Justia Public Benefits Opinion Summaries

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Murphy served in the Army, 1971-1974. In 2003, he sought disability benefits for PTSD; the VA regional office (RO) denied this claim because Murphy lacked a PTSD diagnosis. A private doctor had diagnosed Murphy with schizophrenia in 1982. In 2006, Murphy submitted another claim for disabilities, including schizophrenia. He requested that the RO reopen his PTSD claim. The RO denied the claim for schizophrenia for failure to show service connection and declined to reopen the PTSD claim for lack of material evidence. In 2007-2012, the RO denied multiple requests to reopen both claims.A 2012 request to reopen listed only PTSD. The VA physician found no PTSD but noted the schizophrenia diagnosis. The RO denied Murphy’s request to reopen his PTSD claim. Murphy filed a Notice of Disagreement. The cover page referred to PTSD; a handwritten attachment mentions “schizophrenia” and “PTSD” multiple times. His Form 9 included numerous mentions of both “PTSD” and “schizophrenia.” The RO determined that Murphy was also seeking to reopen his schizophrenia claim but denied that request for lack of new and material evidence. Murphy did not appeal. The Board remanded the PTSD claim; the RO maintained its denial.The Veterans Court determined that the Board correctly found it lacked jurisdiction over the schizophrenia claim, which was a request to reopen, not an initial claim. The Federal Circuit affirmed. Murphy’s request to reopen cannot be construed as seeking to reopen his schizophrenia claim. Although the lenient-claim-scope rule applies to requests to reopen, Murphy demonstrated an understanding that the conditions would be addressed separately. View "Murphy v. Wilkie" on Justia Law

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Perry served in the Wisconsin Army National Guard from January 1977 to March 1977, with active duty for training in February-March 1977. Active duty for training is “full-time duty in the Armed Forces performed by Reserves for training purposes,” 38 U.S.C. 101(22). Medical Board examiners at his March 1977 separation opined that enuresis and incontinence existed prior to service. Perry died in 2014. There was no claim for service-connected disability during his lifetime.The Board of Veterans’ Appeals held that Mrs. Perry was not eligible for nonservice-connected death pension benefits because Perry did not have active duty service during a period of war nor did he have a service-connected disability, as required by 38 U.S.C. 1541, that Mr. Perry did not attain veteran status, and that he “was not service-connected for any disability at the time of his death, and there is no evidence that his death was in any way related to" his 1977 military service. The Veterans Court and Federal Circuit affirmed. Service in the state National Guard including a period of active duty for training, without disability incurred or aggravated in line of duty, does not achieve “veteran” status for these purposes. View "Perry v. Wilkie" on Justia Law

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The Fourth Circuit reversed the district court's order affirming the SSA's denial of plaintiff's application for disability insurance benefits, holding that the ALJ erred by determining that plaintiff was not disabled during the relevant period.The court concluded that the ALJ erred in discrediting plaintiff's subjective complaints by applying the wrong legal standard by effectively requiring plaintiff to provide objective medical evidence of her symptoms; improperly cherry-picking, misstating, and mischaracterizing facts from the record; and drawing various conclusions unsupported by substantial evidence and failing to explain them adequately. Furthermore, the ALJ's decision exhibits a pervasive misunderstanding of fibromyalgia. Applying its discretion to review the issue, the court concluded that the ALJ erred by according little weight to plaintiff's treating physician's opinion. In this case, the ALJ's treatment of the doctor's opinion contains several errors and is not supported by substantial evidence. The court held that the record as a whole clearly establishes plaintiff's disability and thus her legal entitlement to disability benefits. The court remanded to the Commissioner for calculation of disability benefits. View "Arakas v. Commissioner" on Justia Law

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The National Organization of Veterans’ Advocates (NOVA), sought review under 38 U.S.C. 502. The Knee Joint Stability Rule, promulgated in 2018 and set forth in the Veterans Affairs Adjudication Procedures Manual, assigns a joint instability rating under Diagnostic Code (DC) 5257, 38 C.F.R. 4.71a, based on the amount of movement that occurs within the joint. The Knee Replacement Rule provides that evaluation under DC 5055, 38 C.F.R. 4.71a, is not available for partial knee replacement claims. The Replacement Rule was published in the Federal Register in 2015, stating that section 4.71a was amended to explain that “‘prosthetic replacement’ means a total, not a partial, joint replacement.” It was published in a 2016 Manual provision, which informs regional office staff that evaluation under DC 5055 is not available for partial knee replacement claims filed on or after July 16, 2015.The Federal Circuit referred the case for adjudication on the merits. NOVA has standing because it has veteran members who are adversely affected by the Rules. The Manual provision is an interpretive rule reviewable under 38 U.S.C. 502 and constitutes final agency action. The Knee Replacement Rule is a final agency action. The merits panel will determine whether the Manual provision or the Federal Register publication constitutes the reviewable agency action. The challenge is timely under the six-year statute of limitations, 28 U.S.C. 2401(a); Federal Circuit Rule 15(f), establishing a 60-day time limit for bringing section 502 petitions, is invalid. View "National Organization of Veterans’ Advocates, Inc. v. Secretary of Veterans' Affairs" on Justia Law

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The First Circuit dismissed these consolidated appeals, and a companion appeal, arising out of long-running litigation between Puerto Rico and several Federally Qualified Health Centers (FQHCs) over the Commonwealth's failure to make payments to the FQHCs, holding that the orders appealed from were void.Here, the FQHCs asserted new claims that the Commonwealth failed fully to pay the statutorily required reimbursement amounts for the services they provided to underserved patients under the Medicaid Act. The First Circuit dismissed the appeals, holding that the Court lacked jurisdiction to resolve the merits of the underlying orders because they were void. View "HealthproMed Foundation, Inc. v. Department of Health And Human Services" on Justia Law

