Opinion ID: 175324
Heading Depth: 2
Heading Rank: 2

Heading: Cognitive Impairments Considered

Text: Meade also argues that the decision to deny him benefits was arbitrary and capricious because, he maintains, National City overlooked his cognitive impairments and depression. Notably, Meade does not challenge the Appeal Committee’s determination that there was no identifiable cause for the claimed physical symptoms which he admits were his “primary” allegations of disability. The plan contains different standards for short‐term and long‐term benefits. For the long‐term benefits at issue in this case, the plan requires a showing that the participant’s condition makes him “unable to perform the duties of your particular job . . . After you have been disabled for two years . . . [t]he Plan Administrator must determine that your condition makes you unable to perform the duties of any other occupation for which [he is], or could become, qualified by education, training or experience.” Meade sought benefits within two years after his injury, so National City analyzed whether he could perform the duties of his job as branch manager. The arbitrary and capricious standard of review is deferential, and we will not substitute our judgment for that of the administrator as long as the administrator makes an informed decision and articulates an explanation that is satisfactory in light of the relevant facts. Mote v. Aetna Life Ins. Co., 502 F.3d 601, 606 (7th Cir. 2007). However, “‘we will not uphold a termination [of benefits] where there is an absence of reasoning in the record to support it.’” Love v. National City Corp. Welfare Benefits Plan, 574 F.3d 392, 396 (7th Cir. 2009), (quoting Hackett v. Xerox Corp. Long‐Term Disability Income Plan, 315 F.3d 771, 773 (7th Cir. 2003)). In addition, ERISA administrators must address reliable evidence of eligibility submitted by a claimant and communicate specific reasons to a claimant for a denial of benefits. Id. Meade argues that his cognitive impairments were not assessed in combination with his physical impairments. The record reflects, however, shows otherwise. The Appeal Committee decision reflects that the Committee considered his cognitive complaints, as its decision letter states in part: No. 08-2441 Page 6 Although Mr. Meade reports subjective complaints of neck pain, shoulder pain, thoracic pain, difficulty raising arms above shoulders, headaches, blurry vision, and difficulty reading, these subjective complaints are not substantiated by any objective finding. Review of radiological test results, MRI, CT, x‐rays does not indicate acute objective findings. Complaints are unsubstantiated, such as inability to lift arms; however there was no atrophy or objective test result. The Committee noted inconsistency in Mr. Meade’s reports of inability, such as unable to read, however, he is still able to do other activities requiring use of vision, such as watch TV, drive, and watch sporting events. In addition, Dr. Soriano’s report specifically set forth complaints Meade made relating to his cognitive impairments. Dr. Soriano’s description of Meade’s current complaints included that Meade could not read for more than two to three minutes because he becomes dizzy, the room spins, and he becomes nauseated, as well as that he had pain radiating behind his right ear and eye. Dr. Soriano’s report also recounted that Meade’s wife read a written description of the purpose of the exam to Meade because Meade alleged that he could not read it and said he would become dizzy and experience other neurological symptoms after more than a few minutes of reading. And he stated that Meade’s “overall affect is blunted,” an observation that Meade appeared depressed when Dr. Soriano examined him. Dr. Soriano went on to state, however, that although Meade made these complaints, he found the complaints unsubstantiated by any objective findings in the normal neurological examination he performed. Dr. Soriano concluded that he believed Meade’s complaints regarding his vision were “exaggerated.” Notably, Dr. Soriano based his conclusion in part on his own examination of Meade. Cf. Love v. National City Corp. Welfare Benefits Plan, 574 F.3d 392 (7th Cir. 2009) (independent medical examiner reviewed the file but did not examine the claimant); Gessling v. Group Long Term Disability Plan for Employees of Sprint/United Mgmt. Co., 693 F. Supp. 2d 856 (S.D. Ind. Mar. 16, 2010) (same). Dr. Soriano also pointed out that Meade was able to attend sporting events and watch television without experiencing similar problems with his eyes. Dr. Hoffman’s report also reflects that he considered Meade’s cognitive complaints. He wrote that Meade’s complaints of headaches, blurry vision, and difficulty reading, along with his complaints of other pain, were not substantiated by objective findings, and he noted that Meade’s neurological examination had been normal.1 1 Dr. Hoffman’s report notes that he had a phone conversation with Meade’s primary care physician, Dr. Barnhart, about a month before Dr. Hoffman filed his report. According to Dr. Hoffman’s notes, Dr. Barnhart stated Meade was taking a lot of pain medication and he did not feel comfortable giving him medication, so he referred him to another doctor, as well as that there was a lack of objective findings. No. 08-2441 Page 7 Meade also emphasizes that neither Dr. Soriano nor Dr. Hoffman mentioned the April 2005 neuropsychological examination he had at the Mayo Clinic. That report notes in the “History of Present Illness” section that Meade “admits that he has some cognitive difficulty since the accident, but he cannot really say if it is progressing or improving. He does have some cognitive complaints as have already been outlined in the medical record.” The report’s “Impression/Report/Plan” section states “comprehension intellectual ability is firmly in the average range . . . verbal comprehension intellectual ability is actually high average. Working memory is somewhat lower and just within the average range. Lexical and semantic fluency performances are normal. Delayed auditory verbal memory of paragraph‐length information is normal. Acquisition of a supraspan word list presented over serial presentations is mildly to moderately reduced.” The report also noted learning efficiency that was lower than expected and in the compromised range but that the percentage of information recalled thirty minutes later was normal. As the district court noted, nothing in this report was so compelling or different from that in other referenced documentation that the failure to mention the report means we would set aside the decision. See Davis v. Unum Life Ins. Co. of American, 444 F.3d 569, 578 (7th Cir. 2006) (consulting physicians need not recite every piece of evidence reviewed). Our standard of review asks whether the denial decision was arbitrary and capricious, which means that we ask only “whether [the] decision to deny [the claimant] benefits finds rational support in the record.” Fischer v. Liberty Life Assur. Co. of Boston, 576 F.3d 369 (7th Cir. 2009). Although some of the medical opinions in this case differ as to whether Meade’s conditions were disabling, under our deferential standard of review, we must defer to National City’s choice between competing medical opinions so long as the choice is rationally supported by record evidence. Black v. Long Term Disability, 582 F.3d 738, 746 (7th Cir. 2009). The denial decision has rational support here. None of Meade’s physicians identified an organic cause of his pain, and they recommended against any surgical treatment. The explanations given by the consulting physicians and Appeal Committee shows that they adequately considered Meade’s cognitive complaints, and they presented reasonable explanations for their conclusions. See id. Therefore, National City was entitled to believe them. Finally, that National City both determined eligibility for benefits and paid them does not alter our conclusion. Although Glenn instructs that a conflict of interest is one factor to be considered in conducting our review, we do not find it pushes things over the edge here. See Glenn, 128 S. Ct. at 2351 (“any one factor will act as a tie‐breaker when the other factors are closely balanced, the degree of closeness necessary depending on the tie‐breaking factors inherent or case‐specific importance”).