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

Disabled children are entitled to benefits from the Social Security Administration, 42 U.S.C. 1382c(a)(3)(C). While benefits for an adult depend on a work history plus current inability to perform a job, administrative officials ask whether the child’s limitations meet one of the many listed categories of disability or are functionally equivalent to one of them. When determining whether a child’s impairment is functionally equivalent to a listing, the issue is whether it produces a marked limitation in at least two—or an extreme limitation in one—of six “domains of functioning,”McCavic argued that his son, N., is disabled by attention deficit hyperactivity disorder, intellectual limitations (an IQ near 70), oppositional defiant disorder, and nocturnal enuresis. He claimed that these conditions meet, or are functionally equivalent to certain listings. An ALJ found that N. did not meet any of the listings and has a marked limitation in only one functional category, “acquiring and using information.” A district judge affirmed. The ALJ was entitled to credit the views of a special-education teacher, who knew N well and had a good grasp of gradations among children with intellectual shortcomings. While N. may have met the standards of the old version of the regulations, but not the new one, the change applies “to claims that are pending on or after the effective date.” View "McCavitt v. Kijakazi" on Justia Law

Butler, age 51, worked in the past as a millwright and machine repair maintenance worker. He stopped working, claiming he was disabled as of November 4, 2015, because of severe impairments stemming from a stroke, seizures, and heart disease and that he is unable to perform his prior occupation. Butler’s claim for disability insurance benefits under the Social Security Act, 42 U.S.C. 401–433, was denied by the Administrative Law Judge (ALJ) following a hearing. The Appeals Council declined to review the denial.The Seventh Circuit affirmed, upholding the ALJ’s determination that Butler was capable of doing light work with some restrictions, and that a sufficient number of such jobs existed that he could perform. Butler has limitations that precluded a determination that he could either perform all light work or perform none. The ALJ clearly recognized that Butler was in the category of persons closely approaching advanced age and appropriately considered that factor as well as Butler’s exertional and non-exertional residual capacity in consulting a vocational expert. View "Butler v. Kijakazi" on Justia Law

Kaplarevic filed for disability insurance benefits in 2012, alleging that he became disabled on August 1, 2012. His “date last insured” was December 31, 2014, meaning that if his disability arose any later than that, he would not be eligible for benefits.The Seventh Circuit affirmed the denial of benefits, rejecting Kaplarevic’s arguments that an ALJ improperly considered his own observations of Kaplarevic’s physical condition and ability to perform certain physical tasks at a 2018 hearing. Kaplarevic sought an open-ended period of disability so he needed to show that he became disabled before his date last insured and that he was still disabled. The court noted the ALJ’s 15-page opinion, which evaluated extensive medical and behavioral evidence. It was Kaplarevic’s burden to show disability, and if he wanted to do so, he should have accepted the ALJ’s invitation “to identify the portions of the medical records that he believed supported various of [his] allegations.” Vague references to the “totality of the evidence” are not helpful. The ALJ’s opinion did not rely on the failure to seek treatment as a factor demonstrating lack of disability; the record showed that Kaplarevic did not comply with prescribed therapy and that his pain complaints were not consistent with objective medical findings. View "Kaplarevic v. Saul" on Justia Law

Prosser, a 37-year-old Medicare recipient, suffers from glioblastoma, which causes brain tumors. The five-year survival rate hovers around 5%. Though not curative, Prosser benefits from tumor treating fields therapy (TTF), approved by the FDA in 2011. For most of the day, patients use a device that attaches to the head via adhesive patches that connect to a mobile power supply. The device emits electrical fields to the tumor, which disrupt the division of cancer cells. Early studies show that the device holds promise in prolonging life. TTF therapy is available through a single supplier, Novocure, which rents the device on a monthly basis. The therapy is expensive. Prosser must file a Medicare benefits claim for each period she uses the device. Medicare denied coverage for the treatment period January-April 2018. Though Prosser received the therapy and owed nothing, the denial left Novocure with the bill. Prosser challenged this denial through Medicare’s appeals process before filing suit.The Seventh Circuit affirmed the dismissal of Prosser’s claim for Medicare Part B coverage, holding that she has suffered no injury-in-fact sufficient to satisfy Article III’s standing requirement. Prosser received—and continues to receive—the TTF therapy. She faces no financial liability for the treatment period Medicare denied coverage. Any future financial risk is too attenuated from the denial of the past coverage and far too speculative to establish standing. View "Prosser v. Becerra" on Justia Law

Gedatus, born in 1976, sought social security disability benefits, alleging many medical conditions, including lumbar degenerative disc disease, sciatica, leg pain, knee pain, wrist difficulties, tremors, and residual effects from a head hemorrhage. She graduated from high school. By 2003, she worked at a bar. Over the years, she underwent multiple surgeries and other treatments.After a hearing, the Administrative Law Judge agreed with Gedatus about several issues, but concluded she could perform light work with some limits, so she was not disabled. No doctor opined she needed more limits than the ALJ determined. The district judge affirmed. The Seventh Circuit affirmed the denial as supported by substantial evidence, rejecting claims that errors permeated the ALJ’s symptom evaluation and that the ALJ erred by not setting forth an assessment of her limited sitting tolerance or tremors. View "Gedatus v. Saul" on Justia Law

