Opinion ID: 170023
Heading Depth: 2
Heading Rank: 2

Heading: Letters of Dr. Peters and Dr. Caster

Text: The district court's entire explanation of its decision to admit the 2005 letters of Drs. Peters and Caster was the brief statement that they do appear to include some information not contained in the administrative record that could assist the Court in understanding the medical issues in this case. App. 786. That thin basis, however, is insufficient for admitting evidence under Hall, and a full analysis according to our precedent does not support admission of the letters either. In making a discretionary decision, a court must present an explanation for its choice sufficient to enable a reviewing court to determine that it did not act thoughtlessly, but instead considered the factors relevant to its decision and in fact exercised its discretion. Patton v. MFS/ Sun Life Fin. Distribs., Inc., 480 F.3d 478, 491 (7th Cir.2007); see also, e.g., O'Toole v. Northrop Grumman Corp., 499 F.3d 1218, 1226 (10th Cir.2007) (district court must explain its discretionary denial of prejudgment interest); Okland Oil Co. v. Conoco Inc., 144 F.3d 1308, 1329 (10th Cir.1998) (district court must provide adequate explanation of its discretionary denial of costs). Here, the district court accurately recited the terms of the Hall test, but its conclusory analysis failed to explain how the doctors' letters might meet these requirements for admissibility. To be sure, the district court stated that the letters could assist the Court in its review. App. 786. But evidence that is potentially helpful is not perforce  necessary to the district court's de novo review, Hall 300 F.3d at 1203 (emphasis added). We discuss the nuances of the term necessary below, see infra § II.B.1, but suffice it here to say that the word connotes a stronger requirement than the mere possibility of utility. And although the district court's opinion shows that the letters were not merely cumulative or repetitive of the other evidence already in the record, Hall, 300 F.3d at 1203, it does nothing to indicate that the other factors of the Hall test were met. Specifically, the court did not explain why this evidence could not have been submitted to the plan administrator at the time the challenged decision was made, or why it was not `simply better evidence than the claimant mustered for the claim review.' Id. (quoting Quesinberry, 987 F.2d at 1027). Without more than its meager finding that the letters might perhaps be useful, the district court should not have admitted them. If our own analysis of the letters showed that they were admissible on a basis the district court did not provide, we may nonetheless affirm . . . `in the interest of efficiency and judicial economy.' Id. at 1207 (quoting Ohlander v. Larson, 114 F.3d 1531, 1538 (10th Cir.1997)); see also Hill v. SmithKline Beecham Corp., 393 F.3d 1111, 1116 (10th Cir.2004). Applying the Hall test ourselves further persuades us that the letters' admission was an abuse of discretion.
First, extra-record evidence must be necessary to the district court's de novo review. Hall, 300 F.3d at 1203. Necessary is a term with a spectrum of meanings. At one end, it may import an absolute physical necessity, so strong, that one thing, to which another may be termed necessary, cannot exist without that other; at the opposite, it may simply mean no more than that one thing is convenient, or useful, or essential to another. M'Culloch v. Maryland, 4 Wheat. (17 U.S.) 316, 413, 4 L.Ed. 579 (1819); cf. Colautti v. Franklin, 439 U.S. 379, 400, 99 S.Ct. 675, 58 L.Ed.2d 596 (1979) (necessary in abortion statute suggested indispensable); Comm'r v. Tellier, 383 U.S. 687, 689, 86 S.Ct. 1118, 16 L.Ed.2d 185 (1966) (necessary in tax statute meant appropriate and helpful). Neither end of this spectrum, we think, is appropriate here. Too strict a view of necessity is foreclosed by our very holding in Hall. There, we allowed admission of evidence regarding two surgeries which took place after the closing of the administrative record. The decisive issue in Hall was the degree of the plaintiff's enduring pain, and we agreed with the district court that the fact the plaintiff chose to undergo the surgeries was strong evidence that her pain was real and unrelenting. 300 F.3d at 1206 (internal quotation marks omitted). The evidence was not, however, absolutely indispensable to reviewing the plan administrator's decision. On the other hand, necessary evidence in this context cannot be evidence that is merely convenient, or useful, or conducive to the end of conducting review. Cf. M'Culloch, 4 Wheat. at 413, 415, 4 L.Ed. 579. If this were what the term meant, the admission of extra-record evidence would not be limited to unusual cases or extraordinary circumstances, as we require. See Hall, 300 F.3d at 1206 (quoting Quesinberry, 987 F.2d at 1025). [3] Rather, the term necessary, as we used it in Hall, must be harmonized with its context. Armour & Co. v. Wantock, 323 U.S. 126, 130, 65 S.Ct. 165, 89 L.Ed. 118 (1944). We are