Justia Public Benefits Opinion Summaries

Hohman, age 53, applied for Social Security benefits after she stopped working. She suffers from fibromyalgia, PTSD, depression, and anxiety, and alleged that the combined effects of these conditions left her unable to work as a medical records clerk or patient access representative. A vocational expert testified that someone with Hohman’s limitations could work as a photocopy machine operator, small products assembler, or mail clerk. Relying on that testimony, an ALJ denied the claim for benefits, finding that despite her limitations, Hohman still had the capacity to perform light work with physical and social limitations available in significant numbers in today’s economy. The vocational expert stated that he arrived at his final numbers about jobs available in the economy through a “weighted estimate" based upon professional experience, 25 years of both placement and labor market survey work, and 2,000 labor market surveys, explaining that many of the job titles in the database had been merged or had been eliminated by technology, so he decided that the job titles should not receive equal weight.The Seventh Circuit and the district court affirmed. Substantial evidence supports the denial. The court acknowledged Hohman’s frustration with the equal distribution method and concerns about the method’s reliability but stated that it is not, by itself, reversible error for an ALJ to rely on the equal distribution method to make a job-number determination. View "Hohman v. Kijakazi" on Justia Law

Leisgang suffers from depression, anxiety, and a personality disorder, among other conditions. He sought supplemental security income and disability insurance benefits. The ALJ concluded that Leisgang could undertake only simple, routine, and repetitive work; could not work at a rapid, production-rate pace; could tolerate few changes in routine work settings; and could interact only occasionally with supervisors, coworkers, and the public. Those limitations precluded Leisgang from performing his past work. To determine whether Leisgang could perform other available jobs, the ALJ sought assistance from a vocational expert, who testified that someone with Leisgang’s limitations could work as a kitchen helper, sweeper/cleaner, or hospital cleaner. The expert estimated that there were meaningful numbers of each job across the country, identifying job titles using the Department of Labor's 1977 dictionary, not revised since 1991. The primary data came from the Occupational Employment Quarterly, which applies the equal distribution method to estimate the distribution of job numbers within a larger group of occupations. When Leisgang asked if that method was reliable, the expert reported that it was the only method he had available. Leisgang asked no further questions about the methodology.The district court and Seventh Circuit affirmed the denial of benefits. Leisgang forfeited his argument that the ALJ should have done more to ensure the soundness of the vocational expert’s methodology by failing to object at the hearing. Substantial evidence otherwise supports the ALJ’s determination. View "Leisgang v. Kijakazi" on Justia Law

Out-of-work residents of Michigan may claim unemployment benefits if they meet certain eligibility criteria. The State’s Unemployment Insurance Agency oversees the benefits system. In 2011, with the help of private contractors, the Agency began to develop software to administer the unemployment system. The Agency sought to equip the software to auto-adjudicate as many parts of the claims process as possible. The Agency programmed software that used logic trees to help process cases and identify fraud. A claimant’s failure to return the fact-finding questionnaire, for example, led to a fraud finding, as did the claimant’s selection of certain multiple-choice responses. In August 2015, problems arose with some features of the system, prompting the Agency to turn off the auto-adjudication feature for fraud claims.Plaintiffs are four individuals who obtained unemployment benefits, which were terminated after the Agency flagged their claims for fraud. Plaintiffs filed a putative class action against three government contractors and nineteen Agency staffers, raising claims under the Fourth, Fifth, and Fourteenth Amendments, 26 U.S.C. Sec. 6402(f), and Michigan tort law. In a previous proceeding, the court held that plaintiffs’ due process rights clearly existed because they had alleged a deprivation of their property interests without adequate notice and without an opportunity for a pre-deprivation hearing.At this stage, because the remaining plaintiffs have failed to show that these procedures violate any clearly established law, the supervisors of the unemployment insurance agency are entitled to judgment as a matter of law. The court also found that an intervening plaintiff was properly prevented from joining the case, based on her untimely filing. View "Patti Cahoo v. SAS Institute, Inc." on Justia Law

