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Edelman v. Roofers' Pension Fund

United States District Court, N.D. Illinois, Eastern Division

April 24, 2014




Plaintiff Robert Edelman ("Edelman") brings this action pursuant to Section 502 of the Employee Retirement Income Security Act of 1974 ("ERISA"), 29 U.S.C. ยง 1132, seeking review of the Defendant Roofers' Pension Fund's (the "Fund") decision denying him disability pension benefits. Presently before the Court are Cross-Motions for Summary Judgment pursuant to Rule 56 of the Federal Rules of Civil Procedure [ECF Nos. 15 & 24], and the Fund's Motion to Strike Evidence Outside of the Administrative Record [ECF No. 20]. For the reasons stated herein, the Fund's Motion for Summary Judgment and Motion to Strike are granted. Edelman's Motion for Summary Judgment is denied.


Edelman is fifty-one years old and was employed as a roofer at Sullivan Roofing, Inc. until November 11, 2011. He was a participant in the Fund's multi-employer pension benefit plan (the "Plan"), which provided disability benefits to eligible employees. To qualify for benefits under the Plan, a participant must show that he is "totally and permanently disabled." This requires proof of "a physical or mental condition that permanently prevents [the participant] from engaging in any occupation or performing any work for wage or profit."

On December 12, 2011, Edelman filed an application for disability benefits under the Plan, in which he alleged that he became disabled on November 11, 2011, due to Chronic Obstructive Pulmonary Disease ("COPD") and related complications. In connection with that application, Edelman submitted medical records indicating that, from November 11 to November 14, 2011, he had been hospitalized for fever, wheezing, shortness of breath, and a cough that had persisted for two weeks. While in the hospital, Edelman was examined by Dr. John Kyncl, an internist, and Dr. Beth Ginsberg, a consulting pulmonologist. Both Dr. Kyncl and Dr. Ginsberg noted Edelman's history as a heavy smoker and diagnosed him with COPD exacerbation, atelectasis (collapse or closure) of the lung bases, and a respiratory tract infection. Edelman was prescribed antibiotics, steroids, and nebulizer treatments.

After being discharged, Edelman continued treatment with Dr. Kyncl. At a follow-up examination on December 3, 2011, Edelman reported that he experienced "passing out symptoms" associated with his cough. Dr. Kyncl diagnosed Edelman with COPD and syncope (the medical term for fainting or passing out).

The following day, Edelman was hospitalized again after complaining of increased shortness of breath. Dr. Kyncl ordered a full medical evaluation, noting his concern that Edelman's job as a roofer placed him at an increased likelihood for injury if he were to pass out at work.

Edelman was examined first by Dr. David Bicknell, an electrophysiologist. Dr. Bicknell observed that Edelman had a six to seven year history of cough-induced syncope. Edelman reported to Dr. Bicknell that, although he never had lost consciousness or experienced "blackouts, " he felt dizzy or lightheaded following coughing episodes and sometimes would need to grab onto something or sit down. Edelman stated that, although his condition had improved over the years, he still experienced symptoms several times per month. Dr. Bicknell concluded that Edelman suffered from "significant lung disease, shortness of breath, and dyspnea on exertion, likely related to COPD, in addition to a history of cough-related near syncope and syncope." Dr. Bicknell recommended treatment for Edelman's underlying cough symptoms and a follow-up appointment in three to four weeks.

On the same day, Edelman saw Dr. Robert Koch for a cardiology consultation. Dr. Koch assessed Edelman as having no coronary symptomology, but ordered additional tests to exclude the possibility that his syncope was the result of any carotid or coronary condition.

Edelman also was examined by Dr. Dennis Hoffman, a pulmonologist. Dr. Hoffman noted that Edelman's chest x-ray results revealed no acute pulmonary findings. Edelman's myocardial stress test was normal and a carotid Doppler study did not show any significant plaque or stenosis. Dr. Hoffman assessed Edelman as having COPD and cough-related syncope, although he noted that Edelman's cough was "markedly improved" since his prior hospitalization. Dr. Hoffman recommended bronchodilator treatments by nebulizer, systemic steroids to minimize his cough, and an oxygen tank to ensure that Edelman's oxygen saturation remained at levels between 92 and 95 percent.

