Justia Public Benefits Opinion Summaries

Brayden O. was a seventeen-year-old girl who suffered from Coffin-Lowry Syndrome and other disabilities. Brayden had been receiving home and community-based waiver services through the Medicaid division of the Nebraska Department of Health and Human Services (DHHS) for almost a dozen years before the DHHS determined that Brayden no longer met the necessary qualifications for such services. Merie B., Brayden’s mother, appealed DHHS’ determination, which was affirmed after an administrative appeal hearing. The district court affirmed. On appeal, the Supreme Court reversed and remanded with directions that the district court order DHHS to reinstate waiver services to Brayden, effective as of the date services were originally terminated. On remand, Merie requested reimbursement for expenses she incurred due to the wrongful termination of Brayden’s services, along with attorney fees. The district court granted the request and entered judgment against DHHS in the amount of $76,260.48. The Supreme Court reversed, holding that the district court was without authority to expand the mandate in Merie B. I and hold an evidentiary hearing on Merie’s “Motion to Determine Expenses.” View "Merie B. on behalf of Brayden O. v. State" on Justia Law

In 2005, while serving in the Army National Guard, Bird injured a tendon in his right shoulder. He was operated on in 2006. He reported to Veterans Affairs doctors that he suffered hearing loss, migraines, and stiffness and pain in his hands, back and right shoulder, as well as anxiety, weakness in gripping objects, and ringing in his ears. The medical records include contradictory opinions from treating physicians. The Department of Veterans Affairs gave Bird a 70% service-connected disability rating but pays him at the 100% rate because they found him unemployable. The Social Security Administration denied Douglas Bird’s application for disability insurance benefits. The district court remanded. The Seventh Circuit affirmed. The VA’s finding that Bird is 70% disabled and unemployable does not establish that he is entitled to SSA benefits. There are differences in how the agencies evaluate claims: the VA’s evaluation is pro-claimant rather than neutral. The grounds for the VA’s decision finding Bird to be 70% disabled and unemployable were not available to the ALJ and neither were the results of Bird’s x-ray and MRI. The record even includes evidence conflicting with a finding of disability. View "Bird v. Berryhill" on Justia Law

The trial court denied appellant's petition for writ of administrative mandamus seeking to overturn the denial of his claim for services under the Lanterman Developmental Disabilities Services Act (Lanterman Act), Welf. & Inst. Code, 4500 et seq. The trial court denied the petition based on the doctrine of res judicata because his ineligibility for services had been previously adjudicated in two prior proceedings. The court agreed, and rejected appellant's claim that res judicata does not apply because the court’s decision in Samantha C. v. State Dept. of Developmental Services and a 2003 amendment to the Lanterman Act constitute an intervening change in the law or a doctrinal change that precludes application of the doctrine. In this case, the court concluded that neither the Samantha C. decision nor the 2003 amendment to section 4512 bars application of res judicata. Accordingly, the court affirmed the judgment. View "Ronald F. v. Department of Developmental Services" on Justia Law

In 2009, the Social Security Administration notified Casey that he needed to repay about $334,000 in disability benefits he should not have received. Casey unsuccessfully sought a waiver. Six months later, Casey submitted an untimely request for review to the Appeals Council, arguing that he had good cause for his delay. The Appeals Council extended Casey’s deadline to submit evidence or a statement in support of his waiver claim; 15 months later, the Council reversed course, informing Casey that it had dismissed his review request because there was “no good cause to extend the time for filing.” Casey then sued the Acting Commissioner of Social Security. The district judge dismissed. The Seventh Circuit reversed. The Council's action in first granting and then retroactively denying Casey’s good cause request was arbitrary, having the effect of an unfair bureaucratic bait‐and‐switch. The Council had discretion to determine initially whether Casey offered good cause for his late administrative appeal, but, having granted Casey’s request, the Council could not simply change its mind on the theory that he had not adequately justified his delay, after leading him on for over a year without suggesting he needed to provide more information, an affidavit, or anything else by way of support. View "Casey v. Berryhill" on Justia Law

Kentucky’s Health and Family Services commenced a Dependency, Neglect, and Abuse proceeding. The mother stipulated to neglecting her children. Kentucky placed both boys in foster care. R.O., the mother’s aunt, sought custody of the children. The state conducted a standard home evaluation and criminal background check on R.O. and eventually both children were placed in her home by court order. The family court closed the action and granted joint custody to the mother and R.O., though the boys remained living with R.O., who sought foster care maintenance payments. The family court declined to rule on the issue, “indicating that permanency had been achieved.” R.O. then sued the state, arguing that the federal Child Welfare Act, 42 U.S.C. 672(a), required the state to provide maintenance payments, and that the failure to make payments violated the Equal Protection and Due Process Clauses. The state removed the case to federal court. The district court dismissed, reasoning that the Child Welfare Act provides no privately enforceable rights, that the family lacked a property interest in the payments, and that Kentucky’s scheme rationally distinguished between relative and non-relative foster care providers. The Sixth Circuit reversed, finding that the Act creates a private right of action. View "D.O. v. Glisson" on Justia Law

