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

In 2009, Grotts applied for Social Security disability benefits, citing depression and low functional capacity. She had previously worked as a caretaker for a child with disabilities and he cared for her own child. Her case was remanded four times. Five times, an ALJ concluded that Grotts was not disabled. The final ALJ found that she could still perform light work with some restrictions and because a significant number of jobs fitting that description existed in the national economy.The district court agreed. The Seventh Circuit affirmed, rejecting arguments that the ALJ erred in its evaluation of Grotts’s subjective complaints about her symptoms, in its evaluation of the medical opinion evidence, and in its residual functional capacity determination. Substantial evidence supported the ALJ’s weighing of the medical opinion evidence and its RFC determination. The ALJ did not patently err in its evaluation of Grotts’s subjective complaints. View "Grotts v. Kijakazi" on Justia Law

Mandrell, born in 198, pursued her education through one year in college. In 2005-2009, she served in the Coast Guard, which she left with an honorable discharge. While in service she was the victim of a rape by a fellow service member. She developed PTSD and anxiety afterward. The VA found her to be 100% disabled based on a service-related cause and awarded benefits but later revised her level of disability down to 70%. Mandrell’s 2017 application for Social Security disability benefits was denied and the Appeals Council denied her request for review. The district court affirmed.The Seventh Circuit reversed and remanded. The ALJ failed to connect the residual functional capacity he found with the evidence in the record, and he did not adequately account for her deficits in concentration, persistence, and pace. The ALJ apparently accepted that Mandrell suffered from PTSD as a result of the rape, but dismissed most of the symptoms that accompanied that condition. While the Social Security Administration is not bound by the VA’s assessment of Mandrell’s disability, the underlying medical evidence on which the VA relied is just as relevant to the social‐security determination as it was to the VA. View "Mandrell v. Kijakazi" on Justia Law

Reynolds, born in 1992, graduated from high school and previously worked part-time in retail. Reynolds suffers from migraines, vertigo, and “major depressive disorder, recurrent moderate with anxious distress.” She applied for Social Security disability benefits in 2017. Reynolds testified that she suffers from back pain, vertigo, and migraines, and she cannot stand for more than 10 minutes. Her parents handle household chores. She has migraines every day. She stopped taking some prescription medications for her migraines because of the side effects. Reynolds quit her job at Walmart because of her migraines. Reynolds testified has never gone to an emergency room or crisis center for mental health treatment but suffers from anxiety around “more than five people.” She was taking medication for her mental health conditions.The ALJ concluded that Reynolds was not disabled under the Social Security Administration’s five-step method and that Reynolds had the residual functional capacity to perform a full range of work with certain non-exertional limitations. The Seventh Circuit affirmed the denial as supported by substantial evidence. The court rejected an argument that the ALJ erred by failing to include a qualitative interaction limitation in the residual functional capacity determination. No medical evidence called for a qualitative interaction limitation; the ALJ was not required to intuit such a limitation from the administrative record. View "Reynolds v. Kijakazi" on Justia Law

Ruenger applied for Social Security Disability benefits in 2015, alleging that he had limited use of his left arm and mental impairments including anxiety and depression. At a hearing, the ALJ determined that Ruenger had not worked within the claim period, that his mental and physical impairments were severe but did not presumptively establish a disability, and that he had the capacity to perform light work with certain physical and social limitations. At the final step of the inquiry, the ALJ determined—based on a vocational expert’s testimony—that Ruenger could still perform jobs that exist nationwide in significant numbers and denied Ruenger’s application.The Seventh Circuit vacated and remanded. Substantial evidence does not support the ALJ’s decision. ALJs cannot afford complete discretion to vocational experts. When a claimant challenges a vocational expert’s job-number estimate, the ALJ must inquire whether the methodology used by the expert is reliable. In this case, the vocational expert enlisted by the agency to estimate the number of jobs suitable for Ruenger omitted crucial details about her methodology, such as the source of her job numbers and the reason she used the equal distribution method; the ALJ nevertheless relied on the expert’s testimony. View "Ruenger v. Kijakazi" on Justia Law

For almost 30 years, Prill worked for the Eau Claire, Wisconsin County Highway Department performing physically demanding work, including driving a dump truck and maintaining roads. She suffered from pain in her lower back and knees, which was exacerbated by a car accident and multiple work injuries. Prill retired in 2014 and later filed for Social Security disability benefits alleging she could no longer perform heavy or medium work. Several doctors examined Prill or reviewed her medical records but reached different conclusions about her physical limitations.An ALJ found Prill’s testimony only partially credible, concluding that her report about the severity of her symptoms and the extent of her limitations was inconsistent with other record evidence. The ALJ also weighed the competing medical evidence and gave greater weight to the opinions of consulting physicians who reviewed Prill’s medical records than to the opinion of Prill’s treating physician. The ALJ concluded that Prill had not been disabled since August 2014. The Appeals Council of the Social Security Administration denied her request for review. The district court and Seventh Circuit affirmed. Substantial evidence supported the ALJ’s decision. The court rejected arguments the ALJ wrongly discounted Prill’s subjective allegations and improperly weighed the differing medical opinions. View "Prill v. Kijakazi" on Justia Law