Dr. Kyncl's final diagnosis upon discharge was that Edelman suffered from cough-induced syncope and near-syncope, COPD exacerbation with end-stage lung disease, oxygen and steroid dependence, weight gain, and hypercholesterolemia (high levels of cholesterol in the blood). Dr. Kyncl reported that, despite having been treated with various medications, Edelman continued to experience symptoms of shortness of breath and near-syncope.

Edelman saw Dr. Koch for a follow-up appointment on January 4, 2012. In his treatment notes, Dr. Koch indicated that Edelman continued to suffer from shortness of breath, cough, difficulty breathing, and dizziness related to his syncope. Dr. Koch posited that Edelman's syncope was related to bradycardia (an abnormally slow heart rate). He referred Edelman to a cardiologist to determine whether a pacemaker would be required. Dr. Koch also noted that Edelman might be suffering from obstructive sleep apnea. Further testing confirmed that Edelman suffered from clinically significant oxygen desaturations, but that his condition could be treated through the use of oxygen and a Continuous Positive Airway Pressure ("CPAP") titration mask.

On January 16, 2012, Edelman saw Dr. Mehran Jabbarzadeh, a cardiologist, who confirmed that his syncope was not attributable to any cardiac condition. Dr. Jabbarzadeh recommended against the implementation of a pacemaker and instead suggested treatment for Edelman's underlying cough symptoms.

In February 2012, Edelman again saw Dr. Kyncl after being hospitalized for a kidney stone. Dr. Kyncl assessed Edelman's COPD as "severe" and stated that had "strongly encouraged [Edelman] to stop smoking again." Dr. Kyncl further observed that Edelman was "unable to work, " although he did not indicate whether this was a restriction from his current job or from all types of work.

As part of his application for disability benefits, Edelman submitted "attending physician statements" from Dr. Kyncl and Dr. Hoffman. Dr. Kyncl opined in his statement that Edelman suffered from severe functional limitations and was disabled from his current job and all other work. He stated that Edelman was incapable of sedentary activity and that he was not a suitable candidate for trial employment at his own or any other job. Dr. Kyncl noted, however, that Edelman's condition might improve over time and that he would be willing to revisit his assessment at a later date.

Similarly, Dr. Hoffman opined that Edelman was totally disabled from his job. Contrary to Dr. Kyncl's finding, however, Dr. Hoffman found that Edelman would be a suitable candidate for trial employment at a different job. Specifically, he noted that Edelman might be capable of performing non-exertional work.

On January 18, 2012, Dr. Scott Kale, an independent specialist in internal medicine, reviewed Edelman's medical records at the Fund's request. Dr. Kale acknowledged that Edelman's conditions rendered him incapable of working as a roofer, but asserted that the objective medical evidence did not demonstrate an inability to function at any job. Specifically, Dr. Kale noted that the record was silent as to Edelman's functional capacity with the use of oxygen, discontinuation of smoking, and other remedial methods that might be used to treat his underlying pulmonary condition. Dr. Kale concluded that, while Edelman was unable to function in a work environment that required exertion and balance, the medical evidence did not establish that he was incapable of performing sedentary work, where such concerns were not an issue.

Based upon Dr. Kale's review, the Fund determined that Edelman had failed to prove that he was totally and permanently disabled such that he was unable to perform any work for wage or profit. Consequently, on January 30, 2012, the Fund denied Edelman's claim.

On February 8, 2012, Edelman appealed the Fund's benefits determination. Thereafter, he submitted an additional attending physician statement from Dr. Koch. Dr. Koch's statement indicated that Edelman suffered from moderate functional limitations, but was capable of sedentary activity. Although Dr. Koch noted that Edelman's syncope seemed "not recoverable" and that he ...

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