In the

United States Court of Appeals

For the Seventh Circuit ____________

No. 07-1207

JANET SPECIALE,

Plaintiff-Appellee,

v.

BLUE CROSS AND BLUE SHIELD ASSOCIATION

and NON-CONTRIBUTORY NATIONAL LONG TERM

DISABILITY PROGRAM,

Defendants-Appellants.

____________

Appeal from the United States District Court

for the Northern District of Illinois, Eastern Division.

No. 04 C 5390—David H. Coar, Judge.

____________

ARGUED SEPTEMBER 7, 2007—DECIDED AUGUST 7, 2008

____________

Before BAUER, POSNER, and SYKES, Circuit Judges.

SYKES, Circuit Judge. Janet Speciale was an employee

of the Health Care Service Corporation (“HCSC”) for a

little over two years when she applied for long-term

disability benefits under Blue Cross and Blue Shield

Association’s (“Blue Cross”) Non-Contributory National

Long Term Disability Program (“the Program”). Speciale

suffered from fibromyalgia since 1986, but in 2001 claimed

an exacerbation of her symptoms disabled her from
2 No. 07-1207

1 Section 1(p) of the Program contains the relevant definition:

“Disabled” means . . . that a Participant is, determined on

the basis of medical evidence satisfactory to the Committee,

wholly prevented, by reason of mental or physical disability, from engaging in any occupation comparable to that in

which he was engaged for the Employer, at the time his

disability occurred. An occupation is considered comparable to that in which the Participant was engaged for the

(continued...)

working. The Program’s Medical Review Committee

(“MRC”) denied Speciale’s claim and her subsequent

appeal. It found that her symptoms, although troublesome, did not rise to the level of disability because two

of her treating physicians believed she could work with

certain physical restrictions. Speciale filed this action in

the district court, and both parties moved for summary judgment. Applying an arbitrary-and-capricious

standard of review, the district court overturned the MRC’s

decision and granted Speciale’s application for benefits.

This appeal followed. Because the reasons given by the

MRC for its decision were reasonable and supported by

the record, we reverse the district court’s judgment and

remand for entry of summary judgment in favor of

Blue Cross and the Program.

I. Background

Speciale worked for HCSC as a senior account executive

from June 1998 through November 7, 2000. HCSC is an

independent licensee of Blue Cross, and as an employee,

Speciale was covered by the Program, entitling her to

benefits if she should ever become disabled.1

 The Program
No. 07-1207 3

(...continued)

Employer if the earnings potential of the occupation is

comparable to the employee’s salary range at the time

he became Disabled.

is administered by the National Employee Benefits Committee (“NEBC”) of Blue Cross. The NEBC delegated dayto-day responsibilities for the Program to the National

Employee Benefits Association (“NEBA”), which in turn

assigned the authority to determine claims to the Medical Review Committee.

Speciale’s job was hectic; she was required to respond

constantly to problems and emergencies with clients or

brokers and spent nearly half of her time traveling to

meetings. Her job required fine-finger movement, talking,

and listening, as well as climbing stairs and lifting up to

50 pounds from either the floor or table level. She was

also required to work overtime seven or more times per

month.

A. Speciale’s Medical History

Although her job could be considered stressful for the

average person in good health, Speciale suffered from a

number of medical conditions that made her position even

more difficult. She was diagnosed with fibromyalgia in

1986, and her symptoms, though initially manageable,

began to worsen in 2000. Dr. Kevin Snydersmith, her

physician, recorded in September of 2000 that Speciale

complained of severe back pain, as well as pain and

numbness in her left shoulder and leg. Snydersmith did

not think all of her symptoms were explained by the

fibromyalgia, so he diagnosed her with chronic pain
4 No. 07-1207

syndrome. He noted that her job is “fairly intense” and

she had used most of her sick days because of her medical problems.

