NOT RECOMMENDED FOR PUBLICATION
File Name: 16a0495n.06
No. 16-3043
UNITED STATES COURT OF APPEALS
FOR THE SIXTH CIRCUIT
FILED
CHRISTINA SAUNDERS, ) Aug 23, 2016
) DEBORAH S. HUNT, Clerk
Plaintiff-Appellant, )
)
ON APPEAL FROM THE
v. )
UNITED STATES DISTRICT
)
COURT FOR THE
PROCTER & GAMBLE HEALTH AND LONG- )
SOUTHERN DISTRICT OF
TERM DISABILITY BENEFIT PLAN, )
OHIO
)
Defendant-Appellee. )
)
BEFORE: BATCHELDER and KETHLEDGE, Circuit Judges; LEVY, District Judge*
ALICE M. BATCHELDER, Circuit Judge. Former Procter & Gamble (P&G)
employee Christina Saunders has an unexplained chronic pain condition. From April 2012 until
July 2013, Saunders received disability benefits from the P&G Health and Long-Term Disability
Benefit Plan (the Plan) for a claimed “total disability.” But when the Plan switched third-party
administrators, the new administrator concluded that Saunders had not furnished objective
medical evidence establishing her disability. Accordingly, it terminated her payments. Saunders
lost her administrative appeal and at summary judgment below. We AFFIRM.
I. FACTS AND PROCEDURAL HISTORY
Saunders’s health problems began in April 2012, when she underwent surgery for a
ruptured ectopic pregnancy. Although her surgeon originally scheduled her to return to work on
*
The Honorable Judith E. Levy, United States District Judge for the Eastern District of Michigan, sitting by
designation.
No. 16-3043
Saunders v. Procter & Gamble Health and Long-Term Disability Plan
April 30, 2012, Saunders began experiencing additional, unexplained pain and did not go back to
work. She sought a diagnosis and effective treatment for over a year, to no avail. No doctor
officially extended Saunders’s work restrictions, but the Plan’s third-party administrator, Reed
Group, continually approved her disability benefits.
In July 2013, the Plan switched third-party administrators to GENEX Services, Inc.
GENEX contacted Saunders’s doctors to confirm her eligibility for benefits. On August 1, 2013,
Dr. Scott Long, a physical therapist who treated Saunders from June 2012 through July 2013,
indicated that there were no medical restrictions on Saunders’s ability to work “at this time.”1
Subsequent follow-up with Saunders and with her other doctors’ offices failed to reveal
any work restrictions on file. Without a doctor’s note stating that Saunders could not work, the
GENEX case manager recommended terminating Saunders’s disability benefits.
The Plan sent Saunders a letter, dated September 17, 2013, informing her that her
benefits were terminated effective July 20, 2013. The letter detailed GENEX’s failed attempts to
obtain from Saunders’s physicians “objective medical documentation” that Saunders was
“unable to work.” From this the Plan concluded that “there is insufficient objective medical
information to support your claim for disability as defined by the Plan.” The letter included the
Plan’s definition of total disability, stated the requirement that Saunders “furnish . . . additional
objective medical records, clinical notes or testing results to indicate that [she was] disabled as
1
In this same response, Dr. Long erroneously stated that Saunders was “[c]urrently working.” This error,
Saunders suggests, indicates that Dr. Long must have gotten her records confused with another patient’s.
Appellant’s Br. at 41. However, Saunders herself submitted records from a July 2013 visit with Dr. Long in which
Dr. Long noted that Saunders “[w]orks as a PR manager.” Dr. Long may have been mistaken about Saunders’s
work status, but this is enough to refute Saunders’s speculation that he was referring to someone else.
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Saunders v. Procter & Gamble Health and Long-Term Disability Plan
defined by the Plan,” and outlined her right to appeal the decision to the Plan’s Board of
Trustees.2
Saunders appealed pro se. She stated that “[t]he information from Dr. Long was
inconsistent with the restrictions imposed by [her] treating physician, Dr. Kelly,” who
“specifically state[d]” that Saunders was “unable to work.” Saunders attached the records from
her recent visits with Dr. Kelly, as well as records from a psychiatrist (Dr. Kelso), her
acupuncturist, and Dr. Long.
These new records contained evidence of pain, but little to indicate how that pain restricts
Saunders’s abilities. For example, Dr. Kelly—who saw Saunders in August, October, and
November 2013—diagnosed Saunders with “[a]typical pain syndrome, of uncertain etiology,”
based on “tender[ness] to light/medium touch throughout the right hemithorax.” He concluded
that “because of the severity of her pain, and relative refractoriness to treatment, . . . she is
unable to remain mentally focused enough to perform any form of work activities.” But Dr.
