Opinion ID: 3010493
Heading Depth: 3
Heading Rank: 2

Heading: Mitchell's Record Support

Text: To determine whether Mitchell has carried his burden, we look to the record as a whole. Cf. Smith v. Califano, 637 F.2d 968, 970 (3d Cir. 1981) (noting that court reviewing denial of Social Security disability benefits retain[s] a responsibility to scrutinize the entire record and to reverse or remand if the ... decision is not supported by substantial evidence). Under the arbitrary and capricious standard of review, the whole record consists of that evidence that was before the administrator when he made the decision being reviewed. See Luby, 944 F.2d at 1184 n.8; Woolsey v. Marion Laboratories, Inc., 934 F.2d 1452, 1460 (10th Cir. 1991); Voliva v. Seafarers Pension Plan, 858 F.2d 195, 196 (4th Cir. 1988). Here, because the Administrator made two decisions--the January 17, 1992 denial that precipitated this lawsuit and the April 12, 1995 re-affirmation of that denial that preceded the district court's grant of summary judgment and this appeal--there is some dispute regarding what constitutes the whole record. The January 17, 1992, letter communicating the Administrator's initial decision to deny LTD benefits advised Mitchell that if he had additional objective medical evidence that [he] was disabled within the meaning of [the Plan] as of June 26, 1989, he should submit it and the Administrator would reopen [his] file. App. at 24. Consistent with that position, Kodak does not ask us to review and overturn the district court's order directing reconsideration by the Administrator after an opportunity to supplement the record. Nevertheless, Kodak asks us to review the district court's subsequent judgment of December 14, 1995, directing payment of benefits, on the basis of the record as it existed before supplementation. We decline to do so. In the absence of a successful attack on the order requiring reconsideration, our only appropriate course is to review the district court's December 14, 1995, judgment based on the legally relevant record then before it. Given our conclusion that the district court should have 11 asked only whether the Administrator's denial was arbitrary and capricious, on the basis of the record before the Administrator, this means that the relevant record on appeal is the evidence before the Administrator at the time of his final denial on April 12, 1995. The undisputed evidence in his claim file as of April 12, 1995, shows that as of June 26, 1989, Mitchell's chronic and unpredictable fatigue and loss of concentration made it impossible for him to sustain regular paid employment. Mitchell's medical records indicate that he began complaining of fatigue, fever, a persistent cough, and other flu-like symptoms in the fall of 1988. An infectious disease specialist diagnosed Mitchell with chronic fatiguing illness in January 1989, and Physician's Statements submitted in support of Mitchell's claim in June 1989, May 1990, and July 1990 all indicated that Mitchell suffered from chronic fatigue. Although the doctors who completed the two earlier Statements expressed uncertainty regarding whether Mitchell's fatigue rendered him totally disabled, the third clearly stated that Mitchell was totally disabled from gainful employment because of his CFS.7 In 1991, the Social Security Administration agreed with that conclusion, awarding Mitchell Social Security Disability benefits after comprehensively reviewing his medical history and concluding that [t]he medical evidence establishes that the claimant has severe chronic fatigue syndrome with EpsteinBarr Virus and that he lacks the residual functional _________________________________________________________________ 7. Kodak contends that the July 1990 Physician's Statement is unreliable because it is internally inconsistent, indicating that Mitchell suffered only No Limitation or Some Limitation in performing activities such as sitting, standing, pushing, pulling, and spoken and written communication, but that he was nonetheless totally disabled from any occupation. We do not find this inconsistency dispositive. It seems to us to be attributable largely to the inappropriateness of the Physician's Statement form for evaluating disability resulting from CFS. CFS does not disable an individual afflicted with it from performing particular, isolated activities, but rather prevents him from performing all activities for any prolonged period of time. Thus, it is not inconsistent, given the characteristics of CFS, for Mitchell's doctor to conclude that Mitchell was totally unable to engage in substantial gainful activity, even though his ability to perform isolated activities such as standing, pushing, pulling, and communicating was only somewhat limited. 