guided by our qualification in Hall, following the Fourth Circuit's opinion in Quesinberry, that extra-record evidence may be admitted when `necessary to conduct an adequate de novo review of the benefit decision.' Hall, 300 F.3d at 1202 (emphasis added) (quoting Quesinberry, 987 F.2d at 1025). If, for instance, the administrator based its decision on information not in the record perhaps on principles generally known within the medical communitythe district court likely could not meaningfully review the decision without the admission of that evidence. Or if the court cannot understand abstruse medical terminology central to the issues of a case, the claimant may supplement the record with explanatory evidence. Likewise, if the administrator simply neglected to include in the record exhibits the claimant had submitted to it, those may be offered to the district court. (Even necessary evidence, however, may only be admitted if the other three prongs of the Hall test are satisfied. The consequences of a record insufficient to allow meaningful review will be borne by the party responsible for the insufficiency.) Mr. Jewell suggests that admission of the letters of Dr. Peters and Dr. Caster was justified by one or more of the exceptional circumstances which we said in Hall could warrant the admission of additional evidence. 300 F.3d at 1203. First, Mr. Jewell argues that the proper diagnosis of his disorder is a complex medical question and requires additional explanatory evidence. Appellee's Opening Br. 32. The letters, however, provide no assistance to a court seeking to resolve on de novo review the medical complexities of the case. They state a diagnosis, but there are other diagnoses already in the recordfrom Dr. Peters and Dr. Caster as well as from four other doctors. The letters do not elucidate the medical principles or terminology, nor offer any account of how the facts support the diagnosis. The letters are, in a sense, black boxes: facts go in, diagnoses come out. When doctors offer new or revised diagnoses several years after the fact, one would expect to see explanations of what has changed and why. A doctor's mere announcement of a new conclusion is not evidence genuinely directed toward helping a court engage in de novo review of the decision previously made. Second, Mr. Jewell argues that, by disbelieving what he claims was his doctors' diagnosis of an organic disorder, LINA put the doctors' credibility at issue. The question of the credibility of an expertas opposed to the question of the reliability of the expert's conclusionsconcerns whether the expert is believable. See, e.g., Washington v. Schriver, 255 F.3d 45, 52 (2d Cir.2001). Credibility embraces such matters as professional qualifications, mental capacity, bias and interest, and bad moral character. So, for instance, the size of an expert's fee or the fact that he only testifies for plaintiffs in civil cases may be relevant to his credibility. See Edward J. Imwinkelried, The Silence Speaks Volumes, 1998 U. Ill. L.Rev. 1013, 1034-35. Whether, as is important here, these doctors were correct, or whether their conclusions were based on sufficient evidence and sound medical science, bears on their credibility in no genuine sense. And although LINA's brief before this Court contains a few vague references to the doctors' credibilitycalling them loyal to Mr. Jewell and stating that for reasons we do not know, a few doctors agreed to modify their diagnoses, Appellant's Opening Br. 39, 63those comments were in reaction to the recent letters; the letters were not responsive to any pre-existing challenges to the doctors' credibility. Even if they were, the statements and diagnoses contained in these letters have nothing to do with the doctors' qualifications, bias or interest, or the like. We cannot conclude that consideration of these letters would be at all helpful to evaluating the doctors' credibility, properly understood; still less that the district court could not conduct meaningful review without them. Mr. Jewell further argues that the letters are necessary to prove that his disability is ongoing. Dr. Caster's letter, in particular, indicates that, although Mr. Jewell's financial situation had improved by the time of writing, nevertheless this man can not be gainfully employed, and his [sic] is unable to adequately function, not only because of poor cognitive processing and poor attention and difficulties around cognition, but also because of a worsening at these times of his depression. App. 744. LINA, however, does not contest that Mr. Jewell is disabled, or indeed that he has been since it began paying him benefits in 1998. The issue in this case is the cause of his disability, not its duration. Nor has Mr. Jewell presented any evidence or argument tending to show that the ongoing character of his disability would be proof of an organic cause. Because the necessity of extra-record evidence must be established by its proponent, see Hall, 300 F.3d at 1203, Mr. Jewell has not met his burden with respect to this argument.
