Justia Public Benefits Opinion Summaries

The Seventh Circuit affirmed the ALJ's determination that plaintiff has the capacity to perform light work and is therefore not entitled to disability benefits. Plaintiff claimed that the ALJ committed reversible error when determining her residual functional capacity (RFC) by selectively reviewing evidence of cervical and lumbar degenerative disc disease (back problems); incorrectly discounting plaintiff's credibility regarding her description of the intensity, persistence, and limiting effects of her symptoms; and not including any manipulative limitations in the RFC assessment.The court found plaintiff's arguments unpersuasive and concluded that substantial evidence supports the ALJ's denial of benefits where the ALJ did not ignore a line of evidence contradicting her decision; the ALJ's assessment of plaintiff's symptoms was not patently wrong; and the ALJ did not fail to note any supported manipulative limitations. View "Deborah M. v. Saul" on Justia Law

For decades, the U.S. Virgin Islands Government Employees Retirement System (GERS) experienced annual deficits between its assets and projected liabilities to participants. Its aggregate shortfall is now about three billion dollars. The Government of the Virgin Islands (GVI) has sometimes failed to remit to GERS all the employer contributions it is statutorily mandated to make. GERS sued GVI for these contributions, first in 1981, resulting in a consent judgment, and most recently in 2016, when GERS sought to enforce that judgment. GERS claimed that, as far back as 1991, GVI had contributed tens of millions of dollars less than required by the statutory percentages of employee compensation. GERS also claimed that independent of these fixed-percentage contributions, GVI must fund GERS to the point of actuarial soundness.The district court awarded GERS an amount calculated to reflect GVI’s historical percentage-based under-contributions. The Third Circuit affirmed that award of principal but vacated an enhancement of the award that applied late-arriving interest and penalty statutes, enacted in 2005, retroactively. The consent judgment does not require GVI to fund GERS for the gap between its assets and liabilities. Virgin Islands law apparently fails to obligate anyone to fund GERS when employee-compensation-based contributions and associated investment returns fall short of the assets required, based on actuarial assessments, to meet future pension commitments. The citizens of the Virgin Islands (population 106,4052) simply cannot pay the necessary billions. The cure for GERS’s chronic underfunding is legislative. View "Government Employees Retirement System of the Virgin Islands v. Government of the Virgin Islands" on Justia Law

Pavlicek, age 49. applied for Disability and Supplemental Security Income benefits. He suffers from anxiety, depression, severe tremors, and pseudoseizures that resemble epileptic seizures but stem from psychological causes. A truck driver, he has a high-school education. Two non-examining agency consultants determined that he could function with some limitations. Pavlicek testified that he had constant tremors and had seven pseudoseizures in the past 16 months when he lost consciousness; in seven other episodes, he remained conscious. A vocational expert testified about employers’ tolerance for absenteeism and about a hypothetical employee with various restrictions. The treating psychiatrist reported that Pavlicek could not work.The ALJ determined that Pavlicek retained the residual functional capacity to perform medium work with exceptions and could perform work that existed in significant numbers in the national economy. The ALJ largely dismissed the report by the treating psychiatrist, who had not justified how his findings could apply “as far back as 2013,” having not treated Pavlicek until 2015 and who relied heavily on Pavlicek’s subjective reporting. The ALJ noted the “infrequent” nature of the treatment relationship and that the report’s assessment of severe functional limitations was unsupported by the clinical records. The Seventh Circuit affirmed. The decision was supported by substantial evidence. The court rejected claims that the ALJ gave inadequate reasons for rejecting the treating psychiatrist's opinion, afforded too much weight to the opinions of non-examining agency physicians, and posed hypothetical questions to the vocational expert that failed to account for his limitations. View "Pavlicek v. Saul" on Justia Law

Vollono served on active duty in the Navy, 1996-1997 and 2001-2005. Vollono’s second stint was compulsory as a condition of his Naval Academy education. Vollono used chapter 30 Montgomery G.I. Bill educational benefits to pursue post-graduate education, 38 U.S.C. 3001, 3011. In 2009, the VA notified Vollono that he might be eligible for chapter 33 Post-9/11 G.I. Bill educational assistance. Vollono was mistakenly found eligible and elected to receive Post-9/11 benefits in lieu of Montgomery benefits to complete post-graduate education. In 2011, the VA regional office (RO) notified Vollono that he had erroneously received $60,507.08 in benefits, because his post-9/11 service was obligatory, precluding his eligibility for such benefits. The VA did not recoup the benefits. The Board of Veterans’ Appeals and Veterans Court affirmed the decision.The Board found that Vollono did not waive entitlement to Montgomery benefits; the RO found Vollono eligible for $29,107 in Montgomery benefits for completing his studies but found that it could not release payment of these funds that would be duplicative of his previous receipt of Post-9/11 benefits. The Board agreed, reasoning that 38 C.F.R. 21.7143(a) and 38 U.S.C. 3033 preclude the payment of duplicative educational benefits regardless of current eligibility. The Veterans Court and Federal Circuit affirmed. Awarding Montgomery benefits to Vollono would “lead to an absurd result of placing the appellant in a better position than that of those worthy veterans who were actually eligible for Post-9/11 GI Bill benefits.” View "Vollono v. McDonough" on Justia Law

