UNITED STATES COURT OF APPEALS TENTH CIRCUIT

ROXANN LOUGHRAY, Plaintiff-Appellant,

v. HARTFORD GROUP LIFE INSURANCE COMPANY, Defendant-Appellee. No. 07-1189 (D.C. No. 05-cv- 01450-CBS-BNB) (D. Colo.)

ORDER AND JUDGMENT *

Before TACHA , EBEL and LUCERO , Circuit Judges.

In this action, pursued under the Em ployee Retirement Income Security Act (“ERISA”), Plaintiff-Appellant Roxann Loughr ay challenges the decision of DefendantAppellee Hartford Group Life Insurance Comp any (“Hartford”) to terminate Loughray’s long-term disability benefits paid under a group plan provided through her former employer, Ultimate Electronics. Loughray claims that she has been disabled since April 2000, when she first stopped working because of health pr oblems, and that she remains

* This order and judgment is not binding preced ent except under the doctrines of law of the case, res judicata and collateral estoppel. It may be cited, however, for its persuasive value consistent with Fed. R. A pp. P. 32.1 and 10th Cir. R. 32.1. FILED United States Court of Appeals Tenth Circuit February 23, 2010
Elisabeth A. Shumaker Clerk of Court2 disabled because of a numbe r of subjective symptoms—h eadaches, fatigue, cognitive dysfunction—resulting from some medical co ndition or conditions that have proven difficult to determine. Initia lly, Hartford deemed Loughray disabled base d on a thyroid dysfunction, but after that condition was re solved, Hartford term inated Loughray’s benefits, upholding its decision three separa te times after consid ering new information submitted by Loughray. The district cour t concluded that while Loughray reported several subjective symptoms, Hartford did not abuse its discretion in concluding that the medical evidence did not support deeming Lo ughray disabled and entitled to long-term disability benefits. Loughray appeals that de cision, and we have ju risdiction to review that final decision pursuant to 28 U.S.C. § 1291. We agree with the district court, and therefore, we AFFIRM.

I. BACKGROUND A. The Long-Term Disability Benefits Plan Loughray worked as a salesperson for Ultimate Electronics, beginning in September 1992. She worked five days per week, eigh t or nine hours per day, and she was paid based on sales commissions. As a salesperson, her job duties included interacting with customers, demonstrating pr oducts, and operating credit card processors, cash registers, and other store equipment. Her job also involved frequent standing and walking.3 During her employment at Ultimate Electronics, Loughray was covered by the Ultimate Electronics Group Disability Plan (“the Plan”). Both parties agree that Hartford both administered and insured the Plan. 1 Under the Plan, a disabled employee under age 61, such as Loughray, would re ceive long-term disability benef its for as long as she was disabled, up until she reached age 65. The Plan defines di sability as follows: Disability means that during the Elimination Period [90 days after an eligible employee becomes disabled] and the following 24 months, Injury or Sickness causes physical or mental impa irment to such a degree of severity that You are: 1. continuously unable to perform the Material and Substantial Duties of Your Regular Occupation ; and
2. not working for wages in any occupation for which You are or become qualified by education, training or experience. After the Monthly Benefit has been payable for 24 months, “ Disability ” means that Injury or Sickness causes physical or mental impairment to such a degree of severity that You are: 1. continuously unable to engage in any occupation for which You are or become qualified by education, training or experience; and
2. not working for wages in any occupation for which You are or become qualified by education, training or experience.
(Aple. Supp. App. at 10-11.) Loughray claims she falls within this definition of disabled and is entitled to receive long-term disability benefits under the terms of the Plan.

1 At the time Loughray’s disability claim first arose, Continental Casualty Company, also referred to as CNA or CNA Gr oup Benefits, insured and ad ministered the plan. On January 1, 2004, however, Hart ford “acquired CNA Group Bene fits” (Aplt. App. at 3), and Loughray accordingly named Hartford in her suit. Fo r purposes of convenience, we will refer to Hartford as if it had al ways insured and administered the plan.4 B. Loughray’s Initial Health Problems and Approval for Disability Benefits On April 20, 2000, Loughr ay stopped working at Ultimate Electronics because of health problems. For several years, Loughra y had been treated fo r a thyroid condition; however, her endocrinologist ha d altered her dosage of thyroi d medication, which caused her to have low levels of thyroid stimul ating hormone. Conseq uently, on April 20, Loughray went the hospital suffering from a thyroid dysfunction, which caused her to feel tired, feverish, shaky, anxious, nervous, weak, and confused, as well as to have concentration problems and suicidal thoughts. The hospital instruct ed her to resume her original dosage of thyr oid medication and released her the same day. After her release, Loughray contin ued to suffer from headaches, loss of consciousness and other ailments. On April 26, Loughray’s thyroi d stimulating hormone levels remained low, but by May 15, Dr. Zacharias, Loughr ay’s original primary care physician, indicated that he r thyroid condition was “much better (but persists).” (Aple. Supp. App. at 748.) And on May 30, blood tests indicated that Loughray’s thyroid stimulating levels had stabilized. Nonetheless, Loughray’s subjective symp toms persisted and she would undergo several examinations