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Dr. Korban and his medical practice Delta, practice diagnostic and interventional cardiology. In 2007, Dr. Deming filed a qui tam action under the False Claims Act (FCA), 31 U.S.C. 3729(a)(1)(A)–(C), (G) against Korban, Jackson Regional Hospital, and other Tennessee hospitals, alleging “blatant overutilization of cardiac medical services.” The United States intervened and settled the case for cardiac procedures performed in 2004-2012. Korban entered into an Integrity Agreement with the Office of Inspector General, effective 2013-2016 that was publicly available and required an Independent Review Organization. The U.S. Department of Justice issued a press release that detailed the exposed fraudulent scheme and outlined the terms of Korban’s settlement. In 2015, Jackson Regional agreed to a $510,000 settlement. The Justice Department and Jackson both issued press releases.In 2017, Dr. Maur, a cardiologist who began working for Delta in 2016, alleged that Korban was again performing “unnecessary angioplasty and stenting” and “unnecessary cardiology testing,” paid for in part by Medicare. In addition to Korban and Jackson, Maur sued Jackson’s corporate parent, Tennova, Dyersburg Medical Center, and Tennova’s corporate parent, Community Health Systems. The United States declined to intervene. The district court dismissed, citing the FCA’s public-disclosure bar, 31 U.S.C. 3730(e)(4). The Sixth Circuit affirmed. Maur’s allegations are “substantially the same” as those exposed in a prior qui tam action and Maur is not an “original source” as defined in the FCA. View "Maur v. Hage-Korban" on Justia Law

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Plaintiffs filed suit alleging discrimination under Government Code section 11135 based on a requirement that all San Diego County applicants eligible for the state's CalWORKs (welfare) program participate in a home visit. The County demurred, arguing there was no discriminatory effect on of the program, no disparate impact caused by the home visits, and the parties lacked standing to sue. The superior court granted the demurrer without leave to amend, and entered judgment. Plaintiffs argued on appeal that their complaint stated a viable cause of action. The Court of Appeal disagreed, finding the complaint did not allege a disparate impact on a protected group of individuals and could not be amended to do so. Therefore, the Court affirmed the superior court. View "Villafana v. County of San Diego" on Justia Law

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Alleging debilitating pain in her back, legs, and hands, Zoch sought disability insurance benefits, 42 U.S.C. 413, 423. An ALJ denied the application, finding that, based on the opinions of three of her four treating physicians, a consulting physician, and the objective medical evidence, she could perform sedentary work.The district court and Seventh Circuit affirmed, rejecting Zoch’s arguments that the ALJ improperly discounted her assertions and an opinion by a physician who relied on those assertions. Substantial evidence supports the ALJ’s decision. Zoch’s testimony of incapacitating pain conflicted with the objective medical evidence, including normal test results: lumbar MRI, wrist x-rays, range of motion, straight-leg raising, strength in extremities, and pressure on her nerves. Zoch’s testimony that she usually walked with a cane conflicted with the doctors’ reports that at all but one appointment she walked normally. Zoch’s testimony that she could not raise her arms or bend over to dress conflicted with a doctor’s observation that Zoch could comfortably bend over to touch her fingertips to her knees. Zoch’s hearing testimony that she could not perform the usual activities of daily living was inconsistent with her assertions in her application. View "Zoch v. Saul" on Justia Law

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While plaintiffs sought judicial review in federal district court of their denial of Social Security disability benefits, the Supreme Court issued its opinion in Lucia v. Securities and Exchange Commission, 138 S. Ct. 2044 (2018), which elucidated a possible constitutional objection to administrative proceedings pursuant to the Appointments Clause. At issue in this appeal is whether plaintiffs may raise an Appointments Clause challenge in federal court that they did not preserve before the agency.The Fourth Circuit held that claimants for Social Security disability benefits do not forfeit Appointments Clause challenges by failing to raise them during their administrative proceedings. Balancing the individual and institutional interests at play, including considering the nature of the claim presented and the characteristics of the ALJ proceedings, the court declined to impose an exhaustion requirement. Therefore, the court affirmed the judgments of the district courts remanding these cases for new administrative hearings before different, constitutionally appointed ALJs. View "Probst v. Saul" on Justia Law

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The Supreme Court affirmed the judgment of the circuit court entering judgment in favor of Yankton County on Sacred Heart Health Service Inc.'s (Hospital) declaratory judgment against the County, holding that circuit court did not err in holding S.D. Codified Laws chapter 28-13 is the proper mechanism for the Hospital to obtain reimbursement from the County for medical costs associated with the twenty-three patients in the involuntary commitment process.The Hospital brought a declaratory judgment action against the County seeking a declaration as to the County's liability and reimbursement for charges for the medical care and treatment of patients subject to an emergency hold under S.D. Codified Laws chapter 27A-10. The circuit court first entered a memorandum decision in favor of the Hospital, but after granting the County's motion to reconsider issued a second memorandum decision and corresponding judgment in favor of the County. The Supreme Court affirmed, holding (1) the circuit court did not err in granting the County's motion for summary judgment; (2) the Hospital did not have a claim in quantum merit for reimbursement from the County; and (3) the circuit court did not err in granting the County's motion to reconsider. View "Sacred Heart Health Services v. Yankton County" on Justia Law