T h e Honorable John R . Adams, United States District Judge f or the Nor

thern District of * Ohio sitti ng by

desig nation. Trac y ’s claim wa s handled by an insurance company hired by the Plan. While Prudential 1 I nsuranc e Company

of Amer ica wa s the orig inal disability case manage r, that re sponsibili ty was transfe rre d to Aetna L ife Insuranc e Company eff ective January

1, 2002. J A at 310. F ile Nam e: 06a0760n.06 F ile d: Oc to be r 12 , 2 00 6N OT REC OM M EN DE D F OR

F UL L- TEX T P UB LIC AT ION

No:05-2212 U N IT E D S T A T E S C O U R T O F A P P E A LS F O R T H E S IX T H C IR C U IT
J O EL T RACY , Plaintif f - Appellant On Appea l from the United States District Court for the Ea stern District of Michig an v. P HAR MAC I A & U PJ OHN A BS ENCE P AY ME NT P L AN , P RU D EN T I A L I

NS URANCE C O M PA N Y O F A M ERI CA , P HAR MAC I A AND U PJ OHN C OMPANY , P F I Z ER , I NC ., AND A ETNA L I F E I

NS URANCE C OMPANY Defendants - A

ppellees ______________________________/
BEFORE: K

ENNEDY, DAUG HTREY, Circuit Judges; and ADAM S, District Judge. * KENN EDY, Circuit Judge. Plaintiff J oel Tra cy appea ls the district court’s dec ision upholding the f

inding by

the Employ ee Re tirement Incom e S ecur ity Act (ERI SA) Plan Ad min istrator that Mr. Tr a c y is n ot e nti tle d to pe rm ane nt l on g -t e rm dis a bil ity pa y me nts . O n a

pp e a l, 1 Tr a c y argue s th a t he ha s d e mon str a te d th at he is u na ble to b e g a inf

ull y e mpl oy e d b e c a

us e of his2

disability . For

the reas o n s t h at foll ow, we AF F IRM the district court’s f inding that Tr acy

is not entitled to continued long -term disability pay m en t s u n der the terms of the Phar macia & Upjohn Absenc e Pay

ment Plan. BACK GR OUND On April 23, 1989, P laintiff J oel Tra cy (“Plaintiff” or “Tr acy”) w as hired by Pharmac ia & Upjohn (now Pfizer) ( “Upjohn”) as a pla nnin g manag er. Tr acy

eventua lly

beca me a Ma rket I ntellige nce PlanningManag er. A. Leave of Absence I n April of 1996, Trac y

reque sted leave under the Family and Medic al L eave Act (“ FML A”) for de pression and idiopathic hy persomnolenc e. He submitt ed a letter fr om Dr. Michae l Fusillo, a psy chiatrist, wh o fo u nd that Trac y was suff eringfrom depr ession and hy persomnia ( excessive d ay ti me s le e p in e s s an d

/o r p r o lo n g e d n ig h tt im e s le e p )
. D r . F u s il lo r e p o rte d th a t T r a c y h a d been treated for de pression and hy persomnia f

or a n u m b er of y ear s and he note d that Trac y had soug ht help from the University of Mi chig an S leep Disorder Center. Dr. Fusillo treated Tra cy with Rit alin, wh ic h e ve ntu a lly

los t it s e ff

e c t. H e the n tr e a te d Tr a c y wi th De xed ri ne , wh ic h a lso be g an to los e its eff ect. Dr
. Fusillo rec ommended that Trac y take a month’s leave of abse nce, dur ing w hich time Dr. Fusillo would try

alteringthe medica t i o n re gi me and Tr acy could try to develop a r eg ular slee p
sc he du le
. Dr . F us ill o r e c omm e nd e d th a t th is p e ri od be fo llo we d b y

a re tur n to wo rk a t a pa rt -t ime status: 20 hours a wee k with some acc ommodations for his sleep disability . Dr. F usillo ex plained, “That is, if he coul d h av e ac ce s s t o a bed so that he could nap, he then would be a ble to plan a schedule with sleep and w ork.” J.A. at 146. He wrote f urther, “ Of sig nificanc e is the fa ct that work3

that bo re s h im t e nd s to c on tr ibute to t he hy pe rs omn ia

and wo rk that he fi nd s sti mul a tin g , te nd s to help it.” Id. at 147. Dale Peerbolte, a phy sician at Upjohn, revie wed Dr. Fusillo’s letter and appr o v ed T ra cy ’s FMLA ce rtification. Trac y took me dical leave from Apr il 17, 1996 to May 17, 1996, followed by intermittent leave throug h J une 1, 1996. B. I niti al D isa bil ity Determin ation Tr a c y re tur ne d to wo rk

in Jun e , b ut h e wa s una

ble to w or

k f or mor e tha n 20 to 30 ho urs a
wee k. On Novembe r 19, 1996, Tra cy left his job at Upjohn and re quested disability status. Under the Pharmac ia & Upjohn Absenc e Pay ment Plan (“Plan”) a par

ticipant is entitled to ini tial long- term disability (“L TD”) benef

its if he is “perma

nently unable to be g ainfully

employ ed at Upjohn .” J.A. at 428 (e mphasis added)
. Whil e Upjohn re viewed his disability status, Trac y proposed that he could continue wor king
a s a pla nn ingmana g e r i f t

he c omp any pr ov ide d him with ce rt a in a c c omm od a tio ns inc lud ing : a ho me office or fa cilities at work to allow rest when he g ets tired, fle x ible hours, and se cre tarial or te chnica l
su pp or t. Tr a c y ’s su

pe rv iso r fo un d tha t Tra c y wa s limit e d to 20 ho ur s o f w or k a we e k a nd , b e c a us e the po sit ion

wa s a fu ll- tim e po sit ion , T ra c y wa s in c a pa ble of pe rf or min g his job be c aus e of hi s impairment. J .A. at 691. On De cembe r 13, 1996, the Disability Re v i ew Commi ttee dete rmined Trac y met the standar d for a

