Justia Public Benefits Opinion Summaries

Plaintiff appealed the denial of his claim for disability-insurance benefits and supplemental-security-income benefits. The magistrate judge recommended reversing the SSA's denial of benefits and remanded for plaintiff's claim to the SSA for further proceedings. The district court then entered an order adopting the magistrate judge's recommendation and granted plaintiff's counsel's request and award for attorneys' fees. At issue in this appeal was the type of judgment for which a district court could grant attorneys' fees under the Social Security Act, 42 U.S.C. 406(b). The court reversed the district court's denial of attorneys' fees, concluding that the district court's construction of section 406(b) unavoidably reduced the likelihood that an attorney who undertook a disability benefits representation would receive reasonable compensation for his work. Section 406(b) fees were authorized in cases where an attorney obtained a favorable decision on remand and the SSA has not opposed such fees for over 25 years. View "Jackson v. Astrue" on Justia Law

Reimbursement providers for inpatient services rendered to Medicare beneficiaries is adjusted upward for hospitals that serve disproportionate numbers of patients who are eligible for Supplemental Security Income. The Centers for Medicare & Medicaid Services annually submit the SSI fraction for eligible hospitals to a “fiscal intermediary,” a Health and Human Services contractor, which computes the reimbursement amount and sends the hospitals notice. A provider may appeal to the Provider Reimbursement Review Board within 180 days, 42 U. S. C. 1395oo(a)(3). The PRRB may extend the period, for good cause, up to three years, 42 CFR 405.1841(b). A hospital timely appealed its SSI fraction calculations for 1993 through 1996. The PRRB found that errors in CMS’s methodology resulted in a systematic under-calculation. When the decision was made public, hospitals challenged their adjustments for 1987 through 1994. The PRRB held that it lacked jurisdiction, reasoning that it had no equitable powers save those granted by legislation or regulation. The district court dismissed the claims. The D. C. Circuit reversed. The Supreme Court reversed. While the 180-day limitation is not “jurisdictional” and does not preclude regulatory extension, the regulation is a permissible interpretation of 1395oo(a)(3). Applying deferential review, the Court noted the Secretary’s practical experience in superintending the huge program and the PRRB. Rejecting an argument for equitable tolling, the Court noted that for nearly 40 years the Secretary has prohibited extensions, except as provided by regulation, and Congress not amended the 180-day provision or the rule-making authority. The statutory scheme, which applies to sophisticated institutional providers, is not designed to be “unusually protective” of claimants. Giving intermediaries more time to discover over-payments than providers have to discover underpayments may be justified by the “administrative realities” of the system: a few dozen intermediaries issue tens of thousands of NPRs, while each provider can concentrate on its own NPR. View "Sebelius v. Auburn Reg'l Med. Ctr." on Justia Law

Roddy, born in 1964, suffers from several serious medical problems, including severe lower back pain attributable to degenerative disc disease. When her pain became unbearable, she stopped working and applied for disability insurance benefits. She was unsuccessful before the Social Security Administration. An administrative law judge found that there were jobs in the national economy within her capabilities, although she no longer could perform her old job as a shift manager at a Taco Bell restaurant. The district court affirmed. The Seventh Circuit vacated and remanded. The ALJ improperly discounted the opinion of a physician and improperly considered Roddy’s testimony about her ability to do housework. View "Roddy v. Astrue" on Justia Law

Stephenson began receiving a Federal Employees Retirement System disability retirement, annuity and applied for SSA disability benefits, as required of applicants for FERS disability retirement. SSA determined that he was entitled to receive monthly SSA disability benefits; the Office of Personnel Management reduced his FERS annuity, 5 U.S.C. 8452(a)(2)(A); 42 U.S.C. 423. The Social Security Act allows a “trial work period,” without loss of benefits. Stephenson completed a nine-month trial work period and demonstrated ability to work. SSA notified Stephenson that he was not entitled to payments beginning September 2009, but that he could get a 36-month extended period of eligibility after the trial work period. Stephenson requested that OPM terminate the offset in his FERS annuity. OPM denied the request finding that he retained eligibility for Social Security benefits and that the offset did not depend on actual receipt of benefits. An administrative judge and the Merit Systems Protection Board denied appeals, acknowledging section 8452’s use of the word “entitled,” not “eligible,” but finding Stephenson remained “entitled” to SSA benefits during the 36-month period. The Federal Circuit reversed; because Stephenson performed substantial gainful activity during that period, he was not “entitled” to benefits under section 223 of the Social Security Act. View "Stephenson v. Office of Pers. Mgmt." on Justia Law

