Justia U.S. 4th Circuit Court of Appeals Opinion Summaries

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

Jerry L. Blankenship applied for living miner benefits under the Black Lung Benefits Act, claiming he suffered from coal dust-induced pneumoconiosis and was totally disabled. An Administrative Law Judge (ALJ) found Blankenship entitled to a rebuttable presumption of total disability due to pneumoconiosis under 30 U.S.C. § 921(c)(4) and determined that his former employer, Island Creek Coal Company, failed to rebut this presumption. Consequently, Blankenship was awarded benefits. The Benefits Review Board affirmed the ALJ’s decision.Island Creek petitioned for review, arguing that the ALJ improperly conflated the presence of pneumoconiosis and disability causation with the separate total disability analysis. Additionally, Island Creek contended that the ALJ failed to adequately explain his decision to credit the opinions of Blankenship’s medical experts over those of Island Creek’s experts.The United States Court of Appeals for the Fourth Circuit reviewed the case and agreed with Island Creek. The court found that the ALJ improperly relied on the presence of pneumoconiosis and the causation of Blankenship’s impairment in concluding that he was totally disabled. The court also determined that the ALJ failed to provide a sufficient explanation for crediting the medical opinions of Drs. Nader and Green over those of Drs. McSharry and Sargent, violating the duty of explanation under the Administrative Procedure Act.The Fourth Circuit granted Island Creek’s petition for review, vacated the decision of the Benefits Review Board, and remanded the case with instructions for the Board to return Blankenship’s case to the ALJ for reconsideration consistent with the court’s opinion. View "Island Creek Coal Co. v. Blankenship" on Justia Law

In 2013, Johnny Ray Penegar, Jr. was diagnosed with mesothelioma, and Medicare partially covered his treatment costs. He filed a workers' compensation claim against his employer, UPS, and its insurer, Liberty Mutual. After his death, his wife, Carra Jane Penegar, continued the claim and added a death benefits claim. The North Carolina Industrial Commission (NCIC) ruled in her favor, ordering Liberty Mutual to cover all medical expenses related to the mesothelioma and reimburse any third parties, including Medicare. The NCIC's decision was affirmed by the North Carolina Court of Appeals and the Supreme Court of North Carolina denied further review. In 2020, Penegar and Liberty Mutual settled, with Liberty Mutual agreeing to pay $18,500 and to handle any Medicare liens.Penegar filed a class action lawsuit in the Western District of North Carolina under the Medicare Secondary Payer Act (MSP Act), alleging that Liberty Mutual failed to reimburse Medicare, leading to a collection letter from the Centers for Medicare and Medicaid Services (CMS) demanding $18,500. Liberty Mutual moved to dismiss, arguing Penegar lacked standing and that the settlement precluded her claims. The district court agreed, finding Penegar lacked standing and dismissed the case.The United States Court of Appeals for the Fourth Circuit reviewed the case and affirmed the district court's decision. The court held that Penegar did not suffer a cognizable injury in fact at the time she filed the lawsuit. The NCIC had ordered Liberty Mutual to reimburse Medicare directly, not Penegar, distinguishing her case from Netro v. Greater Baltimore Medical Center, Inc. Additionally, the CMS letter only posed a risk of future harm, which is insufficient for standing in a damages suit. Finally, any out-of-pocket expenses Penegar incurred were already compensated by Liberty Mutual before she filed the lawsuit, negating her claim of monetary injury. View "Penegar v. Liberty Mutual Insurance Co." on Justia Law

Donna Ard applied for disability benefits, claiming she was disabled due to various health issues, including anemia, chronic pain, depression, PTSD, and OCD. She was 49 years old at the time of her application, six months and seventeen days shy of her 50th birthday. Ard's application was denied by the Social Security Administration, and she subsequently requested a hearing before an administrative law judge (ALJ). The ALJ also denied her application, finding that she was not disabled under the Social Security Act.Ard appealed the ALJ's decision to the Social Security Appeals Council, which denied her request for review. She then filed a complaint in the United States District Court for the District of South Carolina. The magistrate judge affirmed the ALJ's decision, holding that the ALJ was not required to consider whether Ard should be treated as a person closely approaching advanced age under the borderline age rule, as she was more than six months away from her 50th birthday.The United States Court of Appeals for the Fourth Circuit reviewed the case and affirmed the magistrate judge's decision. The court held that the borderline age rule, which allows for consideration of a higher age category if an applicant is within a few days to a few months of reaching that category, did not apply to Ard because she was more than six months away from turning 50. The court found that the ALJ had correctly applied the legal standards and that the factual findings were supported by substantial evidence. Therefore, the court concluded that the ALJ was not required to consider treating Ard as a person closely approaching advanced age. The decision of the district court was affirmed. View "Ard v. O'Malley" 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

Appellants challenged the appointment of Social Security Administration Acting Commissioner Nancy Berryhill under the Federal Vacancies Reform Act (FVRA). They argue that no one may serve as an acting officer under 5 U.S.C. Section 3346(a)(2), which allows acting service while a nomination is pending in the Senate unless that nomination occurred during the initial 210-day period of acting service allowed by 5 U.S.C. Section 3346(a)(1). Appellants assert that Section 3346(a)(2) serves only to toll Section 3346(a)(1)’s time limit and does not authorize an independent period of acting service.   The Fourth Circuit affirmed. The court rejected Appellants’ argument because Section 3346(a)(1) and Section 3346(a)(2) are, by their plain text, disjunctive and independent. Because Berryhill was legally serving as Acting Commissioner, her appointments of the ALJs who decided Appellants’ cases were valid. The court explained that Appellants’ reading of the statute would shift the balance against the President. It would prevent him from designating anyone to serve as an acting officer if he submits a nomination after the 210-day period has elapsed, thus leaving the office vacant for as long as the Senate takes to consider it. View "Barbara Rush v. Kilolo Kijakazi" on Justia Law

