Justia Public Benefits Opinion Summaries

Crystal Hultz, a woman born in 1987, stopped working full-time in December 2013 due to multiple health conditions, including lupus, fibromyalgia, spinal disorders, and depression. Although some of her conditions improved with treatment and surgery, she continued to experience severe, persistent symptoms of fibromyalgia, leading to fatigue and periods of being bedridden. Her daily functioning depended heavily on support from her family. Based on these ongoing symptoms, Hultz applied for Social Security disability benefits, asserting that her fibromyalgia and related health problems rendered her unable to work.Her claims for benefits were initially denied by the Social Security Administration (SSA) and again after reconsideration. Following a hearing, an Administrative Law Judge (ALJ) denied her applications, a decision upheld by the SSA's Appeals Council. Hultz sought review in the United States District Court for the District of Maryland, which remanded the case to the ALJ for further consideration of certain impairments. On remand, another ALJ again denied benefits, finding that Hultz's subjective reports of her symptoms were not fully supported by objective medical evidence. The District Court affirmed this denial.The United States Court of Appeals for the Fourth Circuit reviewed the case and found that the ALJ erred by discounting Hultz’s subjective testimony about her fibromyalgia symptoms based on a lack of objective medical evidence. The Fourth Circuit emphasized its precedent that, for conditions like fibromyalgia—which cannot be measured by objective tests—ALJs may not use the absence of such evidence to discredit claimants’ subjective accounts. The court also held that the ALJ improperly gave little weight to the opinion of Hultz’s treating physician. The Fourth Circuit reversed the denial of benefits and remanded the case for a calculation of benefits. View "Hultz v. Bisignano" on Justia Law

After the death of her husband, who had worked in coal mining for nearly 28 years, a widow applied for survivor benefits under the Black Lung Benefits Act (BLBA). Her husband died in 2014 following a hospitalization, and she filed her claim shortly thereafter. The BLBA provides survivor benefits to eligible dependents if a miner’s death is due to pneumoconiosis (“black lung disease”) arising from coal mine employment. A key question in this case was whether the miner’s terminal arterial blood gas (ABG) studies, taken during his last hospitalization, could be used to establish that he was totally disabled due to a chronic respiratory or pulmonary condition at the time of his death.Initially, the District Director awarded benefits and identified the employer as the responsible operator. The employer requested a hearing before the Office of Administrative Law Judges. The first Administrative Law Judge (ALJ) denied benefits, finding that although the miner worked long enough to invoke a presumption that his death was due to pneumoconiosis, the ABG tests lacked an adequate physician’s report linking the results to a chronic condition, as required by regulation. The widow sought modification, arguing that a mistake of fact had been made. A second ALJ granted modification and awarded benefits, relying on a comprehensive report from one of the physicians that sufficiently connected the ABG results to the miner’s chronic lung disease. The Benefits Review Board (BRB) affirmed, holding that the widow established her entitlement to benefits and that the employer failed to rebut the statutory presumption.The United States Court of Appeals for the Fourth Circuit reviewed the case and denied the employer’s petition. The court held that substantial evidence supported the BRB’s decision affirming the award of benefits. Specifically, the court found the physician’s report was sufficient to link the terminal ABG results to a chronic respiratory condition, thus satisfying regulatory requirements and entitling the widow to the statutory presumption. The court also concluded that the ALJ properly granted modification based on a mistake of fact. View "Clinchfield Coal Company v. Mullins" on Justia Law

