Opinion ID: 4167896
Heading Depth: 3
Heading Rank: 2

Heading: Orzechowski Becomes Disabled

Text: Talana Orzechowski worked at Boeing until February 27, 2009. In 2004, she was diagnosed with fibromyalgia and chronic fatigue syndrome. In January and February 2009, Orzechowski began suffering memory problems and increases in fatigue. Orzechowski suffered from a number of serious symptoms of largely unknown cause, including fatigue, loss of motor control, spinal and joint pain, and loss of cognitive functioning. Some of the symptoms appeared to be psychological in nature, including depression, obsessive compulsions, and suicidal thoughts. Other symptoms were more typical of physical illness, such as profuse sweating, muscle and nerve pains, and lung weakness. She also suffered from a wide range of other physical ailments, including fatigue, headaches, tiredness, extended periods of sleeping, asthma, decreasing muscle tone, and nausea. Orzechowski saw numerous doctors to attempt to diagnose and address these issues. In February 2009, Orzechowski applied for short-term disability benefits under Boeing’s employee benefits plan, which Aetna approved for the maximum duration of six months (26 weeks), until July 28, 2009. Aetna then completed a long-term disability ORZECHOWSKI V. BOEING CO. NON-UNION 7 LONG-TERM DISABILITY PLAN review, and approved long-term disability benefits under the “own occupation” definition of disability effective July 29, 2009. This benefits period would run through July 28, 2011. In 2010, Aetna informed Orzechowski that the definition of disability would change from the “own occupation” to “any reasonable occupation” standard after her current benefit period ended. Aetna requested documentation to support her disability claim under the new standard. Aetna received substantial medical records prepared by Orzechowski’s physicians. It then sent Orzechowski’s file to two physicians to review, a psychiatrist and a neurologist. Neither examined her. The psychiatrist agreed with Orzechowski’s physicians that she could perform no work, including “even simple, routine and repetitive work duties reliably and safely.” His conclusion was based on her psychiatric impairments, and the report noted that “potential physical impairment [was] outside the scope of [his] expertise.” The neurologist acknowledged her extensive diagnoses, including “chronic fatigue, mood disorder, adrenal disorder and inflammatory polyarthropathy,” and her symptoms of “fatigue, depression, memory impairment . . . loss of motor strength [and] deteriorating motor and cognitive skills,” but he, however, concluded she had “[n]o functional limitations” on her ability to work and that she “can likely perform own occupation (light)” with “[n]o limitations or restrictions.” Based on these reports, Aetna denied Orzechowski’s claim. In a response to Aetna’s reviewers, Orzechowski’s own treating physician wrote a letter formally disagreeing: 8 ORZECHOWSKI V. BOEING CO. NON-UNION LONG-TERM DISABILITY PLAN It is concerning to me that a simple common sense review of the multiple historic findings detailed thoroughly in my monthly hour long evaluations of the patient would make it quite clear that this patient is not able to perform any level of work. She has not been able to care for herself without assistance and is unable to even administer her own medication .... And while no specific neurological cause had been discovered for her condition, he noted that “if the patient has no neurological disorder, why has she remained so neurologically and functionally impaired? It is clear in this case that the absence of evidence does not constitute evidence of absence.” Aetna asked its outside reviewing neurologist to examine her file again. After a peer-to-peer conference with her doctors, he again concluded that Orzechowski’s symptoms must be psychiatric in origin because there is no definite evidence of a neurologic diagnosis. In July 2011, Aetna terminated payment of Orzechowski’s long-term disability benefits based on its determination that her disability is caused by a mental condition, more specifically depressive disorder and mood disorder, which falls under the Plan’s 24month mental health limitation. Aetna determined she was physically capable of “light work.” Orzechowski’s attorney appealed Aetna’s denial and provided additional documentation showing that “Orzechowski’s depression and anxiety symptoms are clearly secondary to her medical conditions.” Aetna referred ORZECHOWSKI V. BOEING CO. NON-UNION 9 LONG-TERM DISABILITY PLAN Orzechowski’s evidence to yet a third reviewer. He found that Ms. Orzechowski had “no functional impairment” that would preclude her ability to perform any reasonable occupation. Orzechowski’s primary physician sent another letter in disagreement and pointed out the problems with attempting to diagnose Orzechowski’s medical condition based only on a paper review and suggested Aetna examine the patient in person: [B]asing your assessment solely on the “provided documentation” is as silly as trying to assess the quality of a meal at a restaurant by reading the menu’s description without actually tasting the dish. He also attacked Aetna’s attempts to evaluate the severity of the chronic fatigue Orzechowski experienced, through objective evidence, when, by definition, there is no objective evidence of chronic fatigue. In June 2012, Aetna upheld its decision to terminate Orzechowski’s long-term disability benefits, stating that “there was insufficient medical evidence to support [Orzechowski’s] continued disability for the period of July 29, 2011, and beyond based upon any physical conditions.”