Justia Public Benefits Opinion Summaries

The Eighth Circuit affirmed the district court's order affirming the Social Security Administration's denial of plaintiff's claim for disability benefits. Plaintiff filed a claim for a period of disability, disability insurance benefits, and supplemental security income based on her diagnoses of mood disorders, lupus, and fibromyalgia, among other ailments.The court concluded that substantial evidence in the record supported the ALJ's denial of plaintiff's claim for benefits. In this case, the ALJ did not err by relying exclusively on the lack of objective evidence supporting plaintiff's fibromyalgia diagnosis to deny benefits. Rather, the ALJ noted that objective findings did not support her subjective allegations of disabling symptoms. Likewise, the court rejected plaintiff's claims that the ALJ erred in disregarding evidence of her moderate-severe musculoskeletal pain and widespread arthralgia, as well as the multidimensional health assessment questionnaire indicating that she had difficulty performing daily tasks. The court explained that there was substantial evidence in the record for the ALJ to focus on the "normal" reports and findings by plaintiff's treating physicians. Even if the ALJ made some misstatements in his order, the errors were harmless.The court also concluded that the district court did not err in failing to develop the record to clarify the number of tender points where any inconsistences were harmless error. The court further concluded that the ALJ's credibility determination and weight assigned to the testimony was supported by undisputed facts that plaintiff suffered from addiction, smoked, and failed to follow her treatment advice. Finally, the ALJ properly considered plaintiff's allegations of pain and properly weighed the decisions of her treating physicians and state agency consultant's opinions. View "Grindley v. Kijakazi" on Justia Law

The Eleventh Circuit granted the petition for panel rehearing, withdrew its prior opinion, and issued the following opinion.The court concluded that the ALJ gave little or no weight to three pieces of evidence in the record indicating that plaintiff's mental illness prevents him from maintaining a job: (1) the opinions of plaintiff's treating psychiatrist, (2) the opinions of a consulting psychologist who examined plaintiff at the request of the SSA, and (3) plaintiff's own testimony as to the severity of his symptoms. In this case, the ALJ did not articulate adequate reasons for discounting this evidence, which provided support for a finding of disability. Accordingly, the court reversed and remanded to the agency for further proceedings. View "Simon v. Commissioner, Social Security Administration" on Justia Law

In 1982, while serving in the Air Force in Germany, Jones was struck in the eye by the door of an armored personnel carrier. He developed intense headaches; it became increasingly difficult for Jones to perform his duties. A 1988 Clinical Resume reflects that Jones had developed “intermittent right cranial nerve 4th palsy associated with chronic right retro-orbital stabbing pain, usually occurring during the late afternoon or night.” Jones described "a nearly constant headache which was relieved only with repetitive doses of intramuscular Demoral.” A Physical Evaluation Board recommended that Jones be discharged with severance pay based on a 10% disability rating for “Post-traumatic pain syndrome manifest[ing] as headaches.”Jones was honorably discharged with severance pay. In 1989, his discharge was amended to reflect that his injury was combat-related. Effective in 2017, the VA awarded Jones a 100% disability rating. Jones petitioned the Air Force Board for Correction of Military Records for changes to his record that would entitle him to a disability retirement dating back to 1988, when he was discharged, 10 U.S.C. 1201. The Board denied Jones’s petition. The Federal Circuit affirmed the Claims Court: the claim for disability retirement pay and benefits was a claim under a money-mandating statute, as required by the Tucker Act, 28 U.S.C. 1491(a)(1), but jurisdiction was lacking because the claim was barred by the six-year statute of limitations, 28 U.S.C. 2501. View "Jones v. United States" on Justia Law

The Montgomery County Council established the Emergency Assistance Relief Payment Program (EARP) in March 2020 to provide emergency cash assistance to County residents with incomes equal to or less than 50% of the federal poverty benchmark who were not eligible for federal or state pandemic relief. Although eligibility for EARP aid is not dependent on a person’s status as an undocumented immigrant, such individuals are eligible to receive EARP payments. To fund EARP, the County appropriated $10,000,000 from reserve funds to the County’s Department of Health and Human Services. Taxpayers filed suit in Maryland state court, asserting that EARP violated 8 U.S.C. 1621(a), which, with few exceptions, generally prohibits undocumented persons from receiving state and local benefits. Recognizing that Section 1621 does not authorize private enforcement, the plaintiffs cited the Maryland common law doctrine of taxpayer standing, which “permits taxpayers to seek the aid of courts, exercising equity powers, to enjoin illegal and ultra vires acts of [Maryland] public officials where those acts are reasonably likely to result in pecuniary loss to the taxpayer.” The case was removed to federal court based on federal question jurisdiction, 28 U.S.C. 1331. The court granted the County summary judgment. The Fourth Circuit affirmed. Congress has declined to authorize private parties to enforce Section 1621, a legislative decision that cannot be circumvented by invocation of a state’s law of taxpayer standing. View "Bauer v. Elrich" on Justia Law

