Articles Posted in Public Benefits

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Neighbors is a skilled nursing facility participating in Medicare and Medicaid. The Centers for Medicare and Medicaid Services (CMS) determined that Neighbors inadequately addressed sexual interactions between three cognitively impaired residents and that Neighbors’ failure to act put the residents in “immediate jeopardy,” and issued Neighbors a citation and an $83,800 penalty under 42 U.S.C. 1395i‐3(h)(2)(B)(ii)(I). An ALJ and the Department of Health and Human Services Departmental Appeals Board upheld the decision. The Seventh Circuit affirmed, concluding that substantial evidence supports the Agency’s determinations and rejecting claims that the sexual interactions were consensual. The court noted findings that staff, aware of the sexual interactions, did not talk to the residents about their feelings about these “relationships”; did not document the residents’ capacity for consent (or lack thereof) or communicate with residents’ physicians for medical assessment of how their cognitive deficits impacted that capacity; did not discuss the developments with the residents’ responsible parties; and did not record any monitoring of the behaviors or make any care plans to account for them. Neighbors’ non‐intervention policy prevented any real inquiry into consent, except in the extreme situation where a resident was yelling or physically acting out. View "Neighbors Rehabilitation Center, LLC v. United States Department of Health and Human Services" on Justia Law

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Hardy, a 55-year old man who worked previously as a maintenance mechanic, had a discectomy in 2005 and a lumbar spinal fusion in 2006. His previous application for Disability Insurance Benefits was denied in 2012. Hardy filed another application for DIB benefits, claiming an onset date of April 2012. The agency denied Hardy’s claim; state-agency doctors reviewed Hardy’s file and determined that he had postural limitations, could frequently lift up to 10 pounds and could stand or walk for six hours during a workday so that Hardy could perform light work. His treating doctors reported that Hardy was unable to work and that his “legs give out and he tends to fall.” In concluding that Hardy was not disabled, an ALJ determined that Hardy had not engaged in substantial gainful employment since his alleged onset date; that his conditions were severe impairments; that these conditions did not equal a listed impairment; that he had the residual functional capacity to perform light work, with limitations; and that he could work as a wire assembler, assembly press operator, circuit board screener, or finish assembler. The Seventh Circuit vacated the denial of benefits. A treating doctor’s opinion generally is entitled to controlling weight if it is consistent with the record, and it cannot be rejected without a “sound explanation.” The ALJ impermissibly discounted the opinions of Hardy’s treating neurosurgeon. View "Hardy v. Berryhill" on Justia Law

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Ashby’s son was a member of his elementary school choir. In 2014 and 2015, the choir performed a Christmas concert at a local museum in a historic building. The building was not then accessible to persons with disabilities. Ashby, who uses a wheelchair, was unable to attend the concerts. She sued the School Corporation, alleging discrimination under the Americans with Disabilities Act, 42 U.S.C. 12132, and the Rehabilitation Act. The district court concluded that the Christmas concert was not a “service, program, or activity of” the Warrick Schools, nor was the concert an activity “provided or made available” by the School Corporation and granted summary judgment. The Seventh Circuit affirmed, accepting the Department of Justice’s suggestion that when a public entity offers a program in conjunction with a private entity, the question of whether a service, program, or activity is one “of” a public entity is fact-based and that there is a “spectrum” of possible relationships ranging from a “true joint endeavor” to participation in a wholly private event. The Department’s interpretation of its regulations is a reasonable one that offers a loose but practical framework that aids in decision-making. Upon close examination of the record, it is clear that the event in question was not a service, program, or activity provided or made available by the School Corporation. View "Ashby v. Warrick County School Corp" on Justia Law

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The Seventh Circuit affirmed the district court's denial of disability insurance benefits to plaintiff. The court held that substantial evidence supported the ALJ's decision to deny benefits where the opinion's of plaintiff's treating physician were inconsistent with the opinions from other doctors, and the physician's opinions lacked detail and did not show that he knew of the functional capacity evaluation from 2008. Furthermore, the ALJ did not improperly discount plaintiff's own testimony where the ALJ found plaintiff not fully credible for many specific reasons supported by the evidence. View "Hall v. Berryhill" on Justia Law

Posted in: Public Benefits

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Barrett applied for disability insurance benefits and supplemental security income based on limitations from bipolar disorder and alcohol addiction. If an administrative law judge (ALJ) had found him disabled, then Barrett would shoulder the burden of showing that his alcoholism was not material to his disability. An ALJ found that he was not disabled, however, even considering his alcohol addiction, and denied him benefits. The district court and Seventh Circuit affirmed, noting that the ALJ determined that Barrett’s impairments, including his alcoholism, taken together were at most moderately limiting, and that he could have sustained full-time employment. That conclusion is supported by substantial evidence: Barrett performed in workplace-like settings tasks such as summarizing depositions and medical records and maintaining attendance records of 100 people. He also sat for the LSAT—though the ALJ emphasized his “above-average” score when it was in fact below average, the fact that he sat for the test and achieved the score he did was consistent with someone capable of working. View "Barrett v. Berryhill" on Justia Law