Plaintiff filed a claim under 42 U.S.C 405(g), believing the Social Security Administration miscalculated his benefits. He filed his claim more than one year after the SSA verbally denied his request for review, and after he did not receive the requested written documentation of the SSA's denial.The SSA filed a motion to dismiss, arguing that the district court lacked subject matter jurisdiction because Sec. 405(g)’s waiver of sovereign immunity applied only with respect to judicial review of a “final decision of the Commissioner of Social Security” and that Plaintiff had not obtained a final decision, having refused to exhaust the four-step administrative process. The district court granted SSA’s motion.Finding that Sec. 405(g)’s exhaustion requirement is not jurisdictional, the Fourth Circuit nonetheless concluded that exhaustion is a mandatory requirement of the Social Security Act that may be excused only in a narrow set of circumstances, which were not present in this case. Accordingly, the court affirmed the district court’s dismissal. View "L.N.P. v. Kilolo Kijakazi" on Justia Law

Plaintiff initiated a civil action in district court contesting the denial of her claim for disability insurance benefits by Defendant Commissioner of the Social Security Administration (the “SSA”). Plaintiff has asserted that the SSA Commissioner erred in multiple ways. Her arguments include that, pursuant to precedents of this Court, the Commissioner should have accorded substantial weight to a prior determination by the Department of Veterans Affairs (the “VA”) that Plaintiff is 100% disabled, but the Commissioner instead followed contrary new SSA rules providing that such a determination need not be considered, much less given any weight. As Rogers would have it, the new SSA rules cannot — and thus do not — abrogate this Court’s precedents. The district court concluded, however, that the new SSA rules supersede our precedents and that the Commissioner acted appropriately in adhering to those rules. After then addressing many, but not all, of Plaintiff’s other arguments, the court affirmed the Commissioner’s decision. Plaintiff appealed from the court’s judgment.   The Fourth Circuit vacated the court’s judgment and remanded for the court to further remand this matter for administrative proceedings. The court concluded that by omitting the menstrual cycle evidence from the residual functional capacity assessment as to Plaintiff, the ALJ’s decision is sorely lacking in the analysis needed for the court to review meaningfully the ALJ’s conclusions. That legal error alone demands further administrative proceedings. View "Shanette Rogers v. Kilolo Kijakazi" on Justia Law

Plaintiff appealed the district court’s order affirming the Social Security Administration’s (“SSA”) denial of her application for Social Security Disability Insurance (“SSDI”). In her application, she alleged major depressive disorder (“MDD”), anxiety disorder, and attention deficit disorder (“ADHD”). Following a formal hearing, the Administrative Law Judge (“ALJ”) determined that Plaintiff suffered from severe depression with suicidal ideations, anxiety features and ADHD, but he nonetheless denied her claim based on his finding that she could perform other simple, routine jobs and was, therefore, not disabled. Plaintiff contends that the ALJ erred by (1) according to only little weight to the opinion of her long-time treating psychiatrist (“Dr. B”) and (2) disregarding her subjective complaints based on their alleged inconsistency with the objective medical evidence in the record.   The Fourth Circuit reversed and remanded with instructions to grant disability benefits. The court agreed with Plaintiff that the ALJ failed to sufficiently consider the requisite factors and record evidence by extending little weight to Dr. B’s opinion. The ALJ also erred by improperly disregarding Plaintiff’s subjective statements. Finally, the court found that the ALJ’s analysis did not account for the unique nature of the relevant mental health impairments, specifically chronic depression. The court explained that because substantial evidence in the record clearly establishes Plaintiff’s disability, remanding for a rehearing would only “delay justice.” View "Shelley C. v. Commissioner of Social Security Administration" on Justia Law

Plaintiff appealed from the 2021 opinion of the district court affirming the final decision of Defendant Kijakazi, as the Acting Commissioner of Social Security, which denied Plaintiff’s claim for disability benefits.   The Fourth Circuit, without resolving the merits, vacated the judgment of the district court and directed a remand to the Commissioner for a new and plenary hearing on Plaintiff’s disability benefits claim, to be conducted before a different and properly appointed administrative law judge (ALJ). The court agreed with Plaintiff’s appellate contention that, pursuant to the Supreme Court’s 2018 decision in Lucia v. SEC, 138 S. Ct. 2044 (2018), the (“ALJ Bright”) who rendered the Commissioner’s final decision did so in contravention of the Constitution’s Appointments Clause.   The court explained that the Supreme Court made clear that if an ALJ makes a ruling absent a proper constitutional appointment, and if the claimant interposes a timely Appointments Clause challenge, the appropriate remedy is for the claim to be reheard before a new decisionmaker. Plaintiff did not receive that remedy. The Appointments Clause violation as to Plaintiff was thus not cured, and the 2019 ALJ Decision was likewise rendered in contravention of that Clause. View "Camille Brooks v. Kilolo Kijakazi" on Justia Law