Justia Public Benefits Opinion Summaries

The Fifth Circuit reversed the denial of social security benefits for plaintiff, a former physician and army veteran, who was diagnosed with post traumatic stress disorder (PTSD), depression, and bipolar disorder. The court held that the ALJ's decision was not supported by substantial evidence where the ALJ erred in finding for step two of the five-step approach that plaintiff's impairments were not severe. Accordingly, the court remanded for further consideration. View "Salmond v. Berryhill" on Justia Law

The IHSS program (Welf. & Inst. Code 12300) provides in-home services to elderly or disabled persons so that they may avoid institutionalization. For purposes of the state unemployment insurance system, IHSS service recipients are considered employers of their service providers if the providers are directly paid by the program or the recipient receives IHSS funds to pay their providers (Unemp. Ins. Code 683.) Generally, an employee of a close family member (child, parent or spouse) is excluded from unemployment insurance coverage. The California Unemployment Insurance Appeals Board ruled that, because a close-family-member IHSS service provider under the Direct Payment Mode is employed by the recipient, the provider is subject to the exclusion of Unemployment Insurance Code 631 (Caldera). Skidgel, an IHSS provider for her daughter, challenged the validity of Caldera, arguing government entities were joint employers with the recipient, thereby qualifying providers for unemployment insurance coverage despite the close-family-member exclusion. The court of appeal rejected the challenge, concluding that the Legislature, in enacting Unemployment Insurance Code section 683, intended to designate the recipient as the IHSS provider’s sole employer for purposes of unemployment insurance coverage. View "Skidgel v. California Unemployment Insurance Appeals Board" on Justia Law

The VA denied the veterans’ claims for service-connected disability benefits. Based on delays in their cases, they sought writs of mandamus in the Veterans Court. The Federal Circuit vacated that court’s denial of relief, finding that the court did not apply the proper standard. The court noted the significant delays that occur in most cases and that the government has not explained the cause of the delays; the petitions alleged that a veteran whose disability benefits are denied waits, on average, 1448 days after the denial for a ruling on an appeal.” Whether the agency’s delay is so egregious as to warrant mandamus under the “TRAC” standard requires consideration of six factors: the time agencies take to make decisions must be governed by a “rule of reason”; where Congress has provided an indication of the speed with which it expects the agency to proceed, that statutory scheme may supply content for this rule of reason; delays that might be reasonable in the sphere of economic regulation are less tolerable when human health and welfare are at stake; the court should consider the effect of expediting delayed action on agency activities of a higher or competing priority and the nature and extent of the interests prejudiced by delay; and the court need not find “any impropriety lurking behind agency lassitude” in order to hold that agency action is unreasonably delayed. View "Martin v. O'Rourke" on Justia Law

Four veterans appealed the VA's denial of their claims for service-connected disability benefits. Based on delays in their cases, they unsuccessfully sought writs of mandamus from the Veterans Court. The Federal Circuit remanded two cases, citing its 2018 decision, Martin v. O’Rourke, so that the mandamus petitions may be considered under the TRAC standard: “whether the agency’s delay is so egregious as to warrant mandamus.” The TRAC standard involves six factors: the time agencies take to make decisions must be governed by a “rule of reason”; where Congress has provided a timetable or other indication of the speed with which it expects the agency to proceed, that statutory scheme may supply content for this rule of reason; delays that might be reasonable in the sphere of economic regulation are less tolerable when human health and welfare are at stake; the court should consider the effect of expediting delayed action on agency activities of a higher or competing priority; the court should also consider the nature and extent of the interests prejudiced by delay; and the court need not find “any impropriety lurking behind agency lassitude” to hold that agency action is unreasonably delayed. One veteran had died, rendering his appeal moot and another had his claim for benefits granted. View "Rose v. O'Rourke" on Justia Law

The First Circuit affirmed the district court’s order upholding an administrative law judge’s (ALJ) denial of Appellant’s application for Social Security Disability Insurance Benefits and Supplemental Security Income. The Court held (1) even if this Court reviews the ALJ’s ruling on the understanding that it must apply a certain Social Security Ruling in reviewing the ALJ’s ruling, the ALJ’s determination that Appellant was not disabled still must be upheld; (2) substantial evidence supported the ALJ’s determination that Appellant’s ability to carry out certain daily activities undermined his contention that he was unable to perform light work; and (3) Appellant’s remaining allegations of error were without merit. View "Coskery v. Berryhill" on Justia Law

The Ninth Circuit reversed the denial of disability insurance benefits and supplemental security income for claimant. The panel held that the ALJ erred in not adequately addressing claimant's 100 percent Veterans Affairs (VA) disability rating in her decision; although the ALJ noted claimant's VA disability rating at the hearing and in her written decision, she did not address how she had considered and weighed the VA's rating or articulated any reasons for rejecting it; and thus remand was appropriate where it was unclear from the record whether the ALJ would be required to find claimant disabled after evaluating the VA disability rating. View "Luther v. Berryhill" on Justia Law

