Justia Public Benefits Opinion Summaries

Presumptive service connection exists for veterans who served in the Persian Gulf War and have chronic: undiagnosed illness; medically unexplained chronic multisymptom illness (MUCMI); or any diagnosed illness as determined by the Secretary, 38 U.S.C. 1117(a)(2). VA regulations define MUCMI as “a diagnosed illness without conclusive pathophysiology or etiology, that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. Chronic multisymptom illnesses of partially understood etiology and pathophysiology, such as diabetes and multiple sclerosis, will not be considered medically unexplained.”. Both the statute and regulation identify sleep disturbances and signs or symptoms involving the respiratory system as possible MUCMI manifestations. The VA revised its M21-1 Manual, changing the definition of MUCMI to require “both an inconclusive pathology, and an inconclusive etiology.” Under the subsection “Signs and Symptoms of Undiagnosed Illnesses or MUCMIs,” the VA added, “Sleep apnea cannot be presumptively service-connected (SC) under the provisions of 38 C.F.R. 3.317 since it is a diagnosable condition.” The Federal Circuit dismissed a veterans’ group’s petition for review for lack of jurisdiction, reasoning that the revisions are not binding and not reviewable under 38 U.S.C. 502. View "Disabled American Veterans v. Secretary of Veterans Affairs" on Justia Law

This case focused on whether the Department for Children and Families (DCF) could deny an applicant temporary housing assistance under General Assistance (GA) Rule 2652.3 for having left her housing in response to a notice of termination without cause from her landlord. DCF argued that applicant Dezarae Durkee caused her own loss of housing and therefore was ineligible for assistance. The Human Services Board upheld this determination. Applicant argued that leaving in response to a notice of termination without cause does not constitute causing her own lack of housing and sought a declaration of such damages. The Vermont Supreme Court granted the declaratory judgment but concluded damages were not appropriate relief. View "In re Appeal of Dezarae Durkee" on Justia Law

Sunny Radebaugh contested both her inability to cross-examine the nurse who performed an annual assessment and the Department of Health and Social Services' reversal of an administrative law judge’s determination. Radebaugh was a Medicaid in-home nursing care benefits recipient, who had her benefits terminated by the Department after an annual assessment. The assessment concluded that Radebaugh’s physical condition had materially improved to the point where she no longer required the benefits. She challenged the termination of her benefits at an administrative hearing, and the nurse who performed the assessment did not testify. Following the hearing, the administrative law judge determined that the Department erroneously terminated her benefits. The Department, as final decision maker, reversed the administrative law judge’s determination and reinstated the decision to terminate Radebaugh’s benefits. Radebaugh appealed to the superior court, which first determined that the Department had violated her due process rights but then reversed itself and upheld the Department’s decision. After review, the Alaska Supreme Court concluded Radebaugh waived the right to challenge her inability to cross-examine the nurse who performed the assessment. The Court held that the agency sufficiently supported its final decision. The Court therefore affirmed the superior court’s affirmance of the Department’s final decision. View "Radebaugh v. Dept. of Health & Social Services" on Justia Law

The Eighth Circuit affirmed the denial of plaintiff's social security disability benefits, holding that substantial evidence supported the ALJ's decision to deny benefits. The court held that substantial evidence supported the ALJ's decision to assign little weight to the opinion of plaintiff's treating psychiatrist based on internal inconsistency and conflict with other evidence on the record; the ALJ did not err by assigning insufficient weight to the opinions of plaintiff's caseworker and Mental Health Paraprofessional (MHPP); and the ALJ's residual functioning capacity determination, as well as the other evidence in the record, reflected the limitations of plaintiff's ability to follow instructions, socialize, and maintain concentration. View "Chesser v. Berryhill" on Justia Law

Snyder represented a veteran, Beck, under a 2001 fee agreement (38 U.S.C. 5904). Eight months later, Snyder requested the Board of Veterans’ Appeals to cancel his fee agreement. In 2003 the VA awarded past-due benefits based on a 100% disability rating effective 1992. Snyder sought attorney fees. A VA regional officer (RO) determined that Snyder was entitled to $41,920.47, deductible from the past-due benefits. Beck filed notice of disagreement. Beck died. His widow sought to recover the disputed fees as accrued benefits. The RO denied that request. The Board dismissed Beck’s dispute over attorney fees, citing 38 C.F.R. 20.1302, and remanded Mrs. Beck’s claim. The RO determined Mrs. Beck could not recover the disputed attorney fees because her husband’s claim ceased to exist upon his death. She appealed. The VA’s General Counsel published a precedential opinion stating: A claim, pending at the time of a veteran’s death, challenging an attorney’s entitlement to payment of attorney fees under section 5904 from the veteran’s retroactive periodic monetary benefits may provide a basis for an accrued benefits claim under section 5121, because such a claim concerns entitlement to periodic monetary benefits allegedly due and unpaid to the veteran at the time of death. The Federal Circuit dismissed Snyder’s appeal. That 38 C.F.R. 20.1302 requires dismissal of a veteran’s appeal upon his death has no bearing on a claimant’s separate entitlement to accrued benefits under section 5121. The attorney fee dispute remains pending. View "Snyder v. Secretary of Veterans Affairs" on Justia Law

