### In the



# United States Court of Appeals

For the Seventh Circuit

____________________

No. 13

‐ 2037

T ONY C ERENTANO

, Plaintiff

‐ Appellant

,

v.

UMWA H EALTH AND R ETIREMENT F UNDS

, Defendant

‐ Appellee

.

____________________

Appeal from the United States District Court for the

Southern District of Illinois.

No. 3:12-cv-00153 — Michael J. Reagan

, Judge

.

____________________

A RGUED N OVEMBER 6, 2013

— D ECIDED N OVEMBER 22, 2013

____________________

Before W OOD

, Chief Judge, and F LAUM and T INDER

, Circuit

Judges

.

F LAUM

, Circuit Judge

. From 1978 to 2000, Tony Cerentano

worked as a coal miner. He was injured in fi fteen mining

incidents and received six separate awards of permanent

partial disability, but he was able to return to work after

each injury. In 2005, Cerentano’s car was rear

‐ ended,

resulting in more injuries. After this accident, Cerentano

sought and was awarded Social Security disability bene fi ts.2 No. 13

‐ 2037

He then applied for disability pension bene fi ts under the

United Mine Workers of America 1974 Pension Trust Plan.

The plan’s trustees denied Cerentano’s application for

bene fi ts, concluding there was no causal link between his

mine injuries and the award of Social Security bene fi ts.

Cerentano then fi led suit, challenging the trustees’ decision

pursuant to the Employee Retirement Income Security Act of

1974 (ERISA), 29 U.S.C. § 1332(a)(1)(b). The district court

granted summary judgment to the defendant plan. We

reverse and remand to the plan’s trustees.

I. Background

This case has three relevant periods: (1) 1978–2000;

(2) 2001–2004; and (3) 2005 and after. Cerentano worked in

the mines in the first period, worked out of the mines in the

second period, and did not work in the third period.

A. Injuries in the coal mines, 1978–2000

From 1978 until 2000, Cerentano worked for Monterey

Coal Company and was involved in various accidents on the

job, resulting in injuries to his elbow, knee, back, neck, and

shoulders. The relevant accidents include (but are not

necessarily limited to) the following.

On January 29, 1986, Cerentano sprained the right side of

his back while lifting a shovelful of slate. He missed work

for ten days. He received temporary total disability benefits

and a 1.25 percent permanent partial disability award.

On May 23, 1989, Cerentano injured his left elbow while

he was throwing a rock dust bag. He ultimately missed 247

days of work, including having surgery to repair a ruptured

biceps tendon. He received a 20 percent permanent partial

disability award. He later reinjured that elbow at work.No. 13

‐ 2037 3

On February 10, 1994, Cerentano sprained his left knee

when he slipped while pulling loose cable. Despite popping

and occasional pain in his knee, he did not miss work after

this injury. However, on June 3, 1994, he twisted this knee

when he stepped on a piece of coal while stepping off a

ladder. After an MRI, Cerentano had surgery to repair a

meniscal tear and reconstruct the anterior cruciate ligament

(“ACL”). Seven months later, he returned to work without

restriction. He received a 35 percent permanent disability

award for his left leg.

On February 27, 1999, Cerentano slipped and fell when

he caught his foot on the lip of a coal

‐ hauling cart, straining

a muscle in his back. A follow

‐ up examination found no

neurological deficits, and an MRI of his spine was negative

for disc herniation and did not suggest a compression

fracture. Cerentano missed 88 days of work before returning.

He received temporary total disability benefits and a five

percent permanent partial disability award. 1

On July 27, 2000, Cerentano inhaled fumes when he

opened the lid on a battery compartment in a coal car that he

had been operating. After complaining of chest tightness

and dizziness, he was given oxygen and sent home. The next

day, he returned to work, but power was interrupted in the

mine. During the subsequent evacuation of the mine, he fell

ill, became light headed, and fell out of a moving cart. He

was taken to the hospital because of pain in his shoulders,

1 In May 2000, Cerentano’s family doctor (Dr. Cantrell) also began

treating him for dysthymia, a mood disorder whose symptoms are

longer

‐ lasting but less severe than depression. She prescribed

antidepressants.4 No. 13

‐ 2037

left ankle, and left knee. Various x

‐ rays were negative, but

he was diagnosed with an injury to his left medial meniscus.