Kelly’s examination revealed that Saunders’s “[m]entation [was] clear,” and she had “[g]ood
recent and remote recall” with “[n]ormal affect.” Her muscle tone and gait were normal. Dr.
Kelly also noted that Saunders was “able to take care of” her two-year-old child.
Similarly, Dr. Kelso’s intake exam in September 2013 was unremarkable, although
Saunders’s thought process was “[n]ormal but pr[e]occupied with her experience of pain.” At a
subsequent visit, Dr. Kelso indicated that Saunders appeared “[a]nxious and exhibit[ed] pain
behaviors such as wincing and moaning.” Saunders’s acupuncturist stated that Saunders’s “pain
level is so extreme that it is hazardous to her physical function and mental-emotional being.”
2
Contrary to Saunders’s assertions, therefore, this letter did inform Saunders what type of objective
evidence was necessary to support her claim.
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Saunders v. Procter & Gamble Health and Long-Term Disability Plan
Records from her visits with Dr. Long added nothing to these pain assessments, nor did they
indicate a consistent diagnosis. For example, in June 2013 Dr. Long diagnosed Saunders with
myalgia, myositis, and chronic pain disorder, stating, “I do not see objective data to support a
diagnosis of CRPS (complex regional pain syndrome).” But less than a month later, his
diagnosis had changed to complex regional pain syndrome. None of these records indicated any
physical restrictions on Saunders’s activities.
Before the Board decided Saunders’s appeal, GENEX sought an opinion from
independent reviewer Dr. Philip Marion. Dr. Marion acknowledged the lack of “specific clinical
documentation that [Saunders’s] condition ha[d] changed,” but he nonetheless concluded that
“there is not objective medical information documented to substantiate an inability to work in
any capacity, including sedentary, at P&G or with another employer.” The Board subsequently
denied Saunders’s appeal on January 22, 2014.
Saunders then sued the Plan in federal district court, bringing a single claim for benefits
under ERISA. See 29 U.S.C. § 1132(a). The parties filed cross-motions for judgment as a
matter of law on the administrative record. The district court granted the Plan’s motion and
denied Saunders’s motion. Saunders then filed this appeal.
II. ANALYSIS
We review the Board’s decision using the same standard of review as the district court
was required to use. Whitaker v. Hartford Life & Accidental Ins. Co., 404 F.3d 947, 949 (6th
Cir. 2005). Here, the parties dispute whether the district court should have reviewed the Board’s
decision for abuse of discretion or de novo. We need not resolve that debate because, even under
de novo review, Saunders did not meet her burden of presenting objective evidence to support a
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No. 16-3043
Saunders v. Procter & Gamble Health and Long-Term Disability Plan
finding that she is disabled within the terms of the Plan. See Javery v. Lucent Techs., Inc. Long
Term Disability Plan for Mgmt. or LBA Emps., 741 F.3d 686, 700 (6th Cir. 2014) (“To succeed
in [a] claim for disability benefits under ERISA, Plaintiff must prove by a preponderance of the
evidence that he was ‘disabled,’ as that term is defined in the Plan.”).
The Plan defines “total disability” as
a mental or physical condition resulting from an illness or injury which is
generally considered totally disabling by the medical profession and for which the
Participant is receiving regular recognized treatment by a qualified medical
professional. Usually, total disability involves a condition of such severity as to
require care in a hospital or restriction to the immediate confines of the home.
In her briefing, Saunders does not directly argue that she is disabled according to this definition.
She identifies her condition as “complex regional pain syndrome,” but does not specifically
explain how this condition disables her. For example, she does not dispute her ability to drive or
perform other activities of daily living.3 See Appellant’s Br. at 44. Saunders does cite several
forms of objective evidence to support her diagnosis: (1) the results of “several objective tests”
that “demonstrated a physical disorder”; (2) her doctors’ findings regarding her pain; (3) the
medications she was prescribed; and (4) her doctors’ multiple referrals to neurologists and pain
specialists. Id. at 39–40. Otherwise, her arguments merely attack the Board’s reasoning rather
than its ultimate decision.
Accepting that Saunders suffers from unexplained, severe, and constant pain, we still
must assess whether Saunders has submitted objective evidence that she is disabled as defined by
the Plan. In other words, her objective evidence must show that her pain is “considered totally
disabling” and that she “is receiving regular recognized treatment” for it. Since Saunders’s pain
3
In contrast to the Plan’s definition of total disability, the Plan defines “partial disability” to include
impairments that do not prevent a person “from performing useful tasks, utilizing public or private transportation, or
taking part in social or business activities outside the home.” Saunders’s claim has always been for total disability.
