Justia U.S. 7th Circuit Court of Appeals Opinion Summaries

Articles Posted in Public Benefits
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Zellweger applied for disability benefits in 2013, claiming a per se disabling spinal condition equivalent to Listing 1.04. His amended onset date was August 28, 2013. His last-insured status expired on September 30, 2013, so the application presented a narrow question: whether he was disabled during the one-month period from August 28 to September 30 (42 U.S.C. 416(i)(3)(B)). The primary medical basis for his application was cervical and lumbar degenerative disc disease.An ALJ denied his claim, concluding that the medical evidence did not meet the criteria for Listing 1.04 and that Zellweger could perform light work. A magistrate reversed, ruling that the ALJ’s discussion was too cursory at step three of the sequential analysis prescribed in the agency regulations: assessing whether the claimant has an impairment that meets or medically equals one of the Listings. Although the ALJ explained his reasoning more thoroughly later in his decision, the magistrate refused to consider that discussion.The Seventh Circuit reversed and remanded. The sequential process is not so rigidly compartmentalized. Nothing prohibits a reviewing court from reading an ALJ’s decision holistically. The ALJ thoroughly analyzed the medical evidence at the step in the sequential analysis that addresses the claimant’s residual functional capacity. That analysis elaborated on the more cursory discussion at step three and was easily adequate to support the ALJ’s rejection of a per se disability under Listing 1.04. View "Zellweger v. Saul" on Justia Law

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Lothridge applied for disability insurance benefits and supplemental security income in 2013 when she was 33 years old. She asserted that she was disabled by fibromyalgia, COPD, asthma, and hypertension. She was diagnosed with bipolar disorder, learning disabilities, significant problems with decision-making, moderate problems with social functioning, and problems with remote memory. She had worked as a CNA, a daycare worker, a cashier, and a telemarketer. She had tried, unsuccessfully. to earn her GED. Hip and back pain caused her to stop working in 2009.After an ALJ denied her application, a district judge remanded for further explanation of how the ALJ considered Lothridge’s periodic non-compliance with treatments. The ALJ again denied the application, finding that Lothridge could still perform light work with certain limitations. A district judge affirmed.The Seventh Circuit vacated. In assessing Lothridge’s impairments using the five-step disability analysis, the ALJ found moderate limitations in concentration, persistence, and pace. In determining her residual functional capacity, the ALJ failed to take those limitations into account. The jobs that the ALJ determined that Lothridge could still perform would require the ability to stay on-task for at least 90% of the workday and would have little tolerance for tardiness or absences. The ALJ made no determination of whether Lothridge is capable of meeting these requirements. View "Lothridge v. Saul" on Justia Law

Posted in: Public Benefits
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O’Donnell, represented by attorney Horn, challenged the Social Security Administration’s (SSA) denial of her application for disability insurance benefits. A magistrate remanded the case, awarding O’Donnell $7,493.06 in Equal Access to Justice Act (EAJA), 28 U.S.C. 2412(b), fees, paid to Horn. On remand, an ALJ found that O’Donnell was disabled. SSA determined that she was eligible for benefits dating back several months and withheld 25% of O’Donnell’s past-due benefits, $14,515.37, for possible future payment of fees under 42 U.S.C. 406(a), which authorizes SSA to award a “reasonable fee” to persons who successfully represent claimants in administrative proceedings.Horn filed an unopposed motion for authorization to collect $14,515.37 in section 406(b) fees; having already received the $7,493.06 EAJA award, Horn proposed to keep the EAJA fee, with SSA to pay the balance ($7,022.31), leaving $7,493.06 with SSA for future payment of section 406(a) fees. The magistrate’s order stated that Horn was awarded $14,515.37 under section 406(b), payable by the SSA from the past-due benefits and that “Horn will refund" to O'Donnell $7,493.06, equal to the EAJA award, so that Horn would have to look to O’Donnell, not SSA, to satisfy any future section 406(a) fees. An ALJ subsequently awarded Horn $4,925.21 under section 406(a); he had to seek that amount from O’Donnell. The Seventh Circuit affirmed. No statute requires that the court order netting; the Savings Provision contemplates a refund by the attorney. View "O'Donnell v. Saul" on Justia Law

