Justia Public Benefits Opinion Summaries

Plaintiff appealed the district court's grant of summary judgment to the Commissioner in its review of the Commissioner's denial of Social Security Disability Insurance (SSDI) and Social Security Income (SSI) benefits. Based on the rarity of the surveillance system monitor jobs, and considering plaintiff's physical and mental limitations, the court was compelled to find that the ALJ's decision was not supported by substantial evidence. Accordingly, the court reversed the district court's grant of summary judgment and remanded for further proceedings. View "Beltran v. Astrue" on Justia Law

T.B.'s parents, on behalf of their autistic child, appealed the district court's finding that the school district did not violate the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1400 et seq., by failing to provide a free appropriate public education (FAPE) to T.B., making the parents ineligible for reimbursement for the costs of T.B.'s home-based program. Given the parents' decision to ultimately settle the issue of the adequacy of the proposed individualized education program (IEP), the court questioned whether they could claim, much less successfully show, that the school district failed to provide a FAPE to T.B. Nonetheless, based on the record, the court could not say that T.B.'s home-based program was "reasonably calculated to enable [him] to receive educational benefits." The program was therefore not "proper" within the meaning of the IDEA and the parents were not entitled to reimbursement for the costs associated with it. Accordingly, the court affirmed the judgment. View "T.B., et al. v. St. Joseph School District" on Justia Law

Plaintiff, the Chapter 7 trustee for the bankruptcy estate of BioniCare Medical Technologies, contested determinations of the Medicare Appeals Council (MAC) refusing to provide coverage for the BIO-1000, a device to treat osteoarthritis of the knee. Plaintiff alleged that the Secretary improperly used the adjudicative process to create a policy of denying coverage for the BIO-1000, that the MAC's decisions were not supported by substantial evidence, and that the MAC's decisions were arbitrary and capricious on account of a variety of procedural errors. The court rejected those contentions and affirmed the judgment of the district court. View "Almy v. Sebelius" on Justia Law

Plaintiffs sought compensation under the National Vaccine Injury Compensation Program, 42 U.S.C. 300aa, for injuries to their children allegedly caused by the Diptheria-Tetanus-acellular Pertussis vaccine. The children suffer a seizure disorder, known as Severe Myoclonic Epilepsy of Infancy. The same special master presided over both cases and determined that plaintiffs failed to show entitlement to compensation because evidence showed that a gene mutation present in both children was the sole cause of their injuries. The Court of Federal Claims affirmed. The Federal Circuit affirmed, noting considerable evidentiary support for the conclusion. View "Stone v. Sec'y of Health & Human Servs." on Justia Law

Petitioner served in the Army for about 30 months, 1981-1983 and suffered injury to her knees and wrist. The VA regional office assigned a 10 percent rating to her left wrist with an effective date of 1986. In 1987, her right arm was injured as a result of medical care she received from the VA. In 1990, her injury to right knee and shoulder were each rated at 20 percent and her left knee at 30 percent. In 1996, she was unable to continue working as a bookkeeper and brought a claim for total disability based on individual unemployability. The regional office rated her service-connected disabilities at 70 percent, but denied a total rating based on unemployability under 38 C.F.R. 4.16(a). The regional office and Board of Veterans’ Appeals rejected her 2004 application for review. The Secretary conceded that the regional office committed error by incorrectly computing petitioner’s rating. The Veterans Court found no “clear and unmistakeable error” and that the error was harmless because the RO had made an unemployability determination that satisfied the requirements for a 4.16(a) analysis. The Federal Circuit dismissed for lack of jurisdiction because there was no issue of the interpretation of 4.16(a)View "Githens-Bellas v. Shinseki" on Justia Law

A psychologist challenged the government's claim that he had over-billed Medicare and owed the government more than $600,000 in overpayments. At a hearing on the claim, the doctor presented extensive evidence, but the government neither appeared nor presented argument or advocacy, either written or in person. The ALJ concluded that the overpayment was actually $5,434.48. The doctor moved, under the Equal Access to Justice Act, 5 U.S.C. 504(a)(1), to recoup tens of thousands of dollars in attorneys' fees and expenses incurred in fighting the claim. His request was denied by an administrative appeals council and the district court based on their conclusion that the hearing before the ALJ was not an adversary adjudication, as is required for a fee award under the EAJA. The Third Circuit affirmed denial, finding that the government did not engage in purposeful advocacy.View "Handron v. Sec'y of Health & Human Servs." on Justia Law

