Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-arwd-5_05-cv-05218/USCOURTS-arwd-5_05-cv-05218-0/pdf.json

Nature of Suit Code: 791
Nature of Suit: Employee Retirement Income Security Act (ERISA)
Cause of Action: 29:1001 E.R.I.S.A.: Employee Retirement

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IN THE UNITED STATES DISTRICT COURT

WESTERN DISTRICT OF ARKANSAS

FAYETTEVILLE DIVISION

LANNA J. MEYERS PLAINTIFF

v. No. 05-5218

HARTFORD LIFE & ACCIDENT DEFENDANT

INSURANCE COMPANY

MEMORANDUM OPINION & ORDER

This disability benefit claim is before the Court for

decision on the stipulated administrative record (Doc. 7) and

the stipulated supplement to the record (Doc. 10), as well as

respective briefs of the parties (Docs. 8 and 11). Plaintiff

brings this action pursuant to the provisions of the Employee

Retirement Income Security Act of 1974 (“ERISA”), 29 U.S.C.

§ 1001 et seq., alleging that Defendant’s decision to deny her

claim for long-term disability benefits was unreasonable. For

the reasons stated below, the Court finds that Defendant’s

decision was supported by substantial evidence and is

AFFIRMED. Plaintiff’s claim is denied and Plaintiff’s

Complaint (Doc. 1) is dismissed with prejudice. 

Background

Plaintiff worked for Wal-Mart Stores, Inc. from 1987 to

2004. She held the position of Buyer/Assistant Buyer from

1987-2000 and that of Planogram Manager from 2000-2004.

Plaintiff’s last day at work was March 2, 2004. Plaintiff

contends she quit working due to back pain, extreme fatigue,

leg pain, chronic diarrhea, incontinence, muscle and joint

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aches and pain. 

Plaintiff’s primary physician was Dr. James Baker, D.O.,

who primarily diagnosed her condition as Churg-Strauss

syndrome, interstial [sic] lung disease, and peripheral

neuropathy. (Rec. 51). On March 24, 2004, Dr. Baker stated

Plaintiff had the following limitations: standing for 10

minutes maximum; walking with use of a cane and for no more

than 15 minutes; sitting for a limit of 15 minutes due to pain

and paresthesia; and lifting/carrying a 20 pound maximum.

(Rec. 52). On May 19, 2004, in a letter to Geraldine

Martinez, R.N., Dr. Baker stated that Plaintiff would not be

able to function in a sedentary type occupation full time.

(Rec. 115). Dr. Templeton, a pulmonary specialist, also

treated Plaintiff. He stated on February 12, 2003 that

Plaintiff’s pulmonary fibrosis and Churg-Strauss syndrome

appeared to be stable. (Rec. 91). In the records of the

February 12th visit, Dr. Templeton noted that “she has been

doing fairly well since her last visit.” (Rec. 91). Meyers

was not prescribed any new medications for her Churg-Strauss

syndrome and was to return in one-year for a check-up. The

record does not reflect Plaintiff ever returned to Dr.

Templeton. 

Dr. Baker, in response to a questionnaire submitted to

him by Defendant, stated that he, likewise, believed

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Plaintiff’s pulmonary fibrosis was “stable.” (Rec. 114). Dr.

Baker submitted this response in his Attending Physician’s

Statement three weeks after Plaintiff ceased working. (Rec.

114). Dr. Moon conducted an MRI of Plaintiff’s spine in

2003. In a May 2004 response to Defendant, Dr. Moon stated

that nothing in Plaintiff’s medical findings precluded her

from returning to her own sedentary occupation. (Rec. 123).

Dr. Moon limited Plaintiff’s lifting capacity to 20 pounds and

stated there was no limit in her driving a vehicle. Also, she

could sit two hours if she would change positions as needed.

On May 21, 2004, Dr. Moon confirmed his opinion that Plaintiff

could perform her sedentary job in his response to Hartford’s

request for additional information. (Rec. 117). Plaintiff was

also examined by Dr. Gallaher, a Neurologist, in 2003. Dr.

Gallaher opined that the MRI failed to “provide a good

explanation for her symptoms.” (Rec. 157). 

