Document ID: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ca8-05-02923/USCOURTS-ca8-05-02923-0/pdf.json

Parties Involved:
Danny Alexander
Appellee
American Standard
Appellant
American Standard Merged Hourly Pension Plan
Appellant
The Trane Company
Appellant

Document Text:

United States Court of Appeals

FOR THE EIGHTH CIRCUIT

___________

No. 05-2923

___________

Danny Alexander, *

*

Appellee, *

* Appeal from the United States

v. * District Court for the

* Western District of Arkansas.

The Trane Company; American *

Standard, Inc; American Standard *

Merged Hourly Pension Plan, *

*

Appellants. *

___________

Submitted: April 21, 2006

Filed: July 13, 2006

___________

Before WOLLMAN, HANSEN, and BENTON, Circuit Judges.

___________

WOLLMAN, Circuit Judge.

The Trane Co. (Trane), American Standard, Inc. (American Standard), and the

American Standard Merged Hourly Pension Plan (pension plan) appeal the district

court’s judgment that the pension plan’s administrator, the American Standard

Pension Board (pension board), abused its discretion in denying Danny Alexander’s

claim for benefits under his qualified pension plan governed by the Employee

Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. §§ 1001 et seq. We

reverse.

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I.

In July of 1977, Alexander began working at Trane, a subsidiary of American

Standard, as a shipping clerk. His essential job duties included preparing and loading

equipment for shipment, operating powered material handling equipment, loading and

staging trailers, and using powered hand tools and equipment. The job also required

that he be able to stand and sit for four hours at a time, have use of all of his limbs, be

able to lift forty-nine pounds, and be able to operate a forklift.

On April 17, 2001, Alexander sought treatment for vascular insufficiency and

the swelling, pain, and chronic ulcerations in his legs. He was examined by Janina B.

Bonwich, M.D., who noted that Alexander was fifty-one years old, was over six feet

tall, weighed 420 pounds, and had a five-year history of discoloration in his pretibial

skin. Dr. Bonwich observed that Alexander had dorsalis pedis and posterior tibial

signals bilaterally, that both of his legs had some varicosities, and that it appeared as

though anterior branches of his greater saphenous vein were dilated. Alexander also

had pretibial swelling and ankle swelling. Dr. Bonwich determined that Alexander

had venous insufficiency and had no history of deep vein thrombosis (DVT). She

stated that he was “not in very bad shape” and thus did not need surgery. J.A. at 180.

Dr. Bonwich concluded that if Alexander continued to wear his compression hose and

elevate his legs, he would be fine. She also stated, however, that she wanted to fully

assess his veins to determine if she needed to further treat his condition.

Alexander returned to Dr. Bonwich’s office on April 23, 2001, for another

examination. Dr. Bonwich observed that Alexander’s right leg had a normal greater

saphenous vein, but that he did have some varicosities. She determined that

Alexander did not have DVT. Further, Dr. Bonwich observed that Alexander’s deep

system was also normal on the left but that he had some greater saphenous reflux in

his left leg. She noted that he also had some partially thrombosed areas in his thigh

and lower calf with some incompetent perforators at the ankle. Dr. Bonwich

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concluded that Alexander had superficial thrombosis and incompetence of the greater

saphenous vein, that his deep system was normal bilaterally, and that he had a normal

saphenous vein system on the right.

On August 21, 2001, Dr. Bonwich again examined Alexander and concluded

that he had severe venous insufficiency and no history of DVT. She observed that his

symptoms were worsening—he was experiencing greater aches, pains and swelling,

and was developing an ulcer that had not been there on his April 17th examination.

Dr. Bonwich stated that Alexander’s varicose veins and perforating veins were clearly

causing his symptoms and that he would experience ulceration. She further stated that

she believed that surgery might be beneficial and that Alexander would also benefit

from a more experienced vein surgeon. She thus referred Alexander to John Eidt,

M.D.

