Opinion ID: 3050437
Heading Depth: 2
Heading Rank: 2

Heading: Howard’s Medical History and Benefits Award

Text: In April 2005, Howard stopped working and applied for disability benefits. Her treating physician, Dr. Gary Decker, submitted to Hartford an Attending Physician’s Statement, stating he had been treating Howard for “many years” and, in his opinion, “she should qualify for total disability” based upon her “multiple debilities.” R at 1443. Dr. Decker reported Howard was 5’6” and weighed over 300 pounds. He made a primary diagnosis of lupus, fibromyalgia, and severe joint 2 The Plan defines “Disability or Disabled” to mean “during the Elimination Period and for the next 24 months [a participant] [is] prevented by: 1. accidental bodily injury; 2. sickness; 3. Mental Illness; 4. Substance Abuse; or 5. pregnancy, from performing one or more of the Essential Duties of [her] Occupation, and as a result [her] Current Monthly Earnings are no more than 80% of [her] Indexed Pre-disability Earnings.” R at 55. 3 Case: 13-11619 Date Filed: 04/15/2014 Page: 4 of 16 pain, as well as secondary diagnoses of depression, short-term memory loss, and asthma. R at 1437. Dr. Decker concluded Howard “became unable to work due to impairment” on April 29, 2005. R at 1438. He listed Howard’s impairments to include walking, sitting, lifting/carrying, pushing, pulling, driving, and keyboard use. In a second Attending Physician’s statement, Dr. Decker listed his primary diagnosis as lupus and his secondary diagnosis as fibromyalgia. He reported Howard was precluded from performing several of the functions of her job, including standing or walking for more than a few minutes at a time and sitting for longer than an hour. Based on this information, Hartford approved Howard’s claim for Short Term Disability benefits, which expired on November 3, 2005. Beginning in July 2005, Hartford sent further inquiries to Dr. Decker and requested more information about Howard’s health and limitations. He acknowledged Howard’s lab work did not support lupus, but she was diagnosed “per Rheumatology.” R at 1346. He also stated Howard was unable to work in sedentary to light positions because of “[s]evere joint pain” in her hips and hands, difficulty with handwriting, and “lower extremity swelling.” R at 1346. Hartford later sent Dr. Decker a second questionnaire, based on a rheumatologist’s findings that Howard was not experiencing spasms, severe joint pain, or other symptoms limiting her function. In response to Hartford’s question as to how Dr. Decker determined Howard was having “severe problems” and “severe symptoms,” he 4 Case: 13-11619 Date Filed: 04/15/2014 Page: 5 of 16 stated his determinations were based on Howard’s own reports of pain and multiple exams. On October 22, 2005, Howard filed for LTD benefits. Dr. Decker provided Hartford with an Attending Physician’s Statement of Continued Disability, again reporting his primary diagnosis of lupus and fibromyalgia and his secondary diagnosis of severe joint pain, asthma, and depression. He also completed a Physical Capacities Evaluation Form stating Howard could not sit for more than an hour at a time and could not stand for more than five minutes. Additionally, Howard submitted a statement reporting she (1) was unable to multi-task because of short-term memory problems and chronic fatigue; (2) had suffered a loss of finemotor skills; (3) was unable to life or carry more than 2 to 3 pounds; (4) could not stand or walk without support for more than a few minutes; (5) could not write more than a sentence or two without severe pain; and (6) had memory deficits, sometimes causing her to become confused or disoriented. On November 1, 2005, Hartford advised Howard her claim for LTD benefits had been approved, effective November 4, 2005. She also was advised an Independent Medical Examination (“IME”) would be performed. Dr. Mark Hofmann performed the IME and concluded, based on Howard’s self-reported pain, Howard probably had fibromyalgia. He provided restrictions of “[n]o lifting or carrying greater than 10 pounds occasionally, less than one hour per day of 5 Case: 13-11619 Date Filed: 04/15/2014 Page: 6 of 16 keyboarding and repetitive hand motion, [and] avoidance of . . . standing/walking more than 10 minutes at a time.” R at 1236. Based on the IME and Dr. Decker’s submissions, Howard’s LTD benefits were continued beyond November 2005.