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Watson v. Reliance Standard Life Insurance Co.

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

November 14, 2017

CHERYL WATSON, Plaintiff,
v.
RELIANCE STANDARD LIFE INSURANCE COMPANY, Defendant.

          OPINION AND ORDER

          SARA L. ELLIS United States District Judge

         Plaintiff Cheryl Watson worked as a research study coordinator at the Hektoen Institute (“Hektoen”), through which she obtained long-term disability insurance from Defendant Reliance Standard Life Insurance Company (“Reliance Standard”). In March 2013, after complaining to her doctors for a number of years of depression, fatigue, cognitive issues, and pain, Watson took a leave of absence from and then left her job. Watson sought long-term disability benefits from Reliance Standard, but Reliance Standard denied her claim based on its finding that Watson was not disabled under the policy. Watson then brought this suit challenging Reliance Standard's denial of her claim under Section 502(a)(1)(B) of the Employee Retirement Income Security Act (“ERISA”), 29 U.S.C. § 1132. In June 2015, the Court remanded the case to the claims administrator to conduct additional examinations and proceedings. Upon further review of her claim, Reliance Standard granted Watson benefits under the plan's twenty-four month mental or nervous disorder limitation, terminating benefits as of June 10, 2015. Watson now returns to the Court seeking all long-term disability benefits allegedly due from June 10, 2015 through the present and beyond, pre-judgment interest, costs, and attorneys' fees. The parties have agreed to proceed with a trial on the papers in accordance with Federal Rule of Civil Procedure 52, and the Court heard oral argument on September 5, 2017. See, e.g., Hess v. Hartford Life & Accident Ins. Co., 274 F.3d 456, 461 (7th Cir. 2001) (trial on the papers is an appropriate procedure for resolving ERISA disputes); Baxter v. Sun Life Assurance Co. of Canada, 833 F.Supp.2d 833, 835 (N.D. Ill. 2011) (court would conduct “paper trial in which the Court reviews the record, and, in accordance with Rule 52 of the Federal Rules of Civil Procedure, enters findings of fact and conclusions of law”). Having considered all the evidence in the record, the Court finds that the preponderance of the evidence demonstrates that Watson remains totally disabled due to her physical limitations and thus entitled to continued long-term disability benefits.

         FACTS[1]

         I. Watson's Medical History

         Watson, born in 1959, has a master's degree from the University of Chicago and is a licensed clinical social worker. She worked at Hektoen as the WIHS/MACS Neuropsych & Mental Health Study Coordinator from 2002 until March 31, 2013. In this position, she was responsible for coordinating various mental health, behavioral, and neuropsychiatric substudies. Watson's job responsibilities included, among others, submitting regulatory documents and annual progress reports, designing and implementing study procedures, identifying study participants, scheduling participants for study visits and providing study incentives, training research staff, maintaining study tracking databases, ensuring high quality data collection, and conducting research interviews.

         In late 2007, Watson began complaining to her doctors of fatigue and numbness. On November 4, 2007, she underwent a brain MRI, which showed mild scattered signal abnormality within deep white matter. Watson also had an MRI of her cervical spine on November 6, which revealed a small central disc herniation with mild central spinal stenosis. On November 19, a visual evoked response test rendered an abnormal visual evoked response, noted as consistent with a demyelinating process. On December 6, Watson had a lumbar puncture, with normal results. On December 31, Watson saw Dr. Afif Hentati, a neurologist, who concluded that Watson was suffering from “[n]umbness of unknown cause” and suggested that she might have either small vessel disease or demyelinating disease. AR 495. When Watson returned to Dr. Hentati in May 2008, complaining of “more pronounced muscle weakness, ” “profound fatigue, ” “[b]rain fog forgetfulness, difficulty retrieving words, and lack of concentration, ” Dr. Hentati's impression was that Watson was suffering from “[f]atigue and numbness, ” with “a definite element of sleep disturbance and possibly sleep apnea.” AR 492-93. Dr. Hentati referred Watson for a sleep evaluation. A July 9 polysomnogram showed approximately 33.5 arousals per hour of unknown cause but was otherwise “[e]ssentially normal.” AR 563.