Second, the party attempting to bring evidence before the district court which it did not offer to the plan administrator must demonstrate that [the evidence] could not have been submitted . . . at the time the challenged decision was made. Hall, 300 F.3d at 1203. [4] During the claims administration process a claimant must come forward with all evidence which he knows or should know. See Davidson v. Prudential Ins. Co. of Am., 953 F.2d 1093, 1095 (8th Cir.1992). By evidence, we of course mean not just the particular document or testimony that a claimant might offer to the district court, but its substance. In this case, then, it is not enough for Mr. Jewell to demonstrate that he could not have offered to LINA the particular letters in question. The letters were written some thirteen months after this litigation was commenced in state court, so meeting that requirement would be trivial. Rather, he must show that the information contained in those letters was not of a substance known to him, or which should have been known to him, during the administrative process. We agree with the Eighth Circuit that where additional evidence, now believed by the claimant to be necessary to the benefit determination, is created after litigation had begun, [but] was known or should have been known to [the claimant] during the administrative proceedings, the claimant's subsequent proffer of that evidence amounts to nothing more than a last-gasp attempt to quarrel with the administrator's benefit determination, and should not be permitted. Id. (emphasis added). In the first disputed letter, dated February 7, 2005, Dr. Peters states that he had conducted three examinations of Mr. Jewell: on December 9, 1999, November 11, 2002, and January 13, 2003. (Dr. Peters' notes from those examinations were already in the administrative record compiled by LINA.) Mr. Jewell has offered no reason why he could not have solicited this explanatory letter promptly, instead of waiting two years after the last examination to do so. Nor do the contents of the letter seem to be outside the scope of information that was known or should have been known to Mr. Jewell during the administrative process. The only new matter of real substance in the letter is the claim that Mr. Jewell could be diagnosed with complex partial seizure disorder, apparently an organic defect, on the basis of his clinical history alone, and that any type of seizure is never diagnosed on the basis of [an] electroencephalogram. App. 734. But in the same letter Dr. Peters states that this clinical-history method of diagnosing seizures is well-known and even axiomatic in the neurologic community. App. 734. If so, it is information Mr. Jewell should have known, and could have presented to the plan administrator, long before 2005. Dr. Peters' letter, therefore, fails under this prong of the Hall admissibility test. See also Davidson, 953 F.2d at 1095. The second disputed letter, that of Dr. Caster dated February 9, 2005, begins by reprinting verbatim the six paragraphs of a 2002 letter from Dr. Caster which was already in the administrative record. The next paragraph contains information relating to the period up to June 2003, which could have been presented to LINA during Mr. Jewell's administrative appeals. The final paragraph, however, contains a statement that Mr. Jewell had suffered grand mal seizures in March 2003 and July 2004, names the medicines Mr. Jewell was subsequently prescribed specifically to treat seizure activity and other manifestations of his organic mental disorder, and opines that Mr. Jewell's condition continued to be completely disabling up to the time the letter was written. App. 743. The first seizure was reported by Dr. Caster elsewhere in the record in an April 18, 2003 note. The rest, however, was new information concerning events that had not occurred by the time the administrative record was closed; the second seizure and subsequent treatment history could not have been presented to LINA during the claim administration. These portions of Dr. Caster's letter accordingly would survive the second prong of the Hall test.
