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

Vaughn, a quadriplegic, has received home‐based care for over 30 years. She requires help with personal care, household maintenance, mobility exercises, transportation, medications, suctioning secretions from her tracheostomy, and use of the ventilator. When nursing shifts cannot be staffed, Vaughn has relied on friends. Indiana funded her care through two federally-reimbursed Medicaid programs: A&D waiver and core Medicaid. Vaughn could select her own caregivers to receive A&D waiver funds but could not personally direct nursing care funded through core Medicaid. In 2016, Vaughn was hospitalized with pneumonia. She was cleared to be discharged but the state could not find nurses to provide round‐the‐clock care at home at Medicaid rates Vaughn was transferred to a nursing home and filed suit under the Americans with Disabilities Act, 42 U.S.C. 12132; the Rehabilitation Act, 29 U.S.C. 794; and the Medicaid Act, 42 U.S.C. 1396a(a)(8). The court granted Vaughn summary judgment with an injunction requiring the state to “do whatever is necessary to achieve” round‐the‐clock home‐based care, fully paid for by the state.The Seventh Circuit vacated. Vaughn is not entitled to the services she has requested under Indiana’s version of the Medicaid program, as the program was structured before the state adopted a new pilot program. The state is not obligated to reimburse Vaughn’s providers at rates above the approved Medicaid caps, nor must it use funds outside the Medicaid program to comply with a rule about accommodation within the program. View "Vaughn v. Walthall" on Justia Law

Mitze unsuccessfully appealed the denial of her application for social security benefits. Several years later, Mitze moved to seal her medical information and all other information pertaining to her case, citing “harassing phone calls from solicitors” who knew her personal medical information because the courts had “publicized” it by issuing opinions. She claims that she and her children have experienced social stigma and that thieves broke into her home to steal pain medication, which publicly available documents revealed that she had been prescribed.The Seventh Circuit affirmed the denial of Mitze’s motion. A strong presumption exists in favor of publishing dispositional orders, even in cases involving substantial privacy interests such as state secrets, trade secrets, and attorney-client privilege. The court acknowledged that the existing remedies of proceeding anonymously, requesting redactions, or sealing records may be inadequate in the social security context. News outlets have the right to publish information obtained from public court records and cannot be ordered to remove articles reporting on the decisions in her case. The court rejected an argument under the Health Insurance Portability and Accountability Act, 42 U.S.C. 1320d-6, which regulates the disclosure of information by only healthcare providers and their affiliates. View "Mitze v. Saul" on Justia Law

Surprise injured a tendon in the middle finger of his right hand in 2009, resulting in two surgeries and several months of physical therapy. He initially experienced severe pain. Weeks later Surprise’s therapist noted that his pain had decreased significantly and that therapy was no longer necessary as he could open soda cans and use a coffee cup with his right hand. Surprise suffered a concussion, resulting in post-concussion syndrome, in a 2000 snowmobile accident. In 2009, a psychologist noted Surprise could not read well, could follow only a simple, three-step command, and had poor short-term memory and a limited knowledge base. Surprise also experiences depression and anxiety, although his doctors noted that medications kept these conditions under control. Surprise’s claim for disability insurance benefits and supplemental social security income was denied following a remand. Surprise argued that the ALJ failed to adequately account for a portion of the medical expert’s opinion in the hypothetical question posed to the vocational expert and that her decision violated the law of the case doctrine by failing to adopt the fine manipulation limitation the initial ALJ found in the course of his RFC assessment. The Seventh Circuit affirmed. Surprise did not identify any obvious conflict between the hypothetical question and the Dictionary of Occupational Titles nor did the district court make any factual findings that became the law of the case. View "Surprise v. Saul" on Justia Law

