Opinion ID: 16667
Heading Depth: 3
Heading Rank: 3

Heading: sufficiency of the evidence

Text: The district court reviewed all the evidence considered by the Committee in denying Whitaker’s claim for LTD benefits. Viewing the evidence in the light most favorable to Whitaker, the court found that the Committee’s conclusion that Whitaker was not “totally disabled” reflected a reasonable and impartial judgment, and that there is a rational connection between the facts known to or determined by the Committee and its decision to deny Whitaker continuing LTD benefits. Whitaker now appeals the district court’s finding. The evidence that the Committee and the district court considered included reports and medical records from doctors 8 Whitaker had consulted, an independent medical evaluation and a functional capacity evaluation arranged by the Plan, and a surveillance report and video purportedly showing Whitaker engaged in physical activity.2 These records were independently evaluated by a registered nurse and a doctor employed by the Plan, and were provided to each member of the Committee. Upon reviewing the medical records and reports considered by the Committee in denying Whitaker’s request for LTD benefits, we agree with the district court that there was sufficient evidence for the Committee to conclude that Whitaker was not “totally disabled.” The medical reports disclosed that Whitaker complained of back pain and had a limping gait, but an MRI of the lumbar spine and lumbar spine x-rays were normal, and her physician found no reflex, motor, or sensory changes. An orthopedic surgeon that Whitaker consulted found some “mild degeneration,” performed a course of epidural steroid injections, and gave her a mild anti-inflammatory. Whitaker tested negative on the Faber’s and the Patrick’s, two orthopedic tests used to determine whether a problem exists in the hip or lower back 2 Whitaker claims the Committee’s use of a “surreptitious video tape” supports her argument that the Committee’s decision was arbitrary and capricious. The only legal support Whitaker offers for her proposition, however, is the court’s decision in Rigby v. Bayer Corp., 933 F. Supp. 628, 633-34 (E.D. Tex. 1996) (finding abuse of discretion where plan administrator relied exclusively on a surveillance video, disregarding the only medical assessment found in the record). We find Rigby inapplicable in the instant case in light of the Committee’s evaluation of Whitaker’s medical records, especially since the district court was “unimpressed” by the videotape but still found sufficient evidence to support the Committee’s denial of benefits. 9 regions. A discogram revealed that Whitaker’s pain provocation was only mildly positive and her disc contrast pattern was normal, although the physician performing the discogram felt she may be a candidate for lumbar facet injections or a lumbar fusion to permanently relieve her pain.3 In addition to considering the medical records from doctors Whitaker had consulted, the Committee also based its decision on an independent medical examination and functional analysis of Whitaker. Although tests performed in the functional analysis indicated Whitaker had poor overall strength, the physical therapist performing the test found the validity of the results “equivocal” because of Whitaker’s “submaximal effort” and “symptom exaggeration.” This report, together with the medical reports and investigation reports, were reviewed by both the registered nurse and the doctor employed by the Plan. They both determined that the evidence demonstrated Whitaker was not disabled from doing any job and recommended the Committee deny her LTD benefits. Based on the medical records and reports reviewed by the Committee in its decision to deny Whitaker LTD benefits, we agree with the district court that the Committee’s conclusion was 3 Although Whitaker alleges that the Committee’s decision was arbitrary and capricious because the Committee “set the LTD Committee hearing knowing Whitaker was to undergo back surgery that would likely clarify and confirm her disabling condition,” she provides no factual or legal support for her proposition, and we see no need to impose a duty for the Committee to delay consideration in light of the significant medical evidence it reviewed. 10 reasonable and that there exists a rational connection between the facts known to the Committee and its decision to deny benefits. As the district court found in reviewing the record and as the facts stated above make clear, substantial evidence exists to support the decision that Whitaker was not “totally disabled.” The Committee’s decision therefore did not represent an abuse of discretion.4 Whitaker contends that the evidence the Committee considered was insufficient, however, because the Committee did not consult a vocational expert in reaching its decision. Whitaker contends the lack of any evidence in the administrative record suggesting specific jobs Whitaker was able to perform resulted in an arbitrary and capricious decision. We disagree. The authority upon which Whitaker relies for this proposition reveals the weakness of her argument. In Duhon v. Texaco, Inc., 15 F.3d 1302 (5th Cir. 1994), we held the absence of vocational rehabilitation evidence does not require a finding of abuse of discretion. See id. at 1309. Rather, “we will allow 4 We find no merit in Whitaker’s argument that the Committee’s decision was an abuse of discretion because the Plan Administrator had previously awarded her twelve months of LTD benefits. The Plan provides that a participant unable to perform his or her own occupation is entitled to LTD benefits for a maximum of twelve months, but to receive benefits after twelve months a participant must be unable to engage in any occupation for which he or she is, or could become, reasonably suited by education, experience, or training. It is only this second element that Whitaker now challenges. See McKenzie v. Gen. Tel. Co., 41 F.3d 1310, 1317-18 (9th Cir. 1994) (finding no abuse of discretion where LTD benefits plan terminated benefits under an “any occupation” standard after awarding eighteen months of benefits under an “own occupation” standard). 11 the reviewing court to decide, on a case-by-case basis, whether under the particular facts the plan administrator abused his discretion by not obtaining the opinion of a vocational rehabilitation expert.” Id.; see Thibodeaux v. Continental Cas. Ins. Co., 138 F.3d 593, 596 (5th Cir. 1998). The Duhon court found that, given the medical evidence presented, “the plan administrator could competently determine disability without vocational testimony.” Duhon, 15 F.3d at 1309; see McKenzie, 41 F.3d at 1317 (“[C]onsideration of vocational evidence is unnecessary where the evidence in the administrative record supports the conclusion that the claimant does not have an impairment which would prevent him from performing some identifiable job.”). Under the facts of the instant case, we hold that it was not an abuse of discretion for the Committee to evaluate only the medical evidence and deny Whitaker’s request without consulting a vocational expert. As found by the district court, substantial evidence exists in the record to support the decision that Whitaker was not “totally disabled.” While other circumstances where the medical evidence is more equivocal may require the testimony of a vocational expert, see Rigby, 933 F. Supp. at 63334 (holding the denial of benefits an abuse of discretion where the plan administrator disregarded the only medical assessment and had not consulted a vocational expert), the absence of such testimony here did not make the Committee’s decision an abuse of 12 discretion.5