Justia Public Benefits Opinion Summaries

The court affirmed the denial of plaintiff's application for supplemental security income, concluding that substantial evidence supported the ALJ's decision. Substantial evidence supported the ALJ's conclusion that claimant did not meet or equal Listing 12.05C because he did not demonstrate the adaptive function limitations necessary to qualify; the ALJ adequately accounted for plaintiff's limitations in concentration persistence, or pace in the residual functional capacity; and the vocational expert's testimony constituted substantial evidence supporting the ALJ's finding at step five. View "Scott v. Berryhill" on Justia Law

Monk served in the Marine Corps during the Vietnam War. In 2012, Monk sought VA disability benefits, alleging service-connected PTSD, diabetes, hypertension, and strokes. The VA denied the claim, finding that his discharge was “other than honorable.” Monk filed a Notice of Disagreement (NOD) and separately applied to the Board of Correction of Naval Records (BCNR) to upgrade his discharge status. In 2015, the VA informed Monk that it could not process his appeal until it received BCNR records. Monk sought a writ of mandamus with Veterans Court and requested that the court certify a class of all veterans who had applied for VA benefits, had timely filed an NOD, had not received a decision within 12 months, and had demonstrated medical or financial hardship (38 U.S.C. 7107(a)(2)(B)–(C)). The Veterans Court denied the request for class certification, denied another veteran’s request to join the action, and ordered the VA to respond to Monk’s petition regarding the denial of disability benefits. BCNR then granted Monk an upgraded discharge status. The Federal Circuit reversed the denial of class certification, finding that the Veterans Court has authority to certify a class for a class action and to maintain similar aggregate resolution procedures with respect to benefit denials. View "Monk v. Shulkin" on Justia Law

Plaintiff appealed the partial denial of his applications for disability insurance benefits (DIB) and supplemental security income (SSI). Plaintiff suffers from asthma, chronic obstructive pulmonary disease, high blood pressure, depression, hepatitis C, diabetes, liver damage, hepatomegaly, uveitis of the left eye, coronary artery disease, and degenerative disc disease. In this case, the Commissioner concluded that plaintiff was able to perform light work, with limitations, for a period of time before he became disabled under the Guidelines, after the Commissioner reviewed the entire record and considered the objective test results, plaintiff's subjective reports and complaints of pain, as well as the opinions of treating and consulting physician. The court found that the Commissioner's determination was within a reasonable "zone of choice." Because the Commissioner's decision to deny benefits prior to August 24, 2012, was supported by substantial evidence on the record as a whole, the court affirmed the judgment. View "Fentress v. Colvin" on Justia Law

John F. Murphy Homes, Inc. operates a private school that offers medical services that are paid for by MaineCare, a State Medicaid program. The State pays one-third of costs for MaineCare, a contribution commonly referred to as the Seed. In 2013, Murphy Homes filed a complaint that, as construed by the trial court, stated claims for breach of contract, quantum meruit, and an equitable claim for unjust enrichment or equitable estoppel, alleging that it was owed $7.5 million for Seed payments not paid between 2001 and 2011. The trial court granted summary judgment for the State on all claims. The Supreme Judicial Court affirmed, holding (1) the breach of contract and quantum meruit claims were not legally viable; and (2) Murphy Homes failed to allege facts to generate a trial worthy issue of fact on the reliance element of its equitable estoppel claim. View "John F. Murphy Homes, Inc. v. State" on Justia Law

While implementing changes required by the Patient Protection and Affordable Care Act of 2010, Michigan experienced a systemic computer problem that erroneously assigned thousands of non-citizens, who may have been eligible for comprehensive Medicaid coverage, to Emergency Services Only (ESO) Medicaid. Plaintiffs, two eligible noncitizen residents of Michigan who were erroneously assigned ESO coverage, filed a class action complaint against the Director of the Michigan Department of Health and Human Services, alleging violations of the Medicaid statute and the Due Process Clause. The district court found that actions taken by the state since the complaint was filed had resolved all systemic errors, so that plaintiffs’ claims were moot. The Sixth Circuit reversed the summary judgment, noting that not one of the individuals identified as a named plaintiff or potential named plaintiff was granted relief on the basis of a systemic fix and that that it is not “absolutely clear the allegedly wrongful behavior could not reasonably be expected to recur.” Material questions of fact remain regarding claims that the state failed to provide comprehensive Medicaid coverage and a reasonable opportunity to verify immigration status, precluding summary judgment. View "Unan v. Lyon" on Justia Law