n initial term of disability benef its through De cembe r 31, 1999. Whil e re ceivinginitial L TD bene fits, on J anuar y 22, 1999, Trac y

consulted with Dr. Richa rd Munson of the S leep Disorders C enter at Evanston Hospital. Dr. Munson complete d an attending ph y sic ia n’ s r e p o rtan d

a t t a c h e d a l e t t e r , w h i c h s t a t e d

t h a t“ [i ]n

o r d e r t o i mp r o v e h i s d a y

t i me fu nc tio nin g , a

nd to p re ve nt p os sib le inj ur

y du e to fa lli ng a sle e p w hil e dr ivi ng , h e sh ou ld m a int a in4

a re g ula r w or k- sle e p s c he du le . T his sh ou ld i nclud e a c on sis te nt s tart ingand e nd ingtim e to h is workda y , as we ll as a normal e ight- hour shift without overtime.” J.A. at 190. T r a c y d i d i n f a c tw o r k d u r i n g t h e f

i r s tt h r e e y e ar s h e w a s o nd i s a b i l i t y l e a v e w i t h U p

j o h n . It appea rs from the repor

t of a Dr. Richard Hurlburt, Ph.D., ( dated 4/1/00) and other doc uments in the
rec ord (J.A. at 233, 386), that Tra cy worke d at Sear le as Mar

keting Resear ch Mana g er for one y ear during 1998-1999 and that he notified S ear le t hat he was on disability . Trac y stated in a re sume he
su bmi tte d to S earl e that, p ri or to S e arl e , h e wo rk e d f

ro m 19 97 -1 99 8 at We stw oo d Sq uib a s a manag er. H e also told the cla im investigator that he was e ventually let g o by Searle beca

use he ha d been w orking an ave rag e of e leven hour s a day and it did not have an e ight- hour position. J .A. at 386. No other infor

mation is available in the re cord co n ce rn i n g either of these jobs. Ther e is no oth e r i nf or ma tio n a bo ut j ob a tte mpt s. C. Perm anent Disabi lity Determi nation B y N o v e mb e r

1 9 , 1 9 9 9 , P r

u d e n t i a l In s u r an c e C o mp an y ( “ P r u d e n t i a l ” ) h a d

c o n t a c t e d

T r a c y, ide nti fi e d it se lf

a s a c la ims se rv ic e pr ov ide r, and in fo rm e d h im that hi s c on tin ue d e lig ibi lity

to
re c e ive dis a

bil ity pa y me nts wo uld be e va luate d. Af te r t he ini tia l th re e -y e ar t e rm

of L TD be ne fi ts, Tr a c y ’ s e l i g i b i l i t y t o r e c e i v e c o n t i n u e d L T D b e n e f i t s w a s g o v e r

n e d b y a d i f

f e r e n t s t an d a rd : a participa nt must now be “unable to be g ainfully employ ed

an y whe re .” J.A. at 428 (emphasis adde d). This determination is “base d on the exist ence or non-existence of a qualifying disability and will not depend on the availability of ac tual employ

ment.” J.A. at 428. Pr ud e nti a l c on sid e re d th e inf or ma tio n th a t T ra c y

su bmi tte d a nd oth e r i nf or ma tio n in his fi le
and no tif ie d h im o n Jan

ua ry 11 , 2 00 0, that he wa s not e lig ibl e to r e c e ive c on tin ue d d isa bil ity be ne fi ts
un de r t he Plan. Th e le tte r n ote d th e dif fe re nce i n the s tand ard

fo r i nit ia l L TD be ne fi ts l imi te d to5

three y ear s, which he ha d been r ece iving, a nd continuing L TD benefits he was now claiming and that Tr a c y c ou ld no t sh ow he wa s “ un a ble to pe rf

or m any wo rk any wh e re .” J.A. a t 20 1. Pr

ud e nti a l di d extend his benefits throug h Fe bruar y 29, 2000, and off

ere d him job placement assistanc e. Trac y met with B arba

ra L emke, a vocational c onsultant with P rudential, in F ebrua ry 2000 for
a vocational evaluation. She advised Tr acy that by using his “c urre nt skill s, abilities, and education” he could be employ able in the field of marke t r esea rch consulting. J .A. at 2 0 9
. T ra cy i nformed L emke that he had been “working the s tock marke t at home” since his termination from his last job in M ay 19 99 . J.A . at 21 9. He a sk e d th a t he be g ra nte d $ 3, 00 0 to $5 ,0 00 to p ay fo r a c la ss i n investment training and he e x presse d confide nce that he could support himself by day trading from his home. He ex plained that at hom e he could work eig ht hours a day and take naps whe n require d. Prudential denied his re quest for r etra ining be nefits, finding that he wa s employ able without furthe r retra ining. J.A. at 209. On Fe bruar

y 24, L emke mailed T rac y a letter indicating that she had le ft him sever al phone messag es that had not be en re turned. She a lso indicated that she was still available to provide job place ment assistance if he wa s interested. A we ek afte r mailing the letter, a nd with authorization from Prudential, L emke c losed Tra cy ’s file. On Fe bruar

y 25, 2000, Trac y

appe al ed t h e denia l of continued L TD bene fits to the Administrative Commi ttee of th e P h ar m acia Plan. He ar g ued that Dr . Munson’s letter wa s not intended to support a disability deter mination. He enc ourag ed the Committee to disreg ard that letter
as it wa s intended for Trac y to g ive to pote ntial e mploy ers and did not mention the naps that Trac y
ne e de d e a c h d ay . F ur

the r, he c on te nd e d th a t th e le tte r w a s a “ bo ile r plate ” state me nt n ot s pe c if ic toWhil e pla int if f a sse rt s th a t D r. Muns on ’s le tte r of Janu ary 22 , 19 99 (J.A
. a t 17 4) wa s to he lp 2 him se c ur e e mpl oy

me nt, Tr a c y ’s le tte r t o D r. Muns on that re su lte d in

the le tte r s ou g ht t o h a ve him complete a

form for the per manent bene fits he see ks here and was written after his employ ment at Wes tw oo d Sq

uib a nd Se arl e we re ob ta ine d. Th e re is n o e vid e nc e in the re c or d o f a ny e ff or t to ob ta in employ ment afte r that date. Trac y ’s letter a lso mentions that he is movi ng to Wi sconsin. The for m completed by

