Justia Public Benefits Opinion Summaries

More than a decade ago, Medicaid recipients filed this suit alleging that in violation of the Due Process Clause, the District of Columbia is failing to provide them notice and an opportunity to be heard when denying them prescription coverage. The case is now before the DC Circuit for the third time. In the first two appeals, the DC Circuit reversed the district court’s dismissals for lack of standing and for failure to state a claim, respectively. On remand, the district court once more dismissed the case, this time for mootness.   The DC Circuit again reversed and remanded with instructions to proceed expeditiously with discovery and allow Plaintiffs to make their case. The court explained that Plaintiffs challenged the District’s failure to give Medicaid recipients reasons for denying their prescriptions and an explanation of how to appeal, and uncontested evidence demonstrates that, notwithstanding the transmittal memorandum, some number of Plaintiffs are still not receiving the information they claim they are entitled to under the Due Process Clause. Because it is not “impossible for [the district] court to grant any effectual relief,” the case is not moot. View "Elsa Maldonado v. DC" on Justia Law

Fetting, 50 years old and suffering from back pain, headaches, depression, and anxiety, unsuccessfully applied for supplemental security income. During an administrative hearing, a vocational expert (VE) testified to Fetting’s physical and mental limitations and his ability to perform certain jobs, stating that Fetting could perform the representative occupations of a cleaner/housekeeper, routing clerk, and marker. The VE estimated that, in the national economy, there were 200,000 cleaner/housekeeper jobs, 40,000 routing clerk jobs, and 200,000 marker jobs. During cross-examination, the VE stated that he calculated his estimates from numbers published by the Bureau of Labor Statistics, using his “knowledge of the labor market, [acquired] over 30+ years of job placement activities.” He stated: “It’s not a hard and fast scientific type formula” and that he had not conducted any “formal analysis” to validate his estimates but had “in the past checked numbers in other reporting formats.”The ALJ found that Fetting did not have a disability under the Social Security Act based on the VE’s testimony. The district court and Seventh Circuit affirmed, rejecting an argument that the VE’s methodology for calculating his job number estimates was unreliable. Substantial evidence supports the finding that a significant number of the identified jobs exist in the national economy. View "Fetting v. Kijakazi" on Justia Law

Spicer served in the Air Force from 1958-1959 and was exposed to benzene in aircraft fuel. Years later, he developed chronic myeloid leukemia, a blood cancer. The VA recognized his leukemia as service-connected and granted him a 100 percent disability rating. Spicer developed arthritis in both knees, which required him to use a wheelchair. His scheduled knee replacement surgery was canceled because the leukemia medications lowered his hematocrit (red blood cell level). Spicer's hematocrit will never rise to a level that would permit surgery. He sought secondary service connection for his knee disability. The Board of Veterans’ Appeals and Veterans' Court affirmed the VA's denial of his claim. The statute, 38 U.S.C. 1110 establishes entitlement to service connection, providing compensation for veterans “[f]or disability resulting from personal injury suffered or disease contracted in line of duty.” The court reasoned that unless “the current state of his arthritis would not exist in the absence of his cancer or chemotherapy,” there is “no actual but-for causation.”The Federal Circuit vacated. Section 1110 provides that the United States will pay a veteran “[f]or disability resulting from personal injury suffered or disease contracted in line of duty”; “disability” refers to a veteran’s present-day “functional impairment.” “Resulting from" requires “but-for causation,” which is not limited to bringing something about or the onset or etiological link. That language may encompass situations where the service-connected disease or injury impedes the treatment of a disability. View "Spicer v. McDonough" on Justia Law

