Opinion ID: 77173
Heading Depth: 2
Heading Rank: 2

Heading: Slomcenski’s Disability

Text: On 21 July 1999, Slomcenski applied for disability benefits. She claimed that she suffered from headaches, nausea, insomnia, depression, loss of caring, loss of interest, and allergies. According to Slomcenski, these conditions developed following a change of management at her work. Dr. Gilson Webb, a psychiatrist who examined Slomcenski, diagnosed her with major depressive disorder. On the basis of Dr. Webb’s diagnoses and Slomcenski’s failure to respond to antidepressants and psychotherapy, Continental awarded Slomcenski disability benefits under the Plan. Following this initial benefits determination, Slomcenski’s condition was routinely monitored and re-evaluated. In December 1999, Continental referred Slomcenski to Dr. Daniel Sprehe for an independent psychiatric medical evaluation. Dr. Sprehe confirmed that Slomcenski still suffered from severe 6 depression. Under a category for physical medical problems, Dr. Sprehe diagnosed Slomcenski with Hashimoto’s Thyroid Disease. In March 2000, Continental arranged for Dr. Charles Paskewicz, a licensed psychologist, to conduct an independent review of Slomcenski’s file. Paskewicz found that all the available evidence indicated that Slomcenski was continuing to suffer from severe depression. As a result of these diagnoses, Continental informed Slomcenski that she would continue to receive benefits. However, in the benefits award letter, Continental stated that, if Slomcenski remained disabled, her receipt of benefits would be limited to thirty months because her disability was the result of a mental or nervous disorder. According to the letter, her benefits would terminate in January 2002. In October 2000, Dr. Robert Gilbert diagnosed Slomcenski with irritable bowel syndrome. In January 2001, Dr. Webb re-examined Slomcenski and found that, while Slomcenski continued to suffer from major depressive disorder, “some of [her] symptoms [appeared to be] related to her physical condition.” R1-31 (Exhibits) at SYN00035. In September 2001, Dr. Paul Winters examined Slomcenski after she complained of fatigue, numbness on part of her foot, and lower back pain. Dr. Winters noted that Slomcenski was scheduled to be evaluated for fibromyalgia. During this time, Slomcenski was also evaluated by a 7 rheumatologist, Dr. Michael Burnette, for her complaints of persistent joint pain and chronic fatigue. Dr. Burnette found that Slomcenski had some trigger points for pain in her upper back and some pain with the movement of her spine. Dr. Burnette concluded that Slomcenski “ha[d] manifestations of a fibromyalgia disorder, and [that] her history suggest[ed] chronic fatigue.” Id. at SYN00038. Following Burnette’s evaluation, Slomcenski sent a letter to Continental which indicated that she had been diagnosed with fibromyalgia and chronic fatigue syndrome. Slomcenski also reported that she experienced severe pain on a daily basis. In December 2001, Continental responded that Slomcenski’s letter and supporting documentation were insufficient to support the finding that Slomcenski suffered from a physical impairment. Accordingly, Continental maintained that Slomcenski’s benefits would be terminated in January 2002 pursuant to the thirtymonth mental or nervous disorder limitation. Slomcenski appealed Continental’s determination and argued that her depression stemmed from the fibromyalgia, which was a physical condition. By this time, MetLife had assumed responsibility for making benefits determinations under the Plan and referred Slomcenski’s file to Dr. Amy Hopkins for an independent review. Based on her review of all the diagnoses in Slomcenski’s file, Dr. Hopkins observed that Slomcenski “ha[d] major depression, and all of her 8 [symptoms] can be explained on [that] basis.” Id. at SYN0009. She concluded that Slomcenski did not have an “objectively documented physical impairment” and that her disability was related to a mental disorder. Id. at SYN00010. Accordingly, the original determination by Continental that Slomcenski’s benefits would terminate in January 2002 was affirmed.