Dr. Munson shows he w as the attending phy sician in 1998-1999 and prescr ibed the m ed i ca t i o n s T ra cy

wa s t ak i n g. 6 him. Trac y also submitt ed test results from April 1, 2000 from Dr . Hurlbut, a psy cholog ist (as noted 2 above) . Dr. Hur lbut concluded that Tr acy suffe red f

rom schizoaffe ctive disorder with a nx iety and depre ssion and probable somatiz ation (numerous phy sical sy mptoms over many

y ear s which ca

nnot be fully explained by

medical diag noses), idiopathic hy persomnolenc e, and a

rthritis in his feet and
c he st. Dr . Hur lbut indi c a te d tha t Tra c y ne e de d two na ps a da y of a pp ro xima te ly

45 min ute s in le ng th
and that he wo ke up un a

ble to m ov e a

pp ro xima te ly

15 to 2 0 ti me s p e r y e ar. Dr . H ur lbut’ s r e po rt did not express a conc lusion on Tracy ’s ability to work. I n support of his appea l, Trac y also submitted responses b y Dr. B ahri Gung or, M.D., a neurolog ist, to a questionnaire reg ardinghis ability to work (dated 9/26/01). Dr. Gung or explained that “[i] n g ener al, [Tracy ] t akes two na ps a day . The fir st one up to one hour in the morning betwee n 11 a.m. and 1 p.m. H e take s the second na p betwee n 3 p.m. and 6 p.m. This lasts for two hours.” J .A. at 266. He also stated that Trac y ’s reaching , handling , fing ering , fee ling, a nd pushing/pulling
wer e af fec ted by his impairment as he suff ers f rom “narcolepsy

and catalepsy .” J.A. at 266. Dr. Gung or circ led “no” in response to whe ther Tr acy can “ work in a sustained work setting, e ight hour s per day , forty hours per wee k.” J .A. at 271. In response to written follow up questions from Tra cy ’s attorney , Dr. Gung or wrote that Trac y was limit ed to w alking or sitti ng two hours eac h day , slept 12 to 14 hours daily , and would nee d acc ommodations for up to four hours per day for his naps. J .A. at 276-277.Trac y stated in his Brie f in Response to Defenda nt’s Motion to Affir

m the Administrator’s 3 Dec ision, submi tted to the district court below, that Dr. Gungor was an examiner appointed by the SSA . JA at 77 1. Why

the AL J wou ld the n r e fe r t o D r. Gung or a s a “ tr e a tin g sp e c ia lis t” is unexpl a in e d
. Re g a

r d le s s , his admission further supports our c onclusion that Dr. Gung or’s re port was no t e nti tle d to any

de fe re nc e a s a

tr e a tin g ph y sic ian’ s. We note that in the SSA procee ding, the burden was o n t h e gover nment to prove Tr acy ’s 4 a b i l i t y t o w o r

k
. In t h i s c a s e , a s w e h a v e p r e v i o u s l y n o t e d , t h e b u r d e ns h i f t s t o T r a c y. 7 The opinion of the Ad

mi n is tr a ti v e L a w Ju d g e ( A SA ) in Tra cy ’s Social Secur ity Administration (SSA) proce eding (discussed inf ra ) d e sc ri be s D r. Gung or , in pa ssi ng and wi tho ut e xplanatio n, a s a “tre ating specia list.” J .A. at 303. Howe ver, ne ither of the doc uments from Dr. G ung or i n the re cord, J .A. at 265, et seq ., indicate his status t h em s elves. P laintiff counse l’s corr espondenc e with Dr. Gung or indicate s only an examining, and not ongoing , relationship. For example, plaintiff’s counse l

r e q u e s te d that Dr. Gung or cla rify his conclusions based on Tr acy ’s medica l rec ords and Dr . Gung or’s examination. C ounsel did not, nor did Dr. G u n gor in his responses, make any ref ere nce to or
rec ommendations of treatment. The questions and re sponses do not ref ere nce a ny ong oing
re la tio ns hip . N o oth e r e xami natio n wa s re fe re nc e d, no r any c ha ng e in c on dit ion no te d. F ro m th is 3 limit ed re cord w e ca

nnot determine t hat Dr. G ung or wa s a trea ting spe cialist and not mere ly an examining one. D. Social Security Benefits Appl ication Tr a c y a pp lie d f or Soc ia l Se c ur ity

Di sa bil ity B e ne fi ts a

nd on Marc h 5 , 2 00 2, the Soc ia l Se c ur ity Administration (“SSA”), base d on Dr. Gung or’s repor t, de termined that Trac y had been totally and perma nently disabled due to his depre ssion and hy persomnia since Marc h 31, 1999 (Tra cy applied fo r the se be ne fi ts i n D e c e mbe r 1 99 9)
. J.A. a t 28 5. On his a pp lic a tio n f

or Soc ia l Se c ur ity

be ne fi ts, 4 he indicate d that he wa s day trading stocks 4-5 hours ever y day
. Howeve r, he a lso indicated to a Dr
.8

O’ Ma lle y (r e po rt 4/1 4/ 2000 , J.A . 3 73 ) t

hat he wa s tr a din g 6- 8 h ours a da ily . Wh e the r h is e ff

or ts in the s toc k

ma r k e t w e r e p r o f

it a b le is u n kn o w n . J. A
. a t 3 8 5 ( s u mm ar y o f T r a c y ’ s f il e , in c luding interviews with Tra cy

