Articles Posted in Public Benefits

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The Fourth Circuit vacated the district court's decision affirming the denial of plaintiff's application for supplemental security income (SSI). The court held that the ALJ erred by not sufficiently explaining the reasoning underlying plaintiff's residual functional capacity evaluation. Furthermore, the ALJ neither identified nor resolved an apparent conflict between the testimony of a vocational expert and the Dictionary of Occupational Titles. Accordingly, the court remanded for further proceedings. View "Thomas v. Berryhill" on Justia Law

Posted in: Public Benefits

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Nursing Homes, on behalf of eleven residents, filed suit against the Secretaries, alleging that the Secretaries wrongfully denied the residents Medicaid benefits in violation of the Fourteenth Amendment and several federal statutes. The Fourth Circuit affirmed the district court's dismissal of the complaint for lack of subject matter jurisdiction and failure to state a claim. The court held that the Eleventh Amendment barred the Nursing Homes' constitutional and Medicaid Act claims for damages or other relief based on past actions; the Nursing Homes' claims for declaratory and injunctive relief were moot and required dismissal because the court lacked subject matter jurisdiction; and, because the Nursing Homes failed to state a viable Americans with Disabilities Act claim, they failed to state a cognizable Rehabilitation Act claim. View "Wicomico Nursing Home v. Padilla" on Justia Law

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The Fourth Circuit affirmed the district court's grant of summary judgment to the school district in an action under the Individuals with Disabilities Education Act (IDEA), alleging that the school district failed to provide plaintiff, a former student, with a free appropriate public education (FAPE). The court held that the school district committed a procedural violation of the IDEA by failing to respond to parents' requests and conduct a timely evaluation of whether the student was eligible for special education or related services. Nonetheless, plaintiff failed to show that this defect in the process had an adverse effect on his education. Therefore, plaintiff was not actually deprived of a FAPE. View "T.B. v. Prince George's County Board of Education" on Justia Law

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The Fourth Circuit vacated the Social Security Administration's denial of plaintiff's application for disability insurance benefits. The court held that the ALJ erred by not according adequate weight to a prior disability determination by the North Carolina Department of Health and Human Services. Accordingly, the court remanded the case with instructions to vacate the denial of benefits and remanded for further administrative proceedings. View "Woods v. Berryhill" on Justia Law

Posted in: Public Benefits

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The Fourth Circuit vacated the district court's judgment affirming the denial of disability benefits to plaintiff. The court agreed with plaintiff and held that the ALJ improperly assessed the medical opinion evidence and disregarded the treating physician rule in rendering his residual functioning capacity (RFC) determination and finding that plaintiff could persist through an eight-hour workday. Accordingly, the court remanded for further proceedings. View "Brown v. Commissioner Social Security Administration" on Justia Law

Posted in: Public Benefits

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Plaintiff appealed the denial of her application for disability insurance benefits and supplemental security income. The Fourth Circuit held that the ALJ did not give appropriate weight to the opinions of plaintiff's treating physicians and failed to adequately explain his decision to deny her benefits. Accordingly, the court vacated and remanded for further proceedings. View "Lewis v. Berryhill" on Justia Law

Posted in: Public Benefits

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Social security survivors' benefits are a thing of value of the United States that can support a conviction under 18 U.S.C. 641. Viewed in the light most favorable to the government, the Fourth Circuit concluded that substantial evidence supported defendant's conviction for theft of government property beyond a reasonable doubt. In this case, the jury could reasonably infer from two denied benefits applications that defendant had a motive to file under a different benefits program to again attempt to obtain benefits to which he was not entitled. Finally, the district court's trial management was reasonable and far from an abuse of discretion. Accordingly, the court affirmed the judgment. View "United States v. Kiza" on Justia Law

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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

Posted in: Public Benefits

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An ALJ found that Jerry Addison was entitled to benefits under the Black Lung Benefits Act, 30 U.S.C. 901-944, because he had established the existence of clinical and legal pneumoconiosis that resulted in a total respiratory disability. Sea-B, Addison's former employer, filed a petition for review of the ALJ's decision. The court concluded that the ALJ’s decision to exclude the additional CT scan evidence was not harmless. This error affects the determination of both clinical and legal pneumoconiosis and impacts the ALJ’s consideration of the other evidence in this case. The omitted CT scan evidence is unquestionably probative of the central issue in dispute: whether Addison suffered from pneumoconiosis. Furthermore, the court could not determine from the ALJ’s sparse explanation how, or if, he weighed the x-ray readings in light of the readers’ qualifications. Finally, because the proffered explanation for elevating Dr. Forehand’s diagnosis is not supported, the ALJ must reevaluate that opinion to determine the proper weight it should be given. Accordingly, the court granted the petition for review, vacated the order, and remanded for further proceedings. View "Sea "B" Mining Co. v. Addison" on Justia Law

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Relators filed suit against medical laboratory businesses in 2007 in state court, alleging that the labs had submitted false claims to the Commonwealth for Medicaid reimbursement. Defendants removed to federal court. After the Commonwealth entered into a settlement agreement with defendants, the district court awarded relators a share of the settlement proceeds. Relators appealed, contending that the district court's award was insufficient under state law. The court vacated and remanded to the state court, concluding that the district court lacked subject matter jurisdiction over the qui tam action. In this case, by the plain terms of the complaint, relators could have prevailed on their state law claims by proving that defendants contravened the Commonwealth’s Medicaid regulations, without showing any violation of federal law. View "Commonwealth of Virginia ex rel. Hunter Labs. v. Commonwealth of Virginia" on Justia Law