Opinion ID: 4707703
Heading Depth: 2
Heading Rank: 2

Heading: Unpublished Decisions

Text: In two appeals in the same case, this Court later considered a pro se veteran’s FTCA lawsuit involving an MRI. See Milbauer v. United States, 587 F. App’x 587, 588 (11th Cir. 2014) (Milbauer I); Milbauer v. United States, 636 F. App’x 556, 557 (11th Cir. 2016) (Milbauer II). The VA staff recommended an MRI. But due to his claustrophobia, Milbauer wanted an “open” MRI, which 28 USCA11 Case: 20-11365 Date Filed: 07/29/2021 Page: 29 of 58 required that the MRI be performed at a non-VA facility. Milbauer I, 587 F. App’x at 588. Milbauer’s complaint “alleged he was entitled to have an open MRI performed at a non-VA facility at the VA’s expense, and he described the numerous problems he had faced in attempting to obtain authorization for the outside MRI.” Id. (emphasis added). He further alleged that the VA staff should have authorized alternative imaging studies to assess his injury. Id. at 589. In the first appeal, this Court concluded that “[t]he district judge could not adjudicate Milbauer’s [MRI] claim ‘without determining first whether [Milbauer] was entitled to a certain level of benefits,’ namely, whether he was entitled to an outside MRI, paid for by the VA.” Id. at 591–92 (emphasis added) (quoting Thomas v. Principi, 394 F.3d 970, 974 (D.C. Cir. 2005)). While this Court acknowledged that the VA had not actually denied the request for an MRI altogether, it observed in dicta that “there is no meaningful legal difference between a delay of benefits [for approval of the outside MRI] and an outright denial of benefits for purposes of the VJRA.” Id. (quoting Mehrkens v. Blank, 556 F.3d 865, 870 (8th Cir. 2009)) (quotation marks omitted). Specifically, the delay between when the VA medical staff recommended the procedure and when Milbauer “finally obtained . . . authorization and received an open MRI at a nonVA facility” was ten months. Id. at 588. Milbauer alleged that the medical staff had deviated from the appropriate standards of medical care by failing “to have the 29 USCA11 Case: 20-11365 Date Filed: 07/29/2021 Page: 30 of 58 appropriate paperwork prepared to authorize the outside MRI for a period of ten months.” Id. at 589 (emphasis added) (quotation marks omitted). As for Milbauer’s alternative-diagnostic-procedures claim, our Court similarly concluded, in the second appeal, that Milbauer had fundamentally contended that “the VA was obligated to provide him with a particular benefit—an alternative imaging procedure to diagnose his shoulder injury—and failure of the VA to provide that benefit caused a delay in his diagnosis.” Milbauer II, 636 F. App’x at 561. Beyond the non-binding nature of these decisions, 9 we note two points. First, the Milbauer case is materially different. This Court said: “Milbauer’s grievance was with the VA’s benefits procedure [for approving outside imaging], not the medical treatment he received.” Milbauer I, 587 F. App’x at 589. In contrast, in Mr. Smith’s case, the VA approved and never disputed his eligibility for and entitlement to the benefits, both inside and outside the VA. Rather, Mr. Smith alleges that the VA’s medical personnel negligently performed the medical care that was approved and committed medical negligence. Second, we recognize that the government cites our dicta in Milbauer I that “there is no meaningful legal difference between a delay in benefits and an outright 9 Unpublished opinions are non-precedential. See Bonilla v. Baker Concrete Const., Inc., 487 F.3d 1340, 1345 n.7 (11th Cir. 2007) (“Unpublished opinions are not controlling authority and are persuasive only insofar as their legal analysis warrants.”). 30 USCA11 Case: 20-11365 Date Filed: 07/29/2021 Page: 31 of 58 denial of benefits.” See Gov’t Br. at 9. But as shown above, the delay in benefits in Milbauer I was getting an outside MRI approved—not a delay in conducting that MRI after it was authorized and approved. See Milbauer I, 587 F. App’x at 588. Our Court actually took that statement from an Eighth Circuit case, Mehrkens v. Blank, involving an adverse denial of benefits that provides context for this statement. Specifically, in Mehrkens, a Vietnam War veteran brought a Bivens 10 action against doctors and employees of the VA. Mehrkens, 556 F.3d at 866. He claimed that “VA officials violated his due-process rights by withholding information from him about his diagnosis of PTSD and preventing him from obtaining proper treatment for that condition.” Id. at 867 Mehrkens alleged that VA officials “lie[d]to him and others about his PostTraumatic Stress Disorder (PTSD)” and “withheld treatment from him.” Id. at 866. Mehrkens filed a benefits claim for military service–connected PTSD, which the VA denied. Id. at 867. The VA determined that “the diagnosis of PTSD was not supported by the details of any service-connected stressor” and that the medical evidence did not show symptoms of PTSD. Id. (quotation marks omitted). After multiple failed attempts to reopen his case, Mehrkens filed a Notice of 10 Bivens v. Six Unknown Named Agents of Fed. Bureau of Narcotics, 403 U.S. 388, 91 S. Ct. 1999 (1971). 31 USCA11 Case: 20-11365 Date Filed: 07/29/2021 Page: 32 of 58 Disagreement, and the VA reversed its prior decisions, granting him “benefits” for PTSD, retroactive to 1992. Id. In rejecting Mehrkens’s Bivens claim, the Eighth Circuit noted that “[i]n this case” there was no meaningful difference between a delay and a denial of benefits. Id. at 870. But that was because “[i]n [that] case,” the delay in Mehrkens’s PTSD benefits was the result of an adverse decision by the VA. The delay was between the initial adverse benefits decision in 1992 and the later approval of PTSD benefits in 2004. See Mehrkens, 556 F.3d at 870 (noting that, had Mehrkens “been granted benefits in 1992 instead of 2004, he would not have brought the current action”). As a result, any court tasked with adjudicating whether the VA personnel violated Mehrkens’s rights would necessarily have to address whether the VA acted properly in denying his PTSD benefits claim in the first instance. In contrast, in Mr. Smith’s case, the VA approved and authorized his benefits, and there was never an adverse benefits decision for a federal court to reexamine. Because no authority from our Court resolves the issues before us, we further review our sister circuits’ decisions cited by the parties.