). The r ecor d is silent as to whether plaintiff submitted Dr. M unson’s letter to the AL J . No re fer ence to it is made in the AL J ’s opinion. E. P ro c e dural H

ist or y in the Di stric t Co urt The Administrative Committee - U.S. Plans af fi rmed Prudential’ s decision in a letter dated Marc h 10, 2 0 0 3 , fi n ding T rac y had not met the def

inition for continued L TD bene fits as he wa s capa ble of wor

king w ith certa in restrictions. J .A. at 389. I t also noted that he ha d been da y -trading up to 6-8 hours a da

y and had pr eviously

indicated a

n ability to w ork fr om home with flexi ble hours
and se c re tari a l/t e c hn ic a l su

pp or t. On Aug ust 10, 2004, Trac y filed his c omplaint in this action in the United States District Court for the E astern D istrict of Michig an ag ainst the P lan, Pharmac ia & Upjohn, Pfiz er, Prude ntial, and Aetna L ife Insuranc e Company (“D efe ndants”) seeking continued pay ment of L TD bene fits. The parties f iled cross-motions for judg ment on the administrative re cord, w hich wer e refe rr ed t o a mag istrate judg e. The mag istrate judg e’s r eport filed June 6, 2005, rec ommended that Tra cy ’s motion should be denied and the Def endants’ g rante d. On J une 30, 2005, the district court issued an Or der A dopting the Re port and Rec ommendation of the Mag istrate Judge, g ranting the De fe nd ants ’ m oti on , a

nd dis mis sin g the c a se . T ra c y fi le d th is t ime ly

a pp e a l. STA ND AR

D O F RE VI EW Th e pa rt ie s a g re e that, d e sp ite c e rt a in langua g e in t he pla n, bo th t he dis tr ic t c ourt

and thi s court re view de novo T rac y ’s elig ibilit y for be nefits and c onstruction of the ter ms of the plan. AN AL YSI S9

We beg in with the relevant st andar ds set forth in the P lan t hat are at iss ue in this case. A s discussed, initial L TD bene fit determinations ar e base d on: [T] he exis tence or non-existence of a qualifying disability and will not depend on the availability

of ac tual employ

ment at Upjohn or elsew here (i.e., a n employ ee w ill not have a qu ali fy ingdis a

bil ity if ph y sic a lly

and me nta lly a ble to p e rf

or m in his c us tom ary

or re a so na ble su bs tit ute e mpl oy

me nt a t Upjo hn e ve n if the re are c ur

re ntl y no opening s for him in such employ ment at Upjohn).
J .A. at 428. In other wor ds, an employ ee must establish he is unable to work at Upjohn. Pl aintiff argues not only

that he met this standard, but also that Def endants admit t hat he met this standar d. I n order to be elig ible for c ontinuing L TD bene fits, the standard is heig htened, a nd the employ ee
mu s t b e “ u n a

b le to be g a i n

f ully employe d anywhere. ” J.A. at 429 (emphasis adde d). Ag ain, the burden of proof is on the e mploy ee. Tr a c y argue s th a t, a s a

pp lie d to him , the “ dif

fe re nc e be tw e e n the tw o Pl an s tand ard s in t his

c as e is n e g lig ib le. ” App ell ant B r. a t 25 (e mph a sis a dd e d) . T his is f or tw o r e a so ns . F ir st, Def endants c oncede that Trac y could not perf

orm his sedentar

y job with reg ular hours a s a marke t
rese arc her at Upjohn. Trac y points out that this was not, for example, a construc tion job where the differ ence betwee n the phy sical dema nds of his pr evious occupation a nd a job “a

ny wher e” is star

k. Mo re ov e r, Tr a c y

no te s th a t Upjo hn is “o ne of the larg e st c or po ratio ns in t

he wo rl d, wh ic h b oa sts a diverse w orkfor ce in virtua lly ever y rang e of e mploy

ment.” Appe llant Br. at 25. Secondly , Trac y points to t he fa ct that the voca tional consultant at Upjohn enc ourag ed him to b ecome a mar ket
rese arc her, e x actly

the ty pe of job Upjohn told him he was inca pable of doing a t Upjohn. Trac y misreads the Plan. As Def endants note in their brief, the Summary Plan Descr iption (“ SPD ” ) d ist inguis he s th e tw o s tand ard s a s f oll ow s:As previously mentioned, the Plan s tates t hat “[ b]enefit deter minations will be based on the 5 exis tence or non-e x istence of a qualify ing disa bility and will not depend on the ava ilability of ac tual e mpl oy me nt a t Upjo hn or e lse wh e re (i .e . a

n e mpl oy e e wi ll n ot h a ve a qu a lif iyingdis a bil ity if ph y sic a lly

and me nta lly a ble to p e rf

or m in his customary or reasonable substitute employme nt at Upjo h n... ), ” J.A. a t 42 8, wh ic h q uit e re a so na

bly le a ds to t he inf e re nc e that th e ph ra se , “ g a inf ull y employ ed at Upjohn” ref

ers to “c ustomary

or re asonable substitut e employ ment” at Upjohn. 10 - Due to health re asons, the employ ee is unable to perf orm their customary

work at [ Up j o h n ] , an d

t h er e i s n o re as o n ab l e e x p ec t at i o nt h at t h e s i tu at i o nwi l l ch an ge (improve)
. - Due to health re as o n s , the employ ee is pe rmane ntly unable to per form any

work any wher e. J .A. at 667. This inter

pretation is consistent with the lang uag e in the Plan itself. T h erefore , 5 inability to work at Upjohn incorpora tes an inabili ty to perf

orm only customary

or re asonably

simil ar work duties, wherea s the i nability to work any wher e requires a disability that preve nts any

ty pe of
wo rk in a ny pla c e . T he dif

fe re nc e be tw e e n th e se tw o s tand ard s is sig nif ic ant. A. Proper Weight to B e Give n to th e SSA Decision As a pr e lim ina

