NOT RECOMMENDED FOR PUBLICATION

File Name: 16a0495n.06

No. 16-3043

UNITED STATES COURT OF APPEALS

FOR THE SIXTH CIRCUIT

CHRISTINA SAUNDERS, 

Plaintiff-Appellant,

v.

PROCTER & GAMBLE HEALTH AND LONGTERM DISABILITY BENEFIT PLAN,

Defendant-Appellee.

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ON APPEAL FROM THE 

UNITED STATES DISTRICT 

COURT FOR THE 

SOUTHERN DISTRICT OF 

OHIO

BEFORE: BATCHELDER and KETHLEDGE, Circuit Judges; LEVY, District Judge*

ALICE M. BATCHELDER, Circuit Judge. Former Procter & Gamble (P&G) 

employee Christina Saunders has an unexplained chronic pain condition. From April 2012 until 

July 2013, Saunders received disability benefits from the P&G Health and Long-Term Disability 

Benefit Plan (the Plan) for a claimed “total disability.” But when the Plan switched third-party 

administrators, the new administrator concluded that Saunders had not furnished objective 

medical evidence establishing her disability. Accordingly, it terminated her payments. Saunders 

lost her administrative appeal and at summary judgment below. We AFFIRM.

I. FACTS AND PROCEDURAL HISTORY

Saunders’s health problems began in April 2012, when she underwent surgery for a 

ruptured ectopic pregnancy. Although her surgeon originally scheduled her to return to work on 

 

*The Honorable Judith E. Levy, United States District Judge for the Eastern District of Michigan, sitting by 

designation. 
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April 30, 2012, Saunders began experiencing additional, unexplained pain and did not go back to 

work. She sought a diagnosis and effective treatment for over a year, to no avail. No doctor 

officially extended Saunders’s work restrictions, but the Plan’s third-party administrator, Reed 

Group, continually approved her disability benefits.

In July 2013, the Plan switched third-party administrators to GENEX Services, Inc. 

GENEX contacted Saunders’s doctors to confirm her eligibility for benefits. On August 1, 2013, 

Dr. Scott Long, a physical therapist who treated Saunders from June 2012 through July 2013, 

indicated that there were no medical restrictions on Saunders’s ability to work “at this time.”1

Subsequent follow-up with Saunders and with her other doctors’ offices failed to reveal 

any work restrictions on file. Without a doctor’s note stating that Saunders could not work, the 

GENEX case manager recommended terminating Saunders’s disability benefits.

The Plan sent Saunders a letter, dated September 17, 2013, informing her that her 

benefits were terminated effective July 20, 2013. The letter detailed GENEX’s failed attempts to 

obtain from Saunders’s physicians “objective medical documentation” that Saunders was 

“unable to work.” From this the Plan concluded that “there is insufficient objective medical 

information to support your claim for disability as defined by the Plan.” The letter included the 

Plan’s definition of total disability, stated the requirement that Saunders “furnish . . . additional 

objective medical records, clinical notes or testing results to indicate that [she was] disabled as 

 

1

In this same response, Dr. Long erroneously stated that Saunders was “[c]urrently working.” This error, 

Saunders suggests, indicates that Dr. Long must have gotten her records confused with another patient’s. 

Appellant’s Br. at 41. However, Saunders herself submitted records from a July 2013 visit with Dr. Long in which 

Dr. Long noted that Saunders “[w]orks as a PR manager.” Dr. Long may have been mistaken about Saunders’s 

work status, but this is enough to refute Saunders’s speculation that he was referring to someone else.
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defined by the Plan,” and outlined her right to appeal the decision to the Plan’s Board of 

Trustees.2

Saunders appealed pro se. She stated that “[t]he information from Dr. Long was 

inconsistent with the restrictions imposed by [her] treating physician, Dr. Kelly,” who 

“specifically state[d]” that Saunders was “unable to work.” Saunders attached the records from 

her recent visits with Dr. Kelly, as well as records from a psychiatrist (Dr. Kelso), her 

acupuncturist, and Dr. Long. 

These new records contained evidence of pain, but little to indicate how that pain restricts 

Saunders’s abilities. For example, Dr. Kelly—who saw Saunders in August, October, and 

November 2013—diagnosed Saunders with “[a]typical pain syndrome, of uncertain etiology,”

based on “tender[ness] to light/medium touch throughout the right hemithorax.” He concluded 

that “because of the severity of her pain, and relative refractoriness to treatment, . . . she is 

unable to remain mentally focused enough to perform any form of work activities.” But Dr. 

