Justia Public Benefits Opinion Summaries

Petitioner Theresa Freeman appealed the denial of her applications for social security disability insurance benefits and supplemental security income benefits. Petitioner applied for benefits in June 2007, alleging she was unable to work as the result of obesity and an on-the-job back injury that had occurred in February 2007. Her applications were denied at the administrative level, on reconsideration, and after a hearing before an administrative law judge (ALJ). The ALJ found that Petitioner's degenerative disk disease and obesity were severe impairments, but that none of her impairments, either alone or in combination, met or equaled one of the listings. Furthermore, the ALJ found that Petitioner had "the residual functional capacity to perform less than the full range of light work." After the Appeals Council denied her request for review, Petitioner filed her complaint in district court, and a magistrate judge affirmed the Commissioner's denial of benefits. Upon review, the Tenth Circuit concluded that Petitioner wanted the Court to "reweigh the evidence or substitute [the Court's] judgment for that of the Commissioner" which the Court declined to do. Accordingly the Court affirmed the Commissioner's decision to deny Petitioner's benefits.

In 1996 petitioner, who had served in the Marine Corps from 1965 to 1968, filed a claim for compensation for post-traumatic stress disorder. The VA Regional Office granted the claim and assigned a disability rating of 30%, effective October 1996. Petitioner requested an increase in the percentage and made multiple submissions before 2000, when the Office increased the rating to 70%, effective July 1999. The Veterans Court affirmed as to the rating, but remanded with instructions for assigning an effective date. On remand, the Board found that a February 1998 submission met the requirements for an informal claim for TDIU and assigned an effective date of February 11, 1998 that was affirmed by the Veterans Court. The Federal Circuit vacated. To comply with the directive of 38 C.F.R. 3.156(b) that new and material evidence be treated as having been filed in connection with the pending claim, the VA must evaluate submissions received during the relevant period and determine whether they contain new evidence relevant to a pending claim, whether or not the relevant submission might otherwise support a new claim; the VA failed to make such a determination.

This opinion consolidated two cases brought before the Supreme Court on certified appeals from the Court of Appeals. Both cases involved the Public Employees Retirement Board's (PERB or the Board) revision or reduction of benefits with respect to "Window Retirees." These cases involved the Board's efforts to recoup overpayments of benefits to retirees that were predicated on a 20 percent earnings credit for calendar year 1999 that the Board approved by order in 2000. PERB sought to recoup these overpayments to the Window Retirees through an overpayment recovery mechanism set out in ORS 238.715.2. A number of members challenged the statutory mechanism for returning the payments, and the methodology the Board used in making its individualized determinations. Upon review, the Supreme Court determined that the trial court correctly granted summary judgment to the "Arken defendants" on all four of the claims raised by the "Arken plaintiffs." Furthermore, the Court determined that the trial court erred in granting summary judgment to the "Robinson petitioners" on their claims for relief. Because the Court concluded that PERB correctly applied ORS 238.715 to recoup overpayments that were made to the Window Retirees based on the 20 percent earnings credit for 1999, the Court also determined that the trial court erred in denying PERB's cross-motion for summary judgment.

Petitioners sought judicial review of a final order of the Public Employees Retirement Board (PERB). They contested the reduction of their retirement benefits as a result of PERB's efforts to recoup benefit overpayments that Petitioners had received because of an erroneous 20 percent earnings credit for 1999. The Court of Appeals certified the matter to the Supreme Court, and upon review of the applicable legal authority, the Supreme Court affirmed PERB's final order.

Petitioner Ruben Espinosa sought permanent partial disability benefits for injuries to his hands, arms, and shoulders. The Workers' Compensation Court awarded benefits, but a three-judge en banc panel reduced the award to account for Petitioner's previously awarded benefits for injuries to other parts of his body. The Court of Civil Appeals vacated the panel, determining that both the trial court and the panel misapplied the applicable statute. The Supreme Court granted certiorari to resolve a conflict between two Court of Civil Appeals' opinions with differing interpretations of the limitations provided in the applicable statute. Upon review, the Supreme Court held that when the Workers' Compensation Court awards compensation for an accidental personal injury or occupational disease, pursuant to 85 O.S. 2001 Sec. 22(7), the sum of all permanent partial disability awards is limited to a total of 100% or 520 weeks (10 years) for any individual, but awards against the Multiple Injury Trust Funds, or awards for amputations and surgeries are excluded from both limitations.