before filing her first claim for long-term disability benefits with Hartford. In June 2000, Loughray underwent a Magnetic Resonance Imaging (MRI) and a Magnetic Resonance Angiogram (MRA) (to ru le out a brain aneurysm), as well as a lumbar puncture (to rule out meningitis). All three tests produced normal results. Later in June, Loughray obtained a neurological consult from Dr. H. Rai Kakkar. Dr. Kakkar found no “neurologica l/musculoskeletal” problems, (Apl e. Supp. App. at 787) but he5 prescribed her Depakote for her headaches and gave her samples of Celebrex for her pain. Dr. Kakkar also indicat ed that Loughray suffered fo r the past two months from a headache and fever “of undeterm ined etiology” and was not “a ble to perform work of any kind.” (Id. at 773.) On the same day she vis ited Dr. Kakkar, Loughray was also examined by an endocrinologist, Dr. Thomas Higgins, who found that her thyroid was functioning normally and that her current symp toms were not related to her thyroid. After these examinations, Lou ghray twice contacted her primary care physician, Dr. Zacharias, informing him that she felt better overall, but s till had a headache, though the Depakote was ameliorating the h eadaches to some degree. Soon after these examinations , on July 15, 2000, Loughr ay applied with Hartford for long-term disability benefits under th e Plan. She submitted reports from her examinations in support of her claim. Lou ghray would later supplement this information with reports from a new primary care physicia n, Dr. Pierre Brunschwig, who she began to see in place of Dr. Zacharias. Loughray began to see Dr. Brunschwig around the same time she applied for longterm disability benefits. To Dr. Brunschwig, she reiterated her previous complaints of fatigue, headaches, intermittent fever, nausea, and high blood pressu re. Additionally, she discussed not only her previous thyroid probl ems with Dr. Brunschwig, but also revealed to him, apparently for the fi rst time with any doctor, that she had fallen in 1999, hit her head, and lost consciousness. After Dr. Br unschwig examined Loughray a few times, he and a nurse practitioner, Carol Dalton, author ed a letter to Hartford indicating that Loughray had “been diagnosed with Fibr omyalgia, Chronic Fatigue Syndrome and6 uncontrollable fluctuating thyr oid function resulting in hypert hyroidism alternating with hypothyroidism.” (Aple. Supp. App. at 511 .) The letter further explained that “[w]ith any activity, such as walking for one or two blocks, Loughray develops a fever, vertigo, blurred vision, severe nausea, and hypertension” and is th erefore “currently unable to work without increasing her symptoms.” (Id. ) After Hartford requested clarification, Dr. Brunschwig’s office clarified th at Loughray’s thyroid conditio n was in fact the cause of her disability and that her chronic fatigue and fibromyalgia were symptoms of the thyroid condition. In September 2000, upon receiving this cl arification, Hartford readily approved Loughray’s application for long -term-disability benefits. Ha rtford deemed Loughray to have been disabled since Ap ril 20, 2000, when Loughray first went to the hospital complaining of her symptoms. Because the Plan provided for a 90-day elimination period, Hartford retroactively paid Loughr ay’s benefits starting from July 19, 2000, ninety days after the onset of Loughray’s disability. Hartford al so informed Loughray that the Plan “requires that you be under the regular care of a licensed physician and provide proof of your continui ng disability,” and that a Hart ford case manager would be “periodically contacting your doctor direct [ly] for more detailed updated reports regarding your functionality and ability to return to work.” (Aple. Supp. App. at 728.) Loughray received long-term disability bene fits until January 2 002, at which point Hartford terminated her benefits after engaging an independent medical examiner. During the approximately 18-month peri od during which Loughray received disability benefits, Hartford in deed checked on her pr ogress. The administrative record7 indicates that, after seeing Dr. Brunschwig in mid-August 2000 a nd being approved for long-term disability benefits in Septembe r 2000, Loughray did not return to Dr. Brunschwig, or any other doctors, until late March 2001. 2 Nonetheless, when Hartford requested updates, Dr. Brunschwig’s office continued to respond that Loughray remained disabled. After Loughray made an unsuccessful attempt to return to work part-time, Dr. Brunschwig, on January 15, 2001, recommended that Loughray could work a maximum of ten hours per week, with a goal of return ing to work full-time by June 2001. By April 2001, however, Loughray reporte d to Hartford that she had suffered a setback in her efforts to return to work. Ultimate Electronics would eventually terminate her a few months later on June 8, 2001. After apparently not having seen a ny doctors for eight months, Loughray underwent a flurry of medical tests and exam inations beginning in late March and early April 2001. She visited Dr. Brunschwig twic e, complaining of extreme fatigue, loss of appetite, and sleep problems. She reported th at her headaches had generally decreased slightly, but that they worsen ed with exertion. Blood test s revealed that Loughray had been exposed to or was sufferi ng from bacterial and viral infections. On April 5, 2001, Dr. Brunschwig and Nurse Dalton together wr ote Hartford that Loughray “continues to be plagued with her thyroid problem” and th at, as a result of her weakened immune system, “she has contracted 3 infections th at will require treatment for 2 to 3 more months.” (Aple. Supp. App. at 702.)

