Articles Posted in Public Benefits

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Presumptive service connection exists for veterans who served in the Persian Gulf War and have chronic: undiagnosed illness; medically unexplained chronic multisymptom illness (MUCMI); or any diagnosed illness as determined by the Secretary, 38 U.S.C. 1117(a)(2). VA regulations define MUCMI as “a diagnosed illness without conclusive pathophysiology or etiology, that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. Chronic multisymptom illnesses of partially understood etiology and pathophysiology, such as diabetes and multiple sclerosis, will not be considered medically unexplained.”. Both the statute and regulation identify sleep disturbances and signs or symptoms involving the respiratory system as possible MUCMI manifestations. The VA revised its M21-1 Manual, changing the definition of MUCMI to require “both an inconclusive pathology, and an inconclusive etiology.” Under the subsection “Signs and Symptoms of Undiagnosed Illnesses or MUCMIs,” the VA added, “Sleep apnea cannot be presumptively service-connected (SC) under the provisions of 38 C.F.R. 3.317 since it is a diagnosable condition.” The Federal Circuit dismissed a veterans’ group’s petition for review for lack of jurisdiction, reasoning that the revisions are not binding and not reviewable under 38 U.S.C. 502. View "Disabled American Veterans v. Secretary of Veterans Affairs" on Justia Law

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Snyder represented a veteran, Beck, under a 2001 fee agreement (38 U.S.C. 5904). Eight months later, Snyder requested the Board of Veterans’ Appeals to cancel his fee agreement. In 2003 the VA awarded past-due benefits based on a 100% disability rating effective 1992. Snyder sought attorney fees. A VA regional officer (RO) determined that Snyder was entitled to $41,920.47, deductible from the past-due benefits. Beck filed notice of disagreement. Beck died. His widow sought to recover the disputed fees as accrued benefits. The RO denied that request. The Board dismissed Beck’s dispute over attorney fees, citing 38 C.F.R. 20.1302, and remanded Mrs. Beck’s claim. The RO determined Mrs. Beck could not recover the disputed attorney fees because her husband’s claim ceased to exist upon his death. She appealed. The VA’s General Counsel published a precedential opinion stating: A claim, pending at the time of a veteran’s death, challenging an attorney’s entitlement to payment of attorney fees under section 5904 from the veteran’s retroactive periodic monetary benefits may provide a basis for an accrued benefits claim under section 5121, because such a claim concerns entitlement to periodic monetary benefits allegedly due and unpaid to the veteran at the time of death. The Federal Circuit dismissed Snyder’s appeal. That 38 C.F.R. 20.1302 requires dismissal of a veteran’s appeal upon his death has no bearing on a claimant’s separate entitlement to accrued benefits under section 5121. The attorney fee dispute remains pending. View "Snyder v. Secretary of Veterans Affairs" on Justia Law

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Ollis, a veteran, sought disability benefits under 38 U.S.C. 1151, which provides benefits for certain injuries incurred as a result of VA medical care. Ollis suffers from atrial fibrillation and claims a disability resulting from complications of a heart procedure to treat that condition. The procedure (miniMAZE) was allegedly recommended by a VA doctor but was performed by a private doctor. The VA denied Ollis’s application for benefits. The Board of Veterans’ Appeals and the Court of Appeals for Veterans Claims affirmed. The Federal Circuit vacated in part, remanding the question of whether Ollis’s VA doctors were negligent by recommending the mini-MAZE procedure to him. The Veterans Court focused on whether VA medical treatment caused Ollis to utilize Dr. Hall and Methodist Medical Center, rather than on whether VA medical treatment caused him to have the mini-MAZE procedure itself. On remand, the Veterans Court must also address the “not reasonably foreseeable” and “proximate cause of the disability” requirements. The court affirmed rejection of an argument that VA’s failure to provide him notice that a referral to a private facility for his miniMAZE procedure could extinguish his eligibility for benefits constituted a violation of his right to due process. View "Ollis v. Shulkin" on Justia Law

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Monk served in the Marine Corps during the Vietnam War. In 2012, Monk sought VA disability benefits, alleging service-connected PTSD, diabetes, hypertension, and strokes. The VA denied the claim, finding that his discharge was “other than honorable.” Monk filed a Notice of Disagreement (NOD) and separately applied to the Board of Correction of Naval Records (BCNR) to upgrade his discharge status. In 2015, the VA informed Monk that it could not process his appeal until it received BCNR records. Monk sought a writ of mandamus with Veterans Court and requested that the court certify a class of all veterans who had applied for VA benefits, had timely filed an NOD, had not received a decision within 12 months, and had demonstrated medical or financial hardship (38 U.S.C. 7107(a)(2)(B)–(C)). The Veterans Court denied the request for class certification, denied another veteran’s request to join the action, and ordered the VA to respond to Monk’s petition regarding the denial of disability benefits. BCNR then granted Monk an upgraded discharge status. The Federal Circuit reversed the denial of class certification, finding that the Veterans Court has authority to certify a class for a class action and to maintain similar aggregate resolution procedures with respect to benefit denials. View "Monk v. Shulkin" on Justia Law

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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