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Alleging debilitating pain in her back, legs, and hands, Zoch sought disability insurance benefits, 42 U.S.C. 413, 423. An ALJ denied the application, finding that, based on the opinions of three of her four treating physicians, a consulting physician, and the objective medical evidence, she could perform sedentary work.The district court and Seventh Circuit affirmed, rejecting Zoch’s arguments that the ALJ improperly discounted her assertions and an opinion by a physician who relied on those assertions. Substantial evidence supports the ALJ’s decision. Zoch’s testimony of incapacitating pain conflicted with the objective medical evidence, including normal test results: lumbar MRI, wrist x-rays, range of motion, straight-leg raising, strength in extremities, and pressure on her nerves. Zoch’s testimony that she usually walked with a cane conflicted with the doctors’ reports that at all but one appointment she walked normally. Zoch’s testimony that she could not raise her arms or bend over to dress conflicted with a doctor’s observation that Zoch could comfortably bend over to touch her fingertips to her knees. Zoch’s hearing testimony that she could not perform the usual activities of daily living was inconsistent with her assertions in her application. View "Zoch v. Saul" on Justia Law

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The Randolph-Sheppard Act, 20 U.S.C. 107(a), provides economic opportunities by granting blind persons priority to operate vending facilities at certain government properties. When a blind vendor, Belsha, was awarded certain vending operations in Racine County, Wisconsin, a different blind vendor, Taylor, became unhappy and challenged the award. The Act is administered by state licensing agencies; Taylor’s challenge traveled first through Wisconsin’s regulatory process. Although Taylor achieved some success through the Wisconsin Division of Vocational Rehabilitation, she commenced federal administrative proceedings with the Secretary of Education. An arbitration panel awarded Taylor money damages and a permanent vending machine services contract for a site in Racine.The district court vacated the arbitration decision, ruling that there were no material deficiencies in the choice of Belsha for the Racine site, that the arbitration panel’s key factual findings were not supported by substantial evidence, and the arbitration panel’s ultimate conclusion was arbitrary and capricious. The Seventh Circuit affirmed. The arbitration panel mistakenly substituted the APA standard of review for the burden of proof of a disappointed vendor under the Act. View "Wisconsin Department of Workforce Development v. Taylor" on Justia Law

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Most people eligible for Medicaid benefits are “categorically needy” because their income falls below a threshold of eligibility. People with higher income but steep medical expenses are “medically needy” once they spend enough of their own assets to qualify, 42 U.S.C. 1396a(a)(10). Plaintiffs contend that medical expenses they incurred before being classified as “medically needy” should be treated as money spent on medical care, whether or not those bills have been paid, which would increase Illinois's payments for their ongoing care.The Seventh Circuit affirmed the dismissal of their suit. Medicaid is a cooperative program through which the federal government reimburses certain expenses of states that abide by the program’s rules. Medicaid does not establish anyone’s entitlement to receive particular payments. The federal-state agreement is not enforceable by potential beneficiaries. Plaintiffs bypassed their administrative remedies and do not have a judicial remedy under 1396a(r)(1)(A). Section 1396a(a)(8) provides that a state’s plan must provide that all individuals wishing to apply for medical assistance under Medicaid shall have the opportunity to do so and that assistance shall be furnished with reasonable promptness to all eligible individuals; some courts have held that this requirement can be enforced in private suits. If such a claim were available, it would fail. Plaintiffs are receiving benefits. The court also rejected claims under the Americans with Disabilities Act, 42 U.S.C. 12131–34, and the Rehabilitation Act, 29 U.S.C. 794. Plaintiffs receive more governmental aid than nondisabled persons. View "Nasello v. Eagleson" on Justia Law

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Beeler, a dual citizen of Canada and the U.S., worked in Canada for 19 years and contributed to the Canada Pension Plan. In 1989 Beeler moved to the U.S. Until she retired in 2013, she worked and paid Social Security taxes. Beeler’s Canadian earnings were not subject to Social Security taxes; her U.S. earnings were not subject to Canada Plan taxes. Beeler has received Canada Pension Plan benefits since 2013. In 2013, Beeler was awarded reduced Social Security retirement benefits because she was entitled to Canada Pension Plan benefits based on work not covered by Social Security taxation.Rejecting claims that the reductions did not apply to Beeler and similarly-situated plaintiffs, the Seventh Circuit affirmed summary judgment in favor of the government. The windfall elimination provision, 42 U.S.C. 415(a)(7)(A)(ii), states that an individual who becomes eligible for a monthly payment “which is based in whole or in part upon his or her earnings for service which did not constitute ‘employment’ as defined in [42 U.S.C. 410]” shall have their benefits recomputed. The provision excludes in part “payment by a social security system of a foreign country based on an agreement between the United States and such foreign country" under 42 U.S.C. 433. The plaintiffs’ work in Canada is not considered “employment” under section 410, so section 415 reduces their Social Security benefits. The agency’s interpretations of the provision and its implementing regulation and its application of the provision to reduce their benefits were permissible. View "Lorraine Beeler v. Andrew M. Saul" on Justia Law

