United States Court of Appeals
For the First Circuit
No. 00-1956
CLYDE N. VLASS,
Plaintiff, Appellee,
v.
RAYTHEON EMPLOYEES DISABILITY TRUST;
RAYTHEON COMPANY; METROPOLITAN
LIFE INSURANCE COMPANY,
Defendants, Appellants.
APPEAL FROM THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF MASSACHUSETTS
[Hon. Joseph L. Tauro, U.S. District Judge]
Before
Torruella, Chief Judge,
Lipez, Circuit Judge,
and Stearns,* District Judge.
Stephen S. Churchill, with whom James F. Kavanaugh, Jr. and Conn
Kavanaugh Rosenthal Peisch & Ford, LLP, were on brief, for appellants.
Daniel C. Finbury, with whom Karen Alexanian Benger and Finbury
& Sullivan, P.C., were on brief, for appellee.
* Of the District of Massachusetts, sitting by designation.
March 26, 2001
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TORRUELLA, Chief Judge. Appellant Metropolitan Life
Insurance Company ("Met Life"), in its capacity as Claims Administrator
of the Raytheon Company Long Term Disability Benefits Plan (the
"Plan"), concluded that appellee Raymond Vlass was no longer eligible
for long-term disability benefits as of September 8, 1996 because he
was no longer "totally disabled." The district court concluded that
Met Life's decision to discontinue benefits was "arbitrary and
capricious," and granted summary judgment to Vlass. Vlass v. Raytheon
Employees Disability Trust, 96 F. Supp. 2d 51 (D. Mass. 2000) (denying
summary judgment for defendants); Vlass v. Raytheon Employees
Disability Trust, Civ. No. 99-10146-JLT (D. Mass., June 6, 2000) (order
granting summary judgment to plaintiff). For the reasons stated below,
we reverse.
BACKGROUND
Vlass began working for appellant Raytheon in October 1985.
In February 1995, he was diagnosed with diabetic neuropathy and chronic
pain. He was deemed "fully disabled" in March 1995, which entitled him
to the receipt of short-term disability benefits.1 After eighteen
1 An employee is eligible for benefits during the first eighteen months
of disability if he is "fully disabled," meaning that "because of a
sickness or injury," he "cannot perform the essential elements and
substantially all of the duties of his . . . job at Raytheon even with
a reasonable accommodation."
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months of receiving disability benefits under the Plan, an employee
must be "totally disabled" to continue receiving benefits.2
On September 8, 1996, Met Life concluded that Vlass was not
"totally disabled" under the terms of the Plan, and accordingly denied
Vlass's request for long-term disability payments. Met Life relied on
four pieces of evidence in making its decision: (1) an August 7, 1996
report by Dr. Elizabeth Buchanan which indicated that Vlass was
"capable of working in a desk job" and could perform certain physical
tasks; (2) a May 24, 1996 independent medical examination performed by
Dr. Robert Levine, which indicated that Vlass suffered some physical
restrictions, but that these physical limitations did not make
employment an impossibility; (3) an independent vocational assessment
undertaken by Crawford Disability Management which found Vlass "capable
of performing skilled employment at a sedentary to light level
capacity;" and (4) a two-day surveillance of Vlass, which demonstrated
his ability to perform at least some physical activity. Based on this
evidence, and considering Vlass's other skills, Met Life concluded that
there was "insufficient medical evidence of a functional impairment
that would interfere with [his] ability to perform any and all
occupations."
2 To be "totally disabled," an employee must be "fully disabled" under
the Plan, and he must be unable to "do any other job for which he . . .
is fit by education, training or experience."
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The district court disagreed. It re-evaluated the two
medical reports on which Met Life had relied and found that they
undermined Met Life's position. Vlass, 96 F. Supp. 2d at 52-53.
Because earlier reports filed by Dr. Buchanan conflicted with the
August 7 report, the district court discounted it as a cursory "block
form" prepared at Met Life's request. Id. at 52. The court read Dr.
Levine's opinion as indicating that Vlass was "totally," if not
necessarily "permanently" disabled as of May 24, 1996. Id. at 53. In
addition, the district court relied heavily on nine reports prepared by
Dr. Richard Levy, a treating neurologist, who repeatedly opined that
Vlass was "totally disabled." The district court thus concluded that
Met Life had relied on "unduly selective, . . . extracted medical
observations," taken out of context. Id. It then discounted the
vocational assessment report and surveillance report as having "little
independent merit" because they were based on "mischaracterizations of
the medical reports." Id. The court concluded that Met Life lacked
"substantial evidence" to support its termination of benefits, and that
the only reasonable conclusion was that Vlass was "totally disabled"
under the terms of the Plan. Id. at 54.
