Justia Public Benefits Opinion Summaries

Plaintiff-Appellant Tyla Newbold appealed a magistrate judge's order that granted her Social Security benefits from October 2006 to November 2007, but denied them thereafter. The Commissioner of the Social Security Administration determined Plaintiff had been disabled during that period due to physical and mental impairments, but that she recovered and the disability ceased. The issue on appeal to the Tenth Circuit was whether the administrative law judge (ALJ) used the proper medical-improvement standard in deciding Plaintiff ceased being disabled. Finding that the ALJ used the proper standard, the Tenth Circuit affirmed. View "Newbold v. Astrue" on Justia Law

Pirkl served in the Navy, 1947-1949. Effective in 1949, the VA awarded him disability benefits for paranoid schizophrenic reaction, evaluated as 10% disabling. A regional office increased his disability rating to 100%, effective in 1952. In 1953, the office reduced the rating to 70%. Pirkl did not appeal. In 1956, the office reduced Pirkl’s rating to 50%, based on a newly acquired medical examination and changes in Pirkl’s employment status. Pirkl did not appeal. In 1966, the office reduced the rating to 30%. The Board of Appeals affirmed. In 1991, Pirkl was awarded a 100% disability rating, effective 1988. In 2001, Pirkl unsuccessfully sought to revise the 1953, 1956, and 1966 rating decisions based on clear and unmistakable error (CUE). In 2005, Pirkl filed Notice of Disagreement with respect to the 1953 rating. The Board found CUE. The regional office awarded a 100% rating for 1952 to 1957, when the 1956, decision made effective a 50% rating. The Board dismissed Pirkl’s claim for 100% disability for the entire period between 1952 and August 30, 1988. The Veterans Court affirmed. The Federal Circuit vacated and remanded, concluding that the Board did not consider the effect of certain regulations governing a reduction of a total disability rating. View "Pirkl v. Shinseki" on Justia Law

Catholic Health filed suit under the Administrative Procedure Act (APA), 5 U.S.C. 500 et seq., challenging the agency's interpretation of the Medicare statute and its application to the 1997 cost-reporting period. The district court held that the Secretary's decision was unlawful because the agency, in calculating reimbursements owed for a 1997 cost-reporting period, had retroactively applied a 2004 rulemaking without congressional authorization. The court concluded that the policy on which the agency relied was first announced in an adjudication in 2000, not in the 2004 rulemaking; the agency's interpretation of the statute was permissible; the denial of reimbursements was not arbitrary and capricious; and Catholic Health had not shown that it relied to its detriment on the position the agency allegedly held before 2000. Accordingly, the court reversed the judgment of the district court. View "Catholic Health Initiatives Iowa Corp. v. Sebelius" on Justia Law

Crawford began working for the Department of the Army in 1986, with credit for military service. In 2006, when called to uniformed service, Crawford was an IT Specialist, GS-2210-11, in the Corps of Engineers. The Army subsequently outsourced many IT functions and abolished Crawford’s position, but formed a new organization, the Corps of Engineers Information Technology (ACE-IT). When Crawford completed uniformed service, the Army briefly returned him to an IT Specialist position, but reassigned him as Program Support Specialist, GS-0301-11. Crawford claimed violation of reemployment protections for those in uniformed service under 38 U.S.C. 4313(a)(2). The administrative judge ordered the Army to place Crawford in a position of “like status” to an IT Specialist. The Army later submitted notice that it was not able to find a position of “like status” and had requested the Office of Personnel Management’s placement assistance. Crawford sought enforcement with the Merit Systems Protection Board, claiming that the search for positions was limited to vacant positions. The AJ agreed. The Army then reassigned Crawford to a position as an IT Specialist within ACE-IT, with the same duty station, title, and grade as his old position. The Board concluded that the Agency was in compliance and dismissed Crawford’s appeal. The Federal Circuit affirmed. View "Crawford v. Dep't of the Army" on Justia Law

Natale,a vascular surgeon, was compensated by Medicare for repairing a patient’s aortic aneurysm. Another doctor reviewed the post-surgical CT scan, which did not match the procedure Natale described in his operative reports. After an investigation, Natale was indicted for health care fraud related to his Medicare billing, mail fraud, and false statements related to health care. A jury acquitted Natale on the fraud counts but convicted him of making false statements, 18 U.S.C. 1035. The trial court used jury instructions that seemingly permitted conviction for false statements completely unrelated to Medicare reimbursement. The Seventh Circuit affirmed, finding the error harmless, but clarified that under the statute, even conviction for false statements made in connection with items or services still must relate to a “matter involving a health care benefit program.” View "United States v. Natale" on Justia Law