Posted in: Public Benefits

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Plessinger was born with congenital spinal stenosis. He began experiencing back pain in 2010, at age 23. He worked as a diesel mechanic, electric lineman, fast food worker, welder, and truck driver. A 2012 accident exacerbated a prior injury from falling at work. He had surgery for a disc rupture in 2013. Later in 2013, in connection with Plessinger’s application for Social Security disability benefits, non‐examining consultants assessed his residual functional; one determined that Plessinger had the residual functional capacity to perform light work, another determined he could perform only sedentary work. Plessinger was later diagnosed with failed back surgery syndrome. In 2014, a doctor determined that Plessinger could walk only 20-30 feet and could stand for only five minutes. An ALJ found that he was severely impaired by his lumbar degenerative disc disease and stenosis, thoracic degenerative disc disease, obesity, and systemic hypertension but found the impairments not disabling. The Seventh Circuit reversed. In the face of the great weight of medical evidence supporting Plessinger’s claims of disabling impairments, the ALJ gave undue weight to the opinion of a medical expert who did not examine Plessinger and hedged his opinion in a critical way that was never resolved. The ALJ’s decision to discount the credibility of Plessinger's complaints of pain was not supported by substantial evidence. View "Plessinger v. Berryhill" on Justia Law

Posted in: Public Benefits

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The Social Security Administration (SSA) reduced the payment of a back-award that it owed Berg by the amount of an earlier overpayment that Berg owed to SSA. Berg contested this setoff because it was taken during the 90-day period before the filing of her bankruptcy petition. The bankruptcy court concluded that SSA permissibly recovered $17,385 of overpayment but impermissibly improved its position by $2,015. The Seventh Circuit affirmed. Under 11 U.S.C. 553(b)(2), a debtor (Berg) may recover from a creditor (SSA) an amount set off by the creditor in the 90 days preceding the filing of the bankruptcy petition only to the extent that the creditor improved its position during that 90-day period. The bankruptcy court correctly calculated the accrual of Berg’s benefits as occurring on the dates that she had a right to benefits--the last day of each month that she was eligible for benefits and survived to the end of the month. On May 9, 2014, 90 days before the filing of the petition, that amount was $17,385. Because Berg then owed SSA $19,400, the insufficiency on that date was $2,015. On July 30, the date the SSA took the setoff, Berg still owed SSA $19,400, but SSA owed her $20,307; SSA improved its position by $2,015 during the 90-day preference period. That is the amount that Berg may now recover. View "Berg v. Social Security Administration" on Justia Law

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Walker has degrees in robotics and electrical engineering and worked for 21 years, primarily as an engineer, before suffering a stroke in 2008. Walker was not able to return to work after his stroke. Medical records show that his physical and cognitive condition has gradually worsened since 2008. In 2012, medical professionals documented his cognitive and memory deficits, and difficulty with balance and walking, dizziness. By 2013 Walker was unable to live alone and moved in with his mother. The Social Security Administration determined that Walker became disabled in December 2014. An ALJ, in a separate proceeding, determined that Walker was not disabled before that date. The district court affirmed. The Seventh Circuit vacated and remanded. The ALJ’s conclusion sweeps too broadly by not accounting for medical and other evidence strongly suggesting that Walker’s condition and residual functional capacity had worsened to such a degree that he became disabled by approximately the middle of 2012. View "Walker v. Berryhill" on Justia Law

Posted in: Public Benefits

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Penrod applied for disability benefits and supplemental security income in 2010, at age 45, after having a heart attack. The district court affirmed the denial of benefits. Penrod filed a second application for disability insurance benefits only, alleging that he was disabled because of arthritis, diabetes, high blood pressure, high cholesterol, short‐term memory loss, and asthma, from April 2012-June 2013. Medical evidence was sparse. After his heart attack, Penrod received a stent and regular follow‐up care. Penrod’s poverty and lack of health insurance complicated his treatment. After reviewing Penrod’s medical records, two consultative doctors agreed that he could perform light work, with postural and environmental limitations. At a hearing, Penrod focused on the difficulty of finding a job with his limited education, noting his inability to stand or sit for prolonged periods, limited grip, fatigue and dizziness from his medications, pain in his hips and back, and kidney stones. He had suffered another heart attack in 2014. After the hearing, Penrod died from cardiac arrest. The ALJ denied Penrod’s application, finding that although Penrod’s impairments could result in the types of symptoms he alleged, the medical evidence did not support his testimony about his limitations. The ALJ noted Penrod’s smoking and his frequent reports that he was unable to afford medications and recommended tests in assessing his credibility. The Seventh Circuit affirmed. Substantial evidence supported a finding that Penrod retained the capacity to work through his last insured date. View "Penrod v. Berryhill" on Justia Law

Posted in: Public Benefits

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Spicher suffers from osteoarthritis, degenerative disc disease, chronic obstructive pulmonary disease, fibromyalgia, and morbid obesity. In 2010, Spicher applied for Social Security Disability Insurance Benefits and Supplemental Security Income dating back to 2003. After a 2012 hearing, an ALJ found that Spicher was not disabled from 2003-2012. The district court remanded because the ALJ had not properly considered the limitations imposed by Spicher’s obesity, independently and in combination with her other impediments. On remand, Spicher focused on whether she had been disabled since December 2008, when her insured status expired. The ALJ consulted a second doctor who essentially adopted the findings of the medical reports already in the record. The ALJ stated that further consideration of Spicher’s obesity had not motivated her to change her conclusion, finding that Spicher could hold a sedentary position and perform three jobs identified by a vocational expert, and could occasionally crouch, crawl, balance, stoop, and kneel. The Seventh Circuit reversed, finding that the decision was not supported by substantial evidence. The ALJ did not address contradictory medical evidence when determining the types of sedentary jobs that Spicher could hold and failed to consider the interaction between her obesity and her non‐severe impairments. The court rejected a claim that the ALJ displayed antagonism toward Spicher in violation of her due process rights. View "Spicher v. Berryhill" on Justia Law