After an MRI, a doctor surgically repaired this knee, and also

found that the ACL was lax but not torn. In the aftermath of

the accident, another doctor examined Cerentano for neck

and back pain. He diagnosed contusions of the cervical,

dorsal, and lumbar spines with a possible tear in the cervical

area and degenerative changes in one location. He

recommended weight loss, but no orthopedic treatment.

Another physician, Dr. Dusek, treated Cerentano for pain in

both shoulders, and performed an arthroscopy of the right

shoulder. Cerentano recovered full range of motion.

Cerentano received workers’ compensation benefits for

the July 28th accident, and was awarded an additional 20

percent permanent partial disability for his left leg and 28.7

percent for his right arm. His shoulder pain continued, so he

had more testing. An MRI suggested a partial tendon tear in

the right shoulder but was negative for the left shoulder.

B. Events from 2001–2004

Although he was ultimately released to return to work

without restriction, Cerentano last worked in the mines on

July 28, 2000, because he was wrongfully discharged after a

false positive drug test. A few months later, Dr. Cantrell

diagnosed Cerentano with depression due to his firing and

prescribed antidepressants. Based on various symptoms, a

psychologist also diagnosed and treated Cerentano for

dysthymia and anxiety. Ultimately, Cerentano found work

as a real estate agent and a recreational vehicle transporter.No. 13

‐ 2037 5

C. Car accident and aftermath, 2005 and after

On February 16, 2005, Cerentano interviewed for a job as

a laborer in a warehouse. On his way back from the

(successful) interview, his car was rear

‐ ended. Dr. Cantrell

diagnosed Cerentano with cervicalgia (neck pain) and

lumbar pain. X

‐ rays showed a loss of normal cervical

curvature and mild scoliosis with mild disc space narrowing

in his lumbar spine. One month later, an MRI showed slight

disc bulging with an annular tear. Cerentano soon returned

to Dr. Cantrell complaining of left knee pain. X

‐ rays revealed

a small fracture, which was a tt ributed to the car accident.

Dr. Scherer evaluated Cerentano’s left knee for popping

and crunching. He noted Cerentano’s prior ACL surgery and

said that Cerentano “did not have pain in his knee before the

accident.” Dr. Scherer’s impression was a knee injury from

the car accident, either from a blow to the dashboard or a

violent contraction of the quadriceps. Cerentano requested

permission to start his new job; the doctor said that it might

be problematic but that Cerentano could work if he felt well

enough to do so.

In September 2005, Dr. Cantrell diagnosed Cerentano

with diabetes, left arm neuropathy, lumbar pain with

radiculopathy, depression, and left knee pain. In December

2005, Dr. Gornet examined Cerentano for headaches with

neck pain, pain between the shoulder blades, pain into his

left arm, occasional pain in his right arm, back pain, and left

leg pain. Dr. Gornet said that the problems were a tt ributable

to the car accident on February 16, 2005.

Dr. Miller examined Cerentano in 2006 for left shoulder

pain, and noted that the pain began with the 2005 car6 No. 13

‐ 2037

accident. After an MRI showed in fl ammatory changes in the

left rotator cu ff

, Dr. Miller diagnosed rotator cu ff tendonitis

and acromioclavicular (shoulder

‐ clavicle) degenerative joint

disease. He later injected Cerentano with cortisone, but the

results were disappointing. Dr. Miller’s impression was that

the pain actually emanated from Cerentano’s neck.

Cerentano continued having neck and back pain thereafter.

After the car accident, Cerentano applied for Social

Security Disability Insurance (SSDI) bene fi ts. He sought

bene fi ts beginning on February 16, 2005, the date of the car

accident. In a February 2008 opinion, an Administrative Law

Judge (ALJ) in the Social Security Administration (SSA)

applied the SSA’s fi ve

‐ step sequential test. See 20 C.F.R.

§ 404.1520(a). The steps ask whether the claimant

(Cerentano) is engaged in substantial gainful activity;

whether he has a severe impairment (or a combination of

severe impairments); whether he is automatically disabled

because his severe impairment is referenced in 20 C.F.R.