DISCUSSION
Our review of the district court's grant of summary judgment
is de novo. Doyle v. Paul Revere Life Ins. Co., 144 F.3d 181, 183 (1st
Cir. 1998). When a Plan Administrator has discretion to determine an
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applicant's eligibility for benefits, such as here,3 the administrator's
decision must be upheld unless "arbitrary, capricious, or an abuse of
discretion." Id. (quoting Díaz v. Seafarers Int'l Union, 13 F.3d 454,
456 (1st Cir. 1994)). This standard means that the administrator's
decision will be upheld if it is reasoned and "supported by substantial
evidence in the record." Id. at 184 (quoting Associated Fisheries of
Maine, Inc. v. Daley, 127 F.3d 104, 109 (1st Cir. 1997)). Evidence is
"substantial" if it is reasonably sufficient to support a conclusion.
Id. Moreover, the existence of contradictory evidence does not, in
itself, make the administrator's decision arbitrary. Id. (citing
Sprague v. Director, O.W.C.P., 688 F.2d 862, 865-66 (1st Cir. 1982)).
We begin with the evidence supporting Vlass's claim of total
disability. Vlass's most impressive evidence is the opinion of Dr.
Levy, one of his primary treating physicians. At the beginning of
Vlass's treatment, Dr. Levy opined that Vlass was virtually incapable
of any physical activity. A March 9, 1995 evaluation (made soon after
Vlass filed his original disability claim) found that Vlass had 0%
capacity to drive, use public transportation, walk, stand, sit, reach,
3 The Plan provides that "[t]he Plan Administrator, and, with respect
to claims administration, the Claims Administrator, shall have the
exclusive right, in their sole discretion, to interpret the Plan and
decide all matters arising thereunder, including the right to remedy
possible ambiguities, inconsistencies, or omissions. All
determinations of the Plan Administrator and Claims Administrator with
respect to any matter within their assigned responsibilities hereunder
shall be conclusive and binding on all persons unless it can be shown
that the interpretation or determination was arbitrary or capricious."
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grasp and climb. A year later, on March 4, 1996, Levy wrote that
Vlass's "pain interfere[s] with his ability to function at work," and
that his pain medication "could interfere with his cognitive function."
Levy concluded that Vlass remained "disabled from his prior and all
occupations." In September 1996, Levy reasserted that the pain
attributable to the diabetic neuropathy was disabling, but also relied
on Vlass's underlying diabetes and unrelated heart problems as support
for a finding of total disability. Finally, in November, after
viewing the surveillance videotape, Levy acknowledged that "[Vlass] is
capable of doing things . . . from a physical standpoint," but still
concluded that Vlass "remain[ed] permanently disabled."
Vlass also relies, in part, on reports submitted by
Dr. Buchanan and Dr. Levine. In a September 11, 1995 letter, Buchanan
concluded that Vlass's "[in]ability to maintain adequate concentration
and endurance [sufficient for a] regular job" made Vlass "currently
totally disabled." A May 24, 1996 evaluation by Levine indicated that
Vlass remained temporarily disabled at that point, although his
condition was unlikely to be permanent.
Finally, Vlass points to his own reports of subjective
feelings of pain, which have remained consistent throughout the term of
his disability.
We now turn to the evidence supporting Met Life's position.
Although the district court criticized appellant for relying on
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"selective consideration of the medical evidence," our evaluation of
the record indicates that the particular selection made by appellant
was appropriate and reasonable. First, Met Life chose to focus on Dr.
Buchanan's August 7, 1996 evaluation (finding that Vlass was no longer
totally disabled), and placed little weight on her earlier
determinations to the contrary. Buchanan's later reports indicate that
she had changed her opinion of Vlass's disability by September 1996;
moreover, a close look at her evaluations indicates that this shift was
not arbitrary or sudden, but reflected Vlass's ongoing improvement. In
September 1995, Buchanan found that Vlass was "not currently
employable," but that it was "possible that over the next year he
[would] have improvement." Her diagnosis was based not on Vlass's
inability to perform physical tasks, but instead on "his [in]ability to
maintain adequate concentration and endurance." On March 25, 1996,
Buchanan opined that physical exertion continued to cause Vlass pain,
but that he was probably capable of undertaking vocational training for
a desk job. To the extent that Buchanan had previously focused on
Vlass's inability to concentrate as indicative of total disability, her
March letter indicates a shift in her opinion. Furthermore, in August
1996, Buchanan concluded that Vlass could work 5-6 hours in a day,
albeit with frequent changes in position.4 Buchanan also indicated in
4 The district court criticized this report, and discounted it, for
having been entered on a Met Life supplied "block form." Vlass, 91
F. Supp. 2d at 52. It provided no legal or factual reasoning for so
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August that Vlass could perform a host of physical activities, and even
lift (on infrequent occasions) up to 50 pounds. Buchanan's final
report thus directly contradicts Levy's opinion. Moreover, it is
consistent both with Levine's report and her own earlier findings,
which indicated that Vlass's disability was unlikely to be permanent,
had lasted longer than normal for diabetic neuropathy, and was showing
signs of improvement.