2 The record does contain a document indicating that Loughray went to Boulder Internal Medicine, P.C., as a new patient for a cons ultation regarding her thyroid condition, but the record contains no other in formation about this visit.8 In light of these infecti ons, Loughray, complaining of chronic fatigue and “slight headaches,” was examined in May 2001 by Dr. Rebekah Ga ss of Infectious Disease Consultants. (Id. at 718-19.) Dr. Gass opined that Loughray was not suffering from infections, but “that it is more likely that th is is [Loughray’s] body’s slow recovery from all the endocrine disorders, which are now coming under control with therapy.” (Id. ) Dr. Gass’ examination also produced normal neur ological results, blood tests that showed a normal level of thyroid stimul ating hormone and no hepatitis, and a chest x-ray that did not produce abnormal results. When Loughray retu rned to Dr. Gass in June 2001, Dr. Gass noted that she was concer ned about Loughray’s “persist ent endocrine abnormality.” (Id. at 343-44, 438-39, 455, 820.) After Dr. Gass’s examination, Dr. Brunschw ig’s office wrote Hartford. First, on June 26, 2001, Dr. Brunschwig and Nurse Dalton, notwithstanding Dr. Gass’s conclusion that Loughray was not currently suffering from any infections, together wrote that Loughray’s thyroid condition “h as resulted in a severely compromised immune system, which has resulted in her cont racting four chronic and de bilitating infections.” (Id. at 701.) They concluded that “[t]hese infec tions and her thyroid condition have created extreme exhaustion for [Loughray] . . . [and] [i]t would be im possible for her to maintain any type of work schedule.” (Id. ) In late July 2001, after blood tests indicated Loughray had high insulin levels, Dr. Brunschwig wrot e to Hartford that he had been treating Loughray for “disabling fatigue” and that “she has also been diagnosed with hyperinsulinemia [i.e. , excess levels of insulin] for whic h she is being treated [and she] remains completely disabled relative to her previous employment.” (Id. at 675.)9 In September 2001, Loughray was diag nosed with moderate sleep apnea, for which she began using oxygen. Also in September 2001, Loughray underwent a CAT scan that produced what her doctors appeared to treat as normal results. C. Hartford’s Subsequent Denial of Loug hray’s Disability Benefits Claim In October 2001, Hartford notified L oughray that, “as part of [its] ongoing evaluation” of her claim, it was referring her case for an “independent medical review.” (Aple. Supp. App. at 659.) The independent medical examiner, Dr . Eugene Truchelut, reviewed Loughray’s records, but did not examine her. (Id. at 646-52.) Dr. Truchelut also spoke with Dr. Brunschwi g, who informed Dr. Truchelut that he had not seen Loughray in three months, was unaware of he r diagnosis of sleep apnea, and could not offer an opinion on her curre nt state of health. After reviewing the records, Dr. Truchelut, on October 28, 2001 , concluded that “the medical information furnished . . . does not support a current loss of functions capacity which would preclude the claimant from performing the type of work activities described in the employer’s [Physical Demands Analysis form regarding Loughray’s job duties].” (Id. at 652.) Dr. Truchelut observed that, based on the medical record , Loughray’s thyroid condition was stabilized by late May 2000, but he declined to co mment on Loughray’s sleep apnea diagnosis because, at that time, “the recent evaluation at the National Jewish Medical Center Sleep Lab was incomplete.” (Id. ) Loughray, upon learning that Hartford was sending her records for an independent review, obtained several more medical opini ons indicating she remained disabled. For instance, in December 2001, Joyce Campbell, a licensed professional counselor indicated10 that Loughray remained “unable to work at this time,” despite her “strong work ethic and desire to be back in the marketplace.” (Id. at 654.) Similarly, Betty James, a registered nurse who was also a “friend and colleague ” of Loughray’s, wrote two statements indicating the difficulties from wh ich Loughray suffered. (Id. at 629-33.) No medical records, however, were included with these letters. Based upon Dr. Truchelut’s review of Loughray’s records and despite the disability opinions of Campbe ll and James, Hartford notifie d Loughray, in January 2002, that it was terminating her long-t erm disability benefits because [m]edical information in file [sic ] does not support a current loss of functional capacity, which would precl ude you from perfo rming the duties of your occupation. A lthough we acknow ledge that you have a condition, there is no medical evidence presen ted to illustrate that a functional impairment is present to such a degree it could reas onably be expected to prevent you from performing your j ob duties as a Sales Commissioned employee. (Id. at 628.)
D. Loughray’s First Administrative Appeal Hartford’s termination notice to Loughra y also invited her to file a formal administrative appeal and to submit any ad ditional evidence she might have supporting her disability claim. Loughray did pursue an administrative appeal and, after obtaining a six-month extension of time from Hartford, Loughray submitted additional evidence in support of her disability claim. Loughray’s additional evidence c onfirmed her sleep apnea diagnosis. Loughray also underwent an EEG and MRI of her brain, and other blood and stool sample tests, none of which produced results showing a disabling condition. The examiner noted a11 blood test that showed Loughray’s thyroid stimulating hormone level was low, but this test was apparently not include d in the administrative record and a test dated April 23, 2002 indicated a stabilized level of the hormone. In support of her appeal, Loughray submitted a letter to Hartford in July 2002. For the first time, Loughray asserted her sympto ms of fatigue and cognitive difficulties were the result of sleep apnea and a closed head in jury she suffered in 19 99, one year before the April 2000 onset of her disability. Loughray offered reports from Dr. Ronald Murray of the Rocky Mountain MS Center in whic h Dr. Murray opined th at she did not suffer from multiple sclerosis and suggested that he r symptoms were “pro bably” caused by sleep apnea and/or a prior closed head injury. (Id. at 278.) His neurological exam, however, revealed normal results. Loughray also submitted pieces of other medical records, such as an August 2001 blood test that suggested she had been exposed to the parvovirus two or three months before, and notes from Dr. Ju lie Stapleton, M.D., and Dr. Thomas Groover, a chiropracto r, opining on Loughray’s disab ility, but no indication of when or for what these doc tors treated Loughray. After examining this additional eviden ce, Hartford’s independent medical examiner, Dr. Truchelut, concluded that th e evidence established only one medical problem: sleep apnea, as “docum ented on the polysomnogram.” (Id. at 254.) Dr. Truchelut further noted that this problem, ho wever, was treated effectively with oxygen, which Loughray had begun usi ng in October 2001, and even without this treatment, the occupational restrictions would be unrelat ed to Loughray’s employment as a sales12 commissioned employee (e.g. , “avoidance of . . . unprotected heights or moving machinery”). (Id. ) In light of Dr. Truchelut’s conclusions, Hartford, on August 5, 2002, upheld its January 2002 decision to termin ate Loughray’s long-term disab ility benefits. It justified its decision based on a lack of medical evidence to support Lo ughray’s “self-reported complaints” as disabling and that the sleep a pnea disorder appeared under control. (Id. at 237.) Hartford concluded by informing Lou ghray that “[a]ll administrative remedies offered by the Appeals process have been ex hausted” and that the “decision is final and binding.” (Id. at 238.)
