Justia Public Benefits Opinion Summaries

In 2009, six-month-old Trystan received vaccines, including DTaP-HepB-IPV. Hours later, Trystan developed a fever and was in pain; he developed a hot lump on his thigh. Trystan’s mother took him to urgent care, where he was diagnosed with a “common cold.” Trystan’s arm contortions continued. At his one-year exam, Trystan could not stand, crawl, grasp, hold his head up while sitting, or attempt to move his lower extremities. Trystan received additional vaccinations. His arm contortions returned. Trystan had muscle spasms, developmental delays, seizures, dystonia, and other neurologic issues. In 2014, Trystan was diagnosed with Leigh’s syndrome, a severe neurological disorder that often presents in the first year of life, is characterized by progressive loss of mental and movement abilities, and typically results in death. Genetic testing showed that Trystan has two associated disease-causing mutations.His parents sought compensation under the Vaccine Act, 42 U.S.C. 300aa–1. The Claims Court upheld determinations that Trystan did not experience neurologic deterioration until many weeks after his 2009 vaccination and that Trystan’s genetic mutations solely caused his Leigh’s syndrome. The Federal Circuit reversed. Because the contortions began within two weeks of his vaccinations, Trystan has shown a logical chain of cause and effect between his vaccination and his neurodegeneration, satisfying his burden. He is entitled to compensation unless the Secretary establishes the injury was due to factors unrelated to the vaccine. There is no evidence that Trystan’s mutations would have resulted in the same progression and severity of his Leigh’s syndrome absent the vaccine. View "T.S. v. Secretary of Health & Human Services" on Justia Law

Albert suffers from epilepsy, Asperger syndrome, ADHD, migraines, and insomnia. Born in 1998, Albert’s parents support her financially, help manage her medications, and assist her with daily living. Albert has never had a driver’s license nor worked. Albert graduated from high school in 2017. Although she struggled in math, her academic performance was otherwise average. She enrolled in an online college course but stopped attending after suffering a grand mal seizure in September 2017. She applied for supplemental security income.The ALJ determined that, although Albert suffered from severe mental and physical impairments, these impairments, taken alone or together, did not amount to a “listed disability"; Albert had the residual functional capacity to perform a full range of work at all exertional levels, subject to a few restrictions; Albert “was likely to have difficulty with social interactions” and had poor concentration and a low frustration tolerance; that Albert can “understand, carry out and remember simple instructions” and “make judgments commensurate with functions of simple, repetitive tasks”; and that there are a significant number of jobs that someone with Albert’s RFC could perform.The district court and Seventh Circuit affirmed the denial of benefit, finding substantial evidence supporting the ALJ’s determination. “Should Albert try to work but find herself unable, nothing will prevent her from applying anew for benefits.” View "Albert v. Kijakazi" on Justia Law

Groves served in the Army on active duty, 1970-1971, including service in Vietnam. In 1990, a VA regional office awarded Groves benefits for PTSD, shell fragment wounds, and a nerve injury. In 1998, Groves sought education benefits through the Vocational Rehabilitation and Employment (VRE) program. Groves never attended the initial VRE evaluation—due at least in part to the isolated nature of his town and his asserted inability to travel—notwithstanding the VA counseling officer’s attempts to accommodate Groves over a period of years. During the ensuing proceedings, Groves twice sent the VA letters in which he stated that he “enjoin[ed]” further action on the claims.“The Board of Appeals ultimately denied Groves entitlement to VRE benefits, finding that his letters did “not constitute[] withdrawal[s] of the appeal, such that there [was] no basis for the Board to not proceed.” The Veterans Court affirmed, finding that the Board lacked authority to adjudicate Groves’s appeal under “Hamilton,” which required an automatic stay when requested by a veteran but that any error was harmless. The Federal Circuit vacated. The Veterans Court legally erred in finding that the Board was compelled to grant an automatic indefinite stay of proceedings; it should have determined whether Groves had established good cause for a stay and, if so, the appropriate duration and conditions of the stay. View "Groves v. McDonough" on Justia Law

