Justia Government & Administrative Law Opinion Summaries

Miller is a single father who, before his alleged disability, held positions as a security guard, machine operator, material handler, and night-club bouncer. In 2006, Miller visited a hospital emergency department with an injured knee. He did not return to work but applied for disability insurance benefits, and supplemental security income. On remand from the Appeals Council, an ALJ determined that Miller was not disabled within the meaning of the Social Security Act and did not qualify for benefits. The Appeals Council declined another review. The district court granted summary judgment, affirming the denial of benefits. Miller’s timely appeal followed. The Sixth Circuit vacated, finding the decision not supported by substantial evidence. A determination concerning Miller’s residual functional capacity (particularly his ability to stand) did not comport with the ALJ’s determination that a doctor’s assessment should be accorded significant weight; the limited discussion of Miller’s obesity arguably did not comply with SSR 02- 1p; the ALJ’s focus on isolated, often stale, portions of the record was an insufficient basis to determine that Miller could conduct work activities on a sustained basis, especially in light of the Appeals Council’s original decision to remand for failure to adequately evaluate Miller’s mental impairments. View "Miller v. Comm'r of Social Sec." on Justia Law

Plaintiff Leslie Taylor asked the Colorado Medicaid program to combine the benefits she received through two assistance programs to help her get to medical appointments. If approved, this combination would allow the agency to pay attendants for time driving Taylor to and from her appointments. The agency refused, and the plaintiffs in this case alleged that the refusal constituted discrimination against Taylor based on her disability. The Tenth Circuit concluded that this refusal did not constitute discriminate against Taylor based on her disability. View "Taylor v. Colorado Dept of Health Care" on Justia Law

Before enactment of the 2008 Veterans’ Benefits Improvement Act, if a veteran seeking DVA benefits died while his claim was pending, the veteran’s survivor could not take the place of the veteran and continue prosecuting the claim. The survivor had to file a claim for accrued benefits, 38 U.S.C. 5121, proceeding from the beginning of the process, regardless of how far the veteran’s claim had progressed. The Act, 38 U.S.C. 5121A, authorizes eligible survivors to be “substituted as the claimant for the purposes of processing the claim to completion.” The Federal Circuit rejected a challenge to regulations intended to implement the Act, which require that a request to substitute be filed with the agency of original jurisdiction (DVA regional office) within one year of the claimant’s death; the prospective substitute is required to submit evidence of his eligibility to substitute; and, if the claimant died while his appeal was pending before the Board of Veterans’ Appeals, the Board must dismiss the appeal without prejudice so that the agency of original jurisdiction can address the substitution request. If the agency of original jurisdiction grants the request to substitute, then the case returns to the same place on the Board’s docket that it held at the time of the veteran’s death. View "Nat'l Org. of Veterans Advocates, Inc. v. Sec'y of Veterans Affairs" on Justia Law

Cogburn served in the Army, 1968-1971, including 12 months in Vietnam. In 1974, Cogburn sought VA disability compensation and pension benefits based on a severe nervous condition. A 1975 denial of his pension claim did not address the disability claim. He did not appeal. In 1983, Cogburn again sought disability compensation and pension benefits. He was diagnosed with Post-PTSD after a VA examination that failed to connect Cogburn’s PTSD to stressors from military service; the VA granted a non-service connection pension but denied service connection. In 1985, the Board of Veterans’ Appeal concluded that the record did not identify any in-service traumatic events, noting that Cogburn repeatedly failed to attend VA examinations to determine if service-connected stressors caused his PTSD. The Board determined that “the preponderance of the medical evidence suggests that the veteran’s post service emotional and adjustment difficulties are manifestations of schizophrenia.” There was no opportunity for further review. In 2002, Cogburn claimed that his 1974 disability compensation claim was never adjudicated. The RO determined that the claim was adjudicated as a claim for PTSD and had been implicitly denied in the 1985 decision. In 2012, on remand, the Board affirmed the finding of implicit denial. The Veterans Court and Federal Circuit affirmed; the implicit denial rule applies to both formal and informal claims. Its use does not violate the VA due process regulation's notice provision.. View "Cogburn v. McDonald" on Justia Law

Plaintiff appealed the denial of his application for Social Security disability benefits, contending that the ALJ failed to resolve a conflict between the vocational expert's testimony and the Dictionary of Occupational Titles. The court held that an ALJ has not fully developed the record if it contains an unresolved conflict between the expert’s testimony and the Dictionary; nor has the ALJ fulfilled this duty if he ignores an apparent conflict because the expert testified that no conflict existed. In this case, the ALJ did not fulfill his duty to make an independent identification of apparent conflicts. Accordingly, the court reversed and remanded for further proceedings. View "Pearson v. Colvin" on Justia Law

Plaintiff applied for disability benefits, listing eight impairments. The Social Security Administration denied Plaintiff’s application and did so again on reconsideration. The next year, Plaintiff testified before an Administrative Law Judge (ALJ). The ALJ disbelieved Plaintiff’s testimony that she could not sit, stand, or walk for extended periods of time and denied Plaintiff’s application for Disability Insurance Benefits and Supplemental Security Income. The Appeals Council denied review, making the ALJ’s decision the final decision of the Commissioner of Social Security. Plaintiff challenged the ALJ’s adverse credibility finding on appeal. The Seventh Circuit reversed, holding that the ALJ’s analysis was flawed in several respects, and the ALJ’s mistakes in evaluating Plaintiff’s credibility were not harmless. Remanded. View "Hill v. Colvin" on Justia Law