E. Loughray’s Additional Administrative Appeals In response to Hartford’s decision upho lding its denial of Loughray’s claim, Loughray protested that the decision should no t be “final and binding” since she was still receiving treatment and being evaluated. Loughray now asserted there were three conditions preventing her from working: “post-concussion sy ndrome, chronic migrainous disorder, and central sleep apnea.” (Id. at 217.) In support of these claims, Loughray submitted additional evidence, including reports from a physician’s assistant at the Mayo Clinic Scottsdale that indicated Loughray suffered from “post multiple h ead trauma with postconcu ssive syndrome” and [n]ewonset chronic daily headache” and recommended treatment with Botox injections, a diagnosis based on Loughr ay’s reporting that she had suffere d four head injuries between the ages of 3 and 19, plus a final fall in 19 99 that caused her to lose consciousness (Id. at 222-23); a note from a doctor regarding her alle rgies and an apparent need to visit the13 emergency room regularly to control the alle rgic reactions, but no information regarding this doctor’s treatment of Lo ughray nor evidence of any emergency room visits; and another letter from her chiropractor, Dr. Gr oover, asserting that she could not work because of severe migraines, but no treatment r ecords from him. Despite referring to its earlier appeals decisi on as final, Hartford considered this evidence and, on August 30, 2002, again upheld its deci sion denying Lough ray disability benefits. Harford informed Lo ughray, “[t]here will be no fu rther review of your claim” and “the decision remains fi nal and binding, and your ad ministrative record remains closed.” (Id. at 211.) However, a month later, after receiving a complaint from Loughr ay, the Colorado Division of Insurance requested that Harford consider still more ev idence from Loughray because she was struggling financially. Hartfo rd again agreed to consider Loughray’s additional evidence, even though it had al ready “met its oblig ation under ERISA requirements.” (Id. at 158-60.) This time, Loughray presen ted Hartford with a report of Dr. Andrea Cohen. Dr. Cohen examined Loughray in September 2002, noting some neurological deficits, some diminished sensations and reflexes, a nd “slowed” cognitive processing. (Id. at 169-70.) Dr. Cohen indicated Loughray’ s cognitive dysfunction had been present since her fall in 1999, though there is no such indication in Loughray’s earlier medical records. Dr. Cohen concluded that Loughray’s cognitive co mplaints were consistent with a closed head injury. According to D r. Cohen, this injury combined with her headaches rendered Loughray “unable to work due to continue d symptoms” from her 19 99 head injury. (Id. )14 Loughray also submitted reports from two ot her doctors. Dr. Eric Eross treated Loughray’s headaches with Botox injections in August 2002. And in a letter dated October 2002, Dr. Steven Gulevi ch also indicated that Lough ray needed Botox injections for headaches and that Loughray reported she made “t wo to three visits to the Emergency Department every month for extreme head pain” (id. at 151), though the administrative record does not contain medical records of any such trips to the emergency room. Despite this additional evid ence, Hartford’s independ ent medical examiner, Dr. Truchelut, remained unconvinced, explaini ng that “the additional medical information supplied here does not clearly establish a functional impairment, at least from the physical standpoint, which wo uld have precluded the claima nt from her work activity as of 12/20/01 and continuing.” (Id. at 84.) He further noted the significant gaps in Loughray’s medical treatment or history that undermine Loughray’s claim of “a continuous and significant f unctional impairment.” (Id. ) Accordingly, on October 31, 2002, Hartford affirmed—for the third tim e—its decision to terminate Loughray’s benefits. Hartford informed Loughray the decision was “final and binding,” but that she “does have the right to pursue civil action following an adverse decision under ERISA.” (Id. at 87.) Almost 18 months later, in March 2 004, Loughray again submitted additional evidence to Hartford in suppor t of her disability claim. This evidence consisted of a report by Dr. Stuart Kutz, Jr., Ph.D., who had conducted neurolog ical tests on Loughray one year earlier, in March 2003 . These tests indicated that Loughray, who had several years of college experience, had an IQ of 71. Dr. Kutz expressed his belief that15 Loughray’s efforts on the tests seemed genuine, diagnosed her as suffering from dementia, and suggested she would have difficu lty working. Loughray did not offer any other evidence supporting a diagnosis of deme ntia. Hartford, howev er, refused to even consider Dr. Kutz’ report because it had alre ady issued its final decision and closed the administrative record. Loughray ultimately brought a civil action against Hartford in August 2005. The magistrate judge, however, explained that a lthough “Loughray’s medical records show a plethora of symptoms and extensive eval uations by numerous physicians without any definitive conclusions . . . the physical, la boratory, and radiological findings were inconclusive.” (Aplt. App. at 16-17.) Thus , the magistrate concluded that “the record supports Hartford’s termination of disability benefits.” (Id. at 17.) Loughray now appeals from that determination.