Plaintiff-Appellant Timothy Arles appealed a district court judgment that affirmed the Commissioner of Social Security's denial of his application for supplemental security income benefits (SSI). An Administrative Law Judge (ALJ) denied Plaintiff's request for benefits at the last step of the five-step sequential process for determining disability. At the time of the hearing before the ALJ, Plaintiff was 44 years old and weighed 329 pounds. He testified about his difficulties with cramping and swelling hands after carpal tunnel surgery, swollen knees, a painful left foot, daily migraine headaches, neck pain, loss of near vision from glaucoma, low-back problems, and an ache from a rupture in his stomach. He stated that medical providers prescribed eye drops for his diagnosed low-tension glaucoma and also pain pills, sleeping pills,nerve pills, arthritis pills, and high-blood-pressure pills. Plaintiff further related that he did not take any of these medications or seek medical care because he lacked the financial resources to afford them. The ALJ therefore concluded that Plaintiff was not entitled to SSI and denied his application. The Appeals Council denied review, making the ALJ’s decision the final agency decision. The district court affirmed. On appeal of the district court’s ruling to the Tenth Circuit, Plaintiff argued that the Commissioner’s denial of benefits should have been reversed because the ALJ did not perform a proper credibility determination. He also contended that throughout the sequential-evaluation process, the ALJ failed to give appropriate consideration to his restricted vision and obesity. Upon review, the Tenth Circuit found that the ALJ’s decision provided "an adequate discussion of the effect of obesity on [Plaintiff]’s RFC. Further, the ALJ’s conclusion that obesity did not interfere with Plaintiff's ability to perform a restricted range of sedentary work is supported by substantial evidence." Therefore, the Court affirmed the Commissioner's decision to deny Plaintiff SSI benefits.

Plaintiff-Appellant Timothy Grede appealed a district court's order upholding the Commissioner of Social Security's denial of disability benefits. In 2004, Plaintiff applied for benefits asserting an onset date of 2002 due to kidney stones, high blood pressure, renal and intestinal problems, hemorrhoids, pulmonary problems and left hand problems. When his insurance ended, he was required to show the disability onset for one year plus the four-month period between when his insurance ended until the time of his benefit application. After receiving denials of disability at all stages of administrative review, Plaintiff appealed to the district court, who remanded his case to the Commission for further review. And administrative law judge concluded again that Plaintiff was not disabled. On appeal, Plaintiff argued that the Commissioner failed to conduct a proper analysis of his residual functional capacity (RFC). Because the Commissioner’s decision was supported by substantial evidence and the law was properly applied, the Tenth Circuit affirmed the Commissioner's decision.

An elderly woman requiring long-term medical care gave $120,000 to her son in February 2007. The mother believed that the gift would not prevent her from receiving Medicaid coverage if she lived long enough to exhaust her remaining assets. She relied on a provision in Alaska's Medicaid eligibility manual that suggested prospective Medicaid beneficiaries could give away a portion of their assets while retaining sufficient assets to pay for their medical care during the period of ineligibility that Medicaid imposes as a penalty for such gifts. But by the time the mother applied for Medicaid in September 2008, the Alaska legislature had enacted legislation with the retroactive effect of preventing the kind of estate planning the mother had attempted through her gift. The State temporarily denied the mother's application. The son appealed pro se on behalf of his mother, who died in 2009. Upon review, the Supreme Court found that the Alaska legislature's retroactive change to the Medicaid eligibility rules was valid. The Court thus affirmed the State's temporary denial of the mother's application.

Plaintiff suffered a back injury in a work-related vehicle accident in 1994, developed depression, then sought social security disability benefits. The Commissioner of Social Security adjudged him not to be disabled for purposes benefits. The district court affirmed. The Sixth Circuit reversed. The ALJ did not apply the "treating physicians" or "good reasons" rules in rejecting the treating doctor's opinion. That opinion was not patently wrong, so the ALJ's decision was not supported by substantial evidence.

Claimant Claud Sloan appealed a district court judgment that affirmed a Workforce Safety & Insurance (WSI) order awarding him additional permanent impairment benefits. In December 1985, Sloan sustained a compensable work-related injury while employed at a coal gasification plant in Beulah, North Dakota. WSI awarded Sloan permanent impairment benefits for his injury and has issued several permanent partial impairment orders since his original injury. Effective April 1, 2009, WSI promulgated N.D. Admin. Code 92-01-02-25(4) to address pain impairment ratings. Based on the newly adopted rule, WSI reviewed Sloan's pain rating and determined he had sustained an eight percent impairment for pain which, when combined with his prior impairment ratings, totaled a whole body impairment rating of 38 percent. On June 11, 2009, WSI issued an order awarding Sloan additional permanent impairment benefits, based on his combined whole body impairment of 38 percent for his cervical spine, depression, dysphagia, and chronic pain. Sloan requested a rehearing. At a November 2009, hearing before an administrative law judge, a staff attorney for WSI appeared as the only witness and testified regarding the WSI's promulgation of N.D. Admin. Code 92-01-02-25. The ALJ subsequently issued an order affirming WSI's June 2009 order awarding Sloan additional permanent impairment benefits. Sloan appealed to the district court, which affirmed the order. Upon review, the Supreme Court concluded WSI's promulgation of administrative rules for assessing pain impairment did not conflict with its statutory authority and was not arbitrary, capricious, or unreasonable.