ry ma tte r w e mus t de te rm ine the pr op e r a mou nt o f w e ig ht, if

any , to g ive to the SSA ’s fi nd ingtha

t T ra c y is dis a

ble d. At the ou tse t, w e no te that th e SPD state s th a t, “[d] eter minations made by

the [S SA] , [etc.] are not rele vant to de termining a disability under [the P l an ]
. ” J
. A
. a t6 6 7
. N e v e rt h e l e s s , T r a c y r e c e i v e d a f u l l y f a v o r a b l e N o t i c e o f D e c i s i o n o f t h e A LJ
as a result of the evidentiar y hear ing held to de termine Trac y ’s disability status unde r t h e S ocial Se c ur ity ru le s, J.A. at 298- 30 6, and he c on te nd s th a t th a t de c isi on sh ou ld n ot b e ig no re d b e c a us e there was a

n evidentiar

y basis for the A L J ’s conc lusion, ther e is no c ontradictory evidenc e, and the evidentiar y hear ing r epre sents the only independe nt evaluation of the evidenc e in this case.11

De fe nd ants po int

ou t th a t th e sta

ndards fo r q

ua lif y ingfo r S SA d isa

bil ity and fo r b e ne fi ts
un de r Up john’ s pla n d if fe r. De fe nd ants c la im that un de r t he “ tr e a tin g ph y sic ian r

ule ,” the AL J must
a c c or d spe c ia l we ig ht to the tr e a tin g ph y sic ian. De fe nd ants argue that nei the r c on c lus ion a t th e SSA hear ing ( that Trac y

is d i s abled a

nd that jobs did not ex ist, which someone with his char acte ristics could per form) “ bear [s] upon th e P l an’s standard for disability ,” (D ef. B r. at 24) a s the Plan’s lang uag e re quires a f

inding that Trac y

cannot wor

k “any wher e” a nd the disability

standard r equire s that there is n ot a sig nificant number of jobs in the economy that he could pe rfor

m, Jones v

. Comm is sio ne r o

f So c ial Se c ur ity , 336 F.3d 469, 474 ( 6th Cir. 2003). We also reiterate that the burd e n o f p ro of

is d if fe re ntl y a llo c a te d. I n th e SSA pr oc e e din g , th e g ov e rnme nt was oblig a te d to sh owthat T ra c y

c ou ld w or

k, wh e re a s h e re , T ra c y

mus t pr ov e that he c ann ot. This c ircuit has previously addre ssed the weig ht to be g iven to a n SSA dec ision in Cal

v e rt v. Firstar Finance, Inc

. , 4 09 F .3 d 2 86 , 2 94 (6 th C ir . 2 00 5) . We re je c te d th e su g g e sti on

that an SSA deter mination is “meaning less,” but found that it is “not binding.” Id. at 295. We further stated: Whil e it i s tr

ue that th e SSA mus t a pp ly the ‘t re a tin g phy si cia n r

ule ’ i n it s deter minations, that rule provides that def ere nce i s t o be g iven to the opinions of treating phy sicians (over those of non-treating or re viewing phy sicians) whe re, and only where, there is obje ctive support for those opinions in the rec ord.... He nce, the SSA determination, t houg h cer tainly not binding, is far

from mea

ningle ss. As the Court said in Blac k

& De c k e r, a plan a dminist rator ma y not arbitrar ily

disreg ard the medical e vidence proff

ere d by the claimant, i n cludi ng the opinions of her tre ating phy sicians. Her e, the SSA deter mination, a t a m in im um , p ro v ides support for the conclusion that an administrative ag ency char g ed with examining Calver t’s medical rec ords found, a s it ex pressly said it did, objective support for Dr. H ester’ s opinion in t ho se re c or ds
. Cal v e rt , 409 F.3d at 294 (empha sis added) (citations om itted). Ther efor e, we ag ree that, despite the Plan lang uag e, the de cision of the AL J provides evidentiar y insight. Howeve r, in line with the Plan12

langua g e and

our e arl ie r d isc us sio n, we re vie w A L J con c lus ion s de novo. I n s um, wh ile the SSA de te rm inatio n is no t bi nd ing , s ome we ig ht i s to be g ive n to the SSA de te rm inatio n th a t T ra c y is disabled and una

ble to work. B. W hat Cons tit ute s G ain fu l Emplo

y ment
B e fo re ana ly

zingwh e the r T ra c y

is un abl e to be “ g a inf

ull y e mpl oy e d a

ny wh e re ,” we mus t deter mine what it means to be “ g ainfully employ ed” unde r the Plan. This circ uit has not y et def ined wh a t c on sti tut e s “ g a inf

ul e mpl oy

me nt, ” bu t th e El e ve nth C ir cui t add re sse d a sim ila r q ue sti on in Helms v . Monsanto, 728 F.2d 1416 (11 Cir. 1984). I n Helms , the disability plan at issue provide d th that in order to be elig i b l e fo r b en ef i ts an employ ee must be “ preve nted from e ng ag ing in any
oc c up ati on or

e mp loy me nt for r emuner ation or prof it.” He lm s, 728 F.2d at 1419 (emphasis adde d). The c ourt stated: Total disability

under this ty

pe of provision is not consider ed to exist if the insured can f ollow any remune rative occupation, whether in his prese nt vocation or a nother. The phra se should not b e g iven an a bsolute and literal inter

pretation. I t should not mean that the a ffe cted indivi dual m ust be utterly helpless to be conside red disable d. I t must be a relative term which me ans that the individual is u n able to eng ag e in a remune rative occupation or t o do work in some profitable e mploy ment or ente rprise. Permane nt disabilit y

is a question of fa ct that depe nds upon all the circ umstances of a par ticular c ase. Id. at 1420. The c ourt pointed out that it is d i ff i cu l t t o define the phra se “a ny occupation or employ ment for remunera