Rush retired in 2012. The California State Teachers Retirement System (CalSTRS) calculated his pension as 92.58 percent of his final compensation. Rush disputed the determination of his “final compensation,” defined as “the highest average annual compensation earnable by a member during any period of 12 consecutive months” For 12 consecutive months over portions of two school years, Rush served as an associate dean at a salary significantly higher than his salary during the other portions of those years.CalSTRS applied Education Code section 22115(d): If a member worked at least 90 percent of a school year at the higher pay rate, compensation earnable was to be calculated as if the member earned all service credit for the year at the higher rate. If the member worked less than 90 percent of the year at the higher rate, as Rush did, compensation earnable “shall be the quotient obtained when creditable compensation paid in that year is divided by the service credit for that year.” The court of appeal upheld CalSTRS’s calculation as within the range of reasonable statutory construction. View "Rush v. State Teachers' Retirement System" on Justia Law

The Eighth Circuit affirmed the district court's order upholding the Social Security Administration's denial of plaintiff's benefits claim, because substantial evidence supports the finding that the SSA has met its burden. The court concluded that the Vocational Expert relied on sufficient evidence, such as plaintiff's own testimony, when he formed his expert opinion. The court also concluded that the evidence supports the ALJ's finding that plaintiff can transfer her job skills to new sedentary positions, such as the suggested positions of order clerk, receptionist, or appointment clerk. Furthermore, there is sufficient evidence in the record to show that plaintiff possessed job skills that would transfer to other sedentary occupations. View "Swedberg v. Saul" on Justia Law

The statutory presumption of soundness states: [E]very veteran shall be taken to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at the time ... or where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and was not aggravated by such service, 38 U.S.C. 1111. The VA’s prior section 1111 implementing regulation did not require clear and unmistakable evidence of lack of aggravation by service for rebuttal but required only clear and unmistakable evidence that the disorder “existed prior [to service].” In 2003, the VA invalidated the regulation for conflicting with the statutory language and amended the regulation to require evidence of both preexisting condition and no aggravation, 70 Fed. Reg. 23,027, 23,028. The Federal Circuit affirmed.Veterans, whose claims for disability benefits were denied decades ago, sought revision of the denial decisions, alleging that the VA had committed clear and unmistakable error (CUE). The Veterans Court affirmed the Board of Veterans’ Appeals’ denials of the motions, reasoning that the VA did not commit a clear and unmistakable legal error when it faithfully applied the version of the presumption of soundness regulation that existed at the time. The Federal Circuit affirmed. A legal-based CUE requires a misapplication of the law as it was understood at that time, and cannot arise from a subsequent change in interpretation in the law. View "George v. McDonough" on Justia Law

In these consolidated appeals, the Supreme Court affirmed the district court's dismissal of separate actions challenging the Nebraska Department of Health and Human Services' (DHHS) denial of an administrative appeal hearing, holding that the district court correctly determined that the hearing request was untimely submitted to DHHS under the governing regulation.Robert Colwell, DDS, P.C., was a Nebraska corporation through which Colwell (collectively, Colwell) provided medical services. Colwell entered into an agreement with Managed Care of North America (MCNA), which provided managed care services to Nebraska's Medicaid program, agreeing to provide dental services for individuals enrolled in Nebraska Medicaid. When MCNA allegedly failed to compensate Colwell for covered services, Colwell filed one action challenging the MCNA's decision to terminate the Medicaid provider agreement with Colwell. In this action, Colwell filed a request for a fair hearing with DHHS, which DHHS denied and dismissed. Colwell then filed another action challenging the DHHS order of dismissal. The district court dismissed both appeals for lack of subject matter jurisdiction. The Supreme Court affirmed, holding that Colwell's request for a hearing before DHHS was not timely filed within ninety days of the "date of the action." View "Colwell v. Managed Care of North America" on Justia Law

Bailey became partially disabled by pneumoconiosis, caused by the inhalation of coal dust. In 2002, he entered into an agreement with his employer to settle his state workers’ compensation claim; $27,677.50 was designated as Bailey’s take-home amount, representing payments of $135.67 per month, for 17 months beginning in July 2002. In November 2011, Bailey filed a claim under the Black Lung Benefits Act. The Office of Workers’ Compensation Programs (OWCP) granted Bailey’s claim in October 2013, but his benefits entitlement began the month he filed his claim and continued through May 2016—the month preceding the month that he died. At the time of his death, he had received benefits totaling $30,507.70 but was still owed benefits for the months from November 2011 through September 2013, $21,508.90. Bailey’s employer went bankrupt. He sought the remaining benefits from the federal Black Lung Disability Trust Fund. While the OWCP approved that claim, a District Director reevaluated the original award, finding that Bailey’s state workers’ compensation award represented monthly state benefits, some of which ran concurrently with his federal benefits eligibility period, so that the federal benefits must be offset by the state benefits received for that time—$135.67 per month over 55 months ($7,461.85). The OWCP subtracted this amount from the $21,508.90. The Seventh Circuit affirmed. The offset is required by the Act; that Bailey received his state benefits years before he became eligible for federal benefits does not alter the conclusion. View "Bailey v. Director, Office of Workers’ Compensation Programs, United States Department of Labor" on Justia Law

Arnold applied for Social Security disability benefits based on ailments related to her back, heart, and joints, and chronic pain syndrome. Following the initial denial of her claim, Arnold requested a hearing before an ALJ. Arnold testified at the hearing, as did a vocational expert. The ALJ concluded that Arnold was not disabled, finding Arnold had several severe impairments, but that she retained the ability, with certain movement restrictions, to perform her past relevant work as a daycare center director. The district court and Seventh Circuit affirmed the ALJ’s decision, rejecting an argument that the ALJ failed to analyze whether the side effects of her medications impacted Arnold’s ability to work. While there is some evidence of side effects in the record, there is no evidence that the side effects impacted Arnold’s ability to work. On this record, the ALJ was not required to make findings about Arnold’s side effects. View "Arnold v. Saul" on Justia Law