Boyd worked for the Postal Service, 1985-2010. In 2011, she sought disability retirement benefits under the Federal Employees Retirement System (FERS). The Office of Personnel Management (OPM) approved her application, stating it would provide interim FERS benefits; that she would not receive FERS benefits until OPM received confirmation that she had applied for Social Security disability (SSDI) benefits; that her FERS benefits would be offset by SSDI benefits; and that Social Security checks should not be negotiated until the FERS benefit had been reduced. Boyd provided OPM with notice of her SSDI award but cashed the SSDI checks. Five months later, OPM notified Boyd that she had been overpaid by $3,322, which it would recover by offsetting 36 monthly FERS benefits by $92.27. Boyd requested a waiver or a reduced payment based on financial hardship. Boyd completed a Financial Resources Questionnaire but did not provide a later-requested update. OPM denied a waiver but reduced the monthly offset to $40. Boyd appealed to the Merit Systems Protection Board, pro se, but did not file evidence nor respond to a show-cause order. The ALJ affirmed, finding that she was “not without fault” and did not refute the reasonableness of the reduced payment schedule. The Board affirmed. The Federal Circuit vacated, citing erroneous application of the overpayment recovery statute, 5 U.S.C. 8346(b), and remanded for determination of whether Boyd knew or suspected that she had been overpaid, and, if not, whether the recovery would be against equity and good conscience. View "Boyd v. Office of Personnel Management" on Justia Law

In 2014, the Board of Veterans Appeals denied Parrott’s claims for benefits on account of her veteran husband’s esophageal adenocarcinoma, with liver and peritoneal metastasis, and his ensuing death. The Veterans Court vacated and remanded. Parrott then timely sought attorney fees and expenses under the Equal Access to Justice Act (EAJA), 28 U.S.C. 2412. The Veterans Court awarded her $4,050. The Federal Circuit affirmed, rejecting arguments that, in arriving at its award of attorney fees, the Veterans Court misinterpreted EAJA and adopted an incorrect approach for determining the cost of living adjustment to be used in calculating her attorney’s hourly rate and that the court then abused its discretion by not allowing her to resubmit her application using the approach the court had adopted. EAJA states that “attorney fees shall not be awarded in excess of $125 per hour unless the court determines that an increase in the cost of living . . . justifies a higher fee.” The court properly rejected Parrott’s request for a cost of living increase, based on Washington D.C., based on the location of the Veterans Court and applied rates based on the locations of her attorney’s offices in San Francisco, Dallas, and Little Rock. View "Parrott v. Shulkin" on Justia Law

Plaintiff suffers from physical, cognitive, and psychological impairments. In this appeal, plaintiff challenged the denial of her social security disability benefits. The court concluded that the ALJ legally erred by rejecting an examining physician's opinion without explanation. In this case, the physician opined that plaintiff could not work any job that entailed standing for longer than 30 minutes or walking farther than 50 years. Accordingly, the court vacated and remanded for the ALJ to consider plaintiff's impairments, taking into account the examining physician's opinion. View "Kneeland v. Berryhill" on Justia Law

The Acting Commissioner of the Social Security Administration appealed a district court order reversing her decision to deny Marla Vallejo’s application for supplemental security income benefits and remanding the case for further administrative proceedings. Because the district court’s order rested on a misapplication of controlling law, the Tenth Circuit reversed and remanded to the district court for further proceedings. View "Vallejo v. Berryhill" on Justia Law

In the underlying action, JCHCC sought to permanently enjoin the Parish from evicting it from two Parish-owned facilities in which JCHCC currently provides medical services to medically underserved populations. The district court granted JCHCC's motion for a preliminary injunction, enjoining the Parish from evicting JCHCC but allowing it to terminate the injunction by establishing that the medical needs of the population currently served by the relevant JCHCC facilities would be met if JCHCC were evicted. The court reversed, concluding that JCHCC has not established a substantial likelihood of success on the merits of the only claim that was properly before the court. In this case, JCHCC failed to establish a likelihood of success on the merits of its Medicaid violation claim where JCHCC does not point to any authority suggesting that every local government in every participating state must provide the relevant medical services, nor does it point to authority establishing that the Parish has any obligation under Louisiana state law to provide such services on behalf of the state. View "Jefferson Community Health Care Centers v. Jefferson Parish Government" on Justia Law