Until 2006, plaintiff worked as an engineer for Lockheed Martin Corporation, where he participated in the company's Long Term Disability Group Insurance Plan ("the Plan").(Doc. No. 24-1 at 1291; see also Administrative Record [AR], Doc. No. 16 at 1192-1216.1) Under the Plan, a claimant is disabled if, "because of Injury or Sickness, [the claimant is] unable to perform each and every material duty of [the claimant's] regular occupation." (AR at 1200.) After LINA pays twenty-four months of LTD benefits, a claimant qualifies as disabled under the Plan only if the claimant's "Injury or Sickness makes [the claimant] unable to perform all the material duties of any occupation for which [the claimant] may reasonably become qualified based on education, training or experience." (Id. (emphasis added).) The claimant must provide "satisfactory proof" of disability before benefits are paid and must further provide "continued proof of [the] Disability" for benefits to continue. (Id. at 1203.)
Benefits terminate under the Plan when the claimant earns more than 80% of the claimant's covered earnings,2 when the claimant returns to active service, when LINA determines that the claimant is no longer disabled, when the maximum benefit period ends, or when the claimant dies. (AR at 1203.) The Plan also contains a mental illness, alcoholism, and drug abuse limitation. Once LINA has paid twenty-four monthly benefits, a claimant will not receive any further benefits if his or her disability is caused by or contributed to by, among others, anxiety disorders, depressive disorders, or mental illness. (Id.)
Under the Plan terms, the plan administrator—Lockheed Martin—appointed LINA as the named fiduciary for adjudicating claims and appeals for benefits under the Plan. (AR at 1213.) Further, the plan administrator has given LINA "the authority, in its discretion, tointerpret the terms of the Plan, to decide questions of eligibility for coverage or benefits under the Plan, and to make any related findings of fact." (Id.)
B. Claim Denial and the 2010 Lawsuit Plaintiff's claim for LTD benefits under the Plan first came before this Court in 2010. In a memorandum opinion and order denying LINA's motion for judgment on the administrative record and granting in part plaintiff's motion for same, the Court provided a detailed account of plaintiff's treatment and receipt of LTD benefits. The Court reproduces relevant portions of its opinion below:
On March 24, 2006, Neubert suffered a stroke and was unable to continue working for Lockheed. (AR 3, 15.) On April 10, 2006, Neubert suffered a second stroke. (AR 15, 313.) On July 25, 2006, Neubert tried to return to work part-time without success due to self-reported stress, anxiety, an inability to concentrate or multitask, memory problems, fine motor difficulty and sensitivity to noise. (AR 345, 403.)
On July 31, 2006, Neubert applied for disability benefits from the Plan. (AR 962.)
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On November 7, 2006, LINA approved Neubert for LTD benefits retroactive to October 10, 2006. (AR 230.) Neubert continued to see a neurologist after he received LTD benefits. (AR 312.)
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On April 28, 2008, LINA sent Neubert a letter notifying him that it had begun a review of his file to determine his continued eligibility to receive LTD benefits after October 10, 2008, the date upon which the definition of disability applicable to his claims would change. (AR180-81.) LINA requested updated information from Neubert and his treating physicians and indicated that upon receipt of the information, it would compare his restrictions and limitations to his training, education, and work experience. (Id.)
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On May 15, 2008, Neubert completed a Disability Questionnaire, stating that the primary physical or mental conditions preventing him from working were an inability to focus, burning pain in his arm and leg, fatigue and lack of stamina, neck pain, stress, and memory problems, all because of "permanent stroke damage." (AR 843-47.) He reported the following regular activities: a half hour of cooking a day, one to two hours of shopping once a week, fifteen minutes of laundry twice a month, one to two hours of gardening or yard work twice a week,walking on the treadmill or lifting weights three to four times a week, and watching television three to four hours a day. (Id.) He stated that he did not engage in outside activities and was mostly house bound with the exception of walking a half-mile for twenty minutes four times a week. (Id.)
