Atkins v. Bert Bell/Pete Rozelle NFL Player Ret. Plan

• Decision Date: 11 September 2012
• Docket Number: No. 11–51202.,11–51202.
• Parties: Gene ATKINS, Plaintiff–Appellant, v. BERT BELL/PETE ROZELLE NFL PLAYER RETIREMENT PLAN; The NFL Supplemental Disability Plan; Management Trustees of the NFL Player Retirement Plan, Defendants–Appellees.
• Court: U.S. Court of Appeals — Fifth Circuit

694 F.3d 557

Gene ATKINS, Plaintiff–Appellant,

v.BERT BELL/PETE ROZELLE NFL PLAYER RETIREMENT PLAN; The NFL Supplemental Disability Plan; Management Trustees of the NFL Player Retirement Plan, Defendants–Appellees.

No. 11–51202.

United States Court of Appeals,Fifth Circuit.

Sept. 11, 2012.

Jeffrey E. Dahl (argued), San Antonio, TX, for Plaintiff–Appellant.

Lars Calvin Golumbic (argued), Joshua Joseph Coleman, Groom Law Group, Chartered, Washington, DC, John R. Breihan, McGinnis, Lochridge & Kilgore, L.L.P., Austin, TX, for Defendants–Appellees.

Appeal from the United States District Court for the Western District of Texas.

Before REAVLEY, SMITH and CLEMENT, Circuit Judges.

EDITH BROWN CLEMENT, Circuit Judge:

Gene Atkins, a former player for the New Orleans Saints and Miami Dolphins National Football League (“NFL”) teams, filed suit seeking more generous disability benefits under the Bert Bell/Pete Rozelle NFL Player Retirement Plan (the “Plan”). The district court granted summary judgment in favor of the Plan, affirming its benefits determinations that Atkins is only eligible for “Inactive” player disability benefits instead of the more generous “Football Degenerative” disability benefits he seeks. Atkins challenges the standard of review employed by the district court and the substantive merits of the benefits determinations. We AFFIRM.

FACTS AND PROCEEDINGS

1. The Bert Bell/Pete Rozelle NFL Player Retirement Plan

The Plan is an employee, multi-employer welfare benefit plan governed by the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. §§ 1002(3)(2)(A), 1002(37)(A), and the Labor Management Relations Act (“LMRA”), 29 U.S.C. §§ 141 et seq., also known as the “Taft–Hartley Act.” As required by statute, the Plan is jointly administered by employee (NFL players) and employer (NFL club owners) representatives. 29 U.S.C. § 186(c)(5)(B). Three player representatives are appointed by the NFL Players Association (“NFLPA”) and three club ownership representatives are appointed by the NFL Management Committee (“NFLMC”) (collectively the “Retirement Board” or the “Board”). The Retirement Board, which meets quarterly, is the “named fiduciary” of the Plan and is responsible for administering the Plan. The Plan grants the Board “full and absolute discretion, authority and power” to interpret the Plan and decide claims for benefits. The Plan also provides that, in exercising its discretionary powers, the Retirement Board “will have the broadest discretion permissible under ERISA and any other applicable laws.”

The Plan provides monthly total and permanent (“T&P”) disability benefits to eligible NFL players. Retired players such as Atkins may be eligible for benefits categorized as either “Football Degenerative” or “Inactive.” A player may qualify for “Football Degenerative” T&P benefits if his disability “arises out of League football activities.” A player may qualify for “Inactive” T&P benefits if his disability “arises from other than League football activities.” Football Degenerative benefits are significantly greater than Inactive benefits. After an initial benefits determination, a player's benefit category may be altered only upon a showing of “changed circumstances” based on “clear and convincing” evidence.

A player's claim for T&P disability benefits is first reviewed by the Disability Initial Claims Committee (“DICC”). The DICC is composed of two members, one appointed by the NFLPA and one by the NFLMC. If the two members of the DICC are deadlocked, the claim is deemed denied. Decisions of the DICC are appealable to the Retirement Board. If the members of the Retirement Board are deadlocked, they may vote to submit the matter to a Medical Advisory Physician (“MAP”) for a determination regarding medical issues. In the event of a deadlock concerning eligibility or entitlement to benefits, the Retirement Board may vote to refer the dispute for final and binding arbitration.

2. Atkins' Initial Claim for Disability Benefits

Gene Atkins played professional football from 1987 until 1996, spending the majority of his time playing with the New Orleans Saints and the last several years with the Miami Dolphins. During his career he was well-recognized for his aggressive, hard-hitting play as a defensive back and he sustained a number of injuries resulting from on-field collisions.

