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

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

Genesis Healthcare was a healthcare provider participating in the federal “340B Program,” which was designed to provide drugs to qualified persons at discounted prices. Under the Program, the Secretary of the Department of Health and Human Services (“HHS”) enters into agreements with drug manufacturers to sell drugs at discounted prices to entities such as Genesis Healthcare, which could, in turn, sell the drugs to their patients at discounted prices. After Genesis Healthcare purchased the covered drugs from the manufacturers, it dispensed them to patients through its wholly owned pharmacies or contract pharmacies. After the Health Resources and Services Administration (“HRSA”) conducted an audit of Genesis Healthcare in June 2017 for Program compliance, HRSA removed Genesis Healthcare from the 340B Program. The audit report found, among other things, that Genesis Healthcare dispensed 340B drugs to individuals who were ineligible because they were not “patients” of Genesis Healthcare. HRSA rejected Genesis Healthcare’s challenges; Genesis Healthcare, in turn, filed suit seeking a declaration it did not violate the requirements of the Program, and injunctive relief requiring HRSA to reinstate it into the Program and to retract any notifications that HRSA had provided to manufacturers stating that Genesis Healthcare was ineligible under the Program. In response to the lawsuit, HRSA ultimately: (1) notified Genesis Healthcare by letter that it “ha[d] voided” all audit findings and that Genesis Healthcare “ha[d] no further obligations or responsibilities in regard to the audit” and (2) filed a motion to dismiss Genesis Healthcare’s action as moot based on the letter. The district court granted HRSA’s motion, finding that the action was moot. The Fourth Circuit reversed the district court's finding the case was moot: Genesis Healthcare continued to be governed by a definition of “patient” that, Genesis maintained, was illegal and harmful to it. Therefore, there remained a live controversy between the parties. View "Genesis HealthCare, Inc. v. Becerra" on Justia Law

The Fourth Circuit affirmed the district court's dismissal of an action brought by plaintiff, alleging that the school district had violated her daughters' rights under the Individuals with Disabilities Education Act (IDEA). The court held that plaintiff's withdrawal of the children from the school district system rendered moot her request for prospective relief. Furthermore, because the district court proceedings under the IDEA are original civil actions, the court held that plaintiff's failure to specify in her complaint that she was seeking compensatory education for her children, or to include allegations from which a request for compensatory education reasonably could be inferred, precludes her present assertion of a live controversy in the district court. View "Johnson v. Charlotte-Mecklenburg Schools Board of Education" on Justia Law

The Montgomery County Council established the Emergency Assistance Relief Payment Program (EARP) in March 2020 to provide emergency cash assistance to County residents with incomes equal to or less than 50% of the federal poverty benchmark who were not eligible for federal or state pandemic relief. Although eligibility for EARP aid is not dependent on a person’s status as an undocumented immigrant, such individuals are eligible to receive EARP payments. To fund EARP, the County appropriated $10,000,000 from reserve funds to the County’s Department of Health and Human Services. Taxpayers filed suit in Maryland state court, asserting that EARP violated 8 U.S.C. 1621(a), which, with few exceptions, generally prohibits undocumented persons from receiving state and local benefits. Recognizing that Section 1621 does not authorize private enforcement, the plaintiffs cited the Maryland common law doctrine of taxpayer standing, which “permits taxpayers to seek the aid of courts, exercising equity powers, to enjoin illegal and ultra vires acts of [Maryland] public officials where those acts are reasonably likely to result in pecuniary loss to the taxpayer.” The case was removed to federal court based on federal question jurisdiction, 28 U.S.C. 1331. The court granted the County summary judgment. The Fourth Circuit affirmed. Congress has declined to authorize private parties to enforce Section 1621, a legislative decision that cannot be circumvented by invocation of a state’s law of taxpayer standing. View "Bauer v. Elrich" on Justia Law

Plaintiffs, former recipients of Social Security disability benefits and former clients of an attorney who orchestrated one of the largest fraud schemes in the history of the SSA, argued in consolidated appeals that SSA's categorical exclusion of allegedly fraudulent medical evidence during the redetermination process was unlawful because they were never afforded any opportunity to rebut the allegation that their evidence was tainted by fraud.The Fourth Circuit joined its sister circuits and held that the SSA's redetermination procedures violate the Administrative Procedure Act (APA) and the Due Process Clause of the Fifth Amendment. The court agreed with plaintiffs that it is arbitrary and capricious for the agency to deny beneficiaries an opportunity to contest the Office of the Inspector General's fraud allegations as to their cases, while permitting other similarly situated beneficiaries to challenge similar allegations arising from SSA's own investigations. The court also agreed with plaintiffs that the SSA's redetermination procedures violated their due process rights under the Fifth Amendment because they were denied the opportunity to contest the Office of the Inspector General's fraud allegations against them. In this case, the court considered each Mathews factor and concluded that each factor supports a finding that the SSA's redetermination procedures violated plaintiffs' due process rights. Accordingly, the court affirmed in No. 19-1989 and reversed in No. 19-2028. View "Kirk v. Commissioner of Social Security Administration" on Justia Law

The Fourth Circuit reversed the district court's decision affirming the ALJ's determination that plaintiff's disability had ceased as of March 31, 2013. The court concluded that the ALJ committed two legal errors: first, the ALJ erred by failing to consider each of the factors listed in 20 C.F.R. 404.1527(c) before affording only negligible weight to the medical opinion of one of plaintiff's treating physicians; and second, the ALJ erred by assessing plaintiff's residual functional capacity (RFC) pursuant to an incorrect framework and without explaining his RFC-related findings in the manner required by Social Security regulations. Accordingly, the court remanded for further administrative proceedings. View "Dowling v. Commissioner of Social Security Administration" on Justia Law

The Fourth Circuit reversed the district court's order affirming the SSA's denial of plaintiff's application for disability insurance benefits, holding that the ALJ erred by determining that plaintiff was not disabled during the relevant period.The court concluded that the ALJ erred in discrediting plaintiff's subjective complaints by applying the wrong legal standard by effectively requiring plaintiff to provide objective medical evidence of her symptoms; improperly cherry-picking, misstating, and mischaracterizing facts from the record; and drawing various conclusions unsupported by substantial evidence and failing to explain them adequately. Furthermore, the ALJ's decision exhibits a pervasive misunderstanding of fibromyalgia. Applying its discretion to review the issue, the court concluded that the ALJ erred by according little weight to plaintiff's treating physician's opinion. In this case, the ALJ's treatment of the doctor's opinion contains several errors and is not supported by substantial evidence. The court held that the record as a whole clearly establishes plaintiff's disability and thus her legal entitlement to disability benefits. The court remanded to the Commissioner for calculation of disability benefits. View "Arakas v. Commissioner" on Justia Law

While plaintiffs sought judicial review in federal district court of their denial of Social Security disability benefits, the Supreme Court issued its opinion in Lucia v. Securities and Exchange Commission, 138 S. Ct. 2044 (2018), which elucidated a possible constitutional objection to administrative proceedings pursuant to the Appointments Clause. At issue in this appeal is whether plaintiffs may raise an Appointments Clause challenge in federal court that they did not preserve before the agency.The Fourth Circuit held that claimants for Social Security disability benefits do not forfeit Appointments Clause challenges by failing to raise them during their administrative proceedings. Balancing the individual and institutional interests at play, including considering the nature of the claim presented and the characteristics of the ALJ proceedings, the court declined to impose an exhaustion requirement. Therefore, the court affirmed the judgments of the district courts remanding these cases for new administrative hearings before different, constitutionally appointed ALJs. View "Probst v. Saul" on Justia Law