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

Akin, a 47-year-old woman, claims that she became disabled in 2011 principally from fibromyalgia, back and neck pain, and headaches. An administrative law judge denied her application for Supplemental Security Income. The Seventh Circuit remanded, based on Akin’s arguments that the ALJ wrongly discounted her allegations of back pain; improperly credited the opinions of agency physicians who had not reviewed all of the medical records, including relevant MRI scans; and ignored her complaints of headaches. The ALJ impermissibly “played doctor” by impermissibly interpreting the MRI results himself. The ALJ should have developed a more fulsome record about Akin’s testimony of pain before discounting it and improperly discredited Akin because of her conservative course of treatment. View "Akin v. Berryhill" on Justia Law

RTSI produces and maintains traffic safety systems. Rosenberg was RTSI’s Vice President of Sales. RTSI contracted to manage Chicago's automated red light enforcement program. In 2012, the Chicago Tribune published articles, disclosing an improper relationship between a city employee (Bills) and RTSI. The city removed RTSI’s bid for the new contract. The City Office of Inspector General (OIG) investigated the bribery scheme. RTSI conducted an independent investigation and provided OIG with information. OIG advised Rosenberg that he had a duty to cooperate and that his statements would not be used against him in a criminal proceeding. Rosenberg described the bribery scheme between RTSI and Bills. RTSI terminated Rosenberg’s employment.The Tribune reported that RTSI courted Bills with thousands of dollars in free trips. Rosenberg sued RTSI under the qui tam provision of the City’s False Claims Ordinance, alleging that RTSI engaged in bribery and other illegal activities to obtain a city contract. The city intervened, making additional claims. The court dismissed Rosenberg as relator. The remaining parties settled and moved for dismissal with prejudice. Rosenberg unsuccessfully sought an award of a relator’s share of the settlement and attorney’s fees for his lawyer’s contributions to the case. The Seventh Circuit affirmed, noting that Rosenberg helped to perpetrate the fraud and referring to Rosenberg’s “audacity.” Rosenberg was neither the original source of the information nor was he a volunteer under the ordinance. View "Rosenberg v. Redflex Traffic Systems, Inc." on Justia Law

In 2006, Moreno fell off scaffolding and landed on his back while working. An orthopedist found a soft tissue injury but no signs of fracture. He continued to feel significant pain. A follow-up test revealed acute lumbar radiculopathy—lower back pain caused by compression, inflammation or injury to a spinal nerve root. Moreno also is diabetic, has high blood pressure, and is obese. Moreno sought treatment from a psychologist, who reported that Moreno manifested depressed mood, irritability, memory difficulties, inability to concentrate, and an ongoing inability to sleep, sometimes for days. Moreno took several medications. In 2007, Moreno sought Supplemental Security Income and Disability Insurance Benefits. An ALJ affirmed the denial of his application. In the district court, the parties agreed to a remand to a different ALJ, who concluded that Moreno was not disabled although he was suffering from severe impairments and could not perform his past work as a drywall taper. The Seventh Circuit reversed. The ALJ improperly relied on an outdated assessment although later evidence containing new, significant medical diagnoses reasonably could have changed the reviewing physician’s opinion. Doctors’ notes set forth problems with Moreno becoming distracted, “spacing out,” and experiencing difficulties concentrating; these limitations were not included in the hypothetical question posed to the vocational expert. View "Moreno v. Berryhill" on Justia Law

In 2006, Moreno fell off scaffolding and landed on his back while working. An orthopedist found a soft tissue injury but no signs of fracture. He continued to feel significant pain. A follow-up test revealed acute lumbar radiculopathy—lower back pain caused by compression, inflammation or injury to a spinal nerve root. Moreno also is diabetic, has high blood pressure, and is obese. Moreno sought treatment from a psychologist, who reported that Moreno manifested depressed mood, irritability, memory difficulties, inability to concentrate, and an ongoing inability to sleep, sometimes for days. Moreno took several medications. In 2007, Moreno sought Supplemental Security Income and Disability Insurance Benefits. An ALJ affirmed the denial of his application. In the district court, the parties agreed to a remand to a different ALJ, who concluded that Moreno was not disabled although he was suffering from severe impairments and could not perform his past work as a drywall taper. The Seventh Circuit reversed. The ALJ improperly relied on an outdated assessment although later evidence containing new, significant medical diagnoses reasonably could have changed the reviewing physician’s opinion. Doctors’ notes set forth problems with Moreno becoming distracted, “spacing out,” and experiencing difficulties concentrating; these limitations were not included in the hypothetical question posed to the vocational expert. View "Moreno v. Berryhill" on Justia Law

Brown, the manager of a company that provided home physician visits, and Talaga, who handled the company’s billing, were convicted of conspiracy to commit health-care fraud, 18 U.S.C. 1349; six counts of health-care fraud, 18 U.S.C. 1347; and three counts of falsifying a matter or providing false statements, 18 U.S.C. 1035(a). The district court sentenced Mr. Brown to 87 months’ imprisonment, 34 months below the Guidelines’ range, stating that a significant sentence was warranted because of the duration of the scheme, the amount of the fraud, the need for general deterrence, and Brown’s failure to accept responsibility. Ms. Talaga was sentenced to 45 months. The Seventh Circuit affirmed, rejecting Brown’s argument that the court’s assumptions about the need for general deterrence were unfounded and constituted procedural error and Talaga’s arguments that the court calculated the amount of loss for which she was responsible by impermissibly including losses that occurred before she joined the conspiracy. The district court was under no obligation to accept or to comment further on Brown’s deterrence argument. Talaga, as a trained Medicare biller, knew that that the high-volume billings were fraudulent. View "United States v. Talaga" on Justia Law

