Justia Government & Administrative Law Opinion Summaries

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

Defendant Christopher Boisvert appealed his conviction for welfare fraud. Defendant was the father of Carrie Gray's two children. He and Gray moved into a Bristol apartment in 2009 or 2010. Defendant's name was removed from the lease at some point prior to late 2010. On December 31, 2010, defendant filed an application for public assistance. On January 14, 2011, he met with a department of health and human services representative and stated that he was homeless and had no resources; he was certified to receive benefits. Defendant was recertified for benefits at six-month intervals, and again reported in June 2011 and December 2011 that he was homeless. Between December 2010 and March 2012, Gray received medical, food stamp, and cash public assistance. The total amount of assistance that she received was calculated based upon a household consisting only of Gray and her children. She would not have been eligible for the same level of benefits if defendant had disclosed that he was living in the apartment. At some point, the special investigations unit of the department of health and human services received an allegation of welfare fraud concerning Gray. After interviewing witnesses and reviewing records provided by Gray and defendant, the investigator concluded that the case should be referred to the county attorney's office. Defendant was subsequently indicted on one count of welfare fraud. Because it was alleged that the value of the fraudulently obtained payments exceeded $1,000, the offense was classified as a class A felony. The case went to trial, and at the close of the State's case, defendant moved to dismiss the charge, arguing that the State had failed to present sufficient evidence that he was living with Gray during the relevant time period. The trial court denied the motion, and the jury found defendant guilty. This appeal followed. He argued on appeal to the Supreme Court that the Superior Court erred by denying: (1) defendant's motion to dismiss that challenged the sufficiency of the evidence; and (2) his request to give an accomplice liability jury instruction. Finding no reversible error, the Supreme Court affirmed. View "New Hampshire v. Boisvert" on Justia Law

Alaura, age 22, was struck in the back of his head by an assailant wielding a bar stool. The blow shattered his skull, necessitating emergency surgery to remove part of his brain and place a metal plate in his skull. During this craniotomy Alaura had a seizure. Alaura has repeatedly seen neurologists, complaining of headaches, dizziness, and confusion, and has been diagnosed with post-traumatic headaches, cognitive impairment, and occipital neuralgia, an injury to or inflammation of nerves that run from the spinal cord at the base of the neck up through the scalp. It causes piercing or throbbing pain in the neck, the back of the head, and the front of the head behind the eyes. A year later, Alaura still complained of daily headaches, “absence-type” seizures several times a week, and back and neck pain. The Seventh Circuit reversed denial of Alaura’s claim for social security disability benefits as premature, stating that the “long list” of severe impairments “don’t sound like trivial obstacles to being able to hold full-time employment.” The administrative law judge’s explanations were “thin,” he made no effort to consider the combined effects on Alaura’s ability to work of all his impairments and limitations. View "Alaura v. Colvin" on Justia Law