Daugherty, an ALJ hearing disability-benefits applications for the Social Security Administration, took bribes. Conn, who represented many claimants, paid Daugherty $400 per favorable decision; Conn received $5,000 or more per case out of the benefits that Daugherty awarded. Four physicians, including Huffnagle, submitted evaluations to support Daugherty’s decisions, even if the applicant failed to appear for examination. Conn and Daugherty pleaded guilty to federal felonies. One of the physicians was convicted. Huffnagle died. The total cost of benefits granted by Daugherty exceeds $500 million. Following an investigation, a notice under 42 U.S.C. 1320a–8(l), set in motion a process for redetermination of the benefits awarded in connection with the scheme. In a suit under 42 U.S.C. 405(g), 1383(c)(3), Jaxson claimed that the ALJ who presided over his redetermination should have considered Huffnagle’s report but declined to do so only because an internal claims-processing manual and ruling say that an ALJ cannot accept evidence that the Inspector General found is likely a product of fraud. The Seventh Circuit affirmed a ruling in favor of Jaxson. Jaxson may have a hard time persuading an ALJ that there is not even “reason to believe” that Huffnagle’s report is fraudulent but he is entitled to try; 42 U.S.C. 405(b)(1), requires a “reasonable notice and opportunity for a hearing”, and “hearing” means a procedure at which both sides can present views on potentially dispositive matters. View "Jaxson v. Saul" on Justia Law

Immigrants have historically been eligible for various public benefits and the receipt of those benefits, with limited exceptions did not jeopardize the immigrant’s chances of becoming a lawful permanent resident or citizen. The Department of Homeland Security (DHS) issued a new rule, intended to prevent immigrants whom the Executive Branch deems likely to receive any amount of public assistance, from entering the country or adjusting their status. The rule purports to implement the “public charge” provision of 8 U.S.C. 1182(a)(4).The Seventh Circuit affirmed a preliminary injunction against the rule’s enforcement in favor of Cook County, Illinois. The county had standing because the law threatened immediate financial harm because it would cause immigrants to forego preventative health care. The interests of the county are among those protected or regulated by federal law. There is “abundant evidence” supporting the county’s interpretation of the “public charge provision” as being triggered only by long-term primary dependence and that provision does not provide DHS unfettered discretion. The rule is unlikely to survive “arbitrary and capricious” review; it is unclear how immigration officials are to make “public charge” predictions. Cook County lacks legal remedies for the harms imposed by the rule. View "Cook County v. Wolf" on Justia Law

In October 2012, Jeske, working at a cemetery, was carrying a heavy casket when she stumbled, injuring her back. Four years later, she applied for disability insurance benefits and supplemental security income based on disability; she claimed that back and spine problems, anxiety, depression, and suicidal tendencies made her unable to work. At a hearing, Jeske told the ALJ that she was 44 years old and lived with her husband and three sons. She changed the date on which she allegedly became disabled to more than a year after her injury because she had substantial gainful activity in 2013. She explained that she received treatment through a workers’ compensation program and her employer allowed her to work from home many days. When the doctor released her from treatment, Jeske’s boss no longer permitted her to work from home and she quit. Since then she has worked as a part-time security guard.The ALJ found Jeske not disabled under the Social Security Act, 42 U.S.C. 423(d), 1382c(3). The Seventh Circuit affirmed. The ALJ applied the proper standards and sufficiently explained the decision. Although the evidence showed Jeske suffered from limiting back pain, abundant evidence supports the ALJ’s determination that her condition lacked the requirements of a presumptively disabling impairment. The use of daily-living activities, to assess credibility and symptoms, was not improper. The evidence supported a conclusion that Jeske could perform light work with specific restrictions. View "Jeske v. Saul" on Justia Law

Until 2010, Reinaas, now in his mid‐fifties, worked as a machine operator. He injured his spine and tore his rotator cuff on the job, and underwent two neck fusion surgeries. Reinaas planned to return to work but continued to suffer from severe headaches (treated with hydrocodone), shoulder pain, and a decreased range of motion. A neurologist diagnosed him with cervicogenic headaches, and his family doctor diagnosed “long term nuchal headaches” and “[p]ermanent pain syndrome post cervical fusion.” Dr. Bodeau, a Mayo Clinic occupational physician, opined that Reinaas could not return to his factory job and suggested surgical intervention. In 2013, Reinaas had shoulder surgery and attended physical therapy; he took naproxen and Vicodin for pain.Reinaas applied for social security disability benefits. Benefits were denied after state‐retained physicians reviewed his records and concluded that Reinaas’s accounts of his symptoms were not fully credible. Dr. Bodeau opined that Reinaas had “deteriorated significantly” and was “highly unlikely to successfully regain employment at any physical demand level.” The ALJ concluded that Reinaas was not disabled. In determining Reinaas’s residual functional capacity, the ALJ afforded great weight to the opinions of the two non‐examining physicians and gave little weight to Dr. Bodeau’s opinion, explaining that Bodeau lacked knowledge of Social Security disability rules and that his report was based on subjective complaints of questionable credibility.The Seventh Circuit vacated. Substantial evidence does not support the ALJ’s decision to discount the treating physician’s opinion and the ALJ did not adequately evaluate Reinaas’s subjective complaints. View "Reinaas v. Saul" on Justia Law