On active Army duty in the 1970s, Kennedy fell from a lawnmower and injured his knee. Although no disability was noted at his discharge, Kennedy received service connection for his knee injury in 2000. He later received service connection for depression secondary to his knee injury. In 2005, Kennedy died; his death certificate listed “melanoma, metastatic” as the immediate cause of death and listed “other significant conditions contributing to death,” including diabetes, hypertension, and “depression disorder.” Mrs. Kennedy three times unsuccessfully sought Dependency and Indemnity Compensation (DIC), 38 C.F.R. 3.114. The VA found no evidence that Kennedy’s death was related to military service.In 2013, VA “Fast Letter 13-04, “Simplified Processing of Dependency and Indemnity Compensation (DIC) Claims,” instructed personnel to grant “service connection for the cause of death when the death certificate shows that the service-connected disability is [a] . . . contributory cause of death.” In 2015, the VA granted Mrs. Kennedy DIC, effective July, 2015. The Board of Appeals denied her appeal of the effective date, explaining that Fast Letter 13-04 was a “change[] to VA procedural manuals and guidance provisions,” not a liberalizing law or liberalizing VA issue. The Veterans Court affirmed, reasoning that Fast Letter 13-04 does not constitute a VA issue approved by the Secretary because it does not bind the Agency. The Federal Circuit affirmed. Kennedy forfeited her argument that the Veterans Court erred in its interpretation of “VA issue.” View "Kennedy v. McDonough" on Justia Law

Plaintiff, who receives two government pensions, one from noncovered employment and one from covered employment, alleged that the Government Pension Offset (“GPO”) should not apply to his benefits. During Plaintiff’s administrative proceedings, the Social Security Administration (“SSA” or the “agency”) agreed with Plaintiff and paid him spousal benefits without applying any offset. Ultimately, though, the agency decided that the GPO should apply. The agency then temporarily withheld Plaintiff’s spousal benefits to recoup approximately $15,000 in overpayments to him, and it reduced his spousal benefits going forward. On appeal, the parties disputed whether the GPO applies to Plaintiff’s spousal benefits and if it does apply, whether the agency was entitled to recoup the overpayment.   The Ninth Circuit held that the GPO applies to Plaintiff’s spousal benefits but that a remand to the agency is necessary to determine whether SSA was entitled to recoupment. The court reasoned that under both the old and new version of Social Security regulation 20 C.F.R. Sec 404.408a, the existence of Plaintiff’s pension earned through noncovered employment triggered the GPO’s application to his spousal benefits notwithstanding his later covered employment in a job with a different pension plan.  Further, the court held that the ALJ’s finding of Plaintiff’s fault for the overpayment was not supported by substantial evidence and that on remand the agency could consider whether any evidence in the record beyond that relied on by the ALJ supported the proposition that Plaintiff was at fault for the overpayment and, if so, whether recoupment would be appropriate. View "PAUL MISKEY V. KILOLO KIJAKAZI" on Justia Law

In July 2019, the Appeals Council denied Claimant’s appeal without elaboration. Claimant challenged, among other rulings, the ALJ’s analysis of her testimony. Claimant did not assert any constitutional challenges to the district court. The district court entered a judgment reversing the ALJ’s denial of benefits and remanded the matter to the agency for further proceedings. The Commissioner filed a motion pursuant to Federal Rule of Civil Procedure 59(e) to amend or alter the judgment, arguing that the court had clearly erred by overlooking the ALJ’s explanation for rejecting Claimant’s testimony. The district court agreed with the Commissioner and entered an order granting the Rule 59(e) motion   The Ninth Circuit affirmed the amended judgment in favor of the Commissioner.  The court upheld the Commissioner’s decision denying her application for benefits because claimant did not show that the removal provision caused her any actual harm. Further, Federal Rule of Civil Procedure 59(e) allows a district court to alter or amend a judgment if the court determines that its original judgment was clearly erroneous. Because the district court properly concluded that it had clearly erred in its original ruling in favor of Claimant, the court’s granting of the Commissioner’s Rule 59(e) motion fell within the court’s considerable discretion View "JODY KAUFMANN V. KILOLO KIJAKAZI" on Justia Law