The second piece of evidence relied on by Met Life is the
vocational assessment performed by Crawford in August 1996. The
assessment considered the most recent opinions of Drs. Buchanan,
Levine, and Levy.5 Given the functional capacity gleaned from those
opinions, and Vlass's educational and experiential background, Crawford
concluded that "Vlass [was] capable of performing skilled employment as
a sedentary to light level." The report also suggested several
employment alternatives that Vlass might pursue.
The third piece of evidence, the surveillance report, is the
most damning to Vlass. This is not so much because of the physical
doing. In our de novo review of the district court's decision, we
consider the form as we would all other evidence in the record.
5 Although the district court implied that the assessment was based on
the appellants' mischaracterization of the medical evidence, our
reading of the record cannot support such a suggestion. The assessment
did rely on the most recent opinion of each doctor. Given that all of
the doctors agreed that diabetic neuropathy was potentially a temporary
condition, it seems eminently reasonable for Crawford to have focused
on their most recent diagnoses.
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activity Vlass was seen doing while under surveillance: one can imagine
circumstances in which lifting a lawnmower out of a car, carrying trash
bags, or helping dogs into a car are tasks consistent with the Plan
definition of total disability.6 However, the surveillance report does
more than establish Vlass's physical capabilities. It also directly
conflicts with Dr. Levy's opinion as to these capabilities. Levy had
originally opined that Vlass had virtually no ability to perform
physical tasks, which would indeed make him totally disabled. More
recent opinions by Levy, although they did not focus on the previously
diagnosed physical incapacity, did not suggest any change in this
diagnosis. The surveillance indicated that Vlass's physical
limitations in no way matched Levy's original (unchanged) diagnosis.
Moreover, to the extent that Levy's later opinions shifted from a
determination of pure physical incapacity to one of diminished
6 Vlass filed an affidavit suggesting that the physical activity in
question was consistent with his total disability because his doctors
had counseled him to exercise. Vlass filed the affidavit, however, on
February 28, 2000, months after Met Life had announced its decision to
discontinue benefits. We have not yet decided whether the record in a
case such as this should only include items available to the
administrator at the time of its decision. Doe v. Travelers Ins. Co.,
167 F.3d 53, 57 (1st Cir. 1999) (assuming arguendo such a limitation);
see also Chandler v. Raytheon Employees Disability Trust, 53 F. Supp.
2d 84, 85 n.1 (D. Mass. 1999), aff'd 229 F.3d 1133 (2000) (holding that
the record is limited in this manner); McLaughlin v. Reynolds, 886 F.
Supp. 902, 906 (D. Me. 1995) (refusing to supplement the record when
review is under an "arbitrary and capricious" standard, as it is here).
In this case, as we explain, whether we consider the affidavit as part
of the record or not is of no consequence, given that the surveillance
effectively impeaches Dr. Levy's opinion, which provides almost all of
Vlass's supporting evidence.
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cognitive function, they were directly contradicted by the opinion of
Dr. Buchanan, and partially contradicted by that of Dr. Levine.
It is the responsibility of the Administrator to weigh
conflicting evidence. Guarino v. Metropolitan Life Ins. Co., 915 F.
Supp. 435, 445 (D. Mass. 1995). Dr. Levy's original diagnosis that
Vlass was entirely incapacitated was gainsaid by the diagnoses of other
doctors and the surveillance report. Different doctors gave different
opinions as to the effect of Vlass's pain on his ability to function in
a normal workplace without physical demands. And the vocational
assessment indicated that Vlass was capable of performing adequately in
other occupations despite his pain. Given this conflicting evidence,
we cannot say that Met Life was arbitrary and capricious in its
decision to discontinue Vlass's benefits. We must therefore reverse
the decision of the district court.
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