Kays served in the Navy, 1972-1976. In 2005, he sought benefits for disability caused by PTSD, allegedly caused by two non-combat stressors during his service. He was stabbed during a fight as he left an Enlisted Men’s Club, and while off-duty and taking diving lessons, he was asked to help with the recovery effort of a downed civilian helicopter; in the water, he was separated from the group and became stressed. Kays submitted a newspaper article, statements, records, and in-person testimony about those events. In 2005, the VA Regional Office denied Kays’s claim. The Board of Veterans Appeals remanded for further development of the record. The Regional Office again denied the PTSD claim. The Board affirmed. Meanwhile, the pertinent regulation, 38 C.F.R. 3.304(f), was amended and the Veterans Court held that the amendments were retroactive. On remand, the Board again denied Kays’s claim, finding that statements by Kays and his former spouse about the alleged stabbing were unsupported and contradicted by other evidence and that Kays’s testimony about the search and rescue was not credible because of the lack of supporting detail in the article, his delay in reporting the event, and his changing story. The Veterans Court found the Board’s decision to be a question of fact reviewed under the clearly erroneous standard. The Federal Circuit affirmed, finding that the Veterans Court applied the correct standard of review and correctly determined that the regulations require credible supporting evidence. View "Kays v. McDonald" on Justia Law

Plaintiff challenges the denial of her application for social security disability benefits. Before the court is an issue of first impression regarding whether an ALJ's failure to follow the special technique required by 20 C.F.R. 404.1520a when evaluating a claimant’s mental impairment requires remand or may constitute harmless error. The court held that such an error does not automatically require remand, but that the error was not harmless on these facts. Accordingly, the court reversed the district court's order denying benefits and remanded with instructions to the ALJ for appropriate review of plaintiff's mental impairment. View "Patterson v. Commissioner of SSA" on Justia Law

N.S. was placed in foster care when she was 11 years old. After she turned 18 in 2014, she remained under the jurisdiction of the juvenile court as a nonminor dependent. (Welf. & Inst. Code, 11400(v).) N.S. had been diagnosed with posttraumatic stress disorder, attention-deficit/hyperactivity disorder, and depressive disorder. She was participating in therapy and taking medication and would be enrolled in an educational program. In 2015, the Agency took the position that N.S. qualified for extended foster care because her mental health diagnoses prevented her from attending an educational or employment program or working at least half time. In 2016, the Agency recommended that N.S.’s dependency be dismissed because her exact whereabouts were unknown. N.S. was abusing methamphetamines and declined offers of housing, substance abuse treatment support, and options to get back on track with services. The Agency sought to have N.S.’s psychotherapist testify as to confidential communications. The court overruled N.S.’s objection. The court of appeal granted a writ prohibiting any inquiry concerning the psychotherapist’s confidential communications with N.S. N.S. did not put her mental condition at issue by responding to questions posed by the Agency in its case-in-chief with respect to her eligibility or by submitting documentation. View "N.S. v. Superior Court" on Justia Law

Petitioner Kelly Hagenbuch challenged the termination of her food stamp benefits by the New Hampshire Department of Health and Human Services (department). The department terminated the benefits because it found that her income exceeded the maximum amount permitted by the program. In calculating petitioner’s income, the department included distributions from an irrevocable trust, of which petitioner was the sole beneficiary, that had been made by the trustee to third parties. These distributions included payments for trust expenses and for legal fees that the petitioner had incurred to obtain public benefits. This case presented an issue of first impression in New Hampshire: whether a distribution made by the trustee of an irrevocable trust to third parties counted as income to the trust beneficiary for the purpose of determining food stamp benefits. The narrow question before the New Hampshire Supreme Court was whether the trust distributions were “owed” to the petitioner. The Court did not decide the validity of the premise underlying the department’s argument—that because the money used to establish the Trust was derived from the settlement of the petitioner’s personal injury lawsuit, the Trust was established with the petitioner’s “own funds.” Even assuming that the premise was correct, the Court concluded that the vendor payment exclusion applied to the trust distributions because the regulations do not recognize the distinction that the department attempts to draw regarding trusts originally funded by the household. In this case, given that the distributions made by the trustee to third parties were not owed to the petitioner—and therefore, were excluded vendor payments—the department should have excluded the trust distributions from the petitioner’s income. Accordingly, the Court reversed the presiding officer’s decision that the department properly counted the trust distributions as income. View "Petition of Kelly Hagenbuch" on Justia Law

Childress unsuccessfully sought Social Security Administration disability benefits in 2008, at age 35. He appealed to the district court, which remanded for reevaluation of the medical opinions in the record and reconsideration of the plaintiff’s credibility. After a second hearing, in 2013, the same ALJ again ruled that Childress was not disabled. The district court affirmed. The Seventh Circuit reversed. The ALJ did not give proper weight to medical evidence presented by Childress’s treating physicians, which was extensive and indicated that Childress suffers from congestive heart failure, cardiomyopathy, severe asthma, COPD (chronic obstructive pulmonary disease), occasional chest pain, obesity, hypertension, and dyspnea (difficult or uncomfortable breathing, resulting in shortness of breath). He was prescribed Advair, Benazepril, Coreg, Diovan, Lanoxin, Lasix, Norvasc, Proventil, and Spiriva, but the cardiologist estimated that in an eight‐hour workday Childress would be able to stand or walk for no more than one hour and to sit for no more than two hours. The court characterized the ALJ’s conclusion as “absurd,” noting that the vocational expert admitted that an employee who misses three or more days of work a month is unemployable. The court also noted the ALJ’s reference to Childress’s history of smoking. View "Childress v. Colvin" on Justia Law