Justia Public Benefits Opinion Summaries

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

The 2017 Veterans Appeals Improvement and Modernization Act (AMA) reforms the VA's administrative appeals system, 131 Stat. 1105, replacing the existing system, which had shepherded all denials of veteran disability claims through a one-size-fits-all appeals process. Under the AMA, claimants may choose between three procedural options: filing a supplemental claim based on additional evidence, requesting higher-level review within the VA based on the same evidentiary record, and filing a notice of disagreement to directly appeal to the Board of Veterans Appeals. The VA promulgated regulations to implement the AMA. Veterans’ service organizations, a law firm, and an individual (Petitioners) filed separate petitions raising 13 rulemaking challenges to these regulations under 38 U.S.C. 502.1The Federal Circuit concluded that two veterans’ service organizations had associational standing based on claimed injuries to their members to collectively bring three of their challenges. No Petitioner demonstrated standing to raise any of the remaining challenges. The regulations the organizations have standing to challenge are invalid for contravening the unambiguous meaning of their governing statutory provisions: 38 C.F.R. 14.636(c)(1)(i), limiting when a veteran’s representative may charge fees for work on supplemental claims; 38 C.F.R. 3.2500(b) barring the filing of a supplemental claim when adjudication of that claim is pending before a federal court; and 38 C.F.R. 3.155 excluding supplemental claims from the intent-to-file framework. View "Military-Veterans Advocacy v. Secretary of Veterans Affairs" on Justia Law

Ortiz served during the Vietnam era, a “period of war,” under 38 U.S.C. 1110, which provides for compensation for service-connected disabilities. The VA denied Ortiz’s 1997 claim for disability benefits based on PTSD, finding Ortiz did not provide corroborating evidence, as required by the PTSD regulation. The VA reopened and granted the claim in 2012, pursuant to the 2010 addition of 38 C.F.R. 3.304(f)(3), an exception to the corroborating evidence requirement. The VA rated Ortiz 100 percent disabled and made the benefits effective as of May 2012, when it received the request to reopen. Ortiz contended that the effective date should have been one year earlier; 38 C.F.R. 3.114(a), provides that when compensation “is awarded or increased pursuant to a liberalizing law, or a liberalizing VA issue approved by the Secretary” and the “claim [for compensation] is reviewed at the request of the claimant more than 1 year after the effective date of the law or VA issue,” the effective date is “1 year prior to the date of receipt of such request.”The Board of Veterans’ Appeals and the Veterans Court rejected his request for an earlier effective date. The Federal Circuit reversed. The regulatory change that enabled Ortiz to obtain the benefits was a “liberalizing” one, entitling Ortiz to the earlier effective date, and a larger award. View "Ortiz v. McDonough" on Justia Law

The Supreme Judicial Court affirmed the judgment of the superior court reversing the determination of the Massachusetts Office of Medicaid's board of hearings that Plaintiff's home was a countable asset, making her ineligible for Medicaid long-term care benefits, holding that the superior court did not err.While they were both still living, Plaintiff and her husband created an irrevocable trust, the corpus of which included their home. The terms of the trust granted Plaintiff, during her lifetime, a limited power of appointment to appoint all or any portion of the trust principal to a nonprofit or charitable organization over which she had no controlling interest. MassHealth denied Plaintiff's application for long-term care benefits, determining that the home was a countable asset because Plaintiff purportedly could use her limited power of appointment to appoint portions of the home's equity, which was included as part of the trust principal, to the nursing home where Plaintiff lived as payment for her care. The superior court reversed. The Supreme Judicial Court reversed, holding that the plain terms of the trust neither intended for nor permitted Plaintiff to exercise her limited power of appointment for her benefit, as contemplated by MassHealth. View "Fournier v. Secretary of Executive Office of Health & Human Services" on Justia Law

Saunders worked as a bus attendant for the Washington, D.C., school system, helping students with special needs and those in wheelchairs on and off the bus. On January 7, 2014, she slipped and fell on ice at work, suffering a hip contusion and back pain. Saunders never returned to work but filed a disability claim with the Social Security Administration six months after her fall. She obtained multiple opinions from Dr. Williams, her generalist, and Dr. Liberman, her neurologist. Saunders received disability benefits from the Washington, D.C., workers’ compensation board.After Saunders’s federal disability claims were denied an ALJ held a hearing and concluded that she was not disabled. The ALJ gave “some” weight to certain medical opinions but “no weight” to others, including Dr. Lieberman’s opinion that Saunders was permanently disabled. The ALJ placed considerable weight on the vocational expert’s testimony and found that someone with Saunders’s functional capacity could perform her past work as generally performed in the national economy. The district court affirmed. The D.C. Circuit remanded. The ALJ erroneously failed to consider certain medical opinions, particularly those of Saunders’s treating physician. View "Saunders v. Kijakazi" on Justia Law

The Supreme Court affirmed in part and vacated in part the judgment of the circuit court rejecting Plaintiffs' claims challenging the refusal by the Department of Social Services (DSS) to provide MO HealthNet coverage, holding that the circuit court erred in declaring Mo. Const. art. IV, 36(c) constitutionally invalid.Plaintiffs, three Missourians eligible for MO HealthNet coverage under article IV, section 36(c), brought this action challenging the DSS's refusal to provide coverage on the grounds that the General Assembly failed to appropriate adequate funding. The circuit court rejected the claims, finding that the ballot initiative that enacted article IV, section 36(c) violated Mo. Const. art. III, 51, which prohibits initiatives from appropriating money without creating revenue to fund the initiative. The Supreme Court affirmed in part and vacated in part the circuit court's judgment, holding (1) article IV, section 36(c) does not appropriate money and does not remove the General Assembly's discretion in appropriating money to MO HealthNet; and (2) therefore, the circuit court erred in concluding that article IV, section 36(c) violates article III, section 51. View "Doyle v. Tidball" on Justia Law