Kelly’s examination revealed that Saunders’s “[m]entation [was] clear,” and she had “[g]ood 

recent and remote recall” with “[n]ormal affect.” Her muscle tone and gait were normal. Dr. 

Kelly also noted that Saunders was “able to take care of” her two-year-old child. 

Similarly, Dr. Kelso’s intake exam in September 2013 was unremarkable, although

Saunders’s thought process was “[n]ormal but pr[e]occupied with her experience of pain.” At a 

subsequent visit, Dr. Kelso indicated that Saunders appeared “[a]nxious and exhibit[ed] pain 

behaviors such as wincing and moaning.” Saunders’s acupuncturist stated that Saunders’s “pain 

level is so extreme that it is hazardous to her physical function and mental-emotional being.” 

 

2 Contrary to Saunders’s assertions, therefore, this letter did inform Saunders what type of objective 

evidence was necessary to support her claim.
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Records from her visits with Dr. Long added nothing to these pain assessments, nor did they 

indicate a consistent diagnosis. For example, in June 2013 Dr. Long diagnosed Saunders with 

myalgia, myositis, and chronic pain disorder, stating, “I do not see objective data to support a 

diagnosis of CRPS (complex regional pain syndrome).” But less than a month later, his 

diagnosis had changed to complex regional pain syndrome. None of these records indicated any 

physical restrictions on Saunders’s activities. 

Before the Board decided Saunders’s appeal, GENEX sought an opinion from 

independent reviewer Dr. Philip Marion. Dr. Marion acknowledged the lack of “specific clinical 

documentation that [Saunders’s] condition ha[d] changed,” but he nonetheless concluded that 

“there is not objective medical information documented to substantiate an inability to work in 

any capacity, including sedentary, at P&G or with another employer.” The Board subsequently

denied Saunders’s appeal on January 22, 2014.

Saunders then sued the Plan in federal district court, bringing a single claim for benefits 

under ERISA. See 29 U.S.C. § 1132(a). The parties filed cross-motions for judgment as a 

matter of law on the administrative record. The district court granted the Plan’s motion and 

denied Saunders’s motion. Saunders then filed this appeal.

II. ANALYSIS

We review the Board’s decision using the same standard of review as the district court 

was required to use. Whitaker v. Hartford Life & Accidental Ins. Co., 404 F.3d 947, 949 (6th 

Cir. 2005). Here, the parties dispute whether the district court should have reviewed the Board’s 

decision for abuse of discretion or de novo. We need not resolve that debate because, even under 

de novo review, Saunders did not meet her burden of presenting objective evidence to support a 
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finding that she is disabled within the terms of the Plan. See Javery v. Lucent Techs., Inc. Long 

Term Disability Plan for Mgmt. or LBA Emps., 741 F.3d 686, 700 (6th Cir. 2014) (“To succeed 

in [a] claim for disability benefits under ERISA, Plaintiff must prove by a preponderance of the 

evidence that he was ‘disabled,’ as that term is defined in the Plan.”).

The Plan defines “total disability” as 

a mental or physical condition resulting from an illness or injury which is 

generally considered totally disabling by the medical profession and for which the

Participant is receiving regular recognized treatment by a qualified medical 

professional. Usually, total disability involves a condition of such severity as to 

require care in a hospital or restriction to the immediate confines of the home.

In her briefing, Saunders does not directly argue that she is disabled according to this definition. 

She identifies her condition as “complex regional pain syndrome,” but does not specifically 

explain how this condition disables her. For example, she does not dispute her ability to drive or 

perform other activities of daily living.3 See Appellant’s Br. at 44. Saunders does cite several 

forms of objective evidence to support her diagnosis: (1) the results of “several objective tests” 

that “demonstrated a physical disorder”; (2) her doctors’ findings regarding her pain; (3) the 

medications she was prescribed; and (4) her doctors’ multiple referrals to neurologists and pain 

specialists. Id. at 39–40. Otherwise, her arguments merely attack the Board’s reasoning rather

than its ultimate decision.

Accepting that Saunders suffers from unexplained, severe, and constant pain, we still 

must assess whether Saunders has submitted objective evidence that she is disabled as defined by 

the Plan. In other words, her objective evidence must show that her pain is “considered totally 

disabling” and that she “is receiving regular recognized treatment” for it. Since Saunders’s pain 

 

3

In contrast to the Plan’s definition of total disability, the Plan defines “partial disability” to include 

impairments that do not prevent a person “from performing useful tasks, utilizing public or private transportation, or 

taking part in social or business activities outside the home.” Saunders’s claim has always been for total disability.
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admittedly does not restrict her to her home environment, her task of demonstrating total 

disability is that much harder. Notably, the Plan does not define “total disability” according to 

whether Saunders can perform her job.