Dr. Snydersmith’s diagnosis of chronic pain syndrome

set in motion treatment and diagnostic regimes that

ultimately resulted in Speciale’s application for long-term

disability benefits on April 18, 2001. In October 2000

Dr. Snydersmith noted that Speciale was on at least

four different medications and also received shots of

Toradol once or twice per month to control her pain. That

same month Speciale met with rheumatologist Dr. Ann

Winny, who spoke at length with Speciale and believed

her symptoms were “progressively worsening.” Speciale

mentioned she might take time off from work to see if

the stress of her job was the cause of her deterioration.

Dr. Winny believed the symptoms were due to

fibromyalgia and chronic pain syndrome but did not

rule out the possibility of multiple sclerosis (“MS”).

Speciale met with Dr. Brian O’Shaughnessy on November 1, 2000. After evaluating her symptoms and a recent

MRI of the brain, he believed she was suffering from

some form of demyelinating disease and wanted her to

have a lumbar puncture to further investigate this possibility. Dr. O’Shaughnessy reiterated his suspicions in February 2001 when Speciale came into his office and reported

that she was dizzy and tired, suffered extreme back pain,

and had difficulty walking. Dr. O’Shaughnessy thought

this could be explained by an exacerbation of a

demyelinating disease but noted that Speciale had an

appointment with Dr. Boris Vern, head of the multiple

sclerosis clinic at the University of Illinois, for testing.

Dr. O’Shaughnessy reported to Blue Cross on March 17

that Speciale could not work due to her severe pain and
No. 07-1207 5

fatigue and her return to work was “indefinite pending

[the] outcome of testing” by Dr. Vern. Tests conducted

on March 22 indicated that Speciale’s “sensory symptoms

are overshadowed and probably colored by her chronic

pain, which seems to [be] of myofascial origin.” Dr. Vern

thought that MS could be a possibility but that it was

“not strongly supported by the available lab studies.”

While under the care of Dr. O’Shaughnessy, Speciale

continued to see Dr. Snydersmith. In mid-January 2001, he

provided her with a “quad” cane to ease her walking

difficulties. His notes reveal that Speciale was suffering

from frequent, painful kidney stones. She was put on

various medications, including Vicodin, and at one point

was admitted to the emergency room for pain control and

hydration. In February Snydersmith referred Speciale to

physiatrist Dr. Dennis Keane. After an initial consultation, Dr. Keane wrote that Speciale’s symptoms were

somewhat alleviated after a vacation to Arizona; however,

she still experienced a great deal of pain in her back that

often radiated down her left leg. He seemed to assume

that Speciale suffered from MS because she used a quad

cane to help her “slightly unsteady gait from her MS.” He

reexamined Speciale in early June and found her to be

doing “dramatically better” after being placed on oral

steroids.

Despite Dr. Vern’s doubts, Speciale’s other doctors

believed she was suffering from symptoms related to MS.

Dr. O’Shaughnessy wrote on May 17 that he doubted

fibromyalgia accounted for her problems because “she

has had [it] for 14 years and it has not caused” the symptoms of which she was more recently complaining. Less

then a month later he wrote: “I feel her clinical picture is

most compatible with multiple sclerosis. I do not see her
6 No. 07-1207

improving enough at this time to return to work.” Dr.

Snydersmith supported this diagnosis and found her

symptoms were “likely due to developing MS.” Dr. Winny

agreed that Speciale “is probably disabled at this point”

because her MS makes it difficult for her to walk.

Although Speciale’s symptoms were serious, the tentative diagnosis of MS turned out to be inaccurate. Dr.

Snydersmith told Blue Cross Nurse Sue Majewski on

August 27 that the lumbar puncture did not confirm MS

and the diagnosis was simply fibromyalgia that had

been worsening in recent months. He could not predict

how long Speciale could stand or walk each day as he no

longer managed her case (Dr. Keane had taken over

treatment of her pain).

Speciale’s application for disability benefits was reviewed in August 2001 by Dr. E. Richard Blonsky, Blue

Cross’s senior medical consultant. Dr. Blonsky filled out

a Physician’s Recommendation Form and noted that

there was no clear evidence of MS. He went on to state

that Speciale suffered from fibromyalgia for 20 years and

had worked, making this a “very marginal case.” He also

noted the lack of “confirmatory findings” and that the

record contained “a lot of subjective complaints.” He

concluded: “I am not totally convinced of her disability.

