Justia Public Benefits Opinion Summaries

In the four cases giving rise to these eleven consolidated appeals, the Secretary of the Department of Health and Human Services (HHS) and the Director of the California Department of Health Care Services (DHCS), appealed the district court's grant of preliminary injunctions to plaintiffs, various providers and beneficiaries of California's Medicaid program (Medi-Cal). At issue was the implementation of Medi-Cal reimbursement rate reductions. The court held that Orthopaedic Hospital v. Belshe did not control the outcome in these cases because it did not consider the key issue here - the Secretary's interpretation of 42 U.S.C. 1396a(a)(30)(A); the Secretary's approval of California's requested reimbursement rates were entitled to Chevron deference; and the Secretary's approval complied with the Administrative Procedures Act, 5 U.S.C. 500 et seq. The court further held that plaintiffs were unlikely to succeed on the merits on their Supremacy Clause claims against the Director because the Secretary had reasonably determined that the State's reimbursement rates complied with section 30(A). The court finally held that none of the plaintiffs had a viable takings claim because Medicaid, as a voluntary program, did not create property rights. View "Managed Pharmacy Care, et al v. Sebelius, et al" on Justia Law

A VA regional office awarded King disability compensation for residuals of a left knee surgery and right knee arthritis. King later sought disability compensation for disabilities of the back and hips on a direct basis and as secondary to his service-connected knee disabilities. Records revealed no treatment for back or hip problems during King's active duty service 1973-1974. King underwent a VA spine examination in 2000. The examiner diagnosed minimal degenerative joint disease of both hips and lumbosacral spine, related to age. A private physician disagreed. In 2007, the Board of Veterans denied King's appeal. The Veterans Court remanded. Additional evidence was developed and, in 2008, the Board obtained an opinion from a Veterans Hospital Administration orthopedist that it was not likely that King’s back and bilateral hip disabilities were directly caused or permanently worsened by the service-connected knee disabilities. The Board and Court of Appeals for Veterans Claims affirmed the denial. The Federal Circuit affirmed, rejecting an argument that the Veterans Court erred by discounting lay testimony offered by King and his wife. The Veterans Court did not fail to consider the proffered lay evidence, so King’s appeal was merely a challenge to the weight given his evidence.View "King v. Shinseki" on Justia Law

Plaintiff challenged the district court's judgment upholding the decision of the SSA denying his application for disability benefits. The court held that a VA disability determination must be accorded substantial weight in Social Security disability proceedings. The court also held that an ALJ must give retrospective consideration to medical evidence created after a claimant's last insured date when such evidence could be "reflective of a possible earlier and progressive degeneration." After considering all relevant evidence, and upon determining that plaintiff was disabled at any time, an ALJ must consult with a medical advisor if the date of onset of the disability was ambiguous. In this case, the ALJ made two errors of law in conducting his analysis of the evidence concerning whether plaintiff was disabled before his DLI and therefore, the court vacated the district court's judgment. View "Bird v. Commissioner of Soc Sec" on Justia Law

Youngman, fiduciary for deceased veteran Richardson, sought payment of accrued benefits of about $350,000 that had been awarded to Richardson before his death. Payment had been delayed while the Kansas state courts were accrediting Youngman as successor fiduciary for Richardson, who had been adjudged incompetent several years earlier. Richardson died after the accreditation but before payment. The VA denied payment. The Court of Appeals for Veterans Claims affirmed. Periodic monetary benefits to which an individual was entitled at death are to be paid to the veteran's spouse, children, or dependent parents and, in “all other cases, only so much of the accrued benefits may be paid as may be necessary to reimburse the person who bore the expense of last sickness and burial” 38 U.S.C.5121(a). Richardson had only cousins as heirs. The Federal Circuit affirmed. While 38 U.S.C. 5502 allows a fiduciary to stand in the shoes of a veteran, it does not grant the fiduciary rights beyond those of the veteran himself. Richardson died without any heirs in the categories qualifying under 5121, so his unpaid benefits died with him. View "Youngman v. Shinseki" on Justia Law

Tim Wilborn appealed the reduction of attorneys' fees he earned while representing plaintiff in a Social Security benefits claim. At issue was whether Wilborn received fees for the same work under the Equal Access to Justice Act (EAJA), 28 U.S.C. 2412, and the Social Security Act (SSA), 42 U.S.C. 406(b)(1). The court held that the $5,000 award under the EAJA was for the "same work" as the work for which Wilborn received the section 406(b)(1) award, and therefore the district court correctly offset the $5,000 from the 25% award. View "Parrish v. Commissioner Social Security" on Justia Law