Discussion

Under ERISA, a denial of benefits by a plan administrator

must be reviewed de novo unless the benefit plan gives the

administrator discretionary authority to determine eligibility

for benefits or to construe the terms of the plan, in which

case the administrator’s decision is reviewed for an abuse of

discretion. Woo v. Deluxe Corp., 144 F.3d 1157, 1160 (8th

Cir. 1998) citing Firestone Tire & Rubber Co. v. Bruch, 489

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U.S. 101, 115 (1989). Accordingly, the Court must be guided

by the language of the plan to determine the proper standard

of review.

The Plan provides, in pertinent part, “[t]hat Hartford

has full discretion and authority to determine eligibility for

benefits and to construe and interpret all terms and

provisions of the Group Insurance Policy.” Therefore,

Hartford’s decision can only be reviewed for an abuse of

discretion. 

The Eighth Circuit Court of Appeals has "variously

defined . . . an abuse of discretion as being 'extremely

unreasonable,' 'virtually' the same as arbitrary and

capricious, and 'extraordinarily imprudent.'" Shell v.

Amalgamated Cotton Garment, 43 F.3d 364, 366 (8th Cir. 1994)

(citations omitted). "The proper inquiry into the deferential

standard is whether 'the plan administrator's decision was

reasonable; i.e., supported by substantial evidence.'" Cash

v. Wal-Mart Group Health Plan, 107 F.3d 637, 641 (8th Cir.

1997) (quoting Donaho v. FMC Corp., 74 F.3d 894, 899 (8th Cir.

1996)). 

"While the word 'reasonable' possesses numerous

connotations, this court has rejected any such definition that

would 'permit a reviewing court to reject a discretionary

trustee decision with which the court simply disagrees[.]'"

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Id. at 641 (citation omitted). A decision is reasonable "if

'a reasonable person could have reached a similar decision,

given the evidence before him, not that a reasonable person

would have reached that decision.' If the decision is

supported by a reasonable explanation, it should not be

disturbed, even though a different reasonable interpretation

could have been made." Id. (citation omitted). 

Where there is a difference of opinion between a

claimant’s treating physicians and the plan administrator’s

reviewing physicians, the plan administrator has discretion to

find that the employee is not disabled unless “the

administrative decision lacks support in the record, or . . .

the evidence in support of the decision does not ring true and

is . . . overwhelmed by contrary evidence.” Donaho, 74 F.3d

at 901 (8th Cir. 1996). 

The Court must first determine whether Defendant abused

its discretion by finding Plaintiff able to perform the duties

of her occupation, and if no abuse is found then the analysis

is over. Plaintiff contends her chronic pain and limited

mobility render Defendant’s decision unreasonable as she is

not capable of performing the essential duties of her former

occupation or any occupation for which she is qualified by

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Plaintiff submitted her application for long-term disability benefits and stated that she 1

suffered from “degenerative spine, chronic diarrhea, incontinence bladder and bowel, Drop foot,

Churg strauss granuloma, Interstial (sic) lung disease, Ocular migraines, chronic neck and back

pain, leg and feet fall asleep, numb, neuropathy.” (Rec. 44). However Plaintiff’s medical records

indicate that these were all secondary diagnoses that were never reported as disabling by her

treating physicians. 

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education, training, or experience . Defendants contend 1

Plaintiff never demonstrated she was unable to perform the

functions of her own occupation. (Rec. 288). 

Defendants relied on Plaintiff’s own version of her job

description in her long-term disability application, and a

copy of the Job Description for Planogram Manager obtained

from Wal-Mart, to determine her eligibility. (Rec. 102 and

288). Plaintiff indicated that her work involved completing

layouts for clubs, preparing reports, meetings, and

presentations. Defendants contend that Plaintiff submitted a

variety of conditions in her application for long-term

disability benefits, but none of these, alone or combined,

prevented Plaintiff from performing her sedentary job. 

According to the medical records, Plaintiff suffered from

Churg-Strauss syndrome, pulmonary fibrosis, and lower back

pain. (Rec. 91-92). However, Dr. Templeton’s long term

findings indicated that Plaintiff’s conditions appeared to be

stable (Rec. 91), and he never placed any limitations on

Meyers. Dr. Baker completed an Attending Physician Statement

in support of Meyers’s application for benefits and reported

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Plaintiff has continued to smoke cigarettes, although she has reported to her doctors that 2

she has tried to stop. (Rec. 117). 