tion for employ

ment,” because a “person would almost neve r be de prived of the a bility to ear n a nominal sum unless he is rende red co m p l et el y i m m o bile and without any cog nitive ability .” Id. at 1420. The Helms court then dr ew f rom Social Security

disability provisions and pointed out that in that cont ex t re q uirements for disability

are “fr amed in ter

ms of gainful employm ent

and not just nominal employ ment.” Id. at 1421 (e mphasis added)
.13

I n th is c a se , th e Plan , like the Soc ia l Se c ur ity Ac t, d e fi ne s a

qu a lif y ingdis a bil ity a s a dis a bil ity that pr e ve nts “ g a inf

ul e mpl oy me nt. ” Thus , the re a so nin g fr om Helms is e sp e c ia lly us e fu l. The Helms c ourt

we nt o n to state that: Although the achie vements of disable d persons have bee n rema rkable , we will not a do pt a str ic t, lite ra l con str uc tio n o f s uc h a

pr ov isi on

wh ic h w ou ld d e ny

be ne fi ts t o the dis a ble d if he sh ou ld e ng a g e in s ome min ima l oc c up a tio n, su c h a s se lli ngpe anu ts or penc ils, which would y ield only a pit tance
. The insured is not to be dee med “a ble” mere ly beca use it is shown that he could per form some task. Id. a t 14 21 . T he c ourt

fo un d th a t to ba

r r e c ov e ry un de r the pr ov isi on a t iss ue (“ any oc c up a tio n” ) i n that case : [T]he e arn ing s p os sib le mus t a pp ro a c h the dig nit

y of a liv e lih oo d. [Th e pla int if f] i s re qu ir ed to sh ow phy sic a l in a bil ity to f oll owany oc c up a tio n f

ro m w hic h h e c ou ld ear n a re asonably

substantial income rising to the dignity of an income or livelihood, e v e nt h o u g h th e i n c o m e i s n o ta s m u c h a s h e e ar n e d b e f o r e t h e d i s a

b i l i t y. Id. at 1421-22. This circ uit has alrea dy ag ree d with the court in Helms “that the phr ase ‘ preve nted from eng ag ing in every business or occ upation’ ca nnot be construe d so narr owly that an individual must be utterly

helpless to be conside red disable d.’” VanderKlok v. Provident L ife and Acc . Ins. Co., Inc
. , 9 5 6 F. 2 d

6 1 0 , 6 1 4 -1 5 (6 C i r. 1 9 9 2 ) ( qu o t i n g Helms, 728 F

. 2d at 1421). Ye t, in VanderKlok , th this court established only that “a c lai m an t’s entitlement to pay ments based on a

claim of total disability must be based on the cl ai m an t ’s ab i lity to pursue ga inf

ul e mp loy me nt in light of a ll the circ umstances,” id. (quotation omitted) (empha sis a dded), and failed to further elabor ate on what
c on sti tut e d g a inf

ul e mpl oy

me nt. We now further

adopt the holding in Helms that “g ainful employ ment” is that employ

ment fr om w hic h a c la ima

nt may “ e arn

a re a so na bly su bs tanti a l in c ome ri sin gto t he dig nit y of an in c ome or livelihood, even though the income is not as much a s he ea rned be fore the disability .” Id. at 1421-14

22 ; se e als o To rix

v . B all Cor p ., 86 2 F .2 d 1 42 8 ( 10 Cir . 198 8) (a lso a do pti ng the sta nd ard se t f or th th in Helms ). C. Se lf -E mployment Def endants a rg ue that Plaintiff could be “ g ainfully employ ed” unde r the mea ning of the Plan by rea son of self- employ

ment as a da

y -trad er o f s ec u rities or as a consultant, eve n if he c ould not find employ

ment with an employ er be cause of a need to take a long noon rest. Thus, it is imperative that we a ddress whe ther “ g ainful employ ment” includes se lf-employ ment. Under

the above

discussed definition of “g ainful employ ment,” ther e ar e obviously some circ umstances whe re suc h
se lf -e mp lo y men t w ou ldres ul t i n a s uff ici ent in com e. Fo r ex amp le, an i nd iv id ual who hadprev iou sly established himself or he rself a s a consultant, who maintaine d a viable client list, and who ha d the po te nti a l to e arn

e no ug h to su sta in a

liv e lih oo d, mig ht b e g a inf ull y e mpl oy e d. Th e re wi ll b e so me circ umstances whe re a

n i n d i v i d u al may

be unable to find work for an employ er due to his or her disability , but has both the experience and the likelihood of a su ff i ci en t i n come from selfemploy ment to support a finding of “g ainful employ ment.” As n o t ed , Def

endants c ite to two possible income source s for Tr acy : day -tradingand selfemploy ment as a c onsultant
. He re T ra cy himself stated he ha d eng ag ed in some day -tradingand suggested he could e arn a

substantial income as a day trade r whe n he aske d Def endant to adva

nce $ 3 , 0 0 0 t o $ 5 , 0 0 0 t o p e r

m i th i m t o a t t e n d

s o m e a d d i t i o n a l t r a i n i n g i nt h a te mp l o ym e n t
. A d d i t i o n a l l y, t h e A L J ’ s o p i n i o nr e f

e r s t o t h e f

a c tt h a tP l a i n t i f

f s p e n d s f i v e h o u r s a

d ay, f i v e d a y s a w e e k

d a ytrading . The re cord indicates that he may have spe nt even more time than that. I t is sil ent, howeve r,
a s t o an a m o u n t h e h a s a c tu a l l y e ar n e d f r o m t h i s e n d e a v o r . T h e e xt e n s i v e t i m e h e h a s de vo te d to15

day -tradingand his silence as to what he has actually ear ned jus tify the i nfer ence that he has be en
e ng a g e d in g a inf

ul e mpl oy me nt. So do e s his pr e vio us c on du c t in c on tin uin g to d ra w d isa bil ity wh ile
e mpl oy e d f