Horace Meredith worked as a coal miner for several decades, with his last employment at Hobet Mining, Inc. During Meredith’s tenure at Hobet, Arch Coal Company, Inc. was Hobet’s parent company and provided self-insurance for black lung liabilities. Years after Meredith left Hobet and after Arch had sold Hobet to Magnum Coal (which was later acquired by Patriot Coal Company), Meredith filed a claim for black lung benefits. By the time of his claim, both Patriot and Hobet were defunct, and the Department of Labor sought to hold Arch liable for Meredith’s benefits, despite Arch no longer owning or insuring Hobet.After Meredith filed his claim, the district director designated Hobet as the responsible operator and Arch as the insurance carrier. Arch and Hobet contested this designation, arguing that Arch was no longer responsible for Hobet’s liabilities and that the Black Lung Disability Trust Fund should cover the claim. The Administrative Law Judge (ALJ) found Hobet to be the responsible operator and Arch liable as its self-insurer at the time of Meredith’s last employment. The Department of Labor’s Benefits Review Board affirmed the ALJ’s decision, holding Hobet and Arch liable for the claim.The United States Court of Appeals for the Fourth Circuit reviewed the Board’s decision. The court held that neither the Black Lung Benefits Act nor its regulations imposed liability on Arch under these circumstances. Specifically, the court found that Hobet did not meet the regulatory requirements to be a financially capable responsible operator, and Arch could not be held liable as a self-insurer for claims filed long after it ceased to own or insure Hobet. The Fourth Circuit granted the petition for review, vacated the Board’s decision, and remanded for further proceedings consistent with its opinion. View "Hobet Mining, Inc. v. Director, Office of Workers' Compensation Programs" on Justia Law

Dawn Drumgold, a former employee of the Social Security Administration, applied for Social Security disability benefits in 2020, citing mental health issues including depression, bipolar disorder, and PTSD. Her application included medical records from her primary-care doctor, Dr. Sylvia Luther, and her mental-health counselor, Shideh Sarmadi, as well as reports from an independent examiner and two consultants. The records and reports provided conflicting assessments of her level of impairment.The Administrative Law Judge (ALJ) reviewed the evidence and found that Drumgold's limitations were moderate, not severe enough to qualify for disability benefits. The ALJ found Dr. Luther's records, which often noted that Drumgold's depression was in remission, more persuasive than Sarmadi's unsupported and conclusory submissions. The ALJ also found the reports from the two consultants, who concluded that Drumgold had only moderate limitations, to be consistent with the overall record.Drumgold appealed the ALJ's decision to the Social Security Appeals Council, which declined to reverse it. She then took her case to the United States District Court for the Eastern District of Virginia, which upheld the ALJ's decision, finding that it was supported by substantial evidence.The United States Court of Appeals for the Fourth Circuit reviewed the case and affirmed the district court's decision. The court held that the ALJ had reasonably assessed the persuasiveness of the medical opinions based on their supportability and consistency with the overall record. The court found that substantial evidence supported the ALJ's conclusion that Drumgold's limitations were moderate and that she retained some capacity for work. View "Drumgold v. Commissioner of Social Security" on Justia Law

Glen Lawson worked for coal-mining companies for twelve years and has a lengthy smoking history, smoking a pack a day for thirty years before quitting in 2014. He is now totally disabled due to respiratory ailments, including chronic obstructive pulmonary disease (COPD), and has used a portable oxygen tank since 2014, required lung surgery in 2017, and been hospitalized with pneumonia several times. In 2017, Lawson applied for benefits under the Black Lung Benefits Act.A claims examiner approved Lawson's application, and an administrative law judge (ALJ) upheld that determination. The Benefits Review Board affirmed the ALJ's decision. Lawson's former employer, Extra Energy, Inc., petitioned the United States Court of Appeals for the Fourth Circuit for review, arguing that Lawson did not provide sufficient evidence that his respiratory disabilities were attributable at least in part to his coal-mining employment rather than solely to his smoking history.The United States Court of Appeals for the Fourth Circuit reviewed the case and denied Extra Energy's petition for review. The court held that the ALJ sufficiently supported his conclusions regarding the cause of Lawson's disabilities. The ALJ credited the opinions of three medical experts who concluded that Lawson's respiratory and pulmonary ailments were caused by both his smoking history and his coal-mine employment, thus diagnosing him with legal pneumoconiosis. The court found that the ALJ's decision was supported by substantial evidence and consistent with applicable law, affirming the award of black-lung benefits to Lawson. View "Extra Energy, Incorporated v. DOWCP" on Justia Law

