Justia Public Benefits Opinion Summaries

Sevec filed for disability social security benefits, alleging an onset of disability in 2014. At the time of her hearing, Sevec was 60 years old and suffered from knee pain caused by osteoarthritis. Sevec stated that she worked as a registered nurse until 2014, doing narcotics counts, answering call lights and bed alarms, assisting patients to the bathroom; administering IV medications, doing breathing treatments; and taking care of feeding tubes. After leaving that job, she provided care for a neighbor. A vocational expert (VE) stated Sevec’s work as an RN was “level 7, medium in its physical demand, medium as performed. And then we also have home health nurse … also, level 6. Medium in its physical demand; light as performed.” The ALJ asked whether “any of the past work [would] be available?” The VE replied, “Possibly the home health being as performed at a light level, not per the [Dictionary of Occupational Titles], though, but as performed.”The ALJ concluded that Sevec was not disabled. The Appeals Council and the district court agreed. The Seventh Circuit reversed. The VE’s testimony is not well grounded in the record, and is not sufficient, standing alone, to support the ALJ’s determination. The record does not contain evidence from which the ALJ could determine, with any degree of confidence, that Sevec is capable of performing her past work; the ALJ specified that her “past work” did not include "home health nurse." View "Sevec v. Kijakazi" on Justia Law

The Supreme Judicial Court remanded these consolidated cases seeking a judgment declaring the parties' respective rights to each of the remainder proceeds of two annuity contracts, holding that the cases were governed in all material respects by the Court's decision today in Dermody v. Executive office of Health & Human Servs., 491 Mass. __ (2023).In each of these cases, the Executive Office of Health and Human Services (Commonwealth) claimed entitlement to remainder proceeds of the two annuity contracts up to the amount of medical assistance paid on behalf of an institutionalized spouse, whose eligibility for Medicaid long-term care benefits was obtained through the purchase of an annuity during the relevant "look-back" period, as defined under 42 U.S.C. 1396p(c). The Supreme Judicial Court held that the Commonwealth was entitled to remainder proceeds from the annuities to the extent of benefits it paid on behalf of the institutionalized spouses in this case. View "Executive Office of Health & Human Services v. Mondor" on Justia Law

The Supreme Judicial Court reversed the order of the superior court allowing Plaintiff's motion for summary judgment in this lawsuit brought against the Executive Office of Health and Human Services and Nationwide Life Insurance Company in this dispute over the remainder of an annuity issued by Nationwide, holding that the superior court erred.Robert Hamel purchased the annuity at issue to help Joan Hamel, his wife, become eligible for Medicaid benefits, which was necessary to pay for her long-term care. Robert named the Commonwealth as the primary remainder beneficiary to the "extent benefits paid" and Plaintiff, his daughter, as the contingent remainder beneficiary. Before the end of the annuity period Robert died. Plaintiff filed this lawsuit alleging that she was entitled to the remainder. The superior court entered summary judgment in favor of Plaintiff and denied the Commonwealth's motion for summary judgment as to Plaintiff's claim for declaratory judgment. The Supreme Judicial Court vacated and reversed the judgment below, holding that, upon Robert's passing, the remainder of the annuity properly belonged to the Commonwealth up to the amount it paid for Joan's care. View "Dermody v. Executive Office of Health & Human Services" on Justia Law

Doyon served in the Navy, 1966-1968; he received several medals and commendations. In 1967, Doyon witnessed the immediate aftermath of an explosion and fire that resulted in more than 130 deaths. When four of his friends went AWOL. Doyon was allegedly harassed and threatened by his shipmates. In 1968, Doyon went AWOL for two days. Upon his return, Doyon was referred to the sick bay. He was sedated with Thorazine, and later was diagnosed with “passive-aggressive personality disorder.” Doyon later witnessed a fatal plane crash, including the dismemberment of a fellow Airman, while he was standing duty at a video recording console. Doyon later spent hours replaying video recordings of the crash for Report Personnel. In 1968, Doyon was discharged. Doyon’s DD-214 form characterized his discharge as “Honorable,” and the “Reason and Authority” field contained a code indicating unsuitability due to a personality disorder. Doyon was not eligible to receive a military disability retirement.In 2013, Doyon unsuccessfully petitioned the Board for the Correction of Naval Records to correct his service records to state that he was discharged for service-connected PTSD, to be eligible for disability retirement payment under 10 U.S.C. 1201. The Claims Court upheld the denial. The Federal Circuit vacated. Doyon challenges the correctness of the narrative reason for his discharge, as stated in his military records. Both 10 U.S.C. 1552(h) and a Department of Defense memorandum (Kurta Memo) require “liberal consideration” for such correction requests. View "Doyon v. United States" on Justia Law

Approximately 30 years after Arellano’s honorable discharge from the Navy, a VA regional office granted Arellano service-connected disability benefits for his psychiatric disorders. Applying the default rule in 38 U.S.C. 5110(a)(1), the VA assigned an effective date of June 3, 2011—the day that it received Arellano's claim—to the award. Arellano argued that the effective date should be governed by an exception in section 5110(b)(1), which makes the effective date the day following the date of the veteran’s discharge or release if the application “is received within one year from such date of discharge or release.” Alleging that he had been too ill to know that he could apply for benefits, Arellano maintained that this exception’s one-year grace period should be equitably tolled to make his award effective the day after his 1981 discharge.The Board of Veterans’ Appeals, Veterans Court, Federal Circuit, and Supreme Court disagreed. Section 5110(b)(1) is not subject to equitable tolling. Equitably tolling one of the limited exceptions would depart from the terms that Congress “specifically provided.” The exceptions do not operate simply as time constraints, but also as substantive limitations on the amount of recovery due. Congress has already considered equitable concerns and limited the relief available, aware of the possibility that disability could delay an application for benefits. View "Arellano v. McDonough" on Justia Law