In an ordinary trial, evidence, even though relevant, may be excluded if its probative value is substantially outweighed . . . by considerations of . . . needless presentation of cumulative evidence. Fed. R.Evid. 403. The trial judge's discretion is wide, because cumulative evidence is excluded in the interests of trial efficiency, time management, and jury comprehension. United States v. Socony-Vacuum Oil Co., 310 U.S. 150, 230, 60 S.Ct. 811, 84 L.Ed. 1129 (1940). Under Hall, however, a judge must refuse admission to any extra-record evidence that is [c]umulative or repetitive. 300 F.3d at 1203. In this context, the concern is not only that cumulative evidence is a waste of time, but also, as discussed above, that all relevant evidence should be developed and presented to the plan administrator as early as possible. Parties may not easily be able to judge at the administrative stage whether evidence will be important or merely cumulative. Accordingly, under Hall, the exclusion of new, cumulative evidence is not merely discretionary, so as to avoid waste of time; it is mandatory, to spur the presentation of all potentially relevant evidence to the administrator. Evidence is cumulative if its probative effect is already achieved by other evidence in the record; that is, if the small increment of probability it adds may not warrant the time spent in introducing it. United States v. Davis, 40 F.3d 1069, 1076 (10th Cir.1994) (internal quotation marks and citation omitted). It is distinguished from corroborating evidence, which buttresses weak or assailable evidence, often by establishing data which refute possible discrediting circumstances. 2 John Henry Wigmore, A Treatise on the Anglo-American System of Evidence in Trials at Common Law § 874, at 235 (1923). New evidence need not be identical to previous evidence to be cumulative, but only of the same general substance, related to the same fact or point, and of little additional probative value. Although large portions of the letters of Dr. Peters and Dr. Caster were cumulative, we cannot conclude that the letters were cumulative in toto. Mr. Jewell's claim of an organic seizure disorder was not established by the evidence in the administrative record to the point of needing no further supportindeed, LINA advances that, without the disputed letters, the court should find that Mr. Jewell failed to prove the existence of an organic disorder at all. The additional grand mal seizure Dr. Caster mentions, as well as the seizure medication, is corroborative evidence. Likewise, we cannot say that the well-known and even axiomatic proposition Dr. Peters invokesthat no type of seizure is ever diagnosed on the basis of an electroencephalogramwas already established in the administrative record. True, the record contained Dr. Peters' 2002 clinical note commenting that it is not demanded that a diagnosis of seizure disorder be documented by an electroencephalogram but it is a helpful certifying finding. App. 293. But Dr. Peters' clinical notes also reveal that in 1999 he ordered an EEG to make a decision about whether this man has complex partial seizures, App. 325, and that in 2002 he did so once more, noting that the electroencephalogram is again of great importance in assisting with differentiation of a primarily functional from a primarily organic circumstance. App. 294. (These EEGs showed no significant abnormalities.) There is obvious tension between Dr. Peters' various statements, and the 2005 letter can be read as resolving this tension by repudiating some of the earlier statementsrejecting the great importance of the EEG and the notion that one could make a decision about complex partial seizure disorder on the basis of an EEG, after the EEGs turned out not to certify[] the doctor's suspicions. The letter reinforces the earlier claim that although an abnormal EEG might be helpful it is not demanded for a diagnosis. In this sense, whatever other questions this letter may raise, we cannot say that it was cumulative of other facts established in the administrative record.
