United States District Court, D. Alaska
Maurice K. Mason, Plaintiff,
Federal Express Corporation, et al., Defendants.
ORDER AND OPINION [RE: MOTIONS AT DOCKETS 55 AND 57]
JOHN W. SEDWICK SENIOR UNITED STATES DISTRICT JUDGE
I. MOTIONS PRESENTED
At docket 55 plaintiff Maurice K. Mason (“Mason”) moves for judgment after a trial on the record pursuant to Federal Rule of Civil Procedure (“Rule”) 52 or, alternatively, summary judgment pursuant to Rule 56. Defendants Federal Express Corporation, FedEx Trade Networks Transport & Brokerage, Inc., Aetna Life Insurance Company, Federal Express Corporation Short Term Disability Plan, and Federal Express Corporation Long Term Disability Plan (collectively, “Defendants”) oppose Mason’s motion at docket 58 and cross-move for summary judgment at docket 57. These two filings are supported by a memorandum at docket 59. Mason replies in support of his motion at docket 66 and opposes Defendants’ cross-motion at docket 67. Mason’s memorandum in support of these two filings is at docket 64, and his declaration is at docket 65. At docket 73 Defendants reply in support of their cross-motion.
Oral argument was not requested and would not assist the court.
While he was employed by defendant FedEx Trade Networks Transport & Brokerage, Inc. (“FedEx Trade”) Mason was diagnosed with a rare autoimmune disease known as Stiff Person Syndrome (“SPS”). SPS is “manifested clinically by the continuous isometric contraction of many of the somatic muscles; contractions are usually forceful and painful and most frequently involve the trunk musculature, although limb muscles may be involved.” After defendant Aetna Life Insurance Company (“Aetna”) denied his claim for short-term disability benefits, he filed suit under the Employee Retirement Income Security Act of 1974, as amended (“ERISA”). His complaint alleges: (1) wrongful denial of his claim for short-term disability benefits; (2) wrongful refusal to consider his claim for long-term disability benefits; (3) breach of fiduciary duty; and (4) failure to provide requested plan documents. Although the parties style their cross-motions as summary judgment motions, they would be more accurately described as partial summary judgment motions because they only address the merits of the first of Mason’s four causes of action: whether Aetna abused its discretion in denying Mason’s short-term disability claim.
Mason argues that Aetna abused its discretion by ignoring objective medical evidence in the record that shows that his SPS and the side effects of his medications prevent him from performing the duties of his former job. The following is a summary of the evidence in the record.
A. Initial Treatment from Medical Park Family Care
Beginning in early 2008 Mason repeatedly complained about muscle spasms to his primary care physicians at Medical Park Family Care,  but the physicians were unable to determine their cause. For example, Mason saw Dr. James R. Lord on May 8, 2009, complaining of “continuing very unusual symptoms, ” including “various types of body spasms in the hands, legs, feet”; “some cramping”; swollen joints; and blurred vision. Dr. Lord stated that Mason’s symptoms were “very difficult to explain.”
B. SPS Diagnosis from the VA
In February 2010 Mason saw neurologist Gregg Meekins, M.D. with the VA Medical Center. Dr. Meekins noted Mason’s lengthy history “of severe spasms affecting hands, feet, torso, etc., ” and the multiple medications that Mason was taking “without benefit or intolerable side effects of excessive sedation.” Dr. Meekins ordered laboratory testing, which “came back positive for very high anti-glutamic acid decarboxylase [“GAD”] 65 antibody level consistent with the diagnosis of stiff-person’s syndrome.” After diagnosing Mason with SPS, he prescribed baclofen to treat Mason’s condition. Although a subsequent laboratory test in July 2010 came back normal, Mason’s blood was retested in December 2010 and the results were positive for SPS (“although not as high a level” as the February result). Defendants do not contest the validity of Mason’s SPS diagnosis.
C. Consult with Neurologist Wayne Downs, M.D.
Mason met with neurologist Wayne Downs, M.D. in April 2010. Mason described his history of cramping, which he said had gotten gradually worse. He also explained that he was being treated with several “potentially sedating drugs” which caused a “lack of focus and short-term memory loss.” Mason told Dr. Downs that he was not able to perform his job and in “the last few days he [had] been found asleep at his desk on two occasions.”