II. DISCUSSION A. Standard of Review This Court reviews de novo the district court’s decision, according it no deference.
See Weber v. GE Group Life Assurance Co , 541 F.3d 1002, 1010 (10th Cir. 2008). Instead, like the district court, our review fo cuses on the plan admini strator’s decision to deny the benefits sought by the claimant. Holcomb v. Unum Life Ins. Co. of Am. , 578 F.3d 1187, 1192 (10th Cir. 2009 ). Ordinarily, we review de novo an administrator’s decision to deny benefits, unless th e plan provides otherwise. See Metro. Life Ins. Co. v. Glenn , 128 S.Ct. 2343, 2348 (2008) (citing Firestone Tire & Rubber Co. v. Bruch , 48916 U.S. 101, 115 (1989)). If, however, the plan affords “the administrator or fiduciary discretionary authority to determ ine eligibility for benefits or to construe the terms of the plan, we review the decision for abuse of discretion.” Holcomb , 578 F.3d at 1192 (quotations and citations omitted). In this ca se, the parties agree that the plan allows Hartford to make benefit dete rminations, and the Plan summary specifically indicates that “[t]he Administrator and other Plan fiduciaries have discretionary authority to interpret the terms of the Plan and to determine e ligibility for and entitleme nt to benefits in accordance with the Pl an” (Aple. Supp. App. at 21; see also id. at 9.). Thus, the abuse of discretion standard applies in this case. In the ERISA context, we treat the a buse of discretion and the arbitrary and capricious standards of review as interchangeable. See Weber , 541 F.3d at 1010 n.10. Under the abuse of discretion st andard, we uphold an administ rator’s decision “so long as it is predicated on a reasoned basis.” Ad amson v. Unum Life Ins. Co of Am. , 455 F.3d 1209, 1212 (10th Cir. 2006). “[T]here is no re quirement that the basis relied upon be the only logical one or even the superlative one.” Id. Thus, we ask only “whether the administrator’s decision resides somewhere on a continuum of reasonableness—even if on the low end.” Id. (quotations and citations omitted). In cases such as this one, where the same entity serves as the administrator and payor, an inherent, dual-role conf lict of interest exists. Glenn , 128 S.Ct. at 2346. The existence of a dual-role conflict does not alte r the standard of review, but we weigh the conflict as one of many case-specific factors in determining whethe r the administrator’s decision was an abuse of discretion. Id. at 2350; Holcomb , 578 F.3d at 1192. We17 employ a sliding scale approach in which the conflict is accorded more or less weight depending upon the seriousness of the conflict, giving it greater weight “where circumstances suggest a higher likelihood that it affected the benefits decision” and less weight where the administrator has minimized the risk that the conflict would impact the benefits decision. 3 Glenn , 128 S.Ct. at 2351.
B. Analysis Under the Plan Loughray bore the burde n to provide “written proof of loss” establishing that she was disabled as defined by the Plan. (Aple. Supp. App. at 16.) The Plan also required that Loughray provide “o bjective medical findings” that supported the existence and the extent of her disability. (Id. ) Loughray submitted reports detailing her subjective complaints and visits to seve ral doctors. However, Loughray has not submitted sufficient objective medical evid ence that she suffers from a disabling

3 Prior to the Supreme Court’s recent decision in Glenn , we employed an approach in dual-role conflict of interest cases that “s hifted the burden to the administrator ‘to establish by substantial evidence that the denial of benefits was not arbitrary and capricious.’” Holcomb , 578 F.3d at 1192 (quoting Fought v. Unum Life Ins. Co of Am. , 379 F.3d 997, 1005 (10th Cir. 2004) (per curiam )). Since Glenn , however, we have expressly rejected this burden-shifting appr oach as inconsistent with the approach articulated in Glenn . Holcomb , 578 F.3d at 1192-93 (explaining that Glenn expressly rejects and therefore abrogates this approach ). Because the district court decided this case prior to both Glenn and Holcomb , the district court, c onsistent with our thencontrolling precedent, applied the abroga ted burden-shifting approach. (See Aplt. App. at 7 (explaining that because “Hartford is both the insurer and administ rator of the Plan, the court applies the less deferentia l standard” that places the bu rden on Hartford).) In light of our resolution of this case in favor of Hartford, the application of the abrogated burden-shifting approach, which made it more difficult for Hartford to prevail in the district court, was harmless. See 28 U.S.C. § 2111 (“On the he aring of any appeal . . . in any case, the court shall give judgment after an examination of the record without regard to errors or defects which do not affect the substantial rights of the parties.”).18 condition to render Hartford’s decision unr easonable. Thus, we cannot conclude that Hartford abused its discretion in term inating Loughray’s disability benefits. i. Hartford’s Conflict of Interest We begin by concluding that Hartford’s conflict of interest warrants only little weight in our review of the decision. In denying Loughray’s cl aim and her appeals, Hartford employed the services of an independent medical examiner, Dr. Truchelut, and Loughray never presented persuasive evidence undermining Dr. Truchelut’s independence. 4 See Holcomb , 578 F.3d at 1193 (noting that the administrator “took steps to reduce its inherent bias by hiring two inde pendent physicians”). Moreover, in addition to considering the appeal to which Loughray was entitled, Hart ford also twic e considered additional information submitted by Loughray after having resolved her initial appeal— once at Loughray’s request, and once at the re quest of a state agency . Although Hartford and Dr. Truchelut did not affirm atively seek out this new info rmation, they did diligently consider it before reaching thei r respective conclusions. See id. (commending the