Plaintiff applied for and was denied disability benefits from the Social Security Administration (“SSA”). Plaintiff appealed the decision to the District of Minnesota, arguing in part that the Administrative Law Judge (“ALJ”) who oversaw the case lacked authority because SSA Acting Commissioner Nancy Berryhill was not properly serving as Acting Commissioner when she ratified the ALJ’s appointment. The district court agreed.   The Eighth Circuit reversed. The court found that Berryhill was properly serving as Acting Commissioner when she ratified the appointment. Plaintiff argued the district court’s decision can be affirmed because Berryhill was never directed to serve by the president. In essence, he argued the 2016 succession memo became null and void when administrations changed in 2017. The court concluded that this argument fails. The general rule is that presidential orders without specific time limitations carry over from administration to administration. Plaintiff provides no authority indicating succession orders are any different from other presidential orders. The text of the FVRA likewise does not change the default position that presidential orders, including succession memos under the FVRA, carry over from one administration to the next. View "Brian Dahle v. Kilolo Kijakazi" on Justia Law

The Northern Arapaho Tribe and the Indian Health Service (IHS) entered into a contract under the Indian Self-Determination and Education Assistance Act for the Tribe to operate a federal healthcare program. Under the contract, the Tribe provided healthcare services to Indians and other eligible beneficiaries. In exchange, the Tribe was entitled to receive reimbursements from IHS for certain categories of expenditures, including “contract support costs.” The contract anticipates that the Tribe will bill third-party insurers such as Medicare, Medicaid, and private insurers. The Tribe contended that overhead costs associated with setting up and administering this third-party billing infrastructure, as well as the administrative costs associated with recirculating the third-party revenue it received, qualified as reimbursable contract support costs under the Self-Determination Act and the Tribe’s agreement with the IHS. But when the Tribe attempted to collect those reimbursements, IHS disagreed and refused to pay. Contending it had been shortchanged, the Tribe sued the government. The district court, agreeing with the government’s reading of the Self-Determination Act and the contract, granted the government’s motion to dismiss. A divided panel of the Tenth Circuit Court of Appeals voted to reverse (for different reasons). Under either of the jurists' interpretations, the administrative expenditures associated with collecting and expending revenue obtained from third-party insurers qualified as reimbursable contract support costs. View "Northern Arapaho Tribe v. Becerra, et al." on Justia Law

May is a disabled child of a deceased veteran. The VA found that May was disabled from birth, with permanent incapacity for self-support, and granted him entitlement to dependency and indemnity compensation (DIC) benefits in October 2018, with an effective date of May 18, 2016, concluding that May’s entitlement to DIC benefits ended on February 1, 2017, when he married. May sought reinstatement of DIC benefits based on his divorce. May filed a notice of appeal to the Veterans Court in February 2021, listing the date of the Board’s decision as February 19, 2019. The Board had not rendered a decision on February 19, 2019; rather, May had received correspondence that day from a VA regional office certifying an appeal to the Board.The Veterans Court ordered May to show cause why his appeal should not be dismissed. In letters, May asked that his appeal not be dismissed and that his benefits be reinstated. May did not identify a Board decision from which he was appealing, nor did he argue that the Board had unreasonably delayed its decision. The Federal Circuit affirmed the dismissal of the appeal for lack of jurisdiction. The court’s jurisdiction is limited to appeals from Board decisions; absent such a decision, it could not consider May’s appeal, 38 U.S.C. 7252(a), 7266(a)). View "May v. McDonough" on Justia Law

Plaintiff appealed the district court’s order upholding a decision by the Commissioner of the Social Security Administration denying her disability insurance benefits and supplemental security income. She argued that the Commissioner’s decision was not supported by substantial evidence. Plaintiff contends that the ALJ failed to sufficiently articulate his rationale for rejecting Plaintiff’s treating physician’s opinion, rendering the ALJ’s decision legally erroneous and unsupported by substantial evidence on the record as a whole.   The Eighth Circuit affirmed. The court held that ALJ was justified in finding the physician’s opinion unpersuasive. The opinion’s bare, formulaic conclusion presumptively warranted little evidentiary weight “because it was rendered on a check-box and fill-in-the-blank form.” The physician checked some boxes and left blank the short-answer section asking what objective medical findings supported his assessment. The ALJ also found the checkbox form “unsupported and highly inconsistent” with the record because the physician’s conservative treatment plan, other medical opinions, and Plaintiff’s own descriptions of her activities contradict the checkbox assessment. View "Vickie Nolen v. Kilolo Kijakazi" on Justia Law