Rhonda and Robert Notgrass fraudulently obtained benefits from the Pandemic Unemployment Assistance program by falsely claiming unemployment due to the COVID-19 pandemic. Robert, a minister, and Rhonda, his wife, were ineligible for these benefits as Robert was fired for reasons unrelated to the pandemic, and Rhonda had not lost her job. They both pleaded guilty to misdemeanors and were sentenced to probation by the district court.The United States District Court for the Southern District of West Virginia sentenced the Notgrasses to five years of probation, including several conditions. The Notgrasses appealed four of these conditions: obtaining permission before leaving their judicial district, prohibition on possessing dangerous weapons, registering with an unemployment agency, and Robert's participation in a supervised mental-health treatment program. They argued that these conditions were both procedurally and substantively unreasonable.The United States Court of Appeals for the Fourth Circuit reviewed the case. The court first determined that the Notgrasses' appellate waiver did not cover challenges to probation conditions, allowing the appeal to proceed. On the merits, the court found that the district court had adequately explained the conditions in light of the Notgrasses' objections. The travel-permission and weapons prohibition conditions were standard and self-evident, while the unemployment registration and mental-health treatment conditions were tailored to the Notgrasses' specific circumstances. The court held that all four conditions were reasonably related to the § 3553(a) sentencing factors and were not an abuse of discretion.The Fourth Circuit affirmed the district court's sentences, finding the probation conditions both procedurally and substantively reasonable. View "US v. Notgrass" on Justia Law

Social security survivors' benefits are a thing of value of the United States that can support a conviction under 18 U.S.C. 641. Viewed in the light most favorable to the government, the Fourth Circuit concluded that substantial evidence supported defendant's conviction for theft of government property beyond a reasonable doubt. In this case, the jury could reasonably infer from two denied benefits applications that defendant had a motive to file under a different benefits program to again attempt to obtain benefits to which he was not entitled. Finally, the district court's trial management was reasonable and far from an abuse of discretion. Accordingly, the court affirmed the judgment. View "United States v. Kiza" on Justia Law

Plaintiff challenges the denial of her application for social security disability benefits. Before the court is an issue of first impression regarding whether an ALJ's failure to follow the special technique required by 20 C.F.R. 404.1520a when evaluating a claimant’s mental impairment requires remand or may constitute harmless error. The court held that such an error does not automatically require remand, but that the error was not harmless on these facts. Accordingly, the court reversed the district court's order denying benefits and remanded with instructions to the ALJ for appropriate review of plaintiff's mental impairment. View "Patterson v. Commissioner of SSA" on Justia Law

An ALJ found that Jerry Addison was entitled to benefits under the Black Lung Benefits Act, 30 U.S.C. 901-944, because he had established the existence of clinical and legal pneumoconiosis that resulted in a total respiratory disability. Sea-B, Addison's former employer, filed a petition for review of the ALJ's decision. The court concluded that the ALJ’s decision to exclude the additional CT scan evidence was not harmless. This error affects the determination of both clinical and legal pneumoconiosis and impacts the ALJ’s consideration of the other evidence in this case. The omitted CT scan evidence is unquestionably probative of the central issue in dispute: whether Addison suffered from pneumoconiosis. Furthermore, the court could not determine from the ALJ’s sparse explanation how, or if, he weighed the x-ray readings in light of the readers’ qualifications. Finally, because the proffered explanation for elevating Dr. Forehand’s diagnosis is not supported, the ALJ must reevaluate that opinion to determine the proper weight it should be given. Accordingly, the court granted the petition for review, vacated the order, and remanded for further proceedings. View "Sea "B" Mining Co. v. Addison" on Justia Law

Relators filed suit against medical laboratory businesses in 2007 in state court, alleging that the labs had submitted false claims to the Commonwealth for Medicaid reimbursement. Defendants removed to federal court. After the Commonwealth entered into a settlement agreement with defendants, the district court awarded relators a share of the settlement proceeds. Relators appealed, contending that the district court's award was insufficient under state law. The court vacated and remanded to the state court, concluding that the district court lacked subject matter jurisdiction over the qui tam action. In this case, by the plain terms of the complaint, relators could have prevailed on their state law claims by proving that defendants contravened the Commonwealth’s Medicaid regulations, without showing any violation of federal law. View "Commonwealth of Virginia ex rel. Hunter Labs. v. Commonwealth of Virginia" on Justia Law