         Over the next year, Watson continued complaining to her doctors of chest pressure, foot pain, and sinus congestion, among other issues. On June 18, 2010, when she saw Dr. Hentati, Watson complained of fatigue, joint pain, forgetfulness, difficulty concentrating, and tingling in her legs. Watson admitted she felt stable overall however, and Dr. Hentati's examination returned normal physical and neurological results. Watson returned to Dr. Hentati on October 17, with Dr. Hentati noting that her evening and variable work schedule qualified her for shift work sleep disorder. In November, Watson also began complaining of neck pain, for which she received a muscle relaxant. A year later, in November 2011, Watson complained of lower back pain, which she aggravated when planting spring bulbs, and was prescribed a painkiller.

         In December 2011, Watson complained to her primary care physician, Dr. Rhonda Stein, of chronic fatigue and waking up several times throughout the night. Watson returned to Dr. Hentati on February 13, 2012, also complaining of fatigue, lack of energy, and difficulty sleeping. On June 22, she had another brain MRI, which again showed mild scattered signal abnormality within deep white matter but was considered stable. Watson saw Dr. Hentati again on August 10, complaining that she was more fatigued and that her work performance had diminished as a result. Dr. Hentati noted impressions of “[f]atigue of unknown cause” and “[b]rain MRI abnormalities [that] remain stable but [are] of unknown cause.” AR 448. He suggested that Watson obtain a second opinion from the Mayo Clinic. When Watson visited Dr. Stein on October 4, she continued complaining of fatigue and reported “[m]aking a lot of mistakes at work, ” being “[v]ery discouraged about fatigue and [the] lack of [a] specific diagnosis, ” and having “[c]oncern[s] about cognition.” AR 444. Dr. Stein diagnosed Watson with fatigue and piriformis syndrome, giving her stretches to address the latter. On January 4, 2013, Dr. Hentati noted “[d]emyelinating disease is [a] consideration but no progression of the abnormalities, and normal spinal tap.” AR 444. After an e-consult with a physician at the Mayo Clinic, in which the physician agreed with Dr. Hentati's management plan, Watson returned to Dr. Hentati on January 21. Dr. Hentati noted that Watson reported her symptoms got worse when under stress but that otherwise her fatigue was stable, even with some improvement on her current medication. Dr. Hentati would not rule out multiple sclerosis as a diagnosis but noted that Watson's stability was “reassuring.” AR 442.

         On March 7, Watson saw Dr. Stein, complaining of weakness in her limbs, which required her to stop typing at work, issues with finding words, trembling sensations, fatigue, and difficulty sleeping. Watson also reported being stressed at work and depressed. Watson and Dr. Stein discussed the fact that a multiple sclerosis diagnosis was “far from confirmed, ” as her “symptoms have been stable” and there had been “no multiple sclerosis defining event as of yet.” AR 440. Subsequent laboratory results revealed an elevated creatine kinase level and insufficient levels of Vitamin D. Watson and Dr. Stein agreed during the March 7 visit that Watson should take a leave of absence from her job. Dr. Stein completed a certification under the Family and Medical Leave Act (“FMLA”), stating that Watson could not perform her job due to extreme fatigue, muscle weakness, and poor sleep and would be on leave from March 11 through June 11, 2013. Dr. Stein provided a similar statement to Reliance Standard on March 12 in connection with Watson's application for short-term disability benefits, indicating that Watson suffered from depression, demyelinating disease, and sleep disorder, with the symptoms having begun in November 2007. Dr. Stein estimated that Watson should be able to return to work on June 12, 2013.

         In May, Watson began seeing a new primary care physician, Dr. Weisberger, complaining of ongoing depression, lower back pain, intense fatigue, and mild cognitive impairment. Dr. Weisberger diagnosed Watson with major depression. AR 393. Watson also began seeing a therapist, Robert Van Treeck, on June 6. Van Treeck diagnosed Watson with adjustment disorder with mixed anxiety/depressed mood. Van Treeck continued to see Watson for therapy sessions over the next several years. On July 15, Watson again saw Dr. Weisberger, who noted that Watson complained of “[m]uch more pain in the coccygeal area radiating to both butt[o]cks and posterior thighs, ” which was “[n]ot noticeable when sitting still” but was exacerbated by any movement. AR 314. Dr. Weisberger instructed Watson to take 600 mg of ibuprofen every six hours as needed for her lower back pain. On July 26, Dr. Weisberger added a muscle relaxant for Watson's back pain because Watson complained that the ibuprofen did not fully manage the pain.