In December 2004, Atkins submitted an application for disability benefits to the Plan administrators, claiming T&P disability as a result of three conditions stemming from his football career. The conditions Atkins listed were: (1) right shoulder ailments, including movement limitations and chronic pain; (2) chronic constant pain in his neck that radiated through his arms and hands, affecting his ability to drive, sense of touch, and ability to hold objects; and (3) depression and mood issues that limited his ability to function, due in part to his constant physical pain and inability to work. Atkins reported that he worked at a Target store for five months but had to stop because of pain, headaches, and difficulties in dealing with people.

Following receipt of his disability application, Plan administrators sent Atkins to two neutral physicians for evaluation, Keith Kesler (“Kesler”), a psychiatrist, and Tarek Souryal (“Souryal”), an orthopedist. Kesler reported that Atkins suffered from poor cognitive function, which he stated “cannot be determined” as to whether it resulted from football. Kesler also reported that Atkins had chronic pain and headaches, as well as possible neurologic defects, all of which were the result of football. Kesler found Atkins totally disabled as a result of his impairments. In contrast, Souryal reported that Atkins suffered from neck and shoulder impairments which were the result of football, but the impairments did not render him totally disabled.

Atkins' application and Kesler's and Souryal's reports were reviewed by the DICC on June 7, 2005. The two members deadlocked and the claim was deemed denied. Atkins appealed the decision to the Retirement Board as provided for under the Plan. The Retirement Board scheduled Atkins for two additional examinations by neutral physicians, orthopedist J. Bryan Williamson (“Williamson”) and neurologist Raymond Martin (“Martin”).

Williamson concluded that Atkins suffered from long-term neck and right shoulder impairments due to football-related injuries. However, Williamson also concluded Atkins was not totally disabled. Martin found that Atkins was totally disabled due to a combination of problems. He concluded Atkins' physical impairments were a result of football, but his memory problems were of an unknown source. He suggested that formal neuropsychological testing would have to be done to determine the etiology of Atkins' problems with intellect, memory, and mental status.

With the benefit of Williamson's and Martin's reports, the Retirement Board considered Atkins' claim at its next scheduled quarterly meeting held on October 20, 2005. The Retirement Board deadlocked and referred the matter to a MAP. The Plan defines a MAP as a board-certified orthopedic physician or a physician in another medical discipline as designated by the NFLPA and NFLMC. A MAP has the authority to decide only those medical issues submitted by the Retirement Board. Atkins was referred to Thomas Boll (“Boll”), a Ph.D. clinical neuropsychologist, for an examination. The referral states that Boll was to evaluate the impaired body parts identified by Atkins, specifically his “head ache, numbness, shoulders, neck [and] hands.”

Boll concluded that Atkins suffered from illiteracy and borderline mental ability, neither of which resulted from football. He further concluded that Atkins suffered from depression, which could not be determined to be the result of football, and pain which was the result of football. Specifically, Boll stated that “Atkins' difficulties appear to be primarily in the psychiatric arena and there is no evidence of a neurological disorder” and further concluded that Atkins' limitations are primarily the product of his “extremely limited” literacy that places him “at a substantial disadvantage with regard to a wide variety of occupational pursuits outside of those specifically related to the athletic field.” Boll concluded that Atkins was totally disabled and suggested psychological and psychiatric intervention to increase his ability to function adequately on a day-to-day basis.

After receiving Boll's report, the Retirement Board considered Atkins' appeal in a meeting conducted on February 9, 2006. The minutes of the meeting reflect a decision to approve Inactive T&P disability benefits, retroactively effective to June 1, 2005. In a letter dated February 23, 2006, the Plan director explained the award of Inactive T&P benefits was for psychiatric impairments which did not “arise out of League football activities” under the language of the Plan. Atkins was informed his T&P disability benefits were therefore not categorized as Football Degenerative.

3. Atkins' Multiple Requests for Reconsideration

Atkins submitted another appeal to the Retirement Board by way of a letter dated March 3, 2006. In the letter, Atkins requested reclassification into the Football Degenerative category, stating that he believed his disability resulted from football activities. However, Atkins did not submit any additional evidence or argument in support of his reclassification request. On May 10, 2006, the Retirement Board tabled its consideration of the appeal to allow additional time for Atkins to be evaluated by a neutral physician.

Atkins was examined by neurologist Robert W. Gilbert, Jr. (“Gilbert”) on June 12, 2006. Gilbert found that Atkins suffered from the impairments of right shoulder pain with limited motion, cervical spasms with neck and arm pain, and carpal tunnel syndrome. Gilbert concluded all of the impairments resulted from football, but also concluded that Atkins was...