In 2008, four long-term care hospitals that treat patients who are dually eligible for the Medicare and Medicaid programs were denied reimbursement by the Secretary of Health and Human Services for “bad debts,” unpaid coinsurances and deductibles owed by patients. The Secretary denied reimbursement on the grounds that the hospitals failed to comply with the “must-bill” policy, 42 C.F.R. 413.89(e)(2), which requires hospitals to bill the state Medicaid program to determine whether Medicaid will cover the bad debts first, and obtain a “remittance advice” indicating whether the state “refuses payment,” before seeking reimbursement under Medicare. uring the relevant time period, the hospitals were not enrolled in Medicaid and were unable to bill their state Medicaid programs; they claim they were previously reimbursed and that there was an abrupt policy change.The D.C. Circuit affirmed summary judgment for the Secretary, concluding that substantial evidence supported a finding that there was no change in policy. The court rejected arguments that the denial decision impermissibly required them to enroll in Medicaid, despite the fact that Medicaid participation is voluntary, and was arbitrary. View "New LifeCare Hospitals of North Carolina LLC v. Becerra" on Justia Law

Buffington served on active duty in the Air Force, 1992-2000. After leaving active duty service, Buffington sought disability benefits. The VA found that Buffington suffered from service-connected tinnitus, rated his disability at 10 percent, and awarded him disability compensation. In 2003, Buffington was recalled to active duty in the Air National Guard. He informed the VA of his return to active service, and the VA discontinued his disability compensation, 38 U.S.C. 5112(b)(3), 5304(c). In 2004, Buffington completed his active service in July 2005. Buffington did not seek to recommence his disability benefits until January 2009. The VA determined Buffington was entitled to compensation effective on February 1, 2008—one year before he sought recommencement; 38 C.F.R. 3.654(b)(2) sets the effective date for recommencement of compensation, at the earliest, one year before filing. Buffington challenged the effective-date determination.The VA Regional Office rejected his challenge, providing further reasoning for the February 2008 effective date. The Board of Veterans Appeals affirmed. The Veterans Court held that section 3.654(b)(2) was a valid exercise of the Secretary of Veterans Affairs rulemaking authority and was not inconsistent with 38 U.S.C. 5304(c). The Federal Circuit affirmed. Section 3.654(b)(2) reasonably fills a statutory gap. View "Buffington v. McDonough" on Justia Law

This appeal arose from a district court order affirming the North Dakota Department of Human Services’ determination that Harold Ring was ineligible for Medicaid. In Ring v. North Dakota Department of Human Services, 2020 ND 217, 950 N.W.2d 142 (“Ring I”), the North Dakota Supreme Court remanded the case for the district court to determine whether a party should be substituted due to Ring’s death, which occurred before the court entered its order. On remand, the district court found substitution of a party was unwarranted and entered an order dismissing the case. The North Dakota Supreme Court affirmed the dismissal order. View "Ring v. NDDHS" on Justia Law

North Dakota Workforce Safety and Insurance (“WSI”) appealed a district court judgment reversing an administrative order sustaining a WSI order denying Bruce Bahmiller’s claim for workers’ compensation benefits. After review, the North Dakota Supreme Court affirmed the district court judgment, concluding the administrative law judge’s (“ALJ”) finding that Bahmiller failed to file a timely claim for benefits within one year of his work injury was not supported by the weight of the evidence. View "Bahmiller v. WSI, et. al." on Justia Law

The Eleventh Circuit vacated its prior opinion and substituted the following opinion.The court affirmed the district court's decision affirming the agency's finding that plaintiff was ineligible for disability insurance benefits. The court held that there is no apparent conflict between one's limitation to following simple instructions and positions that require the ability to follow "detailed but uninvolved" instructions. The court concluded that the agency's decision was otherwise supported by substantial evidence. View "Buckwalter v. Acting Commissioner of Social Security" on Justia Law

Plaintiff Family Health Centers of San Diego operated a federally qualified health center (FQHC) that provided various medical services to its patients, some of whom are Medi-Cal beneficiaries. Section 330 of the Public Health Service Act authorized grants to be made to FQHC’s. In addition, FQHC’s could seek reimbursement under Medi-Cal for certain expenses, including reasonable costs directly or indirectly related to patient care. Plaintiff appealed a trial court’s order denying its petition for writ of mandate seeking to compel the State Department of Health Care Services (DHCS) to reimburse plaintiff for money it expended for outreach services. The Court of Appeal rejected plaintiff’s contention that the trial court and the DHCS improperly construed and applied applicable guidelines in the Centers for Medicare & Medicaid Services Publication 15-1, The Provider Reimbursement Manual (PRM). The Court concluded that the monies spent by plaintiff were not an allowable cost because they were akin to advertising to increase patient utilization of plaintiff’s services. View "Family Health Centers of S.D. v. State Dept. of Health Care Services" on Justia Law