         On July 30, Watson was evaluated by another neurologist, Dr. Jesse Taber. Watson did not report any new or worsening symptoms and stated that her pain level at the time was a two. Dr. Taber referred Watson for another sleep evaluation, surmising that she suffered from sleep disruption and may have sleep apnea and narcolepsy. Watson's therapist recorded on August 1 that Watson was frustrated after her visit with Dr. Taber, as she did not have sufficient clinical symptoms to meet the diagnostic criteria for multiple sclerosis and felt as if her doctors were being evasive. Watson expressed a desire to return to work but could not because of her fatigue and pain. She explored alternative work options with Van Treeck, such as opening a small private practice, so as to “adjust [it] according to her energy level, ” AR 302, or horticulture therapy after completing classes in the field. On August 8, Van Treeck noted Watson reported “difficulty finding words, mild slurred speech approx[imately] daily, and stumbling over words to the point that others notice.” AR 302. Watson also described being in a “vice grip of pain” in the mornings from her lower back to her lower thighs, which then continued throughout the day in her joints. AR 302. On August 22, Watson reported feeling discouraged because she felt as if there was “no end in sight, ” with everything taking longer to accomplish and her not knowing how to treat her symptoms. AR 303.

         On September 27, Watson saw Dr. Weisberger, complaining of mid-back pain. Dr. Weisberger referred her for an MRI and prescribed her an additional pain reliever. In January 2014, Watson returned to Dr. Weisberger, not having obtained the MRI or the sleep study that Dr. Taber had ordered in July 2013. She reported that her symptoms had stayed consistent, but that she was also suffering from daily migraines causing intense pain in her right neck and right arm, photophobia, and phonophobia. Although Watson reported “[d]aily fatigue, full body tremor, weakness and tingling in limbs, intermittent numbness in legs, mild forgetfulness, problems with word-finding and pronunciation[, ] [i]ntermittent intense pain in legs, thighs and buttocks[, ] and [m]oderate joint pain, ” AR 381, she also reported her pain did not affect her activity level. On February 6, Watson again saw Dr. Weisberger, complaining of two episodes of vision darkening in her right eye. Watson also complained that she had grown more fatigued over the previous ten days, but she denied any “change in speech or gait, weakness in any part of [her] body, or difficulty swallowing.” AR 377. Dr. Weisberger noted that the visual disturbance episodes suggested amaurosis fugax and could be related to migraine prodrome. On February 14, an MRI of Watson's lumbar spine revealed degenerative changes, particularly at ¶ 3-L4. An April brain MRI showed a “[s]lightly greater prominence of one right inferior frontal nonenhancing juxtacortical white matter lesion” but an “[o]therwise stable pattern of white matter lesion.” AR 579.

         Watson continued to experience visual disturbances over the next several months. On November 24, 2014, she saw Dr. John Pula, a neuro-ophthalmologist, complaining of blurred vision, subjective darkening of her right eye, and dizziness. On December 5, 2014, Watson saw Dr. Hentati, complaining of vision problems, headaches, increased light sensitivity, fatigue, cognitive difficulties, inability to concentrate or multi-task, general weakness in her limbs, tingling in her calves, and lower back pain. Dr. Hentati again expressed his opinion that Watson may be suffering from demyelinating disease but stated he could not diagnose multiple sclerosis because there had been no change in her brain lesion. Visual field examination testing done on December 9 indicated a decreased foveal threshold in Watson's right eye, possibly indicating macular disease. But visual evoked response testing done on January 26, 2015 returned normal results.

         Watson underwent another cervical spine MRI on March 17, 2015, which revealed moderate stenosis of the right half of the spinal canal and noted slight progression of the changes compared to her prior MRI in 2005. On March 27, Watson returned to Dr. Hentati, who noted no cognitive deficits and a negative review of her systems. He again concluded that Watson suffered from “[f]atigue of unknown cause, ” with a demyelinating disease such as multiple sclerosis a possibility. SAR 325. Dr. Hentati did not diagnose Watson with multiple sclerosis, however, because she had a normal spinal tap and no progression of any brain abnormalities. Although Dr. Hentati noted normal results for her reflexes, motor exam, cranial nerve exam, and sensory exam, only several days later, on March 31, when Dr. Jay Bhatt saw Watson, he found Watson had decreased range of motion on her lower left side and pain in that area. An April 1 brain MRI was stable, with no changes that could be demyelination.