For more than a decade, the Commissioner of the Social Security Administration (SSA) has paid directly to qualified attorneys who bring Supplemental Security Income (SSI) claims a fee of no more than twenty-five percent of the successful recovery of past-due benefits to clients. When a state chooses to administer its own payments, the amount of state payments are not included as “past-due benefits” for the purpose of attorney compensation. In 2012, Attorney represented a client in a claim for SSI benefits before the SSA. In 2013, Attorney’s client received a partially favorable decision. In 2012, however, Massachusetts changed its practice and began administering its own program of supplementary payments rather than rely on federal administration of its supplementary payments. Upon learning that the SSA attorney’s fee award did not include twenty-five percent of the Massachusetts state-administered state supplementary payments, Attorney filed a complaint for declaratory relief and petition for writ of mandamus in the federal district court. The district court granted summary judgment to the Commissioner. The First Circuit affirmed, holding that the Commissioner’s interpretation of 42 U.S.C. 1383(d)(2)(B) was reasonable. View "Moriarty v. Colvin" on Justia Law

The Supreme Court granted certiorari in this matter to determine whether a retiree of the City of Slidell, plaintiff Dean Born, could continue participating in the City of Slidell's health insurance plan following the City's adoption of Ordinance No. 3493, which required each city retiree to apply for Medicare coverage upon reaching the age of sixty-five. After review, the Supreme Court affirmed the Court of Appeal's finding that the City could not terminate plaintiff's desired plan coverage and require him to accept Medicare coverage, because plaintiff retired before the effective date of the Ordinance. View "Born v. City of Slidell" on Justia Law

In 2009, plaintiff Dr. Ralph Slaughter retired as president of Southern University System (“Southern”) after thirty-five years of service. Upon retirement, the Louisiana State Employees’ Retirement System (“LASERS”) began paying plaintiff retirement benefits. Plaintiff filed suit against Southern for past due wages. The district court ruled that Southern had miscalculated plaintiff’s income base by including supplemental pay plaintiff had received from the Southern University Foundation, and determined plaintiff’s terminal pay (500 hours of unused leave) and retirement should have been calculated only on his annual base salary due from Southern. The court of appeal affirmed on appeal, noting plaintiff “manipulated the system and used his position for his own benefit.” Southern sent a letter to LASERS advising it had committed an error in including supplemental funds in plaintiff’s earnings. Because plaintiff's lawsuit was ongoing at the time, LASERS filed a concursus proceeding seeking to deposit the disputed amount of plaintiff’s benefit in the registry of court pending resolution of the litigation. Plaintiff filed an exception of no cause of action. The district court granted the exception and dismissed the second suit with prejudice. LASERS did not appeal this judgment. After the first suit became final, LASERS sent correspondence to plaintiff advising it intended to retroactively reduce his retirement benefit starting June 1, 2012 “due to an error made by Southern University in the reporting of your earnings.” Relying on La. R.S. 11:192, LASERS maintained it could adjust benefits and further reduce the corrected benefit to recover overpayment within a reasonable number of months. Plaintiff then filed the instant suit against LASERS, seeking a writ of mandamus, injunctive relief, and a declaratory judgment confirming LASERS had no authority or ability to reduce his retirement benefits. The petition alleged plaintiff’s retirement benefits should have been calculated based on the entirety of his earnings over thirty-five years of employment, including salary supplements. The Supreme Court was called on to determine whether the lower courts erred in finding the defendant retirement system failed to prove that it followed the proper procedure before initiating action to reduce and recoup plaintiff’s retirement benefits. The Court found the lower courts did not apply the proper statutory analysis and reached an erroneous result. The case was remanded for further proceedings. View "Slaughter v. Louisiana State Employees' Retirement System" on Justia Law

In December, 2009, Heelan, a Vernon Hills police officer for approximately 20 years, responded to an emergency call, slipped on ice, and fell. He was ultimately diagnosed with significant osteoarthritis in both hips, aggravated by the fall, and had two hip replacement surgeries. He did not return to work. The Village Police Pension Board awarded a line-of-duty disability pension, 40 ILCS 5/3-114.1. The Village sought a declaration that it was not obligated to pay Heelan’s health insurance premium under the Public Safety Employee Benefits Act (the Act), 820 ILCS 320/10. The circuit court entered judgment in favor of Heelan. The appellate court and Illinois Supreme Court affirmed, Proof of a line-of-duty disability pension establishes a catastrophic injury under section 10(a) of the Act as a matter of law; a public safety officer’s employer-sponsored health insurance coverage expires upon the termination of the officer’s employment by the award of the line-of-duty disability pension. The Act lengthens such health insurance coverage beyond the termination of the officer’s employment. View "Village of Vernon Hills v. Heelan" on Justia Law