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

Hall, an aviation mechanic, was discharged in 2001 by the military because of pain from an ankle injury. He was deemed by the Department of Veterans Affairs to be 70 percent disabled and to be “unemployable” in “a substantially gainful occupation” and totally disabled, 38 C.F.R. 4.16. In 2010 he applied for social security disability benefits on the ground that pain from his ankle injury, plus back and knee pain and other ailments, had worsened and rendered him totally disabled under Social Security Act standards. From 2005-2011 he underwent physical examinations and diagnostic tests. Some results were normal but many were not, revealing torn ligaments, obesity, possible arthritis, an “alignment problem” in his back, and fibromyalgia. Hall testified about his pain and inability to perform normal functions. The Seventh Circuit reversed the denial of benefits. Several doctors noted that Hall had been in pain when examined, which was some corroboration of his testimony. The ALJ could have resolved her doubts by ordering an MRI or directing a further examination by a medical expert. In addition, her failure to analyze and weigh the VA determination that Hall is totally disabled was a further oversight. View "Hall v. Colvin" on Justia Law

When the applicant was 15 years old, “Harrington rods” were inserted into his spine to correct a 57-degree curvature of the spine. He then developed chronic back pains. He also has cognitive difficulties. At age 20 he was determined to be eligible for social security disability benefits, but he later obtained a job at a nonprofit organization, driving disabled clients, helping with cooking and cleaning, and performing clerical tasks. The Social Security Administration determined in 1999 (when the applicant was 32) that he was not disabled and tried to recover the $65,000 in benefits. He declared bankruptcy. Three years later, he was fired because he could not keep up with the demands of the job. Two years later he reapplied for social security disability benefits. Several physicians and mental-health professionals diagnosed: chronic back pain; cubital tunnel syndrome; a somatoform disorder; depression, anxiety, panic attacks, agoraphobia, low intelligence, dizziness, migraine headaches, and deficient short-term memory. The applicant and his father testified to sleeplessness, loss of balance, blurred vision, and abdominal pain. The ALJ concluded that he was capable of unskilled light work of a routine and repetitive character and was not disabled. The Seventh Circuit reversed the denial of benefits, finding the opinion “riddled with errors.” View "Adaire v. Colvin" on Justia Law

In 2010, Curvin applied for disability benefits under the Social Security Act, 42 U.S.C. 401, alleging that she became disabled beginning in January 2009 from glaucoma, overactive thyroid, high blood pressure, difficulty sleeping, and knee pain. The ALJ denied her claim in 2011, finding that Curvin had not engaged in substantial gainful activity since the alleged onset of her disability; that Curvin’s glaucoma in her right eye was a severe impairment, and that the objective medical evidence showed that her remaining impairments were not severe; that based on the conclusions of Curvin’s treating and examining physicians and objective medical evidence, Curvin did not have an impairment or combination of impairments that met the severity of a listed impairment. The ALJ determined that Curvin had a residual functional capacity to perform a full range of work at all exertion levels, but with a nonexertional limitation of no peripheral vision on her right side due to her glaucoma. The district court vacated. The agency appealed. The Seventh Circuit reinstated the denial as being supported by substantia evidence. View "Curvin v. Colvin" on Justia Law

Sprinkle applied for supplemental social security income. After exhausting administrative remedies, Sprinkle sought judicial review of a final decision that he was not disabled. The district court held that the agency failed to properly evaluate evidence of Sprinkle’s disability and reversed. Sprinkle sought attorney’s fees under the Equal Access to Justice Act. While the EAJA contains a presumptive rate cap of $125 an hour, courts may award enhanced fees if justified because of an increase in the cost of living. The court found that Sprinkle was entitled to fees, but rejected his request for a cost-of-living enhancement. The Seventh Circuit vacated. An EAJA claimant seeking an adjustment need not offer proof of the effects of inflation on the particular attorney’s practice or proof that no competent attorney could be found for less than the requested rate. The claimant may rely on a readily available measure of inflation such as the Consumer Price Index, as well as proof that the requested rate does not exceed the prevailing market rate in the community for similar services by lawyers of comparable skill and experience. An affidavit from a single attorney testifying to the prevailing market rate may suffice to meet that burden. View "Sprinkle v. Colvin" on Justia Law

Minnick suffers from several serious medical problems, including fibromyalgia, chronic obstructive pulmonary disease (COPD), and degenerative disc disease. Minnick was a truck driver for 24 years until taking short term leave in 2008 due to pain in his legs and hip. After returning to work, he was laid off. In 2010, he applied for disability insurance benefits under the Social Security Act. After the Disability Determination Bureau denied Minnick’s claim, an Administrative Law Judge determined that Minnick is not disabled within the meaning of the Social Security Act. The Appeals Council denied review. The district court affirmed. The Seventh Circuit reversed, finding that the ALJ did not fully develop the record nor adequately articulate her analysis in discrediting the testimony of one of Minnick’s treating physicians. View "Minnick v. Colvin" on Justia Law

