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

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

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