Were there any H.R., performance issues?” Dr. Blonsky

reevaluated Speciale’s file on September 5, this time

confirming she did not have MS and reaffirming his

previous finding that she was not disabled. Indeed, Dr.

Keane had responded to an inquiry from the MRC by

pointing out that Speciale suffered from back pain, leg

spasms, weakness, and fatigue. Even so, he told the

MRC that Speciale was physically capable of performing

sedentary and light-duty jobs.
No. 07-1207 7

B. Procedural History

The MRC informed Speciale of its decision to deny her

benefits application on October 30, 2001. It noted that

Drs. Snydersmith, O’Shaughnessy, and Winny all believed Speciale had MS when they said she was disabled, but it was not known whether the negative lumbar

puncture would change their opinions. Further, the

committee noted that Dr. Keane believed she could work

with some limitations (such as changing positions frequently) and his opinion carried weight because of his

specialty in pain management. The letter also stated

that the MRC conducted a vocational analysis, which

revealed at least six career opportunities in the surrounding area that would pay a comparable salary while

still accommodating Speciale’s restrictions.

Speciale timely appealed the denial of benefits. She

supplemented the record with new evidence, including

progress notes and a functional-capacity questionnaire

from Dr. Winny and progress notes from Dr. Keane. The

questionnaire noted Speciale’s “marked limitation” in

dealing with work-related stress due to her fibromyalgia.

Her physical limitations were also quite severe: she

could only sit for 10 minutes and stand for 15 minutes in

a 60-minute period; she had to walk every 30 minutes

for at least 5 minutes at a time; she needed a job that

permitted shifting positions and allowed her to take

unscheduled breaks; Speciale could not lift more than ten

pounds and was limited in her ability to reach or handle

objects repetitively. Finally, Winny noted that Speciale

would have to be absent from work more than three

times every month.

Dr. Blonsky reevaluated Speciale’s file in April 2002. He

spoke with Dr. Winny, who told him that trigger-point
8 No. 07-1207

injections help control Speciale’s fibromyalgia symptoms.

Dr. Winny also believed that a job that did not require

driving or travel might be tolerable and could be attempted. Based on this, Dr. Blonsky concluded “that the

claimant was not totally disabled [on] 5/1/01 or currently.”

The MRC denied Speciale’s appeal on May 8, 2002, in

a letter written by Barbara Grant, R.N., the NEBC’s assistant secretary and the director of the disability program

for the NEBA. Grant noted that Dr. O’Shaughnessy’s

opinion was given little weight because he was not available for comment after it was revealed that Speciale did

not have MS. Similarly, Dr. Snydersmith still thought

Speciale was declining due to fibromyalgia but was no

longer treating her and could not identify any present

restrictions. Dr. Winny’s functional-capacity questionnaire provided Speciale with her strongest argument, but

the MRC did not give it great weight because Dr. Winny

had told Dr. Blonsky that Speciale could likely work in a

job that did not require travel. Finally, Dr. Keane believed

that Speciale could work with certain restrictions. Grant

had also asked Nurse Majewski to conduct a second

vocational analysis, which confirmed the availability of

comparable jobs that did not require bending or twisting,

allowed for variable sitting and standing, and did not

require travel.

After her appeal failed, Speciale sent the MRC a copy

of a favorable ruling by the Social Security Administration granting her application for disability benefits.

Speciale asked the MRC to reconsider its decision based

on this new evidence. Grant responded, stating that

reconsideration requests were not normally granted after

a final decision. Grant also noted that Social Security

rulings carried little weight because the Program used

an alternate definition of “disabled.”
No. 07-1207 9

2 A denial of benefits is normally reviewed de novo “unless

the benefit plan gives the administrator or fiduciary discretionary authority to determine eligibility for benefits or to

construe the terms of the plan.” Firestone Tire & Rubber Co. v.

Bruch, 489 U.S. 101, 115 (1989). In such a case, the court applies

the “arbitrary and capricious” standard. Hess v. Reg-Ellen Mach.

