Justia Public Benefits Opinion Summaries

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

Slaughter served on active duty in the Navy, 1975-1995. In 2008, a VA Regional Office determined that Slaughter, who is righthanded, suffered right ulnar nerve entrapment as a result of his service and awarded a 10% disability rating under 38 C.F.R. 4.124a, Diagnostic Code (DC) 8516. Slaughter pursued a higher rating. VA examiners eventually additionally diagnosed Slaughter with a median nerve injury, not service-connected. In 2018, the Board of Veterans’ Appeals increased Slaughter’s rating for right ulnar nerve entrapment to 40%, finding that it could not distinguish the symptoms of his service-connected ulnar nerve entrapment from those of his non-service-connected median nerve injury and attributing the entirety of the disability to the service-connected injury. The Board determined that it would be inappropriate to rate Slaughter under DC 8512, which provides ratings for injuries to the lower radicular group, because only the ulnar nerve entrapment was service-connected.The Veterans Court and Federal Circuit affirmed. While the Veterans Court placed too heavy a burden on Slaughter to show prejudice, that error was harmless because the Board correctly interpreted section 4.124a. The section provides that “[c]ombined nerve injuries should be rated by reference to the major involvement, or if sufficient in extent, consider radicular group ratings” and refers to service-connected injuries, not to a combination of service-connected and non-service-connected injuries. View "Slaughter v. McDonough" on Justia Law

The 2010 Caregivers and Veterans Omnibus Health Services Act required the VA to establish two programs to help individuals who provide eligible veterans with personal care services. One program provided assistance to family caregivers, 38 U.S.C. 1720G(a); the other provided assistance to general caregivers, section 1720G(b). The VA promulgated implementing regulations, 38 C.F.R. 71 (2015). In 2018, Congress amended the Act.; the VA MISSION Act expanded the class of veterans who qualify as eligible under the family caregivers program. The program now applies to all veterans regardless of their service dates, and there are new avenues for a veteran to qualify as eligible for benefits. The VA overhauled its regulations that attempted to clarify, streamline, and regularize implementation of the Act.Objectors challenged six definitions in 38 C.F.R. 71.15 and a residency requirement imposed in 38 C.F.R. 71.10(b). The Federal Circuit addressed standing; rejected challenges to the definitions of “three or more activities of daily living,” “serious injury,” “inability to perform one or more activities of daily living,” and “monthly stipend rate”; and to the imposition of a geographic residence requirement. View "Veteran Warriors, Inc. v. Secretary of Veterans Affairs." on Justia Law

In 2012, United Healthcare of Mississippi (United) entered into provider agreements with Mississippi’s fourteen Community Mental Health Centers (CMHCs) to provide Medicaid services under the Division of Medicaid’s (DOM’s) managed care program. From 2012 until 2019, United paid the CMHCs an agreed upon amount for Medicaid services - 100 percent of the medicaid fee schedule rates. In July 2019, United unilaterally imposed a 5 percent rate cut, retroactive to January 1, 2019, and later demanded that the CMHCs refund 5 percent of all payments made from July 1, 2018, through December 31, 2018, all of which totaled more than $1 million. The CMCHs demanded that United immediately cease and desist from the 5 percent rate cut and recoupments. When United refused, the CMHCs filed a Complaint for Damages and Injunctive Relief, specifically requesting, inter alia, a preliminary injunction. United responded with a motion to compel arbitration and to stay the proceedings. After a two-day evidentiary hearing, the circuit court denied United’s motion to compel arbitration, granted the CMHCs’ request for injunctive relief, and issued a preliminary injunction. The limited issues presented to the Mississippi Supreme Court were whether the trial court properly enjoined United from imposing a 5 percent rate cut and whether the trial court erred by denying arbitration. After review, the Supreme Court affirmed the trial court’s decision to grant a preliminary injunction and to deny the motion to compel arbitration. View "United Healthcare of Mississippi Inc. et al. v. Mississippi's Community Mental Health Commissions, et al." on Justia Law