Under the Medicaid program, 42 U.S.C. 1396, states must ensure that certain medical assistance is available to all eligible beneficiaries. Illinois administers its Medicaid program through HFS. For managed care programs, HFS contracts with Medicaid managed care organizations (MCOs), which a flat monthly fee per patient. The MCOs pay providers for services rendered to Medicaid beneficiaries. Plaintiffs, consultants who offer business services to Illinois nursing homes and supportive living facilities, sued on behalf of a class of nursing home residents entitled to Medicaid benefits, alleging violations of Title XIX of the Social Security Act, the Americans with Disabilities Act, the Rehabilitation Act, and the Due Process and Equal Protection Clauses. They alleged that the MCOs failed to process timely payments for claims submitted by nursing homes—the plaintiff‐consultants’ clients—to the MCOs, putting the resident‐beneficiaries at risk of being discharged from the facilities. The Seventh Circuit affirmed the dismissal of the case for lack of subject matter jurisdiction. The regulation cited by plaintiffs does not permit authorized representatives to bring civil lawsuits on behalf of Medicaid beneficiaries so the plaintiffs lacked standing. The residents would be unlikely to benefit if the plaintiffs won; they apparently filed suit in an effort to push the state to pay outstanding bills owed to the consultants’ clients. View "Bria Health Services, LLC v. Eagleson" on Justia Law

Martin, a 67-year-old woman, sought Social Security Disability benefits. Her persistent back pain stems from two car accidents; she also suffers from depression, anxiety, bipolar disorder, panic disorder, and PTSD. These conditions caused Martin to stop working in 2009. Before then she had worked as a home health aide, data entry clerk, and administrative assistant. An ALJ determined that Martin’s severe impairments left her capable of performing only a limited range of sedentary jobs. The district court remanded for a more thorough consideration of Martin’s mental health problems. A new ALJ then found that Martin had no physical limitations whatsoever and declined to award benefits.The Seventh Circuit reversed, finding the second ALJ’s decision not supported by substantial evidence, and took “the rare step of ordering the award of benefits.” The court rejected Martin’s argument that the ALJ’s residual functional capacity determination failed to translate her mental health symptoms into limitations related to concentration, persistence, and pace but the record is clear that Martin’s physical limitations leave her unable to perform any work above the light level. Given her restricted range of motion and symptoms of pain, light exertion would likely be a challenge for Martin because it requires “a good deal of walking or standing.” View "Martin v. Saul" on Justia Law

Prater was denied Social Security Disability Insurance benefits when she was 47-years-old and weighed about 400 pounds at 64 inches tall. X-rays showed mild-to-moderate degenerative joint disease in her feet and knees and degenerative disc disease in her spine. She was diabetic and had a history of gout. Prater stated that at her last job she experienced pain and fatigue “all the time.” None of her treating physicians indicated that she must alternate between sitting and standing. A vocational expert testified that a hypothetical individual with Prater's vocational background, education, and age, limited to sedentary work with restrictions on lifting, carrying, climbing, driving, and more, who could stand and walk no more than two hours of an eight-hour day and would need to change positions during the day but could remain in place for at least 30 minutes, whether sitting or standing, could not do any of Prater’s past jobs but could perform other jobs available in the national economy.The ALJ concluded that Prater was not disabled, finding that she had the residual functional capacity (RFC) to perform sedentary work with numerous restrictions; that her statements about the intensity, persistence, and limiting effects of her symptoms were “not entirely consistent” with the evidence; and that, although Prater was morbidly obese, “her physical examination was otherwise unremarkable.” The Appeals Council, the district court, and the Seventh Circuit upheld the decision. The sit/stand limitation in the RFC assessment is not too vague. The ALJ’s finding that she could sit and stand for 30 minutes at a time does not lack medical support; the ALJ did not improperly discredit her testimony that she could remain in position for only 20 minutes. View "Prater v. Saul" on Justia Law