The 57-year-old woman, diagnosed with frozen shoulder and later with chronic obstructive pulmonary disease, stopped medical treatment in 2003, having no health insurance and income of $4500 to $9000 a year as a clerical worker. Her last significant employment, as a hotel night-clerk, ended in 2007. She got another clerical job, but was immediately fired because unable to lift a box of paper. She sought social security disability benefits and resumed treatment. She had regained the full range of motion, but muscles in her arms and shoulders were weak and she had chronic obstructive pulmonary disease, causing bronchitis, respiratory infections, and shortness of breath. The ALJ decided that she was capable of performing as hotel clerk and was not disabled; he disregarded findings by a doctor whom he had appointed and with whom the applicant had no prior relationship. He noted the “lack of aggressive treatment” and that she smoked, overlooking that she stopped smoking 30 years earlier. The ALJ focused on her ability to do laundry, take public transportation, and grocery shop. The Appeals Council declined review. The Seventh Circuit remanded, stating that: “Really the Social Security Administration and the Justice Department should have been able to do better.” View "Hughes v. Astrue" on Justia Law

The plaintiff claimed that an influenza vaccination he received n 2004 at the age of 34 resulted in the onset of multiple sclerosis or significantly aggravated his preexisting, but asymptomatic, multiple sclerosis. A special master denied his claim for compensation under the National Childhood Vaccine Injury Act of 1986, 42 U.S.C. 300aa-1 to -34. The Claims Court and the Federal Circuit affirmed. View "W.C. v. Sec'y of Health & Human Servs." on Justia Law

Sexton, a smoker, spent 25 years working in coal mines. He first applied for Black Lung Act (30 U.S.C. 901) benefits in 1973. The application was unsuccessful as were two other claims. In 2001, two years after the denial became final, Sexton filed a subsequent claim. The district director recommended an award of benefits. Buck Creek Coal requested a formal hearing. While his claim was pending Sexton died. His widow filed her own claim and the district director issued a proposed order awarding benefits in the survivor claim. Buck Creek requested a hearing. The administrative law judge considered four medical opinions, and based on that new evidence, determined that Sexton suffered a total disability from clinical and legal pneumoconiosis and that Sexton established a change in an applicable condition of entitlement pursuant to 20 C.F.R. 725.309 and awarded benefits. The Benefits Review Board affirmed with respect to Sexton’s claim and affirmed in part and vacated in part with respect to the survivor claim. The Sixth Circuit affirmed, holding that 20 C.F.R. 725.309 is valid and was correctly applied and that the Board’s decision did not violate principles of finality or res judicata. View "Buck Creek Coal Co. v. Sexton" on Justia Law

Plaintiff appealed the denial of his disability benefits. The court held that the ALJ's failure to complete the psychiatric review technique (PRT) was not harmless where the ALJ specifically found that plaintiff had the severe impairment of a closed-head injury, with symptoms that were mental in nature. On remand, the ALJ must reevaluate its findings in light of the PRT. Thus, the court need not address plaintiff's arguments about the evaluation of evidence and his residual functioning capacity. Accordingly, the court reversed and remanded. View "Cuthrell v. Astrue" on Justia Law

Harris served on active duty in the U.S. Army from 1963 to 1966 and from 1967 to 1970. In 1985, he had a VA Medical Center examination; an “Agent Orange” form associated with that examination indicates that Harris complained of “skin rashes on trunk and arms.” Another form, listing his service in Vietnam, is an “Application for Medical Benefits,” stated that it “will be used to determine your eligibility for medical benefits.” In 2002, Harris, pro se, sought service-connected disability compensation for contact dermatitis and latex allergy. The DVA regional office ultimately granted the claims and assigned an effective date of 2002. Harris sought an effective date of 1985. The Board held that the report of the Agent Orange Registry examination did not constitute a claim. The Veterans Court affirmed The Federal Circuit vacated, stating that pro se filings must be read liberally; the Veterans Court did not apply the proper legal standard for determining whether the Board had correctly determined the earliest applicable date for the claim. View "Harris v. Shinseki" on Justia Law

Plaintiff appealed the district court's decision affirming the Commissioner's denial of social security benefits. The court rejected plaintiff's contention to the extent that she alleged the ALJ failed to develop the record or make explicit findings regarding the mental and physical demands of her past relevant work as a factory packer and assembler. The court concluded that the ALJ had sufficient evidence on the record as a whole to reach his determination where the ALJ adequately compared the demands of plaintiff's past with her residual functioning capacity to perform light work, including with her manipulative limitations. Accordingly, the court affirmed the denial of benefits. View "Young v. Astrue" on Justia Law