The primary evidence supporting Saunders’s claim that she is totally disabled is Dr. 

Kelly’s assessment that she is unable to focus enough to work. Saunders also presents plenty of 

evidence that she has a chronic pain condition. But nothing in the record indicates that this pain 

condition restricts her daily activities, and several of her treating physicians have specifically 

indicated that Saunders can work. Dr. Kelly’s lone opinion that Saunders cannot work does not 

establish her disability in light of the other evidence in the administrative record.

Most prominent in the Board’s decision is Dr. Long’s statement on August 1, 2013, that 

Saunders had work capacity and no medical restrictions. But Dr. Long is hardly alone in his 

assessment. Nine months prior, Saunders’s then-treating physician, Dr. Katheryn Jadeed, stated, 

“[G]iven the available info, I do not have any work restrictions for her, now or in the past . . . .” 

And around the same time Dr. Jason Heil, a neurologist, indicated that he was “probably not the 

best person to be filling out disability papers” since he could not identify “a clear neurological 

cause for her pain.”4

Saunders has no objective evidence with which to counter these opinions. For example, 

she presents no evidence of any physical restrictions, such as on the length of time she may sit or 

stand, or on the amount of weight she may lift. See, e.g., Koning v. United of Omaha Life Ins. 

 

4

Saunders criticizes the Plan’s reference to Dr. Jadeed’s and Dr. Heil’s statements, arguing that they are 

irrelevant because the Board did not rely on them and because they were made several months before the time frame 

at issue in this case. Reply Br. at 3–4. Yet on a de novo review, we consider all evidence in the administrative 

record without deference to the Board’s decision. Wilkins v. Baptist Healthcare Sys., Inc., 150 F.3d 609, 616 (6th 

Cir. 1998) (“When conducting a de novo review, the district court must take a ‘fresh look’ at the administrative 

record . . . .”). And given Saunders’s adamancy that her condition has not changed, her insistence that earlier 

assessments are irrelevant rings hollow. 
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Co., 627 F. App’x 425, 434 (6th Cir. 2015) (finding a claimant disabled who was “unable to sit, 

stand and/or bend for any significant period of time,” had restricted range of motion, chronic 

headaches, and other physical incapacities). Nor is Saunders taking any medications with 

debilitating side effects. See, e.g., Godmar v. Hewlett-Packard Co., 631 F. App’x 397, 407 (6th 

Cir. 2015) (holding that a denial of benefits was arbitrary and capricious because, among other 

reasons, the plaintiff’s prescription pain medications prevented him from driving, a requirement 

of his job). Overall, the record does not support a finding that Saunders’s pain condition renders 

her totally disabled.

The record accordingly supports Dr. Marion’s conclusion that, “from a physical medicine 

and rehabilitation/pain management perspective, there remains no specific medical information 

to substantiate [Saunders’s] inability to work with or without restrictions from [July 20, 2013,]

through [the] present.” Dr. Marion emphasized Saunders’s “consistently normal” 

musculoskeletal and neurological examinations. He contrasted Dr. Kelly’s opinion that Saunders 

“is unable to remain mentally focused enough to” work with Dr. Long’s conclusion that she can. 

He also noted that Dr. Kelly undermined his own opinion with the results of his physical 

examination: “Mentation clear. Good recent and remote recall. Normal affect.” That the Plan 

previously awarded benefits and her condition has not changed did not alter this conclusion.5

Saunders is therefore left with the argument that, because her condition has not changed, 

the Board erred in terminating her benefits after awarding them for over a year. But following 

Saunders’s logic, no disability plan would ever be able to terminate benefits that had erroneously 

been approved at some prior time. As Saunders stated, ironically, in her opening brief, “The best 

 

5

For the same reasons—because the records from Saunders’s own doctors supported Dr. Marion’s 

conclusion—the Board was not required to conduct an independent medical examination of Saunders.
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that can be said of [GENEX’s] review of Saunders’[s] claim is that Saunders was never disabled 

in the first place[.]” Appellant’s Br. at 37. Saunders actually did not present sufficient evidence 

to support an award of disability benefits for over a year before her benefits were terminated. 

The Plan was not required to continue paying out benefits to Saunders indefinitely without 

objective evidence to support her disability simply because a prior third-party administrator had 

done so and her non-disabling condition had not changed.

III. CONCLUSION

Because Saunders has not shown by a preponderance of the evidence that she is totally 

disabled as defined by the Plan, we AFFIRM the judgment of the district court.