Tool Corp. Employee Stock Ownership Plan, 502 F.3d 725, 727 (7th

Cir. 2007). The district court found sufficient discretionary

language in the Program and applied the more deferential

standard. That ruling is not challenged on appeal.

Speciale filed this action in the district court seeking

relief under the Employee Retirement Income Security

Act of 1974 (“ERISA”), 29 U.S.C. § 1132(a)(1)(B). Both

parties moved for summary judgment. The district court,

applying an arbitrary-and-capricious standard of review,

granted Speciale’s motion and denied the Association’s.2

The court found Dr. Blonsky’s and Nurse Grant’s reasoning flawed because of the emphasis each put on the

difference between subjective and objective evidence of

pain. Further, the court believed that Grant had not

sufficiently explained why she did not give weight to

Dr. Winny’s functional-capacity questionnaire. Based on

these flaws, the court held the denial was “downright

unreasonable.” Blue Cross and the Program timely appealed.

II. Discussion

A. Standards of Review

We review a grant of summary judgment de novo. Ruiz

v. Cont’l Cas. Co., 400 F.3d 986, 989 (7th Cir. 2005). Summary judgment is appropriate when “there is no genuine
10 No. 07-1207

issue as to any material fact and . . . the movant is entitled

to judgment as a matter of law.” FED. R. CIV. P. 56(c).

Where, as here, the court is faced with cross-motions

for summary judgment, “our review of the record requires that we construe all inferences in favor of the

party against whom the motion under consideration is

made.” Tegtmeier v. Midwest Operating Eng’rs Pension

Trust Fund, 390 F.3d 1040, 1045 (7th Cir. 2004) (internal

quotation marks omitted).

The district court held, and the parties concede, that

review of the MRC’s denial of benefits proceeds under

the arbitrary-and-capricious standard, and we will only

look to ensure that the Program’s decision “has rational

support in the record.” Davis v. Unum Life Ins. Co. of Am.,

444 F.3d 569, 576 (7th Cir. 2006) (internal quotation

marks omitted). “Put simply, an administrator’s decision

will not be overturned unless it is downright unreasonable.” Id. (internal quotation marks omitted). Although

deferential, we do not “rubber stamp” the administrator’s

decision. Hackett v. Xerox Corp. Long-Term Disability Income

Plan, 315 F.3d 771, 774 (7th Cir. 2003). However, “we

will uphold the plan’s 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.” Sisto v. Ameritech Sickness

& Accident Disability Benefit Plan, 429 F.3d 698, 700 (7th

Cir. 2005) (internal quotation marks omitted).
No. 07-1207 11

B. Reasonableness of the MRC’s Decision

On appeal, Blue Cross and the Program argue that the

district court misapplied the arbitrary-and-capricious

standard and instead conducted a plenary review of the

record by reweighing the relevant evidence. They maintain

that the MRC’s denial of benefits rested on two solid

grounds that entitle it to deference. First, the MRC determined that the weight of the evidence—including

Dr. Winny’s belief that Speciale could attempt work

with some restrictions and Dr. Keane’s statement that

she could engage in sedentary or light-duty jobs—did not

support a finding of disability. Second, even if Speciale

could not continue in her current position, other comparable employment opportunities existed that rendered her

not disabled for purposes of the Program. Speciale responds by questioning the clarity of Dr. Keane’s report as

well as the basis upon which Dr. Blonsky made his recommendation to deny benefits. She also argues that the

vocational analyses conducted by Blue Cross did not

consider all of her symptoms and were therefore unreliable.

Speciale claims that Dr. Blonsky’s review of her file—in

which he noted a lack of “confirmatory findings” and

pointed out that the record was only full of “subjective

complaints”—was flawed in light of our decision in

Hawkins v. First Union Corp. Long-Term Disability Plan,

326 F.3d 914 (7th Cir. 2003). There, we held that the plan

acted arbitrarily and capriciously in denying a claim

for benefits because its primary medical consultant

stated that sufferers of fibromyalgia could never be disabled because the pain experienced was entirely subjective and not capable of being confirmed by objective

findings. Hawkins, 326 F.3d at 919. However, as we noted
12 No. 07-1207

3 Speciale points to 29 C.F.R. § 2560.503-1(h)(3)(v) that disallows the use of a medical consultant on appeal who was

involved in the original benefit denial. However, that regulation

applies only to claims filed on or after January 1, 2002. See 29

C.F.R. § 2560.503-1(o). Speciale filed her claim on April 18, 2001.