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Peeters sought disability benefits, citing degenerative disc disease in the lumbar spine, degenerative joint disease of the right shoulder, depressive disorder, post-traumatic stress disorder, generalized anxiety disorder, and learning disabilities. Peeters has not sustained gainful employment since 2014. After a hearing, an ALJ denied Peeters disability benefits in 2016. On stipulated remand, the Appeals Council instructed the ALJ to reconsider Peeters’ maximum residual functional capacity, obtain evidence and examples of jobs Peeters could perform from a vocational expert, provide a new hearing, and issue a new decision. At the second hearing in 2018, the ALJ issued a 15-page decision denying Peeters disability benefits because he failed to meet the severity requirements of 20 C.F.R. pt. 404 and 20 C.F.R. pt. 416.The district court and Seventh Circuit affirmed the denial as supported by substantial evidence. The court upheld the greater weight given to the opinions of six state agency psychologists who evaluated Peeters; three found Peeters would have moderate limitations completing a normal workday and carrying out detailed instructions, but could handle simple two to three-step instructions, while three found Peeters capable of performing light work. View "Peeters v. Saul" on Justia Law

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Brace, now age 40, was injured on the job in 2013 and can no longer perform his past work in health service, food service, and construction. He applied for Social Security disability benefits, claiming persistent back and neck pain and several other conditions. An ALJ found that Brace’s severe impairments from degenerative disc disease, neuropathy in the elbow and forearm, and a history of surgery in his shoulder. did not presumptively establish a disability. The ALJ ruled that Brace could not perform any of his past work. A vocational expert testified that Brace could perform jobs as a callout operator, semiconductor bonder, or registration clerk, or a counter clerk, subject to restrictions and that a significant number of jobs exist across those job categories—an estimated 140,000. Brace’s lawyer asked the vocational expert to explain how he arrived at his job estimates; the answer was inscrutable. The ALJ nonetheless accepted his testimony and rejected Brace’s claim for benefits.The Seventh Circuit reversed. The ALJ’s approach does not satisfy the substantial evidence standard. The court rejected the ALJ’s justifications that Brace’s counsel should have objected to the expert’s qualifications before he testified and that the cited jobs number was so large that “[e]ven if the methodology used create[d] a significant margin of error[,] … a significant number of jobs exist.” View "Brace v. Saul" on Justia Law

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Vaughn, a quadriplegic, has received home‐based care for over 30 years. She requires help with personal care, household maintenance, mobility exercises, transportation, medications, suctioning secretions from her tracheostomy, and use of the ventilator. When nursing shifts cannot be staffed, Vaughn has relied on friends. Indiana funded her care through two federally-reimbursed Medicaid programs: A&D waiver and core Medicaid. Vaughn could select her own caregivers to receive A&D waiver funds but could not personally direct nursing care funded through core Medicaid. In 2016, Vaughn was hospitalized with pneumonia. She was cleared to be discharged but the state could not find nurses to provide round‐the‐clock care at home at Medicaid rates Vaughn was transferred to a nursing home and filed suit under the Americans with Disabilities Act, 42 U.S.C. 12132; the Rehabilitation Act, 29 U.S.C. 794; and the Medicaid Act, 42 U.S.C. 1396a(a)(8). The court granted Vaughn summary judgment with an injunction requiring the state to “do whatever is necessary to achieve” round‐the‐clock home‐based care, fully paid for by the state.The Seventh Circuit vacated. Vaughn is not entitled to the services she has requested under Indiana’s version of the Medicaid program, as the program was structured before the state adopted a new pilot program. The state is not obligated to reimburse Vaughn’s providers at rates above the approved Medicaid caps, nor must it use funds outside the Medicaid program to comply with a rule about accommodation within the program. View "Vaughn v. Walthall" on Justia Law