Court Opinion

ID: 9498638
Source: CourtListenerOpinion
Date Created: 2023-08-05 17:23:34.036117+00
Date Added: 2024-06-11T17:58:58.237283
License: Public Domain

BYE, Circuit Judge,
dissenting.
While I agree MetLife did not commit a serious procedural irregularity, I would nevertheless affirm the district under the abuse-of-discretion standard typically applied in ERISA cases. I therefore respectfully dissent.
MetLife abused its discretion when it denied Pralutsky’s claim based on a lack of objective evidence she could not work, because the record also lacks objective evidence she could work. In House v. The Paul Revere Life Ins. Co., 241 F.3d 1045 (8th Cir.2000), the administrator denied long-term disability benefits after citing the treating physician’s failure to provide “any objective medical findings [or] test data” to support a claim of total disability. 241 F.3d at 1047. We determined the administrator abused its discretion because there was “not even a scintilla of evidence refuting the extensive documentation of House’s severe heart disease supplied by the specialist who had treated House for a decade.” Id. at 1048. Like in House, there is no evidence in this record showing Pralutsky could work. Although the independent review performed by Dr. Chou concluded Pralutsky could function adequately to perform her job, Dr. Chou made that finding solely because of the lack of objective evidence in the record to support the severity of Pralutsky’s fibro-myalgia diagnosis. See A.R. at 100 (“Based on the diagnosis of possible fibro-myalgia with significant subjective pain and fatigue, Ms. Pralutsky has a mild impairment. The medical records do not provide any objective medical findings to support more significant impairment.”). Dr. Chou did not refer to any other evidence to refute the opinions of Pralutsky’s treating physicians.
The majority distinguishes House by citing three cases, McGee v. Reliance Standard Life Insurance Co., 360 F.3d 921 (8th *842Cir.2004), Hunt v. Metropolitan Life Insurance Co., 425 F.3d 489 (8th Cir.2005), and Coker v. Metropolitan Life Insurance Co., 281 F.3d 793 (8th Cir.2002). McGee turned on the combination of the lack of objective evidence and the fact McGee’s treating psychiatrist and psychologist changed their diagnoses without explanation. See McGee, 360 F.3d at 923, 924-25 (emphasizing the inconsistent nature of the treating physicians’ medical records). Coker represents a case in which the claimant’s subjective complaints were contradicted by or inconsistent with other record evidence. See Coker, 281 F.3d at 798-99 (noting the record showed Coker had not fainted or experienced a blackout— conditions which allegedly prevented him from working — in several months and concluding “reasonable physicians could disagree on the extent of Coker’s disability”). Finally, I dissented in Hunt for the same reason I am dissenting here, because the plan administrator “abused its discretion in denying benefits based solely on absence of any objective evidence [where] the claimant’s subjective complaints are not contradicted by or inconsistent with other record evidence.” See Hunt, 425 F.3d at 492 (Bye, J., dissenting).
[Fjibromyalgia [is] a common, but elusive and mysterious, disease, much like chronic fatigue syndrome, with which it shares a number of features. Its cause or causes are unknown, there is no cure, and, of greatest importance to disability law, its symptoms are entirely subjective. There are no laboratory tests for the presence or severity of fibromyalgia.
Hawkins v. First Union Corp. Long-Term Disability Plan, 326 F.3d 914, 916 (7th Cir.2003) (quoting Sarchet v. Chater, 78 F.3d 305, 306-07 (7th Cir.1996)). “Objective tests are administered to rule out other diseases, but do not establish the presence or absence of fibromyalgia.” Jordan v. Northrop Grumman Corp. Welfare Benefit Plan, 370 F.3d 869, 872 (9th Cir.2003). In my view, MetLife places too much emphasis on the lack of objective evidence where the issue is the severity of a disability caused by fibromyalgia. In such a case, I believe the plan needs more to deny a claim than a reviewing physician’s opinion based solely upon a lack of objective evidence.
I respectfully dissent.