4 Speciale argues that Dr. Winny’s statement to Dr. Blonsky

is inadmissible hearsay and should be disregarded. However,

our task is only to review the reasonableness of the denial. A

(continued...)

in Williams v. Aetna Life Ins. Co., 509 F.3d 317, 322 (7th Cir.

2007), “[a] distinction exists . . . between the amount of

fatigue or pain an individual experiences, which as

Hawkins notes is entirely subjective, and how much an

individual’s degree of pain or fatigue limits his functional

capabilities, which can be objectively measured.” Dr.

Blonsky did not question that Speciale suffered from

fibromyalgia or that she experienced constant pain;

rather, he only pointed out the lack of objective evidence

supporting Speciale’s claim that her pain resulted in

severe functional limitations rendering her disabled.

The only evidence of such limitations is the functionalcapacity questionnaire completed by Dr. Winny. That

form did indicate that Speciale was unable to cope with the

stress of her job because it heightened her symptoms and

limited her physical capabilities. Dr. Blonsky reported,

however, that Dr. Winny believed Speciale would be

able to go back to work on a trial basis so long as she

was not required to travel.3

 Indeed, it was Dr. Winny

who questioned—in her October 28, 2000 progress

notes—“whether [Speciale] can continue her work which

involves a lot of travel, [as] sitting in the car is very

uncomfortable.”4

 This restriction was then reincorporated
No. 07-1207 13

4 (...continued)

plan administrator is not a court of law and is not bound by

the rules of evidence. Karr v. Nat’l Asbestos Workers Pension

Fund, 150 F.3d 812, 814 (7th Cir. 1998). Our review may thus

consider even testimonial statements made outside of court if

the MRC did so in rendering its decision.

into the second vocational analysis, which confirmed the

availability of comparable employment that did not require travel.

Speciale contends that the vocational analysis undertaken by Blue Cross was inadequate because it did not

consider side effects from her medication, fatigue, or

inability to work overtime. However, none of these side

effects were listed as definite restrictions by either Dr.

Winny or Dr. Keane. Responding to a request for more

information, Dr. Keane checked “yes” on a form asking if

Speciale was “physically capable of performing the duties

of a sedentary or light duty job with restrictions.” Though

he unnecessarily listed “[b]ack pain, leg spasms, weakness, [and] fatigue” as symptoms that “would have prevented her from working” if he had checked “no,” his

intent to indicate that Speciale could work with restrictions is clear. Keane goes on to note that Speciale needs

“frequent changes of position” and she is “unable to

bend/twist fully,” both of which were included as restrictions in the second vocational analysis conducted by

Nurse Majewski.

Similarly, the functional-capacity questionnaire completed by Dr. Winny does not say that the claimed side

effects were actual restrictions that prevented Speciale

from doing any sort of work, sedentary or otherwise.

Her conversation with Dr. Blonsky indicated just the
14 No. 07-1207

5 Speciale argues that both Abram v. Cargill, Inc., 395 F.3d 882

(8th Cir. 2005), and Godfrey v. BellSouth Telecommunications, Inc.,

89 F.3d 755 (11th Cir. 1996), support her position that the MRC

acted unreasonably by not considering all of her symptoms

in their totality. However, in both Abram and Cargill, the plan

administrators irrationally limited their inquiry to only one of

the claimant’s medical conditions. See Abram, 395 F.3d at 886-87

(“The record shows three conditions that may be contributing

to Abram’s disability: PPS, depression, and obesity. . . . [T]he

Plan focused only on Abram’s PPS, asking whether it was

the cause of her fatigue.”). The defendants in Godfrey went

further and completely ignored evidence of fibromyalgia

submitted to them by the claimant. See Godfrey, 89 F.3d at 759

(“[T]he only rational explanation for the failure of the defendant’s physicians to follow up on evidence which they did

have and to ignore the effects of the medications that the

plaintiff was taking is that they knew that in fact the plaintiff

was disabled and following up leads and considering the effect

of the medications would only confirm what any reasonable

doctor would have already known.”). Here, the MRC considered all the evidence and determined that it did not rise to

the level of disability given the statements of Drs. Winny and

Keane that Speciale could work with certain restrictions.