Donnellan served in the National Guard from 1969 until 2000. In 1996, a portion of his sigmoid colon was removed as treatment for colon cancer. In March 1998, after diagnosis of acquired polyposis, he had a total colectomy. While on active duty for training in May-June 1998, he became ill and underwent emergency surgery to remove a portion of his small intestine because of a small bowel perforation. After surgery, his doctors treated a small bowel fistula. The DVA denied a service connection to ensuing complications. In 2007, the Board of Veterans’ Appeals denied benefits, finding by clear and unmistakable evidence that Donnellan’s disease and ensuing complications did not increase in severity beyond natural progression during his period of active duty for training. The Veterans Court remanded, holding that the statutory presumption of aggravation does not apply to an increase in the degree of a disability suffered by a member of the National Guard while on active duty for training who is not a veteran under 38 U.S.C. 101(2) and that his doctor’s medical opinion did not satisfy the Board’s instructions on remand. The Federal Circuit dismissed an appeal. The Veterans Court’s remand order is not a final decision. View "Donnellan v. Shinseki" on Justia Law

For 20 years, George was a clerk-magistrate. In 1995, he was charged with conspiracy to commit honest-services wire fraud, 18 U.S.C. 371, 1343, 1346 for selling blank search warrants, used to commit robberies. George entered a plea for a sentence of 20 months and a $10,000 fine. George retired before his plea and began receiving a monthly benefit of $1,424.91, plus health-care. In 2003, the state retirement board suspended benefits; his attorney had advised him that he would remain eligible if he started receiving benefits before he entered a plea. The district court denied his petition for a writ of error coram nobis. The First Circuit affirmed. The Board authorized recoupment of benefits in excess of contributions. In 2010, the Supreme Court held that "intangible right of honest services," in 18 U.S.C. 1346, would be unconstitutionally vague unless limited to schemes involving bribes or kickbacks. George’s second petition was denied. The court found that, in light of Skilling, a fundamental error had occurred, but that cessation of benefits did not constitute a continuing collateral consequence sufficient to justify the remedy. The First Circuit affirmed, referring to a “Hail Mary pass.” A court has discretion to withhold the remedy where the interests of justice dictate.View "United States v. George" on Justia Law

This case addressed the effect of a pooled special-needs trust created by an over-65-year-old beneficiary on his medicaid benefits. The Center for Special Needs Trust Administration appealed a summary judgment in favor of the North Dakota Department of Human Services. Invoking 42 U.S.C. 1983 and the Constitution's Supremacy Clause, the Center alleged that North Dakota's demand for reimbursement and its state regulations violated a paragraph of the Medicaid Act, 42 U.S.C. 1396p(d)(4)(C). The court held that the district court properly determined that section 1396p(d)(4)(C) afforded the Center a right of action under section 1983; that North Dakota did not waive its claim to recover for reimbursements and should not be estopped from making that claim; that the Center's claim was without merit; and that preemption did not apply. View "Center for Special Needs, etc. v. Olson, etc." on Justia Law

Plaintiffs, parents of children who were eligible to receive a free and appropriate public education, filed suit to challenge the exclusion of mapping of cochlear implants from the regulatory definition of "related services" under the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1401(26)(B). The court concluded that the phrase "audiology services" as used in the IDEA's "related services" definition did not unambiguously encompass mapping of cochlear implants. The court also found that the Mapping Regulations embodied a permissible construction of the IDEA because they were rationally related to the underlying objectives of the IDEA. The court further found that the Mapping Regulations did not substantially lessen the protections afforded by the 1983 regulations. Because the Department's construction of its own regulation was neither plainly erroneous nor inconsistent with the regulation, the court owed it deference. Accordingly, the court affirmed the district court's grant of summary judgment to the Department. View "Petit, et al. v. US Dept. of Education, et al." on Justia Law