On September 24, 2008, Neubert's primary care physician, Dr. Elizabeth M. Salay, completed an Attending Physician's Statement of Disability ("PSD"). (AR 824.) Dr. Salay reported that she began treating Neubert in March 2006 and that she saw him four times a year. (Id.) The PSD noted a diagnosis of hemiparesis, vertebral artery dissection, and history of stroke without residual deficits. (Id.) The reported subjective symptoms were weakness and memory disturbance. (Id.) The PSD noted that Neubert's progress was unchanged and that, "he has had maximal therapy for his medical illness." (Id.) In the prognosis section, Dr. Salay indicated that Neubert was totally disabled from any work due to impaired fine motor skills, memory and word finding problems, and balance problems. (Id.) She stated that she did not expect his condition to improve in the future, nor did she expect that he would be capable of working any job in the future because the symptoms from his previous stroke were "not likely to resolve." (Id.) Dr. Salay also noted that Neubert was not a suitable candidate for medical rehabilitation, that no job modifications would enable him to work with his impairment, and she recommended against vocational counseling and/or retraining. (Id.)
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On November 19, 2008, Neubert saw Dr. Dipti Shah, his new primary care physician. (AR 401.) Dr. Shah's examination notes indicate that Neubert reported residual symptoms from his previous strokes, including weakness, burning in his right arm and leg, fine motor skill difficulties, trouble concentrating, anxiety, limited cognitive function and memory problems. (AR 403.) He opined that Neubert was permanently disabled. (Id.) Dr. Shah's primary diagnosis of Neubert was cerebrovascular accident with residual cognitive deficit. (AR 404.)
On November 20, 2008, Dr. Shah submitted a PSD form (AR 736-37) to LINA, which was later updated by a Physical Ability Assessment form ("PAA") (AR 703-04). Dr. Shah indicated in the PSD that he took over treatment of Neubert from Dr. Salay on November 19, 2008. (AR 736.) The PSD noted diagnoses of stroke, Type 2 diabetes mellitus, hemiparesis, hyperlipidemia and hypertension. (Id.) Dr. Shah reported Neubert's subjective symptoms to be residual weakness, burning in his right leg and arm, and memory problems. (Id.) The PSD also noted: "patient has cognitive function." (Id.) The response to the objective findings section of the PSD was marked, "NA." (Id.) Finally, in the remarks section, Dr. Shah noted: "patient is totally disabled." (AR 737.)
Dr. Shah's PAA, which updated the PSD, indicated that Neubert can frequently sit, reach, grasp, lift 10 to 20 lbs., carry 10 lbs., push 25 lbs., pull 25 lbs., and can occasionally stand, walk, use fine manipulation, lift 21 to 100 lbs.,carry 11 to 100 lbs., climb stairs, stoop, kneel, crouch, crawl, and has difficulty with fine motor activities, balancing, working extended shifts, using his feet for foot controls, and cannot work around machinery. (AR 707-08.) Dr. Shah noted that "patient has more problems with cognitive ability than physical ability because of stoke." (Id.)
On January 12, 2009, at the request of LINA, Neubert underwent an independent neuropsychological evaluation with a neuropsychologist, Dr. Thomas Swales. (AR 712-25.) Dr. Swales interviewed Neubert and reviewed his laboratory reports and medical records, including the treatment notes and physician statements from his doctors. (Id.) Neubert described to Dr. Swales that he suffered from burning pain in his right leg, an inability to feel temperature, neck pain, fatigue, difficulty focusing, stress, anxiety, and an inability to multitask. (AR 714.) The report stated that, during the interview, Neubert described himself as "a workaholic" and described his daily activities since leaving his job due to his strokes, including mowing his lawn, gardening, having dinner with friends or family once a month, and spending most of his time playing "World of Warcraft." (AR 713-15.) According to Dr. Swales's report, "He reportedly shoots a button over and over in a repetitive action," and Neubert told him, "I talk to people on a headset. I get a sense of accomplishment." (AR 715.)
Dr. Swales administered a battery of tests to evaluate Neubert's cognitive function. Of the intelligence testing, Dr. Swales noted that Neubert scored in the ninth percentile on the coding subtest, which he characterized as Neubert's "worst performance, in the borderline range, [...] which reflects
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