§ 404.1520(d); if not, whether he can perform his past work

given his “residual functioning capacity,” which is based on

all of his impairments (not just his severe ones); and if he

cannot do his past work, whether he can do any other work,

given his residual functioning capacity, age, education, and

work experience. See 20 C.F.R. § 404.1520. Thus, under this

test, an individual can be found disabled either under 20

C.F.R. § 404.1520(d), or because he cannot do any work.

Applying this test, the ALJ found that Cerentano could

not do any work, and therefore was disabled and entitled to

bene fi ts. Speci fi cally, Cerentano was not employed, and he

had nine severe impairments: “asthma, diabetes mellitus,

morbid obesity, degenerative disc disease of the lumbar andNo. 13

‐ 2037 7

cervical spine, status post cervical fusion, degenerative joint

disease of the acromioclavicular joint, rotator cu ff tendonitis,

depression, and anxiety.” Despite these impairments, he

could not be found disabled under 20 C.F.R. § 404.1520(d).

However, he could not perform his past work because of his

residual functioning capacity, which was limited due to

asthma; diabetes; obesity; back and neck pain due to his 2005

car accident; degenerative disc disease of the lumbar,

thoracic, and cervical spine; degenerative joint disease of the

acromioclavicular joint; rotator cu ff /subacromial bursitis;

chronic back strain; “ fl exion contracture of the left elbow”;

“internal derangement of the left knee”; anxiety, depression,

and mood swings; severe headaches and pain running down

the neck into the arms and hands; and “knee pain

a tt ributable to a prior knee injury.” The ALJ then found that

there were no jobs that Cerentano could perform given his

age, education, work experience, and residual functioning

capacity. The ALJ therefore found Cerentano disabled as of

February 16, 2005.

Cerentano then applied for disability pension bene fi ts

from the United Mine Workers of America 1974 Pension

Trust Plan (“the Plan”). The Plan trustees denied both his

application for bene fi ts and his appeal. Cerentano then fi led

suit in federal district court, challenging the trustees’

determination. The parties stipulated to a remand to the

trustees to take another look, including analyzing additional

documentation. The trustees then issued another denial.

In the district court, both parties moved for summary

judgment, and the Plan’s motion was granted. The district

court first determined that arbitrary and capricious review

applied, because the Plan gives the trustees full discretion to8 No. 13

‐ 2037

determine eligibility for benefits. The district court then

noted that the trustees had reviewed Cerentano’s file three

times and concluded that “none of his mine accidents alone

or in combination substantially contributed to his total

disability.” The court found this determination reasonable.

II. Discussion

We review a district court’s grant of summary judgment

de novo. Holmstrom v. Metro. Life Ins. Co.

, 615 F.3d 758, 766

(7th Cir. 2010). “Judicial review of an ERISA administrator’s

benefits determination is de novo unless the plan grants the

administrator discretionary authority to determine eligibility

for benefits or to construe the terms of the plan.” Id. (citing

Firestone Tire & Rubber Co. v. Bruch

, 489 U.S. 101, 115 (1989)).

When, as here, the trustees possess such discretionary

authority, we ask only whether their decision was arbitrary

and capricious. Tompkins v. Cent. Laborers’ Pension Fund

, 712

F.3d 995, 999 (7th Cir. 2013). Under arbitrary and capricious

review, we will uphold the trustees’ decision “as long as (1)

it is possible to offer a reasoned explanation, based on the

evidence, for a particular outcome, (2) the decision is based

on a reasonable explanation of relevant plan documents, or

(3) the administrator has based its decision on a

consideration of the relevant factors that encompass the

important aspects of the problem.” Id. at 999 (citation

omitted). Although our review is highly deferential, it “is

not a rubber stamp.” Holmstrom

, 615 F.3d at 766. We will not

uphold a denial of benefits “when there is an absence of

reasoning in the record to support it.” Williams v. Aetna Life

Ins. Co.

, 509 F.3d 317, 321 (7th Cir. 2007) (citation omitted).

In this case, the Plan’s text states that a participant who

“becomes totally disabled as a result of a mine accident

...No. 13

‐ 2037 9

shall

... be eligible for a pension while so disabled. A

Participant shall be considered to be totally disabled only if

by reason of such accident such Participant is subsequently

determined to be eligible for Social Security Disability

Insurance benefits

... .” The phrases “as a result of” and “by

reason of” do not establish how closely connected the mine

accident(s) must be to the disability. When a plan’s language

is “ambiguous,” the trustees’ “interpretation

... is entitled to

deference.” Tompkins

, 712 F.3d at 1002. The trustees provide

an interpretation here, stating in their denial that

Cerentano’s SSDI benefits were not “causally related” to his

mine injuries, and that he did not establish “a causal link”

between his mine accidents and his award of SSDI benefits.