Brigance worked as a coal miner for 20 years, until he stopped working in 1994 because of shortness of breath, which prevented him from obtaining other employment. Brigance obtained Kentucky state black lung benefits, which expired after about eight years. Brigance sought federal benefits under the Black Lung Benefits Act. An administrative law judge held that the claim was not barred by the Act’s three-year statute of limitations, 30 U.S.C. 932(f). The Benefits Review Board affirmed an award of benefits. The Sixth Circuit reversed. Brigance admitted that he had a medical determination of total disability (pneumoconiosis) seven years before filing his claim. View "Peabody Coal Co. v. Dir., Office of Workers' Comp." on Justia Law

Hall entered active duty in the Army in 1990, but refused to go to basic training and asked to go home. He made threats and admitted to an arrest for carrying a gun. A psychiatric evaluation showed that Hall was believed to suffer from an “avoidant personality disorder” and he was discharged after 15 days in service. In 2006, Hall sought VA disability benefits, claiming that he suffered post-traumatic stress disorder as a result of an in-service sexual assault perpetrated by a superior officer. The claim was denied because Hall was not regarded as credible and could not prove the assault. The Veterans Court and Federal Circuit affirmed. View "Hall v. Shinseki" on Justia Law

Madison received a DTaP vaccination at age seven months and the next day suffered a prolonged seizure. Her temperature was recorded as 103.6 degrees. She continued to experience seizures and was admitted to the hospital again, a year later, with recurrent convulsive episodes. When she was about four years old, genetic testing revealed that Madison had a DNA sequence variation that was not inherited and arose spontaneously. Such mutations have been associated with several epilepsy syndromes. Her parents sued under the National Childhood Vaccine Injury Act of 1986, 42 U.S.C. 300aa, which established the National Vaccine Injury Compensation Program through which claimants can obtain compensation for vaccine-related injuries or death. Before the DNA test, a special master concluded that Madison was entitled to compensation, but the DNA test was disclosed during the damages phase. The special master ultimately denied compensation. The Federal Circuit affirmed, finding that the special master properly analyzed whether, after the plaintiffs established a prima facie case, the government carried its burden to prove that a factor unrelated to the vaccine was the sole substantial cause of the injuries. View "Deribeaux v. Sec'y of Health & Human Servs." on Justia Law

Plaintiffs appealed the Secretary's denial of their claims for Medicare coverage for dental services. Plaintiffs contended that this denial was premised on the Secretary's unreasonable interpretation of the Medicare Act, Pub. L. No. 89-97, 79 Stat. 286, which contravened the intent of Congress and violated plaintiffs' right to equal protection under the Fifth Amendment. The court concluded that, although the statutory provision for exclusion of dental services was ambiguous in the sense that plausible divergent constructions could be urged, the Secretary's interpretation of the statute was reasonable. The court also concluded that the Secretary's statutory interpretation warranted Chevron deference and the Secretary's statutory interpretation was reasonable. Accordingly, the court affirmed the judgment. View "Fournier v. Sebelius" on Justia Law

The National Childhood Vaccine Injury Act of 1986 established a no-fault compensation system to stabilize the vaccine market and expedite compensation to injured parties. Under the Act, a proceeding for compensation is “initiated” by service upon the Secretary of Health and Human Services and “the filing of a petition containing” specified documentation with the clerk of the Court of Federal Claims, who forwards the petition for assignment to a special master. 42 U. S. C. 300aa–11(a)(1). An attorney may not charge a fee for services in connection with such a petition, but a court may award attorney’s fees and costs incurred by a claimant in any proceeding on an unsuccessful petition, if that petition was brought in good faith. In 1997, shortly after receiving her third Hepatitis-B vaccine, Cloer began to experience symptoms that led to a multiple sclerosis (MS) diagnosis in 2003. In 2004, she learned of a link between MS and the Hepatitis-B vaccine, and in 2005, she filed a NCVIA claim. The special master concluded that Cloer’s claim was untimely because the Act’s 36-month limitations period began to run when she had her first MS symptoms in 1997.The Federal Circuit agreed. Cloer then sought attorney’s fees and costs. The Federal Circuit ruled in Cloer’s favor. The Supreme Court affirmed. Nothing in the attorney’s fees provision suggests that the reason for the subsequent dismissal of a petition, such as untimeliness, nullifies the initial filing. An NCVIA petition delivered to the court clerk, forwarded for processing, and adjudicated before a special master is a “petition filed under section 300aa–11.” The government’s contrary position is inconsistent with the fees provision’s purpose, which was to avoid limiting petitioners’ ability to obtain qualified assistance by making awards available for “non-prevailing, good-faith claims.” View "Sebelius v. Cloer" on Justia Law