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

Fetting, 50 years old and suffering from back pain, headaches, depression, and anxiety, unsuccessfully applied for supplemental security income. During an administrative hearing, a vocational expert (VE) testified to Fetting’s physical and mental limitations and his ability to perform certain jobs, stating that Fetting could perform the representative occupations of a cleaner/housekeeper, routing clerk, and marker. The VE estimated that, in the national economy, there were 200,000 cleaner/housekeeper jobs, 40,000 routing clerk jobs, and 200,000 marker jobs. During cross-examination, the VE stated that he calculated his estimates from numbers published by the Bureau of Labor Statistics, using his “knowledge of the labor market, [acquired] over 30+ years of job placement activities.” He stated: “It’s not a hard and fast scientific type formula” and that he had not conducted any “formal analysis” to validate his estimates but had “in the past checked numbers in other reporting formats.”The ALJ found that Fetting did not have a disability under the Social Security Act based on the VE’s testimony. The district court and Seventh Circuit affirmed, rejecting an argument that the VE’s methodology for calculating his job number estimates was unreliable. Substantial evidence supports the finding that a significant number of the identified jobs exist in the national economy. View "Fetting v. Kijakazi" on Justia Law

Sevec filed for disability social security benefits, alleging an onset of disability in 2014. At the time of her hearing, Sevec was 60 years old and suffered from knee pain caused by osteoarthritis. Sevec stated that she worked as a registered nurse until 2014, doing narcotics counts, answering call lights and bed alarms, assisting patients to the bathroom; administering IV medications, doing breathing treatments; and taking care of feeding tubes. After leaving that job, she provided care for a neighbor. A vocational expert (VE) stated Sevec’s work as an RN was “level 7, medium in its physical demand, medium as performed. And then we also have home health nurse … also, level 6. Medium in its physical demand; light as performed.” The ALJ asked whether “any of the past work [would] be available?” The VE replied, “Possibly the home health being as performed at a light level, not per the [Dictionary of Occupational Titles], though, but as performed.”The ALJ concluded that Sevec was not disabled. The Appeals Council and the district court agreed. The Seventh Circuit reversed. The VE’s testimony is not well grounded in the record, and is not sufficient, standing alone, to support the ALJ’s determination. The record does not contain evidence from which the ALJ could determine, with any degree of confidence, that Sevec is capable of performing her past work; the ALJ specified that her “past work” did not include "home health nurse." View "Sevec v. Kijakazi" on Justia Law

In 2017 Durham, age 46, applied for Social Security disability benefits, she had been diagnosed with diabetes and hypertension. She had also seen medical professionals about neck pain and heart palpitations. She had been experiencing shortness of breath and lightheadedness and was referred to a cardiologist, who counseled her to reduce her caffeine intake and to adopt a healthy lifestyle. Durham continued to have intermittent symptoms and, in 2019, was admitted to a hospital due to “exertional shortness of breath and palpitations.” Testing disclosed that Durham had no cardiac instability, “no acute problems, [and] no functional limitations.”An Administrative Law Judge concluded that Durham’s diabetes, hypertension, and tachycardia were limiting, but not disabling, conditions. The district court and Seventh Circuit upheld the denial of benefits as supported by substantial evidence. The court rejected arguments that the ALJ relied on outdated evidence and overstepped his authority by interpreting, without supporting medical opinions, the results of medical tests. The record reveals that the ALJ carefully considered Durham’s entire medical history and relied on the opinions of her treating physicians in reaching his conclusions about her physical limitations. View "Durham v. Kijakazi" on Justia Law

