent symptoms and, in 2019, was admitted to a hospital due to “exertional shortness of breath and palpitations.” Testing disclosed that Durham had no cardiac instability, “no acute problems, [and] no functional limitations.”An Administrative Law Judge concluded that Durham’s diabetes, hypertension, and tachycardia were limiting, but not disabling, conditions. The district court and Seventh Circuit upheld the denial of benefits as supported by substantial evidence. The court rejected arguments that the ALJ relied on outdated evidence and overstepped his authority by interpreting, without supporting medical opinions, the results of medical tests. The record reveals that the ALJ carefully considered Durham’s entire medical history and relied on the opinions of her treating physicians in reaching his conclusions about her physical limitations. View "Durham v. Kijakazi" on Justia Law

Claimant an Arizona woman in her forties filed an application for Social Security disability insurance benefits and supplemental security income. The agency repeatedly denied the claimant’s claims. The district court affirmed the ALJ’s decision, concluding that the ALJ reached a reasonable determination based on substantial evidence in the record. On appeal, the claimant argues that the ALJ erred by insufficiently supporting his analysis, failing to account for the claimant’s symptoms and limitations in the residual functional capacity (RFC) assessment, improperly discounting the opinion of one medical provider while giving undue weight to the opinion of another, and failing to satisfy the “clear and convincing” standard for rejecting subjective symptom testimony.   The Ninth Circuit affirmed. The court held that the ALJ did not err in discounting the opinion of the claimant’s treating physician because the “extreme limitations” described by the physician were incompatible with the rest of the objective medical evidence. Likewise, the ALJ did not err in giving significant weight to the opinion of the consultative examiner because the examiner’s determination that the claimant could perform light-exertion work was consistent with the objective medical evidence. Finally, the ALJ provided “clear and convincing” reasons for discounting Claimant’s subjective pain testimony. The claimant’s self-reported limitations were inconsistent with (1) the objective medical evidence, (2) her self-reported daily activities, and (3) her generally conservative treatment plan. View "MISTY SMARTT V. KILOLO KIJAKAZI" on Justia Law

Rhone served in the military 1950-1953 and 1959-1988. In 1986, Rhone and JoAnne, divorced; the Florida Divorce Decree stated that JoAnne would receive 40% of Rhone’s military retirement benefits. In 1988, Rhone left military service due to disability. To receive disability compensation, Rhone waived part of his military retirement pay (38 U.S.C. 5305). The state court denied Rhone’s motion to modify the Divorce Decree, stating that the payment of retirement benefits constituted alimony, not a property division. The state court issued a Continuing Writ of Garnishment directing the VA to withhold that payment from Rhone’s retirement pay. The VA determined that the order obliged the VA to make payments from Rhone’s disability compensation. After Rhone attempted to avoid garnishment by renouncing benefits, in 2002 the VA determined that Rhone's compensation benefits were not subject to garnishment and had been erroneously withheld. Rhone was reimbursed for $27,664. In 2005, the VA determined that it must comply with the alimony award and resumed garnishing Rhone’s disability compensation.The Board of Veterans’ Appeals issued a 2020 decision, finding the 1991 order “valid on its face” and providing for “permanent periodic alimony” so that the VA legally garnished Rhone’s disability compensation under 42 U.S.C. 659(a); (h)(1)(A)(ii)(V). The Veterans Court and Federal Circuit affirmed, finding no due process violation. The statutes authorize the VA to withhold a portion of a veteran’s VA disability payment for alimony or child support pursuant to legal process when a veteran has waived a portion of military retirement pay to receive VA benefits. The VA lacks jurisdiction to decide questions associated with a state garnishment order. View "Rhone v. McDonough" on Justia Law