4 Loughray attempts to challenge Dr. Truchelut’s i ndependence by merely crossreferencing an argument made before the distri ct court. Loughray’s counsel apparently found websites, which do not facially appear affiliated with Hartford or CNA, that identified Dr. Truchelut as the “medical di rector” for CNA Insurance, which handled Loughray’s claim until it was acquired by Hartfo rd. (Aplt. App. at 179-83 & n.3, 207.) The district court concluded th at Dr. Truchelut was in fact independent because (a) he “maintained his own private practice as a Boar d Certified specialist in Internal Medicine at all times he provided independent consulti ng services to CNA Grou p Benefits,” (b) at least one affidavit indicated he had served as an independent consultant for CNA on various occasions, but never ha d been employed by CNA or Hartford, and (c) there was no evidence that the content of Dr. Truchelut’ s reports were at all influenced by CNA or Hartford. (Aplt. App. at 9.) We agree with the district court’s conclusion that “[t]he evidence simply does not support Ms. Lou ghray’s argument that Dr. Truchelut’s evaluations were unreliable due to a lack of independence.” (Id. )19 administrator for “diligently e ndeavor[ing] to discover the nature of [the claimant’s] ailments”). Accordingly, we do not perceive a significant risk that Hartford’s dual-role conflict affected its decision, and we afford that conflict little weight. Next, we address the various disabling conditions from which Loughray asserts she suffers, concluding that Hartford had a reasonable basis to find that the evidence showing Loughray was not disabled outweighed the evidence showing she was disabled. ii. Thyroid Dysfunction Hartford initially approved Loughray’s claim largely based on Dr. Brunschwig and Nurse Dalton’s reports that her thyroid condition rendered her unable to work. That Hartford originally deemed Loughray disabled by her thyroid condition does not foreclose Hartford’s “s ubsequent principled review” of th at determination. Kimber v. Thiokol Corp. , 196 F.3d 1092, 1098 (10th Cir. 1999). In fact, prior to April 20, 2000, Loughray’s thyroid dysfunction had been contro lled for several years. And the parties contemplated that Loughray’s disability, though qualifying for long-term disability benefits, would not be permanent. (See Aple. Supp. App. at 636-37 (anticipating Loughray would return to work by June 2001).) At the time Hartford terminated L oughray’s benefits, Loughray’s thyroid condition appeared controlled. On May 30, 2000, a little over a month after Loughray first went to the hospital in April for her th yroid dysfunction, blood tests indicated that her thyroid stimul ating levels had stabilized. In J une 2000, an endocrinologist, Dr. Higgins, found her thyroid wa s functioning normally and th at her symptoms were not related to her thyroid condition. Admitte dly, around this same time, Dr. Gass of20 Infectious Disease Consultants opined th at Loughray continued to suffer a “slow recovery” from her thyroid and endocrine diso rders as opposed to an infection. (Id. at 718-19.) Dr. Gass, however, did not update he r diagnosis at any point closer to when Hartford terminated Loughray’s benefits severa l months later in January 2002. Similarly, as of July 2001 Dr. Brunschwig’s office c ontinued to opine that Loughray remained unable to work because of her thyroid cond ition; however, when Ha rtford’s independent medical examiner, Dr. Truchelu t, contacted Dr. Brunschwig in November 2001 to obtain additional information on Lo ughray current condition, D r. Brunschwig informed Dr. Truchelut that he could not address Loughra y’s current condition as it had been three months since he last examined her. In su m then, when Hartford made its decision, Loughray did not present any recent blood tests that indicated her thyroid condition remained uncontrolled, and neither Dr. Ga ss nor Dr. Brunschwig had provided a recent evaluation of Loughray’s symptoms. Unde r those circumstances, Hartford quite reasonably declined to find that Loughray remained disabled based on stale diagnoses. Tests performed during the appeals proc ess confirmed that Loughray’s thyroid condition remained under control. A blood test dated April 23, 2002 indicated a stabilized level of thyroid stimulating hormon e. Moreover, Loughray’s doctors began to focus on other diagnoses, su ch as sleep apnea and closed head injury, instead of Loughray’s apparently contro lled thyroid condition. Thus , under these circumstances, Hartford had a reasonable basis for conclu ding that Loughray did not suffer from a disabling thyroid dysfunction.21 iii. Sleep Apnea Medical evidence supports the claim that Loughray suffers from sleep apnea, but not the claim that it constitutes a disabling co ndition. The specialists at National Jewish Medical and Research Sleep Centers diagno sed Loughray with sleep apnea. However, nothing in the record suggests this condition disables Loughr ay or cannot adequately be controlled by using oxygen; rath er Loughray was advised to use oxygen to counteract the effect of this disorder. In his review, D r. Truchelut explained th at Loughray’s sleep apnea could affect her, but not in a manner th at impaired her ability to work as a sales commissioned employee, and furthermore, that the condition was being treated with the use of oxygen: Because of the polysomn ogram findings, some occu pational restrictions might be reasonable, but this would be limited to avoidance of hazardous workplace environments such as unprotected heig hts or moving machinery, or at least until such time as her sl eep specialist or other providers had determined that treatmen t with oxygen or some ot her therapy was adequate to correct the condition. This appears to have occurred at the time when the second polysomnogram of 10/01/01 was performed. (Id. at 254.) Thus, based on this independent review, Hartford did not act arbitrarily and capriciously in concluding that Loughray was not disabled as a result of sleep apnea. iv. Chronic Fatigue Loughray has consistently complained of chronic fatig ue. Although her doctors have not suggested she is exa ggerating her complaints of fa tigue, Loughray cannot point to any objective medical condition that may be producing the disab ling fatigue of which22 she complained. 5 Moreover, “during interviews prior to the diagnosis of Central Sleep Apnea, [Loughray] reported no trouble with sleeping and that morning was the best time of day for [her] and as the day goes on [she] begin[s] to wear out.” (Id. at 237.) As Hartford pointed out, “[t]his would be a r easonable occurrence within the general public and would not be considered a significant finding with regard to any medical condition.” (Id. ) As Loughray lacked any objective medi cal proof that her fatigue impaired her ability to perform her work as a sales commissioned employee, Hartford was not unreasonable in concluding she did no t suffer from disabling chronic fatigue.