Hibbard, then 41 years old and working as a teacher, received a flu vaccination in 2003. She claims that the flu vaccine caused her to develop a neurological disorder known as dysautonomia, a dysfunction of the autonomic nervous system and sought compensation under the National Childhood Vaccine Injury Act of 1986, 42 U.S.C.300aa-1 to 300aa-34. Following a two-day hearing, a special master found that Hibbard had failed to show that her dysautonomia resulted from autonomic neuropathy caused by the vaccine she received in 2003. The Court of Federal Claims upheld the decision. The Federal Circuit affirmed, finding substantial evidence to support the denial. View "Hibbard v. Sec'y Health & Human Servs." on Justia Law

Plaintiff is the surviving spouse of a 39-year AK employee, who died in 2008, then receiving a monthly pension benefit of $1,386. Plaintiff applied for the surviving spouse benefit and was advised that she was entitled to$693 (50%), reduced by 50% of her social security widow’s benefit (not yet determined), but not less than $140 per month. SSA first advised AK that plaintiff’s monthly benefit would be $458. Weeks later, SSA indicated that the widow’s benefit would be $1469. AK calculated the $140 benefit. Plaintiff received a statement from SSA indicating her widow’s benefit amount was $485 and plaintiff’s own earnings benefit was $973: a total monthly payment of $1,458. Plaintiff calculated that 50% of the $485 widow’s benefit, subtracted from $693, yielded a monthly benefit of $450.50 under the AK Plan. According to AK, $458 represented only the remainder of the entire widow’s benefit, $1,469, after offset for plaintiff’s own old-age retirement benefit, $1,011. In an action under ERISA, 29 U.S.C. 1001, the district court awarded judgment to plaintiff. The Sixth Circuit reversed, holding that AK’s proposed interpretation of the plan language to be truer to its plain meaning when read with reference to the law it expressly refers to. View "Lipker v. AK Steel Corp." on Justia Law

The dispute before the Tenth Circuit in this case centered on interest earned on block grants made to Indian tribes pursuant to the Native American Housing Assistance and Self-Determination Act. Specifically, Appellant Muscogee (Creek) Nation's Division of Housing challenged both a regulation placing a two-year limit on the investment of grant funds and two notices issued by the U.S. Department of Housing and Urban Development stating that any interest accrued after the expiration of this two-year period must be returned to the Department. The Nation sought declaratory relief invalidating the regulation and notices as well as an injunction to prevent HUD from recouping interest earned on grant funds. The Nation also sought recoupment of the approximately $1.3 million of earned interest it wired to HUD after HUD sent a letter threatening an enforcement action based on the Nation’s investment of grant funds for longer than two years. The district court dismissed the complaint, holding that HUD’s sovereign immunity was not waived by the Administrative Procedures Act and, in the alternative, that the Nation had failed to state a claim on which relief could be granted because HUD’s interpretation of the statute was permissible. Upon review, the Tenth Circuit concluded that HUD was authorized to promulgate a regulation limiting the period for investments, and required to demand remittance of interest earned in violation of the regulation. The Nation was therefore not entitled to recouping the interest it paid to HUD pursuant to HUD's enforcement of its rules. View "Muscogee (Creek) Nation v. HUD, et al" on Justia Law

Debtor Fred Fausett Cranmer filed a Chapter 13 repayment plan, which excluded Social Security income (SSI) from the projected disposable income calculation. The bankruptcy trustee objected to the plan on that basis. The bankruptcy court denied confirmation of the plan, concluding, inter alia, SSI must be included in the projected disposable income calculation and Cranmer's failure to do so meant he did not propose his plan in good faith. Cranmer appealed and the district court reversed. Upon review, the Tenth Circuit Court of Appeals concluded that SSI need not be included in the calculation of projected disposable income and Cranmer's failure to include it was not grounds for finding he did not propose his plan in good faith. View "Anderson v. Cranmer" on Justia Law

Plaintiff appealed from the magistrate judge's decision affirming the Commissioner's denial of social security disability insurance benefits. The court held that, when viewing the entire record, it perceived no error in the minimal weight the ALJ afforded plaintiff's treating neurologist's evaluation and concluded that substantial evidence supported the ALJ's decision. Accordingly, the court affirmed the judgment. View "Anderson v. Astrue" on Justia Law