Claimant appealed the district court’s judgment upholding the denial of social security benefits by an administrative law judge (“ALJ”). Reviewing de novo the district court’s decision, Farlow v. Kijakazi, 53 F.4th 485, 487 (9th Cir. 2022), the Ninth Circuit reversed The ALJ materially mischaracterized Claimant’s functional capacity when posing a question to a vocational expert, so the vocational expert’s testimony lacked evidentiary value with respect to jobs that Claimant could perform. Here, Claimant argued that the ALJ’s question posed to the vocational expert inaccurately described her actual limitations. First, the hypothetical posed to the expert did not provide that claimant was limited to jobs with “little or no judgment.” The panel concluded that the error was harmless because the vocational expert identified only jobs with that limitation. Second, the hypothetical did not provide that Claimant could “follow short, simple instructions” only. Third, in the question posed to the vocational expert, the ALJ described a hypothetical person who “can work in an environment with occasional changes to the work setting.” The panel concluded that the ALJ materially mischaracterized Claimant’s functional capacity when posing a question to a vocational expert, so the vocational expert’s testimony lacked evidentiary value with respect to jobs that Claimant could perform. View "CAROLINE LEACH V. KILOLO KIJAKAZI" on Justia Law

Plaintiff sought disability benefits from the Social Security Administration in 2018. He primarily based his application on pain in his lower back, hips, legs, knees, and feet, as well as on hypertension. Throughout the administrative process and upon review in federal district court, Plaintiff was denied benefits. He appealed.   The Fourth Circuit reversed and remanded the district court’s ruling affirming the ALJ’s final decision denying Plaintiff’s application for disability benefits. The court explained that nothing in the record expressly reconciles the differing mobility conclusions between 2018 and 2019, but it seems reasonable to believe that perhaps Plaintiff’s objective ailments worsened during that time, thereby impacting his mobility. To be sure, neither this Court nor an ALJ may infer a medical diagnosis—like symptom progression. But when insufficient evidence prevents an ALJ from soundly determining whether providers’ opinions are consistent, a Section 404.1520b(b)(2) inquiry by the ALJ could remedy the uncertainty with relative ease. Second, the court held that the ALJ improperly considered Plaintiff’s subjective complaints. Third, the court found that the ALJ improperly considered whether Plaintiff’s daily activities were inconsistent with his claim of disability. View "Renard Oakes v. Kilolo Kijakazi" on Justia Law

Hampton served in the Navy from 1985-1989. In 1997, she filed a claim for VA disability compensation for migraines. In 1998, the regional office (RO) increased Hampton’s rating to 30 percent, effective from 1997. In 1999, Hampton applied for a total disability rating based on individual unemployability (TDIU) effective from 1997 due to “migraine[s], bladder, [and] reflux.” The RO denied TDIU. Hampton never filed a notice of disagreement but filed a new claim for increased compensation based on migraines. This claim was denied in 1999; Hampton filed a notice of disagreement. In 2000, the Board affirmed the RO. In 2003, Hampton filed a new claim for increased compensation and a second TDIU application. The Board ultimately granted Hampton TDIU, effective from 2003. Hampton argued that her 1999 TDIU claim was still pending because she submitted additional evidence within the one-year appeal window but never received a determination. The Board denied entitlement to an earlier effective date, finding that the 1999 TDIU claim was not still pending when Hampton filed her 2003 claims.The Veterans Court and Federal Circuit affirmed; 38 CFR 3.156(b) does not require the VA to explicitly state whether submitted evidence is new and material to a claim, where that claim is implicitly denied after consideration of the evidence. The Board’s 2020 decision, by finding the 2000 decision an implicit denial of TDIU, was not making a new and material evidence determination in the first instance. The RO did so in 1999. View "Hampton v. McDonough" on Justia Law