12 capacity to perform the physical exertion and nonexertional requirements of work. App. at 136. By 1993, Mitchell was under the care of Dr. Nelson Gantz, a doctor familiar with CFS. On September 21, 1993, Dr. Gantz wrote a letter to the Plan Administrator diagnosing Mitchell's CFS and describing his symptoms: In my opinion [ ]his illness had an acute onset and my impression is that Mr. Mitchell has chronic fatigue syndrome. The treatment for chronic fatigue syndrome is symptomatic and the prognosis is unknown. Based on these last two items and his symptomatology it would make him physically incapable of increased or sustained activities. He cannot keep a regular schedule because of his constant fatigue and his loss of concentration. Based on Mr. Mitchell's history, it is my opinion his acute onset developed in October 1988. Since chronic fatigue syndrome is a disease of exclusion, Mr. Mitchell has been extensively worked up in the past and in this office .... App. at 165-66. On August 18, 1994, Dr. Gantz wrote another letter that clarified how Mitchell's symptoms of fatigue, fevers, joint pain, muscle pain, sore throats, markedly decreased concentration, headaches, muscle weakness and occasional sleep problems disabled him from all substantial gainful activity: The frequency and severity of symptoms in patients with the Chronic Fatigue Syndrome vary greatly and can wax and wane. There is no pattern to the cycle, and unfortunately it is difficult to say when he will have good days or bad days.... At present, restricting activities is the only way to prevent exacerbation of his CFS symptoms. He is capable of only mild, intermittent activities. His ability to sustain any activity, even for a few hours, is unpredictable.... I feel that Mr. Mitchell is 100% disabled at this time and work for him is out of the question. 13 Letter of Aug. 18, 1994, App. at 191. Dr. Gantz's letters, taken together with the earlier records of Mitchell's persistent CFS symptoms, support the proposition that Mitchell began suffering acute CFS symptoms in the fall of 1988, and that his symptoms rendered--and continue to render--him incapable of sustaining prolonged activities, including any gainful employment. There is no evidence to the contrary. Kodak argues that because Mitchell's records contain no explicit doctor's statement that Mitchell was totally disabled as of June 26, 1989, they fail to establish that Mitchell was in fact totally disabled by CFS on June 26, 1989. Although it is true that the records lack such an explicit statement, we conclude that that alone does not support the Administrator's conclusion that Mitchell failed to show total disability as of June 26, 1989. The undisputed reports from Mitchell's treating physicians show that he began suffering CFS symptoms well before June 1989, and Dr. Gantz's letter of August 18, 1994 clearly explains how those symptoms rendered Mitchell totally disabled from gainful work. Moreover, Mitchell's treating physicians' early difficulty diagnosing Mitchell's CFS and understanding how it disabled him from work do not support the Administrator's conclusion. Mitchell's CFS symptoms have remained consistent since before June 1989 and later, undisputed evidence from a doctor more knowledgeable about the diagnosis and symptomatology of CFS clearly supports Mitchell's contention that CFS has rendered him totally unable to engage in any substantial gainful work since January 1989. As the Tenth Circuit explained in Sisco v. United States Dep't of Health & Human Services, in which the patient's CFS had gone undiagnosed from 1983 to 1989, [u]nder the facts of this case, the early examinations cannot be considered as contradicting or rebutting [Plaintiff 's] recent diagnosis.... [C]hronic fatigue syndrome was not even recognized as a disease until 1988, and the first technique to diagnose it was not published until that same year.... It is highly unlikely that any of the physicians who examined Plaintiff prior 14 to the Mayo Clinic [which diagnosed her] would have considered or even been aware of chronic fatigue syndrome. The government has not cited to a single physician who examined Plaintiff after the Mayo Clinic or in light of the medical community's new understanding of chronic fatigue syndrome who contradicted or in any way questioned the conclusions of the Mayo Clinic and her treating physician. Moreover, because chronic fatigue syndrome is diagnosed partially through a process of elimination, an extended medical history of nothing-wrong diagnoses is not unusual for a patient who is ultimately found to be suffering from the disease. The Mayo Clinic and her treating physician considered Plaintiff's entire medical history--including all the failed attempts to diagnose--in making their assessments. Finally, in a purely linguistic sense, an early report that I am unable to find the cause does not contradict a later report that I have now found the cause. The statements together demonstrate an evolution rather than a contradiction. 10 F.3d 739, 745 (10th Cir. 1993). Here, the doctors who examined Mitchell between 1988 and 1990 were apparently unfamiliar with CFS, see, e.g., Physician's Progress Notes of June 6, 1989, App. at 60 ([Mitchell] brought in some literature from CBC [sic; CDC (Centers for Disease Control)?] on a chronic fatigue syndrome. He may well have this, but I don't know how to prove it.), and thus were unable to declare with confidence that he was totally disabled by the disease. However, Dr. Gantz's letters of September 1993 and August 1994 dispel the confusion evidenced in the earlier medical records, and make clear that Mitchell's CFS, though misunderstood, clearly disabled him from all substantial gainful work as of June 26, 1989.