Plaintiff sought benefits under the Social Security Act based on various physical and mental impairments. An administrative law judge (“ALJ”) found that she was not disabled and denied her claim. The district court affirmed.The Ninth Circuit affirmed the district court’s decision affirming the Commissioner of Social Security’s denial of claimant’s application for benefits under the Social Security Act based on various physical and mental impairments.The court decided that recent changes to the Social Security Administration’s regulations displaced case law requiring an administrative law judge (“ALJ”) to provide “specific and legitimate” reasons for rejecting an examining doctor’s opinion. The “relationship factors”, such as length and purpose of the treatment relationship, frequency of visits, and extent of examinations the medical source has performed are still relevant. However, the ALJ no longer needs to make specific findings regarding those factors. Under the new regulations, an ALJ cannot reject an examining or treating doctor’s opinion without providing an explanation supported by substantial evidence.In this case, the ALJ acknowledged the doctor’s opinion that the claimant had marked and extreme limitations in various cognitive areas; but the ALJ found this opinion unpersuasive because it was inconsistent with the overall notes in the record. The court held that substantial evidence supported the ALJ’s finding. View "LESLIE WOODS V. KILOLO KIJAKAZI" on Justia Law

The Department of Human Services for Arapahoe County (“the Department”) sued Monica Velarde and Michael Moore to enforce a final order it had issued against them to recover Medicaid overpayments. But the Department did so only after undertaking extensive efforts on its own to recoup the fraudulently obtained benefits. The district court dismissed the Department’s suit, finding that section 24-4-106(4), C.R.S. (2021), which was part of the State Administrative Procedure Act (“APA”), required an agency seeking judicial enforcement of one of its final orders to do so within thirty-five days of the order’s effective date. The Colorado Supreme Court determined district court and the court of appeals incorrectly relied on an inapplicable statutory deadline in ruling that the complaint was untimely filed. Each court was called upon to determine whether a thirty-five-day deadline governing proceedings initiated by an adversely affected or aggrieved person seeking judicial review of an agency’s action also applied to proceedings initiated by an agency seeking judicial enforcement of one of its final orders. Both courts answered yes. The Supreme Court, however, answered no. Judgment was reversed and the case remanded for further proceedings. View "Arapahoe County v. Velarde & Moore" on Justia Law

Plaintiff filed a claim for Social Security benefits. In support of her disability claims, she presented the opinions of two of her treating physicians. After a hearing, an ALJ assigned partial weight to the treating physicians’ opinions, ultimately concluding that the plaintiff was not disabled. Congress has authorized federal courts to engage in a limited review of final SSA disability benefit decisions.Plaintiff argued that the ALF’s residual functional capacity (“RFC”) finding was not supported by substantial evidence. The court reasoned that in this instance, the ALJ had complete records such as medical opinions, treatment notes, and relevant test results. The court found that the plaintiff failed to identify any missing medical records, and therefore the ALJ did not err in failing to supplement the administrative record. Similarly, the ALJ found notable inconsistencies between the plaintiff's treating doctors' conclusions and the longitudinal records of the plaintiff’s physical health.Thus, the court concluded that substantial evidence supports the ALJ’s ultimate RFC determination. Finally, although the ALJ committed procedural error by failing to explicitly apply each of the factors listed in 20 C.F.R. Sec. 404.1527(c), the error was harmless because substantial evidence supported the ALJ's determinations. View "Schillo v. Saul" on Justia Law

The Supreme Court reversed the judgment of the trial court denying ResCare Health Service's request for a declaratory judgment, holding that ResCare sufficiently pleaded its declaratory judgment request.ResCare, which operates intermediate care facilities in Indiana for individuals with intellectual disabilities, petitioned for administrative reconsideration after an auditor with the Indiana Family & Social Services Administration’s Office of Medicaid Policy and Planning (FSSA) adjusted cost reports to prevent ResCare from recovering costs for over-the-counter medicines under Medicaid. An ALJ granted summary judgment for ResCare. The trial court affirmed the agency's final decision. The Supreme Court reversed, holding (1) ResCare did not need to file a separate complaint for a declaratory judgment; (2) ResCare sufficiently pleaded its declaratory judgment claim; and (3) ResCare's patients did not have to be joined to the litigation before the declaratory judgment request could be considered. View "ResCare Health Services Inc. v. Indiana Family & Social Services Administration" on Justia Law