Moreover, “[t]he Trustees recognize that a combination of

injuries can cause a disability under the Plan.” At oral

argument, counsel for the trustees reiterated that a

combination of injuries from mine accidents and non

‐ mine

accidents can suffice. Thus, under the trustees’

interpretation, the crucial question is whether there is “a

causal link” between Cerentano’s injuries from mine

accidents and the ALJ’s decision to award benefits.

The trustees’ denial decision does not directly address

this key question, however. Instead, it incorrectly states that

the ALJ awarded benefits “based on” Cerentano’s nine severe

impairments. The trustees’ denial addresses each of these

severe impairments, concluding that none resulted from a

mine accident. The denial also determined that none of

Cerentano’s many accidents, from 1978–2000, was itself a

disabling injury. After all, he returned to work after each

injury, the denial notes. At this point, the analysis ends.10 No. 13

‐ 2037

Even under arbitrary and capricious review, this analysis

is insufficient. By their own interpretation, the trustees

needed to assess whether Cerentano’s mine injuries were “a

causal link” in the ALJ’s decision to award benefits. There

are two ways that an individual can be awarded SSDI

benefits: the first relies only on severe impairments, while

the second considers all impairments. Cerentano was

deemed disabled through this second path, after the ALJ

considered non

‐ severe injuries, several of which are or may

be from mine accidents (for instance, “flexion contracture of

the left elbow,” “internal derangement of the left knee,” and

“knee pain attributable to a prior knee injury”). Non

‐ mine

‐

related injuries certainly contributed to Cerentano’s

disability, but the Plan states that it is appropriate to award

benefits in certain cases based on a combination of injuries,

only some of which were caused by mine accidents. On that

sensible interpretation, Cerentano’s elbow (and perhaps

several other) injuries could comprise “a causal link” in the

ALJ’s decision. 2 Thus, it was insufficient for the trustees to

conclude that each individual injury was not itself totally

disabling, because that is not the question in this case.

2 Our interpretation is consistent with—and therefore buttressed by—

our sister circuits’ interpretations of this particular defendant’s Plan.

Specifically, the Fourth Circuit said, “if the plaintiff was injured in a

mine accident and that injury, whether in combination with a previous

or subsequent condition, is substantially responsible for plaintiff’s

inability to perform his job and for whatever medical and vocational

reasons he is unable to perform an alternative job, then his total

disability results from a mine accident.” Boyd v. Trs. of UMW Health &

Ret. Funds

, 873 F.2d 57, 59 (4th Cir. 1989) (citation omitted). To similar

effect the Sixth Circuit noted that “[t]he question is whether the accident

contributed in some part to the disability of [the applicant].” Odom v.

UMWA Health & Ret. Funds

, 687 F.2d 843, 847 (6th Cir. 1982).No. 13

‐ 2037 11

The Plan also argues that its denial is strongly supported

by the date of onset for Cerentano’s SSDI benefits—the date

of his car accident, which is more than four years after he

last worked in the mines. Yet the date of onset does not cure

the trustees’ incomplete analysis, nor preclude the

possibility that injuries from mine accidents were a causal

link in the ALJ’s decision.

In sum, the trustees should have examined all of the

injuries—both severe and non

‐ severe—that the ALJ relied on

in finding Cerentano disabled. The trustees also should have

determined which of those injuries were caused by mine

accidents and whether, in combination, those mine

‐ related

injuries comprised “a causal link” in the ALJ’s award of

disability benefits. Of course, we do not answer these

questions here. We merely remand to the trustees to address

these issues in a new round of review. See Holmstrom

, 615

F.3d at 778 (“When an ERISA plan administrator’s benefits

decision has been arbitrary, the most common remedy is a

remand for a fresh administrative decision rather than an

outright award of benefits

... .”).

III. Conclusion

For the foregoing reasons, we R EVERSE and R EMAND to

the Plan trustees.