Finally, Hall requires that extra-record evidence presented to a district court not be `simply better evidence than the claimant mustered for the claim review.' 300 F.3d at 1203 (quoting Quesinberry, 987 F.2d at 1027). We have not yet explained what this requirement entails. We think it is clear from the context of Hall that new evidence which is of the same kind as evidence in the administrative record, but simply more persuasive, is not admissible. New evidence must be of a significantly different type than existing evidence to meet the standard of Hall. In Hall, we permitted the introduction of extra-record evidence of the plaintiff's two subsequent surgeries because the probative value of the surgeries was far greater than the probative value of the evidence of Hall's pain in the administrative record, and so the surgeries were of obvious importance . . . to the question of whether she was disabled. 300 F.3d at 1207. The issue of Ms. Hall's disability turned on the extent of her pain, a subjective matter which is not susceptible of objective measurement, and the only information in the administrative record from which answers could be gleaned were the statements of Ms. Hall and her doctors, plus the fact of Ms. Hall's heavy use of pain medication. See Hall v. Unum Life Ins. Co. of Am., No. 97-CV-1828, 1999 WL 33485551, at - (D.Colo. Nov.1, 1999). And on this subjective question, Ms. Hall's credibility was at issue, as her demeanor and manner while giving her testimony suggest[ed] that she was exaggerating her difficulty. Id. at . Against this background, then, her choice to undergo pain-relieving surgeries that removed muscle tissue and her first rib, id. at , constituted verifiable and hard-to-manipulate corroborating evidence of a kind to be found nowhere else in the record. As the district court noted, [i]t is highly unlikely that any person would undergo those procedures unless the pain she experienced was real and unrelenting. Id. The surgeries were more than merely better or more convincing versions of Ms. Hall's testimony and the conclusions of her doctors. The letters at issue in this case do not meet this standard. Above, we observed that Dr. Peters' assertion of the insignificance of the EEG in diagnosing complex partial seizure disorder appears to repudiate some of his earlier statements and actions. It might, if true, be stronger or clearer evidence than Mr. Jewell had previously mustered of what method should be used to diagnose his problems. It is certainly more emphatic. To this extent, however, it is simply better evidenceevidence perhaps more favorable or more persuasive but certainly not different in kindthan what was in the administrative record. The record already contained Dr. Peters' contemporaneous views, and extra-record evidence cannot be used to edit or redo the record. Hall forbids precisely this sort of second bite at the apple. Similarly, although Dr. Peters' letter states more emphatically than did his previous notes that he believes Mr. Jewell's disorder to be organic in nature, this again cannot not meet the Hall standard. As to Dr. Caster's letter, the reference to a 2004 seizure and to Mr. Jewell's seizure medication are not enough to make the letter admissible. There was already evidence in the record of the possibility that Mr. Jewell had had seizures. Dr. Peters reported as early as November 9, 1999 that Mr. Jewell has no history of generalized seizures, but that I am quite concerned that this man has complex partial seizures. App. 323, 325. His physician Dr. Lisa Dunham had recorded on November 6 and November 14, 2002, that Mr. Jewell reports recently having seizure type activity and that he had had episodes suspicious for seizure disorder. App. 180, 182. Dr. Peters wrote on November 11, 2002, that Mr. Jewell reports having episodes where he has found himself where he hadn't known he had been (once in the basement) and thinks that he must have had a seizure. App. 293. Another doctor, Patricia Fodor, wrote in a December 3, 2002 clinic note that Mr. Jewell had a history of seizures. App. 321. Dr. Caster recorded on April 18, 2003 that [i]t is apparent that [Mr. Jewell] had a seizure about a month ago. App. 254. There was in the record, as well, some contradictory evidence: most or all of these seizures appear to have occurred after a May 12, 2002 motorcycle accident which left Mr. Jewell unconscious, with, as Dr. Caster put it, fairly significant physical injuries with evidences [sic] of a head injury. App. 252. Even assuming that the 2004 seizure and use of seizure medication reported in Dr. Caster's disputed letter is evidence that Mr. Jewell's disability, which manifested itself in 1998, was organic in nature, the letter would be simply better evidence of conditions already documented in the record. Finally, Dr. Caster's statements that Mr. Jewell's finances had improved but that his disability continued, to the extent they are relevant, cast no light on the medical provenance of his condition.