Claimant argued that the administrative law judge (“ALJ”) erred by rejecting the uncontested opinion of a non-examining physician, that supported her claim. Under the pre-2017 regulations that apply to the claim, ALJs are required to give greater weight to certain medical opinions. To reject the uncontested opinion of an examining or treating doctor, an ALJ must provide “clear and convincing” reasons supported by substantial evidence.   The Ninth Circuit affirmed the district court’s decision affirming the denial of claimant’s application for disability benefits under Title II of the Social Security Act. The panel held that the “clear and convincing” standard did not apply to the physician’s opinion because he never treated or examined claimant. Rather his opinion was based solely on a review of claimant’s medical records. The panel held that nothing in the relevant regulations required an ALJ to defer to an opinion from a non-treating, non-examining medical source. In rejecting the physician’s opinion, the ALJ cited specific contradictive medical evidence in the record. In making these findings, the ALJ cited the record at length. The panel concluded that this satisfied the requirements of Sousa v. Callahan, 143 F.3d 1240, 1244 (9th Cir. 1998), the relevant regulations, and the substantial evidence standard. Further, the panel concluded that the district court properly concluded that the ALJ’s denial of benefits was supported by substantial evidence View "RUTH FARLOW V. KILOLO KIJAKAZI" on Justia Law

Milhem applied for Social Security disability insurance benefits, alleging that several conditions limited her ability to work. Milihem, age 38, had completed three years of college and had previously worked as a canvasser, receptionist, portrait photographer, and graphic designer. A vocational expert concluded that the evidence supported limiting Milhem’s work to that which can be learned in 30 days or less, that Milhem could stand or walk for at least two hours in an eight-hour workday, and that Milhem “could make judgments commensurate with functions of simple, repetitive tasks”; such an individual could not perform Milhem’s past work, but could work as a router, price marker, and cafeteria attendant, of which there were approximately 53,000, 307,000, and 63,000 jobs in the national economy, respectively. Changing the exertion level to sedentary, the expert testified, would include the work of an addresser, table worker, or document preparer, of which there were approximately 19,000, 23,000, and 47,000 jobs in the national economy, respectively.Based on this testimony, and “considering [Milhem’s] age, education, work experience, and residual functional capacity,” the ALJ found that there were a significant number of jobs that Milhem could perform, so Milhem was not under a qualifying disability. The district court upheld that determination. The Seventh Circuit affirmed. A reasonable person would accept 89,000 jobs in the national economy, a figure supported by substantial evidence, as a significant number. Other circuits have accepted similar numbers as significant. View "Milhem v. Kijakazi" on Justia Law

In this case arising out of the Department of Human Services' attempt to recover payments made to Dr. Frederick Nitta from its Medicaid Primary Care Physician Program the Supreme Court vacated the judgment of the intermediate court of appeals (ICA) to the extent it remanded the case and otherwise affirmed, holding that DHS's claims largely lacked merit.The Program at issue was established by 42 U.S.C. 1396a(a)(13)(C) of the Affordable Care Act (ACA) and enabled certain physicians to temporarily receive increased payments for primary care services provided in 2013 and 2014 to Medicaid patients. In this case, DHS demanded repayment of more than $200,000 in enhanced payments received by Nitta through the program after it determined that Nitta was ineligible for participation in the Program because he did not meet specialty requirements as set forth in a federal administrative rule. While Nitta's appeal was pending, the Court of Appeals for the Sixth Circuit invalidated the rule and remanded the case. The ICA adopted the Sixth's Circuit's analysis. The Supreme Court largely affirmed, (1) the rule is invalid because it contravenes the statute; and (2) Nitta was entitled to enhanced payments under the statute. View "Nitta v. Department of Human Services" on Justia Law