Dr. Downs assessed Mason as having “anti-GAD65 stiff person syndrome.” As to Mason’s lack of focus and memory loss, Dr. Downs stated that Mason’s encephalopathy was “worse on his current medications” and suspected that this was because of the baclofen he was taking. At the time Mason was taking 60 mg of baclofen daily. Dr. Downs wrote that “[w]ere l treating him I would taper the baclofen off relatively rapidly and then start pushing the Valium.” “If we can get him off his sedating medications and he is still having an encephalopathic problem, ” Dr. Downs wrote, “then I think a neuropsych[ological] test would be indicated to quantitate [sic] this as this may be a source of employment difficulties.”
D. Follow-Up Treatment
Following his consult with Dr. Downs, Mason returned to Medical Park Family Care complaining about the side effects of his medications. On May 7, 2010 Dr. Lord ordered Mason to taper off baclofen but stated that he would still “likely need high doses of muscle relaxants for the muscle cramps and stiffness.”
On July 8, 2010 Mason saw Dr. Lord again, complaining that his SPS was worsening and that the tapering of the dosage of his muscle relaxants was not helping. The notes from Dr. Lord’s physical examination state that Mason was in “moderate pain/distress” and “[v]isibly uncomfortable, some palpable spasms on chest wall, discomfort with walking and changing positions.”
On July 15, 2010, Mason was admitted to the emergency department of Providence Alaska Medical Center, complaining of cramps and muscle spasms with pain that he described as a 10 on a scale of 0 to 10. The emergency department physician noted that Mason did not appear to be in distress or discomfort despite his stated pain level, and that he was alert and oriented. Mason was given morphine and Ativan for his pain and instructed to follow up with his primary care physician.
The next morning Mason met with Dr. Lord, who noted in his physical exam that Mason was suffering from “moderate pain/distress.” Later that day Mason was again admitted to the emergency room complaining of pain. The emergency department physician noted that Mason’s inability to control his SPS-related pain was “unfortunately par for this unfortunate malady, ” which he described as “ultimately . . . very difficult to treat.”
In the following months Mason sought medical treatment repeatedly for his SPS, including the following visits:
• Dr. Lord’s July 27, 2010 physical exam notes state that Mason was suffering from “mild pain/distress” and had a “depressed affect.”Dr. Lord concluded that Mason’s SPS had deteriorated.
• The next day Mason met with Dr. Meekins, complaining of painful spasms and stiffness in his trunk and extremities. Dr. Meekins described Mason’s SPS as “progressive.”
• On August 16, 2010, Dr. Lord again examined Mason, assessed Mason’s SPS had deteriorated, and noted that he was suffering from “mild pain/distress” and “[c]ontinued diffuse muscle spasms.”
• Dr. Lord examined Mason again on August 25, 2010, and again noted that Mason was suffering from “mild pain/distress” and had a “depressed affect.”
• On September 22, 2010, Mason was referred to VA internist Madeleine M. Grant, M.D., who addressed Mason’s reports that his medicine was causing him to be too sedated to drive or work. Dr. Grant listed Mason’s treatment goal as “find[ing] medication that worked and did not affect him cognitively.” She recommended tapering Mason’s baclofen usage and gradually increasing diazepam.
• In Dr. Lord’s notes to Mason’s September 29, 2010 visit, Dr. Lord states that he discussed Mason’s SPS with the VA and they agreed to “maximize the dosing of Valium to try and treat his spasms” and “[s]lowly titrate down the baclofen.”
• On October 6, 2010, Mason complained to Dr. Lord that his body cramps had “worsened especially the feet and arms since tapering off of the baclofen” but he noticed less sedation.
• On October 28, 2010, Dr. Lord again noted that Mason’s SPS had deteriorated, he was suffering “moderate pain/distress, ” and had a “depressed affect.”
• On November 15, 2010, Mason complained to Dr. Lord about “pain and discomfort and depression” from SPS. Dr. Lord’s physical exam noted that Mason was suffering from “moderate pain/distress” and had a “depressed affect.”
• On December 23, 2010, Mason told another Family Park Medical Care physician, Jeffrey Kim, M.D., that he was doing “okay” on Valium but it made him “very sleepy and very poor functioning.”
• On January 9, 2011, Mason was admitted to the emergency department at the hospital complaining of severe abdominal pain, which he graded as a 9 on a scale of 0 to 10. The emergency department physician noted that Mason alleviated his pain by taking his medication at home, but within about 20 minutes of presenting himself at the hospital Mason had already fallen asleep.
