Justia Public Benefits Opinion Summaries

Breland served in the Army in Vietnam, 1965-1968, and was exposed to Agent Orange. In 2006, Breland was diagnosed with carcinoma of the tongue; he completed his treatments in January 2007. The VA Regional Office denied Breland’s claim for service connection. A January 2008 biopsy revealed the recurrence of Breland’s tongue cancer. He underwent surgery. Breland filed a Notice of Disagreement. In 2010, a VA examiner note Breland’s complaint of continuing dry mouth, found no recurrence of Breland’s cancer, and concluded that the condition was “less likely related” to herbicide exposure. Breland’s claim was again denied.In 2015, Breland submitted a medical opinion tying his tongue cancer to Agent Orange exposure and retroactively granted service connection, with a 100% rating for December 2006-August 2007, and a non-compensable rating, based on Breland’s inactive disease. Following a September 2017 VA examination, the Regional Office granted service connection for certain residual conditions and determined that a 100% rating for Breland’s tongue cancer was warranted retroactively for an additional eight-month period. The Board of Veterans’ Appeals and Federal Circuit upheld those determinations. Diagnostic Code 7343 does not require the VA to continue a 100% disability rating until it performs a “mandatory VA examination” six months following treatment when the disability rating is assigned retroactively after the six-month period has passed. Breland has been and is fairly compensated based on the actual state of his health. View "Breland v. McDonough" on Justia Law

The Medi-Cal program, California’s enactment of the federal Medicaid program, was administered by the California Department of Health Care Services (the department) administers the Medi-Cal program. In this case, the department sought reimbursement from a revocable inter vivos trust for the Medi-Cal benefits provided on behalf of Joseph Snukst during his lifetime. Following his death, the probate court ordered the assets in the revocable inter vivos trust to be distributed to the sole beneficiary, Shawna Snukst, rather than to the department. The Court of Appeal concluded federal and state law governing revocable inter vivos trusts, as well as public policy, required that the department be reimbursed from the trust before any distribution to its beneficiary. Judgment was therefore reversed and remanded. View "Riverside County Public Guardian v. Snukst" on Justia Law

The Eighth Circuit affirmed the denial of supplemental security income benefits to claimant, concluding that substantial evidence supported the ALJ's determination that claimant was capable of performing certain work available in the national economy. In this case, the ALJ provided good reasons for giving little weight to claimant's testimony regarding his limitations and to his treating physician's opinion on the subject. Furthermore, perhaps the most persuasive medical reason the ALJ offered in support of his finding as to claimant's residual functional capacity is the relatively conservative course of treatment that he undertook to deal with the pain. Finally, the ALJ did not accept the consulting physician's opinion in its entirety. View "Pierce v. Kijakazi" on Justia Law

B.W., a two-year-old in good health, experienced immune thrombocytopenic purpura after receiving his measles, mumps, and rubella vaccine. Later blood tests showed his condition had resolved. More than six months after he was first diagnosed, B.W. presented with bruising, a possible symptom of immune thrombocytopenic purpura, but blood tests showed the condition had not recurred. In a suit under the National Childhood Vaccine Injury Act of 1986, the Claims Court ruled in favor of B.W., holding that those blood tests, occurring more than six months after his initial diagnosis, were “residual effects” of B.W.’s vaccine injury that satisfied the severity requirement of 42 U.S.C. 300aa-11(c)(1)(D).The Federal Circuit reversed. A residual effect must be a change within the patient that is caused by the vaccine injury. B.W.’s later bruising was not caused by his vaccine injury, and his tests did not reveal, constitute, or cause any somatic change. Tests revealed B.W. had no lingering symptoms or recurrence of thrombocytopenic purpura. There was no argument that the testing itself was detrimental to B.W.’s health such that it might qualify under section 300aa-11(c)(1)(D)(i) as a “residual effect” or a “complication” of thrombocytopenic purpura. View "Wright v. Secretary of Health and Human Services" on Justia Law

Wilder, born in 1970, has a high school education. She previously worked as a motor vehicle quality worker and a sales clerk. She has not worked since October 2015. Wilder applied for Social Security disability benefits in 2016, alleging a disability onset date in October 2015. She alleged hip pain, difficulty walking, lower back pain, and balance issues. Her claim was administratively denied. An ALJ concluded that Wilder’s impairments, while severe, did not meet or equal one of the impairments listed in 20 C.F.R. Part 404, Subpart P, App’x 1, that Wilder had the residual functional capacity to perform sedentary work with limitations, and that suitable jobs existed in significant numbers in the national economy. The Appeals Council denied Wilder’s request for review.The district court and Seventh Circuit held that substantial evidence supported the ALJ’s decision. The court rejected Wilder’s arguments that the ALJ erred by failing to consider whether she met or equaled Listing 11.17(a), even though her attorney did not argue to the ALJ that she met or equaled that Listing (or any Listing) and by failing to request the opinion of a medical expert, and that the ALJ’s evaluation of her subjective symptoms was patently wrong. View "Wilder v. Kijakazi" on Justia Law