or ov e r a y e ar at f ull -t ime e mpl oy

me nt w ithtw o d if

fe re nt e mpl oy e rs . D. Alte rna tiv e ly

, Eve n If We Do No t Rely on this Sel f- Employment, Has Trac

y Est ab lis he d Hi

s Condi tion Prevents Him From Being Gain fully Em ployed? Our review of the evidence leads us to conclude that Trac y , who has the burden of pr oof, has not established that he is unable to be g ainfully employ ed, by

an employ er, a

ny wher e. Ev e n tho ug h we may c on sid e r the fi nd ing s by the SSA , w e are no t r e qu ir e d to a bid e by its de c isi on . We no te ini tia lly tha t we do no t have Pla int if

f’ s te sti mony or

oth e r t e sti mony

in t he SSA proce eding , but only

the AL J ’s opinion and Plai n t i ff’ s applications. Henc e, we have not be en pr ov ide d w ithsu ff

ic ie nt e vid e nc e to d e te rm ine ind e pe nd e ntl y that T ra c y

su ff e rs fr om a

dis a bil ity preve nting him from be ing ga infully employ ed. Although the SSA decision resulted in a finding of disability , we are provided onl y with the AL J ’s summary

of medica l and vocational reports that lea d to that finding. While we g ive re spectful we ight to the f indings of that court, such respec t does not pr ov ide lit ig ants carte blancheto transmute its findings to other c ircumstance s in other fora
. I n sum, Trac y has not met his burden of e stablishing that he suf fer s from this disabilit y . The only doctor’s r eport in the a dminist rative r ecor d that supports his contention t hat he is unable to be g ainfully employ ed is the re sponse of Dr . Gung or to a wor k questi o n n ai re . The following is the
na rr a tiv e po rt ion

of the re po rt in i ts e nti re ty :
6. I n g e ne ra l, the patie nt ha s to take tw o na ps a da y . T he fi rs t on e up to o ne ho ur in the mor nin g be tw e e n 11 a. m. an d 1 p. m. H e take s th e se c on d n a p b e tw e e n 3 p. m. t o 6 p .m. Th is l a sts fo r t

wo ho ur s.16

9. The patient is im paire d, all functions ar e int er ru p t ed
. Once or twice a month, so me tim e s mo re of

te n, the patie nt is un a

ble to g e t ou t of be d a ll da y . He g e ts u

p in the eve ning f

or a short period of time. He would eat, go ba ck to the bedr oom and then g o back to slee p. 12. About twice a

month, sometim es more of ten, the patient is unable to ge t out of bed all day . He g ets up in the eve ning f or a shor t period of time. H e would eat, g ot ba c k to the be dr oo m and

g o b a c k to sle e p. Th is w ou ld l a st f or on e or tw o d ay s. J .A. a t 2 6 6
. M an y o f th e qu e s ti o n s p o s e d b y th e q u e s ti o n n a ir e w e r e u n an s w e r e d
. N o ta b ly , Dr. Gung or fa iled to answer question seven, which reque sted that he re port the medica l findings that led to hi s con clu sio ns . Su c h s c ant e vid e nc e fr om a n in c omp le te me dic a l r e po rt , e ve n if oth e rw ise
un c on tr a dic te d, wo uld

a pp e ar t o b e ins uf

fi c ie nt.
Mo re ov e r, that e vid e nc e is c on tr ov e rt e d b y oth e r e vid e nc e in t

he re c or d b efo re us , b ut t o wh ic h the AL J ma

ke s no re fe re nc e . F ir st, the re are me dic a l r e po rt s in dic a tin g that T ra c y is c a pa ble of work. D r. Munson completed a n attending phy sician’s re port and wr ote a letter dated January 22, 1999, which stated that to improve Trac y ’s day time functioning , “he should maintain a re g ular worksleep sche dule. This should include a consistent st arting and endingtime to his workday , as we ll as
a norma l eig ht-hour shift without overtime. These r estrictions should remain in ef fec t indefinitely .” J.A. a t 19 0. Al so , D r. Hurl bu t’ s r e po rt , c on te mpor aneo us wi th D r. Gung or ’s re po rt and a lso p r o v i d e d b y T r a c y t o s u

p p o rt h i s a

p p e a l o f t h e d e n i a l o f b e n e f i t s , p a i n t s a

s i m i l ar p i c tu r e o f

T r a c y: that of on e wh o c ou ld w or

k w itha c c omm od a tio ns . Se c on d, we no te that T ra c y he ld t wo se pa rate jo bs whi le on

ini tia l di sa

bil ity le a ve wi th Upjohn. Fr om 1997 to 1998 he worke d at Westwood Squibb, Br istol-My ers, a s a Mana g er of Global Marke ting Rese arc h (J .A. at 193), a nd from 1998 to 1999 Tra cy worke d at Sear le as a

Marke ting Resear ch Mana g er f

or an e ntire y ear

(J.A. at 193). Trac y

has indicate d that he wa s forc ed to leave17

his job at Sea

rle beca use he could not w ork eleve n hours a da y . Yet this say s nothing a

bout whether he could work a ty

pical eig ht-hour day . The re cord doe s not ex plain why he lef t Westwood S quibb.
Th ir d a nd fi na lly , T ra c y

has st ate d in va

ri ou s le tte rs a

nd int e rv ie ws that he be lie ve s h e is capa ble of wor k. I n Trac y ’s re sponse to D r. Munson’s re quest that he c omplete a medic al eva luation f o r m f o r D e f e n d an t s , T r a c y e x p l a i n e d

h i s s i tu a t i o nc an d i d l y:
Ire a lly ne e d to qu a lif

y fo r [U pjo hn ]’s pla

n to be a ble to c on tin

ue wi th t he ir fa mil y he a lth c are c ov e ra g e , and to po te nti a lly su pp le me nt my