E. Neuropsychological Exam
Because Mason was complaining of memory decline, Dr. Meekins referred Mason to neuropsychologist Paul D. Dukarm, Ph.D. for testing in September 2010. In his summary of his findings Dr. Dukarm states that Mason was “exhibiting variable neurocognitive performance deficits in the areas of executive functioning. Specifically, he [was] demonstrating impaired performance in the area of visuospatial organization and planning during problem solving and impaired response flexibility under changing conditions.” In addition, Dr. Dukarm found that Mason was “borderline deficient” with regard to “[d]eductive logic as it relates to attribute identification and concept formation, ” and he showed “deficiencies for learning and retaining uncontexualized verbal information, such as a word list.” Dr. Dukarm noted, however, that Mason’s “recognition [was] intact as well as his learning efficiency and retention of other forms of verbal information (prose) and non-verbal information.” And although Mason’s “[b]asic auditory attention and working memory” were “low average, ” he was in the average range with regard to “visual working memory, ” “verbal fluency under time pressure, sequencing and alternating attention under time pressure, and inhibiting automatic responses under time pressure.”
Dr. Dukarm concluded that the findings of his exam were “compatible with a diagnosis of Cognitive Disorder, NOS.” “Etiology of neurocognitive deficits is unclear and likely multifactorial. . . . . The most likely contributing factors to this patient’s performance deficits include medication effects, pain, and sleep disturbance. Other contributing factors include the autoimmune disease of which he is diagnosed, but the cognitive effects are unclear as to the nature and source of the impact from this condition.”
On September 1, 2010, Mason was seen by Camilla A. Madden, Ph.D., a psychologist at the VA, who diagnosed Mason with severe depression related to his struggles at work and with his family because of the side effects of his medications and the limitations of his disorder. Mason continued to see Dr. Madden regularly for treatment of his depression.
G. Mason Applies For Short-Term Disability Benefits
Mason applied for short-term disability benefits in December 2010, stating that he was no longer able to work due to his SPS and described his symptoms as follows: “Muscle spasms all over, cramps all over, dystonia in the hands and feet, chronic fatigue, unable to concentrate and chronic headache.” In order for employees to qualify for short-term disability benefits under the Short Term Disability Plan (“the Plan”) administered by defendant Federal Express Corporation (“FedEx”), they must show that they suffer from an “occupational disability, ” which the Plan defines as “the inability of a Covered Employee, because of a medically-determinable physical impairment or Mental Impairment, to perform the duties of his regular occupation.”
H. Mason’s Supervisor States that Mason is Unable to Work
Mason worked as a manger for FedEx Trade who oversaw a group of 26 employees. His former supervisor, Linda Combs (“Combs”), wrote an email stating that Mason “would suffer from severe muscle cramping” at work “and his limbs would ‘lock up.’” For example, Combs reported that she had observed Mason not being able to get up from a meeting table “because his legs locked up” and “his hands cramp up and lock where he could not open his hand.” Combs also stated that she saw Mason “fall to the ground with leg spasms at an employee picnic.”
Combs stated that Mason started “really declining in the fall of 2009, ” when he had “spasms much more frequently and more severely.” Mason started taking medication but it was “very sedating, ” causing him to take most of March and some of April 2010 off from work so that he could “try to cope on these medications.” When he returned to work, he “struggled with staying awake and alert through an 8 hour work day, ” had a bad limp, and experienced difficulty walking around the two-floor office.Combs reported that Mason had “trouble focusing and remembering things, ” and “many times” on the job “was falling asleep, slurring his words and making very little sense.”Combs stated that she “would send him things that he didn’t ever remember seeing” and that he “could not keep up with his deadlines.” “I finally told him that this was getting way out of control, ” Combs wrote. “We wouldn’t allow any other employee to come in and pass out at their desk. I felt like I was dealing with a situation that presented the company with a grave liability.”
Combs’ report is consistent with a December 13, 2010 entry in Aetna’s claim records which states that Mason’s “HR Advisor” called Aetna because she wanted to help Mason with his claim. The advisor stated that she would “make [Mason] understand” what Aetna needed and would “ask [Mason’s] girlfriend to help him, because he is in a lot of ...