Opinion ID: 3062257
Heading Depth: 3
Heading Rank: 1

Heading: Treatment of SSA Disability Determination

Text: Like the plan administrator in Glenn, Aetna “ignored the [SSA’s] finding [that Ms. Liebel could do no work] in concluding that [she] could in fact do sedentary work.” Glenn, 554 U.S. at 118. Glenn noted this could “suggest[] [a] procedural unreasonableness” that would be “an important factor in its own right.” Id. Aetna - 16 - responds to this concern by arguing that disability under the plan was not contingent upon or related to SSA disability, and cites an unpublished pre-Glenn decision stating that SSA determinations cannot be dispositively equated with their counterparts under ERISA. That broad-brush argument is not very helpful. While concededly not formally equivalent, the SSA all-occupation disability standard and the plan’s any-reasonable-occupation disability standard overlap to such a degree that contrary determinations at least call for some reconciliation—as Glenn indicates. Aetna and the district court are more on the mark in distinguishing SSA and ERISA here more specifically in light of the special rule of deference in SSA cases for treating-physician opinions, which does not apply under ERISA,13 and in noting that the SSA determination, made nearly two years before Aetna’s final decision,14 covered an earlier period implicating medical evidence (including treating opinions) different from the evidence directly relevant to Aetna’s decision. Prominent medical records underlying Aetna’s final decision, including examinations carried out in the relevant period specifically for disability purposes by Dr. Carl and Dr. Johnson, did not exist when the SSA issued its decision. Nor did the multiple medical-record reviews, FCE, and home assessment report ordered in conjunction with Aetna’s 13 The Supreme Court established this significant distinction in Black & Decker Disability Plan v. Nord, 538 U.S. 822, 825, 834 (2003). 14 SSA issued its decision on August 21, 2010. Aetna’s initial decision terminating benefits on February 9, 2012, was upheld by a final decision on July 3, 2012. - 17 - reassessment of LTD benefits in light of the any-reasonable-occupation standard. Earlier, when Aetna assisted Ms. Liebel in obtaining SSA benefits (and granted her twenty-four months’ disability benefits itself under the past-occupation standard), no medical opinions indicating a sedentary work capacity then existed to contrast with Ms. Liebel’s evidence from her earlier treating sources. Under the circumstances, the discrepancy between the SSA determination, deferring to old treating opinions, and Aetna’s later decision, based on a greatly augmented medical record unskewed by special deference to evidence provided by Ms. Liebel’s physicians, does not bespeak arbitrary and capricious conduct under the standard governing our review. B. Skewed and Incomplete Assessment of the Evidence Ms. Liebel complains that Aetna relied on its own experts rather than on the more detailed and specific findings of her treating physicians. This complaint is meritless. First of all, as already noted, a claimant’s own treating physicians are not entitled to particular weight in the ERISA context. Second, the IME and FCE obtained by Aetna—from independent sources—were, if anything, more detailed and specific as to the critical findings regarding functional capacity and limitation than were Ms. Liebel’s treating sources who offered any opinions as to disability. Ms. Liebel contends Aetna’s physicians failed to consider her failed back syndrome, radiculopathy, fibromyalgia, and narcotic use. We reject this contention as well. Failed back syndrome refers to chronic back pain following surgery, which was obviously considered by every physician reviewing her claim of back pain. - 18 - Radiculopathy associated with Ms. Liebel’s spine problems was noted sporadically throughout the medical records and nowhere was it found to be a condition rendering her unable to work. The physicians reviewing these records for functional impairment did not have to specifically refer to this reported symptom to demonstrate that they considered it insufficient to support Ms. Liebel’s disability claim. Fibromyalgia is a different matter. It would not be a symptom of Ms. Liebel’s well-documented spine problems, naturally reported and considered in conjunction with the rest. Ms. Liebel complains that Aetna’s physicians did not discuss this condition and that it was not mentioned in Aetna’s decisions denying LTD benefits. But no fault may properly be attributed to Aetna in this regard. The condition was first diagnosed by Dr. Mackey (and Dr. Mackey only) in August 2011, but his records were not provided to Aetna until Ms. Liebel’s appeal from the initial denial of LTD benefits was pending. Aetna promptly provided these records to pain-management specialist Dr. Rubin, who reviewed them along with the rest of the evidence in the case and reaffirmed the previously determined functional capacity underlying Aetna’s initial decision. He did not specifically refer to the condition. But given the fact that none of Ms. Liebel’s doctors—not Dr. Mackey himself and not one of the doctors who had opined that Ms. Liebel was disabled for other reasons—stated that fibromyalgia caused or contributed to an inability to work, the absence of a specific reference to this condition in Dr. Rubin’s report or Aetna’s final - 19 - decision does not demonstrate any impropriety warranting disturbance of the denial of LTD benefits here. The effect of Ms. Liebel’s narcotic use on her ability to work was expressly considered by Aetna’s physicians. As recounted in the evidentiary summary above, after Dr. Carl raised the question, Dr. VanderPutten engaged in a peer-to-peer consultation with Dr. Johnson to confirm that Ms. Liebel’s pain medication would not interfere with work. In a related vein, Ms. Liebel complains that doctors used by Aetna were not provided with various items of evidence. But, again, that was largely a function of the sequence in which evidence was developed by and/or provided to Aetna. For example, it is hardly a cogent criticism that Dr. Mackey’s records, which are noted prominently in this regard, were not considered in the course of medical reviews and examinations conducted long before Ms. Liebel provided Aetna with those records. As a general matter, the evidentiary summary shows Aetna proceeded in a reasonable fashion to develop the record relevant to its determination of disability for the period in question. As new evidence arose or was submitted, Aetna made an effort to supply that evidence to its own and to Ms. Liebel’s doctors for review and comment. Ms. Liebel complains in particular that a letter she drafted about her condition and related events was not considered. See App. at 514-21. But that letter does not contain material information not already sufficiently represented in the record. - 20 - In sum, Aetna gave Ms. Liebel a full and fair opportunity to present her claim, conducted a procedurally reasonable review of the material evidence, and reached a decision supported by substantial evidence. The judgment of the district court upholding the administrator’s decision is affirmed. Entered for the Court Stephen H. Anderson