         On May 22, Watson returned to Dr. Weisberger, complaining of achiness throughout her body and fatigue throughout the day. Her creatine kinase levels came back elevated. On July 27, Watson saw Dr. Lawrence Layfer, a rheumatologist. Dr. Layfer suspected Watson suffered from fibromyalgia and fatigue based on her reports of “poor sleep, tiredness and diffuse pains.” SAR 847.

         On February 1, 2016, Dr. Weisberger saw Watson, who noted that although Watson had normal range of motion with no joint enlargement or other tenderness in her upper or lower extremities, she continued to complain of constant pain everywhere. Dr. Weisberger prescribed amitriptyline for the fibromyalgia and Nuvigil for her fatigue, although Nuvigil was not approved by her insurance. About a month later, Watson saw Dr. Jennifer R. Bello Kottenstette, an internist, complaining of neck pain. Watson followed up with Dr. Weisberger on April 1, who suggested changing medications and ordered a shoulder x-ray. Lab results taken after this visit again showed elevated creatine kinase levels.

         On May 6, Dr. Weisberger completed a fibromyalgia residual functional questionnaire. She indicated that Watson met the American Rheumatological Society's criteria for fibromyalgia, with the signs and symptoms including multiple tender points, nonrestorative sleep, severe fatigue, morning stiffness, depression, female urethral syndrome, numbness and tingling, lack of endurance, impaired concentration, and anxiety. Dr. Weisberger further noted that Watson had pain in the lumbosacral spine, cervical spine, right arm, and bilateral shoulders, hands, fingers, hips, legs, knees, and feet. She noted that Watson's pain was precipitated by changing weather, stress, heat, cold, and fatigue. Dr. Weisberger indicated that emotional factors contributed to the severity of Watson's symptoms and functional limitations. She found a marked limitation in Watson's ability to deal with work stress and that the fatigue and pain frequently impacted Watson's concentration and attention, meaning she could not return to work even in a sedentary occupation on a full-time basis. Further, Dr. Weisberger opined Watson would need to lie down at unpredictable intervals if she did return to work and would miss work more than three times per month.

         On June 7, Watson again saw Dr. Hentati. He noted her complaints of fatigue and cognitive issues, including difficulties finding words and pronouncing them, in addition to weakness in the limbs, trembling, and stumbling. Dr. Hentati's examination revealed normal results, however, and he again concluded Watson suffered from “[f]atigue of unknown cause consistent with chronic fatigue syndrome, ” as well as a potential demyelinating disease. SAR 34. On July 31, Watson had a brain MRI. The MRI did not show any significant change when compared to her prior MRI, with no evidence of expanding intracranial mass, areas of abnormal enhancement, hemorrhage, or pathologic susceptibility.

         In a letter to Watson's counsel sent on August 25, Dr. Weisberger stated that Watson “receives regular care for demyelinating disease of the central nervous system, chronic fatigue syndrome with fibromyalgia, degenerative joint disease of the right shoulder, and degenerative disc disease of the lumbar spine.” SAR 38. She noted that Watson could not work because of her “severe fatigue, pain in the cervical spine, lumbar spine, shoulders, hips, legs, knees and feet, morning stiffness and impaired concentration, ” indicating that her “pain is constant at a moderate level; every several months she has a 2 to 3 week flair of her pain into severe levels.” Id. Finally, Dr. Weisberger indicated that Watson's symptoms have been resistant to treatment with both antidepressant and analgesic medications.

         In her therapy sessions between 2014 and 2016, Watson discussed both how she found gardening therapeutic and how, despite that therapeutic value, she had little energy for gardening because of worsening pain and because it took her a long time to recover from the activity. Other phobias did contribute to her decreased gardening work, however, such as seeing rats in the garden. Watson also reported that she found taking her dog for a walk to be stress-relieving, although she again noted she could not take him for long ...


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