Cooper served on active duty in the Marine Corps from March-September 1972 and from February-April 1973. In 2008, the VA granted Cooper entitlement to a non-service-connected (NSC) pension. In 2014, the VA notified Cooper that it had adjusted his income from December 2008-2010 based on his receipt of unemployment compensation from the state of Wisconsin, which resulted in an overpayment of $13,094.The Board of Veterans’ Appeals and Veterans Court found that unemployment compensation payments are not excluded from a veteran’s annual income under an exception for “donations from public or private relief or welfare organizations,” 38 U.S.C. 503(a)(1). The Federal Circuit affirmed NSC pensions are need-based, so the maximum annual rate of pension is “reduced by the amount of the veteran’s annual income.” In general, a veteran’s “annual income” includes “all payments of any kind or from any source,” 38 U.S.C. 1503(a). View "Cooper v. McDonough" on Justia Law

Van Dermark served in the Navy from 1963 until his 1976 honorable discharge. The VA found Van Dermark to be totally and permanently disabled due to service-connected injuries. Van Dermark received treatment in Thailand (where he lived) at non-VA facilities, from physicians and others not affiliated with VA, in 2016 and in 2018, both times for cardiac conditions not related to his service-connected disability. For each of the two instances of treatment abroad, Van Dermark filed a claim with VA under 38 U.S.C 1728 and 1725 seeking VA payment—to him or his medical creditors—for the surgical or other heart-related treatment he received abroad.VA Community Care denied both claims. The Board of Veterans’ Appeals maintained the denials. The Veterans Court and Federal Circuit affirmed. Section 1724(a) prohibits the VA from “furnish[ing] hospital . . . care or medical services” abroad, where the care or services are unrelated to the service-connected disability. The “furnishing” phrase encompasses the payment for a veteran’s hospital care or medical expenses abroad at issue here; sections 1728 and 1725 do not override that prohibition. View "Van Dermark v. McDonough" on Justia Law

Chaudhary arrived in the U.S. from Pakistan in 2007-2008. She married Ramzan while in Pakistan. They have three children together. Ramzan also has a daughter from a different marriage. In 2012, Chaudhary divorced Ramzan. She moved to West Chicago (White Oak address). Chaudhary received Supplemental Nutrition Assistance Program (SNAP) benefits for herself and her three children. He separately received benefits for himself and his daughter. Under separate accounts, Chaudhary and Ramzan received SNAP benefits from May 2015-December 2017, both listing the White Oak address as their SNAP benefits mailing address. In 2019, the Department of Human Services investigated Chaudhary under the Illinois Public Aid Code (305 ILCS 5/12-4.4) and determined that she received overpayments totaling $21,821. The Department began an overpayment collection process. Chaudhary filed an agency appeal. The ALJ and the Secretary of Human Services upheld the determination.The circuit court reversed. The appellate court and Illinois Supreme Court affirmed. Chaudhary, as a SNAP recipient, having been previously approved and awarded SNAP benefits, was not required to prove the absence of an overpayment. The Department’s evidence was not sufficiently authenticated and does not support the determination that Ramzan resided at White Oak during the overpayment period. The Secretary’s credibility determination was unreasonable and not supported by the record. View "Chaudhary v. Department of Human Services" on Justia Law

The First Circuit affirmed the judgment of the district court determining that Act 90, passed by the Legislative Assembly of Puerto Rico in 2019, was preempted by federal law, holding that the district court did not err.Act 90 requires that Medicare Advantage plans compensate Puerto Rico healthcare providers in Puerto Rico at the same rate as providers are compensated under traditional Medicare. Plaintiffs, several entities that managed Medicare Advantage plans, filed suit seeking a declaratory judgment and an injunction barring the "mandated price provision," arguing that the Medicare Advantage Act preempted the challenged provision and that provision was unconstitutional. The district court ruled in favor of Plaintiffs. The First Circuit affirmed, holding that Act 90's mandated price provision was preempted by federal law. View "Medicaid & Medicare Advantage Products Ass'n of Puerto Rico, Inc. v. Emanuelli-Hernandez" on Justia Law

Mattox served in the Navy from 1967-1971, including on a vessel in the waters of Vietnam. In 2015, Mattox sought disability benefits with a service connection for PTSD. He submitted the diagnosis by a private doctor. A VA psychologist concluded that Mattox did not present “a diagnosis of PTSD according to the DSM-5 diagnostic criteria” but that Mattox suffered from moderate alcohol and cannabis use disorder, which explained his depression, anxiety, and irritability. Mattox had indicated that he used cannabis “about daily.” The Board of Veterans’ Appeals and the Veterans Court affirmed the denial of Mattox’s claim.The Federal Circuit affirmed. Mattox’s appeal to the Board was not subject to the Veterans Appeals Improvement and Modernization Act of 2017, 131 Stat. 1105 (AMA); Mattox was not prejudiced by the Board’s failure to provide him with a notice of its decision that met the requirements of 38 U.S.C. 5104(b), as amended by the AMA. The Board did not err in concluding that the benefit-of-the-doubt rule, 38 U.S.C. 5107(b), did not apply because, although a veteran is entitled to the benefit of the doubt “where the evidence is in approximate balance,” it found that, in Mattox’s case, “the preponderance of the evidence” was against his claim for service connection. View "Mattox v. McDonough" on Justia Law