Justia Government & Administrative Law Opinion Summaries

The United States Court of Appeals for the Ninth Circuit affirmed the decision of the district court, which upheld the Commissioner of Social Security's denial of a claimant's application for supplemental security income. The claimant argued that the Social Security Administration's 2017 revised regulations for evaluating medical opinions were partially invalid because they did not provide a reasoned explanation for permitting an administrative law judge to avoid articulating how he or she accounts for the "examining relationship" or "specialization" factors under the Social Security Act or the Administrative Procedure Act (“APA”). The court found that the Commissioner's decision to promulgate the 2017 medical evidence regulations fell within his wide latitude to make rules and regulations, particularly those governing the nature and extent of the proofs and evidence to establish the right to benefits. The court also joined the Eleventh Circuit in holding that the regulations were valid under the APA, as the agency's response to public comment and reasoned explanation for the regulatory changes established that the regulations were not arbitrary or capricious. View "CROSS V. O'MALLEY" on Justia Law

Erik Bertaud, who suffered serious injuries when a tree branch fell on his head, applied for disability insurance benefits and supplemental security income from the Social Security Administration. His application was denied, and he appealed. The Appeals Council remanded the case twice, but after the third denial, Bertaud's request for review was denied, making the ALJ's decision the final decision of the Commissioner. Bertaud then sought judicial review, arguing that the ALJ had failed to develop the record of his disability, pointing to over 800 pages of new medical evidence. The district court denied Bertaud's motion for summary judgment and affirmed the Commissioner's decision, and Bertaud appealed to the United States Court of Appeals for the Seventh Circuit.The court held that although an ALJ has a duty to develop a full and fair record, this duty is limited when the claimant is represented by an attorney. The claimant's duty to submit evidence is ongoing and covers any additional related evidence they become aware of. The court noted that Bertaud was represented and his attorney had confirmed that the evidence was complete and supplemented the record when necessary. Therefore, the court concluded that the ALJ did not fail to develop Bertaud's medical record. The court affirmed the district court's decision denying Bertaud's motion for summary judgment and affirming the decision of the Commissioner. View "Bertaud v. O'Malley" on Justia Law

The case involves the plaintiff-appellant, Chris Martin, who suffered a back injury in June 2016 and stopped working. He sought medical attention in February 2018 and was diagnosed with a spine disorder in May 2018. Martin applied for Social Security disability benefits and was awarded supplemental security income after an administrative law judge (ALJ) found him disabled under the Social Security Act's stringent definition. However, he was denied disability insurance benefits because his insured status for those benefits had expired on December 31, 2017, a few weeks before he was found to have been disabled. Martin appealed, arguing that the ALJ should have consulted an additional medical expert to determine whether he was disabled earlier, before his insured status lapsed. The United States Court of Appeals for the Seventh Circuit concluded that the ALJ did not abuse her discretion in deciding not to consult another medical expert. The court explained that Social Security Ruling 18–01p allows an ALJ to decide whether to consult an additional medical expert to answer that question. Therefore, the court affirmed the denial of disability insurance benefits. View "Martin v. Kijakazi" on Justia Law

The case before the Supreme Court of the State of Delaware concerned an appeal by Carrah LeBoon Odell against an order from the Superior Court of the State of Delaware. The order affirmed a decision made by the Unemployment Insurance Appeal Board (UIAB) that upheld decisions by an appeals referee concluding that Odell was liable to repay overpaid unemployment benefits totaling $7,139.Odell had originally filed a claim for unemployment insurance benefits after her employer, Allied Universal, reduced her hours. She later obtained a second job at Rater Labs and reported income from both employers to the Department of Labor. She received traditional unemployment benefits and Federal Pandemic Unemployment Compensation under the CARES Act for a period. It was later determined that Odell’s total income during the period was too high to qualify for unemployment benefits, and the benefits she received were therefore an overpayment subject to recoupment by the Department.Odell appealed the overpayment determinations, admitting that she was ineligible for traditional unemployment benefits during the period in question because her income was too high. She requested a waiver of the obligation to repay the benefits, arguing that she met the conditions for a repayment waiver established by the US Department of Labor’s instructions to states regarding processing overpayment waivers under the CARES Act.The UIAB affirmed the appeals referee’s decision. Odell then appealed to the Superior Court, which also affirmed the Board’s decision.Odell appealed to the Supreme Court of the State of Delaware, which concluded that the Board’s decision was supported by substantial evidence and free from legal error. The Supreme Court ruled that Odell was liable for repayment, regardless of the cause of the overpayment. Her arguments concerning the Department’s computer system and discovery relating to that system did not establish reversible error. Furthermore, her argument that her repayment obligation should have been waived did not establish reversible error as repayment waivers were not available at the time of the proceedings below.Therefore, the Supreme Court affirmed the judgment of the Superior Court. View "Odell v. Unemployment Insurance Appeal Board" on Justia Law