Securus Technologies, LLC (Securus), is one of six telecommunications companies providing incarcerated persons calling services (IPCS) in California. In this original proceeding, Securus challenges the decision of the California Public Utilities Commission (PUC) adopting interim rate relief for IPCS in the first phase of a two-phase rulemaking proceeding. Among other things, the PUC’s decision: (1) found IPCS providers operate as locational monopolies within the incarceration facilities they serve and exercise market power; (2) adopted an interim cap on intrastate IPCS rates of $0.07 per minute for all debit, prepaid, and collect calls; and (3) prohibited providers from charging various ancillary fees associated with intrastate and jurisdictionally mixed IPCS.   The Second Appellate District affirmed the PUC’s decision. The court concluded Securus has not shown the PUC erred by finding providers operate locational monopolies and exercise market power. The court held that facts do not—as Securus contends—demonstrate Securus “cannot recover its costs (including a reasonable rate of return)” under the interim rate cap and do not amount to a “clear showing” that a rate of $0.07 per minute “is so unreasonably low” that “it will threaten Securus’s financial integrity.” Thus, Securus has failed to satisfy its “burden of proving . . . prejudicial error” on constitutional grounds. View "Securus Technologies v. Public Utilities Com." on Justia Law

Plaintiff appealed from the 2021 opinion of the district court affirming the final decision of Defendant Kijakazi, as the Acting Commissioner of Social Security, which denied Plaintiff’s claim for disability benefits.   The Fourth Circuit, without resolving the merits, vacated the judgment of the district court and directed a remand to the Commissioner for a new and plenary hearing on Plaintiff’s disability benefits claim, to be conducted before a different and properly appointed administrative law judge (ALJ). The court agreed with Plaintiff’s appellate contention that, pursuant to the Supreme Court’s 2018 decision in Lucia v. SEC, 138 S. Ct. 2044 (2018), the (“ALJ Bright”) who rendered the Commissioner’s final decision did so in contravention of the Constitution’s Appointments Clause.   The court explained that the Supreme Court made clear that if an ALJ makes a ruling absent a proper constitutional appointment, and if the claimant interposes a timely Appointments Clause challenge, the appropriate remedy is for the claim to be reheard before a new decisionmaker. Plaintiff did not receive that remedy. The Appointments Clause violation as to Plaintiff was thus not cured, and the 2019 ALJ Decision was likewise rendered in contravention of that Clause. View "Camille Brooks v. Kilolo Kijakazi" on Justia Law

Plaintiff appealed the district court’s order affirming the Social Security Administration’s (“SSA”) denial of her application for Social Security Disability Insurance (“SSDI”). In her application, she alleged major depressive disorder (“MDD”), anxiety disorder, and attention deficit disorder (“ADHD”). Following a formal hearing, the Administrative Law Judge (“ALJ”) determined that Plaintiff suffered from severe depression with suicidal ideations, anxiety features and ADHD, but he nonetheless denied her claim based on his finding that she could perform other simple, routine jobs and was, therefore, not disabled. Plaintiff contends that the ALJ erred by (1) according to only little weight to the opinion of her long-time treating psychiatrist (“Dr. B”) and (2) disregarding her subjective complaints based on their alleged inconsistency with the objective medical evidence in the record.   The Fourth Circuit reversed and remanded with instructions to grant disability benefits. The court agreed with Plaintiff that the ALJ failed to sufficiently consider the requisite factors and record evidence by extending little weight to Dr. B’s opinion. The ALJ also erred by improperly disregarding Plaintiff’s subjective statements. Finally, the court found that the ALJ’s analysis did not account for the unique nature of the relevant mental health impairments, specifically chronic depression. The court explained that because substantial evidence in the record clearly establishes Plaintiff’s disability, remanding for a rehearing would only “delay justice.” View "Shelley C. v. Commissioner of Social Security Administration" on Justia Law