Dr. Eidt examined Alexander on September 4, 2001. He concluded that

Alexander had severe venous insufficiency in his left leg, resulting in chronic venous

stasis disease and ulceration. Dr. Eidt determined that surgery was not currently

warranted, and he recommended elevation and a variety of compression dressings to

bring Alexander’s condition under control. Dr. Eidt further stated that Alexander

“may have to be off work in order to get this to heal.” J.A. at 186. Although Dr. Eidt

indicated the need to reassess Alexander’s improvement, he did not arrange for a

specific follow-up appointment with him.

On September 27, 2001, Alexander returned to Dr. Bonwich’s office, primarily

to obtain a work release. Dr. Bonwich noted that Alexander’s job involved some

standing and concluded that he needed “to be off from work until he can either recover

from this condition or maybe he will need to be off forever.” J.A. at 188. She noted

that Alexander had recently transitioned from driving a forklift at work to standing on

a concrete floor, a change which Dr. Bonwich did not think would work well for him

if he continued to suffer from ulcers, which she suspected he would.

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On December 27, 2001, Alexander returned to Dr. Bonwich for a follow-up

examination. Dr. Bonwich noted that Alexander’s severe skin changes had previously

had some preulcerative areas that had broken down to form some punctate ulcers and

that this had concerned her. She now observed that because Alexander had been off

of his feet, his preulcerative areas had healed and were significantly better.

On June 18, 2002, Alexander returned to Dr. Bonwich for another follow-up

examination. Dr. Bonwich noted that Alexander had venous insufficiency and venous

skin changes, varicose veins in his left anterior shin region, and continued swelling

in his left leg while standing. She further noted that Alexander’s use of his

compression hose had helped, but that he would probably have to continue his offwork status to avoid developing an ulcer.

On or about June 25, 2002, Alexander submitted his application for disability

pension benefits. Under the plan, a claimant is eligible for benefits only if he is

“totally disabled from performing further work . . . , and in [American Standard’s]

opinion is likely to remain so disabled continuously and permanently.” J.A. at 55. In

support of his claim, Alexander submitted a medical application completed by Dr.

Bonwich, in which she diagnosed him as suffering from varicose veins of the lower

extremities, peripheral vascular disease, vascular insufficiency, and a history of

venous ulcerations in the left leg. In response to the question of whether, if

Alexander’s condition was chronic, changes had occurred that caused him to be

disabled for further work, Dr. Bonwich stated that Alexander continued to have leg

swelling bilaterally after getting out of bed in the morning and that this swelling

caused him pain throughout the day. In response to the question about Alexander’s

remaining physical and mental capacities, Dr. Bonwich noted that he needed time off

from work for leg swelling, skin changes, and ulceration and noted that Alexander

could not stand for more than thirty to sixty minutes.

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After reviewing Alexander’s file, Keith F. Holden, M.D., Medical Director for

Trane’s Unitary Products Group, determined that Alexander had failed to meet the

medical eligibility requirements for a disability pension. Dr. Holden observed that Dr.

Eidt had not recommended surgery or disability but had instead recommended

conservative care. Dr. Holden also noted that, although Alexander’s condition was

improving, he had not yet returned to work. Trane’s Human Resources Team Leader

also reviewed Alexander’s file, including Alexander’s physical limitations as outlined

by Dr. Bonwich in the medical application, and determined that there were suitable

job placement opportunities at Trane within Alexander’s remaining work capacities

and for which he was reasonably suited by education, training, or experience.

On July 2, 2002, Trane notified Alexander that his application for pension

benefits had been denied because he was not permanently incapacitated from

performing further work. It also advised Alexander that he had a right to appeal this

determination, and on July 30, 2002, Alexander submitted his written appeal.