Plaintiff, proceeding pro se, filed suit against multiple private entities and government officials, including, as relevant to the instant appeal, the Social Security Commissioner, a Social Security claims representative, the Secretary of the Treasury, and the Secretary of Education (the “Federal Defendants”), asserting a number of claims relating to the Social Security Administration’s (SSA) allegedly improper withholding of his disability benefits.   The Fifth Circuit affirmed. The court concluded that it did not have subject matter jurisdiction over Mr. Chambers’ claims against the Social Security Administration representatives concerning his Social Security benefits and that Plaintiff has failed to state a claim as to its remaining claims against the Federal Defendants. The court explained that while the lack of jurisdiction is a sufficient basis on which to affirm the district court, Plaintiff’s broad challenges to “any of [the court’s] holdings dismissing the federal government defendants” warrant but a brief note. The court found no error in the district court’s dismissal of the Treasury Secretary, given its purely ministerial role in administering the offset for Plaintiff’s outstanding loan, or its dismissal of the Secretary of Education, given Plaintiff’s similar failure to exhaust administrative remedies with that department and failure to advance a colorable constitutional violation. View "Chambers v. Kijakazi" on Justia Law

Plaintiff first applied for disability insurance benefits on September 3, 2019, alleging a disability onset date of December 1, 2017. His date last insured for the purpose of benefits eligibility was June 30, 2018. The Social Security Administration (“SSA”) denied his application initially and on reconsideration, and he requested an administrative hearing. After the December 14, 2020, hearing, the ALJ determined that Plaintiff was not disabled. The Social Security Appeals Council denied Plaintiff’s request for review. Plaintiff then sought review in the district court, and the district court granted the Commissioner’s motion for summary judgment. This appeal followed.   The Ninth Circuit reversed. The panel explained that at step two of the sequential analysis, claimants need only make a de minimis showing for the ALJ’s analysis to proceed past this step and that properly denying a claim at step two requires an unambiguous record showing only minimal limitations. The seven-month period for which Plaintiff seeks disability benefits falls within a two-and-a-half-year gap in his medical treatment records. The panel held that Plaintiff made the requisite showing to meet step two’s low bar, where he submitted evidence that he suffered from multiple chronic medical conditions that both preceded and succeeded the gap in his treatment. The panel concluded that this cumulative evidence was enough to establish that Plaintiff’s claim was nonfrivolous and to require the ALJ to proceed to step three. Therefore, the ALJ’s denial of Plaintiff’s claim at step two was premature. View "BRIAN GLANDEN V. KILOLO KIJAKAZI" on Justia Law

Fitschen was diagnosed with advanced cancer and stopped working. In 2000 the Social Security Administration (SSA) found Fitschen eligible for disability benefits. Fitschen returned to work in 2001 but continued to receive benefits for a nine-month “trial work period,” 42 U.S.C. 422(c)(4). After that period, he could continue to work and receive benefits for another 36-month period if his wages did not exceed the level at which a person is deemed to be capable of engaging in substantial work activity. The SSA's 2003 review determined that Fitschen had engaged in substantial work and should not have received benefits for much of 2002-2003. The SSA notified him of his overpayment liability but his benefits continued because he had again ceased substantial work. Fitschen again returned to work in 2004 but did not report the change. The SSA initiated another review in 2007 and suspended his benefits. The SSA may waive recovery of overpayments if the recipient was without fault.In 2019 the Commissioner of Social Security found Fitschen liable for an overpayment of $50,289.70 and declined to waive recovery. The district court and Seventh Circuit affirmed, rejecting an argument that the SSA was procedurally barred from recovering the overpayment because it failed to comply with its “reopening” regulation; the overpayment assessment did not “reopen” Fitschen’s initial eligibility determination or any later determination concerning the continuation or recomputation of his benefits. Substantial evidence supports the finding that Fitschen was at fault. View "Fitschen v. Kijakazi" on Justia Law

