Justia U.S. 6th Circuit Court of Appeals Opinion Summaries

Petitioner worked as an underground surveyor for a coal company for more than 22 years. He filed an unsuccessful claim for black lung benefits (30 U.S.C. 901) about a year after being laid off. He filed a second claim 10 years later, accompanied by medical opinions and x-ray interpretations. The DOL provided a pulmonary examination for each claim. The first diagnosed shortness of breath of unknown etiology but opined that petitioner suffered no impairment. The second resulted in diagnosis of restrictive lung disease, right mid lung density, bilateral hilar adenopathy and concluded that there was no impairment. An ALJ rejected the second claim. The Benefits Review Board affirmed. The Sixth Circuit vacated for consideration under an amendment to the Act, under which a miner who worked underground for at least 15 years and who demonstrates that he suffers from a total respiratory disability is presumed to be totally disabled due to pneumoconiosis (30 U.S.C. 921(c)(4)). Rebuttal requires an affirmative showing; it is not enough to show that medical evidence does not include a well documented opinion of pneumoconiosis. The ALJ failed to consider all evidence relevant to the issue of disability.

In 2006 the claimant sought disability benefits, alleging injury in a construction accident. An ALJ denied the claim and the appeals council denied review. The district court upheld the denial. The Sixth Circuit vacated. The ALJ's decision was incomplete and improperly gave greatest weight to the opinion of a non-treating state agency physician, rather than to the opinion of a treating physician. The ALJ mischaracterized the treating physician's treatment notes.

Plaintiff filed several suits against healthcare groups on behalf of the United States, claiming violation of the Medicare Secondary Payer Act, 42 U.S.C. 1395y(b). No court has ever found that the MSP is a qui tam statute, permitting private attorneys general to sue on behalf of the United States. The Sixth Circuit found plaintiff was on notice of the frivolous nature of his filings from their inception in the Tennessee district courts and remanded for a show-cause hearing on why sanctions should not issue. The district court awarded sanctions to two defendants in amounts of $131,158.50 and $145,431.19. The Sixth Circuit affirmed, but denied an award for the appeal.

Petitioner was awarded disability insurance benefits for a period beginning in 1983. In 2002 the Social Security Administration produced evidence he had engaged in substantial gainful employment; the Appeals Council accordingly reopened and remanded to an administrative law judge, who determined that petitioner was not entitled to disability benefits. The district court and Sixth Circuit affirmed. Petitioner's subsequent application for supplemental security income benefits was denied; the district court and Sixth Circuit affirmed. The petitioner then sought a writ of mandamus to compel the SSA to reopen his case and reinstate benefits. The Sixth Circuit dismissed for lack of jurisdiction to issue a writ directly to the agency.