Milhem applied for Social Security disability insurance benefits, alleging that several conditions limited her ability to work. Milihem, age 38, had completed three years of college and had previously worked as a canvasser, receptionist, portrait photographer, and graphic designer. A vocational expert concluded that the evidence supported limiting Milhem’s work to that which can be learned in 30 days or less, that Milhem could stand or walk for at least two hours in an eight-hour workday, and that Milhem “could make judgments commensurate with functions of simple, repetitive tasks”; such an individual could not perform Milhem’s past work, but could work as a router, price marker, and cafeteria attendant, of which there were approximately 53,000, 307,000, and 63,000 jobs in the national economy, respectively. Changing the exertion level to sedentary, the expert testified, would include the work of an addresser, table worker, or document preparer, of which there were approximately 19,000, 23,000, and 47,000 jobs in the national economy, respectively.Based on this testimony, and “considering [Milhem’s] age, education, work experience, and residual functional capacity,” the ALJ found that there were a significant number of jobs that Milhem could perform, so Milhem was not under a qualifying disability. The district court upheld that determination. The Seventh Circuit affirmed. A reasonable person would accept 89,000 jobs in the national economy, a figure supported by substantial evidence, as a significant number. Other circuits have accepted similar numbers as significant. View "Milhem v. Kijakazi" on Justia Law

Jarnutowski sought Social Security disability benefits, claiming she could not work due to a foot condition, neck and leg pain, obesity, and mental health issues. Jarnutowski underwent multiple surgeries, X-rays, and CT scans on her foot between 2011-2015. An ALJ awarded Jarnutowski found that she was disabled during September 2013-January 2016, with only the ability to perform light work with some limitations; her foot condition, neck issues, and obesity were severe impairments; and, she was disabled by direct application of the Medical-Vocational Guidelines due to her age. The ALJ concluded that Jarnutowski’s disability ended when she regained the ability to perform medium work after her foot surgery and was again able to perform her past work as a store manager. The ALJ did not explicitly address Jarnutowski’s functional capabilities related to medium work, including Jarnutowski’s ability to lift objects weighing up to 50 pounds and frequently lift or carry objects weighing up to 25 pounds, emphasizing Jarnutowski’s ability to walk.The Seventh Circuit reversed. In Social Security disability determinations, the lifting and carrying weight requirements associated with medium work are more than double those of light work. The ALJ found that Jarnutowski’s “residual functional capacity” was limited to light work with some restrictions before her final foot surgery, but increased to medium work after the surgery without explaining how, after surgery, Jarnutowski could lift or carry objects more than twice the weight that she lifted or carried before surgery. View "Jarnutowski v. Kijakazi" on Justia Law

Plaintiffs worked for MBO and Trustmark, which provide medical billing and debt‐collection services to healthcare providers. After they raised concerns about their employers’ business practices, the plaintiffs were fired. They sued MBO, Trustmark, and MBO's client, the University of Chicago Medical Center (UCMC), under the False Claims Act, 31 U.S.C. 3729. Regulations specify that Medicare providers seeking reimbursement for “bad debts” owed by beneficiaries must first make reasonable efforts to collect those debts. The plaintiffs claim that UCMC knowingly avoided an obligation to repay the government after it effectively learned that it had been reimbursed for non-compliant debts; MBO and Trustmark caused the submission of false claims to the government. Each plaintiff also claimed retaliation.The Seventh Circuit affirmed the dismissal of the complaint, in part. The district court properly dismissed the claim against UCMC, which neither had an established duty to repay the government nor acted knowingly in avoiding any such duty. The direct false claim against MBO was also correctly dismissed. The complaint failed to include specific representative examples of non-compliant patient debts, linked to MBO, for which reimbursement was sought. The court reversed in part; the complaint includes specific examples of patient debts involving Trustmark. Two plaintiffs alleged facts that support the inference that they reasonably believed their employers were causing the submission of false claims. View "Sibley v. University of Chicago Medical Center" on Justia Law