v. Headaches Loughray also asserts severe headaches have rendered her disabled. When Loughray’s thyroid dysfunction became uncontrolled in April 2000, Loughray complained of severe and deb ilitating headaches. Her complain ts persisted even after her thyroid condition stabilized. Subsequently, however, she i ndicated that while she still suffered from headaches, their severity had decreased beca use she had begun to take Depakote. At other times, particularly du ring the several month gap in Loughray’s medical record, Loughray does not appear to have regu larly complained about headaches or have been taking medication for them. At still other times, Lou ghray received Botox injections to treat recurring headaches. Desp ite these later complain ts about headaches, Loughray’s physicians never provided any objective medical evidence that the headaches were disabling. Given the lack of obj ective medical evidence and that Loughray’s

5 As discussed, the fatigue caused by sleep ap nea would not render Loughray unable to perform her job duties and was being treated with oxygen.23 complaints were inconsistent, it was not i rrational for Hartford to reject Loughray’s subjective complaints as a source of her disability. Loughray’s other evidence would not sup port finding Hartford acted arbitrarily and capriciously. In mid-2002, a physician’s assistant and a doctor at the Mayo Clinic indicated Loughray suffered from headaches a nd treated her with Botox injections. Neither, however, addressed whether Loughra y’s headaches rendered her disabled, and the doctor who performed the injections di d so upon the assistant’s recommendation without making any assessment of Loughray’s functional capacity. Similarly, in a letter dated October 2002, Dr. Gulevi ch informed Hartford he ha d injected Loughray with Botox for her headaches. This letter, howeve r, did not opine on Loug hray’s capacity to work. And although it noted that Loughray reported multiple visits to the emergency room each month for her headaches, no eviden ce in the record indicates any such emergency room visits occurre d. Given the discrepancie s and lack of an explicit disability diagnosis by these medical prof essionals, Hartford acted reasonably in declining to find a di sability based on them. vi. Closed Head Injury Loughray next argues that Hartford acted arbitrarily and capriciously regarding her claim that she suffers a disab ling condition from a closed head injury. Loughray appears first to have revealed that sh e fell and lost conscious in 1999 to her original primary care physician, Dr. Brusnchwig, in mid-2000. Dr . Brunschwig, however, did not conclude she suffered from a closed head injury.24 In contrast, Dr. Cohen specifically diagno sed Loughray as having a closed head injury from her 1999 fall. Dr. Cohen examined Loughray in September 2002 and identified some neurological defects and “s lowed” cognitive processing. Dr. Cohen’s diagnosis was based in part on his belief th at Loughray’s cognitiv e dysfunction had been present since her fall in 1999. The admini strative record, however, lacks any objective medical evidence that Loughr ay had previously suffered any cognitive or neurological dysfunction. In fact, several doctors perform ed exams that produced normal results. In June 2000, Dr. Kakkar found no “neuro logical/musculoskeletal problems” (Id. at 787) and Louhray’s MRI and MRA produced norm al results. In May 2001, Dr. Gass’s neurological exam produced normal results , as did a CAT scan in September 2001 and a later neurological exam by Dr. Murray. Thus , Hartford could have reasonably concluded in January 2002 when it term inated Loughray’s benefits that she did not suffer from a closed head injury. The subsequent repor t of Dr. Cohen submitte d during the appeals process could have reasonably been viewed as inconclusive give n Loughray’s prior neurological and cognitive history. The other medical evidence offered by Loug hray also fails to render Hartford’s termination decision unreasonable. A physicia n’s assistant at the Mayo Clinic suggested she suffered a closed head injury, but he failed to examine her level of disability. In fact, his neurological exam produced normal results, and he de scribed Loughray as “alert, [and] oriented to person, place, time, and situation.” (Id. at 222.) Dr. Groover, Loughray’s chiropractor, also identified Loughr ay as disabled because “her head injury and spinal misalignment” had resulted in “h er sympathetic nervou s system [being] in25 constant fight or flight.” (Id. at 515.) Dr. Groover, however, failed to specify any medical basis underlying his opinion and later suggests an endocrine problem could be causing Loughray’s difficulties. Dr. Murray, of the Ro cky Mountain MS Center examined Loughray to determine if she suffer ed from multiple sclerosis. In concluding that she did not, Dr. Murray suggested that her symptoms were “p robably” caused by sleep apnea and/or a prior closed head injury. (Id. at 278.) As mentioned, however, his neurological exam of Loughra y produced normal results, and his examinations do not appear to have established any objective findings that woul d support these two diagnoses or that they were disabling conditions, though his sleep apnea diagnosis ultimately proved true. A letter provided by Nurse Arlene James is equally inconclu sive. Nurse James explained specific functional difficulties Loughray suffered, but there is no indication that Nurse James ever saw Loughray professionally or treated her for anything. Moreover, Nurse James’ statements were not entirely cons istent with other evid ence in Loughray’s medical records. For example, she noted a “dramatic change” that Loughray underwent “[i]n 1998,” which “result[ed] in overwhelm ing fatigue, slurred and missing speech and halted and missing thoughts.” (Id. at 