Opinion ID: 175293
Heading Depth: 2
Heading Rank: 1

Heading: Cytec's decision to deny benefits

Text: As a claimant under § 1132(a)(1)(B), Anderson bore the initial burden of demonstrating . . . that [the] denial of benefits under an ERISA plan [was] arbitrary and capricious. Perdue v. Burger King Corp., 7 F.3d 1251, 1254 n. 9 (5th Cir.1993). We conclude that he failed to do so. The evidence Anderson presented to Cytec and to Cytec's third-party benefits administrator while they were considering his STDP application and subsequent appeals was, as the district court correctly characterized it, mixed. Broadspire's two independent experts reviewed evidence supporting a diagnosis of PTSD that had been aggravated by the trauma of Anderson's experience in the aftermath of Hurricane Katrina. That evidence consisted of both self-reported symptoms and the observations of Anderson's treating physician, nurse, and therapist. The reviewing experts did not question the PTSD diagnosis or downplay the significance of Anderson's self-reported symptoms of depression, persistent nightmares, flashbacks, hallucinations (which he reported during early visits but repeatedly denied in most subsequent visits), and anxiety, or the observation that Anderson's concentration was impaired. Also in the administrative record, however, is evidence that Anderson had been able to work while managing his PTSD symptoms, pre-Katrina, through medication and therapy; statements by Anderson that he could not return to New Orleans and to his job because he could not find suitable housing for his wife; a nearly four-week gap between Anderson's evacuation to Atlanta and his first date of treatment (during which time Anderson was without his medication); some evidence that Anderson's situation improved at least marginally after he began treatment; and numerous treatment notes from Anderson's therapist describing his judgment and insight as fair and his thought processes and memory as intact. In light of these facts, it was not unreasonable for Cytec to request an initial review by an independent expert or to require Anderson to support his claim with regular updates. Nor was it unreasonable to ask for some objective showing that Anderson's PTSD-related disability prevented him from performing his job. Cytec also did not abuse its discretion by relying on the independent experts' opinion that Anderson had not offered objective clinical proof showing the functional effect of his PTSD. Like the experts in Corry v. Liberty Life Assurance Company of Boston , the experts on which Cytec relied took into consideration Anderson's subjective complaints and the conclusions of his doctors. See 499 F.3d at 401. But, also as in Corry, the experts here were not required to accept the opinion of Anderson's treating physician that his symptoms rendered him incapable of performing his job. See id. This was neither arbitrary nor an abuse of discretion: the administrator, under the established standard of review that restricts the courts, was not obliged to accept the opinion of [Anderson's] physicians. In this `battle of the experts' the administrator is vested with discretion to choose one side over the other. Id. ; see also Simoneaux v. Cont'l Cas. Co., 101 Fed.Appx. 10, 12 (5th Cir.2004) (Continental was neither irrational nor arbitrary in failing to give overriding weight to the treating physician's statement that [the claimant] was totally disabled, a generalized statement not supported by objective medical findings.). Anderson's case does bear some factual similarity to Martin v. SBC Disability Income Plan, an unpublished decision in which this court reversed the district court's judgment in favor of a plan administrator. 257 Fed.Appx. 751 (5th Cir. 2007). The plan administrator had rejected the claim of a benefits applicant disabled by psychiatric problems, citing the applicant's failure to submit objective clinical findings to support [her] inability to perform [her] essential job duties and an alleged absence of findings from a formal mental status examination. Id. at 754. In Martin, however, the applicant's doctor had administered a Minnesota Multiphasic Personality Inventory-II test before diagnosing the applicant and described the applicant as appearing barely able to function, and only able to perform the most basic activities of daily living; the applicant was also hospitalized for three weeks after a suicide attempt. Id. at 752-53. Unlike the applicant in Martin, Anderson was able to function day-to-day with the help of therapy and prescription drugs; he was also helping to care for his wheelchair-bound wife. We do not find a lack of rational connection between the facts and the denial decision here. The independent experts did not misread Anderson's record or dismiss his complaints out of hand. Like the experts in