Opinion ID: 2790080
Heading Depth: 3
Heading Rank: 1

Heading: Substantial Evidence for Limitation

Text: The Mental Disorder Limitation applies if Mental Disorders cause[] or contribute[] to the claimant's disability. Mental Disorder, in turn, is defined as: [A]ny mental, emotional, behavioral, psychological, personality, cognitive, mood or stress-related abnormality, disorder, disturbance, dysfunction or syndrome, regardless of cause . . . or the presence of physical symptoms. In this case, there is substantial evidence that Dutkewych's mental illness, whether or not related to chronic Lyme disease, contributed to his disability as of June 2011.7 The contrary argument is flatly contradicted by his own admissions and the numerous medical opinions from both his own and other doctors. Reports from Dutkewych's own treating physicians establish that he had ongoing mental disabilities, in addition to his physical symptoms, as of the period around June 2011. In a report dated March 28, 2011, Dr. Statlender stated that Dutkewych continues to experience a range of both physical and emotional 7 The parties dispute whether it is Standard's burden to prove that Dutkewych was subject to the limited pay period, or Dutkewych's burden to prove that he was not. Under traditional insurance law principles, once an insured has met [his] initial burden of proving that a claim falls within the grant of coverage, the burden shifts to the insurer to show that an exclusion defeats coverage. Gent v. CUNA Mut. Ins. Soc'y, 611 F.3d 79, 83 (1st Cir. 2010). We noted the difficulty of characterizing a similar mental illness provision as an exclusion or as a limitation on the continuation of benefits in Gent. Id. Here, as in Gent, we need not decide how to allocate the burden of proof since Standard would prevail regardless. See id. -24- symptoms, including ongoing symptoms of anxiety and depression, and diagnosed him with Mood Disorder Due to Neuroborreliosis (central nervous system Lyme disease), with Depressive Features. Likewise, in a report dated August 21, 2011, Dr. Ruiz listed cognitive limitations, depression, and anxiety amongst Dutkewych's persistent symptoms. Finally, in Dutkewych's 2011 neuropsychological evaluation, Dr. Shea wrote that Dutkewych's presenting symptoms included cognitive limitations, anxiety and depression that impacts his mood, and severe fatigue. Testing revealed that Dutkewych suffers from significant cognitive deficits, which are consistent with neurological Lyme disease that has gone untreated for a prolonged period of time, and which significantly impacts his professional career and has restricted his ability to continue working at his designated position. In addition, Dutkewych's own letter to Standard on April 27, 2011, highlighted the mental disorders with which he struggled. He stated that his symptoms fell into four primary areas: extreme fatigue and lethargy, intense joint pain, cognitive issues and depression/anxiety. To date all of these issues persist. Of all of the symptom areas, Dutkewych wrote, the cognitive issues are often the most troubling to me. Like his physicians, Dutkewych ascribed his physical symptoms, cognitive issues, and mental health issues to Lyme disease. -25- Dutkewych maintains that these symptoms of chronic Lyme disease cannot form the basis for the Mental Disorder Limitation. He argues that [e]xperiencing depression derivative of a physical condition and being disabled by a psychiatric disorder are two very different animals. He stresses that his treating physicians did not attribute his disability to his psychiatric conditions in June 2011. The Mental Disorder Limitation, however, is broadly written. The Limitation applies if a mental disorder, regardless of its own cause, caused or contributed to a claimant's disability. It is clear from Dutkewych's own evidence that mental disorders, regardless of cause, continue to contribute to his disability. This is sufficient to trigger the Mental Disorder Limitation based on the facts of this case and the wording of this Plan. In Schwob v. Standard Insurance Co., 248 F. App'x 22 (10th Cir. 2007), the Tenth Circuit reached the same conclusion when faced with an almost identical limitation. At best, the claimant's evidence indicated that a mental disorder, such as depression, could be secondary to Lyme disease, which she may or may not have. Id. at 28. The Tenth Circuit concluded that, even so, Standard was reasonable in applying the Mental Disorder Limitation. Id. at 29. The court explained: [E]ven if we accept the premise that [the claimant]'s mental disorder is secondary to a -26- physical illness, this would not prevent Standard from applying the mental-disorder limitation to her claim. The Plan's definition of mental disorder includes mental disorders 'regardless of cause.' As long as [the claimant]'s mental disorder contributed to her disability, the limitation would apply even if the mental disorder resulted from Lyme disease or another physical disease. Id. The same logic applies to the case at hand.