629.) But Loughray claimed that her disabling condition began in April 2000, and the fall on which Dr. Cohen relied for his diagnosis occurred in 1999. vii. Hartford’s Refusal to Co nsider Dr. Kutz’ Report Nearly 18 months after Hart ford upheld its termination decision for the third time, Loughray, in March 2004, subm itted another piece of medica l information, a report by26 Dr. Kutz, Ph.D. Although th e other doctors that examined Loughray had not diagnosed Loughray with dementia, Dr. Kutz conclude d that Loughray suffere d from dementia. Dr. Kutz believed Loughray suffered serious cogn itive problems because she earned a 71 on an IQ test administered in March 2003, no twithstanding Loughray’s college education. Hartford, however, refused to consider the additional ev idence submitted by Loughray. This decision by Hartford does not re nder Hartford’s termination decision arbitrary and capricious. ERISA require s that a fiduciary “afford a reasonable opportunity to any participant whose claim for benefits has been denied for a full and fair review by the appropriate named fiduciary of the decision denying the claim.” 29 U.S.C. § 1133(2). Here, Hartford first terminated Lo ughray’s benefits in January 2002, and as discussed above, with a reasonable basi s for doing so. As permitted by ERISA, Loughray then sought a review of that decision, supplementing her request with additional medical information. Hartford granted Loughray an extension of time to gather material for her appeal before uphol ding its decision. Then, Hartford twice reopened the file to reconsider its decision and a llow Loughray to supplement her file— once at her request and once at the request of a state agency. Both times Hartford affirmed its termination decision. At least by the time Hartford issued its third decision affirming its original termination decision, Hartford had satisfi ed its obligation to provide Loughray “a reasonable opportunity . . . for a full and fair review.” See 29 U.S.C. § 1133(2). Neither ERISA nor the Plan required Hart ford perpetually to hold open Loughray’s file and to go above and beyond this requirement by reopenin g her file nearly 18 months later. Cf.27 Metzger v. UNUM Life Ins. Co. of Am. , 476 F.3d 1161, 1166 (10th Cir. 2007) (“Permitting a claimant to receive and rebut medical opinion reports generated in the course of an administrative appeal—even wh en those reports contain no new factual information and deny benefits on the same ba sis as the initial decision—would set up an unnecessary cycle of submission, review, re -submission, and re-revi ew.”). Deadlines and finality in ERISA administrative decisions are important aspects of the ERISA framework. See Gilbertson v. Allied Signal, Inc. , 328 F.3d 625, 63 5 (10th Cir. 2003) (stating that “deadlines play a crucial role ” in ERISA administrative appeals). Once Hartford completed its “full and fair” administrative review, it was not obliged indefinitely to continue considering information submitted by Loughray. See Davidson v. Prudential Ins. Co. of Am. , 953 F.2d 1093, 1096 (8th Cir. 1992) (recognizing that, where the administrator review ed a claim three times but later declined to reopen claimant’s file to take new evidence, “the ad ministrative review process must end at some point and in this case [the claimant] has not be en denied the opportunity for a full and fair review” (alterations, quotations , and citations omitted)). viii. Other Medical Evidence of Disability Loughray also criticizes Hartford’s “dis regard” of a variety of other pieces of medical evidence she feels confirms her disab ility. Much of this medical evidence was, at best, inconclusive, and given the other information in the administrative record, Hartford acted reasonably in concluding that th e evidence that Loughray was not disabled outweighed the remaining pieces of evidence provided by Loughray.28 For example, the letters s ubmitted by Drs. Stapleton a nd Fliege, as well as one submitted by Joyce Campbell, do not show that Hartford abused its discretion in denying Loughray’s benefits. Dr. Stapleton’s note , a single sentence written on prescription paper, asserts that Loughray was disabled, bu t lacks any indication of when or for what she treated Loughray. Nor does it precisely identify the ailments that render Loughray disabled. Similarly, Dr. Fleige, in a two se ntence note, informed Hartford that Loughray had “frequent allergic reactions [] that often . . . leav[e] her incapacitated for days” and that she “needs to be ab le to go to the ER for shots of adrenaline” to ameliorate these reactions. (Aple. Supp. App. at 224.) Dr. Fleige, however, does not identify these allergies. And the record fails to contain any information to clarify this diagnosis. Moreover, the record fails to show any vi sits to the emergency room for allergic reactions. Finally, Campbell, a licensed counse lor, also stated that Loughray was “unable to work at this time,” but it did not contain any of the specific facts on which Campbell relied to determine Loughray suffered a disability. (See id. at 654.) Thus, Harford had good reason to credit other medi cal evidence over these letters. CONCLUSION Loughray’s situation is a difficult one as she has suffered various maladies since April 2000. Our task, however, is to determin e whether Hartford abused its discretion in denying disability benefits to Loughray because she failed to furnish objective medical evidence establishing a disability. Based on the record before us, Hartford had a reasonable basis for discrediting much of th e evidence presented by Loughray and for29 concluding that Loughr ay did not suffer from a disabli ng condition. Accordingly, we AFFIRM the district court’s order upho lding Hartford’s te rmination decision.
ENTERED FOR THE COURT

David M. Ebel Circuit Judge