With the onset of COVID-19, the Alabama Department of Labor received a record number of applications for unemployment benefits. The Department struggled to process the additional million-plus applications in a timely fashion. The plaintiffs-appellants in this case were among the many individuals who experienced delays in the handling of their applications. They brought this lawsuit in an effort to jumpstart the administrative-approval process. In their operative joint complaint, each plaintiff raised multiple claims for relief, all of which sought to compel the Alabama Secretary of Labor, Fitzgerald Washington, to improve the speed and manner in which the Department processes their applications for unemployment benefits. Secretary Washington responded to the suit by asking the circuit court to dismiss all claims against him, arguing (among other things) that the circuit court lacked jurisdiction over the suit because the plaintiffs had not yet exhausted mandatory administrative remedies. After the circuit court granted that motion, the plaintiffs appealed to the Alabama Supreme Court. The Supreme Court agreed with Secretary Washington that the Legislature prohibited courts from exercising jurisdiction over the plaintiffs' claims at this stage. The Court therefore affirmed the circuit court's judgment of dismissal. View "Johnson, et al. v. Washington" on Justia Law

Adams, born in 1960, smoked about a pack a day starting at age 18 and worked in coal mines at times between 1979-1995, mostly underground using a “cutting machine” in the “dustiest” areas. Adams struggled to breathe after his retirement. Adams’s 1998 application under the Black Lung Benefits Act, 30 U.S.C. 901(b), was denied because he failed to prove that he had pneumoconiosis. In 2008, Adams sought benefits from Wilgar. His treating physician, Dr. Alam, identified the causes of his 2013 death as cardiopulmonary arrest, emphysema, coal worker’s pneumoconiosis, throat cancer, and aspiration pneumonia.A 2019 notice in the case stated “the Court may look to the preamble to the revised” regulations in weighing conflicting medical opinions. Wilgar unsuccessfully requested discovery concerning the preamble and the scientific studies that supported its conclusions. The ALJ awarded benefits, finding that Adams had “legal pneumoconiosis” and giving Dr. Alam’s opinion that Adam’s coal mine work had substantially aggravated his disease “controlling weight.” All things being equal, a treating physician’s opinion is “entitled to more weight,” 30 C.F.R. 718.104(d)(1). Wilgar's three experts had opined that Adams’s smoking exclusively caused his disease The ALJ gave “little weight” to these opinions, believing that they conflicted with the preamble to the 2001 regulation.The Benefits Review Board and Sixth Circuit affirmed. The preamble interpreted the then-existing scientific studies to establish that coal mine work can cause obstructive diseases, either alone or in combination with smoking. The ALJ simply found the preamble more persuasive than the experts. View "Wilgar Land Co. v. Director, Office of Workers’ Compensation Programs" on Justia Law

The Supreme Court reversed the decision of the court of appeals affirming the final order of the Commissioner of the Department of Human Services' (DHS) concluding that Trinity had engaged in the abuse outlined in DHS's notices and spreadsheets, holding that the first report of the administrative law judge (ALJ) was the binding decision in this matter.Trinity Home Health Care, which provided nursing and personal care assistant services, received reimbursement from DHS for services that it provided to Medicaid-eligible people with disabilities. After an investigation, DHS sent Trinity notices of termination from the program and demanding return of overpayments and payment-withholding. Both before and after remand by the Commissioner, the ALJ found that terminating Trinity's participation in the Minnesota Health Care Programs was an inappropriate sanction for Trinity's failure to provide certain records. The Commissioner modified the report, concluding that Trinity had engaged in the abuse alleged by the DHS. The court of appeals affirmed. The Supreme Court reversed, holding (1) the Commissioner did not have the authority to remand the case due to the DHS's general authority to administer and supervise Medicaid; and (2) the Commissioner did not have implied authority to remand the case to the ALJ under case law. View "In re Surveillance & Integrity Review Appeals by Trinity Home Health Care Services" on Justia Law