inc ome , if

it i s ever neede d. Ifee l like Iam betwe en a r ock and a hard pla ce . Although I cannot consistenly work eight hours a day , Ican be productive. ... The ref ore, Ine e d to fi nd

temp orary

c on su lti ngpo sit ion s. Ho we ve r, Ine e d h e a lth insurance cover age fo r m e and my family , if Iam consulting - which [Upjohn] can pr ovide. J .A. at 182. Tr a c y ha s si mpl y

no t me t hi s b ur de n o f e sta bli sh ingtha

t he su ffers fro m a dis a bil ity preve ntin g h im f

r o m b e in g g a in f

u ll y e mp lo y e d
. T h e c o u rt is c o n f r o n te d w it

h o n ly p ie ces of
c on fl ic tin g do c tor s’ re po rt s th a t, r e a d to g e the r, do no t e sta bli shthat he su ff

e rs fr om a

di sability preve nting him from be ing g ainfully employ ed any

wher e. B as ed on the totality of the e vidence submitt ed, we ag ree with the district court that he ha s not carr ied his burden to prove he ca nnot work any wher e. E. The G le nn Dec ision The rec ent decision of this court in Gl e nn v . M e tLif e , _ F.3d _, 2006 WL 2519293 (6th Cir. Sept. 1, 2006), is not to the contrary . Whil e the decision was for the plaintiff in that case , the salient fac ts are disting uishable. More over, the rea soning in that case is in line with our own and bolsters
our o wn c on c lus ion s.18

L ike Trac y ’s benef

its, Wanda Glenn’s disability benef its we re revie wed afte r a t wo-y ear initial dis ability

period. She suffe red from “‘ sever e dilated c ardiomy opathy ,’ a disea se of the he art muscle that ca

uses the hea

rt to become enlar g ed and, f or that re ason, to pump inadequately .” Id. at *1 (interna l c itations omi tted). He r employ er’ s plan denied he r per manent disability

benef its after an administrative c ommitt ee de termined that she w as not unable to be g ainfull y em p l o y ed . That
e mpl oy e r’ s p lan, ho we ve r, de fi ne d p e rm ane nt dis a bil ity a s, “ c omp le te ly and c on tin uo us ly un a

ble to perf orm the duties of any g a inf ul wo rk or se rv ic e fo r w hic h [sh e is] r e a so na bly qu a lif ie d ta kin g int o consideration [ her] training , education, ex perie n ce , and past e arning .” Id. (empha sis in original). I n c on tr a st, the Plan in

the ins tant c a se de fi nes pe rm ane nt d isa bil ity a s, “ un a ble to b e g a inf

ull y employ ed any

wher e,” a more string ent standar d. More importantly , in Glenn , the plaintiff’s treating phy sician, whom she had bee n seeingfor

m ed i ca l t re at m en tfo r h er co n d i t i o n s i n ce i t wa s d i agn o s ed , s u b m i t t ed m u l t i p l e le n gt h y an d t h o ro u gh repor ts describing her c ondition and specifica lly rec ommending that she not return to w ork. Be fore she we n t o n her initial two-y ear period of le ave, he stated that her “main proble m now is stress at work . She
.. . do e s have ph y sic a l a s we ll a s ps y c ho log ic a l str e ss. .. . I fe e l th a t sh e may

no t be a ble to continue to wo rk i n an y k i nd of environme nt that would cause any signific ant phy sical or psy cholog ical stress a

nd demands.” Id. (i nte rn a l c itatio ns omi tte d) . A lth ou g h he r d oc tor ini tia lly pr e dic te d th a t G le nn

wo uld be a ble to re tur

n to wor k, he la te r de te rm ine d tha t her c on dit ion

wo uld not allow it. “She also continues to have signific ant diffi cult y in returning to even a

ny kind of sedenta ry job be cause any kind of psy cholog ical stress at work cause s signific ant problems with her
car di o v as cular

condition and she de compensates fast.” Id. a t9 ( i n t e r n a l c i t a t i o n s o m i t t e d )
. In conclusion, the Glenn co u rt held that the administrative committee ha d err ed bec ause, “ there was19

no adequate basis for the plan administrator’s deci s i on not to factor in one of the major considerations in Glenn’s pathology , that of the role that stress play ed in ag g ravating he r condition and, in the l ang uag e of the M etL ife poli cy , in preve nting her return to ‘g ainful work or ser vice f or which [she is] r easona

bly qualified takinginto consideration [her] training, e ducation, experienc e, and past e arning .’” Id. at 12-13 (inter nal citations omitted). I n this case, howe ver, the re has been no indication that work exacer bates Trac y ’s condition
or eve n that h e is completely unable to wor

k. Rather, one of his doctors has r ecommende d, “a consistent starting and endingtime to his workday , as we ll as a nor m al ei gh t -h our shift without overtime” in order to improve hi s condition. J .A. at 190. W hile that letter fr om Dr. Munson is not
a s r e c e n t a s D r . G u n g o r ’ s r e p o rt , i t i s p art o f an a t t e n d i n g p h y s i c i an ’ s t r e a t m e n t h i s tor y tha t is thor o u g h ly p r e s e n te d in th e r e c o r d
. Wh il e w e w o u ld v e r y mu c h a p p r e c iate th e in s ig ht of a more
curr ent evaluation, Dr . Gung or’s is sparse and, while the A L J ref err ed to Dr. G ung or as a

treating phy sician, we have no rec ord of any treatment or of any tests that would lead us to conc lude that he is a treating doctor. Most sig nificantly , Dr. Gung or does not explain on what his conclusions are based. F inally , Trac y ’s history of work a

nd stock-mar

ket ac tivity

over the past few

y ear s indicates that his present c ondition has not chang ed since Dr. Munson wrote his letter and a s such does not rende r him “unable to be g ainfully employ ed an

y whe re .” J.A. at 428

. CO NC LU SION
Thus , f or the fo re g oin g re a so ns , th e dis tr ic t c ourt ’s op ini on is AF F IR M ED
.