Acree served on active duty in the Navy from 1985-1989 and 2007-2008. He was deployed to Iraq and received Seabee Combat Warfare Medals. Acree was diagnosed with post-traumatic stress disorder (PTSD) while serving in Iraq. After leaving the service, Acree filed several claims for service-connected disability benefits and appealed 11 claims to the Board of Veterans’ Appeals. A representative from the Disabled American Veterans (DAV) organization was present with Acree at the board hearing. Acree said “yes” when asked to withdraw seven issues. The board listed the four issues that would be discussed and would “continue to be in appellate status” and asked the DAV representative whether it had “correctly identified the issues.” The representative responded: “Yes.” The board remanded four and dismissed seven claims. Acree appealed, arguing that a veteran’s withdrawal of a claim “is not effective unless the withdrawal ‘is explicit, unambiguous, and done with a full understanding of the consequences’” and that since he “ha[d] a long history of taking psychotropic medications,” the hearing officer should have inquired as to his capacity to appreciate the consequences of dismissing the claims. The Veterans Court affirmed, citing the hearing transcript. The Federal Circuit vacated. Precedent (DeLisio) explicitly states that a withdrawal is effective only if undertaken with “a full understanding of the consequences of such action on the part of the [veteran].” The Veterans Court was required to make that determination even though a DAV representative was present. View "Acree v. O'Rourke" on Justia Law

Robinson, a Marine Corps veteran, served in Vietnam from 1966-1969 and later had coronary problems. He sought treatment at a VA medical facility. In 2006, a VA cardiologist recommended that he undergo certain medical testing. The tests, performed 14 months later, revealed that Robinson suffered from left ventricular diastolic dysfunction. The VA granted Robinson a 60% disability rating effective April 2, 2007, the date he underwent cardiac testing. The Board denied Robinson entitlement to a higher rating. In the Veterans Court, Robinson argued for the first time—through the same counsel that represented him before the Board—that his rating should have been assigned an effective date in February 2006, when his doctor ordered tests. The court did not identify any error by the Board but “set aside” its decision and remanded for it to address Robinson’s argument in the first instance. Robinson sought attorney fees, arguing that, because he secured remand, he was a prevailing party under the Equal Access to Justice Act. The Federal Circuit affirmed denial of Robinson’s application. This particular remand did not confer prevailing party status on Robinson because it “was not predicated on administrative error by the Board,” did not materially alter the legal relationship of the parties, and was solely to allow the Board to consider an issue first raised on appeal. View "Robinson v. O'Rourke" on Justia Law

In this discretionary appeal, we consider whether Appellant, the Pennsylvania State Police (“PSP”), is entitled to subrogation of benefits that a trooper – who was injured in a motor vehicle accident – was eligible to receive under the Workers’ Compensation Act (“WCA”) against the trooper’s recovery from a third-party tortfeasor pursuant to the Motor Vehicle Financial Responsibility Law (“MVFRL”). In 2011, Pennsylvania State Trooper Joseph Bushta (“Claimant”) was on duty when his police vehicle was hit by a tractor-trailer. As a result of the collision, Claimant suffered various cervical, thoracic, and lumbar injuries which required medical treatment and physical therapy, and which resulted in Claimant’s inability to perform his job duties for approximately 16 months. PSP, a self-insured public employer, issued a notice of compensation payable (“NCP”) indicating a weekly compensation rate of $858.08 under the WCA. The Pennsylvania Supreme Court determined that all of the benefits Claimant received were Heart and Lung benefits, not WCA benefits. Thus, pursuant to the MVFRL, PSP does not have a right of subrogation against Claimant’s settlement with the third-party tortfeasors. View "Penn. State Police v. WCAB (Bushta)" on Justia Law

The district court properly placed the burden of proof on a grocery store (Store) in this action brought by Plaintiffs alleging that the Store unlawfully trafficked in Supplemental Nutrition Assistance Program (SNAP) benefits.The Food and Nutrition Service (FNS), the bureau within the United States Department of Agriculture (USDA) charged with administering the SNAP regime, concluded that the Store had engaged in trafficking and permanently disqualified the Store from SNAP participation. The Store brought an action in Maine’s federal district court challenging the agency’s final decision. The district court granted summary judgment for the USDA. The First Circuit affirmed, holding (1) the burden of proof is imposed on the claimant - here, the Store; and (2) no rational fact-finder could conclude that the Store had demonstrated by a preponderance of the evidence that the finding of trafficking was incorrect. View "Irobe v. United States Department of Agriculture" on Justia Law