After receiving Alexander’s appeal, the pension board forwarded Alexander’s

file to the Reed Group, an independent medical review authority. The Reed Group’s

Vice President of Clinical Operations, Cecile Childrose, RN, conducted the initial

review of Alexander’s file and concluded that it did not support a determination that

he was totally disabled from performing any further work. She noted that there was

no documentation that Alexander had experienced blood clots or thrombophlebitis;

that in April 2001, Dr. Bonwich had found only superficial thrombosis and that

Alexander’s deep system was normal bilaterally and with adequate blood flow; that

Dr. Bonwich had determined that surgery was unnecessary; that by December 2001,

Alexander’s ulcerations were healing; that Alexander had a recent job change from

driving a forklift to standing on a concrete floor; and that Alexander’s ongoing plan

for care involved only office visits every six months. The Reed Group’s Medical

Director, James C. Leyhane, M.D., also reviewed Alexander’s file and similarly

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concluded that the file did not support a determination that Alexander was totally and

permanently disabled for all occupations.

On September 13, 2002, the pension board notified Alexander that it had denied

his appeal because, in its opinion, his condition would not render him totally disabled

from performing further work for the remainder of his life.

Alexander then brought this action against American Standard, Trane, and the

pension plan under ERISA, arguing that the pension board had abused its discretion

in denying him pension benefits. The district court determined that, “[a]lthough

Plaintiff’s treating physicians were not in lock step in any recommendation that

Plaintiff be off work ‘continuously and permanently,’ the practical implications of

their review reflect this to be the bottom line.” D. Ct. Order of June 2, 2005, at 19-20.

It also noted that, although Trane’s Human Resources Team Leader had indicated that

there were jobs available at Trane suited to Alexander’s remaining work capacities

and for which he was reasonably fitted by education, training, or experience, she had

indicated this with only a check mark and had failed to provide any evidence that

alternative jobs were actually available. Accordingly, the district court concluded that

the pension board had abused its discretion in denying disability pension benefits to

Alexander and granted judgment in Alexander’s favor.

II.

The parties agree that an abuse of discretion standard of review applies in

determining whether the pension board erroneously denied Alexander pension

benefits. Under this standard, the pension board’s decision need be only reasonable,

meaning that it must be supported by substantial evidence. Jackson v. Metro. Life Ins.

Co., 303 F.3d 884, 887 (8th Cir. 2002). A court is not to substitute its own judgment

for that of the plan administrator. Ferrari v. Teachers Ins. & Annuity Ass’n, 278 F.3d

801, 807 (8th Cir. 2002). We review de novo the district court’s application of this

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standard, Norris v. Citibank, N.A. Disability Plan (501), 308 F.3d 880, 884 (8th Cir.

2002), and we will reverse the pension board’s decision only if it was arbitrary and

capricious, Groves v. Metro. Life Ins. Co., 438 F.3d 872, 874 (8th Cir. 2006).

The terms of the pension plan provide that Alexander must be totally and

permanently disabled to be eligible for benefits. We conclude that substantial

evidence supported the pension board’s determination that this standard was not met.

The reviewing physicians concluded that Alexander was not totally and permanently

disabled. Further, the conclusions of Alexander’s treating physicians fail to

conclusively support his claim that he is totally and permanently disabled. As

recounted above, Dr. Bonwich observed that Alexander’s condition had improved

considerably after Alexander had taken time off of work, and she indicated that there

was only a possibility that Alexander would have to continue his off-work status

indefinitely. Similarly, Dr. Eidt concluded that surgery was unnecessary to treat

Alexander’s condition and stated that Alexander might have to maintain his off-work

status to allow his ulcers to heal. These treating physicians’ conclusions demonstrate

that there was only a possibility of permanent disability. In light of this ambivalence,

the plan administrator’s decision to deny Alexander benefits was reasonable. Even

if Alexander’s treating physicians’ conclusions had supported his claim, the pension

board was within its rights in relying on the reviewing physicians’ conclusions

because, as Black & Decker Disability Plan v. Nord made clear, plan administrators

need not accord special weight to treating physicians’ opinions. 538 U.S. 822, 828,

834 (2003) (overruling Donaho v. FMC Corp., 74 F.3d 894 (8th Cir. 1996)); see also

McGee v. Reliance Standard Life Ins. Co., 360 F.3d 921, 925 (8th Cir. 2004).

The judgment is reversed, and the case is remanded to the district court for entry

of judgment in accordance with this opinion.

______________________________

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