Justia Public Benefits Opinion Summaries

Cage, born in 1960, has an extensive medical history. She offered evidence of: bipolar disorder, depression, suicidal ideation, dizziness, blackouts, memory loss and chest pain. She has not worked since November 2003. Before then, she had worked as a retail cashier, hotel maid and home healthcare aide. Cage also has a long history of drug and alcohol abuse. Her ongoing medical care has included treatment for drug addiction and alcoholism and her other conditions. An Administrative Law Judge of the Social Security Administration denied Cage’s application for Supplemental Security Income benefits, finding that although Cage met certain requirements for being “disabled” under the Social Security Act, 42 U.S.C. 301, she was ineligible for SSI because drug addiction or alcoholism was a contributing factor material to that determination. The district court affirmed. The Second Circuit affirmed. The ALJ properly imposed upon Cage the burden of proving that she would be disabled in the absence of drug addiction and alcoholism and the record supported the ALJ’s finding that she would not be disabled absent drug addiction and alcoholism. View "Cage v. Comm'r of Soc. Sec." on Justia Law

Hillyard suffered a head injury and was hospitalized for two weeks while serving in the U.S. Army. Hillyard filed a single claim for service connection for a mental condition, which he attributed to his in-service head injury. The Veterans Administration denied his claim and the Board affirmed and subsequently denied Hillyard’s request for revision. The Veterans Court affirmed. Hillyard later filed a second request for revision alleging clear and unmistakable error (CUE) by the Board in failing to consider and apply 38 U.S.C. 105(a) and 1111, a different CUE allegation from the one he made in his first request. The Board dismissed the second request for revision with prejudice, concluding 38 C.F.R. 20.1409(c) permitted only one request for revision to be filed. The Veterans Court affirmed. The Federal Circuit affirmed. The interpretation of Rule 1409(c) proffered by the VA is consistent with the language of the regulation and is in harmony with the VA’s description of the regulation in its notice of rule-making. View "Hillyard v. Shinseki" on Justia Law

Jewish Home of Eastern Pennsylvania (JHEP) provides nursing care to Medicare beneficiaries and is required to comply with the mandatory health and safety requirements for participation. JHEP must submit to random surveys conducted by state departments of health. In 2005, the Pennsylvania Department of Health conducted a survey that concluded that JHEP had eight regulatory deficiencies, including violations of 42 C.F.R. 483.25(h)(2), which requires a facility to ensure that each resident receives adequate supervision and assistance with devices to prevent accidents. Based on those deficiencies and those found in a 2006 survey, the Center for Medicare and Medicaid Services imposed fines totaling $17,150 and $12,800. JHEP claimed that the allegations of noncompliance were based on the inadmissible disclosure of privileged‖ quality assurance records and that the monetary penalties violated its right to equal protection because they were the product of selective enforcement based on race and religion. An ALJ upheld the fines against JHEP. The Third Circuit denied a petition for review. View "Jewish Home of E. PA v. Centers for Medicare and Medicaid Servs." on Justia Law

Applicants for and recipients of Medicaid home health Services claimed that the New York State Office of Temporary and Disability Assistance and the New York State Department of Health, violated their statutory right, enforceable under 42 U.S.C.1983, to an opportunity for Medicaid fair hearings. They claimed that this right, as construed by federal regulation, entitles them to “final administrative action” within 90 days of their fair hearing requests. The district court declared that “final administrative action” includes the holding of Medicaid fair hearings, the issuance of fair hearing decisions, and the implementation of any relief ordered in those decisions and permanently enjoined the state agencies to ensure that “final administrative action” implemented within 90 days of fair hearing requests. The Second Circuit affirmed in part, holding that the plaintiffs have a right to a Medicaid hearing and decision ordinarily within 90 days of their fair hearing requests, and that such right is enforceable under section 1983. The permanent injunction was, however, overbroad because “final administrative action” refers not to the implementation of relief ordered in fair hearing decisions, but to the holding of fair hearings and to the issuance of fair hearing decisions. View "Shakhnes v. Eggleston" on Justia Law

Appellant applied for Social Security benefits, alleging that he became unable to walk because of a disability in 2005. Appellant's claim was denied in 2008. The ALJ held a hearing at Appellant's request and determined that Appellant's impairments notwithstanding, Appellant had the capacity to perform light work with specified limitations. The ALJ then concluded that Appellant was not disabled as defined in the Social Security Act. The Ninth Circuit Court of Appeals affirmed the ALJ's determination, holding (1) the ALJ conducted a full and fair hearing; (2) the ALJ properly documented his analysis of Appellant's psychiatric impairments, and his analysis was supported by the record; and (3) the ALJ's interpretation of the medical evidence was supported by the record, as was his credibility determination. View "Chaudry v. Astrue" on Justia Law