Corry, they simply found it insufficient to support a total disability. Both denial letters from Broadspire made it clear that Anderson needed to submit objective clinical findings to support his claim of total disability. That request for additional information was not unjustified. A plan administrator does not abuse its discretion by making a reasonable request for some objective verification of the functional limitations imposed by a medical or psychological condition, especially when the effects of that condition are not readily ascertainable from treatment and therapy notesas in this case and analogous cases involving, for example, chronic fatigue syndrome. Accord Williams v. Aetna Life Ins. Co., 509 F.3d 317, 322 (7th Cir.2007) (A distinction exists . . . between the amount of fatigue or pain an individual experiences, which. . . is entirely subjective, and how much an individual's degree of pain or fatigue limits his functional capabilities, which can be objectively measured.); Boardman v. Prudential Ins. Co. of Am., 337 F.3d 9, 16-17 n. 5 (1st Cir.2003) (finding an insurance company not unreasonable when it was willing to accept that [the claimant] suffered from the illnesses she reported to her doctors. . . . [but] wanted objective evidence that these illnesses rendered her unable to work.). Without some objective measurement of Anderson's functional limitations, Cytec had no way to determine whether his concentration was impaired to the point that he could not perform his job or any similar occupation which his Employer may provide. Between the time his STDP benefits were first cut off and the time he was firedat which point he was no longer eligible for STDP benefitsAnderson did not submit cognitive testing results or any clinical documentation other than group therapy notes. He also did not have Dr. Saldivia or another treating physician reaffirm to Cytec that he continued to be unable to work, even though the record indicates that he knew Cytec would require monthly updates on his status, as the STDP plan allowed it to do. Anderson has not argued that he could not have obtained the kind of tests for functional cognitive disability that the denial letters made clear he would need. In his brief, Anderson asserts that he attempted as best he could to comply with Cytec's stated appeal requirements. He explains that he was under the apparent understanding and belief that his treating physicians were providing information to Cytec supporting his ongoing mental disability, but concedes that they were not. While this is highly unfortunate, Cytec is not to blame for the lack of documentation it was within its rights to request. [7] The second question is whether Cytec's decision is supported by substantial evidence i.e., more than a scintilla, less than a preponderance of relevant evidence. Corry, 499 F.3d at 397-98. As explained above, the evidence from the period when Anderson was eligible for STDP benefits is mixed: it does not compel either a finding of total disability or a finding that Anderson could perform his work in spite of his disability. Additionally, Cytec relied on analyses by two independent experts, both of whom opined that the evidence did not, without more, support a finding of total disability. Here, as in Corry, the opinions of Cytec's experts, each of whom are specialists and qualified experts in fields specifically related to [Anderson's] symptoms, constitute substantial evidence supporting Cytec's STDP determination. Corry, 499 F.3d at 402. Finally, Anderson argues that Cytec should not have relied on two experts who did not hold M.D. degrees and who did not personally examine him. He provides no support for the proposition that, in an ERISA case that turns on a patient's mental status, an expert evaluation by a Ph.D. or Psy.D. psychologist is less probative than that of an M.D. psychiatrist. The argument is baseless; courts regularly consider the expert testimony of psychologists, and parties often introduce competency reports and mental health assessments prepared by both a psychiatrist and a psychologist. See, e.g., United States v. Palmer, 507 F.3d 300, 301-02 (5th Cir. 2007); Mata v. Johnson, 210 F.3d 324, 328 (5th Cir.2000). That the independent experts reviewed Anderson's records but did not examine him personally also does not invalidate or call into question their conclusions. In Black & Decker Disability Plan v. Nord, the Supreme Court held that plan administrators are not required to give special deference to the opinions of treating physicians. 538 U.S. 822, 831, 123 S.Ct. 1965, 155 L.Ed.2d 1034 (2003); see also Vercher v. Alexander & Alexander, Inc., 379 F.3d 222, 233 (5th Cir.2004). Under these circumstances, Cytec's decision that Anderson was not totally disabled was not arbitrary and capricious and was supported by substantial evidence.