Justia Government & Administrative Law Opinion Summaries

The First Circuit held that the five-day grace period outlined in 20 C.F.R. 422.210(c) does not apply to final decisions on remand where the individual does not file any written exceptions to the administrative law judge's decision and the Appeals Council does not assume jurisdiction of the case.Plaintiff applied for Title II disability benefits with the Social Security Administration. On remand, an ALJ issued a partially favorable decision on Plaintiff’s claim. Plaintiff did not file any written exceptions to the ALJ’s decision, and the Appeals Council did not review the ALJ’s decision. Therefore, the ALJ’s decision became the final decision of the Commissioner of Social Security. Plaintiff then filed a civil action challenging the ALJ’s decision on remand. The Commissioner moved to dismiss Plaintiff’s claim as untimely. The district court ruled against Plaintiff and dismissed her complaint for being untimely filed. Plaintiff appealed, asking the First Circuit to hold that the five-day grace period outlined in section 422.210(c) applies to final decisions on remand. The First Circuit declined Plaintiff’s request, holding that Plaintiff cannot apply the five-day grace period under section 422.210(c) to save her civil claim from being untimely. View "Walker-Butler v. Berryhill" on Justia Law

The Supreme Court held that “medical assistance” provided to Medicaid recipients includes costs for room and board and other “nonmedical” expenses at nursing facilities, and therefore, those costs can be recovered from the recipient’s estate. In this case, the Nebraska Department of Health and Human Services (DHHS) filed a petition for allowance of a claim for services provided to the decedent while he resided at two different nursing homes. The county court sustained DHHS’ motion for summary judgment, concluding that the services defined as room and board fell within the parameters of services provided under the Medical Assistance Act. The Supreme Court affirmed, holding that DHHS was statutorily authorized to recover the sums it paid for room and board costs and other expenses from the decedent’s estate. View "In re Estate of Vollmann" on Justia Law

The Ninth Circuit affirmed the denial of plaintiff's application for attorney fees under the Equal Access to Justice Act (EAJA), 28 U.S.C. 2412(d)(1)(A), holding that the Commissioner's litigation position was substantially justified. Plaintiff had successfully challenged the Commissioner's denial of her application for disability benefits and obtained a remand of her claim to the agency for further consideration. In this case, the district court did not abuse its discretion in determining that the Commissioner's position was substantially justified because the Commissioner's opposition to remand the claim on the merits was reasonable, even though it turned out to be unsuccessful. Finally, plaintiff's new evidence, though sufficient in the end to persuade the district court to remand the case, did not make that the only reasonable result. View "Decker v. Berryhill" on Justia Law

The Ninth Circuit affirmed the denial of plaintiff's application for attorney's fees under the Equal Access to Justice Act (EAJA), 28 U.S.C. 2412(d)(1)(A). Plaintiff presented new evidence to the Appeals Council after she lost her claim for social security disability benefits before the ALJ. The district court remanded for further consideration and the Commissioner did not appeal. The district court denied plaintiff's request for attorney's fees, concluding that the Commissioner was substantially justified in arguing that the new evidence did not undermine the ALJ's denial of benefits. The issue that was before the district court on the original merits appeal of the ALJ's denial of benefits was not whether there was other evidence that could support a denial of benefits to plaintiff, or whether the Commissioner's denial of benefits might ultimately be sustained. The Ninth Circuit explained that it was whether the actual decision that was made by the ALJ could be affirmed at that time by the district court in light of the new evidence in the record. In this case, it should have been plain that it could not have been affirmed, because the ALJ's decision failed to provide a reason that was still viable for giving the opinion of the treating doctor little weight. The doctor's final report, if credited, would have undermined the ALJ's original finding that plaintiff was not disabled. Even if the Commissioner might have had a legitimate basis for opposing plaintiff's claim, she did not have a basis to oppose remand and to argue that the district court should affirm the existing ALJ opinion. View "Gardner v. Berryhill" 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

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 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

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

Brown applied for disability benefits on the ground that her bad back and obesity left her in too much pain to work. The Social Security Administration denied Brown’s application; an administrative law judge upheld the denial, concluding that Brown could perform sedentary work associated with six jobs identified by a vocational expert. The Seventh Circuit vacated and remanded, holding that the ALJ violated the Treating Physician Rule when he rejected certain opinions proffered by Brown’s doctor regarding Brown’s ability to sit and stand for prolonged periods of time. In substituting his own opinions for the doctor’s, the ALJ focused on facts that did not directly pertain to sitting or standing and misrepresented multiple statements Brown made to treatment providers and others. The court rejected arguments that the ALJ insufficiently considered her obesity and improperly relied on the vocational expert’s testimony from the administrative hearing, claiming that the expert failed to provide enough information to justify her departure from the Dictionary of Occupational Titles and failed to verify the source of the data on which her jobs-related opinions were based. View "Brown v. Colvin" on Justia Law