Griglock, a 70-year-old retired woman, received an influenza vaccination in 2005. Weeks later, she went to her doctor, complaining of weakness, and was admitted to the hospital. Her treating neurologist determined that she suffered from Guillain-Barré Syndrome. She improved initially, but soon developed respiratory failure and was placed on a ventilator. She died about 18 months later; her death certificate lists “ventilator-dependent respiratory failure due to GBS” as the immediate cause of death. Her estate filed a petition for compensation under the Vaccine Injury Compensation Program, 42 U.S.C. 300aa-1, 300aa-10(a). The government responded that there was insufficient evidence to find that the influenza vaccine caused her GBS and death, but that it would not contest the issue and recommended an award of up to $250,000. The estate then sought unreimbursable medical expenses and compensation for pain and suffering. The Special Master determined that Griglock’s death was caused by an influenza vaccination, that her estate had standing, but that entitlement was limited to death benefits because injury benefits were barred by the statute of limitations. The Court of Federal Claims affirmed. The Federal Circuit affirmed. View "Griglock v. Sec'y of Health & Human Servs." on Justia Law

Watson’s father, Hickle, worked for the Department of Energy, 1954 to 1962. Hickle died of Hodgkin’s disease in 1964. Congress enacted the Energy Employees Occupational Illness Compensation Program Act in 2000 to compensate for illnesses caused by exposure to radiation and other toxic substances while working for the Department of Energy. Covered employees or eligible survivors may receive compensation in a lump sum payment; under specific circumstances, a covered employee’s child is also eligible, 42 U.S.C. 7385s-3(d)(2). When her father died, Watson was 19 years old, not a full-time student; she lived with her parents, worked as a waitress, relied on her parents for support, and was listed as a dependent on their income tax returns. She sought survivor benefits in 2002 and received a lump-sum payment of $150,000. She later claimed further compensation as a “covered child,” under a different section of the Act, arguing that she was “incapable of self-support” at the time of Hickle’s death. The Department of Labor denied her claim. Before the district court, Watson challenged the interpretation of “incapable of self-support,” claiming that the Department impermissibly required a showing of physical or mental incapability. The district court denied her motion for summary judgment. The Sixth Circuit affirmed. View "Watson v. Solis" on Justia Law

Appellant appealed a district court judgment affirming the Social Security Administration's (SSA) decision finding him disabled from September 26, 1997 through December 3, 1998, and concluding that the disability ended on December 4, 1998 due to medical improvement. Appellant contended that the ALJ's medical improvement finding was not supported by substantial evidence because she erred in relying on a single proposed rating decision from the Department of Veterans Affairs (VA) (the 2001 decision). Appellant also claimed that the ALJ erred by failing to mention the opinion of his treating physician. The Ninth Circuit Court of Appeals reversed, holding that the ALJ erred in relying solely on the 2001 decision, as (1) the 2001 only proposed changes while ignoring two other decisions that rejected the proposed changes recommended in the 2001 decision; and (2) the ALJ's misunderstanding led her to inaccurately conclude that her finding that Appellant's disability terminated on December 4, 1998 was consistent with the VA's ratings. View "Hiler v. Astrue" on Justia Law

Banks worked as a coal miner for 17 years and smoked about one pack of cigarettes per day for 38 years. His employment ended in 1991. After two unsuccessful attempts, in 2003, Banks filed a claim for benefits under the Black Lung Benefits Act, which provides benefits to coal miners who become disabled due to pneumoconiosis, 30 U.S.C. 901. An ALJ found that Banks had shown a change in his condition and that he suffered from legal pneumoconiosis which substantially contributed to his total disability. Banks was awarded benefits and the Benefits Review Board affirmed. The Sixth Circuit affirmed, adopting the regulatory interpretation urged by the Director of the Office of Workers’ Compensation Programs. The ALJ relied on reasoned medical opinions. View "Cumberland River Coal Co. v. Banks" on Justia Law

Plaintiff filed for disability insurance benefits and supplemental security income under Title II and Title XVI of the Social Security Act. The Social Security Administration denied Hill's application. An ALJ also denied Plaintiff's application, and the appeals council denied Plaintiff's request for review. The district court granted summary judgment in favor of the Commissioner of Social Security and affirmed the ALJ's decision. The Ninth Circuit Court of Appeals reversed, holding (1) the ALJ failed to consider evidence favorable to Plaintiff and posed an improper hypothetical question to the vocational expert; and (2) therefore, substantial evidence did not support the ALJ's determination that Plaintiff was not disabled under the Social Security Act. View "Hill v. Astrue " on Justia Law