Gumila, the head of clinical operations for a company that provided home medical care to the elderly, was convicted of 21 counts of health-care fraud, 18 U.S.C. 1347 and three counts of making a false statement in a health-care matter, 18 U.S.C. 1035. There was testimony from more than 20 witnesses and documentary evidence establishing that Gumila regularly overruled physicians who wanted to discharge patients and instructed employees to bill services at unjustifiably high rates, to claim that patients were homebound even when they weren’t, and to order skilled-nursing services even if no doctor had ever examined the patient. The government estimated Medicare’s financial loss: approximately $2.375 million for unnecessary and upcoded home visits; $9.45 million for unnecessary skilled-nursing services that did not meet Medicare’s requirements; and $3.779 million for oversight services that did not qualify for payment or were never performed. The guidelines range was 151-188 months in prison. Gumila argued that the loss should be limited to payments for the eight patients specifically mentioned in the indictment ($14,449). The judge concluded that the government was not required to present specific evidence to prove the fraudulent nature of each individual transaction contributing to the total loss, determined that the loss estimate was reasonable, imposed a sentence of 72 months, and ordered Gumila to pay $15.6 million in restitution. The Seventh Circuit affirmed, upholding the loss calculation and the prison term as substantively unreasonable. View "United States v. Gumila" on Justia Law

Gerstner, age 27, applied for disability insurance benefits and supplemental security income was denied. An administrative law judge found that she was severely impaired by anxiety, bipolar disorder, panic disorder, depression, and fibromyalgia but that these impairments were not disabling, and denied benefits. The Seventh Circuit vacated the denial as not supported by substantial evidence. The ALJ fixated on select portions of the treating psychiatrist’s treatment notes, inadequately analyzed his opinions, and overlooked the extent to which those opinions were consistent with the diagnoses and opinions of other medical sources who treated Gerstner. ALJs must consider psychologists’ and nurse practitioners’ opinions on the severity of a patient’s impairments. In discrediting Gerstner’s testimony, the ALJ overstated findings from three diagnostic tests and misunderstood the nature of her fibromyalgia pain. Fibromyalgia pain cannot be measured with objective tests aside from a trigger-point assessment. View "Gerstner v. Berryhill" on Justia Law

Cullinan unsuccessfully sought Disability Insurance Benefits and Supplemental Security Income based on several impairments, most of which arose after she suffered a stroke: anxiety, depression, peripheral blindness in one eye, diabetes, obesity, and sleep apnea. An administrative law judge determined that although Cullinan has several impairments, she is not disabled. The Seventh Circuit vacated. The ALJ’s decision to discredit Cullinan’s testimony and that of her treating psychologist was unsupported by the record because the ALJ’s examples of Cullinan’s daily activities and social interactions did “not remotely describe a ‘very active’ lifestyle.” The ALJ did not adequately explain the conclusion that the doctor’s notes were inconsistent with his opinion and did not consider Cullinan’s daily extended naps and frequent debilitating headaches in determining her residual functional capacity. No evidence contradicted Cullinan’s testimony about those limitations. The vocational expert said that needing to take a two-hour nap every day would rule out all work. The ALJ has the burden to develop the record and assess whether symptoms are disabling. View "Cullinan v. Berryhill" on Justia Law

In 2011, Cosenza sought disability benefits on behalf of her minor son. An ALJ determined that J.M.F. was not disabled. The Appeals Council denied her request for review. Cosenza argued that the ALJ improperly found that her son’s autism and Asperger’s syndrome were not “medically determinable” impairments. The district judge granted Cosenza summary judgment and remanded under 42 U.S.C. 405(g); 5), terminating the case in the district court. On remand, another ALJ conducted a hearing in March 2016. In June Cosenza filed a motion in the closed federal case to hold the Commissioner in contempt “for not following court-ordered remand.” In July the ALJ ruled against Cosenza. Cosenza did not wait for the decision to become final but moved for summary judgment in the closed federal case and filed a letter with the Appeals Council requesting review. The district court granted the agency’s motion to strike, reasoning that it had relinquished jurisdiction over Cosenza’s first case; as to most recent decision, the administrative appeals process had not finished so no final decision existed for judicial review. Cosenza had not shown that the Commissioner violated the court’s remand order. The Seventh Circuit affirmed. A district court lacks jurisdiction under the Social Security Act to review an ALJ’s unfavorable decision until the agency’s decision is final; the Appeals Council has not yet decided whether to review the ALJ’s decision. View "Cosenza v. Berryhill" on Justia Law

Schloesser worked for 23 years as a dry curer in a meat‐processing factory, regularly lifting more than 70 pounds. After undergoing rotator cuff surgery on his left shoulder in 2001 and then a lactimectomy (disc removal in his lower back) in 2002, Schloesser left the factory in 2003. Until 2009, he was self‐employed in construction, until his persistent shoulder and lower back problems prevented him from being able to regularly lift more than 50 pounds as required by his work. In 2012, Schloesser applied for disability insurance benefits under 42 U.S.C. 416(i). The Social Security Administration initially denied his application but an Administrative Law Judge found him disabled and granted benefits in 2014. One month later, sua sponte, the SSA Appeals Council commenced review and reversed the ALJ’s favorable decision. The district court affirmed the Appeals Council’s decision as supported by substantial evidence. The Seventh Circuit affirmed, upholding findings that Schloesser did not suffer from severe impairments of cervical radiculopathy, major joint dysfunction, and history of left shoulder surgery and that his residual functional capacity did not include being off‐task up to 10% of the workday or needing unscheduled breaks. View "Schloesser v. Berryhill" on Justia Law