David, age 17 years 11 months, was a victim of past gun violence and is a wheelchair-bound diabetic in need of day-to-day medical assistance. He was living in a homeless shelter when a dependency petition was filed, alleging that he was abandoned by his mother and left without means of support. An investigation revealed that David had not been forthcoming about his family. The court dismissed the petition, finding that David had a support system in place but had chosen to leave it behind to be on his own. Had the petition not been dismissed, David would likely have qualified for transitional support as a nonminor dependent until age 21. The court of appeals dismissed an appeal. Dependency jurisdiction may not be initiated in the first instance over someone who is over age 18; it must be initiated before age 18, and by the plain terms of the Juvenile Court Law, may only be “retain[ed],” “continu[ed]” or “resum[ed]” for nonminors in certain circumstances until age 21. David’s case is now moot because he is 18 and any error by the juvenile court in failing to assume dependency jurisdiction is effectively unreviewable. View "In re David B." on Justia Law

Moshiri, other physicians, and hospital administrators were charged (42 U.S.C. 1320a-7b(b)) based on a kickback scheme. The former director of the podiatry residency program (Noorlag) testified that teaching contracts were a vehicle to pay physicians for referrals. Moshiri received $2,000 per month and was named as the Director of External Podiatric Office Rotations. Another doctor was named to that position at the same time. According to Noorlag, neither doctor was considered to hold that position, and neither performed the related duties. The Chair of the Counsel on Podiatric Medical Education, which oversees and certifies residency programs nationally and publishes standards, offered an expert opinion that teaching stipends are uncommon for attending physicians at residency programs and that he had never heard of such a physician being paid $2,000 per month. According to multiple witnesses, Moshiri did not conduct workshops and did not manage external rotations. Moshiri worked with residents about three times per month, while 11 other program physicians averaged 10 cases per month with residents. During the period at issue, the Hospital billed Medicare and Medicaid $482,000 for patients Moshiri treated. The Hospital’s Chief Operating Officer had recorded conversations in which Moshiri discussed his referrals. The agent who arrested Moshiri testified that Moshiri said that “the contract turned into basically paying for patients.” The Seventh Circuit upheld Moshiri’s conviction, rejecting challenges to the sufficiency of the evidence and to the expert testimony. View "United States v. Moshiri" on Justia Law

Plaintiff appealed the denial of her application for disability insurance benefits and supplemental security income. The Fourth Circuit held that the ALJ did not give appropriate weight to the opinions of plaintiff's treating physicians and failed to adequately explain his decision to deny her benefits. Accordingly, the court vacated and remanded for further proceedings. View "Lewis v. Berryhill" on Justia Law

Neither the grant in an irrevocable trust of a right of occupancy and use in a primary residence to an applicant nor the retention of a life estate by the applicant in the applicant’s primary residence makes the equity in the home owned by the trust a countable asset for the purpose of determining Medicaid eligibility for long-term care benefits under the Federal Medicaid Act.At issue before the Supreme Judicial Court in these two cases was whether applicants were eligible for long-term care benefits under the Act Act where they created an irrevocable trust and deeded their home - their primary asset - to the trust but retained the right to use and reside in the home for the rest of their life. The Director of the Massachusetts Office of Medicaid (MassHealth) found that the applicants were not eligible for long-term care benefits. The superior court upheld MassHealth’s determinations. The Supreme Judicial Court reversed the judgments in both cases because MassHealth found that the equity in both homes was a “countable” asset whose value exceeded the asset eligibility limitation under the Act. View "Daley v. Secretary of Executive Office of Health & Human Services" on Justia Law

M.N. filed a due process complaint alleging that the District committed procedural and substantive violations of the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1400(d)(1)(A). The ALJ denied all claims and the district court affirmed. The Ninth Circuit filed an amended opinion reversing the district court's judgment, holding that neither the duration of the hearing, the ALJ's active involvement, nor the length of the ALJ's opinion can ensure that the ALJ was thorough and careful in its findings of fact; plaintiffs' claim that the District committed a procedural violation of the IDEA by failing to adequately document its offer of the visually impaired (TVI) services was not waived; the District committed two procedural violations as to the individualized education plan (IEP); the District's failure to specify the assistive technology (AT) devices that were provided infringed M.N.'s opportunity to participate in the IEP process and denied the student a free appropriate education (FAPE); the panel remanded for a determination of the prejudice the student suffered as a result of the District's failure to respond to the complaint and the award of appropriate compensation; in regard to substantive violations, the panel remanded so the district court could consider plaintiffs' claims in light of new guidance from the Supreme Court in Endrew F. v. Douglas Cty. Sch. Dist., 137 S. Ct. 988 (2017); and M.N., as the prevailing party, was entitled to attorneys' fees. View "M.C. v. Antelope Valley Union High School District" on Justia Law