MAO-MSO acquired rights to collect conditional payments that Medicare Advantage Organizations (MAOs) made if a primary insurer (such as automobile insurance carriers) has not promptly paid medical expenses. MAO-MSO sued those primary payers. The district court proof of required actual injury. Specifically, MAO-MSO needed to identify an “illustrative beneficiary”— a concrete example of a conditional payment that State Farm, the relevant primary payer, failed to reimburse to the pertinent MAO. MAO-MSO alleged that “O.D.” suffered injuries in a car accident and that State Farm “failed to adequately pay or reimburse” the appropriate MAO. The district court determined that these allegations sufficed for pleading purposes to establish standing.As limited discovery progressed, MAO-MSO struggled to identify evidence supporting the complaint. One dispute centered on whether O.D.’s MAO made payments related to medical care stemming from a car accident before State Farm reached its limit under O.D.’s auto policy so that State Farm should have reimbursed the MAO. The payment in question was to a physical therapist. State Farm argued that the physical therapy services had no connection to O.D.’s car accident and related only to her prior knee surgery.The district court determined no reasonable jury could find that the payment related to O.D.’s car accident, meaning that MAO-MSO lacked standing. The Seventh Circuit affirmed the dismissal. The Medicare Act may authorize the lawsuit but MAO-MSO fail to establish subject matter jurisdiction by establishing an injury in fact. View "MAO-MSO Recovery II, LLC v. State Farm Mutual Automobile Ins. Co." on Justia Law

The Seventh Circuit affirmed the ALJ's determination that plaintiff has the capacity to perform light work and is therefore not entitled to disability benefits. Plaintiff claimed that the ALJ committed reversible error when determining her residual functional capacity (RFC) by selectively reviewing evidence of cervical and lumbar degenerative disc disease (back problems); incorrectly discounting plaintiff's credibility regarding her description of the intensity, persistence, and limiting effects of her symptoms; and not including any manipulative limitations in the RFC assessment.The court found plaintiff's arguments unpersuasive and concluded that substantial evidence supports the ALJ's denial of benefits where the ALJ did not ignore a line of evidence contradicting her decision; the ALJ's assessment of plaintiff's symptoms was not patently wrong; and the ALJ did not fail to note any supported manipulative limitations. View "Deborah M. v. Saul" on Justia Law

Pavlicek, age 49. applied for Disability and Supplemental Security Income benefits. He suffers from anxiety, depression, severe tremors, and pseudoseizures that resemble epileptic seizures but stem from psychological causes. A truck driver, he has a high-school education. Two non-examining agency consultants determined that he could function with some limitations. Pavlicek testified that he had constant tremors and had seven pseudoseizures in the past 16 months when he lost consciousness; in seven other episodes, he remained conscious. A vocational expert testified about employers’ tolerance for absenteeism and about a hypothetical employee with various restrictions. The treating psychiatrist reported that Pavlicek could not work.The ALJ determined that Pavlicek retained the residual functional capacity to perform medium work with exceptions and could perform work that existed in significant numbers in the national economy. The ALJ largely dismissed the report by the treating psychiatrist, who had not justified how his findings could apply “as far back as 2013,” having not treated Pavlicek until 2015 and who relied heavily on Pavlicek’s subjective reporting. The ALJ noted the “infrequent” nature of the treatment relationship and that the report’s assessment of severe functional limitations was unsupported by the clinical records. The Seventh Circuit affirmed. The decision was supported by substantial evidence. The court rejected claims that the ALJ gave inadequate reasons for rejecting the treating psychiatrist's opinion, afforded too much weight to the opinions of non-examining agency physicians, and posed hypothetical questions to the vocational expert that failed to account for his limitations. View "Pavlicek v. Saul" on Justia Law

Bailey became partially disabled by pneumoconiosis, caused by the inhalation of coal dust. In 2002, he entered into an agreement with his employer to settle his state workers’ compensation claim; $27,677.50 was designated as Bailey’s take-home amount, representing payments of $135.67 per month, for 17 months beginning in July 2002. In November 2011, Bailey filed a claim under the Black Lung Benefits Act. The Office of Workers’ Compensation Programs (OWCP) granted Bailey’s claim in October 2013, but his benefits entitlement began the month he filed his claim and continued through May 2016—the month preceding the month that he died. At the time of his death, he had received benefits totaling $30,507.70 but was still owed benefits for the months from November 2011 through September 2013, $21,508.90. Bailey’s employer went bankrupt. He sought the remaining benefits from the federal Black Lung Disability Trust Fund. While the OWCP approved that claim, a District Director reevaluated the original award, finding that Bailey’s state workers’ compensation award represented monthly state benefits, some of which ran concurrently with his federal benefits eligibility period, so that the federal benefits must be offset by the state benefits received for that time—$135.67 per month over 55 months ($7,461.85). The OWCP subtracted this amount from the $21,508.90. The Seventh Circuit affirmed. The offset is required by the Act; that Bailey received his state benefits years before he became eligible for federal benefits does not alter the conclusion. View "Bailey v. Director, Office of Workers’ Compensation Programs, United States Department of Labor" on Justia Law

Arnold applied for Social Security disability benefits based on ailments related to her back, heart, and joints, and chronic pain syndrome. Following the initial denial of her claim, Arnold requested a hearing before an ALJ. Arnold testified at the hearing, as did a vocational expert. The ALJ concluded that Arnold was not disabled, finding Arnold had several severe impairments, but that she retained the ability, with certain movement restrictions, to perform her past relevant work as a daycare center director. The district court and Seventh Circuit affirmed the ALJ’s decision, rejecting an argument that the ALJ failed to analyze whether the side effects of her medications impacted Arnold’s ability to work. While there is some evidence of side effects in the record, there is no evidence that the side effects impacted Arnold’s ability to work. On this record, the ALJ was not required to make findings about Arnold’s side effects. View "Arnold v. Saul" on Justia Law