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In 2014, the Board of Veterans Appeals denied Parrott’s claims for benefits on account of her veteran husband’s esophageal adenocarcinoma, with liver and peritoneal metastasis, and his ensuing death. The Veterans Court vacated and remanded. Parrott then timely sought attorney fees and expenses under the Equal Access to Justice Act (EAJA), 28 U.S.C. 2412. The Veterans Court awarded her $4,050. The Federal Circuit affirmed, rejecting arguments that, in arriving at its award of attorney fees, the Veterans Court misinterpreted EAJA and adopted an incorrect approach for determining the cost of living adjustment to be used in calculating her attorney’s hourly rate and that the court then abused its discretion by not allowing her to resubmit her application using the approach the court had adopted. EAJA states that “attorney fees shall not be awarded in excess of $125 per hour unless the court determines that an increase in the cost of living . . . justifies a higher fee.” The court properly rejected Parrott’s request for a cost of living increase, based on Washington D.C., based on the location of the Veterans Court and applied rates based on the locations of her attorney’s offices in San Francisco, Dallas, and Little Rock. View "Parrott v. Shulkin" on Justia Law

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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

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In 2003, following a physical examination, Contreras, 13 years old, received the Tetanus-Diphtheria and Hepatitis B vaccines. About 24 hours later, he was diagnosed with atypical Guillain-Barre Syndrome (GBS), a peripheral nervous system disease that causes descending paralysis. Three months later, Contreras was discharged from the hospital with a diagnosis of Transverse Myelitis (TM), an inflammatory disease of the spinal cord. His petition for compensation under the Vaccine Act, accompanied by an expert report indicating that he developed both conditions as a result of the vaccines, was denied, on the basis that the time interval between the administration of Contreras’s vaccines and the onset of TM was too short to establish causation. Contreras submitted the expert report of pediatric neurologist concerning his rapid adverse immunological response. In 2012, a Special Master concluded that Contreras failed to establish that the TM arose within a “medically appropriate” timeframe. Following a remand from the Claims Court, the government disclosed that the medical license of its expert (Sladsky) was suspended during the time that he had provided witness services in this case. The Special Master again denied compensation, stating that Sladky’s opinion “retain[ed] some value” and that Contreras did not suffer from GBS—a violation of the court’s instruction to refrain from diagnosing Contreras. The Claims Court again remanded, with instructions to address Sladky’s credibility in light of his misrepresentations and to issue an alternative ruling that disregards Sladky’s testimony. The Special Master denied compensation. The Claims Court denied review based on the time interval. The Federal Circuit vacated. The Special Master improperly diagnosed Contreras and failed to consider evidence relevant to his GBS. View "Contreras v. Secretary of Health & Human Services" on Justia Law

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Aldridge served on active duty in the U.S. Marine Corps, 1984-1992, and was denied a disability rating higher than 10% for patellofemoral syndrome on his knees in 2013. The Board of Veterans Appeals informed Aldridge that he had 120 days to file a notice of appeal with the Veterans Court, 38 U.S.C. 7266(a), by April 23, 2014. The Veterans Court received his notice on October 27, 2014. Aldridge acknowledged that his appeal was late, but argued that deaths in his family and his resulting depressive state prevented him from timely filing. His mother died on September 27, 2013; his daughter gave birth to a stillborn child on December 16; and his sister died on January 14, 2014. He asked the court to apply the doctrine of equitable tolling. The court determined that Aldridge had failed to demonstrate that his family’s losses “themselves directly or indirectly affected the timely filing of his appeal,” noting that Aldridge closed the estates of his deceased mother and sister, became his father’s primary caregiver, maintained his job at a Veterans Affairs hospital, and attempted to hire a lawyer during the time at issue. The Federal Circuit affirmed, upholding the Veterans Court’s application of a legal standard that required proof of causation. View "Aldridge v. McDonald" on Justia Law

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In 1985-1986, Kerrigan was a Navy carpenter. He injured his back and was awarded workers’ compensation benefits by the Office of Workers Compensation (OWCP). In 1993, Kerrigan raised concerns regarding his benefits. Over several years, Kerrigan made multiple requests, some of which were denied. In 2001, Kerrigan contacted the Department of Labor Office of Inspector General (OIG) alleging that DOL employees had based one denial on a form that they falsified or destroyed. The OIG did not investigate, but forwarded the letter to OWCP. Kerrigan pursued, over several years, a suit against DOL for illegal termination of benefits and a suit against the physician who reviewed his medical records. Both were dismissed. In 2013, Kerrigan filed a complaint with the U.S. Office of Special Counsel, which chose not to investigate, but referred him to the Merit Systems Protection Board, where Kerrigan alleged retaliatory termination of benefits. The ALJ dismissed Kerrigan’s appeal, stating that the Whistleblower Protection Act only covers actions taken by an agency concerning its own employees. The Board stated that 5 U.S.C. 8128(b) provides that benefits determinations are within the exclusive jurisdiction of the DOL and are unreviewable and that Kerrigan failed to nonfrivolously allege that his protected disclosures were a contributing factor in the decision to terminate benefits. The Federal Circuit affirmed. While 5 U.S.C. 8128(b) does not bar review, Kerrigan failed to nonfrivolously allege that his protected disclosure was a contributing factor in the decision. View "Kerrigan v. Merit Sys. Protection Bd." on Justia Law