Wilder, born in 1970, has a high school education. She previously worked as a motor vehicle quality worker and a sales clerk. She has not worked since October 2015. Wilder applied for Social Security disability benefits in 2016, alleging a disability onset date in October 2015. She alleged hip pain, difficulty walking, lower back pain, and balance issues. Her claim was administratively denied. An ALJ concluded that Wilder’s impairments, while severe, did not meet or equal one of the impairments listed in 20 C.F.R. Part 404, Subpart P, App’x 1, that Wilder had the residual functional capacity to perform sedentary work with limitations, and that suitable jobs existed in significant numbers in the national economy. The Appeals Council denied Wilder’s request for review.The district court and Seventh Circuit held that substantial evidence supported the ALJ’s decision. The court rejected Wilder’s arguments that the ALJ erred by failing to consider whether she met or equaled Listing 11.17(a), even though her attorney did not argue to the ALJ that she met or equaled that Listing (or any Listing) and by failing to request the opinion of a medical expert, and that the ALJ’s evaluation of her subjective symptoms was patently wrong. View "Wilder v. Kijakazi" on Justia Law

Wisconsin provides transportation to private-school students, limited to only one school “affiliated or operated by a single sponsoring group” within any given attendance area. The state superintendent decided that St. Augustine, a freestanding entity that describes itself as Catholic but independent of the church’s hierarchy, is “affiliated with or operated by” the same sponsoring group as St. Gabriel, which is run by the Catholic Archdiocese.In 2018, the Seventh Circuit rejected a suit by St. Augustine. The Supreme Court vacated and remanded for further consideration in light of intervening precedent. The Seventh Circuit then certified to the Wisconsin Supreme Court the question of how to determine “affiliation” under state law. That court responded: [I]n determining whether schools are “affiliated with the same religious denomination” [i.e., the same sponsoring group] pursuant to Wis. Stat. 121.51, the Superintendent is not limited to consideration of a school’s corporate documents exclusively. In conducting a neutral and secular inquiry, the Superintendent may also consider the professions of the school with regard to the school’s self-identification and affiliation, but the Superintendent may not conduct any investigation or surveillance with respect to the school’s religious beliefs, practices, or teachings.The Seventh Circuit then reversed. The Superintendent’s decision was not justified by neutral and secular considerations, but necessarily and exclusively rested on a doctrinal determination that both schools were part of a single sponsoring group—the Roman Catholic church—because their religious beliefs, practices, or teachings were similar enough. View "St. Augustine School v. Underly" on Justia Law

About 50 businesses that offer live adult entertainment (nude or nearly nude dancing) sought loans under the second round of the Paycheck Protection Program enacted to address the economic disruption caused by the Covid-19 pandemic. Congress excluded plaintiffs and other categories of businesses from the second round of the Program, 15 U.S.C. 636(a)(37)(A)(iv)(III)(aa), incorporating 13 C.F.R. 120.110. Plaintiffs asserted that their exclusion violated their rights under the Free Speech Clause of the First Amendment.The district court issued a preliminary injunction, prohibiting the Small Business Administration (SBA) from denying the plaintiffs eligibility for the loan program based on the statutory exclusion. The Seventh Circuit granted the government’s stay of the preliminary injunction and expedited briefing on the merits of the appeal. The SBA satisfied the demanding standard for a stay of an injunction pending appeal, having shown a strong likelihood of success on the merits. Congress is not trying to regulate or suppress plaintiffs’ adult entertainment. It has simply chosen not to subsidize it. Such selective, categorical exclusions from a government subsidy do not offend the First Amendment. Plaintiffs were not singled out for this exclusion, even among businesses primarily engaged in activity protected by the First Amendment. Congress also excluded businesses “primarily engaged in political or lobbying activities.” View "Camelot Banquet Rooms, Inc. v. United States Small Business Administration" on Justia Law

Molina Healthcare contracted with the Illinois Medicaid program to provide multiple tiers of medical-service plans with scaled capitation rates (fixed per-patient fees that cover all services within the plan’s scope). The Nursing Facility plan required Molina to provide Skilled Nursing Facility (SNF) services. Molina subcontracted with GenMed to cover that obligation. Molina received a general capitation payment from the state, out of which it was to pay GenMed for the SNF component. Molina breached its contract with GenMed. GenMed terminated the contract. After GenMed quit, Molina continued to collect money from the state for the SNF services, but it was neither providing those services itself nor making them available through any third party. Molina never revealed this breakdown, nor did it seek a replacement service provider.Prose, the founder of GenMed, brought this qui tam action under both the state and federal False Claims Acts, 31 U.S.C. 3729, alleging that Molina submitted fraudulent claims for payments from government funds. The district court dismissed the case. The Seventh Circuit reversed. The complaint plausibly alleges that as a sophisticated player in the medical-services industry, Molina was aware that these kinds of nursing facility services play a material role in the delivery of Medicaid benefits. View "Prose v. Molina Healthcare of Illinois," on Justia Law

A False Claims Act, 31 U.S.C. 3729(a)(1)(A), “qui tam” lawsuit against SuperValu claimed that SuperValu knowingly filed false reports of its pharmacies’ “usual and customary” (U&C) drug prices when it sought reimbursements under Medicare and Medicaid. SuperValu listed its retail cash prices as its U&C drug prices rather than the lower, price-matched amounts that it charged qualifying customers under its discount program. Medicaid regulations define “usual and customary price” as the price charged to the general public. The district court held that SuperValu’s discounted prices fell within the definition of U&C price and that SuperValu should have reported them but held that SuperValu did not act with scienter.The Seventh Circuit affirmed, joining other circuits in holding that the Supreme Court’s 2007 “Safeco” interpretation of the Fair Credit Reporting Act’s scienter provision applies with equal force to the False Claims Act’s scienter provision. There is no statutory indication that Congress meant its usage of “knowingly,” or the scienter definitions it encompasses, to bear a different meaning than its common-law definition. SuperValu did not act with the requisite knowledge. SuperValu’s interpretation of “usual and customary price” was objectively reasonable under Safeco. View "Yarberry v. Supervalu Inc." on Justia Law