Petitioners sued retail pharmacies under the False Claims Act (FCA), 31 U.S.C. 3729, which permits private parties to bring lawsuits in the name of the United States against those who they believe have defrauded the federal government and imposes liability on anyone who “knowingly” submits a “false” claim to the government. Petitioners claim that the pharmacies defrauded Medicaid and Medicare by offering pharmacy discount programs to their customers while reporting their higher retail prices, rather than their discounted prices, as their “usual and customary” charge for reimbursement. The Seventh Circuit concluded that the pharmacies could not have acted “knowingly” if their actions were consistent with an objectively reasonable interpretation of the phrase “usual and customary.”The Supreme Court vacated. The FCA’s scienter element refers to a defendant’s knowledge and subjective beliefs—not to what an objectively reasonable person may have known or believed. The FCA’s three-part definition of the term “knowingly” largely tracks the traditional common-law scienter requirement for claims of fraud: Actual knowledge, deliberate ignorance, or recklessness will suffice. Even though the phrase “usual and customary” may be ambiguous on its face, such facial ambiguity alone is not sufficient to preclude a finding that the pharmacies knew their claims were false. View "United States ex rel. Schutte v. Supervalu Inc." on Justia Law

Combs suffers from several physical and mental impairments. An ALJ found that she suffers from lumbar spondylosis, asthma, migraines/headaches, chronic pain syndrome, diabetes with diabetic polyneuropathy, obesity, attention deficit hyperactivity disorder, schizoaffective disorder, bipolar type, posttraumatic stress disorder, social anxiety disorder, generalized anxiety disorder, and borderline personality disorder. Combs sought treatment for lower back pain in March 2018 at PPG, where she received various tests, treatments, and prescriptions through 2020.Combs applied for Disability Insurance Benefits in August 2019, alleging an onset of disability on December 24, 2015. The claim was denied initially and upon reconsideration. The district court concluded the ALJ’s determination was supported by substantial evidence. The Seventh Circuit affirmed, rejecting an argument that the ALJ should have concluded that Combs suffered a closed period of disability from June 2019 to July 2020 due to her back impairment, pain, and multiple invasive procedures that would have rendered her off task or absent beyond employer tolerances. The record amply supports the ALJ’s conclusion that Combs was not disabled at any time, including during that period. View "Combs v. Kijakazi" on Justia Law

Relying on the vocational expert (“VE”)’s testimony, the administrative law judge (“ALJ”) found that there were a significant number of jobs in the national economy that Plaintiff could perform, and, therefore, Plaintiff was not disabled. Plaintiff’s attorney sent a letter to the Appeals Council asking it to review the ALJ’s finding that there were a significant number of jobs in the national economy that Plaintiff could perform. The Appeals Council made the attorney’s letter and a six-page attachment part of the record and denied Plaintiff’s request for review of the ALJ’s disability determination because it “found no reason under [the] rules to review the Administrative Law Judge’s decision.” On appeal, Plaintiff challenged only the ALJ’s conclusion that there were a significant number of jobs in the national economy that a person with Plaintiff’s limitations, age, education, and experience could perform.   The Ninth Circuit affirmed the district court’s decision upholding the Commissioner of Social Security’s denial. The panel held that to determine whether the ALJ had a duty to address a conflict in job-number evidence (and failed to discharge that duty), it considers on a case-by-case “meritless or immaterial” or has “significant probative value.” Because Plaintiff did not present his job-number evidence to the ALJ during or after the hearing, the ALJ did not have any occasion to address the purported inconsistency between the VE’s estimates and Plaintiff’s contrary estimates. The panel held that the letter by Plaintiff’s counsel and the six pages of printouts together provided no basis to conclude that these results qualified as significant and probative evidence. View "JAMES WISCHMANN V. KILOLO KIJAKAZI" on Justia Law

The Supreme Court dismissed this direct appeal brought by the Iowa Department of Human Services (HDS) from a district court ruling requiring Iowa's Medicaid program to pay for sex reassignment surgery for two transgender adults and affirmed the denial of fees on cross-appeal, holding that the appeal was moot.Petitioners, adult transgender Iowans who were denied preauthorization for sex reassignment surgeries through the Medicaid program, appealed their managed care organization's denial of coverage to DHS. DHS affirmed the denials. The district court reversed, concluding that Iowa Code 216.7(3), an amendment to the Iowa Civil Rights Act (ICRA) violated the guarantee of equal protection under the Iowa Constitution. DHS appealed, but, thereafter, agreed to pay for Petitioners' surgeries. The Supreme Court dismissed the direct appeal as moot and affirmed the district court's order denying any fee award, holding that the court erred in denying Petitioners' request for attorney fees. View "Vasquez v. Iowa Dep't of Human Services" on Justia Law