The First Circuit affirmed the judgment of the district court denying Appellant's motion for attorneys' fees, which he filed more than two years after successfully representing Appellee before both the Social Security Administration (SSA) and the district court, holding that the district court properly denied the motion as untimely.In his motion requesting attorneys' fees under 42 U.S.C. 406(b), Appellant argued that the statute does not contain a fixed time for filing a section 406(b) petition. The district court denied the fee request as untimely, concluding that such a motion must be filed within a reasonable time of the SSA's decision awarding benefits. The First Circuit affirmed, holding that, given that Appellant failed to file his section 406(b) petition in a timely manner, the district court did not err in denying his request for attorneys' fees. View "Pais v. Kijakazi" on Justia Law

The Mississippi Division of Medicaid (DOM) and Yalobusha County Nursing Home (YNH) dispute four costs submitted for reimbursement by YNH in its fiscal year 2013 Medicaid cost report. The DOM appeals the Hinds County Chancery Court’s judgment ordering the DOM to reverse the four adjustments at issue. Because the DOM correctly interpreted the appropriate statutes and because its decisions were supported by substantial evidence, the Mississippi Supreme Court reversed the chancery court’s order and rendered judgment reinstating the decisions of the DOM. View "Mississippi Division of Medicaid v. Yalobusha County Nursing Home" on Justia Law

Plaintiff appealed the district court’s1 order upholding the Commissioner of the Social Security Administration’s (Commissioner) denial of Social Security disability insurance benefits, arguing that the Commissioner’s decision was not supported by substantial evidence. Plaintiff challenged two aspects of the Commissioner’s decision. First, Plaintiff argued that the ALJ committed legal error by improperly evaluating the medical evidence. Second, Plaintiff argued that the ALJ’s RFC assessment was unsupported by substantial evidence. 
 The Eighth Circuit affirmed. The court explained that the ALJ found that Plaintiff had the RFC to “perform light work . . . ; except, she should avoid extreme cold and wetness, avoid work in direct sunlight, and avoid loud noises.” Central to this finding was the ALJ’s conclusion that Plaintiff’s surgically implanted neurostimulator resulted in “on-going symptom control without a consistent description of debilitating pain or the inability to function.” A lack of evidence of treatment in the months prior to the hearing undermines Plaintiff’s claim of disabling headaches. The court ultimately concluded that the ALJ’s RFC assessment is within the “available zone of choice” provided by the whole record. View "Lisa Austin v. Kilolo Kijakazi" on Justia Law

The underlying dispute before the Pennsylvania Supreme Court in this case involved the adequacy of state funding for community participation support ("CPS") services, which were designed to help individuals with autism or intellectual disabilities live independently. The primary issue on appeal related to the exhaustion requirement. The Pennsylvania Department of Human Services ("DHS") issued ODP Announcement 19-024, indicating it intended to change the rate structure for CPS services provided under the Home and Community Based Services (“HCBS”) waivers. Petitioners filed an action for declaratory and injunctive relief, challenging the legality of the new fee schedule and alleged the new reimbursement rates were too low to sustain the provision of CPS services to eligible recipients. Pertinent here, the Commonwealth Court agreed with one of DHS' preliminary objections that Petitioners failed to exhaust their administrative remedies, as required by case precedent, before seeking judicial review. The court acknowledged a narrow exception to the exhaustion requirement whereby a court may consider the merits of a claim for declaratory or injunctive relief if a substantial constitutional question is raised and the administrative remedy is inadequate. It clarified, however, that the exception only applied where the plaintiff raises a facial constitutional challenge to the statute or regulation in question, as opposed to its application in a particular case. Here, the court concluded, the Petitioners were attacking the fee schedule in the Final Notice, which was produced by application of the legal authority cited in that notice, and not advancing a facial constitutional challenge. The court also found Petitioners failed to demonstrate the administrative remedy was inadequate. The Supreme Court affirmed the Commonwealth Court’s order insofar as it sustained the preliminary objection asserting that the Petitioners failed to exhaust their administrative remedies, and dismissed the Petition as to those parties. The order was vacated in all other respects, and the matter was remanded for further proceedings. View "Rehabilitation & Community Providers Association, et al. v. Dept. Human Svcs" on Justia Law