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No. 16-3043
Saunders v. Procter & Gamble Health and Long-Term Disability Plan
admittedly does not restrict her to her home environment, her task of demonstrating total
disability is that much harder. Notably, the Plan does not define “total disability” according to
whether Saunders can perform her job.
The primary evidence supporting Saunders’s claim that she is totally disabled is Dr.
Kelly’s assessment that she is unable to focus enough to work. Saunders also presents plenty of
evidence that she has a chronic pain condition. But nothing in the record indicates that this pain
condition restricts her daily activities, and several of her treating physicians have specifically
indicated that Saunders can work. Dr. Kelly’s lone opinion that Saunders cannot work does not
establish her disability in light of the other evidence in the administrative record.
Most prominent in the Board’s decision is Dr. Long’s statement on August 1, 2013, that
Saunders had work capacity and no medical restrictions. But Dr. Long is hardly alone in his
assessment. Nine months prior, Saunders’s then-treating physician, Dr. Katheryn Jadeed, stated,
“[G]iven the available info, I do not have any work restrictions for her, now or in the past . . . .”
And around the same time Dr. Jason Heil, a neurologist, indicated that he was “probably not the
best person to be filling out disability papers” since he could not identify “a clear neurological
cause for her pain.”4
Saunders has no objective evidence with which to counter these opinions. For example,
she presents no evidence of any physical restrictions, such as on the length of time she may sit or
stand, or on the amount of weight she may lift. See, e.g., Koning v. United of Omaha Life Ins.
4
Saunders criticizes the Plan’s reference to Dr. Jadeed’s and Dr. Heil’s statements, arguing that they are
irrelevant because the Board did not rely on them and because they were made several months before the time frame
at issue in this case. Reply Br. at 3–4. Yet on a de novo review, we consider all evidence in the administrative
record without deference to the Board’s decision. Wilkins v. Baptist Healthcare Sys., Inc., 150 F.3d 609, 616 (6th
Cir. 1998) (“When conducting a de novo review, the district court must take a ‘fresh look’ at the administrative
record . . . .”). And given Saunders’s adamancy that her condition has not changed, her insistence that earlier
assessments are irrelevant rings hollow.
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No. 16-3043
Saunders v. Procter & Gamble Health and Long-Term Disability Plan
Co., 627 F. App’x 425, 434 (6th Cir. 2015) (finding a claimant disabled who was “unable to sit,
stand and/or bend for any significant period of time,” had restricted range of motion, chronic
headaches, and other physical incapacities). Nor is Saunders taking any medications with
debilitating side effects. See, e.g., Godmar v. Hewlett-Packard Co., 631 F. App’x 397, 407 (6th
Cir. 2015) (holding that a denial of benefits was arbitrary and capricious because, among other
reasons, the plaintiff’s prescription pain medications prevented him from driving, a requirement
of his job). Overall, the record does not support a finding that Saunders’s pain condition renders
her totally disabled.
The record accordingly supports Dr. Marion’s conclusion that, “from a physical medicine
and rehabilitation/pain management perspective, there remains no specific medical information
to substantiate [Saunders’s] inability to work with or without restrictions from [July 20, 2013,]
through [the] present.” Dr. Marion emphasized Saunders’s “consistently normal”
musculoskeletal and neurological examinations. He contrasted Dr. Kelly’s opinion that Saunders
“is unable to remain mentally focused enough to” work with Dr. Long’s conclusion that she can.
He also noted that Dr. Kelly undermined his own opinion with the results of his physical
examination: “Mentation clear. Good recent and remote recall. Normal affect.” That the Plan
previously awarded benefits and her condition has not changed did not alter this conclusion.5
Saunders is therefore left with the argument that, because her condition has not changed,
the Board erred in terminating her benefits after awarding them for over a year. But following
Saunders’s logic, no disability plan would ever be able to terminate benefits that had erroneously
been approved at some prior time. As Saunders stated, ironically, in her opening brief, “The best
5
For the same reasons—because the records from Saunders’s own doctors supported Dr. Marion’s
conclusion—the Board was not required to conduct an independent medical examination of Saunders.
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Saunders v. Procter & Gamble Health and Long-Term Disability Plan
that can be said of [GENEX’s] review of Saunders’[s] claim is that Saunders was never disabled
in the first place[.]” Appellant’s Br. at 37. Saunders actually did not present sufficient evidence
to support an award of disability benefits for over a year before her benefits were terminated.
The Plan was not required to continue paying out benefits to Saunders indefinitely without
objective evidence to support her disability simply because a prior third-party administrator had
done so and her non-disabling condition had not changed.
III. CONCLUSION
Because Saunders has not shown by a preponderance of the evidence that she is totally
disabled as defined by the Plan, we AFFIRM the judgment of the district court.
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