In response to economic conditions related to the spread of COVID-19, Congress established several programs that made additional federal funds available to the states for providing enhanced unemployment-compensation benefits to eligible individuals. Alabama elected to participate in the programs, and Shentel Hawkins, Ashlee Lindsey, Jimmie George, and Christina Fox, were among the Alabamians who received the enhanced benefits. As the spread of COVID-19 waned, Governor Kay Ivey announced that Alabama would be ending its participation in the programs. When Alabama did so, the claimants received reduced unemployment-compensation benefits or, depending on their particular circumstances, no benefits at all. Two months later, the claimants sued Governor Ivey and Secretary of the Alabama Department of Labor Fitzgerald Washington in their official capacities, alleging that Alabama law did not permit them to opt Alabama out of the programs. After a circuit court dismissed the claimants' lawsuit based on the doctrine of State immunity, the claimants appealed. Finding no reversible error, the Alabama Supreme Court affirmed the circuit court. View "Hawkins, et al. v. Ivey, et al." on Justia Law

Wolfe, who was enrolled in VA health care, obtained emergency treatment at a non-VA health care facility, incurring expenses of $22,348.25. Her employer-sponsored healthcare contract covered most of the expenses. She was responsible for a copayment of $202.93 and coinsurance of $2,354.41. The VA denied reimbursement of those expenses; 38 U.S.C. 1725(c)(4(D) bars reimbursement for “any copayment or similar payment.” Wolfe filed a Notice of Disagreement; rather than await the outcome of her appeal, Wolfe also filed a mandamus petition. The Veterans Court certified her requested class and granted her petition, invalidating a VA regulation prohibiting the reimbursement of deductibles and coinsurance for being within the category of “similar payments,” and requiring the VA to re-adjudicate claims denied under the invalidated regulation.The Federal Circuit reversed. Deductibles are excluded from reimbursement under the correct interpretation of the statute and other adequate remedies (appeal) were available with respect to coinsurance, so mandamus was inappropriate. Coinsurance is the type of partial coverage that Congress did not wish to exclude from reimbursement. View "Wolfe v. McDonough" on Justia Law

Martinez-Bodon served on active duty in the Army, 1967-1969. In 2016, he sought benefits for diabetes and for anxiety secondary to his diabetes. At his VA psychiatric examination, he reported: “I can’t sleep well, my right eye trembles too much and that bothers me and I get very anxious about it.” He denied having other symptoms. The VA examiner found that these symptoms did not meet the “criteria for a mental condition as per DSM–5” and concluded that she could not establish a relationship between Martinez-Bodon’s diabetes and anxiety.The VA granted him a service connection for diabetes but denied him a service connection for a mental condition. The Board of Veterans’ Appeals affirmed. The Court of Veterans Claims rejected an argument that even without a formal diagnosis, his symptoms constitute a disability for service-connection purposes under Federal Circuit precedent defining “disability.” The Federal Circuit affirmed that 38 C.F.R. 4.125(a) and 4.130, “require a DSM–5 diagnosis as a precondition to compensate mental conditions.” View "Martinez-Bodon v. McDonough" on Justia Law

Poole has a degenerative disc disease of the lumbar spine; it causes severe pain in her lower back and leg after she either stands or sits for a brief time. She lost her job as a cashier because her pain made it impossible for her to stand throughout her full shift. Poole also suffers from a learning disability, anxiety, and depression, all of which impair her ability to concentrate, understand, or remember detailed instructions. Now 46 years old, she has only a “marginal education,” meaning sixth grade or less. Poole sought Supplemental Security Income, 42 U.S.C. 423(d). An ALJ denied her application and dismissed her companion application for disability insurance benefits.The Seventh Circuit reversed, concluding that the ALJ’s decision rested on contradictory findings. . Either Poole can stand for four hours a day and should have been put in the “light” exertional level, or the ALJ correctly found that she belonged in the “sedentary” category and could stand (or walk) at most for two hours a day. The ALJ never said that Poole could perform sedentary work if she could sit or stand at will, so the vocational expert never focused on that potential set of jobs. When an agency decision is so ambiguous that it frustrates judicial review, it cannot be upheld. View "Poole v. Kijakazi" on Justia Law

The Eighth Circuit affirmed the district court's order upholding the Commissioner's denial of social security disability insurance benefits (DIB). The court concluded that substantial evidence supported the determination that plaintiff's impairments did not meet or medically equal Listing 11.09B or 12.02. In this case, plaintiff's mental impairment did not cause at least two marked limitations or one extreme limitation, as required by the paragraph B criteria for Listing 12.02. Furthermore, although plaintiff's medical records revealed several minor deficiencies, such as a subtle tremor in her left hand and mild executive dysfunction, those records did not indicate a marked limitation in physical functioning and one of the four areas of mental functioning as required by Listing 11.09B. View "Schmitt v. Kijakazi" on Justia Law