The Seventh Circuit affirmed the judgment of the district court denying Heart of CarDon, LLC's motion for judgment on the pleadings in this interlocutory appeal concerning section 1557 of the Patient Protection and Affordable Care Act, holding that T.S. was a proper plaintiff against CarDon under section 1557, and his suit may continue on that basis.CarDon was a healthcare provider that was reimbursed by Medicare and Medicaid for its serves. CarDon provided health insurance to its employees and their depends through a self-funded employee benefits plan. T.S., a dependent who had autism, brought this action alleging that the plan's exclusion of coverage for autism treatment violated section 1557. CarDon moved for judgment on the pleadings, arguing that only a recipient of CarDon's healthcare services was a permissible plaintiff under section 1557. The district court denied the motion. The Seventh Circuit affirmed, holding that T.S. plausibly alleged an interest that comes within the zone of interests section 1557 seeks to protect. View "T.S. v. Heart of CarDon, LLC" on Justia Law

Illinois moved its Medicaid program from a fee‐for‐service model, where a state agency pays providers’ medical bills, to one dominated by managed care, where private insurers pay medical bills. Most patients of Saint Anthony Hospital are covered by Medicaid, so Saint Anthony depends on Medicaid payments. Over the last four years, it has lost roughly 98% of its cash reserves, allegedly because managed‐care organizations have repeatedly and systematically delayed and reduced Medicaid payments to it. Saint Anthony sued, arguing that Illinois officials owe it a duty under the Medicaid Act to remedy the late and short payments.The Seventh Circuit reversed the dismissal of the suit, concluding that Saint Anthony has alleged a viable claim for relief under 42 U.S.C. 1396u‐ 2(f) and may seek injunctive relief under 42 U.S.C. 1983 against the state official who administers the Medicaid program in Illinois. Illinois has tools available to remedy systemic slow payment problems—problems alleged to be so serious that they threaten the viability of a major hospital and even of the managed‐care Medicaid program as administered in Illinois. If Saint Anthony can prove its claims, the chief state official could be ordered to use some of those tools to remedy systemic problems that threaten this literally vital health care program. View "Saint Anthony Hospital v. Eagleson" on Justia Law

Albert suffers from epilepsy, Asperger syndrome, ADHD, migraines, and insomnia. Born in 1998, Albert’s parents support her financially, help manage her medications, and assist her with daily living. Albert has never had a driver’s license nor worked. Albert graduated from high school in 2017. Although she struggled in math, her academic performance was otherwise average. She enrolled in an online college course but stopped attending after suffering a grand mal seizure in September 2017. She applied for supplemental security income.The ALJ determined that, although Albert suffered from severe mental and physical impairments, these impairments, taken alone or together, did not amount to a “listed disability"; Albert had the residual functional capacity to perform a full range of work at all exertional levels, subject to a few restrictions; Albert “was likely to have difficulty with social interactions” and had poor concentration and a low frustration tolerance; that Albert can “understand, carry out and remember simple instructions” and “make judgments commensurate with functions of simple, repetitive tasks”; and that there are a significant number of jobs that someone with Albert’s RFC could perform.The district court and Seventh Circuit affirmed the denial of benefit, finding substantial evidence supporting the ALJ’s determination. “Should Albert try to work but find herself unable, nothing will prevent her from applying anew for benefits.” View "Albert v. Kijakazi" on Justia Law

Poole has a degenerative disc disease of the lumbar spine; it causes severe pain in her lower back and leg after she either stands or sits for a brief time. She lost her job as a cashier because her pain made it impossible for her to stand throughout her full shift. Poole also suffers from a learning disability, anxiety, and depression, all of which impair her ability to concentrate, understand, or remember detailed instructions. Now 46 years old, she has only a “marginal education,” meaning sixth grade or less. Poole sought Supplemental Security Income, 42 U.S.C. 423(d). An ALJ denied her application and dismissed her companion application for disability insurance benefits.The Seventh Circuit reversed, concluding that the ALJ’s decision rested on contradictory findings. . Either Poole can stand for four hours a day and should have been put in the “light” exertional level, or the ALJ correctly found that she belonged in the “sedentary” category and could stand (or walk) at most for two hours a day. The ALJ never said that Poole could perform sedentary work if she could sit or stand at will, so the vocational expert never focused on that potential set of jobs. When an agency decision is so ambiguous that it frustrates judicial review, it cannot be upheld. View "Poole v. Kijakazi" on Justia Law