Vlass v. Raytheon Employees Disability Trust

• Decision Date: 05 February 2001
• Docket Number: No. 00-1956,00-1956
• Citation: 244 F.3d 27
• Parties: (1st Cir. 2001) CLYDE N. VLASS, Plaintiff, Appellee, v. RAYTHEON EMPLOYEES DISABILITY TRUST; RAYTHEON COMPANY; METROPOLITAN LIFE INSURANCE COMPANY, Defendants, Appellants. Heard
• Court: U.S. Court of Appeals — First Circuit

Page 27

244 F.3d 27 (1st Cir. 2001)

CLYDE N. VLASS, Plaintiff, Appellee, v. RAYTHEON EMPLOYEES DISABILITY TRUST; RAYTHEON COMPANY; METROPOLITAN LIFE INSURANCE COMPANY, Defendants, Appellants.

No. 00-1956

United States Court of Appeals For the First Circuit

Heard February 5, 2001

Decided March 26, 2001

APPEAL FROM THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF MASSACHUSETTS

[Hon. Joseph L. Tauro, U.S. 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.

Before Torruella, Chief Judge, Lipez, Circuit Judge, and Stearns,^* District Judge.

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 Septembera8, 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 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."

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 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 Daz 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, 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 "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,...