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that Plaintiff was being treated for Churg-Strauss and

peripheral neuropathy. (Rec. 51). Dr. Baker also reported

that Plaintiff’s pulmonary conditions were stable, and he

informed the reviewing doctors, Lyon and Siegel, by telephone

that Plaintiff’s pulmonary conditions did not prevent her from

performing a sedentary job. (Rec 158, 161 and 280). Plaintiff

never needed home oxygen therapy and her oxygen saturation was

normal; i.e. her saturation was 94% on March 24, 2004. (Rec.

287). Dr. Baker reported that Plaintiff could breathe on her

own with no evidence of pulmonary symptoms. (Rec. 158-59; 2

161; 283-284). 

According to Hartford, the job description for Plaintiff

obtained from Wal-Mart indicated that no lifting, standing, or

walking was required for Planogram Manager. This

interpretation conforms to the required skills of the job,

i.e. knowledge of merchandising, analytical skills, ability to

draw in Excel, and the ability to read blueprints. (Rec. 102).

Nonetheless, while the job description did not require any

walking, Hartford did verify that “sitting with light walking”

was necessary. (Rec. 106). 

Plaintiff’s lumbar degenerative disc disease did not

prevent her from performing her job. Dr. Steven Moon,

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Neurologist, treated Plaintiff for her disc disease, and his

treatment included an MRI of Plaintiff’s lower back that was

reviewed by Dr. Regan Gallaher, Neurosurgeon. (Rec. 93). Dr.

Gallaher reported that Meyers was “able to easily stand from

sitting position and able to walk with a cane.” (Rec. 281).

In the January 2005 report by Dr. Baker, he indicated that

Plaintiff had developed an irregular gait but failed to

identify any occupational limitations for Plaintiff. (Rec

175). However in July 2004, three months after Plaintiff had

ceased working, Dr. Baker reported to Dr. Lyon that Plaintiff

had a regular gait. (Rec. 161). Further, Dr. Baker’s 2005

letter indicated that Plaintiff walked without any assistance

because she used the cane only intermittently. (Rec. 279). 

Dr. Moon reported to Hartford that no medical evidence

supported Plaintiff’s claim of inability to function as

Planogram Manager. (Rec. 123). Dr. Moon agreed that Plaintiff

could lift/carry 20 pounds, had no limit to driving, and could

sit two hours and get up to change positions as necessary.

(Rec. 123). Dr. Baker also reported to Hartford that

Plaintiff’s lower back pain did not prevent her from sedentary

work. (Rec. 161). 

In July 2004, Dr. Baker indicated to Dr. Lyon that from

an objective and medical perspective Plaintiff appeared to

“retain capacity for full-time sedentary to light demand work

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While not dispositive, the Court notes that Plaintiff’s application for Social Security 3

Benefits was denied. Although applying a different standard, the Social Security Administration

determined that Plaintiff’s condition “was not severe enough to keep her from working and she

possessed the ability to return to the types of jobs [she had] performed in the past.” (Rec. 128).

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with the retained ability to lift up to ten (10) lbs.

occasionally.” (Rec 161). The Court concludes it was

reasonable for the Defendant to determine that Plaintiff’s

lumbar degenerative disc condition did not prevent her from

performing her own occupation. 

Moreover the Court finds the Defendant’s decision

supported by other substantial evidence . Plaintiff is 3

“independent with activities of daily living and instrumental

activities of daily living,” according to Dr. Baker. (Rec.

284). Plaintiff has never requested “any visiting nurse of

home care services, including chore services, meal

preparations services, home health aid services, or

transportation services.” (Rec. 284). Plaintiff’s doctors

have never imposed any limitations for reaching or for working

overhead, pushing, pulling, driving, or keyboard

use/repetitive hand motion.” (Rec. 52). Dr. Baker made it

clear that Plaintiff was not restricted from driving in his

response to Hartford. (Rec. 115). 

Dr. Baker indicated his reasons to support his initial

opinion that Plaintiff could perform her job were “patient has

other issues with urine and bowel irritation problems.” (Rec.

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115). Plaintiff was not being treated for these problems.

Finally, the limitations imposed by her treating physicians

still allow for Plaintiff to perform the duties and functions

described in the Planogram Manager Job Description. (Rec.

280). 

Conclusion

Although the Plaintiff suffers from several medical

problems, the Court affirms the decision of the plan

administrator and finds it supported by the substantial

evidence of the record. Plaintiff’s Complaint is dismissed

with prejudice with each party to bear its own fees and costs.

IT IS SO ORDERED this 1st day of November, 2006. 

 /s/ Robert T. Dawson 

 Robert T. Dawson

 United States District Judge

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