D&G, a Medicare service provider for nursing homes and homebound individuals, filed suit against the H.H.S. Secretary in federal court seeking repayment of recouped funds, which then amounted to $4,136,258.19 in principal and $593,294.54 in accrued interest. The district court dismissed D&G's case for lack of subject matter jurisdiction, holding that there was no federal court jurisdiction pursuant to 42 U.S.C. 405(g), as applied to Medicare appeals by 42 U.S.C. 1395ff(b)(1)(A).The Fifth Circuit held that "effectuations" of final agency decisions when sought to liquidate the amount of repayment owed, are reviewable under 42 U.S.C. 405(g) as continuous aspects of the initial, properly exhausted, administrative decision. The court concluded that the district court had jurisdiction under section 405(g) to resolve this dispute because "effectuations" are inextricably intertwined with the initial exhausted agency action. Therefore, the district court committed reversible error when it granted the Secretary' motion to dismiss. Furthermore, the Secretary's attempted reopening of the "effectuation" was untimely and the purported reopening was void ab initio. The court reversed and remanded for further proceedings. View "D&G Holdings, LLC v. Becerra" on Justia Law

Colgan, a teacher at a special education high school, attempted to break up a fight between students but either fell or was pushed into a wall, leading to serious injuries. Colgan’s injuries and symptoms persisted despite treatment from several medical sources. Her treating physician, Dr. Ward, a concussion specialist, found that Colgan satisfied the medical criteria for mild traumatic brain injury and post-concussion syndrome with persistent cognitive defects and fatigue, chronic post-traumatic headaches, sleep disturbance, and dizziness; Colgan's debilitating headaches severely hampered her ability to carry out activities of daily living and basic job-related functions.Colgan successfully applied for workers’ compensation benefits. In 2016, Colgan sought social security disability insurance benefits. An ALJ denied Colgan’s claim, concluding that she had the residual functional capacity (RFC) to perform sedentary work, subject to physical and cognitive limitations (42 U.S.C. 423(d)(1)(A)). The district court affirmed. The Second Circuit vacated. The ALJ’s factual determination with respect to Colgan’s RFC was not supported by substantial evidence. The ALJ misapplied the treating physician rule to Dr. Ward’s “check-box” medical opinion, which was supported by voluminous treatment notes gathered over almost three years of clinical treatment View "Colgan v. Kijakazi" on Justia Law

The Ninth Circuit affirmed the district court's grant of summary judgment in favor of the SSA in a putative class action alleging that reducing the Social Security benefits of class members based on the receipt of a foreign social security pension violated the Windfall Elimination Program (WEP), its implementing regulation, and the Agreement Between the Government of the United States of America and the Government of Canada with Respect to Social Security.The panel concluded that the WEP applies to a Social Security beneficiary who receives benefits under the Canada Pension Plan. Therefore, the SSA and the district court properly interpreted the WEP and the U.S.-Canada Agreement. In this case, Plaintiff Rosell's Canadian pension was based at least in part on his earnings for noncovered service, and thus the agency correctly reduced the couple's Social Security benefits. View "Michener v. Kijakazi" on Justia Law

The Ninth Circuit affirmed the district court's judgment affirming in part and reversing in part an ALJ's decision in favor of student B.W. The panel held that goals (as opposed to services) in B.W.'s first grade Individualized Education Program (IEP) were not inadequate; Capistrano did not have to file for due process to defend the first grade IEP; and Capistrano did not have to have an IEP in place for the second grade. The panel remanded for the limited purpose of considering attorneys' fees. The panel addressed other issues in a concurrently filed memorandum disposition. View "Capistrano Unified School District v. S.W." on Justia Law

The Fourth Circuit affirmed the district court's dismissal of an action brought by plaintiff, alleging that the school district had violated her daughters' rights under the Individuals with Disabilities Education Act (IDEA). The court held that plaintiff's withdrawal of the children from the school district system rendered moot her request for prospective relief. Furthermore, because the district court proceedings under the IDEA are original civil actions, the court held that plaintiff's failure to specify in her complaint that she was seeking compensatory education for her children, or to include allegations from which a request for compensatory education reasonably could be inferred, precludes her present assertion of a live controversy in the district court. View "Johnson v. Charlotte-Mecklenburg Schools Board of Education" on Justia Law