opposite: she believed that Speciale could work despite her

condition, so long as travel was not required. In other

words, the symptoms Speciale wanted the MRC to weigh

more heavily, in both its general review of her record and

the vocational analyses, are not specified anywhere as

restrictions by her physicians.5

 The MRC’s denial letter

demonstrates that the committee considered all of her

symptoms but did not find them to be totally disabling

in light of the absence of a physician’s report stating

unequivocally that those symptoms resulted in her total

disability.
No. 07-1207 15

Speciale also mentions in passing that the MRC failed to

consider the disability ruling and award of benefits by

the Social Security Administration. However, as

Speciale’s counsel admitted in her June 2004 letter to the

NEBC, the judgment was not sent to the Association

until October 23, 2002—five months after the MRC rendered its decision on Speciale’s appeal. Further, the

Program’s documents make clear that “entitlement to

benefits under the Program shall not be dependent upon

entitlement to [Social Security] benefits.” See Tegtmeier, 390

F.3d at 1046-47 (noting that Social Security decisions “are

instructive” but not “dispositive” and that a plan’s decision “not to reopen the claims process is completely

proper, given [the plan’s] concern for finality of decisions”).

Given the highly deferential standard of review and the

thorough review of the evidence upon which the MRC

based its decision, we cannot say that the committee’s

action was “downright unreasonable.” Our review, and

that of the district court, is limited to the reasons given

by the plan administrator and does not extend to

reweighing evidence. The MRC reasonably disregarded

the tentative findings of Dr. O’Shaughnessy and

Dr. Snydersmith that Speciale was disabled due to MS

because it was ruled out after the negative lumbar puncture. The only evidence of Speciale’s functional capabilities provided to the MRC consisted of the questionnaires

completed by Drs. Winny and Keane and Dr. Blonsky’s

reports. The committee was therefore faced with the

conflict between Dr. Winny’s questionnaire and Dr.

Keane’s belief that Speciale could work, along with

Dr. Winny’s later statement that Speciale could attempt a

position that did not require travel. As stated in the
16 No. 07-1207

initial letter of denial, the MRC chose to give weight to

Dr. Keane’s report because of his expertise in pain management and because “his opinion was specific, and

quantified.” This makes sense, particularly in light of the

apparent contradiction between Dr. Winny’s questionnaire and her statement to Dr. Blonsky.

Moreover, Speciale never produced any objective evidence that her pain caused any functional limitation. Dr.

Blonsky and Nurse Grant were entitled to consider the

subjective nature of Speciale’s complaints when deciding

if she was disabled, and those symptoms, standing

alone, were not enough to rise to the level of total disability. See Ruiz, 400 F.3d at 992 (noting that “the primary

evidence supporting Ruiz’s claim that he cannot perform any work for which he is trained was his own subjective complaints of pain” and finding such evidence

insufficient to render the administrator’s denial unreasonable).

In short, the justifications given by the MRC for its

decision—although certainly not indisputable—are reasonable, which is all that is required. See Davis, 444 F.3d at 576-

77 (“The judicial task here is not to determine if the administrator’s decision is correct, but only if it is reasonable.”);

Sisto, 429 F.3d at 701 (“Raising debatable points does not

entitle [the claimant] to a reversal under the arbitrary-andcapricious standard.”). Because the record contains rational

support for the MRC’s assessment, we will not disturb

its decision to deny Speciale’s claim for disability benefits. Accordingly, the judgment of the district court is

REVERSED, and the case is REMANDED with instructions to

enter judgment in favor of Blue Cross and the Program.

8-7-08