After the U.S. Department of Veterans Affairs determined Evans was no longer competent to manage his veterans’ benefits, it appointed his daughter as the federal fiduciary. The VA later terminated her appointment and appointed the Greenfield Banking Company. Evans’s wife and daughter filed suit asserting breach of fiduciary duty and conversion by the Bank and sought creation of a constructive trust. The complaint alleges that the Bank complied with the terms of its obligations to the VA as federal fiduciary but that doing so meant it breached its fiduciary duty to Evans. The complaint did not claim misuse of funds, mismanagement depriving him of the use of any funds, embezzlement, or the like. The daughter was apparently not fully reimbursed for expenditures she made on behalf of Evans while pursuing a guardianship in state court. Evans died in 2012. The district court dismissed. The Seventh Circuit affirmed, stating that the complaint is really a challenge to a federal fiduciary appointment and to veteran benefits distribution and, as such, not within the court’s jurisdiction. View "Stump v. Greenfield Banking Co," on Justia Law

Herrmann’s application for Supplemental Security Income for benefits for the period before she turned 55 was rejected by an administrative law judge, but because of the less demanding showing of disability, she was deemed to have become disabled when she reached 55. She appealed the partial denial unsuccessfully. Her treating physicians, with three consultative physicians selected by the Social Security Administration, advised the administrative law judge that she suffers from fibromyalgia, spinal disk disease, abnormal sensitivity to light, and other ailments, and that she walks haltingly, has difficulty gripping objects, experiences difficulty in rising from a sitting position, has trouble concentrating in a bright room or when looking at a computer screen, and as a result of this assemblage of impairments cannot do even light work on a full-time basis. The Seventh Circuit reversed, questioning the testimony of the vocational expert concerning available jobs. View "Herrmann v. Colvin" on Justia Law

Grenadyor is a pharmacist formerly employed by Ukrainian Village Pharmacy, which with pharmacies that serve similar communities in other states (joined as additional defendants in this suit), is alleged to be controlled by individuals of Ukrainian origin, mainly members of the Bogacheck family. Grenadyor claims that the pharmacy defrauded the government by making gifts to customers (such as tins of caviar), or forgiving their copays, to induce them to have their prescriptions filled by it rather than by competing pharmacies. He also alleged that the pharmacy sought government reimbursement for drugs that were not delivered to the buyers. The district court dismissed his complaint under the False Claims Act, 31 U.S.C. 3729, which also claimed retaliation. The Seventh Circuit affirmed as to the kickback claims under the Act, noting that Grenadyor was unable to name any person who had received more than $50 worth of kickbacks in a year, when the court requested that he do so. Allegations about claims for reimbursement for undelivered prescriptions were also inadequate. The court reversed with regard to the retaliation claim. View "Grenadyor v. Ukrainian Vill. Pharmacy" on Justia Law

Thulin was a Shopko pharmacist. During his tenure, Thulin observed what he believed to be a scheme in which Shopko submitted inflated claims for prescription drugs to the Medicaid program. Thulin filed a qui tam complaint, claiming violation of the federal False Claims Act by overbilling Medicaid, alleging that Shopko is a “sophisticated,” “multi-regional” business that developed and programmed the PDX system and should have been aware of federal law governing submission of claims, and bringing claims under the laws of eight states. The district court dismissed the federal claim under FRCP 9(b) and 12(b)(6). The Seventh Circuit affirmed. To be liable under the Act, Shopko must have acted with “actual knowledge,” or “deliberate ignorance” or “reckless disregard” of the possibility that its claims were false. Thulin’s allegations were not sufficient to satisfy that requirement even if Shopko’s practices were contrary to the Federal Assignment Law. Although malice, intent, and other conditions of the mind may be alleged generally, vague allegations that a corporation acted with reckless disregard or with reason to know of facts that would lead a reasonable person to realize that it was submitting false claims, simply because of its size or sophistication do not clear even this lower pleading threshold. View "Thulin v. Shopko Stores Operating Co., LLC" on Justia Law

Plaintiff, a 25-year-old woman of 25, was denied Supplemental Security Income benefits. She claims to be mentally retarded and to suffer from knee and hip pain in one leg, caused by a defect in the hip joint resulting from a childhood disease. A psychologist administered an IQ test when she was 18. Her IQ was 68. The psychologist thought her more intelligent than her IQ score of 68 implied, and concluded that she could function in “typical work environments.” Three years later two other psychologists evaluated the plaintiff and concluded that despite her serious mental deficiencies she would be able to work, although one referred to work in “sheltered workshops.” She does not use a computer and cannot obtain a driver’s license because she can’t read the test that one must pass to obtain a learner’s permit. Her work history consists of three hand-packager jobs. The Seventh Circuit reversed, with instructions to remand the case to the Social Security Administration, noting multiple errors in the agency’s assessment of the plaintiff’s condition and of employment possibilities.View "Browning v. Colvin" on Justia Law